When asked to prioritize five basic needs, 529 homeless adults in two Southern California beach communities chose good health above all others, followed by a steady income, a permanent job, a permanent home, and regular meals. Respondents who placed greater value on having a permanent home were more likely to be female, have children, be from an ethnic minority, be more concerned about their homelessness but were homeless a shorter length of time. These respondents were also more likely to be living in a shelter, receiving government support, and have health insurance. However, they were more emotionally distressed, less likely to rate their life or their health favorably, but did not report more frequent symptoms of illness or have more chronic diseases. Respondents who placed greater importance on a permanent job were more likely to be younger, male, have fewer chronic diseases, better functional status, and more favorable perceptions of their current health. They were better groomed, more likely to have been working, and less likely to be receiving government support. These and other findings suggest that homeless adults are a very heterogeneous group with very different needs, habits and priorities which should be considered in providing services to them.

Advance directives, such as the durable power of attorney for health care (DPAHC), help patients and physicians make end-of-life health care decisions. Medical education should prepare student physicians to be knowledgeable about and comfortable with discussing advance directives. The authors developed an educational module for the third-year medical school curriculum and conducted a randomized trial to evaluate in students its effect on various outcome measures regarding the DPAHC. Over a six-week period, students who received written material about the DPAHC and a two-hour seminar significantly increased knowledge about and reported increased skill, comfort, and experience with the DPAHC.

OBJECTIVETo assess the risk behaviors, knowledge, and beliefs regarding human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) among women and their sexual partners who were Mexican-American men who used intravenous drugs.DESIGNSurvey of male methadone users and their female sexual partners.PARTICIPANTS AND SETTINGMexican-American male clients at a methadone clinic in Los Angeles, Calif, were consecutively recruited for the study. A method similar to partner contact tracing was used to identify female subjects. One hundred subjects, representing 50 male-female pairs of sexual partners, answered identical questionnaires. The responses from females were compared with those from their male partners.RESULTSSeventy-four percent of the females disclosed that they used intravenous drugs, and 88% knew that their male partners were intravenous drug users. Of subjects who used intravenous drugs, 73% (27/37) of females and 88% (44/50) of males currently injected themselves and shared uncleaned needles. Seventy-six percent of females and 84% of males never used a condom during the previous year, and about 20% of both sexes had more than one sexual partner. Even though most of the females understood how HIV was transmitted and recognized themselves as at risk for AIDS, they continued to share needles unsafely and place themselves at risk for acquiring HIV infection through sex.CONCLUSIONThis group of females and their male sexual partners engaged in multiple behaviors that may contribute to the further propagation of HIV infection.

Objective:To determine how the physical health of homeless adults varies by the demographic characteristics of age, gender, ethnicity, lifetime length of homelessness, and work status.

BACKGROUND:We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases.METHODS:We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later.RESULTS:At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P less than 0.01), worried more about getting AIDS (P less than 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P less than 0.005).CONCLUSION:HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced.

We surveyed the membership of the American Association of Directors of Psychiatric Residency Training (AADPRT) regarding the presence and characteristics of journal clubs in their general and child psychiatry residency training programs. Responses were obtained from 141 general residency programs and 76 child psychiatry programs. Eighty-six percent (N=180) offered at least one required and/or voluntary journal club, and many offered multiple journal clubs. Higher effectiveness ratings were associated with journal clubs that had mandatory participation, met frequently, were held in a convenient location, reviewed articles on original research, emphasized and taught research methods, and had regular faculty participation. Higher attendance ratings were associated with daytime meetings, smaller residency programs, required clubs, clubs that met more often and for shorter lengths of time within the hospital, and clubs that show continuity in faculty participation. Descriptions of various formats and inducements reported may be useful to other programs wishing to establish or improve journal clubs.

To determine the level of professional satisfaction experienced by physicians practicing in Ontario, Canada, a probability sample of 1,028 physicians was surveyed; 69% responded. The majority of Ontario doctors were at least moderately satisfied with each of 16 aspects of their work, and the percentage who were dissatisfied exceeded 15% for only four aspects. Factor analysis suggested the presence of four underlying satisfaction facets: satisfaction with quality of care, with the rewards of practice, with patients, and with the practice environment. Multivariate regression analysis supported the validity of the four-facet model and demonstrated a consistent association between lower satisfaction and younger age, lower income, and the perception that it is difficult to obtain fair reimbursement for medical services (P less than 0.05). Least satisfied physicians were most likely to have participated in the June, 1986 Ontario doctors' strike (P less than 0.001). Despite some misgivings, the majority of physicians practicing under the Ontario Health Insurance Plan in 1987 were satisfied with their professional lives. They were least satisfied with their ability to make administrative decisions and to manipulate the system for the benefit of their patients. Policymakers should be cognizant of the effects various strategies may have upon physician satisfaction as they consider new approaches to health care organization.

