Efficacy and safety of caspofungin therapy in elderly patients with proven or suspected invasive fungal infections.

Invasive fungal infections (IFIs) are serious complications in elderly adults. Caspofungin may provide a useful therapeutic option for elderly patients with or at high risk for IFIs. We retrospectively compared efficacy and safety outcomes in elderly (> or = 65 years of age) and non-elderly patients in three clinical trials of caspofungin: a double-blind, randomized trial versus amphotericin B for documented invasive candidiasis (IC); an open-label, non-comparative study of definite or probable invasive aspergillosis (IA); and a double-blind, randomized trial versus liposomal amphotericin B as empirical therapy (ET) in febrile neutropenic patients. A total of 159 elderly patients with a median age of 71 years (range, 65-84) received caspofungin in these studies. The median duration of caspofungin therapy was 12 days for IC and ET, and 28 days for IA. Point estimates for the favorable response rates to caspofungin were numerically higher in elderly versus non-elderly patients with IC (83% vs. 68%) or IA (64% vs. 44%) and were similar in patients receiving ET (36% vs. 34%). Adverse events related to caspofungin occurred in generally similar proportions of elderly versus non-elderly patients with IC (clinical, 33% vs. 27%; laboratory, 17% vs. 29%), with IA (clinical, 7% vs. 13%; laboratory, 13% vs. 14%), or receiving ET (clinical, 47% vs. 47%; laboratory, 24% vs. 22%). Nephrotoxicity and infusion-related toxicity developed in comparable proportions of elderly and non-elderly caspofungin recipients in all three studies. In this post-hoc analysis, caspofungin appeared to be as efficacious and well tolerated in elderly patients as in non-elderly patients.

Management of complicated appendicitis and comparison of outcome with other primary sites of intra-abdominal infection: results of a trial comparing ertapenem and piperacillin-tazobactam.

A post-hoc analysis of data from a trial of complicated intra-abdominal infection was performed to compare the demographic and disease characteristics of patients with complicated appendicitis to those whose primary infection involved other intra-abdominal sites, assess the impact of site of primary infection on outcome, and compare the efficacy and safety of ertapenem 1 g daily with piperacillin-tazobactam 3.375 g every 6 h for treatment of complicated appendicitis. Compared with patients who had primary infection of the colon or another site in the abdomen, patients with complicated appendicitis were younger, had less severe disease (based on lower APACHE II score and lower proportion with generalized peritonitis), and were less likely to be managed by percutaneous drainage of an abscess or to have a postoperative infection. Patients with complicated appendicitis were more likely to have a favorable outcome than were patients with infection of the colon (OR, 3.02; 95% CI, [1.54-5.901; P = .001). At the test-of-cure assessment, 109/123 (88.6%) microbiologically evaluable patients with complicated appendicitis who received ertapenem and 102/113 (90.3%) who received piperacillin-tazobactam had a favorable combined clinical and microbiologic outcome. The frequency and severity of drug-related adverse events were similar in the two treatment groups.

An occupation based physical activity intervention program: improving fitness and decreasing obesity.

The purpose of this quasi-experimental study was to determine the effectiveness of an occupation based health and fitness program. Subjects were 1,504 police trainees (85% male, 15% female) with an ethnic distribution of 82% white, 16% African American, and 2% other. Data were collected at 25 sites across the state of North Carolina. The sites were randomly assigned to either the experimental group (implemented the intervention) or the control group (continued usual training). As compared with controls, subjects at the experimental sites improved significantly in cardiovascular fitness (aerobic power), general muscular strength (number of sit ups per minute), and flexibility, and lowered their body fat. The intervention required minimal equipment and was taught primarily by peers who received a 1 week training program. This occupational approach to improving health could be particularly useful in occupations with many workers who seldom engage in leisure time physical activity.

The impact of a preconceptional health promotion program on intendedness of pregnancy.

The objective for this study was to determine whether a brief preconceptional health promotion program for low-income women attending family planning clinics impacts on intendedness of pregnancy. In this prospective study, we examined data on 1378 women presenting for prenatal care at three local health departments. Each of the departments offers a standardized preconceptional health promotion program in its family planning clinics. Comparisons were undertaken for 456 women who had been exposed to the family planning preconception program, 309 women who had attended the family planning clinics but had not been exposed to the program, and 613 women who were unknown to the health department before beginning prenatal care. Women exposed to information on preconceptional health during routine family planning visits, the experimental group, had a 51.8% (p = 0.064) greater likelihood of identifying their pregnancies at intended than a group known to the local health departments' family planning programs but unexposed to the intervention. Furthermore, the experimental group had a 64.2% (p = 0.0009) greater likelihood of intendedness than a comparison group not known to the health departments before the initiation of prenatal care. Our study indicates that an introductory program of preconceptional health promotion which is targeted to women not planning a pregnancy in the immediate future is associated with a higher rate of intendedness in subsequent pregnancies. Expansion of similar preconceptional programs in family planning clinics may prove a useful approach for promoting intendedness of pregnancy in low-income women.

Migraine prevention with timolol. A double-blind crossover study.

One hundred seven patients (77 women and 30 men) with migraine headache were given prophylactic treatment with timolol maleate, 20 to 30 mg/day, or matching placebo during a 20-week, double-blind crossover study. Among the 94 patients who completed the study, timolol was significantly better than placebo in terms of decrease in frequency of headaches from baseline, numbers of patients who had a 50% reduction in headache frequency, global response, and patient preference. Overall global response rates were 65% with timolol compared with 40% with placebo. The severity and duration of headaches that occurred were unchanged. Few side effects were reported with either timolol or placebo. The study demonstrates that the beta-blocker timolol is a safe and effective treatment in patients with frequent migraine headaches.