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Clinical and Cost Outcomes of an Integrative Medicine IPA

ABSTRACT Objective: We hypothesized that primary care physicians (PCPs) specializing in a nonpharmaceutical/nonsurgical approach as their primary modality and utilizing a variety of complementary/alternative medicine (CAM) techniques integrated with allopathic medicine would have superior clinical and cost outcomes compared with PCPs utilizing conventional medicine alone. Design: Incurred claims and stratified randomized patient surveys were analyzed for clinical outcomes, cost offsets, and member satisfaction compared with normative values. Comparative blinded data, using nonrandomized matched comparison groups, was analyzed for age/sex demographics and disease profiles to examine sample bias. Setting: An integrative medicine independent provider association (IPA) contracted with a National Committee for Quality Assurance (NCQA)-accredited health maintenance organization (HMO) in metropolitan Chicago. Subjects: All members enrolled with the integrative medicine IPA from January 1, 1999 through December 31, 2002. Results: Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame. Conclusion: In the limited population studied, PCPs utilizing an integrative medical approach emphasizing a variety of CAM therapies had substantially improved clinical outcomes and cost offsets compared with PCPs utilizing conventional medicine alone. While certainly promising, these initial results may not be consistent on a larger and more diverse population. Sarnat RL, Winterstein J. Journal of Manipulative and Physiological Therapeutics. June 2004; Vol. 27, No. 5.

VA to Begin Chiropractic Care

WASHINGTON -- Veterans can receive chiropractic care at 26 selected Department of Veterans Affairs (VA) facilities beginning this fall, Secretary of Veterans Affairs Anthony J. Principi announced today. VA will hire or contract with doctors of chiropractic to provide the care. In consultation with VA primary care providers, doctors of chiropractic will offer patient evaluations and chiropractic care for neuromusculoskeletal conditions. "Today, VA makes another significant improvement to the world-class health care we provide for eligible veterans," said Principi. "Veterans who will benefit from chiropractic services will now have the opportunity to receive chiropractic care to restore them to good health." Locations where chiropractic care will be provided include Togus, Maine; West Haven and Newington, Conn.; Buffalo and the Bronx, N.Y.; Butler, Pa.; Martinsburg, W.Va.; Columbia, S.C.; Augusta, Ga.; Tampa and Miami, Fla.; Mountain Home, Tenn.; Columbus, Ohio; Danville, Ill.; Iron Mountain, Mich.; Kansas City, Kan.; Jackson, Miss.; San Antonio, Temple, and Dallas, Texas; Albuquerque, N.M.; Fort Harrison, Mont.; Seattle, Wash.; Sacramento and Los Angeles, Calif.; and Sioux Falls, S.D. Eligible veterans in areas distant from these locations will also be able to receive chiropractic care through VA's outpatient fee-basis program after a referral by their primary care provider, and prior authorization by the department. VA was authorized to offer chiropractic care and services under the provisions of section 204 of Public Law 107-135, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001. Chiropractors seeking employment or to provide contract services to veterans should call the Human Resources office of any of the above facilities. Some VA positions may be advertised at:

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NOTICE OF RESCISSION OF REGISTRATION OF IME ENTITY: NORTHEAST MEDICAL EVALUATION & DIAGNOSTIC SERVICES

Effective June 26, 2004, the New York State Workers’ Compensation Board is rescinding the designation of Northeast Medical Evaluation and Diagnostic Services, P.C. as an entity registered to derive income from independent medical examinations in workers’ compensation cases. This rescission is made pursuant to Section 13-n of the Workers’ Compensation Law and 12 NYCRR 300.2 (e). This rescission is permanent. The entity’s address is: Northeast Medical Evaluation and Diagnostic Services, P.C. 900 Merchants Concourse Westbury, New York 11590 On the effective date of this rescission, the entity named above is permanently prohibited from deriving income from independent medical examinations in workers’ compensation cases. Examinations conducted prior to June 26, 2004 are valid. Any questions regarding this matter should be referred to the Office of General Counsel at 518-486-7676. David P. Wehner Chairman

