Abstract: Purpose: Delineating between functional and mechanical instability in those with chronic ankle dysfunction is a challenging task. Current methods of assessing ankle ligamentous laxity are subjective in nature and limit our ability to identify the site and extent of instability; therefore, a need exists for objective laxity measurements. The purpose of this study was to determine whether subjects with self-reported, functional ankle instability (FAI) demonstrated increased mechanical laxity when tested with instrumented arthrometry and stress radiography. Methods: Both ankles were tested in 51 subjects with self-reported unilateral FAI. An instrumented ankle arthrometer measured ankle-subtalar joint motion for total anteroposterior (AP) displacement (mm) during loading at 125 N and total inversion-eversion (I-E) rotation (degrees of ROM) during loading at 4 N[middle dot]m. The Telos GA-II/E device provided either anterior or lateral stress (15 kp) while fluoroscopic radiographs were recorded for anterior displacement (mm) and talar tilt (degrees). Results: The arthrometry measurements of anterior and total AP displacement and the radiographic measurements of anterior displacement were greater (P < 0.05) in the FAI ankles when compared with the uninjured ankles. There were no differences in total I-E rotation, inversion rotation, or talar tilt between ankles when analyzed with either measurement technique. Conclusion: The ability to objectively measure mechanical instability in the functionally unstable ankle is important to understanding the nature and cause of the instability. Ankle arthrometry and stress radiographic measurements are objective assessment tools for mechanical laxity. Despite finding greater laxity in the functionally unstable ankle, the clinical significance of the observed displacement remains unanswered. Further research is needed to determine the amount of laxity that constitutes mechanical instability and how this relates to FAI. Medicine & Science in Sports & Exercise. 36(5):760-766, May 2004. © 2004 American College of Sports Medicine

ABSTRACT Rhinoviruses are major causes of morbidity in patients with respiratory diseases; however, their modes of transmission are controversial. We investigated detection of airborne rhinovirus in office environments by polymerase chain reaction technology and related detection to outdoor air supply rates. We sampled air from 9 A.M. to 5 P.M. each workday, with each sample run for 1 work week. We directly extracted RNA from the filters for nested reverse transcriptase–polymerase chain reaction analysis of rhinovirus. Nasal lavage samples from building occupants with upper respiratory infections were also collected. Indoor carbon dioxide (CO2) concentrations were recorded every 10 minutes as a surrogate for outdoor air supply. To increase the range of CO2 concentrations, we adjusted the outdoor air supply rates every 3 months. Generalized additive models demonstrated an association between the probability of detecting airborne rhinovirus and a weekly average CO2 concentration greater than approximately 100 ppm, after controlling for covariates. In addition, one rhinovirus from a nasal lavage contained an identical nucleic acid sequence similar to that in the building air collected during the same week. These results suggest that occupants in buildings with low outdoor air supply may have an increased risk of exposure to infectious droplet nuclei emanating from a fellow building occupant.

ARLINGTON, VA - The American Chiropractic Association (ACA) and the Virginia Chiropractic Association are set to petition the U.S. Supreme Court to hear the federal antitrust and racketeering lawsuit against Trigon Blue Cross Blue Shield after the U. S. Court of Appeals for the 4th Circuit on June 2 rejected a petition to rehear the case. "The actions of the 4th Circuit were not entirely unexpected, since U.S. Courts of Appeal are reluctant to revisit decisions that have been handed down by any panel," said ACA Chairman of the Board George McClelland, DC. "This only strengthens our resolve to continue this important legal struggle and seek justice for our patients and our profession from the highest court in the land - the U.S. Supreme Court." The issues raised in the petition, however, suggest a direct conflict between the decision of the U.S. Court of Appeals for the 4th Circuit and the two decisions of Supreme Court of the United States [Copperweld Corp. v. Independence Tube Corp., 467 U.S. 752 (1984) and U.S. v. Paramount Pictures, Inc., 334 U.S. 131 (1948)], as well as a direct conflict between the decision of the 4th Circuit and a decision of the U.S. Court of Appeals for the 6th Circuit [Nurse Midwifery Assoc. v. Hibbett, 918 F.2d 605]. Both are issues that are frequently examined by the Supreme Court of the United States: (1) a lower court being out of sync with a controlling decision of the Supreme Court, and/or (2) a conflict between two lower courts of appeal requiring refereeing by the Supreme Court to establish which court of appeals decision and reasoning is correct. The ACA cites in its lawsuit that a conspiracy existed between Trigon and the medical specialty societies in Virginia to ensure that patients with musculoskeletal conditions were diverted to medical doctors instead of doctors of chiropractic. A key piece of evidence in ACA's case was the existence of a committee established by Trigon to review low-back guidelines published in 1994 by the federal government's Agency for Health Care Policy and Research (AHCPR) - guidelines favorable to chiropractic - and to recommend appropriate protocols for referring patients to chiropractic doctors. The committee was appointed from a pool of representatives recommended by medical specialty associations from throughout the state of Virginia. No doctors of chiropractic were appointed to the committee and no chiropractic associations in Virginia were given the opportunity to submit names of nominees to the committee. As a result, the committee published guidelines that did not mention the positive effects of spinal manipulation that had been a highlight of the AHCPR report. The committee instead diminished spinal manipulation's value, and in doing so, essentially invalidated a legitimate federal study, according to the ACA. The Court of Appeals found that the committee was an agent of Trigon - not a separate entity - and therefore no conspiracy existed. Instead, the court likened Trigon's actions to a hospital's credentialing "peer review" process - in which a group of medical physicians determines the qualifications of other medical doctors who are candidates for employment. The ACA believes a conspiracy did exist, and it is inappropriate to compare a hospital's credentialing review process to the types of coverage, payment and referral policy making decisions engaged in by Trigon and the selected medical societies. "We want to bring Trigon's harmful and discriminatory practices to an end, but, equally important, we must keep in mind the big picture," added Dr. McClelland. "We must send a strong signal to all who would seek to oppose, harm, or discriminate against us: we will never give up and will always fight back." The ACA and other plaintiffs have 90 days to petition the Supreme Court of the United States for review.

