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NYCC - TRANSITIONS MAGAZINE WINS AWARD OF DISTINCTION

Transitions, New York Chiropractic College’s alumni magazine, has won two Awards of Distinction from The Communicator Awards 2006 Print Competition. The Communicator Awards is an international competition that recognizes excellence in the field of communication. Transitions magazine was judged by industry professionals and recognized for exceeding industry standards in communicating a message or idea. Over 5,000 entries were received and Transitions was presented with an Award of Distinction in the Educational Institution category for two recent issues; “’Tis the Season” and “Jobs”. Transitions magazine is produced by NYCC’s Department of Institutional Advancement.

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New York State rated 50th for patient-safety incidents in hospitals

According to a study released on Monday April 3, 2006 by HealthGrades medical errors remain a leading cause of death and injury at hospitals nationwide. New York hospitals ranked at the bottom when it comes to keeping patients from developing complications or new infections while in the hospital. To read the full study click on the link below. Third Annual Patient Safety in American Hospitals Study Note: You must have Adobe Acrobat Reader to view the study.

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Effect of 6-Month Calorie Restriction on Biomarkers of Longevity, Metabolic Adaptation, and Oxidative Stress in Overweight Individuals

A Randomized Controlled Trial Context Prolonged calorie restriction increases life span in rodents. Whether prolonged calorie restriction affects biomarkers of longevity or markers of oxidative stress, or reduces metabolic rate beyond that expected from reduced metabolic mass, has not been investigated in humans. Objective To examine the effects of 6 months of calorie restriction, with or without exercise, in overweight, nonobese (body mass index, 25 to <30) men and women. Design, Setting, and Participants Randomized controlled trial of healthy, sedentary men and women (N = 48) conducted between March 2002 and August 2004 at a research center in Baton Rouge, La. Intervention Participants were randomized to 1 of 4 groups for 6 months: control (weight maintenance diet); calorie restriction (25% calorie restriction of baseline energy requirements); calorie restriction with exercise (12.5% calorie restriction plus 12.5% increase in energy expenditure by structured exercise); very low-calorie diet (890 kcal/d until 15% weight reduction, followed by a weight maintenance diet). Main Outcome Measures Body composition; dehydroepiandrosterone sulfate (DHEAS), glucose, and insulin levels; protein carbonyls; DNA damage; 24-hour energy expenditure; and core body temperature. Results Mean (SEM) weight change at 6 months in the 4 groups was as follows: controls, –1.0% (1.1%); calorie restriction, –10.4% (0.9%); calorie restriction with exercise, –10.0% (0.8%); and very low-calorie diet, –13.9% (0.7%). At 6 months, fasting insulin levels were significantly reduced from baseline in the intervention groups (all P<.01), whereas DHEAS and glucose levels were unchanged. Core body temperature was reduced in the calorie restriction and calorie restriction with exercise groups (both P<.05). After adjustment for changes in body composition, sedentary 24-hour energy expenditure was unchanged in controls, but decreased in the calorie restriction (–135 kcal/d [42 kcal/d]), calorie restriction with exercise (–117 kcal/d [52 kcal/d]), and very low-calorie diet (–125 kcal/d [35 kcal/d]) groups (all P<.008). These "metabolic adaptations" (~ 6% more than expected based on loss of metabolic mass) were statistically different from controls (P<.05). Protein carbonyl concentrations were not changed from baseline to month 6 in any group, whereas DNA damage was also reduced from baseline in all intervention groups (P <.005). Conclusions Our findings suggest that 2 biomarkers of longevity (fasting insulin level and body temperature) are decreased by prolonged calorie restriction in humans and support the theory that metabolic rate is reduced beyond the level expected from reduced metabolic body mass. Studies of longer duration are required to determine if calorie restriction attenuates the aging process in humans. JAMA. 2006;295:1539-1548.

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Do You Have Money Waiting For You?

A Message from the Comptroller Dear Friend, The State of New York is currently holding billions of dollars in unclaimed funds. Some of this money may belong to you! For your protection, banks, insurance companies, utilities, investment companies and many other businesses are required by State law to surrender inactive accounts to the State. As State Comptroller, I serve as custodian of this money until you claim it. The State of New York never takes ownership of this money. If you can prove you are entitled to the money, I will gladly return it to you, at any time, without charge. This website will tell you how to avoid having your money turned over to the State and how to get it back if it is abandoned.

