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Home » KUDO CARE NEWS WEEKS

KUDO CARE NEWS WEEKS

Limiting Your Daily Alcohol Intake

According to the 2017 hypertension guidelines from the American Heart Association and the American College of Cardiology, limiting daily alcohol intake to 1–2 drinks in men and 1 drink in women has the least impact on lowering systolic blood pressure (SBP) among non-pharmacologic interventions in hypertensive individuals, with an anticipated reduction of 4 mm Hg in SBP.

Adoption of a DASH eating plan (a diet rich in fruits, vegetables, whole grains, and low-fat dairy products, with reduced content of saturated and total fat) represents the most effective dietary intervention for reducing SBP, with an approximate impact of –11 mg Hg.

Weight loss is a core recommendation in overweight individuals, with an expected drop in SBP of about 1 mm Hg per kilogram of weight loss.

Engaging in regular aerobic exercise 90–150 minutes per week is also an effective intervention, leading to expected reductions of 5–8 mm Hg in SBP.

Reduction of dietary sodium intake by at least 1000 mg/day (with an optimal goal of <1500 mg/day) would be expected to reduce SBP by 5–6 mm Hg.

Limiting Your Daily Alcohol Intake

According to the 2017 hypertension guidelines from the American Heart Association and the American College of Cardiology, limiting daily alcohol intake to 1–2 drinks in men and 1 drink in women has the least impact on lowering systolic blood pressure (SBP) among non-pharmacologic interventions in hypertensive individuals, with an anticipated reduction of 4 mm Hg in SBP.

Adoption of a DASH eating plan (a diet rich in fruits, vegetables, whole grains, and low-fat dairy products, with reduced content of saturated and total fat) represents the most effective dietary intervention for reducing SBP, with an approximate impact of –11 mg Hg.

Weight loss is a core recommendation in overweight individuals, with an expected drop in SBP of about 1 mm Hg per kilogram of weight loss.

Engaging in regular aerobic exercise 90–150 minutes per week is also an effective intervention, leading to expected reductions of 5–8 mm Hg in SBP.

Reduction of dietary sodium intake by at least 1000 mg/day (with an optimal goal of <1500 mg/day) would be expected to reduce SBP by 5–6 mm Hg.

Falling is Becoming More Frequent, Make Sure You’re Prepared

As our population ages, preventing falls is of increasing importance. Approximately 35%–40% of community-dwelling persons age 65 and older fall annually, with 5% of those who fall requiring hospitalization. In addition, it is estimated that up to 40% of nursing-home admissions are fall-related.

Recent U.S. Preventive Services Task Force Findings

In 2018 the U.S. Preventive Services Task Force (USPSTF) found sufficient evidence to recommend exercise interventions (supervised individual and group classes and physical therapy) to prevent falls in community-dwelling adults age 65 or older who are at increased risk for falls.

It also found evidence to recommend that clinicians selectively offer this population customized multifactorial interventions based on a comprehensive individualized fall risk assessment.

In its 2012 report the USPSTF found insufficient evidence for or against the use of the following interventions for preventing falls: medication discontinuation, protein supplementation, education or counseling, hip protectors, and home hazard modification.

Although vitamin D supplementation was recommended in the past to prevent falls, in 2018 the USPSTF concluded that vitamin D supplementation not only offers no benefit in preventing falls in older adults but actually may result in a higher risk at very high dosages.

As a result, the USPSTF now recommends against vitamin D supplementation to prevent falls in community-dwelling adults age 65 or older.

Meningococcal Conjugate Vaccine Updates

Meningococcal conjugate vaccine (MCV) is recommended for normal-risk children at 11–12 years of age, although children with certain medical conditions (such as sickle cell disease or apslenia) may benefit from immunization as early as 2 years of age. HIV-infected patients who are vaccinated should receive two doses of the vaccine.

Being a new military recruit, being a first-year college student living in a dormitory, and visiting endemic areas (e.g., Mecca) are accepted indications for meningococcal vaccination. MCV is preferred for adults younger than 55, although the meningococcal polysaccharide vaccine (MPSV) can be used as an alternative. However, persons previously vaccinated with MPSV who continue to reside in endemic areas may benefit from revaccination after 3–5 years.

Revaccination with MCV4 every 5 years is recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection, including adults with anatomic or functional asplenia or persistent complement component deficiencies.

Preventing Infections

Advancing age and chronic illness are risk factors for herpes zoster and associated post-herpetic neuralgia.

Approximately 99.5% of the U.S. population age 40 and older has serologic evidence of previous varicella infection. Thus, all older adults are at risk for zoster, although many cannot recall any previous history of chickenpox.

The CDC currently recommends that healthy adults age 50 and older get two doses of the recombinant herpes zoster vaccine, separated by 2–6 months, to prevent shingles and the complications from the disease.

Serologic Testing Recommendations

Although the CDC does not recommend serologic testing when vaccinating adults age 50 and older, if serologic evidence of varicella susceptibility is available to the health care provider, the CDC recommends that providers follow the guidelines for varicella vaccination recommended by the Advisory Committee on Immunization Practices (ACIP).

Since the recombinant vaccine has not been evaluated in persons who are seronegative for varicella, it is not indicated for the prevention of varicella and thus should not be administered to patients who test negative for immunity to varicella zoster virus.

Other contraindications to the recombinant vaccine include a severe allergic reaction to any component of the vaccine or after a dose of of the vaccine, a current diagnosis of shingles, and currently being pregnant or breastfeeding.

Zoster Information

A reported history of zoster does not preclude vaccination, as repeat episodes of zoster have been confirmed in immunocompetent persons.

The exact risk for and severity of zoster after a previous episode are unknown, but some experts believe it may be similar to those with no history of zoster.

There is no laboratory test to confirm previous zoster infection, and reports of previous episodes may be erroneous.

Although the safety and efficacy of zoster vaccine have not been assessed in persons with a history of zoster, additional safety concerns are not expected in this group.

Immunocompromised People

Since recombinant vaccine is not a live vaccine, it is not contraindicated in immunocompromised persons.

However, it is not recommended by the ACIP at this time. The ACIP is expected to review the evidence for its use in immunocompromised persons and will modify vaccine policy as necessary.

The CDC does express the opinion that the recombinant vaccine can be given to someone who is taking low-dose immunosuppressive medication, is anticipating immunosuppression, or has recovered from an immunocompromising illness.

 

 

 

 

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