NIH Consensus Development Panel Research Articles

Evaluation of Lipid Profile as Indicators for Patients with Erectile Dysfunction

Patients with cardiovascular diseases or erectile dysfunction initially present to primary care physicians, who have an opportunity to intervene early andfavorably affect the clinical course of either condition. Recognition and aggressive treatment of cardiovascular disease risk factors has a major role in management of cardiovascular disease and erectile dysfunction.Twenty Iraqi patients with age range of 45-50 years were considered in this study. The evaluation of erectile dysfunction was according to NIH ConsensusDevelopment Panel on Impotence Procedure. The NIH provided complete information about severity of erectile dysfunction by using its questionnaire. Thelipid profile was performed individually. The obtained results predicted elevation of all lipid profile parameters. The results were as follow: Cholesterol 6.65±0.27 mmol/L, triacylglyceral 5.93±0.22 mmol/L, LDL-cholesterol 4.424 ± 0.28 mmol/L,VLDL 1.19 ±0.18 mmol/L and HDL 1.04 mmol/L.All collected results showed strong evidence between increased on serum lipids and erectile dysfunction and laboratory evaluation of lipid showed performedto patients with erectile dysfunction.

Does age attenuate aerobic conditioning response in postmenopausal women? Response

Dr. Roy Shephard recently commented on our article examining the age-attenuated response of aerobic power in women participating in a monitored exercise program (Earnest et al. 2010). While we do not totally disagree with his comments, we feel that Dr. Shephard has missed several key points regarding our investigation. Critical to this discussion is that our paper should be taken in the context of its main hypothesis. Our current article is an ancillary report to a parent NIH trial known as the Dose Response of Exercising Women (DREW) trial. Women participating in DREW were recruited based on age, body mass (overweight and obese), elevated blood pressure, and being sedentary. As previously reported in a Methods paper, followed by our primary outcomes paper, the principal aim of DREW was to examine the a priori question of whether there is ‘‘minimal,’’ ‘‘threshold,’’ or ‘‘optimal’’ dose of exercise needed to improve fitness and health by examining the effects of exercise at 50, 100, and 150% of the NIH Consensus Panel physical activity recommendation on cardiorespiratory fitness (NIH Consensus Development Panel on Physical Activity and Cardiovascular Health 1996; Church et al. 2007; Morss et al. 2004). As Dr. Shephard did not cite these papers he may not have read these prior to his critique. Unfortunately, in the era of large clinical trials examining exercise training with multiple outcomes of potential interest the ability to report on the findings of these trials is a two-edged sword that is blunted by the inability to list every methodological detail within every paper given page and/or word count restrictions for most journals. Admittedly, while Methods papers help by providing greater detail than one might have room for in future publications, it is conceivable that some of these details are lost should a reader take each ancillary paper onto itself. For this inconvenience, we apologize and hope that future critiques will consider the body of work surrounding the DREW study; specifically, the design, intent, and primary outcomes for the study. With regard to exercise testing, we used a standardized testing protocol based on three criteria following in the following order of importance: (a) a plateau of VO2 (\100 ml/ min) accompanying a 2 min stage protocol—not a ramp as Dr. Shephard asserts—that increased in small increments (i.e., 20 W/2 min) (b) an RER exceeding 1.10, and (c) and the attainment of a max heart rate within 10 beats of 220— age. An issue within Dr. Shephard’s critique extends to the heart rate response of our older age group. Yet, when one examines the heart rate response of this group (mean age 64.9 years) and our stated criteria, their heart response puts them pretty much spot on for our third criteria. Moreover, Gulati et al. (2010) have recently reported the potential error in using the 220-age equation, thus advocating the prediction of maximal heart rate using 206-0.88 (age), which better estimates the actual maximal heart associated with exercise testing in asymptomatic women (Gulati et al. 2010). Following the latter criteria, our expected maximal heart rate for the[60 years group would be 149 b/min. Given our 10 b/ min allowance for the statistical error surrounding prediction equations, our current report not only matches nicely with this revised equation, but also lies well within the 95% confidence limits also proposed by (Gulati et al. 2010). Communicated by Susan Ward.

