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PubMed1994

Self-disclosure of HIV infection to sexual partners after repeated counseling.

This study, with the objective of examining voluntary self-disclosure of HIV infection after repeated counseling, was conducted in a private setting, and designed to operate in conjunction with HIV testing. Counseling was provided at entry, and then at 3 months, 6 months, and every six months thereafter. The study was conducted among 129 HIV-positive adults; the primary risk factor was history of: males having sex with males (n = 104); injection drug use (n = 19); or heterosexual contact (n = 6). Results showed that after a mean of 2.3 years since initial HIV-positive notification, 29 percent of subjects had not disclosed the HIV infection to any present partner, and 30 percent to any past sex partner. Casual sex and lower perceived social support were significantly associated with nondisclosure. The authors conclude that even after repeated individual counseling and at least several months to inform others, about one-third of the sexually active subjects did not disclose their HIV infection to any present sex partner. Clinical and public health implications are covered.

Adolescent↗

PubMed1994

Anal intercourse and disclosure of HIV infection among seropositive gay and bisexual men.

Human immunodeficiency virus (HIV)-infected gay and bisexual men (n = 609) randomly selected from two HIV outpatient clinics in Los Angeles completed confidential, self-administered questionnaires at the clinics, reporting sexual activities and disclosure during the previous 2 months. Approximately 9% had engaged in unprotected insertive anal intercourse with one or more partners. This activity was 3.27 times more likely to have occurred with seropositive partners than with partners who were seronegative or whose serostatus was unknown. Fourteen men (2.3% of total sample) had engaged in unprotected insertive anal sex with 25 seronegative or unknown serostatus partners who were not informed of their risk of infection. Thirty-three men (5.4% of total sample) had engaged in this activity with 37 seropositive partners who were informed. Clinicians and other health professionals can play an important role in helping to control the HIV epidemic by discussing with seropositive patients the importance of using safer sex and informing sexual partners. Such discussion should include information about the potentially negative health effects of unprotected sex between seropositive persons.

Adult↗

PubMed1996

Searching for the Magic Johnson effect: AIDS, adolescents, and celebrity disclosure.

The objectives of this study were to measure changes in AIDS-related attitudes and behaviors in adolescents in the 13 months following Magic Johnson's disclosure that he was HIV positive, and to test whether gender, race, age, sexual experience, and pre-existing HIV-avoidant behaviors would emerge as significant dependent variables. Adolescent clinic attendees (N = 181) ages 12-19 in four cities completed a questionnaire assessing change in AIDS-related attitudes and behaviors since Johnson's announcement. Respondents were divided into low-risk and at-risk groups. Sixty percent of respondents reported that Magic Johnson's announcement had increased their awareness of AIDS, 65.4% reported increased self-efficacy in a sexual situation, 37.2% reported that they had changed their perceived AIDS risk, 37.8% described increased resistance to peer pressure for sexual intercourse. The low-risk group was more likely to report increased self-efficacy and resistance to peer pressure but no change in perceived risk or increased AIDS awareness. Significant relationships were found between gender and increased AIDS awareness, gender and increased resistance to peer pressure to engage in sexual intercourse, race and increased AIDS awareness, and more lifetime sex partners and increased self-efficacy.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Investigation of the validity of facilitated communication through the disclosure of unknown information.

Three individuals (8, 10, and 24 years old with diagnoses of autism and mental retardation) participated in a message-passing format to determine whether they could disclose information previously unknown to their facilitators. Results showed valid facilitated communication from each participant. The facilitated speakers participated in 14 sessions, each lasting approximately 1 to 1.5 hours. A wide range of information was collected, coded, and analyzed for validity, consistency, language difficulties, behavioral compliance, and style of facilitation. Out of 720 communicative interactions, participants disclosed 77 incidents of unknown information. Each participant revealed unique behaviors and styles of responding, and all were able to demonstrate genuinely independent communication through disclosure of specific information previously unknown to a facilitator, although much inconsistency was noted. Results suggest that a phenomena as complex as facilitated communication eludes a cursory exploration.

Adolescent↗

PubMed1997

Race, self-disclosure, and "forbidden talk": race and ethnicity in contemporary clinical practice.

In this paper I attempt to extend the psychoanalytic conversation about race and ethnicity by discussing the intersubjectivity of race and racial difference. I present clinical material from an interracial treatment in which disclosures about race played an important role in deepening the clinical process. The resulting interactions permitted the patient to admit more of herself into the treatment space. I suggest that contemporary psychoanalytic formulations and multicultural perspectives from outside of psychoanalysis can together create more meaningful conceptualizations which take into account the lived realities of race and the ways in which these may be shaped by individual psychology.

