Objective Recommended as a ‘universal precaution’ for improving provider–patient communication, teach-back has a limited evidence base. Discharge from the emergency department (ED) to home is an important high-risk transition of care with potential for miscommunication of critical information. We examined whether teach-back improves: comprehension and perceived comprehension of discharge instructions and satisfaction among patients with limited health literacy (LHL) in the ED. Methods We performed a randomized, controlled study among adult patients with LHL, to teach-back or standard discharge instructions. Patients completed an audio-recorded structured interview evaluating comprehension and perceived comprehension of (1) diagnosis, (2) ED course, (3) post-ED care, and (4) reasons to return and satisfaction using four Consumer Assessment of Healthcare Providers and Systems questions. Concordance with the medical record was rated using a five-level scale. We analyzed differences between groups using multivariable ordinal logistic regression. Results Patients randomized to receive teach-back had higher comprehension of post-ED care areas: post-ED medication (P < 0.02), self-care (P < 0.03), and follow-up instructions (P < 0.0001), but no change in patient satisfaction or perceived comprehension. Conclusion Teach-back appears to improve comprehension of post-ED care instructions but not satisfaction or perceived comprehension. Our data from a randomized, controlled study support the effectiveness of teach-back in a busy clinical setting. Further research is needed to test the utility and feasibility of teach-back for routine use including its impacts on distal outcomes.

Most U.S. intimate partner violence (IPV) research to date has been limited to women residing in urban areas, with the small body of research focusing on rural populations being primarily qualitative. In this case-control study of Southern rural women, while many factors are consistent with those found in urban settings, unlike findings elsewhere, IPV risk appears to increase with age, and race showed no increased risk. Furthermore, in rural areas where guns are more acceptable than in other parts of the United States, partners of IPV victims are considerably more likely to carry weapons than partners of nonabused women. Given the geographic limitations to police and medical response to severe IPV in a rural setting, an improved understanding of IPV risk among this population can aid health care providers in ascertaining risk before it escalates further.

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IV explicó el 96 % de este costo anual. CONCLUSIONES: Los resultados obtenidos confirman los altos costos del CP atribuido al tabaquismo y presentan evidencia científica para apoyar las políticas de salud orientadas al control del consumo de tabaco. El CP al ser una enfermedad evitable, los recursos económicos destinados al tratamiento de la enfermedad podrían asignarse en otras áreas de interés dentro del Instituto.

INTRODUCTION: HIV stigma marginalizes HIV-infected individuals from society. Twenty-five percent of people living with HIV are women. Because stigma and discrimination could impact the willingness of a person to disclose their HIV status to their sexual partner; it would be valuable to know how much stigma is associated with unprotected sexual behavior in women and the willingness to disclose their status. METHODS: Data were collected through Women’s Interagency HIV Study (WIHS), a longitudinal cohort study started in 1993 of women living with HIV (WLWH) or at risk for HIV, with questions asked from April to October 2015. The relationships between HIV stigma and risky sexual behavior were analyzed using Wilcoxon rank-sum test. RESULTS: Among 2022 participants, 1654 (70%) were HIV positive and 453 (20%) of participants were legally/common law married. Of the HIV + participants, 389 (18%) reported engaging in risky sexual behavior defined as unprotected vaginal or anal sex. There was no statistically significant relationship between HIV disclosure rate and engagement in risky sexual behavior (p=0.119). However, those who were married reported engaging in risky sexual behavior more often than those not in committed relationships (p<.001). No relationship existed between internalized stigma and disclosure or risky sex. CONCLUSION: Increased internalized HIV stigma was not found to correlate with engagement in risky sexual behavior and disclosure rates amongst WIHS participants. The level of commitment among married participants may influence behavior and risk acceptance. Further analysis of viral loads, partner serostatus and disease duration in these participants is needed.