DSS Research, the leader in market research for the health insurance industry,money clips, developed a proprietary set of metrics that gauge the level of engagement in health care on the part of the consumer. This quarter we added extra questions to further test the relationship between different literacy measures and the level of engagement amongst commercial and Medicare populations and the uninsured (see also <http://www.newsrx.com/library/topics/DSS-Research.html> DSS Research).

Consumer engagement is at the forefront of many initiatives to get individuals to take responsibility for their care and health literacy is a critical component of getting these consumers engaged. Even well-educated individuals lack confidence when it comes to understanding medical information and filling out medical forms. Those who are able to follow detailed directions and correctly distill information found on nutrition labels still admit seeking help or lacking confidence when it comes to medical information.

Literacy is highly correlated with demographic characteristics such as education, income and ethnicity, as well as, attitudes about health care and current health status. However, engagement is more correlated with medical claims,tiffany, health care knowledge and healthy behaviors than is literacy alone. Consumer engagement is more correlated with measures of confidence in reading and understanding health related information than it is with more typical literacy measures related to reported problems or difficulties using health information and materials. Household income is a better predictor of self-reported problems with health information and level of confidence in filling out medical forms than is level of education. Hispanics are much more likely than other ethnic groups to report problems with health information,necklaces, but are comparable to other ethnic groups regarding their level of confidence in filling our medical forms and the frequency with which they need someone to help them read instructions or other written materials

There is a difference between having the ability to read and understand complex instructions and having confidence that you have correctly filled out a medical form or correctly interpreted medical instructions. Having the skills to read labels,pendants, interpret charts and make mathematical calculations does not ensure that an individual is capable and comfortable interpreting verbal and written communications from health care providers and health insurance organizations. Only the most engaged consumers exhibit the levels of health literacy and health care knowledge necessary to navigate the complex health care system and follow all the recommended healthy behaviors. Health literacy is a necessary building block, but not sufficient in itself to ensure consumer engagement. Confidence level and household income appear to be better estimators of an individual’s likelihood of successfully obtaining needed medical care than more typical measures of literacy and education level.

A.M.E.N. stands for Always Meet Every Need and Artisan de Luxe of Los Angeles and The A.M.E.N. Initiative founder, Eric Kimmel, are doing just that for one village in the West African nation of Sierra Leone.

After a successful career as a fashion designer, Kimmel decided three years ago to accept an invitation from a friend to come visit Mokanji in Sierra Leone and see for himself the condition and the state of Mokanji in the post war era. A trip that was supposed to last for a few weeks has now turned into a multiple year adventure and into a mission to reinvigorate Mokanji and its people.

Kimmel and the owners of the Artisan de Luxe fashion house have been personal and business acquaintances for many years. Consequently,key rings, a partnership was formed with the purpose of combining Kimmel’s expertise as a fashion designer with the sewing and finishing talents of the people of Mokanji and Artisan’s design and world-wide marketing infrastructure. This combination has resulted in the creation of a very unique high-end fashion brand that is generating jobs and a sustainable way to earn a living for the true "Artisans" of the Mokanji village.

Under Kimmel’s watchful eye,tiffany, each garment is finished by hand using unique and local techniques of the people of the Mokanji Village. The garments are in and of themselves one-of-a-kind high-end fashion pieces but they are truly special because their creation is providing employment to people who currently have few opportunities.

Kimmel stated, "This has been my dream for the last three years and now it is becoming a reality. The people of Mokanji and myself are so excited and I know that with Artisan’s involvement, we can really impact and improve the lives of the people of Mokanji and at the same time create some amazing fashion products. One job feeds two families so what are doing really means something to the people of Mokanji."

Jay Furrow, Artisan de Luxe CEO, went on to comment that, "This is a very special situation that we believe can be very impactful for everyone involved. By partnering with Eric, and with the fashion expertise that he is bringing to the local Mokanji community, retailers and customer who purchase A.M.E.N. products can actually play an instrumental in providing employment and changing the lives of the people in Mokanji."

A.M.E.N.’s unique styles will now be available in the high-end boutiques and better department stores in the U.S., where consumers can not only enjoy the fresh button-up and T-Shirt styles, but also know that they are contributing to the revitalization of a community.

WHAT: A.M.E.N by Artisan de Luxe (www.artisandeluxe.com) is a fashion line with a conscience. The unisex pieces start at $75, and for that customers get a trendy-but-wearable shirt, but also the pleasure of knowing that one day of work at A.M.E.N. feeds two families that day. The shirt styles, which pair beautifully with denim,tiffany, take basics to a new level with unique details added in the finishing process.

WHERE: A.M.E.N. is L.A. based and the Sierra Leone facilities are located in the village of Mokanji. The line will be available where Artisan de Luxe is sold, including the brand’s store in L.A. (8574 Melrose Ave.), as well as other fine boutiques and select department stores nationwide.

