------------- cut here -----------------      HICNet Medical Newsletter                                              Page 13 Volume  6, Number 11                                           April 25, 1993    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                         Food & Drug Administration News ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                FDA Approves Depo Provera, injectable contraceptive                       P92-31 Food and Drug Administration               FOR IMMEDIATE RELEASE Susan Cruzan - (301) 443-3285   The Food and Drug Administration today announced the approval of Depo Provera,  an injectable contraceptive drug.   The drug, which contains a synthetic hormone similar to the natural hormone  progesterone, protects women from pregnancy for three months per injection.  The hormone is injected into the muscle of the arm or buttock where it is  released into the bloodstream to prevent pregnancy. It is more than 99 percent  effective.  "This drug presents another long-term, effective option for women to prevent  pregnancy," said FDA Commissioner David A. Kessler, M.D. "As an injectable,  given once every three months, Depo Provera eliminates problems related to  missing a daily dose."  Depo Provera is available in 150 mg. single dose vials from doctors and  clinics and must be given on a regular basis to maintain contraceptive  protection. If a patient decides to become pregnant, she discontinues the  injections.  As with any such products, FDA advises patients to discuss the benefits and  risks of Depo Provera with their doctor or other health care professional  before making a decision to use it.  Depo Provera's effectiveness as a contraceptive was established in extensive  studies by the manufacturer, the World Health Organization and health agencies  in other countries. U.S. clinical trials, begun in 1963, also found Depo  Provera effective as an injectable contraceptive.  The most common side effects are menstrual irregularities and weight gain. In  addition, some patients may experience headache, nervousness, abdominal pain,  dizziness, weakness or fatigue. The drug should not be used in women who have  acute liver disease, unexplained vaginal bleeding, breast cancer or blood  clots in the legs, lungs or eyes.  The labeling advises doctors to rule out pregnancy before prescribing the  drug, due to concerns about low birth weight in babies exposed to the drug.   HICNet Medical Newsletter                                              Page 14 Volume  6, Number 11                                           April 25, 1993  Recent data have also demonstrated that long-term use may contribute to  osteoporosis. The manufacturer will conduct additional research to study this  potential effect.  Depo Provera was Developed in the 1960s and has been approved for  contraception in many other countries. The UpJohn Company of Kalamazoo, Mich.,  which will market the drug under the name, Depo Provera Contraceptive  Injection, first submitted it for approval in the United States in the 1970s.  At that time, animal studies raised questions about its potential to cause  breast cancer. Worldwide studies have since found the overall risk of cancer,  including breast cancer in humans, to be minimal if any.                                   HICNet Medical Newsletter                                              Page 15 Volume  6, Number 11                                           April 25, 1993         New Rules Speed Approval of Drugs for Life-Threatening Illnesses                       P92-37 Food and Drug Administration                         Monica Revelle - (301) 443-4177  The Food and Drug Administration today announced that it will soon publish new  rules to shed the approval of drugs for patients with serious or life- threatening illnesses, such as AIDS, cancer and Alzheimer's disease.   "These final rules will help patients who are suffering the most serious  illnesses to get access to new drugs months or even years earlier than would  otherwise be possible," said HHS Secretary Louis W. Sullivan, M.D. "The effort  to accelerate FDA review for these drugs has been a long-term commitment and  indeed a hallmark of this administration."   These rules establish procedures for the Food and Drug Administration to  approve a drug based on "surrogate endpoints" or markers. They apply when the  drug provides a meaningful benefit over currently available therapies. Such  endpoints would include laboratory tests or physical signs that do not in  themselves constitute a clinical effect but that are judged by qualified  scientists to be likely to correspond to real benefits to the patient.   