According to a new nationwide government survey, [1] 36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM). CAM is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. When prayer specifically for health reasons is included in the definition of CAM, the number of U.S. adults using some form of CAM in the past year rises to 62 percent. "These new findings confirm the extent to which Americans have turned to CAM approaches with the hope that they would help treat and prevent disease and enhance quality of life," said Stephen E. Straus, M.D., Director, National Center for Complementary and Alternative Medicine (NCCAM). "The data not only assists us in understanding who is using CAM, what is being used, and why, but also in studying relationships between CAM use and other health characteristics, such chronic health conditions, insurance coverage, and health behaviors." The survey, administered to over 31,000 representative U.S. adults, was conducted as part of the Centers for Disease Control and Prevention's (CDC) 2002 National Health Interview Survey (NHIS). Developed by NCCAM and the CDC's National Center for Health Statistics (NCHS), the survey included questions on 27 types of CAM therapies commonly used in the United States. These included 10 types of provider-based therapies, such as acupuncture and chiropractic, and 17 other therapies that do not require a provider, such as natural products (herbs or botanical products), special diets, and megavitamin therapy. Although there have been many surveys of CAM use to date, the various surveys included fewer choices of CAM therapies. In addition, they often surveyed smaller population samples primarily relying on telephone or mail surveys versus in-person interviews used for this survey. Thus, the results from the CAM portion of the NHIS provide the most comprehensive and reliable data to date describing CAM use by the U.S. adult population. Overall, the survey revealed that CAM use was greater among a variety of population groups, including women; people with higher education; those who had been hospitalized within the past year; and former smokers, compared to current smokers or those who had never smoked. In addition, this was the first survey to yield substantial information on CAM use by minorities. For example, it found that African American adults were more likely than white or Asian adults to use CAM when megavitamin therapy and prayer were included in the definition of CAM. "We're continuously expanding the health information we collect in this country, including information on the actions people take in dealing with their own health situations," said NCHS Director Edward J. Sondik, Ph.D. "Over the years we've concentrated on traditional medical treatment, but this new collection of CAM data taps into another dimension entirely. What we see is that a sizable percentage of the public puts their personal health into their own hands." CAM approaches were most often used to treat back pain or problems, colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. However, only about 12 percent of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so without consulting a practitioner. According to the survey, the 10 most commonly used CAM therapies and the approximate percent of U.S. adults using each therapy were: • Prayer for own health, 43 percent • Prayer by others for the respondent's health, 24 percent • Natural products (such as herbs, other botanicals, and enzymes), 19 percent • Deep breathing exercises, 12 percent • Participation in prayer group for own health, 10 percent • Meditation, 8 percent • Chiropractic care, 8 percent • Yoga, 5 percent • Massage, 5 percent • Diet-based therapies (such as Atkins, Pritikin, Ornish, and Zone diets), 4 percent. In addition to gathering data on the use of CAM practices, the survey also sought information about why people use CAM. Key findings indicate that: • 55 percent of adults said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments; • 50 percent thought CAM would be interesting to try; • 26 percent used CAM because a conventional medical professional suggested they try it; and • 13 percent used CAM because they felt that conventional medicine was too expensive. Interestingly, the survey also found that about 28 percent of adults used CAM because they believed conventional medical treatments would not help them with their health problem; this is in contrast to previous findings that CAM users are not, in general, dissatisfied with conventional medicine. The results of the survey reveal new patterns of CAM use among various population groups and provide a rich source of data for future research. Furthermore, the survey results provide a baseline for future surveys, as it establishes a consistent definition of CAM that can be used to track trends and prevalence of CAM use. [1] Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.

It is with great sadness that we acknowledge the passing of former NYSCA’s District 8 member Dr. Kenneth A. Falber who died on Wednesday, May 19, 2004. He was honored by the United States Military and his family at a private funeral. He served his country in the infantry during World War II and was decorated with three purple hearts and a silver cross. Dr. Falber practiced as a chiropractor and a hypnotherapist for 40 years at his Yonkers residence. He is survived by his loving and devoted wife, Roslyn, his children, grandchildren and great grandchild. He will be missed by the countless people whose lives he touched.