Celiac Disease: The Endocrine Connection

CD is an immune-mediated enteropathy caused by genetically predisposed individuals eating gluten-containing foods (Catassi et al., 2007; Celiac Working Group et al., 2008; Green & Cellier, 2007; Hill et al., 2005). There are several endocrine disorders that are associated with CD. In many of these cases, CD does not present with the typical gastrointestinal symptoms. Nurses working with children who have endocrine conditions need to consider CD as part of the differential and follow-up care plan. This awareness will facilitate more efficient diagnosis and minimize the risk of conditions associated with untreated CD.

Improving Inpatient and Follow-Up TBI Services

Improving Inpatient and Follow-Up TBI Services

Heart Rate Variability Characteristics in Sedentary Postmenopausal Women Following Six Months of Exercise Training: The DREW Study

BackgroundDecreased heart rate variability (HRV) is associated with a higher risk of mortality. Overall, postmenopausal women have lower levels of HRV than premenopausal women, which may be additionally complicated by lifestyle related behaviors such as physical inactivity and obesity. Though cardiorespiratory exercise training increases HRV, little is known regarding the exercise dose necessary to promote this improvement.Methodology/Principal FindingsOur primary aim was to measure HRV in post-menopausal women following 6-months of exercise training. We examined supine resting HRV in 373 post-menopausal women (45–75 y) after 6-months of randomly assigned and double-blinded administered exercise training exercise training at 50%, 100% and 150% of the NIH Consensus Development Panel's recommended minimal physical activity level. This corresponded to 4, 8, or 12 kcal/kg per week (KKW) of energy expenditure. At baseline, we observed no significant differences in HRV or hormone replacement use between treatment groups. However, we did observe that Caucasian women and those taking antidepressant medications had lower levels of baseline HRV. After 6-months of exercise intervention, we observed a dose dependent increase in all parasympathetically derived time and frequency domain measurements across exercise groups after adjustment for age, ethnicity, antidepressants, and baseline rMSSD (all, P<0.001). For example, the parasympathetic index rMSSD was greater than control (23.19±1.0) for the 4-KKW (25.98±0.8; P = 0.14), 8-KKW (27.66±1.0; P<0.05), and 12-KKW (27.40±0.0; P<0.05) groups at follow-up.Conclusions/SignificanceModerate intensity exercise training exercise is sufficient to improve HRV in previously sedentary postmenopausal women in a dose-dependent manner, as 4-KKW is insufficient to improve parasympathetic indices of HRV, while 12-KKW conferred no greater improvement than 8-KKW.Trial RegistrationClinicaltrials.gov NCT 00011193

Effects of Different Doses of Physical Activity on Cardiorespiratory Fitness Among Sedentary, Overweight or Obese Postmenopausal Women With Elevated Blood Pressure

Low levels of cardiorespiratory fitness are associated with high risk of mortality, and improvements in fitness are associated with reduced mortality risk. However, a poor understanding of the physical activity-fitness dose response relation remains. To examine the effect of 50%, 100%, and 150% of the NIH Consensus Development Panel recommended physical activity dose on fitness in women. Randomized controlled trial of 464 sedentary, postmenopausal overweight or obese women whose body mass index ranged from 25.0 to 43.0 and whose systolic blood pressure ranged from 120.0 to 159.9 mm Hg. Enrollment took place between April 2001 and June 2005 in the Dallas, Tex, area. Participants were randomly assigned to 1 of 4 groups: 102 to the nonexercise control group and 155 to the 4-kcal/kg, 104 to the 8-kcal/kg, and 103 to the 12-kcal/kg per week energy-expenditure groups for the 6-month intervention period. Target training intensity was the heart rate associated with 50% of each woman's peak Vo2. The primary outcome was aerobic fitness assessed on a cycle ergometer and quantified as peak absolute oxygen consumption (Vo2abs, L/min). The mean (SD) baseline Vo2abs values were 1.30 (0.25) L/min. The mean (SD) minutes of exercising per week were 72.2 (12.3) for the 4-kcal/kg, 135.8 (19.5) for the 8-kcal/kg, and 191.7 (33.7) for the 12-kcal/kg per week exercise groups. After adjustment for age, race/ethnicity, weight, and peak heart rate, the exercise groups increased their Vo2abs compared with the control group by 4.2% in the 4-kcal/kg, 6.0% in the 8-kcal/kg, and 8.2% in the 12-kcal/kg per week groups (P<.001 for each vs control; P for trend <.001). There was no treatment x subgroup interaction for age, body mass index, weight, baseline Vo2abs, race/ethnicity, or baseline hormone therapy use. There were no significant changes in systolic or diastolic blood pressure values from baseline to 6 months in any of the exercise groups vs the control group. In this study, previously sedentary, overweight or obese postmenopausal women experienced a graded dose-response change in fitness across levels of exercise training. clinicaltrials.gov Identifier: NCT00011193.

ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Journey into the Realm of Requests for Help Presented to Sexual Medicine Specialists: Introducing Male Sexual Distress

ABSTRACT Introduction The recent availability of noninvasive pharmacological remedies for male sexual function triggered an exponential increase in the number of men requesting help in the sexuality area. Aim The Italian Society of Andrology explored requests for help, not included in formerly established clinical categories of sexual medicine. Methods A central board of 67 andrologists identified new areas of requests for help, instrumental for a web-based questionnaire, forwarded to 912 members of the Italian Society of Andrology. Results were submitted to an independent consensus development panel. Main Outcome Measures A questionnaire response rate of 30.8% was considered acceptable according to standard response rates of medical specialist samples. Results The Central Board interaction identified two new domains of requests for help: sexual distress and unconventional requests for pro-erectile medications. Web-based questionnaire results suggested that such domains account for 29% and 9% respectively of all requests for help already presented by male patients at sexual medicine clinics. The Independent Consensus Development Panel issued a final consensus document; herewith, the statement defining male sexual distress: A non-transitory condition and/or feeling of inadequacy such as to impair “sexual health” (WHO working definition). Inadequacy can originate both from physiological modifications of male sexual functions, and from diseases, dysfunctions, dysfunctional symptoms and dysmorphisms, both of andrological and non-andrological origin, which do not relate to “erectile dysfunction” (NIH Consensus Development Panel definition), but that might also induce erectile dysfunction. Sexual Distress can lead to a request for help which needs to be acknowledged. Conclusion The Italian Society of Andrology identified two new areas of requests for help concerning male sexual issues: sexual distress and unconventional requests for pro-erectile medications. These domains, which do not represent new diseases, nonetheless induce the sufferers to seek help and, accordingly, need to be acknowledged.

THE COSTS OF CARING FOR ERECTILE DYSFUNCTION IN A MANAGED CARE SETTING: EVIDENCE FROM A LARGE NATIONAL CLAIMS DATABASE

We examined the direct costs of erectile dysfunction (ED) empirically. A naturalistic cohort study was done in 285,436 patients with ED and 51 health plans that covered 28 million lives nationwide from 1999 through 2001. Based on claims that had an ED related diagnosis code, procedure code or medication code we categorized the cost structure of ED care and calculated the annual costs of ED care per patient with ED, per user and per member monthly for individual and for all categories of ED care. A patient with ED in a health plan spent about an average of 83.91 dollars in 1999, 95.41 dollars in 2000 and 119.26 dollars in 2001 for ED care. In 2001, 37.08% of ED care costs per patient with ED were spent on phosphodiesterase type 5 (PDE-5) inhibitor therapy, 14.36% were spent on physician office visits, 10.19% were spent on diagnosis procedures, 8.45% were spent on testosterone hormone therapy, 3.85% were spent on penile prosthesis implantation, 4.41% were spent on intracavernous injection, 2.68% were spent on alprostadil pellet insertion and 0.81% was spent on vacuum erection devices. Of the 7 commonly used ED treatments PDE-5 inhibitor therapy has the lowest annual cost per user. In 2001 ED imposed a 122,669 dollars annual burden to a health plan with 100,000 members, that is or 0.108 dollars per member monthly. Each patient with ED spent 119.26 dollars annually for all ED related services or treatments. Of the 7 commonly used treatments PDE-5 inhibitor therapy had the lowest annual cost per user.

