Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in US Women John P. Forman*; Meir J. Stampfer; and Gary C. Curhan Abstract Acetaminophen, ibuprofen, and aspirin are the most commonly used drugs in the United States. Although the frequency of their use has been associated with hypertension, prospective data examining the dose of these drugs and risk of hypertension are lacking. Furthermore, whether certain indications for analgesic use, particularly headache, mediate the association is unclear. We conducted 2 prospective cohort studies among older women 51 to 77 years of age (n=1903) from the Nurses’ Health Study I and younger women 34 to 53 years of age (n=3220) from the Nurses’ Health Study II who completed detailed supplemental questionnaires pertaining to their analgesic use and who did not have hypertension at baseline. We analyzed incident hypertension according to categories of average daily dose of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin. Information on indications for analgesic use as well as relevant confounders was also gathered prospectively. Compared with women who did not use acetaminophen, the multivariable adjusted relative risk for those who took >500 mg per day was 1.93 (1.30 to 2.88) among older women and 1.99 (1.39 to 2.85) among younger women. For nonsteroidal anti-inflammatory drugs, similar comparisons yielded multivariable relative risks of 1.78 (1.21 to 2.61) among older women and 1.60 (1.10 to 2.32) among younger women. These associations remained significant among women who did not report headache. Aspirin dose was not significantly associated with hypertension. Higher daily doses of acetaminophen and nonsteroidal anti-inflammatory drugs independently increase the risk of hypertension in women. Because acetaminophen and nonsteroidal anti-inflammatory drugs are commonly used, they may contribute to the high prevalence of hypertension in the United States. From the Renal Division (J.P.F., G.C.C.), Department of Medicine, Brigham and Women’s Hospital, Boston, Mass; Channing Laboratory (J.P.F., M.J.S., G.C.C.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; and Department of Epidemiology (J.P.F., M.J.S., G.C.C.), Harvard School of Public Health, Boston, Mass. Hypertension published August 15, 2005, 0.1161/01.HYP.0000177437.07240.70

ABSTRACT Background: Ad libitum, low-carbohydrate diets decrease caloric intake and cause weight loss. It is unclear whether these effects are due to the reduced carbohydrate content of such diets or to their associated increase in protein intake. Objective: We tested the hypothesis that increasing the protein content while maintaining the carbohydrate content of the diet lowers body weight by decreasing appetite and spontaneous caloric intake. Design: Appetite, caloric intake, body weight, and fat mass were measured in 19 subjects placed sequentially on the following diets: a weight-maintaining diet (15% protein, 35% fat, and 50% carbohydrate) for 2 wk, an isocaloric diet (30% protein, 20% fat, and 50% carbohydrate) for 2 wk, and an ad libitum diet (30% protein, 20% fat, and 50% carbohydrate) for 12 wk. Blood was sampled frequently at the end of each diet phase to measure the area under the plasma concentration versus time curve (AUC) for insulin, leptin, and ghrelin. Results: Satiety was markedly increased with the isocaloric high-protein diet despite an unchanged leptin AUC. Mean (±SE) spontaneous energy intake decreased by 441 ± 63 kcal/d, body weight decreased by 4.9 ± 0.5 kg, and fat mass decreased by 3.7 ± 0.4 kg with the ad libitum, high-protein diet, despite a significantly decreased leptin AUC and increased ghrelin AUC. Conclusions: An increase in dietary protein from 15% to 30% of energy at a constant carbohydrate intake produces a sustained decrease in ad libitum caloric intake that may be mediated by increased central nervous system leptin sensitivity and results in significant weight loss. This anorexic effect of protein may contribute to the weight loss produced by low-carbohydrate diets. American Journal of Clinical Nutrition, Vol. 82, No. 1, 41-48, July 2005 © 2005 American Society for Clinical Nutrition

Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial Jiang He, MD, PhD; Dongfeng Gu, MD, MS; Xigui Wu, MD; Jichun Chen, MSc; Xiufang Duan, MD; Jing Chen, MD, MSc; and Paul K. Whelton, MD, MSc ABSTRACT Background: Objective: Design: Setting: Patients: Intervention: Measurements: Results: Limitations: Conclusions:

