El listado de pacientes en la empresa dedicada a la prestación de servicios médicos como objeto material de los delitos de descubrimiento y revelación de secretos de empresa / [The list of patients in the company dedicated to the provision of medical services as a material object of the crimes of discovery and disclosure of company secrets]

En la actualidad podría afirmarse que la mayor problemática existente en torno a los delitos de descubrimiento y revelación de secretos de empresa se encuentra en la indeterminación de su objeto material: el secreto de empresa. Esta indeterminación, que la reciente Ley 1/2019, de 20 de febrero, de Secretos Empresariales ayuda a solventar, ha llevado a los Tribunales de la jurisdicción penal a pronunciamientos dispares sobre la aplicación de los tipos penales relativos al descubrimiento y revelación de secretos de empresa, siendo uno de los supuestos más cuestionados en la práctica de nuestros Tribunales el tratamiento (o no) de un listado de clientes como un secreto de empresa. Si bien, hay muchas resoluciones que abogan por entender que dichos listados de clientes no forman parte de la información confidencial y reservada de una empresa –lo que impediría entenderla como un secreto de empresa–, encontramos también ejemplos de casos en los que se ha adoptado una solución contraria. Por medio del presente análisis, se pretende responder a la siguiente pregunta: ¿Puede un listado de pacientes ser considerado un secreto de empresa y, por tanto, dar lugar su descubrimiento y/o revelación a la comisión de un delito de los recogidos en el artículo 278 y siguientes del Código Penal? ¿Y si dicho listado de pacientes contuviera documentación clínica (con datos médicos) de cada uno de ellos? (AU)

Nowadays, the main problem with the offences of discovery and disclosure of trade secrets may lie in the indeterminacy of its material object: the business or trade secret. This indeterminacy, which the recent Law 1/2019, of 20 February, on Business Secrets helps to resolve, has led the Courts of the criminal jurisdiction to make disparate pronouncements on the application of criminal offences relating to the discovery and disclosure of business secrets, with one of the most questioned cases in the practice of our Courts being the treatment (or not) of a list of clients as a business secret. While there are many rulings that argue that such customer lists do not form part of the confidential and reserved information of a company –which would prevent it from being considered a trade secret–, there are also examples of cases in which the opposite solution has been adopted. This analysis aims to answer the following question: Can a list of patients be considered a business secret and, therefore, can its discovery and/or disclosure give rise to the commission of an offence under Article 278 et seq. of the Criminal Code? What if the list of patients contained clinical documentation (with medical data) for each of them? (AU)

Assessing Quality of Life Using FHIR - How to Combine Patient Reported Outcome with Patient Generated Data for Better Compliance.

Quality of life (QoL) is affected by environmental influences and varies between patients. A combined measurement through Patient Reported Outcomes (PROs) and Patient Generated Data (PGD) may enhance the detection of QoL impairments by a longitudinal survey. Leveraging different approaches of QoL measurement techniques, the challenge is to combine data in a standardized, interoperable way. We developed an app (Lion-App) to semantically annotate data from sensor systems as well as PROs to be merged in an overall analysis of QoL. A FHIR implementation guide was defined for a standardized assessment. To access sensor data the interfaces of Apple Health or Google Fit are used instead of integrating various provider directly into the system. Since QoL cannot be collected exclusively via sensor values, a combination of PROs and PGD is necessary. PGD enable a progression of QoL which offers more insight into personal limitations whereas PROs give insight about personal burden. The use of FHIR enables structured exchange of data while personalized analyses might improve therapy and outcome.

Impact of Digital Health upon the Surgical Patient Experience: The Patient as Consumer.

The adoption of digital health services in surgical care delivery is changing the patient experience. The goal of patient-generated health data monitoring incorporated with patient-centered education and feedback is to optimally prepare patients for surgery and personalize postoperative care to improve outcomes that matter to both patients and surgeons. Challenges include the need for the adoption of new methods for implementation and evaluation and equitable application of surgical digital health interventions, with considerations for accessibility as well as the development of new diagnostics and decision support that include the needs and characteristics of all populations served.