INTERVIEW OPPORTUNITIES: Artisan CEO, Jay Furrow,rings, Artisan Creative Director, Philippe Naouri and A.M.E.N. founder Eric Kimmel are available to further discuss the brand and Eric’s experience in Africa.

“The Payless summer collection includes all the latest footwear trends — a Two Hearts pendant array of silhouettes, colors, materials and details — and an expansive range of accessory items to help women complete their looks for fun summer events,” said LuAnn Via, president and CEO of Payless ShoeSource. “We continue to lead the Fashion Democracy movement to bring forward all the latest accessory items at a great value for all to enjoy.”

Fashion fans shopping on a budget will be happy to know that Payless is currently stocking shelves with hot summer styles at prices starting under $10 an item. Whatever the occasion, the retailer can provide a pair of heels or a summer tote to perfectly complement an ensemble. Wedge cork sandals done in woven and natural upper materials help create a breezy, casual look for seaside strolling, while oxford flats keep city girls skipping across the hot pavement with ease.

The most popular colors of the season are represented in the line — footwear and totes pop with shades of lemon yellow, cobalt blue, blush gold, bright fuchsia, and sunset orange.

Payless’ summer offerings also include its popular Designer Collections, exclusive labels featuring original designs by New York fashion designers including Christian Siriano for Payless(TM) by Christian Siriano, Lela Rose for Payless(TM) by Lela Rose; and alice + olivia for Payless(TM) by Stacey Bendet. Payless Designer Collections are among the most broadly distributed designer footwear labels in America today.

The sneakers and flats in the Christian Siriano for Payless summer line feature a unique Venetian Link bracelet of splashy purples and pinks accented with pops of fuchsia. Strappy sandals and peep-toe flats also dazzle in soft blush gold. Stacey Bendet’s alice+olivia for Payless styles channel a funky downtown vibe with a canvas clog, oxford flats, gladiator-inspired platform heels, among other modern details. The Lela Rose for Payless summer collection represents the designer’s classic-with-a-twist focus with flats, wedges and thong sandals rendered in patterned fabrics, vivid cobalt and lemongrass colorations, and delicate bow accents.

Footwear and accessory trends for the summer include:

Silhouettes – embellished sandals, peep-toe flats, strappy heels, huarache-style sandals, t-strap sandals, platform sandals, sculpted-wedge heels, gladiator-inspired flats, espadrilles, slip-on sneakers

Colors – lemon yellow, cobalt blue, blush gold, bright fuchsia, and sunset orange

Materials – patterned fabrics, canvas, patent, jersey cotton, cork- and woven straw-inspired materials

Details – bead embellishments, flower and bow accents

Handbags featuring zebra, giraffe and croco patterns, as well as metallics and black & white prints offer an overall polished look

Other accessories include: sunglasses, caps and hats, scarves and colorful, layered jewelry

The Payless summer collection for women is currently available in stores nationwide. The Venetian Link necklace boasts dozens of fresh footwear styles, handbags and an expansive range of accessories, with new products arriving every few weeks throughout the summer season. Beyond the women’s collection, additional styles are available for the family and include a range of well-recognized brands including Airwalk(R), Champion(R), Smartfit(R) and Dexter(R), among others.

About Payless Designer Collections

Payless is on a mission to democratize fashion and design in footwear and accessories. The Payless Designer Collections – seasonal lines of original footwear and handbags created by New York fashion designers and hot-off-the-runway – are a key piece of that strategy.

Payless Guest Designers include Lela Rose and the Lela Rose for Payless and Unforgettable Moments(TM) by Lela Rose labels, Stacey Bendet with alice + olivia for Payless, Christian Siriano and Christian Siriano for Payless, style icon Patricia Field with Patricia Field for Payless capsule collections and newcomer Isabel Toledo with Isabel Toledo for Payless due to debut this fall. This select group of fashion designers and stylists create designer footwear and accessory collections for Payless featuring the latest runway and red carpet looks. Each collection is unique and reflective of the designer’s signature style. For more information about Payless at New York Fashion Week and the company’s Guest Designers, please see paylessontherunway.com.

About Payless & Collective Brands, Inc.

Payless ShoeSource, Inc., a unit of Collective Brands, Inc., is the largest specialty family footwear retailer in the Western Hemisphere and is dedicated to democratizing fashion and design in footwear and accessories and inspiring fun, fashion possibilities for the family at a great value. As of year-end 2009, the company operated nearly 4,500 stores. In addition, customers can buy shoes over the Internet through Payless.com(R) at www.payless.com.

