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Physician's First Watch

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November 17, 2006

CDC Releases Annual Compilation of Health Statistics

The latest compilation of government health statistics, Health United States, 2006, reports that life expectancy at birth reached a record high of almost 78 years in 2004, up from 75 in 1990.

Among other statistics in the more than 500-page report:

-- One-fifth of adults aged 65 and older reported pain lasting at least a day in the previous month.

-- The homicide rate for black males aged 15-24 fell by 12% from 2003 to 2004, although homicide remains the leading cause of death in this group.

-- The birth rate for teenage women, aged 15-19, fell for the 13th consecutive year in 2004 to 41 births per 1000 women.

-- Infant mortality declined from 6.9 deaths per 1000 live births in 2003 to 6.8 per 1000 in 2004.

-- The proportion of visits to office-based doctors that were made to general and family practice physicians fell from 34% in 1980 to 23% in 2004.

-- 11% of adults in their 40s and 50s have diabetes, as do 23% in their 60s and older.

Link: CDC report (Free)

Link: CDC press release (Free)

Published in Physician's First Watch November 17, 2006

November 16, 2006

Studies Caution Against Fully Restoring Hemoglobin in Chronic Kidney Disease

Hemoglobin levels in anemic patients with chronic kidney disease should not be fully restored, two studies in the New England Journal of Medicine suggest.

Singh and colleagues found that patients randomized to full restoration (13.5 g/dL) as opposed to partial restoration (11.3 g/dL) of hemoglobin levels showed increased risk for death, stroke, MI, and hospitalization for heart failure, without improving quality of life.

In a similar randomized study, Drueke and colleagues found no difference in cardiovascular events between patients receiving full (13.0-15.0 g/dL) and partial (10.5-11.5 g/dL) restoration. But, despite an increase in quality of life, more patients in the full restoration group progressed to dialysis.

"We now have evidence suggesting that a 13.0 g/dL target is too high," writes Journal Watch General Medicine Editor-in-Chief Allan S. Brett.

Link: Journal Watch General Medicine summary (Free)

Link: Drueke et al. article (Free abstract; full text requires subscription)

Link: Singh et al. article (Free abstract; full text requires subscription)

Link: NEJM editorial (Subscription required)

Published in Physician's First Watch November 16, 2006

Antibiotic-Naive Children Harbor Antibiotic-Resistant Bacteria

Children unexposed to fluoroquinolones were found to harbor fluoroquinolone-resistant, potentially pathogenic bacteria in their feces, according a study in October's Antimicrobial Agents and Chemotherapy and covered in today's Journal Watch Infectious Diseases.

Researchers found ciprofloxacin-resistant E. coli and other resistant organisms in nondiarrheal stool from 13 of 455 children visiting a pediatric clinic, though neither the subjects nor members of their households had taken fluoroquinolones in the 4 weeks before sampling.

Children could have acquired the resistant organisms from food derived from animals treated with antibiotics, household members taking fluoroquinolones more than 4 weeks before sampling, or people outside the children's homes, the researchers say.

Link: Journal Watch Infectious Diseases summary (Free)

Link: Antimicrobial Agents and Chemotherapy article (Free abstract; full text requires subscription)

Published in Physician's First Watch November 16, 2006

New York Times Offers Lessons from Late PCI Findings

This morning's New York Times comments on the larger implications of research (summarized here yesterday) showing the futility of reopening persistently blocked coronary arteries in stable patients.

The analysis reminds readers that medical dogma changes, especially in the face of new, unexpected findings -- the role of bacteria in gastric ulcers being another such example.

James N. Weinstein, a Dartmouth orthopedist, is quoted as saying "As a nation, we're not doing ourselves any favors by going after the next new thing without doing the studies." Otherwise, he says, "everybody's going to lose trust in the system."

Link: New York Times analysis (One-time registration required)

Link: Yesterday's First Watch summary on late PCI (Free)

Published in Physician's First Watch November 16, 2006

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David G. Fairchild, MD, MPH
Chief Medical Officer and Chief, Division of General Medicine at Tufts-New England Medical Center and Floating Hospital for Children

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