HPV vaccination intention among guardians of female secondary school students in Chongqing, China.

Background: In China, Chongqing is the first province implement a province-wide HPV vaccination free program for female students. Given the HPV vaccination of adolescents is largely dependent on the intent of their guardians, this study examined the factors associated with the parental intention to vaccinate their daughter against HPV. And we could explore how to change the factors to incentivize more guardians to vaccinate their children.Methods: This study used a cross-sectional survey designed by multi-stage non-randomized sampling. Study participants were guardians of female students of second year of junior high in all districts and counties of Chongqing, who were most knowledgeable about the immunization status of the adolescents. Data was collected by an online survey platform between December, 2022 to March, 2023.Results: We collected 20, 642 valid samples. Among the participating guardians, nearly 40% guardians had never heard of HPV and HPV vaccine. 68.8% guardians considered vaccinating their children against HPV, 12.5% guardians had vaccinated or vaccinating HPV vaccine for their children, and only 16.7% were reluctant to vaccinate for their children right now. Some individual characteristics of guardians (e.g. age, number of the children) were associated with the intention of HPV vaccines. Sufficient knowledge of HPV and HPV vaccine would promote the HPV vaccination, and vaccine hesitancy prevented guardians from vaccinating their children.Conclusions: Majority of guardians held a positive intention to vaccinate their daughter, higher than the foreign uptake. Exploring the methods of social propaganda to promote HPV-related knowledge and reduce the safety concerns of guardians could help improve HPV vaccination intention.

Palliative Care for Refractory Depressive Symptoms in a Female Veteran Geriatric Patient.

AbstractPsychiatric treatment options, such as electroconvulsive therapy (ECT), can be lifesaving for individuals suffering from severe mental illness. For individuals who are unable to make or communicate their own medical decisions, this decision may fall on a legal guardian, who will make decisions on the patient's behalf. Here we discuss the considerations of end-of-life planning in a patient with severe mental illness under guardianship when treatment modalities, in this case ECT, are no longer effective.

Transcultural Psychiatry in Medical Ethics: Assessing Decision-Making Capacity within the Lens of an East African Refugee.

AbstractA 29-year-old female East African refugee with no formal psychiatric history and a medical history significant for HIV was admitted for failure to thrive and concern for bizarre behavior in the context of abandonment by her husband and separation from her child. After psychiatric evaluation, it was determined that she did not have the capacity to care for herself independently; adult protective services then pursued and was awarded guardianship. While admitted, the patient repeatedly refused medical treatment, had a feeding tube placed for forced nutrition and medications (though she did at one point remove this tube herself), and received two electroconvulsive therapy (ECT) treatments. Soon thereafter, the patient's court-appointed guardian met with the primary medical, psychiatric, and ethics teams to discuss goals of care in the setting of complex social and cultural needs. It was collectively determined that the patient's choices to refuse care (including nutrition, lab work, medications, and ECT) and some repeated behaviors (e.g., denial of divorce, denial of HIV, denial of need for care) could be considered culturally appropriate in the context of the acute stressors leading up to hospitalizations. All teams concluded, therefore, that the patient had the capacity to refuse these interventions and that further forced intervention would pose a greater chance of exacerbating her already-significant trauma history than improving her outcomes. Ultimately, the patient was able to be discharged into the care of her guardian, who would assist her in receiving support from members of her community who share her language and culture.

Guardian Reasons for Accessing Their Transgender and Gender-Diverse Adolescent's Patient Portal Account.

PURPOSE: To understand if and why guardians access their adolescent child's electronic health record patient portal account. METHODS: Guardians of transgender and gender-diverse adolescents completed a survey regarding patient portal use. Descriptive statistics were used to describe items related to guardian access to adolescent portal accounts. RESULTS: Of 82 respondents, 37.8% indicated they had used their child's login to access the patient portal. Most indicated they accessed their adolescent's account because their child asked them to do so. Other common reasons included being worried they might miss important health information and not realizing there was a difference between patient and proxy accounts. DISCUSSION: Results of this study provide a more detailed understanding regarding guardian access to adolescent patient portals. Findings can be used to inform adolescent patient portal design and enrollment practices that protect adolescent confidentiality.

Examining the involvement of guardians of children with acute lymphoblastic leukemia in Tanzania as public contributors to inform the design and conduct of the GuardiansCan project: A mixed-methods study protocol.