Collective Brands, Inc. (NYSE: PSS) is a leader in bringing compelling lifestyle, fashion and performance brands for footwear and related accessories to consumers worldwide. The company operates three strategic units covering a powerful brand portfolio, as well as multiple price points and selling channels including retail, Tiffany Notes Dangle Key ring, ecommerce and licensing. Collective Brands, Inc. includes Payless ShoeSource, focused on democratizing fashion and design in footwear and accessories through its more than 4,500-store retail chain, with its brands Airwalk(R), Dexter(R), Champion(R), Zoe & Zac(TM), the first-ever affordable green footwear brand, and designer collections Lela Rose for Payless, Unforgettable Moments by Lela Rose, Christian Siriano for Payless, Patricia Field for Payless and STLP x Airwalk, among others; Collective Brands Performance + Lifestyle Group, focused on lifestyle and performance branded footwear and high-quality children’s footwear sold primarily through wholesaling, with its brands including Stride Rite(R), Keds(R), Sperry Top-Sider(R), Robeez(R), and Saucony(R), among others; and Collective Licensing International, the brand development, management and global licensing unit, with such youth lifestyle brands as Airwalk(R), Vision Street Wear(R), Sims(R), Lamar(R) and LTD(R). Information about, and links for shopping on, each of the Collective Brand’s units can be found at www.collectivebrands.com.

After Shelby Morris hit a grand slam to give her Columbus North softball team an 8-2 lead against Brownstown Central on Saturday morning, Braves coach Monte Ault said he was interested to see how his team would respond.

He liked what he saw from the Braves, as they rallied back with runs in the final three innings, but they came up short 8-7.

“The grad slam hurt us, but we didn’t give up,” Ault said. “That’s what I like about this team. We came back and didn’t give up. If we get another hit, we tie the game up.”

North held an 8-6 lead going into the top of the seventh. Brooke Metz led off the inning Tiffany Key Rings a double high off the fence in left-center that missed by a foot of going out. She advanced to third on an infield out, and she later scored on a wild pitch.

Alli Nolan then singled for her second hit of the game, but was left stranded at second base when the next batter popped out to the shortstop to end the game.

“I knew they were a good hitting team,” Ault said. “We hit the ball hard, too. Brooke lacked a foot of hitting a home run, Alli hit the ball hard and Chelsea (Scott) hit the ball hard every time she got up. Caitlin (Conrad) made a good bunt and hit the ball hard. Everybody in the lineup hit the ball.”

The Bull Dogs bunched a fielder’s choice and two hits to take a 1-0 lead in the bottom of the first, and then used two hits and two Brave errors to score a pair of unearned runs in the second for a 3-0 lead.

Scott put the Braves on the scoreboard by leading off the fourth inning with a home run.

Kristen Mellencamp doubled in the fifth and scored on an error.

Brownstown scored four runs in the sixth, with the big hit being a two-run single by discount tiffany.

The Braves scored two runs on passed balls and a run on an error.

Brownstown had nine hits, and Scott led the Braves with a home run and a double, while Metz and Mellencamp had doubles and Nolan and Riley had two hits apiece. Scott scored two runs, and Conrad had two RBIs.

Cheyenne Riley allowed six earned runs and 10 hits and didn’t have any strikeouts or walks.

“Our pitching was solid. Alli called a good game,” Ault said. “We made some nice Tiffany Bangles plays. Mellencamp made a big stop, Cat (Allen) made a big stop at third, and Hannah (Bays) played a good second base. ”

The Braves are 13-6 and will travel to Paoli today and to Mitchell on Thursday before turning their attention to the Eastern Sectional, where they will play Providence.

“We didn’t win, but I was pleased as a team,” Ault said. “I want everybody hitting from top to bottom, and we want to be playing our best softball come sectional.”

Box score

At Columbus North

Brownstown 000 114 1–7 9 3

Columbus North 120 050 x–8 10 2

Brownstown Central hits: Chelsea Scott 2, Alli Nolan 2, Cheyenne Tiffany Bracelets 2, Brooke Metz, Kristen Mellencamp, Caitlin Conrad; home run: Scott; doubles: Metz, Scott, Mellencamp; RBIs: Conrad 2, Scott, Riley; runs: Scott 2, Metz, Allen, Mellencamp, Nolan, Riley

Michelle Obama is widely considered one of her husband’s biggest political discount tiffany. Like most first ladies, she has developed a strong following around the country, and 71 percent of Americans think she is doing a good job, according to a recent Associated Press poll. (Her husband’s approval rating is about 50 percent.) White House officials say it’s not yet clear how direct a role she will play on the campaign trail this year, but in 2008 she was constantly on the road promoting her husband. She emphasized the historic change her husband would bring as the first African-American president and the hope that he inspired in so many everyday people. She still prompts intense media attention and public interest in everything she does, and she is sure to lend her name and charisma to the administration’s agenda.

