Michele G. Sullivan

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “The decline reflects reduced force of varicella infection in the population (i.e., herd immunity),” as do declining rates among adults and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou, of the Centers for Disease Control and Prevention, examined varicella treatment codes extracted from a national health plan database of 4 million consumers, from 1994–2002. He found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants; 91% for children aged 9 years and younger; 92% for children aged 10–19 years; and 78% for adults aged 20–49 years. Ambulatory visits for varicella also fell sharply, declining 59% over the period.

National spending on varicella hospitalizations and ambulatory visits fell from $85 million in 1994–1995 to $22 million in 2002.

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “The decline reflects reduced force of varicella infection in the population (i.e., herd immunity),” as do declining rates among adults and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou, of the Centers for Disease Control and Prevention, examined varicella treatment codes extracted from a national health plan database of 4 million consumers, from 1994–2002. He found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants; 91% for children aged 9 years and younger; 92% for children aged 10–19 years; and 78% for adults aged 20–49 years. Ambulatory visits for varicella also fell sharply, declining 59% over the period.

National spending on varicella hospitalizations and ambulatory visits fell from $85 million in 1994–1995 to $22 million in 2002.

Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.

Because infants are not eligible to receive the vaccine, “The decline reflects reduced force of varicella infection in the population (i.e., herd immunity),” as do declining rates among adults and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).

Dr. Zhou, of the Centers for Disease Control and Prevention, examined varicella treatment codes extracted from a national health plan database of 4 million consumers, from 1994–2002. He found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).

Hospitalization rates declined for every age group: 100% for infants; 91% for children aged 9 years and younger; 92% for children aged 10–19 years; and 78% for adults aged 20–49 years. Ambulatory visits for varicella also fell sharply, declining 59% over the period.

National spending on varicella hospitalizations and ambulatory visits fell from $85 million in 1994–1995 to $22 million in 2002.

NASHVILLE, TENN. — Structured weight-training and physical conditioning programs for the elderly can reduce pain and prevent the expected age-related physiologic decline, researchers said at the annual meeting of the American College of Sports Medicine.

The significant improvements associated with weight and aerobic training in these studies reinforce the idea that exercise is beneficial for people of any age. “Our program was structured [to be] effective in reducing and/or reversing age-associated changes in functional performance,” said Jessie Jones, Ph.D., codirector of the Center for Successful Aging at the University of California, Fullerton.

Dr. Jones recruited 85 patients aged 61–82 years for her 5-year study; a total of 21 women and 19 men completed the program. All came to the university exercise center for twice-weekly, 75-minute sessions, 24 weeks each year. The program consisted of warm-up; aerobic training on treadmills, stationary bikes, or step machines; strength training with machines and free weights; and a cool-down period.

Patients were assessed on strength, aerobic fitness, and balance and mobility at baseline, four times each year, and at the end of the program. The data for the changes during the 5 years were compared with the expected age-related changes in a reference population. “On the average, you see a 1%-per-year decline in physical measures between ages 60 and 90,” she said. “So in a reference group, we would expect to see a 5% decline over 5 years.”

The largest changes occurred in upper- and lower-body strength for both men and women. “Instead of the expected 5% decline in upper-body strength, both men and women had a 16%–17% increase,” Dr. Jones told FAMILY PRACTICE NEWS. “It was basically a reversal of the aging process.”

Lower-body strength increased as well. “For this measure, we would have expected a 7.5% decline over 5 years. Instead, we saw an 8% increase for women and a 6% increase for men.”

Aerobic endurance did decline for patients of both sexes but at about half the expected rate of 5% over 5 years. (Women had a decline of 3% and men, a decline of 2%.) Balance and mobility improved 2% in women, rather than declining the expected 6% over 5 years. In men, however, balance and mobility declined 6%.

In addressing the high dropout rate in the study, Dr. Jones acknowledged that it's tough getting any group—especially one composed of members with unpredictable health issues—to commit to a 5-year workout plan. She used social incentives, such as parties, to keep her participants coming back to the gym. “It's hard to get all of them to work out consistently at the same intensity, due to day-to-day fluctuations in health, pain, and medical conditions,” said Dr. Jones. “But this really became a social highlight for a lot of our people.”

Even a brief training program can reap significant benefits, said Kathleen Knutzen, Ph.D., who reported that an 8-week strength-training program reduced the perception of pain among another group of older adults.

The randomized study included 97 community-dwelling adults aged 60–83 years. The intervention group (79 participants) participated in an 8-week training program consisting of a warm-up and stretching routine followed by high-resistance weight training of 8–10 repetitions for each exercise. Participants started out lifting 50% of their one-repetition maximum. The load increased each week, until by week 4, they were lifting 80% of their baseline one-repetition maximum.

Dr. Knutzen, of Western Washington University, Bellingham, used the McGill Pain Questionnaire to assess pain at baseline and at the study's end. Baseline mean score on the total pain index was about 6 for both groups; at study's end, it fell to 3 for the intervention group and rose to 6.2 in the control group. Participants in the intervention group also reported having pain at fewer body sites after the program; the control group reported no change.

“Our older patients often report improvements in both pain and function within a week or two of starting a weight-training program,” Dr. Knutzen said in an interview.

NASHVILLE, TENN. — Structured weight-training and physical conditioning programs for the elderly can reduce pain and prevent the expected age-related physiologic decline, researchers said at the annual meeting of the American College of Sports Medicine.

The significant improvements associated with weight and aerobic training in these studies reinforce the idea that exercise is beneficial for people of any age. “Our program was structured [to be] effective in reducing and/or reversing age-associated changes in functional performance,” said Jessie Jones, Ph.D., codirector of the Center for Successful Aging at the University of California, Fullerton.

Dr. Jones recruited 85 patients aged 61–82 years for her 5-year study; a total of 21 women and 19 men completed the program. All came to the university exercise center for twice-weekly, 75-minute sessions, 24 weeks each year. The program consisted of warm-up; aerobic training on treadmills, stationary bikes, or step machines; strength training with machines and free weights; and a cool-down period.

Patients were assessed on strength, aerobic fitness, and balance and mobility at baseline, four times each year, and at the end of the program. The data for the changes during the 5 years were compared with the expected age-related changes in a reference population. “On the average, you see a 1%-per-year decline in physical measures between ages 60 and 90,” she said. “So in a reference group, we would expect to see a 5% decline over 5 years.”

The largest changes occurred in upper- and lower-body strength for both men and women. “Instead of the expected 5% decline in upper-body strength, both men and women had a 16%–17% increase,” Dr. Jones told FAMILY PRACTICE NEWS. “It was basically a reversal of the aging process.”

Lower-body strength increased as well. “For this measure, we would have expected a 7.5% decline over 5 years. Instead, we saw an 8% increase for women and a 6% increase for men.”

Aerobic endurance did decline for patients of both sexes but at about half the expected rate of 5% over 5 years. (Women had a decline of 3% and men, a decline of 2%.) Balance and mobility improved 2% in women, rather than declining the expected 6% over 5 years. In men, however, balance and mobility declined 6%.

In addressing the high dropout rate in the study, Dr. Jones acknowledged that it's tough getting any group—especially one composed of members with unpredictable health issues—to commit to a 5-year workout plan. She used social incentives, such as parties, to keep her participants coming back to the gym. “It's hard to get all of them to work out consistently at the same intensity, due to day-to-day fluctuations in health, pain, and medical conditions,” said Dr. Jones. “But this really became a social highlight for a lot of our people.”

Even a brief training program can reap significant benefits, said Kathleen Knutzen, Ph.D., who reported that an 8-week strength-training program reduced the perception of pain among another group of older adults.

The randomized study included 97 community-dwelling adults aged 60–83 years. The intervention group (79 participants) participated in an 8-week training program consisting of a warm-up and stretching routine followed by high-resistance weight training of 8–10 repetitions for each exercise. Participants started out lifting 50% of their one-repetition maximum. The load increased each week, until by week 4, they were lifting 80% of their baseline one-repetition maximum.

Dr. Knutzen, of Western Washington University, Bellingham, used the McGill Pain Questionnaire to assess pain at baseline and at the study's end. Baseline mean score on the total pain index was about 6 for both groups; at study's end, it fell to 3 for the intervention group and rose to 6.2 in the control group. Participants in the intervention group also reported having pain at fewer body sites after the program; the control group reported no change.

“Our older patients often report improvements in both pain and function within a week or two of starting a weight-training program,” Dr. Knutzen said in an interview.

