The American journal of medicine
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Largely on the basis of the first publication of findings of net harm with menopausal hormone treatment in the Women's Health Initiative (WHI) hormone trials, current Food and Drug Administration recommendations limit menopausal hormone treatment to the "…shortest duration consistent with treatment goals…," with goals generally taken to mean relief of menopausal symptoms and maximal duration as approximately 5 years. The WHI finding of net harm was due largely to the absence of beneficial effects on coronary heart disease incidence rates. Published analyses of WHI data by age or time since menopause find that excess coronary heart disease risk with menopausal hormone treatment is confined to more remotely menopausal or older women, with younger women showing nonsignificant trends toward benefit (the "timing hypothesis"). ⋯ Thus, current analyses do not support a generalized recommendation for short duration of menopausal hormone treatment. Rather, they suggest that current Food and Drug Administration practice guidelines should be reconsidered to allow individualized care based on risk:benefit considerations. New research is urgently needed evaluating influences of timing, duration, dose, route of administration, and agents on menopausal hormone treatment-related risks and benefits to better understand how to optimize recommendations for individual patients.
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Several studies have suggested an increased risk of cardiovascular events, primarily acute myocardial infarction, around the time of hospital admission for pneumonia. Therefore, we examined cardiovascular events, including myocardial infarction, congestive heart failure, unstable angina, stroke, and serious cardiac arrhythmias, within 90 days after hospitalization for pneumonia. ⋯ A clinically important number of subjects in this cohort had a cardiovascular event within 90 days of hospital admission, suggesting that such events may have an important role in post-pneumonia mortality. Additional research is needed to determine whether interventions may reduce the number of cardiovascular events after pneumonia.
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Although elderly men, particularly patients with low-risk prostate cancer and a life expectancy less than 10 years, are unlikely to benefit from prostate cancer active therapy, treatment rates in this group are high. ⋯ Clinical factors play a limited role in treatment selection among elderly patients with localized prostate cancer.
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Sarcopenia and weakness are known to precipitate risk for disability, comorbidity, and diminished independence among aging adults. Resistance exercise has been proposed as a viable intervention to elicit muscular adaptation and improve function. However, the reported prevalence of resistance exercise participation among US adults aged >50 years is very low. ⋯ Evidence reveals that not only is resistance exercise very effective for eliciting strength gain and increases in lean body mass, but that there is a dose-response relationship such that volume and intensity are strongly associated with adaptations. These findings reflect and support the viability of progression in resistance exercise dosage to accommodate optimal muscular adaptive response. Progressive resistance exercise should thus be encouraged among healthy adults to minimize degenerative muscular function associated with aging.
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Electroconvulsive therapy is used to treat patients with severe or resistant depression. Troponin elevations are associated with an adverse prognosis, and it is well known that central nervous system insults can cause biochemical evidence of cardiac injury. No study previously has studied this with electroconvulsive therapy. ⋯ Elevations of cTn occurred in 11.5% of patients treated with electroconvulsive therapy. Some of the elevations preceded therapy and some occurred during treatment. Given the adverse prognostic importance of cTn elevations in general, in addition to additional studies, an increased degree of medical scrutiny may be appropriate for this group of patients and for those receiving electroconvulsive therapy.