Who says rugby is a sport just for men? The Palmer College of Chiropractic Women's Rugby Football Club played its very first game in the Quad Cities on Saturday, March 27, on Credit Island–and won handily. The women defeated the Dubuque Women's Rugby Football Club 35 to 17. The fledgling club is the first women's rugby team in the Quad Cities and is lead by president Tracy Francis, a 4th tri student from upstate New York, and co-coached by 5th tri student Don Pfau. Francis helped recruit players and organize the team, which began practicing last fall. The 20 teammates meet three times a week to practice, condition and learn the rules and strategies of rugby. Men's rugby club president Jon Glead also has assisted the team by teaching the women fundamentals. "The referee and coach of the Dubuque team commented on the extraordinary level of our players' skills, especially for a start-up team," Francis said, "which is a tribute to Don's coaching skills. Rugby is big on the East Coast, where I learned to play as an undergraduate student, but it's growing in popularity in Iowa.” "We'll be increasing awareness of rugby in the Quad Cities,” added Francis, “but we hope to spread knowledge of chiropractic, too, and how it can help athletes perform at their best."

ABSTRACT Background - Identification and management of women to reduce fractures is often limited to T scores less than –2.5, although many fractures occur with higher T scores. We developed a classification algorithm that identifies women with osteopenia (T scores of –2.5 to –1.0) who are at increased risk of fracture within 12 months of peripheral bone density testing. Methods - A total of 57 421 postmenopausal white women with baseline peripheral T scores of –2.5 to –1.0 and 1-year information on new fractures were included. Thirty-two risk factors for fracture were entered into a classification and regression tree analysis to build an algorithm that best predicted future fracture events. Results - A total of 1130 women had new fractures in 1 year. Previous fracture, T score at a peripheral site of –1.8 or less, self-rated poor health status, and poor mobility were identified as the most important determinants of short-term fracture. Fifty-five percent of the women were identified as being at increased fracture risk. Women with previous fracture, regardless of T score, had a risk of 4.1%, followed by 2.2% in women with T scores of –1.8 or less or with poor health status, and 1.9% for women with poor mobility. The algorithm correctly classified 74% of the women who experienced a fracture. Conclusions - This classification tool accurately identified postmenopausal women with peripheral T scores of –2.5 to –1.0 who are at increased risk of fracture within 12 months. It can be used in clinical practice to guide assessment and treatment decisions.

The NYSCA received the following letter and guidance from the Upstate Medicare Division Contracted Carrier, HealthNow. The letter is self-explanatory. This information is being supplied to you at the request of HealthNow. Please review the attached information and if you have any comments or questions please feel free to contact Barbara Adams, LPET Specialist at the number contained in the letter. Alternatively, you may elect to contact NYSCA’s Medicare Chairperson and CAC representative, Dr. Peter Pramberger at the following telephone exchange: 516-741-2940.

ABSTRACT Objective - To assess the association of ocular disorders and high doses of antioxidants or zinc with mortality in the Age-Related Eye Disease Study (AREDS). Methods - Baseline fundus and lens photographs were used to grade the macular and lens status of AREDS participants. Participants were randomly assigned to receive oral supplements of high-dose antioxidants, zinc, antioxidants plus zinc, or placebo. Risk of all-cause and cause-specific mortality was assessed using adjusted Cox proportional hazards models. Results - During median follow-up of 6.5 years, 534 (11%) of 4753 AREDS participants died. In fully adjusted models, participants with advanced age-related macular degeneration (AMD) compared with participants with few, if any, drusen had increased mortality (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.86). Advanced AMD was associated with cardiovascular deaths. Compared with participants having good acuity in both eyes, those with visual acuity worse than 20/40 in 1 eye had increased mortality (RR, 1.36; 95% CI, 1.12-1.65). Nuclear opacity (RR, 1.40; 95% CI, 1.12-1.75) and cataract surgery (RR, 1.55; 95% CI, 1.18-2.05) were associated with increased all-cause mortality and with cancer deaths. Participants randomly assigned to receive zinc had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89). Conclusions - The decreased survival of AREDS participants with AMD and cataract suggests that these conditions may reflect systemic rather than only local processes. The improved survival in individuals randomly assigned to receive zinc requires further study. Arch Ophthalmol. 2004;122:716-726. To view the full article click on the link below:

ARLINGTON, Va., The American Chiropractic Association (ACA) has Mothers Day advice for active moms who want more time to bond with their babies: take your child along with you when you take a walk or a hike -- but be careful that you do it properly. With new products unheard of a generation ago -- like baby carriers and slings -- even the tiniest among us are able to enjoy the great outdoors. But while these items can make life easier and more enjoyable for both parent and child, they can be the cause of pain and injury if not used properly. As many mothers know, backpack-style or front-side baby carriers can be effective tools for toting your little one. However, Dr. Scott Bautch of ACA's Occupational Health Council cautions that there are risks involved with the popular backpack-style carrier. "Because the cervical spine of a child less than a year old is not fully developed, it's important at that age that the head does not bob around. The backpack-type carrier is not ideal because the parent cannot watch to make sure the child's head is stable. So a front-side carrier is better for a very young child." Dr. Bautch also urges you to consider the following: * A backpack-style or front-side carrier decreases a parent's stability when walking or hiking. It is critical that a parent gets into shape before attempting to use one of these products. * Since these carriers will change the feel of walking or hiking, they should not be used by beginning hikers. * If using a backpack-style or front-side baby carrier, make sure to select one with wide straps for your shoulders and waist. This will help distribute the carrier's weight evenly. The shoulder straps should fit comfortably over the center of your collarbone. * Once you place the child in the carrier, check to make sure there is no bunching of material against the child's body, particularly on the back, buttocks and spine. Isolated, uneven pressure like this can produce pain. The "baby sling" is becoming more and more popular thanks to its versatility of positions and comfort. But if you wish to use a baby sling, keep in mind that it is intended only for very young infants, and be sure to follow these tips: * A baby can become very hot inside the sling, so be mindful of the temperature around you. Also, make certain the baby's breathing is clear and unobstructed by the sling's material. * Never run or jog while carrying a baby in any backpack-style carrier, front-side carrier or baby sling. A baby's body is not adjusted to the cyclic pattern that is a part of running and jogging. This motion can do damage to the baby's neck, spine and/or brain. Finally, don't forget about your own health and comfort. When lifting a child, bend from the waist, but begin in a 3-point squat and implement a two-stage lift that consists of a) pulling the child up to your chest and then b) lifting straight up with your leg muscles. Chiropractic Care Can Help If you or your child experiences any pain or discomfort resulting from these or other outdoor activities, call your doctor of chiropractic. Doctors of chiropractic are licensed and trained to diagnose and treat patients of all ages, and can provide health tips for you and your children that will make enjoying outdoor activities safer and more enjoyable.

ABSTRACT Objective. To correlate the results of a new 3-question headache screen to 3 established methods of diagnosing migraine: the International Headache Society diagnostic criteria, physician's clinical impression, and presence of recurring disabling headaches. Background. A simple tool to recognize patients who experience migraine may facilitate diagnosis of this debilitating and frequently undiagnosed condition. Methods. Primary care physicians and neurologists in the United States enrolled 3014 adults with a diagnosis of migraine based on one of the following: International Headache Society criteria, an investigator's clinical impression, or presence of recurring disabling headaches. Each patient completed a 3-question headache screen: (1) Do you have recurrent headaches that interfere with work, family, or social functions? (2) Do your headaches last at least 4 hours? (3) Have you had new or different headaches in the past 6 months? A diagnosis of migraine was suggested by a yes answer to questions 1 and 2 and a no answer to question 3. Results. The 3-question headache screen identified migraine in 77% of the study population; including 78% of the patients enrolled based on International Headache Society criteria, 74% based on clinical impression, and 68% because of recurring disabling headaches. Conclusions. Positive 3-question headache screen results agreed well with migraine diagnoses based on International Headache Society criteria, clinical impressions, and presence of recurring disabling headaches. These findings support use of the 3-question headache screen to recognize migraine.

April 29, 2004 Editorial Department Newsweek Magazine P.O. Box 2120 Radio City Station New York, New York 10101 To the Editor: For such a widespread condition that costs the U.S. $100B annually, I was deeply disappointed by a glaring misrepresentation which appeared in your April 26 issue on "The Great Back Pain Debate." That distortion had to do with the suggestion that "there's not a lot of data on how effective it is in the long term" when it comes to the chiropractic care of back pain patients. As the Director of Research of the largest and oldest foundation which has contributed substantially to the evidence which supports the effectiveness of spinal manipulation for back pain patients, I take strong exception to Dan Cherkin's statement. In truth, a summary of no less than 73 clinical trials involving spinal manipulation recently published in the Annals of Internal Medicine attests to the effectiveness of this treatment in managing back pain with none of the trials having produced negative results. Furthermore, official guidelines from the governments of at least 8 countries in North America, western Europe and Australia propose that spinal manipulation is one of the two most-documented and effective management strategies for back pain [the other being the use of analgesics and nonsteroidal anti-inflammatory agents]. With this type of documented effectiveness, fewest side effects, and avoidance of expensive alternatives when possible, the treatments which chiropractors apply demand far more thoughtful review in a healthcare environment that is increasingly dependent upon the documentation of rigorous scientific evidence, regrettably overlooked in your article. [Signed] ANTHONY ROSNER, PH.D., LL.D [HON.] BROOKLINE, MASSACHUSETTS Foundation for Chiropractic Education and Research 1330 Beacon Street, Suite 315 Brookline, MA 02446-3202 UNITED STATES 617-734-3397 617-734-0989 FAX [email protected] Newsweek's editorial policy limits letters to the editor to one paragraph.