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NYCC Offers Masters in Applied Clinical Nutrition

American dieters just got some new help in their battle of the bulge. New York Chiropractic College (NYCC) in Seneca Falls, New York, is instituting a nutritional program that will prepare experts to assist patients with their diet-related problems. NYCC’s new program, founded by world-renowned nutritionist, Dr. Shari Lieberman, will enable matriculating healthcare professionals to blend clinical nutrition applications with existing preventative and treatment options. It is structured to provide comprehensive professional education to prepare graduates to practice in a wide range of clinical, consulting and industry settings. It will emphasize an integrative approach to healthcare with the specific aim to provide a professionally oriented curriculum, focused on clinical nutrition and its application in prevention and disease management. The program emphasizes an integrative approach to healthcare, and is applicable to practice in a wide range of clinical, consulting and industry settings. The 36-credit hour (540 hours), six-trimester program differs significantly from many nutrition curricula because of its focus on applied clinical nutrition and its application in prevention and disease management. Graduates will be able to individually design intervention programs that encompass diet, exercise, nutritional supplementation (e.g., vitamins, minerals, botanicals, essential fatty acids, amino acids), well suited for private practitioners, for integrative practice with other professionals, and for consultant roles with research and industry. Coursework: When and Where? The program is designed for working health professionals who are currently healing patients and working to prevent the onset of illness. Consequently, NYCC’s coursework is uniquely designed to be taught one weekend per month allowing busy professionals to participate. Coursework is delivered through NYCC’s interactive video teleconferencing system located in each location: Levittown, NY (Long Island), Seneca Falls, NY, and DePew, NY (near Buffalo) and is supplemented with online computer modules. The College has found that this method of teaching offers a number of benefits for its students. Delivery of the course to students in all three locations allows students to interact with the instructor and other students in real time, thereby allowing for personal interaction between instructor and students to occur at each site at least once per term. The faculty – all highly accredited seasoned professionals with clinical research experience – will “rotate” teaching in each of the centers during the trimester, thereby allowing for physical interaction between instructor and students to occur at each site at least once per term. For more information about New York Chiropractic College’s Applied Clinical Nutrition program, contact the office of Admissions at 1-800-234-6922, visit the College at 2360 State Route 89 in Seneca Falls, N.Y., or log on to www.nycc.edu.

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Patients’ Perspectives on Ideal Physician Behaviors

We incorporated the views of patients to develop a comprehensive set of ideal physician behaviors. Telephone interviews were conducted in 2001 and 2002 with a random sample of 192 patients who were seen in 14 different medical specialties of Mayo Clinic in Scottsdale, Ariz, and Mayo Clinic in Rochester, Minn. Interviews focused on the physician-patient relationship and lasted between 20 and 50 minutes. Patients were asked to describe their best and worst experiences with a physician in the Mayo Clinic system and to give specifics of the encounter. The interviewers independently generated and validated 7 ideal behavioral themes that emerged from the interview transcripts. The ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Ways that physicians can incorporate clues to the 7 ideal physician behaviors to create positive relationships with patients are suggested. Mayo Clin Proc. 2006;81(3):338-344 To read a review by Ann Edmundson, MD click on the link below.

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U.S. SENATE COMMITTEE TO VOTE ON BILL ELIMINATING CHIROPRACTIC PROTECTIONS AT THE STATE LEVEL

