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1.
Chiropr Man Therap ; 28(1): 60, 2020 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148281

RESUMO

BACKGROUND: The COVID-19 pandemic has seen the emergence of unsubstantiated claims by vertebral subluxation-based chiropractors that spinal manipulative therapy has a role to play in prevention by enhancing the body's immune function. We contend that these claims are unprofessional and demonstrate a disturbing lack of insight into the doctrine of informed consent. As such it is timely to review how informed consent has evolved and continues to do so and also to discuss the attendant implications for contemporary health practitioner practice. We review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. We argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered. The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. We discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending "inhouse" products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings. CONCLUSION: Ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.


Assuntos
Quiroprática/legislação & jurisprudência , Revelação/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Betacoronavirus , Infecções por Coronavirus , Humanos , Pneumonia Viral
2.
Georgian Med News ; (306): 166-171, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-33130667

RESUMO

The purpose of the study is to determine the subject of "medical secrecy", to characterize the subjects who are obliged to keep secret information that is the subject of medical secrecy and, based on the results of this study, to make author's proposals to clarify the name for confidential medical information in legislation in the field of medicine in the field of medicine, criminal and criminal procedural legislation. The article explores issues related to the right of every person to the confidentiality of medical information, which is legally defined as "medical privacy". Based on the analysis of international legal acts, decisions of the European Court of Human Rights, the legislation of Ukraine and Georgia on the researched subject, using the foundations of the philosophy of law, carried out a comprehensive study of the concept of "medical confidentiality", defined entities following their professional and career responsibilities, must keep it. In the given article were used such scientific methods as logical, system-structural, comparative-legal, analysis, synthesis. Based on the research, the authors make several proposals for improving certain norms governing medical activities, namely, changes to the wording of Article 40 of the Law of Ukraine "Fundamentals of Ukrainian Legislation on Health Protection", Article 145 of the Criminal Code of Ukraine and Article 65 of the Criminal Procedure Code of Ukraine.


Assuntos
Revelação , Privacidade , República da Geórgia , Direitos Humanos , Humanos , Ucrânia
7.
PLoS One ; 15(10): e0239767, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044968

RESUMO

INTRODUCTION: HIV status disclosure in children is one of acontroversial issue in current health. Over 44,000 children in Ethiopia were living with HIV in the year 2019 with a variable level of disclosure, which ranges from 16.3% to 49%. Therefore, this study aimed to assess HIV-positive status disclosure and associated factors among HIV-infected children. METHODS: A cross-sectional study was conducted in ten public health facilities providing pediatric antiretroviral therapy services. Systematic random sampling was used to select 221 caregivers of children aged 6-15 years. Face-to-face interviews were employed to generate the data. Binary logistic regression was used to analyze the association between HIV-positive status disclosure to children and independent variables with statistical significance set at p-value <0.05. RESULTS: Out of the total, 134 (60.6%) of HIV-infected children knew about their HIV status. The mean age at disclosure was 10.71 years. Children aged older than 10 years [AOR = 22, 95% CI: 5.3-79.2], female children [AOR = 3; 95% CI = 1.2-8.7], children lost their family member by HIV [AOR = 3.5, 95% CI: 1.2-10], caregiver's perception of child did not get stigmatized [AOR = 4, 95% CI: 1.6-11], and children's responsible for anti-retroviral therapy [AOR = 16, 95% CI: 5-50] were significantly associated with HIV positive status disclosure compared to their counterpart respectively. Children who stayed on anti-retroviral for 10-15 years were [AOR = 7; 95% CI: 2-27] more likely to know their HIV positive status compared to those staying on anti-retroviral therapy for <6 years. CONCLUSION: The proportion of disclosure of HIV-positive status among HIV-infected children was low. Factors associated were the age of the child, sex, existence of parent, stigma, ART duration, and responsibility of the child for his/her drugs. HIV care providers should consider these factors while supporting disclosure.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Revelação/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Cuidadores/estatística & dados numéricos , Criança , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pais , Estigma Social , Adulto Jovem
8.
Niger J Clin Pract ; 23(10): 1419-1425, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047700

RESUMO

Background: Nigeria ranks second globally with a HIV/AIDS prevalence of 3.2%. HIV infected children are surviving to adolescence because of anti-retroviral therapy, but many do not know why they need to take these medicines. Disclosure is critical to long-term disease management, yet, if, how and when caregivers and or health professionals disclose to children is not well known in resource-limited settings. The barriers to disclosure remain largely undocumented. Objectives: To determine the prevalence and age of HIV disclosure to children in Abuja, Nigeria and identify caregivers perspectives as well as barriers to disclosure. Methods: A cross-sectional study was done June-July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV-positive children aged 5-16 years receiving antiretroviral therapy for at least 1 year were enrolled. Results: Prevalence of full disclosure was 24.5%, partial disclosure 22.7%, with overall prevalence of 47.2%. Mean age at full disclosure was 11.87 years. Bivariate analysis showed significant difference between disclosure and child's level of education (χ2 for trend 26.710, P < 0.001), support for disclosure (χ2 4.399, P = 0.036) and if caregiver held the opinion that children should have disclosure done (Pearson's χ2 30.174, P < 0.001). However, on logistic regression, only the age of the child (P < 0.001, 95% CI 1.176-1.499) and the caregiver's opinion (P = < 0.001, 95% CI 4.914-2.542) remained significant. Various barriers to disclosure were identified. Conclusion: The prevalence of full disclosure is low and several barriers prevent early disclosure. Caregiver's and HCWs need empowerment with culturally appropriate skills and platforms to increase disclosure rates, which may help improve adherence.


