Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance.

The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction's consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system.

Content Analysis of Official Public Health Communications in Ontario, Canada during the COVID-19 Pandemic.

Effective communication by governmental organizations is essential to keep the public informed during a public health emergency. Examining the content of these communications can provide insight into their alignment with best practices for risk communication. We used content analysis to determine whether news releases by the Ontario government contained key elements of effective risk communication, as outlined by the Health Canada and Public Health Agency of Canada Strategic Risk Communication Framework. News releases between 25 January 2020 and 31 December 2022 were coded following the five elements of the framework: situational transparency, stakeholder-centered content; evidence-based rationales for decisions; continuous improvements in updating information; and descriptions of risk management. All 322 news releases contained at least one element of the framework, and all five elements were identified at least once across the dataset. Risk management, transparency, and stakeholder-centered content were the most frequently identified elements. News releases near the beginning of the pandemic contained most elements of the framework; however, over time, there was an increase in the use of vague language and lack of evidence-based rationales. Increasing transparency regarding evidence-based decisions, as well as changes in decisions, is recommended to improve risk communication and increase compliance with public health measures.

Lactiplantibacillus (Lactobacillus) plantarum as a Complementary Treatment to Improve Symptomatology in Neurodegenerative Disease: A Systematic Review of Open Access Literature.

This systematic review addresses the use of Lactiplantibacillus (Lactobacillus) plantarum in the symptomatological intervention of neurodegenerative disease. The existence of gut microbiota dysbiosis has been associated with systemic inflammatory processes present in neurodegenerative disease, creating the opportunity for new treatment strategies. This involves modifying the strains that constitute the gut microbiota to enhance synaptic function through the gut-brain axis. Recent studies have evaluated the beneficial effects of the use of Lactiplantibacillus plantarum on motor and cognitive symptomatology, alone or in combination. This systematic review includes 20 research articles (n = 3 in human and n = 17 in animal models). The main result of this research was that the use of Lactiplantibacillus plantarum alone or in combination produced improvements in symptomatology related to neurodegenerative disease. However, one of the studies included reported negative effects after the administration of Lactiplantibacillus plantarum. This systematic review provides current and relevant information about the use of this probiotic in pathologies that present neurodegenerative processes such as Alzheimer's disease, Parkinson's disease and Multiple Sclerosis.

Interpretable prediction of brain activity during conversations from multimodal behavioral signals.

We present an analytical framework aimed at predicting the local brain activity in uncontrolled experimental conditions based on multimodal recordings of participants' behavior, and its application to a corpus of participants having conversations with another human or a conversational humanoid robot. The framework consists in extracting high-level features from the raw behavioral recordings and applying a dynamic prediction of binarized fMRI-recorded local brain activity using these behavioral features. The objective is to identify behavioral features required for this prediction, and their relative weights, depending on the brain area under investigation and the experimental condition. In order to validate our framework, we use a corpus of uncontrolled conversations of participants with a human or a robotic agent, focusing on brain regions involved in speech processing, and more generally in social interactions. The framework not only predicts local brain activity significantly better than random, it also quantifies the weights of behavioral features required for this prediction, depending on the brain area under investigation and on the nature of the conversational partner. In the left Superior Temporal Sulcus, perceived speech is the most important behavioral feature for predicting brain activity, regardless of the agent, while several features, which differ between the human and robot interlocutors, contribute to the prediction in regions involved in social cognition, such as the TemporoParietal Junction. This framework therefore allows us to study how multiple behavioral signals from different modalities are integrated in individual brain regions during complex social interactions.

The impact of policy and policy communication on COVID-19 vaccination inequalities among Venezuelan refugees and migrants in Colombia: a comparative cross-sectional interrupted time-series analysis.

