Using Trauma-Informed Care to Address Sexual Assault and Intimate Partner Violence in Primary Care

Interpersonal trauma has long-lasting effects on mental and physical health and is associated with acute and chronic negative health outcomes. Primary care providers can improve health care outcomes by using trauma-informed care to recognize, acknowledge, and respond appropriately to trauma survivors. Routine trauma screening in the primary care setting should be done in a safe environment and with a team approach. This article will offer guidance on screening for and responding to sexual assault and intimate partner violence using trauma-informed principles with the goal of promoting health and healing for survivors.     

Wolves in sheep’s clothing: Is non-profit status used to signal quality?

Why do many firms in the healthcare sector adopt non-profit status? One argument is that non-profit status serves as a signal of quality when consumers are not well informed. A testable implication is that an increase in consumer information may lead to a reduction in the number of non-profits in a market. We test this idea empirically by exploiting an exogenous increase in consumer information in the US nursing home industry. We find that the information shock led to a reduction in the share of non-profit homes, driven by a combination of home closure and sector switching. The lowest quality non-profits were the most likely to exit. Our results have important implications for the effects of reforms to increase consumer provision in a number of public services.     

AIDS and Sex: Is Warning a Moral Obligation?

Common-sense holds that morality requirespeople who know that they are infected with theHuman Immunodeficiency Virus (HIV) to disclosethis fact to their sexual partners. But manygay men who are HIV-positive do not disclose,and AIDS Service Organizations (ASOs) promotepublic-health policies based on safer sex byall, rather than disclosure by those who knowthat they are infected. The paper shows thatthe common-sense view follows from a minimalsexual morality based on consent. ASOs'seeming rejection of the view follows fromtheir need to take seriously widespreadweakness of will in the realm of sexuality. The author argues that gay men take themselvesto follow the common sense view, but hold thatthe possibility of a partner's HIV infection isbackground information that need not bedisclosed for sexual consent. This suggestionis criticized. The paper concludes with aconsideration of HIV disclosure and sexualethics outside of the gay community and oflegal restrictions on the sexuality of theHIV-positive.     

The philosophy of palliative medicine: a challenge for medical education

The hospice movement has admirably improved management of the dying under its care. However, the majority of medical care of the terminally and chronically ill remains in the hands of practitioners outside hospices and is often open to criticism. This paper reviews the philosophy and practice of palliative medicine from the perspective of general practice and the shortcomings of present medical education in this area. Proposals are made for a radical shift in medical undergraduate teaching through an organized interdepartmental contribution by enthusiastic teachers to all years in training.     

A model of HIV disclosure: disclosure and types of social relationships

PURPOSE: The purpose of this study was to assess perceptions of HIV positive (+) persons regarding disclosure of their serostatus to others with the goal of developing a model of HIV disclosure that could be used by healthcare providers (HCPs) in HIV prevention. DATA SOURCES: Data were collected through 13 focus groups from 104 HIV+ participants. The groups were formed based on three HIV risk exposure categories--men who have sex with men, high-risk heterosexuals, and substance users. CONCLUSIONS: Data analysis revealed three themes: disclosure of one's HIV+ serostatus depends on type of social relationships, fear, and stigma, with social relationships being the major theme. A model of HIV disclosure emerged from the data analysis of social relationships. In the model, social relationships were categorized as sexual and nonsexual, with varying degrees of HIV disclosure-depending on the social relationship with the person to whom one did or did not disclose. Results indicated that HIV is still a fearful and stigmatizing disease, and disclosure of HIV status is a complex phenomenon embedded in various types of social relationships. IMPLICATIONS FOR PRACTICE: Results of this study provide a "Model of HIV Disclosure" that can be utilized by nurse practitioners and other HCPs in clinical practice when providing treatment, counseling, and prevention education for HIV+ clients and for prevention education for HIV negative clients--especially for family, friends, sexual partners, and employers of HIV+ clients.     

Secrets and disclosure in donor conception

This article considers the disclosure, sharing and exchange of information on being donor conceived within families, drawing on data from a study undertaken with donor‐conceived adults registered with UK Donor Link (a voluntary DNA‐linking register). This paper considers the narratives of how respondents found out they were donor‐conceived and what events triggered disclosure of this information. This paper then goes on to examine the role secrecy played in their family life and uses the concept of ‘display’ to explore how secrecy affected their relationships with their immediate and extended family. Secrets are notoriously ‘leaky’ and we found complex patterns of knowing and uncertainty about whom in the family knew that the person was donor‐conceived. We argue that what is kept secret and from whom provides insights into the multifaceted web of social relationships that can be created by donor‐conception, and how knowledge can be managed and controlled in attempts to display and maintain family narratives of biogenetic connection.     

An evaluation of personal health information remnants in second-hand personal computer disk drives

Background

The public is concerned about the privacy of their health information, especially as more of it is collected, stored, and exchanged electronically. But we do not know the extent of leakage of personal health information (PHI) from data custodians. One form of data leakage is through computer equipment that is sold, donated, lost, or stolen from health care facilities or individuals who work at these facilities. Previous studies have shown that it is possible to get sensitive personal information (PI) from second-hand disk drives. However, there have been no studies investigating the leakage of PHI in this way.

Objectives

The aim of the study was to determine the extent to which PHI can be obtained from second-hand computer disk drives.

Methods

A list of Canadian vendors selling second-hand computer equipment was constructed, and we systematically went through the shuffled list and attempted to purchase used disk drives from the vendors. Sixty functional disk drives were purchased and analyzed for data remnants containing PHI using computer forensic tools.

Results

It was possible to recover PI from 65% (95% CI: 52%-76%) of the drives. In total, 10% (95% CI: 5%-20%) had PHI on people other than the owner(s) of the drive, and 8% (95% CI: 7%-24%) had PHI on the owner(s) of the drive. Some of the PHI included very sensitive mental health information on a large number of people.

Conclusions

There is a strong need for health care data custodians to either encrypt all computers that can hold PHI on their clients or patients, including those used by employees and subcontractors in their homes, or to ensure that their computers are destroyed rather than finding a second life in the used computer market.