Health, homelessness, and poverty: a study of clinic users

Article Abstract:

With rare exceptions, health centers for the poor were designed to treat those who have homes, not the homeless poor, whose health care needs may be very different. Until now, the physical health of homeless adults has not been compared with that of other poor people living in homes in the same community. This study of 464 homeless and non-homeless patients at a local health clinic compared the physical health status of the two groups and their past use of medical services. It was found that Hispanics were more likely, and whites less likely, to have homes, and those with homes earned twice as much as those without, although all earned incomes below the poverty line. The homeless were also more likely to have been hospitalized during the past year, perhaps because they did not seek care until they were sicker, or because problems that can be treated on an outpatient basis for someone who has a place to live cannot be treated effectively when a person is homeless. The homeless were more likely to perceive their health as fair or poor than other patients, and reported two or more functional limitations, while those with homes generally reported none. The homeless had more risk factors for disease, including a greater likelihood of being unwashed, of smoking, and of abusing alcohol or drugs. They also reported less social activity. The groups did not differ on number of injuries or accidents, incidence of tuberculosis, intravenous drug use, number of sexual partners, or homosexual activity. The homeless were more likely to have seizures and chronic obstructive pulmonary diseases, such as emphysema or chronic bronchitis, but were equally likely to suffer from trauma. Surprisingly, nutritional status did not differ. Whenever a difference was detected, the homeless were worse off. The findings suggest that the homeless need more services targeted at the management of functional disabilities and chronic diseases, as well as dental, eye, and foot care specialists. Mental health and substance abuse programs for the homeless are needed. The authors suggest that a beginning would be to provide social services to assist uninsured patients in obtaining the health insurance and public benefits to which they are entitled. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Medical care, Poverty, Homeless persons, Medical care needs assessment

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Recent sexual behaviors among homosexual men seeking primary medical care

Article Abstract:

Acquired immunodeficiency syndrome (AIDS) is caused by a virus infecting the blood. Transmission of the virus is by the exchange of infected body fluids such as blood or semen. In homosexual men, a group at high risk for the infection, transmission is primarily through sexual contact. Although some studies indicate homosexual men have altered their sexual behaviors, unsafe sex is still being practiced. Sexual practices among homosexual men may differ between cultural groups and geographical locations. The reduction of high-risk sexual behavior is essential to curb the transmission of the AIDS virus. The sexual behaviors of 823 homosexual or bisexual men with AIDS seeking primary health care in Los Angeles County , from either a private physician or health clinic, were assessed. The different sociodemographic groups were asked about their attitudes towards AIDS, sexual practices and knowledge about the disease. Unsafe sex had been practiced at least one time during the two months prior to the study by 64 percent of the men. The men practicing unsafe methods were generally younger, of lower socioeconomic status, and belonged to a minority group, particularly Latino and black. The men practicing unsafe sex were also more likely to use alcohol and drugs, to have many sexual partners and to have had sex more often. They were less likely to discuss safe sex with prospective sexual partners, had less control over the type of sex they engaged in and had poor knowledge of AIDS transmission. It is suggested that educational programs should be designed to target the younger minority men of low socioeconomic status. They should be taught methods to improve the communication of safe sex practices to prospective partners and better control sexual behavior. The primary care setting is a suitable arena to employ these educational and behavioral programs.

Sexual behavior, Sex, Surveys, Disease transmission, Gay men, AIDS (Disease), AIDS virus carriers, HIV carriers

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Attitudes toward mental illness prevention in routine pediatric practice

Article Abstract:

Pediatricians are in a unique position to identify children at risk for mental illness. Children of parents who are divorced, depressed or previously hospitalized with mental illness are at a particularly high risk. The attitudes of 316 pediatric practitioners towards their role in preventing mental illness among children were evaluated. The reliability of measuring attitudes and barriers to implementing prevention programs were assessed among pediatricians practicing at one medical school. Although most pediatricians considered it appropriate, effective and ethical to be involved in the prevention of mental illness in children, they thought that ethical guidelines concerning mental illness prevention were inadequate. The prevention of mental illness was inhibited by financial, educational and time constraints. Preventive health practices were related to their own personal beliefs regarding how people become and stay healthy. It is suggested that more information and improvement in prevention skills are needed to implement mental health-oriented practices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prevention, Practice, Beliefs, opinions and attitudes, Study and teaching, Pediatrics, Mental illness, Mental disorders, Childhood mental disorders, Pediatricians, Child psychopathology, Child mental health

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