INTRODUCTION: Equitable access to vaccines for migrants and refugees is necessary to ensure their right to health and to achieve public health goals of reducing vaccine-preventable illness. Public health policies require regulatory frameworks and communication to effect uptake of effective vaccines among the target population. In Colombia, the National COVID-19 Vaccination Plan implicitly included Venezuelan refugees and migrants; however, initial communication of the policy indicated that vaccine availability was restricted to people with regular migration status. We estimated the impact of a public announcement, which clarified access for refugees and migrants, on vaccination coverage among Venezuelans living in Colombia. METHODS: Between 30 July 2021 and 5 February 2022, 6221 adult Venezuelans participated in a cross-sectional, population-based health survey. We used a comparative cross-sectional time-series analysis to estimate the effect of the October 2021 announcement on the average biweekly change in COVID-19 vaccine coverage of Venezuelans with regular and irregular migration status. RESULTS: 71% of Venezuelans had an irregular status. The baseline (preannouncement) vaccine coverage was lower among people with an irregular status but increased at similar rates as those with a regular status. After the announcement, there was a level change of 14.49% (95% CI: 1.57 to 27.42, p=0.03) in vaccination rates among individuals with irregular migration status with a 4.61% increase in vaccination rate per biweekly period (95% CI: 1.71 to 7.51, p=0.004). By February 2022, there was a 26.2% relative increase in vaccinations among individuals with irregular migration status compared with what was expected without the announcement. CONCLUSION: While there was no policy change, communication clarifying the policy drastically reduced vaccination inequalities across migration status. Lessons can be translated from the COVID-19 pandemic into more effective global, regional and local public health emergency preparedness and response to displacement.

Evaluación de la usabilidad de la teleconsulta durante la pandemia por COVID-19 en un hospital pediátrico / Assessment of the usability of teleconsultations during the COVID-19 pandemic at a children's hospital

Introducción. La usabilidad en un sistema de teleconsulta afecta directamente la eficiencia y efectividad de la atención médica remota. Objetivo. Evaluar la usabilidad de la teleconsulta durante la pandemia por COVID-19. Población y método. Estudio de corte transversal. Incluimos a los cuidadores de niños/as de 1 mes a 12 años. Evaluamos la usabilidad mediante el Telehealth Usability Questionnaire adaptado en español. Además, evaluamos datos socioeconómicos. Resultados. Tasa de respuesta del 70,2 % (n = 221). La mayoría eran mujeres, edad promedio 33 años, con educación secundaria y cobertura de salud pública. El 87,8 % eligió atención telefónica y el 88,2 % tenía su primera teleconsulta. Alta satisfacción general con puntuaciones menores en facilidad de uso y aprendizaje en videollamadas. Conclusión. La teleconsulta mostró alta usabilidad, independientemente de la modalidad, para cuidadores de niños/as de 1 mes a 12 años.

Introduction. Usability in a telemedicine system directly affects the efficiency and effectiveness of remote health care. Objective. To assess the usability of teleconsultations during the COVID-19 pandemic. Population and method. This was a cross-sectional study. The caregivers of children aged 1 month to 12 years were included. Usability was assessed with the Telehealth Usability Questionnaire, adapted to Spanish. Socioeconomic data were also assessed. Results. The response rate was 70.2% (n = 221). Most responders were women whose average age was 33 years, had completed secondary education and had public health insurance. Of them, 87.8% selected telephone health care and 88.2% had their first teleconsultation. The overall satisfaction was high, with lower scores for ease of use and learning how to use video calls. Conclusion. Regardless of modality, the usability of teleconsultations by caregivers of children aged 1 month to 12 years was adequate.

Acceptability and Perceived Utility of Virtual Reality Among People Who Are Incarcerated Who Use Drugs.

People who are incarcerated are at heightened risk of overdose upon community reentry. Virtual reality (VR) may provide an innovative tool for overdose prevention intervention in corrections facilities. This mixed methods study sought to understand incarcerated individuals' perspectives on VR for overdose prevention and explore physiological arousal associated with use of VR equipment. Study participants were 20 individuals, stratified by gender, with an opioid use disorder at a county jail. Qualitative interviews assessed acceptability and perceived utility of VR in the jail setting. Thematic analysis indicated high levels of acceptability and potential utility in the following areas: (a) mental health and substance use interventions, (b) community reentry skills training, and (c) communication and conflict resolution skills. Heart rate variability (HRV) data were collected continuously during the interview and during VR exposure to explore whether exposure to the VR environment provoked arousal. Physiological data analyses showed a significant decrease in heart rate (HR) [b = -3.14, t(18) = -3.85, p < .01] and no arousal as measured by root mean square of successive RR interval differences (RMSSD) [b = -0.06, t(18) = -1.06, p = .30] and high frequency-HRV (HF-HRV) [b = -0.21, t(18) = -1.71, p = .10]. This study demonstrated high acceptability and decreased HR response of VR among incarcerated people who use drugs.

