BACKGROUND: Approximately 15% of women in low-and middle-income countries experience common perinatal mental disorders. Yet, many women, even if diagnosed with mental health conditions, are untreated due to poor quality care, limited accessibility, limited knowledge, and stigma. This paper describes how mental health-related stigma influences pregnant women\'s decisions not to disclose their conditions and to seek treatment in Vietnam, all of which exacerbate inequitable access to maternal mental healthcare.
METHODS: A mixed-method realist study was conducted, comprising 22 in-depth interviews, four focus group discussions (total participants n = 44), and a self-administered questionnaire completed by 639 pregnant women. A parallel convergent model for mixed methods analysis was employed. Data were analyzed using the realist logic of analysis, an iterative process aimed at refining identified theories. Survey data underwent analysis using SPSS 22 and descriptive analysis. Qualitative data were analyzed using configurations of context, mechanisms, and outcomes to elucidate causal links and provide explanations for complexity.
RESULTS: Nearly half of pregnant women (43.5%) would try to hide their mental health issues and 38.3% avoid having help from a mental health professional, highlighting the substantial extent of stigma affecting health-seeking and accessing care. Four key areas highlight the role of stigma in maternal mental health: fear and stigmatizing language contribute to the concealment of mental illness, rendering it unnoticed; unconsciousness, normalization, and low literacy of maternal mental health; shame, household structure and gender roles during pregnancy; and the interplay of regulations, referral pathways, and access to mental health support services further compounds the challenges.
CONCLUSIONS: Addressing mental health-related stigma could influence the decision of disclosure and health-seeking behaviors, which could in turn improve responsiveness of the local health system to the needs of pregnant women with mental health needs, by offering prompt attention, a wide range of choices, and improved communication. Potential interventions to decrease stigma and improve access to mental healthcare for pregnant women in Vietnam should target structural and organizational levels and may include improvements in screening and referrals for perinatal mental care screening, thus preventing complications.

UNASSIGNED: Culture and stigma-relevant issues discourage transgender individuals in China from gender identity disclosure, which may limit their access to comprehensive health care services. This study evaluates how gender identity disclosure to healthcare professionals would facilitate healthcare services in China.
UNASSIGNED: A cross-sectional study was conducted in nine cities across mainland China from December 2019 to June 2020 among transgender individuals. Participants completed questions covering socio-demographic information, Human Immuno-Deficiency Virus and Sexually Transmitted Infections (HIV/STI) testing habits, sexual risk behaviors, and access to medical and mental health services for the past 3 months.
UNASSIGNED: A total of 277 eligible transgender individuals with a mean age of 29 ± 8 years old completed the survey. Overall, 56.0% (155/277) had disclosed their gender identity to health professionals. 83.9% had ever tested for HIV (with HIV prevalence of 12.9%), 54.2% had tested for STIs, 62.6% had used hormone therapy, and 12.3% had undergone gender-affirming surgery. Multivariable logistic regression showed that participants who had ever disclosed their gender identity to healthcare professionals were more likely to have tested for STIs (aOR = 1.94, 95%CI: 1.12-3.39) and HIV (aOR = 1.72, 95% CI 0.82-3.39), received hormone intervention therapy (aOR = 2.81, 95%CI: 1.56-5.05), and used pre-exposure prophylaxis (PrEP) (aOR= 3.51, 95%CI: 1.12-10.97) compared to non-disclosers.
UNASSIGNED: Our study demonstrated strong correlations between gender identity disclosure and healthcare services usage among Chinese transgender individuals. Facilitating the gender identity disclosure of transgender individuals to healthcare professionals with caution would be useful for improving their access to care.

Given recent congressional interest in codifying price transparency regulations, it is important to understand the extent to which newly available price transparency data capture true underlying procedure-level prices. To that end, we compared the prices for maternity services negotiated between a large payer and 26 hospitals in Mississippi across 2 separate price transparency data sources: payer and hospital. The degree of file overlap is low, with only 16.3% of hospital-billing code observations appearing in both data sources. However, for the observations that overlap, pricing concordance is high: Corresponding prices have a correlation coefficient of 0.975, 77.4% match to the penny, and 84.4% are within 10%. Exact price matching rates are greater than 90% for 3 of the 4 service lines included in this study. Taken together, these results suggest that although administrative misalignment exists between payers and hospitals, there is a measure of signal amid the price transparency noise.

