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Archivos Argentinos de Pediatria Oct 2022It is common to see young children playing with a mobile phone or a tablet. However, the decision about the availability of an electronic device and how and when to use...
It is common to see young children playing with a mobile phone or a tablet. However, the decision about the availability of an electronic device and how and when to use it depends on adults. The concern is the increase of such practice at the expense of activities and social interaction by talking and being in contact with others, as well as other aspects of children's health (overweight and sleep disturbances). It is yet unclear how the generalized use of screens affects development. The physical and psychological mechanisms of such effects are also unknown. The purpose of this article is to provide a current view of the effect of early exposure to screens on the comprehensive development of children and parents' perceptions. It would be conducive to implement education projects for parents and legal guardians that promote an adequate child stimulation at home.
Topics: Adult; Child, Preschool; Educational Status; Family; Humans; Parents; Sleep Wake Disorders; Television
PubMed: 36190219
DOI: 10.5546/aap.2022.eng.340 -
Maternal & Child Nutrition Jul 2020This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross-sectional study of 4,740 children aged 9-11 years was...
This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross-sectional study of 4,740 children aged 9-11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate-to-vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable-adjusted ORs based on different breastfeeding durations (none, 1-6, 6-12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (P = .020) and 1.00, 0.64, 047, and 0.64 for high body fat (P = .012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9- to 11-year-old children from 12 countries.
Topics: Breast Feeding; Child; Cross-Sectional Studies; Female; Humans; Internationality; Male; Pediatric Obesity
PubMed: 32141229
DOI: 10.1111/mcn.12984 -
JAMA Oct 2021
Topics: Adult; Advance Care Planning; Advance Directive Adherence; Decision Making; Decision Making, Shared; Health Services Needs and Demand; Humans; Patient Preference; Proxy; Quality Improvement; Quality of Life; Terminal Care
PubMed: 34623373
DOI: 10.1001/jama.2021.16430 -
Dementia and Geriatric Cognitive... 2021In the absence of a cure, dementia is often managed by minimizing risk factors contributing to quality of life (QOL). Attitudes to dementia in older adults may differ...
INTRODUCTION
In the absence of a cure, dementia is often managed by minimizing risk factors contributing to quality of life (QOL). Attitudes to dementia in older adults may differ from those in relatively younger adults. The aim was to conduct a systematic review of the literature to determine how QOL was assessed in adults, 65 years and older with dementia, and identify factors that influence the reported scores.
METHODS
A systematic review of full-text articles addressing QOL in older adults with dementia, published in English from January 1995 to September 2020, was conducted using PubMed and PsycINFO. We included studies that assessed QOL and involved participants 65 years and older. Studies were evaluated for inclusion by 2 independent pairs of reviewers. We assessed the quality of the studies using the Joanna Briggs Institute's Critical Appraisal Checklist. Study characteristics and findings were summarized. Analysis was by narrative synthesis. We identified social and clinical factors influencing QOL scores.
RESULTS
Of the 1,010 articles identified, 19 met the inclusion criteria. These 19 studies involved 6,279 persons with dementia, with sample sizes from 32 to 1,366. Mean age of participants ranged from 77.1 to 86.6 years. Five measurement tools were identified; Quality of Life in Alzheimer Disease (QOL-AD), Alzheimer Disease-Related Quality of Life (ADRQL), Quality of Life in Late-Stage Dementia (QUALID), QUALIDEM (a dementia-specific QOL tool), and DEMQOL (health-related QOL for people with dementia). Self-ratings of QOL were higher than proxy ratings. Factors commonly influencing self-ratings of QOL included depression, functional impairment, and polypharmacy. Common factors that influenced proxy ratings included functional impairment, presence of neuropsychiatric symptoms, cognitive impairment, and caregiver burden.
