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1.
BMC Health Serv Res ; 21(1): 577, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34126980

RESUMO

BACKGROUND: To describe the ethical issues and experiences of scientists conducting mixed methods health services research and to advance empirical and conceptual discussion on ethical integrity in mixed methods health research. METHODS: The study was conducted with 64 scholars, faculty and consultants from the NIH-funded Mixed Methods Research Training Program (MMRTP) for the Health Sciences. This was a cross-sectional study. Survey results were analyzed using descriptive statistics to characterize responses and open coding to summarize strategies about eight ethical mixed methods research issues. Respondents completed an online survey to elicit experiences related to eight ethical issues (informed consent, confidentiality, data management, burden, safety, equitable recruitment, communication, and dissemination) and strategies for addressing them. RESULTS: Only about one-third of respondents thought their research ethics training helped them plan, conduct, or report mixed methods research. The most frequently occurring ethical issues were participant burden, dissemination and equitable recruitment (> 70% endorsement). Despite occurring frequently, < 50% of respondents rated each ethical issue as challenging. The most challenging ethical issues were related to managing participant burden, communication, and dissemination. Strategies reported to address ethical issues were largely not specific or unique to mixed methods with the exception of strategies to mitigate participant burden and, to a lesser degree, to facilitate equitable recruitment and promote dissemination of project results. CONCLUSIONS: Mixed methods health researchers reported encountering ethical issues often yet varying levels of difficulty and effectiveness in the strategies used to mitigate ethical issues. This study highlights some of the unique challenges faced by mixed methods researchers to plan for and appropriately respond to arising ethical issues such as managing participant burden and confidentiality across data sources and utilizing effective communication and dissemination strategies particularly when working with a multidisciplinary research team. As one of the first empirical studies to examine mixed methods research ethics, our findings highlight the need for greater attention to ethics in health services mixed methods research and training.


Assuntos
Confidencialidade , Ética em Pesquisa , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido
2.
JAMA ; 325(18): 1904-1905, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33974022
3.
JAMA ; 325(18): 1903-1904, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33974024
4.
Stud Health Technol Inform ; 281: 496-497, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042618

RESUMO

There is a demand for a pseudonymization service by a Trusted Third Party (TTP), that features clientside pseudonymization. We propose a system using modern web technology, which requires no installation but can handle data preprocessing and pseudonymization safely on the client.


Assuntos
Segurança Computacional , Confidencialidade , Humanos , Tecnologia , Confiança
5.
Stud Health Technol Inform ; 281: 273-277, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042748

RESUMO

We describe the adaptation of a non-clinical pseudonymization system, originally developed for a German email corpus, for clinical use. This tool replaces previously identified Protected Health Information (PHI) items as carriers of privacy-sensitive information (original names for people, organizations, places, etc.) with semantic type-conformant, yet, fictitious surrogates. We evaluate the generated substitutes for grammatical correctness, semantic and medical plausibility and find particularly low numbers of error instances (less than 1%) on all of these dimensions.


Assuntos
Confidencialidade , Privacidade , Humanos
6.
Stud Health Technol Inform ; 281: 845-849, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042793

RESUMO

This article aims to support the design of remote user studies in the healthcare and well-being field. We introduce lessons learned from conducting remote interviews and using visual timelines as pretasks involving patients from two eHealth projects. Based on our experience, we conclude that remote interviews and visual timelines can provide rich data about user needs. However, careful planning is required. Building trust, rapport, confidentiality, and privacy requires extra effort from the researcher in studies involving sensitive topics. In this paper, we present a list of practical tips for planning qualitative health-related user studies.


Assuntos
Telemedicina , Confidencialidade , Atenção à Saúde , Humanos , Privacidade , Pesquisa Qualitativa
7.
BMC Med Educ ; 21(1): 273, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980240

