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JMIR Formative Research Jun 2023Over the last decade, the frequency and size of cyberattacks in the health care industry have increased, ranging from breaches of processes or networks to encryption of...
BACKGROUND
Over the last decade, the frequency and size of cyberattacks in the health care industry have increased, ranging from breaches of processes or networks to encryption of files that restrict access to data. These attacks may have multiple consequences for patient safety, as they can, for example, target electronic health records, access to critical information, and support for critical systems, thereby causing delays in hospital activities. The effects of cybersecurity breaches are not only a threat to patients' lives but also have financial consequences due to causing inactivity in health care systems. However, publicly available information on these incidents quantifying their impact is scarce.
OBJECTIVE
We aim, while using public domain data from Portugal, to (1) identify data breaches in the public national health system since 2017 and (2) measure the economic impact using a hypothesized scenario as a case study.
METHODS
We retrieved data from multiple national and local media sources on cybersecurity from 2017 until 2022 and built a timeline of attacks. In the absence of public information on cyberattacks, reported drops in activity were estimated using a hypothesized scenario for affected resources and percentages and duration of inactivity. Only direct costs were considered for estimates. Data for estimates were produced based on planned activity through the hospital contract program. We use sensitivity analysis to illustrate how a midlevel ransomware attack might impact health institutions' daily costs (inferring a potential range of values based on assumptions). Given the heterogeneity of our included parameters, we also provide a tool for users to distinguish such impacts of different attacks on institutions according to different contract programs, served population size, and proportion of inactivity.
RESULTS
From 2017 to 2022, we were able to identify 6 incidents in Portuguese public hospitals using public domain data (there was 1 incident each year and 2 in 2018). Financial impacts were obtained from a cost point of view, where estimated values have a minimum-to-maximum range of €115,882.96 to €2,317,659.11 (a currency exchange rate of €1=US $1.0233 is applicable). Costs of this range and magnitude were inferred assuming different percentages of affected resources and with different numbers of working days while considering the costs of external consultation, hospitalization, and use of in- and outpatient clinics and emergency rooms, for a maximum of 5 working days.
CONCLUSIONS
To enhance cybersecurity capabilities at hospitals, it is important to provide robust information to support decision-making. Our study provides valuable information and preliminary insights that can help health care organizations better understand the costs and risks associated with cyber threats and improve their cybersecurity strategies. Additionally, it demonstrates the importance of adopting effective preventive and reactive strategies, such as contingency plans, as well as enhanced investment in improving cybersecurity capabilities in this critical area while aiming to achieve cyber-resilience.
PubMed: 37389934
DOI: 10.2196/41738 -
JMIR Formative Research Jun 2023UNAIDS (Joint United Nations Programme on HIV and AIDS) and the Nigeria National HIV/AIDS Strategic Framework recommend HIV self-testing and youth-friendly services to...
Using a Designathon to Develop an HIV Self-Testing Intervention to Improve Linkage to Care Among Youths in Nigeria: Qualitative Approach Based on a Participatory Research Action Framework.
BACKGROUND
UNAIDS (Joint United Nations Programme on HIV and AIDS) and the Nigeria National HIV/AIDS Strategic Framework recommend HIV self-testing and youth-friendly services to enhance HIV testing, linkage to health services, and prevention. However, the voices of youths are seldom incorporated into interventions. We examined qualitative data generated from a series of participatory events in partnership with Nigerian youths focused on enhancing linkage to care.
OBJECTIVE
The aim of this study was to assess youth-initiated interventions developed during a designathon to improve linkage to care and sexually transmitted infection services.
METHODS
This study conducted a designathon informed by crowdsourcing principles and the participatory research action framework. A designathon is a multistage process including an open call, a sprint event, and follow-up activities. The open call solicited Nigerian youths (14-24 years old) to develop intervention strategies for linkage to care and youth-friendly health services. A total of 79 entries were received; from this, a subset of 13 teams responded to the open call and was invited to participate in a sprint event over 72 hours. Narratives from the open-call proposals were analyzed using grounded theory to identify emergent themes focused on youth-proposed interventions for linkage to care and youth-friendly services.
RESULTS
A total of 79 entries (through the web=26; offline=53) were submitted. Women or girls submitted 40 of the 79 (51%) submissions. The average age of participants was 17 (SD 2.7) years, and 64 of 79 (81%) participants had secondary education or less. Two main themes highlighted strategies for enhancing youths' HIV linkage to care: digital interventions and collaboration with youth influencers. A total of 76 participants suggested digital interventions that would facilitate anonymous web-based counseling, text prompt referrals, and related services. In addition, 16 participants noted that collaboration with youth influencers would be useful. This could involve working in partnership with celebrities, gatekeepers, or others who have a large youth audience to enhance the promotion of messages on HIV self-testing and linkage. The facilitators of youths' linkage included health facility restructuring, dedicated space for youths, youth-trained staff, youth-friendly amenities, and subsidized fees. Barriers to HIV linkage to care among youths included a lack of privacy at clinics and concerns about the potential for breaching confidentiality.
