On Friday, the FTC issued a notice indicating that the Red Flags Rule would not be enforced until January 1, 2011.  Over the past few months Congress has been debating whether this regulation should apply to healthcare providers.  The AMA has also filed a lawsuit against the FTC because they believe that the FTC has overstepped its bounds by attempting to apply this regulation to healthcare providers.  In the next few months I believe we will see a bill passed which would exempt healthcare providers from this regulation.

For more information on the Red Flags Rule visit: www.acatoday.org/redflags.  Read the FTC’s release here. 

Greeley, Colo.— Paul D. Townsend, D.C., the NBCE Director of Practical Testing Research and Development , is the lead author on an article published in the January 2010 issue of the journal Teaching and Learning in Medicine.  NBCE Director of Testing and Executive Vice President Mark G. Christensen also contributed to the article.

ABSTRACT Background: Red yeast rice is an herbal supplement that decreases low-density lipoprotein (LDL) cholesterol level. Objective: To evaluate the effectiveness and tolerability of red yeast rice and therapeutic lifestyle change to treat dyslipidemia in patients who cannot tolerate statin therapy. Design: Randomized, controlled trial. Setting: Community-based cardiology practice. Patients: 62 patients with dyslipidemia and history of discontinuation of statin therapy due to myalgias. Intervention: Patients were assigned by random allocation software to receive red yeast rice, 1800 mg (31 patients), or placebo (31 patients) twice daily for 24 weeks. All patients were concomitantly enrolled in a 12-week therapeutic lifestyle change program. Measurements: Primary outcome was LDL cholesterol level, measured at baseline, week 12, and week 24. Secondary outcomes included total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, liver enzyme, and creatinine phosphokinase (CPK) levels; weight; and Brief Pain Inventory score. Results: In the red yeast rice group, LDL cholesterol decreased by 1.11 mmol/L (43 mg/dL) from baseline at week 12 and by 0.90 mmol/L (35 mg/dL) at week 24. In the placebo group, LDL cholesterol decreased by 0.28 mmol/L (11 mg/dL) at week 12 and by 0.39 mmol/L (15 mg/dL) at week 24. Low-density lipoprotein cholesterol level was significantly lower in the red yeast rice group than in the placebo group at both weeks 12 (P < 0.001) and 24 (P = 0.011). Significant treatment effects were also observed for total cholesterol level at weeks 12 (P < 0.001) and 24 (P = 0.016). Levels of HDL cholesterol, triglyceride, liver enzyme, or CPK; weight loss; and pain severity scores did not significantly differ between groups at either week 12 or week 24. Limitation: The study was small, was single-site, was of short duration, and focused on laboratory measures. Conclusion: Red yeast rice and therapeutic lifestyle change decrease LDL cholesterol level without increasing CPK or pain levels and may be a treatment option for dyslipidemic patients who cannot tolerate statin therapy. Annals of Internal Medicine 16 June 2009 Volume 150 Issue 12 Pages 830-839

Abstract Background: Reduced intake of micronutrients during pregnancy exposes women to nutritional deficiencies and may affect fetal growth. We conducted a systematic review to examine the efficacy of prenatal supplementation with multimicronutrients on pregnancy outcomes. Methods: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for relevant articles published in English up to December 2008. We also searched the bibliographies of selected articles as well as clinical trial registries. The primary outcome was low birth weight; secondary outcomes were preterm birth, small-for-gestational-age infants, birth weight and gestational age. Results: We observed a significant reduction in the risk of low birth weight among infants born to women who received multimicronutrients during pregnancy compared with placebo (relative risk [RR] 0.81, 95% confidence interval [CI] 0.73–0.91) or iron–folic acid supplementation (RR 0.83, 95% CI 0.74–0.93). Birth weight was significantly higher among infants whose mothers were in the multimicronutrient group than among those whose mothers received iron–folic acid supplementation (weighted mean difference 54 g, 95% CI 36 g–72 g). There was no significant differences in the risk of preterm birth or small-for-gestational-age infants between the 3 study groups. Interpretation: Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron–folic acid supplementation. There was no significant effect of multimicronutrient supplementation on the risk of preterm birth or small-for-gestational-age infants. CMAJ • June 9, 2009; 180 (12). doi:10.1503/cmaj.081777.