(Dis)harmony in times of crisis? An analysis of COVID-related strategic communication by Swiss public health institutions.

OBJECTIVES: This study aims to assess COVID-related communication by Swiss public health institutions (PHI) as well as the challenges they faced in implementing their communication strategies. STUDY DESIGN: This study uses a two-part mixed methods design, combining automated content analysis of press releases by PHI and semi-structured interviews with PHI communication experts. METHODS: The automated content analysis uses natural language processing techniques to measure semantic themes and linguistic properties of 1882 press releases from national and regional PHI during the first year of the COVID-19 pandemic. The semi-structured interviews with 25 communication experts from key PHI explore the challenges faced in implementing their communication strategies. RESULTS: The content analysis reveals key themes in press releases, including non-pharmaceutical interventions, quarantine, testing, contact tracing, hospital situations, and the pandemic's impact on the economy. The linguistic measures indicated a decrease in complexity and readability over time, with no significant differences between national and regional PHI. Interviews revealed challenges arising from organizational structures, the multi-systemic nature of the pandemic, and from expectations of the public. CONCLUSIONS: The study highlights the importance of agility in public health communication and the need for efficient coordination within and between PHI. Organizational structures should be adapted to allow for more agile modes of operation during crises. Policymakers should clarify roles and responsibilities of different actors in public health frameworks to ensure streamlined communication. Understanding the communication efforts and challenges faced by PHI during the pandemic helps preparing for future health crises and improve public health communication practices.

Ensemble2: Scenarios ensembling for communication and performance analysis.

Throughout the COVID-19 pandemic, scenario modeling played a crucial role in shaping the decision-making process of public health policies. Unlike forecasts, scenario projections rely on specific assumptions about the future that consider different plausible states-of-the-world that may or may not be realized and that depend on policy interventions, unpredictable changes in the epidemic outlook, etc. As a consequence, long-term scenario projections require different evaluation criteria than the ones used for traditional short-term epidemic forecasts. Here, we propose a novel ensemble procedure for assessing pandemic scenario projections using the results of the Scenario Modeling Hub (SMH) for COVID-19 in the United States (US). By defining a "scenario ensemble" for each model and the ensemble of models, termed "Ensemble2", we provide a synthesis of potential epidemic outcomes, which we use to assess projections' performance, bypassing the identification of the most plausible scenario. We find that overall the Ensemble2 models are well-calibrated and provide better performance than the scenario ensemble of individual models. The ensemble procedure accounts for the full range of plausible outcomes and highlights the importance of scenario design and effective communication. The scenario ensembling approach can be extended to any scenario design strategy, with potential refinements including weighting scenarios and allowing the ensembling process to evolve over time.

How denialist amplification spread COVID misinformation and undermined the credibility of public health science.

Denialist scientists played an outsized role in shaping public opinion and determining public health policy during the recent COVID pandemic. From early on, amplification of researchers who denied the threat of COVID shaped public opinion and undermined public health policy. The forces that amplify denialists include (1) Motivated amplifiers seeking to protect their own interests by supporting denialist scientists, (2) Conventional media outlets giving disproportionate time to denialist opinions, (3) Promoters of controversy seeking to gain traction in an 'attention economy,' and (4) Social media creating information silos in which denialists can become the dominant voice. Denialist amplification poses an existential threat to science relevant to public policy. It is incumbent on the scientific community to create a forum to accurately capture the collective perspective of the scientific community related to public health policy that is open to dissenting voices but prevents artificial amplification of denialists.

