By Cynthia Pegram, The News & Advance, Lynchburg, Va.

Jul. 11–The new chief executive officer at Johnson Health Services wants to see the primary care practice recognized as a place that provides good care to all patients, regardless of income.

He’s concerned that many think of the Johnson Center as a place only for the uninsured, under-insured or low-income populations.

“This is, first and foremost, a full-service primary care facility for the whole community,” said Dr. J. Kweku Laast, who has been on the job for about a week at the Federal Street center in Lynchburg.

Laast is a physician-executive, and as such not part of the clinical care team. His education includes a medical degree from East Carolina University and a master’s in public health from the University of North Carolina.

“I’ve come to see the need for us physicians in the public health, medical services arena,” he said. “I’ve seen a lot of programs get established with very little understanding of what the clinical part of what that particular condition is, so if something doesn’t work, it becomes the doctor’s fault.”

As a physician-executive, Laast said, he’s able to create systems that provide more care to more people than he could ever do providing direct care himself.

Laast succeeds CEO John Sniezek, who resigned last year.

For the past eight months, while the search was under way, longtime medical director Dr. Peter Houck has also worn the CEO hat.

He’s glad to relinquish the job to Laast.

“We’re especially happy with his background in public health, and the medical field. We feel this is a dual talent that he has that the 30 applicants for this position didn’t have,” Houck said.

“That’s why we’re so excited he found us and we found him.”

Houck is moving into the position of medical director of the rapidly growing pediatric service soon to be based in a new facility across the street. Dr. Joseph Teel, who has helped develop the obstetrics program, is now interim medical director for Johnson Health Center.

Laast comes to Lynchburg from North Carolina, where he was a main investigator on a federal grant on sickle cell disease, working to develop a community health center model for best practices in handling it as a chronic disease.

Laast said he would like to see the Johnson Health Center become an example of how any chronic disease, including sickle cell, can be treated by a community health center.

“I would like to … quickly elevate us to be a player in the models we would like to roll out nationally,” he said.

Laast said that people with well-managed chronic disease wouldn’t have to continually go the hospital for treatment or to a high-cost emergency department.

He sees the Johnson Health Center as having an opportunity “to be one of the leading community health centers in the country … very comfortable in playing its role of management of chronic

disease.”

It would be great, he said, if that in five to 10 years Lynchburg would be a place in which “access to private health care would not be a problem.”

Laast has an ongoing interest in African and African-American history. Born in Ghana, his own heritage is both African and Dutch.

His birthplace has the largest “slave castle” in sub-Saharan Africa, he said — fort-sized constructions that were holding sites for those captured and sold as slaves.

“One of the former governors of the castles was Dutch; that’s where my name came from,” he said.

Kweku is a Ghanaian name. When people from African nations hear “Kweku Laast” they know he is from the Ghana coast, he said.

Laast hopes to work with many organizations in the Lynchburg community to find ways to enhance patient care for Johnson Health Services.

“I intend to be involved in community in general,” he said. “We’re here for them.”

– Founded by Centra in 1998 to serve the downtown Lynchburg area and low-income populations, Johnson Health Services became an independent federally qualified health center in 2003. Run by an all-volunteer board of directors comprised of center patients and local civic leaders, Johnson maintains close ties to Centra.

– According to the Johnson Web site, about 13,500 patients use an array of medical services and programs at Johnson Health Services. The primary care center is on Federal Street, an obstetrics center is on Fifth Street and a dental clinic is in Madison Heights.

—–

To see more of The News & Advance, or to subscribe to the newspaper, go to http://www.newsadvance.com.

Copyright (c) 2008, The News & Advance, Lynchburg, Va.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

PASQUOTANK COUNTY | The North Carolina Department of Transportation will hold an informational workshop from 4 to 7 p.m. Monday at the Museum of the Albemarle.

The workshop will be about improvements to U.S. 158 from U.S. 17 Business to N.C. 34.

NCDOT representatives will provide information, answer questions and accept written comments.

The NCDOT proposes to reconstruct E. Elizabeth Street between U.S. 17 Business (Road Street) and N.C. 34 (Water Street) to correct uneven road settling. The project also includes the replacement of Bridge No. 19 (eastbound U.S. 158) over the Pasquotank River.

For more information, contact Ted Devens, Project Development and Environmental Analysis Branch, at 1548 Mail Service Center, Raleigh, N.C. 27699-1548 or (919) 733-3141. E-mail [email protected].

A separate meeting will be held for business owners at 9 a.m. Tuesday in the second floor of the Pasquotank County Public Safety Building on Colonial Avenue. RSVP for that meeting by Monday at (252) 335-4365.

Camden County

Commissioners to hold joint meeting

The Camden County Board of Commissioners will hold a joint meeting with the Camden County Board of Education at 6 p.m. Monday in Camden Intermediate School.

The meeting will discuss goals. The public is invited .

Currituck County

Canner testing clinic is Tuesday

The Currituck County Center of North Carolina Cooperative Extension will hold a canner testing clinic from 1 to 3 p.m. Tuesday at its new facility on Shortcut Road.

There are two basic types of canners. One has a dial gauge to indicate the pressure inside the canner; the other has a metal weighted gauge. Dial gauges must be tested for accuracy before each canning season.

For more information, call Georgia Kight, (252) 232-2261.

Dare County

kite festival is this weekend

Kitty Hawk Kites and the Wright Brothers National Memorial will sponsor the 30th annual Wright Kite Festival from 10 a.m. to 4 p.m. Saturday and 10 a.m. to 2 p.m. Sunday.

The event includes kite making, contests, games, demonstrations by kite flyers, as well as history on the Wright Brothers and how they made the first flight on Dec. 17, 1903.

The activities are free, but entrance fee is $4 for adults. Children 16 and younger are admitted free.

bible school STARTS MONDAY

Roanoke Island Baptist Church will hold “Dino Detectives: Digging for God’s Truth” Monday through Friday from 6:30 to 8:30 p.m. for children ages 4 through having completed the eighth grade.

Each night will include Bible lessons, crafts, songs and games. Parents and the public are invited to attend the closing program at 6 p.m. on July 20. .

For transportation or information, call (252) 473-2892.

‘Into the Woods’ wraps up Sunday

The Lost Colony Company will perform “Into the Woods,” a Tony Award-winning musical, at 8:15 p.m. Sunday at Waterside Theatre.

The Stephen Sondheim musical premiered on Broadway in 1987 and provides a journey into the enchanted forest with Little Red Riding Hood, Prince Charming, Rapunzel, Cinderella and other fairy tale characters.

Advance tickets are $15 for producer’s circle and $10 for general admission. Performance day tickets are $20 and $15. For ticket information, call (252) 473-3414.

Northampton County

group receives federal grant

Choanoke Area Development Association of N.C. Inc. has received a $125,000 grant from the Office of Community Service under the U.S. Department of Health and Human Services for the Assets for Independence Program.

The funding will allow CADA to provide the Individual Development Account program for residents of Bertie, Halifax, Hertford and Northampton counties. The program provides matching funds to families who save under its guidelines.

To date, 63 families in the program have reached their savings goals with 98 percent chosen to become homeowners.

For more information, call Brenda Greene, (252) 539-4155.

Pasquotank County

Children can attend power lab

New Life Assembly of Go d will hold Power Lab from 6 to 8:30 p.m. Monday through Friday at 1958 N. Road St.

Power Lab provides Bible learning activities, singing, teamwork- building games, treats and crafts for ages 3 through rising sixth grade.

Family members and friends are encouraged to come daily at 8:15 p.m.

Church vacation Bible School set

Powerhouse Church of Redemption is offering vacation Bible school from 6:30 to 8 p.m. Monday through Friday for all ages.

The church is at 2554 Peartree Road. For information or to register, call (252) 562-1819.

Perquimans County

Church sets VBS marketplace

New Hope United Methodist Church will be transformed into the Bible times city of Jerusalem for Vacation Bible School held 6 to 8 p.m. Monday through Friday.

A complimentary meal is available each day at 5 p.m. The church is located at the corner of New Hope and Woodville roads in Hertford.

regional

money raised for food for thought

The First “Hunger Strike” Skate Contest was held with more than 30 participants.

The event raised over $2,200 from local sponsors and participants to benefit Food For Thought Inc., which provides meals to children who meet specific criteria in Dare County on weekends and holidays during the school year.

The event was hosted by Chris Marik and Bill Folkes from Island Revolution Skate Park in Corolla.

meetings + events

DARE COUNTY

Pancake breakfast Grace Lutheran Church By-The-Sea, 7:30 to 11 a.m. Saturday, social hall. Pancakes, sausage, fruit cup, orange juice and coffee for eat-in or take-out. The cost is $5.

Beverlie Gregory, (252) 441-1620, [email protected]

Karen Santos, (252) 338-2590,

[email protected]

(c) 2008 Virginian – Pilot. Provided by ProQuest Information and Learning. All rights Reserved.

Q: You mentioned several types of medications that increase the risk of hyperthermia during hot weather. Would you provide a detailed list?

A: Hot weather can cause the body to overheat, called hyperthermia. The evaporation of sweat is the body’s primary way of cooling off.

Numerous medications impair the body’s ability to sweat and so boost the risk for heat exhaustion and heat stroke, conditions covered in a recent column.

The chief culprits are drugs with anticholinergic effects, including antihistamines, antidepressants, antipsychotics, anti-Parkinson’s disease agents, anti-nausea/motion sickness agents, anti-diarrheal agents, antispasmodic agents, anti-asthma drugs and antiarrhythmic heart drugs.

The following is the detailed list you requested, by generic name:

_Antihistamines: chlorpheniramine, clemastine, cyproheptadine, dexchlorpheniramine, diphenhydramine, hydroxyzine

_Antidepressants: amitriptyline, clomipramine, doxepin, imipramine, mirtazapine, nortriptyline, protriptyline

_Antipsychotics: chlorpromazine, clozapine, fluphenazine, haloperidol, mesoridazine, olanzapine, pimozide, prochlorperazine, promethazine, risperidone, thioridazine, thiothixene, quetiapine, ziprasidone

_Anti-Parkinson’s agents: amantadine, benztropine, biperiden, trihexyphenidyl

_Anti-nausea/motion sickness agents: dimenhydrinate, meclizine, prochlorperazine, promethazine, scopolamine (e.g., ear patch for motion sickness), trimethobenzamide

_Anti-diarrheal agents: diphenoxylate/atropine

_Antispasmodic agents: belladonna alkaloids, clidinium, darifenacin, dicyclomine, flavoxate, hyoscyamine, oxybutynin, propantheline, solifenacin, tolterodine, trospium

_Anti-asthma drugs: ipratropium bromide, tiotropium

_Antiarrhythmic heart drugs: disopyramide, quinidine, procainamide

If you’ve taken one these medications, you’ve likely experienced one or more of the following anticholinergic side effects: dry mouth, dry skin, blurred vision, rapid heartbeat, constipation and urinary retention. (The last-mentioned effect further worsens urination difficulties caused by an enlarged prostate.)

Anticholinergic drugs also tend to cause confusion and impaired memory, particularly in elderly persons. In fact, they directly oppose the effects of drugs prescribed to improve memory in those with Alzheimer’s disease.

Dehydration, or excessive loss of body water, boosts the risk of hyperthermia.

Drugs with potential to cause diarrhea or nausea/vomiting can lead to dehydration due to loss of body water. These include magnesium-containing antacids, laxatives, misoprostol and exenatide (Byetta injection for diabetes).

Aspirin and other salicylates can contribute to dehydration by increasing perspiration and the rate and depth of breathing. (Each exhalation takes a bit of body water with it).

Amphetamines, carbenicillin, dexmethylphenidate, methylphenidate, topiramate and zonisamide raise the risk for hyperthermia in other ways.

Use extra care not to overheat during hot weather if you take any of these medications.

If you need help sorting out whether any of your meds might put you at greater risk, check with your pharmacist.

___

(Richard Harkness is a consultant pharmacist, natural medicines specialist and author of eight published books. Write him at 1224 King Henry Drive, Ocean Springs, MS 39564 or [email protected].)

___

(c) 2008, The Sun Herald (Biloxi, Miss.).

Visit The Sun Herald Online at http://www.sunherald.com/

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Brian Maass

A 64-year-old Westminster grandfather with epilepsy died after the University of Colorado Hospital left him unmonitored for more than an hour during a test in which they had taken him off nearly all of his medication.

The hospital is accepting responsibility for the lack of monitoring that apparently contributed to the death of Charles Gray, who had entered the facility in good condition, hoping to improve his health, only to end up dead four days later.

A CBS4 investigation found that Gray was left unattended in the hospital for 65 minutes in October, a gap his family believes led to his death.

“I have no doubts my dad would be here today if they monitored him the way they said they would,” said Teresa Napowsa, one of Gray’s three children.

‘He wanted to give’

Gray suffered epileptic seizures his entire life. They prevented him from driving, working or supporting his wife.

“He wanted to give, not receive,” said his younger brother, Steve.

Gray entered University Hospital’s Epilepsy Monitoring Unit on Oct. 15 so doctors could study his brain, learn more about what was causing his seizures and possibly operate on him at some point.

He was placed in a room with a video camera, and the live video feed went to a nearby monitoring station. Gray was one of eight patients being monitored.

The hospital assured Gray he would be cared for and observed round-the-clock. They gave him a form letter that said, “There will also be a neurodiagnostic technologist in the monitoring booth at all times to maintain the equipment and gather data.”

Steve Gray said his brother trusted the hospital.

“He was very confident this would go well, that he would be monitored 2 4/7, and he had given his full trust and laid himself open to that hospital.”

The round-the-clock monitoring was crucial because doctors weaned Gray off his epilepsy medications to intentionally induce seizures so they could better understand what was causing his medical problems.

“An epileptic, when in seizure mode, needs someone with them,” Napowsa said. “And we all had complete trust in the hospital that they were going to care for him and watch him.”

But on the fourth night of his stay, hospital records show the technologist who had been monitoring the video feed from Gray’s room left the post at 11:50 p.m. to get something to eat and check on two other patients. Twenty-eight minutes later, Gray, who had been asleep, suffered one of the seizures doctors were trying to induce.

But there was no one watching, no one there to help. Hospital videotape of Gray provided to CBS4 shows the seizure caused Gray’s face to press into his pillow, apparently cutting off his oxygen supply. He stopped breathing a few minutes later.

According to hospital records, it would be another 37 minutes before the technologist returned to find Charles Gray unresponsive.

Efforts to resuscitate him were unsuccessful. The Adams County coroner listed his cause of death as “seizure.”

The hospital says its protocol at the time allowed staff members to leave the monitoring station unattended for short periods to check on other patients, get food or take a break.

Gray’s family was stunned to learn he was not being monitored round-the-clock, as the hospital had promised.

Hospital makes changes

“My family put their trust and faith in University Hospital to deliver what they said they would, and they chose not to,” Steve Gray said. “They chose not to deliver on the promises they made to my brother to ensure his health and safety through this process.”

The families’ lawyer, Kyle Bachus, said the hospital’s protocol defied logic.

“Common sense would tell you if you are going to take them off meds and you’re going to cause severe seizures to occur, somebody has to be there to help.”

About 3,000 patients have been through the epilepsy monitoring program without serious incident during the past 20 years, according to Dr. Steven Ringel, of University Hospital.

He said the hospital was “troubled by this” and has made changes “to increase safety of the hospital so something like this never happens again.”

‘He didn’t die in vain’

Ringel said the monitoring station is now constantly staffed. If a technologist needs to leave, someone else takes over so patients are always being watched.

Ringel said there will no longer be any gaps in monitoring of patients in the epilepsy unit. Additionally, he said a system has been implemented so that if a patient’s breathing decreases, an alarm goes off, summoning help. “He didn’t die in vain,” Ringel said. “We’re going to make changes to prevent this from happening to someone else.”

Ringel acknowledged that if someone had been monitoring Gray on the morning of his death, there was a “greater likelihood” he would have survived the seizure. “We do feel responsible for it,” he said.

Gray’s family is considering suing the hospital, but since University Hospital is a government facility it’s covered by the Colorado Government Immunity Act and the most it could be held liable for is $150,000. Family members say this isn’t about money but about holding the hospital accountable for its actions.

“It doesn’t seem fair,” said Napowsa. “It doesn’t seem right.”

Originally published by Brian Maass, CBS4 News, Special to the Rocky.

(c) 2008 Rocky Mountain News. Provided by ProQuest Information and Learning. All rights Reserved.

To: LIFESTYLES EDITORS

Contact: Randall Dale Chipkar, Chipkar Health Concepts Limited, author The Motorcycle Cancer Book, [email protected]

MISSISSAUGA, Ontario, July 11 /PRNewswire/ — A new motorcycle seat accessory provides peace of mind for riders concerned about cancer risk. “It’s not just about cancer,” says Canadian author and patent-granted motorcycle seat shield inventor, Randall Dale Chipkar. “Infertility, sexual dysfunction, erectile deficiency or loss of libido may also be side effects of groin exposure to ELF EMFs.

(Photo: http://www.newscom.com/cgi-bin/prnh/20080711/NYF005)

“Many motorcycles generate excessive extremely low frequency electromagnetic field (ELF EMF) radiation up through the seat penetrating into the rider’s groin and torso. This has alarming implications,” Chipkar adds.

“One of the most profound effects of electromagnetic exposure on the body is a decrease in the production and role of melatonin. Melatonin is the body’s natural hormone for fighting cancer growth and the gastrointestinal tract is responsible for synthesizing vast amounts of melatonin. For many motorcycle riders, one of the main sources of the body’s cancer inhibiting hormone is being showered with ELF EMF magnetic fields,” says Chipkar.

“The prostate is of major concern as it is one of the closest delicate glands invaded by the ELF EMF radiation. For both men and women riders, the colon and neighboring organs are also at risk. Unfortunately, if cancer initiates in the prostate it could spread to other locations such as the bone, lymph nodes, etc.,” adds Chipkar.

“Up to date reports link various types of ELF EMFs to biological adversity without molecular heating effects. Many believe this is where obsolete exposure regulations fail us. Major organizations now agree that ELF EMF magnetic fields are a possible carcinogen.

“Cancer is not fully understood and people should not have to gamble with their health because they love riding motorcycles. Personal precaution to reduce risk wherever possible is our best defense,” Chipkar says.

“ELF EMF magnetic fields penetrate through all conventional metals. Only highly processed material can dramatically shield us from these cancer controversial forces. Hopefully this new RiderSaver(TM) EMF shielding internal motorcycle seat accessory will revolutionize the motorcycle industry to keep riders safer,” Chipkar concludes.

Randall Dale Chipkar can be reached through his website along with more information about The Motorcycle Cancer Book, proof of EMF danger, breast cancer, motorcycle seat Gauss meter readings, etc. Please visit http://www.motorcyclecancer.com

CONTACT:

Randall Dale Chipkar of

Chipkar Health Concepts Limited

Randall Dale Chipkar, author of

The Motorcycle Cancer Book

Email: [email protected]

Website: http://www.motorcyclecancer.com

SOURCE Chipkar Health Concepts Limited

(c) 2008 U.S. Newswire. Provided by ProQuest Information and Learning. All rights Reserved.

SAN MATEO, Calif., July 11 /PRNewswire-FirstCall/ — NeurogesX, Inc. , a biopharmaceutical company focused on developing and commercializing novel pain management therapies, announced the initiation of its Phase 1 clinical trial (study C203) of NGX-1998. The product candidate is a high-concentration, capsaicin-based liquid formulation designed to deliver a localized therapeutic dose directly to the pain site.

The randomized, single-blind Phase 1 trial is designed to evaluate potential control formulations for future NGX-1998 clinical trials. NeurogesX expects to complete the trial by the end of 2008.

Anthony DiTonno, President and CEO of NeurogesX, commented, “The initiation of this Phase 1 trial of NGX-1998 marks a significant step in our program to develop a second-generation liquid formulation of capsaicin to manage pain. We believe that our Phase 1 trial will provide us with important information that will help shape the design of further studies with the product candidate. We are pleased with the Company’s progress with NGX-1998 advancing in the clinic and NGX-4010 under regulatory review in Europe and approaching NDA submission in the United States.”

About NGX-1998

NGX-1998 is a topically applied, high-concentration liquid formulation of capsaicin designed to treat pain associated with neuropathic pain conditions. The objective of the NGX-1998 development program is to determine the ability of NGX-1998 to provide protracted pain relief from a single treatment. Similar to NGX-4010, the Company’s late-stage dermal patch that also contains a high concentration of capsaicin, NGX-1998 is designed to deliver localized pain relief however, with a shorter treatment procedure time and potentially with reduced treatment-related discomfort than NGX-4010. NGX-1998, because it is a liquid, is expected to be able to address areas of the skin where dermal patches may be difficult or impractical to apply, such as the hairline. Additionally, the goal of the NGX-1998 program is to develop a product with a treatment procedure that would potentially allow its use by a greater variety of physicians than NGX-4010, including primary care physicians. NGX-1998 was previously studied in two Phase I studies in healthy volunteers conducted under an exploratory investigational new drug application.

About NeurogesX, Inc.

NeurogesX is a biopharmaceutical company focused on developing and commercializing novel pain management therapies. Its initial focus is on chronic peripheral neuropathic pain, including postherpetic neuralgia (PHN), painful HIV-distal sensory polyneuropathy (HIV-DSP) and painful diabetic neuropathy (PDN). NeurogesX’ late stage product portfolio is led by its product candidate NGX-4010, a dermal patch designed to manage pain associated with peripheral neuropathic pain conditions, that the Company believes offers significant advantages over other pain therapies. NeurogesX’ marketing authorization application (MAA) to the European Medicines Agency (EMEA) was accepted for review in September 2007 and NeurogesX plans to file a new drug application (NDA) with the U.S. Food and Drug Administration (FDA) in 2008 for PHN.

Safe Harbor Statement

This press release contains forward-looking statements for purposes of the Private Securities Litigation Reform Act of 1995 (the “Act”). NeurogesX disclaims any intent or obligation to update these forward-looking statements, and claims the protection of the Safe Harbor for forward-looking statements contained in the Act. Examples of such statements include, but are not limited to, the timing of the completion of the Phase 1 clinical trial for NGX-1998; the potential to treat additional indications and skin locations with NGX-1998 than are currently targeted by NGX-4010; and the expected benefits of NeurogesX’ potential products, including its liquid formulation product candidate NGX-1998 and its lead product candidate NGX-4010. Such statements are based on management’s current expectations, but actual results may differ materially due to various risks and uncertainties, including, but not limited to, NeurogesX’ product candidate may have unexpected adverse side effects or inadequate therapeutic efficacy; positive results in clinical trials may not be sufficient to obtain FDA or European regulatory approval; physician or patient reluctance to use NGX-4010 or NGX-1998, if approved, or the inability of physicians to obtain sufficient reimbursement for such procedures; potential alternative therapies; maintaining adequate patent or trade secret protection without violating the intellectual property rights of others; and other difficulties or delays in clinical development, obtaining regulatory approval, market acceptance and commercialization of NGX-4010 or NGX-1998 and the advantages of NGX-4010 or NGX-1998 over other pain therapies. For further information regarding these and other risks related to NeurogesX’ business, investors should consult NeurogesX’ filings with the Securities and Exchange Commission.

   NeurogesX                           The Ruth Group   Stephen Ghiglieri                   Investors / Media   (650) 358-3310                      Stephanie Carrington / Jason Rando   [email protected]            (646) 536-7017 / 7025                                       [email protected]                                       [email protected]  

NeurogesX, Inc.

CONTACT: Stephen Ghiglieri of NeurogesX, +1-650-358-3310,[email protected]; or Investors, Stephanie Carrington, +1-646-536-7017,[email protected], or Media, Jason Rando, +1-646-536-7025,[email protected], both of The Ruth Group

Ensurapet, Inc. (OTCBB:EPTI), a leading provider of pet health insurance, announced today that the Company’s comprehensive pet health insurance programs have expanded their marketing efforts, which have been underway since 2007, with alumni members of Arizona State University.

Arizona State University Alumni members (www.asu.edu/alumni/association/index.shtml) have the opportunity to choose from the four pet health insurance plans offered by Ensurapet, Inc., with premiums starting at as little as $8.00 per month. Alumni members are also offered an introductory accidental life insurance policy in addition to access to the Company’s leading online pet medical resource center VetpetMD.

“We see tremendous opportunities in these areas since we have the ability to introduce our pet health insurance plans to sizeable pet owner groups and long standing loyal associations utilizing an endorsed introduction. CNBC News recently reported that pet insurance is the third most requested employee work benefit. We are experiencing this trend continuing into organized group associations and university alumni associations at an unprecedented rate,” stated Russell Smith, CEO of Ensurapet.

This release includes forward-looking statements intended to qualify for the safe harbor from liability established by the Private Securities Litigation Reform Act of 1995. These forward-looking statements generally can be identified by phrases such as Ensurapet or its management “believes,””expects” or “anticipates,””foresees,””forecasts,””estimates” or other words or phrases of similar import. Similarly, statements in this release that describe the Company’s business strategy, outlook, objectives, plans, intentions or goals also are forward-looking statements. All such forward-looking statements are subject to certain risks and uncertainties that could cause actual results to differ materially from those in forward-looking statements. This is a corporate awareness release and is not a solicitation for insurance coverage or benefits. Pet health insurance plans are issued and delivered as a surplus line coverage pursuant to Michigan insurance statutes to club association members only in accordance with applicable insurance regulations.

Visit: www.ensurapet.com for more information about the company.

By Elizabeth Simpson, The Virginian-Pilot, Norfolk, Va.

Jul. 11–VIRGINIA BEACH — Like any competitive 5-year-old, Sabrina Waide wants to win.

She jogs in her Virginia Beach yard every day to prepare for running and swimming races she’ll join in this weekend. When she wakes up, she asks, “How many more days?”

In the eyes of her adoptive parents, Melissa and Bill Waide, she’s already a winner for having endured years of life-and-death moments and a transplant operation that’s been done on only a small number of children.