The New York State Chiropractic Association asks members to support the ACA chiropractic advocacy network, ChiroVoice.org (ChiroVoice). Through this chiropractic advocacy network, patients and chiropractic supporters can stay informed about important health care issues and contact their legislators in Washington. Chiropractic supporters will be able to educate policymakers about the value of chiropractic and work to positively impact any legislative efforts to reform the current national health care system. ChiroVoice will also enable the NYSCA to mobilize patient support at the state level for legislative action when necessary. Ask your patients to sign up now! (Please be sure to adhere to all HIPAA regulations if signing patients up in your office.) The time is now for ChiroVoice! The opportunity to challenge some of the long standing issues beleaguering our profession. Prevention... Wellness... Fee Parity....Anti Discrimination Statutes, Full Scope Medicare, etc. These are just a few of our issues to be debated in DC. Historically, when given the chance to compete on a level playing field our profession shines. Along the same lines, historically the way we get there is through grass roots activities. The ACA has iniated ChiroVoice. Yet, many docs have not asked patients and staff to sign up. Please take time today to get your patients and staff involved. The Senate is marking up legislation this week and the House in a few weeks. President Obama wants a bill on his desk by the fall if not sooner. We can shape our future. It is said "Inaction has as significant of an impact as action," please don't let inaction cause us to fail. It's up to all of us to get involved, be involved, stay involved and be triumphant...we all benefit! Thanks for your help! Louis Lupinacci, DC, FICC NYSCA Vice President H. William Wolfson, DC, FICC NYS Downstate Delegate

Greeley, Colo.—On May 7, two directors of the National Board of Chiropractic Examiners (NBCE), were honored by the Federation of Chiropractic Licensing Boards (FCLB) who bestowed upon them the 2009 George R. Arvidson Award for Meritorious Service. This award is the highest individual honor presented annually at the FCLB annual meeting. NBCE President Dr. Vernon R. Temple was honored by the FCLB for his exceptional leadership, innovation and service to chiropractic. Dr. Temple was first elected to serve the National Board as District III director in the year 2000. Since then, Dr. Temple has also served on the NBCE Executive Committee as secretary and vice president. He was elected as president of the board in 2007 and will continue in that role until May 2010. Dr. Temple is a graduate of Palmer College of Chiropractic in Davenport, Iowa, and has been in practice in Vermont since 1978. He is a diplomate of the American Board of Chiropractic Orthopedists. He is a former chairman of the Federation of Chiropractic Licensing Boards and has also served as president of the Vermont Board of Chiropractic Examination and Regulation. NBCE Director Dr. Oliver R. Smith, Jr., and outgoing president of the FCLB received an Arvidson Award for his work in financially stabilizing the FCLB and strengthening the organization’s focus. Dr. Smith previously served as president, vice president, treasurer, and District IV director of the FCLB. He served as and NBCE director from 2005-2009 and was elected as director-at-large on the NBCE board in May 2009. He is a past president of the Texas Board of Chiropractic Examiners and received the Keeler Plaque Award in 1997 as an outstanding chiropractic practitioner in Texas. Dr. Smith is a graduate of Texas Chiropractic College. Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

GREELEY, Colo.—On May 8, the National Board of Chiropractic Examiners (NBCE) held its Annual Board Meeting in conjunction with the Federation of Chiropractic Licensing Boards’ (FCLB) 83rd Annual Educational Conference in Hollywood, CA. At the meeting, NBCE delegates elected Dr. Paul N. Morin (ME) as District III Director, replacing Dr. Mary-Ellen Rada (NJ). The delegates re-elected Dr. Norman E. Ouzts, Jr. (SC) as District V Director. Dr. Robin R. Lecy (SD), District I Director; Dr. Donna L. Craft (MI), District II Director; and Dr. Theodore J. Scott (UT), District IV Director will continue their terms. NBCE Directors-at-Large Dr. Vernon Temple (VT), and Dr. N. Edwin Weathersby (AZ) were re-elected to their at-large positions. Dr. Oliver Smith was elected as a new at-large director and NBCE Director-at-Large Dr. Richard L. Cole (TN) will continue his term. The two remaining positions on the 11-member NBCE Board of Directors are filled by the president and vice-president of the Federation of Chiropractic Licensing Boards: Dr. Daniel Saint-Germain (Quebec, Canada) and Dr. Lawrence O’Connor (NJ), respectively, were appointed to serve on the NBCE Board of Directors. The Executive Committee was then elected by the board. Dr. Vernon Temple was re-elected as President, Dr. N. Edwin Weathersby as Vice President and Dr. Theodore Scott as Treasurer. Dr. Richard L. Cole was elected to the Executive Committee as Secretary. Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

The Virginia Chiropractic Association (VCA) and the Virginia Society of Chiropractic (VSC) announced their intent to unite into a single entity and the formation of a Unification Committee. The unification will create a single, more influential association in the Commonwealth of Virginia that will better serve chiropractic doctors, patients, and the profession as a whole. The goal is to reduce duplication, allowing the profession to devote more resources and expertise to public policy, education, legal and legislative initiatives. Over the past several years, the organizations have begun collaborating more and more frequently, assisting each other in legislative activities and conducting joint educational programs. Both presidents accepted honorary memberships in the other organizations and face-to-face meetings and conference calls between the two Boards and staff became regular occurrences. The Unification Committee is charged with fleshing out the myriad of organizational, operational, and legal details and considerations involved in bringing the two groups together. In addition, it will outline a plan to provide a framework for the rules that will govern the organizations during the consolidation period, thereby ensuring a smooth transition.

