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Patients often provide untruthful information about their health to avoid embarrassment, evade treatment, or prevent financial loss. Privacy disclosures (e.g. HIPAA) intended to dissuade privacy concerns may actually increase patient lying. We used new mouse tracking-based technology to detect lies through mouse movement (distance and time to response) and patient answer adjustment in an online controlled study of 611 potential patients, randomly assigned to one of six treatments. Treatments differed in the notices patients received before health information was requested, including notices about privacy, benefits of truthful disclosure, and risks of inaccurate disclosure. Increased time or distance of device mouse movement and greater adjustment of answers indicate less truthfulness. Mouse tracking revealed a significant overall effect (p<0.001) by treatment on the time to reach their final choice. The control took the least time indicating greater truthfulness and the privacy + risk group took the longest indicating least truthfulness. Privacy, risk, and benefit disclosure statements led to greater lying. These differences were moderated by gender. Mouse tracking results largely confirmed the answer adjustment lie detection method with an overall treatment effect (p <.0001) and gender differences (p <.0001) on truthfulness. Privacy notices led to decreased patient honesty. Privacy notices should perhaps be administered well before personal health disclosure is requested to minimize patient untruthfulness. Mouse tracking and answer adjustment appear to be health care lie-detection methods to enhance optimal diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: In sub-Saharan Africa, youth living with HIV, especially those who have lost one or both parents, face economic, socially and psychological challenges that hinder adherence to ART, ultimately leading to poor health outcomes. Partners In Health/Inshuti Mu Buzima implemented an Adolescent Support Group (ASG) to support HIV-positive youth aged 15–25 years. During the evaluation of the ASG program, we sought to better understand youths’ lived experiences to improve our delivery of HIV care. Methods: We conducted qualitative in-depth, semi-structured individual interviews with youth enrolled in the ASG program. All interviews were conducted in-person or by telephone. Thematic analysis applying the framework approach with parallel inductive coding in Kinyarwanda and English was used. Results: We interviewed 35 youth who ranged in age from 16 to 29 years. The main themes related to the lived experiences of youth were (a) Experiences living with HIV, including disclosure, stigma, interactions with the health care system, and medication adherence; (b) external challenges, defined as challenges that were not related to the implementation of the ASG program; and (c) personal vision. Almost all youth reported acquiring HIV from their mothers and disclosure of HIV status occurred around the age of 10. Disclosure was often unintentional and followed by internalized and enacted stigma. Many reported poor past medication adherence which improved following enhanced counselling. External challenges were overwhelmingly economic in nature, and orphanhood was a root cause of other challenges such as difficulty accessing education, lack of transport to health facility, and lack of insurance fees. Despite these challenges, youth have an optimistic view of the future with dreams of health, economic attainment, marriage, and children. Conclusion: Healthcare providers should empower caregivers to support HIV disclosure. Supporting youth as they face many economic challenges could help address socio-economic barriers to good health and promote holistic well-being. [ABSTRACT FROM AUTHOR]

Guided by the Theory of Coming Out Message Production and the Constitutive Model of Coming Out, this study explores how negative COVID-19 experiences (adverse impacts of the pandemic) moderate the effects of cognitive factors (disclosure goals, relational power, and internalized homophobia) on sexual orientation disclosure, and the effects of disclosure on mental health. Results (N = 403 U.S. LGBQ adults) showed that as adverse impacts of the pandemic increased, the positive relationship between disclosure goals and sexual orientation disclosure decreased, but the negative association between internalized homophobia and disclosure increased. Higher disclosure levels predicted lower depression one month later, only when participants reported lower negative impacts of the pandemic. Theoretical accounts for coming out message processes should consider both environmental and cognitive factors and differentiate their distinct roles in predicting disclosure messages. Moreover, the positive impacts of effective coming out seem to disappear when the pandemic heavily impacts LGBQ people's daily lives. [ABSTRACT FROM AUTHOR]

Introduction: While there is growing interest in applying patient‐reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing emperical evidence on the impact of implementing PRMs in routine maternity care. Material and methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines (version 2020). We electronically searched six databases for the literature on the implementation of PRMs in maternity care. A multi‐level (woman, clinical, organizational, national and societal) analytic framework for analyzing and synthesizing emperically proven impacts of PRMs was developed. Quality was assessed using the Mixed Method Appraisal Tool. The GRADE‐CERQual approach was used to assess the confidence in the review findings and arguments. The protocol was registered in PROSPERO (CRD42021234501). Results: Overall, 4971 articles were screened. The emperical evidence, collected from 11 relevant studies, showed that the use of PRMs in routine maternity care could produce positive effects on clinical process (assessment and detection of health problems, clinical visit preparation, resource use, woman–professional communication, decision‐making, woman–professional relationship, and care quality), and health behavior and outcomes (women's health and wellbeing, quality of life, health behavior, experiences and satisfaction with healthcare services), awareness, engagement and self‐management of own health, and disclosure of health issues. The confidence in the review findings was low to moderate due to a limited number of studies, inadequate data and methodological limitations of included studies. Conclusions: The limited emperical evidence available suggested that the use of PRMs may have positive effects at the individual health level and clinical process level. However, the evidence was not strong enough to provide policy recommendations on the use of PRMs in routine maternity care. This review revealed limitations of currently available research, such as lack of generalizability and narrow scopes in investigating impact. Efforts are needed to improve the quality of research on the use of PRMs in routine maternity care by widening the study population, including different types of PRMs, and considering the effects of PRMs at different levels and domains of healthcare. [ABSTRACT FROM AUTHOR]