Sabrina will take part in the U.S. Transplant Games in Pittsburgh, a national competition held every two years for recipients of donated organs.

The purpose of the event, which begins today and continues through Wednesday, is to highlight the success of transplant and to honor donors and recipients.

People who have had a transplant for at least six months are eligible. Many of the competitors have had kidney, lung, heart and liver transplants. Sabrina falls into a smaller category of those who have received a small intestine from a living donor.

She was born in 2003 with a birth defect called gastroschisis, in which the intestines form on the outside of the body. The intestines were reinserted during surgery shortly after birth. Most babies with the condition recover fine, but Sabrina’s small intestine was so damaged, she couldn’t digest food.

She lived at Children’s Hospital of The King’s Daughters for 14 months and received all her nutrition through intravenous feedings.

Her biological parents were young and not able to provide care for such an involved medical condition, Melissa said. They gave up parental rights.

Sabrina was about 6 months old when Melissa met her and had been moved from the hospital’s neonatal unit to a general care floor.

Melissa is a nurse practitioner in the hospital’s plastic surgery department, and was called to check some tough-to-heal skin wounds around Sabrina’s IV sites.

Soon Melissa was visiting during lunch and popping in after work to spend time with the baby.

“She had this allure about her that reached out and grabbed you,” Melissa said. “She was very nosy about everything that was going on.”

Eventually, it became clear that Sabrina needed an organ transplant or she would die. She was running out of places where IV lines could be inserted.

Melissa worried that Sabrina’s chances for receiving an organ would not be good if she did not have a family to care for her. So she asked her husband, Bill, and their three children how they would feel about becoming Sabrina’s foster family.

“She didn’t have anywhere else to go, and I felt she deserved a chance for organ donation.”

Her two sons, Kenny and Ryan, were 17 and 13 at the time, and her daughter, Holly, was 9. Bill and the children met Sabrina for the first time at CHKD.

“She was adorable,” remembers Holly, who’s now 13. “She was very quiet. I held her on my lap and took her for a wagon ride.”

Bill and Melissa went through foster parent training. Sabrina went home with them when she was 14 months old.

She was put on the list for a small intestine donation, but doctors were concerned she might die before one became available.

Meanwhile, a surgeon at the University of Illinois Medical Center at Chicago had begun doing a fairly new procedure using live donors rather than the more common transplant of intestines from deceased donors.

Another CHKD patient, Carter Wells, was among the first children to receive the live donor small intestine transplant, in 2003 in Chicago. The 23-month-old boy’s mother was the donor.

That’s how Waide learned about that type of surgery. It has the best chance of success when a family member provides the organ. So CHKD staff approached Sabrina’s biological mother. Even though she had agreed to give up the child for adoption, the 23-year-old woman said she would donate a portion of her small intestine.

The operation took place on Oct. 19, 2004, in Chicago.

“She gave Sabrina life again,” Melissa said. “She gave her a second chance.”

Sabrina’s biological mother stayed there about a week, then returned home. The Waides have not had contact with her since.

Sabrina recovered in Chicago for eight weeks, and came home in December 2004. Her adoption became final the following October.

She can eat some foods but still receives much of her nutrition through a tube in her belly because she has developed several food allergies, probably due to her condition and anti-rejection medications.

The 40-pound girl is thriving, though. She plays soccer, takes ballet lessons and is getting ready to start kindergarten in the fall. A mottled, raised area on her tummy is the only visible evidence of the transplant.

There are still only a small number of children nationwide who have had the same surgery. Carter died in 2006 at age 5 after his third transplant failed. Some recipients are doing well, but there are so few that the long-term prognosis is unknown.

“You take every day as gift, and you’re grateful for it,” Melissa said.

Once they adopted Sabrina, the Waides decided to continue being foster parents. In December 2006, they took in a baby boy waiting for a liver transplant. He died in February 2007, at less than a year old, before an organ became available. They’re now foster parents to two brothers who are 2 years and 9 months old.

“There are children who need love and a home,” Melissa said. “That’s not too much for a child to ask for.”

Sabrina, her parents, her sister and her two foster brothers will load up the car today to head to Pittsburgh, where Sabrina will be one of 35 organ recipients from Virginia to compete in the U.S. Transplant Games. Team Virginia — 100 people strong — also includes donors and the families of both recipients and donors.

Melissa has told Sabrina not to worry about what place she comes in, just to run and swim. The girl with the pigtails, though, has a one-word answer for what she plans to do.

“Win.”

Elizabeth Simpson, (757) 446-2635, [email protected]

—–

To see more of the The Virginian-Pilot, or to subscribe to the newspaper, go to http://www.pilotonline.com.

Copyright (c) 2008, The Virginian-Pilot, Norfolk, Va.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By DIANA DEL MAURO

EXERCISE, RUSSIAN STYLE

Kettlebells just might fit the bill

Workout: Kettlebell enjoying surge in popularity

Amy Christian squats in a field with what looks like a small cannonball in her hands.

She belts out an audible, forceful breath, and pitches the odd- shaped device, which has a handle, as far as she can.

Mastering proper form is harder than it looks. She fetches the kettlebell, as it’s called, and starts over. She hikes the 26-pound chunk of cast iron between her legs, swings her arms upward, snaps her hips and watches the black kettlebell crash onto the earth before her.

In this explosive fashion, she travels across the field.

“Doesn’t this feel totally Russian?” she says to her comrades. “I feel like we should go drink some vodka.”

Instead of wearing heavy boots in the snow, though, these militants are barefoot in the sun-scorched grass at Patrick Smith Park near Canyon Road. The group meets now at Torreon Park off of West Alameda.

They’re here to get fit. And their commander, Keira Newton, is a small woman with floral tattoos — hardly the brutish drill sergeant you might imagine.

“This is a really intense workout, because you’re using the maximum force in every move,” she tells an introductory class of six. “You’re not doing one thing the whole time; you’re asking your body to do intense interval kind of training, sort of like sprints. You’re using a lot at one time, recovering and then doing it again.”

Pavel Tsatsouline is the Russian behind this fitness fad. When he was an instructor with the Soviet Special Forces, he used “kettlebelling” as a conditioning technique.

In 1998, Tsatsouline first told America’s strongmen about kettlebelling in an article for the magazine MILO. Then, in 2001, he promoted the kettlebell to a broader audience of Americans through his book, The Russian Kettlebell Challenge. That same year, his publisher, Dragon Door, began manufacturing and selling kettlebells in the United States, and Pavel’s instructor certification program got established.

In New Mexico, Newton is one of five Russian-kettlebell- certified instructors trained through Tsatsouline’s program.

The kettlebell has been whipping Russians into shape since the turn of the 18th century — and now its portability has developed a great appeal for busy Americans, who are bored with their weight benches and too tired to get to the gym.

For Christian, a professional aerialist and Wise Fool New Mexico’s artistic director, weightlifting has always seemed dull: “No. Yuck. Not interested.” And between work and raising her daughter, she doesn’t have time to swim anymore.

Killer strength and phenomenal flexibility are already in her possession, but at 42, she is falling short on aerobic conditioning, she admits. When a colleague at Wise Fool told Christian that kettlebell drills combine all three, she was intrigued and signed up for Newton’s two-hour introductory class.

In 2002, Rolling Stone called kettlebells the “hot weight of the year.” Today, kettlebell lifting competitions are held in many countries. And from Boston to L.A., there are studios devoted to kettlebell classes for the average person.

“There are tons of them in California. It’s just blowing up,” Newton said.

Many kettlebell Web sites feature beautiful, bulky men who can’t help but gaze at their ripped navels all day. But here in Santa Fe, Newton’s typical client is a mother with a career.

For the past few months, Newton has held classes in various city parks. “The beauty of kettlebell is you can do it in a small space at home,” the mother of two said. “But I love doing it in a field.”

Using the whole body

From the deltoid to the lateral epicondyle, Newton’s upper arms are nicely proportioned and lithe. Her 108-pound frame is tight and powerful.

For herself and her classes, she designs routines that produce long, lean muscles. “Most women are fearful that they’re going to bulk,” she says.

She mixes in pushups and other exercises so clients don’t get bored or overly fatigued.

Results are seen quickly, because you use the whole body with every movement, Newton says, and you swing heavy weights. The average woman starts with an 18-pound bell, which costs about $80, unless you buy a knock-off brand.

Although 95 percent of Newton’s clients are women, the kettlebell has a strong following among men nationally, including boxers, wrestlers and even martial artists, who can relate to the fluid movements and hip snaps.

For those who want The Hulk look, kettlebells can achieve that, too. You up the poundage and change the drills.

In Minneapolis, Newton just got her level-two certification, which gives her advanced training in more demanding workouts as well as corrective strategies and injury prevention.

Her other job is as a Feldenkrais practitioner at McGhee Therapy. Developed by a Russian-born physicist, this method of working with the human nervous system translates into her work with kettlebells.

‘Like some sort

of torture device’

The first time she saw a kettlebell, Newton wasn’t impressed. As a student at

St. John’s College, her husband, Mark Bixby, caught the kettlebell buzz and went full-throttle with his workouts.

Newton thought he’d gone nuts. He’d take the kettlebells out in the snow and sling them around, and she wondered what drove him.

“I found it to be a little bit abusive and barbaric like some sort of torture device that once belonged to a caveman,” she says.

One day, she tried it. In between diapering and feeding her baby she could get in a tough workout.

“It can be everything in one,” Newton says. “It’s basically your hand-held gym.”

But then this workout wonder backfired. Newton developed tendonitis in her elbows.

Poor form was the cause of the problem. She didn’t give up, though. She found Zar Horton, a Russian Kettlebell Challenge certified trainer at FireBellz in Albuquerque, and was “blown away” by the difference better technique made.

For eight months of her pregnancy with Cora, who is now

2 years old, Newton hoisted the kettlebells. She liked that her other daughter, Ruby, didn’t have to get shuffled off to the gym.

“I had a nursing infant that I couldn’t leave for long stretches,” Newton said. “The kettlebell allowed me to get an intense, 15-minute workout in my living room and still be within five feet of my baby.”

She gained 44 pounds during her pregnancy, but within four months of giving birth to Cora, she was back to her pre-pregnancy weight, thanks to the kettlebell.

“A year later, I had lost another seven pounds and three waist sizes,” Newton said. “Most impressive to me was that as I was getting leaner, I was also getting stronger. After starting my kettlebell training with an 8-kg bell (18 pounds), I am

currently using a 16-kg bell

(35.3 pounds).”

Wide range of appeal

In her classes, Newton is a stickler about form. Flattening the back, thrusting out the hips, zipping up the belly, staking the knees over the feet, driving through the heel — these practices are key to preventing injuries.

Newton has her students wear flat shoes or go barefoot. Cushioned shoes can throw off one’s balance, she said.

The hot potato, the slingshot, the dead lift, the swing and the squat are the first moves Newton teaches to beginners.

“You’re probably going to be sore tomorrow. I’m going to suggest if you have a bell, swing it,” she warned the class.

Only one person in the group, a man, had been lifting weights regularly.

As one woman tried the squat, she felt as though she was going to tip over. Newton said that was because the woman rounded her back when it should be flat.

Newton demonstrated the squat one more time.

“It looks like I’m using my arms,” she said. “But the main part of the movement is in my hips and in my butt.”

Stephen and Pam Trujillo, in their mid-30s, were hooked by the end of the first class. They liked that the workout engaged the core of their body, and that the kettlebell was a small piece of equipment that they could take anywhere.

Maida Rubin, 18, said she learned the value of kettlebells in the physical education program at Desert Academy, where Newton’s husband used to teach with Newton’s assistance. The drills produced outstanding results for the teenagers: weight loss as well as better scores in track and high jump.

“This is a lot more interesting (than lifting weights),” the former track runner said.

She encouraged her mother, 51-year-old Louise Rubin, to take the introductory class with her. Her mother is moving to Boston, which has a kettlebell workout studio.

Newton would like to open such a studio in Santa Fe, but she needs a place where the heavy bells won’t bash polished, wooden floors and participants can spread out. And, in general, she’s trying to recruit more men.

Noticeable rewards

Ana June, 36, has never cared for weight lifting. She took up yoga last summer after hip surgery, and this year turned to kettlebells to raise her fitness level a notch.

“In a month of doing this, I’ve far exceeded doing two months of yoga,” said the mother of four and art director for New Mexico Free Press. “I can now put on a bikini.”

Marja Martin, 43, runs a catering business and expends the rest of her energy keeping up with her 7-year-old son. “The thing that’s amazing about this — I wasn’t exercising at all. This is manageable with a business and a kid,” she said. “That’s the biggest selling point, and that’s why we’re almost all moms.”

For the past two months, she has devoted at least 15 minutes to kettlebells three to four times a week. On Wednesdays and Saturdays she goes to Newton’s class, which is an hour long. The other days she swings kettlebells at home or in the commercial kitchen where she works.

She admitted she was “devastatingly sore” for the first two weeks. But now, she has dropped two dress sizes without changing her eating habits, other than eliminating wheat. “I’m a cook; I don’t do diets,” Martin said.

Her reward: Having a fabulous time trying on dresses at Nieman Marcus in Dallas —

and getting positive remarks from her petite, picky mother.

“It is noticeable, and I’ve only been doing it two months,” Martin said.

That kind of efficiency is exactly what makes this Russian invasion tough to beat in the American fitness industry.

IF YOU GO

What: Russian kettlebell workout sessions with Keira Newton. To attend, you must have prior kettlebell training, preferably with a certified Russian kettlebell instructor.

When: 5:30 p.m. Wednesdays (all levels), 9:30 a.m. Saturdays (advanced), 10:30 a.m. Saturdays (beginners and intermediate levels).

Where: Torreon Park, 1515 W. Alameda St. Cost: $15 per session Information: For additional details, or to schedule a twohour introductory session for $80, call 501-0180 or visit www.dkbfitness.com.

(c) 2008 The Santa Fe New Mexican. Provided by ProQuest Information and Learning. All rights Reserved.

OTTAWA, ONTARIO–(Marketwire – July 11, 2008) – Health Canada is advising consumers not to use unauthorized drugs sold by the company Purepillz. Four unauthorized products, “Peaq”, “Freq”, “PureRush”, and “PureSpun” are promoted on the company’s Web site as “social tonics” and are described as “safer legal alternatives to more dangerous street drugs.” The products contain benzylpiperazine (BZP) and 3-trifluoromethylphenylpiperazine (3-TFMPP), and may pose serious health risks. These products require eight-digit Drug Identification Number (DIN) on the label before they can be legally sold in Canada.

Currently, BZP and 3-TFMPP have no therapeutic uses. While BZP is frequently claimed to be a “natural” substance, it is not a natural health product. Both BZP and 3-TFMPP are synthetic substances that do not occur naturally. These substances may cause effects such as increased body temperature, increased blood pressure, dilated pupils, increased euphoria, alertness and paranoia. When BZP and TFMPP are taken together and in high doses they have been reported to cause hallucinations, convulsions and slowed breathing. Health Canada is carrying out an assessment to determine whether it would be appropriate for these substances to be regulated under the Controlled Drugs and Substances Act (CDSA). Health Canada has repeatedly asked Purepillz to remove these products from the market. The company has not complied and therefore Health Canada is taking enforcement action.

Health Canada advises consumers not to use Purepillz products or any drugs that have not received Health Canada approval. Health Canada also advises Canadians not to purchase these products from the Internet or from any other source. Canadians who have used Purepillz products and are concerned about their health should consult a health care professional.

Consumers requiring more information about this advisory can contact Health Canada(s public enquiries line at (613) 957-2991, or toll free at 1-866-225-0709.

To report a suspected adverse reaction, please contact the Canada Vigilance Program of Health Canada by one of the following methods:

Telephone: 1-866-234-2345 Facsimile: 1-866-678-6789 Canada Vigilance Program Marketed Health Products Directorate Ottawa, Ontario, AL 0701C K1A 0K9 E-mail: [email protected]

The Canada Vigilance adverse reaction reporting form, including a version that can be completed and submitted online, is located in the MedEffect Canada (www.healthcanada.gc.ca/medeffect) area of the Health Canada Web site.

(c) 2008 Marketwire. Provided by ProQuest Information and Learning. All rights Reserved.

By Don Roth

In a formal ceremony before a packed auditorium at the John F. Kennedy Center in Washington, D.C., Loma Linda University graduate Loree Sutton was promoted to the rank of brigadier general of the U.S. Army.

Sutton is assigned to the general staff of the U.S. Army at the Pentagon.

Because of ill health, her mother, Lavaun Sutton of Loma Linda, was unable to attend the ceremony held May 9. Lavaun Sutton died May 30.

Lt. Gen. Eric Shoomaker, the surgeon general of the U.S. Army, hosted the ceremony, and Gens. Benjamin Grifffin and Barry McCaffrey conducted the pinning ceremony.

Loma Linda residents who took part in the program included Wilber Alexander, retired dean of the School of Religion of Loma Linda University and longtime Sutton family friend; and Milford Harrison, former mayor of Loma Linda, another longtime family friend. Sutton’s sister Cheryl and seven other local residents attended the ceremony.

Brig. Gen. Loree Sutton is a soldier and psychiatrist. Her professional interests include warrior and family resilience, holistic fitness, addiction, psychological health and traumatic brain injury.

Before her assignment as special assistant to the assistant secretary of defense (health affairs) and director of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, she served in a variety of leadership, policy and operational roles.

Sutton graduated from Loma Linda University School of Medicine in 1985. Her mother, Lavaun Sutton, was a member of the well-known LLU heart team and served as head cardiac intensive care nurse.

Sutton has received many awards including the Legion of Merit, the Bronze Star Medal, the Order of Military Merit and the Defense Meritorious Service Medal. She has served in a variety of operational positions both in the United States and overseas, including deployment to Operation Desert Storm and as commander of two Army hospitals.

She not only holds a medical degree from Seventh-day Adventist- owned Loma Linda University, but also earned a bachelor of science degree in business administration from Pacific Union College in Angwin, Calif., also an Adventist college.

She completed her internship and residency training in psychiatry at Letterman Medical Center at the Presidio of San Francisco. Board certified by the American Board of Psychiatry and Neurology, Sutton is licensed to practice medicine in California and New Mexico. She is a graduate of the U.S. Army Command and General Staff College, a distinguished graduate of the National War College and a former White House Fellow.

She has earned the Expert Service Medal, the order of Military Medical Merit and the German Armed Forces Efficiency Training badge and is authorized to wear the US Army 9th Infantry Regiment Manchu Warrior Belt Buckle.

Other honors include the Colonel Robert Skelton Award as the outstanding officer in training at Letterman Army Medical Center and the Sandoz Award as the outstanding graduate medical student at Loma Linda University in the field of psychiatry.

At the ceremony, she told the audience, “Today’s ceremony is dedicated to the legacy, service and sacrifice of our wounded, ill, injured and fallen warriors as well as those courageous enough to love them. Please accept my sincere appreciation for all of you who through your participation and presence, whether in person or in spirit – honor my family and me today. We are truly all in this together.”

(c) 2008 Redlands Daily Facts. Provided by ProQuest Information and Learning. All rights Reserved.

Alnylam Pharmaceuticals, Inc. (Nasdaq: ALNY), a leading RNAi therapeutics company, announced today that the Glover patent (EP 1230375), which is exclusively licensed to Alnylam from Cancer Research Technology Limited (CRT), has completed initial oral opposition proceedings in Europe. Through these proceedings, the Opposition Division of the European Patent Office has overturned the previously granted claims of the patent which covered certain features of RNAi therapeutics. Alnylam intends to appeal any decision which does not result in the patent being maintained in its present form or scope. The Glover patent is one of many issued or granted so-called “fundamental” patents in Alnylam’s broad intellectual property (IP) estate for RNAi therapeutics.

“As is well known, the European patent process is lengthy, often involving opposition and appeal procedures that result in varied outcomes, and we consider this outcome just one step for our Glover patent. Moreover, today’s ruling does not alter the significant position of Alnylam IP for developing and commercializing RNAi therapeutics, nor does it impact any of our ongoing business development discussions, as the Glover patent was only one of eleven issued or granted fundamental patents held by Alnylam,” said Barry Greene, President and Chief Operating Officer of Alnylam. “Alnylam’s patent estate remains unparalleled in the industry and we continue to expect that many additional patents owned or licensed exclusively to Alnylam will be awarded through the rest of this year and into the future, broadening the geographic and claim scope of our patent portfolio for all RNAi therapeutics.”

About Alnylam Intellectual Property (IP)

Alnylam’s IP estate includes issued, allowed, or granted fundamental patents in many of the world’s major pharmaceutical markets that claim the broad structural and functional properties of RNAi therapeutic products. These include:

— the Crooke Patents (U.S. Patent Nos. 5,898,031 and 6,107,094 and EP 0928290) issued in over 12 countries and licensed exclusively from Isis Pharmaceuticals, Inc. to Alnylam for RNAi therapeutics, which cover compositions, methods, and uses of modified oligonucleotides to inactivate a target mRNA mediated by a double-stranded RNase, such as “RISC,” which is the cellular enzyme complex that mediates RNAi;

— the Kreutzer-Limmer I ‘623 patent (EP 1144623) granted in August 2002, maintained in amended form in June 2006 and owned by Alnylam, which covers methods, medicaments, and uses of siRNAs having, among other structural features, a length of 15 to 21 base pairs;

— the Kreutzer-Limmer I ‘945 patent (EP 1214945) granted in June 2005 and owned by Alnylam, which covers compositions, methods, and uses of siRNAs with a length between 15 and 49 nucleotides;

— the Kreutzer-Limmer I ‘167 patent (DE 10080167) granted in October 2007 and owned by Alnylam, which covers pharmaceutical compositions and uses of siRNAs with a length between 15 and 49 nucleotides that target certain broad categories of mammalian genes;

— the Kreutzer-Limmer I ‘235 patent (DE 10066235), granted in January 2008 and owned by Alnylam, which covers methods, uses, and medicaments of siRNAs, with a length between 15 and 49 nucleotides, expressed through a vector;

— the Kreutzer-Limmer II ‘061 patent (EP 1352061), granted in May 2006 and owned by Alnylam, which covers therapeutic compositions, methods, and uses of siRNA and derivatives directed toward over 125 disease targets;

— the Tuschl II ‘704 patent (U.S. Patent No. 7,056,704) issued in June 2006 and exclusively licensed to Alnylam from the Max Planck Society, which broadly covers methods of making siRNAs to silence any and all disease targets;

— the Tuschl II ‘196 patent (U.S. Patent No. 7,078,196) issued in July 2006 and exclusively licensed to Alnylam from the Max Planck Society, which broadly covers methods of making siRNAs with or without chemical modifications;

— the Tuschl II ‘044 patent (EP 1407044), granted in January 2008 and exclusively licensed to Alnylam from the Max Planck Society, which broadly covers compositions, methods, and uses of siRNAs;

— the Tuschl II patent (JP 4 095 895) granted in May 2008 in Japan and exclusively licensed to Alnylam from the Max Planck Society, which broadly covers compositions, methods, uses, and systems of siRNAs; and,

— many divisional and continuing patent applications pending of the aforementioned issued or granted patents and additional patent applications pending, including patents and patent applications covering inventions by Fire and Mello (U.S. Patent No. 6,506,559), Glover, Tuschl, Hannon, and Kay.

In addition to fundamental patents, Alnylam is the exclusive licensee in the field of RNAi therapeutics for more than 150 issued chemistry patents owned or controlled by Isis Pharmaceuticals, Inc. broadly covering chemical modifications, including motifs and patterns of modifications of oligonucleotides, including RNAi therapeutics. These patents include:

— phosphorothioate and 2′-O-methyl modifications of oligonucleotides (Buhr, U.S. Patent No. 6,476,205);

— 2′-Ribose modifications of oligonucleotides (Cook, U.S. Patent Nos. 5,670,633; 6,005,087; 6,531,584; and 7,138,517);

— chemical conjugates of oligonucleotides (Manoharan, U.S. Patent No. 6,153,737); and,

— “overhang,””blunt-end,” and nucleotide pairing design motifs (Woppmann et al., UK 2417727).

In addition to fundamental and chemistry patents, Alnylam is also the exclusive licensee in the field of RNAi therapeutics for certain delivery patents, including those owned and controlled by Tekmira Pharmaceuticals, Inc. covering delivery of oligonucleotides, including RNAi therapeutics, with liposomal formulations. These patents include:

— formulations of oligonucleotides, including siRNAs, in cationic liposomes (Wheeler, U.S. Patent Nos. 5,976,567 and 6,815,432; and Semple, U.S. Patent No. 6,858,225).

About RNA Interference (RNAi)

RNAi (RNA interference) is a revolution in biology, representing a breakthrough in understanding how genes are turned on and off in cells, and a completely new approach to drug discovery and development. Its discovery has been heralded as “a major scientific breakthrough that happens once every decade or so,” and represents one of the most promising and rapidly advancing frontiers in biology and drug discovery today which was awarded the 2006 Nobel Prize for Physiology or Medicine. RNAi is a natural process of gene silencing that occurs in organisms ranging from plants to mammals. By harnessing the natural biological process of RNAi occurring in our cells, the creation of a major new class of medicines, known as RNAi therapeutics, is on the horizon. RNAi therapeutics target the cause of diseases by potently silencing specific messenger RNAs (mRNAs), thereby preventing disease-causing proteins from being made. RNAi therapeutics have the potential to treat disease and help patients in a fundamentally new way.