The Natural Treatment of Hypertension

ABSTRACT The goal of this review is to evaluate the efficacy of commonly available dietary supplements in the treatment of hypertension, using the average blood pressure reduction achieved with the implementation of lifestyle modifications as a standard. For this reason, the authors focus on the antihypertensive potential of these agents rather than pharmacology, pharmacokinetics, adverse effects, or supplement ñ drug interactions. For the purpose of this review, dietary supplements are defined as exhibiting some evidence of benefit if a systolic blood pressure reduction of 9.0 mm Hg or greater and/or a diastolic blood pressure reduction of 5.0 mm Hg or greater has been observed in previously published, peer-reviewed trials. These defining limits are based on the average blood pressure reduction associated with the implementation of certain lifestyle modifications. Agents with some evidence of benefit include coenzyme Q10, fish oil, garlic, vitamin C, and L-arginine. J Clin Hypertens (2004) 6;5:242-248

LOGAN COLLEGE OF CHIROPRACTIC TO OFFICIALLY OPEN NEW $4 MILLION RESEARCH AND LEARNING CENTER

CHESTERFIELD, Mo., June 7, 2004 – Logan College of Chiropractic President Dr. George Goodman, D.C. has announced the official opening of a new $4 million state-of-the-art learning and research center that will provide a valuable educational tool to students and healthcare professionals in the St. Louis area. The new Logan Learning Resources Center will be dedicated at ceremonies beginning at 5 p.m., Thursday, June 10, on the school’s campus at 1851 Schoettler Road, in Chesterfield. Area dignitaries and other public officials are expected to attend. “We are extremely proud of our new center because it represents Logan’s commitment to providing its students with a state-of-the-art library and research facility, and exemplifies the generosity and vision of those who help to make it possible,” Dr. Goodman said. The center and library will provide a wide range of books, video, audio, and computer facilities for Logan’s 1,100 students, and also will be available for use by other St. Louis-area college and high school students, teachers, and chiropractors. “St. Louis is nationally recognized as one of the nation’s leading healthcare and research destinations, and we hope this facility will be viewed as a valuable addition to the area’s health and educational facilities,” Dr. Goodman added. The new center houses a library, computer lab that has 75 workstations with Internet access, and a state-of-the-art distance learning facility with a variety of multimedia capabilities. It also contains a collection of approximately 12,000 books, 260 trade and professional journals with 32,000 issues, 1,100 video recordings, and more than 400 audio learning tapes. Because Logan specializes in health and chiropractic education, the center has an extensive collection of human skulls, skeletons, and other bones, along with artificial anatomical models, available for anatomy and human science studies. Bob Snyders, the center’s director, said the facility has a significant concentration of books and other learning tools that focus on anatomy, biology, life sciences, and other health-related topics. “We hope college, university, and high school students throughout the St. Louis area, that might be considering a career in healthcare, research, or related fields of study, will take advantage of the specialized materials available at the new Logan Learning Resources Center,” Snyders said. Group and individual study facilities are available, including separate rooms furnished with computers and media equipment, he added. Logan College is a member of the Missouri Bibliographic Information User System (MOBIUS), a network of more than 50 college and university libraries throughout Missouri that enables students around the state to have Internet access to the online card catalogs of the other member libraries. Snyders said that students, faculty, and staff from any MOBIUS library may borrow books from any of the other MOBIUS libraries. This can be done online or in person. Books requested online are delivered via a statewide courier service, and generally arrive within three business days. Logan is a nonprofit institution of higher education founded in 1935 in St. Louis. The school is the largest chiropractic college in Missouri and the second largest chiropractic college or university in the nation. The college offers Bachelor of Science degrees in human biology and life sciences, as well as the Doctor of Chiropractic degree. Logan also provides healthcare for patients in the greater St. Louis metropolitan area through eight local health centers in St. Louis City, St. Louis County, and St. Charles County. Chiropractic is the third largest profession of healthcare delivery in the world (behind only medicine and dentistry), and more than 26 million Americans seek treatment from doctors of chiropractic each year. State-of-the-Art Facility Is Available to Area Students, Healthcare Professionals

