Correlates of Administrator Tenure in US Residential Care Communities

ObjectiveTo determine community- and individual-level correlates of administrator tenure in US residential care communities (RCCs).DesignSecondary data analysis of the 2010 National Survey of Residential Care Facilities designed by the National Center for Health Statistics. Analysis was conducted using Tobit regression.Setting and participantsA nationally representative sample of RCCs in the United States (n = 2302).MeasuresThe outcome measure for this study is RCC administrator tenure. Residential care community characteristics include chain ownership, size, occupancy rate, profit status, years of operation, if the building was purposely constructed as an RCC, Medicaid census, presence of a dementia care unit, and whether administrative staff provided care. Administrator characteristics included age, gender, race/ethnicity, and level of education.ResultsOver a quarter of administrators in this sample remained employed with the same RCC for 10 or more years (28%). Chain membership, community size, and presence of a dementia care unit are associated with shorter administrator tenure (P < .001). Communities with greater than 80% occupancy, administrator's age 40+, and Hispanic race/ethnicity were associated with longer administrator tenure (P < .001).Conclusions/ImplicationsVarious community and administrator characteristics are associated with shorter or longer tenure within the same community. More setting-specific research is needed to identify how RCC administrators influence care quality and what different lengths of tenure indicate in the context of RCC operations.     

Health Care Response to CCHF in US Soldier and Nosocomial Transmission to Health Care Providers,Germany, 2009

In 2009, a lethal case of Crimean–Congo hemorrhagic fever (CCHF), acquired by a US soldier in Afghanistan, was treated at a medical center in Germany and resulted in nosocomial transmission to 2 health care providers (HCPs). After his arrival at the medical center (day 6 of illness) by aeromedical evacuation, the patient required repetitive bronchoscopies to control severe pulmonary hemorrhage and renal and hepatic dialysis for hepatorenal failure. After showing clinical improvement, the patient died suddenly on day 11 of illness from cerebellar tonsil herniation caused by cerebral/cerebellar edema. The 2 infected HCPs were among 16 HCPs who received ribavirin postexposure prophylaxis. The infected HCPs had mild or no CCHF symptoms. Transmission may have occurred during bag-valve-mask ventilation, breaches in personal protective equipment during resuscitations, or bronchoscopies generating infectious aerosols. This case highlights the critical care and infection control challenges presented by severe CCHF cases, including the need for experience with ribavirin treatment and postexposure prophylaxis.     

Prevention of Unintended Pregnancy and HIV/STIs Among Latinos in Rural Communities: Perspectives of Health Care Providers

Latino women in the United States are disproportionately at risk for unintended pregnancy, HIV, and sexually transmitted infections (STIs). We conducted nine focus groups with health care practitioners who provide reproductive health care to Latinos in rural areas of the Northwest. From the practitioner perspective, we explored barriers and facilitators to the acquisition and use of contraceptives and to the prevention of HIV/STIs among rural Latinos. Suggestions for improving reproductive health care included Spanish-language resources/materials and convenient contraceptive methods. Findings provide context to the complex issues related to unintended pregnancy and disease prevention among Latinos residing in rural communities.     

Staff and Organizational Capacity in the Implementation of Coordinated Care: an Examination of 10 Behavioral Health Agencies in Rural Communities

The Journal of Behavioral Health Services & Research - Providing primary care services in behavioral health settings has become more common and necessary given the needs of individuals with...     

HIV Prevention Services Received at Health Care and HIV Test Providers by Young Men who Have Sex with Men: An Examination of Racial Disparities

We investigated whether there were racial/ethnic differences among young men who have sex with men (MSM) in their use of, perceived importance of, receipt of, and satisfaction with HIV prevention services received at health care providers (HCP) and HIV test providers (HTP) that explain racial disparities in HIV prevalence. Young men, aged 23 to 29 years, were interviewed and tested for HIV at randomly sampled MSM-identified venues in six U.S. cities from 1998 through 2000. Analyses were restricted to five U.S. cities that enrolled 50 or more black or Hispanic MSM. Among the 2,424 MSM enrolled, 1,522 (63%) reported using a HCP, and 1,268 (52%) reported having had an HIV test in the year prior to our interview. No racial/ethnic differences were found in using a HCP or testing for HIV. Compared with white MSM, black and Hispanic MSM were more likely to believe that HIV prevention services are important [respectively, AOR, 95% confidence interval (CI): 3.0, 1.97 to 4.51 and AOR, 95% CI: 2.7, 1.89 to 3.79], and were more likely to receive prevention services at their HCP (AOR, 95% CI: 2.5, 1.72 to 3.71 and AOR, 95% CI: 1.7, 1.18 to 2.41) and as likely to receive counseling services at their HTP. Blacks were more likely to be satisfied with the prevention services received at their HCP (AOR, 95% CI: 1.7, 1.14 to 2.65). Compared to white MSM, black and Hispanic MSM had equal or greater use of, perceived importance of, receipt of, and satisfaction with HIV prevention services. Differential experience with HIV prevention services does not explain the higher HIV prevalence among black and Hispanic MSM. A complete list of the members of the Young Men’s Survey Study Group and cooperating organizations appears at the end of this article.     