About Alnylam Pharmaceuticals

Alnylam is a biopharmaceutical company developing novel therapeutics based on RNA interference, or RNAi. The company is applying its therapeutic expertise in RNAi to address significant medical needs, many of which cannot effectively be addressed with small molecules or antibodies, the current major classes of drugs. Alnylam is leading the translation of RNAi as a new class of innovative medicines with peer-reviewed research efforts published in the world’s top scientific journals including Nature, Nature Medicine, and Cell. The company is leveraging these capabilities to build a broad pipeline of RNAi therapeutics; its most advanced program is in Phase II human clinical trials for the treatment of respiratory syncytial virus (RSV) infection. In addition, the company is developing RNAi therapeutics for the treatment of a wide range of disease areas, including hypercholesterolemia, liver cancers, and Huntington’s disease. The company’s leadership position in fundamental patents, technology, and know-how relating to RNAi has enabled it to form major alliances with leading companies including Medtronic, Novartis, Biogen Idec, Roche, Takeda, and Kyowa Hakko Kogyo. To reflect its outlook for key scientific, clinical, and business initiatives, Alnylam has established “RNAi 2010” which includes the company’s plan to significantly expand the scope of delivery solutions for RNAi therapeutics, have four or more programs in clinical development, and to form four or more new major business collaborations, all by the end of 2010. Alnylam is a joint owner of Regulus Therapeutics LLC, a joint venture focused on the discovery, development, and commercialization of microRNA therapeutics. Founded in 2002, Alnylam maintains headquarters in Cambridge, Massachusetts. For more information, visit www.alnylam.com.

About Cancer Research Technology

Cancer Research Technology Limited (CRT) is a specialist commercialisation and development company, which aims to develop new discoveries in cancer research for the benefit of cancer patients. CRT works closely with leading international cancer scientists and their institutes to protect intellectual property arising from their research and to establish links with commercial partners. CRT facilitates the discovery, development and marketing of new cancer therapeutics, vaccines, diagnostics and enabling technologies. CRT is wholly owned by Cancer Research UK, the largest independent funder of cancer research in the world. Further information about CRT can be found at www.cancertechnology.com.

Alnylam Forward-Looking Statements

Various statements in this release concerning Alnylam’s future expectations, plans and prospects, including its views with respect to the expected validity, enforceability, importance and scope of its intellectual property rights, including the Glover patent, constitute forward-looking statements for the purposes of the safe harbor provisions under The Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by these forward-looking statements as a result of various important factors, including risks related to: Alnylam’s approach to discover and develop novel drugs, which is unproven and may never lead to marketable products; obtaining, maintaining and protecting intellectual property; Alnylam’s ability to enforce its patents against infringers and to defend its patent portfolio against challenges from third parties; Alnylam’s ability to obtain additional funding to support its business activities; Alnylam’s ability to realize future milestones and royalties; Alnylam’s dependence on third parties for development, manufacture, marketing, sales and distribution of products; obtaining regulatory approval for products; competition from others using technology similar to Alnylam’s and others developing products for similar uses; Alnylam’s dependence on collaborators; and Alnylam’s short operating history; as well as those risks more fully discussed in the “Risk Factors” section of its most recent quarterly report on Form 10-Q on file with the Securities and Exchange Commission. In addition, any forward-looking statements represent Alnylam’s views only as of today and should not be relied upon as representing its views as of any subsequent date. Alnylam does not assume any obligation to update any forward-looking statements.

NEW YORK, July 10 /PRNewswire-FirstCall/ — Scientific Games Racing, LLC (SGR), a wholly-owned subsidiary of Scientific Games , announced today an agreement with the California Horse Racing Board (CHRB) regarding the CHRB investigation of the software programming in the Quick-Pick software of SGR’s BetJet terminal — a terminal that was introduced for use in California beginning in July 2007.

The terms of the agreement include the following:

— SGR implemented its software enhancements on BetJets and non-BetJet terminals under the supervision of the CHRB in order to disable the Quick-Pick betting function until such time, if ever, Quick-Pick betting is allowed by the CHRB;

— SGR will reimburse the CHRB for the costs of the CHRB investigation into this matter;

— SGR will make equal voluntary payments to the California Retirement Management Account (CARMA), the Permanently Disabled Jockeys Fund and the California Thoroughbred Health Foundation to support backstretch working family health services;

— SGR will pay refunds to people who placed Quick-Pick bets at BetJet terminals in California between July 1, 2007 and May 17, 2008, as long as the person can establish through legitimate proof, including, but not limited to, a ticket stub, that they placed said bet. This commitment will extend until June 2, 2009;

— SGR will report every month for six months, and again on July 3, 2009, to the CHRB on the status of the implementation of the software enhancements to correct the BetJet programming error and consumer claims, if any. To further protect the wagering public, SGR shall also conduct a quality assurance review of its systems and confirm to the CHRB annually the integrity of its systems and that such systems are in good working order;

— No further administrative action arising from the foregoing facts will be taken by the CHRB against SGR or its affiliated companies, directors, officers or employees.

Richard B. Shapiro, Chairman of the CHRB, stated: “We have found no evidence of intentional misconduct in the programming glitch nor do we find any effort to conceal the error from the public. As SGR management became aware and involved, the Company cooperated with our review and helped bring this matter to closure. We are pleased that SGR will generously contribute to horseracing charities and believe this agreement is in the best interests of both consumers and racing in California.”

Kirk Breed, Executive Director of the CHRB, added: “While Quick-Pick is not a popular form of wagering, it is our responsibility to ensure both the public confidence in all forms of wagering allowed and that everyone has a fair chance to win or lose in all forms of regulated gaming.”

Brooks Pierce, President of SGR, stated: “We are grateful to the CHRB for working with us to help bring this matter to a close and we are confident in the integrity of our system.”

About Scientific Games

Scientific Games Corporation is the leading integrated supplier of instant tickets, systems and services to lotteries worldwide, a leading supplier of server based gaming machines and systems, Amusement and Skill with Prize betting terminals, interactive sports betting terminals and systems, and wagering systems and services to pari-mutuel operators. It is also a licensed pari-mutuel gaming operator in Connecticut, Maine and the Netherlands and is a leading supplier of prepaid phone cards to telephone companies. Scientific Games’ customers are in the United States and more than 60 other countries. For more information about Scientific Games, please visit our web site at http://www.scientificgames.com/.

   Company Contact:   Investor Relation   Scientific Games Corporation   212-754-2233    Forward-Looking Statements  

Certain statements in this press release which are not historical facts, constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements, including those relating to timing of contracts, renewals or other events, business plans and performance objectives, are based upon management’s current expectations, assumptions and estimates and are not guarantees of future results or performance. Actual results may differ materially from those projected in these statements due to a variety of risks and uncertainties and other factors, including, among other things: competition; material adverse changes in economic and industry conditions in our markets; technological change; protection of intellectual property; security and integrity of software and systems; laws and government regulation, including those relating to gaming licenses, permits and operations; seasonality; dependence on suppliers and manufacturers; factors associated with foreign operations; failure to retain, renew or perform on contracts; resolution of pending or future litigation; and other factors described from time to time in our filings with the SEC, including our most recent Annual Report on Form 10-K. Forward-looking statements speak only as of the date they are made, and except for our ongoing obligations under the U.S. federal securities laws, we undertake no obligation to publicly update any forward-looking statements whether as a result of new information, future events or otherwise.

Scientific Games

CONTACT: Investor Relation of Scientific Games Corporation,+1-212-754-2233

Web site: http://www.scientificgames.com/

Company News On-Call: http://www.prnewswire.com/comp/117695.html

Patient Access Solutions, Inc. (OTCBB: PASO), a leading provider of healthcare/financial processing solutions for the healthcare, homecare and dental industries, announced today that they recently relocated their new state of the art servers, along with their new infrastructure, to a much larger collocated facility to handle the current growth they are experiencing.

Their new servers will be collocated with Mithril Technology (Mithril) at the Long Island Data and Recovery Center (LIDARC). Company management chose the LIDARC location for convenience, redundant technical sophistication, Empire Zone designation, and access to multiple bandwidth providers. Management believes that no other facility on Long Island can match LIDARC for the redundancy of the facilities or carrier services available. Mithril was chosen for its infrastructure and security expertise, comprehensive enterprise class managed services offerings, and dedication to excellent customer service.

According to Bruce Weitzberg, CEO/President of Patient Access Solutions, “I believe the LIDARC Center, will provide the security, data transfer, redundancy and back up of healthcare provider information that we need to support our client base.”

According to Jason Aptekar, President/CTO of Mithril Technology, “Patient Access Solutions is taking advantage of the powerful combination of LIDARC infrastructure and Mithril services. They are at the forefront of a true enterprise class infrastructure, connectivity, and service. With Mithril Professional and Managed Services, Patient Access Solutions has access to the skills, technology and experience it needs for today and tomorrow.”

About LIDARC (www.lidarc.com)

The LI Data and Recovery Center is a state of the art 200,000+ sq ft building, with heavy floor loads and heavy duty electrical service. The building is in a NYS Empire Zone, which allows tenants to qualify for State Tax Credits, incentives and discounted Electrical Power. (See Empire Zone Information found at http://www.tax.state.ny.us/sbc/empire_zone.htm) The building has elected to be carrier neutral and built a dedicated carrier meet-me-room to facilitate multi-carrier presence. There are presently 3 bandwidth providers in the building and two additional providers have committed to bring fiber into the building. Two of these five (OCG and Keyspan Communications) have Manhattan Bypass capabilities. LIDARC has also been designed to provide 99.999% monthly uptime and N+1 redundancy for power and cooling. N+1 means that LIDARC has what it needs, and an extra. For example, a room that will need 40 tons of air conditioning and 5 seconds of Uninterrupted Power Supply (UPS) to cut-over to generators when it is full of equipment has been built, in advance, with 90 tons of air conditioning and 6 minutes of UPS! This demonstrates not just the level of redundancy and reliability to which the building is being designed and built, but significantly, the commitment of the building owners to do it right knowing that the business community will recognize the value and come to LIDARC.

About Mithril Technology, Inc. (www.mithriltech.com)

Mithril Technology is a pioneer in the growing field of Managed Services with over seven years of experience in the field. Unlike typical technology companies Mithril has always focused on customizing best of breed solutions for its clients (small and mid-sized businesses of all types) and managing those solutions for flat rate fixed monthly fees. Businesses get predictable IT costs and large-company IT skills and service levels without hiring a large IT staff. The firm operates 24×7 with offices at LIDARC and designs, purchases, tests, installs, trains, monitors and maintains computer, network, voice, and video conferencing systems for its clients. “We take care of technology — with solutions that make you more competitive, efficient and secure — so you can take care of business!”

About Patient Access Solutions Inc. (www.pashealth.com)

Patient Access Solutions Inc. (PASHealth) is a Healthcare Solutions company which has created a formidable array of technology, resources and allies to enable it to become an agent of radical change in what has traditionally been a slowly evolving healthcare environment.

The PASHealth Web Portal System and terminal based solutions offer electronic medical eligibility, electronic referrals, and service authorizations, electronic claims processing, drug formularies, electronic prescriptions, electronic medical records and patient data, automating the labor intensive and expensive manual process currently used by many facilities and healthcare providers. Our D-PAS product utilizes digital pen & paper technology to capture handwritten information from the doctor or office personnel, transfer it into a digital form into the PAS web portal and utilize the data to initiate workflows in a secure environment. A patient’s medical history and patient records are used to initiate necessary workflows within the web portal, securely and much more efficiently, empowering the healthcare business process. In addition, the Web Portal System offers a complete suite of self pay receivable management solutions for the healthcare facilities.

Certain statements in this news release may contain forward-looking information within the meaning of Rule 175 under the Securities Act of 1933 and Rule 3b-6 under the Securities Exchange Act of 1934, and are subject to the safe harbor created by those rules. All statements, other than statements of fact, included in this release, including, without limitation, statements regarding potential future plans and objectives of the companies, are forward-looking statements that involve risks and uncertainties. There can be no assurance that such statements will prove to be accurate and actual results and future events could differ materially from those anticipated in such statements. Factors that could cause actual results to differ materially from those in the forward-looking statements include, among other things, the following: general economic and business conditions; competition; unexpected changes in technologies and technological advances; ability to commercialize and manufacture products; results of experimental studies; research and development activities; changes in, or failure to comply with, governmental regulations; and the ability to obtain adequate financing in the future. This information is qualified in its entirety by cautionary statements and risk factors disclosure contained in certain of Patient Access Solutions Inc. Securities and Exchange Commission filings available at http://www.sec.gov.

 Contact: Patient Access Solutions, Inc. 631-233-3707  

SOURCE: Patient Access Solutions

By Kathleen Shatt

Fellowship Baptist Church will sponsor its annual vacation Bible school program from 9 a.m. to noon Monday through July 18, at the church, 1017 Sundown Road.

This year’s theme is the “Dino Detectives.” The Rev. Michael Hubers said all of the activities will be based on a dinosaur theme.

All children ages 4 through the ninth grade are welcome to attend, regardless of their church affiliation.

Advance registration is requested; registration is free. Participants may sign up online at www.fellowshipofferndale.org. Registrations also will be accepted from 10 a.m. to 2 p.m. Saturday at the church.

Planned daily activities include games, crafts, contests for boys and girls, Bible stories, prizes and free gifts. Refreshments will be served each day.

The Rev. Hubers is expecting several hundred children to participate. He has a large team of volunteers helping him plan and teach activities.

For more information, call the church at 410-766-7755.

Summer concert

The Glen Burnie summer concert series will continue on Friday when the Esquires perform classic rock favorites from 7:30 to 9 p.m. in the Corcoran Pavilion in the Glen Burnie Town Center, 101 Crain Highway N.E.

Admission is free. Those attending should park in the county parking garage on Baltimore Annapolis Boulevard. Parking is free.

Alcoholic beverages and pets are not permitted at the event. Patrons are encouraged to take a lawn chair for seating.

For more information, call Betsy Slikker at 410-647-0057.

Comedy variety show

Ferndale United Methodist Church will host a variety comedy show, “Raising the Roof with Laughter,” on Friday in the church fellowship hall, 117 Ferndale Road.

Dinner will be served at 5:30 p.m., followed by a silent auction at 6:30 p.m.

The menu includes oven fried chicken, macaroni and cheese, green beans, roll, dessert and beverage. Church member Bruce Sponsler and his band will perform during the silent auction.

The variety show will begin at 7 p.m.

Admission is $15 for adults and $8 for children ages 12 and younger. Proceeds will help the Tyler family, which was recently displaced by a house fire. Cash donations will also be accepted for the family.

For more information, call Lelah Baxter at 410-768-9218 or Wanda Eschenbach at 410-672-0406.

Pascal seniors

Food historian Sue Latini and gourmet chef Rosalie Falter will present “A Taste of the Greek Islands” at 12:30 p.m. Monday at the Pascal Senior Center, 125 Dorsey Road.

The duo will demonstrate and prepare three Greek recipes. Participants will be able to sample all of the recipes. Admission is free. Advance registration is required.

Seniors are welcome to watch the movie “Enchanted” at 12:15 p.m. Friday. Admission is free.

Audiologist Stephen Pallett will conduct a free hearing screening and adjust hearing aids by appointment on Friday.

Senior information specialist Wanda Swift will meet with seniors by appointment on Tuesday to help them identify their needs, locate services and complete applications for assistance.

For more information, call the senior center at 410-222-6680.

Bus trips

Glen Burnie Chapter 606 of the AARP will host several bus trips this summer and fall.

A trip to the Suicide Bridge Restaurant on Aug. 15 costs $72 and includes bus transportation, a boat ride, buffet luncheon and a crab feast. The bus will leave the Glen Burnie parking garage at 10:30 a.m. and return at 6:30 p.m.

A tour of New York’s Hudson Valley from Sept. 3 through Sept. 5 costs $419 per person, double occupancy. The trip will include a tour of the Military Academy at West Point and the Culinary Institute of America.

The chapter will travel Nov. 14 to the American Music Theater to see the holiday Christmas show and eat lunch at the Shady Maple restaurant. The trip costs $72. The bus will leave the Glen Burnie parking garage at 9:30 a.m.

A trip to the holiday craft fair in Harrisburg, Pa., on Dec. 5 will cost $36. The bus will leave the Glen Burnie parking garage at 8 a.m. and stop for dinner at a Cracker Barrel restaurant on the way home.

For more information, call trip coordinator Neoma Dearing at 410- 766-4667.

Craft show

Glen Burnie United Methodist Church will sponsor a craft show from 9 a.m. to 2 p.m. Aug. 16 at the church, 5 Second Ave. S.E.

Vendors and crafters are needed. Spaces that include an 8-foot- long table are $30.

For more information, call Frankie Cooke at 410-760-2945.

Yoga Nidra class

Baltimore Washington Medical Center will offer yoga nidra classes at the hospital, 301 Hospital Drive beginning at 7:30 p.m. July 17 and at 4:30 p.m. July 24.

The session will include four classes taught every other week for eight weeks. Participation is limited to 20 students in each class. Participants must sign up for all four sessions.

The cost is $20. Advance registration is required. Participants may sign up online at www.bwmc.org.

Yoga nidra classes offer deep relaxation through guided meditation. Those attending should take a pillow and blanket to the class.

For more information, call the hospital at 410-787-4367.

STAND training

Holy Trinity Catholic Church will offer STAND training for the protection of children from 2 to 4 p.m. Friday at the church Parish Center, 126 Dorsey Road.

The program was designed by the Baltimore Archdiocese to prevent child abuse. All adult volunteers who come in contact with children are required to attend a STAND training session.

Advance registration is required.

For more information, call the church office at 410-766-5070, Ext. 25 or 10.

Bingo

Monsignor Slade Catholic School sponsors bingo games at 8 p.m. Friday nights in the school cafeteria, 120 Dorsey Road.

Early bird games begin at 7:30 p.m.

Cash prizes worth more than $3,000 are available.

Refreshments are sold through intermission.

For more information, call the school at 410-766-7130.

VFW Post 160

The Veterans of Foreign Wars Post 160 and Ladies Auxiliary will meet at 8 p.m. Monday at the post hall, 2597 Dorsey Road.

New members are welcome. Membership in the post is open to veterans who served overseas in certain zones as active-duty members of any branch of military service during wars and specified conflicts.

For more information, call the post hall at 410-766-9802.

CASOS club

The Happy Community Advocates for Senior Opportunities and Services will meet at 10 a.m. Saturday and July 26 in the former county utilities building, 7409 Baltimore Annapolis Blvd. Participants should park behind the building and use the rear entrance.

The meeting will begin with a social hour at 10 a.m. The business meeting will begin at 11 a.m.

All seniors ages 55 and older are welcome.

For more information, call Betty Betz at 410-969-3655.

Lions Club meeting

The Glen Burnie Lions Club will meet at 7 p.m. tomorrow at the Lutheran Church of Our Redeemer, 7606 Quarterfield Road. For more information, call 410-766-0859

Roadrunners

The Ferndale Roadrunners will meet at 11 a.m. tomorrow at the Ferndale Senior Center, 7205 Baltimore Annapolis Blvd.

For more information, call Melvia Scott, president of the club, at 410-761-0484.

Bingo

The North Glen Improvement Association sponsors bingo games every Monday night throughout July and August in the community hall, 303 Wellham Ave.

The doors open for seating at 6 p.m. Bingo games begin at 7 p.m.

For more information, call president Nancy Mason at 410-761-4894 or e-mail [email protected].

Hall rental

The Ferndale Volunteer Fire Company hall at 4 S. Broadview Blvd. is available for rent for all occasions. Catering is available.

For details, call 443-710-5441.

Clubs and organizations in the 21061 ZIP code area can call Maryland Gazette correspondent Kathleen Shatt at 410-766-8547 for publication of their news. They can also fax information to her at 410-766-1520 or send e-mail to [email protected].

(c) 2008 Maryland Gazette. Provided by ProQuest Information and Learning. All rights Reserved.

By NICOLE MILSTEAD

Howard Mewes, 90, sometimes gets lost using public restrooms, his son says. That’s one reason why Mewes now lives in Mill Creek, a locked-down Springfield facility specializing in the care of people with Alzheimer’s disease.

People with Alzheimer’s and dementia may have a tendency to wander away from their houses or care facilities. Locked nursing homes such as Mill Creek are one answer, but other nursing homes employ tracking devices or alarms in case residents become confused and wander off.

And the Schuyler County Sheriff’s Office recently began to use a similar device that is available to the families of people who may become disoriented but still live at home.

Mewes’ son, Harold Watson, 73, moved his father to Mill Creek because he wanted him to be happy.

“If I take him out, he does get lost. If he goes to the bathroom, I have to be right there with him so he doesn’t get mixed up,” Watson said. “He doesn’t want to go out like he used to. He likes it there.”

Trudy Whittington, president of the Illinois County Nursing Home Association, said the state Department of Public Health tracks nursing home “elopements.”

“I can remember recently a woman went missing overnight in the winter and was found in a ravine,” she said.

At Mill Creek, any doors to the outside, closets, kitchen or laundry must be opened by keypad. In the case of a fire alarm, the locks open automatically. In addition, if a resident pushes on a locked door for more than 30 seconds, the door will open and an alarm will sound.

“We have to change the codes periodically because some residents watch what numbers are being pushed and try to input those numbers in the doors,” said administrator Jeanne Campbell.

Other approaches are available to help find people who have walked away from their residences or nursing homes:

* Schuyler County Sheriff Don Schieferdecker said his office received equipment and training in April for the Rapid Recovery tracking system, which is available to help the county and families find missing people.

The equipment includes a tracker in the sheriff’s office, a box in the person’s home and a tracking device for the patient, which looks like a Timex watch.

“It is pretty much impossible to remove. You could cut it, but you would really have to work at it,” Schieferdecker said.

Each tracking device sends out a unique signal and is controlled from the wearer’s home. The initial cost for each home is $300, and monthly maintenance for the device is $20.

More information about the Rapid Recovery system in Schuyler County is available from the sheriff’s department at 322-4366.

Morgan County has had the system for about two years, but chief deputy Mike Carmody said officers there have responded only once, to find a lost child with autism. The child was located within five minutes without the aid of the device.

* WanderGuard and Code Alert are tracking devices used by nursing homes. They are small and can be attached to a resident’s wrist, clothing, walker or wheelchair. When someone wearing one of the devices passes through an outside door, an alarm lets staff members know a patient is wandering off.

The WanderGuard system also can work without alarms. If a person wearing the device gets four to five feet from an external door, it can silently lock the door until the wearer leaves the area.

The bracelets are usually worn only by patients who have been identified as prone to wander off.

“It is not uncommon for a nursing home to have the alarm triggered six to 10 times a day,” said Jason Stevens, WanderGuard vice president of sales.

*MedicAlert is an identification bracelet or pendant with a toll- free emergency phone number and an identification number engraved on it. If a wearer becomes lost, an alert is put out by the community support organization. Someone who finds the person can call the emergency response number, and the operator contacts the individual’s family or caregivers.

The device costs $49.95, with a $25 annual renewal fee. More information is available by calling (888) 572-8566.

* Sangamon County has an Internet-based service that sends recorded messages to telephones in the area where a person has gone missing.

The city of Springfield has no tracking devices. If a person with Alzheimer’s wanders off, city police put out a missing-person’s alert and searches until they are found, said Ray Serati, a spokesman for the Springfield Police Department.

Originally published by NICOLE MILSTEAD STAFF WRITER [email protected].

(c) 2008 State Journal Register. Provided by ProQuest Information and Learning. All rights Reserved.

WALNUT CREEK, Calif., July 10 /PRNewswire-FirstCall/ — Longs Drug Stores Corporation today reported preliminary total retail drug store sales for the 5-week, 9-week and 22-week periods ended July 3, 2008.

                                            Periods ended July 3, 2008                                                        Quarter     Year                                           Month       to Date    to Date   (Dollars in millions)                 (5 weeks)    (9 weeks)  (22 weeks)    Total retail drug store sales           $475         $848       $2,068   Increase from comparable prior    year period                             2.3%         1.4%         2.3%    Same-store sales increase (decrease):     Pharmacy                               2.6%         0.3%         0.4%     Front-end                             (0.4)%       (0.3)%        0.7%     Total                                  1.1%         0.0%         0.6%     

Longs estimated that preliminary June pharmacy same-store sales were unfavorably impacted by approximately 275 to 300 basis points as a result of recent generic introductions being substituted for higher-priced brand name drugs. In addition, a reduction in cold, flu, and allergy prescriptions, primarily due to the impact of the switch of the prescription allergy medicine Zyrtec to over-the-counter status, had an unfavorable impact of approximately 125 to 150 basis points on pharmacy same-store sales.

Longs estimated that preliminary June pharmacy same-store sales were also favorably impacted by approximately 100 to 125 basis points as a result of the calendar shift in Memorial Day, which fell in the Company’s fiscal month of May this year versus the fiscal month of June last year. The Company also noted that, as a result of a shift in its fiscal calendar, the fiscal month of June this year also included the first three days of July. Since there is typically an increase in the number of prescriptions filled in the first several days of a month, this calendar shift favorably impacted preliminary June pharmacy same-store sales by approximately 150 to 200 basis points.

About the Company

Headquartered in Walnut Creek, California, Longs Drug Stores Corporation is one of the most recognized retail drug store chains on the West Coast and in Hawaii. The Company operates 518 retail pharmacies and offers a wide assortment of merchandise focusing on health, wellness, beauty and convenience. Longs also provides pharmacy benefit management services and Medicare beneficiary prescription drug plans through its wholly-owned subsidiary, RxAmerica, LLC. Additional information about Longs and its services is available at http://www.longs.com/ and more information about RxAmerica is available at http://www.rxamerica.com/.

Contact: 925-979-3979

Longs Drug Stores Corporation

CONTACT: Longs Drug Stores Corporation, +1-925-979-3979

Web site: http://www.longs.com/

WASHINGTON, July 10 /PRNewswire-USNewswire/ — The Department of Justice announced today that Raynor Country Day School, in Long Island, N.Y., has entered into a settlement agreement with the United States to resolve two complaints filed by parents of children with diabetes who were turned down for enrollment in the school’s day camp last summer.

Pursuant to the agreement, Raynor School will evaluate each application to its school or camp on a case-by-case basis, and will make reasonable accommodations to permit children with diabetes to attend the school or summer camp. Accommodations may include, but are not limited to, supervising campers while they monitor blood glucose levels, using insulin pumps or other diabetes related medical equipment, and monitoring a child’s consumption of food. The agreement will remain in effect for three years.

