Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review.

This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.

A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

Secure Medical Data Model Using Integrated Transformed Paillier and KLEIN Algorithm Encryption Technique with Elephant Herd Optimization for Healthcare Applications.

In the healthcare industry, where concerns are frequently and appropriately focused on saving someone's life, access to interfaces and computer systems storing sensitive data, such as medical records, is crucial to take into account. Medical information has to be secretive and protected by the laws of privacy with restrictions on its access. E-health security is a holistic notion that encompasses available medical data's integrities and confidentiality which ensures that data are not accessed by unauthorized people and allow doctors to offer proper treatment. The patients' data need to be secured on servers holding medical data. This work adds new features for ensuring storage and access safety through ITPKLEIN-EHO (integrated transformed Paillier and KLEIN algorithms) that use EHOs (elephant herd optimizations) to provide lightweight features. The key space affects lightweight encryption techniques in general. The EHOs (elephant herd optimizations) optimize key spaces by adjusting iteration rounds. The main goal is to encrypt EEGs (electroencephalographic signals) in healthcare and send it to end users using the proposed ITPKLEIN-EHO approach. This suggested technique utilizes MATLAB for its tests on various EEG data sets for implementation. The simulations of the proposed IRPKLEIN-EHO technique are evaluated with other existing techniques in terms of MSEs, PSNRs, SSIMs, PRDs, and encryption/decryption times.

The value of community-integrated health information exchanges: three recent examples from El Paso, Texas.

The foundational role of health information exchanges (HIEs) is to facilitate communication between clinical partners in real time. Once this infrastructure for the secure and immediate flow of patient information is built, however, HIEs can benefit community public health and clinical care in myriad other ways that are in line with their mission, goals, patient privacy, and funding structures. We encourage the development of community-integrated HIEs and list specific steps that can be taken toward community integration. We give three examples of those steps in action from a community HIE in El Paso, TX. Each local partnership, in combination with technology innovation, resulted in the development of informatics tools to address community health needs and generated long-term benefits, especially for the most vulnerable patients. Two examples relate to different aspects of the COVID-19 pandemic and a third to the Afghan refugee evacuation.

BYOD usage and security behaviour of hospital clinical staff: An Australian survey.

OBJECTIVE: Healthcare professionals are known to use their personal devices extensively for work purposes (Bring-Your-Own-Device). However, it is also a source of major concern for healthcare organisations, given the heavy reliance of patient data privacy on clinician's usage behaviour and higher risk of data breaches. Previous research into hospital BYOD security has been scarce and fragmented. Therefore, the aim of this paper is to understand the preferences, behaviour, and knowledge of Australian hospital clinical staff with respect to BYOD security through a survey. METHOD: An online survey was conducted among clinicians working in Australian hospitals, asking them about their BYOD related user behaviour, knowledge of best practices, and support received from their hospitals. Descriptive statistical analysis and cross tabulation were carried out on the survey data. RESULTS: Majority of the surveyed clinicians used BYOD (87%). Some of the good behavioural practices found included use of passcode: (91.95%), never disclosing password (67.82%); strong passwords (63.22%) and no storage of patient data (59.77%) on BYOD devices. However, several risky practices were also found, particularly when usability or clinical workflow mattered to clinicians including use of personal/social apps for clinical communication (e.g. SMS: 57.47%, WhatsApp: 39.08%); connecting BYOD devices containing patient data to public hotspots (40.23%) and use of a common data backup platform for personal and patient data (79.93%). A large proportion of surveyed clinicians were either unaware or didn't receive BYOD related security training (74.71%) or policy (39.08%), but those who did were more confident across all aspects of BYOD security asked in the survey, indicating their importance. CONCLUSION: By taking a wholistic and socio-technical view, this study helps us to better understand BYOD related security behaviour of hospital-based clinicians and its consequential implications. It can therefore provide important insights for both technical and clinical stakeholders of BYOD within hospitals.

Privacy Protection and Secondary Use of Health Data: Strategies and Methods.

Health big data has already been the most important big data for its serious privacy disclosure concerns and huge potential value of secondary use. Measurements must be taken to balance and compromise both the two serious challenges. One holistic solution or strategy is regarded as the preferred direction, by which the risk of reidentification from records should be kept as low as possible and data be shared with the principle of minimum necessary. In this article, we present a comprehensive review about privacy protection of health data from four aspects: health data, related regulations, three strategies for data sharing, and three types of methods with progressive levels. Finally, we summarize this review and identify future research directions.