Adult↗

PubMed1997

The vision in supervision: transference-countertransference dynamics and disclosure in the supervision relationship.

The centrality of the supervision experience in the development of the supervisee's personal and professional capacities is addressed. The supervision relationship and process are explored in light of the potential effects of transference-countertransference configurations of supervisor and supervisee. Parallels between supervision and treatment are highlighted. The importance of developing and utilizing the capacity for reflectivity is reviewed, as is the impact of supervisee nondisclosure to supervisor. The direct use of countertransference experiences in the context of supervision is explored, and the centrality of self-disclosure is highlighted. It is recommended that supervisor and supervisee remain receptive to exploring these experiences in the service of developing a shared subjective sense of the patient, of increasing the supervisee's capacity to treat his or her patient, and of providing the supervisee with a novel, growth-enhancing relationship.

Adult↗

PubMed1998

Cultural influences on medical disclosure.

Personal freedom and individualism are highly valued in Anglo-American culture and consequently in healthcare. However, not all cultures recognize the value of these principles. Healthcare can be compromised when the patient's cultural context differs from that of the clinician. Culture and its influences on the disclosure of health-related information are described. Self-determination from an historical perspective, the role of the family, and a deeper understanding of paternalism as they relate to cultural issues are illustrated through a case study. Suggestions for creating a culturally relevant healthcare practice is presented.

Attitude to Health↗

PubMed2004

Contingent screening for Down syndrome is an efficient alternative to non-disclosure sequential screening.

OBJECTIVE: To present a first and second trimester Down syndrome screening strategy, whereby second-trimester marker determination is contingent on the first-trimester results. Unlike non-disclosure sequential screening ('the Integrated test'), which requires all women to have markers in both trimesters, this allows a large proportion of the women to complete screening in the first trimester. METHODS: Two first-trimester risk cut-offs defined three types of results: positive and referred for early diagnosis; negative with screening complete; and intermediate, needing second-trimester markers. Multivariate Gaussian modelling with Monte Carlo simulation was used to estimate the false-positive rate for a fixed 85% detection rate. The false-positive rate was evaluated for various early detection rates and early test completion rates. Model parameters were taken from the SURUSS trial. RESULTS: Completion of screening in the first trimester for 75% of women resulted in a 30% early detection rate and a 55% second trimester detected rate (net 85%) with a false-positive rate only 0.1% above that achievable by the Integrated test. The screen-positive rate was 0.1% in the first trimester and 4.7% for those continuing to be tested in the second trimester. If the early detection rate were to be increased to 45% or the early completion rate were to be increased to 80%, there would be a further 0.1% increase in the false-positive rate. CONCLUSION: Contingent screening can achieve results comparable with the Integrated test but with earlier completion of screening for most women. Both strategies need to be evaluated in large-scale prospective studies particularly in relation to psychological impact and practicability.

Biomarkers↗

PubMed2001

Employment Concerns of People with Epilepsy and the Question of Disclosure: Report of a Survey of the Epilepsy Foundation.

This article presents the results of a survey of the Epilepsy Foundation affiliates in the United States and Puerto Rico, regarding the employment-related questions and concerns of people with epilepsy. The survey also explored how Epilepsy Foundation affiliates advise people with epilepsy about disclosing epilepsy status in the employment-seeking process. Some of the major employment-related questions and concerns reported by the affiliates included identifying resources to help in finding a job, questions about disclosure of epilepsy status in job applications, questions about job-related discrimination or Americans with Disabilities Act (ADA) violations, questions about the ADA, and questions about how to deal with co-workers or supervisors. Implications and design limitations are discussed.

Journal Article↗

PubMed1975

False positive rubella virus haemagglutination inhibition reactions: occurrence and disclosure.

A floatation centrifugation procedure is described by which antibodies and non-specific rubella virus haemagglutination inhibitors can be completely separated. Using this method it was shown that false positive reactions occur with the conventional pretreatments of sera for removing inhibitors, especially with the heparin-McCl2 procedure. Other methods for removal of inhibitors were examined in view of recent knowledge about the chemical nature of the inhibitors. Treatment with phospholipase C proved useful for disclosure of false positive reactions, while floatation centrifugation was the most sensitive method for demonstration of low antibody concentrations.

Antibodies, Viral↗

PubMed1988

Disclosure of traumas and psychosomatic processes.

