Estimates of the current prevalence of autism and related disorders
have varied markedly. Chakrabarti and FombonneArticle assessed the prevalence of
pervasive developmental disorders in a population of children aged 2.5 to
6.5 years in a geographically defined region of England. From July 1998 to
June 1999, 15 500 children were screened for developmental problems and
97 children were confirmed to have a pervasive developmental disorder. Estimated
prevalences were 16.8 per 10 000 children for autistic disorder and 62.6
per 10 000 for all pervasive developmental disorders. In an editorial,
Hyman and coauthorsArticle emphasize the importance of determining the current prevalence
of pervasive developmental disorders and of improving the early detection
of affected children.
To study risk factors for the acquisition of herpes simplex virus type
2 (HSV-2) infection and the efficacy of condoms to prevent HSV-2 transmission,
Wald and colleagues analyzed data from participants enrolled in a clinical
efficacy trial of an HSV-2 vaccine. Among monogamous couples with 1 partner
who had known symptomatic genital herpes and 1 who was susceptible, the rate
of HSV-2 transmission from men to women was 8.9/10 000 sexual acts and
from women to men, 1.5/10 000 sexual acts. Condom use during more than
25% of sex acts was associated with a significantly decreased risk of HSV-2
acquisition among women, but not among men. Factors associated with increased
HSV-2 acquisition included younger age, more frequent sexual activity, and
seropositivity in the source partner for both HSV-1 and HSV-2 compared with
Cervical cancer is a leading cause of cancer-related mortality among
women in developing countries, and many women present with advanced disease.
Goldie and colleagues developed a model to assess alternative screening strategies
for cervical cancer in developing countries and used the model to compare
the clinical benefits and cost-effectiveness of the different screening strategies
in a hypothetical cohort of previously unscreened black South African women.
A single-lifetime screening at age 35 years with either direct visual inspection
or human papillomavirus DNA testing, and immediate cryotherapy for those with
a positive result, reduced the incidence of cervical cancer by 26% to 32%
compared with no screening and cost less than $50 per woman.
In prior studies, physician patient volume has been shown to be a determinant
of outcomes after invasive cardiac procedures. Using data from the Ontario
Myocardial Infarction Database, Tu and colleagues evaluated the relationship
between physician volume and patient mortality after acute myocardial infarction
(MI). For physicians who treated 5 or fewer patients with acute MI per year,
the 30-day risk-adjusted mortality rate was 15.3% and the 1-year risk-adjusted
mortality rate was 24.2%. In contrast, for physicians who treated more than
24 patients with acute MI per year, the 30-day risk-adjusted mortality rate
was 11.8%, and the 1-year risk-adjusted mortality rate was 19.6%.
Schulz and colleagues studied the effects of bereavement after the death
of a spouse in relation to caregiving activities before the death in a population-based
cohort of elderly individuals enrolled in the Cardiovascular Health Study.
Among caregivers who reported strain associated with caregiving, health risk
behaviors improved after the spouse's death. Symptoms of depression remained
high among strained caregivers but did not increase. Among both nonstrained
caregivers and noncaregivers, depression symptoms increased after the death
of a spouse, but health risk behaviors did not change significantly.
Clinical applications of new neuroimaging techniques.
New federal regulations will add administrative burdens to a physician's
practice, but will boost patients' confidence that information they disclose
to their physicians will remain private.
A reportArticle of the first known experience combining preimplantation genetic
diagnosis (PGD) for Fanconi anemia with HLA antigen testing to preselect unaffected
embryos as a potential donor source for transplantation of HLA-compatible
stem cells to an affected sibling. DamewoodArticle discusses the ethical implications
of this new application of preimplantation diagnosis.
Ms K, who became infected with HIV in 1996, noticed a serious medication
error when Stelazine (trifluoperazine) and ranitidine were dispensed to her
instead of the antiretroviral medications stavudine and lamivudine. Bates
discusses the prevalence of medication errors, factors that contribute to
their occurrence, and prevention strategies.
For your patients: Information about genital herpes.
This Week in JAMA . JAMA. 2001;285(24):3059. doi:10.1001/jama.285.24.3059