RESUMO

BACKGROUND: Encouraging professional integrity is vital for providing a standard of excellence in quality medical care and education and in promoting a culture of respect and responsibility. The primary objective of this work consisted of studying the relationship of medical students to the right to patient privacy in Spain, specifically by analysing the conditions for accessing patient clinical histories (CHs). METHODS: A cross-sectional study was conducted based on a questionnaire sent by e-mail to final-year students at 41 Spanish universities. It had 14 multiple choice and closed questions framed in 3 large blocks. The first question addressed basic general knowledge issues on the right to privacy and the obligation for confidentiality. The two remaining blocks were made up of questions directed towards evaluating the frequency with which certain requirements and action steps related to students attending patients were performed and regarding the guarantees associated with accessing and handling patient CHs both on paper and in the Electronic Medical Record. RESULTS: A total of 245 valid replies were considered. A total of 67.8 % of participants were women, with an average age of 24.05 ± 3.49 years. Up to 90.6 % were aware that confidentiality affected the data in CHs, although 43.3 % possessed non-anonymized photocopies of patient clinical reports outside the healthcare context, and only 49.8 % of the students were always adequately identified. A total of 59.2 % accessed patient CHs on some occasions by using passwords belonging to healthcare professionals, 77.2 % of them did not have the patients' express consent, and 71.9 % accessed a CH that was not anonymised. CONCLUSIONS: The role of healthcare institutions and universities is considered to be fundamental in implementing educational measures regarding the risks and ethical and legal problems arising from the use of CHs among professionals and students. A thorough study of medical ethics is needed through the analysis of clinical cases and direct exposure to situations in which the patient's confidentiality is questioned.


Assuntos
Estudantes de Medicina , Adulto , Confidencialidade , Estudos Transversais , Ética Médica , Feminino , Humanos , Masculino , Espanha , Adulto Jovem
8.
Stud Health Technol Inform ; 279: 70-77, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33965921

RESUMO

BACKGROUND: Considering the impacts of the COVID-19 pandemic on health service delivery, the US Office for Civil Rights (OCR) updated the policies on health data processing, and Health Insurance Portability and Accountability Act (HIPAA). OBJECTIVES: In this study, we investigated discourses on HIPAA in relation to COVID-19. METHODS: Through a search of media sources in the Factiva database, relevant texts were identified. We applied a text mining approach to identify concepts and themes in these texts. RESULTS: Our analysis revealed six central themes, namely, Health, HIPAA, Privacy, Security, Patients, and Need, as well as their associated concepts. Among these, Health was the most frequently discussed theme. It comprised concepts such as public, care, emergency, providers, telehealth, entity, use, discretion, OCR, Health and Human Services (HHS), enforcement, business, and services. CONCLUSION: Our discourse analysis of media outlets highlights the role of health data privacy law in the response to global public health emergencies and demonstrates how discourse analysis and computational methods can inform health data protection policymaking in the digital health era.


Assuntos
COVID-19 , Health Insurance Portability and Accountability Act , Confidencialidade , Humanos , Pandemias , Privacidade , SARS-CoV-2 , Estados Unidos
9.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33949170

RESUMO

PURPOSE: This paper aims to give an overview of emerging issues relating to the management of patients in custody during the COVID-19 outbreak in France. DESIGN/METHODOLOGY/APPROACH: During custody in France, a medical consultation is provided for any patient who requests it. In the Paris area, this consultation is carried out by a practitioner in forensic medicine, based in a general hospital. Usually, most medical consultations for patients in custody take place directly in police stations. With the COVID-19 outbreak, the authors chose to suspend this activity, asking law enforcement to bring patients directly to their hospitals. Patients presenting with severe infections or indicative symptoms of the severe acute respiratory syndrome Coronavirus 2 infection and a comorbidity are tested for COVID-19. Such patients remain hospitalized until results of the test are received. If the result is positive, they are hospitalized for the length of their custody. If sent to prison, they are transferred to a medical facility in detention. FINDINGS: From the onset of the outbreak, the authors observed increased pressure from law enforcement to obtain medical information. According to the French Code of Medical Ethics, no medical information should be disclosed regarding the authors' patients' medical situations. The authors are also concerned about sending a potentially infected patient back to a police station, to prison or to his/her home. ORIGINALITY/VALUE: This paper provides a snapshot of issues relating to the management of patients in custody during the COVID-19 outbreak in France. Unfortunately, the current situation in France does not permit a wider range of testing for the specified population in this paper.