U.S. Senator Mike Enzi (R-Wyoming) Chairman of the U.S. Senate Health Education and Labor (HELP) Committee is the primary sponsor of S.1955, proposed legislation intended to help small businesses and associations obtain more affordable group health insurance for their employees. While well intended, this legislation would extend ERISA’s preemption to cover the small group insurance market now regulated at the state level. As a practical matter, this legislation would render useless state-enacted legislation such as chiropractic specific mandates, any-willing provider, and insurance equality laws intended to protect health care providers and consumers. If enacted into law, S.1955, would preempt all state mandated benefit legislation not just those that are specific to the chiropractic profession. Press Release LANDMARK AGREEMENT REACHED ON HEALTH INSURANCE MARKET REFORM BILL, ENZI SAYS; MARK-UP SCHEDULED Washington, D.C. - U.S. Senator Mike Enzi (R-WY), Chairman of the Senate Health, Education, Labor and Pensions Committee (HELP Committee), today announced a landmark agreement between key stakeholders on a broad-ranging health insurance bill to provide more affordable health insurance options to America’s small businesses and working families - and confirmed that the Committee will markup up the bill next week. “Working with a diverse group of Senators and business groups representing small business, we’ve bridged the gap between small business proponents of traditional AHPs and state-based interests worried about the prospects of dramatic regulatory changes in health insurance markets,” Enzi said Thursday. The bill is cosponsored by Senator Ben Nelson (D-NE) and Senator Conrad Burns (R-MT). Enzi has scheduled a mark-up of the bill on Wednesday, March 8th at 10 a.m. in the HELP Committee. Senator Nelson said: “If we don’t do something to help small businesses cope with the costs of health care, soon we will have an entire workforce without health insurance coverage. Health care premiums are experiencing double-digit growth annually; small businesses can’t keep up with the costs. As a result, fewer employers are offering health coverage and fewer employees are covered. The continuing problem of skyrocketing heath care costs is a grave threat to our working families. I am pleased to be working with the Chairman to finding a workable solution to this problem.” Senator Burns said: “The Health Insurance Marketplace Modernization and Affordability Act represents the best opportunity to bring affordable health insurance to small businesses in Montana and across the nation. I know this is a goal for all Senators, and I look forward to working with members from both sides of the aisle in achieving this important goal.” The bill, “The Health Insurance Marketplace Modernization and Affordability Act,” (S.1955) will allow business and trade associations to band their members together and offer group health coverage on a national or statewide basis in direct response to runaway costs that are driving far too many employers and families from comprehensive health insurance. Since 2000, for example, group premiums for family coverage have grown nearly 60 percent, compared to an underlying inflation rate of 9.7 percent over the same period. Designed to enhance the market leverage of small groups as well as individual policy holders, “The Health Insurance Marketplace Modernization and Affordability Act” will: give associations a meaningful role on a level playing field with other group health plans; streamline the current hodgepodge of varying state regulation; preserve the primary role of the states in health insurance oversight and consumer protection; make lower-cost health plan options available; and achieve meaningful reform without a big price tag. “We are nearing almost five years of double-digit growth in health insurance premiums – increases that have repeatedly exceeded more than five times the rate of inflation,” Enzi said. “This inflationary spiral is lowering the quality of life for countless families and hurting our economy. But those hardest hit are America’s small businesses and families outside of employer-provided insurance. Never before has there been a more urgent need to encourage market reforms like those proposed in this bill.” It responds to pleas from small business trade groups to be allowed to pool their members and provide group health insurance, called Small Business Health Plans (SBHPs) under the Enzi bill, but will also include safeguards to protect against adverse effects that could result if new group plans were given a blanket exemption from consumer protections available under state laws and regulations. Enzi praised the support of Senator Nelson and Senator Burns, the bill’s cosponsors, saying: “I’m pleased to be joined by my colleagues, Senator Nelson and Senator Burns. They bring invaluable experience to this effort and I am grateful for their commitment to this issue.” He also praised the cooperation of Senator Olympia J. Snowe (R-ME), Chair of the Senate Committee on Small Business, and Senator Jim Talent (R-MO), who have been working for years to give more affordable health insurance options to America’s small businesses. “I want to thank them for their constant efforts,” Enzi added. “We owe them thanks for never losing sight of that important goal.”

President Bush Signs Legislation Reversing Medicare Physician Fee Cuts

Arlington, Va.- President Bush signed legislation yesterday that not only reverses the current 4.4 percent Medicare physician payment reduction, which went into effect on the first of year, but will also provide automatic reprocessing of claims retroactive to Jan. 1, 2006. The legislation was included in the Deficit Reduction Act. “The ACA is extremely pleased that Congress has halted the current cut in physician Medicare payments and that they have made the change retroactive,” said ACA President Dr. Richard G. Brassard. “The return to the 2005 rate is at least partial recognition by Congress that health care providers face significant challenges in today’s practice environment.” The Centers for Medicare & Medicaid Services (CMS) said it expects contractors to begin paying new claims using 2005 rates within two days of the legislation’s enactment. In addition, doctors of chiropractic will not need to resubmit existing claims submitted between Jan. 1 and Feb. 8, 2006. Contractors will automatically reprocess any claims that used the rates effective as of Jan. 1, 2006, and will instead use the zero percent update retroactive to Jan. 1. CMS estimates contractors should be able to reprocess all claims by July 1, 2006. Providers will receive retroactive payment for the differential in a lump sum. Physician fee schedule amounts are determined by regulation and the only way they can be changed is through legislation; this puts the issue in the hands of Congress. In late 2005, Congress evaluated the issue, but technical amendments in the Senate prevented final action on this critical issue until this week. CMS, recognizing that the physician payment adjustment could increase beneficiaries’ co-payments and deductibles for previously billed services, has suggested to the Department of Health and Human Services (HHS) that if a beneficiaries’ co-pay changed on Jan. 1, 2006, a physician waiver of the amount now owed by the beneficiary should not be considered inducement. More information will be available on the ACA Web site once a final decision has been made by HHS. “The ACA will continue to lobby on behalf of its members for fair reimbursement of Medicare services. It is imperative that Congress and HHS develop a permanent solution to the physician fee schedule because those most affected by this annual dilemma are not doctors, but patients,” said Dr. Brassard. Therapy Caps For most doctors of chiropractic – with the exception of those DCs participating in the Medicare Demonstration Project – coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine. However, the ACA has received numerous questions concerning therapy caps. With language included in Deficit Reduction Act, the President also authorized the Centers for Medicare and Medicaid Services (CMS) to develop a new exception process for Medicare beneficiaries to apply for medically necessary therapy services if their treatment is expected to exceed the $1,740 cap in 2006. The ACA will provide more information as it becomes available on its web site.

