Guía de tratamiento de la alteración aguda del estado mental. Academia Iberoamericana de Neurología Pediátrica / Guide for the treatment of acute altered mental status. Iberoamerican Academy of Pediatric Neurology

La alteración aguda del estado mental en pediatría se refiere a un cambio repentino y significativo en la función cerebral y el nivel de conciencia de un niño. Puede manifestarse como confusión, desorientación, agitación, letargo o incluso pérdida de la conciencia. Esta condición es una emergencia médica, y requiere una evaluación y una atención inmediatas. Existen diversas causas de alteración aguda del estado mental en niños, algunas de las cuales incluyen infecciones del sistema nervioso central, como la meningitis o la encefalitis, los traumatismos craneoencefálicos, los trastornos metabólicos, las convulsiones o las intoxicaciones, entre otras. Este estudio tuvo como objetivo analizar, preparar y calificar la bibliografía actual para determinar las mejores recomendaciones sobre el tratamiento ante casos de alteración aguda del estado mental en pediatría de diferentes causas. El estudio se basó en la calificación de expertos en el campo para poder determinar la calificación de las recomendaciones, además de ser sometido a la revisión por parte del comité científico de la Academia Iberoamericana de Neurología Pediátrica. Nuestra guía representa una ayuda para el tratamiento de este síntoma inespecífico desde un enfoque básico y avanzado, aplicable por cualquier neurólogo pediatra.(AU)

In pediatric patients, an acute altered mental status refers to a sudden and significant change in a child’s brain function and level of consciousness. It may manifest as confusion, disorientation, agitation, lethargy or even a loss of consciousness. This condition is a medical emergency, and requires immediate evaluation and attention. There are several causes of acute altered mental status in children, including infections of the central nervous system such as meningitis or encephalitis, traumatic brain injury, metabolic disorders, seizures and poisoning, among others. The aim of this study was to analyse, prepare and classify the current literature in order to determine the best recommendations for the treatment of cases of acute altered mental status with various causes in pediatric patients. The study was based on opinions from experts in the field in order to classify the recommendations, and was submitted to the scientific committee of the Iberoamerican Academy of Pediatric Neurology for review. Our guide is an aid for the treatment of this non-specific symptom based on a basic and advanced approach, which can be applied by any pediatric neurologist.(AU)

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

Enhancing Content Validity Assessment With Item Response Theory Modeling.

BACKGROUND: Ensuring the validity of assessments requires a thorough examination of the test content. Subject matter experts (SMEs) are commonly employed to evaluate the relevance, representativeness, and appropriateness of the items. This article proposes incorporating item response theory (IRT) into model assessments conducted by SMEs. Using IRT allows for the estimation of discrimination and threshold parameters for each SME, providing evidence of their performance in differentiating relevant from irrelevant items, thus facilitating the detection of suboptimal SME performance while improving item relevance scores. METHOD: Use of IRT was compared to traditional validity indices (content validity index and Aiken's V) in the evaluation of items. The aim was to assess the SMEs' accuracy in identifying whether items were designed to measure conscientiousness or not, and predicting their factor loadings. RESULTS: The IRT-based scores effectively identified conscientiousness items ( = 0.57) and accurately predicted their factor loadings ( = 0.45). These scores demonstrated incremental validity, explaining 11% more variance than Aiken's V and up to 17% more than the content validity index. CONCLUSIONS: Modeling SME assessments with IRT improves item alignment and provides better predictions of factor loadings, enabling improvement of the content validity of measurement instruments.

HHS Issues Revised Health Worker Conscience Rule.

The aim is to balance the rights of clinicians and patients.