BACKGROUND: Public contribution in research can lead to the design and conduct of more feasible and relevant research. However, our understanding of the acceptability and feasibility of public contribution and the evidence base regarding its impact in low- and middle-income countries (LMICs) is limited. METHODS: In this study protocol, we describe a mixed-method examination of public contribution activities in the GuardiansCan project. The GuardiansCan project aims to respond to Tanzanian guardians' poor adherence to children's follow-up care after treatment for acute lymphoblastic leukemia (ALL) with the help of Mobile Health technology. We aim to: (1) involve guardians of children treated for ALL as Guardians Advisory Board (GAB) members in the managing and undertaking, analysis and interpretation, and dissemination phases of the GuardiansCan project; and (2) examine the acceptability, feasibility, and perceived impact of GAB members' contribution to the GuardiansCan project from the perspective of the GAB members and public contribution coordinators. We will recruit six to eight guardians of children treated for ALL to the GAB. We will hold workshops where GAB members contribute to all project phases. Using impact logs, we will record GAB workshop activities and the perceived impact of these activities. We will interview GAB members and public contribution coordinators 6 months after establishing the GAB, and at the end of each study within the project, to examine the acceptability, feasibility, and perceived impact of public contribution activities. DISCUSSION: We expect GAB contribution to increase project quality and relevance, and inform how to best embed public contribution in research in LMICs.

Using a Large Language Model to Identify Adolescent Patient Portal Account Access by Guardians.

This diagnostic/prognostic study assesses the ability of a large language model (LLM) to detect guardian authorship of messages originating from adolescent patient portals.

Involuntary psychiatric hospitalisation - differences and similarities between patients detained under the mental health act and according to the legal guardianship legislation.

BACKGROUND: Involuntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL. METHODS: We conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care. RESULTS: Cases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low. CONCLUSION: We found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field.

Bloom's taxonomy-Can evidence-based teaching improve junior medical officers' knowledge of the mental health and guardianship acts?

OBJECTIVE: To determine whether a brief educational intervention for Junior Medical Officers (JMOs), using teaching methods aimed at achieving higher outcomes on Bloom's Taxonomy, significantly improved participant confidence and knowledge in decision making about restrictive care. METHOD: JMOs received a teaching session on restrictive medical and mental health care. Groups were randomly assigned to either sessions including a component of modern pedagogical interventions (Think-Pair-Share and SNAPPS), or sessions including a control period focusing on reviewing a condensed summary of relevant information. Pre- and post-intervention measures were recorded for subjective self-ratings of confidence and scores on standardized clinically relevant extended matching questions (EMQs). RESULTS: There was no difference in subjective confidence improvement between groups; however, the group receiving the modern pedagogical intervention demonstrated significantly greater objective performance on knowledge-based EMQs. CONCLUSIONS: A brief modern pedagogical intervention using interactive teaching methods shows promise for improving knowledge of restrictive care and the Mental Health and Guardianship Acts. In the control group, similarly increased confidence in knowledge did not equate to increased competence on a knowledge assessment. Refurbishing educational interventions presents opportunities for improving clinical outcomes and engaging junior doctors in psychiatry.

Minors' and guardian access to and use of a national patient portal: A retrospective comparative case study of Sweden and Finland.

BACKGROUND: Approaches to implementing online record access (ORA) via patient portals for minors and guardians vary internationally, as more countries continue to develop patient-accessible electronic health records (PAEHR) systems. Evidence of ORA usage and country-specific practices to allow or block minors' and guardians' access to minors' records during adolescence (i.e. access control practices) may provide a broader understanding of possible approaches and their implications for minors' confidentiality and guardian support. AIM: To describe and compare minors' and guardian proxy users' PAEHR usage in Sweden and Finland. Furthermore, to investigate the use of country-specific access control practices. METHODS: A retrospective, observational case study was conducted. Data were collected from PAEHR administration services in Sweden and Finland and proportional use was calculated based on population statistics. Descriptive statistics were used to analyze the results. RESULTS: In both Sweden and Finland, the proportion of adolescents accessing their PAEHR increased from younger to older age-groups reaching the proportion of 59.9 % in Sweden and 84.8 % in Finland in the age-group of 17-year-olds. The PAEHR access gap during early adolescence in Sweden may explain the lower proportion of users among those who enter adulthood. Around half of guardians in Finland accessed their minor children's records in 2022 (46.1 %), while Swedish guardian use was the highest in 2022 for newborn children (41.8 %), and decreased thereafter. Few, mainly guardians, applied for extended access in Sweden. In Finland, where a case-by-case approach to access control relies on healthcare professionals' (HCPs) consideration of a minor's maturity, 95.8 % of minors chose to disclose prescription information to their guardians. CONCLUSION: While age-based access control practices can hamper ORA for minors and guardians, case-by-case approach requires HCP resources and careful guidance to ensure equality between patients. Guardians primarily access minors' records during early childhood and adolescents show willingness to share their PAEHR with parents.

