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A large number of mobile health (mHealth) apps have been created to help users to manage their health or receive health care services. Many of these mHealth apps have proven to be helpful for maintaining or improving their users' health. However, many people still choose not to use mHealth apps or only use them for a short period. One of the reasons behind this lack of use is the concern for their health information security and privacy. The goal of this study was to determine the relationship between users' characteristics and their security and privacy concerns and to identify desired security features in mHealth apps, which could reduce these concerns. A questionnaire was designed and validated by the research team. This questionnaire was then used to determine mobile app users' security and privacy concerns regarding personal health data in mHealth apps as well as the security features most users' desire. A semistructured interview was used to identify barriers to and facilitators of adopting mHealth apps. In total, 117 randomly selected study participants from a large pool took part in this study and provided responses to the validated questionnaire and the semistructured interview questions. The results indicate that most study participants did have concerns about their privacy when using mHealth apps. They also expressed their preferences regarding several security features in mHealth apps, such as regular password updates, remote wipe, user consent, and access control. An association between their demographic characteristics and their concerns and preferences in security and privacy was identified; however, in most cases, the differences among the different demographic groups were not statistically significant, except for a few very specific aspects. These study participants also indicated that the cost of apps and lack of security features in mHealth apps were barriers for adoption, whereas having free apps, strong but easy-to-use security features, and clear user protection privacy policies might encourage them to use mHealth apps in their health management. This questionnaire and interview study verified the security and privacy concerns of mHealth app users, identified the desired security and privacy features, and determined specific barriers to and facilitators of users adopting mHealth apps. The results can be used to guide mHealth app developers to create apps that would be welcomed by users.

BackgroundBlack MSM (BMSM) are disproportionately burdened by HIV and STIs in the US. Structural barriers to HIV/STI testing in clinical settings, including prior negative experiences, concerns about privacy/confidentiality and limited care access, compound disparities by contributing to delayed treatment and ongoing transmission. Testing modalities circumventing these barriers are needed for this priority population.MethodsWe recruited 25 MSM (mean age=35;SD=11; 88% Black) following their participation in Safe Spaces and Places (SSP) – a community-based, online-linked, mobile van HIV/STI testing modality in Baltimore, MD. Participants completed 60-minute semi-structured interviews exploring their perceptions of SSP relative to clinic-based testing experiences. Interview transcripts were doubled coded until there was group consensus and analyzed using a constant comparative approach.ResultsParticipants described a preference for the SSP testing modality compared to their clinic-based testing experiences. Three themes related to this preference emerged from the interviews: 1) greater comfort with staff and testing environment – e.g. ‘it was like a different environment than being in a hospital. And everybody was real kind and polite;’ 2) less concern with maintaining privacy/confidentiality – e.g. ‘I felt like the van is much more discrete and private... When you’re in the [STD clinic], you’re out there with a bunch of people…it’s just really crowded;’ and 3) increased accessibility – e.g. ‘I did really like the van being in the evening hours, being offered multiple days per week so that I could fit it in my schedule. I like that it shows up in different places in the community.’DiscussionOur findings suggest this majority Black sample of MSM preferred the SSP testing modality because it removed barriers to HIV/STI testing for this priority population. Increasing access to HIV/STI testing in BMSM will require identifying barriers to testing in this population and developing modalities that attend to these barriers.

Introduction: Clinical ethics support (CES) never takes place in an a-political context. In and outside health care institutions, CES seems to become increasingly vulnerable to, and involved in, political and (social) media sensitive domains. We will present two self-experienced morally challenging situations that we encountered as CES staff, including: conflicting values, protecting users of CES, CES staff and the integrity of CES itself, moral responsibilities, and, how we responded. Norwegian case: Staff from the maternity ward at a Norwegian hospital asked the clinical ethics committee (CEC) for advice regarding women in labor opposing recommended interventions, raising concerns about the child's welfare. A birth right activist group member, also being a journalist, contacted the hospital claiming access to all minutes from meetings - where CEC had discussed the dilemma when the mother opposes interventions in connection with pregnancy and childbirth, obstetric violence, the legal protection of the unborn child or related issues. Dutch case: Due to a serious incident in a Dutch hospital a patient died (not because of the illness or treatment). The head of the department asked the internal Ethics Support team for a Moral Case Deliberation to focus on the moral stress of the team members and to reflect upon various moral questions related to this tragic incident. Afterwards, the Ombudsman and the Health Inspectorate asked for the minutes from that specific MCD session, and requested an interview with the MCD facilitator. Discussion: After comparing the facts and moral reasoning in both examples of ethics support staff's moral challenges, we will present an innovative ethics support tool specifically developed for CES staff experiencing moral challenges when offering CES ina political context (the Confidentiality Compass). During the last part of our presentation, we will engage with the audience in discussions about future needs of CES staff for related moral guidance.

An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.