CONCLUSION
In evaluating QOL in dementia, self- and proxy reports may complement each other to ensure that all perspectives are addressed.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Caregivers; Dementia; Humans; Proxy; Quality of Life
PubMed: 34167127
DOI: 10.1159/000515317 -
Women's Health (London, England) 2023State laws that require minors seeking abortion care to notify or obtain consent from a parent or other legal guardian are broadly referred to as parental involvement... (Review)
Review
State laws that require minors seeking abortion care to notify or obtain consent from a parent or other legal guardian are broadly referred to as parental involvement laws. Judicial bypass allows a minor to petition the court to bypass parental involvement. Even before the decision overturned on 24 June 2022, 36 states had at least one parental involvement law, making minor access to abortion care even more complex than adult access. Since the decision, at least 15 states have completely banned abortion, adding further complexity, geographic barriers, and inequities to the pursuit of reproductive healthcare. In this narrative review and commentary, we explain parental involvement laws and judicial bypass from both a legal and medical perspective, exploring the evolving challenges created by this system in the year post-
Topics: Pregnancy; Adult; Female; Humans; United States; Judicial Role; Abortion, Legal; Abortion, Induced; Parents
PubMed: 38146197
DOI: 10.1177/17455057231219601 -
Frontiers in Public Health 2022Biobanks play a central role in pediatric translational research, which deals primarily with genetic data from sample-based research. However, participation of children... (Review)
Review
Biobanks play a central role in pediatric translational research, which deals primarily with genetic data from sample-based research. However, participation of children in biobanking has received only limited attention in the literature, even though research in general and in clinical trials in particular have a long history in involving minors. So, we resolved to explore specific challenging ethical, legal, and societal issues (ELSI) in the current pediatric biobanking landscape to propose a way forward for biobanking with children as partners in research. Methodologically, we first established the accessibility and utilization of pediatric biobanks, mainly in Europe. This was supported by a literature review related to children's participation, taking into account not only academic papers but also relevant guidelines and best-practices. Our findings are discussed under five themes: general vulnerability; ethical issues-balancing risks and benefits, right to an open future, return of results including secondary findings; legal issues-capacity and legal majority; societal issues-public awareness and empowerment; and responsible research with children. Ultimately, we observed an on-going shift from the parents'/guardians' consent being a sine-qua-non condition to the positive minor's agreement: confirming that the minor is the participant, not the parent(s)/guardian(s). This ethical rethinking is paving the way toward age-appropriate, dynamic and participatory models of involving minors in decision-making. However, we identified a requirement for dynamic tools to assess maturity, a lack of co-produced engagement tools and paucity of shared best practices. We highlight the need to provide empowerment and capability settings to support researchers and biobankers, and back this with practical examples. In conclusion, equipping children and adults with appropriate tools, and ensuring children's participation is at the forefront of responsible pediatric biobanking, is an ethical obligation, and a cornerstone for research integrity.
Topics: Adult; Biological Specimen Banks; Child; Europe; Humans; Parents; Research Personnel; Translational Research, Biomedical
PubMed: 36238242
DOI: 10.3389/fpubh.2022.917615 -
Journal of Family Medicine and Primary... Jun 2021Informed consent is a cornerstone of the ethics of modern medical care. In an ideal world, informed consent is a process of education - a conversation between a surgeon...
BACKGROUND
Informed consent is a cornerstone of the ethics of modern medical care. In an ideal world, informed consent is a process of education - a conversation between a surgeon and a patient or family that allows the patient or family to make the best possible decision regarding care.
OBJECTIVE
The study was conducted with objectives of assessing information given to the patient before taking consent for surgery and determining the compliance to various contents of the consent forms.
MATERIAL AND METHODS
This was a prospective study over a period of 12 weeks in wards of various surgical departments of a 1000+ bedded tertiary care hospital. Patient interviews were conducted to assess their level of information and the consent forms were reviewed to assess the compliance.
OBSERVATIONS
The overall level of information r4egarding various aspects among the participants was 75.14%. The level of information varied statistically with age, literacy level, annual income and the type of surgery. All the patients (100%) stated that they were informed about the current clinical condition/ problem, while only 34% were informed about risk and 26% about the alternative options. All the forms (100%) had a statement regarding the explanation of procedure to the patient/ guardian and none of the forms (0%) contained names of all practitioners performing the procedure.
CONCLUSION
There is need to create awareness among doctors and also to educate patients regarding the importance of informed consent.
PubMed: 34322428
DOI: 10.4103/jfmpc.jfmpc_2393_20 -
Journal of Pain and Symptom Management Jul 2021Guardians are surrogate decision makers appointed by a court when other health care decision-makers are unable, unwilling, or unavailable to make decisions. Prior...
CONTEXT
Guardians are surrogate decision makers appointed by a court when other health care decision-makers are unable, unwilling, or unavailable to make decisions. Prior studies suggest that persons under guardianship may experience delays in transitions of care.
OBJECTIVES
To compare quality of end-of-life care for persons under guardianship to a matched group on objective indicators and to identify narrative themes characterizing potential obstacles to quality end-of-life care.
METHODS
One hundred sixty-seven persons under guardianship who died between 2003 and 2019 within the Veterans Healthcare Administration in Massachusetts and Connecticut matched on a 1:1 basis to persons without guardians. The groups were compared on treatment specialty at death, days of hospice and intensive care unit care, and receipt of palliative care consultation. Additionally, patient narratives for those under guardianship with extended lengths in intensive care unit were subjected to qualitative analysis.
RESULTS
Overall, <1% were under guardianship. Within this sample of persons who died within the Veterans Health Administration, persons under guardianship were as likely as patients in the comparison group to receive palliative care consultation (odds ratio [CI] = 0.93 [.590-1.46], P = .359), but were more likely to have ethics consultation (odds ratio [CI] = 0.25 [0.66-0.92], P = .036) and have longer lengths of ICU admission (β = -.34, t = -2.70, P = .009). Qualitative findings suggest that issues related to family conflict, fluctuating medical course, and limitations in guardian authority may underlie extended lengths of stay.
CONCLUSION
Guardianship appears to be rare, and as a rule, those under guardianship have equal access to hospice and palliative care within Veterans Health Administration. Guardianship may be associated with health-care challenges in a small number of cases, and this may drive perceptions of adverse outcomes.
Topics: Hospice Care; Humans; Intensive Care Units; Legal Guardians; Massachusetts; Palliative Care; Terminal Care
PubMed: 33212143
DOI: 10.1016/j.jpainsymman.2020.11.008