According to a research published in the June 11, 2005 issue of The British Medical Journal, painkillers with ibuprofen may increase the risk of heart attacks by up to 24 percent. Abstract Aims To determine the comparative risk of myocardial infarction in patients taking cyclo-oxygenase-2 and other non-steroidal anti-inflammatory drugs (NSAIDs) in primary care between 2000 and 2004; to determine these risks in patients with and without pre-existing coronary heart disease and in those taking and not taking aspirin. Design Nested case-control study. Setting 367 general practices contributing to the UK QRESEARCH database and spread throughout every strategic health authority and health board in England, Wales, and Scotland. Subjects 9218 cases with a first ever diagnosis of myocardial infarction during the four year study period; 86 349 controls matched for age, calendar year, sex, and practice. Outcome measures Unadjusted and adjusted odds ratios with 95% confidence intervals for myocardial infarction associated with rofecoxib, celecoxib, naproxen, ibuprofen, diclofenac, and other selective and non-selective NSAIDS. Odds ratios were adjusted for smoking status, comorbidity, deprivation, and use of statins, aspirin, and antidepressants. Results A significantly increased risk of myocardial infarction was associated with current use of rofecoxib (adjusted odds ratio 1.32, 95% confidence interval 1.09 to 1.61) compared with no use within the previous three years; with current use of diclofenac (1.55, 1.39 to 1.72); and with current use of ibuprofen (1.24, 1.11 to 1.39). Increased risks were associated with the other selective NSAIDs, with naproxen, and with non-selective NSAIDs; these risks were significant at < 0.05 rather than < 0.01 for current use but significant at < 0.01 in the tests for trend. No significant interactions occurred between any of the NSAIDs and either aspirin or coronary heart disease. Conclusion These results suggest an increased risk of myocardial infarction associated with current use of rofecoxib, diclofenac, and ibuprofen despite adjustment for many potential confounders. No evidence was found to support a reduction in risk of myocardial infarction associated with current use of naproxen. This is an observational study and may be subject to residual confounding that cannot be fully corrected for. However, enough concerns may exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs. BMJ 2005;330:1366 (11 June)

The New York State Department of Health (DOH) today released changes in New York's health advisories in the 2005-06 'Chemicals in Sportfish and Game.' This year's guide highlights health advisory changes for 25 ponds, lakes and reservoirs across the state. Twenty-four of the 25 advisories were issued due to mercury contamination identified in fish. As a result of these findings, the DOH is advising women of childbearing years and children under the age of 15 to avoid eating ANY FISH from the waters listed below. They should also avoid eating specific species of fish (northern pike, pickerel, walleye, largemouth bass, smallmouth bass and larger yellow perch) from ALL WATERS in the Adirondack and Catskill Mountain regions because of mercury contamination. The DOH recommends that all other individuals adhere to the advisories and the specified limits listed below when eating fish. The New York State Department of Environmental Conservation (DEC) regularly samples fish in New York State waters. The new information on mercury in fish is part of a comprehensive DEC study supported by the New York State Energy Research and Development Authority. Mercury and other contaminants may affect the nervous system and organs in the fetus, newborns and young children. Some of these contaminants may also build up in women's bodies and some chemicals may be passed to newborns in their mother's milk. Because some contaminants may accumulate and remain in the body for a long time, women should follow the stricter consumption advice throughout their childbearing years. New York State's waters include more than 70,000 miles of rivers and streams, three million acres in thousands of lakes, reservoirs and ponds and one million acres of marine waters. New York's fish monitoring and advisory program is among the most comprehensive in the nation. The DOH's annual health advisories provide advice for sports anglers, hunters and the general public about how to reduce exposure to chemical contaminants in the State's sportfish and game. Specific advisories now apply to 117 New York waters. This year, the DOH reviewed DEC sampling data collected from more than 2,500 fish in 84 waters across the state. A general, and long-standing, statewide advisory applies to sportfish taken from any fresh waters in the state and some marine waters at the mouth of the Hudson River. The general advice is to EAT NO MORE THAN ONE MEAL (1/2 pound) of fish per week. The fish advisories are published in the Fishing Regulations Guide and the game advisories are published in the Hunting and Trapping Regulations Guide issued by DEC. The complete Health Advisories and additional information can be obtained from the DOH's web site at http://www.nyhealth.gov/nysdoh/fish/fish.htm or by contacting the Department's toll-free information line at 1-800-458-1158. New DOH health advisories have been issued for the following waters: • Breakneck Pond (Rockland County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Canada Lake (Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches and chain pickerel (all sizes). • Chase Lake (Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches. • Chodikee Lake (Ulster County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Crane Pond (Essex County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Dunham Reservoir (Rensselaer County) – EAT NO walleye and EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • Elmer Falls Reservoir (Lewis County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • Francis Lake (Lewis County) –EAT NO MORE THAN ONE MEAL PER MONTH of chain pickerel (all sizes). In addition, based on lower mercury levels in smaller yellow perch, the previous advisory for yellow perch has been changed to EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches (the previous advisory applied for all sizes of yellow perch.) • Franklin Falls Flow (also known as Franklin Falls Pond; Franklin and Essex Counties) - EAT NO walleye (all sizes). • High Falls Pond (Lewis County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Kings Flow (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Loch Sheldrake (Sullivan County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Meacham Lake (Franklin County) - EAT NO smallmouth bass and EAT NO MORE THAN ONE MEAL PER MONTH of northern pike (all sizes of both species). • Middle Stoner Lake (Also known as East Stoner Lake; Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Moshier Reservoir (Herkimer County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • North-South Lake (Greene County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Red Lake (Jefferson County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Rio Reservoir (Orange and Sullivan Counties) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Russian Lake (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches. • Salmon River Reservoir (Oswego County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass and smallmouth bass (all sizes of both species). • Spy Lake (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Sunday Lake (Herkimer County) - EAT NO chain pickerel (all sizes). • Swinging Bridge Reservoir (Sullivan County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Weller Pond (Franklin County) - EAT NO MORE THAN ONE MEAL PER MONTH of northern pike (all sizes). • Advisory Change for Canadice Lake Canadice Lake (Ontario County) – The advisory for Canadice Lake trout has been changed to EAT NO MORE THAN ONE MEAL PER MONTH of lake trout larger than 25 inches, based on lower PCB levels in smaller lake trout (the previous advisory applied to all sizes of lake trout.) A previous advisory to EAT NO MORE THAN ONE MEAL PER MONTH of brown trout (all sizes) remains in effect.