UNASSIGNED: This study examined risk and protective factors in dancers with/without posttraumatic stress disorder (PTSD) and with/without trauma exposure.
UNASSIGNED: Exposure to traumatic events and developing PTSD can compromise daily functioning and performance ability. Despite exposure many dancers adapt, whereas others suffer psychopathology such as depression, anxiety, PTSD, and difficulties regulating emotions.
UNASSIGNED: Two hundred ninety two pre-professional/professional dancers provided informed consent (IRB approved) and completed 8 self-report measures. A subsample (66%) exposed to a significant traumatic event was evaluated for PTSD. Multivariate analyses of covariance (MANCOVA) were conducted to compare dancers with/without PTSD and with/without trauma exposure. A logistic regression analysis determined predictors of PTSD.
UNASSIGNED: The MANCOVAs indicated that dancers exposed to trauma (66%) and who had PTSD (32%) had significantly more difficulty regulating emotions, engaged more emotion-oriented coping under stress, and had increased depression, trait anxiety, and cumulative trauma. In these group comparison analyses there were non-significant differences regarding flow experiences and task- and avoidance-oriented coping strategies. In the logistic regression analysis childhood physical and sexual abuse, childhood emotional neglect, mental illness within the family, and difficulty disclosing abuse experiences were predictors of PTSD. In the total sample 21% had PTSD.
UNASSIGNED: This study identified types of abuse/trauma, emotion regulation/coping, and psychopathology associated with PTSD in dancers exposed to trauma (66%) and with PTSD (32%). In the total sample 21% had PTSD. Regardless of exposure to trauma or PTSD, the non-significant findings indicated similarities for dancers for global and autotelic flow experiences and task- and avoidance-oriented coping strategies. These positive factors may mitigate trauma-related symptoms. It is recommended that dancers, educators, and clinicians understand the effects of trauma exposure and promote the development of effective coping strategies, emotion regulation, and flow states which may diminish the negative effects of PTSD.

Enacted in 2010 as part of the Affordable Care Act, the Physician Payments Sunshine Act (PPSA) mandates transparency in financial interactions between pharmaceutical companies and healthcare providers. This study investigates the PPSA\'s effectiveness and its impact on industry payments to physicians. Utilizing ProPublica and Open Payments databases, a difference-in-difference analysis was conducted across ten states. Results reveal a significant reduction in pharmaceutical companies\' meal-related payments post-PPSA, impacting both the total payment amount and the number of unique physicians reached. Conversely, travel payments showed no significant impact in the primary analysis. However, subsequent analyses revealed nuanced reductions in the number of unique physicians reached, highlighting a more intricate relationship wherein pharmaceutical companies likely adjusted their financial interaction strategies with physicians differently across states. State-level variations in meals further underscore the complexity of PPSA\'s influence. This pioneering research contributes valuable empirical evidence, addressing gaps in prior studies and emphasizing the ongoing need for policy assessment to guide industry-physician relationships.

OBJECTIVE: Enhancing workplace communication and support processes to enable individuals living with disabilities to sustain employment and return to work is a priority for workers, employers, and community stakeholders. The objective of this study was to evaluate a new resource that addresses support challenges, the Job Demands and Accommodation Planning Tool (JDAPT), and assess its use, relevance, and outcomes over a nine-month follow-up period.
METHODS: Workers with physical and mental health/cognitive conditions causing limitations at work were recruited using purposive sampling. Online surveys were administered at baseline (prior to using the JDAPT), and at three and nine months post-baseline. Information was collected on demographics (e.g., age, gender) and work characteristics (e.g., job sector, organization size). Outcomes included assessing JDAPT use and relevance, and changes in self-efficacy, work productivity difficulties, employment concerns, difficulties with job demands, and absenteeism.
RESULTS: Baseline participants were 269 workers (66% women; mean age 41 years) of whom 188 (69.9%) completed all three waves of data collection. Many workers reported using JDAPT strategies at and outside of work, and held positive perceptions of the tool\'s usability, relevance, and helpfulness. There were significant improvements (Time 1-2; Time 1-3) in self-efficacy, perceived work productivity, and absenteeism with moderate to large effect sizes in self-efficacy and productivity (0.46 to 0.78). Findings were consistent across gender, age, health condition, and work context variables.
CONCLUSIONS: The JDAPT can enhance support provision and provide greater transparency and consistency to workplace disability practices, which is critical to creating more inclusive and accessible employment opportunities.

Family reactions to coming out can affect the mental health of individuals who disclose their sexual orientation or gender identity. Therefore, it is important to have an appropriate tool to assess them. The Perceived Parental Reactions Scale (PPRS) assessed perceived parental reactions to the disclosure of gay, lesbian, or bisexual sexual orientation by their children. We adapted the PPRS so that it can be answered by any individual belonging to a sexual or gender minority, and can be answered regarding any member of the family, not just parents. A total of 2627 individuals from Spain participated in this study, with a mean age of 31.59 (SD = 11.26). Participants completed the adapted PPRS questionnaire, now named the Family Reaction to Coming Out (FRCO). The FRCO assessed family reactions when disclosing their sexual orientation or gender identity. The majority of participants identified as cisgender men (47.5%) or cisgender women (44.9%), and as gay/lesbian (51.9%). A one-factor model emerged through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The FRCO displayed excellent internal consistency and demonstrated good levels of invariance for participants\' gender (male vs female vs nonbinary gender), family member\'s gender (male vs female), and type of family member (parents vs other family member). Supporting convergent validity, the FRCO has shown a positive correlation with fear of family reaction to coming out. These findings support the validity and reliability of the FRCO tool in assessing the reactions of any family member within the Spanish context.

