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Purpose In spite of progress in understanding the importance of social support for health outcomes in Persons Living with HIV (PLWH), more remains to be known about mechanisms of support most beneficial at each stage of HIV treatment. In this study, we use a qualitative analytic approach to investigate the forms and sources of social support deemed most integral to the diagnosis, care engagement, and medication adherence behaviors of a diverse sample of PLWH in a mostly rural health district in the Southeastern United States. Methods In-depth interviews (N = 18) were collected during the qualitative phase of a larger mixed methods needs assessment for the Northeast Georgia Health District. A deductive-inductive analysis of participant narratives revealed variation in the perceived importance of particular forms and sources of social support during the initial versus advanced stages of HIV care. Findings PLWH identified the emotional, informational, and appraisal support provided by family as especially critical for emotional stability, coping, and care linkage during the initial stages of diagnosis and treatment. However, once in care, PLWH emphasized informational and instrumental forms of support from care providers and appraisal support from peers as key influences in care engagement and retention behaviors. Conclusion Increased understanding of the social support mechanisms that contribute to the HIV treatment behaviors of PLWH can fill knowledge gaps in research and inform the efforts of health care providers seeking to leverage various aspects of the social support toward improving the care retention, health, and wellness outcomes of PLWH.

Objectives Chronic kidney disease (CKD) almost universally occurs in individuals with other medical problems. However, few studies have described CKD-related multimorbidity using a framework that identifies chronic conditions as concordant (having overlap in treatment goals) versus discordant (having opposing treatment recommendations) and unrelated (having no overlap, but contributing to complexity via different resource requirements). Design Retrospective cohort. Setting Veterans Affairs (VA) Medical Centers. Participants VA patients (n = 821,334) ages 18–100 years with at least one outpatient visit and incident CKD defined as an estimated glomerular filtration rate

Purpose Differences in stroke care quality for patients in rural and urban locations have been suggested, but whether differences exist across Veteran Administration Medical Centers (VAMCs) is unknown. This study examines whether rural-urban disparities exist in inpatient quality among veterans with acute ischemic stroke. Methods In this retrospective study, inpatient stroke care quality was assessed in a national sample of veterans with acute ischemic stroke using 14 quality indicators (QIs). Rural-Urban Commuting Areas codes defined each VAMC's rural-urban status. A hierarchical linear model assessed the rural-urban differences across the 14 QIs, adjusting for patient and facility characteristics, and clustering within VAMCs. Findings Among 128 VAMCs, 18 (14.1%) were classified as rural VAMCs and admitted 284 (7.3%) of the 3,889 ischemic stroke patients. Rural VAMCs had statistically significantly lower unadjusted rates on 6 QIs: Deep vein thrombosis (DVT) prophylaxis, antithrombotic at discharge, antithrombotic at day 2, lipid management, smoking cessation counseling, and National Institutes of Health Stroke Scale completion, but they had higher rates of stroke education, functional assessment, and fall risk assessment. After adjustment, differences in 2 QIs remained significant—patients treated in rural VAMCs were less likely to receive DVT prophylaxis, but more likely to have documented functional assessment. Conclusions After adjustment for key demographic, clinical, and facility-level characteristics, there does not appear to be a systematic difference in inpatient stroke quality between rural and urban VAMCs. Future research should seek to understand the few differences in care found that could serve as targets for future quality improvement interventions.

Over the last decade, online continuing dental education (CDE) has seen a major transformation in the way it is delivered, marketed, and accessed. The University of Florida College of Dentistry (UFCD) developed and evaluated a web-based CDE format ("Case of the Month") that specifically focused on clinical oral pathology. Over a four-month period, three oral pathology cases were presented monthly (a total of twelve cases overall) using a clinical pathologic conference format including a brief patient history, along with pictures and radiographs needed to make a treatment diagnosis. A differential diagnosis in the form of a question was developed, followed by a detailed description and rationale describing why the option was correct or incorrect. At the conclusion of the case of the month, respondents completed an online survey that ascertained their needs, expectations, attitudes, level of clinical knowledge gained, and experience with the online environment. The primary purpose of this study was to evaluate the expectations and attitudes of these CDE participants. Results suggested that the participants' needs and expectations were generally met: they were able to navigate the website with ease and found the design to be appealing. The biggest disadvantage reported was the inability to communicate with others, including the instructor, while viewing the case, and more respondents would like to have seen some more general/common oral pathology information.

Background This study examined whether there were gender and kinship (spouse, child, more distant relative) differences in caregiver burden. It further examined the constellation of gender and kinship by examining whether adult daughter caregivers experienced greater burden compared to wives, husbands, sons, and other more distant relatives. Methods The sample consisted of 305 family caregivers of memory-impaired individuals who were age 70 years or older and resided in non-institutional settings in Arkansas. A cross-sectional design was employed using validated measures to assess both the memory-impaired elders' and family caregivers' self-reported physical and memory status. Results After controlling for the age and health status characteristics of the memory-impaired elder, sociodemographic and health status characteristics of the family caregiver, and the caregiver coping response (measured by the sense of coherence), multiple regression analyses found kinship, but not gender differences in caregiver burden. Adult children experienced more caregiver burden than more distant relatives. There were no significant differences in caregiver burden between adult children and spouses. Adult daughters had greater caregiver burden scores compared to more distant relatives, but had comparable scores to wives, sons, and husbands. Other significant correlates of burden included caregiver personal characteristics (age and ethnicity) and the sense of coherence. Conclusions The study discusses the practice implications of adult children and adult daughters' propensity to suffer burden when caring for their memory-impaired parents living in the community. It also discusses the relevance of caregiver personal characteristics and the sense of coherence as correlates of burden. Copyright © 2003 John Wiley & Sons, Ltd.