Great Brands of Europe, Inc. Issues Allergy Alert on Le PIM's Soft Biscuits with Fruit Filling ( March 14, 2002)
Wilton, CT -- Great Brands of Europe, Inc. is voluntarily recalling all three flavors (Orange, Pear and Raspberry) of its Le PIM’s soft biscuits with fruit filling sold in the United States, because the products may contain undeclared traces of milk protein. Only people who have an allergy or severe sensitivity to milk protein run the risk of serious or life-threatening allergic reaction if they consume these products.

These products were distributed nationwide through retail stores.

The products come in cardboard packaging of 150 g (5.29 oz), in three flavors: Orange, Pear and Raspberry (UPC codes 6-94990-00850-6, 6-94990-00855-1, and 6-94990-08370-1). No other UPC codes are affected by this action.

One allergic reaction to milk protein has been reported.

This voluntary action was initiated after it was discovered that product containing traces of milk protein was distributed in packaging that did not reveal the presence of milk.

Great Brands of Europe, Inc. was made aware of the situation after receiving one consumer complaint. 

Consumers who have known food allergies to milk protein should not eat this product and are urged to return it to the store where it was purchased for a full refund. These products are safe for consumption by all other consumers.

Should consumers have questions regarding this matter they should call Great Brands of Europe’s consumer line at 1-800-322-4619.

Stopping the Spread of Cancer ( March 11, 2002)
JACKSONVILLE, Fla. (Ivanhoe Newswire) -- New treatments have helped improve the survival rates of women first diagnosed with breast cancer. Doctors say, however, the cancer will return in other organs in one-third of the women. It’s called metastatic breast cancer and is what kills 45,000 women each year. Now, a new class of anticancer drugs looks promising for these women. 

These days Paul Lilling takes over kitchen duties for his wife, Irene. Irene was diagnosed with breast cancer in 1996. She was in remission for five years. Then, the cancer returned in her neck, lung and liver.

"It was disappointing, but from what I’ve read, that’s not uncommon," Paul tells Ivanhoe.

Irene says, "I was in complete shock. I thought I was home free."

Irene has her feet up because of the side effects she’s experiencing from an experimental cancer drug, called epothilone B. Edith Perez, M.D., tells Ivanhoe that, while the drug is tough on patients, it is also tough on the cancer.

"I think, based on the information we have so far, this is a promising therapy for patients with advanced breast cancer," says Dr. Perez, a hematologist/oncologist at the Mayo Clinic in Jacksonville, Fla.

The drug is particularly useful for patients who do not respond to commonly used breast cancer drugs.

"It is critical that we continue our research to improve the lives of our patients, because we want people to live longer and to live better," says Perez.

The new treatment seems to be working for Irene. At last check, her tumors had shrunk. She says, "One doctor uses the word remission, and I want to believe it. I’m excited about that."

For Irene, the side effects are worth it, if it means more time with her family.

Epothilone B is only available to women participating in clinical trials and is not approved by the FDA. Side effects of the drug include numbness and tingling in the patients’ fingers and toes. 

If you would like more information, please contact:

Erik Kaldor
Mayo Clinic
4500 San Pablo
Jacksonville, FL 32224
(904) 953-2299
kaldor.erik@mayo.edu

Effects of Late Pregnancy ( March 11, 2002)
(Ivanhoe Newswire) -- More babies are beginning with rocky starts because more women are waiting to have children later in life. New research finds older mothers are more likely to have babies who are delivered early, have low birth weight, or are a multiple. The Canadian study is published in the current issue of Pediatrics.

In the year 2000, research shows 13.3 percent of all births in the United States were to women 35 years and older. Of those, 22 percent were first-time mothers. In Canada, first-time mothers aged 30 to 34 increased 21 percent in 20 years. Researchers in Alberta, Canada, were curious as to whether babies born to older mothers were at increased risk of any medical problems.

The findings do indicate that the increase in low birth weight babies and pre-term deliveries (less than 37 weeks) is partly connected to the age of the mothers. The researchers write, "Our findings suggest that the number of infants who require neonatal transport, intensive care, and ongoing medical care will continue to rise if the trend toward delayed childbearing continues, given that lower birth weight infants have 20.5 percent more physician visits than heavier birth weight peers during the first five years."

Additionally, waiting to have children is directly related to having multiples. "Delayed childbearing accounted for 15 percent of the twin increase and 69 percent of the triplet increase," write the researchers. These high numbers are contributed partly to the number of women who use in-vitro fertilization.

Researchers say these findings are important for both prospective parents and heath care workers to be aware. In particular, they point out the higher risk for neonatal illnesses and the impact on health care resources.

SOURCE: Pediatrics, 2002;109:399-403

Saving Lives at Gyms ( March 11, 2002)
(Ivanhoe Newswire) -- Move over treadmills and stationary bicycles and make room for defibrillators. A new statement by the American Heart Association and the American College of Sports Medicine urges fitness centers to have automated external defibrillators (AED) on hand. They say with these devices, and more awareness by gym personnel and members, lives can be saved.

The statement, written by a group of doctors representing the American Heart Association, is in this week's issue of Circulation. They write, "Importantly, for victims of sudden, shockable cardiac arrest, the single greatest determinant of survival is the time from collapse to defibrillation." 

An AED is a textbook-sized device that can shock the heart back into its normal rhythm. They are simple to use and doctors say can make the difference between life and death. They range in price from $3,000 to $4,500 and as they gain in popularity, the price is expected to drop.

The AHA urges fitness centers to have an AED because of the increase in fitness attendees and the likelihood that many of these people are living with heart disease. While the AHA is asking gyms with more than 2,500 members to respond to their request, they also recommend unsupervised gyms consider adding an AED or at the least, a telephone. These types of places include workout facilities in apartment complexes, hotels and office buildings. 

SOURCE: Circulation, 2002;105:1147-1150

Understanding Eating Disorders ( March 11, 2002)
(Ivanhoe Newswire) -- A father's role may be more important than previously thought in the development of eating disorders. New research finds the paternal relationship may have more influence in this area than the mother-child relationship.

Researchers from New York, recently reviewed the medical files of 782 mothers and their children. The doctors were trying to understand how childhood adversities (abuse, mistreatment, problematic relationships) contribute to the development of eating disorders or weight problems. Previous research shows that individuals with eating disorders are more likely to report a history of childhood problems.