OBJECTIVE: The main objective of this study was twofold: to investigate what kind of information patients with heart failure (HF) tell their doctors about their medication adherence at home, and how often such information is provided in consultations where medication reconciliation is recommended. To meet these objectives, we developed an analysis to recognise, define, and count (1) patient utterances including medication adherence disclosures in clinical interactions (MADICI), (2) MADICI including red-flags for non-adherence, and (3) MADICI initiated by patients without prompts from their doctor.
METHODS: Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient-doctor consultations, audio-recorded at three time-points for each patient: (1) first ward visit in hospital, (2) discharge visit from hospital, and (3) follow-up visit with general practitioner (GP).
METHODS: Norway (2022-2023).
METHODS: 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs).
RESULTS: We recognised MADICI by two criteria: (1) they are about medication prescribed for use at home, AND (2) they involve patients\' action, experience, or stance regarding medications. Using these criteria, we identified 427 MADICIs in 25 patient trajectories: 143 (34%) at first ward visit (min-max=0-35, median=3), 57 (13%) at discharge visit (min-max=0-8, median=2), 227 (53%) at GP-visit (min-max=2-24, median=7). Of 427 MADICIs, 235 (55%) included red-flags for non-adherence. Bumetanide and atorvastatin were most frequently mentioned as problematic. Patients initiated 146 (34%) of 427 MADICIs. Of 235 \'red-flag MADICIs\', 101 (43%) were initiated by patients.
CONCLUSIONS: Self-managing older patients with HF disclosed information about their use of medications at home, often including red-flags for non-adherence. Patients who disclosed information that signals adherence problems tended to do so unprompted. Such disclosures generate opportunities for doctors to assess and support patients\' medication adherence at home.

Sharing experiences with racism (racial discrimination disclosure) has the power to raise awareness of discrimination and spur meaningful conversations about race. Sharing these experiences with racism on social media may prompt a range of responses among users. While previous work investigates how disclosure impacts disclosers and listeners, we extend this research to explore the impact of observing discussions about racial discrimination online-what we call vicarious race talk. In a series of experiments using real social media posts, we show that the initial response to racial discrimination disclosure-whether the response denies or validates the poster\'s perspective-influences observers\' own perceptions and attitudes. Despite observers identifying denial as less supportive than validation, those who observed a denial response showed less responsive attitudes toward the poster/target (Studies 1-3) and less support for discussions about discrimination on social media in general (Studies 2-3). Exploratory findings revealed that those who viewed denial comments also judged the transgressor as less racist, and expressed less support and more denial in their own comments. This suggests that even as observers negatively judge denial, their perceptions of the poster are nonetheless negatively influenced, and this impact extends to devaluing the topic of discrimination broadly. We highlight the context of social media, where racial discrimination disclosure-and how people respond to it-may be particularly consequential.

UNASSIGNED: Despite the recognized value of experiential knowledge, drug use and disclosure of drug use within the drug research community is rarely discussed or studied.
UNASSIGNED: We distributed a cross-sectional online survey using targeted recruitment. Researchers provided information on drug use, disclosure of use (or abstinence) professionally, and their impact via write-in text boxes. We used the general inductive approach to analyze the data.
UNASSIGNED: Of the sample (n=669, 43 countries), 52 % were cisgender women, 89 % had post-graduate education, and 79 % worked in academia. Most (86 %) reported lifetime drug use and 47 % past 3-month use. Among 557 researchers who used drugs, 59 % disclosed their use to institutional colleagues, 59 % to colleagues outside their institution, 25 % to research participants, and 11 % in their research/scholarship. Themes included frequency; context; meaning of drug use disclosure personally, professionally, and socially; and how drug use experience and disclosure informs research. Respondents connected their concerns about disclosure in research with issues of social identity, professional risk, and the role of stigma related to lived experience. Some respondents felt that such concerns reinforce a vacuum, noting that the inability to disclose drug use limits research questions and the knowledge base overall.
UNASSIGNED: Our findings support the dichotomy of thought surrounding the lived experience of drug use: \"[They\'ve] used drugs- [they\'re] biased!\" and \"[They\'re] not a drug user-what would [they] know!\" Our findings provide an opportunity to reflect upon our positionality and the impact researchers\' own drug use may have on the field.