WASHINGTON, D.C. —During a conference call today with reporters, Senator John D. (Jay) Rockefeller IV (D-W.Va.), Chairman of the Senate Finance Subcommittee on Health Care, and Congressman Joe Courtney (D-Conn.), Member of the House Education and Labor Committee, announced the introduction of the Pre-existing Condition Patient Protection Act that would end insurance discrimination against those who live with pre-existing or chronic illness. “We have 133 million Americans living with chronic illness – insurance companies should no longer be allowed to reap profits by denying care to sick Americans,” said Senator Rockefeller. “We as a nation can no longer stand by and continue to allow this practice to occur. These medical services are not optional, and most times, they are not affordable without insurance. Our system is broken—which is why we must eliminate the ability of insurers to deny coverage for pre-existing conditions in every single market. The time for serious action is now.” “It is wrong and impractical to commit ourselves to health care reform without addressing the faulty and ill-advised pre-existing condition exclusion,” stated Congressman Courtney. “This discriminatory practice prevents millions of hardworking Americans from changing or finding new jobs and in this economy that is just plain wrong. Senator Rockefeller and I agree that it is time for the most advanced nation in the world to have a world-class health care system that is fair and affordable.” Background The Pre-existing Condition Patient Protection Act will eliminate pre-existing condition exclusions in all insurance markets, a major step forward for the 133 million Americans living with at least one chronic condition. Eliminating pre-existing condition exclusions is a priority of the Obama Administration and Senator Rockefeller and Congressman Courtney plan to work closely with President Obama to enact this vital legislation. Insurance market reform must be a central part of comprehensive health reform. Both Senator Rockefeller and Congressman Courtney believe that all individuals should have access to comprehensive, meaningful, and affordable health insurance coverage—and this legislation is a critical component of achieving that goal. Summary of the legislation ****The Pre-existing Condition Patient Protection Act is a bill to protect consumers excluded from receiving health insurance coverage due to a “pre-existing condition.” ****The Pre-existing Condition Patient Protection Act would require the Secretary of Health and Human Services to submit a report to Congress on the extent of adverse selection (i.e. which happens when less healthy people disproportionately enroll in a risk pool) that occurs because insurers can no longer exclude patients with pre-existing conditions. This report must include data from private insurers on the characteristics of their insured population. This new reporting requirement would provide transparency on the true mix of patients and patient claims experience among private insurers; and ****Require the Government Accountability Office to submit a report to Congress addressing the impact of this legislation on reducing the number of uninsured and underinsured, as well as its effect on the affordability of health insurance coverage. This is meant to highlight both the positive impact this new policy will have on making coverage more accessible for individuals with chronic conditions, but also recognize that without further regulatory changes, coverage may not be affordable for these individuals. ****The Pre-existing Condition Patient Protection Act of 2009 has been endorsed by twenty-two organizations, including: American Autoimmune Related Diseases Association; American Heart Association/American Stroke Association; Association of Black Cardiologists, Inc.; Association of Community Cancer Centers; Breast Cancer Network of Strength; Children’s Cause for Cancer Advocacy; Congenital Heart; Information Network; Dermatology Nurses’ Association; First Focus; International Myeloma Foundation; Lung Cancer Alliance; Lupus Foundation of America; Mended Little Hearts; National Association of Pediatric Nurse Practitioners; National Patient Advocate Foundation; Oncology Nursing Society; Ovarian Cancer National Alliance; Pediatric Stroke Network, Inc.; Sarcoma Foundation of America; Sudden Cardiac Arrest Association; The Leukemia & Lymphoma Society; and The Wellness Community.

Vitamin C Intake and the Risk of Gout in Men Abstract A Prospective Study Background Several metabolic studies and a recent double-blind, placebo-controlled, randomized trial have shown that higher vitamin C intake significantly reduces serum uric acid levels. Yet the relation with risk of gout is unknown. Methods We prospectively examined, from1986 through 2006, the relation between vitamin C intake and risk of incident gout in 46 994 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain the American College of Rheumatology criteria for gout. Vitamin C intake was assessed every 4 years through validated questionnaires. Results During the 20 years of follow-up, we documented 1317 confirmed incident cases of gout. Compared with men with vitamin C intake less than 250 mg/d, the multivariate relative risk (RR) of gout was 0.83 (95% confidence interval [CI], 0.71-0.97) for total vitamin C intake of 500 to 999 mg/d, 0.66 (0.52-0.86) for 1000 to 1499 mg/d, and 0.55 (0.38-0.80) for 1500 mg/d or greater (P < .001 for trend). The multivariate RR per 500-mg increase in total daily vitamin C intake was 0.83 (95% CI, 0.77-0.90). Compared with men who did not use supplemental vitamin C, the multivariate RR of gout was 0.66 (95% CI, 0.49-0.88) for supplemental vitamin C intake of 1000 to 1499 mg/d and 0.55 (0.36-0.86) for 1500 mg/d or greater (P < .001 for trend). Conclusions Higher vitamin C intake is independently associated with a lower risk of gout. Supplemental vitamin C intake may be beneficial in the prevention of gout. Authors Affiliations: Division of Rheumatology, Department of Medicine, Arthritis Research Centre of Canada, Vancouver General Hospital, University of British Columbia, Vancouver, Canada (Dr Choi); Channing Laboratory (Drs Choi, Gao, and Curhan) and Renal Division, Department of Medicine (Dr Curhan), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston (Drs Gao and Curhan). Dr Choi is now with the Rheumatology Section, Clinical Epidemiology Unit, Boston University School of Medicine, Boston. Arch Intern Med. 2009;169(5):502-507.