Doctors looked at psychiatric disorders in parents and children, as well as parenting styles and behavior, abuse or neglect and the physical environment in which the child grew up. Fifty-two or 6.6 percent of the children were diagnosed as having an eating disorder during their adolescence or early adulthood.

The researchers report, "Children who experienced physical neglect or sexual abuse during childhood were at elevated risk for eating disorders and for several types of eating or weight problems during adolescence or early adulthood." Children who experienced three or more negative behaviors from their fathers were three times as likely to have eating disorders. The doctors were surprised at this finding, as previous research has relied heavily on the mother-child relationship.

SOURCE: American Journal of Psychiatry, 2002;159:394-400

Too Fat? Pop a Pill ( March 10, 2002)
Your dietician is lying if she tells you that there is no magic pill to knock off a few kilos. There is. In fact, there are a variety of them. Walk into any chemist shop and ask for allopathic anti-obesity pills. Chances are, you will be dazed by the assortment and the accompanying guarantees.

Roughly, these pills can be categorized into two groups-ones that suppress hunger, and other that reduce fat absorption. The first-chemical fat absorption. The first-chemical name sibutramine, sold under brand names Obestat, sibutrex, Sibutrim and Slenfig-work by interfering with chemical messages in the central nervous system so as to produce a feeling of fullness. The other pills, available under the brand name Xenical (chemical name orlisatat), decrease absorption of fat by about 30 per cent. While sibutramine pills are freely available in India, Xenical can be bought on the Internet or at select chemist shops, under the counter.

Though technically, sibutramine and orlistat pills are meant for obese people, in reality, teenagers and others who are slightly overweight are popping these pills to avoid getting on to the stepper for a few minutes.

Manufacturers admit that though these are prescription drugs, their unregulated, self-referring market is expanding rapidly. Already, India's monthly consumption of anti-obesity pills is worth Rs. 1.1 crore.

But can a pill really make you lose your appetite and turn your body into a calorie-burning machine? Well, opinion is divided.

Dr. R.K.Suri, A Delhi-based diabetologist says, "Though these drugs are made for people with obesity-related diseases, most can't take them because their side effects far outweigh the risk of being mildly overweight." About 40 to 50 per cent of his patients who were prescribed sibutramine, complained of high blood pressure. "And in the rest negligible weight loss was recorded."

Dr. Suri, however, is all praise for Xenical, a "beautiful drug that reduces fat absorption by 30 per cent." But warns that Xenical may result in loose stools.

Dr. Rakesh Gupta, a senior consultant with Apollo Hospital, who has been prescribing sibutramine pills for over a year-and-a-half , however, finds them very effective. "When taken along with a controlled diet and regular exercise, they help in reducing 8 to 10 per cent body weight in six months. And frankly, I have not seen any side effects, " he said.

"Sibutramine acts on the brain's satiety centres and kills hunger. As, for some, feeling satisfied with less food is a major barrier to weight loss, medication is necessary to control their appetite." Dr. Gupta said.

But if you are tempted to knock off a few kilos by popping these pills, be warned. Sibutramine pills have a long list of side effects, the most common being insomnia. "People who take sibutramine often return to buy sleeping pills," a chemist said. More serious, though, are depression, visual disorders and impotence. Slimming pills have also been known to lead to addiction, blood disorders, psychosis and even death.

The Duchess of York is one of the most famous victims of slimming pills. The pills fogged Fergie`s brain and she became "hysterical" and had to be weaned off the pills.

Dr. Manish Chawla, who works at Cipla and is happy that their Obestat is doing "great business" said, "These medicines have been tested internationally. All drugs have side effects and so do these. But compared to the benefits, the side effects are negligible." Obestat, he says, can be taken once daily for up to two years, and helps in shedding 5-10 per cent body weight.

Dr. Sanghi, who runs Delhi's Pulse Impulse health clinic, however, rejects the sales pitch. "If these pills are so wonderful, why do drug companies restrict their use to two years?" Because, she explains, long term use of these pills will result in complications similar to those of starving and anemia: Vitamin deficiency that may affect eyes, hair, skin, and other body parts.

Dr. Makhija, a well-known Delhi dietician says," These drugs help initially-by motivation you and reducing your food intake. But you have to get off them soon. You have to learn to manage your food and not fool your brain into thinking that your have eaten.

The bottom line is, these pills are handy in curing obesity-caused by a sedentary lifestyle, abundance of high-calorie foods and ever-expanding portion sizes-when taken under supervision, along with controlled diet and exercise, they get the initial push and motivation with these pills, " Dr. Sangh said. But remember, these will only suppress your appetite. Not greed.

SOURCE: Article is taken from HINDUSTAN TIMES SUNDAY MAGAZINE, March 10, 2002

Self-Injury and Eating Disorders ( March 7, 2002)
(Ivanhoe Newswire) -- There may be a new sign or symptom for families and doctors to look for in connection with eating disorders. A new study confirms what doctors previously suspected: Women with eating disorders might physically try to injure themselves. 

Researchers from Germany set out to study 376 women with eating disorders to determine if they are at higher risk of self-injury. Earlier research shows 4 percent to 10 percent of psychiatric patients deliberately harm themselves. The behaviors mostly include cutting, hitting or scratching. 

The women were an average of 24 years old. Of the participants, 119 were hospitalized for anorexia, 137 for bulimia, and another 120 for other types of eating disorders. Nearly 35 percent reported having injured themselves deliberately in their lifetime and 21 percent of those had done it in the previous six months. 

Earlier studies have connected sexual abuse and self-injury. In this study, 67 patients reported sexual abuse before age 13 and another 78 reported being abused after that age. The researchers write, "Group comparisons emphasized the relevance of traumatic experiences." They feel it is important for doctors to understand this association so they may be prepared to look for self-injurious behavior in patients. 

The doctors conclude patients with eating disorders are at higher risk of self-injury and recommend routine screening for this group of patients. They point out bulimic patients who binge and purge are the most likely ones to be at risk and that anorexic patients do not necessarily share the same amount of risk. 

SOURCE: American Journal of Psychiatry, 2002;159:408-411

Yoga For Your Pain (March 7, 2002)
ORLANDO, Fla. (Ivanhoe Newswire) -- From 25 percent to 30 percent of all Americans suffer from chronic pain. Most turn to medication for relief. A new study shows there is a more natural way to find relief. In fact, your body may already have what it takes to be pain-free. 