Level of Awareness about Air Pollution among Decision-makers in Jordan: Unveiling Important COPD Etiology

Purpose: The complete awareness of policymakers about air pollution can play a significant role in dealing with this environmental threat. This study aimed to examine the awareness and perception among the policymakers regarding air pollution in Jordan. Methods: This is a cross-sectional study conducted in Jordan. The participants included in this study were governmental and non-governmental officials from different sectors. An interview and questionnaire were used to examine the extent of knowledge of these decision-makers regarding air pollution types, sources, and threats. Results: Most participants acknowledged that air pollution in Jordan was a huge problem. Most participants (90%) were familiar with the term air pollution, and regularly read about different contaminants that cause air pollution. However, most of the participants had a low level of knowledge about air contaminant types in Jordan. The least known pollutants were PM2.5 (Particulate Matter 2.5 microns in width) and PM10 (Particulate Matter 10 microns in width). Only 7.5% of the participants knew about PM2.5, while 12.5% knew about PM10. Conclusion: Policymakers have the full authority to initiate and implement policies that intend to limit air pollution. Their complete awareness of air pollution can result in conducting certain protocols to approve new policies and legislations that can improve the air quality in Jordan. Unfortunately, no previous studies were conducted to analyze policymakers’ knowledge regarding air pollution in Jordan, and this study’s results hoped to reflect the importance of air pollutants and their greater significance on public health. (AU)

Relación entre la conciencia de madres y padres sobre el abuso sexual y las habilidades de los niños para decir «no» / The relationship between parental awareness of sexual abuse and children's skills to say «no»

Introducción: El abuso sexual infantil es un problema social global y multidimensional que provoca resultados devastadores y permanentes en las relaciones psicológicas, emocionales, cognitivas, conductuales, físicas, sexuales e interpersonales. Este estudio examina la relación entre la capacidad de decir «no» y la conciencia de madres y padres sobre el abuso sexual en estudiantes de 4.° de primaria. Métodos: El estudio se realizó entre abril de 2022 y junio de 2022 en escuelas primarias de un distrito central provincial en el noreste de Turquía. La muestra del estudio estuvo formada por 310 alumnos de 4.° de primaria y sus madres y padres. Compilamos los datos del estudio con el Formulario de información personal, la Escala de capacidad para decir «no» para niños y la Escala de conciencia de abuso sexual para padres. Resultados: Hubo una correlación positiva débil (p˂0,05) entre las puntuaciones medias de conciencia de las madres sobre el abuso sexual y las puntuaciones medias de rechazo y resistencia de los niños, y una correlación positiva débil (p˂0,05) entre las puntuaciones medias de la conciencia de los padres sobre el abuso sexual y las puntuaciones medias de rechazo de los niños. Conclusión: A medida que aumentó la conciencia de las madres y los padres sobre los mitos y las enseñanzas sobre el abuso sexual y las acciones para combatir el abuso sexual, también aumentó la negativa de los niños. Se encontró que a medida que aumentaba la conciencia de los padres sobre las señales de abuso sexual, aumentaba la negativa de los niños.(AU)

Introduction: Child sexual abuse is a global and multidimensional social problem and causes devastating and permanent psychological, emotional, cognitive, behavioural, physical, sexual and interpersonal sequelae. This study examines the relationship between the ability to say «no» and parental awareness of sexual abuse in 4th grade primary school students. Methods: The study was conducted between April 2022 and June 2022 in primary schools in the central district of a province in north-eastern Turkey. The sample consisted of 310 students enrolled in 4th grade and their parents. We collected the data through a personal information form, the ability to say «no» scale for children and the sexual abuse awareness scale for parents. Results: There was a weak positive correlation between the mean maternal scores of sexual abuse awareness and the mean scores of refusal and resistance in children (P˂.05), as well as a weak positive correlation between the mean paternal scores of sexual abuse awareness and the mean scores of refusal and resistance in children (P˂.05). Conclusion: As mothers’ and fathers’ awareness of sexual abuse myths and of teachings and actions to combat sexual abuse increased, the refusal of children also increased. Also, as fathers’ awareness of the signs of sexual abuse increased, children's refusal increased.(AU)

Health providers' reasons for participating in abortion care: A scoping review.