Psychometric properties of the Persian version of the osteoporosis knowledge and health belief questionnaires

Osteoporosis has emerged as one of the most common diseases in the aged population. Approximately 25% of women and 10% of men aged 60 years or above are affected by osteoporosis [ [1] Nguyen TV, Eisman JA. Risk factors for low bone mass in elderly men. In: Orwoll ES, editor. Osteoporosis in men. San Diego: Academic Press; 1999. p. 335–62. Google Scholar ]. Osteoporosis is one of the most significant public health problems in the world because it pre-disposes to fractures with minimal or no antecedent trauma. These fractures are, in turn, associated with increased mortality, reduced quality of life and high health care costs [ [2] Cummings S.R. Melton L.J. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002; 359: 1761-1767 Abstract Full Text Full Text PDF PubMed Scopus (2781) Google Scholar ]. Prevention, including regular physical activity and adequate calcium intake, is recognized as a valuable strategy to reduce the prevalence and burden of osteoporosis [ 3 NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis and Therapy. Osteoporosis prevention, diagnosis and therapy. JAMA 2001;285(6):785–95. Google Scholar , 4 North American Menopause Society. The role of calcium in peri- and postmenopausal women: consensus opinion of the North American Menopause Society. Menopause 2001;8(2):84–95. Google Scholar , 5 Dawson-Hughes B. Calcium and vitamin D nutritional needs of elderly women. J Nutr. 1996; 126: 1165S-1167S PubMed Google Scholar , 6 Kanis J.A. The use of calcium in the management of osteoporosis. Bone. 1999; 24: 279-290 Abstract Full Text PDF PubMed Scopus (68) Google Scholar , 7 Forwood M.R. Larsen J.A. Exercise recommendations for osteoporosis; a position statement of the Australian and New Zealand Bone and Mineral Society. Aust Fam Physician. 2000; 29: 761-764 PubMed Google Scholar ].

Bone quality and bone metabolism (marker)

NIH Consensus Development Panel states that bone strength primarily reflects the integration of bone density and bone quality. In addition, it is reported that bone quality refers to architecture, turnover, damage accumulation, and mineralization. Increased bone turnover is an independent risk of fracture of low bone mineral density. Increased bone turnover of urinary CTX, free DPD and free PYD, or decreased turnover of serum ICTP leads to increased relative risk of fractures in the femoral neck or spine/non-spine. Reduction of 50-70% in bone metabolic markers with therapy reduces fracture risk by 40-44%.

LONG-TERM EFFICACY OF SILDENAFIL AND TACHYPHYLAXIS EFFECT

Purpose: We observed that patients who initially responded to sildenafil frequently became resistant to it with time. We evaluated the long-term efficacy of sildenafil.Materials and Methods: A telephone survey was conducted of patients during the first year of sildenafil usage, and another one was completed 2 years later of the same group.Results: During the first survey, the etiology of impotence included post radical prostatectomy in 25, arterial insufficiency in 26, diabetes in 19, neurogenic impotence in 12, suspected venous leak in 9, proved venous leak in 7, Peyronie’s disease in 6 and unspecified in 47 patients. The overall improvement rate, which was defined as the ability to initiate and maintain erections for successful intercourse, was 74%. The dose necessary to achieve this response was 100 mg. sildenafil in 15% of patients, 50 mg. in 83% and 25 mg. in 2%. During the second survey, information was collected on 82 patients and only 43 (52%) had continued treatment. Of the 69 patients who report...

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000: Highlights of the Conference*

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000: Highlights of the Conference*