Assuntos
COVID-19/prevenção & controle , Medicina Legal , Prisioneiros , Controle de Doenças Transmissíveis/normas , Confidencialidade/normas , França/epidemiologia , Acesso aos Serviços de Saúde/normas , Humanos , SARS-CoV-2
10.
Fertil Steril ; 115(5): 1156-1158, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33823992

RESUMO

The prevalence and ease of electronic communication, specifically email through patient portals associated with electronic medical records or via traditional enterprise email clients (e.g., Outlook) and video, have resulted in increased use for rapid communication between practitioners and their patients. Concerns regarding patient privacy and compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) remain a barrier to routine incorporation of electronic communication into practice. Furthermore, capital investment, implementation, and maintenance costs may provide additional barriers. These long-standing concerns have been heightened and tested by the COVID-19 pandemic. Best-practice guidelines for the secure and safe use of electronic communication with reproductive care patients are provided.


Assuntos
Confidencialidade/normas , Correio Eletrônico/normas , Medicina Reprodutiva/normas , Telemedicina/normas , Envio de Mensagens de Texto/normas , Gravação em Vídeo/normas , COVID-19/epidemiologia , Registros Eletrônicos de Saúde/normas , Fidelidade a Diretrizes/normas , Humanos , Medicina Reprodutiva/métodos , Telemedicina/métodos , Gravação em Vídeo/métodos
11.
Sensors (Basel) ; 21(7)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33918266

RESUMO

Blockchain technology provides a tremendous opportunity to transform current personal health record (PHR) systems into a decentralised network infrastructure. However, such technology possesses some drawbacks, such as issues in privacy and storage capacity. Given its transparency and decentralised features, medical data are visible to everyone on the network and are inappropriate for certain medical applications. By contrast, storing vast medical data, such as patient medical history, laboratory tests, X-rays, and MRIs, significantly affect the repository storage of blockchain. This study bridges the gap between PHRs and blockchain technology by offloading the vast medical data into the InterPlanetary File System (IPFS) storage and establishing an enforced cryptographic authorisation and access control scheme for outsourced encrypted medical data. The access control scheme is constructed on the basis of the new lightweight cryptographic concept named smart contract-based attribute-based searchable encryption (SC-ABSE). This newly cryptographic primitive is developed by extending ciphertext-policy attribute-based encryption (CP-ABE) and searchable symmetric encryption (SSE) and by leveraging the technology of smart contracts to achieve the following: (1) efficient and secure fine-grained access control of outsourced encrypted data, (2) confidentiality of data by eliminating trusted private key generators, and (3) multikeyword searchable mechanism. Based on decisional bilinear Diffie-Hellman hardness assumptions (DBDH) and discrete logarithm (DL) problems, the rigorous security indistinguishability analysis indicates that SC-ABSE is secure against the chosen-keyword attack (CKA) and keyword secrecy (KS) in the standard model. In addition, user collusion attacks are prevented, and the tamper-proof resistance of data is ensured. Furthermore, security validation is verified by simulating a formal verification scenario using Automated Validation of Internet Security Protocols and Applications (AVISPA), thereby unveiling that SC-ABSE is resistant to man-in-the-middle (MIM) and replay attacks. The experimental analysis utilised real-world datasets to demonstrate the efficiency and utility of SC-ABSE in terms of computation overhead, storage cost and communication overhead. The proposed scheme is also designed and developed to evaluate throughput and latency transactions using a standard benchmark tool known as Caliper. Lastly, simulation results show that SC-ABSE has high throughput and low latency, with an ultimate increase in network life compared with traditional healthcare systems.


Assuntos
Blockchain , Registros de Saúde Pessoal , Computação em Nuvem , Segurança Computacional , Confidencialidade , Humanos
12.
Sensors (Basel) ; 21(8)2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33921738

RESUMO

In the current epoch of smart homes and cities, personal data such as patients' names, diseases and addresses are often violated. This is frequently associated with the safety of the electronic health records (EHRs) of patients. EHRs have numerous benefits worldwide, but at present, EHR information is subject to considerable security and privacy issues. This paper proposes a way to provide a secure solution to these issues. Previous sophisticated techniques dealing with the protection of EHRs usually make data inaccessible to patients. These techniques struggle to balance data confidentiality, patient demand and constant interaction with provider data. Blockchain technology solves the above problems since it distributes information in a transactional and decentralized manner. The usage of blockchain technology could help the health sector to balance the accessibility and privacy of EHRs. This paper proposes a blockchain security framework (BSF) to effectively and securely store and keep EHRs. It presents a safe and proficient means of acquiring medical information for doctors, patients and insurance agents while protecting the patient's data. This work aims to examine how our proposed framework meets the security needs of doctors, patients and third parties and how the structure addresses safety and confidentiality concerns in the healthcare sector. Simulation outcomes show that this framework efficiently protects EHR data.


