Exploring the association between quality of homecare services and older adults' well-being.

Homecare services play an important role in enabling older adults with chronic illness or functional impairment to continue living in their homes and communities. Previous research on homecare services has not fully explored the potential psychological benefits of homecare services. This study investigates the association between quality of homecare services and psychological well-being by analyzing two surveys. The results showed that the association between well-being and the quality of homecare services was mediated by satisfaction with health (z = 4.36, p = .000), satisfaction with family life (z = 4.96, p = .000) and satisfaction with friendship (z = 3.56, p = .000). The top three most important life domains, health, family life, and friendships, combined fully mediated the association between well-being and the quality of homecare services. These findings suggest that quality homecare services could enhance clients' well-being in the areas of family life and friendships beyond health.

Guiding principles for physician reentry programs.

Physician reentry is defined by the American Medical Association (AMA) as: "A return to clinical practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment." Physician reentry programs are creating an avenue for physicians who have left medicine in good standing to return to clinical practice. To date, however, programs have developed independently, with little coordination among them. If, as predicted, more physicians seek to reenter practice and more programs are developed in response, the need for information on program outcomes will grow. Valid assessment tools should be developed and shared across reentry programs to assess individual learner outcomes. This discussion paper sets forth Guiding Principles for Physician Reentry Programs as a step toward a more coordinated approach to physician reentry education and training. They serve as a reference for setting priorities and standards for action and, more specifically, offer a foundation from which programs can be planned, evaluated, and monitored. In addition to the guiding principles, an overview of physician reentry is provided including information on reentry physicians and physician reentry programs as well as a definition of physician reentry, reasons for taking leave and returning to clinical practice, and barriers physicians face as they seek to reenter clinical care.

Transgender health: findings from two needs assessment studies in Philadelphia.

HIV/AIDS, suicide, violence, and barriers to health care access among transgender people were explored using two needs assessment surveys conducted in Philadelphia in 1997. A total of 182 people responded to a face-to-face interview or self-administered mail survey: 113 male-to-female individuals and 69 female-to-male individuals. About three-fifths of respondents had engaged in unprotected sexual activity during the past 12 months. The risk for HIV infection from unprotected sex was significantly higher among respondents of color than among white respondents. About one-third (30.1 percent) of respondents had attempted suicide. More than half of respondents had been forced to have sex, 56.3 percent had experienced violence in their homes, and 51.3 percent had been physically abused. Twenty-six percent of respondents had been denied medical care because they were transgender. These findings suggest that prevention services that specifically address HIV/AIDS, suicide, and violence among transgender people are urgently needed.

Service utilization, service barriers, and gender among HIV-positive consumers in primary care.

Title I of the Ryan White CARE Act provides emergency assistance to localities disproportionately affected by HIV and AIDS. In 1999, the Title I Chicago Area HIV Services Planning Council expressed concern regarding the lack of a client-level database. In response to the Planning Council, evaluators conducted a longitudinal interview study of HIV-positive individuals who were receiving primary care at Title I funded clinics within Chicago and the surrounding collar counties. Analysis of baseline data explored gender differences in transmission risk, service utilization, and service barriers among study respondents. Among the 161 respondents, men were more likely than women to use alcohol and other drugs during sexual activity. Men were also more likely to use HIV medication. Women, however, were more likely to have someone to coordinate their HIV care. Close to half (47.2%) of these primary case patients reported at least one unmet service need, most frequently dental care, housing support and transportation. These findings suggest a continued need for HIV-related community-based services as well as increased attention to the unique experiences of both men and women within the HIV service system.