Should Eric Small ever need proof he is making a difference, he could find it in the back row of his 7 a.m. yoga class. One of his students, Mary Jean Scheuer, says, "But, I’ll tell you, you can see it in the hands. They’d swell up like little hams. I do the yoga. And see my hands? I couldn’t do that before."

This 71-year old says her arthritis pain disappeared when she met Small and started practicing iyenger yoga, a type of yoga that combines breathing exercises with difficult poses.

Child & adolescent psychiatrist Sonia Gaur, M.D., is not surprised. She practices the same type of yoga, and recently put it to the test.

Eighteen chronic pain patients took a 90-minute yoga class three times a week. Four weeks later, "They managed to decrease their medication and actually, you know, improve their quality of life," says Guar, of the Harbor-UCLA Medical Center in Torrance. The chronic patients also reported a decrease in anxiety and medication.

It has not cured Gerrie Wormser’s fibromyalgia, but it is making her pain easier to live with. She says, "The thumb pains are still there, the knees, the back. It’s still there, but I can manage it."

Popping a pill may be easier, but fewer side effects and results that are more permanent make this tough medicine worth swallowing for some.

Dr. Gaur says iyengar yoga can also improve your mood and increase your resistance to disease. She says a larger study is needed to determine whether it can actually cure chronic pain. 

If you would like more information, please contact:

Sonia Gaur, M.D.
Department of Child & Adolescent Psychiatry
Harbor-UCLA Medical Center
ypain2000@yahoo.com

Alcohol's Heart-Healthy Benefits ( March 4, 2002)
(Ivanhoe Newswire) -- Studies have shown drinking a moderate amount of alcohol can protect against heart disease. Now researchers studying results from the Framingham Heart Study find the same is true for congestive heart failure.

Congestive heart failure (CHF) is a condition in which the heart weakens and is unable to maintain adequate circulation of the blood. One of the major risk factors for the condition is heart attack, which is caused by heart disease. Since moderate drinking protects against heart disease, doctors have speculated it may also protect against CHF, although studies have been lacking. 

These researchers looked at drinking habits and CHF rates among a group of participants in the Framingham Heart Study, a long-running study of more than 5,000 residents of Framingham, Mass., and their offspring. All were free of CHF and heart disease at the beginning of the study. At follow-up, they found 59 cases of CHF had developed in the men and 120 cases among the women.

Analysis of the data on drinking habits revealed no increased risk for the development of CHF with any level of alcohol consumption. Those who drank a moderate amount of alcohol -- between 8 and 14 drinks a week for men and 3 and 7 drinks a week for women -- had the lowest rates of the disease.

The study's authors write, "In the community, alcohol consumption is not associated with increased risk for congestive heart failure, even among heavy drinkers. To the contrary, when consumed in moderation, alcohol appears to protect against congestive heart failure."

SOURCE: Annals of Internal Medicine, 2002;136:181-191

Stress and Heart Disease in Women ( March 4, 2002)
(Ivanhoe Newswire) -- A new study shows reduced estrogen levels before menopause may influence future heart disease risk in women.

Researchers from Wake Forest University in North Carolina and the University of Pittsburgh have new evidence that a deficiency of estrogen before menopause places women on a high-risk path to heart disease. After studying nearly 200 female monkeys through menopause, researchers linked pre-menopausal stress levels and the depletion of estrogen to heart disease. Estrogen is a hormone believed to be essential to cardiovascular health.

Researchers began the study by determining if the animals were socially dominant or subordinate within their groups. They observed those that were considered subordinate experienced higher levels of stress in their daily lives, a factor that contributed to reduced estrogen levels. These estrogen-deficient monkeys were twice as likely to develop heart disease than the dominant monkeys that maintained normal levels of estrogen until after menopause. 

Subordinate monkeys were further divided into those that received hormone replacement therapy before menopause and those that received treatment after menopause. Researchers found those that received HRT before menopause were half as likely to develop heart disease than "stressed" monkeys that did not receive treatment.

Jay Kaplan, Ph.D., from Wake Forest University, says, "This study adds to the growing body of evidence that cardiovascular health after menopause is influenced by hormone levels many years earlier." He warns women that factors that reduce hormone levels in young adulthood, such as stress or diet and exercise habits, may increase their risk of developing heart disease later in life. Researchers conclude this study "implies that efforts directed at primary prevention of coronary disease in women should include pre-menopausal considerations."

SOURCE: The Green Journal, 2002;99:381-388

Dietary Fiber for Heart Disease ( March 4, 2002)
(Ivanhoe Newswire) -- Women who want to stave off heart disease might want to consider eating more foods high in dietary fiber, such as whole grains, fruits, and vegetables. According to a new study in the Journal of the American College of Cardiology, women who consumed the most dietary fiber were the least likely to suffer a heart attack or develop cardiovascular disease (CVD).

The study involved nearly 40,000 middle-aged women taking part in the Women's Health Study. All participants filled out questionnaires regarding their eating habits, beginning in 1993. At the beginning of the study, none of the women suffered from heart disease or cancer. The women were followed for six years. At the end of the study, there were 570 cases of CVD, including 177 heart attacks. After adjusting for age, results show women who consumed the most fiber had the lowest risk of developing heart disease. 

The relative risk of heart disease remained lower even after adjusting the results to take into account other risk factors, such as smoking history and body mass index. Authors of the study write, "These prospective data generally support current dietary recommendations to increase the consumption of fiber-rich whole grains and fruits and vegetables as a primary preventive measure against CVD."

SOURCE: Journal of the American College of Cardiology, 2002;39:49-56

Nutrition Bars Treat Angina ( March 4, 2002)
(Ivanhoe Newswire) -- Doctors may soon be writing their angina patients prescriptions for nutrition bars. Researchers publishing in this month's Journal of the American College of Cardiology believe food bars containing key nutrients known to improve the symptoms of angina may help treat the condition.

Most people with angina also have coronary artery disease (CAD) and many of the risk factors associated with CAD are linked to reduced nitric oxide activity. While drugs can improve this activity, a number of naturally occurring products can have the same effect, including the nutrient L-arginine, folic acid, vitamins B6 and B12, vitamin C, vitamin E, phytoestrogens and niacin. Previous studies have found this combination of nutrients in a food bar is effective in improving some symptoms of angina. In this study, researchers furthered that work, studying the effects of the food bars on 36 patients with CAD and class II or III angina.