“I congratulate Raynor School for working cooperatively with the Department of Justice to ensure that children with diabetes will have the opportunity to attend Raynor School and to participate fully in its programs,” said Grace Chung Becker, Acting Assistant Attorney General for the Civil Rights Division. “The Department of Justice recognizes the critical importance of enforcing the Americans with Disabilities Act so children with disabilities can access educational programs.”

The Raynor School allegedly denied requests to permit children with diabetes to attend the camp and denied requests for the school to supervise the children in daily monitoring of their diabetes, including personal testing by the children of blood glucose levels and administering insulin to themselves using a personal insulin pump. Insulin pumps are commonly used by children and young adults to administer insulin without a syringe.

“Schools should not refuse admission or equal opportunity to a child because the child has diabetes,” said Benton J. Campbell, the U.S. Attorney for the Eastern District of New York. “The summer camp offered by Raynor School benefits parents as well as children. Camp programs allow parents to work or carry out essential responsibilities while children play and learn in a safe and healthy environment. No family should be denied the opportunity for this kind of beneficial summer experience on the basis of disability.”

People interested in finding out more about the ADA or the agreement can call the Justice Department’s toll-free ADA Information Line at (800) 514-0301 or (800) 514-0383 (TTY), or access its ADA Web site at http://www.ada.gov/.

U.S. Department of Justice

CONTACT: U.S. Department of Justice, Office of Public Affairs,+1-202-514-2007, TDD: +1-202-514-1888

Web Site: http://www.usdoj.gov/

SOUTHFIELD, Mich., July 10 /PRNewswire/ — Sommers Schwartz, P.C., attorney Kenneth Watkins, announces that their client, Chantia Calhoun, involved in a medical malpractice and negligence case arising out of a sexual assault by defendant Dr. Anthony Baisden during a gynecological exam at a Henry Ford Hospital Detroit Clinic, is now being cited by defendant Henry Ford Hospital for their attorney fees and costs totaling over $100,000.00. The sexual assault occurred on September 27, 2004.

   HEARING: Motion for case evaluation sanctions hearing at 8:30 a.m. on   Friday, July 11, 2008, in the Wayne County Circuit Court. Case no.   06-627499-NH assigned to Judge Michael Sapala.    The Law Offices of Sommers Schwartz P.C. are located at 2000 Town Center,   Suite 900. To reach Sommers Schwartz, P.C., in Southfield, Michigan, phone   248-355-0300.    MEDIA CONTACTS: Mort Meisner 248.545.2222 or Kristin Schenden   248.895.5638.  

The Law Offices of Sommers Schwartz P.C.

CONTACT: Mort Meisner, +1-248-545-2222, or Kristin Schenden,+1-248-895-5638

IntegraMed America, Inc. (NASDAQ: INMD), the nation’s leading operator of fertility centers and vein care clinics in the United States, announced today it has executed a 25-year contract to provide business, marketing and facility services to Arizona Reproductive Medicine Specialists (ARMS) in Phoenix, Arizona. Phoenix represents the first fertility center in the Southwest and the 13th major market where IntegraMed has committed to providing its full range of services.

Under the terms of the agreement, IntegraMed will phase in the implementation of its services over time, dependent upon ARMS meeting specific performance targets. Initially IntegraMed will receive a fixed percentage of the Center’s revenues with an option to participate in an additional fixed amount of the Center’s earnings at a later date plus reimbursed cost of services, once all services have been phased into the ARMS operations. The transaction became effective July 9, 2008.

ARMS is one of the largest and most well-established fertility centers in the Phoenix area. It is centrally located in Phoenix with satellite offices in Scottsdale, Chandler, and the West Valley. ARMS physicians serve as clinical faculty for one of only two academic obstetrics and gynecology residency programs in Phoenix, the Banner Good Samaritan Residency Program, and for the University of Arizona. Their new, state-of-the-art facility includes the Phoenix Preimplantation Genetic Diagnosis Center.

Drew V. Moffit, M.D., FACOG, is the co-medical director of Arizona Reproductive Medicine Specialists, the director of the Division of Reproductive Endocrinology and Infertility at Good Samaritan Regional Medical Center and an assistant professor at the University of Arizona. He completed his training in reproductive endocrinology and infertility medicine at the Jones Institute of Reproductive Medicine in Norfolk, Virginia. He is a board-certified reproductive endocrinologist.

Mark D. Johnson, M.D., is the Director of Reproductive Genetics at ARMS. He completed fellowships at the Medical College of Georgia and the National Institutes of Health and has earned board certification in Reproductive Endocrinology and infertility. Dr. Johnson was the 2004-2005 president of the Phoenix OB-GYN Society and was named one of the “Top Docs” in Infertility in Phoenix Magazine.

Barbara M. Faber, M.D., is board certified in Ob/GYN as well as Reproductive Endocrinology and Infertility. Dr. Faber has extensive experience in Assisted Reproductive Technologies (in-vitro fertilization), ovulation induction, and endoscopic surgery for the evaluation and treatment of infertility. Dr. Faber is also a clinical assistant professor at the University of Arizona.

Kimball O. Pomeroy, Ph.D., is the Director of the Reproductive Lab at ARMS with expertise in embryology and andrology, the study of male reproduction. He served as a postdoctoral fellow at The Salk Institute in San Diego and was trained in human in-vitro fertilization in Bristol, England.

“We’re delighted to align ourselves with IntegraMed because they have repeatedly demonstrated nationwide that they can help foster growth of fertility practices,” said Dr. Moffit. “Working with IntegraMed will enable us to manage our growth and development for the foreseeable future.”

“We look forward to a longstanding relationship with ARMS,” said Joseph J. Travia, Jr., President of IntegraMed’s Fertility Centers Division. “ARMS is one of the few multi physician practices in the state and has established a reputation for providing expert patient care and treatment. We are excited to establish a footprint in the Southwest United States with one of the eminent Fertility Centers in Arizona and believe the Phoenix market is underserved and ripe for expansion and growth.”

About IntegraMed America, Inc.

IntegraMed America, Inc. is the leading operator of fertility centers and vein care clinics in the United States. The Company supports its provider networks with state-of-the art information systems; marketing and payer contracting; financial planning, reporting and analysis; organizational planning and development; quality assurance initiatives; human resources administration; and purchasing services. IntegraMed also offers consumer treatment-financing programs and operates www.integramed.com, a leading fertility portal.

The IntegraMed Fertility network consists of 32 contracted centers in 104 locations across the United States, including 175 physicians and Ph.D. scientists. Nearly one of every four IVF procedures in the U.S. is performed in an IntegraMed fertility practice. The IntegraMed Vein Clinic network is the leading provider of vein care services in the US and operates 31 centers in 11 states, principally in the Midwest and Southeast.

Statements contained in this press release that are not based on historical fact, including statements concerning future results, performance, expectations and expansion of IntegraMed are forward-looking statements that may involve a number of risks and uncertainties. Actual results may differ materially from the statements made as a result of various factors, including, but not limited to, the risks associated with IntegraMed’s ability to finance future growth; changes in insurance coverage, government laws and regulations regarding health care or managed care contracting; and other risks, including those identified in the company’s most recent Form 10-K and in other documents filed by IntegraMed with the U.S. Securities and Exchange Commission. All information in this press release is as of July 10, 2008 and IntegraMed undertakes no duty to update this information.

CARLSBAD, Calif., July 10 /PRNewswire/ — Jenny Craig, Inc. is pleased to announce the signing of an exclusive license agreement for the worldwide rights to use the Volumetrics(R) approach developed by Dr. Barbara Rolls, PhD. An endowed Guthrie Chair in Nutritional Sciences at The Pennsylvania State University, Dr. Rolls is the author of the New York Times’ bestselling books The Volumetrics Eating Plan and The Volumetrics Weight Control Plan: Feeling Full on Fewer Calories, and one of America’s leading authorities on weight management for the past 20 years. The agreement acknowledges Jenny Craig as the only weight loss organization that is authorized to use Volumetrics(R), which has inspired the creation of Jenny Craig’s new satiety-centric menus.

“The new menus allow clients to eat more food, feel fuller and add nutrients with fewer calories,” explained Lisa Talamini, RD – Vice President, Research & Program Innovation for Jenny Craig, Inc. “Not only is this significant from a nutritional standpoint, it also supports the findings of health experts around the world that consuming low-calorie density fruits, vegetables, high fiber starches and lean protein can help lower the risk of heart disease, high cholesterol, diabetes, cancer and other medical conditions.”

As a result of this exclusive agreement, Jenny Craig has even more tools to offer its clients. “Even since the company was founded 25 years ago, we’ve recognized the importance of offering our clients satisfying portions of delicious, nutritious foods,” said Patti Larchet, CEO of Jenny Craig, Inc. “Two years ago, we began implementing Dr. Rolls’ science-based principles into our program by releasing The Volumetrics Cookbook for Jenny Craig featuring recipes adapted from Dr. Rolls’ book, The Volumetrics Eating Plan. As we build our new relationship with Dr. Rolls, we are introducing new Volumetrics(R) Plus menus and resources, which now have an added ‘plus’ for our clients — more food.”

This food-based approach effectively marries portion control with the latest research in meal satiety, plus is highly visual and easy to teach Jenny Craig clients. Recently introduced Tomato Florentine and Chicken Rosemary Soupitizers(TM), for example, allow clients to enjoy soup as a first course at dinner or lunch. This helps them control their hunger and calorie consumption, while enhancing the overall satisfaction of their meal.

By continuing to emphasize the science in weight loss, Jenny Craig retains its position as a preeminent force in the health and wellness arena. “As a researcher, I recognize that people need simple, scientifically sound suggestions for balancing healthy eating with regular physical activity,” said Dr. Rolls. “I also firmly believe in the need for diets that promote both weight loss and health benefits. With its focus on health and practical suggestions for lifestyle change, the Volumetrics(R) approach is a natural addition to the Jenny Craig Program.”

As part of her new arrangement with Jenny Craig, Dr. Rolls will be stepping down from her position as one of the company’s esteemed Medical Advisory Board members. During her tenure over the past several years, she has made valuable contributions to the ongoing evolution of the Jenny Craig Program to ensure that it remains current, practical, user-friendly and science-based.

About Jenny Craig

Since 1983, Jenny Craig’s comprehensive food/body/mind approach to safe, effective weight management has helped millions of people worldwide learn how to create a healthy relationship with food, build an active lifestyle, and develop a balanced approach to living. With its individually tailored weight loss program, personal consultants provide clients with one-on-one support, tips and motivation, and Jenny’s Cuisine(TM) helps them learn proper portion sizes and mindful eating.

Based in Carlsbad, CA, Jenny Craig, Inc. is one of the world’s largest weight management companies, with 687 company-owned and franchised Centres in the United States, Canada, Australia, New Zealand and Puerto Rico.

About Dr. Barbara Rolls

Dr. Barbara Rolls obtained a B.A. in biology from the University of Pennsylvania and a Ph.D. in physiology from the University of Cambridge, England. In 1992, she became Professor of Nutritional Sciences and Guthrie Chair in Nutrition at The Pennsylvania State University. Dr. Rolls has served as Past-President of both the Society for the Study of Ingestive Behavior and the North American Association for the Study of Obesity.

She has been the recipient of a number of awards including: the American Society of Nutritional Sciences Award in Human Nutrition, a MERIT award from the National Institute of Diabetes and Digestive and Kidney Diseases, the International Award for Modern Nutrition, and Honorary Membership in the American Dietetic Association. In 2006 she was elected a fellow of the American Association of the Advancement of Science and was selected as the 2007 W.O. Atwater Lecturer at Experimental Biology. In 2008, Dr. Rolls received the Centrum Center for Nutrition Science Award at the Experimental Biology Annual Meeting.

She is the author of five books including Thirst, The Volumetrics Weight-Control Plan: Feel Full on Fewer Calories, and The Volumetrics Eating Plan.

Jenny Craig, Inc.

CONTACT: Gail Manginelli of Jenny Craig, +1-480-563-3414,[email protected]

By Winthrop Quigley Journal Staff Writer

The University of New Mexico Cancer Center will become the exclusive medical oncology provider for Lovelace Health Plan members beginning Oct. 1, UNM and Lovelace announced Wednesday.

About 450 patients who are receiving care from other medical oncology practices will be affected, said UNM Cancer Center CEO Cheryl Willman. Those who are already in a course of treatment will remain with their current physicians until treatment is completed, she said, adding, “We don’t want to create patient chaos and disruption.”

Lovelace Health Plan CEO Dennis Wilson said the plan will not renew its contracts with two private medical oncology practices: New Mexico Cancer Center and Hematology Oncology Associates. However, Willman said, UNM Cancer Center works closely with Hematology Oncology Associates and expects to refer some cases there and collaborate on others.

Lovelace members will continue to receive radiation oncology care from Radiation Oncology Associates, with which Lovelace also has an exclusive provider agreement.

UNM will also assume responsibility for the oncology clinics located in Lovelace Health System facilities, including the Lovelace Medical Center near Downtown. UNM physicians have seen patients in Lovelace facilities for some time but did not control the clinics.

“We’ve decided to enter into an exclusive relationship with UNM Cancer Center, from the plan’s perspective, for quality reasons, for quality enhancement reasons,” Wilson said. Quality of care has always been good, but the UNM relationship will “bring it up a significant notch,” he said. He added that economic considerations “weren’t on the table” when the decision was made.

Wilson said the plan has evaluated outcome data and other measures and decided the best care was provided by UNM.

(c) 2008 Albuquerque Journal. Provided by ProQuest Information and Learning. All rights Reserved.

By Arv Koontz, The Tribune, Seymour, Ind.

Jul. 10–Noah Bullard said he looks forward to making new friends when he competes this weekend in the 18th annual Seymour Coca Cola Swim Invitational at the Shield Park swim pool.

“My event is probably the 50 free,” he said. “I like the pool here at the park. I usually make new friends at every meet.”

Mallory Thias and Mallory Nierman both swim at the dolphins level. They both swam in the Invitational last summer, and both said the breaststroke is their favorite event.

Thias said she appreciates how the coaches work with the swimmers to try and help them go faster in the water. “The breaststroke is my favorite event, and I like how the coaches are really nice.”

Nierman said, “I just like swimming.” She said she became interested in swimming because of her older sister, Makayla, who is a member of the team

Andrew Rodriguez said his favorite event is also the 100 breast, and he is hoping to get the state cut time in that event so he can compete in the state meet at the Natatorium in Indianapolis later this summer.

Katie Turner said she likes swimming in both the outdoor pool and the indoor pool at the high school. “I like this (Shields) pool and I like swimming the butterfly. I want to get a state cut time.”

Dave Boggs, head coach of the Seymour team, said 58 members of the Seymour team will be among the 600 swimmers that will compete. “This is the last meet they have to get their ‘cuts’ (qualifying times) for the state meet coming up in a couple of weeks.”

Boggs has made a few changes over the years. “It’s more organized. We have better things. We’ve learned a little bit by trial and error. We’ve got things more streamlined, we’re more efficient. It’s a big meet for us, for the kids, for our program. It gives Seymour a lot of notoriety around this part of the state in the swimming community.

“The Seymour Park and Recreation Dept. has been great in helping us get things ready to make this a special event.”

Boggs said members of his team lost some practice time due to cold water and pool renovation at the high school, but “We’ve had a good turnout this summer. I’ve been pretty pleased with their effort physically and mentally.”

—–

To see more of The Tribune or to subscribe to the newspaper, go to http://www.tribtown.com/.

Copyright (c) 2008, The Tribune, Seymour, Ind.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Republican & Herald, Pottsville, Pa.

Jul. 10–A local McDonald’s owner-operator is inviting the community to help “Pay it Forward” by turning dinner into dollars today at the Frackville restaurant.

McDonald’s at 960 Schuylkill Mall Road said it will donate 20 percent of sales from 4:30 p.m. to 9 p.m. to Frank and Jane Ulicny and family, winners of The REPUBLICAN & Herald and PPL’s recent “Pay It Forward” contest.

Frank Ulicny is suffering from neurofibromatosis and is undergoing extensive treatment at Geisinger Medical Center, Danville.

“Jane was a valued, a much-loved employee at the Frackville McDonald’s for many years,” said Elizabeth A. Dal Santo, community relations coordinator for R&K Foods, owner/operators of six area McDonald’s restaurants.

“If you are employed by McDonald’s for as long as Jane was, you become part of a big extended family. When we found out that Frank’s condition was worsening and he would need additional treatments, money for gas and car expenses while he is in the hospital and extensive renovations to his home upon his release from the hospital, we immediately decided that we had to do something to help.”

Two $500 prizes, to be used to carry out a good deed for individuals or groups,

were awarded in the “Pay It Forward” contest sponsored by The REPUBLICAN & Herald and PPL.

The other winner was Jane Hardy, a Shenandoah Valley Elementary computer teacher diagnosed with brain cancer.

If readers would like to assist in “paying it forward” for any of the causes, they can contact Janet Joyce at 628-6145 or Rachel Evans at 628-6075.

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To see more of the Republican & Herald or to subscribe to the newspaper, go to http://www.republicanherald.com.

Copyright (c) 2008, Republican & Herald, Pottsville, Pa.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

NYSE:MCD,

By Stephen J. Lee, Grand Forks Herald, N.D.

Jul. 10–New details about a new clinic for veterans in Grand Forks were released Wednesday by North Dakota’s three-man Congressional delegation.

It’s one of five new Veterans Affairs clinics opening around the state to bolster care already provided at VA centers in Fargo, Grafton, Bismarck and Minot, according to Sens. Byron Dorgan and Kent Conrad and Rep. Earl Pomeroy, all D-N.D., who put out a joint news release.

The Grand Forks clinic will be completed within about 15 months, but its location isn’t set yet, said aides to the lawmakers.

Grand Forks Air Force Base remains one possible location, but the clinic might be in or nearer to Grand Forks, the aides said.

All that has been stipulated so far is that it will be in Grand Forks County.

The projected start-up costs will be $292,601, with a projected annual operating budget of $917,712 and eight full-time employees. It will serve about 1,225 patients, including 300 new ones, making 5,513 visits a year, according to the proposal that has been authorized by Congress.

The clinic will provide services to veterans such as comprehensive primary care, health promotion, maintenance, routine procedures and education, screening, evaluations and interventions for mental health disorders, substance abuse, post-traumatic stress disorder and sexual trauma counseling. Patients can be referred to Fargo’s VA Medical Center for more care, and “telemedicine,” using interactive TV, will be used at the clinic, too. Currently, veterans in the Grand Forks area usually go to Grafton or Fargo for VA medical care.

The clinic is part of a five-year effort to provide more care to veterans in rural areas, the delegation said.

Community-based VA clinics recently opened in Williston, Jamestown and Dickinson, N.D., and one in Devils Lake will open soon.

Reach Lee at (701) 780-1237; (800) 477-6572, ext. 237; or send e-mail to [email protected]

—–

To see more of the Grand Forks Herald, or to subscribe to the newspaper, go to http://www.grandforks.com.

Copyright (c) 2008, Grand Forks Herald, N.D.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

WASHINGTON, July 10 /PRNewswire/ — Today Howard University and CVS/pharmacy officially opened Howard University’s newly upgraded Pharmacy Practice Laboratory, where pharmacy students may sharpen their skills in a practice setting, learning how to dispense medication, counsel patients and utilize state-of-the-art technology found in many pharmacies. CVS/pharmacy donated $300,000 to the renovation of the laboratory, building upon the Company’s strong partnership with the school to provide enhanced educational and career opportunities.

“We are pleased that CVS/pharmacy has contributed to the renovation of our laboratory, so that we may continue to attract talented students and better train them for their pharmacy careers,” said Clarence E. Curry, Pharm.D., Interim Associate Dean at Howard University’s School of Pharmacy, Nursing, and Allied Health Sciences. “As the demand for pharmacists increases nationwide, due to an aging population and increased use of prescription drugs, Howard University is experiencing a dramatic increase in the number of applicants to our pharmacy school. Partnerships such as with CVS/pharmacy have helped us become more competitive.”

“CVS/pharmacy is committed to building an outstanding workforce through win-win partnerships such as with Howard University, and through the hiring, training, development and retention of quality colleagues,” said Gordon Howard, Area Vice President-Washington D.C. Market, CVS/pharmacy. “We are thrilled to expand our relationship with Howard University, a school with many outstanding alums who are now talented pharmacists at our CVS/pharmacy stores in Washington, D.C. and beyond.”

The Pharmacy Practice Laboratory houses 24 state-of-the-art workstations that allow students to gain experience in entering and assessing patient-related information, such as health, allergy and medication history. The workstations also provide access to other technical support needed to ensure appropriate delivery of medications, patient counseling and medication therapy management. The laboratory is also stocked with prescription and over-the-counter medications, alternative medications, and home-testing devices so that students may practice dispensing and advising on medication and home tests.

CVS/pharmacy has partnered with Howard University in a number of ways beyond the laboratory. For example, CVS pharmacists guest lecture at the school’s pharmacy management class, judge the annual Patient Counseling competition and mentor Howard University pharmacy school interns at CVS/pharmacy stores. Partly as a result of the strong relationship, more than 35 percent of Howard University pharmacy graduates began careers at CVS/pharmacy stores this year. The Company has similar partnerships with other schools nationwide.

Howard University has received an increased demand for its 70 freshmen class seats in the Doctor of Pharmacy program, growing from 300 applicants annually 10 years ago to 1,300 applicants today. A main driver for this growth is the booming job market. While many new college graduates in other fields may struggle to find jobs, pharmacist graduates generally receive numerous job offers with highly competitive salaries.

Nnenna Okeke, 26, graduated from Howard University’s college of pharmacy in May with a doctorate in Pharmacy, and after receiving multiple job offers for pharmacy positions, she decided to work at a CVS/pharmacy store in downtown Washington, D.C.

“Both Howard University and a summer internship at CVS/pharmacy prepared me well for a career as a pharmacist,” said Okeke. “I chose to work at CVS because of the value they place on patient care and employee development, because of their community involvement — such as offering disease state management clinics and their active participation in health expositions, and also because of their unique integrated health services model resulting from their merger with Caremark. Current and future Howard students are in for a treat with the new laboratory and will be even better prepared for their careers.”

About Howard University

Howard University is one of 48 U.S. private, Doctoral/Research-Extensive universities and comprises 12 schools and colleges. Founded in 1867, students pursue studies in more than 120 areas leading to undergraduate, graduate and professional degrees. Since 1998, the University has produced two Rhodes Scholars, a Truman Scholar, 19 Fulbright Scholars and 10 Pickering Fellows. Howard also produces more on-campus African-American Ph.D.s than any other university in the world. For more information about Howard University, call 202-238-2330, or visit the University’s Web site at http://www.howard.edu/.

About CVS/pharmacy

CVS/pharmacy, the retail division of CVS Caremark Corporation , is America’s largest retail pharmacy with more than 6,300 retail locations. CVS/pharmacy is committed to improving the lives of those we serve by making innovative and high-quality health and pharmacy services safe, affordable and easy to access, both in its stores and online at CVS.com. General information about CVS/pharmacy and CVS Caremark is available at http://www.cvs.com/pressroom, as well as http://investor.cvs.com/.

   Contact:    Ronald Harris   Howard University   (202) 238-2331   [email protected]    Sara Steindorf   for CVS/pharmacy   (617) 520-7259   [email protected]  

CVS/pharmacy

CONTACT: Ronald Harris of Howard University, +1-202-238-2331,[email protected]; or Sara Steindorf for CVS-pharmacy, +1-617-520-7259,[email protected]

Web site: http://www.cvs.com/http://www.howard.edu/http://investor.cvs.com/http://www.cvs.com/pressroom

By Katie Curley, The Daily News of Newburyport, Mass.

Jul. 10–NEWBURYPORT — The city has created a staff position for a public health nurse in an effort to save money and expand health programs.

The move means the city will cut ties with Home Health VNA and its parent organization, Home Health Foundation, the agency that has provided the nursing service to the city for many years. The new position will report to the Director of Public Health.

Judy Anderson, who works for Home Health Foundation and has served as the city’s public health nurse for the past 20 years, will be replaced by Linda Gibbons of Amesbury on July 21.

According to Mayor John Moak, Public Health Director Jack Morris initiated the change, submitting his recommendation to the Massachusetts Board of Health that the city hire its own public health nurse.

“Linda will be a hands-on public health nurse and there will be more interaction with the public than by using an agency,” Moak said.

Beth Dimitruk, a spokesperson for the Home Health Foundation, the parent organization that includes Home Health VNA and Merrimack Valley Hospice, said the decision was unexpected.

“Judy Anderson is a well known and highly respected nurse,” Dimitruk said. “We were very surprised by the decision.”

For the past 20 years, Anderson’s job has included things such as implementing clinics and the annual flu vaccinations.

In a public letter to be run as a paid advertisement in The Daily News in coming weeks, Joan Stygles Hull, chief executive of Home Health Foundation, says the organization was notified on June 24 that the city will no longer contract with the company to provide public health services. The letter apologizes to those residents who had planned to attend this month’s clinics.

Anderson will continue to run the federally-funded Wellness Promotion Clinic at the Newburyport Council on Aging through September, but all other public health services, such as the regular flu clinics, must now go through Gibbons at the City Hall office.

Anderson will continue to serve as the public health nurse for Newbury, West Newbury, Salisbury and Georgetown.

Under the new structure in Newburyport, Moak said there will be some cost savings as money is re-directed towards the city position and the city becomes eligible for some reimbursements through Medicare.

“Its still only a part-time position — 18 hours,” Moak said. “But we felt we had some strong criteria for having control of our own nurse and we will have our own clinics and medical resources.

“Overall we will just have more benefits by having our own nurse,” Moak said.

—–

To see more of The Eagle-Tribune or to subscribe to the newspaper, go to http://www.newburyportnews.com/.