Data-driven decision-making for district health management: a cluster-randomised study in 24 districts of Ethiopia.

BACKGROUND: Use of local data for health system planning and decision-making in maternal, newborn and child health services is limited in low-income and middle-income countries, despite decentralisation and advances in data gathering. An improved culture of data-sharing and collaborative planning is needed. The Data-Informed Platform for Health is a system-strengthening strategy which promotes structured decision-making by district health officials using local data. Here, we describe implementation including process evaluation at district level in Ethiopia, and evaluation through a cluster-randomised trial. METHODS: We supported district health teams in 4-month cycles of data-driven decision-making by: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritising; and (e) a consultative process to develop, commit to and follow up on action plans. 12 districts were randomly selected from 24 in the North Shewa zone of Ethiopia between October 2020 and June 2022. The remaining districts formed the trial's comparison arm. Outcomes included health information system performance and governance of data-driven decision-making. Analysis was conducted using difference-in-differences. RESULTS: 58 4-month cycles were implemented, four or five in each district. Each focused on a health service delivery challenge at district level. Administrators' practice of, and competence in, data-driven decision-making showed a net increase of 77% (95% CI: 40%, 114%) in the regularity of monthly reviews of service performance, and 48% (95% CI: 9%, 87%) in data-based feedback to health facilities. Statistically significant improvement was also found in administrators' use of information to appraise services. Qualitative findings also suggested that district health staff reported enhanced data use and collaborative decision-making. CONCLUSIONS: This study generated robust evidence that 20 months' implementation of the Data-Informed Platform for Health strengthened health management through better data use and appraisal practices, systemised problem analysis to follow up on action points and improved stakeholder engagement. TRIAL REGISTRATION NUMBER: NCT05310682.

How can technology be used to support communication in palliative care beyond the covid-19 pandemic: a mixed-methods national survey of palliative care healthcare professionals.

BACKGROUND: Developments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative care professionals of using digital health to support communication during the pandemic. We aimed to describe how palliative care professionals used technology to support communication (multidisciplinary team working, education and with patients and family caregivers) during the COVID-19 pandemic. METHOD(S): UK based palliative care healthcare professionals completed an electronic questionnaire to describe their use of digital health, during the COVID-19 pandemic, to support (1) communication within the multidisciplinary team (MDT), (2) education and (3) to support communication with patients and carers. RESULTS: Two hundred and thirty-four palliative care professionals participated. Most (n = 227, 97%) described an increase in their use of digital health, to support communication, since the start of the COVID-19 pandemic. We identified benefits and challenges for digital health communication, which we summarised into themes, including 'a new way of working', 'developing a new approach to learning' and 'impacting care'. CONCLUSION(S): Since the pandemic, palliative care professionals have increased their use of digital health to support communication in clinical practice. We have identified facilitators and barriers for future practice. Further work should identify the levels of support needed for organisations to ensure that digital health interventions are meaningfully used to help palliative care professionals effectively communicate with patients, caregivers and staff.

Measuring the Coverage of the HL7® FHIR® Standard in Supporting Data Acquisition for 3 Public Health Registries.

With the increasing need for timely submission of data to state and national public health registries, current manual approaches to data acquisition and submission are insufficient. In clinical practice, federal regulations are now mandating the use of data messaging standards, i.e., the Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard, to facilitate the electronic exchange of clinical (patient) data. In both research and public health practice, we can also leverage FHIR® ‒ and the infrastructure already in place for supporting exchange of clinical practice data ‒ to enable seamless exchange between the electronic medical record and public health registries. That said, in order to understand the current utility of FHIR® for supporting the public health use case, we must first measure the extent to which the standard resources map to the required registry data elements. Thus, using a systematic mapping approach, we evaluated the level of completeness of the FHIR® standard to support data collection for three public health registries (Trauma, Stroke, and National Surgical Quality Improvement Program). On average, approximately 80% of data elements were available in FHIR® (71%, 77%, and 92%, respectively; inter-annotator agreement rates: 82%, 78%, and 72%, respectively). This tells us that there is the potential for significant automation to support EHR-to-Registry data exchange, which will reduce the amount of manual, error-prone processes and ensure higher data quality. Further, identification of the remaining 20% of data elements that are "not mapped" will enable us to improve the standard and develop profiles that will better fit the registry data model.