ABSTRACT Background There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy’s effects in this population. Objective To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. Design Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). Setting Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. Patients Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. Interventions Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. Main Outcome Measure The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. Results At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. Conclusion Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise. Arch Gen Psychiatry. 2005;62:409-416. Author Affiliations: Departments of Psychology (Dr DeRubeis), and Psychiatry (Drs Amsterdam, Young, O’Reardon, and Gladis), University of Pennsylvania, Philadelphia; Departments of Psychology (Dr Hollon), and Psychiatry (Drs Shelton, Salomon, Lovett, and Brown), Vanderbilt University, Nashville, Tenn; Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pa (Dr Gallop).

Each year, an estimated 200,000 to 600,000 Americans will suffer from deep-vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs usually in the lower limbs, when a blood clot forms in a deep vein. Pulmonary embolism a complication of DVT can occur when a clot breaks loose from the wall of the vein and travels to the lungs, blocking a pulmonary artery or one of its branches. PE will be fatal in 60,000 to 200,000 individuals who develop this condition. According to a national survey conducted on behalf of the American Public Health, almost three-quarters (74 percent) of adults have little or no awareness of DVT. Click here to assess your risk for DVT LEARN MORE ABOUT DEEP-VEIN THROMBOSIS AND PULMONARY EMBOLISM For additional information click on the link below.

ABSTRACT Background: Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. Objective: The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. Design: A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. Results: During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend < 0.0001 for all). Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs. Adjustment for BMI substantially attenuated RRs for both WC and WHR. The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes. The cumulative proportions of type 2 diabetes cases identified according to medians of BMI (24.8), WC (94 cm), and WHR (0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. Conclusions: Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate. American Journal of Clinical Nutrition, Vol. 81, No. 3, 555-563, March 2005 © 2005 American Society for Clinical Nutrition