BACKGROUND: There is a global shortage of health providers in abortion care. Public discourse presents abortion providers as dangerous and greedy and links 'conscience' with refusal to participate. This may discourage provision. A scoping review of empirical evidence is needed to inform public perceptions of the reasons that health providers participate in abortion. OBJECTIVE: The study aimed to identify what is known about health providers' reasons for participating in abortion provision. ELIGIBILITY CRITERIA: Studies were eligible if they included health providers' reasons for participating in legal abortion provision. Only empirical studies were eligible for inclusion. SOURCES OF EVIDENCE: We searched the following databases from January 2000 until January 2022: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Centre for Agricultural and Biosciences International Abstracts. Grey literature was also searched. METHODS: Dual screening was conducted of both title/abstract and full-text articles. Health providers' reasons for provision were extracted and grouped into preliminary categories based on the existing research. These categories were revised by all authors until they sufficiently reflected the extracted data. RESULTS: From 3251 records retrieved, 68 studies were included. In descending order, reasons for participating in abortion were as follows: supporting women's choices and advocating for women's rights (76%); being professionally committed to participating in abortion (50%); aligning with personal, religious or moral values (39%); finding provision satisfying and important (33%); being influenced by workplace exposure or support (19%); responding to the community needs for abortion services (14%) and participating for practical and lifestyle reasons (8%). CONCLUSION: Abortion providers participated in abortion for a range of reasons. Reasons were mainly focused on supporting women's choices and rights; providing professional health care; and providing services that aligned with the provider's own personal, religious or moral values. The findings provided no evidence to support negative portrayals of abortion providers present in public discourse. Like conscientious objectors, abortion providers can also be motivated by conscience.

Conscientious objection and barriers to abortion within a specific regional context - an expert interview study.

BACKGROUND: While most countries that allow abortion on women's request also grant physicians a right to conscientious objection (CO), this has proven to constitute a potential barrier to abortion access. Conscientious objection is regarded as an understudied phenomenon the effects of which have not yet been examined in Germany. Based on expert interviews, this study aims to exemplarily reconstruct the processes of abortion in a mid-sized city in Germany, and to identify potential effects of conscientious objection. METHODS: Five semi-structured interviews with experts from all instances involved have been conducted in April 2020. The experts gave an insight into the medical care structures with regard to abortion procedures, the application and manifestations of conscientious objection in medical practice, and its impact on the care of pregnant women. A content analysis of the transcribed interviews was performed. RESULTS: Both the procedural processes and the effects of conscientious objection are reported to differ significantly between early abortions performed before the 12th week of pregnancy and late abortions performed at the second and third trimester. Conscientious objection shows structural consequences as it is experienced to further reduce the number of possible providers, especially for early abortions. On the individual level of the doctor-patient relationship, the experts confirmed the neutrality and patient-orientation of the vast majority of doctors. Still, it is especially late abortions that seem to be vulnerable to barriers imposed by conscientious objection in individual medical encounters. CONCLUSION: Our findings indicate that conscientious objection possibly imposes barriers to both early and late abortion provision and especially in the last procedural steps, which from an ethical point of view is especially problematic. To oblige hospitals to partake in abortion provision in Germany has the potential to prevent negative impacts of conscientious objection on women's rights on an individual as well as on a structural level.

Understanding the extent of and limitations to conscientious objection to abortion by health care practitioners: A hermeneutic study.

The United Kingdom's Abortion Act 1967 has attracted substantial controversy, which has centred not only on the regulation of abortion itself, but also on the extent to which conscientious objection should be permitted. The aim of this study was to examine a range of healthcare professionals' views on conscientious objection and identify the appropriate parameters of conscientious objection to abortion. Gadamer's hermeneutic was utilised to frame this study. We conducted semi-structured interviews in two UK locations with 18 pharmacists, 17 midwives, 12 nurses and nine doctors, encompassing a mix of conscientious objectors and non-objectors to abortion. A multi-faceted in-depth data analysis led to the development of a hermeneutic of "respecting self and others". Four major themes of "doing the job", "entrusting to others", "acknowledging institutional power" and "being selective" and 18 subthemes contributed to this overarching theme. The complexity of the responses indicates that there is little consistency within and between each profession. They show that participants who were conscientious objectors were accepted by their colleagues and accommodated without detriment to the service, and that in larger hospitals, such as those where our work was carried out, it is possible to be employed in the service areas that include abortion while still being a conscientious objector. Finally, our results indicate that, by respecting of self and others, each profession should be able to accommodate conscience-based objections where individual practitioners seek to exercise them. Conscientious objectors as well as non-objectors have something to contribute to the ongoing development of the maternity and gynaecological services as abortion is only a small part of the work of these services.

[Is individualized education for a medical students desirable? A common policy on how to handle medical students requests for individual adaptations is needed]. / Bör individualiserad utbildning för läkarstudenter eftersträvas?