Copyright (c) 2008, The Daily News of Newburyport, Mass.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

DARE COUNTY | The Outer Banks Community Foundation reminds local nonprofit organizations of the Aug. 8 deadline for applications for third-quarter grants.

Since the foundation was established in 1982, it has helped donors give more than $2.1 million in grants and scholarships in the Outer Banks . For a grant application and guidelines, call (252) 261- 8839 or visit www.obcf.org.

Currituck County

Park holds summer concert series

The North Carolina School of the Arts and local musicians will perform at 7 p.m. each Thursday on the south lawn of the Whalehead Club in Corolla.

Today, the school will bring its Saxophone Quartet. Admission is free. Concessions are available and leashed pets are welcome.

Dare County

Open mic night begins friday

GEM Adult Day Services and the Nags Head Lions Club will sponsor a coffee house at 7 p.m. Friday at His Dream Center, 205 Baltic St.

The evening will feature Nick Hodsden and Angelo Sonnesso. Those interested in signing up for open mic should call Sonnesso at (252) 202-1190. Walk-ins are welcome.

Coffee and homemade treats will be available for a $5 donation. Proceeds will support Nags Heads Lions Club community projects and GEM.

Frisco jubilee held every friday

The Frisco Jubilee, featuring performers from Hatteras and Ocracoke islands, will be held every Friday at 7:30 p.m. at Little Grove United Methodist Church in Frisco.

There also will be performances in Rodanthe on some Thursday evenings.

Tickets will be available at the door for $10 per person.

Hyde County

changes at trash convenience sites

Hyde County has made changes, effective July 1, for its trash convenience sites.

New hours for Swan Quarter and Engelhard are 10 a.m. to 6 p.m. Tuesday through Saturday. The sites will be closed on Sunday and Monday.

Construction and demolition material weighing more than 500 pounds costs $150 per ton. Items with no charge include trees, limbs, appliances, tires, recyclables and used motor oil. At the Ocracoke site, construction and demolition material will be charged by the size of the load, with the same items at no charge.

Trailers longer than 12 feet will not be accepted at Ocracoke and may be taken to Swan Quarter or Englehard sites, where site attendants will have discretion on whether to accept them.

On the mainland, a solid waste bill of $20 a month will be added to a water bill, or a separate bill will be mailed monthly. Curbside trash collection will be the same as now, with the exception of recyclable items, which will be accepted at the sites.

Pasquotank County

Safety training course offered

The North Carolina Department of Labor and College of the Albemarle’s Small Business Center will offer a training opportunity for employers and employees.

The workshop will help them understand the requirements and programs necessary for a safe workplace.

The training will provide an overview of safety and health standards for general industry at 8 a.m. Wednesday and next Thursday in the Foreman Technology Center (formerly E Building).

The workshop is free. Upon completion, attendees will receive a 10-hour certificate-of-attendance card. All 10 hours must be attended.

Seating is limited to the first 35 registrants. Call (252) 335- 0821, ext. 2231.

pesticide license testing offered

Testing for commercial pesticide licenses will be conducted at 1 p.m. Tuesday at the Pasquotank County Center of North Carolina Cooperative Extension, 1209 McPherson St., Elizabeth City.

Testing will be held for all categories of commercial applicators, dealers and farmers . The test does not cover structural pesticide applicators.

A picture ID is required, and a calculator will be useful. To register, call (252) 338-3954.

Church to hold dinner and auction

Berea Baptist Church in Elizabeth City will hold a barbecue dinner and silent auction during its sixth annual Family Life Center Weekend, with proceeds donated to the Family Life Center.

On Friday from 11 a.m. to 2 p.m., plates will be sold and delivered to businesses. Plates will cost $6 and include barbecue, baked beans, coleslaw and roll.

On Saturday, plates (for eating in or taking out) will be served from 11 a.m. to 7 p.m. Bids for the auction will close at 6:45 p.m.

To buy plates, call (252) 264-2167 or (252) 338-8128.

regional

pre-k program taking applications

The Choanoke Area Development Association of North Carolina Inc. Head Start/Early Start program is accepting applications for children in Bertie, Halifax, Hertford and Northampton counties for the 2008-09 year.

The child must be at least 3 years old on or before Aug. 31 . Some transportation is available.

Parents/guardians should call (252) 539-4155 .

meetings + events

camden COUNTY

Benefit dinner/bake sale 4 to 7 p.m. Saturday, Camden County High School cafeteria. Sponsored by Old Trap Wesley United Methodist Church for Stephen Swinson.

PASQUOTANK COUNTY

Blood drive 11 a.m. to 3 p.m. Saturday, Southgate Mall.

Beverlie Gregory, (252) 441-1620,

[email protected]

Karen Santos, (252) 338-2590,

[email protected]

(c) 2008 Virginian – Pilot. Provided by ProQuest Information and Learning. All rights Reserved.

By Luke Mundo, Chicago Tribune

Jul. 10–Mack McGhee remembers when neighbors talked to one another and even knew one another’s names.

“Now no one talks until something bad happens,” said the longtime University Park resident and community activist.

McGhee would like that to change because having more tight-knit communities would help stem violence in the south suburbs. He helped organize a talk about community involvement, to be held at 7 p.m. Saturday at Prairie State College in Chicago Heights.

After being attacked with a claw hammer at a New Year’s Eve party when he was 19, McGhee decided to turn his life around. He went from academic probation to a master’s degree in political and justice studies from Governors State University in five years.

“Each of us has the ability to stand up and be active,” McGhee said.

In addition to motivational speakers, representatives from local agencies and law enforcement will share resources, information and strategies for successful parenting and keeping communities safe.

Tickets are $25 or $35 at the door. Students with an ID will be admitted for $20. Part of the proceeds will go to the 100 Men Association of University Park and the Beacon Hill Community Improvement Association. Call 888-624-4333 or visit www.anightofinspiration.com.

[email protected]

—–

To see more of the Chicago Tribune, or to subscribe to the newspaper, go to http://www.chicagotribune.com.

Copyright (c) 2008, Chicago Tribune

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

WALTHAM, Mass., July 10 /PRNewswire/ — According to Millennium Research Group’s Global Markets for Hysterectomy Alternatives 2008 report, which covers global endometrial ablation (GEA) devices, uterine artery embolization (UAE) devices, hysteroscopes, and endometrial resection devices, the global hysterectomy market will generate more than $700 million in 2012, primarily driven by expanding GEA procedure volumes.

In the US and UK, the availability of a sufficient level of reimbursement has facilitated gynecologist adoption of GEA and, as a result, the procedure has become the gold standard for treating menorrhagia, an abnormally heavy menstrual period. The lack of adequate reimbursement, on the other hand, has stunted GEA market growth in France, Germany, and Italy.

In the US, the number of GEA procedures performed in physician offices will continue to expand over the next five years. This shift will occur because reimbursement levels for in-office GEA procedures will make these treatments lucrative for physicians. Furthermore, physicians can perform a higher volume of procedures in-office because they do not face the same competition for operating room space that they may encounter in hospitals. In- office growth will be further aided by the efforts of various suppliers to provide extensive support to doctors who wish to adopt the procedure.

“Suppliers are providing more treatment advice, promoting the procedure through advertising, and helping doctors to improve their business management so that use of GEA will be profitable for them,” says Barbara Prud’homme, Senior Analyst at Millennium Research Group. “The number of facilities performing GEA procedures will also grow in the US, increasing patient accessibility to the treatment.”

The Global Markets for Hysterectomy Alternatives 2008 report provides coverage of all key industry competitors, including Hologic, Gynecare, Boston Scientific, KARL STORZ, and American Medical Systems. The report also includes data on the US, European (France, Germany, Italy, UK), and Japanese markets.

About Millennium Research Group

Millennium Research Group (http://www.mrg.net/), a Decision Resources, Inc. company (http://www.decisionresources.com/), is the global authority on medical technology market intelligence and the leading provider of strategic information to the health care sector. The company provides specialized industry expertise through published reports, ongoing Marketrack(TM) projects, and customized consulting services.

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

   For more information, contact:    Amy Krohn   Millennium Research Group   416-364-7776 x101   [email protected]  

Millennium Research Group

CONTACT: Amy Krohn of Millennium Research Group, +1-416-364-7776 x101,[email protected]

Web site: http://www.mrg.net/http://www.decisionresources.com/

FALLS CHURCH, Va., July 10 /PRNewswire/ — Isabel Healthcare, a leading provider of diagnosis decision support software, today announced two new subscribers to its system: Luther Midelfort-Mayo Health System, Eau Claire, WI and Children’s Hospitals and Clinics of Minnesota, Minneapolis and St. Paul, MN.

(Logo: http://www.newscom.com/cgi-bin/prnh/20061003/LATU006LOGO)

With the addition of Children’s Hospitals and Clinics of Minnesota, Isabel is now used for diagnosis decision support at four (or 10 percent) of the 43 hospitals which form the Child Health Corporation of America, a purchasing and performance improvement network of leading, independent children’s hospitals.

The Isabel system, now available in a variety of configurations to serve physicians in both adult and children’s medicine, was first marketed to children’s hospitals in 2001.

Children’s Hospitals and Clinics of Minnesota is the seventh-largest children’s health care organization in the U.S., with 332 beds at its two hospital campuses in St. Paul and Minneapolis. The system was named one of “America’s Best Children’s Hospitals” in 2008 by U.S.News & World Report. To view the list, see http://health.usnews.com/sections/health/best-hospitals

Based in Eau Claire, Luther Midelfort operates as part of the Mayo Health System and offers a wide range of medical services in several locations in western Wisconsin.

The Isabel system is now in use and improving diagnosis decision making, patient safety and quality of care at a number of major medical centers, including Loma Linda Medical Center, Yale-New Haven Children’s Hospital, University of Virginia Health System, Seattle Children’s Hospital, Washington University School of Medicine and Carle Foundation Hospital.

The Isabel system enables a physician to enter a patient’s signs, symptoms, results of tests and investigations and instantly receive a checklist of likely diagnoses to consider. Data can also be sent to the web-based Isabel from an organization’s EMR system enabling single-click diagnosis decision support.

In Isabel, physicians can click on a diagnosis to access diagnosis specific knowledge from medical textbooks, journals, client’s protocols, pathways, order sets and web-resources. The knowledge base contains all age groups, has 11,000 diagnoses including bio-terrorism and other emergency preparedness situations. It also contains 4,200 causative drugs. Isabel is available as a web-based stand-alone subscription or can be purchased interfaced with several EMR partner systems.

Based in Falls Church, VA, Isabel Healthcare was founded in 2000 by Jason Maude and Dr. Joseph Britto, a pediatrician. The company is named after Maude’s young daughter, who almost died in 1999 after a potentially fatal illness was not recognized by a physician. For company background, see http://www.isabelhealthcare.com/

    Contacts:    James Harris, Westside Public Relations    [email protected]    Tel: 310.398.5565     Dr. Joseph Britto, CEO, Isabel Healthcare    [email protected]    Tel: 703-787-0380  

Photo: http://www.newscom.com/cgi-bin/prnh/20061003/LATU006LOGOAP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

Isabel Healthcare

CONTACT: Dr. Joseph Britto, CEO of Isabel Healthcare, +1-703-787-0380,[email protected]; or James Harris, +1-310-398-5565,[email protected], of Westside Public Relations, for Isabel Healthcare

Web site: http://www.isabelhealthcare.com/http://health.usnews.com/sections/health/best-hospitals

Doctors close down health service in Nepali capital

KATHMANDU, July 9 (Xinhua) — Doctors closed down all health services except emergency in governmental, non-governmental and private health institutions within Nepali capital Kathmandu on Wednesday, demanding security for their profession.

According to a leading website, eKantipur.com, the Nepal Medical Association (NMA) have called the shutdown to protest against the government’s failure to ensure security to health workers and health institutions.

The doctors’ move is seen as a response to another protest being carried out by the family members of Narayan Shah, 39, who died after undergoing surgery for removing kidney stone in Everest Nursing Home in the capital last Saturday.

The family members of deceased Shah have been claiming negligence on the part of the doctor who performed surgery and other hospital staff led to Shah’s death.

Everest Nursing Home was shut down from Saturday claiming that no mistake was committed in Shah’s treatment.

The doctors also met with Prime Minister Girija Prasad Koirala Wednesday morning, demanding proper security arrangement and compensations for the vandalism carried out by Shah’s relatives.

The NMA has warned to shut down health institutions for indefinite period and organize other protests unless their demands are addressed through the Council of Ministers.

(c) 2008 Xinhua News Agency – CEIS. Provided by ProQuest Information and Learning. All rights Reserved.

Heather “Lane” Wood, valedictorian of the December 2007 graduating class of the University of Tulsa College of Law, has been selected to receive the Roscoe Pound Civil Justice Institute’s Elaine Osborne Jacobson Award as the nation’s top female student in health law.

Wood will receive a $3,000 scholarship and an all-expense paid trip to the Association of Trial Lawyers of America annual meeting in Philadelphia.

It is the third time in the past decade that a TU College of Law student has been presented the national award. Previous winners were Donna DeSimone in 1998 and Corrine O’Day in 2003. Each recipient wrote seminar papers for TU’s health law program under the guidance of Professor Marguerite Chapman, director of the program.

Wood’s paper entitled A Young Vaccine for Young Girls: Should the Human Papillomavirus Vaccination Be Mandatory for Public School Attendance? was published in the American Bar Association’s The Health Lawyer.

She also researched and drafted a 36-page consumer guide, Your Right to Decide: Oklahoma’s Advance Directive and Other Health Care Planning Tools published in November in conjunction with Attorney General Drew Edmondson’s office and St. John Medical Center in Tulsa.

Wood is now an associate member practicing health law for the Dallas firm of Haynes and Boone.

Originally published by Journal Record Staff.

(c) 2008 Journal Record – Oklahoma City. Provided by ProQuest Information and Learning. All rights Reserved.

Power3 Medical Products, Inc. (OTCBB:PWRM) announced today the filing of a US Patent application for the diagnosis of multiple forms of Alzheimer’s disease by monitoring a panel of protein biomarkers in human blood serum. This latest filing further extends the reach of the recently filed US Utility Patent Application that identified 47 protein biomarkers useful in the early diagnosis of Alzheimer’s disease.

Because early signs of AD are often hard to distinguish from normal signs of aging, most patients are not diagnosed until neuronal damage is extensive. A diagnostic test that will allow physicians to diagnose AD patients earlier and with greater accuracy would enable those patients to begin drug treatment when it could be most effective. More than 18 million people world-wide have Alzheimer’s disease. This figure is projected to nearly double to 34 million by 2025.

“One of the most critical issues in medicine is the ability to distinguish Alzheimer’s disease from other forms of dementia and other neurological and vascular disorders that have similar symptoms, but are different diseases with different causes, prognoses, and treatments. This issue is further complicated by the fact that there are also multiple forms of Alzheimer’s disease that are driven by distinct variations in the disease mechanism,” said Dr. Ira L. Goldknopf, Power3’s Director of Proteomics.

This new application discloses how a select group of the protein biomarkers of neurodegenerative disease in the blood may be employed to distinguish between patients with different forms of Alzheimer’s disease (AD). These biomarkers may also enhance the sensitivity and specificity of diagnosis, to monitor disease severity, progression, and response to treatment as well as detect and monitor disease processes and mechanisms.

“The discoveries outlined in this patent application, based on our many years of pioneering proteomics experience, are critical to the value of our intellectual property and essential for developing high-throughput commercial diagnostic tests for early detection. We see potential use of these biomarkers as a companion diagnostic for screening prospective clinical trial patients, monitoring the progress of patients during treatment or clinical trials and as targets in the discovery of new drugs,” said Steven B. Rash, Power3’s CEO.

About Power3 Medical Products

Power3 Medical Products, Inc. (OTCBB: PWRM, www.Power3Medical.com) is a leading proteomics company engaged in the commercialization of protein biomarkers, pathways, and mechanisms of diseases through the development of diagnostic tests and drug targets for cancer and neurodegenerative diseases. Power3’s patent-pending technologies are being used to develop screening and diagnostic tests for the early detection and prognosis of disease, identify protein biomarkers, and drug targets. Diagnostic tests are targeted toward markets with critical unmet needs in areas such as breast cancer and neurodegenerative disease. Power3 has signed its first distribution agreement to provide its blood serum diagnostic for breast cancer, BC-SeraPro(TM), in twelve Middle Eastern countries. Power3 operates a state-of-the-art CLIA certified proteomics laboratory in The Woodlands (Houston), Texas. The Company is preparing to commercialize its IP portfolio, centering on the 543 biomarkers the Company has discovered from a broad range of diseases as the basis of blood-based tests for breast cancer, ALS, Alzheimer’s, and Parkinson’s Diseases.

Forward Looking Statement

This press release contains forward-looking statements within the meaning of section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. With the exception of historical information contained herein, the matters discussed in this press release involve risk and uncertainties. Actual results could differ materially from those expressed in any forward-looking statement.

By Blythe Bernhard, St. Louis Post-Dispatch

Jul. 10–Alicia Keys and Mickey Mouse needed some relief. Luckily, some fledgling pharmacists knew how to make calamine lotion. The Career Explorers Program sponsored by Walgreens and the St. Louis College of Pharmacy lets high school students work as pharmacists for four weeks each summer to learn the basics of the trade — and fill fake prescriptions for their favorite celebrities.

This week, their assignment involved mixing calamine, zinc oxide, methylcellulose and other ingredients with a mortar and pestle to make the gooey solution used for skin irritations. After mixing the lotion, the students filled plastic orange bottles and printed labels with instructions for their (imaginary) customers.

Bonus points went to students whose bottles had smooth labels and no drops of pink lotion on the outside.

Despite the six-figure average salaries, pharmacists are in demand because of the aging population, a proliferation of 24-hour pharmacies and increases in chronic diseases controlled by medication. Experts predict a national shortage of about 160,000 pharmacists by 2020, according to the nonprofit Pharmacy Manpower Project.

Express Scripts and Barnes-Jewish Hospital launched a similar introduction-to-pharmacy program for high schoolers this summer and recruited 30 students. Nearly 200 local students applied for the Walgreens program this year, and 25 were chosen for their high test scores, average GPAs of 3.75 and outgoing personalities suited for the retail setting.

Students divide their time between classrooms and labs at the college and working as pharmacy technicians in local Walgreens stores. There they talk with customers, fill prescriptions, type labels and work the drive-throughs during six-hour shifts.

“At first I thought it was just putting pills in a bottle, but a lot more goes on behind the scenes,” said Ashley Johnson, 17, a senior at East St. Louis High. “It’s hard work, and it instills in you the desire to help people.”

Ashley said she plans on applying to the pharmacy college after graduating from high school.

“Now I know this is what I want to do,” she said. “When I do start school, I’ll be a step ahead of the game.”

The program primarily targets minority students to spur their interest in pharmacy education and jobs. The Institute of Medicine has called for greater diversity in medical professions because minorities are more likely to work in minority communities and have a greater awareness of their special needs. For example, African-Americans and Latinos have a higher risk of developing diabetes and high blood pressure.

At least 10 former participants in the high school program are now working as technicians or pharmacists at local Walgreens. Pharmacy technicians work under the guidance of pharmacists to fill prescriptions but typically don’t counsel patients.

“We’ve already seen it pay dividends,” said Tim Stewart, a district pharmacy training coordinator for the company’s St. Louis region.

Students who get the hands-on preview are more likely to stick with pharmacy school and their careers. They already have experienced the bad and the good, Stewart said: irritable, sick customers, and helping people to feel better.

Mellai Haile, one of the program’s first graduates, now works as a pharmacist at a Walgreens in Florissant. “It gave me experience and reinforced that it would be a good career for me,” she said. Haile said she much preferred the summer job in a pharmacy compared to a previous job making sandwiches.

“It’s someone’s health,” she said. “Any mistake you make really matters.”

Students get $1,200 upon finishing the program. The program is in its eighth year, and 175 students have participated. More than half have gone on to pharmacy school.

“We don’t say they have to apply here, but they inevitably do because they like what they see,” said Nimita Thekkepat, an assistant professor at St. Louis College of Pharmacy.

DeJuan Rogers, 17, a senior at Miller Career Academy, spent a day last week filling prescriptions for arthritis medications and other drugs and said he is definitely interested in a medical career.

“I feel that I should be different and make something out of my life.”

[email protected] — 314-340-8129

—–

To see more of the St. Louis Post-Dispatch, or to subscribe to the newspaper, go to http://www.stltoday.com.

Copyright (c) 2008, St. Louis Post-Dispatch

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

NASDAQ-NMS:ESRX,

By Kelsey, Jennifer L Lamster, Ira B

Both musculoskeletal disorders and diseases of the oral cavity are common and potentially serious problems among older persons, yet little attention has been given to the links between them. Several musculoskeletal diseases, including osteoporosis, Paget’s disease, and arthritic disorders, may directly involve the oral cavity and contiguous structures. Drugs used to treat musculoskeletal diseases, including corticosteroids and bisphosphonates, increase the risk of suppression of the immune system and osteonecrosis of the jaw, respectively.

Many people with disabling osteoarthritis, rheumatoid arthritis, and other conditions have difficulty practicing good oral hygiene and traveling to dental offices for professional help. Various inexpensive measures can help such individuals, including education of their caregivers and provision of antimicrobial mouthwashes and special toothbrushes. (Am J Public Health. 2008;98:1177-1183. doi:10.2105/AJPH.2007.129429)

DISEASES OF THE musculoskeletal system and of the oral cavity are among the most common and potentially disabling conditions of older adults. Little attention has been given to the relation between the 2 disease groups, but important linkages exist. An increased understanding and awareness of these associations can lead to interventions to improve the health status and quality of life of older people. We review the relations between some common musculoskeletal disorders and diseases of the oral cavity and contiguous structures in older adults and then suggest preventive measures. Some of the material for this essay is adapted from a chapter in Improving Oral Health Care for the Elderly: An Interdisciplinary Approach.1

EFFECTS OF MUSCULOSKELETAL CONDITIONS

Musculoskeletal conditions are the most frequent impairment reported in the US National Health Interview Survey and are the leading cause of disability among persons 65 years and older.2,3 In the US National Health Interview Survey, older persons reported an average of 20 days of restricted activity and 7 days in bed per year for each of their musculoskeletal impairments. Approximately one third of nursing home residents have musculoskeletal impairments, with arthritis and osteoporosis being most frequent. Injuries are also a major problem for older individuals. Each year, about 2% of noninstitutionalized persons 65 years and older experience a fracture.3 A survey in the United Kingdom found that among adults reporting a longstanding musculoskeletal disorder, the most important areas of daily life affected were ability to get around, stand, walk, go shopping, and participate in social and leisure- time activities.4 In general, obtaining medical or dental care is known to be a problem for many older people with impaired functional status, especially those who are homebound or who reside in longterm care facilities.5,6 People with disabling musculoskeletal conditions are likely among those thus affected.7

EFFECTS OF ORAL CAVITY CONDITIONS

Diseases of the oral cavity are also very common in older people. In the United States, almost half of individuals 75 years and older have caries of the root surface (in which the tooth root is exposed as a consequence of periodontal disease) on 1 or more teeth, and 65% have at least 4 mm loss of attachment (an indicator of significant loss of supporting structures of the teeth) on at least 1 tooth.8

Oral diseases can have a large impact on quality of life. In a random sample of people 65 years and older in England, 72% said their oral health was important to their quality of life, particularly regarding their eating habits, level of comfort, ability to maintain a carefree manner, appearance, and general wellbeing. 9 In a study of older individuals in North Carolina, 30% said that their teeth had an adverse effect on chewing, 19% on enjoyment of eating, 15% on appearance to others, 11% on smiling and laughing, and 10% on having confidence.10 It is known that persons with oral infections are at increased risk of major systemic diseases such as cardiovascular diseases, cerebrovascular diseases, and diabetes.4

Although oral health among older adults has improved in recent decades, widespread problems remain, especially among those of low socioeconomic status and among institutionalized individuals of poor health or poor functional status. Homebound and institutionalized elderly have many dental needs that are not currently being met.6

OSTEOARTHRITIS

Osteoarthritis, sometimes called degenerative joint disease, is a gradual deterioration of the joint cartilage with proliferation and remodeling of the bone beneath the cartilage. The usual symptoms are pain and stiffness accompanied by loss of function. The course of osteoarthritis is variable and may differ from one joint to another. The joints most commonly involved are the knees, hands, feet, hips, and spine. The strongest risk factor for osteoarthritis is age, and on autopsy, some cartilage damage is almost universal among older people. Several factors contribute to the increased incidence and prevalence with age, including accumulated wear and tear, stress from superincumbent weight, increased joint instability from ligamentous laxity, increased vulnerability of the joints to mechanical insults, and decreased resilience and reparative capacity of cartilage.12

In Western countries, osteoarthritis is a leading cause of pain and physical disability in older people. The World Health Organization predicts that osteoarthritis will become the fourth leading cause of disability worldwide by 2020.13 Osteoarthritis adversely affects many components of quality of life, including general health, physical health, mental health, extent of activity limitation, pain, sleep, and feeling healthy and full of energy.14

Severity of osteoarthritis in the hands is correlated with impaired functional ability.15 Hence, many people with osteoarthritis in their hands are unable to maintain proper oral hygiene, resulting in accumulation of plaque and calculus, which increases the likelihood of dental caries and periodontal disease.7 Certain medications used to treat osteoarthritis, including corticosteroids and nonsteroidal anti-inflammatory drugs, may suppress the immune system, thus potentially affecting the tissues of the oral cavity by increasing the risk of delayed wound healing, prolonged bleeding time, and fungal infections.

Mobility limitation resulting from osteoarthritis, particularly in the lower extremities, makes it difficult for those affected to visit dental offices for both routine hygiene and treatment. A large national survey in Australia7 found that persons who reported that they had osteoarthritis were less likely to have visited a dental professional within the past 2 years than were persons from the general population without arthritis (57% vs 72%; Table 1).