Autopercepción de salud de adolescentes escolarizados en tiempos de pandemia por COVID-19 / Self-perception of health among school-aged adolescents in times of pandemic by COVID-19 / Auto-percepção da saúde entre adolescentes em idade escolar em tempos de pandemia pela COVID-19

Introducción: La adolescencia es una etapa esencial dentro del ciclo de vida humano. La presencia de enfermedades en esta etapa puede afectar la capacidad para crecer y desarrollarse a plenitud, sobre todo cuando son de índole física, psicológica y ocurren en contextos escolares. Objetivo: Evaluar la autopercepción de salud que tienen los estudiantes adolescentes matriculados en instituciones educativas en tiempos de pandemia por Covid-19. Cartagena 2021. Materiales y métodos: Estudio cuantitativo, de corte transversal, y correlacional. Población de 1188 estudiantes de 12-17 años de dos instituciones educativas en Cartagena (Colombia). Muestra estimada de 319 sujetos, seleccionados a través de muestreo aleatorio simple. Se aplicó encuesta sociodemográfica diseñada por el equipo investigador y validada por expertos y para el estado de salud percibido se usó el Cuestionario de Salud SF-36, la versión en español adaptada culturalmente al contexto colombiano por Lugo, García y Gómez la cual cuenta con alfas de Cronbach entre 0,7 y 0,94. Resultados: Los adolescentes fueron principalmente de 15 años (21,9%), de octavo (21,7%) y noveno (27,7%), se dedican a estudiar (95,9%), en sus familias se devengan menos del salario mínimo (42,3%) y entre 1-2 (40,8%). Viven con padre y madre, con o sin hermanos (72,7%), los padres están casados o en unión libre (60,5%) y han estudiado hasta bachillerato tanto madres (54,9%) como padres (49,2%). La autopercepción de la salud fue buena (32,6%) y excelente (33,9%). Se observaron correlaciones estadísticamente significativas (p < 0,05) entre dicha autopercepción y edad, grado, escolaridad del padre y valoración del rendimiento académico. Conclusión: Pese a la emergencia sanitaria ocasionada por la pandemia de covid-19, la autopercepción de salud que tienen un grupo de estudiantes adolescentes resulta ser favorable y positiva.

Introduction: Adolescence is an essential stage within the human life cycle. The presence of diseases at this stage can affect the ability to grow and develop to the fullest, especially when they are physical, psychological and occur in school contexts. Objective: To evaluate the self-perception of health of adolescent students enrolled in educational institutions in times of the Covid-19 pandemic. Cartagena 2021. Materials and methods: Quantitative, cross-sectional, correlational study. Population of 1188 students aged 12-17 years from two educational institutions in Cartagena (Colombia). Estimated sample of 319 subjects, selected through simple random sampling. A sociodemographic survey designed by the research team and validated by experts was applied and for perceived health status the SF-36 Health Questionnaire was used, the Spanish version culturally adapted to the Colombian context by Lugo, García and Gómez, which has Cronbach's alphas between 0.7 and 0.94. Results: The adolescents were mainly 15 years old (21.9%), in eighth grade (21.7%) and ninth grade (27.7%), they are dedicated to study (95.9%), in their families they earn less than the minimum wage (42.3%) and between 1-2 (40.8%). They live with father and mother, with or without siblings (72.7%), the parents are married or in union (60.5%) and both mothers (54.9%) and fathers (49.2%) have studied up to high school. Self-perception of health was good (32.6%) and excellent (33.9%). Statistically significant correlations (p < 0.05) were observed between self-perception and age, grade, father's schooling and assessment of academic performance. Conclusion: Despite the health emergency caused by the covid-19 pandemic, the self-perception of health of a group of adolescent students was favorable and positive.

