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This Week in JAMA
JAMA. 2001;285:3059.
Prevalence of Pervasive Developmental Disorders
Estimates of the current prevalence of autism and related disorders have varied markedly. Chakrabarti and Fombonne (SEE ARTICLE) 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 coauthors (SEE ARTICLE) emphasize the importance of determining the current prevalence of pervasive developmental disorders and of improving the early detection of affected children.
Condom Use and Transmission of Genital Herpes
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 HSV-2 alone.
(SEE ARTICLE)
Screening for Cervical Cancer in Low-Resource Settings
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.
(SEE ARTICLE)
Physician Volume and Patient Mortality After Acute MI
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%.
(SEE ARTICLE)
Adjustment After the Death of a Spouse
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.
(SEE ARTICLE)
Contempo Updates
Clinical applications of new neuroimaging techniques.
(SEE ARTICLE)
Medical News & Perspectives
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.
(SEE ARTICLE)
Preimplantation HLA Testing With PGD
A report (SEE ARTICLE) 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. Damewood (SEE ARTICLE) discusses the ethical implications of this new application of preimplantation diagnosis.
A Woman Who Noticed a Medication Error
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.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about genital herpes.
(SEE ARTICLE)
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