After carefully listening and reviewing member comments, the Foundation for Chiropractic Education and Research has opened its popular new DCConsult® website to all at no cost. The former subscription only site has been revamped, with a new emphasis on the needs of the practicing clinician. Driven by two major search engines anyone can now visit www.DCConsult.com and instantaneously run a search for the most current research abstracts. A click of a button and the site immediately translates from English to Spanish, French, German, Italian or Portuguese. For the past two years, it has been the goal of the FCER’s Board of Trustees to provide easy access for the profession to the literature, articles, links, educational products and more. DCConsult is now the globally recognized repository of such information. From South Africa, Evalie K. Heath, DC writes, “This is Wonderful news. A Very Big Thank you for your new policy to make DCConsult available to everyone at no cost. DCConsult will be a wonderful tool for ALL Chiropractors to access chiropractic articles, research and news. Those of us in more remote areas of the Earth (remote from Chiropractic schools and centers of research) and especially those in areas with economic difficulties greatly appreciate this decision.” Dr. Heath goes on to encourage colleagues in Uganda, South Africa, Nambia, Mozambique, Mauritius, Kenya, Ghana, Ethiopia, Congo: “Dear Africa Members, DCConsult opens the world of Chiropractic information to our very finger tips. Please enjoy this new privilege. Please inform all of your members and colleagues.” FCER’s President, Dr. Charles Herring stated, “As long as new research and articles emerge – DCConsult will never be finished. Information, as well as translations are being added as quickly as possible. The web site will continually change – so visit often.” FCER Vice President, Dr. Ronald Evans explains, "Moving DCConsult into the open access domain has not been without significant challenges. Newer site designs require more data to keep content current. FCER/DCConsult is seeking volunteer expertise to make the content more robust in several ways: 1) Contribution of original Evidence Based Medicine/Evidence Based Principles (EBM/EBP) material, 2) Abstract mining from any source germane to chiropractic science, 3) Book/Textbook recommendations for a website book list, and 4) Occasional chiropractic research consultancy. Never before in the 65-year history of this foundation has the need been greater for the chiropractic profession to step forward and assist with a project of this global magnitude." Coming soon is a FCER Member only section offering free audios, patient handouts and other downloads especially for those who financially support FCER activities. DCConsult would not be possible without the support of Standard Process Inc., National Board of Chiropractic Examiners, Future Health Inc., Academy of Chiropractic Orthopedists, American College of Chiropractic Consultants, College on Forensic Sciences and others. The Foundation for Chiropractic Education and Research celebrates its 65th Anniversary in 2009. FCER is a 501(c)3 not-for-profit foundation with a mission To promote the health and well being of humanity by encouraging and supporting research and education relative to the field of chiropractic care, and to provide information needed to document and improve chiropractic healthcare capacity worldwide. DCConsult directly aligns with FCER’s mission and is worthy of your support.

A Randomized Controlled Trial ABSTRACT Context Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease (PAD) without intermittent claudication have been established as beneficial. Objective To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication. Design, Setting, and Participants Randomized controlled clinical trial performed at an urban academic medical center between April 1, 2004, and August 8, 2008, involving 156 patients with PAD who were randomly assigned to supervised treadmill exercise, to lower extremity resistance training, or to a control group. Main Outcome Measures Six-minute walk performance and the short physical performance battery. Secondary outcomes were brachial artery flow-mediated dilation, treadmill walking performance, the Walking Impairment Questionnaire, and the 36-Item Short Form Health Survey physical functioning (SF-36 PF) score. Results For the 6-minute walk, those in the supervised treadmill exercise group increased their distance walked by 35.9 m (95% confidence interval [CI], 15.3-56.5 m; P < .001) compared with the control group, whereas those in the resistance training group increased their distance walked by 12.4 m (95% CI, –8.42 to 33.3 m; P = .24) compared with the control group. Neither exercise group improved its short physical performance battery scores. For brachial artery flow-mediated dilation, those in the treadmill group had a mean improvement of 1.53% (95% CI, 0.35%-2.70%; P = .02) compared with the control group. The treadmill group had greater increases in maximal treadmill walking time (3.44 minutes; 95% CI, 2.05-4.84 minutes; P < .001); walking impairment distance score (10.7; 95% CI, 1.56-19.9; P = .02); and SF-36 PF score (7.5; 95% CI, 0.00-15.0; P = .02) than the control group. The resistance training group had greater increases in maximal treadmill walking time (1.90 minutes; 95% CI, 0.49-3.31 minutes; P = .009); walking impairment scores for distance (6.92; 95% CI, 1.07-12.8; P = .02) and stair climbing (10.4; 95% CI, 0.00-20.8; P = .03); and SF-36 PF score (7.5; 95% CI, 0.0-15.0; P = .04) than the control group. Conclusions Supervised treadmill training improved 6-minute walk performance, treadmill walking performance, brachial artery flow-mediated dilation, and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication. Lower extremity resistance training improved functional performance measured by treadmill walking, quality of life, and stair climbing ability. Click on the link below to read the full article:

The U.S. Department of Health and Human Services today released an updated and improved version of the Surgeon General’s Internet-based family health history tool. The new tool makes it easier for consumers to assemble and share family health history information. It can also help practitioners make better use of health history information so they can provide more informed and personalized care for their patients. “This valuable tool can put family histories to work to improve patient well-being and the quality of care,” HHS Secretary Mike Leavitt said. “The tool is built on health information technology standards that make it more convenient for consumers and more useful for practitioners. It is ready for use in electronic health records. And its software code will be openly available to other health organizations, so they can customize and build on its standards base.” “Family history has always been an important part of good health care, but it has been underused,” said Acting Surgeon General Steven Galson, a rear admiral in the U.S. Public Health Service. “Today, with our growing knowledge of genetics, family history is becoming even more important. The new tool will help consumers and clinicians alike. It will also serve as a platform for developing new risk assessment software that will help in screening and prevention of cancer, heart disease, diabetes, and other conditions.” Key features of the new version of the Surgeon General’s My Family Health Portrait include: ---Convenience – Consumers can access the tool easily on the Web. Completing the family health history profile typically takes 15-20 minutes. Consumers should not have to keep filling out different health history forms for different practitioners. Information is easily updated or amended. ---Consumer control and privacy – The family health history tool gives consumers access to software that builds a family health tree. But the personal information entered during the use of the tool is not kept by a government or other site. Consumers download their information to their own computer. From there, they have control over how the information is used. ---Sharing – Because the information is in electronic form, it can be easily shared with relatives or with practitioners. Relatives can add to the information, and a special re-indexing feature helps relatives easily start their own history based on data in a history they received. Practitioners can help consumers understand and use their information. ---EHR-ready, Decision support-ready – Because the new tool is based on commonly used standards, the information it generates is ready for use in electronic health records and personal health records. It can be used in developing clinical decision software, which helps the practitioner understand and make the most use of family health information. ---Personalization of care – Family history information can help alert practitioners and patients to patient-specific susceptibilities. ---Downloadable, customizable – The code for the new tool is openly available for others to adopt. Health organizations are invited to download and customize, using the tool under their own brand and adding features that serve their needs. Developers may also use the code to create new risk assessment software tools. The first adopter of the HHS-developed tool is the National Institute of Genomic Medicine of Mexico (INMEGEN). Dr. Gerardo Jimenez-Sanchez, director general of the institute, will release the Mexican Spanish-language version of the tool in Mexico City this month. The Mexican family health history tool will be available on the INMEGEN Web site, http://www.inmegen.gob.mx. The Indian Health Service, an agency of HHS that was instrumental in developing the new Surgeon General tool, will also adopt it into the IHS care system. One organization saying it will link to the new tool is the Lance Armstrong Foundation (LAF), a cancer advocacy organization. “A strong family health history tool can be an important element for guiding medical decision-making, especially in the area of cancer screening, prevention and early detection,” said LAF founder and chairman Lance Armstrong. “This tool will further the capabilities of electronic health records and takes a significant step toward improving clinical care.” The Surgeon General’s My Family Health Portrait was originally launched in 2004, but the first version was not standards-based. The new tool was developed under Secretary Leavitt’s Initiative on Personalized Health Care. It will be hosted by the National Cancer Institute, where the caBIG® initiative is pioneering health IT networks and software sharing. A ready process for organizations to download the family health history code is at https://gforge.nci.nih.gov/projects/fhh. The Surgeon General’s new My Family Health Portrait tool is located at https://familyhistory.hhs.gov. In addition, a presentation of sample risk assessment tools under development can be viewed at http://videocast.nih.gov/summary.asp?live=7297.