Although the data in Table 1 were not adjusted for socioeconomic characteristics or insurance status, education and income level were not strongly or consistently related to frequency of dental visits, although urban versus rural residence was. The results of the Australian study are consistent with other studies that found impaired functional status and poor health in general to be associated with less use of dental services.5,16 When those participating in the Australian study did visit a dentist, those who reported osteoarthritis were more likely to require extractions and fillings than were those without arthritis. They were also more likely to visit the dentist for restorative and prosthodontic treatment involving construction and insertion of dentures as well as for denture repairs and for denture and teeth cleaning. They were less likely to see dentists for routine checkups and preventive treatment.

In addition, osteoarthritis of the temporomandibular joint, the joint between the temporal bone of the skull and the mandible, is one cause of temporomandibular joint dysfunction. A disk of cartilage separates the skull from the mandibular condyle. When this cartilage disk degenerates, the result can be discomfort of the joint or an altered occlusion and associated pain in the mandible. Most patients with temporomandibular disorders who seek treatment do so because of pain, although for a subset the main symptoms are popping, clicking, and other noises when the joint is in motion.17 With severe osteoarthritis of this joint, the person cannot open the mouth wide.

RHEUMATOID ARTHRITIS

Rheumatoid arthritis is an inflammatory disease that damages the synovial tissue connecting bones and joints. About 1.6% to 1.9% of people aged 60 to 69 years and 2.5% to 2.8% of those 70 years and older have rheumatoid arthritis.18 Although it is less common than osteoarthritis, the manifestations of rheumatoid arthritis are generally more severe. The synovitis results in destruction of joint cartilage and erosion of bone. The typical symptoms are stiffness, pain, and swelling of multiple joints, most commonly of the hands and wrists. Systemic manifestations of rheumatoid arthritis, including vascular, renal, and eye complications, may also be present. The clinical course is variable, but as the disease progresses, most people with rheumatoid arthritis experience functional limitations, physical disabilities, and sometimes early mortality. Rheumatoid arthritis is considered to be of autoimmune etiology, and genetic factors are important.19 As with osteoarthritis, rheumatoid arthritis can affect oral health in several ways.7,15 Because of the usual involvement of the hands, personal oral hygiene may be difficult. This poor oral hygiene, along with the inflammatory reactions in the disease process, results in an increased risk of periodontal infections and dental caries. Mercado et al.20 found a high prevalence (62.5%) of advanced periodontal disease in patients with rheumatoid arthritis. Immunosuppressive agents used in the treatment of rheumatoid arthritis also increase the risk of opportunistic infections, delayed wound healing, and prolonged bleeding time. In addition, dry mouth frequently occurs in persons with rheumatoid arthritis, 21 which leads to difficulty chewing, an increased risk of root caries, and other problems of the teeth and their supporting structures. Rheumatoid arthritis can also contribute to the occurrence of temporomandibular joint dysfunction.

People with rheumatoid arthritis are less likely to visit a dental professional than are persons without arthritis. In the Australian study by Pokrajac- Zirojevic et al., 7 only 55% of those with rheumatoid arthritis had visited a dental professional within the past 2 years, compared with 72% of persons without arthritis (Table 1). Similar to the persons with osteoarthritis, persons with rheumatoid arthritis were more likely than were persons without arthritis to require extensive dental care when they did visit a dental professional.

OSTEOPOROSIS

Osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes a person to an increased risk of fracture.22 Hip fractures are particularly common and disabling in older people. When the definition of the World Health Organization is applied,23 about 20% of postmenopausal White women in the United States have osteoporosis in their femoral neck.24 About 40% of White women and 13% of White men in the United States experience an osteoporosisassociated fracture of the hip, vertebrae, or distal forearm after 50 years of age.25 Factors that affect the risk of osteoporotic fractures include low bone mineral density and other components of poor bone quality, a propensity to fall, lack of protective responses during a fall, and various other characteristics of the fall.

Studies have quite consistently found that bone mineral density in the mandible (lower jawbone) and maxilla (upper jawbone), as well as bone mineral density specifically in the alveoli (tooth sockets), are modestly correlated with bone mineral density of other skeletal sites.26-28 Dense mandibular alveolar trabecular patterns (a component of bone strength) are strongly correlated with higher skeletal bone mineral density.29 In addition, menopausal hormone replacement therapy is associated with higher bone mineral density in mandibular alveolar bone, as it is with bone mineral density in other skeletal sites.27 Evidence is inconsistent as to whether low bone mineral density contributes to the development of such dental problems as tooth loss and loss of attachment.30-33 More work in this area is needed.

Of the drugs currently used in the treatment and prevention of osteoporosis and associated fractures, bisphosphonates are used most frequently. Their use has rapidly increased since their introduction in the 1990s.34,35 In 2005 in the United Kingdom, approximately 10% of all women 70 years and older were prescribed bisphosphonates.35 Bisphosphonates are of particular concern to oral health because a potential side effect is osteonecrosis of the jaw, which consists of areas of bone necrosis that do not heal. Osteonecrosis generally appears as an area of exposed alveolar bone in the mandible or maxilla. Usually, the area of exposed bone develops after a tooth extraction or oral injury, but this is not always the case.

Osteonecrosis of the jaw was first reported in association with bisphosphonate therapy in 2003,36 mainly among patients with multiple myeloma or breast cancer who were receiving high doses of the intravenous bisphosphonates pamidronate or zoledronic acid, especially after recent dental pathology, trauma, or oral surgery. Another series of 63 patients with osteonecrosis of the jaw was reported soon thereafter. 37 Again, most of the cases were cancer patients who had received intravenous bisphosphonates, but a few had taken oral alendronate or risedronate for osteoporosis.

In a review of 368 cases reported in the literature through January 2006, Woo et al.38 found that 60% of the cases occurred after a tooth extraction or other dentoalveolar surgery, and the other 40% occurred spontaneously. The spontaneous cases tended to occur in patients wearing dentures, which are a potential source of local trauma. Ninety-four percent of the cases had been treated with intravenous bisphosphonates (primarily pamidronate and zoledronic acid), and 85% of the patients had multiple myeloma or metastatic breast cancer. The other 15% of patients were taking oral bisphosphonates for osteoporosis or Paget’s disease.

Most information on risk factors for osteonecrosis of the jaw comes from follow-up of cancer patients. The most important risk factors are type of bisphosphonate (pamidronate or zoledronic acid), total dose, and a history of trauma, dental surgery, or dental infection.38,39 Risk increases with longer length of follow-up after initiation of bisphosphonate treatment.38-40 The risk of osteonecrosis of the jaw among patients using oral bisphosphonates for osteoporosis or Paget’s disease has been estimated to be around 1 per 10000 to 1 per 100 000 per year of use, compared with 1 to 10 per 100 (depending in part on duration of use) among cancer patients treated with higher doses of intravenous bisphosphonates.41 Although its occurrence thus appears to be relatively rare among bisphosphonate-treated persons with osteoporosis and Paget’s disease, there is concern that more cases of osteonecrosis of the jaw will be seen among users of oral bisphosphonates as their length of use becomes greater.42

No effective treatment is available for patients who have developed osteonecrosis of the jaw. Therefore, prevention of its occurrence in the first place, to the extent possible, is highly desirable. The recommendations made by a task force of the American Society of Bone and Mineral Research to minimize the risk of osteonecrosis of the jaw among bisphosphonatetreated patients with osteoporosis and Paget’s disease are shown in the box on this page.41 Following these guidelines should minimize the risk of osteonecrosis of the jaw in treated patients.

PAGET’S DISEASE

Paget’s disease is a thickening and weakening of bone that occurs when the normal balance of bone formation and bone loss is disrupted. Large, highly active boneresorbing cells (osteoclasts) produce abnormal bone resorption. The bone-forming cells (osteoblasts) try to repair this damage, but the new bone that is formed is structurally disorganized, weaker, and prone to fracture and deformities. Paget’s disease can affect any part of the skeleton, but most frequently involves the spine, skull, pelvis, and legs. Osteoarthritis in adjacent joints is common, and neurologic, cardiovascular, and metabolic complications may occur. The most common neurologic complication is hearing loss in patients with Paget’s disease of the temporal bone. The causes of Paget’s disease are unknown, although the disease appears to run in families.43

The incidence increases with age, and Paget’s disease occurs in 1.5% to 3.0% of people 60 years and older in the United States.44 Only about 10% of affected persons have symptoms, usually consisting of aching pain caused by small fractures or from nerve compression. Sometimes visible deformities develop, such as an enlarged skull or curvature of the femur of lower leg. A survey of mostly long-term patients with Paget’s disease documented the strong adverse effect of the disease on quality of life.45

The jaw is affected in about 17% of cases.46 When the jaw is involved, the effect on dental health is usually substantial. In early stages of the disease, loss of bone around the base of the teeth can result in loosening of the teeth and eventual tooth loss. More often, overgrowth of bone with spreading of the teeth and malocclusion occurs. Patients without teeth often have trouble with the proper fit of dentures. Other complications include root resorption, an increase in the amount of tooth cementum, excessive bleeding on extraction, and osteomyelitis. Tooth extractions may be difficult because of increased amount of cementum. Infections are a frequent complication following dental procedures. 47 Because of the many potential oral complications, some dentists avoid patients with Paget’s disease.48

Among pharmaceutical agents, bisphosphonates are often used to decrease bone resorption and slow bone turnover. The doses used are generally higher than those used in the treatment of osteoporosis.44 Patients who use bisphosphonates for Paget’s disease have an elevated risk of osteonecrosis of the jaw, as described in the section on osteoporosis. 38,41 The guidelines given in the “Osteoporosis” section for minimizing risk of osteonecrosis of the jaw among patients using bisphosphonates should also be followed by patients with Paget’s disease who are using these agents (see the box on page 1180)

OTHER MUSCULOSKELETAL DISORDERS

Although not specifically diseases of older individuals, low back and neck pain are common, are frequently associated with mobility limitation, and thus also may result in fewer visits to dental professionals for routine care. In addition, because of the functional integration of the cervical spine and the masticatory (chewing) system, cervical spine disorders can affect jaw function, and persons with temporomandibular disorders may seek care for pain and dysfunction in the neck region.49,50 Less-common musculoskeletal conditions may also affect the oral cavity. Osteomyelitis, in which bacteria or fungi infect bone and bone marrow, can occur in the jaw bones of elderly patients, especially those with poor dentition or periodontal disease.51 Abscesses involving the dentition and adjacent bone are common, and the abscess may extend deep into the bone. Osteomyelitis may also occur in association with bisphosphonateinduced osteonecrosis of the jaw, as described in the “Osteoporosis” section.

Across all ages, fracture of the jaw bones most commonly occurs as a result of violent acts such as assault and gunshot wounds. In older individuals, however, falls and motor vehicle accidents are the most common causes of fracture of the jaw.52,53

WHAT SHOULD BE DONE?

Musculoskeletal conditions are linked to diseases of the oral cavity and contiguous structures in 3 main ways. First, several diseases of the musculoskeletal system can involve the oral cavity as part of the disease process. Dental and medical professionals should be aware of this and monitor patients for these problems. Dentists should schedule extra time for patients with musculoskeletal diseases, as needed.

Second, drugs used to treat several musculoskeletal disorders, including bisphosphonates for osteoporosis and Paget’s disease and corticosteroids for the arthritic disorders, can increase the risk of oral problems. If these drugs are used, then increased surveillance by dental professionals is needed. Also, treatment for oral diseases, such as dental procedures, can affect the risks associated with use of these agents. Such patients need to be treated with particular care. The guidelines presented in the box on page 1180 should be carefully applied to patients using bisphosphonate therapy.

Third, many musculoskeletal conditions, whether or not they directly affect oral health, make it more difficult for people to get around and can thus make it less likely that those afflicted will receive good dental care. Persons with arthritic disorders and other disabling diseases need to be aware of the importance to their health of routine dental visits, despite the possible inconvenience of the visit. When office visits are not feasible, home visits for prophylactic oral hygiene could be helpful to persons with disabling musculoskeletal diseases. Although oral hygiene services are available in almost all nursing homes, they are usually provided by nursing staff rather than dental professionals, and many studies of nursing home residents indicate a high prevalence of inadequate oral hygiene, along with associated dental, gingival, and periodontal conditions.6

Interventions undertaken among elderly disabled people in general almost certainly have relevance to persons disabled with musculoskeletal conditions. Several studies in countries such as Japan54,55 and Switzerland56 have shown beneficial effects of programs in which dental hygienists or dentists visit institutionalized and community-dwelling dependent elderly individuals or their caregivers. In addition, the burden to the caregivers of trying to provide oral care is reduced.55 A study in England reported that oral hygiene can be enhanced with the education of caregivers (mainly non-nurses) in a nursing home setting (Table 2).57 In Finland, a study showed that organized, hands-on instruction of the nursing staff caring for long-term hospitalized patients resulted in substantial improvement in the oral hygiene of the patients.58 In the United States, a need exists for the provision of primary dental services to disabled individuals. New approaches to the delivery of these services need to be explored.

Also helpful would be such simple and inexpensive measures as providing antimicrobial mouthwashes and high-fluoride toothpastes and mouth rinses to disabled individuals. Mouthwashes containing chlorhexidine may be especially useful in helping to control plaque accumulation when mechanical oral hygiene practices are not feasible.59 Electric or other special toothbrushes can be provided to those afflicted with impairments of their hands and upper extremities. Such measures would enable them to maintain better oral hygiene even without professional intervention. Sonic and ultrasonic toothbrushes may be advantageous in decreasing plaque and gingival bleeding in individuals whose hand function is limited.60 A pilot crossover trial among institutionalized care-dependent elderly persons in Japan showed the effectiveness of a chewable toothbrush for plaque removal.61

CONCLUSION

Older persons with a variety of musculoskeletal conditions are at increased risk of deterioration of their oral health. All those associated with the health of older persons need to be aware of this issue and take preventive and therapeutic measures as needed. On the basis of current knowledge alone, much can be done to improve the oral health of disabled older persons.

Recommendations of the Task Force of the American Society of Bone and Mineral Research Regarding Risk of Osteonecrosis of the Jaw Among Patients With Osteoporosis and Paget’s Disease Who Are Initiating or Already Using Bisphosphonate Therapy

1. Good communication among physicians, dentists, and patients should take place. Patients should inform their dentists that they are initiating bisphosphonate therapy.

2. Patients initiating or already taking bisphosphonates should be informed of the benefits and risks, including the risk of osteonecrosis of the jaw, its signs and symptoms, and the risk factors for developing it.

3. Patients should be informed that the risk of osteonecrosis of the jaw associated with routine oral bisphosphonate therapy for osteoporosis or Paget’s disease is low, ranging between 1 per 10000 and 1 per 100000.

4. Patients taking bisphosphonates should be encouraged to maintain good oral hygiene and to have regular dental visits. They should report any oral problems to their dentist and physician.

5. Patients concerned about osteonecrosis of the jaw should be encouraged to seek additional information from a dental specialist.

6. Because the risk of osteonecrosis of the jaw is low and associated with longer duration of use, it is not necessary to have a dental examination before beginning therapy or otherwise to alter routine dental management.

7. For patients who have been receiving oral bisphosphonate therapy for more than 3 years, the following precautions are advised:

* Patients with periodontal disease should be given appropriate nonsurgical therapy. Any necessary surgical treatment should be aimed primarily at reducing or eliminating periodontal disease. Minimal bone recontouring may be considered when necessary.

* On the basis of current information, dental implant procedures may be undertaken, but informed consent should be obtained and documented.

* When possible, endodontic treatment (root canal therapy) is preferable to extraction or periapical surgery (surgical endodontic therapy involving removal of the root tips).

* It is uncertain whether bisphosphonate therapy should be stopped for a period before and after an invasive dental procedure.

Note. Adapted from Khosla et al.41

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20. Mercado F, Marshall RI, Klestov AC, Bartold PM. Is there a relationship between rheumatoid arthritis and periodontal disease? J Clin Periodontol. 2000;27:267-272.

21. Arneberg P, Bjertness E, Storhaug K, Glennas A, Bjerkhoel F. Remaining teeth, oral dryness and dental health habits in middle- aged Norwegian rheumatoid arthritis patients. Community Dent Oral Epidemiol. 1992;20:292-296.

22. Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement. 2000;17:1-45.

23. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser. 1994;843:1-129.

24. Looker AC, Orwoll ED, Johnston CC Jr, et al. Prevalence of low femoral bone density in older US adults from NHANES III. J Bone Miner Res. 1997; 12:1761-1768.

25. Melton LJ III, Chrischilles EA, Cooper C, Lane AW, Riggs BL. How many women have osteoporosis? J Bone Miner Res. 1992;7:1005- 1010.

26. Geurs NC, Lewis CA, Jeffcoat MK. Osteoporosis and periodontal disease progression. Periodontol 2000. 2003; 32:105-110.

27. Jacobs R, Ghyselen J, Koninckx P, van Steenberghe D. Long- term bone mass evaluation of mandible and lumbar spine in a group of women receiving hormone replacement therapy. Eur J Oral Sci. 1996;104:10-16.

28. Jeffcoat MK, Lewis CE, Reddy MS, Wang CY, Redford M. Post- menopausal bone loss and its relationship to oral bone loss. Periodontol 2000. 2000;23: 94-102.

29. Jonasson G, Bankvall G, Kiliaridis S. Estimation of skeletal bone mineral density by means of the trabecular pattern of the alveolar bone, its interdental thickness, and the bone mass of the mandible. Oral Surg Oral Med Oral Path Oral Radiol Endod. 2001;92:346-352.

30. Gomes-Filho IS, Passos JD, Cruz SS, et al. The association between postmenopausal osteoporosis and periodontal disease. J Periodontol. 2007;78: 1731-1740.

31. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Hollender LG. Relationship between bone mineral density and tooth loss in elderly Japanese women. Dentomaxillofac Radiol. 1999; 28:219-223.

32. Tezal M, Wactawski-Wende J, Grossi SG, Ho AW, Dunford R, Genco RJ. The relationship between bone mineral density and periodontitis in postmenopausal women. J Periodontol. 2000;71: 1492- 1498.

33. Weyant RJ, Pearlstein ME, Churak AP, Forrest K, Famili P, Cauley JA. The association between osteopenia and periodontal attachment loss in older women. J Periodontol. 1999;70: 982-991.

34. Udell JA, Fischer MA, Brookhart MA, Solomon DH, Choudhry NK. Effect of the Women’s Health Initiative on osteoporosis therapy and expenditure in Medicaid. J Bone Miner Res. 2006;21: 765-771.

35. Watson J, Wise L, Green J. Prescribing of hormone therapy for menopause, tibolone, and bisphosphonates in women in the UK between 1991 and 2005. Eur J Clin Pharmacol. 2007;63: 843-849.

36. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced alveolar necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61: 1115-1117.

37. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004;62: 527-534.

38. Woo SB, Hellstein JW, Kalmar JR. Systematic review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006;144:753-761.

39. Badros A, Weikel D, Salama A, et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol. 2006;24: 945-952.

40. Bamias A, Kastritis E, Bamia C, et al. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol. 2005;23:8580-8587.

41. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research [editorial]. J Bone Miner Res. 2007;22:1479-1491.

42. Hewitt C, Farah CS. Bisphosphonaterelated osteonecrosis of the jaws: a comprehensive review. J Oral Pathol Med. 2007;36:319- 328.

43. Siris ES, Ottman R, Flaster E, Kelsey JL. Familial aggregation of Paget’s disease of bone. J Bone Miner Res. 1991;6:495- 500.

44. Lyles KW, Siris ES, Singer FR, Meunier PJ. A clinical approach, to diagnosis and management of Paget’s disease of bone. J Bone Miner Res. 2001; 16:1379-1387.

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46. Woo TS, Schwartz HC. Unusual presentation of Paget’s disease of the maxilla. Br J Oral Maxillofac Surg. 1995; 33:98-100.

47. Kaplan FS, Horowitz SM, Quinn PD. Dental complications of Paget’s disease: the need for hard facts about hard tissues. Calcif Tissue Int. 1993;53:223-224.

48. Kaplan FS, Haddad JG, Singer FR. Paget’s disease: complications and controversies [editorial]. Calc Tissue Int. 1994;55:75-78.

49. Eriksson PO, Haggman-Henrikson B, Nordh E, Zafar H. Coordinated mandibular and head-neck movements during rhythmic jaw activities in man. J Dent Res. 2000;79:1378-1384.

50. Zafar H. Integrated jaw and neck function in man. Studies of mandibular and head-neck movements during jaw opening-closing tasks. Swed Dent J Suppl. 2000;143:1-41.

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52. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture patterns: a suburban trauma center experience. Am J Otolaryngol. 2004;25:301-307.

53. Rehman K, Edmondson H. The causes and consequences of maxillofacial injuries in elderly people. Gerodontology. 2002;19:60- 64.

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Jennifer L. Kelsey, PhD, and Ira B. Lamster, DDS, MMSc

About the Authors

Jennifer L. Kelsey is with the Departments of Medicine and Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. Ira B. Lamster is with the School of Dental and Oral Surgery, Columbia University, New York, NY.

Correspondence should be sent to Jennifer L. Kelsey, University of Massachusetts Medical School, Department of Medicine, Division of Preventive and Behavioral Medicine, 55 Lake Ave North, Shaw Building, Worcester, MA 01655 (e-mail: [email protected] or [email protected]).

This article was accepted January 7, 2008.

Contributors

J. L. Kelsey had primary responsibility for conducting the literature review and writing the article. I. B. Lamster assisted with dental aspects of the literature review and reviewed the entire article.

Acknowledgments

We thank Janice S. Gnagy, dental hygienist, for her helpful suggestions. Portions of this article were adapted from a chapter by J. L. Kelsey in Improving Oral Health Care for the Elderly: An Interdisciplinary Approach. New York, NY: Springer; 2008:127-156, with kind permission of Springer Science and Business Media.

Copyright American Public Health Association Jul 2008

(c) 2008 American Journal of Public Health. Provided by ProQuest Information and Learning. All rights Reserved.

By White, Sarah L McGeechan, Kevin; Jones, Michael; Cass, Alan; Chadban, Steven J; Polkinghorne, Kevan R; Perkovic, Vlado; Roderick, Paul J

Objectives. We sought to determine whether an elevated burden of chronic kidney disease is found among disadvantaged groups living in the United States, Australia, and Thailand. Methods. We used data on participants 35 years or older for whom a valid serum creatinine measurement was available from studies in the United States, Thailand, and Australia. We used logistic regression to analyze the association of income, education, and employment with the prevalence of chronic kidney disease (estimated glomerular filtration rate

Results. Age- and gender-adjusted odds of having chronic kidney disease were increased 86% for US Whites in the lowest income quartile versus the highest quartile (odds ratio [OR]=1.86; 95% confidence interval [CI]=1.27, 2.72). Odds were increased 2 times and 6 times, respectively, among unemployed (not retired) versus employed non-Hispanic Black and Mexican American participants (OR=2.89; 95% CI=1.53, 5.46; OR=6.62; 95% CI=1.94, 22.64. respectively). Similar associations were not evident for the Australian or Thai populations.

Conclusions. Higher kidney disease prevalence among financially disadvantaged groups in the United States should be considered when chronic kidney disease prevention and management strategies are created. This approach is less likely to be of benefit to the Australian and Thai populations. (Am J Public Health. 2008;98:1306- 1313. doi:10.2105/AJPH.2007.116020)

Chronic kidney disease refers to a chronic, irreversible loss of kidney function, ranging from asymptomatic kidney damage to endstage kidney disease (ESKD), in which death would occur without renal replacement therapy. Principal risk factors include diabetes and hypertension.1 Loss of kidney function usually takes place gradually over many years. Whether an individual develops ESKD depends on the type of primary kidney disease, how well it is managed, and other risk factors and comorbidities. Most people with chronic kidney disease will die of a comorbid condition, usually cardiovascular disease, before experiencing complete kidney failure requiring dialysis or transplantation.2 However, the onset and progression of chronic kidney disease are highly preventable, and early treatment of complications can significantly improve long-term patient outcomes.3

There is strong evidence that low socioeconomic status (SES) is associated with elevated rates of cardiovascular morbidity and mortality. 4-6 Recent reports have observed similar associations between SES and the prevalence and progression of chronic kidney disease,7-10 suggesting the existence of an unrecognized group at risk for ESKD and cardiovascular complications of chronic kidney disease. However, it is difficult to assess whether we can generalize these findings beyond the few countries for which data are available or beyond high-income countries. Environmental and infectious causes of chronic kidney disease11 disproportionately affect the poor of low- and middle-income countries. Combined with a growing prevalence of vascular risk factors accompanying epidemiological transitions12 and inequities in access to medical services, this may result in a similar excess burden of chronic kidney disease among the disadvantaged populations of these countries; but this remains largely unexplored.

Population representative datasets, including data on kidney damage, are now available for Australia, from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), and Thailand, from the International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). We analyzed data from these 2 studies, conducted during 1999-2001 and 2000 respectively, alongside US data from the third National Health and Nutrition Examination Survey (NHANES III).13-15 We hypothesized that the association between disadvantage and elevated rates of chronic kidney disease observed for the US population would also be observed in Australia. We also hypothesized that we would see a similar association for the Thai population, despite differing levels of economic development. Relative advantage versus disadvantage was defined in terms of categories of income, educational attainment, and employment status and explored for its association with chronic kidney disease.

There is currently an international call for primary and secondary prevention of chronic kidney disease, particularly in developing regions in which resources are lacking to sustain expensive dialysis and transplant services. 16 Understanding the relation between SES and chronic kidney disease may help to define new population groups at risk and identify important barriers to disease detection and appropriate management; this information would have implications for the design of preventive interventions and for health service planning and delivery. We sought to determine whether associations between socioeconomic disadvantage and chronic kidney disease are consistent across high-income countries and whether such relations exist outside high-income countries.

