Shelby Scott

Current Vaccination Recommendations for Adults

V accination is very important for public and personal health. The efficacy of immunization (IZ) programs is demonstrated by the decrease in death caused by preventable diseases. Since the advent of the mumps-measlesrubella IZ, there has been a 99.9% reduction in these reportable diseases (17). In 2006, there were only 66 reported cases of measles or rubella in the United States. Other diseases reflect similar statistics; tetanus disease has decreased by 93% since the institution of the vaccine (11), and the number of pertussis cases has decreased by 92% (12). Newer vaccines have similar efficacy. The relatively recently introduced vaccines for chickenpox (varicella) and hepatitis A have resulted in more than 85% reduction in disease burden (1,4). The success of these vaccines is caused largely by the childhood IZ programs, with IZs required for school entry. Because most parents comply with IZ recommendations, most children have immunity to the diseases, reducing the chances of an epidemic even if one child contracts the illness. IZ programs also have lowered the rate of virulent infections (9). Recent outbreaks of preventable illnesses have occurred because not all immunity from IZs is lasting (1,9). To continue disease prevention with passive immunity, people need booster shots to maintain antibody levels. The national goals of Healthy People 2010 include reduction of vaccine-preventable disease in adults as well as in children. Specific goals directed at adults include elimination of diphtheria, measles, mumps, rubella, and tetanus, at least a 75% reduction in the number of cases of hepatitis A and B, and 90% compliance with routine administration of pneumococcal and influenza vaccines (2). Between 1970 and 1990, the number of cases of pertussis in the United States was negligible. After 1990, the number started Medical Report

Living With Cancer: Part 2: Exercise and Other Treatment Options

The first part of this column examined how exercise and other lifestyle modifications help prevent cancer. Cancer is a complex multifactorial disease; people develop cancer because of hereditary, environmental, and infectious factors. Because of the different processes involved, some people will acquire cancer despite the healthiest of lives. Lifestyle modification decreases the incidence of cancer but cannot prevent it completely. There are many different types of cancer, but all cancers are defined as uncontrolled growth and spread of abnormal cells. If the growth of these abnormal cells remains uncontrolled, the result is death. Once a person develops cancer, the treatment options available depend on the type of cancer and stage of the disease. Some cancers are benign, that is, not dangerous. Their treatment is usually limited to surgical resection or removal. Two examples of benign cancers treated surgically are basal cell skin cancer and teratoma. Most other cancers have the potential to become malignant. Malignancy is defined by rapid growth of the tumor, invasion of local tissues, and spread to other areas of the body. The latter process is known as metastasis of the tumor cells. Metastases can occur either as direct growth or through the blood or lymph systems. Hematogenous spread, distribution of cancer cells through the blood, leads tomore global disruption of body function. The staging of the cancer is based on the histological typing of the cell compared with its parent cell type and the extent of invasion of the local and distant tissues. Treatment of malignant cancer aims at slowing growth and reducing tumor bulk (1Y3). Surgical resection of the tumor directly reduces tumor size. It also reduces the mass effect on the surrounding tissues. Chemotherapy and radiation therapy damage the rapidly growing cells, generally at the deoxyribonucleic acid level. Cancer cells lack the repair mechanisms of more mature and differentiated cells; therefore, they are affected more than noncancerous cells. As a result, the cancer cells will die more quickly. These cancer treatments may affect any rapidly reproducing cells in the body, like the cells lining the gastrointestinal tract and hair follicles. That is why some chemotherapy leads to hair loss and gastrointestinal problems. The symptoms and findings related to a cancer illness depend on both the type of cancer and degree of involvement in the body, or the stage of the cancer. A full discussion of the different types of cancers is beyond the scope of this column. Generally, people with cancer have weight loss, anemia of chronic illness, muscle wasting, and fatigue. Pain is a later effect of cancer. It develops from the direct effect of the tumor; invasion of the surrounding tissues, pressure on the nerves, or pressure on surrounding structures as the tumor grows. Chemotherapy-induced neuropathy and radiation-induced fibrosis are common sources of pain associated with cancer treatment. Cancer-related pain, whether from the disease or the treatment, is complex. It varies from person to person and with different treatments and advancement of the disease. Pain stimulus is then processed by the cognitive, affective, behavioral, and cultural influences of the individual. Modification of the psychological response to pain is very important in the course of treatment for cancer (4). Add to this the overriding fear of death, the fear of becoming dependent on others, and individual family issues. Pain is subjective, being interpreted by the person experiencing it. Some people deal with their pain better than others. The ability to handle pain depends on the number and aptitude of a person’s coping skills. A strong self-esteem helps deal with pain, as does an extensive social support system (5). An individual’s spiritual beliefs also can influence how they manage their pain. Fatigue often is the first sign of cancer for some people. As with Medical Report

