Do direito à confidencialidade no atendimento por telemedicina e a efetividade da tutela jurídica

Privacy is one of the fundamental rights of individuals, and concerns the personal control over an environment of shelter, tranquility, solitude, secret and intimacy. The exposure of such personal information, at times involving embarrassing situations in a situation of trust, in confidence, without authorization for disclosure represents a breach of informational privacy. When such an exposure is made not merely in secret, but is also of a private nature and occurs within a specific context, it constitutes a form of private information recognized as confidential. The doctor-patient relationship represents a relationship of confidentiality. In order for complete secrecy to be maintained, informational privacy in the medical sphere presupposes not only the confidentiality in the interpersonal relationship, but also in terms of the register of information. Telemedicine can be characterized as the use of telecommunications for medical diagnosis and patient care, involving the exchange of information that sometimes is sensitive to the patient at a distance. As telemedicine represents the medical care at a distance, some questions arise concerning the ethical and legal principles that guide the physician-patient relationship. One of the major questions concerns the risk of exposing sensitive information pertaining to the individual being attended. As there is expected to be an expansion of health care by telemedicine, there is a need for a revision of the privacy legislation and telemedicine. This paper discusses the concepts of privacy and presents current information on telemedicine, especially in regard to the ethical and legal issues involved, reviews the pertinent international and Brazilian law, examines the possibilities of moral and material damage resulting from a breach of confidentiality in telemedicine care and highlights the appropriate actions to repair such damage. Although there is extensive jurisprudence related to health care through telemedicine, it mainly concerns the handling of medical information and contemplates developed countries. Organizations such as the World Medical Association and the International Bar Association and countries like Germany, Canada, the United States, Great Britain and Portugal have specific legislation on this matter. In these countries, a breach of privacy and issues related to the quality of health information can lead to legal accountability, and the exposure of personal information of health by doctors or their agents have resulted in actions, such as torts, concerning invasion of privacy, breach of confidentiality and even explicit violation of law. While there is no specific legislation in Brazil concerning the repair of material or moral damage consequent to a medical attendance at a distance, a specific action to repair damage resulting from a breach of privacy in a consultation conducted through telemedicine can be settled based on following arguments: 1) The right to the inviolability of private life guaranteed in Federal Constitution of 1988, that also guarantees the right to compensation for material and moral damage caused by its breach, as stated in art. 5o, X; also the right of access to information, safeguarding the confidentiality of its source when necessary for the exercise of a profession, as stated in art. 5o, XIV. 2) The obligation, on the part of the doctor and his assistants, to respect privacy, according to art. 20 of the Civil Code of 2002. 3) Protection of the right to privacy of the patient by a doctor and his assistants in more restricted legislation, such as the Federal Council of Medicine, through Resolution No. 1. 246/1988 CFM, Code of Medical Ethics, in art. 104, art. 107, art. 108 and Resolution No. 1638/2002 CFM, art. 1°.4) Responsibilities attributed the providers of telemedicine care concerning the right to privacy and, as established by the Federal Council of Medicine in Resolution 1. 643/2002 CFM, art. 2. 5) The presumed existence of a service provider contract between the individual and the telemedicine provider, in which the rights and obligations of the parties should be established. Given that the legal process should protect material rights as far as possible, it is understood that the appropriate actions to protect the right to privacy violated or threatened with injury in the case of disclosure of confidential data in a consultation held by telemedicine are Habeas Data, if the party wishes to ensure the knowledge of information related to his person, in the case that the party does not wish to do so, by judicial or administrative confidential proceedings, the Inhibitory Trusteeship, if one wants to prevent the repetition of unlawful conduct, or Action for Material or Moral Damage if one wants to obtain compensation for material or moral damage. Based on this review of the literature it is suggested that the Brazilian legislation should be developed in order to: 1) Recognize the special condition of identifiable health information, which should be seen as highly sensitive information. 2) Provide safeguards for the privacy practices based on the correct handling of information that should be collected and used strictly for important health matters. 3) Give the patient sufficient information and power to exercise informed consent. 4) Limit the exposure of health information. 