Significance Recent surveys of the microbial communities living on and in the human body—the human microbiome—have revealed strong variation in community membership between individuals. Some of this variation is stable over time, leading to speculation that individuals might possess unique microbial “fingerprints” that distinguish them from the population. We rigorously evaluated this idea by combining concepts from microbial ecology and computer science. Our results demonstrated that individuals could be uniquely identified among populations of 100s based on their microbiomes alone. In the case of the gut microbiome, >80% of individuals could still be uniquely identified up to a year later—a result that raises potential privacy concerns for subjects enrolled in human microbiome research projects. Community composition within the human microbiome varies across individuals, but it remains unknown if this variation is sufficient to uniquely identify individuals within large populations or stable enough to identify them over time. We investigated this by developing a hitting set-based coding algorithm and applying it to the Human Microbiome Project population. Our approach defined body site-specific metagenomic codes: sets of microbial taxa or genes prioritized to uniquely and stably identify individuals. Codes capturing strain variation in clade-specific marker genes were able to distinguish among 100s of individuals at an initial sampling time point. In comparisons with follow-up samples collected 30–300 d later, ∼30% of individuals could still be uniquely pinpointed using metagenomic codes from a typical body site; coincidental (false positive) matches were rare. Codes based on the gut microbiome were exceptionally stable and pinpointed >80% of individuals. The failure of a code to match its owner at a later time point was largely explained by the loss of specific microbial strains (at current limits of detection) and was only weakly associated with the length of the sampling interval. In addition to highlighting patterns of temporal variation in the ecology of the human microbiome, this work demonstrates the feasibility of microbiome-based identifiability—a result with important ethical implications for microbiome study design. The datasets and code used in this work are available for download from huttenhower.sph.harvard.edu/idability .

The authors would like to make the following corrections about the published paper [...]

IntroductionInternational sharing of health data opens the door to the study of the so-called ‘Big Data’, which holds great promise for improving patient-centred care. Failure of recent data sharing initiatives indicates an urgent need to invest in societal trust in researchers and institutions. Key to an informed understanding of such a ‘social license’ is identifying the views patients and the public may hold with regard to data sharing for health research.MethodsWe performed a narrative review of the empirical evidence addressing patients’ and public views and attitudes towards the use of health data for research purposes. The literature databases PubMed (MEDLINE), Embase, Scopus and Google Scholar were searched in April 2019 to identify relevant publications. Patients’ and public attitudes were extracted from selected references and thematically categorised.ResultsTwenty-seven papers were included for review, including both qualitative and quantitative studies and systematic reviews. Results suggest widespread—though conditional—support among patients and the public for data sharing for health research. Despite the fact that participants recognise actual or potential benefits of data research, they expressed concerns about breaches of confidentiality and potential abuses of the data. Studies showed agreement on the following conditions: value, privacy, risk minimisation, data security, transparency, control, information, trust, responsibility and accountability.ConclusionsOur results indicate that a social license for data-intensive health research cannot simply be presumed. To strengthen the social license, identified conditions ought to be operationalised in a governance framework that incorporates the diverse patient and public values, needs and interests.

ObjectivesTo determine whether neurosurgical staff are aware of which of the common conditions seen have driving restrictions.To determine whether neurosurgical staff are aware of what they are able to do within current regulations if a patient refuses to comply with DVLA advice given.To build a case for development of more ways for the DMG and medical professionals to engage.DesignObservational questionnaire-based study.SubjectsNeurosurgery staff at the Royal London Hospital – doctors and senior nurses.MethodsResponses collated and represented as percentages.Results37 health care professional took part. 10% uncertain of what to do if advice on driving was not complied with 20% responded no to if confidentiality could be breached in certain cases where it is warranted. 70% responded yes to if confidentiality could be breached in certain cases where it is warranted. 45% unaware of DVLA guidelines for intra-cranial tumours 15% full knowledge of DVLA requirements.ConclusionsAnnually, over 1.25 million people die because of a road traffic crash globally (WHO fact sheet). An estimated 20–50 million suffer non-fatal injuries, with many developing significant disabilities as a result. It is thus not surprising that one of the newly adopted 2030 Agenda for Sustainable Development is a target of halving the global number of deaths and injuries from road traffic crashes by 2020 – less than 2 years away. It has adopted the safe systems approach to help achieve this target, some cornerstones of which are safe road user and adequate law traffic law enforcement which medical personnel have a key role in. Although clinicians are already involved with this, medical standards are continually reviewed/updated when indicated considering recent developments in traffic medicine and seminal events. In October 2016 for instance, the Drivers’ Medical Group (DMG received negative press following a parliamentary and health service ombudsman report. One area identified for improvement was DMG’s processes for engaging with the medical profession. In the same year, the then 25 year old guidance for medicals professional was updated. This study aims to assess the familiarity of neurosurgical clinicians (junior doctors and consultants) and senior neurosurgical nurses with the current DVLA requirements for neurosurgical patients. The goal is to show that the changes to the regulations that occur following seminal events are sometimes not apparent to clinicians involved in the field. We hope that this will help build a case for establishing a system where the DMG and medical professionals are more engaged (for example via clinical nurse specialists who can go on to update their specialty on changes relevant to their field when they occur). Our study has demonstrated suboptimal awareness and poor understanding of the current DVLA regulations. In our study, we have highlighted the importance of improving communication between clinicians and the DMG and developing novel ways to keep medical professionals up to date and continuously engaged with the DMG.