Journal of general internal medicine
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Multicenter Study Comparative Study
Barriers and facilitators to routine HIV testing in VA primary care.
Approximately 21% of the 1.1 million HIV-infected persons in the United States are unaware of their HIV status. The Centers for Disease Control (CDC) recommend routine opt-out HIV testing for all patients aged 13-64. Yet little is known about patient and provider perspectives on routine HIV testing. ⋯ Patients and providers appear ready for implementation of routine HIV testing. However, providers should use patient-centered communication strategies to ease patients' concerns about confidentiality and stigma associated with HIV disease.
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Multicenter Study Comparative Study
The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS.
The stigma of HIV-infection may profoundly affect the lives of persons living with HIV/AIDS (PLHA). However few studies have examined the association of HIV stigma with multiple components of HIV treatment and care. ⋯ The association of stigma with self-reported access to care and adherence suggests that efforts to improve these components of HIV care will require a better understanding of the possible effects of stigma and its mediators.
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Earlier work demonstrated that ACGME duty hour reform did not adversely affect mortality, with slight improvement noted among specific subgroups. ⋯ ACGME duty hour reform was not associated with any consistent improvements or worsening in mortality or failure-to-rescue rates for high risk medical or surgical patients.
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Comparative Study
Environmental and socio-economic factors as contributors to racial disparities in diabetes prevalence.
We deployed a study design that attempts to account for racial differences in socioeconomic and environmental risk exposures to determine if the diabetes race disparity reported in national data is similar when black and white Americans live under similar social conditions. ⋯ Race disparities in diabetes may stem from differences in the health risk environments that African Americans and whites live. When African Americans and whites live in similar risk environments, their health outcomes are more similar.
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Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have less SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans. ⋯ Barriers/facilitators of SDM exist among African-Americans with diabetes, which can be effectively addressed in the outpatient setting. Primary care physicians, particularly academic internists, may be uniquely situated to address these barriers/facilitators and train future physicians to do so as well.