5) Incorporate internationally and nationally established levels of security. 6) Establish a committee of defense and security that recognizes the levels of technology continuously incorporated into telemedicine.A privacidade é um dos direitos fundamentais do indivíduo, abrangendo o controle exclusivo sobre um âmbito de recolhimento, tranqüilidade, solidão, segredo e intimidade. A revelação de informações pessoais, por vezes envolvendo situações embaraçosas em uma situação de confiança, em caráter confidencial, sem que exista autorização para que estas informações sejam reveladas, caracteriza quebra privacidade informacional. Quando esta revelação não apenas é feita sob sigilo, mas tem uma natureza particular e ocorre em um contexto específico, constitui uma forma de privacidade informacional reconhecida como confidencialidade. A relação médico-paciente ilustra bem uma relação de confidencialidade. Para que a manutenção do segredo seja completa, a privacidade informacional na esfera médica pressupõe não apenas a confidencialidade na relação interpessoal, mas estende-se ao registro das informações. A telemedicina pode ser caracterizada como emprego de telecomunicações para diagnóstico médico e cuidado do paciente, implicando a troca, à distância, de informações, por vezes, sensíveis ao paciente. Por representar um atendimento médico à distância, torna um pouco tormentosa a questão acerca de como este atendimento pode respeitar os princípios éticos que orientam a relação médico-paciente. E um dos maiores questionamentos diz respeito ao risco da exposição das informações sensíveis do indivíduo em atendimento. Como a ampliação de atendimento médico por telemedicina é previsível, justifica-se uma revisão sobre a privacidade da telemedicina e legislação pertinente. Este trabalho discute o conceito da privacidade, expõe informações atuais sobre a telemedicina, em especial no que se refere aos aspectos éticos e legais envolvidos, revisa a respectiva legislação internacional e do Brasil, avalia as possibilidades de dano moral e material decorrente da quebra de confidencialidade e da privacidade em um atendimento médico a distância e expõe ações adequadas à reparação a este dano, se conseqüente a atendimento de saúde a distância. Embora exista ampla jurisprudência relativa a cuidados através de telemedicina, esta contempla países mais desenvolvidos e diz respeito à manipulação de informações médicas em sua maior parte. Organizações, como a Associação Médica Mundial e a International Bar Association, e países como Alemanha, Canadá, Estados Unidos, Inglaterra e Portugal possuem legislação específica. Nestes países, a quebra da privacidade e temas referentes à qualidade das informações de saúde podem conduzir à responsabilização judicial; a exposição de informações pessoais de saúde por médicos ou seus agentes já resultaram em processos por invasão de privacidade, quebra de confidencialidade ou violação explícita de legislação. Ainda que não exista em nosso país legislação específica para reparação do indivíduo prejudicado, moral ou materialmente, em atendimento de telemedicina, pode ser considerada ação de reparação reconhecendo-se: 1. Interpretação judicial da Constituição do Brasil, pois a privacidade é assegurada como direito legal pontualmente através dos arts. 5°, X, e XIV da Constituição Federal. 2. Obrigatoriedade de respeito à privacidade pelo médico e seus auxiliares, conforme art. 20 do Código Civil de 2002, parágrafo único. 3. Existência de legislação mais restrita, como resoluções do Conselho Federal de Medicina, que tutelam o direito à privacidade do paciente. Presumível existência de um contrato de atendimento por telemedicina entre o indivíduo e o prestador de serviços, em que direitos e deveres das partes estão estabelecidos e no qual se pressupõe existir um item específico referente à privacidade e confidencialidade. Ao considerarmos que o processo deve proteger, ao máximo, o direito material, entende-se que as ações adequadas para a proteção do direito à privacidade violado ou ameaçado de lesão, no caso de revelação de dados sigilosos, em uma consulta realizada através da telemedicina, são: o Habeas Data, se a parte deseja assegurar o conhecimento de informações relativos a sua pessoa; caso não queira fazê-lo, por processo sigiloso judicial ou administrativo; a Tutela Inibitória, caso queira impedir a prática da reiteração ou a repetição do ilícito; ou por Dano Material ou Moral, caso queira obter a indenização por dano material ou moral. Como não se dispõe em nosso país de instrumentos jurídicos e de normas éticas específicas para regular o sistema eletrônico de troca de informações no campo da medicina, pode-se sugerir que no futuro se crie uma legislação capaz de: 1. reconhecer a condição especial da informação identificável de saúde, que deve ser vista como informação altamente sensível. 2. fornecer salvaguardas à privacidade, baseadas em práticas corretas de manuseio de informações, estas coletadas e usadas apenas para objetivos importantes de saúde. 3. dotar os pacientes de informação e poderes para consentir. 4. limitar a exposição de informações de saúde. 4. incorporar proteções de segurança industrial reconhecidas. 5. Estabelecer um comitê de proteção e segurança que reconheça os níveis tecnológicos continuamente incorporados à telemedicina. 6. determinar um nível mínimo de privacidade em âmbito nacional

