Journal of general internal medicine
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Meta Analysis Comparative Study
Methodological challenges and limitations of research on alcohol consumption and effect on common clinical conditions: evidence from six systematic reviews.
Despite the high prevalence of alcohol consumption in the US, 'mainstream' physicians generally consider it to be peripheral to most patient care. This may be due in part to a dearth of rigorous research on alcohol's effect on common diseases. ⋯ We recommend more high-quality observational and experimental studies in primary care settings as well as a more standard approach to quantifying alcohol use and to defining alcohol use disorders.
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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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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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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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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.