NASHVILLE, TENN. — Structured weight-training and physical conditioning programs for the elderly can reduce pain and prevent the expected age-related physiologic decline, researchers said at the annual meeting of the American College of Sports Medicine.

The significant improvements associated with weight and aerobic training in these studies reinforce the idea that exercise is beneficial for people of any age. “Our program was structured [to be] effective in reducing and/or reversing age-associated changes in functional performance,” said Jessie Jones, Ph.D., codirector of the Center for Successful Aging at the University of California, Fullerton.

Dr. Jones recruited 85 patients aged 61–82 years for her 5-year study; a total of 21 women and 19 men completed the program. All came to the university exercise center for twice-weekly, 75-minute sessions, 24 weeks each year. The program consisted of warm-up; aerobic training on treadmills, stationary bikes, or step machines; strength training with machines and free weights; and a cool-down period.

Patients were assessed on strength, aerobic fitness, and balance and mobility at baseline, four times each year, and at the end of the program. The data for the changes during the 5 years were compared with the expected age-related changes in a reference population. “On the average, you see a 1%-per-year decline in physical measures between ages 60 and 90,” she said. “So in a reference group, we would expect to see a 5% decline over 5 years.”

The largest changes occurred in upper- and lower-body strength for both men and women. “Instead of the expected 5% decline in upper-body strength, both men and women had a 16%–17% increase,” Dr. Jones told FAMILY PRACTICE NEWS. “It was basically a reversal of the aging process.”

Lower-body strength increased as well. “For this measure, we would have expected a 7.5% decline over 5 years. Instead, we saw an 8% increase for women and a 6% increase for men.”

Aerobic endurance did decline for patients of both sexes but at about half the expected rate of 5% over 5 years. (Women had a decline of 3% and men, a decline of 2%.) Balance and mobility improved 2% in women, rather than declining the expected 6% over 5 years. In men, however, balance and mobility declined 6%.

In addressing the high dropout rate in the study, Dr. Jones acknowledged that it's tough getting any group—especially one composed of members with unpredictable health issues—to commit to a 5-year workout plan. She used social incentives, such as parties, to keep her participants coming back to the gym. “It's hard to get all of them to work out consistently at the same intensity, due to day-to-day fluctuations in health, pain, and medical conditions,” said Dr. Jones. “But this really became a social highlight for a lot of our people.”

Even a brief training program can reap significant benefits, said Kathleen Knutzen, Ph.D., who reported that an 8-week strength-training program reduced the perception of pain among another group of older adults.

The randomized study included 97 community-dwelling adults aged 60–83 years. The intervention group (79 participants) participated in an 8-week training program consisting of a warm-up and stretching routine followed by high-resistance weight training of 8–10 repetitions for each exercise. Participants started out lifting 50% of their one-repetition maximum. The load increased each week, until by week 4, they were lifting 80% of their baseline one-repetition maximum.

Dr. Knutzen, of Western Washington University, Bellingham, used the McGill Pain Questionnaire to assess pain at baseline and at the study's end. Baseline mean score on the total pain index was about 6 for both groups; at study's end, it fell to 3 for the intervention group and rose to 6.2 in the control group. Participants in the intervention group also reported having pain at fewer body sites after the program; the control group reported no change.

“Our older patients often report improvements in both pain and function within a week or two of starting a weight-training program,” Dr. Knutzen said in an interview.

NASHVILLE, TENN. — Practicing postural and strength exercises twice a week leads to significant increases in balance and overall activity among the frail elderly, Sue Scott said in a poster presented at the annual meeting of the American College of Sports Medicine.

The fear of a disabling fall causes many older people to severely restrict their activity levels, said Ms. Scott, an exercise specialist in Portland, Ore. The fear is especially intense in those who have already experienced a fall.

“Reductions in activity levels are common, causing greater declines in physical and social activities and activities of daily living,” she told FAMILY PRACTICE NEWS.

However, published research—including her own 40-week randomized study—indicates that balance can improve with even a modest amount of gentle exercise. “About halfway through our study, we were already seeing changes in balance, without a commensurate increase in strength,” she said.

Ms. Scott enrolled 84 participants aged 70 years and older, who were all living in retirement or assisted living communities. The oldest participant was 100 years old; the mean age was 83 years. About 80% of the participants were women.

The 45-participant intervention group attended twice-weekly sessions for 16 weeks; one session included a 45-minute class of flexibility, balance, and strength training, and the other was a 30-minute practice session. From weeks 17–40, the intervention group was asked (but not required) to practice the exercises they had learned.

The control group (30 participants) had no contact with the class leaders and was given no instruction to exercise.

Participants of each of the groups were evaluated at baseline and at weeks 16, 33, and 42.

Ms. Scott began each class with a set of stretching exercises to promote flexibility, followed by simple strength-building moves involving legs, back, and posture. She devoted the rest of the session to balance training. “A lot of what we did was try to get them to use their other senses to promote balance,” she said.

“Most of these people rely heavily on visual clues, but they can't see what's going on under their feet,” Ms. Scott said. To promote balance perception with the inner ear, for example, she dimmed the room and asked participants to walk slowly on a treadmill, or bend over and pick up a lit flashlight.

At the study's end, the intervention group scored significantly better than the control group on all measures: chair stand (lower body strength), functional reach (balance), gait speed, and 8-foot up and go (mobility, agility, and strength).

Additionally, Ms. Scott said, the intervention group showed significantly increased daily activity, as measured by 1-week activity recall questionnaires.

“I think they felt better about their balance and more like doing things because the activities were not as anxiety producing. Also, since we encouraged them to be more active, they might have had increased motivation to go out and do things,” she said.

Information about the exercises mentioned are available on Ms. Scott's Web site, www.ablebodies.org

NASHVILLE, TENN. — Practicing postural and strength exercises twice a week leads to significant increases in balance and overall activity among the frail elderly, Sue Scott said in a poster presented at the annual meeting of the American College of Sports Medicine.

The fear of a disabling fall causes many older people to severely restrict their activity levels, said Ms. Scott, an exercise specialist in Portland, Ore. The fear is especially intense in those who have already experienced a fall.

“Reductions in activity levels are common, causing greater declines in physical and social activities and activities of daily living,” she told FAMILY PRACTICE NEWS.

However, published research—including her own 40-week randomized study—indicates that balance can improve with even a modest amount of gentle exercise. “About halfway through our study, we were already seeing changes in balance, without a commensurate increase in strength,” she said.

Ms. Scott enrolled 84 participants aged 70 years and older, who were all living in retirement or assisted living communities. The oldest participant was 100 years old; the mean age was 83 years. About 80% of the participants were women.

The 45-participant intervention group attended twice-weekly sessions for 16 weeks; one session included a 45-minute class of flexibility, balance, and strength training, and the other was a 30-minute practice session. From weeks 17–40, the intervention group was asked (but not required) to practice the exercises they had learned.

The control group (30 participants) had no contact with the class leaders and was given no instruction to exercise.

Participants of each of the groups were evaluated at baseline and at weeks 16, 33, and 42.

Ms. Scott began each class with a set of stretching exercises to promote flexibility, followed by simple strength-building moves involving legs, back, and posture. She devoted the rest of the session to balance training. “A lot of what we did was try to get them to use their other senses to promote balance,” she said.

“Most of these people rely heavily on visual clues, but they can't see what's going on under their feet,” Ms. Scott said. To promote balance perception with the inner ear, for example, she dimmed the room and asked participants to walk slowly on a treadmill, or bend over and pick up a lit flashlight.

At the study's end, the intervention group scored significantly better than the control group on all measures: chair stand (lower body strength), functional reach (balance), gait speed, and 8-foot up and go (mobility, agility, and strength).

Additionally, Ms. Scott said, the intervention group showed significantly increased daily activity, as measured by 1-week activity recall questionnaires.

“I think they felt better about their balance and more like doing things because the activities were not as anxiety producing. Also, since we encouraged them to be more active, they might have had increased motivation to go out and do things,” she said.

Information about the exercises mentioned are available on Ms. Scott's Web site, www.ablebodies.org

NASHVILLE, TENN. — Practicing postural and strength exercises twice a week leads to significant increases in balance and overall activity among the frail elderly, Sue Scott said in a poster presented at the annual meeting of the American College of Sports Medicine.

The fear of a disabling fall causes many older people to severely restrict their activity levels, said Ms. Scott, an exercise specialist in Portland, Ore. The fear is especially intense in those who have already experienced a fall.

“Reductions in activity levels are common, causing greater declines in physical and social activities and activities of daily living,” she told FAMILY PRACTICE NEWS.