Public Health Responses to the HIV Epidemic Among Black Men Who Have Sex With Men: A Qualitative Study of US Health Departments and Communities

In the United States, Black men who have sex with men (MSM) are disproportionately affected by HIV/AIDS. Thus, there is a need to understand the challenges facing health departments and community-based organizations responding to the HIV epidemic among this population. We interviewed 71 AIDS program directors, health department staff, and leaders of community-based organizations in 9 states and the District of Columbia. Participants identified psychosocial factors, a lack of capacity-building efforts, and stigma as barriers to HIV prevention responses targeting Black MSM. Participants identified culturally competent staff and culturally sensitive interventions as facilitating prevention responses. To ensure that HIV/AIDS interventions targeting Black MSM are effective, it is imperative to solicit the perceptions of frontline workers in health departments and community-based organizations.Black men who have sex with men (MSM) exhibit an extremely high and disproportionate rate of HIV infection in the United States relative to other groups. Three epidemiologic studies conducted within the past 10 years highlight this point. First, the Young Men''s Study employed a multisite, cross-sectional, venue-based survey methodology to collect behavioral and seroprevalence data from more than 3400 MSM between the ages of 15 and 22 years.¹ Findings from the study, released in 2000, showed that 14% of the Black MSM in the sample were HIV positive—the highest prevalence among the 5 ethnic groups represented by the sample. The study also showed that Black MSM were more than 6 times more likely than White MSM to be HIV positive.Second, a study conducted by the North Carolina Department of Health involved a retrospective review of North Carolina men aged 18 to 30 years who were diagnosed with HIV between 2000 and 2003.² The study reported an increase in HIV cases among male college students from 2 in 2000 to 56 in 2003. Of the 56 cases in 2003, 88% were Black, and almost all were MSM.Finally, the most disheartening seroprevalence data were published in 2005, from the Centers for Disease Control and Prevention''s 5-city study of MSM.³ The study, which used a methodology similar to that of the Young Men''s Study, showed an HIV prevalence of 46% among Black MSM, compared with 21% and 17% for White MSM and Latino MSM, respectively. Of the Black MSM who were HIV positive, 64% were unaware of their infection.Given the high and increasing rates of HIV infection among Black MSM, researchers have begun to place a greater emphasis on understanding the psychological, behavioral, sociocultural, and historical factors that may place these men at greater risk of becoming infected with HIV or transmitting the virus to sexual partners. For example, Millett et al.,⁴ in a seminal literature review, noted that rates of HIV risk behavior (e.g., unprotected anal intercourse, injection drug use, and substance use during sex) were no higher among Black MSM than among White or Latino MSM. However, their research suggested that the higher HIV incidence observed among Black MSM might be explained by the higher rates of sexually transmitted infections among this population. Sexually transmitted infections cause decreased immune-system functioning, thus making men more susceptible to the acquisition and transmission of HIV. The literature review also suggested that a lack of HIV testing and late HIV diagnosis among Black MSM could be linked to heightened risk for HIV among this group. Other work by Millett et al.^5,6 points toward characteristics of the sexual partners of Black MSM (e.g., older age, Black race, HIV-positive status) as important factors in explaining heightened HIV risk.Likewise, Malebranche,⁷ in pointing out steps for public health researchers and practitioners to take in thwarting the growth of the HIV/AIDS epidemic among Black MSM, suggested that a comprehensive understanding of HIV risk among Black MSM will require an examination of sexual networks, men''s understandings of masculinity and sexuality, health care access, and increased susceptibility related to social and environmental stressors, among other issues. Other researchers have noted that homophobia and AIDS stigma within the families and communities of Black MSM may also explain heightened HIV/AIDS risk.⁸ Homophobia and stigma may operate to reduce HIV testing and other protective behaviors among Black MSM and may impede HIV-status disclosure among HIV-positive Black MSM. These findings represent just a few of the myriad risk factors that may undergird the high rates of HIV infection and AIDS among Black MSM, highlighting the increased attention that needs to be focused on this public health crisis.