ABSTRACT Background Little is known regarding the health effects of a raw food (RF) vegetarian diet. Methods We performed a cross-sectional study on 18 volunteers (mean ± SD age, 54.2 ± 11.5 years; male/female ratio, 11:7) on a RF vegetarian diet for a mean of 3.6 years and a comparison age- and sex-matched group eating typical American diets. We measured body composition, bone mineral content and density, bone turnover markers (C-telopeptide of type I collagen and bone-specific alkaline phosphatase), C-reactive protein, 25-hydroxyvitamin D, insulin-like growth factor 1, and leptin in serum. Results The RF vegetarians had a mean ± SD body mass index (calculated as weight in kilograms divided by the square of height in meters) of 20.5 ± 2.3, compared with 25.4 ± 3.3 in the control subjects. The mean bone mineral content and density of the lumbar spine (P= .003 and P<.001, respectively) and hip (P = .01 and P<.001, respectively) were lower in the RF group than in the control group. Serum C-telopeptide of type I collagen and bone-specific alkaline phosphatase levels were similar between the groups, while the mean 25-hydroxyvitamin D concentration was higher in the RF group than in the control group (P<.001). The mean serum C-reactive protein (P = .03), insulinlike growth factor 1 (P = .002), and leptin (P = .005) were lower in the RF group. Conclusion A RF vegetarian diet is associated with low bone mass at clinically important skeletal regions but is without evidence of increased bone turnover or impaired vitamin D status. Arch Intern Med. 2005;165:684-689. Author Affiliations: Section of Applied Physiology, Division of Geriatrics and Nutritional Science, Department of Internal Medicine, Washington University School of Medicine, St Louis, Mo (Drs Fontana, Holloszy, and Villareal and Ms Shew); and the Division of Food Science, Human Nutrition, and Health, Istituto Superiore di Sanitá, Rome, Italy (Dr Fontana).

ABSTRACT Background The risk of sudden death from cardiac causes in the general population peaks from 6 a.m. to noon and has a nadir from midnight to 6 a.m. Obstructive sleep apnea is highly prevalent and associated with neurohormonal and electrophysiological abnormalities that may increase the risk of sudden death from cardiac causes, especially during sleep. Methods We reviewed polysomnograms and the death certificates of 112 Minnesota residents who had undergone polysomnography and had died suddenly from cardiac causes between July 1987 and July 2003. For four intervals of the day, we compared the rates of sudden death from cardiac causes among people with obstructive sleep apnea and the following: the rates among people without obstructive sleep apnea, the rates in the general population, and the expectations according to chance. For each interval, we assessed the median apnea–hypopnea index and the relative risk of sudden death from cardiac causes. We similarly analyzed sudden death from cardiac causes during three time intervals that correlate with usual sleep–wake cycles. Results From midnight to 6 a.m., sudden death from cardiac causes occurred in 46 percent of people with obstructive sleep apnea, as compared with 21 percent of people without obstructive sleep apnea (P=0.01), 16 percent of the general population (P<0.001), and the 25 percent expected by chance (P<0.001). People with sudden death from cardiac causes from midnight to 6 a.m. had a significantly higher apnea–hypopnea index than those with sudden death from cardiac causes during other intervals, and the apnea–hypopnea index correlated directly with the relative risk of sudden death from cardiac causes from midnight to 6 a.m. For people with obstructive sleep apnea, the relative risk of sudden death from cardiac causes from midnight to 6 a.m. was 2.57 (95 percent confidence interval, 1.87 to 3.52). The analysis of usual sleep–wake cycles showed similar results. Conclusions People with obstructive sleep apnea have a peak in sudden death from cardiac causes during the sleeping hours, which contrasts strikingly with the nadir of sudden death from cardiac causes during this period in people without obstructive sleep apnea and in the general population. The New England Journal of Medicine Volume 352:1206-1214

ABSTRACT Objective: The objective of this study was to review the evidence that behavioral and emotional factors are triggers of acute coronary syndromes. Method: Systematic review of the published literature from 1970 to 2004 of trigger events, defined as stimuli or activities occurring within 24 hours of the onset of acute coronary syndromes. Results: There is consistent evidence that physical exertion (particularly by people who are not normally active), emotional stress, anger, and extreme excitement can trigger acute myocardial infarction and sudden cardiac death in susceptible individuals. Many triggers operate within 1 to 2 hours of symptom onset. There are methodologic limitations to the current literature, including sampling, retrospective reporting, and presentation biases, the role of memory decay and salience, and reverse causation because of silent prodromal events. Conclusions: Behavioral and emotional factors are probable triggers of acute coronary syndromes in vulnerable individuals, and the pathophysiological processes elicited by these stimuli are being increasingly understood. The benefits to patients of knowledge to these processes have yet to accrue. Psychosomatic Medicine 67:179-186 (2005) © 2005