CONCLUSIONS
Our data suggest specific strategies that may be useful for enhancing HIV linkage to care for Nigerian youths, but further research is needed to assess the feasibility and implementation of these strategies. Designathons are an effective way to generate ideas from youths.
PubMed: 37384385
DOI: 10.2196/38528 -
Brain & Spine 2023Social media have become ubiquitous and their role in medicine is quickly growing. They provide an open platform by which members share educational material, clinical...
INTRODUCTION
Social media have become ubiquitous and their role in medicine is quickly growing. They provide an open platform by which members share educational material, clinical experiences, and collaborate with educational equity.
RESEARCH QUESTION
To characterize the role of social media in neurosurgery, we analyzed metrics of the largest neurosurgical group (Neurosurgery Cocktail), collected relevant data about activities, impact and risks of this groundbreaking technology.
MATERIAL AND METHODS
We extracted Facebook metrics from 60-day time sample, including users demographics and other platform-specific values such as active members and number of posts within 60 days. A quality assessment of the posted material (clinical case reports and second opinions) was obtained establishing four main quality-criteria: privacy violation; quality of imaging; clinical and follow up data.
RESULTS
By December 2022, the group included 29.524 members (79.8% male), most (29%) between 35 and 44 years of age. Over 100 countries were represented. A total of 787 posts were published in 60 days with an average of 12.7 per day. In 173 clinical cases presented through the platform, some issue with privacy was recorded in 50.9%. The imaging was considered insufficient in 39.3%, clinical data in 53.8%; follow up data were missing in 60.7%.
DISCUSSION AND CONCLUSION
The study provided a quantitative evaluation of impact, flaws and limitations of social medial for healthcare. Flaws were mostly data breach and insufficient quality of case reports. There are actions to correct these flaws that can be easily taken to provide a greater credibility and efficacy to the system.
PubMed: 37383446
DOI: 10.1016/j.bas.2023.101728 -
Biotech (Basel (Switzerland)) Jun 2023Genetic risk information has relevance for patients' blood relatives. However, cascade testing uptake in at-risk families is <50%. International research supports direct...
Privacy Implications of Contacting the At-Risk Relatives of Patients with Medically Actionable Genetic Predisposition, with Patient Consent: A Hypothetical Australian Case Study.
Genetic risk information has relevance for patients' blood relatives. However, cascade testing uptake in at-risk families is <50%. International research supports direct notification of at-risk relatives by health professionals (HPs), with patient consent. However, HPs express concerns about the privacy implications of this practice. Our privacy analysis, grounded in a clinically relevant hypothetical scenario, considers the types of personal information involved in direct notification of at-risk relatives and the application of Australian privacy regulations. It finds that collecting relatives' contact details, and using those details (with patient consent) to notify relatives of possible genetic risk, does not breach Australian privacy law, providing that HPs adhere to regulatory requirements. It finds the purported "right to know" does not prevent disclosure of genetic information to at-risk relatives. Finally, the analysis confirms that the discretion available to HPs does not equate to a positive duty to warn at-risk relatives. Thus, direct notification of a patient's at-risk relatives regarding medically actionable genetic information, with patient consent, is not a breach of Australian privacy regulations, providing it is conducted in accordance with the applicable principles set out. Clinical services should consider offering this service to patients where appropriate. National guidelines would assist with the clarification of the discretion for HPs.
PubMed: 37366793
DOI: 10.3390/biotech12020045 -
Current Pediatrics Reports Jun 2023To identify lessons learned about maintaining confidentiality for adolescent telehealth care during the COVID-19 pandemic. (Review)
Review
PURPOSE OF REVIEW
To identify lessons learned about maintaining confidentiality for adolescent telehealth care during the COVID-19 pandemic.
RECENT FINDINGS
Adolescents, parents, and providers recognize benefits of telehealth for confidential care while also identifying potential risks for confidentiality breach unique to the telehealth care setting.
SUMMARY
Rapid implementation of telehealth care during COVID-19 presented an opportunity to test strategies that protect confidentiality for adolescents accessing care through telehealth. Policy, practice, and provider-level interventions are needed to ensure that adolescents can access confidential care through telehealth.
PubMed: 37363323
DOI: 10.1007/s40124-023-00288-1 -
Multimedia Tools and Applications Jun 2023In recent years, there has been a surge in the use of deep learning systems for e-healthcare applications. While these systems can provide significant benefits regarding...
