Evaluation of an Enhanced Role-Based Access Control model to manage information access in collaborative processes for a statewide clinical education program.

BACKGROUND: Managing information access in collaborative processes is a critical requirement to team-based biomedical research, clinical education, and patient care. We have previously developed a computation model, Enhanced Role-Based Access Control (EnhancedRBAC), and applied it to coordinate information access in the combined context of team collaboration and workflow for the New York State HIV Clinical Education Initiative (CEI) program. We report in this paper an evaluation study to assess the effectiveness of the EnhancedRBAC model for information access management in collaborative processes when applied to CEI. METHODS: We designed a cross-sectional study and performed two sets of measurement: (1) degree of agreement between EnhancedRBAC and a control system CEIAdmin based on 9152 study cases, and (2) effectiveness of EnhancedRBAC in terms of sensitivity, specificity, and accuracy based on a gold-standard with 512 sample cases developed by a human expert panel. We applied stratified random sampling, partial factorial design, and blocked randomization to ensure a representative case sample and a high-quality gold-standard. RESULTS: With the kappa statistics of four comparisons in the range of 0.80-0.89, EnhancedRBAC has demonstrated a high level of agreement with CEIAdmin. When evaluated against the gold-standard, EnhancedRBAC has achieved sensitivities in the range of 97-100%, specificities at the level of 100%, and accuracies in the range of 98-100%. CONCLUSIONS: The initial results have shown that the EnhancedRBAC model can be effectively used to manage information access in the combined context of team collaboration and workflow for coordination of clinical education programs. Future research is required to perform longitudinal evaluation studies and to assess the effectiveness of EnhancedRBAC in other applications.

Nutritional status and dietary intake before hospital admission of pulmonary tuberculosis patients.

Conducting research on nutritional status and dietary intake of pulmonary tuberculosis patients is essential for developing interventions in clinical nutrition practice and treatment during hospitalization, which can improve the quality of patients life. This cross-sectional descriptive study aimed to determine nutritional status and some related factors (such as geography, occupation, educational level, economic classification, etc.) of 221 patients with pulmonary tuberculosis who were examined and treated at the Respiratory Tuberculosis Department, National Lung Hospital in July 2019-May 2020. The results showed that the risk of undernutrition: According to BMI (Body Mass Index): 45.8% of patients were malnourished, 44.2% normal and 10.0% overweight/obese. According to MUAC (Mid-Upper Arm Circumference): 60.2% of patients were malnourished, 39.8% of patients were normal. According to SGA (Subjective Global Assessment): 57.9% of patients were at risk of undernutrition, of which 40.7% were at moderate risk of undernutrition and 17.2% risk of severe undernutrition. Classification of nutritional status according to serum albumin index: 50% of patients were malnourished, the rate of undernutrition of mild, moderate and severe levels was 28.9%, 17.9% and 3.2%, respectively. Most patients eat with others and eat less than four meals a day. The average dietary energy of patients with pulmonary tuberculosis in was 1242.6 ± 46.5 Kcal and 1084 ± 57.9 Kcal, respectively. 85.52% of patients did not eat enough food, 4.07% had enough, 10.41% consumed excess energy. The ratio of energy-generating substances in the diet (Carbohydrate:Protein:Lipid) was on average 54:18:28 for males and 55:16:32 for females. Most of the study population had diets that did not meet the experimental study in terms of micronutrient content. Specifically, more than 90% do not meet the requirements for magnesium, calcium, zinc, and vitamin D. The water-soluble and fat-soluble vitamins respond poorly, only about 30-40%. Selenium is the mineral with the best response rate, above 70%. Our findings revealed that the majority of the study subjects had poor nutritional status, as evidenced by diets lacking in essential micronutrients.

Testing reliability and validity of the Vietnamese version of the eHealth literacy scale (eHEALS) among medical students in Vietnam.

BACKGROUND: In the context of COVID-19 pandemic, eHealth Literacy is important and essential for healthcare workers, especially medical students; eHealth Literacy Scale (eHEALS) was developed to measured eHealth literacy of individuals, with higher eHEALS scores indicated greater ehealth literacy. OBJECTIVES: The study evaluates the reliability and validity of Vietnamese version of eHEALS and analyzed some factors affecting on eHEALS score among Hanoi Medical University students in Vietnam. METHODS: A cross-sectional study design was adopted, and data were elicited from 494 medical students. Exploratory Factor Analysis (EFA); Cronbach's alpha and correlation coefficients; split-half assessment; Poisson regression analysis were applied. RESULTS: The total score of our subjects in the eHEALS was 30.34 ± 4.57. The results from Bartlett's test, Kaiser-Meyer-Olkin (KMO) test, calculated Cronbach's alpha coefficient and test-retest reliability were high. Poisson regression identified that eHEALS scores of participants was significantly associated with device, ongoing medical condition and trustworthiness of health information source (p < 0.05). DISCUSSION: Our study helps researchers who conduct studies in eHealth develop optimal applied and intervention researches in subjects with medical knowledge. Additional studies need to be required with numerous different groups of people in Vietnam. CONCLUSION: The Vietnamese version of eHEALS is a reliable and valid measure. Device, medical condition and trustworthiness of health information source are factors affecting on eHEALS score of students in Hanoi Medical University.

An enhancement of the role-based access control model to facilitate information access management in context of team collaboration and workflow.

Although information access control models have been developed and applied to various applications, few of the previous works have addressed the issue of managing information access in the combined context of team collaboration and workflow. To facilitate this requirement, we have enhanced the Role-Based Access Control (RBAC) model through formulating universal constraints, defining bridging entities and contributing attributes, extending access permissions to include workflow contexts, synthesizing a role-based access delegation model to target on specific objects, and developing domain ontologies as instantiations of the general model to particular applications. We have successfully applied this model to the New York State HIV Clinical Education Initiative (CEI) project to address the specific needs of information management in collaborative processes. An initial evaluation has shown this model achieved a high level of agreement with an existing system when applied to 4576 cases (kappa=0.801). Comparing to a reference standard, the sensitivity and specificity of the enhanced RBAC model were at the level of 97-100%. These results indicate that the enhanced RBAC model can be effectively used for information access management in context of team collaboration and workflow to coordinate clinical education programs. Future research is required to incrementally develop additional types of universal constraints, to further investigate how the workflow context and access delegation can be enriched to support the various needs on information access management in collaborative processes, and to examine the generalizability of the enhanced RBAC model for other applications in clinical education, biomedical research, and patient care.

Plasmodium knowlesi malaria in Vietnam: some clarifications.

A recently published comment on a report of Plasmodium knowlesi infections in Vietnam states that this may not accurately represent the situation in the study area because the PCR primers used may cross-hybridize with Plasmodium vivax. Nevertheless, P. knowlesi infections have been confirmed by sequencing. In addition, a neighbour-joining tree based on the 18S S-Type SSUrRNA gene shows that the Vietnamese samples clearly cluster with the P. knowlesi isolates identified in Malaysia and are distinct from the corresponding P. vivax sequences. All samples came from asymptomatic individuals who did not consult for fever during the months preceding or following the survey, indicating that asymptomatic P. knowlesi infections occur in this population, although this does not exclude the occurrence of symptomatic cases. Large-scale studies to determine the extent and the epidemiology of P. knowlesi malaria in Vietnam are further needed.

Low perception of malaria risk among the Ra-glai ethnic minority in south-central Vietnam: implications for forest malaria control.

BACKGROUND: Despite Vietnam's success in reducing malaria mortality and morbidity over the last decade, malaria persists in the forested and mountainous areas of the central and southern provinces, where more than 50% of the clinical cases and 90% of severe cases and malaria deaths occur. METHODS: Between July 2005 and September 2006, a multi-method study, triangulating a malariometric cross-sectional survey and qualitative data from focused ethnography, was carried out among the Ra-glai ethnic minority in the hilly forested areas of south-central Vietnam. RESULTS: Despite the relatively high malaria burden among the Ra-glai and their general awareness that mosquitoes can transmit an unspecific kind of fever (84.2%), the use of bed nets, distributed free of charge by the national malaria control programme, remains low at the farmers' forest fields where the malaria risk is the highest. However, to meet work requirements during the labour intensive malaria transmission and rainy season, Ra-glai farmers combine living in government supported villages along the road with a second home or shelter at their slash and burn fields located in the forest. Bed net use was 84.6% in the villages but only 52.9% at the forest fields; 20.6% of the respondents slept unprotected in both places. Such low use may be explained by the low perception of the risk for malaria, decreasing the perceived need to sleep protected. Several reasons may account for this: (1) only 15.6% acknowledged the higher risk of contracting malaria in the forest than in the village; (2) perceived mosquito biting times only partially coincided with Anopheles dirus ss and Anopheles minimus A true biting times; (3) the disease locally identified as 'malaria' was hardly perceived as having an impact on forest farmers' daily lives as they were unaware of the specific kind of fevers from which they had suffered even after being diagnosed with malaria at the health centre (20.9%). CONCLUSIONS: The progressive confinement of malaria to minority groups and settings in the Greater Mekong sub-region implies that further success in malaria control will be linked to research into these specific socio-cultural contexts. Findings highlight the need for context sensitive malaria control policies; not only to reduce the local malaria burden but also to minimize the risk of malaria spreading to other areas where transmission has virtually ceased.

Epidemiology of forest malaria in central Vietnam: a large scale cross-sectional survey.

In Vietnam, a large proportion of all malaria cases and deaths occurs in the central mountainous and forested part of the country. Indeed, forest malaria, despite intensive control activities, is still a major problem which raises several questions about its dynamics.A large-scale malaria morbidity survey to measure malaria endemicity and identify important risk factors was carried out in 43 villages situated in a forested area of Ninh Thuan province, south central Vietnam. Four thousand three hundred and six randomly selected individuals, aged 10-60 years, participated in the survey. Rag Lays (86%), traditionally living in the forest and practising "slash and burn" cultivation represented the most common ethnic group. The overall parasite rate was 13.3% (range [0-42.3] while Plasmodium falciparum seroprevalence was 25.5% (range [2.1-75.6]). Mapping of these two variables showed a patchy distribution, suggesting that risk factors other than remoteness and forest proximity modulated the human-vector interactions. This was confirmed by the results of the multivariate-adjusted analysis, showing that forest work was a significant risk factor for malaria infection, further increased by staying in the forest overnight (OR= 2.86; 95%CI [1.62; 5.07]). Rag Lays had a higher risk of malaria infection, which inversely related to education level and socio-economic status. Women were less at risk than men (OR = 0.71; 95%CI [0.59; 0.86]), a possible consequence of different behaviour. This study confirms that malaria endemicity is still relatively high in this area and that the dynamics of transmission is constantly modulated by the behaviour of both humans and vectors. A well-targeted intervention reducing the "vector/forest worker" interaction, based on long-lasting insecticidal material, could be appropriate in this environment.

Identifying Effective Approaches for Dissemination of Clinical Evidence--Correlation Analyses on Promotional Activities and Usage of a Guideline-Driven Interactive Case Simulation Tool in a Statewide HIV-HCV-STD Clinical Education Program.

Dissemination of the latest clinical evidence to community-based healthcare providers is a critical step to translate biomedical knowledge into clinical practice. We performed a study to analyze the correlations between the promotional activities and the usage of a guideline-driven interactive case simulation tool (ICST) for insomnia screening and treatment in a statewide HIV-HCV-STD clinical education program. For this purpose, we tracked users' interactions with the ICST and the sending of promotional email newsletters during a study period of 44 weeks. Results showed that promotional activities were strongly correlated with the number of audience as well as the intensity of use of the target resource. The strength of correlation varied in specific use contexts. Strong correlations were found between the sending of email newsletters and the intensity of resource use by promotion recipients, by new users, and through the most convenient access channel associated with the promotion. Selection of approaches for resource dissemination should consider the potentials and limitations of use contexts to make them more effective.

Assessing the usage of a guideline-driven interactive case simulation tool for insomnia screening and treatment in an HIV clinical education program.

Interactive case simulation tools (ICSTs) are important vehicles to disseminate medical knowledge. We conducted a study to examine the usage of an insomnia screening and treatment case simulation tool in an HIV clinical education program. Using system usage diagrams (SUDs) as an instrument, we quantified visit frequency and length of stay for different types of system resources. Preliminary results have shown that both recommendations and interactive decision diagrams were frequently used, with the former having a longer length of stay but fewer visits. Case simulation functions seemed to be able to engage users. Future research is required to verify the generalizability of the identified usage patterns, to investigate issues in usability design, and to perform correlation analyses on system usage and context parameters.

Study on the risk factors of malaria infection among people has regular forest activity in one province central Vietnam

The authors studied epidemiology of forest malaria through a cross-sectional community based study in one province, central Vietnam. A total of 4036 individuals were investigated in 2004. Results: the prevalence of antibodies to P.falciparum was constantly about 20.5% and the prevalence rate of malaria parasite was 13.3%. Multivariate analysis showed that the regular forest activity was the main risk factor for malaria infection (OR = 5.51, p< 0.005). The population- attributable fraction for regular forest activity was estimated to be 99.5%. The results confirmed the major role played by forest activity on the malaria burden in this area and provide the basic for targeting control activities to forest worker. New interventions based on insecticide-treated materials need to urgently evaluated like: bed nets, hammocks...

Characteristics of social migration, malaria epidemiology anf related risk factors in migrants in Ea Sup district, Dak Lak province, 2002-2004

A study on epidemiological characteristics of migration and malaria was carried out in Ea Sup district, Dak Lak province in 2002-2004. The findings showed that the migrants from the North in 2-5 recent years stayed permanently in the new land (98.8%). The main reason for migration was the economic factor (95.5%). The migrants were exposed to the malaria infection during their 1-2 week moving time and lack of protection means, such as bednets (83.0%) and antimalarial drugs (17%). The living place of the migrants was isolated and closed to the forest with temporary house (97%), and the malaria prevalence and incidence were high. There is no significant difference in malaria infection rates by gender, ethnic and parasite species. The risk factors were due to working and sleeping in the forest (98%), and poor structured houses (86%). The knowledge on malaria of the migrants was higher than local people (77% vs. 52%), but the income was lower (50% and 78%). The lack of bednets was 67% and the use of bednets was 90%. The rates of health care seeking behavior and accessing to health information were low: 36-56% and 27 30%.

Using remote sensing and GIS technology to monitor and predict the malaria risk in Ham Thuan Nam district, Binh Thuan province

Remote sensing and GIS technology was studied in 2003 to detect and predict the malaria risk in Ham Thuan Nam district, Binh Thuan province where malaria is endemic. The results showed that: there is a chased relationships between natural, environmental and socio-economic indicators and malaria transmission in different areas of the district. The malaria morbidity rate from 1996 to 2002 and environmental parameters such as land cover, vegetation, climate, meteorology... were used for constructing a map to show the risk of malaria in the district through the retrospective and existing data SPOT, LANDSAT and ASTER satellite imageries. Based on this malaria risk map, the malaria situation and epidemic can be detected and prevented.

Study on current status of malaria and efficacy of control measures among migrants in one malaria endemic district in Central Highland of Vietnam

A study on the current status of malaria and the efficacy of interventions among migrants was carried out in one district with high malaria transmission in Central Highland - Vietnam from 2002-2004. The findings of the study showed that: The malaria prevalence of clinical and parasite were high in the migrant, especially among new comers (clinical rate: 5.2% and parasite rate:4.3%). These rates were higher than that in local people (clinical rate:5.0% and parasite rate: 3.1%) and were still high in the year 3 and decreasing after 3 years. The applied interventions for migrant were: strengthening of the health education, improvement of community health workers and they were effective. The prevalence and incidence of malaria were reduced from 3.9 to 0.65% and 45.3 to 28.1/1000 population, respectively, after 3 years. The malaria rate was reduced by 40-60% compared with that in the control group.

Apply GIS technology and geographical information system in monitoring and predicting malaria risks in Ham Thuan Nam distric, Binh Thuan province

Remote sensing and GIS technology was studied to detect and predict the malaria risk in Ham Thuan Nam district, Binh Thuan province where malaria is endemic in 2003. The result showed that: there was a strong realationship between natural, environmental and socio-economic indicators and malaria transmission in different areas of the district. The factors affect to ecological and developmental environment of mosquite and make advantage developmental condition for mosquite and conversely. GIS method is effect tool to define the factors and play a basic role for building up a map to show the risk of malaria. Remote sensing material and methods to deal with information provide important, objective information as NDVI index. The vary of the index together with another index as geography, climate... are important index in building epidemic forecast system early.

Preliminary results of the study on malaria epidemiology among migrating people in Easup district of DakLak province

A study conducted in 4 communes in Easup district of Daklak province, the result showed that the nomadic people are of the ethnic minority group of Tay, Nung, Thai, Muong coming from Northern provinces. The main reason for their migration is poor economic conditions (100%). Whole families or households moved and settled in new areas (76.42%). Most of them lived in temporary houses (79.1%), near the forest, at edge of the forest or inside the forest (51.9%) Self prevention form mosquito bites was poor with 19.7% of new settles did not regularly sleep under mosquito nets or lack of misquito nets (52.2%). The malaria incidence among the new settlers was found to be higher than that of old settlers as clinical malaria: 4.75% compared to 2.34%, confirmed cases 2.71% compared to 0.20% while it was similar to the local ethnic minority groups with clinical and confirmed cases were equal in both groups

Using remote Sensing and GIS technology to monitor and predict the malaria risk in Ham Thuan Nam district, Binh Thuan province

Remote Sensing and GIS technology was studied in 2003 to detect and predict the malaria risk in Ham Thuan Nam district, Binh Thuan province where malaria is endemic. The results showed that there was a strong relationship between natural, environmental and socio-economic indicators and malaria transmission in different areas of the district. The malaria morbidity rate from 1996 to 2002 and enviromental parameters such as land cover, vegetation, climate, meteorology... were used for building up a map to show the risk of malaria of the district through the retrospective and existing data SPOT, LANDSAT and ASTER satellite imageries. This map is corresponding with the malaria stratification maps of the district. Based on this malaria risk map, malaria situation and epidemic can be detected and prevented