Guidelines for the use of WhatsApp groups in clinical settings in South Africa

In everyday clinical practice, healthcare professionals (HCPs) are exposed to large quantities of confidential patient information, and many use WhatsApp groups to share this information. WhatsApp groups provide efficient mechanisms for clinical management advice, decision-making support and peer review. However, most HCPs do not fully understand the legal and ethical implications of sharing content in a WhatsApp group setting, which is often thought to be hosted on a secure platform and therefore removed from public scrutiny. In our paper, we unpack the legal and ethical issues that arise when information is shared in WhatsApp groups. We demonstrate that sharing content in this forum is tantamount to the publication of content; in other words, those who share content are subject to the same legal ramifications as a journalist would be. We also examine the role of the WhatsApp group administrator, who bears an additional legal burden by default, often unknowingly so. We consider the recommendations made by the Health Professions Council of South Africa in their guidelines for the use of social media, and highlight some areas where we feel the guidelines may not adequately protect HCPs from the legal repercussions of sharing content in a WhatsApp group. Finally, we provide a set of guidelines for WhatsApp group users that should be regularly posted onto the group by the relevant group administrator to mitigate some of the legal liabilities that may arise. We also provide guidelines for group administrators

Association between memory complaints and incident Alzheimer's disease in elderly people with normal baseline cognition

In the community-based Amsterdam Study of the Elderly, a sample of 3,778 nondemented persons, 65-84 yrs old, was divided into 2 cognitive categories: normal, and borderline and impaired. At baseline, the presence or absence of memory complaints was assessed with a single question. At follow-up, incident cases of Alzheimer's disease were diagnosed in a 2-step procedure. After an average of 3.2 yrs, 2,169 persons were reevaluated, of whom 77 had incident Alzheimer's disease. Analyses showed that memory complaints were associated with incident Alzheimer's disease in Ss with normal baseline cognition but not in Ss with impaired baseline cognition. Findings suggest that memory complaints are a relatively strong predictor of incident Alzheimer's disease in older persons in whom cognitive impairment is not yet apparent. Also, they suggest that older persons may be aware of a decline in cognition at a time when mental status tests are still unable to detect a decline from premorbid functioning. (PsycINFO Database Record (c) 2002 APA, all rights reserved

Exploiting linkage information in real-valued optimization with the real-valued gene-pool optimal mixing evolutionary algorithm

The recently introduced Gene-pool Optimal Mixing Evolutionary Algorithm (GOMEA) has been shown to be among the state-of-the-art for solving discrete optimization problems. Key to the success of GOMEA is its ability to efficiently exploit the linkage structure of a problem. Here, we introduce the Real-Valued GOMEA (RV-GOMEA), which incorporates several aspects of the real-valued EDA known as AMaLGaM into GOMEA in order to make GOMEA well-suited for real-valued optimization. The key strength of GOMEA to competently exploit linkage structure is effectively preserved in RV-GOMEA, enabling excellent performance on problems that exhibit a linkage structure that is to some degree decomposable. Moreover, the main variation operator of GOMEA enables substantial improvements in performance if the problem allows for partial evaluations, which may be very well possible in many real-world applications. Comparisons of performance with state-of-the-art algorithms such as CMA-ES and AMaLGaM on a set of well-known benchmark problems show that RV-GOMEA achieves comparable, excellent scalability in case of black-box optimization. Moreover, RV-GOMEA achieves unprecedented scalability on problems that allow for partial evaluations, reaching near-optimal solutions for problems with up to millions of real-valued variables within one hour on a normal desktop computer

Depressive symptoms and risk of Alzheimer's disease in more highly educated older people

In an earlier study we observed that a depressive syndrome was highly predictive of developing Alzheimer's disease (AD) in older persons with normal baseline cognition and higher levels of education. We interpreted these findings as the depression being an early noncognitive manifestation of AD in persons with more cognitive reserve. The present study examines whether specific symptoms of depression can be identified that predict AD among older subjects with higher levels of education. In the community-based Amsterdam Study of the Elderly (AMSTEL), a sample of 3,147 nondemented persons with normal cognition, 65 to 84 years old, was selected and divided into subjects with >8 years and 8 years and 31 with 8 years of education depressed mood and subjective bradyphrenia were strongly associated with incident AD. No association between depressive symptoms and AD was observed among subjects with <or =8 years of education. Both depressed mood and subjective bradyphrenia seem to indicate subclinical AD in older people with higher levels of education. Clinicians should be alert that in these persons, AD may become apparent within a relatively short period of tim

Endothelial dysfunction contributes to renal function-associated cardiovascular mortality in a population with mild renal insufficiency: The Hoorn study