In Sweden, freedom of conscience for health care professionals is not legally permitted. However, requests from medical students to adjust and/or skip compulsory learning activities because of their religious and moral convictions appear to get more abundant. This creates problems when learning activities are directly related to the examination objectives stated by the Higher Education Ordinance of Sweden. Allowing students to abstain from certain parts of the medical program raises difficulties as to what kind of convictions that should be accepted and to what degree. Questions arise regarding equality of learning opportunities, assessment, and reasonable resource allocation. We call for national debate regarding these issues, which different universities now are forced to handle on their own, with the aim of establishing a common approach.

A biphasic relational approach to the evolution of human consciousness

Background/objective: Human consciousness is arguably unique, and its features are hard to explain. Continuous and discrete accounts of consciousness are commonly viewed as incompatible, but both have limitations. Continuous accounts cannot readily account for what appears to be unique about human consciousness; discrete accounts have a hard time explaining how human consciousness could have evolved. The present position paper shows how both continuous and discontinuously elements can be combined. Method: A biphasic model is constructed by unifying complex systems theory, the evolution of symbolic reasoning as a relational extension of human cooperation, and evolutionary science. The application of this approach to modern views of consciousness is then explored. Results: Our analysis suggests that human consciousness may be viewed as a discontinuous event, that emerged from continuous foundations. This biphasic account contains processes that can be targeted clinically. For example, developmentally delayed children with problems in consciousness may be helped by targeting the processes the present account suggests are important at different levels of complexity. Conclusions: This biphasic relational approach fits with the evolutionary record and with data on human cognitive development. It may be useful in guiding clinical intervention. (AU)

The role of mindfulness on theta inter-brain synchrony during cooperation feedback processing: An EEG-based hyperscanning study

Mindfulness appears to improve empathy and understanding in relationships, which are necessary for successful cooperation. However, the impact of mindfulness on cooperation has not been fully studied. This study used hyperscanning technique to examine the effect of mindfulness on the inter-brain synchrony of interacting individuals during the cooperative tasks. Forty-one dyads were randomly assigned to a mindfulness group or a non-mindfulness group. Dyads of the mindfulness group performed a short mindfulness exercise following a 15-minute mindfulness audio guidance. Dyads of the non-mindfulness group were instructed to rest quietly with their eyes closed. Then, simultaneously and continuously EEG was recorded from all dyads when they completed a computer-based cooperative game task. Reaction times (RTs) and success rates were used to indicate the behavioral performance, and phase locking value (PLV) was used to indicate the inter-brain synchrony. The results showed that (1) Greater theta inter-brain synchrony during the cooperative computer game tasks was observed in the mindfulness group than in the non-mindfulness group; (2) Greater theta inter-brain synchrony was observed in the successful cooperation conditions as compared to those in the failure cooperation conditions; (3) Greater theta inter-brain synchrony was observed at the frontal region as compared to those at the parietal-occipital region in the successful cooperation condition. The results expand the neural basis of the effects of mindfulness on cooperation feedback processing. (AU)

The claustrum and consciousness: An update

The seminal paper of Crick and Koch (2005) proposed that the claustrum, an enigmatic and thin grey matter structure that lies beside the insular cortex, may be involved in the processing of consciousness. As a result, this otherwise obscure structure has received ever-increasing interest in the search for neural correlates of consciousness. Here we review theories of consciousness and discuss the possible relationship between the claustrum and consciousness. We review relevant experimental evidence collected since the Crick and Koch (2005) paper and consider whether these findings support or contradict their hypothesis. We also explore how future experimental work can be designed to clarify how consciousness emerges from neural activity and to understand the role of the claustrum in consciousness. (AU)

The Association Between Religion and Healthcare Professionals' Attitudes Towards the Conscience Clause. A Preliminary Study From Poland.