Background: Participation in HIV vaccine trials is an essential step towards development of an effective preventive vaccine. A Phase I/II HIV vaccine trial enrolls volunteers at low risk of acquiring HIV infection, however a few may still become infected. Understanding the experiences of volunteers who acquired HIV infection while participating in such trials is essential for future research. Here, we describe experiences of HIV infected volunteers in Phase I/II HIV vaccine trials conducted in urban Tanzania. Materials and methods: We used a case study design. In-depth interviews were conducted with four participants who became HIV infected during long follow-up visits after completion of vaccination schedules in a Phase I/II trial. Between 3 and 8 years after HIV positive diagnosis, each participant was interviewed at three time points within a two-year interval so as to allow for accumulation of experiences and cross-checking the emerging constructs. Data was analyzed using a qualitative data analysis framework. Results: Analysis revealed that participation in HIV vaccine trials involves balancing controversies and the spirit of informed decision. The participants declared that they did not acquire HIV from the experimental vaccine. Disclosure of HIV status within the family was gender specific. Men were hesitant to disclose their HIV status to their sexual partners fearing for the consequences. Women's attempt to disclose their HIV status yielded negative reactions from the sexual partners. The acquired knowledge from the HIV vaccine research enabled the participants to cope with the uncertainties and their health status. Conclusions: The knowledge acquired during the Phase I/II HIV vaccine trial appears to be an essential resource to cope with uncertainties post research. The HIV vaccine trial implementers need to understand the challenges the volunteers may confront after the trial while coping with their health status. Longitudinal studies are essential to trace the effects of uncertainties to the individual participants. [ABSTRACT FROM AUTHOR]

Oral care during cancer treatment constitutes essential supportive care. We aimed to identify factors associated with cancer patients informing their family dentists about their cancer diagnosis. Using the generated original questionnaire, we conducted a cross-sectional questionnaire study in 500 cancer patients (gastric, colorectal, lung, breast, and prostate cancer) through the Internet from September 10 to 13, 2019. The factors influencing patients' disclosure of their cancer diagnosis to their family dentist were identified by multivariable logistic regression analysis. Nearly half of the respondents (42.2%) informed their family dentist that they had cancer. The disclosing behavior of cancer patients was distinctively associated with their physician's advice (odds ratio [OR] 59.3; 95% confidence interval [CI] 7.7–456.3); 8.6% of all respondents were advised to inform their dentist about their cancer diagnosis. In the group without the physician's advice, good relationship with family dentist was associated with disclosing behavior. This study indicates the need for support for cancer patients to receive appropriate oral care; patients' perceptions of the physician's advice and communication with the family dentist should be motivators for disclosing the cancer diagnosis to dentists. Medical workers involved in cancer care should demonstrate the benefit of medical-dental collaboration in cancer care of patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to learn about the process of disclosing health information to a coworker friend using the lens of Communication Privacy Management Theory. The study explores emerging themes regarding health information disclosure and predicts associations between privacy, social support, risk, stigma, and the willingness to disclose health information to a friend at work. Employees were asked to recall a time they shared health information with a coworker friend and report about the interaction via open-ended items and scales on a survey. The study found that as emotional support, instrumental support, perceived risk, and stigma of the information increased, so did the tendency to disclose to a coworker friend. Increased privacy of the information was associated with a decrease in the tendency to disclose. A thematic analysis of the open-ended results also revealed that employees shared information associated with personal on-going health problems to seek support, to relate to their coworker friends, and to maintain their friendship. The findings also indicated that employees were likely to receive social support from their coworker friends even if they were not seeking it. [ABSTRACT FROM AUTHOR]

Background. Decisions to test, enrol and disclose HIV status are among the ethical challenges that may influence adherence to antiretroviral therapy (ART) and HIV care and treatment in adolescents living with HIV. In the Tanzanian setting, how parental perceptions of ethical issues affect adolescents' adherence to HIV care and treatment is not well known. Objective. To explore parental perceptions of ethical issues in adolescent HIV care and treatment. Methods. The study employed a descriptive qualitative exploratory design and was conducted at Temeke Regional Referral Hospital in Dar es Salaam Care and Treatment Centre (CTC) in the Outpatient Department (OPD). The study population were parents and non-parent caregivers of HIV-infected adolescents 10 - 19 years of age. A total of 16 persons participated in semi-structured interviews after their consent was obtained. All interviews were audiotaped, transcribed verbatim in Swahili and back-translated into English. An inductive content analysis was used, and standards of qualitative rigour applied. Results. Three qualitative themes emerged: balancing adolescents' autonomy with parents' desire to protect their children; parental dilemmas regarding disclosure of adolescents' HIV status; and parental reasons for delayed disclosure. Conclusion. Participants perceived that parental authority should override adolescents' autonomy in HIV care and treatment. Disclosure of HIV status to adolescents is a challenge to parents. Delays in disclosure often occur because parents feel guilty and because they have fears of rejection by their adolescent children. [ABSTRACT FROM AUTHOR]

Background: Disclosure of HIV/AIDS positive test result to children is a continuing routine problem in the health care setting. Some of the families as well as the health care workers are negligent to inform children of their HIV status. This study was aimed at identifying the prevalence of HIV-positivity disclosure and the factors among 6– 15-year-old children currently on HAART in Dessie, Ethiopia. Methods: A facility based cross-sectional study design was performed in Dessie from January 21 to March 12, 2020 among 346 parents/caregivers with children living with HIV and currently on HAART. The data were collected using pre-tested, structured and self-administered questionnaires. The collected data were entered into Epi info v.7.1 and exported into SPSS version 23 for further analysis. Binary and multivariable logistic regression was employed and statistically significant factors were identified at 95% CI and at p-value < 0.05. Results: HIV positivity disclosure was found to be 29.2% (26.3– 34.7%). Being widowed mothers/caregivers, 11– 15-year-old children, child received support from NGOs and having a mother with a negative HIV test were found to be statistically significant factors for disclosure. Conclusion: The overall HIV positivity disclosure to children living with HIV was found to be low in contrast to the WHO standard. In other ways, it was comparable with the Ethiopian figures. Health workers and managers need to focus on strengthening child support, make known the maternal/caregivers' HIV status, and child age specific effective interventions to improve disclosure of HIV positivity status for children living with HIV for better ART adherence and treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: To systematically review evidence regarding prevalence and choices of disclosure of psychological distress, by mental health professionals within the workplace. Methods: Six databases were searched in June 2020. Studies were included if they were published in English language and included empirical quantitative, qualitative or mixed‐methods data. Studies were excluded if they focused on general healthcare professionals or the general population, or on stress or physical health problems. Study quality was assessed using the Mixed Methods Quality Appraisal tool. Results: Nine studies, with a total of 1891 participants, were included. Study quality varied, with studies generally reporting descriptive surveys using hypothetical disclosure scenarios. Distress was often conceptualized in psychiatric terms. These limitations mean conclusions should be treated with caution. Individuals were less likely to disclose in work and had negative experiences of doing so compared to social circles. Fear of stigma inhibited disclosure. There were differing levels of disclosure relating to recipient, trust, quality of supervision, how distress was conceptualized, and type of problem. Disclosure was experienced by some as valuable. Conclusion: There is a need for further research, which addresses the nuanced complexities surrounding disclosure choices for mental health professionals. [ABSTRACT FROM AUTHOR]

