Confidential Services Research Articles

Mental health workers' experiences of support and help-seeking following workplace violence: A qualitative study.

The consequences of workplace trauma among mental health staff can include physical injuries and somatic disorders, professional exhaustion and burnout, depression, anxiety, and other occupational stress injuries. For the well-being of staff and patients, there is a need to understand mental health workers' experiences following exposure to workplace trauma, any subsequent mental health problems, and the process of help-seeking. The nuances of these experiences can best be captured through qualitative exploration. In this study, we explored inpatient mental health workers' experiences of support and help-seeking following workplace violence. Four overall themes emerged from interviews with 12 participants: (i) validation as motivation for help-seeking; (ii) stigma as a barrier to help-seeking; (iii) gaps in services provided; and (iv) desire for accessible and effective trauma support and education. This study demonstrates the need for supportive management responses and peer support, access to specialized and confidential trauma-informed mental health services, and reductions in stigma, victim blaming, and other barriers to help-seeking among mental health workers.

Police officers' MH is focus of bill moving through Maryland legislature

Maryland police officers who are dealing with stressors — such as family issues, substance abuse or mass protests — will have access to confidential mental health aid under a bill progressing in the state legislature, Capital News Service reported Jan. 25. The Police Officers Mental Health Employee Assistance Program, sponsored by Delegate Benjamin Brooks, D‐Baltimore County, and Sen. Mary Washington, D‐Baltimore, would require each law enforcement agency to provide its officers with access to an employee assistance or mental health program at a minimal cost to the officer. These employee assistance programs include confidential counseling services, crisis counseling, stress management counseling and peer support services for police officers. “One in four police officers have thought about committing suicide at one point in their career,” Brooks told Capital News Service. An important component of these em‐ployee assistance programs focuses on protecting police officers' mental health during periods of public demonstration and unrest. Under this bill, police officers would receive the help they need and avoid potential repercussions from the department or fellow officers.

Integrated security for data transfer and access control using authentication and cryptography technique for Internet of things

The entire world is running behind the smart technology to accomplish the daily needs in a smart way such as smart farming, smart irrigation system, smart transportation system, smart medical management, handling of smart home appliances, smart security, etc. Smart technology is the soul property of internet services and accessing data from virtual servers, which raises the alarm of security vulnerability and threats. In recommended system we have focused on application layer security which are concerned with application interface and queue manager for service exchange. As application layer is the closest to end user and produces the big threat to the application platform it motivates us to recommend strong multilevel security system to identify the different activity of handlers and identify their roles to enroute of accessing confidential data services. Subsequently, our work is to assure that every user should have an authentication key with specific privileges to get the desired information. In focus, we see the security management by integrating the Kerberos authentication protocol with honey encryption technique to provide strong multilevel security system.

Addressing Organizational Barriers to Adolescent Access to High-Quality, Low-Cost, Confidential Sexual and Reproductive Health Services in a Community Health Center.

Adolescents face a number of barriers to accessing high-quality, confidential sexual and reproductive health (SRH) services. Although federally qualified health centers (FQHCs), a type of community health center (CHC), are a critical source of health care for medically underserved adolescents, they often lack the capacity and resources to provide specialized SRH services to adolescents. In this article, we describe the development and implementation of an initiative aimed at improving an FQHC's capacity to provide high-quality confidential SRH services to adolescents. For this initiative, a team of clinical and quality improvement staff developed a set of six strategies to improve adolescent SRH services at an FQHC: (1) building community relationships and galvanizing internal organizational support to improve adolescent access to confidential SRH services, (2) developing a long-acting reversible contraception (LARC) program, (3) training clinic staff on SRH and adolescent health topics, (4) adapting the adolescent patient workflow to improve SRH service delivery during appointments, (5) updating and implementing a universal adolescent health assessment tool, and (6) developing billing and registration policies that allow adolescents to receive confidential SRH services. We identified several factors that we believe were key to the successful implementation of our approach in other CHC settings, including encouraging cross-sector collaboration and community focus, providing training as a tool to engage and empower staff as agents of change, involving interdisciplinary staff, piloting on a small scale, and establishing consistent meetings with a clinic champion and improvement team.