Responding to a survey, 303 physicians provided opinions about permissibility of substance use among eight occupational groups, appropriateness of drug-screening programs by employers, and the role of physicians in managing substance abuse problems. The majority felt that neither drugs nor alcohol should be used at lunch by any individuals, but that alcohol and to some degree marijuana use was permissible after work or on weekends. Physicians could not agree about reliability or use of drug-testing programs. However, most believed that employee drug screening was more appropriate after evidence of poor job performance rather than screening all employees or applicants.

Data were collected on indicators of mental health status and substance abuse among 214 homeless and 250 domiciled but impoverished patients who sought care in a community medical clinic in a California beach community. Although both groups had a high prevalence of problems, homeless patients were significantly more likely to have been hospitalized for alcohol or mental problems, to have been arrested because of drinking, and to have experienced delirium tremens. Homeless persons were also more likely to have made a suicide attempt, to have experienced recent psychotic symptoms, and to be dissatisfied with life. The findings suggest that primary medical care settings serving the poor and homeless may present an excellent opportunity for delivering mental health services and that psychiatrists should expand their involvement in such settings.

When seeking medical care, homeless persons often turn to health centers that were designed to treat the poor who have homes. To provide for effective medical care, personnel in such facilities need to know how the health care needs of the homeless are different from those of other clinic users. To compare the physical health of these two groups, we conducted a health survey and screening physical examination of 464 patients who attended the general adult and homeless clinic sessions of one of the main neighborhood health centers in Los Angeles County, California. As compared with the poor who have homes, homeless persons were more likely to have dermatological problems (32% vs 21%), functional limitations (median, 2 vs 0 per person), seizures (14% vs 6%), chronic obstructive pulmonary disease (21% vs 12%), social isolation, serious vision problems (22% vs 12%), foot pain, and grossly decayed teeth (median, 1 vs 0 per person). We conclude that to care more optimally for homeless adults, health centers must pay attention to their functional disabilities, substance abuse, skin abnormalities, vision impairment, dental problems, and foot problems.

Questionnaires concerning attitudes toward alcohol and drug testing in the workplace, personal experiences with these substances, professional experiences in treating abuses, religious and political ideology and other personal and professional characteristics were completed by 303 internists, family physicians, gastroenterologists and psychiatrists. Drug testing was most favored by those who more strongly believed in the efficacy of treatment for abusers, the seriousness of the drug problem, the illegality of drug abuse and that marijuana use should not be permissible. Many other personal but almost no professional characteristics were correlated with attitudes toward drug testing. Physicians' opinions about drug testing strongly reflected personal ideologies rather than medical training or clinical experience.

This paper describes the development of a new self-report anxiety scale. The multidimensional conception of anxiety was used to create a comprehensive self-rated instrument. The study included 694 subjects from three populations: anxiety patients, medical patients, and university employees (controls). Strict selection of criteria was used, including content analysis, factor analysis, and a recently developed multitrait analysis to choose items for the scale from an item pool constructed from most of the known anxiety inventories. The 40-item scale consisted of four major dimensions and nine subscales. The total scale had internal consistency of 0.93 and close to 0.8 for separate dimensions. The scale correlated, as hypothesized, with several validating instruments (Zung Anxiety Scale and others). The analysis revealed the multidimensional and multifactorial structure of self reports of anxiety. More research is needed to further explore the validity and the usefulness of the new scale in biological and social experiments.

Glove-wearing attitudes of 375 physicians, representing 56% of all physicians surveyed, were ascertained. Although the majority were comfortable with their current glove use, 33% preferred wearing them more frequently. The most common reasons for not wearing gloves were a low likelihood of disease transmission and fear of offending patients. Many physicians felt that more frequent glove use in examining human immunodeficiency virus- (HIV)-positive patients might reduce rapport and diminish the adequacy of physical examination procedures, but only 11% felt that increased glove use would compromise overall care of HIV-positive patients. With regard to all patients, 33% felt that increased glove use in examinations would compromise care. Additionally, 56% of physicians stated that they were somewhat concerned about HIV infection. Glove-wearing preferences were significantly associated with greater concern about infection, a younger age and more frequent exposure to blood and body secretions. Contact with high-risk patient groups was not associated with glove-wearing preferences.

