Emerging and Established Trends to Support Secure Health Information Exchange.

This work aims to provide information, guidelines, established practices and standards, and an extensive evaluation on new and promising technologies for the implementation of a secure information sharing platform for health-related data. We focus strictly on the technical aspects and specifically on the sharing of health information, studying innovative techniques for secure information sharing within the health-care domain, and we describe our solution and evaluate the use of blockchain methodologically for integrating within our implementation. To do so, we analyze health information sharing within the concept of the PANACEA project that facilitates the design, implementation, and deployment of a relevant platform. The research presented in this paper provides evidence and argumentation toward advanced and novel implementation strategies for a state-of-the-art information sharing environment; a description of high-level requirements for the transfer of data between different health-care organizations or cross-border; technologies to support the secure interconnectivity and trust between information technology (IT) systems participating in a sharing-data "community"; standards, guidelines, and interoperability specifications for implementing a common understanding and integration in the sharing of clinical information; and the use of cloud computing and prospectively more advanced technologies such as blockchain. The technologies described and the possible implementation approaches are presented in the design of an innovative secure information sharing platform in the health-care domain.

Cyber-attacks and threats for healthcare - a multi-layer thread analysis.

Due to the advent of novel technologies and digital opportunities allowing to simplify user lives, healthcare is increasingly evolving towards digitalization. This represent a great opportunity on one side but it also exposes healthcare organizations to multiple threats (both digital and not) that may lead an attacker to compromise the security of medial processes and potentially patients' safety. Today technical cybersecurity countermeasures are used to protect the confidentiality, integrity and availability of data and information systems - especially in the healthcare domain. This paper will report on the current state of the art about cyber security in the Healthcare domain with particular emphasis on current threats and methodologies to analyze and manage them. In addition, it will introduce a multi-layer attack model providing a new perspective for attack and threat identification and analysis.

Variables associated with general practitioners' knowledge about and diagnostic skills for schizophrenia.

OBJECTIVE: This study investigated the level of knowledge about schizophrenia of primary care doctors working in the city of Brescia, Italy, and variables associated with better information. METHOD: The study design was devised after 2 joint meetings with leading figures of the Italian College of General Practitioners. A cross-sectional evaluation of 215 general practitioners was performed (June 2002). A random subgroup was selected to participate in a 4-month retest session in order to evaluate the reliability of the schedule (October 2002). The setting was the local health unit of Brescia, which involves 706 primary care doctors working in the city and its province. Of these, 30.5% took part in the study. A structured self-report questionnaire (SAKS) was devised for this study. General practitioners were also asked to rate videotaped cases of 5 patients with different DSM-IV diagnoses. The main outcome measures were the scores from subscales measuring knowledge of schizophrenia symptoms and signs, knowledge of antipsychotics and their adverse events, and correct diagnoses of 5 videotaped cases. RESULTS: Primary care doctors identified positive (79.0%), negative (72.6%) and general (72.1%) symptoms of schizophrenia (p < .001). Of the 5 cases on videotape, they correctly rated a mean of 3.1 cases. The mean percentage of anti-psychotics correctly identified was 34.1% (older) and 51.2% (novel) (p < .001). Better answers were given by doctors who knew the diagnostic criteria, had read books on psychiatry, and had attended previous courses. CONCLUSION: More teaching on the diagnosis of schizophrenia and clinical psychopharmacology should be given to general practitioners.

Glutamate AMPA receptor subunit 1 gene (GRIA1) and DSM-IV-TR schizophrenia: a pilot case-control association study in an Italian sample.

Glutamatergic dysfunction is one of the major hypotheses for the pathogenesis of schizophrenia. The GRIA1 gene encodes for one (GluR1) of the four (GluR1-4) ionotropic AMPA receptor subunits. GRIA1 is a good candidate gene for susceptibility to schizophrenia since it maps in 5q33, a region where the presence of susceptibility loci has been suggested by independent genome-wide scans and because its expression has been found to be decreased in the brain of some schizophrenia patients. We present data from a case-control association study on the Italian population with eight polymorphisms spanning the whole GRIA1 gene. Single-locus analysis revealed a significantly different allele distribution in cases and in controls of two SNPs (rs707176, 0.41 vs. 0.31, P = 0.009; rs2963944, 0.41 vs. 0.30, P = 0.007), and one microsatellite (rs10631988, allele 9: 0.40 vs. 0.29, P = 0.004). Haplotype analysis showed an increased frequency of a specific haplotype for these markers (C09CC, 0.39 vs. 0.28, P = 0.009). Therefore our data indicate that GRIA1 may be involved in susceptibility to DSM-IV-TR schizophrenia.

Catechol-O-methyltransferase gene polymorphism is associated with risk of psychosis in Alzheimer Disease.

There is emerging evidence that psychosis in Alzheimer Disease (AD) represents a clinically relevant phenotype with a distinct biological process. It has been reported that a functional polymorphism of the catechol-O-methyltransferase (COMT) gene predisposes to an increased risk for schizophrenia and likely to psychosis susceptibility. Aim of this study was to evaluate functional COMT genetic variation as a risk factor for psychosis in Alzheimer Disease. One hundred eighty-one AD patients and 208 age-matched controls underwent clinical and neuropsychological examination, behavioural and psychiatric disturbances evaluation, and ApoE and COMT genotyping. The distribution of COMT genotypes did not significantly differ in AD compared to controls. Among patients with psychosis (32.6%), 88.1% were COMT*H carriers (COMT H/H or COMT H/L, p < .01). The Odds Ratio (OR) for risk of psychosis in COMT*H carriers was 2.66 (confidence interval, CI 95%: 1.6-6.62), taking into account possible confounding factors. A comparable influence of COMT polymorphism on psychosis over the course of the disease was reported. These findings suggest that COMT polymorphism influences on the risk of psychosis since the early stages, and claims for the possibility to identify distinct phenotypes on genetic basis among AD patients.