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000

ERECTILE DYSFUNCTION IN PATIENTS WITH SPINA BIFIDA IS A TREATABLE CONDITION

No AccessJournal of UrologyNeurogenic Bladder1 Sep 2000ERECTILE DYSFUNCTION IN PATIENTS WITH SPINA BIFIDA IS A TREATABLE CONDITION JEFFREY S. PALMER, WILLIAM E. KAPLAN, and CASIMIR F. FIRLIT JEFFREY S. PALMERJEFFREY S. PALMER More articles by this author , WILLIAM E. KAPLANWILLIAM E. KAPLAN More articles by this author , and CASIMIR F. FIRLITCASIMIR F. FIRLIT More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67225-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Now that individuals with spina bifida live well into adulthood erectile dysfunction has become a recognized associated medical disorder. To our knowledge no study has dealt specifically with treatment of erectile dysfunction in men with spina bifida. Therefore, we conducted a prospective, blinded, randomized, placebo controlled, dose escalation, crossover study to determine the ability to treat erectile dysfunction in men with spina bifida with sildenafil citrate. Materials and Methods: Erectile dysfunction was diagnosed in 15 men 19 to 35 years old with spina bifida who were assigned to take 4 sets of tablets, 5 tablets per set, in a random order. All patients took 25 and 50 mg. sildenafil and 2 identical looking sets of corresponding placebos 1 hour before planned sexual activity. Efficacy was assessed by the effect of treatment compared to baseline, that is before treatment, on rating of erections (scored from 0 to 10), duration of erections, frequency of erections based on response to question 1 (scored from 0 to 5) of the International Index of Erectile Function and confidence to obtain an erection based on response to question 15 (scored from 1 to 5) of the International Index of Erectile Function. Results: Improved erectile function was reported while on sildenafil by 12 (80%) men compared to baseline and placebos. There was a significant dose dependent improvement of erectile function with both 25 and 50 mg. sildenafil compared to baseline (p <0.05), as mean erectile score increased by 50% and 88%, mean duration of erections increased by 192% and 266%, mean frequency of erections increased by 61% and 96%, and mean level of confidence increased by 33% and 63%, respectively. Furthermore, 50 mg. sildenafil provided greater improvement in all 4 parameters compared to 25 mg. The placebo results were not significantly different compared to baseline for any of the parameters. Conclusions: Erectile dysfunction in patients with spina bifida is a medically treatable condition. Sildenafil is effective in this patient population and improves level of sexual confidence. References 1 : The changing epidemiology of neural tube defects. United States, 1968–1989. Am J Dis Child1992; 146: 857. Google Scholar 2 : Sexuality and reproductive issues in children with myelomeningocele. Eur J Pediatr Surg1998; 8: 29. Google Scholar 3 : Oral sildenafil in the treatment of erectile dysfunction. Sildenafil study group. N Engl J Med1998; 338: 1397. Crossref, Medline, Google Scholar 4 : Impotence. NIH Consensus Development Panel on Impotence. JAMA1993; 270: 83. Crossref, Medline, Google Scholar 5 : The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology1997; 49: 822. Crossref, Medline, Google Scholar 6 : Erectile dysfunction in spina bifida is treatable. Lancet1999; 354: 125. Crossref, Medline, Google Scholar 7 : Evaluation and nonsurgical management of erectile dysfunction and priapism. In: . Philadelphia: W. B. Saunders Co.1998: 1181. Google Scholar From the Division of Urology, Children’s Memorial Hospital, Northwestern University Medical School, Chicago, Illinois© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySnow-Lisy D, Yerkes E and Cheng E (2015) Update on Urological Management of Spina Bifida from Prenatal Diagnosis to AdulthoodJournal of Urology, VOL. 194, NO. 2, (288-296), Online publication date: 1-Aug-2015.Gatti C, Del Rossi C, Ferrari A, Casolari E, Casadio G and Scire G (2009) Predictors of Successful Sexual Partnering of Adults With Spina BifidaJournal of Urology, VOL. 182, NO. 4S, (1911-1916), Online publication date: 1-Oct-2009.WOODHOUSE C (2018) PROSPECTS FOR FERTILITY IN PATIENTS BORN WITH GENITOURINARY ANOMALIESJournal of Urology, VOL. 165, NO. 6 Part 2, (2354-2360), Online publication date: 1-Jun-2001. Volume 164Issue 3 Part 2September 2000Page: 958-961 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsspinal dysraphismmeningomyeloceleimpotenceMetricsAuthor Information JEFFREY S. PALMER More articles by this author WILLIAM E. KAPLAN More articles by this author CASIMIR F. FIRLIT More articles by this author Expand All Advertisement PDF downloadLoading ...

NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury

NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury

Osteoporosis in men.