Midwife and nurse students' perceptions of body privacy and self esteem: the case of Turkey / Percepciones de los estudiantes de obstetricia y enfermería sobre la intimidad corporal y la autoestima: el caso de Turquía / Percepções dos estudantes de obstetrícia e de enfermagem sobre a intimidade corporal e a autoestima: o caso da Turquia

Abstract The article reports the results of a study conducted to examine midwifery and nursing students' perceptions of body intimacy and the factors affecting their perceptions. This was a cross-sectional study, with 389 midwifery and nursing students at a public university volunteering to participate in the study. Data were collected using a "Personal Information Form", the "Body Confidentiality Scale for Obstetrics and Gynecology" and the "Rosenberg Self-Esteem Scale". The participants had a mean age of 20.89 ± 1.86 years. The mean score they gave to the question whether they paid attention to privacy was 8.21 ±1.88. The mean Rosenberg self-esteem score was 29.44 ± 4.83 (minimum = 10, maximum = 40). The mean overall privacy score was 36.10 ± 6.84 (min = 9, max = 45), rights and privacy was 20.80 ± 3.71 (min = 5, max = 25), ethics and privacy was 20.45 ± 3.67 (min = 5, max = 25), and clinical privacy was 75.22 ± 12.33 (min = 18, max = 90). According to the results, obstetrics and nursing students, who would later intervene in women's health, had higher than average self-esteem and perception of privacy. Nevertheless, the establishment of the concept of "privacy" is an issue that should be addressed and reinforced in the training of obstetrics and nursing students who will provide services in such a sensitive field as gynecology and obstetrics.

Resumen El artículo informa de los resultados de un estudio llevado a cabo para examinar las percepciones de la intimidad corporal de los estudiantes de obstetricia y enfermería y los factores que afectan a sus percepciones. Se trató de un estudio transversal, con 389 estudiantes de obstetricia y enfermería de una universidad pública que se ofrecieron a participar en el estudio. Los datos se recogieron mediante un "Formulario de información personal", la "Escala de confidencialidad corporal para ginecología y obstetricia" y la "Escala de autoestima de Rosenberg". Los participantes tenían una edad media de 20,89 ± 1,86 años. La puntuación media que dieron a la cuestión de si prestaban atención a la intimidad fue de 8,21 ±1,88. La puntuación media de la autoestima de Rosenberg fue de 29,44 ± 4,83 (mínimo = 10, máximo = 40). La puntuación media de privacidad general fue de 36,10 ± 6,84 (mín = 9, máx = 45), la de derechos y privacidad fue de 20,80 ± 3,71 (mín = 5, máx = 25), la de ética y privacidad fue de 20,45 ± 3,67 (mín = 5, máx = 25), y la de privacidad clínica fue de 75,22 ± 12,33 (mín = 18, máx = 90). De acuerdo con los resultados, los estudiantes de obstetricia y enfermería, que intervendrían luego en la salud de las mujeres, tenían una autoestima y una percepción de la privacidad superiores a la media. No obstante, el establecimiento del concepto de "privacidad" es una cuestión que debería abordarse y reforzarse en la formación de los estudiantes de obstetricia y enfermería que van a prestar servicios en un ámbito tan delicado como la ginecología y la obstetricia.

Resumo O artigo informa sobre os resultados de um estudo realizado para examinar as percepções da intimidade corporal dos estudantes de obstetrícia e de enfermagem e os fatores que afetam suas percepções. Trata-se de um estudo transversal, com 389 estudantes de obstetrícia e de enfermagem de uma universidade pública que se ofereceram para participar no estudo. Os dados foram coletados mediante um "Formulário de informação pessoal", a "Escala de confidencialidade corporal para ginecologia e obstetrícia" e a "Escala de autoestima de Rosenberg". Os participantes tinham uma idade média de 20,89 ± 1,86 anos. A pontuação média que deram à questão de se prestavam atenção à intimidade foi de 8,21 ±1,88. A pontuação média de autoestima de Rosenberg foi de 29,44 ± 4,83 (mínimo = 10, máximo = 40). A pontuação média de privacidade geral foi de 36,10 ± 6,84 (min = 9, max = 45), a de direitos e privacidade foi de 20,80 ± 3,71 (min = 5, max = 25), a de ética e privacidade foi de 20,45 ± 3,67 (min = 5, max = 25) e a de privacidade clínica foi de 75,22 ± 12,33 (min = 18, max = 90). De acordo com os resultados, os estudantes de obstetrícia e de enfermagem, que logo iriam intervir na saúde das mulheres, tinham uma autoestima e uma percepção da privacidade superiores à média. Não obstante, o estabelecimento do conceito de "privacidade" é uma questão que deveria ser abordada e reforçada na formação dos estudantes de obstetrícia e de enfermagem que irão prestar serviços em um âmbito tão delicado como a ginecologia e a obstetrícia.