ANALISIS PERBEDAAN RATA-RATA RETURN SAHAM SEBELUM DAN SESUDAH HARI LIBUR NASIONAL (Studi Pada Saham Jakarta Islamic Index Tahun 2016)

ABSTRAK Peran pasar modal di era globalisasi saat ini sangat dirasakan oleh para pelaku ekonomi di Indonesia. Pasar modal adalah kegiatan yang bersangkutan dengan penawaran umum dan perdagangan efek, perusahaan publik yang berkaitan dengan efek yang diterbitkannya, serta lembaga dan potensi yang berkaitan dengan efek. Berbagai penelitian menyatakan bahwa terjadi penyimpangan atau anomali terhadap pasar modal efisien. Anomali pasar dapat menyebabkan kenaikan dan penurunan harga saham yang berdampak pada return atau keuntungan investasi. Salah satu anomali yang ada pasar modal yaitu efek hari libur nasional atau Holiday Effect. Penelitian ini bertujuan untuk mengetahui apakah ada perbedaan yang signifikan antara return saham sebelum dan sesudah hari libur nasional pada perusahaan yang terdaftar di Jakarta Islamic Index Tahun 2016. Penelitian ini menggunakan data harga saham harian Jakarta Islamic Index tahun 2016 sebagai sampel. Pengambilan sampel dilakukan dengan cara purposive sampling. Penelitian ini menggunakan data return saham sebelum dan sesudah hari libur nasional tahun 2016. Tes statistik yang digunakan untuk uji hipotesis dalam penelitian ini adalah Paired sampel T-Test. Kesimpulan dari hasil penelitian ini adalah tidak ada perbedaan yang signifikan antara rata-rata return saham sebelum dan sesudah hari libur nasional pada saham Jakarta Islamic Index tahun 2016. Kata Kunci : Return Saham, Anomali Pasar, Hari Libur Nasional, Holiday Effec

Analisis Penentuan Lokasi Pembangunan Showroom Furnitur Dengan Metode Kuantitatif

Kota Jepara memiliki akses pasar yang sangat luas dalam hal furniture yang sudah banyak dikenal pasar lokal maupun internasional. Salah satu cara yang tepat untuk bersaing dengan pasar adalah dengan memiliki showroom. Tujuan dari penelitian adalah untuk (1) Mengetahui karakteristik pemilik showroom. (2) Mengetahui lokasi strategis penempatan showroom. (3) Mengetahui faktor yang mempengaruhi penempatan lokasi showroom strategis dan (4) Mengetahui pengaruh lokasi showroom terhadap besarnya tingkat pendapatan. Metode yang digunakan adalah metode kuantitatif. Analisis deskriptif digunakan untuk menganalisis karakteristik pemilik showroom dan lokasi showroom menurut presepsi responden. Analisis faktor digunakan untuk mengetahui faktor yang paling berpengaruh dalam penentuan lokasi showroom. Analisis korelasi digunakan untuk mengetahui hubungan antara lokasi showroom dengan tingkat pendapatan. Hasil penelitian menunjukkan terdapat tiga faktor kuat yang mempengaruhi penentuan lokasi yaitu faktor perizinan, keamanan, dan faktor tempat. Lokasi representatif yang bisa ditentukan sebagai lokasi showroom strategis berada di Kecamatan Tahunan, disepanjang ruas jalan raya utama dan memiliki karakteristik berdekatan dengan pesain

Damage-imperfection indicators for the assessment of multi-leaf masonry walls under different conditions

