Faculty Bibliography

OBJECTIVE: The objective of this study was to characterize emergency preparedness in this vulnerable population, and to ascertain the role of the personal assistant (PA) and the potential impact of prior emergency experience on preparedness efforts. DESIGN: Cross-sectional Internet-based survey conducted in 2011. SETTING: Convenience sample. PARTICIPANTS: Two-hundred fifty-three community residents with cognitive and /or physical disabilities, all receiving personal assistance services. MAIN OUTCOME VARIABLES: Emergency preparedness, operationalized as responses to a seven-item scale. RESULTS: The mean score for the emergency preparedness scale was 2.32 (SD = 2.74), range 0-7. Even though 62.8 percent (n = 159) of the participants had previously experienced one or more large-scale emergencies, only 47.4 percent (n = 120) of the entire sample and 55.3 percent (n = 88) of those with actual emergency experience reported preparing an emergency plan. Sixty-three percent (n = 76) of those reporting a plan had involved their PA in its development. Participants who reported such involvement were significantly more likely to have higher scores on the emergency preparedness scale (p < 0.001). Participants who had experienced a prior emergency were also more likely to score higher on the emergency preparedness scale (p < 0.001). In general, participants reported limited attention to other basic preparedness recommendations: only 28 percent (n = 70) had prepared a "go-bag" with necessary supplies, 29 percent (n = 74) had developed a strategy for communicating with their PA during emergencies, and 32 percent (n = 81) had stockpiled emergency supplies. Of particular importance, only 26 percent (n = 66) had made alternative back-up plans for personal assistance. CONCLUSIONS: Involving the PA in the planning process and experiencing an emergency were both significantly associated with higher emergency preparedness scores in this sample of people living with disabilities. However, critical deficiencies in preparedness were noted, such as lack of back-up plans for replacing their PA. Despite a concerted national effort to improve preparedness in the population of people living with disabilities, important preparedness gaps remain. These findings highlight the need for additional study on emergency preparedness barriers in people living with disabilities so that effective strategies to reduce vulnerabilities can be identified.

PURPOSE: This study examined the social and contextual factors associated with continued high risk sexual behaviors among male-to-female transgender (MTFTG) adolescents living with HIV/AIDS. The study is part of a larger qualitative study of 59 racial/ethnic minority adolescents living with HIV/AIDS. METHODS: In-depth focused interviews were conducted with five MTFTG adolescents (16-24 years) living with HIV. Content analysis was conducted to identify themes related to continued sexual risk behaviors. RESULTS: Four out of five of MTFTG adolescents reported inconsistent condom use since their HIV diagnosis. Transgender stigma contributed to financial vulnerability leading to the adoption of sex work to support themselves. Sex and drugs were used to manage transgender stigma and sexual risk-taking with sex work partners was influenced by financial vulnerability. CONCLUSIONS: MTFTG adolescents with HIV have unique psychosocial needs related to transgender stigma and structural needs to decrease financial vulnerability that contribute to risky sexual behavior.

Health care-associated infections (HAIs) are common and costly patient safety problems that are largely preventable. As a result, numerous policy changes have recently taken place including mandatory reporting and lack of reimbursement for HAIs. A qualitative approach was used to obtain dense description and gain insights about the current practice of infection prevention in California. Twenty-three in-depth, semistructured interviews were conducted at six acute care hospitals. Content analysis revealed 4 major interconnected themes: (a) impacts of mandatory reporting; (b) impacts of technology on HAI surveillance; (c) infection preventionists' role expansion; and (d) impacts of organizational climate. Personnel reported that interdisciplinary collaboration was a major facilitator for implementing effective infection prevention, and organizational climate promoting a shared accountability is urgently needed. Mandatory reporting requirements are having both intended and unintended consequences on HAI prevention. More research is needed to measure the long-term effects of these important changes in policy.

Health advocacy organizations (HAOs) are influential stakeholders in health policy. Although their advocacy tends to closely correspond with the pharmaceutical industry's marketing aims, the financial relationships between HAOs and the pharmaceutical industry have rarely been analyzed. We used Eli Lilly and Company's grant registry to examine its grant-giving policies. We also examined HAO Web sites to determine their grant-disclosure patterns. Only 25% of HAOs that received Lilly grants acknowledged Lilly's contributions on their Web sites, and only 10% acknowledged Lilly as a grant event sponsor. No HAO disclosed the exact amount of a Lilly grant. As highly trusted organizations, HAOs should disclose all corporate grants, including the purpose and the amount. Absent this disclosure, legislators, regulators, and the public cannot evaluate possible conflicts of interest or biases in HAO advocacy

PURPOSE: Policy recommendations specify how academic medical centers should manage clinical conflicts of interest (CCOIs), including gifts and payments to physicians from pharmaceutical companies. However, no reliable data exist on the extent to which schools have policies to manage CCOIs. The authors sought to determine the extent and strength of medical schools' CCOI policies. METHOD: A survey asked compliance officers at 125 MD-granting medical schools in the United States to indicate whether their institutions had policies covering 11 areas of CCOI and to provide copies of relevant policies. Policies were scored as 0 (no policy), 1 (permissive), 2 (moderate), or 3 (stringent), based on published recommendations. Each school's scores were averaged to create a measure of overall policy strength. The authors also collected information on schools' public/private status, hospital ownership/affiliation, and NIH funding to determine whether these characteristics were associated with differences in policy strength. RESULTS: A representative sample of 77 of 125 (62%) medical schools responded between October 2007 and December 2008. Absence of policy was the most frequent finding in 7 of 11 CCOI areas. The mean score for overall policy strength was 1.2. Greater NIH funding was associated with stronger policies in 9 areas. CONCLUSIONS: This analysis provides a comprehensive overview of medical schools' CCOI policies. Wider adoption of CCOI policies is crucial to eliminate undue industry influence in clinical care and to preserve public trust in the medical profession. The authors close with a consideration of why so few medical schools have implemented strong policies.

PURPOSE: Adults aging with HIV/AIDS can experience resilience in spite of the deleterious affects of the disease. This study seeks to examine the lived experiences of older adults with HIV/AIDS as it relates to strengths and resilience in dealing with this devastating disease. DESIGN AND METHODS: Semistructured in-depth interviews were conducted with 25 adults, 50 years and older, living with HIV/AIDS. The interview transcripts were analyzed using constant comparative methodology following the tenets of adaptive theory. RESULTS: The majority of informants expressed experiences of resilience and strengths as related to living with HIV/AIDS. Seven major themes emerged from the analysis including self-acceptance, optimism, will to live, generativity, self-management, relational living, and independence. IMPLICATIONS: The research identified the importance of strengths and resilience among older adults living with HIV/AIDS. Further research is needed to explore these phenomena with larger samples. Practitioners should identify and implement methods for assessing resilience among older HIV-infected adults.