In recent years, there has been a surge in the use of deep learning systems for e-healthcare applications. While these systems can provide significant benefits regarding improved diagnosis and treatment, they also pose substantial privacy risks to patients' sensitive data. Privacy is a crucial issue in e-healthcare, and it is essential to keep patient information secure. A new approach based on multi-agent-based privacy metrics for e-healthcare deep learning systems has been proposed to address this issue. This approach uses a combination of deep learning and multi-agent systems to provide a more robust and secure method for e-healthcare applications. The multi-agent system is designed to monitor and control the access to patients' data by different agents in the system. Each agent is assigned a specific role and has specific data access permissions. The system employs a set of privacy metrics to a substantial privacy level of the data accessed by each agent. These metrics include confidentiality, integrity, and availability, evaluated in real-time and used to identify potential privacy violations. In addition to the multi-agent system, the deep learning component is also integrated into the system to improve the accuracy of diagnoses and treatment plans. The deep learning model is trained on a large dataset of medical records and can accurately predict the diagnosis and treatment plan based on the patient's symptoms and medical history. The multi-agent-based privacy metrics for the e-healthcare deep learning system approach have several advantages. It provides a more secure system for e-healthcare applications by ensuring only authorized agents can access patients' data. Privacy metrics enable the system to identify potential privacy violations in real-time, thereby reducing the risk of data breaches. Finally, integrating deep learning improves the accuracy of diagnoses and treatment plans, leading to better patient outcomes.
PubMed: 37362729
DOI: 10.1007/s11042-023-15363-4 -
Information Systems Frontiers : a... Apr 2023Virtual Social Networks (VSN) act as a catalyst for the success of the active participation of citizens in information sharing, collaboration, and decision making. VSN...
Virtual Social Networks (VSN) act as a catalyst for the success of the active participation of citizens in information sharing, collaboration, and decision making. VSN based e-participation tools allow many-to-many communication and collaboration near real-time with users who might be in geographically dispersed locations. It provides a platform to voice opinions and perspectives and share them with others in new and innovative ways. Cybersecurity is a key area that needs to be considered for the success and continuous use of e-participation systems as it protects user privacy and helps to avoid scams, harassment, and misinformation. The intervening effect of cybersecurity protection mechanisms and citizens' education level on the relationship between VSN diffusion and e-participation initiatives is explored in the proposed research model presented in this paper. Moreover, this research model is explored for different stages of e-participation (e-information, e-consultation, and e-decision making) and the five dimensions of cybersecurity (legal, technical, organizational, capacity building, and cooperation). The findings indicate that improved VSN usage has increased e-participation (especially in e-consultation and e-decision making) as a result of improved cybersecurity protection and public education, highlighting the varying importance of different cybersecurity protection measures for three stages of e-participation. Thus, considering the recent problems like platform manipulation, misinformation and data breaches associated with the use of VSN for e-participation, this study emphasizes the importance of regulations, policies, partnerships, technical frameworks, and research to ensure cybersecurity, as well as the importance of education to enable the public to interact productively in e-participation activities. This study is performed using publicly available data from 115 countries and the research model is developed, drawing theoretical basis from the Protection Motivation Theory, Structuration Theory, and Endogenous Growth Theory. This paper recognizes the theoretical and practical implications, and limitations while recommending future research directions.
PubMed: 37361893
DOI: 10.1007/s10796-023-10385-7 -
Distributed and Parallel Databases Apr 2023Data sharing to the multiple organizations are essential for analysis in many situations. The shared data contains the individual's private and sensitive information and...
Data sharing to the multiple organizations are essential for analysis in many situations. The shared data contains the individual's private and sensitive information and results in privacy breach. To overcome the privacy challenges, privacy preserving data mining (PPDM) has progressed as a solution. This work addresses the problem of PPDM by proposing statistical transformation with intuitionistic fuzzy (STIF) algorithm for data perturbation. The STIF algorithm contains statistical methods weight of evidence, information value and intuitionistic fuzzy Gaussian membership function. The STIF algorithm is applied on three benchmark datasets adult income, bank marketing and lung cancer. The classifier models decision tree, random forest, extreme gradient boost and support vector machines are used for accuracy and performance analysis. The results show that the STIF algorithm achieves 99% of accuracy for adult income dataset and 100% accuracy for both bank marketing and lung cancer datasets. Further, the results highlights that the STIF algorithm outperforms in data perturbation capacity and privacy preserving capacity than the state-of-art algorithms without any information loss on both numerical and categorical data.
PubMed: 37359982
DOI: 10.1007/s10619-023-07423-3 -
JMIR Human Factors Jun 2023Digital peer support enhances engagement in mental and physical health services despite barriers such as location, transportation, and other accessibility constraints....