The complexity of multi-leaf masonry walls suggests further researches on the dy- namic behaviour mainly characterized by incoherent response between the different layers. The intrinsic discontinuity and the manufacturing imperfections are amplified by the incre- mental damage that triggers different failure mechanisms that affect the dynamic parameters, such as modal shapes, frequencies and damping ratios. The dynamic identification with out- put only methodology has been proposed in this work on different multi-leaf masonry walls subjected to uniaxial compressive load. The responses of full infill, damaged infill and strengthened infill masonry panels with different widespread damage have been recorded. The evolution of the damage scenario changes the modal shapes, the related frequencies and the damping ratios that through the comparison with the data of the initial conditions can de- tect the anomalies and then the intrinsic vulnerabilities. Through the curvature modal shape methods and the structural irregularity indices applied to different phases, it was possible evaluate the imperfection and the induced damage entity

The psychosocial impact of assistive device scale: Italian validation in a cohort of nonambulant people with neuromotor disorders

The importance of adaptive seating system on body structure and function is widely accepted, but its impact on psychosocial aspects needs more consideration by health professionals. This article describes the Italian validation of the Psychosocial Impact of Assistive Device Scale (IT-PIADS) for non-ambulant people with neuromotor disorders. Once agreement has been given by the original authors, the scale was translated and adapted to the Italian culture. The IT-PIADS was administered to different wheelchairs users with heterogeneous diagnosis. The internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated with the Italian version of the WheelCon-M-SF. The IT-PIADS was administered to 87 subjects. Cronbach's α was 0.92 (p < 0.05), and the testretest reliability (ICC) for competence, adaptability and self-esteem subscales were 0.96, 0.90, 0.93 respectively. The Pearson correlation coefficient of the IT-PIADS with the WheelCon-M-I-SF scores showed significant data for competence and adaptability subscales. Psychosocial perception on assistive devices can be reliably measure. The IT-PIADS showed good psychometric properties and it is possible to confirm its validity for clinical and research purposes. Nevertheless, before using this measure with greater confidence, further psychometric properties tests of the IT-PIADS are recommended

Illustrando i Balcani: immagini tra cronaca e esotismo nelle pagine di "Illustrazione Italiana" dal 1873 al 1914

Questa tesi ha come oggetto di studio l’immagine dei popoli e dei paesi balcanici mostrata attraverso le pagine della rivista “Illustrazione Italiana” in un arco di tempo che va dai primi anni Settanta del XIX secolo al periodo precedente lo scoppio della Prima guerra mondiale. Lo scopo è quello di analizzare, attraverso le rappresentazioni grafiche e le testimonianze pubblicate dalla rivista, come la complessa realtà balcanica veniva contemporaneamente immaginata, scoperta e riprodotta alla luce di eventi politici e sociali e di influenze culturali fondamentali per la storia europea. Come fonte principale d’indagine di questo multiforme “Oriente europeo”, è stata scelta “Illustrazione Italiana”, una delle più note riviste italiane dell’epoca per alcune caratteristiche che la rendono idonea allo scopo: periodico al tempo stesso politico, culturale, scientifico e di diletto, che raggiungeva un pubblico relativamente ampio, e che fin dagli esordi (nel dicembre del 1873) mostra la volontà di essere una pubblicazione di stampo marcatamente italiano, in un’Italia unita costituitasi solo da poco come tale. Il lavoro è stato quindi articolato in due parti: la prima offre uno sguardo d’insieme sulla fonte utilizzata, sul periodo storico e sui rapporti tra Italia e paesi balcanici, letti attraverso le pagine della rivista, mentre la seconda parte si concentra essenzialmente sulle immagini pubblicate dalla rivista. Nel corso dei quaranta anni esaminati i Balcani vengono presentati come un luogo incognito e mostrati al pubblico come una realtà fatta di miseria e violenza, carente di quei parametri considerati espressione di civiltà, ma che comincia a manifestare una certa spinta verso la modernizzazione. L’immagine generale che la rivista propone è quella di un affascinante e al contempo sconcertante mondo orientale, prossimo solo geograficamente alla “civiltà” europea, filtrato attraverso l’esperienza dei cronisti, che per la volontà politica e l’ideologia del momento permane nell’immaginario italiano come una terra arcaica, ostica, abitata da popolazioni semicivilizzate le cui vicende poco interessano se non alla luce degli avvenimenti internazionali

A Psychometric Properties Evaluation of the Italian Version of the Geriatric Depression Scale