The participants in the study were divided into two groups. One received two food bars with the active ingredients each day for two weeks while the other received two food bars a day without any active ingredients. Then the groups switched. 

While the active food bars did not have any impact on ECG results or angina onset time, patients did report significantly higher exercise times on treadmill tests and higher scores on quality of life questionnaires during the two weeks they were eating the nutrient-rich food bars. 

The researchers conclude nutrition bars containing these key substances, when used along with traditional therapy, can benefit patients with stable angina.

SOURCE: Journal of the American College of Cardiology, 2002;39:37-45

Help For Arthritic Knees ( February 26, 2002)
(Ivanhoe Newswire) -- Doctors have a new tool in their toolbox to help patients who live with painful osteoarthritis of the knee. A new study reports a drug called hyaluronate sodium can help reduce pain and increase function for patients. 

Doctors from three medical centers in Canada compared four different groups of patients with osteoarthritis of the knee. Group 1 was given hyaluronate sodium, group 2 received the drug and nonsteroidal anti-inflammatory drugs (NSAIDs), group 3 was given NSAIDs and a placebo and group 4 received only a placebo. Researchers were looking at the effects of the drug combinations on pain, stiffness, resting pain and function of the knee while walking.

At four weeks, patients who were taking the drug or the drug in addition to NSAIDs reported less pain while walking than those who did not receive the drug. The group given the placebo reported no change in their pain. At week 12, all patients receiving hyaluronate sodium, NSAIDs, or a combination of the two reported less pain while resting than did patients in the placebo group. Those receiving hyaluronate sodium reported significantly less pain during activity than the other groups.

Overall, doctors report the effect of hyaluronate sodium on activity-related pain and function seems to improve with time compared with the effects of NSAIDs alone. Researchers say patients who achieved the greatest amount of pain relief were those who combined some form of simple exercise program with their treatment plan. Authors of the study conclude, "For pain with physical activity and functional performance, hyaluronate sodium may be superior to placebo alone or NSAIDs alone.

SOURCE: Archives of Internal Medicine, 2002;162:292-298

Seafood Helps Pregnancy ( February 25, 2002)
Feb. 25, 2002 (Ivanhoe Newswire) -- A new study shows eating seafood during pregnancy may protect against preterm delivery and low birth weight.

Researchers from Denmark studied the seafood intake of more than 8,700 pregnant women to determine the relationship between intake of seafood during pregnancy and risk of preterm delivery and low birth weight. Research has shown n-3 fatty acids, found in fish, have a healthy impact on humans, such as a reduced risk of a fatal heart attack. Researchers already know these acids may delay spontaneous delivery and prevent recurrence of preterm delivery. However, a large study to determine to what extent low consumption of n-3 fatty acids is a risk factor for preterm delivery had never been done.

Results of this study show low birth weight, preterm birth and intrauterine growth retardation all decreased as intake of fish increased. Researchers found the occurrence of preterm delivery was more than 7 percent in women who never ate fish and just 1.9 percent in those who consumed fish at least once a week.

Authors of the study conclude, "In women with zero or low intake of fish, small amounts of n-3 fatty acids provided as fish or fish oil may confer protection against preterm delivery and low birth weight."

SOURCE: British Medical Journal, 2002;324:447-450

Protecting Your Ears ( February 25, 2002)
(Ivanhoe Newswire) -- We live in a loud society, but the noise could be giving you more than a headache. Too much noise and you could damage your hearing. A new study finds this is what happens to millions of children. 

Thirty-six year old Kevin Stever loves his music. But his tunes have been too much for his ears.

"My ears would ring and I'd notice my ears would ring very loudly after I play. Normally, it would go away by the next morning but, and then one day it didn't go away," say Stever.

The hearing problems began when he was a teenager and he attended many loud concerts with no ear protection.

Stever says, "I live with a high-pitched ringing in my ears." He's not alone. A new study finds about 5 million children age 6 to 19 suffer from noise induced hearing loss in at least one ear.

Audiologist Barbara Lyn Dixon Crotty, of Maitland Audiology/Family Hearing Associates in Orlando, says, "It's permanent damage when you have permanent hearing loss from noise exposure."

Crotty says eight straight hours of noise at 85 decibels or higher can do permanent damage. That includes a hair dryer, loud toys, and personal stereos.

"As a parent if you can hear your child's Walkman while they're wearing it on their ears, it's definitely too loud and you need to turn it down on him," says Crotty.

Some signs your child could have hearing damage include frustration, speech problems, and poor attention span. Hearing loss can also be misdiagnosed as attention deficit disorder.

Older and wiser, Stever now protects his ears. "I carry my earplugs everywhere with me," he says.

His only regret is not having them years ago.

Experts say the noises that damage one person's ears may not hurt another person's ears. That is why it is difficult to say how much is too much for everyone. Experts say, however, once the damage is done, it is permanent. 

If you would like more information, please contact:

National Hearing Conservation Association
9101 E. Kenyon Ave. Ste. 3000
Denver, CO 80237
(303) 224-9022
http://www.hearingconservation.org

Neuromuscular Training Reduces ACL Injury Risk by 88% in Female Athletes

DALLAS (Reuters Health) Feb 22 - Girls and women who play soccer, basketball, or volleyball are two to eight times more likely to injure the anterior cruciate ligament (ACL) than boys and men playing the same sports in the same positions. Research presented here at the 69th annual meeting of the American Academy of Orthopedic Surgeons indicates that the risk of ACL injuries in women can be cut by 88% with a specialized neuromuscular proprioceptive training program. 
Dr. Bert R. Mandelbaum, of the Santa Monica Orthopedic and Sports Medicine Research Foundation in Santa Monica, California, and colleagues compared the rate of knee injuries in 1041 female soccer players between the ages of 14 and 18 from 52 teams in the Coast Soccer League of Southern California. The injury rate of these subjects, who were enrolled in the Prevent injury and Enhance Performance (PEP) program during the 2000 soccer season, was compared with that of 1902 aged-matched players from 95 teams in the same league who did not enroll in the PEP course. 

At the end of the season, the PEP-trained group had only two ACL tears compared with 32 ACL tears in the control group, Dr. Mandelbaum reported. 

