Journal of general internal medicine
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Modifiable risk factors such as diet and physical activity contribute to racial disparities among patients with diabetes. Despite this, little is known about how frequently physicians provide counseling or referral to address these risk factors, or whether such rates differ by patient race. ⋯ Rates of lifestyle modification counseling/referral were similarly low among African-Americans and whites in this national study. Our results highlight a need for interventions to enhance physician counseling for patients with diabetes, particularly those at high-risk for diabetes-associated morbidity and mortality, such as racial/ethnic minorities.
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Practice Guideline
Self-neglect in older adults: a primer for clinicians.
Self-neglect in older adults is an increasingly prevalent, poorly understood problem, crossing both the medical and social arenas, with public health implications. Although lacking a standardized definition, self-neglect is characterized by profound inattention to health and hygiene. In light of the aging demographic, physicians of all specialties will increasingly encounter self-neglectors. ⋯ The individual's capacity is often questioned, and interventions are case-based. More research is needed in basic epidemiology and risk factors of the problem, so that targeted interventions may be designed and tested. The debate of whether self-neglect is a medical versus societal problem remains unresolved, yet as health sequelae are part of the syndrome, physicians should be part of the solution.
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It is unknown whether health-related media stories reach diverse older adults and influence advance care planning (ACP). ⋯ Most diverse older adults had heard of TS and reported that her story activated them to engage in ACP. Media stories may provide a powerful opportunity to engage patients in ACP and develop public health campaigns.
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Psychiatric illness is associated with increased medical morbidity and mortality. Studies of primary care utilization by patients with psychiatric disorders have been limited by nonrepresentative samples and confounding by medical co-morbidity. ⋯ Patients with schizophrenia, bipolar disorder or drug use disorders use less primary care than patients without these disorders. Interventions are needed to increase engagement in primary care by these vulnerable groups.
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Many countries have initiated legislation to detect individuals who are unfit to drive, without any evidence that positive effects of these screening procedures outweigh negative effects. ⋯ Because of the expected difficult application and cost of road tests and annual screening by clinicians, the most acceptable strategy from public health, clinical, and individual points of view is likely to be no screening.