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The prevalence of HIV-positive pregnant women in relationships with HIV-negative men in the United States is unclear. The purpose of this study was to calculate the prevalence of HIV-positive pregnant women with a serodiscordant (HIV-negative) partner within a single clinic population, assess disclosure of their HIV status, and examine factors associated with disclosure. All HIV-positive pregnant women who received prenatal care at the Harris County Hospital District Women's Program at Northwest Health Center in Houston TX between 1/1/2006 and 4/1/2011 were identified. Data were obtained from electronic medical records. Prevalence of serodiscordance and disclosure was calculated, and predictors of disclosure were evaluated. We identified 212 HIV-positive pregnant women. About 40% had a serodiscordant partner, and 34% had a partner with an unknown HIV status. Disclosure occurred in over 90% of women with a serodiscordant partner and in 68% of women with partners whose HIV status was unknown. Among pregnant women who knew their HIV status prior to the current pregnancy and had a serodiscordant partner, 92% reported disclosing their status prior to conception. Our data indicated that serodiscordant relationships are common in our clinic population. Suboptimal disclosure rates were observed, especially among women who have a partner with an unknown HIV status. Further research is needed to evaluate the prevalence of serodiscordance and disclosure in other United States populations.

The Houston Diabetes Control Program is part of an effort by the State of Texas and approximately 30 other programs throughout the United States to ensure that persons with diabetes-related complications receive ongoing state-of-the-art preventive care and treatment. For the past 5 years, this program has served an urban, high-risk patient population with special cultural, ethnic, and economic challenges. The intervention has included the development and implementation of protocols for the prevention and care of diabetes-related complications of the eyes, lower extremities, and cardiovascular system, as well as general management of diabetes and patient and professional education. The program is ongoing in nine community health centers located in low-income neighborhoods of a large metropolitan area. The results thus far indicate an increase in sensitive eye examinations from 8 percent to 26 percent of the patient population, a reduction in incidence of legal blindness from 9.5 to 2.7 per 1,000 during a 4-year period, an increase in foot examinations from 18 percent to 44 percent of the patient population, and 77 percent of hypertensive patients in good control of blood pressure at less than 160 over 95 mmHg (millimeters of mercury). On the average, there have not been significant long-term improvements in weight reduction or blood glucose control. The major challenges for this program are (a) improvement in control of glycemia, hypertension, and cholesterol; (b) more effective diet and physical activity interventions; and (c) more effective education approaches that help patients to understand metabolic and cardiovascular functions. These challenges will require collaboration of health care professionals in constructive and imaginative ways through their unselfish commitment toward common goals.

Mail surveys of samples of dental hygienists (n = 90, 36% response), registered dietitians (n = 262, 52% response), and physician assistants (n = 289, 89% response) in Texas and certified nurse midwives (n = 143, 57% response) in the US provided data regarding their confidence that they possess skills and knowledge to counsel patients about selected areas of health promotion (self-efficacy). Also, the surveys gathered information regarding respondents' beliefs that patients will follow through on their recommendations (adherence expectation), and their interest in continuing education programs. Overall, respondents displayed highest self-efficacy with regard to counseling patients about blood pressure and smoking. Confidence was lowest in illicit drug abuse and mental health areas. Certified nurse midwives and physician assistants indicated confidence in many more areas than the other two groups. Respondents consistently expressed less certainty about patient adherence than about their own skills and knowledge. They generally indicated a high degree of interest in continuing education across the several health promotion topics. Modest relationships were observed between self-efficacy and interest in continuing education programs for physician assistants and registered dietitians, indicating that those with greater self-efficacy had a greater interest in building their skills. A similar pattern was observed among physician assistant respondents with respect to adherence expectations.

With the advent of DRGs, quality and cost have become the chief considerations of care providers and institutional managers; as a result, persons who can perform competently in crossover fields may be more employable and valuable than their single-credentialed counterparts. In academic health centers with more than one health-related school, opportunities exist to combine degree programs that result in educating multicompetent health care providers (MCHCP). In lieu of thinking about interdisciplinary education in the traditional sense, the training of MCHCPs can be achieved by simply combining one or more aspects of their respective curricula. Three methods--intra-, across-, and extra-field combinations--of melding two historically separate fields are described. An example of an across-field combination--the Baylor College of Medicine Physician Assistant/Perfusion Technology Program--is given.

Concern has been expressed over how the volume and effectiveness of physicians' practices relative to prevention can be increased. While a review of the health care services provided by physician assistants in medical practices indicated an emphasis on health education and patient counseling, there has existed an absence of data regarding their beliefs and practices in the area of health promotion. Based upon an analysis of self-reported data from 256 respondents (89%) of a random sample (n = 289) of the 870 physician assistants in Texas, it appears that physician assistants perceive themselves as having a role in health promotion, are generally satisfied with their preventive health care role, view health promotion activities as being more important in the future, and disagree with the idea that health promotion would not be well received by patients. They routinely gather information on health behaviors and discuss or recommend ways to reduce at-risk behavior. Furthermore, while expressing certainty about their knowledge and skills to educate and influence individuals to change certain risk behaviors, physician assistants indicate less certainty about patient follow-through when it relates to such activities as smoking, drinking, and the use of illicit drugs. Considering the perceived challenge and the view that health promotion will become an even larger component of the physician assistant's future role, these findings suggest a need for additional skills training to better assist patients to modify their more complex health risk behaviors.