Using Technology to Enhance Community Health and Territorial Resources Access.

Improving access to health information and territorial resources can be a way to help strengthen health-related quality of life perception in disadvantaged communities. We argue that, in countries facing diverse economic and social disparities and challenges, technology can be leveraged to improve communities' access to evidence-based, up-to-date, comprehensive, and culturally appropriate supportive territorial resources, thereby improving individuals' quality of life, especially for those living with one or more chronic diseases. This paper discusses the benefits of introducing and designing a user-friendly, relevant, and effective web-based technology to broaden patients' access to healthcare resources and tailored health information, supporting community-based quality of life transformation.

Economic Impact of a Hospital Cyberattack in a National Health System: Descriptive Case Study.

BACKGROUND: Over the last decade, the frequency and size of cyberattacks in the health care industry have increased, ranging from breaches of processes or networks to encryption of files that restrict access to data. These attacks may have multiple consequences for patient safety, as they can, for example, target electronic health records, access to critical information, and support for critical systems, thereby causing delays in hospital activities. The effects of cybersecurity breaches are not only a threat to patients' lives but also have financial consequences due to causing inactivity in health care systems. However, publicly available information on these incidents quantifying their impact is scarce. OBJECTIVE: We aim, while using public domain data from Portugal, to (1) identify data breaches in the public national health system since 2017 and (2) measure the economic impact using a hypothesized scenario as a case study. METHODS: We retrieved data from multiple national and local media sources on cybersecurity from 2017 until 2022 and built a timeline of attacks. In the absence of public information on cyberattacks, reported drops in activity were estimated using a hypothesized scenario for affected resources and percentages and duration of inactivity. Only direct costs were considered for estimates. Data for estimates were produced based on planned activity through the hospital contract program. We use sensitivity analysis to illustrate how a midlevel ransomware attack might impact health institutions' daily costs (inferring a potential range of values based on assumptions). Given the heterogeneity of our included parameters, we also provide a tool for users to distinguish such impacts of different attacks on institutions according to different contract programs, served population size, and proportion of inactivity. RESULTS: From 2017 to 2022, we were able to identify 6 incidents in Portuguese public hospitals using public domain data (there was 1 incident each year and 2 in 2018). Financial impacts were obtained from a cost point of view, where estimated values have a minimum-to-maximum range of €115,882.96 to €2,317,659.11 (a currency exchange rate of €1=US $1.0233 is applicable). Costs of this range and magnitude were inferred assuming different percentages of affected resources and with different numbers of working days while considering the costs of external consultation, hospitalization, and use of in- and outpatient clinics and emergency rooms, for a maximum of 5 working days. CONCLUSIONS: To enhance cybersecurity capabilities at hospitals, it is important to provide robust information to support decision-making. Our study provides valuable information and preliminary insights that can help health care organizations better understand the costs and risks associated with cyber threats and improve their cybersecurity strategies. Additionally, it demonstrates the importance of adopting effective preventive and reactive strategies, such as contingency plans, as well as enhanced investment in improving cybersecurity capabilities in this critical area while aiming to achieve cyber-resilience.

Unsupervised algorithms to identify potential under-coding of secondary diagnoses in hospitalisations databases in Portugal.

BACKGROUND: Quantifying and dealing with lack of consistency in administrative databases (namely, under-coding) requires tracking patients longitudinally without compromising anonymity, which is often a challenging task. OBJECTIVE: This study aimed to (i) assess and compare different hierarchical clustering methods on the identification of individual patients in an administrative database that does not easily allow tracking of episodes from the same patient; (ii) quantify the frequency of potential under-coding; and (iii) identify factors associated with such phenomena. METHOD: We analysed the Portuguese National Hospital Morbidity Dataset, an administrative database registering all hospitalisations occurring in Mainland Portugal between 2011-2015. We applied different approaches of hierarchical clustering methods (either isolated or combined with partitional clustering methods), to identify potential individual patients based on demographic variables and comorbidities. Diagnoses codes were grouped into the Charlson an Elixhauser comorbidity defined groups. The algorithm displaying the best performance was used to quantify potential under-coding. A generalised mixed model (GML) of binomial regression was applied to assess factors associated with such potential under-coding. RESULTS: We observed that the hierarchical cluster analysis (HCA) + k-means clustering method with comorbidities grouped according to the Charlson defined groups was the algorithm displaying the best performance (with a Rand Index of 0.99997). We identified potential under-coding in all Charlson comorbidity groups, ranging from 3.5% (overall diabetes) to 27.7% (asthma). Overall, being male, having medical admission, dying during hospitalisation or being admitted at more specific and complex hospitals were associated with increased odds of potential under-coding. DISCUSSION: We assessed several approaches to identify individual patients in an administrative database and, subsequently, by applying HCA + k-means algorithm, we tracked coding inconsistency and potentially improved data quality. We reported consistent potential under-coding in all defined groups of comorbidities and potential factors associated with such lack of completeness. CONCLUSION: Our proposed methodological framework could both enhance data quality and act as a reference for other studies relying on databases with similar problems.

Impact of multimorbidity patterns in hospital admissions: the case study of asthma.

Background: Most previous studies assessing multimorbidity in asthma assessed the frequency of individual comorbid diseases. Objective: We aimed to assess the frequency and clinical and economic impact of co-occurring groups of comorbidities (comorbidity patterns using the Charlson Comorbidity Index) on asthma hospitalizations. Methods: We assessed the dataset containing a registration of all Portuguese hospitalizations between 2011-2015. We applied three different approaches (regression models, association rule mining, and decision trees) to assess both the frequency and impact of comorbidities patterns in the length-of-stay, in-hospital mortality and hospital charges. For each approach, separate analyses were performed for episodes with asthma as main and as secondary diagnosis. Separate analyses were performed by participants' age group. Results: We assessed 198340 hospitalizations in patients >18 years old. Both in hospitalizations with asthma as main or secondary diagnosis, combinations of diseases involving cancer, metastasis, cerebrovascular disease, hemiplegia/paraplegia, and liver disease displayed a relevant clinical and economic burden. In hospitalizations having asthma as a secondary diagnosis, we identified several comorbidity patterns involving asthma and associated with increased length-of-stay (average impact of 1.3 [95%CI=0.6-2.0]-3.2 [95%CI=1.8-4.6] additional days), in-hospital mortality (OR range=1.4 [95%CI=1.0-2.0]-7.9 [95%CI=2.6-23.5]) and hospital charges (average additional charges of 351.0 [95%CI=219.1-482.8] to 1470.8 [95%CI=1004.6-1937.0]) Euro compared with hospitalizations without any registered Charlson comorbidity). Consistent results were observed with association rules mining and decision tree approaches. Conclusions: Our findings highlight the importance not only of a complete assessment of patients with asthma, but also of considering the presence of asthma in patients admitted by other diseases, as it may have a relevant impact on clinical and health services outcomes.

Control of Allergic Rhinitis and Asthma Test: A systematic review of measurement properties and COSMIN analysis.

The Control of Allergic Rhinitis and Asthma Test (CARAT) is a patient-reported outcome measurement (PROM) assessing the control of asthma and allergic rhinitis (AR) at a 4 week interval. This systematic review aimed to evaluate the measurement properties of CARAT. Following PRISMA and COSMIN guidelines, we searched five bibliographic databases and retrieved studies concerning the development, assessment of properties, validation, and/or cultural adaption of CARAT. The studies' methodological quality, the quality of measurement properties, and the overall quality of evidence were assessed. We performed meta-analysis of CARAT measurement properties. We included 16 studies. Control of Allergic Rhinitis and Asthma Test displayed sufficient content validity and very good consistency (meta-analytical Cronbach alpha = 0.83; 95% CI = 0.80-0.86;I2  = 62.6%). Control of allergic rhinitis and Asthma Test meta-analytical intraclass correlation coefficient was 0.91 (95% CI = 0.64-0.98;I2  = 93.7%). It presented good construct validity, especially for correlations with Patient-reported outcome measures assessing asthma (absolute Spearman correlation coefficients range = 0.67-0.73; moderate quality of evidence), and good responsiveness. Its minimal important difference is 3.5. Overall, CARAT has good internal consistency, reliability, construct validity and responsiveness, despite the heterogeneous quality of evidence. Control of Allergic Rhinitis and Asthma Test can be used to assess the control of asthma and AR. As first of its kind, this meta-analysis of CARAT measurement properties sets a stronger level of evidence for asthma and/or AR control questionnaires.

Using Digital Technologies in Response to the COVID-19 Pandemic in Portugal.

Digital technologies revolutionized the way we dealt with the COVID-19 pandemic and outstood the obvious societal change in the information age. Currently, data are an essential element of any health institution. Their use has the potential to radically reduce the cost and time needed to strengthen scientific evidence on the effectiveness of interventions. Likewise, information and the potential of these technologies have become a crucial part of the response to the pandemic. Effective implementation of data management strategies has depended on the adoption of digital technologies and their integration with health policies and care systems. In August 2020, Nature Medicine published an article about technological maturity and digital responses in the context of the COVID-19 pandemic. This paper aims to provide a contextualization of the technologies adopted in Portugal in the current crisis while highlighting, when applicable, requirements, potentials, constraints and aspects of possible improvements. The digital maturity of health services is a gradual process that requires preparation, adaptation and response. The future of public health and health care systems will be increasingly digital, and it is necessary to promote a culture of innovation, coordinate and standardize processes and make room for a new paradigm of sustainable digital transformation.