Chapitre 8. Droit du patient et médecine traditionnelle.

There is currently a growing demand in favor of non-conventional medicines. The use of unconventional practices is interesting, not only for the patient himself, but also for the community (in order to face the contemporary problems of health expenditure, access to healthcare, and the aging of the population). However, we can ask ourselves about the protection of patient's rights when he uses unconventional care practices. There is a gap between the growing demand for unconventional care, and the low level of legal framework of these practices by French law. The near absence of supervision of certain diplomas and the exercise of certain professions raises the question of the safety and quality of the care provided. Other uncertainties appear regarding the respect of the patient's personal rights (information, consent, refusal of treatment, secrecy of health information, etc.). The current legal framework deserves to be developed to ensure a better protection for patients who use unconventional care.

Consensus Report of the Academy of Nutrition and Dietetics: Incorporating Genetic Testing into Nutrition Care.

Personalization of nutrition advice is a process already familiar to registered dietitian nutritionists, but it is not yet clear whether incorporating genetic results as an added layer of precision improves nutrition-related outcomes. Therefore, an independent workgroup of experts, supported by the Academy's Evidence Analysis Center staff, conducted a systematic review to examine the level of evidence measuring the effect of incorporating genetic testing results into nutrition counseling and care, compared to an alternative intervention or control group, on nutrition-related outcomes. This systematic review revealed that only weak quality evidence is available in the scientific literature and observed that this field is still maturing. Therefore, at present, there is insufficient scientific evidence to determine whether there are effects of incorporating genetic testing into nutrition practice. The workgroup prepared this Consensus Report based on this systematic review to provide considerations for the practical application of incorporating genetic testing into the nutrition care process.

O "segredo" sobre o diagnóstico de HIV/Aids na Atenção Primária à Saúde / El 'secreto' sobre el diagnóstico de VIH/Sida en la Atención Primaria de la Salud / The 'secrecy' about the diagnosis of HIV / Aids in Primary Health Care

Este estudo analisou o processo de descentralização do cuidado de pessoas vivendo com HIV/Aids (PVHA) na cidade do Rio de Janeiro, RJ, Brasil, com ênfase na questão do sigilo. Foi realizado por meio de entrevistas com usuários e trabalhadores, grupos focais com profissionais e observação participante em duas unidades de Atenção Primária à Saúde (APS). Guiados por uma abordagem socioantropológica, os resultados abordaram os motivos do sigilo para as PVHA, a gestão do sigilo entre os profissionais de saúde da APS e as repercussões do sigilo para as práticas de cuidado, destacando a posição singular dos agentes comunitários de saúde. O estudo traz à tona implicações da característica territorial da APS brasileira para o cuidado com as PVHA, podendo ampliar acesso, mas também o risco de quebra do sigilo, evidenciando necessidade de seu manejo para o enfrentamento do estigma e melhoria do cuidado. (AU)

Este estudio analizó el proceso de descentralización del cuidado de personas que viven con VIH/Sida (PVVS) en la ciudad de Río de Janeiro (Estado de Río de Janeiro), Brasil, con énfasis en la cuestión del sigilo. Se realizó a partir de entrevistas con usuarios y trabajadores, grupos focales con profesionales y observación participante en dos unidades de Atención Primaria de la Salud (APS). Guiados por un abordaje socio-antropológico, los resultados abordaron los motivos del sigilo para las PVVS, la gestión del sigilo entre los profesionales de salud de la APS y las repercusiones del sigilo para las prácticas de cuidado, destacando la posición singular de los agentes comunitarios de salud. El estudio presenta implicaciones de la característica territorial de la APS brasileña para el cuidado de las PVVS, pudiendo ampliar acceso, pero también el riesgo de ruptura del sigilo, poniendo en evidencia la necesidad de su manejo para el enfrentamiento del estigma y mejora del cuidado. (AU)

This study analyzed the process of decentralizing of care for people living with HIV / Aids (PLHA) in the city of Rio de Janeiro, RJ, Brazil, emphasizing secrecy. We conducted interviews with patients and workers, focus groups with professionals and participant observation in two Primary Health Care units. Guided by a socio-anthropological approach, the results addressed the reasons for secrecy for PLHA, the management of confidentiality among PHC health professionals and the repercussions of secrecy for healthcare practices, highlighting the singular position of community health agents. The study reveals the implications of the territorial characteristic of Brazilian PHC for the care of PLWHA, increasing access, albeit risking a breach of confidentiality, showing the need for management to face stigma and improve care. (AU)

The Promise of Big Data and Digital Solutions in Building a Cardiovascular Learning System: Opportunities and Barriers.