The Institute of Medicine has placed a priority on determining the special health‐care needs of elderly homeless persons. As part of a community‐based study of 521 homeless adults in two beach communities of Los Angeles, we compared the demographic characteristics and health of older (age range, 50–78, n = 61) and younger (age range, 18–49, n = 460) homeless individuals. Compared with younger adults, older adults were more likely to be white (85% versus 61%), veterans (59% versus 27%), retired (36% versus 3%), and living in a vehicle (21% versus 8%). Older adults were more likely to report having a chronic disease (69% versus 49%), functional disabilities, no informal social contacts during the previous month (49% versus 27%), observed high blood pressure (42% versus 22%), elevated creatinine (11% versus 2%), and elevated cholesterol (57% versus 36%). Older adults were less likely to have a toothache (3% versus 30%), report psychotic symptoms (25% versus 42%), and to be illegal drug users (15% versus 55%). Although they are chronologically younger, the constellation of health and functional problems of older homeless adults resemble those of geriatric persons in the general population. We suggest that geriatricians could play a significant role in training other primary‐care providers to evaluate and treat socially isolated older homeless adults in a more comprehensive way than is currently standard in practice (e.g., interdisciplinary team care and emphasis on functional status, rehabilitative medicine, and assessment for sensory impairment).

Information on the physical health of homeless adults is potentially biased either by sampling strategy or by measurement of physical health. Studies that used comprehensive health measures (self-reported and objective measures) relied on samples from shelters or hotels. However, more representative community-based studies relied on self-reports or ratings. We conducted the first study to use both a community-based sample (N = 529) and comprehensive measures of health (an interview, a limited physical examination, and blood testing). Shelter dwellers compared with homeless persons sampled elsewhere were less likely to have used illegal drugs, to have been victimized, to have injured skin, and to have elevated aspartate aminotransferase levels and mean corpuscular volumes. Sixty-two percent of persons observed to have high blood pressure were unaware of their condition. Sampling only shelter dwellers, or relying only on reports of illness by homeless adults, may mask or underestimate existent health problems that are revealed by community-based sampling techniques and more objective measures.

We studied the sociodemographic characteristics, knowledge, and beliefs about acquired immunodeficiency syndrome transmission and sexual practices of 823 gay or bisexual men seeking primary care. During the previous 2 months, 64% had engaged in at least one sexual behavior considered unsafe. These patients compared with those having safer sex, were younger, of lower socioeconomic status, and from a racial minority, especially Latino. The unsafe group also had more sexual partners, engaged in sexual acts more often, felt less in control over their sexual behavior, used recreational drugs more frequently, and were less likely to talk about safe sex with partners. The unsafe group had less adequate knowledge about human immunodeficiency virus transmission but felt safer from the risk of acquired immunodeficiency syndrome even when engaging in unsafe sex. Educational programs dealing more directly with belief systems and the potential addiction to recreational drugs and sexual behaviors need to be developed for primary care settings.

To assess attitudes toward educational programs about AIDS, 540 patients and 36 of their medical providers in primary care clinics were systematically sampled to ascertain what age groups should be exposed to a pamphlet entitled “Am I at Risk for AIDS?”, as well as what was acceptable content for posters and pamphlets placed in clinic waiting rooms. Although fewer than 10% of patients and providers opposed asking both teenagers and adults to read a pamphlet listing risk groups and practices, 24% of patients and 51% of providers opposed exposing children to the pamphlets. Only 6% of patients and none of the providers opposed all posters about AIDS, but 30% of patients and 44% of providers opposed posters listing risk groups, and opposition was even greater to posters describing “safe sex.” Regarding pamphlets acceptable for clinic waiting rooms, resistance among patients and providers was common (>25%) only when sexual practices were specifically mentioned. Although 89% of patients stated they had never been asked about their sexual orientations by a doctor or nurse, 34% of providers stated that they “always” or “often” so inquire. In the primary care clinics surveyed, a wide variety of educational interventions about AIDS could be implemented with little opposition.

We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.