Health Information System Role-Based Access Control Current Security Trends and Challenges

Objective. This article objective is to highlight implementation characteristics, concerns, or limitations over role-based access control (RBAC) use on health information system (HIS) using industry-focused literature review of current publishing for that purpose. Based on the findings, assessment for indication of RBAC is obsolete considering HIS authorization control needs. Method. We have selected articles related to our investigation theme "RBAC trends and limitations" in 4 different sources related to health informatics or to the engineering technical field. To do so, we have applied the following search query string: "Role-Based Access Control" OR "RBAC" AND "Health information System" OR "EHR" AND "Trends" OR "Challenges" OR "Security" OR "Authorization" OR "Attacks" OR "Permission Assignment" OR "Permission Relation" OR "Permission Mapping" OR "Constraint". We followed PRISMA applicable flow and general methodology used on software engineering for systematic review. Results. 20 articles were selected after applying inclusion and exclusion criteria resulting contributions from 10 different countries. 17 articles advocate RBAC adaptations. The main security trends and limitations mapped were related to emergency access, grant delegation, and interdomain access control. Conclusion. Several publishing proposed RBAC adaptations and enhancements in order to cope current HIS use characteristics. Most of the existent RBAC studies are not related to health informatics industry though. There is no clear indication of RBAC obsolescence for HIS use.Sao Paulo Federal University (Unifesp) sponsorshipUniv Fed Sao Paulo, Hlth Informat Dept, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Hlth Informat Dept, Sao Paulo, SP, BrazilWeb of Scienc

Evaluación de equivalencia semántica de la versión portuguesa (Brasil) de la Online Cognition Scale

This study evaluated the semantic equivalence of the Online Cognition Scale in Brazilian Portuguese. The process included five steps: translation, back-translation, technical review, evaluation of semantic equivalence by trained professionals, and evaluation of the instrument for content understanding by a group of professionals (n = 10) and students (n = 37). The instrument was translated and adapted to Portuguese, showing a high level of verbal comprehension by the target population. The adapted version for use in Brazil resulted in an equivalent instrument from the semantic and content point of view, ready for evaluation of its psychometric qualities in the Brazilian cultural context.El objetivo de este estudio fue llevar a cabo la evaluación de la equivalencia semántica de la Online Cognition Scale en portugués (Brasil). El proceso consistió en cinco etapas: traducción, retrotraducción, revisión técnica y evaluación de la equivalencia semántica de los profesionales; habilitación de instrumentos como la comprensión verbal por una muestra de profesionales (n = 10) y estudiantes (n = 37). El instrumento fue traducido y adaptado al portugués, con un excelente nivel final de comprensión verbal por parte de la población objetivo. La versión adaptada del instrumento para su uso en nuestro contexto, que dio como resultado un instrumento equivalente desde el punto de vista semántico y del contenido, está lista para que comience el estudio de sus propiedades psicométricas en el contexto cultural brasileño.Este estudo teve por objetivo realizar a avaliação da equivalência semântica da Online Cognition Scale para o português (Brasil). O processo consistiu em cinco etapas: tradução; retrotradução; revisão técnica e avaliação da equivalência semântica por profissionais capacitados; avaliação do instrumento quanto à compreensão verbal por uma amostra de profissionais (n = 10) e estudantes (n = 37). O instrumento foi traduzido e adaptado para o português, apresentando, ao final, excelente nível de compreensão verbal pela população alvo. A versão do instrumento adaptada para uso em nosso meio resultou em um instrumento equivalente do ponto de vista da equivalência semântica e de conteúdo, estando pronto para iniciar o estudo de suas qualidades psicométricas no contexto cultural brasileiro.Universidade Federal de São Paulo (UNIFESP)Universidade de PernambucoUNIFESPSciEL

Drug overdose deaths in Brazil between 2000 and 2020: an analysis of sociodemographics and intentionality