The current study examined social media content from celebrity influencers during the early stages of the novel coronavirus pandemic. Given the inchoate governmental and media response to the crisis, this paper argues for the importance of celebrity influencer voices. This study utilized a constant comparative method to analyze Instagram posts from 20 celebrity influencers over a two-month period. Findings suggest celebrities demonstrated and normalized the practice of "staying home," whereby the public used social distancing to mitigate the virus spread. Celebrity influencers also demonstrated "we're all in this together" by using their platforms to call for action. [ABSTRACT FROM AUTHOR]

The complex relationship between negligence and autonomy is of increasing practical and theoretical interest, as is shown by recent cases such as Montgomery v Lanarkshire Health Board [2015] UKSC 11, Shaw v Kovac [2017] EWCA Civ 1028 and ACB v Thomson Medical Pte Ltd [2017] SGCA 20. My discussion of this relationship divides into three parts. In the first part, I make some general observations about the relationship between negligence law and autonomy. In the second part, I argue that interference with autonomy per se should not be recognised as a form of damage that grounds a negligence claim, although I acknowledge that it may be useful for the law to recognise specific forms of autonomy loss as damage in this sense. And in the third and final part, I consider the uneasy relationship between negligence doctrine and patient autonomy in the law of liability for medical non-disclosure, and argue that as a result of recent developments, this may no longer be properly described as liability for negligence. [ABSTRACT FROM AUTHOR]

Background: Index case HIV/AIDS testing (ICHT) is a good approach for addressing and improving the efficiency and yield of testing among high-risk populations. Partners and families of people living with HIV/AIDS are among the high-risk populations for contracting HIV/AIDS. However, there is limited study on index case HIV testing among HIV patients attending Anti-Retroviral Therapy (ART). Hence, this study was aimed at assessing the magnitude and factors associated with ICHT among HIV patients attending ART in Nekemte town public health facilities. Methods: An institution-based cross-sectional study was conducted at Nekemte town public health facilities from May 20 to July 21, 2020. A systematic random sampling method was used to select the study participants. Multivariable logistic regression analysis was used to determine the predictors of acceptance of ICHT among HIV patients. Results: The ICHT acceptance was 85.2% (95% CI=84.9– 91.1%). Disclosure of their HIV status (AOR=9.74, 95% CI=4.11– 23.06), having good knowledge of ICHT (AOR=4.70, 95% CI=1.92– 11.61), believing HIV index case testing has benefits (AOR=3.43, 95% CI=1.27– 9.29), and being on ART for more than 1 year (AOR=4.78, 95% CI=2.13– 10.76) were significantly associated with index case HIV test acceptance. Conclusion and Recommendation: This study revealed a significant proportion of index case HIV testing acceptance. HIV status disclosure of index cases, knowledge of ICHT, the perceived benefit of ICHT, and long duration on ART were found to be significantly associated with acceptance of ICHT. Hence, it is essential to give attention to counseling on the importance of ICHT, enhance people living with HIV (PLWHIV) to have positive belief on the advantage of ICHT, strengthen disclosure counseling, and assist HIV status disclosure in health facilities. [ABSTRACT FROM AUTHOR]

Food markets around the world have been disrupted by the COVID‐19 pandemic via consumer behavior upended by fear of infection. In this article, we examine the impact of disclosing COVID‐19 contact tracing information on food markets, using the restaurant industry in China as a case study. By analyzing transaction data at 87 restaurants across 10 cities, we estimate difference‐in‐difference (DID) models to ascertain the impact of COVID‐19 infections and contact information tracing on economic activity as measured by a daily number of transactions. Empirical results show that while the overall number of new COVID‐19 infections at the national level caused a dramatic drop in numbers of transactions in all restaurants, restaurants in cities that disclosed contact tracing information of COVID‐19 infections experienced a 23%–35% higher number of transactions than the ones in cities that did not disclose such information during the recovery period. Ultimately, we show that in the absence of a shelter‐in‐place mandate, disclosing contract tracing information to mitigate consumers' uncertainties about risks of being infected can contribute to a faster recovery of food markets, in addition to reducing COVID‐19 infections. [ABSTRACT FROM AUTHOR]

The article presents the VOWELS approach, a communication framework for disclosing medical errors in medical oncology and palliative care. The acronym VOWELS stands for a commitment to be culturally sensitive, empathetic, listen, and support. The authors emphasize the importance of timely, empathetic, and patient-focused disclosure, which goes beyond supporting autonomous choice and includes rebuilding trust and allowing patients to be heard and understood. The article suggests that training with a purpose-built tool is necessary to overcome fear of litigation and effectively attend to cultural sensitivity. [Extracted from the article]