However, published research—including her own 40-week randomized study—indicates that balance can improve with even a modest amount of gentle exercise. “About halfway through our study, we were already seeing changes in balance, without a commensurate increase in strength,” she said.

Ms. Scott enrolled 84 participants aged 70 years and older, who were all living in retirement or assisted living communities. The oldest participant was 100 years old; the mean age was 83 years. About 80% of the participants were women.

The 45-participant intervention group attended twice-weekly sessions for 16 weeks; one session included a 45-minute class of flexibility, balance, and strength training, and the other was a 30-minute practice session. From weeks 17–40, the intervention group was asked (but not required) to practice the exercises they had learned.

The control group (30 participants) had no contact with the class leaders and was given no instruction to exercise.

Participants of each of the groups were evaluated at baseline and at weeks 16, 33, and 42.

Ms. Scott began each class with a set of stretching exercises to promote flexibility, followed by simple strength-building moves involving legs, back, and posture. She devoted the rest of the session to balance training. “A lot of what we did was try to get them to use their other senses to promote balance,” she said.

“Most of these people rely heavily on visual clues, but they can't see what's going on under their feet,” Ms. Scott said. To promote balance perception with the inner ear, for example, she dimmed the room and asked participants to walk slowly on a treadmill, or bend over and pick up a lit flashlight.

At the study's end, the intervention group scored significantly better than the control group on all measures: chair stand (lower body strength), functional reach (balance), gait speed, and 8-foot up and go (mobility, agility, and strength).

Additionally, Ms. Scott said, the intervention group showed significantly increased daily activity, as measured by 1-week activity recall questionnaires.

“I think they felt better about their balance and more like doing things because the activities were not as anxiety producing. Also, since we encouraged them to be more active, they might have had increased motivation to go out and do things,” she said.

Information about the exercises mentioned are available on Ms. Scott's Web site, www.ablebodies.org

Acupuncture relieves pain and improves function in knee osteoarthritis significantly better than sham acupuncture, at least in the short term, according to the findings of a randomized controlled study.

Over the long term, however, real and sham acupuncture provide about the same benefits. And patients in both groups improved more than patients who had neither treatment, according to Claudia Witt, M.D., and her colleagues (Lancet 2005;366:136–43).

The investigators randomized 294 patients with knee osteoarthritis to acupuncture (149), minimal acupuncture (75), or a waiting list (70). Both acupuncture groups received 12 30-minute sessions over 8 weeks.

The true acupuncture group received needle stimulation at acupuncture points as identified by traditional Chinese medicine practices.

Minimal acupuncture consisted of superficial needling at nonacupuncture points and these needles were not manipulated.

At 8 weeks, response rates, defined as at least a 50% improvement on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were 52% in the acupuncture group, 28% in the minimal acupuncture group, and 3% in the wait list group.

At baseline, the median WOMAC pain score was 51. After 8 weeks, the mean baseline-adjusted WOMAC score decreased to 27 in the acupuncture group and 36 in the minimal acupuncture group.

The score did not change significantly in the wait list group.

On all WOMAC subscales measuring pain, stiffness, and physical function, the acupuncture group showed significantly greater improvement than did the minimal acupuncture and wait list groups.

The percentage of patients taking analgesics decreased from 42% to 22% in the acupuncture group, 38% to 23% in the minimal acupuncture group, and 52% to 45% in the waiting group.

Improvements at 8 weeks persisted in both acupuncture groups throughout the 52 weeks of follow-up.

However, the differences between the groups were no longer significant at 26 or 52 weeks.

In an accompanying editorial, Andrew Moore, Ph.D., and Henry McQuay, M.D., who conduct pain research at Churchill Hospital, Oxford, England, said that while using needles “still has little long-term benefit without continuing acupuncture,” the technique obviously benefits patients (Lancet 2005;366:100–1).

“Certainly, a major benefit patients report is that acupuncture makes them feel better,” they said. “Making patients feel better is important.”

Acupuncture relieves pain and improves function in knee osteoarthritis significantly better than sham acupuncture, at least in the short term, according to the findings of a randomized controlled study.

Over the long term, however, real and sham acupuncture provide about the same benefits. And patients in both groups improved more than patients who had neither treatment, according to Claudia Witt, M.D., and her colleagues (Lancet 2005;366:136–43).

The investigators randomized 294 patients with knee osteoarthritis to acupuncture (149), minimal acupuncture (75), or a waiting list (70). Both acupuncture groups received 12 30-minute sessions over 8 weeks.

The true acupuncture group received needle stimulation at acupuncture points as identified by traditional Chinese medicine practices.

Minimal acupuncture consisted of superficial needling at nonacupuncture points and these needles were not manipulated.

At 8 weeks, response rates, defined as at least a 50% improvement on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were 52% in the acupuncture group, 28% in the minimal acupuncture group, and 3% in the wait list group.

At baseline, the median WOMAC pain score was 51. After 8 weeks, the mean baseline-adjusted WOMAC score decreased to 27 in the acupuncture group and 36 in the minimal acupuncture group.

The score did not change significantly in the wait list group.

On all WOMAC subscales measuring pain, stiffness, and physical function, the acupuncture group showed significantly greater improvement than did the minimal acupuncture and wait list groups.

The percentage of patients taking analgesics decreased from 42% to 22% in the acupuncture group, 38% to 23% in the minimal acupuncture group, and 52% to 45% in the waiting group.

Improvements at 8 weeks persisted in both acupuncture groups throughout the 52 weeks of follow-up.

However, the differences between the groups were no longer significant at 26 or 52 weeks.

In an accompanying editorial, Andrew Moore, Ph.D., and Henry McQuay, M.D., who conduct pain research at Churchill Hospital, Oxford, England, said that while using needles “still has little long-term benefit without continuing acupuncture,” the technique obviously benefits patients (Lancet 2005;366:100–1).

“Certainly, a major benefit patients report is that acupuncture makes them feel better,” they said. “Making patients feel better is important.”

Acupuncture relieves pain and improves function in knee osteoarthritis significantly better than sham acupuncture, at least in the short term, according to the findings of a randomized controlled study.

Over the long term, however, real and sham acupuncture provide about the same benefits. And patients in both groups improved more than patients who had neither treatment, according to Claudia Witt, M.D., and her colleagues (Lancet 2005;366:136–43).

The investigators randomized 294 patients with knee osteoarthritis to acupuncture (149), minimal acupuncture (75), or a waiting list (70). Both acupuncture groups received 12 30-minute sessions over 8 weeks.

The true acupuncture group received needle stimulation at acupuncture points as identified by traditional Chinese medicine practices.

Minimal acupuncture consisted of superficial needling at nonacupuncture points and these needles were not manipulated.

At 8 weeks, response rates, defined as at least a 50% improvement on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were 52% in the acupuncture group, 28% in the minimal acupuncture group, and 3% in the wait list group.

At baseline, the median WOMAC pain score was 51. After 8 weeks, the mean baseline-adjusted WOMAC score decreased to 27 in the acupuncture group and 36 in the minimal acupuncture group.

The score did not change significantly in the wait list group.

On all WOMAC subscales measuring pain, stiffness, and physical function, the acupuncture group showed significantly greater improvement than did the minimal acupuncture and wait list groups.

The percentage of patients taking analgesics decreased from 42% to 22% in the acupuncture group, 38% to 23% in the minimal acupuncture group, and 52% to 45% in the waiting group.

Improvements at 8 weeks persisted in both acupuncture groups throughout the 52 weeks of follow-up.

However, the differences between the groups were no longer significant at 26 or 52 weeks.

In an accompanying editorial, Andrew Moore, Ph.D., and Henry McQuay, M.D., who conduct pain research at Churchill Hospital, Oxford, England, said that while using needles “still has little long-term benefit without continuing acupuncture,” the technique obviously benefits patients (Lancet 2005;366:100–1).

“Certainly, a major benefit patients report is that acupuncture makes them feel better,” they said. “Making patients feel better is important.”

WASHINGTON — Children who received a combined pertussis, diphtheria, tetanus, polio, and Haemophilus influenzae type b vaccine experienced fever and injection site reactions at rates similar to, or less than, those seen in children who received the component vaccines, Arnd Herz, M.D., said in a poster presented at the annual meeting of the Pediatric Academic Societies.