Considerations for Alternative Decision-Making When Transitioning to Adulthood for Youth With Intellectual and Developmental Disabilities: Policy Statement.

With advances in medical care, more youth with intellectual and/or developmental disabilities (IDD) are transitioning into adulthood. Patient- and family-centered, integrated care is warranted around this time of transition. Support teams (including the youth, caregivers, teachers, and pediatricians) should engage in transition planning, ideally starting between 12 and 14 years of age, to identify and develop resources to support the maturing youth's capacity for independent decision-making. Care teams should consider the varied levels of alternative decision-making support, which may include supported decision-making, medical proxy decision-making, power of attorney, and/or establishment of legal guardianship arrangements, to support the youth's health and well-being optimally. Ultimately, if independent decision-making is not appropriate, the goal for youth with IDD should be the least restrictive alternative, while preserving human rights and human dignity and promoting their autonomy. These considerations review alternative decision-making support, concepts, and legal requirements available for youth with IDD and their care teams. Pediatricians can support youth with IDD and their families in the transition process and decision-making autonomy by actively engaging the youth in care decisions, supporting needs for augmentative communication, fostering their expression of preferences and understanding of care decisions, and linking them to resources such as the medical-legal partnership model.

Diverging medical and legal perceptions of the need for legal guardianship in people with dementia: A qualitative study.

BACKGROUND: Dementia is assumed to alter mental capacity, which may necessitate legal guardianship. However, only limited research exists on how dementia affects mental capacity, and most studies have focused solely on a medical perspective and concentrate on memory functions. The aim of this qualitative study was to investigate physicians' and legal experts' perceptions on a broad range of cognitive and neuropsychiatric domains potentially affecting mental capacity and the need for guardianship in people with dementia. METHODS: Physicians (N = 30) and legal experts (N = 20) participated in semi-structured individual interviews. The data were analyzed by using content analysis and further semi-quantified according to the cognitive and neuropsychiatric domains. RESULTS: Physicians considered neuropsychiatric symptoms and executive dysfunction to be the most important deficits in the legal context, while legal experts highlighted episodic memory impairment and dyscalculia. Perceptions regarding the importance of several cognitive and neuropsychiatric symptoms varied between and within the professional groups. CONCLUSIONS: Physicians and legal experts diverged in their perceptions of cognitive and neuropsychiatric domains affecting mental capacity and the need for guardianship. The evaluation and influence of medical evidence among legal experts heavily rely on subjective opinions. Given the substantial potential impact on patients' equal access to their rights, developing standardized guidelines is essential.

Evaluating Health Literacy in Families of Injured Children: A Prospective Observational Cohort Study at a Level One Pediatric Trauma Center.

BACKGROUND: Low health literacy (HL) has been associated with poor health outcomes in children. Optimal recovery after pediatric injury requires caregiver participation in complicated rehabilitative and medical aftercare. We aimed to quantify HL among guardians of injured children and identify factors associated with low HL of guardians. METHODS: A prospective observational cohort study was conducted to evaluate the HL using the Newest Vital Sign™ of guardians of injured children (≤18 years) admitted to a level 1 pediatric trauma center. Patient and guardian characteristics were compared across levels of HL using univariate statistics. We conducted multivariable logistic regression to identify factors independently-associated with low HL. RESULTS: A sample of 95 guardian-child dyads were enrolled. The majority of guardians had low HL (n = 52, 55%), followed by moderate HL (n = 36, 38%) and high HL (n = 7, 7%). Many families received public benefits (n = 47, 49%) and 12 guardians (13%) had both housing and employment insecurity. Guardians with low HL were significantly more likely to have insecure housing and not have completed any college. CONCLUSION: The majority of injured children had a primary guardian with low HL. Pediatric trauma centers should consider screening for low HL to ensure that families have adequate post-discharge support. LEVEL OF EVIDENCE: Level 3.

Temporalidade no estabelecimento do vínculo parento-filial em adoções malsucedidas / Temporality in establishing the parent-child bond in unsuccessful adoptions / Temporalidad en el establecimiento del vínculo padre-hijo en adopciones fallidas

Este estudo é parte de uma ampla investigação sobre a vivência do processo de adoção malsucedida de crianças e adolescentes sob a perspectiva dos adotantes. Foi realizada uma pesquisa qualitativa, com base em entrevistas semiestruturadas com 11 sujeitos independentes, nove mulheres e dois homens, moradores de diferentes estados do Brasil, que vivenciaram adoções malsucedidas. Buscamos analisar as percepções dos adotantes relacionadas à temporalidade no estabelecimento do vínculo parento-filial nessas adoções. A temporalidade da gestação simbólica foi vivenciada pelos participantes de diferentes formas, podendo ser afetada pela lentidão no processo administrativo e/ou por fantasias e idealizações referentes à origem da criança/adolescente. Tanto a demora quanto a tentativa de agilização do processo de adoção são fatores que podem gerar ansiedade na experiência da gestação simbólica e que não serão amparados no tempo cronológico, afetando o estabelecimento do vínculo parento-filial. Ressaltamos a relevância do cuidado nos períodos iniciais de construção do vínculo parento-filial, considerando a temporalidade particular de cada caso e a história pregressa da criança/adolescente, aspecto que influencia o sucesso do processo de adoção.(AU)

This study is part of a broad investigation about the experience of the unsuccessful adoption process of children and adolescents from the perspective of the adopters. Qualitative research was carried out, based on semi-structured interviews with 11 independent subjects, nine women and two men, living in different states of Brazil, who experienced unsuccessful adoptions. We seek to analyze the perceptions of adopters related to the temporality in establishing the parent-child bond in these adoptions. The temporality of the symbolic gestation was experienced by the participants in different ways, which can be affected by the slowness of the administrative process and/or by fantasies and idealizations regarding the origin of the child/adolescent. Both the delay and the attempt to speed up the adoption process are factors that can generate anxiety in the experience of symbolic gestation and that will not be supported in chronological time, affecting the establishment of the parent-child bond. The relevance of care stands out in the initial periods of parent-child bond construction considering the particular temporality of each case and the child's/adolescent's past history, aspect that influences the success of the adoption process.(AU)

Este estudio es parte de una extensa investigación sobre la experiencia del proceso fallido de adopción de niños y adolescentes desde la perspectiva de los adoptantes. Se realizó una investigación cualitativa a partir de entrevistas semiestructuradas con 11 sujetos independientes, nueve mujeres y dos hombres, residentes en diferentes estados de Brasil, que experimentaron adopciones fallidas. En este trabajo se analizan las percepciones de los adoptantes relacionadas con la temporalidad en el establecimiento del vínculo padre-hijo en adopciones fallidas. La temporalidad del embarazo simbólico fue vivida por los participantes de diferentes formas, las cuales pueden verse afectadas por la lentitud del proceso administrativo y por fantasías e idealizaciones sobre el origen del niño/adolescente. Tanto la demora como el intento de agilizar el proceso de adopción pueden generar ansiedad por la vivencia del embarazo simbólico y que no serán sustentados en el tiempo cronológico, lo que afecta establecer este vínculo. Se enfatiza la relevancia del cuidado en los períodos iniciales de construcción del vínculo considerando la temporalidad particular de cada caso y la historia pasada del niño/adolescente, un aspecto que influye en el éxito del proceso de adopción.(AU)

Estado nutricional población pediátrica y funcionalidad familiar en una unidad educativa ecuatoriana / Pediatric population nutritional status and family functionality in an Ecuadorian educa-tional unit

El estado de la funcionalidad de la familia influye en la calidad nutricional de sus miembros. El objetivo del presente estudio fue describir el estado nutricional de población pediátrica y la funcionalidad familiar en una unidad educativa pública en la provincia Cotopaxi, Ecuador, durante 2020. Se desarrolló una investigación descriptiva transversal, en la que participaron 179 familias de alumnos con edades entre 5 y 19 años, cuyos padres o tutores legales aportaron los datos de interés. La población pediátrica estuvo conformada por 91 niños/as de 5 a 9 años y 88 adolescentes de 10 a 19 años. El 54,7% correspondió al sexo femenino. En este contexto predominó el estado nutricional normal en los menores de edad y las familias funcionales (57%). La funcionalidad familiar se asoció significativamente con el grupo etario y el estado nutricional atendiendo a la talla/edad. Sin embargo, esa variable resultó independiente con respecto al estado nutricional según IMC/edad.

