Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study

Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study

Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study

Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study

Penilaian Risiko Data Sistem Informasi Manajemen Puskesmas dan Aset Menggunakan ISO 27005

AbstrakSistem Informasi Manajemen Puskesmas atau SIMPUS merupakan sistem informasi manajemen yang digunakan oleh staf Puskesmas Pasir Putih guna menyediakan layanan kesehatan kepada masyarakat. Keberadaan SIMPUS sangat mendukung kegiatan pelayanan kesehatan. Namun ada permasalahan pada sistem informasi puskesmas dalam pelayanan pasien, pada komputer terkena virus sehingga SIMPUS tidak bisa digunakan sementara. Penelitian ini dilakukan untuk penilaian risiko terhadap kemungkinan ancaman dan risiko yang muncul menggunakan ISO 27005. Hasil penelitian dari penilaian risiko rata-rata risiko sedang dan risiko tinggi masih kecil pada ancaman yang mungkin terjadi dan penanganan risiko dari 30 skenario ancaman yang mungkin terjadi yaitu, risk modification (RM) 20 skenario, risk Avoidance (RA) 3 skenario dan risk sharing (RS) 7 skenario. Rekomendasi untuk penanganan risiko pada Puskesmas Pasir Putih yaitu perlu adanya kebijakan dan aturan dari kepala puskesmas terhadap aset utama aplikasi SIMPUS untuk pengolahan, penghapusan dan output data SIMPUS. Dilakukan pelatihan terhadap pengelola dan pengguna aplikasi SIMPUS. Penambahan keamanan, pemeliharaan dan kontrol pada aset pendukung dan menambah kebutuhan yang diperlukan.Kata Kunci: ISO 27005, Puskesmas Pasir Putih, Penilaian Risiko AbstractSistem Informasi Manajemen Puskesmas or SIMPUS is a health center management information system that is used by Puskesmas Pasir Putih staff to provide health care services for citizens. SIMPUS have supported health care service. But, there is a problem in patient service when virus computer attack SIMPUS. This incident caused SIMPUS cannot be used temporarily. This research was conducted to assess the risk of possible threats and risks that arise using ISO 27005. The result shown that the average risk assessment of moderate risk and high risk were still small on the threats that might occur, and the risk management of 30 possible threat can be occurred such as risk modification (RM) 20 scenarios, risk Avoidance (RA) 3 scenarios and risk sharing (RS) 7 scenarios. There are several recommendations for risk management at Puskesmas Pasir Putih. Policies and rules need to be made by the head of Puskesmas to maintain the main assets of SIMPUS application for processing, deleting and outputing the SIMPUS data. Doing training for maintainers and simpus application users, increasing security, maintaining and controlling to support assets and increasing need. Keywords: ISO 27005, Puskesmas Pasir Putih, Risk Assessment

Gene-Centric Database Reveals Environmental and Lifestyle Relationships for Potential Risk Modification and Prevention

The database at Nutrigenetics.net has been under development since 2007 to facilitate the identification and classification of PubMed articles relevant to human genetics. A controlled vocabulary (i.e., standardized terminology) is used to index these records, with links back to PubMed for every article title. This enables the display of indexes (alphabetical subtopic listings) for any given topic, or for any given combination of topics, including for genes and specific genetic variants. Stepwise use of such indexes (first for one topic, then for combinations of topics) can reveal relationships that are otherwise easily overlooked. These relationships include environmental and lifestyle variables with potential relevance to risk modification (both beneficial and detrimental), and to prevention, or at least to the potential delay of symptom onset for health conditions like Alzheimer disease among many others. Thirty-four specific genetic variants have each been mentioned in at least ≥1,000 PubMed titles/abstracts, and these numbers are steadily increasing. The benefits of indexing with standardized terminology are illustrated for genetic variants like MTHFR 677C-T and its various synonyms (e.g., rs1801133 or Ala222Val). Such use of a controlled vocabulary is also helpful for numerous health conditions, and for potential risk modifiers (i.e., potential risk/effect modifiers).

Risk modifiers and mortality in patients with high platelet reactivity to Adenosine-diphosphate (ADP) in the LURIC study

Background Increased platelet reactivity (PR) is an established predictor of cardiovascular (CV) and all-cause mortality. However, therapeutic targeting of PR by tailored antiplatelet therapy (APT) failed to show significant clinical benefit. It remains unclear whether increased PR constitutes a risk-modifier that identifies patients that benefit from risk-factor adjustment. Purpose To identify risk factors that allow modification and/or elimination of increased CV and all-cause mortality in patients with altered PR. Methods ADP- and TRAP-induced PR was measured by CD62P and CD63 expression in 1780 patients who were referred for coronary angiography between 1997 and 2000 and participated in the LURIC study. Statistical analysis was performed by SPSS v25.0 and R v3.6.1 Results ADP-induced PR was an excellent predictor of CV-mortality and risk-equivalent to the presence of coronary artery disease (Figure 1A). Stratification of platelet ADP-response into tertiles demonstrated that patients with high-PR (HPR) and low-PR (LPR) were at increased risk for CV-mortality when compared to the reference group (HPR: HR 1.7 [95% CI: 1.3–2.3]; LPR: HR 1.4 [95% CI: 1.0–1.8]) (Figure 1B). Multivariable-adjustment did not change the association of PR with CV-mortality. Using a relative weight analysis, we identified HbA1c and estimated glomerular filtration rate (eGFR) as potential risk-modifiers. In addition, presence of APT appeared to be an exclusive risk-modifier in the HPR-group. In an multivariable-adjusted risk assessment, we verified that in the HPR group (i) treatment of PR by APT reduced CV-mortality with a HR of 0.5 (95% CI: 0.3–0.7) p=0.0004), (ii) HbA1c of >7.0% in patients with diabetes increased CV-mortality with a HR of 2.0 (95% CI: 1.2–3.2 p=0.004) and (iii) eGFR <60ml/min increased CV-mortality with a HR 1.7 (95% CI: 1.1–2.6 p=0.013). Other risk-factors including blood pressure (<140mmHg), LDL-C (<100mg/dL) and hs-CRP (<2mg/dL) did not alter the mortality risk. None of the risk-modifiers tested affected CV-mortality risk of patients in the LPR group. In the HPR group, risk modification by APT and HbA1c <7.0% in patients with diabetes independently reduced CV-mortality risk to a level that was no longer statistically different to the reference group (p>0.05). Risk modification by an eGFR >60ml/min led to a profound risk reduction in the HPR group but remained statistically different from the reference group (Figure 1C). Conclusion Here, we demonstrate that HPR and LPR are predictors for CV mortality in the LURIC study. Treatment of platelet hyperreactivity by APT, HbA1c of ≤7% in patients with diabetes and an eGFR ≥60ml/min were associated with a reduced CV-mortality in HPR patients and might constitute adjustable risk factors in this group. In addition, we were unable to identify any significant risk factors for patients with LPR underlining a high-risk patient group with insufficient therapeutic options. Figure 1 Funding Acknowledgement Type of funding source: None