As tecnologias digitais revolucionaram a forma como lidamos com a pandemia da COVID-19, tornando-se evidente a mudança de toda a sociedade na era da informação. Atualmente, os dados são um elemento essencial de qualquer instituição de saúde. O seu uso tem o potencial de reduzir radicalmente o custo e o tempo necessários para fundamentar evidência científica sobre a eficácia das intervenções. Da mesma forma, a informação e potencial tecnológico tornaram-se parte crucial da resposta à pandemia e a implementação eficaz de estratégias de gestão de dados dependeu da adoção de tecnologias digitais e a sua integração com as políticas e cuidados de saúde. Em agosto de 2020, a Nature Medicine publicou um artigo sobre situação de maturidade tecnológica e respostas digitais no contexto da pandemia de COVID-19. Neste sentido, pretendemos contextualizar as tecnologias adoptadas em Portugal na situação de crise atual, realçando, quando aplicável, os requisitos, potenciais, constrangimentos e aspetos de possíveis melhorias. A maturidade digital envolve congruência, preparação, capacidade, infraestrutura e planeamento estratégico com foco nos resultados de saúde. O futuro da saúde pública, e dos sistemas e cuidados de saúde será cada vez mais digital, pelo que, é necessário promover uma cultura de inovação, com processos coordenados e padronizados e criando espaço para um novo paradigma de transformação digital sustentável. © 2022 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.

Instrumental Activities of Daily Living (iADL) Limitations in Europe: An Assessment of SHARE Data.

This study aims to evaluate the instrumental activities of daily living (iADLs) limitations in Europe and its association with socio-demographic characteristics, economic parameters and physical and mental health status. We used data from the wave 6 of SHARE database. Individuals were classified as having either none or one or more limitations on iADLs. Participants aged 65 or more years who answered all questions for the variables included in this work were selected. A total of 54.8% of participants were female and had a mean age of 74.37 (SD = 7.08) years. A global prevalence of 1 or more iADLs in Europe was shown to be 23.8% and more prevalent in women than in men (27.1% vs. 17.6%) and in people aged 85 years or more (51.5%). Older age, female gender, lower education, physical inactivity, frailty, having two or more chronic diseases, presence of depression, polypharmacy, poor self-perception of health and lower network satisfaction were found to be factors associated with the presence of 1 or more iADLs limitation. This study highlights the burden of iADLs limitations at the European level. These are based on a multidimensional biopsychosocial model and are associated with both health conditions and environmental factors. This intersection between the physical and social world underscores its potential as a health indicator and can, to some extent, explain some of the pronounced differences seen among European countries. Different inter-tasks can also stress different dimensions of health indicators in distinct and specific groups of individuals. Minimizing the impact of iADL limitations can improve the quality and sustainability of public health systems.

[A New Paradigm in Health Research: FAIR Data (Findable, Accessible, Interoperable, Reusable)]. / Um Novo Paradigma em Investigação em Saúde: Dados FAIR (Localizáveis, Acessíveis, Interoperáveis, Reutilizáveis).

The digital era, that we are living nowadays, is transforming health, health care models and services, and the role of society in this new reality. We currently have a large amount of stored health data, including clinical, biometric, and scientific research data. Nonetheless, its potential is not being fully exploited. It is essential to foster the sharing and reuse of this data not only in research but also towards the development of health technologies in order to improve health care efficiency, as well as products, services or digital health apps, to promote preventive and individualized medicine and to empower citizens in health literacy and self-management. In this sense, the FAIR concept has emerged, which implies that health data is findable, accessible, shared and reusable, facilitating interoperability between systems, ensuring the protection of personal and sensitive data. In this paper we review the FAIR concept, 'FAIRification' process, FAIR data versus open access data, ethical issues and the general data protection regulation, and digital health and citizen science.

Vivemos uma nova era digital que está a transformar a saúde, os modelos de cuidados e serviços de saúde, e o próprio papel da sociedade nesta realidade. Atualmente dispomos de uma grande quantidade de dados de saúde armazenados, incluindo dados clínicos, biométricos e de investigação científica, cuja potencialidade não está a ser devidamente explorada. É essencial favorecer a partilha e reutilização destes dados não só na investigação, como também para o desenvolvimento de tecnologias para melhorar a eficiência dos cuidados de saúde, de produtos ou serviços de saúde digitais, promover uma medicina preventiva e individualizada, mas também o empoderamento da população em literacia em saúde e na gestão da doença. Recentemente, surgiu o conceito FAIR que implica que os dados de saúde sejam facilmente localizáveis, acessíveis, partilhados e reutilizáveis, facilitando desta forma a interoperacionalidade entre sistemas e assegurando a proteção de dados pessoais e sensíveis. Neste artigo é feita uma revisão do conceito FAIR, processo de 'FAIRificação', dados FAIR versus dados de acesso livre, questões de éticas e o regulamento geral de proteção de dados, e saúde digital e ciência cidadã.