Co-author Dr. Letha Griffin, of the University of Georgia in Atlanta, told Reuters Health that the program teaches girls to "run, jump, and pivot like boys." She said that even the casual observer watching boys and girls play soccer can spot differences. "Girls run and pivot in a stiff-legged upright posture. Boys, on the other hand, have knees bent and play low to the ground." 

Dr. Griffin said that many orthopedic surgeons have offered different theories to explain the gender differences in ACL injuries. "Anatomy, of course, is a popular explanation," she said. "Others have theorized that hormones may play a role, but anatomy cannot be changed, and hormones should not be manipulated," she said. But biomechanics "can and should be manipulated," to prevent injury, she said. 

The PEP program is a comprehensive training system that consists of a special 20-minute warm-up that includes special avoidance techniques, stretching, strengthening, plyometric activities, and sports-specific agilities. The program concentrates on "running, jumping, and pivoting with knees bent," said Dr. Griffin, who is head physician for all sports teams at the University of Georgia.

Ice Therapy for Arthritis (Feb. 18, 2002)
 (Ivanhoe Newswire) -- A new study shows a simple treatment may help patients suffering from arthritis pain.
Researchers in New Jersey and Pennsylvania have found a local application of ice on arthritic joints can significantly reduce pain. Nineteen patients with acute arthritis pain typical of patients with gout were randomized to receive one of two treatment methods: topical ice therapy and a regimen of the inflammation-reducing steroid prednisone or the same drug regimen with no ice therapy added. At a one-week follow-up, the group treated with ice had a significantly greater reduction in pain compared to the control group.

Researchers note: "Although the clinical improvement was impressive, due to the small sample size we could not show statistically significant improvement in all the variables that tended to suggest that effects was more than simply analgesic. Cold applications may be a useful adjunct to treatment of acute gouty arthritis."

SOURCE: The Journal of Rheumatology, 2002;29:331-334

Antidepressants for Hot Flashes (Feb. 18, 2002)
(Ivanhoe Newswire) -- The antidepressant drug venlafaxine may give women an effective alternative to relieve hot flashes, according to a new study.

Researchers from the Mayo Clinic followed 102 postmenopausal women to determine the effects of the antidepressant venlafaxine on hot flashes. Researchers found women who took the drug for eight weeks had a 60 percent reduction in their hot flashes. An earlier study initially showed the drug's effectiveness when taken for a short period. Debra L. Barton, Ph. D., from the Mayo Clinic, says, "This follow-up study provides evidence that venlafaxine continues to be effective and well tolerated over a longer period of time." 

A drug like venlafaxine offers an effective alternative to hormone replacement therapy, which is the standard treatment to relieve hot flashes. However, researchers say for women with breast cancer, HRT is often not an option because of the concern that estrogen may lead to the growth of breast cancer cells. Charles Loprinzi, M.D., from the Mayo Clinic, says, "The clear message is that now many women with breast cancer do no have to suffer with their hot flashes and that women who want a non-estrogenic choice of treatment now have one."

The dose of the drug used in the study was 75 mg a day. Not only did women report a significant reduction in the frequency of hot flashes, they also reported a reduction in the severity of them.

SOURCE: Oncology Nursing Forum, 2002;29:33-40

Eye Exam Detects Stroke ( February 22, 2002)
MADISON, Wis. (Ivanhoe Newswire) -- As many may know, predicting a stroke is nearly impossible for doctors. There are risk factors, including heart disease and diabetes, but what if a doctor could look in your eyes and tell you with near certainty that one day you might have a stroke? Here is a man who is working on just that. 

Typically, a routine eye exam looks at the health of your eyes. Soon it may be able to tell you something about the health of you body, specifically your risk of stroke.

"My role here was to essentially look at the eye changes and see whether that tells us something about the cardiovascular health itself," says University of Wisconsin ophthalmologist Tien Wong, M.D.

Dr. Wong is on a hunt. He is reviewing images of 10,000 people’s eyes in search of a pattern.

"We take the film-based photographs. We scan them. We convert them into, you know, a high-resolution digital image, and then we enlarge them into multiple times their size," he says.

A computer measures the width of blood vessels and compares them to the standard.

Dr. Wong says, "At least the early findings in this study show that even people who are not considered at higher risk of stroke, including the general healthy middle-aged people, if you have some of these changes, you are at a higher risk of stroke."

He warns the research is very early, however, Dr. Wong is optimistic it will shed more light on stroke prevention.

"It is possible that looking at an eye in the future might, you know, give you a bit more information than just measuring the blood pressure or cholesterol," says Dr. Wong.

The computer program that measures the vessels is available only at the University of Wisconsin and the retinal camera is available in most eye clinics. The study itself is taking place around the United States, but all of the images are sent to Dr. Wong’s lab for review.

If you would like more information, please contact:

Tien Wong, M.D., MPH
tienyinwong@yahoo.com

Nerve Damage and Diabetes ( February 22, 2002)
(Ivanhoe Newswire) -- A study in a small area of Greece highlights a large medical concern for diabetics. Researchers pulled in 80 percent of the community's diabetic population of Thessaloniki, Greece, to understand the prevalence of one of the most common complications of the disease -- diabetic neuropathy (DN). DN is damage of the nerve tissues caused by diabetes.

DN can cause chronic open ulcers or wounds specifically on the foot. These wounds often lead to foot amputations. Previous studies have provided conflicting information as to how prevalent neuropathy is among diabetics. 

There were 821 diabetics included in this study. More than 780 of them were type 2 diabetics. Patients were asked if they had experienced pins and needles sensations, hot or cold sensations in their feet, aching pain, burning pain or irritation from their clothing against their skin at night. Doctors determined 33.5 percent of the patients had neuropathy. It was equally present in men and women and between smokers and nonsmokers.

While the rate of chronic foot wounds in this study was only 5 percent, the doctors report the findings "indicate that a large proportion of the diabetic population are neuropathic and, therefore, are at risk of foot ulceration." The risk factors for neuropathy include the age of the patient, how well they control their blood sugar levels, the length of time they have had diabetes and how tall they are. Doctors speculate taller people have longer nerve fibers, and longer fibers are more susceptible to damage from diabetes.

SOURCE: WOUNDS, 2002;14;11-15

Weight Loss Reduces C-Reactive Protein Levels in Overweight Women (Feb. 14, 2002)
NEW YORK (Reuters Health) - Levels of C-reactive protein (CRP), an independent risk factor for cardiovascular disease, fall when obese postmenopausal women lose weight, according to a report published in the February 5th issue of Circulation.
Dr. Eric T. Poehlman, from the University of Montreal, and colleagues measured the CRP levels of 61 obese postmenopausal women and found that the levels were directly related to total body fatness, measured by dual x-ray absorptiometry, and with the area of intraabdominal body fat, assessed by CT. 

