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Frontiers in Digital Health 2024In the big data era, where corporations commodify health data, non-fungible tokens (NFTs) present a transformative avenue for patient empowerment and control. NFTs are...
INTRODUCTION
In the big data era, where corporations commodify health data, non-fungible tokens (NFTs) present a transformative avenue for patient empowerment and control. NFTs are unique digital assets on the blockchain, representing ownership of digital objects, including health data. By minting their data as NFTs, patients can track access, monetize its use, and build secure, private health information systems. However, research on NFTs in healthcare is in its infancy, warranting a comprehensive review.
METHODS
This study conducted a systematic literature review and thematic analysis of NFTs in healthcare to identify use cases, design models, and key challenges. Five multidisciplinary research databases (Scopus, Web of Science, Google Scholar, IEEE Explore, Elsevier Science Direct) were searched. The approach involved four stages: paper collection, inclusion/exclusion criteria application, screening, full-text reading, and quality assessment. A classification and coding framework was employed. Thematic analysis followed six steps: data familiarization, initial code generation, theme searching, theme review, theme definition/naming, and report production.
RESULTS
Analysis of 19 selected papers revealed three primary use cases: patient-centric data management, supply chain management for data provenance, and digital twin development. Notably, most solutions were prototypes or frameworks without real-world implementations. Four overarching themes emerged: data governance (ownership, tracking, privacy), data monetization (commercialization, incentivization, sharing), data protection, and data storage. The focus lies on user-controlled, private, and secure health data solutions. Additionally, data commodification is explored, with mechanisms proposed to incentivize data maintenance and sharing. NFTs are also suggested for tracking medical products in supply chains, ensuring data integrity and provenance. Ethereum and similar platforms dominate NFT minting, while compact NFT storage options are being explored for faster data access.
CONCLUSION
NFTs offer significant potential for secure, traceable, decentralized healthcare data exchange systems. However, challenges exist, including dependence on blockchain, interoperability issues, and associated costs. The review identified research gaps, such as developing dual ownership models and data pricing strategies. Building an open standard for interoperability and adoption is crucial. The scalability, security, and privacy of NFT-backed healthcare applications require further investigation. Thus, this study proposes a research agenda for adopting NFTs in healthcare, focusing on governance, storage models, and perceptions.
PubMed: 38919876
DOI: 10.3389/fdgth.2024.1377531 -
PloS One 2024Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe...
BACKGROUND
Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition.
METHODS
514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020.
RESULTS
Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect.
INTERPRETATION
While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.
Topics: Humans; Child; Emergency Service, Hospital; Female; Male; Adolescent; Canada; Cross-Sectional Studies; Surveys and Questionnaires; Patient Satisfaction
PubMed: 38917134
DOI: 10.1371/journal.pone.0305562 -
JMIR Pediatrics and Parenting Jun 2024The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. (Review)
Review
Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis.
BACKGROUND
The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation.
OBJECTIVE
The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health.
METHODS
We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022).
RESULTS
A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space.
CONCLUSIONS
There is an opportunity to reduce the barriers to implementing tele-mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele-mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation.
PubMed: 38916946
DOI: 10.2196/55100 -
Journal of Acquired Immune Deficiency... Aug 2024HIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by...
BACKGROUND
HIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by community health workers (CHWs) is a scalable option to increase testing coverage, diagnosis, and treatment initiation. We provided HIVSS and assisted linkage to care to men not recently tested (within the past 12 months) residing in high-HIV-burden areas of Johannesburg.
METHODS
CHWs distributed HIVSS in 6 clinic catchment areas. Follow-up to encourage confirmatory testing and antiretroviral therapy initiation was conducted through personal support (PS) or an automated short message service (SMS) follow-up and linkage system in 3 clinic areas each. Using a quasi-experimental pre-post design, we compared differences in the proportion of men testing in the clinic catchment areas during the HIVSS campaign (June-August 2019) to the 3 months prior (March-May 2019) and compared treatment initiations by assisted linkage strategy.
