zoster vaccine. The journal of infectious diseases. 2008;197 Suppl 2:S216. Lu P, Euler GL, Jumaan AO, Harpaz R. Herpes zoster vaccination among adults.
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cost savings if fully used. This live attenuated vaccine formulated from the regular varicella vaccine, but with approximately 14 times greater antigen, demonstrated a reduced burden of illness due to HZ by 61.1%, reduced the incidence of PHN by 66.5%, and reduced the incidence of HZ by 51.3%. Moreover, the vaccine was safe with negligible morbidity. Extrapolations from vaccine trial studies suggest that this vaccine had the potential to prevent 300,000 outpatient visit, 375,000 medication prescriptions, 9700 emergency room visits, and 10,000 hospitalizations per million vaccine recipients. Subsequently the use of the vaccine in immunocompetent adults 60 years of age and older was endorsed by the Advisory Committee on Immunization Practices and the commercial product (Zostavax) was approve by the FDA in May 2006. Subsequently the AFIP specifically recommend administration of the vaccine even in those with a prior documented history of HZ.
ADDITIONAL REFERENCES
Brisson M. Estimating the number needed to vaccine to prevent herpes zosterrelated disease, health care resource use and mortality. Canadian journal of public health. 2008;99:383.
Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: Recommendations of the advisory committee on immunization practices (ACIP). Morbidity and mortality weekly report. Recommendations and reports. 2008;57(RR-5):1.
Hurley LP, Harpaz R, Daley MF, Crane LA, Beaty BL, Barrow J, et al. National survey of primary care physicians regarding herpes zoster and the herpes zoster vaccine. The journal of infectious diseases. 2008;197 Suppl 2:S216.
Lu P, Euler GL, Jumaan AO, Harpaz R. Herpes zoster vaccination among adults aged 60 years or older in the united states, 2007: Uptake of the first new vaccine to target seniors. Vaccine. 2009;27:882-7.
Lu P, Euler GL, Jumaan AO, Harpaz R. Herpes zoster vaccination among adults aged 60 years or older in the united states, 2007: Uptake of the first new vaccine to target seniors. Vaccine. 2009;27:882-7.
Opstelten W, van Essen GA, Hak E. Determinants of non-compliance with herpes zoster vaccination in the community-dwelling elderly. Vaccine. 2009;27:192-6.
Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271-84.
Schmader K, Gnann JW, Watson CP. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. The journal of infectious diseases. 2008;197 Suppl 2:S207.
Reprinted with permission. Copyright 2009 The American College of Physicians.
Weight loss to treat urinary incontinence in overweight and obese women Subak LL, Wing R, West DS, et al. N Engl J Med. 2009;360(5):481-90.
AIM Although obesity is an established and modifiable risk factor for urinary incontinence, there is inconclusive evidence that weight loss has a beneficial effect on incontinence. This trial was designed to test that hypothesis. METHODS This prospective clinical trial enrolled 338 overweight/ obese women with ≥10 urinary incontinence episodes per week to a 6-month weight loss program versus a structured educational program. RESULTS The mean age of participants was 53 +/-11 years, BMI (36) and episodes of weekly incontinence (24) were similar in both groups. Women in the weight loss group had a mean weight loss of 8% (7.8 kg) compared to 1.6% in the control group. After 6 months, the mean weekly number of incontinence, episodes decreased by 47% in the intervention group, as compared with 28% in controls. Improvement in the weight loss group was primarily in those women with stress incontinence, however a higher proportion of weight loss subjects had a clinically relevant reduction of 70% in all incontinence episodes, both stress and urge. CONCLUSIONS A 6 month behavioral intervention targeting weight loss reduced the frequency of urinary incontinence among obese women compared to a control group. IMPACT ON INTERNAL MEDICINE In addition to all the other reasons that obese women should lose weight, improvement in incontinence is now conclusively to the list. Frequent incontinence inhibits socialization, reduces opportunity for physical exercise, and contributes to depression. Moreover the prospect of lessening incontinence may prove to be a very strong
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motivating factor for obese persons to loss weight and keep it off. Reprinted with permission. Copyright 2009 The American College of Physicians.
II. Adverse Effects of Hospitalization
Functional impact of 10 days of bed rest in healthy older adults Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, et al. J Gerontol A Biol Sci Med Sci. 2008;63(10):1076-81.
AIM This study was designed to evaluate the effects of voluntary bed rest (as opposed to acute hospitalization) on multiple functional parameters in older adults. METHODS Healthy, community-dwelling older men and women age 60-85 years (mean age 67 years) were recruited. They remained at bed rest for 10 continuous days. Meticulous observation and testing for the development of DVT was performed. Diet was rigorously calibrated to be eucaloric and provided the Recommended Daily Allowance for protein. Measures of lower extremity strength and power, aerobic capacity and physical performance were performed before and after bed rest. RESULTS All measures of lower extremity strength were significantly lower after bed rest including knee strength (-13.2%), stair climbing (-14%). Maximal aerobic capacity was 12% lower. Despite these decrements, all physical performance measures were unchanged. Voluntary physical activity and time spent inactive increased.
was able to isolate the adverse effects o bed rest on functionality versus the multi-factorial effects of illness, inadequate caloric intake, protein ingestion and drug therapy during acute hospitalization. To put this deconditioning into perspective, the 12% loss in aerobic capacity in just 10days is equivalent to almost a decade of decline noted with age. The unaltered performance measures were likely related to small sample size and general healthy of the sample. Bed rest is dangerous for older adults, and strategies to encourage patients to be out of bed during acute hospital stays, and to walk are likely to attenuate some of these changes. Pre-conditioning before hospital admission is likely also to blunt the magnitude of changes in muscle strength and power as studied in the reference below.
ADDITIONAL REFERENCES
Bautmans I, Njemini R, Predom H, Lemper J, Mets T. Muscle endurance in elderly nursing home residents is related to fatigue perception, mobility, and circulating tumor necrosis factor-alpha, interleukin-6, and heat shock protein 70. J Am Geriatr Soc. 2008;56:389-96
Henwood TR, Taafe DR. Detraining and retraining in older adults following long-term muscle power or muscle strength specific training. J Gerontol A Biol Sci Med Sci. 2008;63(7):751-8.
Hardy SF, Studemski A. Fatigue predicts mortality in older adults. J Am Geriatr Society. 2008;56:1910-1914.
Reprinted with permission. Copyright 2009 The American College of Physicians.
III. Prevention
Exceptional longevity in men: modifiable factors associated with survival and function to age 90 years Yates LB, Djouss L, Kurth T, Buring JE, et al. Arch Intern Med. 2008;168:284-290.
CONCLUSIONS In this small group of healthy older adults (11 subjects) 10 days of strict bed rest resulted in substancial loss of lower extremity strength, power, and aerobic capacity. Yet there was no change in physical performance tests.
AIM Prospective data on non-genetic determinants of exceptional longevity are limited, especially among men. This study examined modifiable factors associated with a life span of 90 years and late life function in men.
IMPACT ON INTERNAL MEDICINE This study is very singular, and very difficult to cary out. It may be the first of its kind that satisfactorily
METHODS This prospective cohort study evaluated 2357 healthy men (mean age, 72 years) within the Physicians Health
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