“Her role is where policy and people intersect,” says Katie McCormick-Lelyveld, the first lady’s press secretary. This is a contrast to Hillary Clinton, spouse of the last Democratic president, who was deeply involved in healthcare legislation and other issues. And it is closer to the example set by Laura Bush, who promoted reading as her special project but was mostly an appealing supporter of her husband, George W. Bush, a Republican and Barack Obama’s predecessor.

Obama considers herself first and foremost a mom to the first couple’s young daughters, Malia and Sasha. And to the surprise of her critics from the campaign, she is rather traditional in her choice of projects to take on as first lady. She is promoting such noncontroversial goals as federal assistance to military families, a Tiffany Bangles to public service, and, her project for 2010, leading the “Let’s Move” campaign to fight childhood obesity through “healthy eating and healthy families.”

She has started a highly publicized White House garden to underscore the importance of fresh vegetables and fruit as the cornerstones of good nutrition. The images of the first lady digging in the dirt behind the presidential mansion, harvesting sweet potatoes, lettuce, and other staples, not only sets an example for home gardeners but also has helped Michelle alter her image as a fashionista who might be a bit too interested in clothes.

There is a little-known personal side to her cause. A few years ago, a family doctor said that the Obama girls had a “body mass index issue,” a nice way of saying they were gaining too much weight. So Barack and Michelle Obama told Malia and Sasha they needed to exercise more frequently and be careful about junk foods. Michelle admits to a weakness for french fries, but has disciplined herself not to eat them too often. Barack limited his intake of cheeseburgers, one of his favorite foods. “Her philosophy is, if you want a cheeseburger, you Tiffany Bracelets have a cheeseburger,” says a family friend. “But don’t have it every day.”

Obama rarely talks directly about race, even though she is the first African-American to serve as first lady. But she clearly believes she can be a role model for young blacks. At Anacostia High School in one of Washington’s poorest neighborhoods, one of her many appearances at public schools in the majority-black capital, she told the students about her early life. “We didn’t have a lot of money,” the first lady said. “I lived in the same house my mother lives in now … I went to public schools. The fact is I had somebody around me who helped me understand hard work. I had parents who told me, ‘Don’t worry about what other people say about you.’ I worked really hard. I did focus on school. I wanted an ‘A.’ I wanted to be smart. Kids would say, ‘You talk funny. You talk like a white girl.’ I didn’t know what that meant.”

Her press secretary says Obama wants young African-Americans, especially girls, to realize that they can be achievers. “She wants people to see themselves in the White House, to see it as a place for all, where they can feel at home, where they belong,” says McCormick-Lelyveld. It could be that serving as an Tiffany Pendants is Michelle Obama’s most important mission.

A Glen Burnie woman pleaded guilty this week to negligent homicide in a drunken crash last tiffany sale that killed a motorcyclist.

Alida Roxana Holyoke, 27, pleaded guilty Wednesday in county Circuit Court to negligent homicide by driving under the influence of alcohol and leaving the scene of an accident that killed Glen Burnie resident William “Shawn” Jacobs.

She could face up to 15 years in jail and a $15,000 fine, but state guidelines call for probation to two years in prison, prosecutors said.

Whatever the sentence, it likely will not seem enough to the more than a dozen tearful members of the victim’s family who attended the hearing in Annapolis.

“She’s not going to get enough time,” said Dawn Jacobs, the victim’s sister. “She tiffany rings sale my brother 6 feet under.”

Her brother, who people called “Shawn” or “Fluffy,” was a truck driver with a zest for life, she said. She said she will always remember his smile.

Assistant State’s Attorney Brian Marsh said in court that at 2:30 a.m. Aug. 18, witnesses said they saw a crash at Crain Highway and Baltimore Annapolis Boulevard.

Had the case gone to trial, they would have testified they saw Holyoke make a left turn onto Baltimore Annapolis Boulevard, cutting off a 2008 Harley Davidson driven by Jacobs while the traffic light was green.

The turn caused Jacobs, 35, who was traveling in the opposite direction, to hitHolyoke’s car on the passenger’s side, throwing him from the motorcycle, Marsh said.

One witness, who said the 2004 Acura did not stop, followed it to a nearby gas station, tiffany bracelets sale said. Police arrived quickly to find Holyoke sitting next to her car.

“She was upset and started to cry,” Marsh said.

She told officers then that she didn’t remember being in an accident or even driving on Crain Highway. She said she’d had four beers earlier in the evening and was going out to get cigarettes.

Police also noticed the large amount of damage to her car and found motorcycle parts near it.

She was taken to the police station, where her blood-alcohol level was tested at a 0.19 percent, more than double the legal limit for driving, Marsh said.