Dr. Herz of the Kaiser Permanente Vaccine Study Center, Oakland, Calif., presented the combined results of three U.S. studies and one Canadian study at the meeting sponsored by the American Pediatric Society, the Society for Pediatric Research, Ambulatory Pediatric Association, and the American Academy of Pediatrics. These studies examined safety of the combined pertussis, diphtheria, tetanus, polio, and Haemophilus influenzae (Hib) type b vaccine (Pentacel) in both the infant series and fourth dose of the toddler series, sponsored by Sanofi Pasteur Inc.

In the infant series, 4,198 infants received the combination vaccine, and 2,486 received control vaccines given separately. In the fourth dose studies, 5,033 children received the combination vaccine, and 1,157 received the control vaccines given separately.

All combination and control vaccines were given along with other recommended childhood vaccines.

The rate of fever was similar between groups in both series. In the infant series, fever occurred in 28% of the combination group and 31% of the control group. In the fourth dose studies, fever occurred in 11% of both groups.

Injection site reactions were similar among groups in both studies. In the infant series, 10% of the combination group experienced mild redness, 5% experienced swelling, and 60% experienced tenderness. Among the control group, 20% experienced redness, 10% experienced swelling, and 78% experienced tenderness. One infant in the combination group had an immediate reaction of urticaria.

In the fourth dose studies, redness occurred in 20% of both groups. Swelling occurred in 10% of both groups, and tenderness occurred in 50% of the combination group and 60% of the control group.

Crying and fussiness in the 3 days after vaccination were similar in all groups.

There were no serious vaccine-related adverse events in any of the studies.

WASHINGTON — Children who received a combined pertussis, diphtheria, tetanus, polio, and Haemophilus influenzae type b vaccine experienced fever and injection site reactions at rates similar to, or less than, those seen in children who received the component vaccines, Arnd Herz, M.D., said in a poster presented at the annual meeting of the Pediatric Academic Societies.

Dr. Herz of the Kaiser Permanente Vaccine Study Center, Oakland, Calif., presented the combined results of three U.S. studies and one Canadian study at the meeting sponsored by the American Pediatric Society, the Society for Pediatric Research, Ambulatory Pediatric Association, and the American Academy of Pediatrics. These studies examined safety of the combined pertussis, diphtheria, tetanus, polio, and Haemophilus influenzae (Hib) type b vaccine (Pentacel) in both the infant series and fourth dose of the toddler series, sponsored by Sanofi Pasteur Inc.

In the infant series, 4,198 infants received the combination vaccine, and 2,486 received control vaccines given separately. In the fourth dose studies, 5,033 children received the combination vaccine, and 1,157 received the control vaccines given separately.

All combination and control vaccines were given along with other recommended childhood vaccines.

The rate of fever was similar between groups in both series. In the infant series, fever occurred in 28% of the combination group and 31% of the control group. In the fourth dose studies, fever occurred in 11% of both groups.

Injection site reactions were similar among groups in both studies. In the infant series, 10% of the combination group experienced mild redness, 5% experienced swelling, and 60% experienced tenderness. Among the control group, 20% experienced redness, 10% experienced swelling, and 78% experienced tenderness. One infant in the combination group had an immediate reaction of urticaria.

In the fourth dose studies, redness occurred in 20% of both groups. Swelling occurred in 10% of both groups, and tenderness occurred in 50% of the combination group and 60% of the control group.

Crying and fussiness in the 3 days after vaccination were similar in all groups.

There were no serious vaccine-related adverse events in any of the studies.

WASHINGTON — Children who received a combined pertussis, diphtheria, tetanus, polio, and Haemophilus influenzae type b vaccine experienced fever and injection site reactions at rates similar to, or less than, those seen in children who received the component vaccines, Arnd Herz, M.D., said in a poster presented at the annual meeting of the Pediatric Academic Societies.

Dr. Herz of the Kaiser Permanente Vaccine Study Center, Oakland, Calif., presented the combined results of three U.S. studies and one Canadian study at the meeting sponsored by the American Pediatric Society, the Society for Pediatric Research, Ambulatory Pediatric Association, and the American Academy of Pediatrics. These studies examined safety of the combined pertussis, diphtheria, tetanus, polio, and Haemophilus influenzae (Hib) type b vaccine (Pentacel) in both the infant series and fourth dose of the toddler series, sponsored by Sanofi Pasteur Inc.

In the infant series, 4,198 infants received the combination vaccine, and 2,486 received control vaccines given separately. In the fourth dose studies, 5,033 children received the combination vaccine, and 1,157 received the control vaccines given separately.

All combination and control vaccines were given along with other recommended childhood vaccines.

The rate of fever was similar between groups in both series. In the infant series, fever occurred in 28% of the combination group and 31% of the control group. In the fourth dose studies, fever occurred in 11% of both groups.

Injection site reactions were similar among groups in both studies. In the infant series, 10% of the combination group experienced mild redness, 5% experienced swelling, and 60% experienced tenderness. Among the control group, 20% experienced redness, 10% experienced swelling, and 78% experienced tenderness. One infant in the combination group had an immediate reaction of urticaria.

In the fourth dose studies, redness occurred in 20% of both groups. Swelling occurred in 10% of both groups, and tenderness occurred in 50% of the combination group and 60% of the control group.

Crying and fussiness in the 3 days after vaccination were similar in all groups.

There were no serious vaccine-related adverse events in any of the studies.

Subcutaneous medroxyprogesterone acetate has been approved for the treatment of endometriosis-related pelvic pain. It is the first new treatment to be approved for this indication in 15 years.

Depo subQ provera 104 (DMPA-SC), which contains 104 mg medroxyprogesterone acetate, treats endometriosis pain as effectively as leuprolide acetate, but is associated with significantly less bone loss and fewer vasomotor symptoms, according to data provided by Pfizer Inc., which manufactures the agent.

The Food and Drug Administration granted approval for the endometriosis pain indication in March. Depo subQ provera 104 received FDA approval for use as a contraceptive in December 2004.

Depo subQ provera 104 is a new formulation of medroxyprogesterone acetate, which is the active ingredient in Depo-Provera Contraceptive Injection (medroxyprogesterone acetate injectable suspension), but with 30% less hormone.

Depo subQ provera 104 is available in prefilled syringes each containing 0.65 mL (104 mg) of medroxyprogesterone acetate sterile aqueous suspension.

Administered by subcutaneous injection four times a year (every 12–14 weeks), DMPA-SC halts menstruation, which results in thinner, more compact endometrial tissue, the company said. This in turn halts the growth of endometrial implants, relieving endometriosis-associated pain.

The package insert contains a black box warning concerning possible bone loss: Women who use DMPA-SC may lose significant bone mineral density. Bone loss is greater with increasing duration of use and may not be completely reversible.

It is unknown if use of depo subQ provera 104 during adolescence or early adulthood, a critical period of bone accretion, will reduce peak bone mass and increase the risk of osteoporotic fracture in later life. Depo subQ provera 104 should be used as a long-term birth control method (that is, longer than 2 years) only if other birth control methods are inadequate.

Pfizer's phase III randomized controlled trial showed that DMPA-SC is associated with significantly less bone loss than leuprolide acetate for depot suspension, the only other drug approved for treatment of endometriosis-related pain.

The 18-month study included 274 women aged 18–49 years who had diagnoses of endometriosis-associated pelvic pain. They were randomized to 6 months of treatment with either DMPA-SC (104 mg every 3 months) or leuprolide (11.25 mg IM every 3 months), and 12 months of follow-up.

There were no significant differences in pain symptom reduction. Women in both groups showed some bone mineral density declines at the end of treatment, but the mean losses were significantly less for women taking DMPA-SC in both the femur (0.3% vs. 1.65%) and the spine (1.1% vs. 3.95%).

In women who had been taking DMPA-SC, bone mineral density return to pretreatment levels 12 months after discontinuing treatment. Those who had been taking leuprolide showed continued bone mineral density losses of 1.3% in the femur and 1.7% in the spine.

DMPA-SC was also associated with significantly fewer vasomotor symptoms, especially hot flashes.

It's important to remember that the only cure for endometriosis is aggressive surgical excision, David Redwine, M.D., Endometriosis Association adviser, said in an interview. Surgery has been repeatedly shown to have a cure rate of about 60% in even resistant cases.

“Excision is the only treatment which has documentation of cure, although this information is typically withheld from patients as they consider their treatment options. The result is that patients undergo repeated rounds of medical therapies without eradication of their disease,” Dr. Redwine said. “Depo subQ 104 adds another form of medical therapy for endometriosis to be used by physicians who cannot treat the disease effectively by surgery.”