Background: With a recent increase in the prevalence of autism spectrum disorder (ASD), an important issue has emerged in clinical practice regarding when and how patients themselves should be given explanations following a diagnosis of ASD. The clinical guidelines of the UK National Institute for Health and Care Excellence state that children diagnosed with ASD should receive an explanation about what ASD is and how it affects their development and functioning—"if appropriate". However, the guidelines do not provide any specifics regarding what constitutes "appropriate" situations Methods: We conducted an anonymous self-administered postal questionnaire survey targeting all members of the Japanese Society for Child and Adolescent Psychiatry (n=1,995). The analysis included only physicians who had newly diagnosed pediatric patients with ASD in the past year. We imposed a limit of one year because diagnoses further back than that are difficult to recall; in other words, this would enhance the recall bias Results: The recovery rate was 30.8%, and the rate of diagnosis disclosure to patients themselves without intellectual disability was 15.3%. We asked 361 physicians who responded that "deciding on a case-by-case basis" was the ideal way to disclose an ASD diagnosis about 20 items prioritized by physicians at the time of diagnosis disclosure and extracted three factors through exploratory factor analysis. Multiple logistic regression analysis was performed with physician attributes, awareness of ASD as a disorder or personality, and the three extracted factors as explanatory variables; diagnosis disclosure was the dependent variable. The patient age group and only one of the three factors (i.e., "factor related to readiness to accept diagnosis") showed a significant association with disclosure of the diagnosis to the individual. Items included in the "factor related to readiness to accept diagnosis" were as follows: the degree of parental understanding, relationship of the patient with their parents/physician, agreement in opinion between parents, parental consent, "sufficient" patient understanding, symptom stabilization, and a guarantee of sufficient time required to explain the diagnosis to the patient Conclusion: In clinical settings, disclosing an ASD diagnosis with the consideration of patient/parent readiness toward accepting the diagnosis could help to guide physicians in determining an ideal timing for disclosure. Future studies are needed to establish detailed and concrete guidelines regarding disclosure of an ASD diagnosis to patients. [ABSTRACT FROM AUTHOR]

Risk disclosures contribute to financial stability by providing stakeholders with a better understanding of companies' risk exposures and risk management practices. Presently, corporate risk has been accelerated by the COVID-19 pandemic, and the level of disclosure varies across industries, companies, and organizations. Due to the strategic importance of the energy industry, the paper aims to assess COVID-19-related risk disclosure in the biggest electricity companies in Central and Eastern European countries, and to identify the main determinants of the disclosure. For this purpose, risk disclosure was assessed based on publicly available data disclosed by the 10 biggest public electricity companies operating in this region. Our findings indicate that factors such as the company's size, leverage, and profitability do not significantly affect COVID-19-related risk disclosure in financial reports; nevertheless, COVID-19 risk disclosure in non-financial reports is significantly correlated with the company's assets and revenues. Moreover, there is a significantly strong positive relationship between the scope of COVID-19-related risk disclosure in the management reports and the number of women on the company's management board. COVID-19-related risk disclosure in management board's reports is significantly higher than disclosure in non-financial reports and explanatory notes of financial statements. Our results suggest that risk disclosure is needed to mitigate information asymmetry, especially in pandemic situations. [ABSTRACT FROM AUTHOR]

The rate of prevalence of HIV among adults has been increasing in sub-Saharan African countries over the last decade. The objective of this study was to evaluate the interventions on HIV case management based on cART adherence and disclosure of HIV disease status among HIV-positive adults under treatment. A retrospective cohort longitudinal data was conducted on 792 randomly selected patients in the study area. Engagement of HIV-positive persons into care and achieving treatment outcomes such as the disclosure of HIV status and cART adherence were fundamental for HIV prevention strategy. The two response variables under the current investigation were evaluation of intervention on HIV case management interims cART adherence and disclosure of HIV status. Binary logistic regression was conducted for separate models. Among the predictors, age of patients (AOR = 1.020, 95% CI (1.016, 1.191); p value = 0.005), the number of follow-up (AOR = 1.014, 95% CI (1.023, 1.030); p value < 0.0001). CD4 cell count (AOR = 0.981; 95% CI (0.765, 0.971), p value < 0.01), Marital status (AOR = 1.013; 95% CI (1.002, 1.015), p value = 0.006), female patients (AOR = 1.014; 95% CI (1.001, 1.121), p value < 0.007), rural (AOR = 0.982; 95% CI (0.665, 0.998), p value = 0.004), non-educated adult patients (AOR = 0.950, 95% CI (0.92. 0.98). p value = 0.003), Non-existence of social violence (AOR = 1.012, 95% CI (1.008, 1.234), p value < 0.01), adult with non-opportunistic diseases (AOR = 1.021, 95% CI (1.002. 1.042). p value = 0.001) significantly affected the two response variables jointly. Interventions on HIV case management lead to an efficient continuum of successful treatment outcomes like disclosure of HIV status and cART adherence. Hence, HIV case management intervention and the two results had a positive association. HIV case management intervention should be given to younger patients, rural residents, and non-educated patients to disclose the disease status and to have a long life with the virus. Health-related education should be conducted for the community in general and for patients in particular on how HIV is transferred from an infected person to an uninfected one. This helps to reduce the stigma of patients and to deliver social support to patients. [ABSTRACT FROM AUTHOR]

Background: HIV status disclosure is one of the pillars of success of the elimination of Mother to Child Transmission of HIV (eMTCT) program. However, there are challenges associated with it that limit full disclosure. Literature shows that for pregnant women in developing countries, who have been diagnosed with HIV, 16% to 86% disclose their status to their sexual partners. This study explored the experiences of newly diagnosed HIV-infected antenatal women in disclosing their HIV status to their male sexual partners in Blantyre, Malawi.Methods: This was a qualitative explanatory multiple case study that was conducted from 2018 to 2019 using in-depth interviews and diaries as data collection tools. We recruited seven newly diagnosed HIV pregnant women who had not disclosed their status to their male sexual partners and were initiated on Option B + strategy of the eMTCT of HIV at Limbe Health Centre. The investigator had 3 contacts with each participant from which data was gathered except for one participant who got lost to follow-up. This study employed content analysis and used a within-case and across-case analysis.Results: Women either use facilitated mutual disclosure process or disclosed directly to their male sexual partners. Women were motivated to disclose because they wanted an HIV-free baby, to know the partners' status, and to resolve the gap on how they got infected with HIV. The disclosure process faced challenges such as uncertainty about a partner's reaction after disclosure, fear of relationship dissolution, and the soberness of the partner. Privacy was an important consideration during the process of disclosure. Following disclosure, male sexual partners either accepted the status immediately after disclosure or initially denied but later accepted.Conclusion: This study has shown that newly diagnosed HIV pregnant women accessing eMTCT services have a plan of either to disclose or conceal their HIV status from their male sexual partner and this decision is affected by the nature of relationship that exist between them and their partner. Factors relating to the unborn baby, the relationship as well as to know partners status motivate women to either disclose or conceal. [ABSTRACT FROM AUTHOR]

