title: Automatic end-to-end De-identification: Is high accuracy the only metric?

authors: Yogarajan, Vithya

subjects: automatic de-identification

abstract: De-identification of electronic health records (EHR) is a vital step towards advancing health informatics research and maximising the use of available data. It is a two-step process where step one is the identification of protected health information (PHI), and step two is replacing such PHI with surrogates. Despite the recent advances in automatic de-identification of EHR, significant obstacles remain if the abundant health data available are to be used to the full potential. Accuracy in de-identification could be considered a necessary, but not sufficient condition for the use of EHR without individual patient consent. We present here a comprehensive review of the progress to date, both the impressive successes in achieving high accuracy and the significant risks and challenges that remain. To best of our knowledge, this is the first paper to present a complete picture of end-to-end automatic de-identification. We review 18 recently published automatic de-identification systems -designed to de-identify EHR in the form of free text- to show the advancements made in improving the overall accuracy of the system, and in identifying individual PHI. We argue that despite the improvements in accuracy there remain challenges in surrogate generation and replacements of identified PHIs, and the risks posed to patient protection and privacy.

text: Automatic end-to-end De-identification: Is high accuracy the only metric? De-identification of electronic health records (EHR) is a vital step towards advancing health informatics research and maximising the use of available data. It is a two-step process where step one is the identification of protected health information (PHI), and step two is replacing such PHI with surrogates. Despite the recent advances in automatic de-identification of EHR, significant obstacles remain if the abundant health data available are to be used to the full potential. Accuracy in de-identification could be considered a necessary, but not sufficient condition for the use of EHR without individual patient consent. We present here a comprehensive review of the progress to date, both the impressive successes in achieving high accuracy and the significant risks and challenges that remain. To best of our knowledge, this is the first paper to present a complete picture of end-to-end automatic de-identification. We review 18 recently published automatic de-identification systems -designed to de-identify EHR in the form of free text- to show the advancements made in improving the overall accuracy of the system, and in identifying individual PHI. We argue that despite the improvements in accuracy there remain challenges in surrogate generation and replacements of identified PHIs, and the risks posed to patient protection and privacy.

year: 2019

title: Validation of the Children's Eating Behaviour Questionnaire (CEBQ) in the population of Saudi preschoolers

authors: Alhamad, Ali Hamad

abstract: The Children's Eating Behaviour Questionnaire (CEBQ) is a multi-dimensional questionnaire filled out by parents to determine the characteristics of eating behaviour of their children and, consequently, children’s propensity to become obese. It assesses eating habits that contribute to childhood obesity. It has been successfully validated mainly in countries of Western-type eating habits, but not in Saudi Arabia or anywhere else in the Middle East, where obesity has become a significant health problem. In the current study, the CEBQ factor structure and reliability were assessed in a sample of Saudi preschoolers aged 2-6 years. In addition, the associations between children's BMI z-scores, eating behaviours and parental weight were examined. Parents of 200 Saudi preschool children (100 boys and 100 girls) completed the Arabic version of the CEBQ. BMI of children and parents, and parental educational levels were collected. The BMI of every child was calculated and converted to BMI z-score. Factor analyses on all the CEBQ items were performed and the differences between genders and age groups were examined. Correlations between children's BMI z-scores and eating behaviours were analysed using linear regression, controlling for age, gender, parental educational levels and parental weight. The factor analysis revealed an eight-factor solution similar to the theoretical factor structure, with good internal reliability and acceptable correlations between subscales. Boys scored slightly higher than girls on food responsiveness, whereas no difference between age groups was found. Significant and positive associations between BMI z-scores and “food approach” subscales, food responsiveness, enjoyment of food and emotional overeating were found, while “food avoidant” subscales, satiety responsiveness and slowness in eating, had significant inverse relationships with BMI z-scores. Maternal BMI had strong positive associations with BMI z-scores and food responsiveness, whereas paternal BMI had no effect on BMI z-scores or eating behaviours of children. The current data suggest that the CEBQ is a valid psychometric tool that can be reliably used to assess eating behaviour characteristics in Saudi preschool children. The results derived from this study can be useful in understanding the aetiology of overweight and obesity in pre-school children in regard to their eating behaviours.

text: Validation of the Children's Eating Behaviour Questionnaire (CEBQ) in the population of Saudi preschoolers The Children's Eating Behaviour Questionnaire (CEBQ) is a multi-dimensional questionnaire filled out by parents to determine the characteristics of eating behaviour of their children and, consequently, children’s propensity to become obese. It assesses eating habits that contribute to childhood obesity. It has been successfully validated mainly in countries of Western-type eating habits, but not in Saudi Arabia or anywhere else in the Middle East, where obesity has become a significant health problem. In the current study, the CEBQ factor structure and reliability were assessed in a sample of Saudi preschoolers aged 2-6 years. In addition, the associations between children's BMI z-scores, eating behaviours and parental weight were examined. Parents of 200 Saudi preschool children (100 boys and 100 girls) completed the Arabic version of the CEBQ. BMI of children and parents, and parental educational levels were collected. The BMI of every child was calculated and converted to BMI z-score. Factor analyses on all the CEBQ items were performed and the differences between genders and age groups were examined. Correlations between children's BMI z-scores and eating behaviours were analysed using linear regression, controlling for age, gender, parental educational levels and parental weight. The factor analysis revealed an eight-factor solution similar to the theoretical factor structure, with good internal reliability and acceptable correlations between subscales. Boys scored slightly higher than girls on food responsiveness, whereas no difference between age groups was found. Significant and positive associations between BMI z-scores and “food approach” subscales, food responsiveness, enjoyment of food and emotional overeating were found, while “food avoidant” subscales, satiety responsiveness and slowness in eating, had significant inverse relationships with BMI z-scores. Maternal BMI had strong positive associations with BMI z-scores and food responsiveness, whereas paternal BMI had no effect on BMI z-scores or eating behaviours of children. The current data suggest that the CEBQ is a valid psychometric tool that can be reliably used to assess eating behaviour characteristics in Saudi preschool children. The results derived from this study can be useful in understanding the aetiology of overweight and obesity in pre-school children in regard to their eating behaviours.