Paramedics quickly arrived at the scene of the accident and began treating Jacobs, but he went into cardiac arrest on his way to Maryland Shock Trauma Center in Baltimore. He was pronounced dead at 3:13 a.m.

Police learned that at the time of the crash, Jacobs had a blood-alcohol level of 0.15 percent.

A crash expert later determined the light at the intersection was green, and Jacobs had the right of way, since he was going straight. Holyoke failed to yield, Marsh said. Defense attorney Warren A. Brown said after the hearing that the crash was unfortunate and that both Holyoke and Jacobs were good people from tiffany pendants sale families.

Brown said that since Jacobs has no prior criminal record, he will ask the judge for probation and that his client not serve any jail time.

“If there was ever a case that should be at the low end of the guidelines … it is this,” he said.

Both parties had been drinking, and turning too closely in front of someone is “not the most egregious traffic violation,” he said.

Marsh said after the plea hearing that he planned to ask for a sentence tiffany earrings sale the guidelines.

Holyoke will be sentenced on June 8.

For Marie-Helene de Taillac, the designer largely credited with spawning the trend for less ostentatious and stone-centred jewellery design, the beauty of the stone is the important thing.

“Stones are quite magical,” she says. “When I choose a stone, it speaks to me. Suddenly, you don’t know why, but one attracts you.”

Ms de Taillac’s words perfectly encapsulate the trend sweeping jewellery design with the valentines jewelry now increasingly on the stone rather than simply on the design.

“Gemstones define the timelessness and value of a piece of jewellery,” says Rebecca Clarke, managing director of jewellery website astleyclarke.com, which was started six months ago.

Ms Clarke confirms that she has noticed an increase in the number of jewellery designers who put the emphasis on the stone and who make the right stone the starting point for design.

“We have four jewellery designers whose principle goal is to find beautiful stones and only then do they design the jewellery around them. When done properly, the stone’s innate beauty shines through and there is little need for further adornment.”

One label, Como Blonde, is, says Ms Clarke, “probably our best example of these ‘stone hunters’: if they don’t find the stones, they don’t make the jewellery”. Other names include Pippa Small, Flora Astor, and The Hudson Collection.

Jewellery designers who usually take a more strict design route have also been succumbing to the lure of the stone. “I normally imagine a design first and I then find the most appropriate stone,” says Victoire de Castellane at Dior Fine Jewellery. “Nevertheless, ‘Le Coffret de Victoire’ collection began because I had ‘love at first sights’ for particular one-of-a-kind stones and every time I find a new one I imagine a story around it. I find these amazing gems during my numerous trips and when I tell a story around it, the stone becomes a real character. “I love to create one-of-a-kind pieces with opals too because this stone is really magic. When I imagine a story around itit brings fairytale to creation.”

It is exactly this one-of-a-kind, more personal approach to jewellery that is driving the trend. “People are looking for individuality from jewellery,” explains Mary Brittain, editor of Jewellery in Britain. She also believes that the increased popularity for coloured stones helps to drive the trend, making stones “very much the tiffany pendants” in many pieces. Ms Brittain also, however, attributes “the opening up of the internet” and the resulting accessibility of stones to consumers as a factor in how they are “more aware of stones that are out there”.

For Leviev, the devotion to stones and the inherent and individual characteristics in each one are at the heart of what this new luxury brand is about. Founded by Lev Leviev, who controls the largest private diamond mines in the world and is the largest privately-held polisher and cutter of diamonds, the company’s focus is naturally on the rare gems it can acquire – so the majority of its pieces are one-off designs centred on these stones.

“We deal with the rare and the exceptional, it’s the nature of our business and very much our reason for being,” says Simon Williamson, the company’s UK managing director. “In terms of our clients, they are buying something unique. Ninety per cent of the stones in store are unusual by virtue of their colour, their shape or size or quality.

“So, with that, comes that ‘bespoke’ design. For us, it is all about simplicity of design to lend itself to a particular shape of stone or specifically to enhance a colour.”

Other houses take a different approach to romancing the stone. At Asprey, for instance, where jewellery sales make up 60 per cent of the business, even in many of the pret-a-porter collections there is an emphasis on stones and the house’s own “Asprey cut”.

“The stone buyers are always looking for the best clarity, best colour in diamonds,” explains Hakan Rosenius, creative director.

“This means that they can really work with very simple settings and create the necklace around the stone, and obviously there is the Asprey cut in diamonds and semi-precious stones. So we sort of create the look at Asprey through our cut,”

At Ritz Fine Jewellery, too, there is a focus on “precious and semi-precious stones of rare beauty and colour (that) have been sourced, and (for which) a special unique design is created,” says Paul Carter, managing director.

This includes a design called The Dancer ring featuring “an outstanding cabochon tanzanite” which has been set in white gold with a surround of briolettes, all of which move.

