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Context: As many as 1 in every 110 children in the United States has an autism spectrum disorder (ASD). Many medical treatments for ASDs have been proposed and studied, but there is currently no consensus regarding which interventions are most effective., Objective: To systematically review evidence regarding medical treatments for children aged 12 years and younger with ASDs., Methods: We searched the Medline, PsycInfo, and ERIC (Education Resources Information Center) databases from 2000 to May 2010, regulatory data for approved medications, and reference lists of included articles. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Studies of secretin were not included in this review. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings on the basis of predetermined criteria., Results: Evidence supports the benefit of risperidone and aripiprazole for challenging and repetitive behaviors in children with ASDs. Evidence also supports significant adverse effects of these medications. Insufficient strength of evidence is present to evaluate the benefits or adverse effects for any other medical treatments for ASDs, including serotonin-reuptake inhibitors and stimulant medications., Conclusions: Although many children with ASDs are currently treated with medical interventions, strikingly little evidence exists to support benefit for most treatments. Risperidone and aripiprazole have shown benefit for challenging and repetitive behaviors, but associated adverse effects limit their use to patients with severe impairment or risk of injury.

Context: As many as 1 in every 110 children in the United States has an autism spectrum disorder (ASD). Secretin is 1 of many medical treatments studied for treating the symptoms of ASDs, but there is currently no consensus regarding which interventions are most effective., Objective: To systematically review evidence regarding the use of secretin in children with ASDs who are aged 12 years and younger., Methods: We searched the Medline, PsycINFO, and ERIC (Education Resources Information Center) databases from 2000 to May 2010 and reference lists of included articles. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings on the basis of predetermined criteria., Results: Evidence from 7 randomized controlled trials supports a lack of effectiveness of secretin for the treatment of ASD symptoms including language and communication impairment, symptom severity, and cognitive and social skill deficits. No studies have resulted in significantly greater improvements in measures of language, cognition, or autistic symptoms when compared with placebo; study authors who reported improvement over time did so equally for both the intervention and placebo groups., Conclusions: Secretin has been studied extensively in multiple randomized controlled trials, and there is clear evidence that it lacks benefit. The studies of secretin included in this review uniformly point to a lack of significant impact of secretin in the treatment of ASD symptoms. Given the high strength of evidence for a lack of effectiveness, secretin as a treatment approach for ASDs warrants no further study.

The objective is to estimate prevalence of parent-reported depression or anxiety among children with ASD, and describe parental concerns for their children. The design is Analysis of National Survey of Children's Health, 2003-2004. The participants are a national sample of 102,353 parents. 311,870 (544/100,000) parents of children ages 4-17 in the US reported that their child was diagnosed with autism. 125,809 also reported that their child had depression or anxiety (219/100,000). These parents report substantially higher concerns about their child's self-esteem, academic success, and potential to be bullied. Clinicians should take into account that children with ASD may face increased risk of depression or anxiety in adolescence. Coordinated care addressing social and emotional health in addition to clinical attention is important in this population.

Objectives: The Vanderbilt Evidence-based Practice Center systematically reviewed evidence on treatment of overactive bladder (OAB), urge urinary incontinence, and related symptoms. We focused on prevalence and incidence, treatment outcomes, comparisons of treatments, modifiers of outcomes, and costs., Data: We searched PubMed, MEDLINE, EMBASE, and CINAHL., Review Methods: We included studies published in English from January 1966 to October 2008. We excluded studies with fewer than 50 participants, fewer than 75 percent women, or lack of relevance to OAB. Of 232 included publications, 20 were good quality, 145 were fair, and 67 poor. We calculated weighted averages of outcome effects and conducted a mixed-effects meta-analysis to investigate outcomes of pharmacologic treatments across studies., Results: OAB affects more than 10 to 15 percent of adult women, with 5 to 10 percent experiencing urge urinary incontinence (UUI) monthly or more often. Six available medications are effective in short term studies: estimates from meta-analysis models suggest extended release forms (taken once a day) reduce UUI by 1.78 (95 percent confidence interval (CI): 1.61, 1.94) episodes per day, and voids by 2.24 (95 percent CI: 2.03, 2.46) per day. Immediate release forms (taken twice or more a day) reduce UUI by 1.46 (95 percent CI: 1.28, 1.64), and voids by 2.17 (95 percent CI: 1.81, 2.54). As context, placebo reduces UUI episodes by 1.08 (95 percent CI: 0.86, 1.30), and voids by 1.48 (95 percent CI: 1.19, 1.71) per day. No one drug was definitively superior to others, including comparison of newer more selective agents to older antimuscarinics. Current evidence is insufficient to guide choice of other therapies including sacral neuromodulation, instillation of oxybutynin, and injections of botulinum toxin. Acupuncture was the sole complementary and alternative medicine treatment, among reflexology and hypnosis, with early evidence of benefit. The strength of the evidence is insufficient to fully inform choice of these treatments. Select behavioral interventions were associated with symptom improvements comparable to medications. Limited evidence suggests no clear benefit from adding behavioral interventions at the time of initiation of pharmacologic treatment., Conclusions: OAB and associated symptoms are common. Treatment effects are modest. Quality of life and treatment satisfaction measures suggest such improvements can be important to women. The amount of high quality literature available is meager for helping guide women's choices. Gaps include weak or absent data about long-term followup, poorly characterized and potentially concerning harms, information about best choices to minimize side effects, and study of how combinations of approaches may best be used. This is problematic since the condition is chronic and a single treatment modality is unlikely to fully resolve symptoms for most women.

Objective: To estimate the number of injury-related hospitalizations of pregnant women in the United States and to identify injury mechanisms associated with hospitalizations that end in delivery., Study Design: Using data on injury hospitalizations of pregnant women from the 2002 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, we compared the mechanism of injuries of nondelivery hospitalizations with those of delivery hospitalizations., Results: Of an estimated 16,982 injury hospitalizations involving pregnant women in 2002, a delivery occurred in 37.7%. Hospitalizations with injuries caused by overexertion had significantly increased odds of including delivery (odds ratio OR 4.55, confidence interval 95% CI 2.21-9.39) compared with hospitalizations with other causes of injury. Hospitalizations with injuries caused by motor vehicle traffic (OR 0.36, 95% CI 0.23-0.58) had significantly lower odds of including delivery., Conclusion: We estimated that there were 4.1 injury hospitalizations of pregnant women per 1000 deliveries in 2002. The majority of injury mechanisms did not significantly increase the odds of the hospitalization ending in delivery. Providers should broaden injury prevention messages to address poisonings and overexertion.

Objective: The purpose of this study was to describe the occurrence, timing, and outcomes of hospital-based diagnoses of preterm labor., Study Design: Administrative records identified hospital admissions for preterm labor among 2534 women in an ongoing cohort study. Factors that were considered risks for prematurity were examined by logistic regression for an association with any preterm labor diagnosis, a preterm labor diagnosis <33 weeks of gestation, or > or =33 weeks of gestation., Results: Of 234 women (9%) who experienced hospitalization for preterm labor, 90 women (38%) were delivered in the first episode. Previous preterm birth consistently was associated with a diagnosis of preterm labor. Reporting a sexually transmitted infection (odds ratio, 1.8; 95% CI, 1.1-3.0) or bacterial vaginosis (odds ratio, 2.6; 95% CI, 1.7-4.1) early in pregnancy was associated with hospitalization for preterm labor between 24 and 32 weeks of gestation., Conclusion: The incidence of first-time hospitalization for preterm labor was 9%, with most episodes not resulting in preterm birth. Previous preterm birth was associated therefore with a preterm labor diagnosis.