Objectives: This study was designed to determine the relationship between religion and healthcare practitioners' attitudes towards conscience clauses in Poland. Methods: We developed a survey assessing impact of religion on attitudes healthcare professionals towards the conscience clause. These questions were explored using a sample of 300 Polish healthcare professionals. Results: The results indicate that religiosity was a significant predictor of acceptance of conscience clauses. It also influenced healthcare practitioners' opinions on medical professionals that should be granted the right to conscience clauses and medical services that may be denied on moral grounds. There was also a significant relationship between healthcare practitioners' religiosity and their eagerness to use conscience clauses in a situation of moral conflict. Finally, religious healthcare practitioners were more concerned about the personal consequences of using this right in a medical environment. Conclusion: This study shows that at the same time, both religious and non-religious healthcare professionals believed that the Polish regulations regarding conscience clause are unclear and inaccurate, therefore leading to misinterpretation and abuse regulation of law.

Mindfulness Fills in the Blank Spaces Left by Affective Uncertainty Uplifting Adaptive Behaviors

Drawing on the integrative model of uncertainty tolerance, we aimed to investigate whether uncertainty relates to adaptive performance, at the within-person level. We argue that daily uncertainty at work will trigger negative affective reactions that, in turn, will minimize adaptive performance. Moreover, we focus on socio-cognitive mindfulness as a cross-level moderator of the indirect relationship of uncertainty on adaptive performance via negative affect. To capture changes in daily life and test our model, we conducted two diary studies across 5-working days: One with a sample of telecommuters (n = 101*5 = 505), and the other with a sample of non-telecommuters (n = 253*5 = 1,265). Study 1 took place between February and March of 2021 (during the mandatory confinement), and Study 2 occurred between April and May 2021 (out of the mandatory confinement). Both studies were conducted in Portugal. The multilevel results showed that at the day-level of analysis, uncertainty decreased adaptive performance through the enhanced negative affect. Moreover, at the person-level of analysis mindfulness moderated (a) the direct relationship of uncertainty to adaptive performance, and (b) the indirect relationship of uncertainty to adaptive performance via negative affect, in such a way that it became weaker when mindfulness was higher (multilevel-mediated moderation effect). This relation was different between Studies 1 and 2; that is, in Study 1, teleworkers who were high on mindfulness engaged in more adaptive performance when negative affect was high. In Study 2, adaptive performance significantly decreased, when negative affect was higher, even though this effect was weaker for mindful of individuals. The findings show that mindfulness helps to fill in the spaces of the affective uncertainty attenuating its detrimental effects. (AU)

Critics Say New State "Conscience Laws" Give Physicians Carte Blanche to Refuse Patients.

This Medical News feature discusses state laws that protect physicians who refuse to provide certain services because of religious or moral beliefs.

The Modern Linguocognitive Aspect of the Concept of "conscience" in the Human Worldview.

The relevance of this work stems from the under-researched nature of the concept of "conscience", including its key attributes and functionality across various national contexts. This concept's analysis is shaped by the worldviews and cultures of distinct populations, as viewed through the lens of linguocognitive examination. This article aims to conduct an in-depth conceptual analysis of the term "conscience", examining its national nuances, linguistic paradigms, cognitive perception, the influence of mental processes on communication, and syntactic and stylistic markers. The methodology of the research is based on a conceptual approach to the study of the problem. The paper comprehends in detail the problems associated with established linguistic traditions on the example of English, French, German, Kazakh and Russian languages in linguocognitive terms of expression of extralinguistic reality, a comparative characteristic between different language systems is carried out, factors of influence on the perception of the term "conscience" in the national plan are indicated. The article's content is useful for examining conceptual fields and cultural spheres, analyzing mechanisms of lexical, structural, and stylistic design of concepts, identifying core and peripheral concepts, and considering worldviews, historical factors, and moral foundations of distinct ethnic groups.

When offering a patient beneficial treatment undermines public health.

Sometimes, offering someone beneficial care is likely to thwart the similar or more serious medical needs of more people. For example, when acute shortage is strongly predicted to persist, providing the long period on scarce intensive care that a certain COVID-19 patient needs is sometimes projected to block several future COVID-19 patients from receiving the shorter periods on intensive care that they will need. Expected utility is typically higher if the former is denied intensive care. A tempting initial account of such cases is that consequentialism supports denying care to that patient and nonconsequentialism supports providing that care. This paper argues that the consequentialist case is more complicated than it may initially seem and that nonconsequentialism sides more readily with denial of the beneficial treatment. It also shows that when denying it would directly enhance public health by a lot, either ethical approach would normally recommend denying it. Practical implications are discussed, including how to address conscientious objection to this shared recommendation.