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A new analysis of data on the effects of the diabetes drug rosiglitazone (sold in the United States as Avandia) found that the risk for heart attack and death from cardiovascular disease is "uncertain: Neither increased nor decreased risk is established." Authors say an earlier study, which found the drug associated with increased risk for myocardial infarction and cardiovascular death, had several flaws. The authors re-analyzed the data from the earlier trial, using a variety of modeling and weighting methods. They say that the risk controversy will only be solved with "prospective clinical trials designed for the specific purpose of establishing the cardiovascular benefit or risk of rosiglitazone."
(This Perspective piece is published early online by Annals of Internal Medicine at www.annals.org.)
A study of data from a large national survey found that geriatric conditions, such as cognitive impairment, falls, and incontinence, were common among adults age 65 years and older and increased in frequency with age (Article, p. 156). At aged 65, almost half (49.9 percent) had one or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes, and presence of geriatric conditions was strongly associated with disability. Most geriatric conditions can be treated or at least alleviated.
Authors note that current models of care that focus on a single disease that dominates health care, or the care management model directed toward patients with multiple illnesses and disability, do not recognize the importance of geriatric conditions on quality of life and as markers for decline and disability.
Motor vehicle accident injuries are the leading cause of death among Americans between the ages of 3 and 33. Counseling during regular physician visits about the proper use of child safety seats, seat belts and the dangers of drunk driving might reduce death and injury from car accidents.
Reviewing published research on the effects of such counseling, the U.S. Preventive Services Task Force (USPSTF) concluded that office-based counseling did not provide any more benefit than other programs that promote driving safety (Clinical Guidelines, p. 194). And most studies were done before the enactment of child safety seat legislation.