RESULTS
Among 4793 participants accepting HIVSS, 62% had never tested. Among 3993 participants with follow-up data, 90.6% reported using their HIVSS kit. Testing coverage among men increased by 156%, from under 4% when only clinic-based HIV testing services were available to 9.5% when HIVSS and HIV testing services were available (z = -11.6; P < 0.01). Reported test use was higher for men followed through PS (99% vs. 68% in SMS); however, significantly more men reported reactive self-test results in the SMS group compared with PS (6.4% vs. 2.0%), resulting in more antiretroviral therapy initiations in the SMS group compared with PS (23 vs. 9; P < 0.01).
CONCLUSIONS
CHW HIVSS distribution significantly increases testing among men. While PS enabled personalized follow-up, reporting differences indicate SMS is more acceptable and better aligned with expectations of privacy associated with HIVSS.
Topics: Humans; Male; HIV Infections; South Africa; Adult; Middle Aged; Mass Screening; Young Adult; Self-Testing; HIV Testing; Community Health Workers; Adolescent
PubMed: 38916430
DOI: 10.1097/QAI.0000000000003442 -
Contraception and Reproductive Medicine Jun 2024Even though family planning 2020 has made remarkable progress about solving the issue of unmet need for family planning, 70% of women in a developing countries who do...
Modern contraceptive utilization and associated factors among postpartum women in Kena Woreda, Konso Zone, South Ethiopian Regional State, Ethiopia, 2023: mixed type community based cross-sectional study design.
BACKGROUND
Even though family planning 2020 has made remarkable progress about solving the issue of unmet need for family planning, 70% of women in a developing countries who do not want to conceive are not using it. There are limited research that provided detail information regarding barriers of modern contraceptive utilization during postpartum period in the study area. In addition, previous study also recommended that to conduct using mixed quantitative and qualitative design for further investigations to answer these "why" questions and narrow these gaps.
OBJECTIVE
This study aimed to assess postpartum modern contraceptive utilization and associated factors among postpartum women in Kena woreda, Konso zone, South Ethiopian Regional State, Ethiopia, 2023.
METHODS
A mixed type community based cross-sectional study design was conducted among 605 women in Kena woreda, from September 1-30/2023 out of 628 sampled mothers. Multistage sampling technique was used to select study participant and data was collected using semi-structured pretested questionnaire and entered in to Epi data version 3.1 and then exported to STATA version 14 for analysis for quantitative. The association between variables was analyzed using bivariate and multivariable binary logistic regression and level of significant determined with adjusted odd ratio at 95% CI and P-value less than < 0.05. After translation and transcription, manual thematic analysis was applied to the qualitative data.
RESULTS
The prevalence of modern contraceptive use among women during postpartum period in Kena woreda was found to be 39.01% [95% CI: 35.18-42.96%]. Menses resumed (AOR = 1.63; 95% CI: 1.02, 2.59), linked to the family planning unit during their child`s immunization (AOR = 2.17; 95% CI: 1.45, 3.25), family planning counselling during antenatal care visit (AOR = 1.63; 95% CI: 1.10, 2.42) and good knowledge towards modern contraceptive (AOR = 1.53; 95% CI: 1.03, 2.26) were factors associated with postpartum contraceptive utilization. Partner oppose, myths and misconception, need for excess family size, religious prohibition, fear of side effect,menses not resumed, lack of counselling and privacy room, and lack of transportation to health facility were barriers to modern postpartum contraceptive utilization. CONCLUSIONS AND RECOMMENDATIONS: The utilization of postpartum contraceptives was found to be lower than the target set by the 2020/21 national reproductive health strategy plan, which aimed to increase contraceptive method usage to 50%. Menses resumed, family planning counselling during antenatal care visit, linked to the family planning unit during child immunization and good knowledge were factors associated to modern postpartum contraceptive utilization. Strengthening service integration and family planning counseling during antenatal care visits and encourage mothers to start using modern family planning methods before menses resume are important. Overcoming barriers including partner opposition, myths, religious beliefs, fear of side effects, lack of counseling at health facilities, and transportation challenges is essential.