Osteoporosis is characterized by bone loss with microarchitectural deterioration, reduced bone strength, and increased risk of fracture (Kanis et al., J Bone Miner Res 9:1137–41, 1994; NIH Consensus Development Panel on Osteoporosis Prevention, South Med J 94:569–73, 2001). It is, in part, a disorder of the aging skeleton and, thus, as the world population ages, it is inevitable that the incidence of this disease will also increase. For example, in the USA during the first quarter of this century, the population greater than 50 years old will increase by 60 % (Day, Population projections of the USA by age, sex, race, and hispanic origin: 1995 to 2050. US Bureau of the Census, Current Population Reports, US Government Printing Office, Washington, DC, P25-1130, 1996; Cummings and Melton, Lancet 359:1761–7, 2002). With that increase in the older population will come a greater incidence of osteoporosis. This disease has traditionally been considered to be a disease of postmenopausal women but men now constitute nearly 1/4 of all osteoporotic patients (Burge et al., J Bone Miner Res 22(3):465–75, 2007; Center et al., JAMA 297:387–94, 2007). Hip fracture, which accounts for at least 1/3 of all fractures in men (Gullberg et al., Osteoporos Int 7:407–13, 1997), is associated with a threefold higher mortality rate in men than in women (Center et al., Lancet 353:878–82, 1999). Data from Trombetti et al. (Osteoporos Int. 13:731–7, 2002) show that more years of life are lost in men than in women after a hip fracture. This may be due, at least in part, to the impression that men are typically older when they sustain a hip fracture and are, therefore, more likely to suffer from serious comorbid events when they fracture. Data from the classic study of Johnell and Kanis (Osteoporos Int 17:1726–33, 2006), however, indicates that worldwide, the peak number of hip fractures occurs at a similar age for men and women, between the ages of 75 and 79.

Cooper institute / the american college of sports medicine: 1997 physical activity interventions conference

Physical inactivity is recognized as a major public health problem in the United States and throughout much of the world. 1 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion: Physical activity and health: A report of the Surgeon General. Atlanta, Georgia; 1996. Google Scholar , 2 NIH Consensus Development Panel on Physical Activity and Cardiovascular HealthNIH Consensus Conference Physical Activity and Cardiovascular Health. JAMA. 1996; 276: 241-246 Crossref PubMed Google Scholar , 3 Pate R.R. Pratt M. Blair S.N. et al. Physical activity and public health A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995; 273: 402-407 Crossref PubMed Scopus (5881) Google Scholar As many as one third of the deaths in the United States from coronary heart disease, colon cancer, and type-2 diabetes can be attributed to sedentary living habits. 4 Powell K.E. Blair S.N. The public health burdens of sedentary living habits Theoretical but realistic estimates. Med Sci Sports Exerc. 1994; 26: 851-856 Crossref PubMed Google Scholar Hundreds, if not thousands, of well-controlled trials over the past 40 years provide evidence on the physiological adaptations to exercise training. We now have sufficient data to specifically quantify the dose of exercise that will produce these adaptations, and this work has led to the development of an exercise prescription for the development and maintenance of physiological fitness adaptations. 5 American College of Sports Medicine Position StandThe recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998; 30: 975-991 Crossref PubMed Scopus (2556) Google Scholar This exercise prescription specifies the recommended amount of exercise in terms of: Frequency, 3 to 5 times per week; Intensity, from 40%–50% to 85% of maximal aerobic power; and Duration, 20 to 60 minutes per session. The American College of Sports Medicine (ACSM) and other groups have promoted the use of the exercise prescription model for broad applications in clinical settings, controlled exercise programs, and the general public. Unfortunately, less than 15% of adults in the United States exercise regularly at the recommended level, 1 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion: Physical activity and health: A report of the Surgeon General. Atlanta, Georgia; 1996. Google Scholar and the situation is comparable in several other countries. 6 Oja P. Descriptive epidemiology of health-related physical activity and fitness. Res Q Exerc Sport. 1995; 66: 303-312 Crossref PubMed Scopus (23) Google Scholar

Late-onset depressive disorders: a preventable variant of cerebrovascular disease?