ABSTRACT Research on physical activity and health has pointed clearly to increasing the time that adults spend doing moderate-to-vigorous intensity activities: 30 minutes a day is generally recommended. Recent evidence, however, underlines the importance of also focusing on sedentary behaviours -- the high volumes of time that adults spend sitting in their remaining ‘non-exercise’ waking hours. In the context of contemporary interest in physical activity and health, we provide a brief overview of recent evidence for the distinct relationships between ‘too much sitting’ and biomarkers of metabolic health, and thus with increased risk of type 2 diabetes, cardiovascular disease and other prevalent chronic health problems. Particular concerns for this new field include the challenges of changing sedentary behaviours in the context of ubiquitous environmental and social drivers of sitting time; examining the effects of interventions for reducing or breaking-up sitting time; and, identifying the most-relevant implications for clinical and public health practice.

Abstract Background Physical inactivity is associated with several diseases, but studies evaluating the association between chronic musculoskeletal complaints (MSCs) and physical exercise have shown conflicting results. The aim of this large-scale prospective population-based study was to investigate the association between self-reported physical exercise at baseline and the prevalence of chronic musculoskeletal complaints (MSCs) 11 years later. Methods The results are based upon two consecutive public health studies conducted within the county of Nord-Trondelag, Norway (The HUNT studies). A total of 39,520 (83%) out of 47,556 adults who participated in HUNT 1 and HUNT 2 responded to questions about physical exercise at baseline in 1984-86, and to questions about musculoskeletal complaints 11 years later (1995-97). Chronic MSCs was defined as MSCs >3 months during the past year, and chronic widespread MSCs such as pain > 15 days during the last month from the axial region, above the waist, and below the waist. Associations were assessed using multiple logistic regression, estimating prevalence odds ratio (OR) with 95 % confidence intervals (CIs). All the final analyses were adjusted for age, gender, body mass index, smoking and education level. Results At follow-up 20,223 (51%) reported chronic MSCs, and among these 2,318 (5.9%) reported chronic widespread MSCs. Individuals who exercised at baseline were less likely to report chronic MSCs 11 years later (OR 0.91, 95 % CI 0.85-0.97) than inactive persons. Among individuals who exercised more than three times per week, chronic widespread MSCs were 28% less common (OR 0.72, 95% CI 0.59-0.88) compared to inactive individuals. Conclusions In this large-scale population-based study, physical exercise was associated with lower prevalence of chronic MSCs, in particular chronic widespread MSCs. Future studies should try to clarify whether chronic MSCs are a cause or a consequence of inactivity. Holth HS, et al. BMC Musculoskeletal Disorders. 2008:

Acting Surgeon General Steven K. Galson, M.D., M.P.H., today issued a Call to Action to reduce the number of cases of deep vein thrombosis and pulmonary embolism in the United States. Galson urged all Americans to learn about and prevent these treatable conditions. Deep vein thrombosis and pulmonary embolism affect an estimated 350,000 to 600,000 Americans each year, and the numbers are expected to increase as the U.S. population ages. Together, deep vein thrombosis and pulmonary embolism contribute to at least 100,000 deaths each year. Deep vein thrombosis is a blood clot in a deep vein, most commonly in the lower leg or thigh. The clot can block blood flow and cause pain, swelling, and skin discoloration. In the most serious cases, deep vein thrombosis can lead to a pulmonary embolism — when part of the blood clot breaks loose and travels through the bloodstream to the lungs, where it can block a lung artery, causing damage to the lungs or other organs from lack of oxygen. "Deep vein thrombosis and pulmonary embolisms are often 'silent' conditions — they can occur suddenly and without symptoms," Galson said. "But we have made a lot of progress in understanding how these disorders develop and how to prevent, diagnose, and treat them. It's time to put this knowledge into action." Researchers have found that in most cases, deep vein thrombosis and pulmonary embolism develops in people who have an inherited blood clotting disorder or other risk factor, and who experience a triggering event. "Being hospitalized or confined to bed rest, having major surgery, suffering a trauma, or traveling for several hours can increase a person’s risk of deep vein thrombosis and pulmonary embolism," Galson said. “We want to increase the awareness and knowledge of these potentially deadly conditions and encourage patients and health care providers to take the steps to prevent them." The Call to Action urges a coordinated, multifaceted plan to reduce the numbers of cases of deep vein thrombosis and pulmonary embolism nationwide. The plan emphasizes the need for: Increased awareness about deep vein thrombosis and pulmonary embolism. Evidence-based practices for deep vein thrombosis. More research on the causes, prevention, and treatment of deep vein thrombosis. The Call to Action resulted from a Surgeon General’s Workshop on Deep Vein Thrombosis which was convened in May 2006. The workshop was co-sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. "Deep vein thrombosis and pulmonary embolism are major public health problems, and NHLBI is committed to continuing to support important basic and clinical research to advance our understanding of these disabling and potentially fatal conditions," NHLBI Director Elizabeth G. Nabel, M.D., noted. "Research is shedding light on genetic factors and the role of triggering events, behaviors, and conditions that increase the risk of developing dangerous blood clots. It is imperative that clinicians and public health experts work together to translate this scientific evidence to save lives." The Agency for Healthcare Research and Quality (AHRQ) contributed to the Call to Action with the release of two new guides — one for patients and another for health care providers — on how to prevent dangerous blood clots. “Fighting deep vein thrombosis and pulmonary embolism is a team effort that involves health care providers and patients,” said AHRQ Director Carolyn M. Clancy, M.D. The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism 2008, is available at:

ABSTRACT Background. Drug-related adverse events are an underappreciated consequence of antibiotic use, and the national magnitude and scope of these events have not been studied. Our objective was to estimate and compare the numbers and rates of emergency department (ED) visits for drug-related adverse events associated with systemic antibiotics in the United States by drug class, individual drug, and event type. Methods. We analyzed drug-related adverse events from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (2004–2006) and outpatient prescriptions from national sample surveys of ambulatory care practices, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2004–2005). Results. On the basis of 6614 cases, an estimated 142,505 visits (95% confidence interval [CI], 116,506–168,504 visits) annually were made to US EDs for drug-related adverse events attributable to systemic antibiotics. Antibiotics were implicated in 19.3% of all ED visits for drug-related adverse events. Most ED visits for antibiotic-associated adverse events were for allergic reactions (78.7% of visits; 95% CI, 75.3%–82.1% of visits). One-half of the estimated ED visits were attributable to penicillins (36.9% of visits; 95% CI, 34.7%–39.2% of visits) and cephalosporins (12.2%; 95% CI, 10.9%–13.5%). Among commonly prescribed antibiotics, sulfonamides and clindamycin were associated with the highest rate of ED visits (18.9 ED visits per 10,000 outpatient prescription visits [95% CI, 13.1–24.7 ED visits per 10,000 outpatient prescription visits] and 18.5 ED visits per 10,000 outpatient prescription visits [95% CI, 12.1–25.0 ED visits per 10,000 outpatient prescription visits], respectively). Compared with all other antibiotic classes, sulfonamides were associated with a significantly higher rate of moderate-to-severe allergic reactions (4.3% [95% CI, 2.9%–5.8%] vs. 1.9 % [95% CI, 1.5%–2.3%]), and sulfonamides and fluoroquinolones were associated with a significantly higher rate of neurologic or psychiatric disturbances (1.4% [95% CI, 1.0%–1.7%] vs. 0.5% [95% CI, 0.4%–0.6%]). Conclusions. Antibiotic-associated adverse events lead to many ED visits, and allergic reactions are the most common events. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients. Clinical Infectious Diseases 2008;47:000–000 1058-4838/2008/4706-00XX DOI: 10.1086/591126

The U.S. Food and Drug Administration (FDA) has notified manufacturers of fluoroquinolone antimicrobial drugs that a Boxed Warning in the product labeling concerning the increased risk of tendinitis and tendon rupture is necessary. Through its new authority under the Food and Drug Administration Amendments Act of 2007 (FDAAA), the agency also determined that it is necessary for manufacturers of the drugs to provide a Medication Guide to patients about possible side effects. The FDA has notified the manufacturers of these drugs that a Risk Evaluation and Mitigation Strategy (REMS) is necessary to ensure that the benefits of the drug outweigh the risks. The Medication Guide will be considered to be an element of the REMS. The new Boxed Warning and Medication Guide would strengthen warning information already included in product labeling for the fluoroquinolone class of systemic antimicrobial drugs. Fluoroquinolones are drugs approved for the treatment or prevention of certain bacterial infections. Like other antibacterial drugs, fluoroquinolones do not treat viral infections such as colds or flu. "Fluoroquinolones are effective in treating certain bacterial infections, but health care professionals and patients need to be aware of the increased risk associated with the use of these drugs of developing tendinitis and tendon rupture, particularly for certain patient populations," said Edward Cox, M.D., director, Office of Antimicrobial Products, Center for Drug Evaluation and Research. "The FDA believes it is important to highlight and strengthen information regarding possible side effects of fluoroquinolones because it may affect decisions about the relative risks and benefits associated with these products." The FDA has conducted a new analysis of the available literature and post-marketing adverse event reports. This new analysisreconfirmsthat use of fluoroquinolones is associated with an increased risk of tendon rupture. It alsodemonstrates that despite the current warning of tendon rupture in the labeling for the fluoroquinolones, large numbers of tendon-related adverse events continue to be reported. The FDA considers this new analysis to be "new safety information" as defined in FDAAA. The FDA also issued Information for Health Care Professionals today to alert health care professionals to the increased risk of tendinitis and tendon rupture in patients taking these drugs and to highlight new information concerning who may be at higher risk for this side effect. The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is further increased in people older than 60, in those taking corticosteroid drugs, and in kidney, heart, and lung transplant recipients. Patients experiencing pain, swelling, inflammation of a tendon or tendon rupture should be advised to stop taking their fluoroquinolone medication and to contact their health care professional promptly about changing their antimicrobial therapy. Patients should also avoid exercise and using the affected area at the first sign of tendon pain, swelling, or inflammation. Manufacturers are being notified of the need to change labeling so that all of the drugs in the class carry uniform updated warning language. These warnings would apply to fluoroquinolones for systemic use (e.g., pills, tablets, capsules and injectable formulations). The warnings would not apply to fluoroquinolones for topical ophthalmic or otic use (e.g., eye and ear drops). Fluoroquinolone manufacturers are required to submit the safety labeling changes, including the strengthened warnings and the Medication Guide, to the FDA within 30 days, or to provide a reason why they do not believe such labeling changes are necessary. If they do not submit new language, or the FDA disagrees with the new language the company proposes, FDAAA provides strict timelines for resolving the labeling changes and allows the agency to issue an order directing the labeling change as deemed appropriate to address the new safety information. In addition, in accordance with FDAAA, sponsors will be required to assess whether their REMS are achieving the goal of informing patients of the risk of tendon-rupture. These assessments may include a survey of patients' and prescribers' understanding of the risks of tendon-rupture and whether the Medication Guide is being distributed and dispensed with the drug. Health care professionals should consider the potential benefits and risks for each patient. While most patients tolerate these medicines well, occasionally some will develop other serious adverse reactions that may include convulsions, hallucinations, depression, abnormalities in heart rhythm, or severe diarrhea. The medications involved in this action are: Cipro and generic ciprofloxacin, Cipro XR and Proquin XR (ciprofloxacin extended release), Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), and Floxin and generic ofloxacin. Information for Healthcare Professionals on Fluoroquinolone Antimicrobial Drugs:

AUBURN - Auburn University researchers have found that wearing thong-style flip-flops can result in sore feet, ankles and legs. The research team, led by biomechanics doctoral student Justin Shroyer, presented its findings at the recent annual meeting of the American College of Sports Medicine in Indianapolis. “We found that when people walk in flip-flops, they alter their gait, which can result in problems and pain from the foot up into the hips and lower back,” Shroyer said. “Variations like this at the foot can result in changes up the kinetic chain, which in this case can extend upward in the wearer’s body.” The researchers, in the AU College of Education’s Department of Kinesiology, recruited 39 college-age men and women for the study. Participants, wearing thong-style flip-flops and then traditional athletic shoes, walked a platform that measured vertical force as the walkers’ feet hit the ground. In addition, a video camcorder measured stride length and limb angles. Shroyer’s team, under the direction of Dr. Wendi Weimar, associate professor of biomechanics and director of the department’s Biomechanics Laboratory, found that flip-flop wearers took shorter steps and that their heels hit the ground with less vertical force than when the same walkers wore athletic shoes. When wearing flip-flops, the study participants did not bring their toes up as much during the leg’s swing phase, resulting in a larger ankle angle and shorter stride length, possibly because they tended to grip the flip-flops with their toes. Shroyer, who owns two pairs of flip-flops himself, said the research does not suggest that people should never wear flip-flops. They can be worn to provide short-term benefits such as helping beach-goers avoid sandy shoes or giving athletes post-game relief from their athletic shoes, but are not designed to properly support the foot and ankle during all-day wear, and, like athletics shoes, should be replaced every three to four months. “Flip-flops are a mainstay for students on college campuses but they’re just not designed for that kind of use,” he said. The study included thong-style flip-flops from well-known retailers and manufacturers and ranged in price from $5 to $50. Athletic shoes included in the study also ranged in price and style. Shroyer’s interest in flip-flops has other footwear applications, as well as applications in other areas of biomechanics research. He will apply conclusions from the flip-flop study to his dissertation research on specialty athletics shoes and how they support the foot and aid in biomechanic performance.

Opinion Several decades ago, medical researcher Jack Wennberg studied health care services in Vermont and found that "Vermonters who lived in towns with more aggressive care weren't healthier," but rather they "were just getting more health care," columnist David Leonhardt writes in the New York Times. Wennberg's results have held true in studies conducted at the national level, and they offer "the key to health reform -- how to spend less on health care while not making the population any less healthy," according to Leonhardt. He writes that Wennberg's story "forms the backbone of 'Overtreated,' by Shannon Brownlee," a senior fellow at the New America Foundation. Leonhardt says Brownlee's work is his "choice for the economics book of the year." He continues that health care spending "simply can't continue to rise at its current pace," adding, "Fortunately -- if that's the right word -- there is an obvious candidate for cost-cutting: all that care that brings no health benefit." In her book, Brownlee "lays out an agenda for reform that is usually confined to academic journals," Leonhardt says, adding, "It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now." He continues, "Other solutions would be more difficult," but "models for reform are out there." Leonhardt notes that since "the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal" and that such progress "is probably the finest human achievement of the last half century." Leonhardt concludes, "If we weren't wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century" (Leonhardt, New York Times, 12/19). The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. (c) 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Kaiser Daily Health Policy Report: Opinion - Dec 20, 2007. You can view the entire Kaiser Daily Health Policy Report by clicking on the link below: