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Isotretinoína , Médicos , Humanos , Isotretinoína/efectos adversos , Wisconsin , Confidencialidad , AnticoncepciónRESUMEN
Patient autonomy as a fundamental principle of modern bioethics is considered in the context of the legal status of a minor in medical law. The authors discuss the specifics of the autonomy of a minor patient, which is determined by the age factor. The following international legal standards defining the bioethical foundations of the legal status of a minor in the medical field are considered: the right to informed voluntary consent, the right to information and confidentiality. The content of the legal concept of “autonomy of a minor patient” is revealed. The autonomy of a minor patient is considered by the authors as the ability to act and make health-related decision independently, and is presented in several aspects: first, the ability to seek medical help; second, the right to provide information in an accessible form; third, the right to decide on consent or refusal of medical intervention; fourth, the right to confidentiality. Foreign experience is provided and features of fixing the principle of autonomy of a minor in Russian legislation in the field of health care are analyzed. Main problems of implementing of the principle of patient autonomy and directions for further research in this area are outlined.
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Bioética , Autonomía Personal , Humanos , Consentimiento Informado , Confidencialidad , InternacionalidadRESUMEN
What is the value of confidentiality? Russian society faced this issue in 2020, when minors aged 15 to 18 lost their privacy. The amendment to the Federal Law, caused the situation, was received ambiguously, but quickly ceased to be the subject of public discussion. In my article, I study this event in a bioethical context, considering the topics of privacy, autonomy and relativity. Social discussion was not productive, since the arguments of both sides contained a double-edged argument: depending on existing relations in a family, the amendment will have a positive or negative meaning. By pointing out all the weaknesses of this shift in emphasis to relationships (that also implies the uselessness of the concept of relational autonomy here), I designate a real problem. A conflict situation has evolved both within bioethical principles and within the single principle – respect for autonomy. Due to the lack of confidentiality, the opportunity to act according to one’s own personal plan, presupposed by informed consent, is devalued. Autonomy turns out to be incomplete, twofold: it exists only for onetime decisions, and it is not in the long-term perspective because of a possibility of interference by others (parents, guardians) in this decision-making process. Since such criteria of autonomous action as intentionality and noncontrol may be violated, the autonomy of minors becomes contradictory. To avoid this, the autonomy should be either established as partial, or, by insisting on the return of confidentiality back to minors of the specified age, restored as full. Partial autonomy is a paradox, and a teenager should be endowed with what I call, considering the age criteria, the “presumption of autonomy”. If we do not give up autonomy completely, then we must restore its context consistently and non-contradictory: the ability of minors of this age category to make medically significant decisions requires the restoration of confidentiality and vice versa. Additionally, I investigate privacy’s impact on confidentiality: in Russian bioethics and medical practice, privacy is not considered as a source of other rights, the initial principle organizing the discourse.
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Confidencialidad , Menores , Adolescente , Humanos , Consentimiento Informado , Privacidad , Federación de RusiaRESUMEN
Healthcare longitudinal data collected around patients' life cycles, today offer a multitude of opportunities for healthcare transformation utilizing artificial intelligence algorithms. However, access to "real" healthcare data is a big challenge due to ethical and legal reasons. There is also a need to deal with challenges around electronic health records (EHRs) including biased, heterogeneity, imbalanced data, and small sample sizes. In this study, we introduce a domain knowledge-driven framework for generating synthetic EHRs, as an alternative to methods only using EHR data or expert knowledge. By leveraging external medical knowledge sources in the training algorithm, the suggested framework is designed to maintain data utility, fidelity, and clinical validity while preserving patient privacy.
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Inteligencia Artificial , Registros Electrónicos de Salud , Humanos , Confidencialidad , AlgoritmosRESUMEN
Synthetic data generation can be applied to Electronic Health Records (EHRs) to obtain synthetic versions that do not compromise patients' privacy. However, the proliferation of synthetic data generation techniques has led to the introduction of a wide variety of methods for evaluating the quality of generated data. This makes the task of evaluating generated data from different models challenging as there is no consensus on the methods used. Hence the need for standard ways of evaluating the generated data. In addition, the available methods do not assess whether dependencies between different variables are maintained in the synthetic data. Furthermore, synthetic time series EHRs (patient encounters) are not well investigated, as the available methods do not consider the temporality of patient encounters. In this work, we present an overview of evaluation methods and propose an evaluation framework to guide the evaluation of synthetic EHRs.
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Confidencialidad , Registros Electrónicos de Salud , Humanos , ConsensoRESUMEN
This study explored adolescent perspectives on school-based health center (SBHC) services and how services differed from school nurses and community agencies. Six focus groups were conducted with adolescents, 13-19 years old, as part of a larger mixed-methods study. Data were analyzed for themes using content analysis. Adolescents (N = 30) described the accessibility, positive attitude of staff, competence of the nurse practitioner, confidentiality/privacy, and trusted relationships with staff as important aspects of SBHC care. SBHC services allowed adolescents to stay in school, provided confidentiality/privacy, were comfortable and convenient, fostered their independence, and adolescents felt SBHC staff knew them and they did not feel like strangers. SBHCs are adolescent-friendly resources that maximize school time and an important source for contraception, sexually transmitted infection testing, and mental health care. Additionally, SBHC services help support adolescents' transition from pediatric to adolescent-focused care and foster their growing self-awareness and empowerment related to their engagement in health care services.
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Servicios de Salud del Adolescente , Servicios de Enfermería Escolar , Humanos , Adolescente , Niño , Adulto Joven , Adulto , Servicios de Salud Escolar , Grupos Focales , ConfidencialidadRESUMEN
Classification of viral strains is essential in monitoring and managing the COVID-19 pandemic, but patient privacy and data security concerns often limit the extent of the open sharing of full viral genome sequencing data. We propose a framework called CoVnita, that supports private training of a classification model and secure inference with the same model. Using genomic sequences from eight common SARS-CoV-2 strains, we simulated scenarios where the data was distributed across multiple data providers. Our framework produces a private federated model, over 8 parties, with a classification AUROC of 0.99, given a privacy budget of [Formula: see text]. The roundtrip time, from encryption to decryption, took a total of 0.298 s, with an amortized time of 74.5 ms per sample.
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COVID-19 , Privacidad , Humanos , SARS-CoV-2/genética , Pandemias , COVID-19/epidemiología , Confidencialidad , Seguridad ComputacionalRESUMEN
This article presents the decryption, historical analysis, and alchemical interpretation of an alchemical cipher found in a shared notebook of John and Arthur Dee (British Library MS Sloane 1902). The cipher is an early example of a Bellaso/Della Porta/Vigenère type, a strong encryption method which was historically deemed indecipherable. The essay explores the medical and alchemical context for the manuscript into which the cipher was copied and provides the transcription, plaintext solution (in Latin), and English translation of the encrypted text. Further, it interprets the enciphered text through the lens of alchemical practice and provides evidence for the dissemination of this cipher as part of a larger alchemical knowledge network.
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Alquimia , Confidencialidad , ConocimientoRESUMEN
The objective of the study is to identify challenges and associated factors for privacy and security related to telehealth visits during the COVID-19 pandemic. The systematic search strategy used the databases of PubMed, ScienceDirect, ProQuest, Embase, CINAHL, and COCHRANE, with the search terms of telehealth/telemedicine, privacy, security, and confidentiality. Reviews included peer-reviewed empirical studies conducted from January 2020 to February 2022. Studies conducted outside of the US, non-empirical, and non-telehealth related were excluded. Eighteen studies were included in the final analysis. Three risk factors associated with privacy and security in telehealth practice included: environmental factors (lack of private space for vulnerable populations, difficulty sharing sensitive health information remotely), technology factors (data security issues, limited access to the internet, and technology), and operational factors (reimbursement, payer denials, technology accessibility, training, and education). Findings from this study can assist governments, policymakers, and healthcare organizations in developing best practices in telehealth privacy and security strategies.
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COVID-19 , Telemedicina , Humanos , Privacidad , Pandemias/prevención & control , Confidencialidad , Factores de RiesgoRESUMEN
Providing medical care and managing the health care needs of adolescents can be a complex process. Knowing, which adolescents can consent to health care and the scope of services adolescents can consent to, what information can be kept confidential and from whom, under which circumstances information must be disclosed, and how to navigate parental involvement, is vital for the practice of adolescent medicine. This chapter aims to address some of these issues and assist health care providers in gaining knowledge and expertise in the optimal delivery of care for adolescents.
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Medicina del Adolescente , Adolescente , Humanos , ConfidencialidadRESUMEN
The conduct of prospective studies on large numbers and with the support of banks of biological samples has been strongly influenced by the increasingly restrictive evolution of laws and regulations enacted to protect the privacy of study participants, often with significant repercussions in terms of delayed achievement of results and increased consumption of human and financial resources. A brief summary of the effects of this evolution on Italian studies in recent decades is reported, along with a reflection on possible solutions.
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Confidencialidad , Privacidad , Humanos , Estudios ProspectivosRESUMEN
BACKGROUND: The 21st Century Cures Act information blocking final rule mandated the immediate and electronic release of health care data in 2020. There is anecdotal concern that a significant amount of information is documented in notes that would breach adolescent confidentiality if released electronically to a guardian. OBJECTIVES: The purpose of this study was to quantify the prevalence of confidential information, based on California laws, within progress notes for adolescent patients that would be released electronically and assess differences in prevalence across patient demographics. METHODS: This is a single-center retrospective chart review of outpatient progress notes written between January 1, 2016, and December 31, 2019, at a large suburban academic pediatric network. Notes were labeled into one of three confidential domains by five expert reviewers trained on a rubric defining confidential information for adolescents derived from California state law. Participants included a random sampling of eligible patients aged 12 to 17 years old at the time of note creation. Secondary analysis included prevalence of confidentiality across age, gender, language spoken, and patient race. RESULTS: Of 1,200 manually reviewed notes, 255 notes (21.3%) (95% confidence interval: 19-24%) contained confidential information. There was a similar distribution among gender and age and a majority of English speaking (83.9%) and white or Caucasian patients (41.2%) in the cohort. Confidential information was more likely to be found in notes for females (p < 0.05) as well as for English-speaking patients (p < 0.05). Older patients had a higher probability of notes containing confidential information (p < 0.05). CONCLUSION: This study demonstrates that there is a significant risk to breach adolescent confidentiality if historical progress notes are released electronically to proxies without further review or redaction. With increased sharing of health care data, there is a need to protect the privacy of the adolescents and prevent potential breaches of confidentiality.
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Confidencialidad , Privacidad , Femenino , Humanos , Adolescente , Niño , Prevalencia , Estudios Retrospectivos , Instituciones de SaludRESUMEN
Most existing secure biometric authentication schemes are server-centric, and users must fully trust the server to store, process, and manage their biometric data. As a result, users' biometric data could be leaked by outside attackers or the service provider itself. This paper first constructs the EDZKP protocol based on the inner product, which proves whether the secret value is the Euclidean distance of the secret vectors. Then, combined with the Cuproof protocol, we propose a novel user-centric biometric authentication scheme called BAZKP. In this scheme, all the biometric data remain encrypted during authentication phase, so the server will never see them directly. Meanwhile, the server can determine whether the Euclidean distance of two secret vectors is within a pre-defined threshold by calculation. Security analysis shows BAZKP satisfies completeness, soundness, and zero-knowledge. Based on BAZKP, we propose a privacy-preserving biometric authentication system, and its evaluation demonstrates that it provides reliable and secure authentication.
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Identificación Biométrica , Telemedicina , Privacidad , Algoritmos , Seguridad Computacional , Identificación Biométrica/métodos , Biometría , ConfidencialidadRESUMEN
INTRODUCTION: Patient safety maintenance and improvement is an expected core function of Hospital Information Systems (HISs). Patient safety can be affected by the privacy, confidentiality, and security of patient information. This study aimed to evaluate the security, confidentiality, privacy, and patient safety in the HISs from the users' perspective. METHODS: A descriptive, analytical, cross-sectional study was conducted in five teaching hospitals affiliated with Zahedan University of Medical Sciences in 2022. The research population consisted of users of HISs in the nursing, medical records, radiology, laboratory, and pharmacy departments. The sample included 397 participants. The data were collected using a researcher-made questionnaire and analyzed with the SPSS software using descriptive (mean, standard deviation, frequency, and percentage) and analytical (Pearson, Spearman, and chi-square tests) statistics. RESULTS: The mean score of patient information privacy, confidentiality, security, and patient safety was 3.19 ± 0.585, 2.48 ± 1.143, 2.53 ± 0.940, and 2.60 ± 0.959, respectively. Patient safety had a strong positive correlation with security and confidentiality, and a moderate positive correlation with patient information privacy (P < 0.05). CONCLUSION: The given HISs were at a relatively desirable level in terms of information privacy, security, and patient safety and at an undesirable level concerning confidentiality from the users' perspective. Developing guidelines and regulations regarding the privacy, confidentiality, security, and patient safety of HISs, supervising their implementation by responsible agencies and departments, and educating and training healthcare professionals about these concepts are essential to improve the existing situation in HISs of the evaluated hospitals.
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Sistemas de Información en Hospital , Privacidad , Humanos , Estudios Transversales , Seguridad del Paciente , Seguridad Computacional , Confidencialidad , Encuestas y CuestionariosRESUMEN
Having secrets is incredibly common. However, secrecy has only recently started to receive more attention in research. What has largely been neglected are the consequences of secret-sharing for the relationship between sharer and receiver; a gap we aim to fill in this project. Previous research has shown that closeness can make secret-sharing more likely. Building on research from the self-disclosure and relationship literature, we experimentally investigate in three studies (N = 705) whether confiding a secret to somebody might in turn increase perceptions of closeness. In addition, we test whether the valence of the secrets moderates the hypothesized effect. While confiding negative secrets might signal a high level of trust and lead to a similar closeness as confiding positive secrets, they might also present a burden to the receiver and lead to a different pattern of closeness. To provide a holistic picture, we build on a variety of methods and investigate three perspectives: Study 1 focused on the receiver and showed that another person sharing secrets (vs. nonconfidential information) decreased the distance in the eyes of the receiver. Study 2 tested how an observer perceives the relationship between two people. Distance was judged to decrease when secrets (vs. nonconfidential information) were shared, however, this difference was not significant. Study 3 tested whether lay theories about sharing secrets predict behavior, and how sharing information may be used to change perceived distance on the receiver's side. Participants preferred to share neutral compared to secret information and positive compared to negative secrets irrespective of the distance condition. Our results contribute to the understanding of how sharing secrets affects the way individuals think about each other, how close they feel to each other, and how they interact with each other.
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Confidencialidad , Autorrevelación , Humanos , Emociones , Confianza , Secreciones CorporalesRESUMEN
Ensuring the confidentiality and protection of health information is the standard of care for adolescents. In 2023 and beyond, the protection of personal health information is more critical than ever. The 21st Century Cures Act Office of the National Coordinator for Health Information Technology Rule, with its requirements for the broad sharing of electronic health information and ban on "information blocking," poses serious concerns for confidentiality in adolescent health care delivery. The coronavirus disease 2019 pandemic has rapidly increased the use of telehealth and, thereby, patient portal use for adolescent health records, increasing risks for disclosure. Understanding the legal and clinical underpinnings for confidential adolescent health services and the clinical challenges and health information technology limitations presented by the Office of the National Coordinator for Health Information Technology Rule is key to providing quality adolescent health services while implementing the Rule. A framework is presented to facilitate decision-making in individual cases by clinicians.