This focus on stones and the individuality they can offer in themselves provides a middle ground between ready-to-wear and bespoke jewellery – but the attention is also helping to reinvigorate bespoke creations.

Melvyn Kirtley, vice president of worldwide client development at Tiffany Group, says that the house has “tiffany earrings always thought about gemstones”.

But he confirms that, in the past three to four years, there has been a greater awareness of how consumers view stones.

“We show our customers some important coloured gemstones, and talk about what makes them so special and their attributes and then we’ll say we’ll work with you to create around it.”

Simultaneously, Tiffany has been working on building its coloured gemstone inventory. “It’s a cycle,” says Mr Kirtley. “For us, it’s always been an important part of our heritage. But it’s coming back round.”

This Valentine’s Day, premiere plus size lingerie site, Hips & Curves, is now offering the first in its line of affordable European Steel-Boned Corsets to its plus size customers. While many shoppers have limited purchasing power in 2009, Hips & Curves’ corset has been developed with budget constraints in mind. While competing corsets of the same quality retail for $350 – $450 and up, the “Duchess” Steel-Boned Corset is being offered by Hips & Curves for $149.95.

“For years I’ve wanted to design high-quality, affordable, steel-boned corsets, but couldn’t find a way to tiffany and co make them affordable without compromising on quality,” Hips & Curves President and CEO Rebecca Jennings said. “That didn’t discourage me. No one else had done it, but that didn’t mean it couldn’t be done. I love a challenge and I love providing unique, hard-to-find items our customers can’t find anywhere else.”

Customers who wear the Victorian-inspired piece can comfortably reduce their waist measurement by two to four inches if they desire, and create a smooth, curvaceous silhouette. The Duchess Steel-Boned Corset is designed to complement and enhance plus size curves with a fuller cut in the bust, a steel busk for mega support, enhanced grommets, reinforced fabric, and an optional modesty back panel. Garter loops allow this item to be worn as lingerie as well as outerwear with a pair of jeans. Never again will curvy customers find themselves squeezing into corsets intended for a smaller-framed woman.

Hips & Curves’ Duchess Steel-Boned Corset is available for $149.95 at hipsandcurves.com and is manufactured in Europe to ensure a quality product. Carefully contoured for an hourglass figure, this corset utilizes flexible steel boning under heavy duty satin. It is offered in a black and antique pink colorway with ruffle bust trim and a ribbon-lace front.

For event dates or to schedule an interview with Rebecca Jennings, contact Marcy Ito, Director of Marketing, valentines earrings at 310-910-9690, or via email at mito@hipsandcurves.com.

About Hips & Curves: Firmly grounded in their motto of “appealing” rather than “concealing” curvy figures, Hips & Curves has evolved from a retail Web site offering sexy and playful intimate fashions and accessories, into a full-service and fun community where curvaceous women (and their men) can speak their mind, share their experiences, read steamy fiction and get tips on everything from posing for the camera to pole dancing. Headquartered in Southern California, Hips & Curves provides entertaining e-newsletters, shopping tips for men and a team of knowledgeable lingerie consultants on call during business hours to help both women and men with product selection. For more information visit http://www.hipsandcurves.com.

Treating pain involves multiple modalities. From medications to physical therapy and acupuncture, the options are numerous and varied. However, despite physicians’ best efforts to provide pain relief, many patients continue to have pain. Increasingly, patients are trying unconventional treatments in place of traditional, evidence-based medical treatments. In fact, the interest in alternative medicine has grown considerably in recent years.1,2 A population-based survey3 indicated that 4 of 10 Americans used complementary and alternative medicine for chronic conditions in 1997 and made an estimated 629 million visits to practitioners of alternative medicine, far exceeding the 388 million visits that were made to primary care physicians during the same year. In addition, the total out-of-pocket expenditures related to the use of complementary and alternative medicine in 1997 were estimated at $27 billion, which is comparable to out-of-pocket expenditures for all physician services.3,4

Many methods used in alternative medicine are insufficiently tested or not tested at all.5 Despite the enormous interest of the general public in alternative medical treatments, little evidence-based research supports claims about the efficacy of such methods. The reasons include lack of interest by the academic community, lack of financial support by corporate sponsors to fund research because the medications are already available, and difficulties in applying current regulatory criteria to alternative medicine.1