MARIETTA - The Georgia Board of Regents has rejected a proposal to allow the fund-raising foundation of Marietta's Southern Polytechnic State University to purchase the neighboring Life University campus. Following a recommendation from University System Chancellor Thomas Meredith, the Board of Regents on Wednesday decided not to approve the deal, citing "the current economic climate facing the state, the University System of Georgia and all (university system) institutions." The Life-SPSU land deal called for the private SPSU Foundation to purchase Life's 89-acre campus to expand its growing operations and, in exchange, pay off Life's $30.7 million in debt. Life, which has been struggling since losing its accreditation and seeing enrollment plummet, would then lease back about 50 percent of the campus to continue operations. SPSU foundation President Mark Graham said he was let down by Wednesday's decision by the regents. "We're just highly disappointed because it looked like a good opportunity for both sides, and it looks like a lost opportunity, too," he said. An appraisal of the Life campus, commissioned by the SPSU Foundation, placed its value at about $55 million, about $24 million less than what the foundation planned to spend. "We are very disappointed in the outcome," said foundation treasurer Gordon Mortin, who engineered plans for the land deal. "It seemed like an extraordinary opportunity. - It's not likely in our lifetime, or the lifetime of our grandchildren, that the opportunity will come again to acquire an adjacent campus for about 55 percent of the appraised value." Wednesday's decision came three days before a May 1 deadline for the regents to take action on the proposal and followed comments made last week by newly hired Life University President Dr. Guy Riekeman indicating he wanted Life to keep its campus. On April 20, the Georgia Board of Regent's Committee on Real Estate and Facilities delayed a scheduled vote on the land deal, saying they needed more time to review the financial details of the proposal. In a statement released after the decision, university system officials acknowledged the "considerable financial support" SPSU managed to gather for the project, but stated, "The Board of Regents was not assured of the long-term fiscal soundness of the project." As part of plans to purchase the Life campus, the SPSU Foundation agreed spend $2.7 million a year to pay off Life's debt. The foundation had agreed to pay about $1.3 million of that amount each year, through a combination of the lease with Life and fees collected from student housing. That left a shortfall of about $1.4 million, with The University System of Georgia expected to provide a large portion of the extra money. Because of the state budget crunch, the Board of Regents last month instructed SPSU President Dr. Lisa Rossbacher to find other sources of funding. She got $500,000 from Cobb County government during the next two years and $100,000 from the city of Marietta for the same period - a total of $600,000, plus other undisclosed sources of money. "We are gratified by the broad support of SPSU from the community, including the city of Marietta, Cobb County, the Cobb Chamber of Commerce and the Marietta Kiwanis," Dr. Rossbacher said in a statement released following Wednesday's decision. "We also have received tremendous support and assistance from our faculty, staff and students over the past months as we have worked on this proposal." While SPSU officials expressed disappointment in the decision, Riekeman celebrated the Board of Regents' decision. "The Board of Trustees and the Life college community are extremely pleased as the circumstances that led to this proposal are dramatically different today with a new administration, increased enrollment and alumni giving exceeding all expectations," he said. "I have met with SPSU's president, Dr. Lisa Rossbacher, and have expressed my desire to work together. I believe that we can all accomplish our goals. Life can maintain its pristine campus while rebuilding enrollment and aid SPSU's need for expansion. This partnership will contribute to Marietta's image and financial future." Last week, Riekeman -hired in March from Palmer Chiropractic College in Iowa in part because of his fund-raising ability - said Life has raised about $3 million from chiropractors who want to help the school. He also said he expects enrollment to grow from about 1,200 students today to between 1,400 and 1,500 students a year from now and about 3,000 within two or three years. At one point, Life University was considered the largest chiropractic college in the world, with an enrollment of about 3,600. But it was stripped of accreditation in July 2002 by the Arizona-based Council on Chiropractic Education, which questioned the operation of the school by its founder and former president Dr. Sid Williams. If SPSU were to take ownership of the land, Riekeman said last week, Life would have had to eventually find a new home to accommodate the expected increase in enrollment. [email protected] This information is reprinted with permission of the Marietta Daily Journal. Copyright 2004. For additional news stories, visit Marietta Daily Journal by clicking on the link below:

Taking vitamin D supplements by older people can cut falls by over 20%, according to new research. A meta-analysis published in the Journal of the American Medical Association looked at data from ten randomised controlled trials. Abstract Context - Falls among elderly individuals occur frequently, increase with age, and lead to substantial morbidity and mortality. The role of vitamin D in preventing falls among elderly people has not been well established. Objective To assess the effectiveness of vitamin D in preventing an older person from falling. Data Sources - MEDLINE and the Cochrane Controlled Trials Register from January 1960 to February 2004, EMBASE from January 1991 to February 2004, clinical experts, bibliographies, and abstracts. Search terms included trial terms: randomized-controlled trial or controlled-clinical trial or random-allocation or double-blind method, or single-blind method or uncontrolled-trials with vitamin D terms: cholecalciferol or hydroxycholecalciferols or calcifediol or dihydroxycholecalciferols or calcitriol or vitamin D/aa[analogs & derivates] or ergocalciferol or vitamin D/bl[blood]; and with accidental falls or falls, and humans. Study Selection - We included only double-blind randomized, controlled trials (RCTs) of vitamin D in elderly populations (mean age, 60 years) that examined falls resulting from low trauma for which the method of fall ascertainment and definition of falls were defined explicitly. Studies including patients in unstable health states were excluded. Five of 38 identified studies were included in the primary analysis and 5 other studies were included in a sensitivity analysis. Data Extraction - Independent extraction by 3 authors using predefined data fields including study quality indicators. Data Synthesis - Based on 5 RCTs involving 1237 participants, vitamin D reduced the corrected odds ratio (OR) of falling by 22% (corrected OR, 0.78; 95% confidence interval [CI], 0.64-0.92) compared with patients receiving calcium or placebo. From the pooled risk difference, the number needed to treat (NNT) was 15 (95% CI, 8-53), or equivalently 15 patients would need to be treated with vitamin D to prevent 1 person from falling. The inclusion of 5 additional studies, involving 10 001 participants, in a sensitivity analysis resulted in a smaller but still significant effect size (corrected RR, 0.87; 95% CI, 0.80-0.96). Subgroup analyses suggested that the effect size was independent of calcium supplementation, type of vitamin D, duration of therapy, and sex, but reduced sample sizes made the results statistically nonsignificant for calcium supplementation, cholecalciferol, and among men. Conclusions - Vitamin D supplementation appears to reduce the risk of falls among ambulatory or institutionalized older individuals with stable health by more than 20%. Further studies examining the effect of alternative types of vitamin D and their doses, the role of calcium supplementation, and effects in men should be considered. Additional information on Vitamin D • Food sources of Vitamin D Fortified foods are the major dietary sources of vitamin D (4). Prior to the fortification of milk products in the 1930s, rickets (a bone disease seen in children) was a major public health problem in the United States. Milk in the United States is fortified with 10 micrograms (400 IU) of vitamin D per quart, and rickets is now uncommon in the US (7). One cup of vitamin D fortified milk supplies about one-fourth of the estimated daily need for this vitamin for adults. Although milk is fortified with vitamin D, dairy products made from milk such as cheese, yogurt, and ice cream are generally not fortified with vitamin D. Only a few foods naturally contain significant amounts of vitamin D, including fatty fish and fish oils (4). The table of selected food sources of vitamin D suggests dietary sources of vitamin D. • Exposure to sunlight Exposure to sunlight is an important source of vitamin D. Ultraviolet (UV) rays from sunlight trigger vitamin D synthesis in the skin (7, 8). Season, latitude, time of day, cloud cover, smog, and sunscreens affect UV ray exposure (8). For example, in Boston the average amount of sunlight is insufficient to produce significant vitamin D synthesis in the skin from November through February. Sunscreens with a sun protection factor of 8 or greater will block UV rays that produce vitamin D, but it is still important to routinely use sunscreen whenever sun exposure is longer than 10 to 15 minutes. It is especially important for individuals with limited sun exposure to include good sources of vitamin D in their diet.

WASHINGTON - During a public meeting today, the U.S. Equal Employment Opportunity Commission (EEOC) voted to approve a proposed final rule that would permit employers, under the Age Discrimination in Employment Act (ADEA), to lawfully coordinate retiree health benefit plans with eligibility for Medicare or a comparable state-sponsored health benefit. This common and long-standing employer practice was called into question in 2000, when the U.S. Court of Appeals for the Third Circuit (Erie County Retirees Association v. County of Erie) held that the federal statute requires employers to assure that pre- and post- Medicare eligible retirees receive health benefits of equal type and value. "This rule is intended to ensure that the ADEA does not have the unintended consequence of discouraging employers from providing valuable health benefits to retirees," said Chair Cari M. Dominguez, emphasizing that the General Accounting Office has estimated 10 million retired individuals aged 55 and over count on employer-sponsored health plans as either their primary source of health coverage or as a supplement to Medicare. "Such benefits are provided on a voluntary basis at the discretion of each employer and the Commission is acting to preserve these valuable benefits for retirees." "We know that health benefits are very important to retirees. Our proposal permits the common-sense practice of coordinating employer-provided retiree health benefits with eligibility for other benefits to continue," added Vice Chair Naomi C. Earp. "This rule should be welcome news for America's retirees." The Commission's prior policy, which was rescinded by a unanimous vote in August 2001, had concluded that coordinating retiree health benefits with Medicare eligibility constituted an illegal age-based distinction under the ADEA. A Notice of Proposed Rulemaking published in the July 14, 2003, Federal Register solicited public comments on the document discussed and voted upon today. The approved proposal now will be submitted, under Executive Order 12067, to federal agencies for final review and any comments they may wish to submit. Pursuant to Executive Order 12866, a review at the Office of Management and Budget will follow. After interagency review, a final rule will be published in the Federal Register. Only after all of these steps occur will the rule become final. In addition to enforcing the ADEA, which prohibits age discrimination against workers age 40 and older, the five-member Commission enforces Title VII of the Civil Rights Act of 1964; the Equal Pay Act of 1963; Title I of the Americans with Disabilities Act of 1990; portions of the Rehabilitation Act of 1973; and sections of the Civil Rights Act of 1991. Further information about the EEOC is available on the agency's web site at:

NEW YORK -- Back-pain sufferers in America cost this country more than $100 billion annually in medical bills, disability and lost productivity at work. And 80 percent of Americans will battle back pain at some point in their lives, making it the number two reason for doctor visits, after coughs and other respiratory infections, Newsweek reports in the current issue. To relieve the pain, Americans wanted a quick fix and thus, between 1996 and 2001, there was a 77 percent increase in spinal-fusion surgery, the most costly (about $34,000 a pop) and invasive form of therapy. But, as General Editor Claudia Kalb reports in the April 26 cover story, "Treating Back Pain," (on newsstands Monday, April 19), many of these procedures simply don't work and doctors are now looking for simpler, more effective ways to treat one of the most vexing problems in medicine. "We've come to the point where we have to think out of the box," says Harvard researcher Dr. David Eisenberg, who is studying nonsurgical alternatives like massage and acupuncture. "The time is now." Kalb examines the controversy around spinal fusion and alternatives to treating pain. Chiropractic treatment, the most popular nonsurgical back therapy, is booming, with 60,000 chiropractors practicing today, a 50 percent increase since 1990. While experts generally agree that the treatment, which involves spinal manipulation and stretching, is safe for the lower back, there's not a lot of data on how effective it is in the long term. Dr. Dan Cherkin, of the Center for Health Studies in Seattle, is now conducting the first large trial of the practice. Massage has seen an increasing number of addicted patients, too, and research shows it does help knead out persistent pain; one study even found that patients took fewer medications during treatment, Kalb reports. Acupuncture is also popular, though there's a dearth of evidence about its effectiveness. But even conventional doctors say if it makes you feel better, go for it. Dr. Jeffrey Ngeow, an anethesiologist by training, pushes the tiny needles into patients at New York's Integrative Care Center. He says acupuncture, which seems to stimulate the release of feel-good endorphins, won't provide instant relief, but it will have a cumulative effect. And then there's back pain's relationship to stress. Dr. John Sarno, of NYU Medical Center's Rusk Institute of Rehabilitation Medicine, believes that almost all back pain is rooted in bottled-up emotions. He says patients need to recognize the connection between mind and body before they'll feel better. In addition, there is currently an NIH-funded pilot program at Harvard where a diverse group of 25 specialists -- surgeons as well as complementary medicine experts -- are educating one another on how they diagnose and treat back pain. The goal: to see if there is a more efficient, multidisciplinary way to attack the problem -- and to make it cost-effective, too. Please click on the link below for more information on this story:

In the first known study of the absorption and anti-tumor effects of green and black tea polyphenols in human tissue, researchers at the University of California at Los Angeles were able to detect tea polyphenols in prostate tissue after a very limited consumption of tea. More importantly, the scientists found that prostate cancer cells grew more slowly when placed in a medium containing blood serum of men who had consumed either green or black tea for five days compared to serum collected before the men began their tea-drinking regimen. Serum from men who drank comparable amounts of diet or regular soda showed no such slowing in cancer cell proliferation. The study was reported at Experimental Biology 2004, in Washington, D.C., as part of the scientific program of the American Society of Nutritional Sciences, one of the six sponsoring scientific societies of this large multi-disciplinary meeting. Recent animal and epidemiological studies have suggested tea may have anti-tumor effects against carcinoma of the prostate, and many of the polyphenolic components of tea have been found in the prostate and many other tissues in rats and mice after chronic consumption of green tea polyphenols in drinking water. Dr. Susanne Henning, UCLA Center for Human Nutrition, says the UCLA research team - a combination of nutrition scientists and urologists - focused on the possible effect of tea polyphenols on factors named polyamines and the enzymes responsible for the production of polyamines. Elevated levels of polyamines have been associated with malignancy in humans, including prostate cancer, and - since polyamines are present in prostate tissue in high concentration - are considered a logical target for chemoprevention of prostate cancer. Five days before they were to undergo radical prostatectomy, 20 men with prostate cancer were randomly assigned to consume daily either five cups of green tea, five cups of black tea, or diet or regular soda containing no tea polyphenols. Their blood serum was then collected and added to prostate tissue samples from a commercially available prostate cancer cell line called LNCaP. Analysis of the prostate tissue showed a large variation in tea polyphenol content between study participants. Tea polyphenols were found in six out of eight participants drinking green tea, seven out of seven drinking black tea, and two out of five drinking soda. The fact that two of the control participants showed polyphenols in the prostate sample might be because they were eating chocolate regularly or drinking tea before entering the study. Chocolate does contain the polyphenols epicatechin and epicatechingallate, and the turnover rate of these polyphenols - how long they might remain in tissue - is not known. They are water-soluble and are all excreted after eight hours. The maximum concentration in plasma is after two to three hours. But two important factors were different in the men who drank tea and those who did not during the five-day study. When the scientists compared the level of total polyamine to the total polyphenol content, the tea drinkers showed a significant negative correlation - the more tea components in the tissue, the less of the polyamines associated with malignancy. And when the scientists measured the proliferation of prostate cancer cells, there was a significant decrease in how fast new cancer cells appeared for the men who had consumed either green or black tea. That was true even when no tea components could be detected in the serum, indicating, says Dr. Henning, that the inhibition of cell proliferation was caused by other compounds altered through tea consumption. Prostate cancer is one of the common cancers among males in the United States, and more than a fourth of all those patients with prostate cancer are known to use alternative therapies, including green tea. This study suggests that both black and green tea are promising natural dietary supplements useful for chemoprevention of prostate cancer, according to Dr. Henning. She plans to investigate if this effect can be enhanced by consuming larger amounts of tea polyphenols in the form of green tea extract supplement capsules.