ABSTRACT Objective: To explore early changes and predictors of bone mass in children with juvenile idiopathic arthritis (JIA) in order to identify patients who will develop bone mass reductions. Methods: We conducted a prospective cohort study of 108 children with early JIA (ages 6-18 years; mean disease duration 19.3 months) who were individually matched with 108 healthy children for age, sex, race, and county of residence. Bone mass and changes in total body, spine, femur, and forearm bone mineral density and bone mineral content (BMC), body composition, growth, and biochemical parameters of bone turnover were examined at baseline and at followup a mean of 24 months later. Low bone mass was defined as a Z score >1 SD below the reference population. Results: Of the 200 children evaluated at followup, the 100 healthy children had greater gains in total body BMC (P = 0.035), distal radius BMC (P < 0.001), and total body lean mass (P < 0.001) than did the 100 JIA patients. Low or very low total body BMC was observed in 24% of the patients and 12% of the healthy children. Bone formation, bone resorption, and weight-bearing activities were reduced in the patients compared with the healthy children. Multiple regression analysis showed that in patients with JIA, serum bone-specific alkaline phosphatase, serum C-telopeptide of type I collagen, and weight-bearing activities were independent predictors of changes in total body BMC. Total body BMC was lower in patients with polyarticular onset than in those with oligoarticular disease onset. Conclusion: Patients with JIA have moderate reductions in bone mass gains, bone turnover, and total body lean mass early in the disease course. Arthritis & Rheumatism - Volume 52, Issue 3, Pages 833 - 840

ABSTRACT Background: Patients with TIA are at increased risk of ischemic stroke and require preventive treatment. However, clinical guidelines differ on how urgently patients should be assessed. Objective: To determine the potential consequences of delays in investigation and treatment, the authors studied the timing of TIAs preceding ischemic stroke. Methods: The authors studied patients who presented with a recent ischemic stroke and had a preceding TIA in two population-based studies (Oxford Vascular Study [OXVASC]; Oxfordshire Community Stroke Project [OCSP]) and two randomized trials (UK TIA Aspirin Trial [UK-TIA]; European Carotid Surgery Trial [ECST]). Results: Of 2,416 patients who had presented with an ischemic stroke, 549 (23%) gave a history of a preceding TIA (18% in OXVASC, 15% in OCSP, 23% in UK-TIA, 26% in ECST). Where a preceding TIA had occurred, the timing was highly consistent across the studies, with 17% occurring on the day of the stroke, 9% on the previous day, and 43% at some point during the 7 days prior to the stroke. No clinical characteristics or vascular risk factors identified patients in whom there was a close temporal association between TIA and stroke. Conclusion: In patients presenting with ischemic stroke, TIAs occur most often during the hours and days immediately preceding the stroke. From the Stroke Prevention Research Unit (Dr. Rothwell), Department of Clinical Neurology, Radcliffe Infirmary, Oxford, and Department of Clinical Neurosciences (Dr. Warlow), Western General Hospital, Edinburgh, UK. NEUROLOGY 2005;64:817-820

ABSTRACT Objective. Reports of large increases in autism prevalence have been a matter of great concern to clinicians, educators, and parents. This analysis uses a national data source to compare the prevalence of autism with that of other disabilities among successive birth cohorts of US school-aged children. Design. Comparison of birth cohort curves constructed from administrative data. Setting and Population. US children 6 to 17 years of age between 1992 and 2001. Main Outcome Measures. A disability category classification of autism, mental retardation, speech and language impairment, traumatic brain injury, or other health impairment, as documented by state departments of education and reported to the Office of Special Education Programs, US Department of Education. Results. Prevalences of disability category classifications for annual birth cohorts from 1975 to 1995 were calculated by using denominators from US Census Bureau estimates. For the autism classification, there were birth cohort differences, with prevalences increasing among successive (younger) cohorts. The increases were greatest for annual cohorts born from 1987 to 1992. For cohorts born after 1992, the prevalence increased with each successive year but the increases did not appear to be as great, although there were fewer data points available within cohorts. No concomitant decreases in categories of mental retardation or speech/language impairment were seen. Curves for other health impairments, the category including children with attention-deficit/hyperactivity disorder, also showed strong cohort differences. Conclusions. Cohort curves suggest that autism prevalence has been increasing with time, as evidenced by higher prevalences among younger birth cohorts. The narrowing in vertical separation of the cohort curves in recent years may mark a slowing in the autism prevalence increase. PEDIATRICS Vol. 115 No. 3 March 2005, pp. e277-e282