Assuntos
Cuidadores/psicologia , Revelação/estatística & dados numéricos , Infecções por HIV/psicologia , Revelação da Verdade , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Pessoal de Saúde , Humanos , Masculino , Nigéria/epidemiologia , Prevalência , Inquéritos e Questionários
9.
Global Health ; 16(1): 101, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081805

RESUMO

Corruption is recognized by the global community as a threat to development generally and to achieving health goals, such as the United Nations Sustainable Development Goal # 3: ensuring healthy lives and promoting well-being for all. As such, international organizations such as the World Health Organizations and the United Nations Development Program are creating an evidence base on how best to address corruption in health systems. At present, the risk of corruption is even more apparent, given the need for quick and nimble responses to the COVID-19 pandemic, which may include a relaxation of standards and the rapid mobilization of large funds. As international organizations and governments attempt to respond to the ever-changing demands of this pandemic, there is a need to acknowledge and address the increased opportunity for corruption.In order to explore how such risks of corruption are addressed in international organizations, this paper focuses on the question: How are international organizations implementing measures to promote accountability and transparency, and anti-corruption, in their own operations? The following international organizations were selected as the focus of this paper given their current involvement in anti-corruption, transparency, and accountability in the health sector: the World Health Organization, the United Nations Development Program, the World Bank Group, and the Global Fund to Fight Aids, Tuberculosis and Malaria. Our findings demonstrate that there has been a clear increase in the volume and scope of anti-corruption, accountability, and transparency measures implemented by these international organizations in recent years. However, the efficacy of these measures remains unclear. Further research is needed to determine how these measures are achieving their transparency, accountability, and anti-corruption goals.


Assuntos
Revelação , Fraude/prevenção & controle , Saúde Global/economia , Responsabilidade Social , Nações Unidas , Organização Mundial da Saúde , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Humanos , Malária/prevenção & controle , Tuberculose/prevenção & controle
10.
N Z Med J ; 133(1523): 55-64, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032303

RESUMO

AIMS: The aim of this study was to investigate the number and correlates of sexual assault among students at a campus-based university in Aotearoa New Zealand and to determine how often students disclose such experiences to health professionals, other services and family/friends. METHODS: An online survey based on the Administrator-Researcher Campus Climate Consortium tool was emailed to all students at the main campus of a large university in Aotearoa/New Zealand. It was completed by 1,540 students (8.1% of those emailed) of any gender in July-August 2019. RESULTS: During their time at university to-date, 28% of the sample had experienced at least one form of sexual assault with 14.9% reporting experiences that meet a definition of rape. Sixty-six percent of victims in the sample and 53% of the reported perpetrators had been using alcohol at the time of the assault. Only 8% of those reporting sexual assault in the sample disclosed the assault to a health professional. CONCLUSIONS: Considering the low number of university students disclosing sexual assaults to health professionals or support services, the results of this survey suggest more work is needed to facilitate greater disclosures to health professionals enabling victims to access the services they need regardless of alcohol use.


Assuntos
Revelação/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Universidades , Adulto Jovem
11.
BMC Public Health ; 20(1): 1526, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33081743

RESUMO

BACKGROUND: Syphilis and gonorrhea reached an all-time high in 2018. The resurgence of syphilis and gonorrhea requires innovative methods of sexual contact tracing that encourage disclosure of same-sex sexual contacts that might otherwise be suppressed. Over 75% of Grindr mobile phone application users report seeking "friendship," so this study asked people diagnosed with syphilis and gonorrhea to identify their friends. METHODS: Patients at the two Baltimore sexually transmitted infection (STI) clinics and the Baltimore City Health Department were asked 12 questions to elicit members of their friendship networks before eliciting sexual networks. The study included 353 index cases and 172 friendship contacts, yielding a friendship network of 331 non-isolates (n = 331) and sexual-only network of 140 non-isolates. The data were plotted and analyzed using exponential family random graph analysis. RESULTS: Eliciting respondents' in-person social contacts yielded 12 syphilis cases and 6 gonorrhea cases in addition to the 16 syphilis cases and 4 gonorrhea cases that would have been found with sexual contacts alone. Syphilis is clustered within sexual (odds ratio = 2.2, 95% confidence interval (1.36, 3.66)) and social contacts (OR = 1.31, 95% CI (1.02, 1.68)). Gonorrhea is clustered within reported social (OR = 1.56, 95% CI (1.22, 2.00)) but not sexual contacts (OR = 0.98, 95% CI (0.62, 1.53)). CONCLUSIONS: Eliciting friendship networks of people diagnosed with syphilis and gonorrhea may find members of their sexual networks, drug use networks, or people of similar STI risk. Friendship networks include more diagnosed cases of syphilis and gonorrhea than sexual networks alone, especially among populations with many non-disclosing men who have sex with men (MSM) and women who have sex with women (WSW). Future research should evaluate whether this friendship network method of contact tracing can be implemented by adapting automated mobile phone COVID-19 contact tracing protocols, if these COVID-19 contact tracing methods are able to maintain anonymity and public trust.