Use of surrogate endpoints for measurement of drug efficacy permits approval  earlier than if traditional endpoints -- such as relief of disease symptoms or  prevention of disability and death from the disease -- are used.   The new rules provide for therapies to be approved as soon as safety and  effectiveness, based on surrogate endpoints, can be reasonably established.  The drug's sponsor will be required to agree to continue or conduct  postmarketing human studies to confirm that the drug's effect on the surrogate  endpoint is an indicator of its clinical effectiveness.   One new drug -- zalcitabine (also called ddC) -- was approved June 19, using a  model of this process, for treating the human immunodeficiency virus, HIV, the  cause of AIDS.   Accelerated approval can also be used, if necessary, when FDA determines that  a drug, judged to be effective for the treatment of a disease, can be used  safely only under a restricted distribution plan.   "The new rules will help streamline the drug development and review process  without sacrificing goad science and rigorous FDA oversight," said FDA  commissioner David A. Kessler, M.D. "While drug approval will be accomplished  faster, these drugs and biological products must still meet safety and  effectiveness standards required by law."    HICNet Medical Newsletter                                              Page 16 Volume  6, Number 11                                           April 25, 1993  The new procedures also allow for a streamlined withdrawal process if the  postmarketing studies do not verify the drug's clinical benefit, if there is  new evidence that the drug product is not shown to be safe and effective, or  if other specified circumstances arise that necessitate expeditious withdrawal  of the drug or biologic.                                         HICNet Medical Newsletter                                              Page 17 Volume  6, Number 11                                           April 25, 1993    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                                    Articles ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                 Research Shows Promise for Preventing or Slowing                        Blindness due to Retinal Disease                     National Retinitis Pigmentosa Foundation          Neutrophilic Factors Rescue Photoreceptor Cells in Animal Tests       Baltimore, MD - Researchers at the University of California San Francisco  and Regeneron Pharmaceuticals, Inc. [NASDAQ: REGN] have discovered that  certain naturally occurring substances known as neurotrophic factors can  prevent the degeneration of light-sensing cells in the retina of the eye. The  degeneration of these cells, known as photoreceptors, is a major cause of  visual impairment       This research, published to in the December issue of the Proceedings of  the National Academy of Science (PNAS), holds promise for people who may lose  their sight due to progressive retinal degeneration -- currently, no drug  treatment for retinal degeneration exists. It is estimated that 2.5 million  Americans have severe vision loss due to age-related macular degeneration and  100,000 Americans are affected by retinitis pigmentosus, a hereditary disease  that causes blindness. In addition, each year more than 15,000 people undergo  surgical procedures to repair retinal detachments and other retinal traumas.       The research was funded in part by the RP (Retinitis Pigmentosa)  Foundation Fighting Blindness, Regeneron Pharmaceuticals and the National Eye  Institute. It was conducted by Drs. Matthew M. LaVail, Kazuhiko Unoki, Douglas  Yasurnura, Michael T. Matthes and Roy H. Steinberg at UCSF, arld Dr. C;eorge  Yancoooulos, Regeneron's Vice President for Discovery. Regeneron holds an  exclusive license for this research from UCSF.      In the research described in the PNAS , a light-damage model was used to  assess the survival-promoting activity of a number of naturally occurring  substances. Experimental rats were exposed to constant light for one week.  Eyes that had not been treated with an effective factor lost most of their  photoreceptor cells -- the rods and cones of the retina -- after light  exposure. Brain Derived Neurotrophic Factor (BDNF) and Ciliary Neurotrophic  Factor (CNTF) were particularly effective in this model without causing  unwanted side effects; other factors such as Nerve Growth Factor (NGF) and  Insulin-like Growth Factor (IGF-1) were not effective in these experiments.       