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Low-Fat Dietary Pattern and Risk of Invasive Breast Cancer

The Women's Health Initiative Randomized Controlled Dietary Modification Trial ABSTRACT Context The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. Design and Setting A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. Interventions Women were randomly assigned to the dietary modification intervention group (40% [n = 19 541]) or the comparison group (60% [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure Invasive breast cancer incidence. Results Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison. Ross L. Prentice, PhD; Bette Caan, DrPH; Rowan T. Chlebowski, MD; Ruth Patterson, PhD; Lewis H. Kuller, MD; Judith K. Ockene, PhD; Karen L. Margolis, MD; Marian C. Limacher, MD; JoAnn E. Manson, MD; Linda M. Parker, DSc; Electra Paskett, PhD; Lawrence Phillips, MD; John Robbins, MD; Jacques E. Rossouw, MD; Gloria E. Sarto, MD; James M. Shikany, DrPH; Marcia L. Stefanick, PhD; Cynthia A. Thomson, PhD; Linda Van Horn, PhD; Mara Z. Vitolins, DrPH; Jean Wactawski-Wende, PhD; Robert B. Wallace, MD; Sylvia Wassertheil-Smoller, PhD; Evelyn Whitlock, MD; Katsuhiko Yano, MD; Lucile Adams-Campbell, PhD; Garnet L. Anderson, PhD; Annlouise R. Assaf, PhD; Shirley A. A. Beresford, PhD; Henry R. Black, MD; Robert L. Brunner, PhD; Robert G. Brzyski, MD; Leslie Ford, MD; Margery Gass, MD; Jennifer Hays, PhD; David Heber, MD; Gerardo Heiss, MD; Susan L. Hendrix, DO; Judith Hsia, MD; F. Allan Hubbell, MD; Rebecca D. Jackson, MD; Karen C. Johnson, MD; Jane Morley Kotchen, MD; Andrea Z. LaCroix, PhD; Dorothy S. Lane, MD; Robert D. Langer, MD; Norman L. Lasser, MD; Maureen M. Henderson, MD JAMA. 2006;295:629-642. FOR FREE FULL TEXT CLICK ON THE LINK BELOW:

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A Randomized Clinical Trial of Continuous Low-Level Heat Therapy for Acute Muscular Low Back Pain in the Workplace

Abstract: Objectives: We sought to compare the therapeutic benefits of ThermaCare Heat Wrap combined with an education program to an education-only program on reducing pain and disability from acute work-related low back pain. Methods: Forty-three eligible patients, aged 20 to 62 years who presented to an occupational injury clinic, were randomized into one of two intervention arms: 1) education regarding back therapy and pain management alone or 2) education regarding back therapy and pain management combined with three consecutive days of topical heat therapy (104[degrees]F or 40[degrees]C for 8 hours). The primary endpoints in this trial were measures of pain intensity and pain relief levels obtained approximately four times per day for the three consecutive working days of treatment, followed by measures of pain intensity and pain relief levels obtained in three follow-up visits at day 4 and 14 from treatment initiation. The secondary measures were overall impairment due to injury and disability caused by low back pain assessed at Intake, Visit 2 (day 4), 3 (day 7), and 4 (day 14). Results and Conclusion: A total of 18 individuals enrolled in the education-only group and 25 in the treatment group completed the intervention and all follow-up visits. The general linear model adjusting for age, sex, baseline pain intensity, and pain medication indicated that the topical heat therapy had significantly reduced pain intensity, increased pain relief, and improved disability scores during and after treatment. Journal of Occupational & Environmental Medicine. 47(12):1298-1306, December 2005.