Multidisciplinary Conference on Manual Therapies If you canft attend the ACC-RAC Conference in Las Vegas this week (Mar 17-20) because of distance, family and practice commitments, then the conference offering below is a must attend alternative. On June 9-10, 2005, the U.S. National Institutes of Health (NIH) and the Canadian Institutes of Health Research (CIHR) will sponsor a conference entitled The Biology of Manual Therapies in Bethesda, Maryland. The conference will emphasize research in neuroscience, immunology, endocrinology, biomechanics, and imaging as they relate to manipulation, massage, and mobilization. The cost of the conference registration is only $35. Experts from the U.S. National Institutes of Health and the Canadian Institutes of Health Research will join academic, patient advocacy, and professional organizations to assess current knowledge and identify opportunities for further research on manual therapies. Manual therapies include a host of techniques that focus primarily on the structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems. There is increasing evidence that manual therapies may trigger a cascade of cellular, biomechanical, neural, and/or extracellular events as the body adapts to the external stress. This conference is vital to the future of chiropractic. Researchers, health care practitioners, patient advocates, and the public are all invited to participate. Manipulative and Body-base Therapeutics: An Overview Under the umbrella of manipulative and body-based practices is a heterogeneous group of CAM interventions and therapies. These include chiropractic and osteopathic manipulation, massage therapy, Tui Na, reflexology, rolfing, Bowen technique, Trager bodywork, Alexander technique, Feldenkrais method, and a host of others (a list of definitions is given at the end of this report). Surveys of the U.S. population suggest that between 3 percent and 16 percent of adults receive chiropractic manipulation in a given year, while between 2 percent and 14 percent receive some form of massage therapy.1-5 In 1997, U.S. adults made an estimated 192 million visits to chiropractors and 114 million visits to massage therapists. Visits to chiropractors and massage therapists combined represented 50 percent of all visits to CAM practitioners.2 Data on the remaining manipulative and body-based practices are sparser, but it can be estimated that they are collectively used by less than 7 percent of the adult population. For more information on Manipulative and Body-base therapies click on the following link: Body-base therapies Tentative Conference Agenda (Link) Tentative Agenda--Workshop on the Biology of Manual Therapies Natcher Conference Center, National Institutes of Health June 9-10, 2005 June 9, 2005 œ Introduction by NIH and CIHR Staff œ Introduction by Session Chairs œ Historical Perspective Murray Goldstein, D.O., M.P.H. Medical Director for the United Cerebral Palsy Research and Educational Foundation œ Overview: Current Use of Manual Therapies in Canada and U.S. Maria Verhoef, Ph.D. Department of Community Health Sciences University of Calgary Janet R. Kahn, Ph.D., L.M.T. Integrative Consulting Break Session 1: Neuroscience Joel Pickar, D.C., Ph.D, (co-chair) Professor Palmer Center for Chiropractic Research James Henry, Ph.D. (co-chair) Professor and Chair in Central Pain McMaster University Scientific Director Michael G. DeGroote Institute for Pain Research and Care Partap S. Khalsa, D.C., Ph.D. Biomedical Engineering State University of New York at Stony Brook Kerstin Uvnas-Moberg, M.D., Ph.D. Professor, Department Of Physiology and Pharmacology Karokinska Institute Summary/Comments by Session Chair--Questions from Audience Lunch Session 2: Immunology/Endocrinology/Other Leslie J. Crofford, M.D. (co-chair) Chair, Department of Rheumatology University of Kentucky Serge Rivest, Ph.D. (co-chair) Laboratory of Molecular Endocrinology CHUL Research Center Department of Anatomy and Physiology Laval University Dan Clauw, M.D. Professor of Internal Medicine, Division of Rheumatology Director, Chronic Pain and Fatigue Research Program Director, Center for the Advancement of Clinical Research University of Michigan Summary/Comments by Session Chair--Questions from Audience June 10, 2005 Session 3: Biomechanics and Imaging John J. Triano, D.C., Ph.D. (co-chair) Research Professor Department of Engineering University of Texas, Arlington Co-director for Research Texas Back Institute Hermano Igo Krebs, Ph.D. Principal Research Scientist & Lecturer Massachusetts Institute of Technology Helene Langevin, M.D., L.Ac. Research Associate Professor, Department of Neurology University of Vermont David G. Wilder, Ph.D., P.E., C.P.E. Director, Jolt/Vibration/Seating Lab Senior Research Scientist Iowa Spine Research Center Associate Professor Biomedical & Mechanical Engineering Summary/Comments by Session Chair--Questions from Audience Lunch Breakout groups Breakout groups lead by session chairs to discuss research gaps and opportunities. Members of patient advocacy groups and professional organizations are invited to participate in the groups. Other conference attendances will self-assign at time of registration. Attendance at breakout groups limited to 50-75 individuals depending on room. Break Session chairs report back to main body--Q & A from audience Closing Comments--NIH and CIHR Staff For more information or to register for the conference, visit: NCCAM

