Zoster vaccine live for the prevention of shingles in the elderly patient

Shingles, also known as herpes zoster, is a common disease in the elderly population that is caused by reactivation of latent varicella zoster virus. Its manifestations and complications can lead to significant short- and long-term morbidity. In 2006, the United States Food and Drug Administration approved Zoster Vaccine Live (Zostavax®) for the prevention of herpes zoster in immunocompetent adults age 60 and over. The approval was based on the results of a large, multi-center clinical trial, the Shingles Prevention Study. This study showed that vaccination significantly decreased shingles incidence, burden of illness due to disease, and the development of, and severity of postherpetic neuralgia. This review offers an overview of varicella zoster virus infection and complications, a summary of the Shingles Prevention Study, and a critical analysis designed to aid the practicing physician who has questions about vaccine administration

Navigating Rough Waters with Key Performance Indicators

Would you start a sailing trip around the world without charting a course? Would you take your chances with bad weather and rough water, or would you want to have a plan before departure? While it seems obvious to plot a course and have a well stocked boat, we all too often rush headlong into projects without a solid plan or an idea on how to track progress. Enter KPI charts! In this session we will introduce you to a powerful tool that can help you set realistic deadlines, track progress, and communicate your results

Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study

Background: The need to tackle sexual health problems and promote positive sexual health has been acknowledged in Irish health policy. Young people’s sexual behaviour however remains under-researched with limited national data available. Methods: This study presents the first nationally representative and internationally comparable data on young people’s sexual health behaviours in Ireland. Self-complete questionnaire data were collected from 4494 schoolchildren aged 15-18 as part of a broader examination of health behaviour and their context. The prevalence of sexual initiation, very early sexual initiation (<14 years) and non-condom use at last intercourse are reported and used as outcomes in separate multilevel logistic regression models examining associations between sociodemographic characteristics, lifestyle characteristics and young people’s sexual behaviours. Results: Overall, 25.7% of boys and 21.2% of girls were sexually initiated. Older age was consistently predictive of initiation for both boys and girls, as were alcohol, tobacco and cannabis involvement, living in poorer neighbourhoods and having good communication with friends. Involvement in music and drama was protective. Very early sexual initiation (<14 years) was reported by 22.8% of sexually initiated boys and 13.4% of the sexually initiated girls, and was consistently associated with rural living, cannabis involvement, bullying others and attending fewer health check-ups for both. Boys’ very early initiation was predicted by alcohol involvement, receiving unhealthy food from parents and taking medication for psychological symptoms, whereas better communication with friends and more experience of health symptoms were protective. Girls’ very early initiation was predicted by belonging to a non-Traveller community, whereas taking medication for physical symptoms was protective. Condom use was reported by 80% of sexually initiated students at last intercourse. Boys’ condom use was associated with older age, higher social class, bullying others and self-care behaviours. For girls, condom use was predicted by belonging to a non-Traveller community, healthy food consumption, higher quality of life and being bullied, whereas taking medication for physical and psychological symptoms was associated with non-condom use. Conclusions: These nationally representative research findings highlight the importance of focusing on young people as a distinct population subgroup with unique influences on their sexual health requiring targeted interventions and policy

Therapist Factors as Predictors of the Experience of Memory Recovery in Psychotherapy

Psychotherapist factors as predictors of client memory recovery of childhood sexual abuse following a period of amnesia were investigated. Marriage and family therapists and clinical psychologists in California were surveyed regarding the degree of research emphasis in academic training, knowledge of memory processes and professional standards of care regarding memory recovery in psychotherapy, degree of ambiguity tolerance, use of memory recovery techniques and client memory recovery. Therapists with greater research emphasis in academic training reported having fewer clients with memory recovery. Also, therapists who were intolerant of ambiguity used memory recovery techniques more than did therapists who were tolerant. Finally, increased therapist use of techniques was correlated with increased numbers of clients with memory recovery. Findings suggest that therapist characteristics appear to play some role in therapist use of techniques and client memory recovery. The extent of that role remains unclear. Limitations of the research project are discussed and suggestions for future research explored

Delayed phase of Hematoporphyrin-Induced Phototoxicity: Modulation by Complement, Leukocytes, and Antihistamines

We have investigated the role of complement, leukocytes, and histamine in the delayed phase of hematoporphyrin-induced phototoxicity in guinea pigs. The phototoxic response was quantified by the accumulation of intravenously injected [125I]bovine serum albumin in the skin. There was a greater than 6-fold increase in the vascular response at the completion of irradiation, which subsided partially to reach a plateau of twice the preirradiation level between 0.5 h and 12 h. At 18 h the vascular responsiveness returned to the baseline value. The 7 h timepoint was selected in this study to evaluate the modulation of the delayed phase. In complement-depleted guinea pigs, as well as in leukopenic animals, the enhancement in the vascular response was significantly suppressed (p vs control, < 0.0001 and 0.0022. respectively). Cimetidine, when administered prior to irradiation, significantly suppressed the phototoxic response (p vs control, 0.0365). The combination of diphenhydramine and cimetidine, administered 6 h after the induction of phototoxicity, also suppressed the vascular response (p vs control, < 0.0001). These data indicate that the expression of the delayed phase of hematoporphyrin-iuduced phototoxicity, similar to the early phase, requires the presence of an intact complement system, leukocytes, and histamine

Palmoplantar keratoderma along with neuromuscular and metabolic phenotypes in Slurp1-deficient mice.

Mutations in SLURP1 cause mal de Meleda, a rare palmoplantar keratoderma (PPK). SLURP1 is a secreted protein that is expressed highly in keratinocytes but has also been identified elsewhere (e.g., spinal cord neurons). Here, we examined Slurp1-deficient mice (Slurp1(-/-)) created by replacing exon 2 with β-gal and neo cassettes. Slurp1(-/-) mice developed severe PPK characterized by increased keratinocyte proliferation, an accumulation of lipid droplets in the stratum corneum, and a water barrier defect. In addition, Slurp1(-/-) mice exhibited reduced adiposity, protection from obesity on a high-fat diet, low plasma lipid levels, and a neuromuscular abnormality (hind-limb clasping). Initially, it was unclear whether the metabolic and neuromuscular phenotypes were due to Slurp1 deficiency, because we found that the targeted Slurp1 mutation reduced the expression of several neighboring genes (e.g., Slurp2, Lypd2). We therefore created a new line of knockout mice (Slurp1X(-/-) mice) with a simple nonsense mutation in exon 2. The Slurp1X mutation did not reduce the expression of adjacent genes, but Slurp1X(-/-) mice exhibited all of the phenotypes observed in the original line of knockout mice. Thus, Slurp1 deficiency in mice elicits metabolic and neuromuscular abnormalities in addition to PPK

Standards for Specialized Nutrition Support: Home Care Patients

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141435/1/ncp0579.pd