Political climate and smoke-free laws in rural Kentucky communities.

The purpose was to determine factors associated with rural communities' political readiness to enact smoke-free laws. Data from baseline assessment of a longitudinal intervention study to promote smoke-free policy in rural Kentucky communities; key informants (n = 144) and elected officials (n = 83) from 29 counties participated in cross-sectional telephone interviews. Controlling for population size and county-level smoking rate, the following factors predicted elected officials' perception of the likelihood of a local smoke-free law passing in the next 12 months: (1) support from the local board of health; (2) support from local leaders; and (3) smoke-free hospitals. Communities with lower adult smoking prevalence were more ready for smoke-free laws. Rural health advocates can increase political readiness for smoke-free laws by educating and engaging Board of Health members and local leaders, promoting the voluntary adoption of smoke-free policies in rural hospitals, and investing in effective population-based approaches to evidence-based tobacco treatment in rural communities.

Condom use errors and problems: a global view.

BACKGROUND: Significantly more research attention has been devoted to the consistency of condom use, with far fewer studies investigating condom use errors and problems. The purpose of this review was to present the frequency of various condom use errors and problems reported worldwide. METHODS: A systematic literature search was conducted for peer-reviewed articles, published in English-language journals between 1995 and 2011. RESULTS: Fifty articles representing 14 countries met criteria for inclusion. The most common errors included not using condoms throughout sex, not leaving space at the tip, not squeezing air from the tip, putting the condom on upside down, not using water-based lubricants and incorrect withdrawal. Frequent problems included breakage, slippage, leakage, condom-associated erection problems, and difficulties with fit and feel. Prevalence estimates showed great variation across studies. Prevalence varied as a function of the population studied and the period assessed. CONCLUSION: Condom use errors and problems are common worldwide, occurring across a wide spectrum of populations. Although breakage and slippage were most commonly investigated, the prevalence of other condom use errors and problems found in this review were substantially higher. As a framework for understanding the role of condom errors and problems in inadequate protection, we put forward a new model: the Condom Use Experience model. This model can be used to generate testable hypotheses for future research. Addressing condom use errors and problems in research and interventions is crucial to closing the gap between the perfect use and typical use of condoms.

Epidural granuloma arising from epidural catheter placement.

Indwelling epidural catheter placement for prolonged drug delivery or is commonplace. Epidural catheter placement leading to a subsequent epidural mass is infrequently symptomatic and thus not often sought after or uncovered. Such masses can mimic lesions causing tumor, infection, and inflammation, and when found, the etiology of granuloma formation is unclear. This article describes a case of a benign epidural granuloma masquerading as an epidural tumor thought to be caused by epidural catheter placement for postoperative total hip replacement pain control. After symptoms of mechanical and radiculopathic pain arose, the patient underwent an open biopsy, spinal decompression, and intradural exploration as an MRI evaluation identified a mass in the spinal canal. Pathologic examination identified a benign fibrous granuloma. At 36-month follow-up, there was no evidence of symptom or tumor recurrence.