Twenty-five of the women completed a weight loss protocol and achieved an average weight loss of 14.5 kg. Significant reductions in fat mass, fat-free mass, visceral fat area, and subcutaneous fat area were noted (all p < 0.0001). Further analysis revealed that weight loss was associated with a significant reduction in CRP levels (p < 0.0001).

The results suggest that weight loss is an important means of reducing CRP levels in obese women and thereby improving their cardiovascular disease risk, the researchers state.

"The contribution of adipose tissue in interleukin-6 secretion has been proposed to be the link between plasma CRP and adiposity, as CRP synthesis in the liver is largely under the control of interleukin-6," the investigators note.

"Whether plasma CRP levels are related more closely to abdominal fat distribution than total body fatness per se remains to unclear at the present time," the authors point out. However, the current findings indicate that overall body fatness is a better predictor of plasma CRP levels.

Circulation 2002;105:564-569.

Obesity Risk Lower Among Women Who Played Sports in Childhood (Feb. 14, 2002)
NEW YORK (Reuters Health) - Women who participated in organized sports as children and adolescents are more likely to be physically active as adults and therefore, less likely to be obese, study findings indicate.
Dr. Catherine M. Alfano of the University of Memphis, Tennessee, and colleagues interviewed 209 African-American women and 277 white women about their participation in sports as youngsters and as adults, and measured the women's body mass index (BMI).

"Results of this study supported the hypothesis that women with higher levels of past sports participation would have lower current BMIs and greater levels of physical activity," the authors write.

However, these same women did not have healthier diets than their peers who had less active childhoods, Dr. Alfano's group reports in the current issue of the journal Preventive Medicine.

"If future studies confirm these relationships, the promotion of girls' involvement in athletics may be an avenue to prevent obesity, which is essential given the difficulty of obesity treatment," Dr. Alfano and colleagues conclude.

Since not all girls are interested, or have the skills necessary to participate in traditional competitive sports, programs that target these girls in particular would be beneficial, they add.

Prev Med 2002;34:82-89.

IUDs Unpopular Among US Obstetrician/gynecologists (Feb. 14, 2002)
NEW YORK (Reuters Health) - While the intrauterine devices (IUD) available today are a safe and effective means of contraception, survey results suggest many US obstetrician/gynecologists rarely prescribe them to patients. This may be due to outdated beliefs about the contraceptive device's safety, the researchers report.
Although the Dalkon Shield was pulled off the US market in 1974, lead author Dr. Nancy L. Stanwood, of the University of Rochester Medical Center in New York, notes that the negative image of IUDs still persists. Currently only 0.8% of US women who use birth control use IUDs, while worldwide 12% of married women of reproductive age are IUD users.

Dr. Stanwood and her colleagues polled obstetrician/gynecologists to investigate their attitudes toward and use of IUDs. The findings are published in the February issue of Obstetrics & Gynecology.

One in five survey respondents had not inserted an IUD during the past year, and of those who had, 79% had inserted 10 or fewer. And while 95% of the 400 physicians polled said they thought copper IUDs were safe, and 98% respondents believed they were effective, almost one third said they believed IUDs increase the risk of PID by 10% or more.

"Some obstetricians and gynecologists still falsely believe that IUDs increase the risk of pelvic inflammatory disease in the long term," Dr. Stanwood told Reuters Health in an interview. "It is contracting a sexually transmitted infection [chlamydia or gonorrhea] that causes pelvic inflammatory disease."

Modern copper IUDs are associated with a low rate of PID--about 16 cases per 10,000 women, Dr. Stanwood and her colleagues note.

Another controversy surrounding IUD use is the belief that it works by causing abortion, but Dr. Stanwood said this idea is incorrect. "Modern IUDs work by setting up an environment in the cervix and uterus that kills sperm," she said. "And by preventing unintended pregnancies, they actually prevent abortions."

Nevertheless, 20% of the respondents agreed that the IUD caused abortion and 16% believed it could lead to lawsuits against them.

The survey also revealed that most obstetricians and gynecologists appropriately select women as IUD candidates who are in monogamous sexual relationships and have not had PID in the past.

Another factor that may explain the low usage rate of IUDs may be economic. Dr. Stanwood pointed out that many insurance programs do not cover the cost of contraception, and IUDs cost $300 to $450, a large up-front cost for most women to pay out of pocket.

But over the long term, Dr. Stanwood said, IUDs are actually the most cost-effective means of contraception.

Dr. Stanwood said she found IUDs easy to promote in her own practice. "When the pros and cons of available contraceptive methods are weighed out, the copper IUD and 5-year progesterone IUD rise to the top for many women as methods that are as effective as tubal ligation but completely reversible and do not require daily pill taking or return visits to the office for shots," she added.

Dr. Stanwood and her co-authors conclude their findings suggest that educational programs could be used to target physicians to expand their IUD use.

Obstet & Gynecol 2002;99:275-280.

Biotin Deficiency Could Be Common in Pregnancy (Feb. 14, 2002)
NEW YORK (Reuters Health) - A significant percentage of women may be vulnerable to mild deficiency of the B-vitamin biotin during pregnancies, possibly increasing their risk of having a child with birth defects, researchers report.
"Researchers have been concerned for many decades that the nutrient status of pregnant women could have both beneficial and deleterious effects on their fetuses," lead author Dr. Donald M. Mock, of the University of Arkansas for Medical Sciences in Little Rock, told Reuters Health. "Our lab is pursuing the possibility that biotin deficiency could be a cause of birth defects in humans."

Previous research has indicated that lab animals induced to have a deficiency in biotin appear normal, but are more prone to having infants with birth defects such as cleft palate. It is still unknown by what process a maternal deficiency in biotin could cause such effects on a fetus, Dr. Mock said.

However, the researchers note, previous studies have shown that many pregnant women eating a normal diet show increased urinary excretion of the organic acid 3-hydroxyisovaleric acid (3-HIA), which may be a marker for biotin deficiency.

In this study, the researchers followed a group of 26 pregnant women who had high levels of 3-HIA excretion. They gave half the women supplements of 300 micrograms of biotin daily for 2 weeks, while the other half were given placebo. The results are published in the February issue of the American Journal of Clinical Nutrition.

