Lynne J. Goebel

Standing orders in an ambulatory setting increases influenza vaccine usage in older people

Objectives: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients.

Correlates of youth smokeless tobacco use

The objectives of this study are to identify knowledge and attitude variables that correlate with smokeless tobacco use and how youth users and non-users differ in their attitudes and knowledge about smokeless tobacco. A randomized cluster sample of 1834 total fifth, eighth, and 11th grade students in West Virginia public schools during the 1996-1997 school year were surveyed on smokeless tobacco knowledge, attitudes and practices. Data from 648 male non-users and 160 male monthly and daily users of smokeless tobacco were compared using chi 2 and two-tailed t-tests. Logistic regression analysis of survey variables revealed the following correlates of smokeless tobacco use: having a family member not living in the home who uses, having a friend who uses, playing football, having tried cigarettes, and having parents who would permit use at home. Important differences exist in knowledge and attitudes regarding smokeless tobacco between users and non-users in fifth, eighth, and 11th grade West Virginia public schools. Correlates of smokeless tobacco use are identified which can be used to target prevention programs.

Barriers to Vaccinating the Elderly With H1N1 Vaccine

Introduction:The development of a monovalent 2009 H1N1 influenza (swine flu) vaccine for the 2009–2010 season prompted a nationwide campaign of vaccination. The authors assessed the frequency of influenza vaccine usage among 3858 elderly patients with their practice and the most common barriers to receiving vaccine. Methods:The authors calculated the usage of seasonal and 2009 H1N1 vaccines among seniors with their university practice and surveyed a cohort of 64 patients to determine whether they had received the 2009 H1N1 vaccine and their reasons for not receiving it. Results:Of the 555 elderly vaccinated with seasonal influenza vaccine, only 18% were vaccinated with 2009 H1N1 vaccine. Among the survey cohort, 72% had not received the 2009 H1N1 vaccine; 39% of them offered no reason for refusing and 22% stated they were unaware of the need for it. Conclusions:Acceptance rates of seasonal influenza vaccine among elderly were low, and a significant proportion did not receive the 2009 H1N1 vaccine because it was unclear that they should receive it. Unambiguous education of patients and physicians is needed to achieve high rates of influenza vaccination among the elderly.

Influenza season triggers pneumococcal vaccination

OBJECTIVES: To investigate the frequency with which influenza and pneumococcal vaccines are administered alone and together.

USE OF MEDICARE BILLING FOR SMOKING CESSATION COUNSELING

correlates, and cardiovascular disease in 5201 older adults: The Cardiovascular Health Study. J Am Geriatr Soc 1997;45:1–7. 5. Paudel ML, Taylor BC, Diem SJ et al. Association between depressive symptoms and sleep disturbances in community-dwelling older men. J Am Geriatr Soc 2008;56:1228–1235. 6. Kiely DK, Cupples LA, Lipsitz LA. Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Geriatr Soc 2009;57:1532–1539.

Vitamin C Deficiency in an Anticoagulated Patient

ABSTRACTA 64-year-old woman presented with a hemorrhagic perifollicular rash on her legs while taking warfarin. After biopsy, vitamin C deficiency was suggested as the diagnosis, which ascorbic acid assays later confirmed. Clinical resolution of the rash followed supplementation with vitamin C. Patients on a vitamin K limited diet may also be limiting their intake of vitamin C. Physicians should be aware of this possible correlation, and consider checking vitamin C levels in patients with a perifollicular hemorrhagic rash or other signs of vitamin C deficiency while on warfarin.

DESPITE GUIDELINES, SOME ELDERLY PEOPLE RECEIVE MORE THAN ONE DOSE OF PNEUMOCOCCAL VACCINE

ACKNOWLEDGMENTS We thank Ms. Satoko Matsueda (Department of Immunology, Kurume University School of Medicine, Fukuoka, Japan) and Mr. Akio Hayashi and Mr. Ryouichi Onda (Mitsubishi Kagaku Bio-Clinical Laboratories, Tokyo, Japan) for their excellent technical assistance. Conflict of Interest: None of the authors have any financial disclosure to report. This study was funded in part by grants from the Ministry of Education, Culture, Sports, Science and Technology of Japan (No. 19591187 to Dr. T. Takahashi) and the Ministry of Health, Labour and Welfare of Japan (to Dr. S. Morimoto). Authors’ Contribution: Takashi Takahashi was responsible for study concept and design, interpretation of data, and preparation of the manuscript. Koji Nomura, Haruhito Honda, Takeshi Nakahashi, Kunimitsu Iwai, Mikiko Atsumi, and Keiichiro Ishigami were involved in data collection and entry. Takashi Inamatsu was responsible for analysis and interpretation of data. Shigeto Morimoto was responsible for study concept and design, analysis of data, and preparation of the manuscript. Sponsor’s Role: None.