The bone loss associated with any hormonal therapy for symptoms is worrisome, he said, especially in women who are still actively laying down bone. “I am concerned about young women being exposed to medicines that do not treat a disease and that can produce systemic side effects, the permanency of which are not fully known,” said Dr. Redwine, medical director of the endometriosis treatment program at St. Charles Medical Center in Bend, Ore.

Daniel Watts, a Pfizer spokesman, said depo subQ provera 104 will offer a much-needed alternative to women who don't elect surgery.

“Not all patients are appropriate candidates for surgery,” Watts said in an interview. “There are also associated risks with surgery, thus making it a less attractive option for some women. Depo provera sub-Q is a valuable option, because it has significantly less decline in bone mineral density and lower incidence and severity of menopausal symptoms, such as hot flashes, compared with leuprolide acetate, the commonly used treatment.”

Subcutaneous medroxyprogesterone acetate has been approved for the treatment of endometriosis-related pelvic pain. It is the first new treatment to be approved for this indication in 15 years.

Depo subQ provera 104 (DMPA-SC), which contains 104 mg medroxyprogesterone acetate, treats endometriosis pain as effectively as leuprolide acetate, but is associated with significantly less bone loss and fewer vasomotor symptoms, according to data provided by Pfizer Inc., which manufactures the agent.

The Food and Drug Administration granted approval for the endometriosis pain indication in March. Depo subQ provera 104 received FDA approval for use as a contraceptive in December 2004.

Depo subQ provera 104 is a new formulation of medroxyprogesterone acetate, which is the active ingredient in Depo-Provera Contraceptive Injection (medroxyprogesterone acetate injectable suspension), but with 30% less hormone.

Depo subQ provera 104 is available in prefilled syringes each containing 0.65 mL (104 mg) of medroxyprogesterone acetate sterile aqueous suspension.

Administered by subcutaneous injection four times a year (every 12–14 weeks), DMPA-SC halts menstruation, which results in thinner, more compact endometrial tissue, the company said. This in turn halts the growth of endometrial implants, relieving endometriosis-associated pain.

The package insert contains a black box warning concerning possible bone loss: Women who use DMPA-SC may lose significant bone mineral density. Bone loss is greater with increasing duration of use and may not be completely reversible.

It is unknown if use of depo subQ provera 104 during adolescence or early adulthood, a critical period of bone accretion, will reduce peak bone mass and increase the risk of osteoporotic fracture in later life. Depo subQ provera 104 should be used as a long-term birth control method (that is, longer than 2 years) only if other birth control methods are inadequate.

Pfizer's phase III randomized controlled trial showed that DMPA-SC is associated with significantly less bone loss than leuprolide acetate for depot suspension, the only other drug approved for treatment of endometriosis-related pain.

The 18-month study included 274 women aged 18–49 years who had diagnoses of endometriosis-associated pelvic pain. They were randomized to 6 months of treatment with either DMPA-SC (104 mg every 3 months) or leuprolide (11.25 mg IM every 3 months), and 12 months of follow-up.

There were no significant differences in pain symptom reduction. Women in both groups showed some bone mineral density declines at the end of treatment, but the mean losses were significantly less for women taking DMPA-SC in both the femur (0.3% vs. 1.65%) and the spine (1.1% vs. 3.95%).

In women who had been taking DMPA-SC, bone mineral density return to pretreatment levels 12 months after discontinuing treatment. Those who had been taking leuprolide showed continued bone mineral density losses of 1.3% in the femur and 1.7% in the spine.

DMPA-SC was also associated with significantly fewer vasomotor symptoms, especially hot flashes.

It's important to remember that the only cure for endometriosis is aggressive surgical excision, David Redwine, M.D., Endometriosis Association adviser, said in an interview. Surgery has been repeatedly shown to have a cure rate of about 60% in even resistant cases.

“Excision is the only treatment which has documentation of cure, although this information is typically withheld from patients as they consider their treatment options. The result is that patients undergo repeated rounds of medical therapies without eradication of their disease,” Dr. Redwine said. “Depo subQ 104 adds another form of medical therapy for endometriosis to be used by physicians who cannot treat the disease effectively by surgery.”

The bone loss associated with any hormonal therapy for symptoms is worrisome, he said, especially in women who are still actively laying down bone. “I am concerned about young women being exposed to medicines that do not treat a disease and that can produce systemic side effects, the permanency of which are not fully known,” said Dr. Redwine, medical director of the endometriosis treatment program at St. Charles Medical Center in Bend, Ore.

Daniel Watts, a Pfizer spokesman, said depo subQ provera 104 will offer a much-needed alternative to women who don't elect surgery.

“Not all patients are appropriate candidates for surgery,” Watts said in an interview. “There are also associated risks with surgery, thus making it a less attractive option for some women. Depo provera sub-Q is a valuable option, because it has significantly less decline in bone mineral density and lower incidence and severity of menopausal symptoms, such as hot flashes, compared with leuprolide acetate, the commonly used treatment.”

Subcutaneous medroxyprogesterone acetate has been approved for the treatment of endometriosis-related pelvic pain. It is the first new treatment to be approved for this indication in 15 years.

Depo subQ provera 104 (DMPA-SC), which contains 104 mg medroxyprogesterone acetate, treats endometriosis pain as effectively as leuprolide acetate, but is associated with significantly less bone loss and fewer vasomotor symptoms, according to data provided by Pfizer Inc., which manufactures the agent.

The Food and Drug Administration granted approval for the endometriosis pain indication in March. Depo subQ provera 104 received FDA approval for use as a contraceptive in December 2004.

Depo subQ provera 104 is a new formulation of medroxyprogesterone acetate, which is the active ingredient in Depo-Provera Contraceptive Injection (medroxyprogesterone acetate injectable suspension), but with 30% less hormone.

Depo subQ provera 104 is available in prefilled syringes each containing 0.65 mL (104 mg) of medroxyprogesterone acetate sterile aqueous suspension.

Administered by subcutaneous injection four times a year (every 12–14 weeks), DMPA-SC halts menstruation, which results in thinner, more compact endometrial tissue, the company said. This in turn halts the growth of endometrial implants, relieving endometriosis-associated pain.

The package insert contains a black box warning concerning possible bone loss: Women who use DMPA-SC may lose significant bone mineral density. Bone loss is greater with increasing duration of use and may not be completely reversible.

It is unknown if use of depo subQ provera 104 during adolescence or early adulthood, a critical period of bone accretion, will reduce peak bone mass and increase the risk of osteoporotic fracture in later life. Depo subQ provera 104 should be used as a long-term birth control method (that is, longer than 2 years) only if other birth control methods are inadequate.

Pfizer's phase III randomized controlled trial showed that DMPA-SC is associated with significantly less bone loss than leuprolide acetate for depot suspension, the only other drug approved for treatment of endometriosis-related pain.

The 18-month study included 274 women aged 18–49 years who had diagnoses of endometriosis-associated pelvic pain. They were randomized to 6 months of treatment with either DMPA-SC (104 mg every 3 months) or leuprolide (11.25 mg IM every 3 months), and 12 months of follow-up.

There were no significant differences in pain symptom reduction. Women in both groups showed some bone mineral density declines at the end of treatment, but the mean losses were significantly less for women taking DMPA-SC in both the femur (0.3% vs. 1.65%) and the spine (1.1% vs. 3.95%).

In women who had been taking DMPA-SC, bone mineral density return to pretreatment levels 12 months after discontinuing treatment. Those who had been taking leuprolide showed continued bone mineral density losses of 1.3% in the femur and 1.7% in the spine.

DMPA-SC was also associated with significantly fewer vasomotor symptoms, especially hot flashes.

It's important to remember that the only cure for endometriosis is aggressive surgical excision, David Redwine, M.D., Endometriosis Association adviser, said in an interview. Surgery has been repeatedly shown to have a cure rate of about 60% in even resistant cases.

“Excision is the only treatment which has documentation of cure, although this information is typically withheld from patients as they consider their treatment options. The result is that patients undergo repeated rounds of medical therapies without eradication of their disease,” Dr. Redwine said. “Depo subQ 104 adds another form of medical therapy for endometriosis to be used by physicians who cannot treat the disease effectively by surgery.”

The bone loss associated with any hormonal therapy for symptoms is worrisome, he said, especially in women who are still actively laying down bone. “I am concerned about young women being exposed to medicines that do not treat a disease and that can produce systemic side effects, the permanency of which are not fully known,” said Dr. Redwine, medical director of the endometriosis treatment program at St. Charles Medical Center in Bend, Ore.

Daniel Watts, a Pfizer spokesman, said depo subQ provera 104 will offer a much-needed alternative to women who don't elect surgery.