BACKGROUND
Digital peer support enhances engagement in mental and physical health services despite barriers such as location, transportation, and other accessibility constraints. Digital peer support involves live or automated peer support services delivered through technology media such as peer-to-peer networks, smartphone apps, and asynchronous and synchronous technologies. Supervision standards for digital peer support can determine important administrative, educative, and supportive guidelines for supervisors to maintain the practice of competent digital peer support, develop knowledgeable and skilled digital peer support specialists, clarify the role and responsibility of digital peer support specialists, and support specialists in both an emotional and developmental capacity.
OBJECTIVE
Although digital peer support has expanded recently, there are no formal digital supervision standards. The aim of this study is to inform the development of supervision standards for digital peer support and introduce guidelines that supervisors can use to support, guide, and develop competencies in digital peer support specialists.
METHODS
Peer support specialists that currently offer digital peer support services were recruited via an international email listserv of 1500 peer support specialists. Four 1-hour focus groups, with a total of 59 participants, took place in October 2020. Researchers used Rapid and Rigorous Qualitative Data Analysis methods. Researchers presented data transcripts to focus group participants for feedback and to determine if the researcher's interpretation of the data match their intended meanings.
RESULTS
We identified 51 codes and 11 themes related to the development of supervision standards for digital peer support. Themes included (1) education on technology competency (43/197, 21.8%), (2) education on privacy, security, and confidentiality in digital devices and platforms (33/197, 16.8%), (3) education on peer support competencies and how they relate to digital peer support (25/197, 12.7%), (4) administrative guidelines (21/197, 10.7%), (5) education on the digital delivery of peer support (18/197, 9.1%), (6) education on technology access (17/197, 8.6%), (7) supervisor support of work-life balance (17/197, 8.6%), (8) emotional support (9/197, 4.6%), (9) administrative documentation (6/197, 3%), (10) education on suicide and crisis intervention (5/197, 2.5%), and (11) feedback (3/197, 1.5%).
CONCLUSIONS
Currently, supervision standards from the Substance Abuse and Mental Health Services Administration (SAMHSA) for in-person peer support include administrative, educative, and supportive functions. However, digital peer support has necessitated supervision standard subthemes such as education on technology and privacy, support of work-life balance, and emotional support. Lack of digital supervision standards may lead to a breach in ethics and confidentiality, workforce stress, loss of productivity, loss of boundaries, and ineffectively serving users who participate in digital peer support services. Digital peer support specialists require specific knowledge and skills to communicate with service users and deliver peer support effectively, while supervisors require new knowledge and skills to effectively develop, support, and manage the digital peer support role.
PubMed: 37335603
DOI: 10.2196/40607 -
Cureus May 2023Social media, leveraging Web 2.0 technologies, plays a vital role in healthcare, medical education, and research by fostering collaboration and enabling research... (Review)
Review
Social media, leveraging Web 2.0 technologies, plays a vital role in healthcare, medical education, and research by fostering collaboration and enabling research dissemination. Healthcare professionals use these platforms to improve public health literacy, but concerns about misinformation and content accuracy persist. In 2023, platforms like Facebook (Meta Platforms, Inc., Menlo Park, California, United States), YouTube (Google LLC, Mountain View, California, United States), Instagram (Meta Platforms, Inc.), TikTok (ByteDance Ltd, Beijing, China), and Twitter (X Corp., Carson City, Nevada, United States) have become essential in healthcare, offering patient communication, professional development, and knowledge-sharing opportunities. However, challenges such as breaches of patient confidentiality and unprofessional conduct remain. Social media has transformed medical education, providing unique networking and professional development opportunities. Further studies are needed to determine its educational value. Healthcare professionals must follow ethical and professional guidelines, particularly regarding patient privacy, confidentiality, disclosure rules, and copyright laws. Social media significantly impacts patient education and healthcare research. Platforms like WhatsApp (Meta Platforms, Inc.) effectively improve patient compliance and outcomes. Yet, the rapid dissemination of false news and misinformation on social media platforms presents risks. Researchers must consider potential biases and content quality when extracting data. Quality control and regulation are crucial in addressing potential dangers and misinformation in social media and healthcare. Stricter regulations and monitoring are needed due to cases of deaths resulting from social media trends and false news spread. Ethical frameworks, informed consent practices, risk assessments, and appropriate data management strategies are essential for responsible research using social media technologies. Healthcare professionals and researchers must judiciously use social media, considering its risks to maximize benefits and mitigate potential drawbacks. By striking the right balance, healthcare professionals can enhance patient outcomes, medical education, research, and the overall healthcare experience.
PubMed: 37332420
DOI: 10.7759/cureus.39111