Bridge the gap caused by public health crises: medical humanization and communication skills build a psychological bond that satisfies patients.

BACKGROUND: Patient satisfaction is an important outcome domain of patient-centered care. Medical humanization follows the patient-centered principle and provides a more holistic view to treat patients. The COVID-19 pandemic posed significant barriers to maintaining medical humanization. However, empirical study on the relationship between medical humanization and patient satisfaction is clearly absent. OBJECTIVES: We examined the mediation effects of communication on the relationship between medical humanization and patient satisfaction when faced with a huge public health crisis like the COVID-19 pandemic, and the moderation effect of medical institutional trust on the mediation models. METHODS: A cross-sectional survey study was performed. A final sample size of 1445 patients was surveyed on medical humanization, communication, patient satisfaction and medical institutional trust. RESULTS: All correlations were significantly positive across the main variables (r = 0.35-0.67, p < 0.001 for all) except for medical institutional trust, which was negatively correlated with the medical humanization (r=-0.14, p < 0.001). Moderated mediation analysis showed that the indirect effect of medical humanization on patient satisfaction through communication was significant (b = 0.22, 95% CI: 0.18 ~ 0.25). Medical institutional trust significantly moderated the effect of medical humanization on patient satisfaction (b=-0.09, p < 0.001) and the effect of medical humanization on communication (b= -0.14, p < 0.001). CONCLUSION: Medical humanization positively influence patient satisfaction, communication mediated the association between medical humanization and patient satisfaction, and medical institutional trust negatively moderated the effects of medical humanization on patient satisfaction and communication. These findings suggest that humanistic communication contributes to patient satisfaction in the face of a huge public health crisis, and patients' evaluation of satisfaction is also regulated by rational cognition.

Boletín de Inmunización, v.45, n.4, Dic. 2023

La Organización Panamericana de la Salud (OPS) publica cuatro veces al año el Boletín de Inmunización en español, francés, inglés y portugués. Su propósito es facilitar el intercambio de ideas e información sobre los programas de inmunización en la Región de las Américas y más allá. Se publica desde 1979 en inglés y español, con versiones en francés y portugués a partir de 2001 y 2019, respectivamente. El número de diciembre de 2023 del Boletín de Inmunización abarca los siguientes temas: un taller sobre la participación de la comunidad y la comunicación de los riesgos relacionados con la vacunación que se llevó a cabo en Lima, Perú, en octubre del 2023 y en el que participaron 10 países sudamericanos; Lo que he aprendido... Por Anne Eudes Jean Baptiste, Asesora Regional de Inmunización del Programa Especial de Inmunización Integral (CIM) de la Organización Panamericana de la Salud (OPS); Construir una mejor inmunidad: Un enfoque del curso de la vida para una longevidad saludable; Conocimientos, actitudes y prácticas de vacunación entre los trabajadores de la salud con énfasis en las vacunas contra la COVID-19 en Paraguay; La OPS y los CDC trabajan juntos para crear capacidades regionales para abordar los retos de la salud pública; La ética de los mandatos de vacunación: Avanzar en el debate para prepararse para el futuro; y Mejora de la capacidad de respuesta a brotes y microplanificación mediante talleres en Guatemala. Estos artículos proporcionan exploraciones y actualizaciones sobre diversos aspectos de los programas de inmunización en la Región, mostrando el trabajo que se está realizando con detalle y fuentes primarias de información. El Boletín de Inmunización es una forma fiable y periódica de conocer el amplio trabajo técnico que se está realizando en este campo, por parte de la OPS, los ministerios de salud y en colaboración con otras entidades y organizaciones internacionales.

An mHealth application for chronic vascular access: A multi-method evaluation.