“Not all patients are appropriate candidates for surgery,” Watts said in an interview. “There are also associated risks with surgery, thus making it a less attractive option for some women. Depo provera sub-Q is a valuable option, because it has significantly less decline in bone mineral density and lower incidence and severity of menopausal symptoms, such as hot flashes, compared with leuprolide acetate, the commonly used treatment.”

The diagnosis of restless legs syndrome is made correctly in only 6% of symptomatic patients, Richard P. Allen, Ph.D., of Johns Hopkins University, Baltimore, and colleagues have reported.

Dr. Allen and his associates surveyed 15,391 adults in the United States and Western Europe; 1,114 (7.2%) reported all four diagnostic symptoms of RLS. Of those, about 37% (416) met the criteria for RLS sufferers (experiencing moderately or severely distressing symptoms at least twice weekly).

Most of the RLS sufferers (88%) reported sensory disturbance 60% reported pain; 76% reported sleep disturbance; 56%, impaired daytime functioning; 37%, symptoms affecting movement; and 26%, mood disturbance (Arch. Int. Med. 2005;165:1286–92).

More than 80% had discussed their symptoms with a primary care physician, but only 6% received a diagnosis of restless legs syndrome. Other diagnoses were poor circulation (18%); arthritis (14%); back or spinal problem (13%); varicose veins (7.5%); depression or anxiety (6%); and trapped nerves (6%), the investigators said.

The correct diagnosis of RLS means patients can be offered dopamine agonist therapy.

The diagnosis of restless legs syndrome is made correctly in only 6% of symptomatic patients, Richard P. Allen, Ph.D., of Johns Hopkins University, Baltimore, and colleagues have reported.

Dr. Allen and his associates surveyed 15,391 adults in the United States and Western Europe; 1,114 (7.2%) reported all four diagnostic symptoms of RLS. Of those, about 37% (416) met the criteria for RLS sufferers (experiencing moderately or severely distressing symptoms at least twice weekly).

Most of the RLS sufferers (88%) reported sensory disturbance 60% reported pain; 76% reported sleep disturbance; 56%, impaired daytime functioning; 37%, symptoms affecting movement; and 26%, mood disturbance (Arch. Int. Med. 2005;165:1286–92).

More than 80% had discussed their symptoms with a primary care physician, but only 6% received a diagnosis of restless legs syndrome. Other diagnoses were poor circulation (18%); arthritis (14%); back or spinal problem (13%); varicose veins (7.5%); depression or anxiety (6%); and trapped nerves (6%), the investigators said.

The correct diagnosis of RLS means patients can be offered dopamine agonist therapy.

The diagnosis of restless legs syndrome is made correctly in only 6% of symptomatic patients, Richard P. Allen, Ph.D., of Johns Hopkins University, Baltimore, and colleagues have reported.

Dr. Allen and his associates surveyed 15,391 adults in the United States and Western Europe; 1,114 (7.2%) reported all four diagnostic symptoms of RLS. Of those, about 37% (416) met the criteria for RLS sufferers (experiencing moderately or severely distressing symptoms at least twice weekly).

Most of the RLS sufferers (88%) reported sensory disturbance 60% reported pain; 76% reported sleep disturbance; 56%, impaired daytime functioning; 37%, symptoms affecting movement; and 26%, mood disturbance (Arch. Int. Med. 2005;165:1286–92).

More than 80% had discussed their symptoms with a primary care physician, but only 6% received a diagnosis of restless legs syndrome. Other diagnoses were poor circulation (18%); arthritis (14%); back or spinal problem (13%); varicose veins (7.5%); depression or anxiety (6%); and trapped nerves (6%), the investigators said.

The correct diagnosis of RLS means patients can be offered dopamine agonist therapy.

NASHVILLE, TENN. – Practicing postural and strength exercises twice a week leads to significant increases in balance and overall activity among the frail elderly, Sue Scott said in a poster presented at the annual meeting of the American College of Sports Medicine.

The fear of a disabling fall causes many older people to severely restrict their activity levels, said Ms. Scott, an exercise specialist in Portland, Ore. The fear is especially intense in those who have already experienced a fall.

“Reductions in activity levels are common, causing greater declines in physical and social activities and activities of daily living,” she told this newspaper.

However, published research– including her own 40-week randomized study–indicates that balance can improve with even a modest amount of gentle exercise. “About halfway through our study, we were already seeing changes in balance, without a commensurate increase in strength,” she said.

Ms. Scott enrolled 84 participants aged 70 years and older, who were all living in retirement or assisted living communities. The oldest participant was aged 100 years; the mean age was 83 years. About 80% of the participants were female.

The 45-participant intervention group attended twice-weekly sessions for 16 weeks; one session included a 45-minute class of flexibility, balance, and strength training, and the other was a 30-minute practice session. From weeks 17 to 40, the intervention group was asked (but not required) to practice the exercises they had learned.

The control group (30 participants) had no contact with the class leaders and was given no instruction to exercise.

Participants of both groups were evaluated at baseline and at weeks 16, 33, and 42.

Ms. Scott began each class with a set of stretching exercises to promote flexibility, followed by simple strength-building moves involving legs, back, and posture. She devoted the rest of the session to balance training. “A lot of what we did was try to get them to use their other senses to promote balance,” Ms. Scott said.

“Most of these people rely heavily on visual clues, but they can't see what's going on under their feet,” Ms. Scott said. To promote balance perception with the inner ear, for example, she dimmed the room and asked participants to walk slowly on a treadmill, or bend over and pick up a lit flashlight.

At the study's end, the intervention group scored significantly better than the control group on all measures: chair stand (lower body strength), functional reach (balance), gait speed, and 8-foot up and go (mobility, agility, and strength).

Additionally, Ms. Scott said, the intervention group showed significantly increased daily activity, as measured by 1-week activity recall questionnaires. “I think they felt better about their balance and more like doing things because the activities were not as anxiety producing. Also, since we encouraged them to be more active, they might have had increased motivation to go out and do things,” she said.

Information about the exercises are available on Ms. Scott's Web site, www.ablebodies.org

In addition to improved balance, participants might have felt less anxiety about doing things after the intervention. Courtesy Sue Scott

NASHVILLE, TENN. – Practicing postural and strength exercises twice a week leads to significant increases in balance and overall activity among the frail elderly, Sue Scott said in a poster presented at the annual meeting of the American College of Sports Medicine.

The fear of a disabling fall causes many older people to severely restrict their activity levels, said Ms. Scott, an exercise specialist in Portland, Ore. The fear is especially intense in those who have already experienced a fall.

“Reductions in activity levels are common, causing greater declines in physical and social activities and activities of daily living,” she told this newspaper.

However, published research– including her own 40-week randomized study–indicates that balance can improve with even a modest amount of gentle exercise. “About halfway through our study, we were already seeing changes in balance, without a commensurate increase in strength,” she said.

Ms. Scott enrolled 84 participants aged 70 years and older, who were all living in retirement or assisted living communities. The oldest participant was aged 100 years; the mean age was 83 years. About 80% of the participants were female.

The 45-participant intervention group attended twice-weekly sessions for 16 weeks; one session included a 45-minute class of flexibility, balance, and strength training, and the other was a 30-minute practice session. From weeks 17 to 40, the intervention group was asked (but not required) to practice the exercises they had learned.

The control group (30 participants) had no contact with the class leaders and was given no instruction to exercise.

Participants of both groups were evaluated at baseline and at weeks 16, 33, and 42.

Ms. Scott began each class with a set of stretching exercises to promote flexibility, followed by simple strength-building moves involving legs, back, and posture. She devoted the rest of the session to balance training. “A lot of what we did was try to get them to use their other senses to promote balance,” Ms. Scott said.

“Most of these people rely heavily on visual clues, but they can't see what's going on under their feet,” Ms. Scott said. To promote balance perception with the inner ear, for example, she dimmed the room and asked participants to walk slowly on a treadmill, or bend over and pick up a lit flashlight.

At the study's end, the intervention group scored significantly better than the control group on all measures: chair stand (lower body strength), functional reach (balance), gait speed, and 8-foot up and go (mobility, agility, and strength).

Additionally, Ms. Scott said, the intervention group showed significantly increased daily activity, as measured by 1-week activity recall questionnaires. “I think they felt better about their balance and more like doing things because the activities were not as anxiety producing. Also, since we encouraged them to be more active, they might have had increased motivation to go out and do things,” she said.