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New comp bill introduced by New York Gov.

On Tuesday, Gov. George E. Pataki introduced the 2006-2007 budget for New York State which includes a comprehensive workers compensation reform. The bill would amend the workers' compensation law, the executive law and the insurance law, in relation to compensation claims. To read the proposed WC bill click on the link below.

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New Fractures after Vertebroplasty: Adjacent Fractures Occur Significantly Sooner

Abstract BACKGROUND AND PURPOSE: Whether vertebroplasty increases the risk of adjacent-level vertebral fractures remains uncertain. Biomechanical and clinical studies suggest an increased risk, but compelling data have not yet been put forth to settle this difficult issue. We believe that an analysis of the time interval between vertebroplasty and subsequent fractures may shed additional light on this debate. We specifically hypothesized that subsequent fractures would occur sooner and more frequently in the vertebrae adjacent to the treated level. METHODS: We performed a retrospective analysis of the risk and timing of subsequent fractures in patients previously treated with vertebroplasty. Multiple linear regression was used to explore factors that influence the time to new fracture following vertebroplasty. Fractures were then divided on the basis of whether they occurred adjacent or nonadjacent to the treated level. Survival analysis was used to compare time to new fracture among the 2 groups, and the relative risk of both types of fracture was calculated. RESULTS: In this study, 186 new vertebral fractures occurred in 86 (19.9%) of 432 patients. Seventy-seven (41.4%) fractures were of vertebrae adjacent to the level treated with vertebroplasty. Median times until diagnosis of new adjacent and nonadjacent level fractures were 55 days and 127 days, respectively. Time to fracture was significantly different between the 2 groups (logrank <0.0001). Distance of the new fracture from the treated level was also significantly associated with time to new fracture (P < .0001). Relative risk of adjacent level fracture was 4.62 times that for nonadjacent level fracture. CONCLUSION: These data demonstrate an association between vertebroplasty and new vertebral fractures. Specifically, following vertebroplasty, patients are at increased risk of new-onset adjacent-level fractures and, when these fractures occur, they occur sooner than nonadjacent level fractures. American Journal of Neuroradiology 27:217-223, January 2006

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Long-Term Caloric Restriction Ameliorates the Decline in Diastolic Function in Humans

ABSTRACT OBJECTIVES: We determined whether caloric restriction (CR) has cardiac-specific effects that attenuate the established aging-associated impairments in diastolic function (DF). BACKGROUND: Caloric restriction retards the aging process in small mammals; however, no information is available on the effects of long-term CR on human aging. In healthy individuals, Doppler echocardiography has established the pattern of aging-associated DF impairment, whereas little change is observed in systolic function (SF). METHODS: Diastolic function was assessed in 25 subjects (age 53 ± 12 years) practicing CR for 6.5 ± 4.6 years and 25 age- and gender-matched control subjects consuming Western diets. Diastolic function was quantified by transmitral flow, Doppler tissue imaging, and model-based image processing (MBIP) of E waves. C-reactive protein (CRP), tumor necrosis factor-alpha (TNF- ), and transforming growth factor-beta1 (TGF-ß1) were also measured. RESULTS: No difference in SF was observed between groups; however, standard transmitral Doppler flow DF indexes of the CR group were similar to those of younger individuals, and MBIP-based, flow-derived DF indexes, reflecting chamber viscoelasticity and stiffness, were significantly lower than in control subjects. Blood pressure, serum CRP, TNF- , and TGF-ß1 levels were significantly lower in the CR group (102 ± 10/61 ± 7 mm Hg, 0.3 ± 0.3 mg/l, 0.8 ± 0.5 pg/ml, 29.4 ± 6.9 ng/ml, respectively) compared with the Western diet group (131 ± 11/83 ± 6 mm Hg, 1.9 ± 2.8 mg/l, 1.5 ± 1.0 pg/ml, 35.4 ± 7.1 ng/ml, respectively). CONCLUSIONS: Caloric restriction has cardiac-specific effects that ameliorate aging-associated changes in DF. These beneficial effects on cardiac function might be mediated by the effect of CR on blood pressure, systemic inflammation, and myocardial fibrosis. Abbreviations and Acronyms BMI = body mass index CR = caloric restriction CRP = C-reactive protein DF = diastolic function LV = left ventricle/ventricular MBIP = model-based image processing SF = systolic function TDI = tissue Doppler imaging TGF-ß1 = transforming growth factor-beta1 TNF- = tumor necrosis factor-alpha WD = Western diet J Am Coll Cardiol, 2006; 47:398-402