To many marketers, the press release is something of a "one size fits all" proposition. You want to get media coverage, you knock out a press release, send it to some journalists and sit back and wait. Of course, smart Publicity Insiders already know that's a prescription for failure. You know that your press release has to have a "hook", be well-written and sent to appropriate journalists in an active, not passive, manner. But there's another part of the puzzle that even savvy publicity-seekers sometimes miss -- you can't just write "a press release", you have to write the right kind of press release. There's no such thing as a "one size fits all" release. Smart publicists have variations of the press release model ready to go, depending on the occasion. (Note: for a general introduction to press release writing and formatting, see: PublicityInsider.com.) Let's look at some releases suitable for "harder" and more timely news... The News Release To some folks, "news release" and "press release" are interchangeable. Not to me. I use the phrase "news release" to refer to a release that, well, carries actual news. Let's face it, most of what a business has to say to a journalist isn't exactly "stop the presses" kind of stuff. But, on occasion, something of real significance occurs. A merger, a stock split, a major new contract, winning a national award...something that's truly timely and important. For these sorts of events, don't mess around. Craft a solid, hard-hitting News Release that's written in pure journalistic style (lead includes "who, what, when, why and how", language is in 3rd person and completely frëe of hyperbole). Use journalism's "inverted pyramid" -- most important information at the top, next most important info in the second paragraph and so on down. Tell the entire story in the headline and subhead. Again, don't get cute -- get straight to the point. The headline "Acme Corporation Selected by Pentagon to Supply Troops with Widgets" is far better than something like "Guess Who's Making Widgets for Uncle Sam?" or something "clever" like that. In the subhead, fill in some details: "$18 Million Contract Largest in Company's History". Talk about getting straight to the point! You've just given the journalist the meat of the story before she's even read your lead. Add a "dateline" (Akron, OH) at the beginning of your lead (first) paragraph. In the dateline, use your company's home town (or the location where some news has broken. You can be a bit creative hëre, if it helps maximize your impact. For the above example, you can dateline it Washington, DC and say that "The Pentagon today announced that it has selected an Akron company..."). In distributing the release, use e-mail, fax, a distribution service such as PRWeb or PR Newswire, or even overnight courier. The goal is to get it into journalists' hands on the same day you distribute it. Executive Appointment Release Most businesses send out a brief release and headshot when someone new is hired or a major promotion is made. That's fine, and it will get them in the "People on the Move" column on page 8 in the business section. It's an ego stroke for the employee, but that's about it. Savvy publicity seekers use the Executive Appointment release to generate real publicity. Here's the key -- don't just announce that someone's been hired or promoted. Rather, explain why the move is significant to the company -- and perhaps the market -- as a whole. For example, Jane Smith has been hired as your company's new director of sales. Not so exciting. However, the reason you hired her is because she came from a major online retailer and is planning to overhaul your salës system to compare with the state-of-the-art systems used by the big guys. Hmmmm...that's a lot more interesting. So why not tell the media about it? The key ingredient is context. Your headline may still look like that of a typical Executive Appointment release (Acme Names Jane Smith New Director of Sales), but starting with the subhead, you begin your journey off page 8 of the business section and onto page one (Hiring of Key Figure in Online Sales Explosion Marks Important Shift in Acme's Sales Strategy). Ah, now you've entered the realm of news, not business as usual. And a sharp business editor will see that a local company is doing something far more significant than just making a hire. Dateline the release, fax (or even messenger), email or regular mail it over to your local business editor and follow up with a phone call. Offer Jane Smith for interview, too. The Media Alert The Media Alert is a deceptively simple creature. It's essentially a memo from you to TV, radio and newspaper assignment editors, city desk editors and others who decide whether a particular news event is worth covering. They're used to alert the press about news conferences, charity events, publicity "stunts" and other events. The point of the Media Alert is to, in just a few seconds, tell a journalist about the event, how to cover it and why it's important that the media outlet, in fact, covers it. Most publicists are pretty good on the first two points -- almost all media alerts do a decent job of telling what the event is, where it will be held and what time it starts. It's the third aspect -- the "why" -- that will make the real difference, though. And it's the thing most publicists do a lousy of job of conveying. First, a word about format. Use standard press release headings (contact info, "For Immediate Release" and headline). The rest of the document should be a few paragraphs, spaced at least three lines apart from one another. The first paragraph, should begin with What: and continue with a one or two line description of the event (WidgetFest 2004, a celebration of young minds). Next paragraph, When:, after that Where: Now here's the key paragraph, Why You Should Cover WidgetFest 2004: The brightest young minds from around the region will gather to present their inventions, as Acme Corp. celebrates the state's top high school science students. The event will be a visual feast, with a host of awe-inspiring inventions, many colorful, active and exotic, on display. As part of the event, more than $10,000 in scholarships will be distributed to budding Einsteins by John Smith, Ohio's Science Teacher of the Year. The key? This line: "The event will be a visual feast, with a host of awe-inspiring inventions, many colorful, active and exotic, on display." I just spoke an assignment editor's language, telling him that this will provide lots of cool visuals, making for great video or photos. The bit about the scholarships and the Science Teacher of the Year assures him that this won't just be a promotional stunt. So what are we offering? A non-promotional, feel-good event with great visuals. Just what an assignment editor is looking for. About The Author Bill Stoller, the "Publicity Insider", has spent two decades as one of America's top publicists. Now, through his website, eZine and subscription newsletter, Free Publicity: The Newsletter for PR-Hungry Businesses he's sharing -- for the very first time -- his secrets of scoring big publicity. For free articles, killer publicity tips and much, much more, visit Bill's exclusive new site:

ABSTRACT Folate Intake and the Risk of Incident Hypertension Among US Women John P. Forman, MD; Eric B. Rimm, ScD; Meir J. Stampfer, MD, DrPH; Gary C. Curhan, MD, ScD Context Folate has important beneficial effects on endothelial function, but there is limited information about folate intake and risk of incident hypertension. Objective To determine whether higher folate intake is associated with a lower risk of incident hypertension. Design, Setting, and Participants Two prospective cohort studies of 93 803 younger women aged 27 to 44 years in the Nurses’ Health Study II (1991-1999) and 62 260 older women aged 43 to 70 years in the Nurses’ Health Study I (1990-1998), who did not have a history of hypertension. Baseline information on dietary folate and supplemental folic acid intake was derived from semiquantitative food frequency questionnaires and was updated every 4 years. Main Outcome Measure Relative risk of incident self-reported hypertension during 8 years of follow-up. Results We identified 7373 incident cases of hypertension in younger women and 12 347 cases in older women. After adjusting for multiple potential confounders, younger women who consumed at least 1000 µg/d of total folate (dietary plus supplemental) had a decreased risk of hypertension (relative risk [RR], 0.54; 95% confidence interval [CI], 0.45-0.66; P for trend <.001) compared with those who consumed less than 200 µg/d. Younger women’s absolute risk reduction (ARR) was approximately 8 cases per 1000 person-years (6.7 vs 14.8 cases). The multivariable RR for the same comparison in older women was 0.82 (95% CI, 0.69-0.97; P for trend = .05). Older women’s ARR was approximately 6 cases per 1000 person-years (34.7 vs 40.4 cases). When the analysis was restricted to women with low dietary folate intake (Conclusion Higher total folate intake was associated with a decreased risk of incident hypertension, particularly in younger women. JAMA. 2005;293:320-329. Author Affiliations: Renal Division (Drs Forman and Curhan), Channing Laboratory (Drs Forman, Rimm, Stampfer, and Curhan), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School and Departments of Epidemiology and Nutrition (Drs Forman, Rimm, Stampfer, and Curhan), Harvard School of Public Health, Boston, Mass.

ABSTRACT Background This study examines the association of potentially inappropriate medication prescribing (PIRx) with hospitalization and death among elderly long-stay nursing home residents. Methods We defined PIRx using the combined version of the Beers criteria. Data were from the 1996 Medical Expenditure Panel Survey Nursing Home Component. The study sample included 3372 residents, 65 years and older, who had nursing home stays of 3 consecutive months or longer in 1996. We performed multivariate logistic regression analyses of longitudinal data using generalized estimating equations. Results Residents who received any PIRx had greater odds (odds ratio [OR], 1.27; P = .002) of being hospitalized in the following month than those receiving no PIRx. Residents with PIRx exposure for 2 consecutive months were at increased risk (OR, 1.27; P = .004) of hospitalization, as were those receiving PIRx in the second month only (OR, 1.80; P = .001), compared with those receiving no PIRx. Residents who received PIRx were at greater risk of death (OR, 1.28; P = .01) that month or the next. Residents with intermittent PIRx exposures were at greater odds of death (OR, 1.89; P<.001), compared with those with no PIRx exposure. Conclusions The association of PIRx with subsequent adverse outcomes (hospitalization and death) provides new evidence of the importance of improving prescribing practices in the nursing home setting. Arch Intern Med. 2005;165:68-74. January 10, 2005 Author Affiliations: Buehler Center on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Lau); Department of Health Policy and Management, Bloomberg School of Public Health (Dr Kasper), and Division of Geriatric Medicine and Gerontology, School of Medicine (Dr Bennett), The Johns Hopkins University, Baltimore, Md; Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Md (Ms Potter); and School of Government and Public Administration, University of Baltimore (Dr Lyles).

