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PubMed2002

Lack of behavior change after disclosure of hepatitis C virus infection among young injection drug users in Baltimore, Maryland.

We evaluated behavior change after disclosure of a positive hepatitis C virus (HCV) antibody test result among a cohort of young injection drug users (IDUs). Participants underwent semiannual interviews, human immunodeficiency virus (HIV) and HCV antibody testing, and pretest and posttest counseling. We used chi(2) statistics to study changes in the frequencies of high-risk behaviors from baseline to a 6-month follow-up visit among 46 IDUs who had a positive HCV test result and among 60 IDUs who did not have a positive HCV test result or who were unaware of their test result. No significant differences were detected between the 2 groups. Both groups continued to share syringes, needles, and other injection paraphernalia. These findings suggest that young IDUs may not be aware of the risk of HCV infection and highlight the urgent need for post-HCV test guidelines and behavioral interventions to reduce ongoing high-risk behavior that perpetuates the risk of HCV transmission.

Adolescent↗

PubMedDate not supplied

Postoperative course after papilloma resection: effects of written disclosure of the experience in subjects with different alexithymia levels.

OBJECTIVE: The aim of the investigation was to assess the effects on postoperative course after bladder papilloma resection of a technique for the written disclosure of traumatic events in interaction with individual differences in alexithymia. METHODS: Forty subjects were administered a general questionnaire and the Toronto Alexithymia Scale (TAS-20) the second day after admittance. Twenty subjects were asked to write for 3 days, 20 minutes a day, about their experience of being in the hospital, following instructions developed by J. W. Pennebaker and coworkers. The postoperative course was assessed objectively by the duration of stay in hospital and subjectively by subjects completing the Symptom Check List 90 (SCL-90) the day before leaving the hospital. RESULTS: Subjects who wrote stayed fewer days in hospital and had lower SCL-90 scores. The same effect was shown by low alexithymia levels. Study of interactions showed that the effect of writing was apparent only in subjects high in alexithymia, whereas subjects low in alexithymia showed a favorable course independent of writing. CONCLUSIONS: Writing about one's thoughts and feelings about being in hospital for a surgical operation has beneficial effects on postoperative course. This holds particularly true for high alexithymic subjects, who obtain through writing the same outcome as low alexithymic subjects.

Adult↗

PubMed1992

Navigating treatment impasses at the disclosure of incest: combining ideas from feminism and social constructionism.

This article describes an approach to the social and emotional schisms that characterize the disclosure of intrafamilial sexual abuse (incest). It argues that ideas from social constructionism and feminism can be combined in such a way that what appear as either/or choices become both--and possibilities. These include: social control versus therapy, shame versus pride, attachment to one's abusive partner versus attachment to one's injured child, and "justice" versus "care."

Adolescent↗

PubMed1986

Displacement of affect in families following incest disclosure.

Long-standing intact families often decide to remain together following disclosure of incest. The defense of displacement, characteristically featured in these families, is discussed. The origins and ramifications of the defense are reviewed with emphasis on its highly reactive nature. Guidelines are suggested for a multidisciplinary treatment approach.

Adaptation, Psychological↗

PubMedDate not supplied

Commentary: public disclosure in the health field: is there a relevant option?

Steadily increasing numbers of private, not-for-profit, and public agencies are releasing quality of care and financial information to enhance the market power of those purchasing America's health services. These sources range widely from the Health Plan Employer Data and Information Set (HEDIS) to the federal Securities and Exchange Commission (SEC). A growing interest in publicly disclosing performance information that concerns providers, as recently recommended by the Institute of Medicine (IOM) report on patient safety, until now has only achieved a modest impact. A major exception is in those metropolitan areas where acute-care facilities experience intense competition for patient admissions. Although the comparative quality and cost information currently available is for the most part in the public interest, it is concluded that, in the foreseeable future, these report cards as now structured will not result in any significant enhancement in access, improvement in quality, or reduction in cost. Options to encourage more public disclosure explored in this paper are Congress potentially passing legislation (a) to establish a Center for Patient Safety within the US Department of Health and Human Services as recommended by the recent Institute of IOM study, or (b) empowering the SEC beyond its current mandate to collect and disseminate all pertinent quality of care and cost information on every provider in the United States. The latter alternative would include user-friendly, comparative analyses to be provided on the Internet and elsewhere and would make readily available information from HEDIS, the Joint Commission on the Accreditation of Healthcare Organization (JCAHO), coronary artery bypass graft (CABG) surgery studies, cost comparisons based on Medicare cost reports and SEC filings, and other similar sources.

