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3.
Pediatrics ; 146(Suppl 1): S25-S32, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32737229

RESUMEN

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide.


Asunto(s)
Toma de Decisiones Clínicas , Competencia Mental/legislación & jurisprudencia , Menores/legislación & jurisprudencia , Consentimiento Paterno/legislación & jurisprudencia , Adolescente , Desarrollo del Adolescente , Niño , Desarrollo Infantil , Servicios de Salud del Niño/legislación & jurisprudencia , Crianza del Niño , Protección a la Infancia/legislación & jurisprudencia , Derechos Civiles , Toma de Decisiones Clínicas/ética , Familia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Consentimiento Informado de Menores/ética , Consentimiento Informado de Menores/legislación & jurisprudencia , Competencia Mental/normas , Menores/psicología , Relaciones Padres-Hijo , Consentimiento Paterno/ética , Patient Self-Determination Act , Autonomía Personal , Apoderado/legislación & jurisprudencia , Negativa del Paciente al Tratamiento/legislación & jurisprudencia , Estados Unidos
4.
Infant Ment Health J ; 41(2): 163-165, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32285498

RESUMEN

This issue of the Infant Mental Health Journal presents the first papers from a tripartite evaluation study of state-sponsored infant mental health home visiting program in Michigan, United States. This series of studies has been led by Kate Rosenblum PhD and Maria Muzik MD, Department of Psychiatry, the University of Michigan and faculty from the Michigan Collaborative for Infant Mental Health Research for the State of Michigan, Department of Health and Human Services, Mental Health Services for Children, to fulfill the requirements of state legislation (State of Michigan Act No. 291, Public Acts of 2013) that required that all home visiting programs meet certain requirements to be established as an evidence-based practice. In this introduction, we provide a historical context for the delivery of infant mental health home visiting through the community mental health system in the state of Michigan.


Asunto(s)
Servicios de Salud del Niño/historia , Visita Domiciliaria , Servicios de Salud Mental/historia , Salud Mental/legislación & jurisprudencia , Servicios de Salud del Niño/legislación & jurisprudencia , Preescolar , Práctica Clínica Basada en la Evidencia , Femenino , Historia del Siglo XX , Humanos , Lactante , Cuidado del Lactante/legislación & jurisprudencia , Salud del Lactante/legislación & jurisprudencia , Recién Nacido , Servicios de Salud Mental/legislación & jurisprudencia , Michigan , Atención Posnatal , Desarrollo de Programa , Gobierno Estatal
5.
Infant Ment Health J ; 41(2): 166-177, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32242955

RESUMEN

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent-child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.


Asunto(s)
Servicios de Salud del Niño/historia , Visita Domiciliaria , Salud del Lactante/legislación & jurisprudencia , Servicios de Salud Mental/historia , Salud Mental/legislación & jurisprudencia , Cuidadores/psicología , Niño , Servicios de Salud del Niño/legislación & jurisprudencia , Preescolar , Femenino , Historia del Siglo XX , Humanos , Lactante , Recién Nacido , Servicios de Salud Mental/legislación & jurisprudencia , Michigan , Relaciones Padres-Hijo , Padres/psicología
6.
Neurotoxicology ; 81: 238-245, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33741109

RESUMEN

Services aimed at improving the health of infants, children and mothers have developed over the years since the initiation of the Seychelles Child Development Study. This paper describes the policies, procedures and facilities and how they have impacted on service provision. The utilisation of antenatal, perinatal and child health services, both in the hospital and community settings, are described. The successes and challenges are illustrated by describing fertility, abortion, teenage pregnancy and infant mortality. This overview of maternal and child services provides a perspective on an important aspect of health care development and the context in which the SCDS is conducted.


Asunto(s)
Servicios de Salud del Niño , Salud Infantil , Prestación Integrada de Atención de Salud , Política de Salud , Salud del Lactante , Servicios de Salud Materna , Salud Materna , Aborto Inducido , Aborto Espontáneo/epidemiología , Adolescente , Adulto , Niño , Desarrollo Infantil , Salud Infantil/legislación & jurisprudencia , Salud Infantil/tendencias , Servicios de Salud del Niño/legislación & jurisprudencia , Servicios de Salud del Niño/tendencias , Mortalidad del Niño , Preescolar , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/tendencias , Femenino , Fertilidad , Regulación Gubernamental , Política de Salud/legislación & jurisprudencia , Política de Salud/tendencias , Humanos , Lactante , Salud del Lactante/legislación & jurisprudencia , Salud del Lactante/tendencias , Mortalidad Infantil , Recién Nacido , Masculino , Salud Materna/legislación & jurisprudencia , Salud Materna/tendencias , Servicios de Salud Materna/legislación & jurisprudencia , Servicios de Salud Materna/tendencias , Mortalidad Materna , Formulación de Políticas , Embarazo , Embarazo en Adolescencia , Seychelles , Factores de Tiempo , Adulto Joven
10.
Arch Dis Child ; 104(12): 1193-1197, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31300411

RESUMEN

OBJECTIVE: To independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services. DESIGN: Full-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016-2017. SETTING: Australian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines. PARTICIPANTS: The sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys. MAIN OUTCOMES AND MEASURES: Standard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual's knowledge, beliefs and attitudes regarding safe sleeping practices. RESULTS: 83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room. CONCLUSION: Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies. TRIAL REGISTRATION NUMBER: ANZCTR 12618001056280-pre-results.


Asunto(s)
Cuidado del Niño/legislación & jurisprudencia , Servicios de Salud del Niño , Adhesión a Directriz , Conocimientos, Actitudes y Práctica en Salud , Sueño , Australia , Niño , Cuidado del Niño/métodos , Servicios de Salud del Niño/legislación & jurisprudencia , Preescolar , Adhesión a Directriz/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Lactante , Posición Supina
11.
Nurs Outlook ; 67(4): 450-461, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31023475

RESUMEN

BACKGROUND: Much of the discourse surrounding children's advocacy in the United States relies on a rights-based approach. We argue that this approach has limitations that impede progress in advancing children's well-being. PURPOSE: The purpose of this article is to explain alternatives to a rights-based approach in advocating for children, such as developmental, economic, capabilities, and mutualism frameworks. METHODS: Our analysis is based on the independent work of two separate university-based groups studying children's rights; the authors were each members of one of the groups and subsequently integrated their findings for this article. DISCUSSION: US policies for children, especially in the domains of health and education, depict an unevenness that results in many children failing to receive certain critical services and benefits. Relying on a rights-based approach to correct these disparities and inequities is contentious and has yet to sufficiently change state and federal policies or improve children's health outcomes. Other approaches are needed to advance children's well-being. CONCLUSION: Nurses individually and collectively need to be mindful of the pitfalls of a rights-based approach and use other frameworks in advocating for children and youth.


Asunto(s)
Defensa del Niño/legislación & jurisprudencia , Servicios de Salud del Niño/legislación & jurisprudencia , Política de Salud , Derechos Humanos/legislación & jurisprudencia , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estados Unidos
13.
Buenos Aires; s.n; nov. 2018. 78 p. graf..
No convencional en Español | LILACS | ID: biblio-1009891

RESUMEN

Ateneo de la Residencia de Psicopedagogía del CESAC Nº 15, del Área Programática del Hospital General de Agudos Cosme Argerich, de la Ciudad de Buenos Aires. A partir del Dispositivo de Crecimiento y Desarrollo, que funciona en el Centro de Salud desde hace más de veinte años, y trabaja con bebés de 0 a 18 meses, y sus madres, padres, o adultos referentes; se plantean distintas preguntas sobre el contexto de la infancia, y sobre estrategias de Atención Primaria en Salud. Se detalla la normativa y programas vigentes, para Nación y CABA; así como el tipo de intervención que se propone desde el Centro de Salud. En el último apartado se abordan diferentes aspectos constitutivos de la infancia, como el vínculo, el juego y el aprendizaje


Asunto(s)
Atención Primaria de Salud , Servicios de Salud del Niño/legislación & jurisprudencia , Servicios de Salud del Niño/provisión & distribución , Servicios de Salud del Niño/tendencias , Salud Infantil , Centros Comunitarios de Salud , Atención Integrada a las Enfermedades Prevalentes de la Infancia , Internado no Médico
14.
NCSL Legisbrief ; 26(39): 1-2, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30296038

RESUMEN

(1) Untreated mental disorders and mental illness in children can lead to costly outcomes such as school dropout, substance use and suicide. (2) Half of lifetime cases of mental illness begin by age 14 and 75 percent of all lifetime cases present by age 24. (3) Early intervention and access to treatment may decrease the financial and health burdens associated with mental illness.


Asunto(s)
Servicios de Salud del Niño/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Trastornos Mentales/terapia , Servicios de Salud Mental/legislación & jurisprudencia , Salud Mental/legislación & jurisprudencia , Adolescente , Niño , Programa de Seguro de Salud Infantil/legislación & jurisprudencia , Humanos , Cobertura del Seguro/legislación & jurisprudencia , Medicaid/legislación & jurisprudencia , Gobierno Estatal , Estados Unidos
16.
J Acquir Immune Defic Syndr ; 78 Suppl 2: S65-S70, 2018 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-29994827

RESUMEN

Partnership between funders plays a vital role in tackling the AIDS epidemic and can help partners deliver "more than the sum of their parts." But how do partnerships form? How is value leveraged and maximized? How can partnerships achieve policy change? This article addresses these questions through the example of the Accelerating Children's HIV/AIDS Treatment Initiative, an ambitious $200 million public private partnership with a goal of doubling the number of children living with HIV on treatment in 9 priority African countries over a 2-year period. It describes how the partnership formed between the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Children's Investment Fund Foundation (CIFF), and the differing styles, vision, and resources each organization contributed. It also gives examples of policy influence at global level and policy change at national level. Finally, the article considers whether working in partnership was more or less effective than independent funding, with reflections on the value and challenges of collaboration.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Antirretrovirales/uso terapéutico , Servicios de Salud del Niño/legislación & jurisprudencia , Infecciones por VIH/tratamiento farmacológico , Política de Salud , Asociación entre el Sector Público-Privado , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , África/epidemiología , Niño , Femenino , Salud Global , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Cooperación Internacional , Masculino , Programas Nacionales de Salud , Estados Unidos
17.
J Acquir Immune Defic Syndr ; 78 Suppl 2: S71-S80, 2018 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-29994828

RESUMEN

BACKGROUND: To reach 90-90-90 targets, differentiated approaches to care are necessary. We describe the experience of delivering multimonth prescription (MMP) schedules of antiretroviral therapy (ART) to youth at centers of excellence in 6 African countries. METHODS: We analyzed data from electronic medical records of patients aged 0-19 years started on ART. Patients were eligible to transition from monthly prescribing to MMP when clinically stable [improving CD4, viral load (VL) suppression, or minimal HIV-associated morbidity] and ART adherent (pill count 95%-105%). Patients were classified as transitioned to MMP after 3 consecutive visits at intervals of >56 days. We used survival analysis to describe death and lost to follow-up. We described adherence and acceptable immunologic response by CD4 using 6-month and VL suppression (<400 copies per milliliter) using 12-month intervals. RESULTS: Twenty-two thousand six hundred fifty-eight patients aged 0-19 years received ART and 14,932 (66%) transitioned to MMP between 2003 and 2015. Of these 2.6% were lost to follow-up and 2.0% died. Median duration of MMP was 3.9 (interquartile range: 2.2-5.9) years. There were significant differences in survival (P < 0.0001) between age groups, worst among those younger than 1 year and 15-19 years. The frequency of favorable clinical endpoints was high throughout the first 5 years of MMP, by year ranging from 87% to 94% acceptable immunologic response, 75% to 80% adherent, and 79% to 85% VL suppression. CONCLUSIONS: These analyses from 6 African countries demonstrate that youth on ART who transitioned to MMP overall maintained favorable outcomes in terms of death, retention, adherence, immunosuppression, and viral suppression. These results reassure that children and adolescents, who are clinically stable and ART adherent, can do well with reduced visit frequencies and extended ART refills.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Antirretrovirales/administración & dosificación , Servicios de Salud del Niño/legislación & jurisprudencia , Infecciones por VIH/tratamiento farmacológico , Adolescente , África , Niño , Preescolar , Prescripciones de Medicamentos , Femenino , Infecciones por VIH/mortalidad , Humanos , Lactante , Perdida de Seguimiento , Masculino , Análisis de Supervivencia , Carga Viral , Adulto Joven
18.
Qual Manag Health Care ; 27(3): 172-177, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29944630

RESUMEN

The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.


Asunto(s)
Servicios de Salud del Niño/organización & administración , Hijo de Padres Discapacitados , Niño , Servicios de Salud del Niño/legislación & jurisprudencia , Familia , Regulación Gubernamental , Humanos , Suecia
20.
Pediatrics ; 141(Suppl 3): S242-S249, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29496975

RESUMEN

Children with medical complexity (CMC) often require multiple services across the continuum of care, such as therapies and home nursing. However, sufficient access to needed services is not assured and varies considerably by payer, many of whom who face pressures to control health spending. In this article, we review the rights of CMC in Medicaid, the Children's Health Insurance Program, and various forms of private health insurance to receive services that are necessary to promote optimal health, development, and family functioning. Controlling laws such as the Americans with Disabilities Act and the Early and Periodic Screening, Diagnostic, and Treatment provisions of the Medicaid Act are discussed, and precedential court decisions affecting CMC are reviewed. Implications for policy, advocacy, and payment model design are explored in the context of current emphasis on spending reduction.


Asunto(s)
Servicios de Salud del Niño/economía , Enfermedad Crónica/economía , Seguro de Salud/economía , Medicaid/economía , Derechos del Paciente , Niño , Salud Infantil/economía , Salud Infantil/tendencias , Servicios de Salud del Niño/legislación & jurisprudencia , Servicios de Salud del Niño/tendencias , Enfermedad Crónica/legislación & jurisprudencia , Enfermedad Crónica/tendencias , Humanos , Seguro de Salud/tendencias , Medicaid/tendencias , Derechos del Paciente/legislación & jurisprudencia , Derechos del Paciente/tendencias , Estados Unidos/epidemiología
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