Ultralightweight resilient mutual authentication protocol for IoT based edge networks

Confidentiality and authentication are primary concerns of RFID (Radio Frequency IDentification) based identification systems. Low cost, non sight-line scanning capability, unique identification and functional haste make RFID systems much more suitable for supply chain management and IoT networks, compare to barcodes and magnetic tapes. Since, RFID tags can be scanned from a greater distance over a radio channel which is easily accessible for adversaries, therefore numerous Ultralightweight Mutual Authentication Protocols (UMAPs) have been proposed to ensure the security of the RFID systems in a cost effective way. These UMAPs mainly involve low cost bitwise logical ( $$Triangular$$ ) operations such as $$XOR, AND OR$$ etc., usually these logical operations offer poor diffusion properties and hence result in disclosure of the concealed secrets. Almost all of the previous UMAPs have certain pitfalls and reported to be susceptible to Denial of Service, traceability, full disclosure and cloning attacks. In this paper, we propose a new UMAP that is resilient to structured and unstructured cryptanalysis techniques. The proposed Ultralightweight Resilient Mutual Authentication Protocol (URMAP) avoids all the pitfalls and unbalanced operators in its design that were the main reasons of failure of previous UMAPs. The incorporation of ultralightweight primitives; $$Per{\text{-}}XOR$$ ( $${P}_{x})$$ and $$Inverse Per{\text{-}}XOR$$ $$({ P}_{x}^{-1})$$ makes the protocol messages more resistant to all types of adversaries. The security and privacy capabilities of URMAP are evaluated through formal analysis. The results of GNY Logic analysis prove that the proposed protocol is resilient to all possible attack scenarios thus ensuring optimal confidentiality, integrity and availability services.

C-L Psychiatrists Launch Innovative Model of Mental Health Care for Residents

C-L Psychiatrists Launch Innovative Model of Mental Health Care for Residents

A collaborative learning approach to improving health worker performance in adolescent sexual and reproductive health service provision: a descriptive feasibility study in six health zones in the Democratic Republic of the Congo

ABSTRACT Poor performance among health service providers is a key barrier to high quality, adolescent-responsive health services. Collaborative learning has been shown to strengthen health service provider performance, but few studies have examined its implementation in adolescent health services. In this paper, we describe a collaborative learning approach for adolescent health service providers implemented as part of a project aiming to prevent HIV in adolescent girls and young women in the Democratic Republic of the Congo (DRC) and explore its feasibility, acceptability, benefits and challenges. To do so, we reviewed plans, budgets and progress reports, as well as nested implementation research related to the project. We also carried out a quantitative analysis of the number, location, participants and topics of collaborative learning sessions conducted as part of this initiative, and thematic analysis to synthesise findings on perceived benefits and challenges. Under the project, 32 collaborative learning sessions of approximately two-hour duration were held with up to 15 participants, most of whom were nurses, between June 2018 and May 2019. The project cost was approximately USD 135,000 over three years. Reported benefits included improving health service provider attitudes, knowledge and skills; ensuring delivery of non-judgemental, empathic and confidential health services; and improving communication and collaboration between health services and adolescents together with their parents. While the novelty of the approach in this context presented challenges, our results suggest that collaborative learning in adolescent health services is feasible, acceptable, and inexpensive. It may help strengthen the knowledge and skills of health service providers, build positive attitudes and motivation, and improve their performance and thereby the adolescent-responsiveness of health services. Further research is needed to confirm these results in other settings and to examine the impact of collaborative learning on the acceptability and uptake of health services.