Only about 39% of infants in low- and middle-income countries are exclusively breast-fed for the first six months. In particular, human immunodeficiency virus (HIV) positive women report confusion about the best feeding methods. Exclusive Breastfeeding (EBF) practices in HIV positive mothers are sub-optimal in Ethiopia. This study aimed to identify the main factors influencing EBF among HIV positive breast-feeding mothers. A facility based cross-sectional study was carried out from September 2017 to June 30 2018 among HIV positive mothers with infants aged 6–23 months. Thirteen public health facilities (7 health centers and 6 hospitals) that provided anti-retroviral treatment (ART) and Prevention of mother-to-child transmission (PMTCT) services, found in three districts of West, East and Kellem Wollega Zones, were randomly selected. Respondents were recruited by systematic random sampling techniques from these facilities using client registers as a sampling frame. Data were collected using face to face interviews with a pre-tested questionnaire. Data were entered into EPI info Version 3.5.1 and analyzed using SPSS Version 20 for windows. Candidate variables for the final multi-variable model were selected considering P≤ 0.05 at bivariable analysis. Associations were declared at P≤ 0.05 by assuming Confidence Intervals did not cross '1'with corresponding 95%. A total of 218 HIV positive mothers were included in this study. Of these, only 122 (56.0%) practiced EBF in the first six months. The proportion of study participants who initiated EBF within the first hour of delivery was 134 (61.8%). Mean age of study participants was 28.6years with SD ± 4. Mothers' having received advice on EBF [AOR 3, 95% CI (1.2–6.7)], disclosure of HIV status to someone close to them including their husband [AOR 6, 95% CI (1.2–29.6)] and believing HIV can be transmitted during delivery [AOR 5.2, 95% CI (1.1–24.0)] were found to increase the likelihood of EBF practices among the study participants (P-value ≤ 0.05). In this study, only just over half of the mothers practiced EBF for the first six months. Care providers should continue to encourage mothers to practice EBF in the first six months and to disclosure of HIV status to someone close to them including their partner. Efforts should be in place to curb the risk of HIV/AIDS transmission during delivery. Continues advise for mothers to practice EBF in the first 6 months is still needed. [ABSTRACT FROM AUTHOR]

Significant differences based on gender, practice setting, and experience exist regarding patient disclosure and medical record documentation of intraoperative gray area surgical complications. Purpose: To explore surgeons' perspectives and practice patterns in gray area surgical complications (GASCs) within cataract surgery. Setting: Tertiary care academic referral center. Design: Retrospective observational cross-sectional study. Methods: An anonymous, online survey consisting of 11 potential intraoperative GASC scenarios was developed and distributed to practicing and resident ophthalmologists in the U.S. Demographic data such as gender, experience, and practice settings were recorded. Using a Likert scale, respondents scaled their perception of likelihood that a GASC could lead to postoperative complications and their obligation toward patient disclosure and documentation in the operative report. Respondents also scaled their likelihood of agreement with a series of statements inserted to assess baseline anxiety levels and inherent perspectives regarding disclosure. Results: 389 responses were analyzed. Female surgeons were more likely than male surgeons to disclose GASCs to their patients and experience psychological anxiety regarding patient outcomes. Both early- and late-stage residents were more likely to believe that GASCs could lead to vision-limiting outcomes when compared with attending surgeons. Surgeons at academic centers were more likely than community-based surgeons to disclose GASCs in the operative report and experience psychological anxiety regarding patient outcomes. Conclusions: Significant differences based on gender, practice setting, and level of experience exist in disclosure and documentation of intraoperative GASCs. Additional studies are needed to further explore reasons for these differences, as reporting patterns may affect patient satisfaction, medicolegal risks, and postoperative surgeon-experienced anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Zimbabwe adopted differentiated HIV care policies in 2015 to promote client‐centred care and relieve strain on health facilities. We examined the availability, experiences and perceptions of differentiated antiretroviral therapy (ART) delivery in rural Zimbabwe following the policy adoption. Methods: We undertook a cross‐sectional mixed methods study in all the 26 facilities providing HIV care in a rural district in Zimbabwe. We collected quantitative data about ART delivery and visit durations from 31 healthcare providers and a purposive stratified sample of 378 clients obtaining ART either through routine care or differentiated ART delivery models. We performed 26 semi‐structured interviews among healthcare providers and seven focus group discussions (FGDs) among clients to elicit their perceptions and experiences of ART delivery. Data were collected in 2019, with one follow‐up FGD in 2021. We analysed the transcripts thematically, with inductive coding, to identify emerging themes. Results: Twenty facilities (77%) offered at least one differentiated ART delivery models, including community ART refill groups (CARGs; 13 facilities, 50%), fast‐track refill (8, 31%), family refill (6, 23%) or club refill (1, 4%). Thirteen facilities (50%) offered only one model. The median visit duration was 28 minutes (interquartile range [IQR]: 16–62). Participants in fast‐track had the shortest visit durations (18 minutes, IQR: 11–24). Confidentiality and disclosure of HIV status, travelling long distances, travel costs and waiting times were the main issues influencing clients' views on differentiated ART delivery. Fast‐track refill was perceived as the preferred model of clients for its limited involuntary disclosure and efficiency. In contrast, group‐ and community‐based refill models reduced travel costs but were felt to be associated with involuntary disclosure of HIV status, which could discourage clients. Healthcare providers also experienced an additional workload when offering facility‐based group models, such as CARGs. Conclusions: Differentiated ART delivery models were widely available in this rural setting, but most facilities did not offer a choice of models to address clients' diverse preferences. A minority offered fast‐track refills, although this model was often mentioned as desirable. Confidentiality, travel expenses and client waiting times are key elements to consider when planning and rolling out differentiated HIV care. [ABSTRACT FROM AUTHOR]