BACKGROUND: Healthcare consumers require diverse resources to assist their navigation of complex healthcare interactions, however, these resources need to be fit for purpose. AIM: In this study, we evaluated the utility, usability and feasibility of children, families and adults requiring long-term intravenous therapy using a recently developed mobile health application (App), intravenous (IV) Passport. DESIGN: Multi-site, parallel, multi-method, prospective cohort study. METHODS: A multi-site, multi-method study was carried out in 2020-2021, with 46 participants (20 adults, 26 children/family) reporting on their experiences surrounding the use of the IV Passport for up to 6 months. RESULTS: Overall, utility rates were acceptable, with 78.3% (N = 36) using the IV Passport over the follow-up period, with high rates of planned future use for those still active in the project (N = 21; 73%), especially in the child/family cohort (N = 13; 100%). Acceptability rates were high (9/10; IQR 6.5-10), with the IV Passport primarily used for documenting new devices and complications. Thematic analysis revealed three main themes (and multiple subthemes) in the qualitative data: Advocacy for healthcare needs, Complexity of healthcare and App design and functionality. CONCLUSION: Several recommendations were made to improve the end-user experience including 'how to' instructions; and scheduling functionality for routine care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The IV Passport can be safely and appropriately integrated into healthcare, to support consumers. IMPACT: Patient-/parent-reported feedback suggests the Intravenous Passport is a useful tool for record-keeping, and positive communication between patients/parents, and clinicians. REPORTING METHOD: Not applicable. PATIENT CONTRIBUTION: Consumers reported their experiences surrounding the use of the IV Passport for up to 6 months.

Electronic Health Record and Semantic Issues Using Fast Healthcare Interoperability Resources: Systematic Mapping Review.

BACKGROUND: The increasing use of electronic health records and the Internet of Things has led to interoperability issues at different levels (structural and semantic). Standards are important not only for successfully exchanging data but also for appropriately interpreting them (semantic interoperability). Thus, to facilitate the semantic interoperability of data exchanged in health care, considerable resources have been deployed to improve the quality of shared clinical data by structuring and mapping them to the Fast Healthcare Interoperability Resources (FHIR) standard. OBJECTIVE: The aims of this study are 2-fold: to inventory the studies on FHIR semantic interoperability resources and terminologies and to identify and classify the approaches and contributions proposed in these studies. METHODS: A systematic mapping review (SMR) was conducted using 10 electronic databases as sources of information for inventory and review studies published during 2012 to 2022 on the development and improvement of semantic interoperability using the FHIR standard. RESULTS: A total of 70 FHIR studies were selected and analyzed to identify FHIR resource types and terminologies from a semantic perspective. The proposed semantic approaches were classified into 6 categories, namely mapping (31/126, 24.6%), terminology services (18/126, 14.3%), resource description framework or web ontology language-based proposals (24/126, 19%), annotation proposals (18/126, 14.3%), machine learning (ML) and natural language processing (NLP) proposals (20/126, 15.9%), and ontology-based proposals (15/126, 11.9%). From 2012 to 2022, there has been continued research in 6 categories of approaches as well as in new and emerging annotations and ML and NLP proposals. This SMR also classifies the contributions of the selected studies into 5 categories: framework or architecture proposals, model proposals, technique proposals, comparison services, and tool proposals. The most frequent type of contribution is the proposal of a framework or architecture to enable semantic interoperability. CONCLUSIONS: This SMR provides a classification of the different solutions proposed to address semantic interoperability using FHIR at different levels: collecting, extracting and annotating data, modeling electronic health record data from legacy systems, and applying transformation and mapping to FHIR models and terminologies. The use of ML and NLP for unstructured data is promising and has been applied to specific use case scenarios. In addition, terminology services are needed to accelerate their use and adoption; furthermore, techniques and tools to automate annotation and ontology comparison should help reduce human interaction.

Mental Health News during the COVID-19 Pandemic: A 3-year analysis in Paraguay / Noticias sobre Salud Mental durante la pandemia de COVID-19: Un análisis de 3 años en Paraguay

Introduction. The connection between news sources and the connotation of mental health articles in Paraguay during the COVID-19 pandemic (2020-2023) significantly impacted public opinion about mental health. Objective.This study analyzednews onmental health in Paraguay in the context of the COVID-19 pandemic. Material and methods.A descriptive retrospective study of all news articles on mental health published in the three primary newspapers of the country between May 2020 and May 2023 was conducted. The keywords were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, and mental health issues. Results. A total of 534 newswereexamined, 39.5% published by La Nación newspaper, 33.1% in 2023, and in 88.4% the author's identity and gender were not specified. Of the writing characteristics, 99.8% were written in the third person, 62.7% had a human-interest context,48.5% had a neutral connotation, 65.7% focused on health and well-being,and 7.5% written by health experts. The year of publication wasstatistically associated to connotation (p=0.003) and context (p<0.001). Conclusion. The media has paid significant attention to mental health. Despite the objectivity provided by third-person narration, problems arise because of a lack of author identification. To encourage balanced and non-polarized reporting, it is crucial to incorporate expert voices and promote the framing of mental health stories as "human interest". Palabras clave: mental health; news; newspaper article; COVID-19; Paraguay

Introducción. La conexión entre las fuentes de noticias y la connotación de los artículos sobre salud mental en Paraguay durante la pandemia de COVID-19 (2020-2023) impactó significativamente en la opinión pública sobre la salud mental. Objetivo. Analizar las noticias sobre salud mental en Paraguay en el contexto de la pandemia COVID-19. Material y métodos. Se realizó un estudio descriptivo retrospectivo de todos los artículos periodísticos sobre salud mental publicados en los tres principales periódicos del país entre mayo de 2020 y mayo de 2023. Las palabras clave fueron trastornos depresivos, trastornos de ansiedad, trastorno bipolar, esquizofrenia y problemas de salud mental. Resultados. Se examinaron 534 artículos periodísticos, 39,5% publicados por el diario La Nación, 33,1% en 2023y en 88,4%no se especificó la identidad ni el género del autor. De las características de redacción, el 99,8% estaban escritos en tercera persona, 62,7% pertenecían a un contexto de interés humano,48,5% tenían una connotación neutra, 65,7% se centraban en la salud y el bienestar y el 7,5% escritos por expertos en salud. El año de publicación se asoció significativamente con la connotación (p=0,003) y con el contexto (p<0,001). Conclusión. Los medios de comunicación han prestado gran atención a la salud mental. A pesar de la objetividad que aporta la narración en tercera persona, surgen problemas por la falta de identificación del autor. Para fomentar una información equilibrada y no polarizada, es crucial incorporar voces expertas y promover el encuadre de las historias de salud mental como "interés humano". Key words: salud mental; noticias; artículo de periódico; COVID-19;Paraguay

Privacy concerns among the users of a national patient portal: A cross-sectional population survey study.

INTRODUCTION: Seeking and receiving care requires disclosure of personal information which is recorded as health data in electronic health records. Thereafter, restricting the flow of information is dependent on data protection, information security, ethical conduct, and law. Privacy concerns may arise as patients' options concerning privacy have been balanced to cater both the privacy of patients and the needs of healthcare, as well as secondary use of data. METHODS: This study examined privacy concerns among the users of a national patient portal in a representative sample of Finnish adults aged 20 to 99 years old (n = 3,731). We used logistic regression analysis with population weights to seek answers to which factors are associated with privacy concerns. The cross-sectional survey data was collected in 2020. RESULTS: Every third patient portal user had privacy concerns. Those who were 50 to 59 years old (p = 0.030) had privacy concerns more often than 20 to 49-year-olds. Those who had financial difficulties (p = 0.003) also had privacy concerns more often while those, who had good digital skills (p=<0.026), did not need guidance on telehealth service use (p=<0.001) and found telehealth service use to be beneficial (p = 0.008), had privacy concerns less often. CONCLUSION: The usefulness of telehealth seems to play an important role in privacy concerns. Another important factor is the skills required to use telehealth services. We encourage providing guidance to those who lack the necessary skills for telehealth service use. We also encourage putting effort not only into data protection and information security measures of telehealth services, but also into providing transparent and comprehensible privacy information for the service users as privacy concerns are common.