HIV infection and its treatment have been associated with adipose tissue changes and disorders of glucose and lipid metabolism. The proportion of HIV-infected adults over the age of 50 is also growing placing HIV-infected adults at particular risk for metabolic perturbations and cardiovascular disease. The metabolic syndrome in HIV-infected adults has been increasingly studied but whether HIV is associated with greater risk remains unclear, likely because of the interplay of host, viral and antiretroviral factors that are associated with the components of the metabolic syndrome. While the Framingham Risk Score is a well-accepted measure of 10-year cardiovascular risk in the general population, it may not accurately predict risk in the HIV setting due to HIV-related factors such as inflammation that are not accounted for. The relationship between HIV and diabetes mellitus (DM) risk has also been debated. We summarize the recent literature on metabolic syndrome, DM, and cardiovascular risk in HIV-infected adults.
“Are you bigger than my teacher?” fouryear- old Jeffery asked his slightly overweight principal on his way to the bus. Responding optimistically, Mrs. Hix said, “Do you mean taller?”
Problem
Traditional medical school curricula lack specific training on caring for individuals experiencing homelessness, and the literature suggests that medical students’ attitudes toward these individuals become increasingly negative during medical school.
Approach
To increase discharge planning support for individuals experiencing homelessness, the Homeless Hospital Liaison (HHL) program was developed at the University Medical Center New Orleans in January 2017–May 2017. Student liaisons are recruited from all 4 years of medical school and a graduate-level social work program. Liaisons administer a social needs questionnaire to assess patients’ connections to services and identify gaps in care, coordinate with hospital social workers to avoid duplicating work, coordinate with the medical team, help patients complete any needed documentation or applications for social benefits, provide patients with referrals to outpatient resources, and provide patients assistance with a variety of basic needs.
Outcomes
As of December 2017, HHL has trained 70 students (65 medical students and 5 social work students) to serve as liaisons and has enrolled 99 patients. For the majority of these patients, student liaisons were able to facilitate successful referrals to community-based services.
Next Steps
Future directions of the HHL program include developing a formal, staffed consult service at the hospital (e.g., the HHL program was awarded hospital funding for 2 full-time staff in the summer of 2019, which will increase the HHL’s capacity); assessing the program’s effect on student knowledge, attitudes, and proficiency related to individuals experiencing homelessness and/or interprofessional collaboration; and assessing the impact of the program on patients’ experiences.
Background: Attitudes of healthcare professionals towards vulnerable patient populations decline throughout their training, and these negative attitudes have been shown to influence health outcomes and access to care. Little is understood about the factors influencing the development of these attitudes. While service-learning has been a proposed solution, there is heterogeneity in curricula, and it is unknown how varying types of exposures affect providers’ stigma towards vulnerable patients.
Methods: Allopathic medical students completed a survey assessing attitudes towards four vulnerable patient populations: people who suffer from schizophrenia, people who suffer from major depressive disorder, people experiencing homelessness, and people with a history of intravenous drug use. Students also rated their level of exposure to three conditions (mental illness, homelessness, and addiction or injection drug use) in clinical volunteer, nonclinical volunteer, and observational and personal capacities. Analysis was conducted using Chi-squared tests and linear regression to assess for association(s) between the self-reported exposure(s) and attitudes towards the vulnerable populations.
Results: There were 278 survey responses. Clinical and non-clinical volunteer exposures were associated with less stigma towards three of the four patient populations studied. Personal exposures to mental health illnesses as well as addiction or injection drug use were also associated with a reduction in stigma towards vulnerable populations. When controlling for gender, year in school, and race, exposure to persons with a mental illnesses or addiction were each associated with less stigma towards multiple vulnerable populations.
Conclusions: Development of curricula for future health care providers should include, if not emphasize, opportunities for students to volunteer in a clinical capacity with vulnerable populations.
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