METHODS

Study Samples

NHANES III, AusDiab I, and InterASIA (Thailand) are nationally representative studies of the health and nutritional status of the US, Australian, and Thai populations, respectively. NHANES III was conducted from 1988 to 1994, AusDiab I from 1999 to 2001, and InterASIA (Thailand) in 2000. Details of sample selection and data collection methods have been described elsewhere.13-15 The minimum age for inclusion in our analysis was 35 years, the inclusion criteria stipulated for the InterASIA study.14

Individual participant data were obtained from the 3 studies (NHANES III: n=10625; InterASIA (Thailand): n=5099; AusDiab I: n=9852) for participants 35 years or older who had a valid serum creatinine measurement. Valid measurements on all required variables were available for 9098 participants from NHANES III, 5063 from InterASIA (Thailand), and 9329 from AusDiab I. Because of documented differences in rates and outcomes of chronic kidney disease among US White, non-Hispanic Black, and Mexican American individuals17,18 as well as differences in relative advantage, we also conducted separate analyses of these groups (n=4482, n=2214, and n=2049, respectively). Although indigenous Australians suffer a disproportionately high burden of chronic kidney disease and ESKD, only 88 people in the AusDiab I study had identified as Aboriginal or Torres Strait Islander (0.8%) and were therefore not examined separately. No data on ethnicity were collected as part of the InterASIA study.

Measures

The outcome of interest was prevalence of chronic kidney disease stage 3 or above,19 defined as estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m^sup 2^. We estimated GFR from serum creatinine level using the Modification of Diet in Renal Disease Study prediction formula20,21:

(1) eGFR (mL/min/1.73 m^sup 2^)=186.3 x (serum creatinine^sup – 1.154^) x (age^sup -0.203^) x (0.742 if female and 1.21 if Black).

Correction is required for gender and race because for any given GFR, serum creatinine concentration is significantly higher in men than in women and in Black persons than in White persons because of differences in muscle mass.20

In each study, serum creatinine was measured at a central laboratory using the modified kinetic Jaffe reaction.14,17,22 Serum creatinine measurements from NHANES III and InterASIA (Thailand) were standardized to samples stored at the Cleveland Clinic (Cleveland, Ohio).23 Serum creatinine measurements from AusDiab I have not been standardized. Although this may affect estimated prevalence of chronic kidney disease for the Australian population, it does not necessarily affect the relation between prevalence and socioeconomic factors.

We compared household income, employment status, and level of education across the 3 countries. From data on household income and educational attainment, we constructed categories to reflect relative disadvantage in each country. A square root equivalence scale was applied to total household income to calculate a figure for household income corrected for the number of people dependent on that income.24 Absolute household income (or the upper limit of the income bracket where actual income was not recorded) was divided by the square root of household size and then grouped into quartiles to form income equivalence groups.

For the NHANES population, quartiles from lowest to highest were defined as corrected household income less than US$12000, $12000 to $20499, $20500 to $27999, and greater than $28000. For the AusDiab population, quartiles were defined as less than Aus$16000, $16000 to $29999, $30000 to $46999, and greater than $47000. For the InterASIA population, quartiles were defined as less than 17000, 17 000 to 31999, 32 000 to 59999, and 60000 or more Thai baht. For the US and Australian populations, the majority of adults 35 years or older had completed at least 12 years of schooling, with a large proportion having completed exactly 12 years, corresponding with the completion of high school. Therefore, we grouped educational attainment into categories of fewer than 12 years, 12 years, or more than 12 years. By contrast, approximately two thirds of the Thai population had completed exactly 4 years of education. Because of the very large size of this group, results for the Thai population were compared for fewer than 4 years, 4 years, and more than 4 years of education. Statistical Analysis

Logistic regression was used to calculate the odds ratio for the association between an eGFR of less than 60 mL/min/1.73 m^sup 2^ and each of the socioeconomic variables (household income, employment status, and educational attainment) separately. We constructed multivariate models to account for potential explanatory variables and separate models estimated for each socioeconomic variable. The first set of models adjusted for diabetes and hypertension status, which are principal risk factors for chronic kidney disease1,25,26 and have been demonstrated to be more prevalent with lower education and lower income. 27 The second set of models, additionally, adjusted for urban or rural area of residence, abdominal obesity, smoking status, and previous cardiovascular events (stroke or heart attack), factors that have also been linked to chronic kidney disease prevalence and incidence.25,28 Analyses were carried out in SAS software version 9.1 (SAS Institute, Cary, North Carolina) using proc survey logistic. In all analyses, we adjusted standard errors for the sampling design of each survey, using the appropriate clustering, stratification, and sampling weights.

RESULTS

Characteristics of the Study Participants

Demographic, socioeconomic, and relevant health characteristics of the US, Australian, and Thai participants appear in Table 1. The Thai population had a younger distribution than the US and Australian populations, which were alike in their age structure. The Australian population was the most urbanized, and the Thai population the least. A significantly higher proportion of the Thai population was employed than the US and Australian populations (77.1% compared with 59.9% and 57.0%, respectively). The prevalence of stages 3 to 5 chronic kidney disease (eGFR

Approximately 40% of adults 35 years and older in the United States and Australia had received more than 12 years of education. The great majority (63.1%) of the Thai population 35 years or older had received exactly 4 years of education. The distribution of educational attainment above 4 years was 6.8% with 5 to 6 years, 6.8% with 7 to 11 years, 4.2% with 12 years, and 7.0% with more than 12 years of education. These figures correspond with World Bank statistics on education, which estimate that, for the population older than 25 years in 2000, an average duration of schooling of 12.25 years in the United States, 10.57 years in Australia, and 6.10 years in Thailand.30

Results of Crude Analysis

The crude associations between risk factors for chronic kidney disease and prevalence of eGFR less than 60 mL/min/1.73 m^sup 2^ across all groups are shown in Table 2. All associations were in the expected direction except for smoking-people who had never smoked or were ex-smokers were more likely than were current smokers to have an eGFR at less than 60 mL/min/1.73 m^sup 2^. However, this association became nonsignificant after adjusting for age. Income in the lowest quartile, shorter duration of education, and being unemployed were associated (P

Results of Multivariate Analysis

Age- and gender- and multivariate-adjusted ORs for the associations between socioeconomic variables and prevalence of eGFR less than 60 mL/min/1.73 m^sup 2^ are given in Table 3. The crude effects of SES reduced substantially with adjustment for age and gender. The odds ratios for prevalence of eGFR at less than 60 mL/ min/1.73 m^sup 2^ for participants with fewer than 12 years of education, compared with those with more than 12 years of education, remained significantly high for US non-Hispanic White and non- Hispanic Black participants. Odds ratios also remained significantly high for unemployed non-Hispanic Blacks and Mexican Americans compared with employed groups, and for US non-Hispanic Whites in the lowest quartile for income compared with the highest quartile.

Testing for trend across income quartile groups indicated a significant negative gradient in the age- and gender-adjusted association between income group and prevalence of eGFR at less than 60 mL/min/1.73 m^sup 2^ among the US White (P = .002) and non- Hispanic Black (P=.04) populations. That is, the odds of prevalent chronic kidney disease increased with descent in income group for these populations. A gradient effect of education is also suggested for non-Hispanic Blacks, whereby the odds of prevalent chronic kidney disease increased with lower categories of educational attainment. None of the results for the Australian or Thai populations was significant after adjustment for age and gender, and there was no evidence of a gradient in the effect of income for either population.

Adjusting for diabetes and hypertension status (Table 3, model 3) and additional potential explanatory variables (Table 3, model 4) did not substantially alter these findings. In the fully adjusted model, the remaining statistically significant associations were unemployment for non-Hispanic Black and Mexican Americans and income in the lowest quartile (vs highest) or fewer than 12 years education (vs greater than 12 years) for US non-Hispanic Whites. The association between chronic kidney disease prevalence and fewer than 12 years education (vs greater than 12 years) was of similar magnitude in the non-Hispanic Black population compared with the US non-Hispanic White population; however, this was borderline significant only, possibly because of the smaller sample size for this group.

DISCUSSION

We explored the relation between disadvantage and chronic kidney disease burden to determine whether disadvantaged groups should be targeted for health promotion, screening, and early intervention. On crude analysis, we found large and consistent effects of disadvantage on chronic kidney disease prevalence across the 3 countries. Following adjustment for age and gender, disadvantage was associated with higher prevalence of chronic kidney disease in the US population. Income quartile had the strongest effect among the White population, whereas employment status had the strongest effect among the non-Hispanic Black and Mexican American populations.

These results are consistent with previous findings for the US population.9 To find prevalent chronic kidney disease, disadvantaged groups in the United States are an excellent group to study. Moreover, adjusting for known chronic kidney disease risk factors did not alter these findings; hence, disadvantage affects chronic kidney disease prevalence in the United States via mechanisms independent of the clustering of risk factors in groups by SES. By contrast, the crude associations observed for the Australian and Thai populations disappeared after adjustment for age and gender, and we cannot definitively conclude on the basis of our results that there is a consistent international association between being in the most disadvantaged socioeconomic group and higher chronic kidney disease prevalence.

It is postulated that education, income, and employment have an impact on health via such mechanisms as deprivation in infancy and childhood, poor diet and nutrient intake, fewer leisure-time activities, lack of social support, and housing and monetary difficulties.32 Other factors relevant to chronic kidney disease prevalence may include exposure to infection, environmental toxins, and poor fetal nutrition influencing kidney development and subsequent function.33 Differences in access to health care and health insurance may also play a role, possibly explaining the high residual risks of chronic kidney disease among unemployed non- Hispanic Black and Mexican American participants. SES affects health through complex pathways. Why income and education have significant effects on chronic kidney disease prevalence in the US non- Hispanic White population but not among the Australian population is not clear. Factors relating to differences in health care systems or issues of access to health care and primary prevention may be involved.

Elevated Burden of Chronic Kidney Disease in Thailand

After adjustment for age and gender, there were no significant associations for the Thai population. Profound social and economic changes accompanied by rapidly changing patterns of diet and exercise are promoting a rising burden of chronic, noncommunicable disease in developing countries.34 Large-scale urbanization of the rural poor has also contributed to escalating rates of cardiovascular disease, diabetes, and other chronic diseases. 35 Cardiovascular diseases are a leading cause of death in Thailand. Major vascular risk factors, including elevated blood pressure and serum total cholesterol, diabetes, obesity, and smoking, are highly prevalent in Thailand, especially in the urban population. 14 Chronic kidney disease is inextricably interrelated with chronic vascular diseases and shares risk factors. We believe the interaction between environmental and socioeconomic circumstances generates an excess burden of chronic kidney disease in Southeast Asia. In Thailand, infectious diseases, exposure to plant and animal toxins, kidney stones causing obstruction to urine flow, and traditional medicines are relatively common causes of chronic kidney disease in rural areas, whereas in larger urban centers, the causes of chronic kidney disease resemble those reported for the United States and Australia, with diabetic nephropathy in particular a significant and growing cause.36 We were unable to detect a robust association between relative disadvantage and prevalence of chronic kidney disease in Thailand, perhaps because escalating rates of vascular risk factors are leading to an elevated burden of chronic kidney disease among the less disadvantaged urban population and infectious and other causes are leading to a high burden of chronic kidney disease among the more disadvantaged rural population.

A number of other factors may have contributed to the null result for the Thai population. First, income, years of education, and employment status are likely to be distributed differently in Thailand than in the United States and Australia. Second, although we defined categories of education and income designed to identify groups of relative disadvantage specific to each country, this relative disadvantage may not have the same effect in Thailand in terms of societal participation, access to services including health care, and detrimental exposure to disadvantage in early life. Although the majority of the Thai population had 4 years of education, this is unlikely to signify the same level of disadvantage in early life, opportunity in later life, or ability to process health-related information as do 12 years of education in the United States or Australia. Third, income, educational attainment, and employment status, when used in cross-national comparisons, may be poorer markers of a person’s place in Thai society. Last, urban or rural area of residence, a factor included in the multivariate model, may be a more important determinant of access to employment, income, and educational opportunities and of access to health care services in a country with less well- developed health and social infrastructures.

Limitations

Our analysis is subject to several limitations. First, our data are cross-sectional. Chronic kidney disease develops slowly, and social position may affect its progression across the life course.37 In each study, serum creatinine was measured on only one occasion; whether kidney damage was persistent was not assessed. The cross- sectional nature of the data introduces the possibility of reverse causality whereby poor physical and mental functioning because of chronic kidney disease and associated comorbidities may limit overall prospects for employment and income. However, because we were interested in earlier stages of chronic kidney disease, which is often asymptomatic, reverse causality is less of a concern.

Second, the need to define measures of SES that were consistent with the available data necessitated broad categorizations of education, income, and employment. Third, GFR-estimating formulae have not been validated for Asian populations, making the accuracy of values estimated for the Thai participants uncertain. A single study among Chinese patients with chronic kidney disease showed some bias in the use of GFR-estimating formulae when compared with gold standard measures of kidney function.38 This would affect estimates of chronic kidney disease prevalence but not necessarily the association with SES. Finally, we considered only individual-level socioeconomic factors and did not account for the possibility that living in a poorer area exerts an independent effect on health.8

Conclusions

Epidemiological studies examining the relation between SES and kidney disease have focused primarily on the link between SES and treated ESKD.39-42 To our knowledge, our study is the first population-representative analysis of the effect of SES on chronic kidney disease prevalence in the Australian and Thai populations and the first use of international data to directly compare the magnitude and consistency of the effects. Data from the InterASIA study indicate a heavy burden of chronic kidney disease in Thailand, with 13.9% of the population 35 years and older having an eGFR at less than 60 mL/min/ 1.73 m^sup 2^ compared with 10% in Australia and 6.6% in the United States. Preventative approaches to chronic kidney disease are particularly critical in low- and middle-income countries such as Thailand because of the extremely high burden of cardiovascular morbidity and mortality associated with chronic kidney disease and, for a smaller number of patients, the enormous resource, infrastructure, and personnel requirements of dialysis and transplant programs.36,43

Our results indicated neither a detrimental effect of being in the group at greatest disadvantage nor a detrimental effect of being at the greatest advantage in terms of chronic kidney disease prevalence among Thai adults. This suggests that the advantaged and the disadvantaged share somewhat equally in the large burden of chronic kidney disease in the Thai population, although likely through different causal pathways. American clinical practice guidelines identify those of low SES as a population group susceptible to chronic kidney disease, and our results are consistent with this. In the United States, chronic kidney disease prevention and management strategies should take particular account of the higher likelihood of disease among lowincome non-Hispanic Whites and unemployed non-Hispanic Black and Mexican American individuals. It is less clear whether disadvantaged Australians would benefit from targeted intervention. More research is needed to determine which population groups in Thailand experience the greatest risk of chronic kidney disease and what is driving the large burden of chronic kidney disease in this country.

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15. Dunstan DW, Zimmet PZ, Welborn TA, et al. The Australian Diabetes, Obesity and Lifestyle Study (Aus- Diab)-methods and response rates. Diabetes Res Clin Pract. 2002;57:119-129.

16. Dirks JH, de Zeeuw D, Agarwal SK, et al. Prevention of chronic kidney and vascular disease: toward global health equity- the Bellagio 2004 Declaration. Kidney Int Suppl. 2005;68(suppl 98):S1-S6.

17. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1-12.

18. United States Renal Data System, USRDS 2006 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 2006.

19. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266. 20. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461-470.

21. Levey AS, Greene T, Kusek JW, Beck GJ, Group MS. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000; 11:A0828.

22. Chadban SJ, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: the Aus- Diab kidney study. J Am Soc Nephrol. 2003;14(suppl 2): S131-S138.

23. Coresh J, Astor BC, McQuillan G, et al. Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis. 2002;39: 920-929.

24. Forster MF, Mira d’Ercole M. Income Distribution and Poverty in OECD Countries in the Second Half of the 1990s. Paris, France: Organisation for Economic Co-operation and Development; 2005. OECD Social, Employment and Migration Working Paper, No. 22.

25. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004;291: 844-850.

26. Ritz E, Orth SR. Nephropathy in patients with type 2 diabetes mellitus. N Engl J Med. 1999;341: 1127-1133.

27. Banks J, Marmot M, Oldfield Z, Smith JP. Disease and disadvantage in the United States and in England. JAMA. 2006;295:2037-2045.

28. Levin A, Stevens L, McCullough PA. Cardiovascular disease and the kidney. Tracking a killer in chronic kidney disease. Postgrad Med. 2002;111:53-60.

29. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome- a new world- wide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23:469-480.

30. The World Bank Group. Education Attainment in the Adult Population (Barro-Lee Dataset). Available at: http:// go.worldbank.org/5Y76FNJ0I0. Accessed December 1, 2006.

31. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluations, classifications, and stratification. Ann Intern Med. 2003;139:137- 147.

32. Marmot MG, Smith GD, Stansfeld S, et al. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337:1387-1393.

33. Brenner BM, Chertow GM. Congenital oligonephropathy and the etiology of adult hypertension and progressive renal injury. Am J Kidney Dis. 1994;23:171-175.

34. Popkin BM. Urbanization, lifestyle changes and the nutrition transition. World Dev. 1999;27: 1905-1916.

35. World Health Organization. The World Health Report 2002. Geneva, Switzerland: World Health Organization; 2002.

36. Sitprija V. Nephrology in South East Asia: fact and concept. Kidney Int Suppl. 2003;63(suppl 83): S128-S130.

37. Shoham DA, Vupputuri S, Kshirsagar AV. Chronic kidney disease and life course socioeconomic status: a review. Adv Chronic Kidney Dis. 2005;12:56-63.

38. Zuo L, Ma YC, Zhou YH, Wang M, Xu GB, Wang HY. Application of GFR-estimating equations in Chinese patients with chronic kidney disease. Am J Kidney Dis. 2005;45:463-472.

39. Young EW, Mauger EA, Jiang KH, Port FK, Wolfe RA. Socioeconomic status and end-stage renal disease in the United States. Kidney Int. 1994;45:907-911.

40. Byrne C, Nedelman J, Luke RG. Race, socioeconomic status, and the development of end-stage renal disease. Am J Kidney Dis. 1994;23:16-22.

41. Cass A, Cunningham J, Wang Z, Hoy W. Social disadvantage and variation in the incidence of endstage renal disease in Australian capital cities. Aust N Z J Public Health. 2001;25:322-326.

42. Perneger TV, Whelton PK, Klag MJ. Race and endstage renal disease. Socioeconomic status and access to health care as mediating factors. Arch Intern Med. 1995; 155:1201-1208.

43. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351:1296-1305.

Sarah L. White, MPH, Kevin McGeechan, MBiostat, Michael Jones, PhD, Alan Cass, PhD, FRACP, Steven J. Chadban, PhD, FRACP, Kevan R. Polkinghorne, FRACP, Vlado Perkovic, PhD, FRACP, and Paul J. Roderick, MD, FRCP

About the Authors

Sarah L. White, Alan Cass, and Vlado Perkovic are with the George Institute, Sydney, Australia, and the Central Clinical School, University of Sydney, Sydney. Kevin McGeechan is with the School of Public Health, University of Sydney, Sydney. At the time of the study, Michael Jones was with the School of Public Health, University of Sydney, Sydney. Steven J. Chadban is with Royal Prince Alfred Hospital, Sydney, and the Central Clinical School, University of Sydney, Sydney. Kevan R. Polkinghorne is with Monash Medical Centre, Melbourne, Australia. Paul J. Roderick is with the University of Southampton, Southampton, England.

Requests for reprints should be sent to Sarah L. White, The George Institute, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia (e-mail: swhite@george. org.au).

This article was accepted November 1, 2007.

Contributors

S.L. White was involved in the conception of the analyses, drew together the results of the analyses, interpreted the data, and led the writing of the article. K. McGeechan conducted the analyses. M. Jones was involved in the conception of the analyses and the acquisition of data and supervised the data analysis. A. Cass was involved in the conception of the analyses and writing. S.J. Chadban was involved in the conception of the analyses and writing. K. R. Polkinghorne was involved in the conception of the analyses and the acquisition of data and assisted in data analysis. V. Perkovic was involved in the conception of the analyses and writing and the acquisition of data. P. J. Roderick was involved in the conception of the analyses and writing and the acquisition of data. All authors helped in the conception and design of the article and interpretation of the data, all critically revised drafts of the article, and all approved the final version for publication.

Human Participant Protection

No protocol approval was needed for this study.

Acknowledgments

S. White was supported by an Australian Postgraduate Award.

Copyright American Public Health Association Jul 2008

(c) 2008 American Journal of Public Health. Provided by ProQuest Information and Learning. All rights Reserved.

EXPERTS are planning to investigate why parents in Yorkshire are shunning the MMR vaccine – following warnings that measles has now become endemic.

Leeds University’s School of Healthcare is launching a study to see what information new parents have available when they decided whether or not to have their children vaccinated for mumps, measles and rubella.

The study, involving more than 500 new parents in the city, will also explore ways of addressing questions and concerns people may have over the MMR jab.

Previous research by the Leeds team showed that parents felt isolated when making their decision. The new project will use interactive software to help identify parents’ concerns and to provide the information needed to answer their questions.

Dr Martin Schweiger, consultant in communicable disease control at the West Yorkshire Health Protection Unit, said: “Mumps, measles and rubella are all serious diseases and become more so the older you get.

“Health professionals need to have credible and appropriate information to give those

parents about to make a decision about immunising their children.”

Simon Balmer, head of health protection for Leeds Primary Care Trust, said: “With the right information we believe that most parents will choose to vaccinate their children.”

In April a 17-year-old from West Yorkshire became the first person in two years to die from measles and the Health Protection Agency has warned that the number of unvaccinated children across the UK is now large enough to sustain a continuous spread of the disease.

(c) 2008 Yorkshire Post. Provided by ProQuest Information and Learning. All rights Reserved.

By Mike Cronin, The Pittsburgh Tribune-Review

Jul. 10–A slide rule and a pair of calipers probably saved Nathan Khosla’s life.

Now Khosla, 17, wants to save others.

When he was 8, the Mt. Lebanon resident passed out during swimming lessons. Khosla remembers waking up to paramedics asking if there was enough room in the parking lot for a helicopter to land to transport him to the hospital.

Tests, including an echocardiogram, showed no abnormalities. But the same thing happened during another swim lesson two weeks later. Again, the sophisticated equipment doctors used to examine Khosla found no problems.

That time, one of the doctors went old-school. He grabbed the slide rule and calipers and measured the ECG printout by hand. The doctor found that Khosla had an arrhythmia, an abnormal rhythm of the heart, which the computers couldn’t detect.

“My father said, ‘You have got to be kidding,'” Khosla said of his dad, Pradeep Khosla, 51, dean of engineering at Carnegie Mellon University.

The younger Khosla’s experience sparked what has become his Eagle Scout project: From 9 a.m. to 5 p.m. Saturday and Sunday, he will host a heart fair with free heart screenings, blood pressure readings, body mass index measurements and CPR classes at the Mt. Lebanon Public Safety Center.

Registration for heart screenings closed on Tuesday, but CPR classes are scheduled from 9:30 a.m. to 12:30 p.m. and 1:30 to 4:30 p.m. on both days.

“I’m doing this because mine wasn’t caught,” said Khosla, who graduated from Mt. Lebanon Senior High School last month and plans to attend Carnegie Mellon in fall. “And since they missed mine, anyone who gets a heart screening will have a panel of cardiologists look at the results to see if there is an arrhythmia.”

He credits his mother, Thespine Kavoulakis, 47, with coming up with the project idea.

Khosla’s specific condition is Long Q-T Syndrome, a disorder of the heart’s electrical system. He takes medication to prevent adrenaline surges from stopping his heart. He hopes his Eagle Scout project helps diagnose others with maladies that fall under what doctors call Sudden Arrhythmia Death Syndrome.

Some in the medical profession advocate a national program modeled on one Italy has to reduce SADS fatalities. That country requires all its young athletes to undergo echocardiograms before competing. Some studies show that program has reduced those types of deaths by 90 percent.

About one in 200,000 high school-age athletes die each year because of SADS, according to a 12-year Minnesota study of 1.4 million student athletes in 27 sports that the American Heart Association cited last year.

Though that number is low, said Dr. Barry J. Maron of the Minneapolis Heart Institute Foundation, “it is more common than previously thought, and does represent a substantive public health problem.”

The St. Margaret Foundation in Aspinwall donated $13,000 to Khosla to put on this weekend’s event.

“Nathan and his mom approached us and we were very impressed,” said Dave Bianco, a St. Margaret program coordinator. “Nathan has done pretty much done it without much help from us. We give the kid credit.”

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To see more of The Pittsburgh Tribune-Review or to subscribe to the newspaper, go to http://www.pittsburghlive.com/x/pittsburghtrib/.

Copyright (c) 2008, The Pittsburgh Tribune-Review

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Emily Bregel, Chattanooga Times/Free Press, Tenn.

Jul. 9–In the wake of a backlash from firefighters and community members, Erlanger hospital officials held a news conference today to clarify last week’s closure of the hospital’s six-bed burn unit.

Officials sought to calm the fears of community members, emphasizing that the immediate care of burn patients in the area has not changed.

“We’re not getting out of the burn business,” said plastic surgeon Woody Kennedy, who will oversee the treatment of burn patients at the hospital.

Patients with severe burns — covering more than 20 percent of their bodies — will be transferred to regional burn centers but only after they have already been stabilized and treated at Erlanger, officials said.

The burn unit’s former medical director, Dr. Lesley Wong, left in February for family reasons.

Her departure prompted hospital physicians and officials to reevaluate the capacity of the burn center and to acknowledge the unlikelihood of recruiting a new medical director to oversee a relatively small unit, Erlanger CEO Jim Brexler said.

Mr. Brexler noted that the transfer of children with serious burn injuries to a major center in Cincinnati, Ohio, has always been hospital protocol.

“I would dare say if you talk to the families there, yes, that’s an inconvenience but they’d much rather be in a center where they’ve got all those resources and then coordinate their care back” to Erlanger, Mr. Brexler said.

