Incorporating quality of evidence into decision analytic modeling.

Our objective was to illustrate the effects of using stricter standards for the quality of evidence used in decision analytic modeling. We created a simple 10-parameter probabilistic Markov model to estimate the cost-effectiveness of directly observed therapy (DOT) for individuals with newly diagnosed HIV infection. We evaluated quality of evidence on the basis of U.

Explaining variability in the relationship between antiretroviral adherence and HIV mutation accumulation.

Objectives: Determining the relationship between antiretroviral adherence and resistance accumulation is important for the design and evaluation of adherence interventions. Our objective was to explain heterogeneity observed in this relationship.

Methods: We first conducted a systematic review to locate published reports describing the relationship between adherence and resistance.

Increasing the efficiency of Monte Carlo cohort simulations with variance reduction techniques.

The authors discuss techniques for Monte Carlo (MC) cohort simulations that reduce the number of simulation replications required to achieve a given degree of precision for various output measures. Known as variance reduction techniques, they are often used in industrial engineering and operations research models, but they are seldom used in medical models. However, most MC cohort simulations are well suited to the implementation of these techniques.

Social construction and cultural meanings of STI/HIV-related terminology among Nguni-speaking inmates and warders in four South African correctional facilities.

Cultural sensitivity is increasingly recognized as a means to enhance the effectiveness of health promotion programmes all over the world. Sociocultural meanings and terminology of diseases are important in understanding how different groups perceive and interpret illness. This study was conducted as part of the process of developing and adapting a sexually transmitted infection (STI)/HIV peer led health education intervention for soon-to-be-released inmates who were predominantly Nguni speakers in South Africa.

Access point analysis on the state of health care services in South African prisons: a qualitative exploration of correctional health care workers' and inmates' perspectives in Kwazulu-Natal and Mpumalanga.

This paper explores inmates and prison health care workers perceptions of the state of health care services in four correctional facilities in South Africa. Structural and organisational issues are explored in terms of how they impact the delivery and provision of health care to inmates within correctional facilities. Additionally, the study forms an access point analysis of prisons as a health care setting as part of the development and testing of a STI/HIV health education intervention for soon to be released inmates.

Findings of the first consensus conference on medical emergency teams.

Background: Studies have established that physiologic instability and services mismatching precede adverse events in hospitalized patients. In response to these considerations, the concept of a Rapid Response System (RRS) has emerged. The responding team is commonly known as a medical emergency team (MET), rapid response team (RRT), or critical care outreach (CCO).

Intoxication before intercourse and risky sexual behavior in male veterans with and without human immunodeficiency virus infection.

Background: Male veterans represent a large population at risk for acquiring or transmitting human immunodeficiency virus (HIV) infection. We sought to determine the prevalence of risky sexual behavior among veterans with and without HIV infection and to assess the relationship of intoxication before intercourse and other measures of drug and alcohol use to risky sexual behavior in this population.

Methods: We analyzed baseline data on 1009 HIV-positive (mean age 49 years) and 710 HIV-negative male veterans (mean age 55 years) who were participating in the Veterans Aging Cohort 5-Site Study (VACS 5).

Predictors of condom use among a sample of male inmates: a social cognitive perspective.

The primary purpose of this study was to determine factors that predict condom self-efficacy among a sample of soon-to-be-released adult male inmates with respect to self-reported HIV/AIDS risk behaviors. Approximately 230 inmates had agreed to enroll in the study. This analysis is based on completed baseline surveys from 187 inmates.

The cost-effectiveness of strategies to reduce mortality from an intentional release of aerosolized anthrax spores.

Background: Intentional exposures to aerosolized Bacillus anthracis spores have caused fatalities.

Objective: To evaluate the cost-effectiveness of strategies to reduce mortality from future inhalational anthrax exposures.

Methods: Computer cohort simulation of a 100,000-person single-site exposure (worst-case scenario) and a 100-person multiple-site exposure (resembling the recent US attack).

Is antiretroviral therapy cost-effective in South Africa?

Braithwaite and Tsevat discuss a new study that suggests that antiretroviral treatment is indeed cost-effective.

Low sea level rise projections from mountain glaciers and icecaps under global warming.