Introduction. HIV-positive status disclosure for children is challenging for family members, guardians, and healthcare professionals. Disclosure is very challenging, particularly for children, yet no systematic synthesis of evidence accurately measures HIVpositive status disclosure in children. This systematic review and meta-analysis study aimed to quantify the national prevalence of pediatric HIV-positive status disclosure in Ethiopia and identify factors associated with HIV-positive status disclosure. Method. We systematically searched PubMed, EMBASE, Web of Science databases, and google scholar for relevant published studies. Studies published in the English language and conducted with cohort, case-control, and cross-sectional designs were eligible for the review. The primary and secondary outcomes of the study were HIV-positive status disclosure and factors associated with HIV-positive status disclosure, respectively. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. A random effect-model was used to estimate the pooled prevalence of HIV-positive status disclosure. Heterogeneity and publication bias of included studies was determined using I2 and Egger's test, respectively. Result. From 601 records screened, nine relevant studies consisting of 2,442 HIVpositive children were included in the analysis. The overall pooled prevalence of HIVpositive status disclosure among children living with HIV/AIDS in Ethiopia was 31.2% (95% CI [23.9-38.5]). HIV-negative status of caregivers (AOR: 2.01; 95% CI [1.28-3.18]), long duration on ART (greater than 5 years) (AOR: 3.2; 95% CI [1.77-5.78]) and older age of the child (>10 years) (AOR: 7.2; 95% CI [4.37-11.88]) were significantly associated with HIV-positive status disclosure. Conclusion. Low prevalence of pediatric HIV-positive status disclosure was observed in Ethiopia. The longer duration of ART, the HIV-negative status of the caregiver, and older age greater than 10 years were the predictors of pediatric HIV-positive status disclosure. Health system leaders and policymakers shall design training and counseling programs for healthcare professionals and caregivers to enhance their awareness about HIV-positive status disclosure. [ABSTRACT FROM AUTHOR]

Background: Dementia is a serious disease that can lead to disability because it impacts the individual's memory, cognition, behavior, and capacity to perform activities of daily living. While most people prefer to receive a full diagnostic disclosure, the actual care requirements of family caregivers of persons with dementia are often unknown after a dementia diagnosis is disclosed. The primary aim of this study was to explore the experiences of family caregivers in response to a dementia diagnosis disclosure and analyze the care needs of caregivers. Methods: A qualitative study conducted in accordance with COREQ guidelines. The grounded theory approach was undertaken in 20 family caregivers of persons with dementia, who were selected using purposive sampling. Data were analysed using the constant comparative method. Results: The core category of this study was "diagnostic disclosure: Start the long road of care challenges", which was defined as describing the experiences of family caregivers of persons with dementia after first being informed of diagnosis. Five major categories describing the experiences of family caregivers following a dementia diagnosis was developed: 'deciding to seek medical attention,' 'the moment of disclosure,' 'conveying information,' 'maintaining the persons' functioning,' and 'receiving support and living well with dementia.' Subcategories within each major category also emerged. Conclusions: Clear diagnostic disclosure is important for ensuring that positive developments can occur in response to disclosure. Healthcare professionals must develop strategies to prevent disclosure from triggering overreactive emotions from persons with cognitive impairments, assist them in understanding their illness in a tactful manner, and ensure that they understand how to cooperate in any subsequent care plans. [ABSTRACT FROM AUTHOR]

Background. Globally, the transmission of HIV from one individual to another causes 1.8 million new infections each year, 36.7 million people living with HIV, and one million people died from HIV-related illnesses. The objective of this study was to determine the prevalence of the disclosure of HIV status to sexual partners and its determinants among adults under cART in the Amhara Region, northwest Ethiopia. Methods. A retrospective study design was conducted on 792 randomly selected samples. The study was conducted in the Amhara Region, from 2015 to 2020. A binary logistic regression modeling was used for data analysis. The data were collected using a stratified random sampling technique where the residential areas were considered strata. Data were collected by trained health practitioners in the ART section in Felege Hiwot Teaching and Specialized Hospital. The hospital is a referral in which many patients from different districts and zonal hospitals in the region are referred to this hospital. Results. The rate of disclosure of HIV status to sexual partners in this study was 21%, which is very low compared to the average rate of disclosure in developing countries. Among the predictors, age of patients (AOR = 1.02, 95% CI:(1.001,1.120); p -value = 0.004); number of baseline CD4 cell count (AOR = 0.980; 95% CI: (0.764, 0.991); p -value<0.01); number of hospital visits (AOR = 1.01; 95% CI: (1.001, 1.034); p -value < 0.01); marital status (living with partner) (AOR = 1.01; 95% CI: (1.003, 1.112); p -value = 0.006); female HIV-positive adults (AOR = 1.01; 95% CI: (1.001, 1.021); p -value = 0.007); rural residence (AOR = 0.98; 95% CI: (0.96, 0.99); p -value = 0.004); non-educated adult patients (AOR = 0.950, 95% CI: (0.92. 0.98); p -value = 0.003); cART non-adherent adult patients (AOR = 0.940, 95% CI: (0.61. 0.97); p -value < 0.001); non-opportunistic infectious diseases (AOR = 1.062, 95% CI: (1.049. 1.191); p -value = 0.002); and non-existence of social violence (AOR = 1.012, 95% CI: (1.008, 1.); p -value < 0.01) significantly affected the variable of interest. Of these, the number of CD4 cell count, male HIV-positive adults, rural residence, and existence of social violence negatively affected the variable of interest. Conclusions. Some groups of HIV patients did not disclose their level of HIV status to their sexual partners. Health-related education is recommended for patients who did not disclose their HIV status to sexual partners. This helps to reduce the transmission of HIV from infected individuals to noninfected ones and from mother-to-child HIV transmission. [ABSTRACT FROM AUTHOR]