Discussing the research, Dr. Jesse M. Cedarbaum, Regeneron's Director of  Clinical Research, said, "BDNF's ability to rescue neurons in the retina that  have been damaged by light exposure may hold promise for the treatment of age- related macular degeneration, one of the leading causes of vision impairment,  and for retinal detachment. Following detachment, permanent vision loss may   HICNet Medical Newsletter                                              Page 18 Volume  6, Number 11                                           April 25, 1993  result frorn the death of detached retinal cells. It is possible that BDNF  could play a role in rescuing those cells once the retina has been reattached  surgically."       "Retinitis pigmentosa is a slowly progressing disease that causes the  retina to degenerate over a period of years or even decades. Vision decreases  to a small tunnel of sight and can result in total blindness. It is our hope  that research on growth factors will provide a means to slow the progression  and preserve useful vision throughout life," stated Jeanette S. Felix, Ph.D.,  Director of Science for the RP Foundation Fighting Blindness.       In addition to the work described , Regeneron is developing BDNF in  conjunction with Aingen Inc. [NASDAQ:AMGN] as a possible treatment for  peripheral neuropathies associated with diabetes and cancer chemotherapy,  motor neuron diseases, Parkinson's disease, and Alzheimer's disease. By  itself, Regeneron is testing CNTF in patients with arnyotrophic lateral  sclerosis (commonly known as Lou Gehrig's disease).       Regeneron Pharlnaceuticals, Inc., based in Tarrytown, New York, is a  leader in the discovery and development of biotechnology-based compounds for  the treatment of neurodegenerative diseases, peripheral neuropathies and nerve  injuries, which affect more than seven million Americans. Drs. LaVail and  Steinberg of UCSF are consultants to Regeneron.                          HICNet Medical Newsletter                                              Page 19 Volume  6, Number 11                                           April 25, 1993                   Affluent Diet Increases Risk Of Heart Disease                            Research Resources Reporter                            written by Mary Weideman                                  Nov/Dec 1992                          National Institutes of Health        High-fat, high-calorie diets rapidly increase risk factors for coronary  heart disease in native populations of developing countries that have  traditionally consumed diets low in fat.  These findings, according to  investigators at the Oregon Health Sciences University in Portland, have  serious implications for public health in both industrialized and developing  countries.       "This study demonstrates why we can develop coronary heart disease and  have higher blood cholesterol and triglyceride levels.  It shows also the  importance of diet and particularly the potential of the diet to increase body  weight, thereby leading to a whole host of other health problems in developing  countries and affluent nations as well," explains principal investigator Dr.  William E. Connor, head of the section of clinical nutrition and lipid  metabolism at Oregon Health Sciences University.       Over the past 25 years Dr. Connor and his team have characterized the  food and nutrient intakes of the Tara humara Indians in Mexico, while  simultaneously documenting various aspects of Tarahumara lipid metabolism.   These native Mexicans number approximately 50,000 and reside in the Sierra  Madre Occidental Mountains in the state of Chihuahua.  The Tarahumaras have  coupled an agrarian diet to endurance racing.  Probably as a result, coronary  heart disease, which is so prevalent in Western industrialized nations, is  virtually non existent in their culture.  Loosely translated, the name  Tarahumara means "fleet of foot," reflecting a tribal passion for betting on  "kickball" races, in which participants run distances of 100 miles or more  while kicking a machete-carved wooden ball.      The typical Tarahumara diet consists primarily of pinto beans, tortillas,  and pinole, a drink made of ground roasted corn mixed with cold water,  together with squash and gath ered fruits and vegetables.  The Tara humaras  also eat small amounts of game, fish, and eggs.  Their food contains  approximately 12 percent of total calories as fat of which the majority (69  percent) is of vegetable origin.  Dietician Martha McMurry, a coinvestigator  in the study, describes their diet as simple and very rich in nutrients while  low in cholesterol and fat.      