One alternative method previously untested in the United States is the use of “ionized” wrist bracelets for pain relief. Promotional information from the manufacturer states that the ionized bracelet can “energize the whole body,” “relieve pain the natural way,” and balance “Yin & Yang (positive and negative ions).” According to the Yin– Yang theory, a relationship exists among acupuncture points, meridians, and the electric currents of the body. An electric current is generated by an interaction of positively and negatively charged ions. If the flow of energy called “chi” remains unimpeded and in balance, individuals are believed to remain physically and mentally balanced and therefore in peak health.6 According to the company’s promotional information, the bracelets were invented by Dr Manuel Polo in 1973 in Spain. The “natural series” bracelets used for this study were 85% copper and 15% zinc, and the cost was approximately $50 each. More expensive models (up to $179) are available from the manufacturer. The ionization process is a secret process not revealed by the manufacturer. A small study (50 patients) from China (not found in a review of the literature) reported benefit with use of the ionized bracelet for headache and for back, hip, leg, and hand pain over a 6-week periods Although numerous professional athletes such as golfers, basketball stars, weight lifters, and hockey players have given testimonials regarding the benefits, questions remain about the effectiveness of these bracelets in relieving pain. We performed a randomized double-blind trial to assess objectively the effects of these ionized wrist bracelets on musculoskeletal pain.

SUBJECTS AND METHODS

Volunteers were recruited from advertisements posted at the Mayo Clinic in Jacksonville, Fla, in 2000 and 2001. Participants included 610 men and women, 18 years of age or older, who had self-reported pain at the beginning of the study in at least 1 of the following areas: neck, shoulders, elbows, wrists, hands, upper back, mid back, lower back, hips, knees, ankles, or feet.

Both ionized and placebo bracelets were provided by the manufacturer. The appearance of each bracelet was identical. The identity of each bracelet was blinded to the manufacturer, participants, and researchers until the study was completed. Specific instructions were given to each participant for correct placement of the bracelets according to the manufacturer’s recommendations. This study was approved by the Mayo Foundation Institutional Review Board, and participants gave informed consent.

Procedures

Participants were randomly assigned to receive either an ionized wrist bracelet (Q-Ray, QT, Inc, Elk Grove Village, Ill) (n=305) or a placebo wrist bracelet of identical appearance (n=305).

Demographic information, collected on all 610 participants in an initial questionnaire, included age, sex, ethnic background, whether the participant had ever seen or used an ionized bracelet, and whether the participant believed that such a bracelet would reduce joint or muscle pain. Participants were asked to indicate the area in which they had pain and whether they had had a serious injury at that site. For each location where pain was present, participants rated the intensity of the pain on a scale of 1 to 10, with 1 indicating “very little pain” and 10 indicating “pain as bad as it could be.” A follow-up questionnaire was given to evaluate pain at these locations after participants wore the bracelets for 1, 3, 7, 14, 21, and 28 days. In this questionnaire, pain was rated on a scale from 0 to 10, with 0 indicating “no pain,” 1 indicating “very little pain,” and 10 indicating “pain as bad as it could be.”

Primary End Points

For each location where pain was present at baseline, changes in pain score were calculated by subtracting the baseline score from the follow-up score at each time point. The percentage of patients whose pain score had improved was also calculated for each time point.

Two primary end points were defined for evaluating efficacy. The first was the change at 4-week follow-up (day 28) in the pain score at the location with the highest baseline value (maximum pain score). The second was the change at 4-week follow-up in the sum of the pain scores for all locations.

Statistical Analysis

Comparisons between groups were based on rank sum tests for quantitative variables and chi^sup 2^ tests for dichotomous variables. Tests about whether the percentage of patients with improvement exceeded 50% within each group were conducted at each time point with the use of a normal approximation to the binomial distribution.

All tests for efficacy were 1-sided because they addressed a 1-sided question. All tiffany jewelry other tests were 2-sided.

Stepwise linear regression was then applied to determine whether group allocation would become significant after adjusting for other factors. The end points used were the 4-week changes in the following scores: maximum pain score, sum of pain scores for all locations, and pain scores for the individual locations where pain had been reported at baseline. The possible confounding variables considered were participants’ age, sex, racial origin, whether they had seen the bracelets before, whether they had used the bracelets before, whether they believed that the bracelets could reduce joint or muscle pain, whether they were taking medication for pain, and the magnitude of the baseline score. The significance level used as a criterion for entering and staying in the model was P<.10. “Group” was then added as a variable in the final model to determine whether there was a difference between those who wore the placebo bracelet and those who wore the ionized bracelet, after adjusting for all significant factors.

RESULTS

The mean age of the 609 participants who gave their age on the questionnaire was 48.27 years (SD, 13.46 years; range, 18-88 years). Of 608 participants who gave information on sex, 157 (25.8%) were male and 451 (74.2%) were female. Of 607 participants who gave information on racial origin, 533 (87.8%) were white and 74 (12.2%) were of other racial origin. Of 409 participants who answered the question about whether they believed the bracelets can reduce joint or muscle pain, 327 (80.0%) gave a positive and 82 (20.0%) a negative answer.