Endometriosis is a stigmatized health disorder that impacts approximately 10% of the female population around the world and is characterized by severe physical and psychological symptoms. Through the interpretive perspective, this study investigated how women with endometriosis disclose about their disorder in the workplace. Potential participants were recruited using Reddit and Facebook. Participants (N = 119) completed an anonymous, online, open-ended questionnaire. Open-ended responses were analyzed using thematic analysis. Five themes emerged related to how endometriosis patients disclose about their disorder at work: 1) frequency of communication 2) level of openness 3) type of content shared 4) preferred setting for conversations and 5) preferred conversational partner. Furthermore, the findings revealed that disclosure about endometriosis is significantly impacted by workplace environment. These findings are contextualized by the theoretical framework provided by the disclosure process model. Overall, this study offers a starting point for deeper empirical investigation of mechanisms influencing disclosure and informs future research directed toward developing interventions that may enable organizations to better accommodate affected employees. [ABSTRACT FROM AUTHOR]

The aim of this study is to present and compare programs for open disclosure of adverse medical events to patients by medical personnel. Australia, Canada, and the United States, based on apology laws, procedures, medical staff handbooks, training, and fair culture, have implemented solutions that focus on the needs of the patient after the adverse event. It has been proven that a proper patient communication process can reduce the number of claims brought against staff or medical institutions. However, there are barriers to communicating adverse events to patients. These are ingrained in the "deny and defend" strategy, which does not promote a culture of learning from mistakes. The paper also discusses the second victim syndrome, which is the second victim of an adverse event such as medical personnel experiencing emotional damage after an incident. [ABSTRACT FROM AUTHOR]

Context: HIV/AIDS is a serious public health, economic and social problem. Stigma is a common human reaction to disease and discrimination follows stigma. Stigma and discrimination act as impediments to uptake of HIV testing, treatment, care and adherence to treatment. Aim: The aim of this study was to estimate the prevalence of the stigma and discrimination faced by HIV positive patients receiving antiretroviral therapy (ART). Settings and Design: A cross-sectional, observational study conducted at ART center of a tertiary care hospital in an urban area. Methods and Material: Participants were selected by simple random sampling among HIV positive patients. A predesigned, pretested and self-administered, semi-structured questionnaire in local language was used to assess stigma and discrimination. Statistical Analysis Used: The data were entered in Microsoft Excel and analyzed with SPSS version 20 statistical software. Simple proportions, mean, standard deviation, median, range and inter-quartile range were calculated. Results: Of 336 participants, 170 were male, whereas 166 were females. The mean age was 36.42 years. The total mean scores for Berger’s HIV stigma scale experienced was 122.82, whereas for individual subscale Personalized stigma, Negative self-image, public attitudes and disclosure of HIV status were 38.31, 27.46, 33.09 and 23.97, respectively. The maximum participants expressed the stigma regarding disclosure concerns (58.63%) followed by negative self-image stigma (43.45%). Conclusions: Stigma hurdles the delivery of effective medical social care. People Living with HIV and AIDS (PLWHA) need to have greater involvement in their care, support and treatment. Support groups of PLWHA need to be established so that stigma and discrimination at various levels can be challenged collectively. [ABSTRACT FROM AUTHOR]

This article investigates the boundary work of young people who disclose personal experiences of mental health illness and trauma in a reality TV series. The programme in focus features group therapy sessions led by a professional psychologist, supplemented by personal video diaries. Combining disclosure theory with media sociological perspectives, the article analyses how boundaries are drawn, negotiated or trespassed in the production process. Data is based on in-depth interviews with participants, supplemented with background interviews with the production team and therapist. A main finding is that participants' experiences in retrospect vary greatly: from accounts of meaningful self-disclosure to regret, increased strain and flare up of illness. Participants with negative experiences highlighted a lack of control over their stories, alienating representations of themselves and guilt about revealing information about third parties. The article concludes that interventional 'do-good TV', which builds authority and rhetorical ethos by offering professional therapy to participants, calls for careful consideration of the often-opaque relations of power and instrumental interests involved in this production setting. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents living with HIV (ALHIV, ages 10-19) experience complex barriers to care engagement. Challenges surrounding HIV status disclosure or non-disclosure to adolescents may contribute to adolescent disengagement from HIV care or non-adherence to ART. We performed a qualitative study to investigate the contribution of disclosure challenges to adolescent disengagement from HIV care.Methods: This was a qualitative study performed with disengaged ALHIV and their caregivers, and with healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Inclusion criteria for ALHIV were ≥1 visit within the 18 months prior to data collection at one of two clinical sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Analysis was conducted by multiple independent coders, and narratives of disclosure and care disengagement were closely interrogated. Overarching themes were elucidated and summarized.Results: Interviews were conducted with 42 disengaged ALHIV, 32 caregivers, and 28 HCW. ALHIV were average age 17.0 (range 12.9-20.9), and 95% indicated awareness of their HIV diagnosis. Issues surrounding disclosure to ALHIV presented important barriers to HIV care engagement. Themes centered on delays in HIV status disclosure; hesitancy and reluctance among caregivers to disclose; struggles for adolescents to cope with feelings of having been deceived prior to full disclosure; pervasive HIV stigma internalized in school and community settings prior to disclosure; and inadequate and unstructured support after disclosure, including for adolescent mental health burdens and for adolescent-caregiver relationships and communication. Both HCW and caregivers described feeling inadequately prepared to optimally handle disclosure and to manage challenges that may arise after disclosure.Conclusions: Complex challenges surrounding HIV status disclosure to adolescents contribute to care disengagement. There is need to enhance training and resources for HCW, and to empower caregivers to support children and adolescents before, during, and after HIV status disclosure. This should include counseling caregivers on how to provide children with developmentally-appropriate and accurate information about their health from an early age, and to support adolescent-caregiver communication and relationships. Optimally integrating peer support can further promote ALHIV wellbeing and retention in care. [ABSTRACT FROM AUTHOR]