The learning health system is a conceptual model for continuous learning and knowledge generation rooted in the daily practice of medicine. While companies such as Google and Amazon use dynamic learning systems that learn iteratively through every customer interaction, this efficiency has not materialized on a comparable scale in health systems. An ideal learning health system would learn from every patient interaction to benefit the care for the next patient. Notable advances include the greater use of data generated in the course of clinical care, Common Data Models, and advanced analytics. However, many remaining barriers limit the most effective use of large and growing health care data assets. In this review, we explore the accomplishments, opportunities, and barriers to realizing the learning health system.

New medical big data for P4 medicine on allergic conjunctivitis.

Allergic conjunctivitis affects approximately 15-20% of the global population and can permanently deteriorate one's quality of life (QoL) and work productivity, leading to societal work force costs. Although not fully understood, allergic conjunctivitis is a multifactorial disease with a complex network of environmental, lifestyle, and host contributory risk factors. To effectively enhance the quality of treatment for patients with allergic conjunctivitis, as well as other allergic diseases, the field must first comprehend the pathology underlying various individualized subjective symptoms and stratify the disease according to risk factors and presentations. Such competent stratification and societal reconstruction that targets the alleviation of the damage due to allergic diseases would greatly help ramify personalized treatments and prevent the projected increase in societal costs imposed by allergic diseases. Owing to the rapid advancements in the information and technology sector, medical big data are greatly accessible and useful to decipher the pathophysiology of many diseases. Such data collected through multi-omics and mobile health have been effective for research on chronic diseases including allergic and immune-mediated diseases. Novel big data containing vast and continuous information on individuals with allergic conjunctivitis and other allergic symptoms are being used to search for causative genes of diseases, gain insights into new biomarkers, prevent disease progression, and, ultimately, improve QoL. The individualized and holistic data accrued from new angles using technological innovations are helping the field realize the principles of P4 medicine: predictive, preventive, personalized, and participatory medicine.

Power, danger, and secrecy-A socio-cultural examination of menstrual waste management in urban Malawi.

Menstrual blood is not just a physical substance; it is laden with symbolism and often powerfully stigmatised. It is important to understand local perceptions and attitudes towards menstrual blood, as well as the preferred practices of menstruating women, in order to design appropriate sanitation and solid waste systems to support menstruation. Failure to take account of socio-cultural factors can jeopardise the effectiveness of such infrastructure. This study, conducted in Blantyre, Malawi, is a qualitative socio-cultural examination of how women manage and view menstruation. Thirty nine interviews, conducted with individuals and with small groups of friends, were carried out with thirty one women using pit latrines, flush toilets, and urine-diverting dry toilets in early 2019. Menstruation in Blantyre was found to be shrouded in secrecy because it was viewed as 'dirty', and therefore remained concealed. There was widespread anxiety about menstrual blood being used in ufiti (witchcraft), which affected how women used and disposed of their menstrual absorbents. At the same time, menstrual blood was also viewed as a powerful healing substance with uses in traditional medicine. The type of infrastructure required by women to support their menstruation depended on the type of menstrual absorbent used. Those using reusable cloth generally preferred a private bathroom with discreet drainage, whilst those using disposable pads needed a discreet and convenient disposal system. Increased preference for disposable pads over reusable cloth (particularly for younger women in education or employment) suggested that menstrual waste profiles of urban areas may be changing. Understanding these changing needs will be crucial for planning effective, sustainable waste disposal and sanitation infrastructure.

Assessing transgender and gender non-conforming pedigree nomenclature in current genetic counselors' practice: The case for geometric inclusivity.

Healthcare professionals rely on national organizations for guidance; the National Society of Genetic Counselors (NSGC) and the National Comprehensive Cancer Network (NCCN) have differing guidelines for acceptable pedigree symbols to represent transgender patients and minimal recommendations for gender non-conforming (GNC) patients. Inconsistency in accepted pedigree symbols to represent these patients is a barrier to providing them appropriate care. We assess variability in pedigree practice among genetic counselors and students, as well as reported education on serving the needs of the transgender and GNC communities, through a survey distributed through NSGC. Participants felt symbols similar to NSGC's (41.1%) and NCCN's (29.7%) recommendations for transgender patients are appropriate and emphasized a desire to affirm gender identity. We identified greater variability in symbols representing a GNC patient; 19.2% of participants selected 'other', explaining they were unsure of the appropriate choice. A high interest (99%) in further training demonstrates a recognition of education as an effective strategy for improving awareness and competency. Promotion of existing resources could help address the fact that 81% of participants were unaware of any standardized symbols used to represent transgender individuals. Creating affirming, standardized pedigree nomenclature is necessary for appropriate and consistent care.