Results from a series of studies are summarized in support of a general theory of inhibition and psychosomatics. According to this view, to inhibit thoughts, feelings, or behaviors is associated with physiological work. In the short term, inhibition results in increased autonomic nervous system activity. Over time, inhibition serves as a cumulative stressor that increases the probability of psychosomatic disease. Actively avoiding thoughts and feelings surrounding a trauma and/or not discussing a trauma is a particularly insidious form of inhibition. The results from recent surveys and experiments indicate: (a) childhood traumatic experiences, particularly those never discussed, are highly correlated with current health problems; (b) recent traumas that are not discussed are linked with increased health problems and ruminations about the traumas; (c) requiring individuals to confront earlier traumas in writing improves health and immune system functioning; (d) actively talking about upsetting experiences is associated with immediate reductions in selected autonomic activity. Implications of these findings for our understanding of disclosure, trauma, and disease are discussed.

Adaptation, Psychological↗

PubMed2006

Synthesis, kinetic evaluation, and utilization of a biotinylated dipeptide proline diphenyl phosphonate for the disclosure of dipeptidyl peptidase IV-like serine proteases.

In this study, we report on the synthesis, kinetic characterisation, and application of a novel biotinylated and active site-directed inactivator of dipeptidyl peptidase IV (DPP-IV). Thus, the dipeptide-derived proline diphenyl phosphonate NH(2)-Glu(biotinyl-PEG)-Pro(P)(OPh)(2) has been prepared by a combination of classical solution- and solid-phase methodologies and has been shown to be an irreversible inhibitor of porcine DPP-IV, exhibiting an over all second-order rate constant (k(i)/K(i)) for inhibition of 1.57 x 10(3) M(-1) min(-1). This value compares favourably with previously reported rates of inactivation of DPP-IV by dipeptides containing a P(1) proline diphenyl phosphonate grouping [B. Boduszek, J. Oleksyszyn, C.M. Kam, J. Selzler, R.E. Smith, J.C. Powers, Dipeptide phophonates as inhibitors of dipeptidyl peptidase IV, J. Med. Chem. 37 (1994) 3969-3976; B.F. Gilmore, J.F. Lynas, C.J. Scott, C. McGoohan, L. Martin, B. Walker, Dipeptide proline diphenyl phosphonates are potent, irreversible inhibitors of seprase (FAPalpha), Biochem, Biophys. Res. Commun. 346 (2006) 436-446.], thus demonstrating that the incorporation of the side-chain modified (N-biotinyl-3-(2-(2-(3-aminopropyloxy)-ethoxy)-ethoxy)-propyl) glutamic acid residue at the P(2) position is compatible with inhibitor efficacy. The utilisation of this probe for the detection of both purified dipeptidyl peptidase IV and the disclosure of a dipeptidyl peptidase IV-like activity from a clinical isolate of Porphyromonas gingivalis, using established electrophoretic and Western blotting techniques previously developed by our group, is also demonstrated.

Affinity Labels↗

PubMed1988

Disclosure by triton X-100 of NMDA-sensitive [3H] glutamate binding sites in brain synaptic membranes.

Pretreatment of brain synaptic membrane homogenates with Triton X-100 resulted in a drastic disclosure of [3H] glutamate (Glu) binding activity which was sensitive to one of the central Glu receptor agonists, N-methyl-D-aspartic acid (NMDA). The NMDA-sensitive binding was inversely dependent on the incubation temperature, and was a reversible and saturable process. Scatchard analysis revealed that Triton X-100 treatment yielded in a significant enhancement of the affinity with a concomitant increment of the density of binding sites. Electrophysiologically identified agonists and antagonists for the NMDA receptors all significantly inhibited the binding to Triton-treated membranes. These results suggest that Triton-treatment may disclose NMDA-sensitive [3H] Glu binding sites in brain synaptic membranes.

Amino Acids↗

PubMedDate not supplied

Disclosure analysis procedures: reliability issues.

Performing disclosure analyses to supplement assessment procedures and facilitate intervention planning is only valuable if the observations are reliable. The purpose of the present study was to evaluate and compare four methods of assessing reliability on one discourse analysis procedure--a modified version of Damico's Clinical Discourse Analysis (1985a, 1985b, 1992). The selected methods were: (a) Pearson product-moment correlations, (b) interobserver agreement, (c) Cohen's kappa, and (d) generalizability coefficients. Results showed high correlation coefficients and high percentages of interobserver agreement when error type was not taken into account. However, interobserver agreement percentages obtained solely for target behavior occurrences and Cohen's kappa revealed that much of the agreement between rates was due to chance and the high frequency of target behavior non-occurrence. Generalizability coefficients revealed that the procedure was fair to good for discriminating among persons with differing levels of language competency for some aspects of communication performance but was less than desirable for others; the aggregate score was below recommended standards for differentiating among people for diagnostic purposes.