ABSTRACT Objective. Each year, children die from heat stroke after being left unattended in motor vehicles. In 2003, the total was 42, up from a national average of 29 for the past 5 years. Previous studies found that on days when ambient temperatures exceeded 86°F, the internal temperatures of the vehicle quickly reached 134 to 154°F. We were interested to know whether similarly high temperatures occurred on clear sunny days with more moderate temperatures. The objective of this study was to evaluate the degree of temperature rise and rate of rise in similar and lower ambient temperatures. In addition, we evaluated the effect of having windows "cracked" open. Methods. . In this observational study, temperature rise was measured continuously over a 60-minute period in a dark sedan on 16 different clear sunny days with ambient temperatures ranging from 72 to 96°F. On 2 of these days, additional measurements were made with the windows opened 1.5 inches. Analysis of variance was used to compare how quickly the internal vehicle temperature rose and to compare temperature rise when windows were cracked open 1.5 inches. Results. . Regardless of the outside ambient temperature, the rate of temperature rise inside the vehicle was not significantly different. The average mean increase was 3.2°F per 5-minute interval, with 80% of the temperature rise occurring during the first 30 minutes. The final temperature of the vehicle depended on the starting ambient temperature, but even at the coolest ambient temperature, internal temperatures reached 117°F. On average, there was an 40°F increase in internal temperature for ambient temperatures spanning 72 to 96°F. Cracking windows open did not decrease the rate of temperature rise in the vehicle (closed: 3.4°F per 5 minutes; opened: 3.1°F per 5 minutes or the final maximum internal temperature. Conclusions. Even at relatively cool ambient temperatures, the temperature rise in vehicles is significant on clear, sunny days and puts infants at risk for hyperthermia. Vehicles heat up rapidly, with the majority of the temperature rise occurring within the first 15 to 30 minutes. Leaving the windows opened slightly does not significantly slow the heating process or decrease the maximum temperature attained. Increased public awareness and parental education of heat rise in motor vehicles may reduce the incidence of hyperthermia death and improve child passenger safety. To read the full report click on the link below. Full Text PEDIATRICS Vol. 116 No. 1 July 2005, pp. e109-e112

Abstract (provisional) Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractic as a primary care provider. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractic as a portal-of-entry provider, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles which would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession. © 2005 Nelson et al., licensee BioMed Central Ltd. Chiropractic & Osteopathy 2005, 13:9 doi:10.1186/1746-1340-13-9 Read the full version by clicking on the link below.

A new study funded by the Canadian Institute for Health Information’s Canadian Population Health Initiative shows that Old Order Mennonite children from Ontario living a similar lifestyle to that of previous generations tend to be fitter, stronger and leaner than children living a contemporary Canadian lifestyle—this despite the fact they do not have physical education classes and do not participate in organized sports. New analyses by obesity expert Dr. Mark S. Tremblay and a group of researchers from the University of Saskatchewan and University of Lethbridge found a strong link between contemporary lifestyles in Canadian children and reduced physical activity and fitness. “What this study proves is that you don’t need to do triathlons to stay fit and active,” says Dr. Tremblay, a Professor of Kinesiology at the University of Saskatchewan. “Children living traditional lifestyles have exercise embedded in their daily lives. In contrast, today’s children engage more in passive activities, such as video games. This may go a long way in explaining why they are less physically fit.” The study found that Old Order Mennonite children, on average, do up to 18 minutes more moderate or vigorous physical activity a day than urban and rural contemporary children. Researchers estimate that, all else being equal, this translates into a caloric difference between the Old Order Mennonite children and children living a contemporary lifestyle of approximately 15,000 kcal per year—or over 40 pounds of fat per person, per decade. The Old Order Mennonite children in the study also had leaner triceps than urban Saskatchewan children, a greater aerobic fitness score than rural Saskatchewan children, and greater grip strength than both rural and urban Saskatchewan children. These findings were true for girls and boys. Researchers attribute the Old Order Mennonite children’s strength and fitness to the fact they get a great deal of physical activity through walking, traditional farming activities and household chores. “Since obesity can lead to life-long health problems, including diabetes and heart disease, it may well be worthwhile to look at how aspects of modern lifestyles may contribute to childhood obesity,” says Lisa Sullivan, Manager of Research and Policy at the Canadian Population Health Initiative. “This research gives us a unique glimpse into the past that may help to explain the rising rates of obesity over the past few decades.” Approximately 30% of all the children in the study were classified as overweight—a figure that is consistent with nationally representative data. Methodology A cross-sectional study design was used to examine physical fitness and activity characteristics of three groups of children aged 8 to 13: Old Order Mennonite children from Ontario; Urban Saskatchewan children; and Rural Saskatchewan children. The data collection for this study took place from September to December 2002. Researchers assessed fitness by collecting height, weight, triceps skin fold, grip strength, push-ups, partial curl-ups and aerobic fitness measurements. Also, physical activity levels were measured for seven consecutive days using an accelerometer—an instrument that measures the intensity of body acceleration—and estimated from a self-reported physical activity questionnaire for older children. Canadian Population Health Initiative The Canadian Population Health Initiative (CPHI), which is part of the Canadian Institute for Health Information (CIHI), funded the research described in this media release. CPHI supports research to advance knowledge on the determinants of health in Canada and to develop policy options to improve population health and reduce health inequalities. Canadian Institute for Health Information (CIHI) The Canadian Institute for Health Information (CIHI) is an independent, pan-Canadian, not-for-profit organization working to improve the health of Canadians and the health care system by providing quality health information. CIHI’s mandate, as established by Canada’s health ministers, is to coordinate the development and maintenance of a common approach to health information for Canada. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health. Media contacts: Leona Hollingsworth (613) 241-7860, Ext. 4140 Cell: (613) 612-3915