We study how the public changes their mobility and retail spending patterns as precautionary responses to the disclosed location of COVID‐19 cases. To look into the underlying mechanisms, we investigate how such change varies spatially and whether there is any spatial spillover or substitution. We use the daily data of cell phone‐based mobility and credit card transactions between February 10 and May 31 in both 2019 and 2020 in Seoul, South Korea, and employ the empirical approach analyzing the year‐over‐year percent change for the mobility and consumption outcomes. Results report that one additional COVID‐19 case within the last 14 days decreased nonresident inflow and retail spending by 0.40 and 0.65 percentage points, respectively. Then, we also find evidence of spatial heterogeneity: the mobility and retail performances of neighborhoods with higher residential population density were more resilient to COVID‐19 case information while neighborhoods with higher levels of land‐use diversity and retail agglomeration experienced a greater localized demand shock. This heterogeneity is not negligible. For example, one additional COVID‐19 case in neighborhoods in the bottom 20% for population density led to a decline of 1.2 percentage points in retail spending, while other neighborhoods experienced a less negative impact. Finally, we find a significant spatial spillover effect of disclosed COVID‐19 information instead of spatial substitution. One additional COVID‐19 case in geographically adjacent areas within the last 14 days reduced nonresident inflow and retail spending in the subject neighborhood by 0.06 and 0.09 percentage points, respectively. [ABSTRACT FROM AUTHOR]

The medical diagnosis of autism, held during childhood and adolescence, is often presented only to the parents. Therefore, they face the dilemma of when, whether and how they should disclose it to their child. While the prevalence of the diagnosis of children and adults with autism has been increasing in recent years, there is still no therapeutic approach that addresses the coping of parents, children, teenagers, and young adults, with the issue. The present study depicts a qualitative inquiry based on a two-sessions focus group with parents confronting this dilemma who have not yet disclosed the diagnosis to their child. The article presents a model of five complex and interconnected dilemmas with which parents must cope. The first concerns the invisibility of autism and the fact that it can be concealed. The second addresses the stigma related to the diagnosis and the difficulty facing the word itself. The third dilemma addresses the time motive and the concerns related to the child's reaction to the diagnosis. The fourth focuses on the child's surroundings who are aware or unaware of the diagnosis, and the last dilemma addresses the child's personal narrative and the practice of disclosure. The article's conclusion contains initial recommendations that can be used as a basis for the further development of a detailed intervention program that can assist parents throughout the diagnostic process. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the impact of ownership concentration on Covid-19 disclosure in the narrative sections of corporate annual reports. It also explores the mediating role of corporate leverage on the ownership concentration–Covid-19 disclosure relationship. Design/methodology/approach: This paper uses automated textual analysis to measure Covid-19 disclosure in annual reports. It also applies different regression models to test the research hypotheses and to address the endogeneity problem. It uses univariate and multivariate analyses through correlations and ordinary least squares. Findings: The analysis shows that ownership concentration has a negative impact on Covid-19 disclosure. It also shows that corporate leverage negatively affects Covid-19 disclosure, and it has a partial mediating effect on the ownership concentration–Covid-19 disclosure relationship. Practical implications: The results offer important practical implications for the government, management, shareholders and policymakers. For example, corporate managers are encouraged to consider small shareholders' interests and provide a sufficient level of Covid-19 disclosure to avoid violating their rights. Also, the government may consider forming a mechanism for balancing the ownership structure to protect small investors and weaken large shareholders' tunnelling behaviours. Originality/value: This paper offers two important contributions to governance and disclosure literature. First, it provides new empirical evidence on the relationship between ownership concentration and Covid-19 disclosure. Second, it provides new evidence on the mediating role of the leverage ratio on the ownership concentration–Covid-19 disclosure relationship. [ABSTRACT FROM AUTHOR]

This study sought to examine the determinants of sexual behaviours among adolescents living with HIV and AIDS. HIV status disclosure and felt stigma which were the determinants studied that relate to living with HIV and AIDS were found to have a close association with engagement in types of sexual behaviours among adolescents. In conclusions, this study shows that while adolescents aspire to leave relatively normal sexual lives by engaging in various types of sexual behaviours, fear to disclose HIV status to partners influence how they conducted sexual lives. One of the key finding that some adolescents engaged in unprotected sex while their preference of sex partner were those who were HIV negative, they were not willing to disclose their HIV status to them. This risk transmission of HIV to partners, acquiring other sexually transmitted infections by the HIV living adolescents, re-infection with other strains of HIV as well as having unplanned pregnancy. The key recommendation generated from this study is the need to re-examine the existing HIV primary prevention interventions that inform behaviours change communication in HIV programming with a view to addressing sexuality issues of adolescents living with HIV and AIDS. [ABSTRACT FROM AUTHOR]

We examine whether the quarterly filing COVID‐19 disclosures reduce uncertainty for investors and analysts. We find a negative relationship between COVID‐19 disclosure and return volatility, suggesting COVID‐19 disclosure reduces investor uncertainty. This reduction effect concentrates mainly during the short window following 10‐Q releases and phases out over time. We then detect that industry‐wide COVID‐19 disclosure dispersion is positively associated with return volatility, suggesting high variation of industry‐wide COVID‐19 disclosures reduces information comparability across firms, resulting in increased investor uncertainty. Moreover, we find that COVID‐19 disclosures are positively associated with analysts' downward earnings forecast revisions and negatively associated with analyst forecast dispersion after 10‐Q releases, suggesting the disclosures reduce information risk even for sophisticated market participants. Further analyses show that COVID‐19 disclosures are negatively associated with future financial and operational performances (i.e., sales, operating cash flow, operating income and ROA). Lastly, we find that the low readability of COVID‐19 disclosure attenuates the negative relation between COVID‐19 disclosure and market volatility. Collectively, our findings suggest that 10‐Q COVID‐19 disclosures contain value‐relevant information that temporarily assists market participants in evaluating the changes in firms' values in the time of a crisis. [ABSTRACT FROM AUTHOR]