Consumer Advocacy↗

PubMed1998

Bearing the burden or baring the soul: physicians' self-disclosure and boundary management regarding medical mistakes.

Within a boundary management framework, this study explored how physicians manage self-disclosure regarding medical mistakes amidst boundary constraints imposed by risk management, legal mandate, and the medical culture. Descriptive statistics from questionnaires and exemplars from accompanying narratives showed that the 39 internists and family physicians in this study chose to control their own boundaries by revealing errors most often to other physicians to facilitate learning. Although risk management and the medical culture do not appear to deter physicians from disclosing errors at a superficial level, physicians maintain tight personal boundaries at the emotional level. Perhaps if physicians could disclose errors at the emotional level, their mental energies could be more positively channeled to patients' needs, resulting in improved patient care.

Journal Article↗

PubMed2004

Improving risk disclosure during the consent process.

OBJECTIVES: To provide guidance about the risks which should be disclosed to patients and documented during the consent process. METHODS: The Delphi Consensus Technique was used to decide what constitutes mandatory risk disclosure for three index procedures. Documentation of risk on consent forms was audited and compared to these locally agreed standards. A four stage strategy for change was undertaken following which practice was reviewed. RESULTS: Mean mandatory risk documentation rose from 61.2% (95% CI: 58.1-64.4) pre-intervention, to 78.1% (95% CI: 72.6-83.6) post-intervention (ccc2; P < 0.001). CONCLUSIONS: Although we demonstrated some benefit from this simple approach, the need for pragmatic means of achieving and sustaining complete discussion and documentation of risks across all surgical interventions based on universally accepted standards remains.

Humans↗

PubMed1995

The brave new world of Medicare and Medicaid fraud and abuse enforcement: whistle-blowers, pre-filing agreements, and voluntary disclosure.

Providers participating in the recent wave of mergers, acquisitions, and affiliations may have unwittingly expanded their false claims exposure because many false claim-type situations are difficult, if not impossible, to identify in pre-closing due diligence. In addition, the possibility of retrospective characterization of ordinary billing mistakes as "false claims" increasingly introduces significant uncertainty to the average provider's financial future. To date, the single most effective approach to this problem is an independent compliance review to identify and resolve any existing exposure, including voluntary disclosure if appropriate, and an ongoing compliance program to communicate to all employees not only the content of applicable rules but also the genuine commitment of management to ensure continuing compliance above other concerns.

Fraud↗

PubMed1998

Financial disclosure by clinical investigators--FDA. Final rule.

The food and Drug Administration (FDA) is issuing regulations requiring the sponsor of any drug, including a biological product, or device marketing application (applicant), to submit certain information concerning the compensation to, and financial interests of any clinical investigator conducting certain clinical studies. This requirement will apply to any covered clinical study of a drug or device submitted in a marketing application that the applicant or FDA relies on to establish that the product is effective, including studies that show equivalence to an effective product, or that make a significant contribution to the demonstration of safety. This final rule requires applicants to certify to the absence of certain financial interests of clinical investigators and/or disclose those financial interests, as required, when covered clinical studies are submitted to FDA in support of product marketing. This regulation is intended to ensure that financial interests and arrangements of clinical investigators that could affect reliability of data submitted to FDA in support of product marketing are identified and disclosed by the sponsor of any drug, biological product, or device marketing application. If the applicant does not include certification or disclosure, or both, if required, or does not certify that it was not possible to obtain the information, the agency may refuse to file the application. FDA intends to propose to extend these requirements to submissions for marketing approval related to human foods, animal foods, and animal drugs in a subsequent issue of the Federal Register.

Conflict of Interest↗

PubMed1998

Workplace privacy: HIV testing, disclosure, and discrimination.

