Recent epidemiological studies, particularly those conducted outside
the United States, suggest that the prevalence of autism is increasing. Yeargin-Allsopp
and colleagues studied the prevalence of autism among 289 456 children
aged 3 to 10 years in metropolitan Atlanta in 1996. Cases were identified
through screening and abstracting records at medical and educational sources,
and case status was determined by expert review. The prevalence of autism
was 3.4 per 1000 children, higher than rates from US studies conducted during
the 1980s and early 1990s, but consistent with more recent studies. In an
editorial, Fombonne critiques the debate about a possible epidemic of autism.
Sexual dysfunction is a common adverse effect of antidepressant therapy.
In this randomized placebo-controlled trial, Nurnberg and colleagues assessed
the efficacy of sildenafil citrate in men with major depression in remission
and sexual dysfunction associated with serotonin reuptake inhibitor antidepressant
therapy. Improvement in sexual function was achieved by a significantly greater
proportion of men in the sildenafil group than in the placebo group.
Few well-tolerated drugs are available for the prophylaxis of migraine
headaches. In this randomized placebo-controlled crossover study, Tronvik
and colleagues assessed the efficacy of the angiotensin II receptor blocker
candesartan for migraine prophylaxis. Over 12 weeks, the mean number of days
with headache was significantly lower in the candesartan group than in the
placebo group. Other secondary end points were also reduced in the candesartan
group, including hours with headache, days with migraine, and hours with migraine.
Binge drinking, defined as consuming 5 or more alcoholic drinks on 1
occasion, generally results in acute impairment and may result in other adverse
health consequences. In this analysis of data from the Behavioral Risk Factor
Surveillance System, Naimi and colleagues found that the total number of binge-drinking
episodes among US adults increased from approximately 1.2 billion in 1993
to 1.5 billion in 2001. Binge-drinking episodes per person per year increased
from 6.3 to 7.4.
Mokdad and colleagues previously reported that the prevalence of obesity
and diabetes among US adults increased substantially from 1990 to 2000. In
this analysis of data from the 2001 Behavioral Risk Factor Surveillance System,
Mokdad and colleagues found that the prevalence of obesity continued to increase
from 19.8% in 2000 to 20.9% in 2001, and the prevalence of diabetes from 7.3%
"Time was when the doctor could diagnose and treat a pneumonia, hydrate
the patient, and correct an arrhythmia. Multiconsultism has changed all that."
From "Will the Real Doctor Please Stand Up?"
Not only is HIV/AIDS affecting ever greater numbers of people—an
estimated 42 million are now infected—but about half of those living
with HIV are now women. A new report, AIDS Epidemic Update
2002, adds that the epidemic is rapidly expanding in Eastern Europe
and Asia and is fueling a famine in southern Africa.
The Rational Clinical Examination A systematic
review of studies of the diagnostic performance of clinical and laboratory
findings for detection of acute cholecystitis.
Rennie discusses new guidelines to improve reports of studies of diagnostic
tests developed by the Standards for Reporting of Diagnostic Accuracy (STARD)
Teaching and assessment of communication skills during medical training
and issues in patient-physician communication in medical practice.
For your patients: Information about acute cholecystitis.
This Week in JAMA. JAMA. 2003;289(1):9. doi:10.1001/jama.289.1.9