PubMed: 38915118
DOI: 10.1186/s40834-024-00292-w -
BMC Medical Informatics and Decision... Jun 2024Many state-of-the-art results in natural language processing (NLP) rely on large pre-trained language models (PLMs). These models consist of large amounts of parameters...
Many state-of-the-art results in natural language processing (NLP) rely on large pre-trained language models (PLMs). These models consist of large amounts of parameters that are tuned using vast amounts of training data. These factors cause the models to memorize parts of their training data, making them vulnerable to various privacy attacks. This is cause for concern, especially when these models are applied in the clinical domain, where data are very sensitive. Training data pseudonymization is a privacy-preserving technique that aims to mitigate these problems. This technique automatically identifies and replaces sensitive entities with realistic but non-sensitive surrogates. Pseudonymization has yielded promising results in previous studies. However, no previous study has applied pseudonymization to both the pre-training data of PLMs and the fine-tuning data used to solve clinical NLP tasks. This study evaluates the effects on the predictive performance of end-to-end pseudonymization of Swedish clinical BERT models fine-tuned for five clinical NLP tasks. A large number of statistical tests are performed, revealing minimal harm to performance when using pseudonymized fine-tuning data. The results also find no deterioration from end-to-end pseudonymization of pre-training and fine-tuning data. These results demonstrate that pseudonymizing training data to reduce privacy risks can be done without harming data utility for training PLMs.
Topics: Natural Language Processing; Humans; Privacy; Sweden; Anonyms and Pseudonyms; Computer Security; Confidentiality; Electronic Health Records
PubMed: 38915012
DOI: 10.1186/s12911-024-02546-8 -
JMIR Human Factors Jun 2024Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19...
BACKGROUND
Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas.
OBJECTIVE
This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient.
METHODS
We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty.
RESULTS
We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients' internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system's barriers were largely privacy, confidentiality, and legal review concerns.
CONCLUSIONS
These findings echo similar studies in other health systems, surrounding providers' lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients' internet access to fully use mHealth in their delivery of care.
Topics: Humans; Telemedicine; Surveys and Questionnaires; COVID-19; Rural Health Services; Male; Attitude of Health Personnel; Female; Adult; Middle Aged; Mobile Applications; Internet
PubMed: 38913992
DOI: 10.2196/55443 -
Journal of Medical Internet Research Jun 2024Photographs from medical case reports published in academic journals have previously been found in online image search results. This means that patient photographs... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Photographs from medical case reports published in academic journals have previously been found in online image search results. This means that patient photographs circulate beyond the original journal website and can be freely accessed online. While this raises ethical and legal concerns, no systematic study has documented how often this occurs.
OBJECTIVE
The aim of this cross-sectional study was to provide systematic evidence that patient photographs from case reports published in medical journals appear in Google Images search results. Research questions included the following: (1) what percentage of patient medical photographs published in case reports were found in Google Images search results? (2) what was the relationship between open access publication status and image availability? and (3) did the odds of finding patient photographs on third-party websites differ between searches conducted in 2020 and 2022?
METHODS
The main outcome measure assessed whether at least 1 photograph from each case report was found on Google Images when using a structured search. Secondary outcome variables included the image source and the availability of images on third-party websites over time. The characteristics of medical images were described using summary statistics. The association between the source of full-text availability and image availability on Google Images was tested using logistic regressions. Finally, we examined the trend of finding patient photographs using generalized estimating equations.
