Antiretroviral therapy (ART) started to become more widely available in Vietnam in 2005. However, up to now, very little is known about factors influencing ART adherence among people living with HIV (PLHIV) in Vietnam. This qualitative study aimed to describe factors influencing ART adherence among PLHIV in a northern province in Vietnam, and to explore possibilities of home delivery of ART. Forty-eight participants (36 men and 12 women), including patients on ART and their relatives, were divided in seven focus group discussions. The topics discussed included: adherence obstacles encountered during ART, methods patients used to enhance adherence, treatment support structures, and attitudes toward home delivery of ART. All interviews were audio-recorded, then transcribed in Vietnamese. Manual manifest and latent content analysis was applied for data analysis in order to elucidate the presence of, meaning of, and relationships between concepts in the text. Stigma was identified as a strong barrier...

"It is not that I forget, it's just that I don't want other people to know": barriers to and strategies for adherence to antiretroviral therapy among HIV patients in Northern Vietnam.

Academic journals in a specialist field provide an interesting historical record of its development and progression over time. This article describes the evolution of some major international journals of occupational medicine, including some historical background on their editorial board. As North America, the United Kingdom, and Northern Europe are known to have the highest contribution to scientific production, it was considered appropriate to investigate the main occupational medicine periodicals in these regions. Given the remarkable improvements in Japanese occupational health following the Second World War, it was also considered worthwhile to investigate the two English-language journals of occupational medicine from this country.

https://www.tandfonline.com/doi/pdf/10.1080/19338240903284672

The Historical Development of Academic Journals in Occupational Medicine, 1901–2009

Background Despite the human and monetary costs of occupational injury and illness, occupational health care has focused more on treatment than prevention, and prevention is not part of many clinical occupational health practices. This represents a failure of occupational health care to meet the health care needs of the working patients. Methods MEDLINE searches were conducted for literature on occupational medical treatment and the prevention of occupational injury and illness were reviewed to for linkages between prevention and treatment. Policy discussions which identify examples of programs that integrated prevention and treatment were included. Results Although examples of the integration of clinical and preventive occupational health services exist, there are challenges and barriers to such integration. These include inaction by clinicians who do not recognize their potential role in prevention; the absence of a relationship between the clinician and an employer willing to participate in prevention; economic disincentives against prevention; and the absence of tools that evaluate clinicians on their performance in prevention. Conclusions Research is needed to improve and promote clinical occupational health preventive services.

Integrating occupational health services and occupational prevention services

Many psychiatrists believe that there is little or no liability associated with conducting examinations at the request of a third party or with providing testimony in civil litigation. Case law has demonstrated otherwise. Psychiatrists conducting independent medical examinations (IMEs) may be vulnerable to tort lawsuits by either the evaluee or the third party who commissions the IME. In addition, breaches of legal or ethical conduct can lead to disciplinary action by state medical boards and professional organizations. Although immunity for certain types of forensic activities is available, such immunity is qualified and may not be applicable to evaluations and related testimony conducted for third parties. Understanding the liability associated with third-party evaluations will assist psychiatrists in minimizing their exposure.

http://jaapl.org/content/jaapl/35/2/200.full.pdf

Do you understand your risk? Liability and third-party evaluations in civil litigation.

Since the onset of the HIV epidemic, AIDS and HIV infection have presented tremendous challenges to infected individuals seeking to remain productive in the workplace, to employers coping with the special needs of such individuals, and to physicians who treat and counsel exposed or infected personnel. OEM physicians should strive to ensure that employers are familiar with legislation and guidelines protecting the rights of infected employees, and they should support rational workplace policies applying to employees with HIV infection or AIDS. When the potential for occupational HIV exposure exists, OEM physicians should ensure that adequate training around exposure prevention, triage, and treatment is provided. OEM physicians who treat individuals with occupational HIV exposures should involve themselves in institutional efforts to prevent exposures through the use of safer devices and procedures, and they should ensure that immediate and adequate clinical evaluation of exposures is available at all times.

HIV and AIDS in the workplace.

Ethical dilemmas involving confidentiality issues are frequently encountered in occupational medicine. The occupational physician faces a unique challenge because in many circumstances, a physicianpatient relationship, in the ordinary or legal sense, may not exist. The occupational physician ofien faces a conflicting interest between the employee's desire for privacy and the employer's legitimate need to know. The occupational physician must carefully balance these interests for the benefit of society and the parties involved. Occupational physicians also work in a wide variety of practice situations, and the ethical and legal duty of confidentiality may vary substantially with these roles. This article provides an overview of the ethical and legal requirements of confidentiality in the workplace. The constitutional, statutory, and common law framework governing the treatment of employee medical information, as well as defenses to liability, are discussed. Recent legislative changes such as the Americans with Disabilities Act, and new challenges such as the proper handling of HIV information, present unique confidentiality problems.

Mary Sue Wester

Papers

ACOEM position on the confidentiality of medical information in the workplace

Commentaries on the Code of Ethical Conduct. I

Ethics, Occupational Medicine and ACOEM Reply