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Vitamin C and the risk of developing inflammatory polyarthritis: prospective nested case-control study

ABSTRACT Objective: To investigate whether, there is an association between consumption of fruit and vegetables and dietary antioxidants and the risk of developing inflammatory polyarthritis (IP). Methods: In a prospective, population based, nested case-control study of residents of Norfolk, UK, men and women aged 45–74 years were recruited, between 1993 and 1997 through general practice age-sex registers to the Norfolk arm of the European Prospective Investigation of Cancer (EPIC-Norfolk). Dietary intake was assessed at baseline using 7 day diet diaries. Seventy three participants who went on to develop IP between 1993 and 2001 and were registered by the Norfolk Arthritis Register (NOAR) were identified. Incident cases of IP, assessed by general practitioners, fulfilled the criteria of two or more swollen joints, persisting for a minimum of 4 weeks. Each case of IP was matched for age and sex with two controls free of IP. Results: Lower intakes of fruit and vegetables, and vitamin C were associated with an increased risk of developing IP. Those in the lowest category of vitamin C intake, compared with the highest, increased their risk of developing IP more than threefold, adjusted odds ratio (OR) with 95% confidence intervals (CI) 3.3 (95% CI 1.4 to 7.9). Weak inverse associations between vitamin E and ß-carotene intake and IP risk were found. Conclusion: Patients with IP (cases) consumed less fruit and vitamin C than matched controls, which appeared to increase their risk of developing IP. The mechanism for this effect is uncertain. Thus similar studies are necessary to confirm these results. Annals of the Rheumatic Diseases 2004;63:843-847

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FDA Gives Dynatronics Go-Ahead to Market New Laser Probe

SALT LAKE CITY, - Dynatronics Corporation today announced the U.S. Food and Drug Administration has given marketing clearance for the company's new Solaris D890 low-power laser probe. The laser treats muscle and joint pain, including the pain and stiffness associated with arthritis. The Solaris D890 is the second probe designed for use as an accessory to the company's popular new Solaris Series products. The probe is expected to be ready for shipment within 30 to 60 days. "We are thrilled with the FDA's decision to allow us to begin marketing this laser probe," stated Kelvyn H. Cullimore Jr., president of Dynatronics. "Our first attempt to obtain approval for a laser probe was over 20 years ago. That makes this clearance even more satisfying." According to Larry K. Beardall, Dynatronics' executive vice president of marketing and sales, "The new D890 probe will expand the foundation of success our Solaris product line has already achieved. With two decades of clinical research behind them, lasers have been of keen interest to the medical community and have found many applications in medical settings. Hundreds of people around the country have already benefited from light therapy. The results have been remarkable." More information regarding this technology is available at:

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Quantitative Assessment of Mechanical Laxity in the Functionally Unstable Ankle

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

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Detection of Airborne Rhinovirus and Its Relation to Outdoor Air Supply in Office Environments

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.

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ACA, VCA To Petition U.S. Supreme Court in Trigon Case

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.

New Government Survey Reflects Widespread Use of Complementary and Alternative Therapies

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.

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Former NYSCA’s District 8 member, Dr. Kenneth A. Falber Passes

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.

The Palmer College of Chiropractic Women's Rugby Tradition Begins

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."

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An Approach to Identifying Osteopenic Women at Increased Short-term Risk of Fracture

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.

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Medicare Service Specific Review of 98941

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.

Associations of Mortality With Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study

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:

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Doctors of Chiropractic Offer Mothers Day Advice for Active Moms

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.

Simple and Efficient Recognition of Migraine With 3-Question Headache Screen

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.

SPSU s land deal with Life dies

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:

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FCER Responds to Newsweek's

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.

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