Adolescent↗

PubMed2002

The multidrug resistance transporters of the major facilitator superfamily, 6 years after disclosure of Saccharomyces cerevisiae genome sequence.

The emergence of multidrug resistance (MDR) plays a crucial role in the failure of treatments of tumors and infectious diseases and in the control of plant pathogens, weeds and food-poisoning and food-spoilage microorganisms. Among the mechanisms underlying the MDR phenomenon in various organisms is the action of transmembrane transport proteins that presumably catalyse the active expulsion of structurally and functionally unrelated cytotoxic compounds out of the cell or their intracellular partitioning. On the basis of the complete genome sequence of Saccharomyces cerevisiae, numerous established and putative multidrug transporters were identified in this non-pathogenic, easy to manipulate eukaryotic model system. In yeast, the putative drug:H(+)-antiporters belong to the major facilitator superfamily; they comprise at least 23 proteins that have largely escaped characterisation by classical approaches. Other MDR determinants are membrane transporters belonging to the ATP binding cassette (ABC) superfamily, that utilize the energy of ATP hydrolysis for activity, and factors for transcriptional regulation of all the MDR transporters. This work reviews the current status of knowledge on the poorly characterized H(+)-antiporters, with 12 and 14 predicted spans, DHA12 and DHA14, drug efflux families. Consideration is given to the inventory and phylogenetic characterization, role as MDR determinants, regulation of gene expression, subcellular localisation and activity as solute transporters. Most of the present knowledge on these putative drug:H(+)-antiporters was driven by disclosure of S. cerevisiae genome sequence, in April 1996, being a paradigm of post-genomic research.

Drug Resistance, Multiple, Fungal↗

PubMed1998

Public disclosure of performance information in Pennsylvania: impact on hospital charges and the views of hospital executives.

BACKGROUND: Forty states have now passed legislation establishing governmental agencies charged with the task of gathering hospital-level data. Since 1988 all acute care hospitals in Pennsylvania have been submitting data to the Pennsylvania Health Care Cost Containment Council (PHC4). Pennsylvania's policy was designed to make patients and purchasers more informed and selective buyers of medical services, to increase the public accountability of providers of these services, and to encourage hospitals and physicians to compete more on clinical outcomes and charges. The impact of Pennsylvania's policy of public disclosure of performance information on hospital charges over time has not previously been evaluated. Nor has the importance that hospital executives assign to the publication of comparative charges and clinical outcomes information been assessed. METHODS: From 1990 through 1994 the PHC4 published a number of hospital-level performance reports (including the regional Hospital Effectiveness Reports and A Consumer's Guide to Coronary Artery Bypass Graft Surgery) containing hospital average charges, average lengths of stay, a rating of severity of illness, and two outcome measurements--morbidity and in-hospital mortality--on a total of 59 diagnosis-related groups. An 18-item survey designed to assess hospital executives' opinions of the usefulness and importance of the PCH4 information was sent to the chief executive officers at the study hospitals. DISCUSSION: There were no significant trends toward a reduction in the dispersion of charges in either category of hospitals during the study period. Most hospital executives assigned low ratings of importance to published comparative charges information; however, executives of high-competition hospitals assigned significantly higher importance ratings to the information as a whole in enouraging hospital competition based on quality.

Attitude of Health Personnel↗

PubMedDate not supplied

[Psychosocial problem disclosure during primary care consultations].

OBJECTIVE: To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure. DESIGN: "Case control". Cases had a GHQ-12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness. SETTING: Six single handed primary care practices. MEASURES: Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index. RESULTS: The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems. CONCLUSIONS: The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.

Female↗

PubMed2001

Disclosure of new and recurrent microbial metabolites by mass spectrometric methods.

The application of modern mass spectrometry methods (SI-CID-MS/MS; MSn) in the disclosure of new and recurrent microbial metabolites is discussed. Spray ion (SI) sources coupled to different kinds of mass analyzers enable the determination of molecular weights and chemical formulas of given samples even in mixtures. Diagnostic fragment formation by collision-induced dissociation (CID-MS/MS) and MSn experiments using ion trap mass analyzers are shown as another indispensable source of structural information. Due to the development of benchtop-type mass spectrometers coupled to high-performance liquid chromatography (HPLC), MS can be practised in almost every laboratory as a powerful tool in natural product analysis. Examples are given for special MS applications in identification of bioactive metabolites from screening strains.

Bacteria↗