The Tarahumaras have average plasma cholesterol levels of 121 mg/ dL,  low-density lipoprotein (LDL)-cholesterol levels of 72 mg/dl, and high-density  lipoprotein (HDL)-cholesterol levels of 32 to 42 mg/dl.  All of those values  are in the good, low-risk range, according to the researchers.  Elevated  cholesterol and LDL-cholesterol levels are considered risk factors for heart   HICNet Medical Newsletter                                              Page 20 Volume  6, Number 11                                           April 25, 1993  disease.  HDL-cholesterol is considered beneficial.  In previous studies the  Tarahumaras had been found to be at low risk for cardiac disease, although  able to respond to high-cholesterol diets with elevations in total and LDL- cholesterol.       Clinical Research Center dietitian McMurry and coinvestigator Maria  Teresa Cerqueira established a metabolic unit in a Jesuit mission school  building near a community hospital in the small village of Sisoguichi.  Food  was weighed, cooked, and fed to the study participants under the  investigators' direct supervision, ensuring that subjects ate only food  stipulated by the research protocol.  Fasting blood was drawn twice weekly,  and plasma samples were frozen and shipped to Dr. Connors laboratory for  cholesterol, triglyceride, and lipoprotein analyses.  Regular measurements  included participant body weight, height, and triceps skin fold thickness.   Thirteen Tarahumaras, five women and eight men, including one adolescent, were  fed their native diet for 1 week, followed by 5 weeks of an "affluent" diet.       "In this study we went up to a concentration of dietary fat that was 40  percent of total calories.  This is the prototype of the holiday diet that  many Americans consume a diet high in fat, sugar, and cholesterol, low in  fiber," elaborates Dr. Conners. Such dietary characteristics are reflected in  the cholesterol-saturation index, or CSI, recently devised research dietitian  Sonja Conner working with Dr. Connor.  "The CSI is a single number that  incorporates both the amount of cholesterol and the amount of saturated fat in  the diet.  CSI indicates the diet's potential to elevate the cholesterol  level, particularly the LDL," Dr. Connor explains.  The Tarahumaran diet  averages a very low CSI of 20; Dr. Connor's "affluent" diet used in the study  ranks a CSI of 149.       The experimental design of this study reflects the importance of  establishing baseline plasma lipid levels, typical of the native diet, before  exposing subjects to the experimental diet.  The standard curve relating  dietary food intake to plasma cholesterol demonstrates a leveling off, or  plateau, for consumption of large amounts of fat.  Changes in dietary fat  and/or cholesterol in this range have little effect on plasma levels.  "You  must have the baseline diet almost free of the variables you are going to put  into the experimental diet.  The Framingham study, for example, did not  discriminate on the basis of diet between individuals who got heart disease  because the diet was already high in fat.  All subjects were already eating on  a plateau," Dr. Connor says.       After 5 weeks of consuming the "affluent" diet, the subjects' mean plasma  cholesterol levels had in creased by 31 percent, primarily in the LDL  fraction, which rose 39 percent.  HDL-cholesterol increased by 31 per cent,  and LDL to HDL ratios changed therefore very little.  Plasma triglyceride  levels increased by 18 percent, and subjects averaged an 8-pound gain in  weight.  According to Dr. Connor, lipid changes occurred surprisingly soon,  yielding nearly the same results after 7 days of affluent diet as after 35  days.   HICNet Medical Newsletter                                              Page 21 Volume  6, Number 11                                           April 25, 1993       The increase in HDL carries broad dietary implications for industrialized  nations.  "We think HDL-cholesterol increased because we increased the amount  of dietary fat over the fat content used in the previous Tarahumara metabolic  study.  In that study we saw no change in HDL levels after raising the dietary  cholesterol but keeping the fat relatively consistent with native consumption.   In the present study we increased fat intake to 40 percent of the total  calories.  We reached the conclusion in the Tarahumara study that HDL reflects  the amount of dietary fat in general and not the amount of dietary  cholesterol.  HDL must increase to help metabolize the fat, and it increased  quite a bit in this study," Dr. Connor explains.      