Assuntos
Busca de Comunicante/métodos , Amigos , Gonorreia/epidemiologia , Rede Social , Sífilis/epidemiologia , Adolescente , Adulto , Baltimore/epidemiologia , Revelação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual , Adulto Jovem
12.
Br J Sports Med ; 54(22): 1314-1320, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32912847

RESUMO

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Medicina Militar/educação , Medicina Esportiva/educação , Atletas/educação , Técnica Delfos , Humanos , Medicina Militar/organização & administração , Militares/educação , Medicina Esportiva/organização & administração , Participação dos Interessados , Estados Unidos , Universidades
13.
BMJ Open ; 10(8): e040448, 2020 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-32868370

RESUMO

OBJECTIVE: To assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours. DESIGN: 2×3 experimental design. SETTING: Online. PARTICIPANTS: 1204 adults from a UK research panel. INTERVENTION: Participants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test). MAIN OUTCOME MEASURES: Primary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing. RESULTS: When using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate-as opposed to Test-had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)). CONCLUSIONS: Using the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/tjwz8/files/.


Assuntos
Anticorpos Antivirais , Comunicação , Infecções por Coronavirus , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Imunidade , Pandemias , Pneumonia Viral , Adulto , Anticorpos Antivirais/sangue , Betacoronavirus , Certificação , Infecções por Coronavirus/sangue , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Revelação , Feminino , Humanos , Internet , Masculino , Razão de Chances , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Medição de Risco , Reino Unido
18.
J Environ Manage ; 275: 111225, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889416

RESUMO

Many studies demonstrate that the booming number of environmental non-governmental organizations (ENGOs) in China have substantially affected on the environmental issues. However, little research has paid attention to discern the different types of ENGOs' activities. Thus, this study aims to provide the first set of quantitative data analysis to demonstrate the effects of different types of ENGOs' effects on the governance from two major perspectives, namely, top-down and grassroots. Both perspectives offer different assumptions of whether the effects of key ENGOs on promoting urban environmental governance are national or local. This paper collects unique data from the websites of several NGO list-collecting organizations, the urban statistical yearbooks published by the Chinese government, and the pollution information transparency index released by ENGOs annually, to accurately identify the characteristics and activities of ENGOs. By using the Ordinary Least Squares regression model in which the city fixed effects are included, this study analyzes the influences of ENGOs on the levels of environmental information disclosure among over 100 prefecture-level cities from 2008 to 2015. The results primarily support the grassroots perspective. Cities with more local ENGOs have better performance in terms of environmental information disclosure. In addition, although local ENGOs allying with national NGOs have certain influences in 2014-2015, they downgrade the effects of other local ENGOs. Taken together, the findings illustrate that, while national ENGOs have received great deal of attention, possessed more resources to align local ENGOs, and had extensive opportunities to connect with international ENGOs, local ENGOs within local contexts and activities play crucial roles in the local environmental governance. Furthermore, the results also imply that although the Chinese government has reinforced control over the civil society after 2012, local ENGOs still strengthen their influences on the environmental governance.


Assuntos
Conservação dos Recursos Naturais , Política Ambiental , China , Cidades , Revelação
20.
Rev Assoc Med Bras (1992) ; 66(8): 1139-1145, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32935811

RESUMO

OBJECTIVE: To analyze the scientific evidence on the disclosure of the diagnostic of adolescents infected by HIV/AIDS in the South American context. DATABASE: Systematic literature review using the PubMed, Cinahal, Embase, Cochrane, BVS, and Global Health databases and the descriptors: adolescent and HIV and family and Argentina or Bolivia or Brasil or Chile or Colombia or Ecuador or French Guiana or Paraguay or Peru or Uruguay or Venezuela. DATA SYNTHESIS: Brasil was the country highlighted. It was verified that parents have a direct and indirect influence over the adolescents' life, especially regarding behaviors and health care. Dialog among family members can reduce adolescents' vulnerability to HIV and encourage diagnostic disclosure. CONCLUSION: It is necessary to amplify research involving adolescents with HIV/AIDS and their parents/caregivers and family members to improve care and reduce the cases of the disease. It is suggested that policies of prevention and treatment should involve families, caregivers, partners, and the community.


Assuntos
Revelação , Infecções por HIV , Adolescente , Argentina , Brasil , Chile , HIV , Humanos , Peru , Venezuela
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