Today we celebrate the 229th birthday of the United States of America. On July 4, 1776, the Second Continental Congress unanimously adopted the Declaration of Independence, as we claimed our independence from Britain. On behalf of the NYSCA’s Officers, we want to wish you and your family a Happy 4th of July. To celebrate 4th of July with your own fire works show, click on the “Fire Works” below. Fire Works Also, examine the US Constitution by clicking on this link.

YONKERS, N.Y., -- Alternative medicine is no longer truly alternative. A Consumer Reports survey of more than 34,000 readers reveals that many people have tried it, and more and more doctors are recommending it. Readers gave the highest marks to hands-on treatments, which worked better than conventional treatments for conditions such as back pain and arthritis. Chiropractic was ranked ahead of all conventional treatments, including prescription drugs, by readers with back pain. (Readers said it also provided relief for neck pain, but neck manipulation can be risky and is not recommended by CR.) Deep-tissue massage was found to be especially effective in treating osteoarthritis and fibromyalgia. While readers suffering from back pain deemed acupuncture and acupressure less effective than chiropractic and massage, one-fourth of readers who had tried these therapies said they helped them feel much better. Of all the hands-on alternative therapies, acupuncture has the most scientific support. Readers also reported good results for exercise, not only for conditions such as back pain, but also for allergies and other respiratory ills, anxiety, rheumatoid arthritis, high blood pressure, high cholesterol, depression, insomnia, and prostate problems. Those results are consistent with a broad range of clinical studies of treatments for all of these conditions except allergies and respiratory ailments. On the other hand, well-known, heavily promoted herbal treatments such as echinacea, St. John's wort, saw palmetto, melatonin, and glucosamine and chondroitin didn't work as well for readers. Readers reported that alternative treatments were far less effective than prescription drugs for eight conditions: anxiety, rheumatoid arthritis, depression, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory problems. Interpreting these results of the reader survey is somewhat difficult because the U.S. regulates alternative and conventional medicines differently. Federal laws ensure that a bottle of prescription or over-the-counter pills contains the amount and kind of medicine stated on the label, and dosages are standardized, but no such standards apply to dietary supplements. Moreover, there are no standard recommended dosages. Treating symptoms of menopause A separate Consumer Reports survey of 10,042 women who had gone through menopause or were experiencing it found that a large minority of women have turned from hormone replacement, which can be risky, to black cohosh, soy supplements, and vitamin E for relief from hot flashes. However, those alternatives were far less effective. Sixty percent of respondents who took estrogen plus progestin said it helped them feel much better, as did 53 percent of those who took estrogen by itself. The botanicals scored far lower. Black cohosh was typical. It helped 17 percent of women feel much better, but 51 percent said it did nothing at all. Some, but not all, studies have found that black cohosh is modestly helpful against hot flashes and night sweats. However, its long-term safety has not been studied. Most studies of soy supplements have suggested that they're not very helpful, and breast-cancer patients should talk with their doctor before taking large amounts of soy. For other supplements, studies show little or no evidence of benefit. For specific, free advice on how to choose an alternative treatment, visit ConsumerReports.org during the month of July. In general, CR recommends the following: -- Ask your doctor. Many doctors will refer patients to preferred alternative practitioners. And your doctor may be able to steer you away from potentially hazardous alternative treatments. -- Do your own research. Objective online references include the National Center for Complementary and Alternative Medicine (nccam.nih.gov), part of the U.S. National Institutes of Health; Medline Plus (medlineplus.gov), for plain-language medical information; and Consumer Reports Medical Guide (ConsumerReportsMedicalGuide.org), which rates treatments, including alternative treatments, for several dozen common conditions. It costs $24 per year or $4.95 per month; the others are free. -- Consult other reliable sources. If your doctor doesn't have a referral list of practitioners, check with a local hospital or medical school. You can also turn to national professional organizations, many of which have geographic search functions on their Web sites. -- Check your health plan. Many cover some alternative therapies. -- Check the practitioner's credentials. Make sure your practitioner has the proper license, if applicable, or check for membership in professional associations, which require minimum levels of education and experience. Some also make practitioners pass an exam. The August 2005 issue of Consumer Reports is on sale now wherever magazines are sold. To subscribe, call 1-800-765-1845.

