Predictors of condom errors among sex workers in Armenia.

This cross-sectional study identified the prevalence and correlates of condom-use errors among female sex workers (FSWs) in Armenia. One hundred and seventeen street-based FSWs aged 20-52 years completed an interviewer-administered questionnaire. Condom-use errors were reported by 78.0% of participants. Number of clients, higher frequency of condom application on clients by FSWs, greater perceived barriers to condom use, elevated depressive symptomatology and having sex while drinking alcohol were significantly associated with higher number of condom-use errors. History of sexually transmitted infections (STIs) was marginally significant while consistent condom use was not significant in the final model. The multiple regression model accounted for 32.5% of the variance in condom-use errors. Condom-use errors are prevalent in this population, thus attenuating the intended protective effects of condoms. Interventions with FSWs in Armenia should specifically address the factors identified in this study toward the goal of reducing condom errors and ultimately preventing acquisition of STIs including HIV.

Effects of delayed-entry conditions on the recovery and detection of microorganisms from BacT/ALERT and BACTEC blood culture bottles.

Manufacturers generally recommend that blood culture bottles be loaded into instruments within a short time of collection. However, in our experience, delays often occur prior to loading the bottles. We examined the effect of holding bottles under various temperatures (T)-room temperature (RT), 4 degrees C, 37 degrees C, and RT for 2 h following incubation at 37 degrees C (to simulate transit [TR])-and for various holding times of 4, 12, and 24 h. We utilized the BacT/ALERT system with FA and FN bottles and the BACTEC system with Plus (PL) and Lytic 10 (LY) bottles. Standardized inocula and 5 ml of blood were added to each bottle. Fifteen organisms were evaluated based upon expected performance: aerobic (FA and PL), anaerobic (FN and LY 10), and facultative (all bottles). Based upon expected performance, the FA and FN bottles recovered 458 of 468 organisms and 282 of 288 organisms, respectively, whereas the PL and LY bottles recovered 453 of 468 organisms and 257 of 288 organisms, respectively (P = <0.001, FN versus LY). There were 3, 11, 21, and 27 false-negative results for bottles held at 4 degrees C, RT, 37 degrees C, and TR, respectively. There were 4, 8, and 50 false-negative results for bottles held for 4, 12, and 24 h, respectively. Our results support holding these four bottle types at 4 degrees C or at RT for up to 24 h and at 37 degrees C for up to 12 h. We propose that manufacturers only need to make claims for "delayed entry" when these bottles are held for more than 24 h at 4 degrees C or at RT or for more than 12 h at 37 degrees C.

Biologically confirmed sexually transmitted infection and depressive symptomatology among African-American female adolescents.

OBJECTIVE: To determine prospectively the relation between sexually transmitted infection (STI) diagnosis and depressive symptomatology. METHODS: Secondary data analyses were performed on 175 sexually active African-American female adolescents, who were recruited from high risk neighbourhoods in Birmingham, Alabama, United States. RESULTS: ANCOVA was used to compare adolescents who tested positive with adolescents who tested negative on three waves of depressive symptom scores, controlling for age. The STI positive group had higher depressive symptom levels at 6 months relative to the STI negative group. This result was moderated by baseline depressive symptom levels: for adolescents above the clinical threshold, the STI negative group experienced a decrease in symptoms at 6 months whereas the STI positive group maintained the same level. For adolescents below the clinical threshold, there were no changes in depressive symptom levels regardless of diagnosis. CONCLUSIONS: Receiving an STI diagnosis may affect depressive symptomatology for those at risk for depression. Screening for depression in settings that provide STI testing and treatment may be warranted for this population.

Use of pharmacoeconomics in prescribing research. Part 5: modelling--beyond clinical trials.

This paper provides an overview of modelling in the economic evaluation of pharmaceuticals, reflecting the increasing use of models in analyses prepared for reimbursement applications to national and local drug formularies. The paper seeks to demystify the most commonly encountered modelling techniques (extrapolation, decision analysis, Markov modelling and Monte Carlo simulation), and to provide guidance in assessing the quality of submitted or published modelled economic evaluations.

Use of pharmacoeconomics in prescribing research. Part 3: Cost-effectiveness analysis--a technique for decision-making at the margin.

This is the third Research Note addressing pharmacoeconomics in prescribing research, reflecting the increasing use of economic evaluation in drug purchasing decisions in a variety of settings. In this segment we provide an overview of the theoretical basis, practical application and methodological limitations of cost-effectiveness analysis (CEA).

An instrument for assessing the quality of tobacco-control policies: the ACT-L scale.

BACKGROUND: Efforts to prevent and decrease tobacco use and tobacco-related disease include improving the quality of tobacco-control laws to make them more stringent in controlling tobacco advertising, youth access, and exposure to environmental tobacco smoke (ETS). However, because there are no instruments to empirically evaluate the quality of such laws, it has been difficult to demonstrate that their quality is associated with decreased youth access or tobacco-related morbidity. We present the first instrument for empirically assessing the quality of tobacco-control policies. METHODS: Recommendations for the content of an ideal, comprehensive tobacco-control policy were used as the 55 items in the Assessment of the Comprehensiveness of Tobacco Laws Scale (ACT-L Scale). Raters evaluated 71 tobacco-control laws with the scale; 70 of these were actual California laws and 1 was a model law from Americans for Non-smokers' Rights (ANR). RESULTS: Interrater (r = 0.64-0.89) and internal-consistency (r = 0.63-0.88) reliability of the scale and subscales were high, and validity was established by demonstrating that the ANR model law received a significantly higher total score (mean = 18.75) than all actual laws (mean = 2.04). California tobacco-control laws were poor in all areas (youth access, ETS, tobacco advertising). CONCLUSIONS: The ACT-L scale can be used to compare and evaluate the quality of tobacco-control laws, highlight areas in which further policy efforts are needed, quantify improvement in such policies, and empirically demonstrate the positive health impact of high-quality tobacco-control laws.

Introduction: the state of research on black women in health psychology and behavioral medicine.

In this article we briefly review data on the poor state of Black women's health and then analyze the nature of research on their health in health psychology and behavioral medicine. We demonstrate that health psychology and behavioral medicine not only exclude Black women as participants in empirical studies, but also fail to thoroughly investigate the problems that are most prevalent among and accountable for the poor health of Black women. We conclude that this special issue devoted to Black women's health is crucial and long overdue.