Human immunodeficiency virus (HIV) testing and the disclosure of HIV-related information pose questions of privacy and public policy that are of concern in both public- and private-sector workplaces. Public-sector employees have constitutional protection from discrimination on the basis of their HIV-positive status. The Americans with Disabilities Act (ADA) is an important source of protection for private-sector employees. There are also other federal laws that provide protection from discrimination. However, the scope of these laws is unclear. Similarly, while some state legislatures have attempted to set standards to protect the privacy of HIV-positive employees, laws vary from state to state. Case precedent is also inconsistent. This article examines some current issues regarding HIV testing, employee privacy, and protection from discrimination.

AIDS Serodiagnosis↗

PubMed1983

Privacy Act of 1974; proposed new routine uses--PHS. Notification of new routine uses permitting disclosures of information from five Privacy Act systems of records.

In accordance with the requirements of the Privacy Act, PHS is publishing notice of a proposal to establish 24 new routine uses permitting disclosure of information from five Privacy Act systems of records maintained by the Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of Management, which include: 09-37-0002, "PHS Commissioned Corps Personnel Records, HHS/OASH/OM". 09-37-0003, "PHS Commissioned Corps Medical Records, HHS/OASH/OM"; 09-37-0005, "PHS Commissioned Corps Board Proceedings, HHS/OASH/OM"; 09-37-0006, "PHS Commissioned Corps Grievance, Non-Board and Pre-Board Involuntary Retirement/Separation, and Disciplinary Files, HHS/OASH/OM"; and 09-37-0008, "PHS Commissioned Corps Unofficial Personnel Files and Other Station Files, HHS/OASH/OM". Some of the routine uses added to system notice 09-37-0005 do not apply to that portion of the system that includes the Board for Correction of PHS Commissioned Corps Records. When a routine use does not apply to that portion of the system, the description of the new routine use will include a statement to that effect. When the routine use does apply to the Board for Correction of PHS Commissioned Corps Records, no additional statement will be made.

Civil Rights↗

PubMed1984

Privacy Act of 1974; system of records--PHS. Notification of a proposal to add a routine use and to add a special disclosure statement to the existing system of records 09-37-0015.

In accordance with the requirements of the Privacy Act and the Debt Collection Act of 1982 (Pub. L 97-365), the Public Health Service (PHS) is publishing notice of a proposal to add a new routine use and the (b)(12) special disclosure statement to consumer reporting agencies to system of records 09-37-0015, National Center for Health Services Research Grant Records System. The new routine use is for the purpose of determining credit worthiness of individual grant applicants of the National Center for Health Services Research (NCHSR).

Civil Rights↗

PubMed1985

Providers influence reporting policies, improve financial disclosure.

Because of the healthcare provider's increased financial accountability to the public, it is important that healthcare organizations take a more active interest in improving the disclosure policies of their financial activities. To do so, these providers must understand existing reporting requirements, become more actively involved in influencing financial reporting policies, and develop relevant, forward looking information to be communicated to internal groups such as the board of directors and the finance committee.

Accounting↗

PubMed1980

Health Care Financing Administration--Medicare and Medicaid programs, Medicare and Medicaid disclosure of provider information and access to provider records; correction notice. Correction of final regulation.

This document corrects a technical error in final regulations published in the Federal Register on July 17, 1974 (44 FR 41636) on requirements for disclosure of information by institutions and organizations providing services under Medicare and Medicaid (titles XVIII and XIX of the Social Security Act).

Health Services↗

PubMed1998

Proposed revisions to certain regulations regarding annual reporting and disclosure requirements--Pension and Welfare Benefits Administration, DOL. Notice of proposed rulemaking.

This document contains proposed amendments to Department of Labor (Department) regulations relating to the annual reporting and disclosure requirements under part 1 of Title I of the Employee Retirement Income Security Act of 1974, as amended (ERISA or the Act). In part, the amendments contained in this document are necessary to conform the regulations to the previously published revisions to the annual return/report forms (Form 5500 Series) filed by administrators of employee pension and welfare benefit plans under part 1 of Title I of ERISA. The regulatory amendments, in conjunction with the revisions to the Form 5500 Series, are intended to reduce the annual reporting burdens on employee benefit plans while ensuring that the Department has access to the information it needs to carry out its administrative and enforcement responsibilities under ERISA and that participants and beneficiaries have access to the information they need to protect their rights and benefits under ERISA. Other proposed amendments contained in this document would modify the reporting requirements for certain group insurance arrangements. The remaining amendments are technical in nature and are designed to either simplify or clarify the existing reporting regulations. If adopted, the amendments will affect the financial and other information required to be reported and disclosed by employee benefit plans filing From 5500 Series reports under part 1 of Title I of ERISA.