The mean sea level has been projected to rise in the 21st century as a result of global warming. Such projections of sea level change depend on estimated future greenhouse emissions and on differing models, but model-average results from a mid-range scenario (A1B) suggests a 0.387-m rise by 2100 (refs 1, 2).

Short-term impact of an HIV risk reduction intervention for soon-to-be released inmates in Georgia.

The purpose of this study was to determine the impact of an intervention seeking to reduce risk for HIV/AIDS infection among a sample of soon-to-be-released adult male inmates. This analysis is based on a random sample of 116 adult male prisoners recruited and interviewed prior to their participation in an HIV/AIDS and recidivism risk reduction intervention and again three months after they were reintegrated into the community. The intervention program was designed to reduce risky sexual behaviors and alcohol, tobacco, and other drug-related behaviors.

Estimating the proportion of patients infected with HIV who will die of comorbid diseases.

Purpose: Effective antiretroviral therapies have improved the prognosis for patients infected with the human immunodeficiency virus (HIV). We aimed to estimate the likelihood that HIV-infected patients would die of comorbid disease.

Methods: A probabilistic simulation of antiretroviral-naïve HIV-infected patients in the United States was calibrated with data from an observational cohort (N = 3545) and validated with data from a separate patient cohort (N = 12574).

A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care.

Background: Previous studies have shown that alcohol consumption is associated with decreased medication adherence, but this association may be confounded by characteristics common among those who drink heavily and those who fail to adhere (e.g., illicit drug use).

A review of the clinical and toxicological aspects of 'traditional' (herbal) medicines adulterated with heavy metals.

The popularity of traditional remedies has greatly increased in westernised countries over recent years. Although many of these remedies are used safely, there have recently been an increasing number of case reports being published of heavy metal poisoning after the use of traditional remedies, in particular, Indian Ayurvedic remedies. This study reviews the data on published cases, along with the history of Ayurvedic medicine in an attempt to provide an insight into why heavy metals, in particular lead, mercury and arsenic are added in such large concentrations to these remedies.

Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae.

Background: Testing of urine samples is noninvasive and could overcome several barriers to screening for chlamydial and gonococcal infections, but most test samples are obtained directly from the cervix or urethra.

Purpose: To systematically review studies that assessed the sensitivity and specificity of nucleic acid amplification tests for Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens and to compare test characteristics according to type of assay, site of sample collection, presence of symptoms, disease prevalence, and characteristics of the reference standard.

Data Sources: Relevant studies in all languages were identified by searching the MEDLINE database (January 1991 to December 2004) and by hand-searching the references of identified articles and relevant journals.

A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service.

Background: Delays in the care of hospitalized patients may lead to increased length of stay, iatrogenic complications, and costs. No study has characterized delays among general medicine inpatients in the current prospective payment era of care.

Objective: To quantify and characterize delays in care which prolong hospitalizations for general medicine inpatients.

Use of protective barriers and unprotected sex among adult male prison inmates prior to incarceration.

Research documents the challenges associated with preventing HIV/AIDS among prison inmate populations. This paper describes the predictors of protective barrier use and unprotected sexual intercourse among a sample of adult male inmates. Descriptive and scale information was collected on several variables using standard response formats.

Blood lead levels in iron-deficient and noniron-deficient adults.

Iron deficiency (ID) has been reported to increase lead absorption. This relationship has been investigated in detail in children but not in adults. This study was designed to investigate whether blood lead levels are significantly higher in iron-deficient adults.

Marine biofouling on fish farms and its remediation.

The fish farming industry suffers significantly from the effects of biofouling. The fouling of cages and netting, which is costly to remove, is detrimental to fish health and yield and can cause equipment failure. With rapid expansion of the aquaculture industry, coupled with the tightening of legislation on the use of antifouling biocides, the problems of fish farm biofouling are increasing.

Prisoners' knowledge and attitude toward prophylactic treatment and therapy.

Identifying factors that hinder an inmate's compliance with Pneumocystis carinii pneumonia (PCP) prophylaxis therapy can be critical in preventing or decreasing the occurrence of PCP in this population. Anticipated factors include lack of knowledge about PCP and its proposed treatment, fear of the adverse effects of prophylaxis therapy, and lack of trust in the correctional facility medical team. Structured interviews were administered to HIV-positive male inmates chosen randomly (n = 104) at a medium- to maximum-security medical correctional facility located in the western portion of the United States.