RESULTS
From a random sample of 585 case reports indexed in PubMed, 186 contained patient photographs, for a total of 598 distinct images. For 142 (76.3%) out of 186 case reports, at least 1 photograph was found in Google Images search results. A total of 18.3% (110/598) of photographs included eye, face, or full body, including 10.9% (65/598) that could potentially identify the patient. The odds of finding an image from the case report online were higher if the full-text paper was available on ResearchGate (odds ratio [OR] 9.16, 95% CI 2.71-31.02), PubMed Central (OR 7.90, 95% CI 2.33-26.77), or Google Scholar (OR 6.07, 95% CI 2.77-13.29) than if the full-text was available solely through an open access journal (OR 5.33, 95% CI 2.31-12.28). However, all factors contributed to an increased risk of locating patient images online. Compared with the search in 2020, patient photographs were less likely to be found on third-party websites based on the 2022 search results (OR 0.61, 95% Cl 0.43-0.87).
CONCLUSIONS
A high proportion of medical photographs from case reports was found on Google Images, raising ethical concerns with policy and practice implications. Journal publishers and corporations such as Google are best positioned to develop an effective remedy. Until then, it is crucial that patients are adequately informed about the potential risks and benefits of providing consent for clinicians to publish their images in medical journals.
Topics: Cross-Sectional Studies; Humans; Photography; Internet
PubMed: 38913416
DOI: 10.2196/55352 -
Frontiers in Medicine 2024The rapid spread of COVID-19 pandemic across the world has not only disturbed the global economy but also raised the demand for accurate disease detection models....
The rapid spread of COVID-19 pandemic across the world has not only disturbed the global economy but also raised the demand for accurate disease detection models. Although many studies have proposed effective solutions for the early detection and prediction of COVID-19 with Machine Learning (ML) and Deep learning (DL) based techniques, but these models remain vulnerable to data privacy and security breaches. To overcome the challenges of existing systems, we introduced Adaptive Differential Privacy-based Federated Learning (DPFL) model for predicting COVID-19 disease from chest X-ray images which introduces an innovative adaptive mechanism that dynamically adjusts privacy levels based on real-time data sensitivity analysis, improving the practical applicability of Federated Learning (FL) in diverse healthcare environments. We compared and analyzed the performance of this distributed learning model with a traditional centralized model. Moreover, we enhance the model by integrating a FL approach with an early stopping mechanism to achieve efficient COVID-19 prediction with minimal communication overhead. To ensure privacy without compromising model utility and accuracy, we evaluated the proposed model under various noise scales. Finally, we discussed strategies for increasing the model's accuracy while maintaining robustness as well as privacy.
PubMed: 38912338
DOI: 10.3389/fmed.2024.1409314 -
Frontiers in Public Health 2024Digital health disparities continue to affect marginalized populations, especially older adults, individuals with low-income, and racial/ethnic minorities, intensifying...
Digital health disparities continue to affect marginalized populations, especially older adults, individuals with low-income, and racial/ethnic minorities, intensifying the challenges these populations face in accessing healthcare. Bridging this digital divide is essential, as digital access and literacy are social determinants of health that can impact digital health use and access to care. This article discusses the potential of leveraging community Wi-Fi and spaces to improve digital access and digital health use, as well as the challenges and opportunities associated with this strategy. The existing limited evidence has shown the possibility of using community Wi-Fi and spaces, such as public libraries, to facilitate telehealth services. However, privacy and security issues from using public Wi-Fi and spaces remain a concern for librarians and healthcare professionals. To advance digital equity, efforts from multilevel stakeholders to improve users' digital access and literacy and offer tailored technology support in the community are required. Ultimately, leveraging community Wi-Fi and spaces offers a promising avenue to expand digital health accessibility and use, highlighting the critical role of collaborative efforts in overcoming digital health disparities.
Topics: Humans; Telemedicine; Health Services Accessibility; Healthcare Disparities; Digital Divide; Digital Health
PubMed: 38912273
DOI: 10.3389/fpubh.2024.1418627