A Public Platform for Virtual IoT-Based Monitoring and Tracking of COVID-19

The world is developing an app that alerts my smartphone when a COVID-19 (COrona VIrus Disease 19) confirmed case comes near me. However, regardless of what will be put to practical use first, the COVID-19 tracking system should satisfy the issues of legalization of location tracking and scalability as a public platform used by the world. Additional problems need solutions related to real-time authentication for information gathering, blind naming and privacy of tracked persons, and quality of service on the Query/Reply procedure. This paper proposes the Software-Defined Networking Controller-centric global public platform to monitor and track information for the COVID-19 relevant people and provide real-time information disclosure services to world-wide Centers for Disease Control and Prevention (CDCs) and regular users. The CDC manages a list of people who needs to be monitored related to the COVID-19 and forcibly installs COVID-19 virtual Internet of Things (vIoT) nodes in the form of applications on their smartphones. In addition to these nodes, the vIoT support nodes also engage as information providers to improve the quality of information services. The design of our platform aims to ensure confidentiality and authentication services giving individually different secret keys. In addition, our platform meets system scalability and reduces Query/Reply latency, where the platform accommodates a large number of world-wide CDCs and persons in control per CDC.

Association of the National Dependent Coverage Expansion With Insurance Use for Sexual and Reproductive Health Services by Female Young Adults

Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Eligibility for parental coverage under the ACA-DCE as of 2010. Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.

The manifestation of coordination failures in service triads

PurposeThis paper aims to investigate governance in service triads, specifically studying significant steering and connecting coordination failures, to reveal typically hidden characteristics and consequences.Design/methodology/approachThis study focuses on coordination functions and activities between a buyer (a government department), a customer (a military service) and two service providers. Rich data on these normally confidential service ties are drawn from an official report into the causes of a fatal accident involving a UK reconnaissance aircraft and specifically from the evidence presented regarding the earlier development of its complex safety case. The authors also analysed a range of additional secondary data sources.FindingsThe authors examine the sources, drivers and manifestation of coordination failures. The authors uncover a series of coordination failures driven from the bridge position, revealing that while bounded rationality and opportunism influenced steering coordination failures, connecting coordination failures were associated with knowledge asymmetry, dyadic inertia and unethical practices.Practical implicationsOrganisations and governments delivering complex projects and knowledge-intensive professional services should guard against outsourcing the “coordination” activity to a third party, thereby relinquishing the bridge position. Handing over the bridge position to an integrator would leave the client vulnerable to coordination dysfunctions such as bounded rationality, opportunism, knowledge asymmetry, dyadic inertia and unethical practices.Originality/valueThe study links the previously separate research streams of service triads and inter-organizational coordination. While extant research pays attention to mainly positive control functions, this study focuses on all three actors in two (failed) service triads – and highlights the impact of coordination activities and failures.

Domestic abuse among female doctors: thematic analysis of qualitative interviews in the UK.

Doctors can be victim-survivors of domestic abuse (DA), but how this impacts their work and wellbeing, and whether they face barriers to seeking help is not well understood. To understand single doctor mothers' lived experience of DA, barriers to seeking help, and impact on their work. Individual qualitative interviews with female doctors in the UK who had left an abusive relationship. Interviews were conducted between August 2019 and March 2020. Participants were invited via a closed online forum for female doctors who are single parents. In total, 114 females expressed interest. In-depth semi-structured telephone interviews were audiorecorded and transcribed. Transcripts were uploaded to NVivo and analysed using inductive thematic analysis. A total of 21 participants were interviewed. The internalised stigma of DA affected participants' sense of identity and belonging as a doctor, causing social and professional isolation. Many participants felt that the acute stress of DA had an impact on their work, yet often felt unable to take time off. Barriers to seeking help included lack of confidentiality, especially where the abusive partner was also a doctor (sometimes accusing the victim-survivor of mental illness or threatening to report them to the General Medical Council). Participants found peer support helpful, as well as consulting health professionals who were empathic towards them. After they had left the abusive relationship victim-survivors felt better equipped to support patients going through DA. Domestic abuse impacts on the work and wellbeing of female doctors, who face unique barriers to help seeking and reporting DA. An online peer support group can help to break the sense of isolation, but specialised confidential support services are also required to help doctors experiencing DA.

Implementation of Lashkari et al Scheme and Convergent Encryption on Cloud-Based Secure Deduplication Application

The development and growth of data is rapidly increasing and it triggers development on storage technology namely cloud storage. In this research, implementation of Lashkari et al scheme and convergent encryption was conducted on cloud application to provide data confidentiality service and cloud storage space efficiency. Tests were conducted through comparing application that implemented this scheme with application that did not implement scheme within the same condition. Based on statistically significant comparison results, application that implements the scheme reduce 5% of storage space and takes less time for files uploading. Moreover, it can prevent attacker to obtain data illegally by implementing the convergent encryption.

