Background We sought to determine whether perceived patient-centered medical home (PCMH) characteristics are associated with staff morale, job satisfaction, and burnout in safety net clinics. Methods Self-administered survey among 391 providers and 382 clinical staff across 65 safety net clinics in 5 states in 2010. The following 5 subscales measured respondents’ perceptions of PCMH characteristics on a scale of 0 to 100 (0 indicates worst and 100 indicates best): access to care and communication with patients, communication with other providers, tracking data, care management, and quality improvement. The PCMH sub-scale scores were averaged to create a total PCMH score. Results Six hundred three persons (78.0%) responded. In multivariate generalized estimating equation models, a 10% increase in the quality improvement subscale score was associated with higher morale (provider odds ratio [OR], 2.64; 95% CI, 1.47–4.75; staff OR, 3.62; 95% CI, 1.84–7.09), greater job satisfaction (provider OR, 2.45; 95% CI, 1.42–4.23; staff OR, 2.55; 95% CI 1.42–4.57), and freedom from burnout (staff OR, 2.32; 95% CI, 1.31–4.12). The total PCMH score was associated with higher staff morale (OR, 2.63; 95% CI, 1.47–4.71) and with lower provider freedom from burnout (OR, 0.48; 95% CI, 0.30–0.77). A separate work environment covariate correlated highly with the quality improvement subscale score and the total PCMH score, and PCMH characteristics had attenuated associations with morale and job satisfaction when included in models. Conclusions Providers and staff who perceived more PCMH characteristics in their clinics were more likely to have higher morale, but the providers had less freedom from burnout. Among the PCMH subscales, the quality improvement subscale score particularly correlated with higher morale, greater job satisfaction, and freedom from burnout.

Objective Increased mortality risk following spousal bereavement (often called the “widowhood effect”) is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. Design Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. Method Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: “recent widows” (N = 396) were bereaved between 2004 and 2006, before outcomes were assessed; “near widows” (N = 380) were bereaved between 2006 and 2008, after outcomes were assessed; “married” individuals (N = 7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. Results Compared to married individuals, recent widows had worse depressive symptoms (β = 0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β = 0.21, 95% CI: [0.08, 0.34]), mobility (β = 0.14, 95%CI: [0.01, 0.26]), and word recall (β = −0.13, 95%CI: [−0.23, −0.02]) compared to married individuals. Conclusions Health declines before spousal death suggests some portion of the “widowhood effect” may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.

The SNMHS demonstrated reliability and convergent validity for measuring PCMH adoption in safety-net clinics. Some clinics have significant PCMH adoption. However, room for improvement exists in most domains, especially for clinics with fewer providers.

OBJECTIVETo describe sexual activity, behavior, and problems among middle-age and older adults by diabetes status.RESEARCH DESIGN AND METHODSThis was a substudy of 1,993 community-residing adults, aged 57–85 years, from a cross-sectional, nationally representative sample (N = 3,005). In-home interviews, observed medications, and A1C were used to stratify by diagnosed diabetes, undiagnosed diabetes, or no diabetes. Logistic regression was used to model associations between diabetes conditions and sexual characteristics, separately by gender.RESULTSThe survey response rate was 75.5%. More than 60% of partnered individuals with diagnosed diabetes were sexually active. Women with diagnosed diabetes were less likely than men with diagnosed diabetes (adjusted odds ratio 0.28 [95% CI 0.16–0.49]) and other women (0.63 [0.45–0.87]) to be sexually active. Partnered sexual behaviors did not differ by gender or diabetes status. The prevalence of orgasm problems was similarly elevated among men with diagnosed and undiagnosed diabetes compared with that for other men, but erectile difficulties were elevated only among men with diagnosed diabetes (2.51 [1.53 to 4.14]). Women with undiagnosed diabetes were less likely to have discussed sex with a physician (11%) than women with diagnosed diabetes (19%) and men with undiagnosed (28%) or diagnosed (47%) diabetes.CONCLUSIONSMany middle-age and older adults with diabetes are sexually active and engage in sexual behaviors similarly to individuals without diabetes. Women with diabetes were more likely than men to cease all sexual activity. Older women with diabetes are as likely to have sexual problems but are significantly less likely than men to discuss them.

The African Comprehensive HIV/AIDS Partnerships.