The severe depressive disorders of late life are associated with high rates of medical morbidity and mortality, cognitive impairment, suicide, disability, complex treatment regimens, institutionalization and high costs to the community (Murphy, 1983; Murphy et al. 1988; Bruce &amp; Leaf, 1989; NIH Consensus Development Panel, 1992; Alexopoulos et al. 1993a, b; Brodaty et al. 1993; Bruce et al. 1994; Forsell et al. 1994; Hickie et al. 1995; Blazer, 1996). Those disorders that are accompanied by cognitive impairment and/or concurrent medical morbidity have a particularly poor outcome (Bruce &amp; Leaf, 1989; Alexopoulos et al. 1993b; Hickie et al. 1995, 1997a). Although psychosocial models of late-life depression place considerable importance on age-related psychological and social risk factors, those who survive into later life may actually be characterized by psychological resilience (Henderson, 1994; Blazer, 1997).Current aetiological research in late-life depression, therefore, places particular emphasis on the potential role of biological risk factors. The potential importance of vascular risk factors is receiving renewed attention and may provide opportunities for specific prevention and intervention strategies in high-risk populations. This emphasis on possible vascular risk factors, and the wider importance of vascular pathologies in late-life neuropsychiatric disorders, mirrors the emphasis of much earlier clinico-pathological studies (Binswanger, 1894; Alzheimer, 1895). The specific focus on the importance of small progressive changes within the subcortical white matter, as distinct from more discrete cortical infarcts (Olszewski, 1962), is now supported by the emerging neuroimaging literature and theoretical constructs in late-life depression (Krishnan, 1991, 1993; Hickie et al. 1996, 1997b; Krishnan et al. 1997).

Glucocorticoid use in patients with preterm premature rupture of the fetal membranes

Antenatal glucocorticoid use in patients with preterm premature rupture of membranes (PPROM) is controversial. The majority of prospective, randomized studies on antenatal glucocorticoid use evaluate the effect of this intervention on preterm infants delivered due to multiple, diverse etiologies, only one of which is PPROM [corrected]. These studies present a variety of conflicting conclusions; meta-analysis indicates a potential benefit of steroids in the reduction of RDS, intraventricular hemorrhage, and mortality. Meta-analysis of studies specifically evaluating pregnancies complicated by PPROM demonstrates a significant reduction in RDS; however, this effect is primarily due to the work of a single author with a potentially atypical study population [corrected]. The remaining studies fail to show a benefit of steroids. The strongest argument for steroid use in patients with PPROM is extrapolation of data from studies of patients delivered preterm due to a variety of etiologies, not just PPROM. While such an extrapolation is currently recommended by the NIH Consensus Development Panel, it may be premature to assume that the same pathophysiological mechanisms and the same propensity for benefit from steroids occur in these different populations. Further studies are necessary before glucocorticoids can be confidently recommended in pPROM.

Physical activity and cardiovascular health. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health

To provide physicians and the general public with a responsible assessment of the relationship between physical activity and cardiovascular health.A nonfederal, nonadvocate, 13-member panel representing the fields of cardiology, psychology, exercise physiology, nutrition, pediatrics, public health, and epidemiology. In addition, 27 experts in cardiology, psychology, epidemiology, exercise physiology, geriatrics, nutrition, pediatrics, public health, and sports medicine presented data to the panel and a conference audience of 600 during a 2-day public session. Questions and statements from conference attendees were considered during the open session. Closed deliberations by the panel occurred during the remainder of the second day and the morning of the third day.The literature was searched through MEDLINE and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. There-after, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.All Americans should engage in regular physical activity at a level appropriate to their capacity, needs, and interest. Children and adults alike should set a goal of accumulating at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days of the week. Most Americans have little or no physical activity in their daily lives, and accumulating evidence indicates that physical inactivity is a major risk factor for cardiovascular disease. However, moderate levels of physical activity confer significant health benefits. Even those who currently meet these daily standards may derive additional health and fitness benefits by becoming more physically active or including more vigorous activity. For those with known cardiovascular disease, cardiac rehabilitation programs that combine physical activity with reduction in other risk factors should be more widely used.