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Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication

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

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Surgeon General’s New Family Health History Tool Is Released, Ready for “21st Century Medicine”

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

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Too Much Sitting: A Novel and Important Predictor of Chronic Disease Risk?

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

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Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: Results from the Nord-Trondelag Health Study

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

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Acting Surgeon General Issues ‘Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism’

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

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Emergency Department Visits for Antibiotic-Associated Adverse Events

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

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FDA Requests Boxed Warnings on Fluoroquinolone Antimicrobial Drugs

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

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AU study shows that overuse of flip-flops can lead to orthopedic problems

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

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U.S. Health Care System 'Wasting' Money on 'Overtreatment,' Columnist Writes

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

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Snap judgments decide a face's character, psychologist finds

We may be taught not to judge a book by its cover, but when we see a new face, our brains decide whether a person is attractive and trustworthy within a tenth of a second, according to recent Princeton research. Princeton University psychologist Alex Todorov has found that people respond intuitively to faces so rapidly that our reasoning minds may not have time to influence the reaction -- and that our intuitions about attraction and trust are among those we form the fastest. "The link between facial features and character may be tenuous at best, but that doesn't stop our minds from sizing other people up at a glance," said Todorov, an assistant professor of psychology. "We decide very quickly whether a person possesses many of the traits we feel are important, such as likeability and competence, even though we have not exchanged a single word with them. It appears that we are hard-wired to draw these inferences in a fast, unreflective way." Todorov and co-author Janine Willis, a student researcher who graduated from Princeton in 2005, used timed experiments and found that snap judgments on character are often formed with insufficient time for rational thought. They published their research in the July issue of the journal Psychological Science. The study formed part of Willis' senior thesis work, which was inspired by an earlier paper by Todorov investigating the outcome of a political campaign. "I had done studies with my students that found there was a direct correlation between how competent a campaigning politician's face was and how great his margin of victory turned out in the final election," Todorov said of his earlier work, published in the journal Science last year. "We might assume that our judgments are founded on deliberate and rational thought processes, but observers had made their judgments about politicians based on a one-second look at their faces. I mentioned the findings to Janine, who suggested we look into just how fast we form these (judgments about) character traits." For the current study, the two researchers conducted several experiments on about 200 people. For one experiment, the researchers asked observers to look at 66 different faces for one of three time durations: either 100 milliseconds, 500 milliseconds or a full second. After each face flashed on the screen and vanished, the observers marked whether they found the face to be trustworthy or not, and also how confident they were in their analysis. Other experiments conducted in similar fashion tested for different specific traits, such as likeability and competence. "What we found was that, if given more time, people's fundamental judgment about faces did not change," Todorov said. "Observers simply became more confident in their judgments as the duration lengthened." Why the brain makes such snap judgments is not yet entirely clear, Todorov said. However, he often works with a sophisticated technological tool for probing brain activity called a functional magnetic resonance imager (fMRI), and Todorov said some of his general research suggests that the part of the brain that responds directly to fear may be involved in judgments of trustworthiness. "The fear response involves the amygdala, a part of the brain that existed in animals for millions of years before the development of the prefrontal cortex, where rational thoughts come from," he said. "We imagine trust to be a rather sophisticated response, but our observations indicate that trust might be a case of a high-level judgment being made by a low-level brain structure. Perhaps the signal bypasses the cortex altogether." The research, Todorov said, explores some of the same topics addressed in "Blink," the recent best-selling book by New York journalist Malcolm Gladwell about the rapid cognition our minds experience when making decisions quickly, especially those based on first impressions made in the "blink" of an eye. Gladwell, who is often described as a type of popular sociologist, has said the impetus for his book was the rapid judgments people made about him because of his long hair. "This paper's results concern specific mechanisms in the mind, while 'Blink' makes broader generalizations," Todorov said. "Gladwell's basic message is not essentially different from ours, though he views snap judgments to be primarily rational in nature. Our research finds that this is often the case, but not always." Todorov cautioned that his findings do not imply, however, that quick first impressions cannot be overcome by the rational mind. "As time passes and you get to know people, you, of course, develop a more rounded conception of them," he said. "But because we make these judgments without conscious thought, we should be aware of what is happening when we look at a person's face." What aspects of a face inspire such judgments remain undetermined, Todorov said. "We still don't know the physical features of a face that lead to a particular trait inference," he said. "We know generally what makes a face attractive, such as its symmetry, the proportions of its parts and the like. But what is it about a face that makes you think its owner is an essentially competent person? That's the subject of another study, one that needs to be done." This research was sponsored in part by the National Science Foundation. Abstract First Impressions: Making Up Your Mind After a 100-Ms Exposure to a Face Janine Willis and Alexander Todorov, Princeton University People often draw trait inferences from the facial appearance of other people. We investigated the minimal conditions under which people make such inferences. In five experiments, each focusing on a specific trait judgment, we manipulated the exposure time of unfamiliar faces. Judgments made after a 100-ms exposure correlated highly with judgments made in the absence of time constraints, suggesting that this exposure time was sufficient for participants to form an impression. In fact, for all judgments — attractiveness, likeability, trustworthiness, competence, and aggressiveness—increased exposure time did not significantly increase the correlations. When exposure time increased from 100 to 500 ms, participants’ judgments became more negative, response times for judgments decreased, and confidence in judgments increased. When exposure time increased from 500 to 1,000 ms, trait judgments and response times did not change significantly (with one exception), but confidence increased for some of the judgments; this result suggests that additional time may simply boost confidence in judgments. However, increased exposure time led to more differentiated person impressions.

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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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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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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 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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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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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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