Introdução: A adolescência é uma etapa essencial no ciclo de vida humana. A presença de doenças nesta fase pode afetar a capacidade de crescimento e desenvolvimento pleno, especialmente quando elas são físicas, psicológicas e ocorrem em contextos escolares. Objetivo: Avaliar a autopercepção da saúde entre os estudantes adolescentes matriculados em instituições educacionais em tempos da pandemia de Covid-19. Cartagena 2021. Materiais e métodos: Estudo quantitativo, transversal, correlacional. População de 1188 estudantes de 12-17 anos de duas instituições educacionais em Cartagena (Colômbia). Amostra estimada de 319 sujeitos, selecionados através de amostragem aleatória simples. Foi aplicada uma pesquisa sociodemográfica projetada pela equipe de pesquisa e validada por especialistas e para a percepção do estado de saúde foi utilizado o questionário de saúde SF-36, a versão espanhola culturalmente adaptada ao contexto colombiano por Lugo, García e Gómez que tem a alfabetização de Cronbach entre 0,7 e 0,94. Resultados: Os adolescentes tinham principalmente 15 anos (21,9%), na oitava série (21,7%) e na nona série (27,7%), dedicam-se aos estudos (95,9%), em suas famílias ganham menos do que o salário mínimo (42,3%) e entre 1-2 (40,8%). Eles vivem com ambos os pais, com ou sem irmãos (72,7%), os pais são casados ou em união (60,5%) e ambas as mães (54,9%) e os pais (49,2%) estudaram até o ensino médio. A auto-percepção da saúde foi boa (32,6%) e excelente (33,9%). Foram observadas correlações estatisticamente significativas (p < 0,05) entre autopercepção e idade, série, escolaridade do pai e avaliação do desempenho acadêmico. Conclusão: Apesar da emergência sanitária causada pela pandemia de covid-19, a autopercepção da saúde de um grupo de estudantes adolescentes é favorável e positiva.

Dataísmo (de la salud), tecnología y privacidad / (Health) dataism, technology and privacy

El dataísmo puede privar al individuo de su privacidad. Las personas reflexionan sobre el coste de oportunidad que supone ceder sus datos y otorgan mayor importancia a la efectividad en la lucha contra enfermedades y pandemias frente a su uso ilícito, ilegal o poco ético. El big data es un bien común de la humanidad, y compartir datos puede salvar vidas, pero aprovechémoslo aplicando correctamente la ética de los datos, donde los gobiernos y organizaciones estén implicados y se respete el derecho fundamental de protección de datos. (AU)

Dataism can deprive the individuals of their privacy. People are reflecting on the opportunity cost of giving away their data and are placing greater importance on the effectiveness of fighting diseases and pandemics than on its illicit, illegal or unethical use. Big data is a common good of humanity, and sharing data can save lives, but let’s harness it with the right application of data ethics, where governments and organisations are involved and the fundamental right to data protection is respected. (AU)

Remote sampling of biomarkers of inflammation with linked patient generated health data in patients with rheumatic and musculoskeletal diseases: an Ecological Momentary Assessment feasibility study.

BACKGROUND: People with rheumatic diseases experience troublesome fluctuations in fatigue. Debated causes include pain, mood and inflammation. To determine the relationships between these potential causes, serial assessments are required but are methodologically challenging. This mobile health (mHealth) study explored the viability of using a smartphone app to collect patient-reported symptoms with contemporaneous Dried Blood Spot Sampling (DBSS) for inflammation. METHODS: Over 30 days, thirty-eight participants (12 RA, 13 OA, and 13 FM) used uMotif, a smartphone app, to report fatigue, pain and mood, on 5-point ordinal scales, twice daily. Daily DBSS, from which C-reactive Protein (CRP) values were extracted, were completed on days 1-7, 14 and 30. Participant engagement was determined based on frequency of data entry and ability to calculate within- and between-day symptom changes. DBSS feasibility and engagement was determined based on the proportion of samples returned and usable for extraction, and the number of days between which between-day changes in CRP which could be calculated (days 1-7). RESULTS: Fatigue was reported at least once on 1085/1140 days (95.2%). Approximately 65% of within- and between-day fatigue changes could be calculated. Rates were similar for pain and mood. A total of 287/342 (83.9%) DBSS, were returned, and all samples were viable for CRP extraction. Fatigue, pain and mood varied considerably, but clinically meaningful (≥ 5 mg/L) CRP changes were uncommon. CONCLUSIONS: Embedding DBSS in mHealth studies will enable researchers to obtain serial symptom assessments with matched biological samples. This provides exciting opportunities to address hitherto unanswerable questions, such as elucidating the mechanisms of fatigue fluctuations.

Influenza Screening Using Patient-Generated Health Data in Post COVID-19 Pandemic.

It is very important to ensure reliable performance of deep learning model for future dataset for healthcare. This is more pronounced in the case of patient generated health data such as patient reported symptoms, which are not collected in a controlled environment. Since there has been a big difference in influenza incidence since the COVID-19 pandemic, we evaluated whether the deep learning model can maintain sufficiently robust performance against these changes. We have collected 226,655 episodes from 110,893 users since June 2020 and tested the influenza screening model, our model showed 87.02% sensitivity and 0.8670 of AUROC. The results of COVID-19 pandemic are comparable to that of before COVID-19 pandemic.