Information about the exercises are available on Ms. Scott's Web site, www.ablebodies.org

In addition to improved balance, participants might have felt less anxiety about doing things after the intervention. Courtesy Sue Scott

NASHVILLE, TENN. – Practicing postural and strength exercises twice a week leads to significant increases in balance and overall activity among the frail elderly, Sue Scott said in a poster presented at the annual meeting of the American College of Sports Medicine.

The fear of a disabling fall causes many older people to severely restrict their activity levels, said Ms. Scott, an exercise specialist in Portland, Ore. The fear is especially intense in those who have already experienced a fall.

“Reductions in activity levels are common, causing greater declines in physical and social activities and activities of daily living,” she told this newspaper.

However, published research– including her own 40-week randomized study–indicates that balance can improve with even a modest amount of gentle exercise. “About halfway through our study, we were already seeing changes in balance, without a commensurate increase in strength,” she said.

Ms. Scott enrolled 84 participants aged 70 years and older, who were all living in retirement or assisted living communities. The oldest participant was aged 100 years; the mean age was 83 years. About 80% of the participants were female.

The 45-participant intervention group attended twice-weekly sessions for 16 weeks; one session included a 45-minute class of flexibility, balance, and strength training, and the other was a 30-minute practice session. From weeks 17 to 40, the intervention group was asked (but not required) to practice the exercises they had learned.

The control group (30 participants) had no contact with the class leaders and was given no instruction to exercise.

Participants of both groups were evaluated at baseline and at weeks 16, 33, and 42.

Ms. Scott began each class with a set of stretching exercises to promote flexibility, followed by simple strength-building moves involving legs, back, and posture. She devoted the rest of the session to balance training. “A lot of what we did was try to get them to use their other senses to promote balance,” Ms. Scott said.

“Most of these people rely heavily on visual clues, but they can't see what's going on under their feet,” Ms. Scott said. To promote balance perception with the inner ear, for example, she dimmed the room and asked participants to walk slowly on a treadmill, or bend over and pick up a lit flashlight.

At the study's end, the intervention group scored significantly better than the control group on all measures: chair stand (lower body strength), functional reach (balance), gait speed, and 8-foot up and go (mobility, agility, and strength).

Additionally, Ms. Scott said, the intervention group showed significantly increased daily activity, as measured by 1-week activity recall questionnaires. “I think they felt better about their balance and more like doing things because the activities were not as anxiety producing. Also, since we encouraged them to be more active, they might have had increased motivation to go out and do things,” she said.

Information about the exercises are available on Ms. Scott's Web site, www.ablebodies.org

In addition to improved balance, participants might have felt less anxiety about doing things after the intervention. Courtesy Sue Scott

Most children with conjunctivitis will get better by themselves and don't need an ophthalmic antibiotic, Peter W. Rose, M.B., and his colleagues reported.

“Parents should be encouraged to treat children themselves without medical consultation, unless their child develops unusual symptoms or the symptoms persist for more than a week,” said Dr. Rose of Oxford (England) University. The researchers suggest that parents cleanse their children's eyes with eye drops instead of rushing to the pediatrician at the first sign of conjunctivitis (Lancet 2005;366:37–43).

The investigators randomized 326 children (mean age 3.3 years) with a diagnosis of conjunctivitis to chloramphenicol eye drops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents used drops every 2 hours for the first 24 hours when the child was awake and four times a day until 48 hours after symptoms resolved.

After 7 days, 86% in the antibiotic group were clinically cured, compared with 83% of the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% had experienced a relapse or new infection.

Only one reaction—a case of swollen eyelids and face—was attributed to antibiotic treatment.

Baseline cultures showed 80% had bacterial infections. In this group, the clinical cure rate did not differ significantly between chloramphenicol and placebo (85% vs. 80%), but more of the chloramphenicol group than the placebo group experienced bacterial eradication (40% vs. 23%).

Although eradication is not necessary for a clinical cure, the researchers said failure to eradicate bacteria could impact transmission. “Despite our results, antibiotic treatment might still reduce the absolute number, and, hence, transmissibility of pathogens, and further research might be necessary if antibiotics cease to be prescribed for this disorder.”

The data appear to support prescription policy changes for uncomplicated conjunctivitis, but it still could be a tough sell for parents and schools, they admitted.

Here is a case of hemorrhagic conjunctivitis with subconjunctival hemorrhages and lid swelling. ©Mosby, Inc. 2004. Gershon: Krugman's Infectious Diseases of Children, 11E

Most children with conjunctivitis will get better by themselves and don't need an ophthalmic antibiotic, Peter W. Rose, M.B., and his colleagues reported.

“Parents should be encouraged to treat children themselves without medical consultation, unless their child develops unusual symptoms or the symptoms persist for more than a week,” said Dr. Rose of Oxford (England) University. The researchers suggest that parents cleanse their children's eyes with eye drops instead of rushing to the pediatrician at the first sign of conjunctivitis (Lancet 2005;366:37–43).

The investigators randomized 326 children (mean age 3.3 years) with a diagnosis of conjunctivitis to chloramphenicol eye drops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents used drops every 2 hours for the first 24 hours when the child was awake and four times a day until 48 hours after symptoms resolved.

After 7 days, 86% in the antibiotic group were clinically cured, compared with 83% of the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% had experienced a relapse or new infection.

Only one reaction—a case of swollen eyelids and face—was attributed to antibiotic treatment.

Baseline cultures showed 80% had bacterial infections. In this group, the clinical cure rate did not differ significantly between chloramphenicol and placebo (85% vs. 80%), but more of the chloramphenicol group than the placebo group experienced bacterial eradication (40% vs. 23%).

Although eradication is not necessary for a clinical cure, the researchers said failure to eradicate bacteria could impact transmission. “Despite our results, antibiotic treatment might still reduce the absolute number, and, hence, transmissibility of pathogens, and further research might be necessary if antibiotics cease to be prescribed for this disorder.”

The data appear to support prescription policy changes for uncomplicated conjunctivitis, but it still could be a tough sell for parents and schools, they admitted.

Here is a case of hemorrhagic conjunctivitis with subconjunctival hemorrhages and lid swelling. ©Mosby, Inc. 2004. Gershon: Krugman's Infectious Diseases of Children, 11E

Most children with conjunctivitis will get better by themselves and don't need an ophthalmic antibiotic, Peter W. Rose, M.B., and his colleagues reported.

“Parents should be encouraged to treat children themselves without medical consultation, unless their child develops unusual symptoms or the symptoms persist for more than a week,” said Dr. Rose of Oxford (England) University. The researchers suggest that parents cleanse their children's eyes with eye drops instead of rushing to the pediatrician at the first sign of conjunctivitis (Lancet 2005;366:37–43).

The investigators randomized 326 children (mean age 3.3 years) with a diagnosis of conjunctivitis to chloramphenicol eye drops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents used drops every 2 hours for the first 24 hours when the child was awake and four times a day until 48 hours after symptoms resolved.

After 7 days, 86% in the antibiotic group were clinically cured, compared with 83% of the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% had experienced a relapse or new infection.

Only one reaction—a case of swollen eyelids and face—was attributed to antibiotic treatment.

Baseline cultures showed 80% had bacterial infections. In this group, the clinical cure rate did not differ significantly between chloramphenicol and placebo (85% vs. 80%), but more of the chloramphenicol group than the placebo group experienced bacterial eradication (40% vs. 23%).

Although eradication is not necessary for a clinical cure, the researchers said failure to eradicate bacteria could impact transmission. “Despite our results, antibiotic treatment might still reduce the absolute number, and, hence, transmissibility of pathogens, and further research might be necessary if antibiotics cease to be prescribed for this disorder.”

The data appear to support prescription policy changes for uncomplicated conjunctivitis, but it still could be a tough sell for parents and schools, they admitted.

Here is a case of hemorrhagic conjunctivitis with subconjunctival hemorrhages and lid swelling. ©Mosby, Inc. 2004. Gershon: Krugman's Infectious Diseases of Children, 11E

Women who exercise moderately after a diagnosis of breast cancer experience a 20%–50% reduction in their risk of breast cancer death or breast cancer recurrence, data from the Nurses' Health Study suggest.

The survival advantage is particularly strong for women who have estrogen or progesterone receptor-positive tumors.

These women experienced a 50% decrease in the risk of breast cancer death, reported Michelle D. Holmes, M.D., of Harvard Medical School, Boston, and her colleagues.

“Our results suggest a possible hormonal mechanism for improved survival among women who are physically active,” the researchers said.