Documentation↗

PubMed2001

A metadata vocabulary for self- and third-party labeling of health web-sites: Health Information Disclosure, Description and Evaluation Language (HIDDEL).

We describe HIDDEL (Health Information Disclosure, Description and Evaluation Language), formerly known as medPICS (platform for Internet content selection in medicine), a metadata vocabulary designed to enhance transparency, trust and quality of health information on the web. The vocabulary may be used (1) by webmasters to self-describe their contents and policies; (2) by infomediaries (e.g. Healthfinder, NHS Direct/NeLH), e.g. third party evaluators, rating or portal services, to annotate other websites; (3) and by users, to describe their preferences. As an XML application it conforms to the W3C's RDF Specification. The metadata vocabulary is primarily intended to enable descriptions of whole health websites or health information providers. The vocabulary is designed to provide a computer-readable electronic "label" of a health website, telling users who is behind the website, how the website is sponsored, what the con-tent, aim and target audience is, how the information was compiled, what risks the service bears, or what people say about the resource. Client-software can "read" this label automatically, compare it to the user s own set of preferences and needs, and alert and advise users.

Information Services↗

PubMed2001

[Attitude to voluntary HIV testing and result disclosure among rural residents in China].

OBJECTIVE: To identify the determinants of individual acceptance of voluntary HIV testing and the scope of test results disclosure. METHODS: A cross-sectional study was performed to interview 1 057 subjects aged 15 - 49. RESULTS: Among 653 subjects who had heard of HIV/AIDS, 575 (88.1%) reported willingness to be tested for HIV infection. Of subjects who would accept the offer, 90.2% agreed to disclose testing results to their spouse, 77.1% to other family member, 54.8% to their friends and 50.8% to their neighbors. Logistic regression analysis indicated that the acceptability was associated with being a man, and having better knowledge in HIV/AIDS. CONCLUSIONS: The level of acceptability of voluntary HIV testing is high among people who know about HIV/AIDS. Given the large number of people in rural China who never heard of HIV/AIDS, it is important to carry out information-oriented education activities to increase AIDS awareness among rural residents.

Adult↗

PubMed1982

Oral contraceptive labeling disclosure of possible benefits.

Oral contraceptive (OC) labeling disclosure of possible benefits from use of the products, was recommended by the U.S. Food and Drug Administration's (FDA) Fertility and Maternal Health Drugs Advisory Committee at its February 11 meeting. Committee member Howard Orr, Centers for Disease Control, noting the emphasis on cautionary and warning statements contained in current OC labeling maintained: "Women should make informed decisions and this is the other half. The package insert must include the benefits information." The recommendation by the committee represents a shift in the approach to what constitutes proper labeling for OC products. Since first approved, the drugs have never carried a discussion of benefits on their labels. "A number of additional benefits from OCs--other than contraception--have emerged from the large number of studies recorded in the literature on OC use," Ron Nelson, White Memorial Medical Center, stated. "Studies cited a more regular and lighter menstrual flow, resulting in less blood loss and lower iron deficiency and anemia in contraceptive pill users, and dysmenorrhea and premenstrual tension have been sifnificantly reduced." "Ovarian cysts and pelvic inflammatory disease occurred less frequently in pill users than in controls," Nelson continued, "and the incidence of fibrocystic disease of the breast were less. There are some instances where OCs may incur protection against the development of ovarian cancer, endometrial cancer, and rheumatoid arthritis." Orr added: "I think there are 2 good studies that show almost a total elimination of ectopic pregnancy with women who took the pill. Given that now there's an epidemic of the disease going around, I think it's worth adding." The committee was asked by FDA last November to recommend changes in the current physician and patient OC labeling. FDA's Solomon Sobel, MD, Endocrine and Metabolic Drugs Division, told the committee that an agency subcommittee would review the recommendations, present them to the committee in May for final comment, then publish them in the Federal Register.

Contraception↗