Security risk and response analysis of typical application architecture of information and communication blockchain

As the role of blockchain technology in various industries becomes more and more important, the technical limitations of its consensus mechanism, private key management and smart contracts are gradually emerging. However, security events such as blockchain platform applications are emerging one after another. As a new round of transformative power in the network era, it combines the blockchain with existing technologies to generate new formats and new models. Technology applications and existing cybersecurity regulatory policies have brought new challenges. This paper analyzes the typical application architecture of blockchain technology, and analyzes the security risks of blockchain application architecture from key layers such as storage layer, protocol layer, extension layer, and application layer. This article combines the DOC mechanism with IOT application scenarios to propose a blockchain-based confidential IOT service model (Beekeeper 1.0) that supports first-order homomorphic multiplication, and a blockchain-based confidential IOT service model that supports high-order homomorphic multiplication (Beekeeper 2.0), Beekeeper 2.0 significantly improves Beekeeper 1.0 in server capabilities, verification efficiency, verification key length, and device work diversity. This article finds that the chain code call delay basically increases with the increase in the transaction sending rate. When the transaction sending rate reaches 300TPS, the chain code calling delay only increases a little, and when the transaction sending rate reaches 300TPS, the success rate of the transaction on the chain increases. Finally, the average blockchain access delay increases with the increase in the transaction sending rate. The blockchain access delay is affected by less throughput, and the transaction success rate is stable at 98%.

Challenges of Seeking Reproductive Health Care in People Experiencing Intimate Partner Violence.

Title X is a federally funded family planning initiative that provides low-cost and confidential reproductive health services to its clients. In recent years, Title X has been the subject of debate as its core tenants have been revised by the current administration. Though advocates have fought against these changes, the voices of survivors on intimate partner violence are absent from this conversation. This study was designed to elicit the opinions and experiences on survivors of intimate partner violence on reproductive decision-making, their access to care, and their opinions about political efforts to restrict this access. Twenty-six semi-structured interviews were conducted with women who were seeking services for intimate partner violence. These interviews were audio-recorded, transcribed, and coded. Codes were then organized into themes. Participants endorsed the need for confidential services due to experiences of coercion from their partners and the fear of retaliation against them. Participants largely supported accessible contraception but reported the need for contraception to be reliable. Participants addressed pregnancy and its many complexities and advocated for nondirective options-counseling. Overall, participants spoke about their challenges with reproductive health care and their opinions on how best to service survivors of intimate partner violence. This study asserts the need for advocates for survivors to advocate for the preservation of Title X and establishes the need for future studies on the prevalence of intimate partner violence in Title X clinics.

An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study

Background Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare. Objectives Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT. Design This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed. Setting Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south). Participants In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up. Interventions REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams. Main outcome measures The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)]. Results Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant. Conclusions Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions. Limitations REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited. Trial registration Current Controlled Trials ISRCTN16267685. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Adolescents' right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia.

Confidential counseling is a critical condition of the healthcare quality in adolescent medicine. This study aimed at assessing knowledge, attitudes and practice of primary healthcare pediatricians and gynecologists regarding adolescents' rights to confidentiality. A cross-sectional study was conducted in a sample of 152 pediatricians and gynecologists who are employed at 13 primary healthcare centers in Belgrade, Serbia, in 2017-2018. Data were collected by a self-administered questionnaire purposefully constructed for this study. The questionnaire examined knowledge and attitudes toward adolescents' right to confidentiality as well as whether participating physicians practice confidential health care with adolescents. Physicians scored 4 out of 7 on a knowledge scale, but they overall supported adolescents' right to confidential health care (average attitude score was 71 out of 95). On average, physicians scored 21 out of 30 on practice of confidentiality scale. Multivariate analysis showed that better knowledge and stronger positive attitudes toward duty of confidentiality were associated with consistent practice of confidential health care. Knowledge about adolescents' rights to confidentiality and attitudes toward keeping adolescents' information confidential influence the practice of providing confidential services.