Exercise for Life: Cancer Prevention with Exercise and Lifestyle Modifications

A lthough heart disease is the number one cause of death (COD) in the United States, cancer is more feared by most Americans. This may be with good reason too. According to the Department of Health and Human Services, the incidence of cancer is increasing. In 2006, one in every four deaths in the United States was due to cancer (1). Awareness of heart disease and its causes and prevention have been in the forefront of public health since the 1960s. As a result, the percentage of deaths caused by heart disease has decreased. During the same period, the percentage of total deaths attributed to cancer has increased. If the trend continues, within the next 10 years, cancer may surpass heart disease as the leading COD (Table 1) (1). There are many different types of cancer, but all cancers are defined as uncontrolled growth and spread of abnormal cells. If the growth of these abnormal cells remains uncontrolled, the result is death. Cancers result from a combination of external and internal forces. External, or environmental, forces include tobacco, carcinogenic (or cancer-causing) chemicals, radiation, and various types of infection. Internal, or intrinsic, causes of cancer include mutations to the cellular deoxyribonucleic acid strands or the proteins controlling their replication, hormones and hormone receptors, genetic susceptibility factors, and metabolic mutations (1). The National Cancer Institute estimates that the lifetime risk of developing cancer is approximately 50% for men and 34% for women (1). In 2002, combined cancer-related deaths surpassed cerebral vascular accidents as the number two COD (5). There are 1,500 cancerrelated deaths every day. Lung cancer is the number three COD; and colon cancer, the number five COD in the United States. The rates of various cancers, like lung and breast cancers, are increasing (3). Breast cancer is the number one cause of cancer-related death for Hispanic women and the second leading cause of cancer-related deaths for White, Black, Asian, and Native American women (3). The National Institutes of Health estimated the cost of cancer in the United States in 2005 at

Essential Hypertension: Treatment with Medications (Part 2 of 2)

209.9 billion. Most of this cost is from lost work production (

Medical Report: Exercise in the Postpartum Period

17.5 billion) and premature death of a productive community (

Exercise-Induced Bronchospasm: An Update

118.4 billion). Approximately 75% of cancers are diagnosed in people older than 55 years (1). As the age of theworking public increases, the amount of productivity lost will increase. Therefore, it becomes increasingly important to prevent cancer and improve screening to facilitate earlier treatment. According to the American Cancer Society (ACS), cancers related to cigarette smoking and alcohol consumption are totally preventable. In 2006, there were 170,000 preventable tobacco-related cancer deaths. One in every three of the 564,830 cancer deaths in 2006 were due to poor Medical Report

Headaches: Common Medical Treatment

Hypertension (HTN) is the medical term for high blood pressure (Table). It affects 60 million adults in the United States or approximately 25% of the population (1). Worldwide, more than 1 billion people have HTN, with 7.1 million deaths directly related to elevated blood pressure (2). Elevated blood pressure leads to heart failure, kidney disease, and stroke. Recent studies have shown that cardiovascular disease risk doubles for each 20/10 mmHg measure of blood pressure more than 115/75 mmHg (3). Before a diagnosis of HTN is assigned to a person, the pressure must be elevated on at least two separate occasions, measured with the person seated and after rest (1). Untreated HTN can lead to serious health complications. To prevent these adverse effects, it is imperative to lower the blood pressure to near normal levels once the diagnosis is made. Some providers delay starting treatment of athletic patients, which does not make sense because regular aerobic exercise can lower blood pressure by 5 to 15 mmHg. An athlete with pressures that remain elevated requires treatment as soon as possible, just like all patients diagnosed with HTN. There are various classes of antihypertensive medications. All medicines have side effects or unwanted outcomes associated with usage. However, some medications must be used cautiously in athletes because of the side effects. Many people will respond well to one class of medication but not to another. Current treatment guidelines recommend adding a second agent, rather than maximizing a dose of a single agent (4,5). People usually have fewer side effects at lower doses, so adding a second agent may result in fewer problems than increasing doses of a single agent to maximal levels. First-line agents for the nonathletic population are diuretics (4). Diuretics lower blood pressure in two ways. They increase the excretion of water and salts from the kidneys as the main mechanism. Most diuretics also have an immediate effect of widening blood vessels in the skeletal system. There are different types of diuretics that act at different areas of the kidneys. The most commonly used diuretics are thiazide diuretics, but they can result in loss of potassium and Medical Report