Comparisons at baseline between those who wore the placebo bracelet and those who wore the ionized wrist bracelet are summarized in Tables 1 through 3. The groups did not differ significantly from each other at baseline for any variable except elbow injury (Table 3). In view of the large number of statistical tests undertaken, some comparisons might have been expected to differ significantly by chance.

No significant differences were seen between groups for either of the primary end points, ie, change at 4-week follow-up in maximum pain score and in sum of pain scores for all locations. The groups did not differ in the magnitude of change in these variables at any time point during the study, although statistically significant decreases from baseline were observed within each group at all time points (Figures 1 and 2). Similarly, no significant differences were seen between groups in the mean change from baseline after 4 weeks at any site where pain had been pendants present at baseline, although significant decreases from baseline were observed within each group at each site (Table 4).

When the percentages of patients with improvement in maximum pain score or sum of pain scores for all locations were evaluated at each time point, we again saw no significant difference between groups, although within-group improvement rates were significantly greater than 50% in most instances (Table 5).

Analyses were also undertaken in which comparisons were made between groups after adjusting for other factors that may influence change in pain (eg, age). The results of regression analysis taking such factors into account are listed in Table 6. For each end point, the factors that were significantly (P<.10, see Subjects and Methods section) associated with change in pain scores were identified, and then treatment group was added to the regression model. In each case, no significant association with treatment was identified. This indicates that the failure to identify an effect from the ionized wrist bracelet beyond the effect available from placebo cannot be ascribed to other factors.

DISCUSSION

The results of this study suggest that the use of ionized bracelets for treating muscle and joint pain was no more effective for relieving musculoskeletal pain than was the use of placebo bracelets. However, both groups showed subjective improvement in pain scores.

Up to 30% to 40% of patients with a wide range of clinical conditions, such as pain, asthma, high blood pressure, and even myocardial infarction, have reported subjective improvement with the use of placebos. However, the effectiveness of placebos has been questioned recently. In an analysis of clinical trials comparing placebo with no treatment, Hrobjartsson and Gotzsche7 found little evidence that placebos had powerful clinical effects except for “possible small benefits in studies with continuous subjective outcomes and for the treatment of pain.” Additionally, earrings therapeutic patterns that heighten placebo effects are especially prominent in unconventional healing, and this form of healing may have “enhanced” placebo effects in particular conditions.8 Although the goal of our study was not to assess the effectiveness of placebos, our results supported the benefits of using placebos to treat pain. The participants in both the ionized and the placebo bracelet group showed a subjective improvement in pain scores. This study did not include participants who received no bracelet. Such a group would have allowed us to study pain in an untreated group during the same period and could have strengthened the results of this study. Accordingly, it is unclear whether pain would have improved in similar populations with observation alone. Further studies could help clarify this issue.

CONCLUSION

Alternative medical treatments are increasing in popularity. Although patients may perceive benefits from alternative medical therapies, there is little objective evidence to support the effectiveness of most alternative methods. Our finding that the subjective improvement in pain scores was similar for ionized and placebo bracelets questions the benefit of using an ionized bracelet. As practicing clinicians, we need continued research to test claims made by manufacturers of alternative medical products to ensure that our recommendations are adequately and sufficiently supported by objective, research– based evidence.

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Jun. 21–Starting Sunday, Stop & Shop Supermarkets in Connecticut will sell red, white and blue wristbands in bins near the registers, with the proceeds going to veterans’ groups in the state to help soldiers injured in the “War on Terror.”

The Coalition to Salute America’s Heroes is giving the Quincy, Mass.-based grocery tiffany and co chain 492,000 bracelets, which the company will sell for $2 each at its Stop & Shop and Giant food stores in Massachusetts, Rhode Island, New Hampshire, Connecticut, New York, Maryland, Virginia, Delaware and Washington, D.C. Stores in New Jersey won’t carry the bracelets because there aren’t enough to go around, company spokeswoman Faith Weiner said.

“We thought that it would be a great patriotic symbol of support,” she said.

The partnership with the coalition came out of a dinner that Stop & Shop President and Chief Executive Marc Smith had with coalition founder Roger Chapin, Weiner said. Smith was had been looking for a way to help wounded veterans, she said.

“Marc felt that the public, and especially our customers — if they knew what these men and women needed would want to help,” she said.

The funds raised will help wounded veterans put their lives back together, she said. That earrings assistance could be financial or structural, such as building a ramp onto the house of a veteran who uses a wheelchair.

“We understand the government is helping them — [but] we know the government can never do it all,” she said.

The bracelets cost the coalition 41 cents each, and the coalition will recover that cost, Weiner said. The remaining $1.59 will go to local groups to help veterans, but Weiner on Monday did not have a list of how the money will be distributed or to which agencies or groups.

However, she said, the coalition won’t be able to use any of the money for its administrative costs, and “Stop & Shop isn’t making any money [on the sales].”