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MVP Health Care and Preferred Care Complete Merger

Two upstate New York based health plans, MVP Health Care of Schenectady and Preferred Care of Rochester, announced today that their proposed merger has been completed creating a major new plan serving three quarters of a million members across upstate New York, Vermont and New Hampshire. "The regulatory and legal steps needed to conclude the merger have been completed, and during the months ahead MVP and Preferred care coworkers will be working together to combine two great health plans into one plan that will be a 'leading player' in the Northeast," said David W. Oliker, president and CEO of MVP Health Care. "I want to reassure current MVP and Preferred Care customers that they will not see any changes in day to day operations as a result of this merger, customers will call the same telephone numbers they've always called, talk to the same people they've always talked to, and see the same doctors and health care providers as they did prior to the merger," said Lisa Brubaker, MVP Health Care executive vice president for Rochester operations, and government programs. "The combination gives us the resources to make needed investments in technology to meet the needs of our customers and providers," she said. The company said: • Members of the two plans will see no change in their products and services; • Members, employers and providers will continue to call the same telephone numbers and work with the same people from the same offices across the new combined service area; • Jobs across the new service area will be preserved; • The new combined organization will continue to operate as a not-for-profit. Its board of directors will be a combination of current MVP and Preferred Care directors; • MVP Health Care president and CEO David W. Oliker is the president and CEO of the combined company, which will continue to operate as both MVP Health Care and Preferred Care. During meetings with employees in both Rochester and Schenectady, Oliker outlined his goals for the combined company including: -- A provider network stretching from Rochester to New Hampshire that will be seamless for members and employers. -- Product offerings that will combine the best of both MVP and Preferred Care products and that can be sold throughout the expanded market area. -- Expansion of Preferred Care Medicare programs into several MVP counties. In addition to Oliker, other members of the senior management team for the combined company are drawn from both company's management teams. Lisa Brubaker, Preferred Care senior vice president and chief operating officer will assume the newly created position of MVP executive vice president, Rochester operations and government programs. Thomas Combs, Preferred Care senior vice president and chief financial officer will become executive vice president and chief financial officer of MVP. David Field, MVP chief financial officer and chief operating officer will be the executive vice president and chief operations officer for the combined company. Dennis Allen, M.D, MVP executive vice president and chief medical officer; will have the same role in the combined company. Scott Averill, MVP executive vice president and chief marketing officer will be the chief marketing and sales officer for the combined company. Denise Gonick, Esq., MVP executive vice president and chief legal officer will hold the same position in the combined company. "These executive vice president appointments reflect a blending of the talent of the two organizations," Oliker said. This is a leadership team that will make MVP the perfect example of a well-managed and successful, regional health benefits company," Oliker said. The combined company's service area covers upstate New York, the Hudson Valley, the entire state of Vermont and southern New Hampshire.

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Stressful Experiences in Childhood and Chronic Back Pain in the General Population

ABSTRACT Objectives: To determine if stressful experiences in childhood are associated with an increased risk of chronic back problems later in life. Methods: We conducted a prospective cohort study in the Canadian household population. Study participants were respondents to the first 3 cycles of the National Population Health Survey in Canada who were 18 years of age or older at baseline (n = 9552). Cases of chronic back pain during a 4-year follow-up period were ascertained with an interviewer-administered questionnaire. Stressful experiences in childhood were measured by an index consisting of 7 questions. Results: In multivariate analyses, the risk of back pain was 1.17 (95% confidence interval 0.97-1.41) for 1 stressful event and 1.49 (95% confidence interval 1.21-1.84) for 2 or more events. The effect was consistent across subgroups defined by gender, socioeconomic status, and health status. Specific events associated with an increased risk included fearful experiences, prolonged hospitalization, and parental unemployment. Discussion: Our study shows that persons reporting multiple stressful experiences in childhood are at increased risk of developing chronic back problems. Clinical Journal of Pain. November/December 2005; Vol. 21, No. 6, pp. 478-483.