Low HDL in the Tarahumarans is not typically an important predictor of  coronary heart disease because they do not normally consume large amounts of  fat or cholesterol.  HDL remains an important predictor to Americans because  of their usual high fat intake.       Dr. Connor recommends a diet for Americans that contains less than 20  percent of total calories as fat, less than 100 mg of cholesterol, and a CSI  around 20, varying in accordance with caloric needs.  Such a diet is low in  meat and dairy fat, high in fiber.  Dr. Connor also comments on recent  suggestions that Americans adopt a "Mediterranean-style" diet.  "The original  Mediterranean diet, in its pristine state, consisted of a very low intake of  fat and very few animal and dairy products.  We are already eating a lot of  meat and dairy products.  Simply to continue that pattern while switching to  olive oil is not going to help the situation."       The World Health Organization (WHO) is focusing much attention on the  emergence of diseases such as coronary heart disease in nations and societies  undergoing technological development.  Dr. Connor says that coronary heart  disease starts with a given society's elite, who typically eat a different  diet than the average citizen.  "If the pattern of afluence increases, the  entire population will have have a higher incidence of coronary heart disease,  which places a termendous health care burden on a society.  WHO would like the  developing countries to prevent coronary heart disease, so they can  concentrate on other aspects of their economic development and on public  health measures to improve general well-being, rather than paying for  unnecessary, expensive medical technology," Dr. Connors says.      "The overall implication of this study is that humans can readily move  their plasma lipids and lipoprotein values into a high-risk range within a  very short time by an affluent, excessive diet.  The present rate of coronary  heart disease in the United States is 30 percent less than it was 20 years  ago, so a lot has been accomplished.  We are changing rapidly," he concludes.       HICNet Medical Newsletter                                              Page 22 Volume  6, Number 11                                           April 25, 1993    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                              General Announcments ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::          Publications for Health Professionals Available from NCI (1/93)  Unless otherwise noted, the following materials are provided free of charge by  calling the NCI's Publication Ordering Service, 1-800-4-CANCER.  Because  Federal Government publications are not subject to copyright restriction, you  are free to photocopy NCI material.      GENERAL INFORMATION          ANTICANCER DRUG INFORMATION SHEETS IN SPANISH/ENGLISH.  Two-      sided fact sheets (in English and Spanish) provide      information about side effects of common drugs used to treat      cancer, their proper usage, and precautions for patients.      The fact sheets were prepared by the United States      Pharmacopeial Convention, Inc., for distribution by the      National Cancer Institute.  Single sets only may be ordered.        CANCER RATES AND RISKS, 3RD EDITION (85-691).  This book is      a compact guide to statistics, risk factors, and risks for      major cancer sites.  It includes charts and graphs showing      incidence, mortality, and survival worldwide and in the      United States.  It also contains a section on the costs of      cancer. 136 pages.        DIET, NUTRITION & CANCER PREVENTION: A GUIDE TO FOOD CHOICES      (87-2778).  This booklet describes what is now known about      diet, nutrition, and cancer prevention.  It provides      information about foods that contain components like fiber,      fat, and vitamins that may affect a person's risk of getting      certain cancers.  It suggests ways to use that information      to select from a broad variety of foods--choosing more of      some foods and less of others. Includes recipes and sample      menus.  39 pages.        NATIONAL CANCER INSTITUTE FACT BOOK.  This book presents      general information about the National Cancer Institute      including budget data, grants and contracts, and historical      information.    HICNet Medical Newsletter                                              Page 23 Volume  6, Number 11                                           April 25, 1993       NATIONAL CANCER INSTITUTE GRANTS PROCESS (91-1222) (Revised      3/90).  This booklet describes general NCI grant award      procedures; includes chapters on eligibility, preparation of      grant application, peer review, eligible costs, and post-      award activities.  