Abstract: Ambulatory Care Visits for Treating Adverse Drug Effects in the United States, 1995–2001: Zhan, Chunliu; Arispe, Irma; Kelley, Edward; Ding, Tina; Burt, Catharine W.; Shinogle, Judith; Stryer, Daniel Background:: Adverse drug events (ADEs) are a well-recognized patient safety concern, but their magnitude is unknown. Ambulatory visits for treating adverse drug effects (VADEs) as recorded in national surveys offer an alternative way to estimate the national prevalence of ADEs because each VADE indicates that an ADE occurred and was serious enough to require care. Methods: A nationally representative sample of visits to physician offices, hospital outpatient departments, and emergency departments was analyzed. VADEs were identified as the first-listed cause of injury. Results: In 2001, there were 4.3 million VADEs in the United States, averaging 15 visits per 1,000 population. VADE rates at physician offices, hospital outpatient departments, and hospital emergency departments were at 3.7, 3.4, and 7.3 per 1,000 visits, respectively. There was an upward trend in the total number of VADEs from 1995 to 2001 (p < .05), but the increases in VADEs per 1,000 visits and per 1,000 population were not statistically significant. VADEs were lower in children younger than 15 and higher in the elderly aged 65–74 than in adults aged 25–44 (p < .01) and were more frequent in females than in males (p < .05). Discussion: Although methodologically conservative, the study suggests that ADEs are a significant threat to patient safety in the United States. Joint Commission Journal on Quality and Patient Safety, July 2005, vol. 31, no. 7, pp. 372-378(7)

New study confirms conclusions from earlier studies linking sleep disorders and inattention in children. Children who snore may be at greater risk of becoming hyperactive later in life than those who sleep quietly. The study, published in the journal Sleep, corroborate earlier conclusions linking sleep disorders and hyperactivity, with snoring coming first followed by hyperactivity. ABSTRACT Autonomic Dysfunction in Children with Sleep-Disordered Breathing Louise M. O’Brien, PhD; David Gozal, MD - Kosair Children’s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY Study Objectives: To measure sympathetic responses in children with and without sleep-disordered breathing. Design: Prospective, observational study. Setting: Kosair Children’s Hospital Sleep Medicine and Apnea Center. Participants: Subjects were prospectively recruited from children undergoing overnight polysomnographic assessments and were retrospectively grouped according to the results of the polysomnogram. Sleep-disordered breathing was defined as an apnea-hypopnea index >5 and children were assigned to the control group if their apnea-hypopnea index was < 1. Intervention: N/A. Measurements and Results: During quiet wakefulness, pulse arterial tonometry was used to assess changes in sympathetic activity following vital capacity sighs in 28 children with sleep-disordered breathing and 29 controls. Each child underwent a series of 3 sighs, and the average maximal pulse arterial tonometry signal attenuation was calculated. Further, a cold pressor test was conducted in a subset of 14 children with sleep-disordered breathing and 14 controls. The left hand was immersed in ice cold water for 30 seconds while right-hand pulse arterial tonometry signal was continuously monitored during immersion and 20-minute recovery periods. Signal amplitude changes were expressed as percentage change from corresponding baseline. Results: The magnitude of sympathetic discharge-induced attenuation of pulse arterial tonometry signal was significantly increased in children with sleep-disordered breathing during sigh maneuvers (74.1%±10.7% change compared with 59.2%±13.2% change in controls; P<.0001) and the cold pressor test (83.5%±7.3% change compared with 74.1%±11.4% change in controls; P=.039). Further, recovery kinetics in control children were faster than those of children with sleep-disordered breathing. Conclusion: Children with sleep-disordered breathing have altered autonomic nervous system regulation as evidenced by increased sympathetic vascular reactivity during wakefulness. Journal SLEEP Volume 28/ Issue 6, June 1, 2005, Pages 747-752