Piloting the UK's First Home-Office-Licensed Pharmacist-Led Drug Checking Service at a Community Substance Misuse Service.

(1) Introduction: Drug-related deaths in the UK are at concerning high levels. The unknown content and purity of illicit substances can cause unpredictable adverse effects and thus a public health risk with no sign of abating. On-site drug checking is a public health strategy that has previously been implemented, predominantly in festival settings, but without Home Office licensing. (2) Aims: The aim of this study was to pilot the UK’s first pharmacist-led, Home Office-licensed community drug checking service. (3) Methods: A bespoke protocol incorporating legally, professionally and ethically binding documents was implemented. This free, confidential service ran between February and March 2019, was available to anyone over 18 who were purposefully recruited, gave informed consent and agreed to relinquish their drug sample. Samples were checked on-site within an established Substance Misuse Service (SMS) using a handheld Raman spectrometer to determine likely drug content and adulterants. In parallel, participants completed a questionnaire about their substance use and the drug sample(s) being tested. A pharmacist-led multidisciplinary approach was adopted to discuss the analytical findings. Informed by the results of the analysis and the questionnaire, people who used the service received tailored harm reduction advice. (4) Results and Discussion: The pilot operated for a total of four days over four weeks. Eleven people visited and relinquished a total of thirteen samples. Half of the participants had previously overdosed and were known to the SMS. Seventy per cent were male, all were White British individuals, 30% were employed and two people disclosed visiting from another nearby town. Samples included what was thought to be heroin, synthetic cannabinoids, stimulants, benzodiazepines and LSD and none required activation of the “alerts cascade” process. Most participants drank alcohol regularly and the concomitant use of traditional illicit drugs and prescribed medication (including opioids, anxiolytics and antidepressants) with sedating profiles was common. Given some of the ethical decisions and interpretation of the results, specialist pharmacist involvement was deemed essential. (5) Conclusions: This pilot demonstrated the proof-of-concept that a pharmacist-led Home Office-licensed drug checking service can be successfully implemented in community SMSs.

Patient acceptance of HIV testing services in rural emergency departments in South Africa.

BackgroundSouth Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs.ObjectivesThis study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies.MethodWe conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented.ResultsAcross sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were ‘does not want to know status’ (37.6%), ‘in too much pain’ (34%) and ‘does not believe they are at risk’ (19.9%).ConclusionsDespite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.

"Obviously there is a conflict between confidentiality and what you are required to do by law": Chilean university faculty and student perspectives on reporting unlawful abortions.

While Chile recently decriminalized abortion in cases of rape, lethal fetal anomaly, and to save a woman's life, most abortions are still criminalized. We assessed medical and midwifery school faculty and students' views on punishing and reporting people involved in unlawful abortion, and their understanding of their obligation to protect patient confidentiality and to report unlawful abortions. We interviewed 30 medical and midwifery school clinician faculty from seven public, private, secular and Catholic-affiliated universities, all located in the metropolitan region of Santiago, Chile. Medical (n=239) and midwifery (n=79) students at these same seven universities completed an online survey. We coded faculty interview transcripts, and analyzed codes related to maintaining patient confidentiality and reporting unlawful abortion. We summarized student views related to reporting and imprisoning people involved in unlawful abortion, and used general estimating equation (GEE) models to identify the factors associated with support for criminalization. Faculty and students generally did not support reporting or imprisoning anyone involved in an unlawful abortion and believed that protecting patient information takes precedence over reporting. Yet, faculty described pressures to report in the public sector and several cases where they or their colleagues were involved in reports. Most students somewhat/strongly agreed (78%) that patient information concerning an unlawful abortion should be kept confidential; 35% strongly/somewhat agreed that a clinician involved in an unlawful surgical abortion should be imprisoned, and 18% agreed that the woman involved should be imprisoned, with students from secular universities being significantly less likely to support reporting and punishing people involved in unlawful abortion, than students from Catholic universities. There is a need to clarify clinicians' ethical obligations in abortion care, in particular in Catholic universities, so that they can ensure that their patients have access to high quality confidential health care services.