Physical activity might also increase survival through short- and long-term improvements in insulin resistance and reduction in hyperinsulinemia (JAMA 2005;293:2479–86).

Since the maximum benefit occurred with moderate levels of exercise (walking 3–5 hr/wk at a moderate pace), the researchers concluded that women with breast cancer should follow the exercise recommendations set forth by the Centers for Disease Control and Prevention: exercise at moderate intensity for 30 or more minutes per day, at least 5 days per week.

It has been estimated that women decrease their physical activity levels by 2 hr/wk after a diagnosis of breast cancer, and that less than one-third of survivors exercise at the recommended level.

The investigators used data from the national Nurses' Health Study for their retrospective analysis, which followed 2,987 women with stages I, II, or III breast cancer who were diagnosed between 1984 and 1998. The women were followed until June 2002 or death, whichever came first.

Activity was determined by self-report and analyzed by metabolic equivalent task (MET)-hours. Three MET-hours are equivalent to walking 2–2.9 mph for 1 hour.

After adjusting for variables such as age, smoking status, and hormone therapy use, women who engaged in 3–8.9 MET-hr/wk had a 20% decreased risk of death from breast cancer, compared with those who exercised less.

Those who engaged in 9–14.9 MET-hr/wk had a 50% decreased risk. There was no additional benefit for more exercise: women who engaged in 15–23.9 MET-hr/wk had a 44% decreased risk, and women who exercised more than that had a 40% decreased risk.

Risk of recurrence also was lowest for women who engaged in 9–14.9 MET-hr/wk. These women had a 43% decreased risk, compared with women who accrued less than 3 MET-hr/wk.

Exercise also improved 10-year survival rates, the researchers said. The survival rate was 86% for less than 3 MET-hr/wk; 89% for 3–8.9 MET-hr/wk; and 92% for at least 9 MET-hr/wk.

The protective benefit was similar among overweight women and those of normal weight, and greater for women with hormone receptor-positive tumors.

Those with hormone receptor-positive tumors who exercised moderately had a 50% decreased risk, compared with a 9% decreased risk for those whose tumors lacked hormone receptors.

Exercise was also particularly beneficial for women with more advanced breast cancer.

Women who had stage III breast cancer and engaged in at least 9 MET-hr/wk had a 63% decreased risk of breast cancer death, compared with women with stage III breast cancer who exercised less.

However, the researchers noted, these results were based on only 76 women and 15 breast cancer deaths.

When they analyzed risk by type of exercise, the researchers found that both walking and vigorous exercise contributed to lowering the risks.

Women who exercise moderately after a diagnosis of breast cancer experience a 20%–50% reduction in their risk of breast cancer death or breast cancer recurrence, data from the Nurses' Health Study suggest.

The survival advantage is particularly strong for women who have estrogen or progesterone receptor-positive tumors.

These women experienced a 50% decrease in the risk of breast cancer death, reported Michelle D. Holmes, M.D., of Harvard Medical School, Boston, and her colleagues.

“Our results suggest a possible hormonal mechanism for improved survival among women who are physically active,” the researchers said.

Physical activity might also increase survival through short- and long-term improvements in insulin resistance and reduction in hyperinsulinemia (JAMA 2005;293:2479–86).

Since the maximum benefit occurred with moderate levels of exercise (walking 3–5 hr/wk at a moderate pace), the researchers concluded that women with breast cancer should follow the exercise recommendations set forth by the Centers for Disease Control and Prevention: exercise at moderate intensity for 30 or more minutes per day, at least 5 days per week.

It has been estimated that women decrease their physical activity levels by 2 hr/wk after a diagnosis of breast cancer, and that less than one-third of survivors exercise at the recommended level.

The investigators used data from the national Nurses' Health Study for their retrospective analysis, which followed 2,987 women with stages I, II, or III breast cancer who were diagnosed between 1984 and 1998. The women were followed until June 2002 or death, whichever came first.

Activity was determined by self-report and analyzed by metabolic equivalent task (MET)-hours. Three MET-hours are equivalent to walking 2–2.9 mph for 1 hour.

After adjusting for variables such as age, smoking status, and hormone therapy use, women who engaged in 3–8.9 MET-hr/wk had a 20% decreased risk of death from breast cancer, compared with those who exercised less.

Those who engaged in 9–14.9 MET-hr/wk had a 50% decreased risk. There was no additional benefit for more exercise: women who engaged in 15–23.9 MET-hr/wk had a 44% decreased risk, and women who exercised more than that had a 40% decreased risk.

Risk of recurrence also was lowest for women who engaged in 9–14.9 MET-hr/wk. These women had a 43% decreased risk, compared with women who accrued less than 3 MET-hr/wk.

Exercise also improved 10-year survival rates, the researchers said. The survival rate was 86% for less than 3 MET-hr/wk; 89% for 3–8.9 MET-hr/wk; and 92% for at least 9 MET-hr/wk.

The protective benefit was similar among overweight women and those of normal weight, and greater for women with hormone receptor-positive tumors.

Those with hormone receptor-positive tumors who exercised moderately had a 50% decreased risk, compared with a 9% decreased risk for those whose tumors lacked hormone receptors.

Exercise was also particularly beneficial for women with more advanced breast cancer.

Women who had stage III breast cancer and engaged in at least 9 MET-hr/wk had a 63% decreased risk of breast cancer death, compared with women with stage III breast cancer who exercised less.

However, the researchers noted, these results were based on only 76 women and 15 breast cancer deaths.

When they analyzed risk by type of exercise, the researchers found that both walking and vigorous exercise contributed to lowering the risks.

Women who exercise moderately after a diagnosis of breast cancer experience a 20%–50% reduction in their risk of breast cancer death or breast cancer recurrence, data from the Nurses' Health Study suggest.

The survival advantage is particularly strong for women who have estrogen or progesterone receptor-positive tumors.

These women experienced a 50% decrease in the risk of breast cancer death, reported Michelle D. Holmes, M.D., of Harvard Medical School, Boston, and her colleagues.

“Our results suggest a possible hormonal mechanism for improved survival among women who are physically active,” the researchers said.

Physical activity might also increase survival through short- and long-term improvements in insulin resistance and reduction in hyperinsulinemia (JAMA 2005;293:2479–86).

Since the maximum benefit occurred with moderate levels of exercise (walking 3–5 hr/wk at a moderate pace), the researchers concluded that women with breast cancer should follow the exercise recommendations set forth by the Centers for Disease Control and Prevention: exercise at moderate intensity for 30 or more minutes per day, at least 5 days per week.

It has been estimated that women decrease their physical activity levels by 2 hr/wk after a diagnosis of breast cancer, and that less than one-third of survivors exercise at the recommended level.

The investigators used data from the national Nurses' Health Study for their retrospective analysis, which followed 2,987 women with stages I, II, or III breast cancer who were diagnosed between 1984 and 1998. The women were followed until June 2002 or death, whichever came first.

Activity was determined by self-report and analyzed by metabolic equivalent task (MET)-hours. Three MET-hours are equivalent to walking 2–2.9 mph for 1 hour.

After adjusting for variables such as age, smoking status, and hormone therapy use, women who engaged in 3–8.9 MET-hr/wk had a 20% decreased risk of death from breast cancer, compared with those who exercised less.

Those who engaged in 9–14.9 MET-hr/wk had a 50% decreased risk. There was no additional benefit for more exercise: women who engaged in 15–23.9 MET-hr/wk had a 44% decreased risk, and women who exercised more than that had a 40% decreased risk.

Risk of recurrence also was lowest for women who engaged in 9–14.9 MET-hr/wk. These women had a 43% decreased risk, compared with women who accrued less than 3 MET-hr/wk.

Exercise also improved 10-year survival rates, the researchers said. The survival rate was 86% for less than 3 MET-hr/wk; 89% for 3–8.9 MET-hr/wk; and 92% for at least 9 MET-hr/wk.

The protective benefit was similar among overweight women and those of normal weight, and greater for women with hormone receptor-positive tumors.

Those with hormone receptor-positive tumors who exercised moderately had a 50% decreased risk, compared with a 9% decreased risk for those whose tumors lacked hormone receptors.

Exercise was also particularly beneficial for women with more advanced breast cancer.

Women who had stage III breast cancer and engaged in at least 9 MET-hr/wk had a 63% decreased risk of breast cancer death, compared with women with stage III breast cancer who exercised less.

However, the researchers noted, these results were based on only 76 women and 15 breast cancer deaths.

When they analyzed risk by type of exercise, the researchers found that both walking and vigorous exercise contributed to lowering the risks.