Objective. The Geriatric Depression Scale (GDS) is an evaluation tool to diagnose older adult's depression. This questionnaire was defined by Yesavage and Brink in 1982; it was designed expressly for the older person and defines his/her degree of satisfaction, quality of life, and feelings. The objective of this study is to evaluate the psychometric properties of the Italian translation of the Geriatric Depression Scale (GDS-IT). Methods. The Italian version of the Geriatric Depression Scale was administered to 119 people (79 people with a depression diagnosis and 40 healthy ones). We examined the following psychometric characteristics: internal consistency reliability, test-retest reliability, concurrent validity, and construct validity (factor structure). Results. Cronbach's Alpha for the GDS-IT administered to the depressed sample was 0.84. Test-retest reliability was 0.91 and the concurrent validity was 0.83. The factorial analysis showed a structure of 5 factors, and the scale cut-off is between 10 and 11. Conclusion. The GDS-IT proved to be a reliable and valid questionnaire for the evaluation of depression in an Italian population. In the present study, the GDS-IT showed good psychometric properties. Health professionals now have an assessment tool for the evaluation of depression symptoms in the Italian population

Effect of different lignocellulosic fibres on poly(ε-caprolactone)-based composites for potential applications in orthotics

This work compares the mechanical and thermal behaviour of fully biodegradable biocomposites based on polycaprolactone reinforced with three different natural fibres, namely hemp, sisal and coir, for potential applications in the field of orthoses. The same properties were further compared to those of two commercially available materials commonly used in the same prospective field. The results confirmed that the addition of natural fibres, irrespective of the origin of the fibres (leaf, bast or fruit) to a biodegradable matrix allows for significant improvement of the mechanical behaviour of the ensuing composites compared to traditional thermoplastic materials used in orthotics

Reliability and validity of the geriatric depression scale in Italian subjects with Parkinson's disease

Introduction. The Geriatric Depression Scale (GDS) is commonly used to assess depressive symptoms, but its psychometric properties have never been examined in Italian people with Parkinson's disease (PD). The aim of this study was to study the reliability and validity of the Italian version of the GDS in a sample of PD patients. Methods. The GDS was administered to 74 patients with PD in order to study its internal consistency, test-retest reliability, construct, and discriminant validity. Results. The internal consistency of GDS was excellent (α = 0.903), as well as the test-retest reliability (ICC = 0.941 [95% CI: 0.886-0.970]). GDS showed a strong correlation with instruments related to the depression (ρ = 0.880) in PD (ρ = 0.712) and a weak correlation with generic measurement instruments (-0.320 < ρ <-0.217). An area under the curve of 0.892 (95% CI 0.809-0.975) indicated a moderate capability to discriminate depressed patients to nondepressed patient, with a cutoff value between 15 and 16 points that predicts depression (sensitivity = 87%; specificity = 82%). Conclusion. The GDS is a reliable and valid tool in a sample of Italian PD subjects; this scale can be used in clinical and research contexts

Quality of life in Parkinson’s disease: Italian validation of the Parkinson’s Disease Questionnaire (PDQ-39-IT)

Translation and cross-cultural adaptation of the 39-item Parkinson’s Disease Questionnaire (PDQ-39) to the Italian culture was performed by Oxford University Innovation in 2008, but this version has never been validated. Therefore, we performed the process of validation of the Italian version of the PDQ-39 (PDQ-39-IT) following the “Consensus-Based Standards for the Selection of Health Status Measurement Instruments” checklist. The translated PDQ-39-IT was tested with 104 patients diagnosed with Parkinson’s disease (PD) who were recruited between June and October 2017. The mean age of the participants was 65.7 ± 10.2 years, and the mean duration of symptoms was 7.4 ± 5.3 years. The internal consistency of the PDQ-39-IT was assessed by Cronbach’s alpha and ranged from 0.69 to 0.92. In an assessment of test-retest reliability in 35 of the 104 patients, the infraclass correlation coefficient (ICC) ranged from 0.85 to 0.96 for the various subitems of the PDQ-39-IT (all p < 0.01). Spearman’s rank correlation coefficient for the validity of the PDQ-39-IT and the Italian version of the 36-Item Short Form (SF-36) was − 0.50 (p < 0.01). The results show that the PDQ-39-IT is a reliable and valid tool to assess the impact of PD on functioning and well-being. Thus, the PDQ-39-IT can be used in clinical and research practice to assess this construct and to evaluate the overall effect of different treatments in Italian PD patients