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Association Between Protein Intake and Blood Pressure

ABSTRACT Background Findings from epidemiological studies suggest an inverse relationship between individuals’ protein intake and their blood pressure. Methods Cross-sectional epidemiological study of 4680 persons, aged 40 to 59 years, from 4 countries. Systolic and diastolic blood pressure was measured 8 times at 4 visits. Dietary intake based on 24-hour dietary recalls was recorded 4 times. Information on dietary supplements was noted. Two 24-hour urine samples were obtained per person. Results There was a significant inverse relationship between vegetable protein intake and blood pressure. After adjusting for confounders, blood pressure differences associated with higher vegetable protein intake of 2.8% kilocalories were –2.14 mm Hg systolic and –1.35 mm Hg diastolic (PConclusions Vegetable protein intake was inversely related to blood pressure. This finding is consistent with recommendations that a diet high in vegetable products be part of healthy lifestyle for prevention of high blood pressure and related diseases. Archives of Internal Medicine 2006;166:79-87

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Back pain in school children—Where to from here?

Abstract Back pain is now recognised to occur early in childhood and is associated with high prevalence rates when estimated by survey. This review paper considers the risk factors associated with back pain in children aged 11–14 years, and particularly those present in a school setting. The risk factors most significantly associated with back pain are primarily characteristics of the individual with less strong associations with factors present in the school environment. The majority of intervention studies undertaken in a school setting have focussed on the effect of school furniture on posture and comfort and were of short-term duration. There is a need for further research in order to achieve a better understanding of the risk factors present in a school environment and to address ways to reduce the currently recognised perceived problem of back pain among school children. A strategy for an evidence-based longitudinal intervention study is proposed, with the content outlined under the headings: policy, school equipment and furniture, individual and family. For full text click on the link to the right: FULL TEXT

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Patient Recall of the Mechanics of Cervical Spine Manipulation

ABSTRACT Objective: To determine how accurately patients with neck pain and/or headache can recall the mechanics of their cervical spine manipulative therapy immediately after its administration. Methods: A survey analysis of immediate patient recall after cervical spine manipulative therapy was performed in a private clinic. The group consisted of 94 sequentially presenting neck pain and/or headache patients with 54 (57%) females and 40 (43%) males. The mean age of the patients was 41.9 years (SD = 13.8; range, 17-96 years). Patients received diversified cervical spine manipulative therapy using a standardized set-up of lateral flexion coupled with flexion. Immediately after the cervical spine manipulative therapy, each patient completed a one-page questionnaire regarding the mechanics of the procedure. Patient responses were analyzed to determine the accuracy of their recall of head positioning. Results: Among the patients, 78.7% reported that they experienced a component of rotation and/or extension, although the technique used involved a premanipulative set-up of lateral bending coupled with flexion. Conclusion: Patients with primary complaints of neck pain and/or headache, when asked to recall the mechanics of their recently applied cervical spine manipulative therapy, displayed a low rate of accuracy. Rotation and/or extension of the cervical spine were the most frequently given incorrect responses. Journal of Manipulative and Physiological Therapeutics. November 2005; Vol. 28, Iss. 9, pp. 708-712.

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The Effectiveness of Screening for Prostate Cancer

ABSTRACT Background Screening for prostate cancer is done commonly in clinical practice, using prostate-specific antigen (PSA) tests or digital rectal examination (DRE). Evidence is lacking, however, to confirm a survival benefit among screened patients. We evaluated the effectiveness of PSA, with or without DRE, in reducing mortality. Methods We conducted a multicenter nested case-control study at 10 Veterans Affairs medical centers in New England. Among 71 661 patients receiving ambulatory care between 1989 and 1990, 501 case patients were identified as men who were diagnosed as having adenocarcinoma of the prostate from 1991 through 1995 and who died sometime between 1991 and 1999. Control patients were men who were alive at the time the corresponding case patient had died, matched (1:1 ratio) for age and Veterans Affairs facility. The exposure variable (determined blind to case-control status) was whether PSA testing or DRE was performed for screening prior to the diagnosis of prostate cancer among case patients, with the same time interval for control patients. The association of screening and overall or cause-specific (prostate cancer) mortality was adjusted for race and comorbidity. Results A benefit of screening was not found in our primary analysis assessing PSA screening and all-cause mortality (adjusted odds ratio, 1.08; 95% confidence interval, 0.71-1.64; P = .72), nor in a secondary analysis of PSA and/or DRE screening and cause-specific mortality (adjusted odds ratio, 1.13; 95% confidence interval, 0.63-2.06; P = .68). Conclusions These results do not suggest that screening with PSA or DRE is effective in reducing mortality. Recommendations for obtaining "verbal informed consent" from men regarding such screening should continue. Arch Intern Med. 2006;166:38-43.