ABSTRACT Objective: To compare longitudinal changes in bone mineral density (BMD) among first-time depot medroxyprogesterone acetate (DMPA) users to women using no hormonal contraception, and evaluate user characteristics associated with that BMD change. Design: Prospective longitudinal study. Setting: Healthy volunteers in an academic research environment. Patient(s) Women, aged 18 to 35, choosing DMPA for contraception (n = 178) and women using no hormonal contraception (n = 145). Main outcome measure(s) : Hip and spine BMD measured, at three-month intervals for 24 months, by dual energy x-ray absorptiometry. Result(s) : Mean hip BMD declined 2.8% (SE = 0.034) 12 months following DMPA initiation and 5.8% (SE = 0.096) after 24 months. Mean spine (L1–L3) BMD declined 3.5% (SE = 0.022) and 5.7% (SE = 0.034), respectively, after one and two years of DMPA use. Mean hip and spine BMD of control participants changed less than 0.9% over the same period. Among DMPA users, body mass index (BMI) change was inversely associated with BMD change at the hip, but not at the spine. Calcium intake, physical activity, and smoking did not influence BMD change in either group. Conclusion(s) : Hip and spine BMD declined after one DMPA injection and this decline continued with each subsequent injection for 24 months. With the exception of increasing BMI among DMPA users, no user characteristics offered protection against DMPA-related BMD loss. SOURCE: Fertility and Sterility, December 2004, Volume 82, Issue 6, Pages 1580-1586

ABSTRACT Objective: To discuss the diagnosis and treatment of a patient with cubital tunnel syndrome and to illustrate novel treatment modalities for the ulnar nerve and its surrounding structures and target tissues. The rationale for the addition of nerve-gliding techniques will be highlighted. Clinical Features: Two months after onset, a 17-year-old female nursing student who had a traumatic onset of cubital tunnel syndrome still experienced pain around the elbow and paresthesia in the ulnar nerve distribution. Electrodiagnostic tests were negative. Segmental cervicothoracic motion dysfunctions were present which were regarded as contributing factors hindering natural recovery. Intervention and Outcomes: After 6 sessions consisting of nerve-gliding techniques and segmental joint manipulation and a home exercise program consisting of nerve gliding and light free-weight exercises, a substantial improvement was recorded on both the impairment and functional level (pain scales, clinical tests, and Northwick Park Questionnaire). Symptoms did not recur within a 10-month follow-up period, and pain and disability had completely resolved. Conclusions: Movement-based management may be beneficial in the conservative management of cubital tunnel syndrome. As this intervention is in contrast with the traditional recommendation of immobilization, comparing the effects of both interventions in a systematic way is an essential next step to determine the optimal treatment of patients with cubital tunnel syndrome. November/December 2004; Vol. 27, No. 9. Journal of Manipulative and Physiological Therapeutics

ABSTRACT Objective: To investigate the possible association of dietary caffeine consumption and medicinal caffeine use with chronic daily headache (CDH). Methods: Population-based cases and controls were recruited from the Baltimore, MD, Philadelphia, PA, and Atlanta, GA, metropolitan areas. Controls (n = 507) reported 2 to104 headache days/year, and cases (n = 206) reported 180 headache days/year. Current and past dietary caffeine consumption and medication use for headache were based on detailed self-report. High caffeine exposure was defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter analgesic as the preferred headache treatment. Results: In comparison with episodic headache controls, CDH cases were more likely overall to have been high caffeine consumers before onset of CDH (odds ratio [OR] = 1.50, p = 0.05). No association was found for current caffeine consumption (i.e., post CDH) (OR = 1.36, p = 0.12). In secondary analyses, associations were confined to younger (age <40) women (OR = 2.0, p = 0.02) and those with chronic episodic (as opposed to chronic continuous) headaches (OR = 1.69, p = 0.01), without physician consultation (OR = 1.67, p = 0.04) and of recent (Conclusion: Dietary and medicinal caffeine consumption appears to be a modest risk factor for chronic daily headache onset, regardless of headache type. Scher AI, et al. Neurology. December 14, 2004; Vol. 63, No. 11, pp. 2022-2027.