Assuntos
Blockchain , Segurança Computacional , Confidencialidade , Registros Eletrônicos de Saúde , Humanos , Privacidade
13.
Sensors (Basel) ; 21(8)2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33924024

RESUMO

Healthcare is now an important part of daily life because of rising consciousness of health management. Medical professionals can know users' health condition if they are able to access information immediately. Telemedicine systems, which provides long distance medical communication and services, is a multi-functional remote medical service that can help patients in bed in long-distance communication environments. As telemedicine systems work in public networks, privacy preservation issue of sensitive and private transmitted information is important. One of the means of proving a user's identity are user-controlled single sign-on (UCSSO) authentication scheme, which can establish a secure communication channel using authenticated session keys between the users and servers of telemedicine systems, without threats of eavesdropping, impersonation, etc., and allow patients access to multiple telemedicine services with a pair of identity and password. In this paper, we proposed a smartcard-based user-controlled single sign-on (SC-UCSSO) for telemedicine systems that not only remains above merits but achieves privacy preservation and enhances security and performance compared to previous schemes that were proved with BAN logic and automated validation of internet security protocols and applications (AVISPA).


Assuntos
Privacidade , Telemedicina , Comunicação , Segurança Computacional , Confidencialidade , Humanos , Sistemas de Informação
14.
Sensors (Basel) ; 21(9)2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33925813

RESUMO

The Internet of things (IoT) has emerged as a topic of intense interest among the research and industrial community as it has had a revolutionary impact on human life. The rapid growth of IoT technology has revolutionized human life by inaugurating the concept of smart devices, smart healthcare, smart industry, smart city, smart grid, among others. IoT devices' security has become a serious concern nowadays, especially for the healthcare domain, where recent attacks exposed damaging IoT security vulnerabilities. Traditional network security solutions are well established. However, due to the resource constraint property of IoT devices and the distinct behavior of IoT protocols, the existing security mechanisms cannot be deployed directly for securing the IoT devices and network from the cyber-attacks. To enhance the level of security for IoT, researchers need IoT-specific tools, methods, and datasets. To address the mentioned problem, we provide a framework for developing IoT context-aware security solutions to detect malicious traffic in IoT use cases. The proposed framework consists of a newly created, open-source IoT data generator tool named IoT-Flock. The IoT-Flock tool allows researchers to develop an IoT use-case comprised of both normal and malicious IoT devices and generate traffic. Additionally, the proposed framework provides an open-source utility for converting the captured traffic generated by IoT-Flock into an IoT dataset. Using the proposed framework in this research, we first generated an IoT healthcare dataset which comprises both normal and IoT attack traffic. Afterwards, we applied different machine learning techniques to the generated dataset to detect the cyber-attacks and protect the healthcare system from cyber-attacks. The proposed framework will help in developing the context-aware IoT security solutions, especially for a sensitive use case like IoT healthcare environment.


Assuntos
Internet das Coisas , Cidades , Segurança Computacional , Confidencialidade , Atenção à Saúde , Humanos
15.
J Pak Med Assoc ; 71(2(A)): 537-539, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33819245

RESUMO

Privacy and confidentiality are considered a cornerstone in the practice of medical ethics. However, these notions may play out differently in the cultural context of Pakistan. In order to understand the perceptions and expectations of privacy and confidentiality, a cross-sectional mixed method study was undertaken in a tertiary care hospital in Karachi, Pakistan. While the subjects demonstrated unfamiliarity with the Western terms, majority of them also exhibited a high expectation for privacy (both informational and physical) and confidentiality. Patients appeared most comfortable with sharing private medical information with the primary physician, indicating the level of trust placed in the physician. Participants also showed high expectations for confidentiality, thus, even in a collectivist society, patients may not want their private information shared across the medical team and also among family members. The onus is, therefore, on healthcare professionals to assess patients' preferences and choices.