year: 2013

title: Indigenous knowledges in health policy in Aotearoa New Zealand and Saskatchewan Canada: A comparative study

authors: Green, Jane Alison

subjects: Indigenous

abstract: For more than two decades, components of Māori knowledges in the form of Māori words and concepts have been part of health policy in Aotearoa New Zealand. Health policy that engages Māori words and concepts resonates with Māori community values and aspirations and is thought to contribute to the revitalisation of Māori knowledges. Absent from the literature is an examination of this phenomenon; specifically, the socio-political factors that facilitate and limit the engagement of Māori knowledges with health policy. Of the four settler states, only in Aotearoa New Zealand are the knowledges of the Indigenous peoples engaged with health policy. In Saskatchewan, Canada, the First Nations and Métis peoples have engaged their knowledges with federal and provincially funded health programmes and services but not health policy. This study adopts a two-country comparative policy framework to investigate and theorise the historical and contemporary socio-political factors associated with the engagement of Indigenous knowledges in health policy in Aotearoa New Zealand and Saskatchewan, Canada. An adaption is made to the Kaupapa Māori approach so that the complexities of a two-country case study approach are addressed and engagement in health policy as a strategy for knowledge revitalisation is theorised. The study also takes a path less travelled which is to investigate the impact that engagement with health policy has upon the intangible or the ontological aspects of Māori knowledges. Māori describe their knowledges as comprised of tangible and intangible elements, both of which are important. Another adaption is made to the Kaupapa Māori theoretical approach which is to add speculative inquiry. The study argues that speculative inquiry in the form of contemplative, analytical, relational and viscerally aware practices are commonplace in Māori communities. Adding speculative inquiry to an already rich theoretical body that is Kaupapa Māori research provides an opening for other Kaupapa Māori researchers to expand non-empirical inquiry. The study concludes that government policies have had a decimating effect upon Māori, First Nations and Métis knowledges. Moreover, recent reports from commissions and inquiries indicate these knowledges and associated languages continue to decline for a number of reasons, including the impact of contemporary government policies. Health policy, this study asserts, is an uncertain site from which to revitalise Māori, First Nations and Métis knowledges.

text: Indigenous knowledges in health policy in Aotearoa New Zealand and Saskatchewan Canada: A comparative study For more than two decades, components of Māori knowledges in the form of Māori words and concepts have been part of health policy in Aotearoa New Zealand. Health policy that engages Māori words and concepts resonates with Māori community values and aspirations and is thought to contribute to the revitalisation of Māori knowledges. Absent from the literature is an examination of this phenomenon; specifically, the socio-political factors that facilitate and limit the engagement of Māori knowledges with health policy. Of the four settler states, only in Aotearoa New Zealand are the knowledges of the Indigenous peoples engaged with health policy. In Saskatchewan, Canada, the First Nations and Métis peoples have engaged their knowledges with federal and provincially funded health programmes and services but not health policy. This study adopts a two-country comparative policy framework to investigate and theorise the historical and contemporary socio-political factors associated with the engagement of Indigenous knowledges in health policy in Aotearoa New Zealand and Saskatchewan, Canada. An adaption is made to the Kaupapa Māori approach so that the complexities of a two-country case study approach are addressed and engagement in health policy as a strategy for knowledge revitalisation is theorised. The study also takes a path less travelled which is to investigate the impact that engagement with health policy has upon the intangible or the ontological aspects of Māori knowledges. Māori describe their knowledges as comprised of tangible and intangible elements, both of which are important. Another adaption is made to the Kaupapa Māori theoretical approach which is to add speculative inquiry. The study argues that speculative inquiry in the form of contemplative, analytical, relational and viscerally aware practices are commonplace in Māori communities. Adding speculative inquiry to an already rich theoretical body that is Kaupapa Māori research provides an opening for other Kaupapa Māori researchers to expand non-empirical inquiry. The study concludes that government policies have had a decimating effect upon Māori, First Nations and Métis knowledges. Moreover, recent reports from commissions and inquiries indicate these knowledges and associated languages continue to decline for a number of reasons, including the impact of contemporary government policies. Health policy, this study asserts, is an uncertain site from which to revitalise Māori, First Nations and Métis knowledges.

year: 2018