62 pages.        PHYSICIAN TO PHYSICIAN: PERSPECTIVE ON CLINICAL TRIALS. This      15-minute videocassette discusses why and how to enter      patients on clinical trials.  It was produced in      collaboration with the American College of Surgeons      Commission on Cancer.          STUDENTS WITH CANCER: A RESOURCE FOR THE EDUCATOR (91-2086).      (Revised 4/87) This booklet is designed for teachers who      have students with cancer in their classrooms or schools. It      includes an explanation of cancer, its treatment and      effects, and guidelines for the young person's re-entry to      school and for dealing with terminally ill students.      Bibliographies are included for both educators and young      people.  22 pages.        UNDERSTANDING THE IMMUNE SYSTEM (92-529). This booklet      describes the complex network of specialized cells and      organs that make up the human immune system. It explains how      the system works to fight off disease caused by invading      agents such as bacteria and viruses, and how it sometimes      malfunctions, resulting in a variety of diseases from      allergies, to arthritis, to cancer. It was developed by the      National Institute of Allergy and Infectious Diseases and      printed by the National Cancer Institute.  This booklet      presents college level instruction in immunology.  It is      appropriate for nursing or pharmacology students and for      persons receiving college training in other areas within the      health professions.  36 pages.     MATERIALS TO HELP STOP TOBACCO USE        CHEW OR SNUFF EDUCATOR PACKAGE (91-2976).  Each package      contains:             Ten copies of CHEW OR SNUFF IS REAL BAD STUFF, a           brochure designed for seventh and eighth graders that           describes the health and social effects of using  HICNet Medical Newsletter                                              Page 24 Volume  6, Number 11                                           April 25, 1993            smokeless tobacco products.  When fully opened, the           brochure can be used as a poster.             One copy of CHEW OR SNUFF IS REAL BAD STUFF:  A GUIDE           TO MAKE YOUNG PEOPLE AWARE OF THE DANGERS OF USING           SMOKELESS TOBACCO.  This booklet is a lesson plan for           teachers.  It contains facts about smokeless tobacco,           suggested classroom activities, and selected           educational resources.        HOW TO HELP YOUR PATIENTS STOP SMOKING: A NATIONAL CANCER      INSTITUTE MANUAL FOR PHYSICIANS (92-3064).  This is a step-      by-step handbook for instituting smoking cessation      techniques in medical practices.  The manual, with resource      lists and tear-out materials, is based on the results of NCI      clinical trials.  75 pages.        HOW TO HELP YOUR PATIENTS STOP USING TOBACCO: A NATIONAL      CANCER INSTITUTE MANUAL FOR THE ORAL HEALTH TEAM (91-3191).      This is a handbook for dentists, dental hygienists, and      dental assistants.  It complements the physicians' manual      and includes additional information on smoking prevention      and on smokeless tobacco use.  58 pages.        PHARMACISTS HELPING SMOKERS QUIT KIT.  A packet of materials      to help pharmacists encourage their smoking patients to      quit.  Contains a pharmacist's guide and self-help materials      for 25 patients.        SCHOOL PROGRAMS TO PREVENT SMOKING: THE NATIONAL CANCER      INSTITUTE GUIDE TO STRATEGIES THAT SUCCEED (90-500).  This      guide outlines eight essential elements of a successful      school-based smoking prevention program based on NCI      research.  It includes a list of available curriculum      resources and selected references.  24 pages.          SELF-GUIDED STRATEGIES FOR SMOKING CESSATION: A PROGRAM      PLANNER'S GUIDE (91-3104). This booklet outlines key      characteristics of successful self-help materials and      programs based on NCI collaborative research.  It lists      additional resources and references. 36 pages.          SMOKING POLICY: QUESTIONS AND ANSWERS. These ten fact sheets  HICNet Medical Newsletter                                              Page 25 Volume  6, Number 11                                           April 25, 1993       provide basic information about the establishment of      worksite smoking policies. Topics range from the health      effects of environmental tobacco smoke to legal issues      concerning policy implementation.        STRATEGIES TO CONTROL TOBACCO USE IN THE UNITED STATES:  A      BLUEPRINT FOR PUBLIC HEALTH ACTION IN THE 1990s (92-3316:      Smoking and Control Monograph No. 1).  