Mildly impaired renal function is associated with cardiovascular morbidity and mortality. There are indications that endothelial dysfunction and/or chronic inflammation, which play an important role in atherothrombosis, are present in early stages of renal insufficiency. This study investigated whether and to which extent endothelial dysfunction and inflammation were related to renal function and contributed to renal function-associated cardiovascular mortality in a population-based cohort (n = 613), aged 50 to 75 yr, that was followed with a median duration of 12.5 yr. During follow-up, 192 individuals died (67 of cardiovascular causes). At baseline, renal function was estimated with serum creatinine, the Cockcroft-Gault formula, and the Modification of Diet in Renal Disease equation of GFR (eGFR). Endothelial function was estimated by plasma von Willebrand factor, soluble vascular cell adhesion molecule-1, and the urinary albumin-creatinine ratio. Inflammatory activity was estimated by plasma C-reactive protein and soluble intercellular adhesion molecule-1. Renal function was mildly impaired (mean eGFR 68 ± 12 ml/min per 1.73

Associations between the urban environment and psychotic experiences in adolescents

Objective: In 2050 two-thirds of the world's population is predicted to live in cities, which asks for a better understanding of how the urban environment affects mental health. Urbanicity has repeatedly been found to be a risk factor, in particular for psychosis. Here, we explored what factors of the urban exposome underlie the association between urban characteristics and psychotic experiences (PE) in adolescents. Methods: Participants were 815 adolescents (mean age 14.84 years, SD 0.78) from an at-risk cohort (greater Rotterdam area, the Netherlands) oversampled on their self-reported emotional and behavioral problems. We used linear regression analysis to examine the association with detailed geodata on urbanicity (surrounding address density), green space density (high and low vegetation), and mixed noise levels (road, rail, air, industry, and wind power) with PE in adolescents. Analyses were adjusted for multiple socio-economic and parental confounders. Furthermore, we explored sex-interaction effects. Results:Higher surrounding address density and low greenspace density were each independently associated with more PE (B = 0.18, 95 % CI 0.02; 0.34 and B = 0.17, 95 % CI 0.01; 0.32, respectively). High mixed noise levels were only associated with more PE in boys (B = 0.23, 95 % CI 0.01; 0.46). A sex-interaction effect was found for high urbanicity (B = −0.46, 95 % CI −0.77; −0.14) and low greenspace density (B = −0.49, 95 % CI −0.73; −0.11), illustrating that these associations with PE were specific for boys. Conclusion: Multiple characteristics of living in an urban area are associated with more PE in adolescent boys. Our observations provide leads for prevention of mental health problems via urban designing.</p

Large-scale parallelization of partial evaluations in evolutionary algorithms for real-world problems

The importance and potential of Gray-Box Optimization (GBO) with evolutionary algorithms is becoming increasingly clear lately, both for benchmark and real-world problems. We consider the GBO setting where partial evaluations are possible, meaning that sub-functions of the evaluation function are known and can be exploited to improve optimization efficiency. In this paper, we show that the efficiency of GBO can be greatly improved through large-scale parallelism, exploiting the fact that each evaluation function requires the calculation of a number of independent sub-functions. This is especially interesting for real-world problems where often the majority of the computational effort is spent on the evaluation function. Moreover, we show how the best parallelization technique largely depends on factors including the number of sub-functions and their required computation time, revealing that for different parts of the optimization the best parallelization technique should be selected based on these factors. As an illustration, we show how large-scale parallelization can be applied to optimization of high-dose-rate brachytherapy treatment plans for prostate cancer. We find that use of a modern Graphics Processing Unit (GPU) was the most efficient parallelization technique in all realistic scenari

Hyperhomocysteinemia is associated with an increased risk of cardiovascular disease, especially in non-insulin-dependent diabetes mellitus - A population-based

A high serum total homocysteine (tHcy) level is an independent risk factor for cardiovascular disease. Because it is not known whether the strength of the association between hyperhomocysteinemia and cardiovascular disease is similar for peripheral arterial, coronary artery, and cerebrovascular disease, we compared the three separate risk estimates in an age-, sex-, and glucose tolerance-stratified random sample (n=631) from a 50- to 75-year-old general white population. Furthermore, we investigated the combined effect of hyperhomocysteinemia and diabetes mellitus with regard to cardiovascular disease. The prevalence of fasting hyperhomocysteinemia (>14.0 micromol/L) was 25.8%. After adjustment for age, sex, hypertension, hypercholesterolemia, diabetes, and smoking, the odds ratios (ORs; 95% confidence intervals) per 5-micromol/L increment in tHcy were 1.44 (1.10 to 1.87) for peripheral arterial, 1.25 (1.03 to 1.51) for coronary artery, 1.24 (0.97 to 1.58) for cerebrovascular, and 1.39 (1.15 to 1.68) for any cardiovascular disease. After stratification by glucose tolerance category and adjustment for the classic risk factors and serum creatinine, the ORs per 5-micromol/L increment in tHcy for any cardiovascular disease were 1.38 (1.03 to 1.85) in normal glucose tolerance, 1.55 (1.01 to 2.38) in impaired glucose tolerance, and 2.33 (1.11 to 4.90) in non-insulin-dependent diabetes mellitus (P=.07 for interaction). We conclude that the magnitude of the association between hyperhomocysteinemia and cardiovascular disease is similar for peripheral arterial, coronary artery, and cerebrovascular disease in a 50- to 75-year-old general population. High serum tHcy may be a stronger (1.6-fold) risk factor for cardiovascular disease in subjects with non-insulin-dependent diabetes mellitus than in nondiabetic subjects