The investigators found that all the women provided with biotin supplements showed a drop in 3-HIA excretion to normal levels, while the women given placebo continued to excrete high levels of 3-HIA.

The women who received biotin also had a significant increase in biotin excretion, while women who received the placebo showed no change in biotin excretion.

The results provide evidence that increased 3-HIA excretion indicates mild or moderate biotin deficiency, Dr. Mock said. "It is not proof that biotin deficiency causes birth defects," he added. "This is one more step in that line of research."

The study authors warn that the results are preliminary and it is too early to recommend that women seek out biotin supplements or get more biotin in their diets. "It's not routinely provided in maternal supplements, and there's not enough evidence to strongly recommend it be included in maternal vitamins," Dr. Mock noted.

The researchers hope to conduct further studies to determine if infants born with cleft palate have signs of biotin deficiency in their cord blood, or to conduct a large, randomized controlled trial to see if widespread biotin supplementation would reduce the number of infants with cleft palate.

"After that, there may be a mandate to make sure it is in maternal vitamins," Dr. Mock said. "This is potentially important in the long run."

Am J Clin Nutr 2002;75:295-299.

Low Vitamin K1 May Contribute to Hip Fractures in Women With Parkinson's Disease (Feb. 14, 2002)
NEW YORK (Reuters Health) - Vitamin K1 deficiency is associated with reduced bone mineral density (BMD) in functionally dependent women with Parkinson's disease (PD), according to report by Japanese investigators. This may, in part, explain the increased incidence of hip fracture found in this population.
The mechanism appears to involve reduced production of fully carboxylated osteocalcin, the researchers write in the January issue of the Archives of Physical Medicine and Rehabilitation.

Dr. Yoshihiro Sato and colleagues, from Hirosaki University School of Medicine, assessed the vitamin K1 levels and BMDs of 62 elderly women with PD and of 62 age-matched controls. All of the women with PD were vitamin D-deficient and 36 were functionally dependent.

Functionally dependent PD patients had significantly lower metacarpal BMDs, vitamin K1 levels, and 25-hydroxyvitamin D levels than the other, functionally independent PD patients, the authors report. In addition, undercarboxylated osteocalcin levels were higher in functionally dependent patients than the others.

Vitamin K1 levels were directly related to 25-hydroxyvitamin D levels and inversely associated with undercarboxylated osteocalcin levels, the researchers state. Multivariate analysis revealed that functional stage, vitamin K1 level, 25-hydroxyvitamin D level, and undercarboxylated osteocalcin level were independent predictors of BMD.

"Routine determinations of serum undercarboxylated osteocalcin and vitamin K1 concentrations are important in management of functionally dependent PD patients," the authors conclude. The findings suggest that "the incidence of hip fracture may be reduced by routine use of both vitamin D and K supplements."

Arch Phys Med Rehabil 2002;83:86-91.

Treating Panic Disorders in the ER (Feb. 10, 2002)
(Ivanhoe Newswire) -- People who come to the emergency room complaining of chest pains but who aren't having a heart attack are usually sent home without much treatment. Researchers say many of these patients are actually having a panic attack. New research suggests treatment can begin in the emergency room if ER doctors are better equipped to recognize the condition. 

Studies have shown people with panic disorders are high users of emergency room services. One study, for example, found more than 17 percent of patients coming to an ER with chest pain were actually suffering from panic attacks. The emergency room doctors, however, correctly diagnosed none. Since effective drug treatment now exists for panic attacks, mental health professionals believe better identification of these disorders in the ER could lead to more timely treatment.

In a study published in this month's Annals of Emergency Medicine, investigators from the University of Cincinnati tested the use of a special protocol to help ER doctors correctly diagnose and treat panic disorders. All patients seen at the hospital's Chest Pain Center over a 14-month period completed a six-hour chest pain evaluation and short panic disorder screening. Fifty of the 156 patients enrolled in the study met the criteria for panic disorder. They were then evaluated by both ER doctors and a research psychiatrist using additional panic disorder screening methods.

The study shows ER doctors who used the screening methods were just as likely to correctly diagnose panic disorders in this group of patients as the research psychiatrist.

The study also evaluated treatment of the patients. Half of the patients with panic disorders were prescribed an anti-panic disorder medication in the ER and half received usual care, which consisted of discharging the patient to his primary care physician. All of the patients given the medication began taking it, and about half continued on it for at least one month. Only about a quarter of the patients in the usual care group were eventually prescribed any medication by their physicians.

SOURCE: Annuals of Emergency Medicine, 2002;39:139-143

Uncovering Clues to Cancer (Feb. 10, 2002)
(Ivanhoe Newswire) -- Many studies have attempted to link dietary and other lifestyle choices to the development of cancer, but most have not included enough people to reach solid conclusions. 

Experts say that is not the case with large-scale studies such as those conducted by the American Cancer Society since the 1950s. These population-based studies have included thousands of people who were followed for many years. Many have resulted in breakthrough findings. Now, researchers involved in the American Cancer Society Cancer Prevention Study II Nutrition Cohort hope their work will continue this trend.

The study, which involves more than 84,000 men and 97,000 women, began in 1992 when participants filled out their first questionnaire. In addition to questions about diet, cancer incidence and mortality, participants are being asked to provide information about obesity, exercise, weight gain, cancer screening, hormone use, vitamin supplement use, and use of other medications such as aspirin and non-steroidal anti-inflammatory drugs. Participants will fill out the questionnaire every other year, and investigators have taken blood samples from 40,000 of the individuals for future study. DNA samples have been collected from 50,000 and are currently being evaluated.

In a report on the study, published in a recent issue of Cancer, the authors write: "The ACS Nutrition Cohort establishes a new, large, prospective cohort of both men and women, with detailed information on their dietary and other exposure characteristics, who will be followed actively for all incidents cancer and for all causes of death. This cohort promises to be particularly valuable for the study of cancer occurrence, mortality and survival."

SOURCE: Cancer, 2002;94:500-509

Campbell Soup Company Issues Allergy Alert on Ready to Serve Classic Tomato Soup (Feb. 08, 2002)
Campbell Soup Company (NYSE:CPB) is voluntarily recalling one day's production, 19,792 cases (12 cans in a case) of its 18.7 ounce cans of soup labeled Campbell's Ready To Serve Classic Tomato because it may contain undeclared milk and soy protein. People who have an allergy or severe sensitivity to milk and/or soy proteins run the risk of serious or life-threatening allergic reaction if they consume these products.

