Eating disorders, which are associated with a host of adverse medical morbidities, negative psychological sequelae, and considerable reductions in quality of life, should be diagnosed and treated promptly. However, primary care physicians may find it uniquely challenging to detect eating disorders in their early stages, before obvious physical problems arise and while psychological symptoms are subtle. Although psychological symptoms may dominate the presentation, the physician is an integral member of the treatment team and is in a unique role to diagnose and treat eating disorders. This clinical review surveys the eating disorders literature, identified by searching MEDLINE and PubMed for articles published from January 1, 1983, to September 30, 2009, using the following keywords: anorexia nervosa, bulimia nervosa, eating disorders, eating disorders NOS, binge eating, binge eating disorder, and night eating syndrome. This review also focuses on practical issues faced by primary care physicians in the management of these conditions and other issues central to the care of these complex patients with medical and psychiatric comorbid conditions.

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Thirty-four states criminalize HIV in some way, whether by mandating disclosure of one's HIV status to all sexual partners or by deeming the saliva of HIV-positive persons a "deadly weapon." In this paper, we argue that HIV-specific criminal laws are rooted in historical prejudice against HIV-positive persons as a class. While purporting to promote public health goals, these laws instead legally sanction discrimination against a class of persons.

Background: Intra-individual variability on cognitive testing increases with age and may be an underappreciated challenge to the early and accurate identification of Mild Cognitive Impairment (MCI). We previously reported high initial prevalence estimates of MCI from a community sample, the Adult Changes in Thought (ACT;E.Larson,PI) cohort. The current study aimed to examine the patterns of change in classification at a biennial follow-up to assess the stability of results in this elderly population. Methods: Cognitive examinations are conducted biennially and include tests known to be sensitive to the early effects of cognitive decline. Prevalence of MCI at timepoint1 and at timepoint2 was determined based on published definitions 1 using individualized estimates of premorbid ability as benchmarks rather than age-referenced normative information. A cut-off of 1.5 standard deviations(sd) below these individualized premorbid estimates prompted classification into MCI subtypes. Trends across the two visits were assessed. Results: Of the first sequential 200 subjects, N ¼ 180 agreed to participate at timepoint1. Seventeen met criteria for dementia and were excluded from follow-up. Of the remaining participants, 113/163 had complete data at timepoint2. About 20% of participants diagnosed with MCI at baseline no longer met MCI criteria at follow-up and a similar number (18.5%) who were initially defined as ''normal control'' met criteria for MCI at timepoint2. Diagnostic stability across time points was seen in only 61% of the sample. Within the MCI diagnostic category, heterogeneity was noted as well, with many shifts between sub-types. In this sample, no specific measures or cognitive domains could be identified to suggest which participants would remain diagnostically stable versus those who did not. Conclusions: These data highlight the need to attend to intra-individual variability, which may influence the reliability of the MCI diagnosis. Although some argue that a wider range of within-person fluctuations on cognitive testing is a natural part of aging 2 , others have suggested that these fluctuations are a hallmark of impending decline 3 . Given the importance of early identification of cognitive decline predictive of incipient dementia, larger sample sizes and an analysis of broader patterns of change, perhaps including functional indices, might be necessary to accurately identify those individuals most at risk for dementia. Background: Amnestic mild cognitive impairment (aMCI) is a subtype of MCI that has been associated with a likely progression to Alzheimer's disease (AD), and non-amnestic MCI (naMCI) likely represents the early stages of AD and non-AD dementias. However, some subjects with MCI revert to ''normal cognition,'' and this raises the question of the stability of the diagnosis. Methods: The Mayo Clinic Study of Aging is a longitudinal population-based study of non-demented subjects ages 70-89 years. The subjects are evaluated every 15 months with a history from the subject and informant, neurop...

The author_s initials should read R.G.