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics.

In this article, we provide an overview of remote monitoring of pediatric PGHD and family-generated health data, including its current uses, future opportunities, and implementation resources.

Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer: A Systematic Review and Individual Patient Data Meta-analysis.

OBJECTIVE: To compare overall survival of patients with a cCR undergoing active surveillance versus standard esophagectomy. SUMMARY OF BACKGROUND DATA: One-third of patients with esophageal cancer have a pathologically complete response in the resection specimen after neoadjuvant chemoradiotherapy. Active surveillance may be of benefit in patients with cCR, determined with diagnostics during response evaluations after chemoradiotherapy. METHODS: A systematic review and meta-analysis was performed comparing overall survival between patients with cCR after chemoradiotherapy undergoing active surveillance versus standard esophagectomy. Authors were contacted to supply individual patient data. Overall and progression-free survival were compared using random effects meta-analysis of randomized or propensity score matched data. Locoregional recurrence rate was assessed. The study-protocol was registered (PROSPERO: CRD42020167070). RESULTS: Seven studies were identified comprising 788 patients, of which after randomization or propensity score matching yielded 196 active surveillance and 257 standard esophagectomy patients. All authors provided individual patient data. The risk of all-cause mortality for active surveillance was 1.08 [95% confidence interval (CI): 0.62-1.87, P = 0.75] after intention-to-treat analysis and 0.93 (95% CI: 0.56-1.54, P = 0.75) after per-protocol analysis. The risk of progression or all-cause mortality for active surveillance was 1.14 (95% CI: 0.83-1.58, P = 0.36). Five-year locoregional recurrence rate during active surveillance was 40% (95% CI: 26%-59%). 95% of active surveillance patients undergoing postponed esophagectomy for locoregional recurrence had radical resection. CONCLUSIONS: Overall survival was comparable in patients with cCR after chemoradiotherapy undergoing active surveillance or standard esophagectomy. Diagnostic follow-up is mandatory in active surveillance and postponed esophagectomy should be offered to operable patients in case of locoregional recurrence.

Ações para a adequação da RNDS à lei geral de proteção de dados

A implementação da Rede Nacional de Dados em Saúde (RNDS) iniciou-se em junho de 2019 com os objetivos de oferecer benefícios de melhoria da assistência à saúde, a partir do acesso às informações e continuidade do cuidado nos níveis de atenção, de permitir eficiência na gestão dos recursos públicos e de impulsionar a Inovação na Saúde. Em março de 2020, a abrangência e o escopo do projeto da RNDS foram direcionados ao enfrentamento da COVID-19, para o fortalecimento da resposta do sistema de saúde, monitoramento e gestão da saúde populacional, oferta de soluções para engajamento ativo do usuário no controle da epidemia e processamento do esperado número de casos da doença. Desde as primeiras ações de planejamento, governança, definição de arquitetura e de regras negociais, o DATASUS se prepara para manter a RNDS em conformidade com a Lei Geral de Proteção de Dados (LGPD), com previsão de entrada em vigor para 3 de maio de 2021, conforme Medida Provisória n° 959, de 29 de abril de 2020.

FHIR: RIA campanha COVID-19

Registro de imunobiológico administrado em campanha COVID-19.

Reunião técnica DATASUS/MS com os laboratórios com a Rede Nacional de Dados em Saúde (RNDS)

Reunião Técnica DATASUS/MS com os Laboratórios de Análises Clínicas para integração com a Rede Nacional de Dados em Saúde (RNDS).

Coletiva de apresentação do Conecte SUS Cidadão - 03/08/2020

O Ministério da Saúde, através do Departamento de Informático SUS (DATASUS) integrou o app Conecte SUS cidadão à Rede Nacional de Dados em Saúde (RNDS), possibilitando o acesso ao resultado dos exames de Covid-19 pelo cidadão através do smartphone. O diretor do DATASUS, Jacson Barros, apresentou o Conecte SUS Cidadão no dia 03/08 em coletiva no Ministério da Saúde juntamente com o Secretário-Executivo Élcio Franco

Modelo de Informação do RIA-ROTINA

Integração de sistemas próprios à RNDS: campanha de vacinação contra a COVID-19