How can HIV/STI testing services be more accessible and acceptable for gender and sexually diverse young people? A brief report exploring young people's perspectives in Queensland.

ISSUE ADDRESSED: Gender and sexually diverse young people (GSDYP) are an important target group for HIV/sexually transmitted infection (STI) prevention and there is an immediate need to explore ways to make testing interventions accessible and appropriate for this group. METHODS: We used a modified World Café workshop with 14 GSDYP in Brisbane Australia, to inform the development of a pilot community-based testing intervention. RESULTS: The workshop identified the key features of an ideal service, which would include multiple, accessible sites that offer holistic, affordable services and confidential care by respectful and knowledgeable providers. The service would allow young people to engage in decision-making processes, have a culturally inclusive, comfortable and friendly atmosphere, and provide free sexual and reproductive health technologies. CONCLUSION: When designing HIV/STI testing interventions for key groups, health promotion practitioners need to be cognisant of localised and nuanced expectations and ensure that services are tailored to the needs and experiences of the local population. SO WHAT?: This study provides insights into the needs and expectations of HIV/STI testing interventions for GSDYP in Australia, a key at-risk group whose perspectives are not adequately voiced in sexual health research and intervention design. SUMMARY: This study explores facilitators and current barriers to HIV/STI testing with a group of gender and sexually diverse young people in Brisbane, Australia. Outcomes provide insights into the needs and expectations of HIV/STI testing services for this group.

[Politicians' Personal Physicians: careers and complications from King David until today]. / Leib- und Seelenärzte Karrieren und Komplikationen von König David bis heute.

Court physicians need to deal with a clientele posing particular personality problems (e. g. rex inutilis) in a difficult environment characterized by specific health issues (morbi aulici) and they may have to avoid serious risks or want to seek great opportunities (medicus politicus). Very few have been successful as King David, a former music therapist without a medical degree, or the dentist and president Gurbanguly Berdimuhamedow. Several became victims of fatal circumstances. Not all could resist temptation of questionable literary fame at the expense of confidentiality. All told, a career close to high profile leaders needs to be considered carefully as risks may outweigh benefits.

eHealth Cloud Security Challenges: A Survey.

Cloud computing is a promising technology that is expected to transform the healthcare industry. Cloud computing has many benefits like flexibility, cost and energy savings, resource sharing, and fast deployment. In this paper, we study the use of cloud computing in the healthcare industry and different cloud security and privacy challenges. The centralization of data on the cloud raises many security and privacy concerns for individuals and healthcare providers. This centralization of data (1) provides attackers with one-stop honey-pot to steal data and intercept data in-motion and (2) moves data ownership to the cloud service providers; therefore, the individuals and healthcare providers lose control over sensitive data. As a result, security, privacy, efficiency, and scalability concerns are hindering the wide adoption of the cloud technology. In this work, we found that the state-of-the art solutions address only a subset of those concerns. Thus, there is an immediate need for a holistic solution that balances all the contradicting requirements.

In Their Own Words: Experiences of Caregivers of Adults With Cancer as Expressed on Social Media.

PURPOSE: To explore caregivers' writings about their experiences caring for adult individuals with cancer on a social media health communication website. PARTICIPANTS & SETTING: Journal entries (N = 392) were analyzed for 37 adult caregivers who were posting on behalf of 20 individuals with cancer. CaringBridge is a website used by patients and informal caregivers to communicate about acute and chronic disease. METHODOLOGIC APPROACH: A retrospective descriptive study using qualitative content analysis of caregivers' journal entries from 2009 to 2015. FINDINGS: Major categories identified in caregivers' online journals included patient health information, cancer awareness/advocacy, social support, caregiver burden, daily living, emotions (positive and negative), and spirituality. IMPLICATIONS FOR NURSING: Nurses often recommend using social media as a communication strategy for patients with cancer and their caregivers. The findings from this study provide potential guidance nurses may wish to offer caregivers. For example, nurses may talk with caregivers about how and what to post regarding treatment decisions. In addition, nurses can provide support for caregivers struggling with when and how often to communicate on social media.