Assuntos
Motivação , Privacidade , Confidencialidade , Estudos Transversais , Humanos , Paquistão
16.
BMC Res Notes ; 14(1): 148, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879233

RESUMO

OBJECTIVE: Through collating observations from various studies and complementing these findings with one author's study, a detailed overview of the benefits and drawbacks of asynchronous email interviewing is provided. Through this overview, it is evident there is great potential for asynchronous email interviews in the broad field of health, particularly for studies drawing on expertise from participants in academia or professional settings, those across varied geographical settings (i.e. potential for global public health research), and/or in circumstances when face-to-face interactions are not possible (e.g. COVID-19). RESULTS: Benefits of asynchronous email interviewing and additional considerations for researchers are discussed around: (i) access transcending geographic location and during restricted face-to-face communications; (ii) feasibility and cost; (iii) sampling and inclusion of diverse participants; (iv) facilitating snowball sampling and increased transparency; (v) data collection with working professionals; (vi) anonymity; (vii) verification of participants; (viii) data quality and enhanced data accuracy; and (ix) overcoming language barriers. Similarly, potential drawbacks of asynchronous email interviews are also discussed with suggested remedies, which centre around: (i) time; (ii) participant verification and confidentiality; (iii) technology and sampling concerns; (iv) data quality and availability; and (v) need for enhanced clarity and precision.


Assuntos
Comunicação , Correio Eletrônico , Entrevistas como Assunto , Confidencialidade , Humanos , Pesquisa Qualitativa
17.
Sensors (Basel) ; 21(7)2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33800574

RESUMO

Obesity is a major public health problem worldwide, and the prevalence of childhood obesity is of particular concern. Effective interventions for preventing and treating childhood obesity aim to change behaviour and exposure at the individual, community, and societal levels. However, monitoring and evaluating such changes is very challenging. The EU Horizon 2020 project "Big Data against Childhood Obesity (BigO)" aims at gathering large-scale data from a large number of children using different sensor technologies to create comprehensive obesity prevalence models for data-driven predictions about specific policies on a community. It further provides real-time monitoring of the population responses, supported by meaningful real-time data analysis and visualisations. Since BigO involves monitoring and storing of personal data related to the behaviours of a potentially vulnerable population, the data representation, security, and access control are crucial. In this paper, we briefly present the BigO system architecture and focus on the necessary components of the system that deals with data access control, storage, anonymisation, and the corresponding interfaces with the rest of the system. We propose a three-layered data warehouse architecture: The back-end layer consists of a database management system for data collection, de-identification, and anonymisation of the original datasets. The role-based permissions and secured views are implemented in the access control layer. Lastly, the controller layer regulates the data access protocols for any data access and data analysis. We further present the data representation methods and the storage models considering the privacy and security mechanisms. The data privacy and security plans are devised based on the types of collected personal, the types of users, data storage, data transmission, and data analysis. We discuss in detail the challenges of privacy protection in this large distributed data-driven application and implement novel privacy-aware data analysis protocols to ensure that the proposed models guarantee the privacy and security of datasets. Finally, we present the BigO system architecture and its implementation that integrates privacy-aware protocols.


Assuntos
Big Data , Segurança Computacional , Criança , Confidencialidade , Data Warehousing , Atenção à Saúde , Humanos , Privacidade
19.
Eur Rev Med Pharmacol Sci ; 25(5): 2449-2456, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33755984

RESUMO

Countries responded to the COVID-19 pandemic with various levels of restrictions and lockdown in an effort to save lives and prevent the saturation and collapse of national health systems. Unfortunately, the blockades have entailed hefty socioeconomic costs. In order to contrast the spread of the virus, states have used contact tracing technology, in the form of mobile phone applications designed to track close contacts of those infected with COVID-19. Recent research has shown the effectiveness of this solution, particularly when used in conjunction with manual tracking. Nonetheless, the contact tracing app raises concerns due to the potential privacy implications. The authors have delved into the European legislation that protects privacy through the principles of proportionality and minimization, arguing that in order to quickly resolve the pandemic caused by COVID-19, one cannot blindly trust the exclusive help of technology. Instead, we need the involvement of health personnel, scientists, and no less importantly, the citizenry's sense of solidarity and the duty to abide by the rules of social distancing, the use of protective devices and hygiene rules to protect public health.


Assuntos
Busca de Comunicante/métodos , Infecções por Coronavirus/prevenção & controle , COVID-19/epidemiologia , Telefone Celular , Confidencialidade , Infecções por Coronavirus/epidemiologia , Humanos , Aplicativos Móveis , Pandemias/prevenção & controle , Distanciamento Físico , Privacidade , SARS-CoV-2 , Tecnologia
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