Dr. Peter J. Cueter 06/02/1952 – 04/16/2004 It is with great sadness that we acknowledge the passing of NYSCA’s District 2 (Kings County / Brooklyn) Secretary, Dr. Peter J. Cueter 51, of Westbury New York on Friday April 16, 2004. Dr Cueter died peacefully at North Shore Glen Cove Hospital. He is survived by his wife Vicky, and three sons Adam, Matthew and Andrew. He will be waked at: Dalton Funeral Home 47 Jerusalem Avenue, Hicksville, New York 11801 516-931-0262 on Sunday April 18, 2004 and Monday April 19, 2004 / Hours 2 – 5 & 7 - 9 For those who would like to forward a card or note, kindly send it to: Mrs. Vicky Cueter 7 Mellow Lane Westbury, NY 11590 Please make all donations for a scholarship in the name of, Peter J. Cueter, DC (Class of 1984) and mail to: NYCC Attention: Peter VanTyle PO Box 800 Seneca Falls, NY 13148

America on the Move' Program Fits Chiropractic Model of Wellness ARLINGTON, Va. -- Revitalizing your health could be just steps away, according to the American Chiropractic Association (ACA). While seeking out the latest, trendiest exercise craze can be an intimidating endeavor, a good, old-fashioned walk may be all you need to help you feel great and get into shape. In support of a program called "America on the Move" -- a national initiative dedicated to helping individuals and communities make positive changes to improve their health and quality of life -- the ACA is urging Americans everywhere to simply take 2,000 more steps and consume 100 fewer calories each day than they normally would. And it's even easier to do than you might think. Dr. George McClelland, ACA Chairman and member of ACA's Wellness Committee, explains that, "Adding a short walk to your lunchtime schedule, coupled with taking the stairs at work rather than the elevator, could add up to 2,000 additional steps for many of us. And cutting just one can of soda from your day and replacing it with water can eliminate more than 100 calories." The easiest way to keep track of your extra 2,000 steps is to get your hands on a pedometer -- a small device that can count the number of steps you take. It just might be the best 10 dollars you ever spend. A lack of physical activity and poor eating habits have earned the United States the dubious distinction of being the most overweight nation in the world. The ACA aims to reverse that trend by encouraging people to take control of their own health and prevent disease before it sets in. In fact, ACA's official vision statement indicates that the ACA "seeks a transformation in health care from a focus on disease to a focus on wellness." According to Dr. McClelland, "Many health care providers are now beginning to talk with their patients about healthy lifestyles -- an approach doctors of chiropractic have taken for many years. It's simply not good enough to wait until someone gets sick to start thinking about making them well. As we've seen, that model of health care is just not working." The ACA and America on the Move hope to inspire Americans to engage in fun, simple ways to become more active and eat more healthfully. Putting their words into action, the staff at ACA not only participated in and promoted Prevention magazine's recent "National Walk to Work Day," but also formed a walking club through which staff members will take a lunchtime walk together on at least one selected day each month. As part of its mission to promote a more wellness-centered society, ACA regularly promotes and participates in national observances and programs that help people live healthier lives. To this end, promotes National Public Health Week (www.nphw.org) and participates on the steering committee of the U.S. Bone & Joint Decade (www.usbjd.org), among other initiatives. In addition, the ACA recently partnered with the Healthy People 2010 Consortium. Healthy People 2010 is a set of national health objectives designed to identify the most significant preventable threats to health and to establish national goals and objectives to reduce these threats. Through this partnership, ACA joins over 600 national membership organizations and state agencies in promoting public health. For more information, please visit www.healthypeople.gov. To learn more about how chiropractic care can help you achieve a healthier lifestyle, visit the American Chiropractic Association's Web site at:

Abstract Acetaminophen decreases glutathione levels in the lung, which may predispose to oxidative injury and bronchospasm. Acetaminophen use has been associated with asthma in cross-sectional studies and a birth cohort. We hypothesized that acetaminophen use would be associated with newly diagnosed adult-onset asthma in the Nurses' Health Study, a prospective cohort study of 121,700 women. Participants were first asked about frequency of acetaminophen use in 1990. Cases with asthma were defined as those with a new physician diagnosis of asthma between 1990 and 1996 plus reiteration of the diagnosis and controller medication use. Proportional hazard models included age, race, socioeconomic status, body mass index, smoking, other analgesic use, and postmenopausal hormone use. During 352,719 person-years of follow-up, 346 participants reported a new physician diagnosis of asthma meeting diagnostic criteria. Increasing frequency of acetaminophen use was positively associated with newly diagnosed asthma (p for trend = 0.006). The multivariate rate ratio for asthma for participants who received acetaminophen for more than 14 days per month was 1.63 (95% confidence interval, 1.11–2.39) compared with nonusers. It would be premature to recommend acetaminophen avoidance for patients with asthma, but further research on pulmonary responses to acetaminophen is necessary to confirm or refute these findings and to identify subgroups whose asthma may be modified by acetaminophen.