Arlington, Va. (June 23, 2005) — The American Chiropractic Association today responded to the report issued by the Office of the Inspector General with the following statement: It is the opinion of the American Chiropractic Association (ACA) that the findings stated in the report issued by the Department of Health and Human Services, Office of the Inspector General reflect a universal problem in physician documentation and do not represent a concerted effort by doctors of chiropractic to over bill the government for non-reimbursable Medicare services. As has been shown with other physician groups, the documentation process frequently presents challenges and oftentimes results in perceived errors; however, it is simply wrong to conclude, based solely on this report, that chiropractic care typically rendered to Medicare beneficiaries is not necessary or appropriate. In far too many instances, chiropractic providers are simply failing to adequately document the medically necessary care provided. The ACA is committed to working with Centers for Medicare and Medicaid Services (CMS) to develop and implement efficient mechanisms to greatly improve the documentation process and help eliminate errors. It is unfortunate that the Inspector General’s report, drawn from 2001 data, provided only a passing reference to a program initiated in October 2004 that specifically addresses the very problems mentioned in this report. In addition, the Inspector General’s analysis completely ignores ACA’s vigorous and ongoing development of a documentation manual for use by doctors of chiropractic, and its educational programs targeted at state associations, chiropractic colleges, and Medicare carriers. The solution offered by the Inspector General -- to impose arbitrary caps or limits on chiropractic services -- does not take into account the individual needs of the patient. Medicare beneficiaries have the right to receive care which is reasonable and necessary, and the solution offered by the OIG arbitrarily cuts short this right, rather than to addressing the true problem of documentation. The ACA contends that placing arbitrary limits -- or caps -- on care is not an appropriate solution. Lastly, the ACA strenuously objects to the suggestion made in the report that it, at any time, supported the notion of arbitrary caps on services. The cited letter does not support that contention. The ACA is highly confident that the chiropractic care being provided through the Medicare program is both appropriate and medically necessary. We believe access to chiropractic care in Medicare saves taxpayer dollars as it is typically far less expensive than alternative forms of treatment, which often require the use of drugs and surgery. The ACA will continue to pursue all possible means to ensure that doctors of chiropractic have access to the resources they need to help correct the documentation issues raised in this report. We will also continue to protect the rights of all Medicare beneficiaries so they may continue to receive chiropractic services.

According to the Inspector General (IG) report, the government overpaid nearly $285 million in 2001 for chiropractic services. To prevent abuses, the IG recommends that caps should be placed on the number of treatments a chiropractor could bill Medicare. The ACA said that the government instituted new procedures last year to help Doctors of Chiropractic avoid improperly billing Medicare, nothing that the IG’s data cited is four years old. To examine the IG’s report click on the link below:

Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection Paul Little, MD; Kate Rumsby, BA; Joanne Kelly, BSc; Louise Watson, PhD; Michael Moore, MRCGP; Gregory Warner, MRCGP; Tom Fahey, MD; Ian Williamson, MD ABSTRACT Context Acute lower respiratory tract infection is the most common condition treated in primary care. Many physicians still prescribe antibiotics; however, systematic reviews of the use of antibiotics are small and have diverse conclusions. Objective To estimate the effectiveness of 3 prescribing strategies and an information leaflet for acute lower respiratory tract infection. Design, Setting, and Patients A randomized controlled trial conducted from August 18, 1998, to July 30, 2003, of 807 patients presenting in a primary care setting with acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups by a factorial design: leaflet or no leaflet and 1 of 3 antibiotic groups (immediate antibiotics, no offer of antibiotics, and delayed antibiotics). Intervention Three strategies, immediate antibiotics (n = 262), a delayed antibiotic prescription (n = 272), and no offer of antibiotics (n = 273), were prescribed. Approximately half of each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics). Main Outcome Measures Symptom duration and severity. Results A total of 562 patients (70%) returned complete diaries and 78 (10%) provided information about both symptom duration and severity. Cough rated at least "a slight problem" lasted a mean of 11.7 days (25% of patients had a cough lasting 17 days). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed, 0.75 days; 95% confidence intervals [CI], –0.37 to 1.88; immediate, 0.11 days; 95% CI, –1.01 to 1.24) or other primary outcomes. Compared with the immediate antibiotic group, slightly fewer patients in the delayed and control groups used antibiotics (96%, 20%, and 16%, respectively; P<.001), fewer patients were "very satisfied" (86%, 77%, and 72%, respectively; P = .005), and fewer patients believed in the effectiveness of antibiotics (75%, 40%, and 47%, respectively; P<.001). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics, 0.19; delayed, 0.12; and immediate, 0.11; P = .04) and higher attendance with a leaflet (mean attendances for no leaflet, 0.11; and leaflet, 0.17; P = .02). Conclusion No offer or a delayed offer of antibiotics for acute uncomplicated lower respiratory tract infection is acceptable, associated with little difference in symptom resolution, and is likely to considerably reduce antibiotic use and beliefs in the effectiveness of antibiotics. Author Affiliations: Primary Medical Care Group, University of Southampton, Highfield (Drs Little, Watson, and Williamson, and Mss Rumsby and Kelly); Nightingale Surgery, Romsey, Hants (Dr Warner); Three Swans Surgery, Salisbury (Drs Moore and Fahey), England; and Department of Primary Care, Dundee University, Dundee, Scotland (Dr Fahey). JAMA. 2005;293:3029-3035

ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Author Affiliations: Department of Public Health, University of Massachusetts, Amherst (Dr Bertone-Johnson); Channing Laboratory (Drs Hankinson, Willett, and Manson) and Division of Preventive Medicine (Dr Manson), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; Departments of Epidemiology (Drs Hankinson, Willett, and Manson) and Nutrition (Dr Willett), Harvard School of Public Health, Boston; GlaxoSmithKline Consumer Healthcare, Parsippany, NJ (Dr Bendich); and Department of Obstetrics and Gynecology, The University of Iowa, Iowa City (Dr Johnson). Arch Intern Med. 2005;165:1246-1252.

IMMEDIATE ACTION REQUIRED Earlier this week, Senate Bill S.3169a and Assembly Bill A.5622a, legislation that would grant physical therapists “direct access” in New York state were amended to “A” prints and started to move. The former Senate Bill, S.3169, contained protections penned into the legislation by the NYSCA and the Medical Society in the Fall of 2002. These protections have been completely discarded in the “A” print of S.3169 – now S.3169a. The companion legislation in the state Assembly, A. 5622a, has been amended to mirror the Senate legislation making the possibility of passage of Physical Therapy Direct Access more probable. YOU NEED TO ACT NOW. For more information, click on the link below.

One of the most common disorders of premenopausal women is premenstrual syndrome (PMS) however, women that get plenty of calcium and vitamin D may prevent PMS. ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Archives of Internal Medicine 2005;165:1246-1252.

ABSTRACT: Health insurance is in the midst of a design shift toward greater financial risk for patients. Where medical cost exposure is high relative to income, the shift will increase the numbers of underinsured people. This study estimates that nearly sixteen million people ages 19–64 were underinsured in 2003. Underinsured adults were more likely to forgo needed care than those with more adequate coverage and had rates of financial stress similar to those of the uninsured. Including adults uninsured during the year, 35 percent (sixty-one million) were under- or uninsured. These findings highlight the need for policy attention to insurance design that considers the adequacy of coverage. You can view the article (full text) by clicking on the link below:

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