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New Cough Guidelines Recommend Against OTC Medications

New evidence-based guidelines issued by the American College of Chest Physicians (ACCP) provide the most comprehensive recommendations for the diagnosis and management of cough in adults and children, including specific recommendations for the prevention of whooping cough in adults. Diagnosis and Management of Cough: Evidence-Based Clinical Practice Guidelines is published as a supplement to the January issue of CHEST, the peer-reviewed journal of the ACCP. “Cough is the number one reason why patients seek medical attention. Although an occasional cough is normal, excessive coughing or coughing that produces blood, or thick, discolored mucus is abnormal,” said Chair of the guidelines Richard S. Irwin, MD, FCCP, University of Massachusetts Medical School, Worcester, MA “The new ACCP guidelines define how physicians should diagnose and manage cough associated with everything from the common cold to chronic lung conditions. The guidelines also are the most comprehensive evidence-based recommendations for treating cough in children.” The ACCP cough guidelines put new emphasis on the prevention of whooping cough in adults and address the role of over-the-counter (OTC) cough medications in both adults and children. The guidelines also include more than 200 recommendations for diagnosing and managing acute cough (a cough that lasts for less than 3 weeks), subacute cough (a cough that lasts 3 8 weeks), and chronic cough (a cough that lasts for more than 8 weeks) in adults and children. WHOOPING COUGH The guidelines strongly recommend that adults up to 65 years old receive a new adult vaccine for whooping cough (pertussis), a highly contagious type of subacute cough that gets its name from the loud “whooping” noise patients make when they cough. Because antibiotics are only effective early on in the infection, preventing whooping cough with a vaccine is the only way to eventually eliminate the disease. Once whooping cough takes hold, the coughing patient is at risk of serious complications of coughing, such as vomiting, breaking ribs, passing out, and passing the infection on to others. “Most of us think of whooping cough as a childhood disease, yet 28 percent of whooping cough cases in the United States is in adults,” said Dr. Irwin. “Although most of us were vaccinated against whooping cough when we were children, the older vaccine only gives protection for less than 10 years. Because the older vaccine caused serious side effects when given to older children and adults, it was only given to children. Fortunately, there is a now a new safe and effective whooping cough vaccine that can prevent adults from contracting this disease.” OTC COUGH MEDICATION The guidelines also stress that most over-the-counter cough expectorants or suppressants, including cough syrups and cough drops, do not treat the underlying cause of the cough. Therefore, the guidelines recommend that for adults with acute cough or upper airway cough syndrome (previously named postnasal drip syndrome), an older variety antihistamine with a decongestant is the preferred therapy. “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough,” said Dr. Irwin. “There is considerable evidence that older type antihistamines help to reduce cough, so, unless there are contraindications to using these medicines, why not take something that has been proven to work?” PEDIATRIC RECOMMENDATIONS The ACCP guidelines are the first to provide comprehensive, specific, evidence-based recommendations for the diagnosis and management of cough in children. Although the guidelines address all types of pediatric cough, they make a strong recommendation against the use of OTC cough and cold medications for children age 14 years and younger. “Cough is very common in children. However, cough and cold medicines are not useful in children and can actually be harmful,” said Dr. Irwin. “In most cases, a cough that is unrelated to chronic lung conditions, environmental influences, or other specific factors, will resolve on its own.” Of the estimated 829 million visits to office-based physicians in the United States, approximately 29.5 million are for cough. Additional recommendations address the most common causes of chronic cough, including upper airway cough syndrome (previously named postnasal drip syndrome), asthma, and gastroesophageal reflux disease (GERD). Chronic cough also may be a result of smoking or taking angiotensin-converting enzyme (ACE) inhibitors. An acute cough is generally caused by a “common cold”; a subacute cough can linger after a cold or may persist due to a respiratory tract infection, such as whooping cough or other postinfectious cough. “Chronic cough can significantly compromise quality of life for patients. However, patients with chronic cough do not have to continue suffering from their condition,” said W. Michael Alberts, MD, FCCP, President of the American College of Chest Physicians. “The new ACCP guidelines provide clinicians with proven methods of identifying and treating the underlying causes of chronic cough, ultimately, leading to more effective management of chronic cough and better quality of life for patients.” Endorsed by the American Thoracic Society and the Canadian Thoracic Society, the new ACCP cough guidelines were developed by an international committee of individuals with expertise and research experience related to cough from the fields of adult and pediatric pulmonology and respirology, pharmacology, neurology, speech and swallowing, and anatomy and physiology. CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at:

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