Objectives: To examine drug overdose records in Brazil from 2000 to 2020, analyzing trends over time in overdoses and overall sociodemographic characteristics of the deceased. Methods: Using data from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade), we identified records from 2000-2020 in which the underlying cause-of-death was one of the following codes: X40-X45 (accidental poisoning), X60-X65 (intentional poisoning), or Y10-Y15 (undetermined intentionality poisoning). The Brazilian dataset included 21,410 deaths. We used joinpoint regression analysis to assess changes in trends over time. Results: People who died of drug overdoses in Brazil between 2000 and 2020 had a mean age of 38.91 years; 38.45% were women, and 44.01% were identified as White. Of the overdose deaths, 44.70% were classified as intentional and 32.12% were classified as unintentional. Among the identified drugs, stimulants were the most common class. However, most records did not report which drug was responsible for death. Conclusion: Sociodemographic trends in overdose deaths in Brazil must guide country-specific policies. Nevertheless, data collection protocols must be improved, particularly regarding the drug used in overdoses

The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting

IntroductionPremature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births.MethodsThis is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0–27 days). Survival functions were calculated using the Kaplan–Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs).ResultsThe neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89–4.65), independent of sex, 1-min Apgar score, and five maternal factors.DiscussionThe risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil

Adopción de las normas para la historia clínica electrónica en Brasil

Made available in DSpace on 2017-01-27T16:31:06Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 10.pdf: 310773 bytes, checksum: 01f9757e65cda99250fca33d1afea6e0 (MD5) Previous issue date: 2014Universidade Federal de São Paulo. Programa de Pós-Graduação em Gestão e Informática em Saúde. São Paulo, SP, Brasil.Universidade Federal de São Paulo. Escola Paulista de Medicina. Departamento de Informática em Saúde. Grupo Interdisciplinar de Ciências Exatas em Saúde. São Paulo, SP, Brasil.Universidade Federal de São Paulo. Escola Paulista de Medicina. Departamento de Informática em Saúde. São Paul, SP, Brasil.Registro Eletrônico de Saúde (RES) constitui um conjunto de informações de saúde e assistência de um paciente durante a sua vida. Além de conter informações que guiarão todos os procedimentos, exames e consultas desse paciente, um RES também pode ser utilizado como fonte de informações a respeito de toda a sociedade, através de levantamentos epidemiológicos e dados demográficos de grupos ou regiões. Para garantir a interoperabilidade entre os diferentes sistemas e, consequentemente, entre registros gerados em diferentes instituições e hospitais, o desenvolvimento de um RES deve adotar alguns padrões para seus dados. O Ministério da Saúde do Brasil regulamentou o uso de alguns padrões para RES através da Portaria nº 2.073, de 31 de agosto de 2011. Este artigo apresenta um estudo sobre os principais padrões e terminologias mencionados nessa Portaria, que são o HL7 e o CDA, o modelo de arquétipos da Fundação openEHR e ISO 13606-2, a TISS e o DICOM, e as terminologias SNOMED-CT, LOINC e CID-10.Electronic Health Record (EHR) is a digital collection of patient health and care information during patient lifetime. Besides containing information that will guide all procedures, tests and appointments for this patient, one RES can also be used as a source of information about the whole society through epidemiological surveys and demographics of groups or regions. To ensure interoperability between different systems and, consequently, between medical records generated in different institutions and hospitals, the development of a RES should consider some standards for representation ofits data. The Brazil Ministry of Health has regulated the use of some standards for RES by means of the document titled Portaria nº 2.073 passed Aug 31, 2011. This work is a study of the major standards and terminology mentioned in that regulation: HL7 CDA, model of openEHR Foundation archetypes, ISO 13606-2, TISS, DICOM, and SNOMED-CT, LOINC and ICD-10 terminology.Historia clínica electrónica (HCE) es un conjunto de informaciones de salud y atención de un paciente durante su vida. Contiene informaciones que guiarán todos los procedimientos, exámenes y citas del paciente, y además una HCE también puede ser utilizada como una fuente de información sobre el conjunto de la sociedad a través de encuestas epidemiológicas y de los grupos o regiones demográficas. Para garantizar la interoperabilidad entre los distintos sistemas y, en consecuencia, entre los registros generados en diferentes instituciones y hospitales, el desarrollo de una HCE debe considerar algunas normas para sus datos. El Ministerio de Salud de Brasil ha regulado el uso de algunas de las normas para la HCE a través de la instrucción denominada Portaria nº 2073, de 31 de agosto de 2011. Este trabajo es un estudio de las principales normas y terminologías mencionadas en laquella instrucción: HL7 CDA, el modelo de arquetipos openEHR Fundación, ISO 13606-2, TISS, DICOM, y las terminologías SNOMED-CT, LOINC y ICD-10