This volume provides      a summary of what has been learned from 40 years of a public      health effort against smoking, from the early trial-and-      error health information campaigns of the 1960s to the NCI's      science-based project, American Stop Smoking Intervention      Study for Cancer Prevention, which began in 1991.  It offers      reasons why comprehensive smoking control strategies are now      needed to address the smoker's total environment and to      reduce smoking prevalence significantly over the next      decade.     MATERIALS FOR OUTREACH PROGRAMS        CANCER PREVENTION AND EARLY DETECTION:  COMMUNITY OUTREACH      PROGRAMS FOR HEALTH PROFESSIONALS           Three kits are available for community program planners         and health professionals to set up local cancer         prevention and early detection education projects:              DO THE RIGHT THING. . . GET A NEW ATTITUDE ABOUT            CANCER COMMUNITY OUTREACH PROGRAM.  This community            outreach kit targets Black American audiences.  It            contains materials to help health professionals            conduct community education programs for black            audiences.  The kit emphasizes the early detection of            breast cancer by mammography and of cervical cancer by            the Pap test.  It also discusses smoking and            nutrition.  The kit includes helpful program guidance,            facts, news articles, visuals, and brochures.              HAGALO HOY COMMUNITY OUTREACH PROGRAM.  This community            outreach kit targets Hispanic audiences.  It contains            bilingual and Spanish language materials to help            health professionals conduct community education            programs.  The materials educate Hispanic audiences            about early detection of breast cancer by mammography  HICNet Medical Newsletter                                              Page 26 Volume  6, Number 11                                           April 25, 1993             and of cervical cancer by Pap tests.  The kit also            discusses smoking and related issues.  The kit            includes helpful guidance, facts, news articles,            visuals and brochures.              ONCE A YEAR..FOR A LIFETIME COMMUNITY OUTREACH            MAMMOGRAPHY PROGRAM.  This community outreach kit            targets all women age 40 or over.  It supplies            community program planners and health professionals            with planning guidance, facts about mammography, news            articles, visuals and brochures.          MAKING HEALTH COMMUNICATION PROGRAMS WORK: A PLANNER'S GUIDE      (92-1493).  This handbook presents key principles and steps      in developing and evaluating health communications programs      for the public, patients, and health professionals.  It      expands upon and replaces "Pretesting in Health      Communications" and "Making PSAs Work." 131 pages.        SUPPORT MATERIAL FOR COMMUNITY OUTREACH PROGRAMS        The video and slide presentations listed below support the      mammography outreach programs.           ONCE A YEAR...FOR A LIFETIME VIDEOTAPE.  This 5-minute         VHS videotape uses a dramatic format to highlight the         important facts about the early detection of breast         cancer by mammography.           UNA VEZ AL ANO...PARA TODA UNA VIDA VIDEOTAPE.  This 27-         minute Spanish videotape informs Spanish-speaking women         of the need for medical screening, particularly         mammography.  It explains commonly misunderstood facts         about breast cancer and early detection.  The program, in         a dramatic format, features Edward James Olmos and         Cristina Saralegui.           ONCE A YEAR...FOR A LIFETIME SPEAKER'S KIT (SLIDE SHOW).         This kit includes 66 full-color slides and a number-         coded, ready-to-read script suitable for a mammography         presentation to a large group.  It addresses the         misconceptions prevalent about mammography and urges         women age 40 and older to get regular mammograms so that         breast cancer can be detected as early as possible.  Kit  HICNet Medical Newsletter                                              Page 27 Volume  6, Number 11                                           April 25, 1993          includes a guide, poster, media announcement, news         feature, flyer, and pamphlets on mammography.  This kit         is available directly by writing to:  Modern, 5000 Park         Street North, St. Petersburg, FL 33709-9989. --------- end of part 2 ------------