Patients with burns on more than 20 percent of their bodies will be transferred to the Joseph M. Still Burn Center in Augusta, Ga., or the Vanderbilt Regional Burn Center in Nashville, after being assessed and stabilized, hospital officials said.

For complete coverage, see tomorrow’s Chattanooga Times Free Press.

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To see more of the Chattanooga Times/Free Press, or to subscribe to the newspaper, go to http://www.timesfreepress.com.

Copyright (c) 2008, Chattanooga Times/Free Press, Tenn.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By JOHN McCANN

RELATIVES of patients who died in hospital after contracting the C. diff bug are to take legal action.

A total of 18 deaths have been linked to the clostridium difficile bacteria at the Vale of Leven Hospital in Alexandria, Dunbartonshire, and in half of the cases it was the main cause of death.

Families of seven of the nine victims have announced they intend to pursue NHS Greater Glasgow and Clyde through the courts.

One of the family members, Michelle Stewart, 33, whose mother-in- law Sarah McGinty, 67, died after contracting C. diff, said the case was not about financial gain .

She added: “My motherin-law had had a stroke, but that was in December last year.

“She was all set to come home, but then she contracted C. diff.

“They put down the stroke as the cause of death, but she was coming home.

We had a care package in place.”

The families are meeting today in Dumbarton to outline the grounds of their legal challenge and are expected to announce details of its legal team.

In the outbreak, dating back to January, 55 patients have been diagnosed with C. diff. The last one died last month and two patients are still being treated in isolation for the bug.

An unconnected outbreak at Glasgow’s Victoria Infirmary has closed a ward to new admissions. No one has died there but four patients have been isolated.

A NHS Greater Glasgow and Clyde spokeswoman said: “We have not been informed of any intended legal action at this stage.

“However, we recognise the rights of patients or their next of kin to use the complaints procedure, or indeed take legal action, and we have processes in place to deal with such matters.”

Last week it was revealed a record number of pensioners have been diagnosed with the C. diff bug in Scotland.

Figures showed there were 1861 cases among the over-65s between January and March this year, up 16-per cent from 1608 in the past three months of 2007.

Health professionals said the rise could be linked to the changing seasons but warned it is too early to draw defi nite conclusions, as rates have been monitored for less than two years.

The cases at the Vale of Leven led to accusations that Health Secretary Nicola Sturgeon did not act quickly enough to tackle the outbreak.

But she hit back, stating as soon as it was brought to her attention a review of infection control procedures was ordered. She also announced an independent review, with results expected later this month.

Last month Tom Divers, chief executive of NHS Greater Glasgow and Clyde, said he “bitterly regretted” the shortcomings at the Vale of Leven and offered to apologise if further failures were identified.

News of the legal action in Scotland came as it emerged the NHS is being sued for tens of millions of pounds in damages over bugs contracted in hospitals.

Almost GBP7.5m has already been paid out to more than 100 victims of the superbug MRSA and C. diff.

A backlog of hundreds more claims are yet to be settled, with GBP42m set aside to cover potential payouts.

Originally published by Newsquest Media Group.

(c) 2008 Evening Times; Glasgow (UK). Provided by ProQuest Information and Learning. All rights Reserved.

By ROAD TO FITNESS MARJIE GILLIAM

Cynthia Brooks is a Certified Hydro Pilates instructor with more than 25 years of fitness education. Since discovering Hydro Pilates, a form of water exercise, and recognizing the many benefits that can be gained from this type of activity, she has become passionate about spreading the word to others.

Water workouts improve overall fitness levels by providing an excellent workout for the cardiovascular system, as well as improving flexibility and muscular strength. Hydro Pilates exercises involve nonimpact strengthening and stretching movements that help develop trunk stabilization, enhance muscle strength, correct posture and relieve stress. The water allows for ease of movement, making it an ideal activity for those with joint problems or other conditions that may prohibit traditional forms of exercise.

Brooks says, “People can maneuver themselves more easily in the water than they can trying to get up and down from a mat on the floor. Hydro Pilates strengthens the lower back muscles and can increase range of motion since the water alleviates the pull of gravity. Folks who are recovering from an injury or surgery find aquatic exercise an excellent way to rehabilitate. Many top athletes (even race horses) use exercise in the water as a complement to their training. You can move your body in ways that you simply couldn’t on land. For example, people who cannot do a karate type kick on land are able to in the water. The cardio section of the Hydro Pilates class involves minimum impact, just enough for bone health.”

As a former triathlete, Brooks was drawn to the water to stretch and workout in a nonjarring environment, which led to her teaching water aerobics, first in 1980 at Wright State and then at various facilities in the area including Five Seasons, the Metro YMCA’s, Country Club of the North and private swim clubs. For the past 10 years she has worked with Beavercreek High School’s cross-country team. “I try to make the workouts challenging, since I really like to work out, but the class participants are encouraged to go at their own pace and listen to their bodies.”

Anyone can have fun and benefit from taking a water class, Brooks says. “It can be performed by young and old alike, healthy and not so healthy, and women who are pregnant. You don’t need to know how to swim to benefit from water exercise; success can be achieved with no previous experience.”

Mary Lou Snyder has taken the Hydro Pilates class for several years. She says, “It has strengthened my body core tremendously and improved my breathing. In addition to all the improvements health- wise, I enjoy the fun and fellowship it provides. Cynthia’s class has improved my attitude and reason for exercising. I am 75 years old, and my doctor tells me, ‘Don’t stop Hydro Pilates.’ “

Brooks is currently teaching half of her water workouts at the Metro YMCA’s and has held classes at Five Seasons since 1999. Hydro Pilates is also featured at the Club of the North and Green Valley Swim Club, and if you have a backyard pool, personal training sessions can be arranged. Private sessions with one or more participants offer more individualized workouts, exercise form correction and lots of motivation. The classes are built on having fun.

Most sessions are 40 minutes long and include 15 minutes of cardio work, 15 minutes of Pilates and 10 minutes of stretching. Some of the workout moves designed for core strength involve the use of “noodles” — 3-foot-long foam flotation devices that provide support and safety in the water as participants perform a variety of abdominal exercises. Other moves use a noodle under the foot for resistance for both strengthening and flexibility, sweeping the leg across the body to work inner thighs and hip area.

Brooks says, “Most of the stresses and fatigue felt in the body are the result of poor posture, strength and/or flexibility imbalances, and incorrect breathing patterns. Pilates initiates movements from the abdominal, lower back, hip and buttock areas, flowing outward to the extremities. In Hydro Pilates movement, control is essential and begins with redefining the torso. You simultaneously stretch and strengthen the body, creating a habit of relaxed effort to follow. Instead of developing bulky muscles, a more streamlined shape can be achieved. Most of all, Hydro Pilates and water workouts are kind to the body, invigorating and ultimately relaxing.”

For more information on Hydro Pilates, Brooks can be reached at (937) 581-0164.

Marjie Gilliam is an International Sports Sciences Association Master certified personal trainer and fitness consultant. She owns Custom Fitness Personal Training Services. Write to her in care of the Dayton Daily News, call her at (937) 878-9018 or send e-mail to [email protected]. Her Web site is at www.ohtrainer.com.

(c) 2008 Dayton Daily News. Provided by ProQuest Information and Learning. All rights Reserved.

By K. ANDREW CRIGHTON

IN THIS HIGHLY charged political year, one issue continues to stand out: fear over the ever-escalating cost of health care.

Although the candidates from both parties differ in how they would approach this problem, they agree that increasing access to primary and preventive health care is key to reducing the staggering expense of chronic diseases.

This position is well-placed. Indeed, 30 percent of Americans live with chronic diseases that account for 70 percent of all deaths in the United States. And despite the fact that chronic diseases are simultaneously the most costly and the most preventable among our health problems, our system is focused on treating diseases rather than preventing or curing them.

A recent report published by the World Economic Forum identified chronic disease as a phenomenon as threatening as global warming, terrorism, infectious disease or poverty. Representing 75 percent of our nation’s $2 trillion in medical spending, chronic disease is literally and figuratively crippling our nation.

The forum looked beyond the easily measurable direct costs of chronic disease and examined its impact on productivity costs. They found that productivity losses associated with workers dealing with chronic disease are as much as 400 percent more than the cost of treating the chronic disease itself.

Shortchanging arthritis

One of the most overlooked chronic diseases is arthritis. Arthritis affects 1.6 million people in our state alone and is the No. 1 cause of disability in people over the age of 16.

The estimated direct and indirect costs of arthritis in New Jersey in 2003 were $3.5 billion and have been on the rise since. A study of four large U.S. employers published by the Journal of Occupational and Environmental Medicine, and cited in the forum’s report, identified the top 10 drivers of health care and productivity costs. Among them, arthritis ranked seventh in overall cost.

Despite the ever-increasing prevalence and impact of arthritis, government spending continues to decline. National Institutes of Health funding for arthritis research has been steadily declining for the past six years, falling from $374 million in 2004 to a projected $339 million in 2008 – a loss of $35 million in real dollars.

Funding for prevention of arthritis at the Centers for Disease Control and Prevention has remained flat for more than five years at $13 million just about 25 cents per American with arthritis. And right here in New Jersey, we are entering our second year of zero funding for arthritis in our state.

The United States has always been known for providing the highest quality of life for its citizens. Arthritis, along with other chronic diseases, robs people of their quality of life from both economic and health standpoints.

The forum’s report stresses that if we don’t address the problem of chronic disease, our ability to fight other global issues will be greatly jeopardized.

Political issue

It’s time our nation stood up for the millions of Americans fighting the disabling effects of arthritis and other chronic diseases, as well as protected those at risk for developing a chronic disease in the future.

Our economy, our health care system, our citizens, our family members, our children and our friends deserve better.

Our nation simply cannot afford to ignore this looming crisis. We need to keep this issue in front of the candidates and ask them, along with our elected officials, to pass legislation that will encourage our health care system to focus on preventing and curing chronic diseases such as arthritis, not just treating them.

***

K. Andrew Crighton is chairman of the board of directors of the New Jersey chapter of the Arthritis Foundation and vice president and chief medical officer of Prudential Financial.

(c) 2008 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.

In addition to helping protect us from heart disease and cancer, a balanced diet and regular exercise can also protect the brain and ward off mental disorders.

“Food is like a pharmaceutical compound that affects the brain,” said Fernando G³mez-Pinilla, a UCLA professor of neurosurgery and physiological science who has spent years studying the effects of food, exercise and sleep on the brain. “Diet, exercise and sleep have the potential to alter our brain health and mental function. This raises the exciting possibility that changes in diet are a viable strategy for enhancing cognitive abilities, protecting the brain from damage and counteracting the effects of aging.”

G³mez-Pinilla analyzed more than 160 studies about food’s affect on the brain; the results of his analysis appear in the July issue of the journal Nature Reviews Neuroscience and are available online at www.nature.com/nrn/journal/v9/n7/abs/nrn2421.html.

Omega-3 fatty acids “” found in salmon, walnuts and kiwi fruit “” provide many benefits, including improving learning and memory and helping to fight against such mental disorders as depression and mood disorders, schizophrenia, and dementia, said G³mez-Pinilla, a member of UCLA’s Brain Research Institute and Brain Injury Research Center.

Synapses in the brain connect neurons and provide critical functions; much learning and memory occurs at the synapses, G³mez-Pinilla said.

“Omega-3 fatty acids support synaptic plasticity and seem to positively affect the expression of several molecules related to learning and memory that are found on synapses,” G³mez-Pinilla said. “Omega-3 fatty acids are essential for normal brain function.

“Dietary deficiency of omega-3 fatty acids in humans has been associated with increased risk of several mental disorders, including attention-deficit disorder, dyslexia, dementia, depression, bipolar disorder and schizophrenia,” he said. “A deficiency of omega-3 fatty acids in rodents results in impaired learning and memory.”

Children who had increased amounts of omega-3 fatty acids performed better in school, in reading and in spelling and had fewer behavioral problems, he said.

Preliminary results from a study in England show that school performance improved among a group of students receiving omega-3 fatty acids. In an Australian study, 396 children between the ages 6 and 12 who were given a drink with omega-3 fatty acids and other nutrients (iron, zinc, folic acid and vitamins A, B6, B12 and C) showed higher scores on tests measuring verbal intelligence and learning and memory after six months and one year than a control group of students who did not receive the nutritional drink. This study was also conducted with 394 children in Indonesia. The results showed higher test scores for boys and girls in Australia, but only for girls in Indonesia.

Getting omega-3 fatty acids from food rather than from capsule supplements can be more beneficial, providing additional nutrients, G³mez-Pinilla said.

Scientists are learning which omega-3 fatty acids seem to be especially important. One is docosahexaenoic acid, or DHA, which is abundant in salmon. DHA, which reduces oxidative stress and enhances synaptic plasticity and learning and memory, is the most abundant omega-3 fatty acid in cell membranes in the brain.

“The brain and the body are deficient in the machinery to make DHA; it has to come through our diet,” said G³mez-Pinilla, who was born and raised in salmon-rich Chile and eats salmon three times a week, along with a balanced diet. “Omega-3 fatty acids are essential.”

A healthy diet and exercise can also reduce the effect of brain injury and lead to a better recovery, he said.

Recent research also supports the hypothesis that health can be passed down through generations, and a number of innovative studies point to the possibility that the effects of diet on mental health can be transmitted across generations, G³mez-Pinilla said.

A long-term study that included more than 100 years of birth, death, health and genealogical records for 300 Swedish families in an isolated village showed that an individual’s risk for diabetes and early death increased if his or her paternal grandparents grew up in times of food abundance rather than food shortage.

“Evidence indicates that what you eat can affect your grandchildren’s brain molecules and synapses,” G³mez-Pinilla said. “We are trying to find the molecular basis to explain this.”

Controlled meal-skipping or intermittent caloric restriction might provide health benefits, he said.

Excess calories can reduce the flexibility of synapses and increase the vulnerability of cells to damage by causing the formation of free radicals. Moderate caloric restriction could protect the brain by reducing oxidative damage to cellular proteins, lipids and nucleic acids, G³mez-Pinilla said.

The brain is highly susceptible to oxidative damage. Blueberries have been shown to have a strong antioxidant capacity, he noted.

In contrast to the healthy effects of diets that are rich in omega-3 fatty acids, diets high in trans fats and saturated fats adversely affect cognition, studies indicate.

Junk food and fast food negatively affect the brain’s synapses, said G³mez-Pinilla, who eats fast food less often since conducting this research. Brain synapses and several molecules related to learning and memory are adversely affected by unhealthy diets, he said.

Emerging research indicates that the effects of diet on the brain, combined with the effects of exercise and a good night’s sleep, can strengthen synapses and provide other cognitive benefits, he added.

In Okinawa, an island in Japan where people frequently eat fish and exercise, the lifespan is one of the world’s longest, and the population has a very low rate of mental disorders, G³mez-Pinilla noted.

Folic acid is found in various foods, including spinach, orange juice and yeast. Adequate levels of folic acid are essential for brain function, and folate deficiency can lead to neurological disorders such as depression and cognitive impairment. Folate supplementation, either by itself or in conjunction with other B vitamins, has been shown to be effective in preventing cognitive decline and dementia during aging and enhancing the effects of antidepressants. The results of a recent randomized clinical trial indicate that a three-year folic acid supplementation can help reduce the age-related decline in cognitive function.

In patients with major depression and schizophrenia, levels of a signaling molecule known as brain-derived neurotrophic factor, or BDNF, are reduced. Antidepressants elevate BDNF levels, and most treatments for depression and schizophrenia stimulate BDNF. Here, too, omega-3 fatty acids are beneficial, as is the curry spice curcumin, which has been shown to reduce memory deficits in animal models of Alzheimer’s disease and brain trauma. BDNF is most abundant in the hippocampus and the hypothalamus “” brain areas associated with cognitive and metabolic regulation.

The high consumption of curcumin in India may contribute to the low prevalence of Alzheimer’s disease on the subcontinent.

In humans, a mutation in a BDNF receptor has been linked to obesity and impairments in learning and memory.

“BDNF is reduced in the hippocampus, in various cortical areas and in the serum of patients with schizophrenia,” G³mez-Pinilla said. “BDNF levels are reduced in the plasma of patients with major depression.”

Smaller food portions with the appropriate nutrients seem to be beneficial for the brain’s molecules, such as BDNF, he said.

G³mez-Pinilla showed in 1995 that exercise can have an effect on the brain by elevating levels of BDNF.

He noted that while some people have extremely good genes, most of us are not so lucky and need a balanced diet, regular exercise and a good night’s sleep.

The research was funded by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke.

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• University of California – Los Angeles

By JONI AVERILL

Unity College will hold the Maine International Film Festival Pre- Party from 6:30 to 8:30 p.m. Thursday, July 10, at the Unity College Centre for the Performing Arts, reports Mark Tardiff of the college.

Free and open to the public, the pre-party is co-sponsored by Unity College and UniTel of Unity. Light refreshments will be served.

Special guests include festival participants housed on the Unity campus, festival director Shannon Haines, festival programmers Ken and Beth Eisen and directors Christina Hemaner and Roman Keller.

Tardiff wrote that Hemaner and Keller will screen a trailer of their documentary titled “A Road Not Taken,” which will be among the works screened during the festival.

“This film was shot, in part, at Unity College,” Tardiff said, “and tells a timely story about American oil dependence, and a lack of will to pursue alternative energy.”

The pre-party also will feature a re-enactment of former President Carter’s “historic Rose Garden speech given during the installation of the solar panels atop the White House.”

More information about the 2008 Maine International Film Festival is available at http://www.miff.org/about/

Executive director Joshua Campbell Torrance reports the first of a series of Woodlawn Museum Wednesday Afternoon Teas and Tours is at 3 p.m. today at the museum on Route 172 in Ellsworth.

The cost is $20 for nonmembers, $18 for museum members, and includes a tour of the museum. Reservations are suggested and can be made by calling 667-8671.

The remaining tea dates, at the same time, are July 23, Aug. 6 and Aug. 20.

In addition, from 1 to 4 p.m. Tuesday through Sunday, tea will be presented in a picnic basket for guests who would like to “take their tea anywhere they choose on the estate,” Torrance wrote.

The cost for the tea with refreshments is $10, or $5.95 for just the tea. A different homemade treat will be offered each week.

More information about the museum and its activities is available at www.woodlawnmuseum.org.

Pianist Roberto Pace and flutist Andrea Maurer entertain during the free Mary Potterton Memorial Piano Concert at 7:30 tonight at Lubec Congregational Christian Church.

Free intermission refreshments will be provided by the Blueberry Point Chefs and Ice House Wine and Cheese Shop of Perry. For more information, call 733-2316.

In memory of their late friend Ernie Griswold, Roger and Sally Lycette will open their gardens to the public from 1 to 6 p.m. Friday, July 11, at their home, 1348 Ohio St. in Bangor.

Admission is free, but “anyone who would like to make a donation to help the family with expenses may do so at the gardens,” they wrote.

Jackie Nicholson e-mailed that “all women are welcome to attend” the Hancock Woman’s Club meeting at 7 p.m. Thursday, July 10, at the Hancock Community Center.

Rich Malaby of Hancock and Rob Eaton of Sullivan will discuss the topic of “School District Consolidation and its Impact on Towns.”

The event includes “refreshments and socializing,” Nicholson wrote, encouraging interested women to attend this informative meeting.

For more information call 422-6614.

Nancy Herr reminds residents and visitors that the nonprofit Ruggles House Society, which maintains and supports the historic Ruggles House Museum, offers guided tours from 9:30 a.m. to 4:30 p.m. Monday through Saturday and from 11 a.m. to 4:30 p.m. Sundays. The museum is located at 146 Main St. in Columbia Falls.

Noted for its Federal period architecture, Herr wrote that the building features a “flying staircase, intricate carvings and period antiques.”

Admission is $5 for adults, $2 for children. More information can be obtained by calling 483-4637 or at www.ruggleshouse.org.

The reservation deadline for those planning to attend the EMGH, EMMC, Husson College Nurses Alumni Association Alumni Reunion is Saturday, July 12. The reunion begins at 1 p.m. Saturday, July 19, at Campus Center at Husson College in Bangor.

After the meet-and-greet session at 1 p.m., the reunion features games and surprises from 2 to 4 p.m., a silent auction from 4 to 5:30 p.m. and dinner served by Chef Brian Ross of JB Cafe and Catering at 5:30 p.m.

The cost of the dinner is $16 and reservations must be made with Gloria Lee, Treasurer, 238 Goshen Road, Winterport 04496.

For more information, call Barbara Higgins of Veazie at 942-9648 or 399-1872.

Joni Averill, Bangor Daily News, P.O. Box 1329, Bangor 04402; [email protected]; 990-8288.

(c) 2008 Bangor Daily News. Provided by ProQuest Information and Learning. All rights Reserved.

The National Institutes of Health (NIH) awarded ICF International (NASDAQ:ICFI) subsidiary, Z-Tech, a new contract, Electronic Research Administration (eRA)–Systems Engineering Support Services, for $60 million for five years. Z-Tech will provide systems engineering, architecture, requirements analysis, and other related IT support to the eRA program.

“Z-Tech is pleased to expand its longstanding support to the eRA program, which makes concrete and direct contributions to people’s lives via the use of state-of-the-art information technology,” said Paul Tardif, a senior vice president with the company. “We are committed to helping NIH achieve its mission to fund and support life-saving medical research.”

“This contract win reaffirms ICF’s position as a major provider of high-end IT services to the federal government, and it also enhances our ability to provide health information technology and grants management services,” said Ellen Glover, executive vice president.

eRA, a NIH mission-critical system, manages all of NIH’s grants processing and also supports other federal agencies. The system processes more than 80,000 grant applications per year and administers 55,000 research and non-research grants totaling $30 billion annually. eRA is used by over 150,000 federal staff and applicants at more than 9,500 institutions worldwide.

About Z-Tech and ICF International

With the addition of Z-Tech, ICF International now offers the services of an established leader in health information and health technology services. Z-Tech provides full life-cycle services in grants management, bioinformatics, scientific computing, modeling and simulation, software engineering, Web design and development, and health technology solutions. Together, ICF and Z-Tech have expanded capabilities to assist governments at all levels and private organizations to develop more effective health information technology, health communications, health policy analysis, and health information clearinghouses.

ICF International (NASDAQ:ICFI) partners with government and commercial clients to deliver consulting services and technology solutions in the energy, climate change, environment, transportation, social programs, health, defense, and emergency management markets. The firm combines passion for its work with industry expertise and innovative analytics to produce compelling results throughout the entire program life cycle, from analysis and design through implementation and improvement. Since 1969, ICF has been serving government at all levels, major corporations, and multilateral institutions. More than 3,000 employees serve these clients worldwide. ICF’s Web site is www.icfi.com.

Caution Concerning Forward-looking Statements

This document may contain “forward-looking statements” as that term is defined in the Private Securities Litigation Reform Act of 1995–that is, statements related to future–not past–events, plans, and prospects. These statements involve known and unknown risks, uncertainties, and other factors that may cause our actual results, levels of activity, performance, or achievements to be materially different from any future results, levels of activity, performance, or achievements expressed or implied by such forward-looking statements. In some cases, you can identify these statements by forward-looking words such as “guidance,””anticipate,””believe,””could,””estimate,””expect,””intend,””may,””plan,””potential,””seek,””should,””will,””would,” or similar words. You should read statements that contain these words carefully because they discuss our future expectations, contain projections of our future results of operations or of our financial position, or state other forward-looking information, and are subject to factors that could cause actual results to differ materially from those anticipated. For ICF, particular uncertainties that could adversely or positively affect the Company’s future results include but are not limited to: risks related to the government contracting industry, including the timely approval of government budgets, changes in client spending priorities, and the results of government audits and investigations; risks related to our business, including our dependence on contracts with U.S. Federal Government agencies and departments and the State of Louisiana; continued good relations with these and other customers; success in competitive bidding on recompete and new contracts; performance by ICF and its subcontractors under our contract with the State of Louisiana, Office of Community Development, including but not limited to the risks of failure to achieve certain levels of program activities, termination, or material modification of the contract, and political uncertainties relating to The Road Home program; uncertainties as to whether revenues corresponding to the Company’s contract backlog will actually be received; the future of the energy sector of the global economy; our ability to attract and retain management and staff; strategic actions, including attempts to expand our service offerings and client base, the ability to make acquisitions, and the performance and future integration of acquired businesses; risks associated with operations outside the United States, including but not limited to international, regional, and national economic conditions, including the effects of terrorist activities, war, and currency fluctuations; and other risks and uncertainties disclosed in the Company’s filings with the Securities and Exchange Commission. These uncertainties may cause ICF’s actual future results to be materially different than those expressed in the Company’s forward-looking statements. ICF does not undertake to update its forward-looking statements.

AHG (NYSE:AHG), the nation’s leading home healthcare company, will hold its quarterly conference call to discuss second quarter 2008 results Wednesday, July 30, at 11:15 a.m. Eastern Time (8:15 a.m. Pacific Time).

This call is being webcast by Thomson Reuters and can be accessed at Apria Healthcare’s web site at http://www.apria.com/.

The webcast is also being distributed over Thomson Reuter’s Investor Distribution Network to both institutional and individual investors. Individual investors can listen to the call through Thomson Reuter’s individual investor center at www.fulldisclosure.com or by visiting any of the investor sites in Thomson Reuter’s Individual Investor Network. Institutional investors can access the call via Thomson Reuter’s password-protected event management site, StreetEvents (www.streetevents.com).

Apria provides home healthcare products and services, including oxygen, home-delivered respiratory medications and respiratory equipment, a broad range of specialty home infusion services and medical equipment, negative pressure wound therapy, and diabetic supplies. With approximately 550 branch and 85 infusion pharmacy locations nationwide, Apria serves 2 million patients annually throughout all 50 states. The Company is contracted with over 2,500 managed care organizations and serves patients covered by Medicare and Medicaid as well.

This release may contain statements regarding anticipated future developments that are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Results may differ materially as a result of the risk factors included in the Company’s filings with the Securities and Exchange Commission and other factors over which the Company has no control.