The recalled soup was distributed in 37 states through retail stores. The states include Alabama, Arizona, Arkansas, California, Connecticut, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin. 

The product comes in an 18.7-ounce can with a Ready To Serve banner, a photo of the product and the date code below stamped on two lines on the bottom of the can: 

Campbell identified the labeling problem after receiving two consumer complaints. The recall was initiated after Campbell investigated the complaints and discovered that a small quantity of the milk- and soy protein-containing product was distributed in packaging that did not reveal the presence of these ingredients. The mislabeled can contains Ready To Serve Classic Creamy Tomato Soup and not Ready To Serve Classic Tomato Soup as shown and described on the label. Subsequent investigation indicates the problem occurred because of an error in a plant's label controls. 

Consumers who have known food allergies or sensitivities to milk and soy proteins should not eat this product. Consumers are urged to return the product to the store where it was purchased for a full refund. 

Should consumers have questions regarding the recall they should call Campbell's consumer hotline at 1-800-637-7687. The hotline is available 24 hours a day.

Type II Diabetes Is Preventable, Major Study Shows (Feb. 06, 2002)
(HealthScoutNews) -- Preventing Type II diabetes is possible, and diet and exercise could be your best defense. That's the conclusion of a long-awaited study just released. 

"Our goal was to discover if we could effectively prevent or delay the onset of Type II diabetes for those at highest risk, and, if so, what was the best way to do that," says Dr. William Knowler, a coordinating investigator of the large, multi-center national trial headed by the National Institutes of Health (NIH). 

That goal was met through the largest study ever of its kind -- one that took place at 27 sites around the United States. 

Conducted under the auspices of the Diabetes Prevention Program Research Group, researchers examined the effectiveness of two important diabetes treatments. The first is lifestyle modifications, primarily dietary changes and exercise, with weight loss being the goal. The second treatment is the medication metformin, a drug commonly used to treat Type II diabetes. The idea was to see if either one could work to prevent diabetes in high-risk patients, and if so, which might work best. 

"We were pleased and happy to see that both interventions proved successful, although the lifestyle modification did yield better results," says Knowler. 

According to diabetes expert Dr. Loren Wissner-Greene, this is a powerful study with far-reaching effects. 

"It showed us that a major disease -- a major killer disease -- can be prevented, and the strategies are something that are available to almost everyone. Everyone can take steps to protect themselves from developing Type II diabetes, even those already showing signs of impending disease. It's just wonderful news," says Wissner-Greene, a professor of endocrinology at New York University Medical Center. 

The study, published in tomorrow's New England Journal of Medicine, included 3,234 non-diabetics whose average age was 51. Sixty-eight percent of the participants were women; 45 percent were from minority groups. 

Each was considered at high risk for diabetes, with a body mass index of at least 24 -- an indication of being overweight. And all had significantly elevated blood sugar levels both after fasting and two hours following ingestion of a high sugar solution. Elevated blood sugar levels is a well-regarded precursor for diabetes. 

The people were randomly assigned to one of three groups. The first group was given a "lifestyle modification program" centered around weight loss. The second group took the medication and was advised to live a healthier lifestyle. The third group was given a placebo drug and also told to live a more healthy lifestyle. 

The lifestyle modification program included a weight loss goal of at least 7 percent of total body weight, along with 150 minutes of exercise a week, consisting mostly of fast walking. The program was implemented with a 16-lesson curriculum taught one-on-one during the first 24 weeks of the study. During that time, most of the participants reached their weight goal -- an average loss of 15 pounds. 

The medication arm of the trial included a twice-daily dose of 850 milligrams of metformin, whose brand name is Glucophage, a medication that helps the body better utilize insulin and is a standard treatment for Type II diabetes. 

The progress of the participants was followed for an average of 2.8 years. 

The final result: Both the lifestyle modification program and the medication worked to delay the onset of diabetes, although the lifestyle program was almost twice as effective. 

When compared to the placebo group, 58 percent of those assigned to the diet-and-weight-loss group avoided developing diabetes, compared to 31 percent in the group taking the medication. 

However, in at least two areas of the study -- the fasting blood sugar level and the hemoglobin level (a kind of "marker" that indicates potential damage to blood vessels) -- results were similar in both the lifestyle intervention and medication groups, Wissner-Greene points out. 

Earlier studies in both China and Finland had found that both lifestyle modification and medication could reduce the risk of diabetes. But this is the first major trial to show that diet and exercise can delay diabetes in a diverse American population that's becoming increasingly overweight and running a higher risk of diabetes. 

In sharp contrast, studies released last year found that taking insulin as a way of preventing the onset of Type I diabetes was not effective. 

Type II diabetes -- also known as adult onset diabetes -- occurs when the body is unable to adequately use its own insulin supply to properly utilize sugars and carbohydrates. Although it differs from Type I diabetes, which affects the body's ability to manufacture any insulin, both forms of the disease result in similar complications. These include dramatically increased risks of heart disease, high blood pressure, kidney failure, blindness and limb amputation. According to the National Institutes of Health, up to 10 million adults have Type II diabetes. 

Knowler notes that the study initially included a second medication known as troglitazone (brand name, Rezulin). But a link to liver toxicity forced this drug off the market shortly after the start of the trial. Although other, similar medications were still available, it was too late to include them in the trial. 

In addition to not knowing whether the results would have changed with the addition of this second medication, Wissner-Greene also points out that it is also not known whether the results could have been any more powerful had there been a third group utilizing the combination of lifestyle modifications and medication. 

Still, she says, the take-home message is clear: "Type II diabetes can be prevented, and the tools are available to everyone." 

And she adds, "There are few killer diseases about which you can say that." 

What to Do: To learn more about Type II diabetes, visit The American Diabetes Association.. For the latest clinical trials on diabetes treatments, click here. 

SOURCES: Interviews with William C. Knowler, M.D., Dr.P.H., study author, and trial coordinator, National Institutes of Health and the Diabetes Prevention Program Research Group in Arizona; Loren Wissner-Greene, endocrinologist, and diabetes specialist, New York University Medical Center, New York City; Feb. 6, 2002, New England Journal of Medicine.

Publication date: 2002-02-06