The state of family functionality influences the nutritional quality of its members. This study aimed to describe the nutritional status of the pediatric population and family functionality in a public educational unit in the Cotopaxi province, Ecuador, during 2020. A cross-sectional descriptive research was developed. The population was constituted by 179 families of students aged between 5 and 19 years old, whose parents or legal guardians provided the data of interest. The pediatric population consisted of 91 children from 5 to 9 years old and 88 adolescents from 10 to 19 years old. 54.7% corresponded to the female sex. In this context, normal nutritional status prevailed in minors and functional families (57%). Family functionality was significantly associated with age group and nutritional status according to height/age. However, this variable was independent with respect to nutritional status according to BMI/age

Grado de información percibida por los tutores legales en el Consentimiento Informado en el servicio de Neumología y Alergia Infantil / Grau d'informació percebuda pels tutors legals en el Consentiment Informat de proves de provocació a Al·lèrgia Pediàtrica / Degree of information perceived by legal guardians in the Informed Consent of challenge tests in Pediatric Allergy

Introduction: Knowledge about the degree of information perceived by the legal guardians from the Informed Consent (IC) in pediatric setting is scarce. Objectives: To evaluate the degree of information perceived by legal guardians in the IC for challenge tests in Pediatric Allergy. Methods and Materials: It is a descriptive, observational and cross-sectional study of information assessment through a questionnaire, in the period April-May 2021. The questionnaire was developed by the author and his team on the base of a publicly available one. A descriptive and analytical statistical study was carried out using the SPSS 15.0 software. Results: Ninety-nine tutors with a mean age of 41 years were recruited, with 52% university, 27% professional, 17% secondary and 4% primary education. More than 70% of the sample positively rated the degree of information provided in relation to the procedure, its objective, its risk-benefit, and the dedication and decision time. 50% of the tutors negatively rated the information provided regarding alternative treatment, the possibility of denying and revoking the IC. The internal consistency of the questionnaire was very good, with a Cronbach's alpha value of 0.88. No correlation was found between the degree of perception and several demographic or clinical variables. Conclusions: The degree of information perceived by the tutors is very good in general. The information in relation to the alternative procedures, the possibility of rejection and revocation of the IC can be improved.

Introducción: Existe escasa información sobre el grado de información percibida por los tutores legales en el Consentimiento informado (CI) en el ámbito pediátrico. Objetivos: Evaluar el grado de información percibida por los tutores legales en el CI de pruebas de provocación en Alergia Pediátrica. Métodos y Materiales: Estudio descriptivo, observacional y transversal de valoración de información mediante cuestionario, en el período de abril-mayo de 2021. El cuestionario fue desarrollado por el autor y su equipo, tomando como base un cuestionario disponible en la literatura. Se realizó estudio estadístico descriptivo y analítico mediante el software SPSS 15.0. Resultados: Se reclutaron 99 tutores con una edad media de 41 años, con formación universitaria 52%, profesional 27%, secundaria 17% y primaria 4%. Más del 70% de la muestra calificó positivamente el grado de información proporcionada en relación al procedimiento, su objetivo, su riesgo-beneficio y el tiempo de dedicación y de decisión. Un 50% de los tutores calificó negativamente la información proporcionada en cuanto al tratamiento alternativo, posibilidad de negar y revocar el CI. La consistencia interna del cuestionario fue muy buena, con un valor de la alfa de Cronbach de 0.88. No se encontró correlación entre el grado de percepción y diversas variables demográficas o clínicas. Conclusiones: El grado de información percibida por los tutores es en general muy bueno. Las informaciones en relación a los procedimientos alternativos, la posibilidad de rechazo y revocación del CI fueron los puntos mejorables.(AU)

Introducció: Hi ha escassa informació sobre el grau d'informació percebuda pels tutors legalsal Consentiment informat (CI) a l'àmbit pediàtric. Objectius: Avaluar el grau d'informació percebuda pels tutors legals al CI de proves de provocació a Al·lèrgia Pediàtrica. Mètodes i Materials: Estudi descriptiu, observacional i transversal de valoració d'informació mitjançant un qüestionari, en el període d'abril-maig de 2021. El qüestionari va ser desenvolupat per l'autor i el seu equip, prenent com a base un qüestionari disponible a la literatura. Es va realitzar estudi estadístic descriptiu i analíticmitjançant el programari SPSS 15.0. Resultats: Es van reclutar 99 tutors amb una edat mitjana de 41 anys, amb formació universitària 52%, professional 27%, secundària 17% i primària 4%. Més del 70% de la mostra va qualificar positivament el grau d'informació proporcionada en relació amb el procediment, el seu objectiu, el risc-benefici i el temps de dedicació i de decisió. Un 50% dels tutors va qualificar negativament la informació proporcionada pel que fa al tractament alternatiu, possibilitat de negar i revocar el CI. La consistència interna del qüestionari va ser molt bona, amb un valor de l'alfa de Cronbach de 0,88. No es va trobar correlació entre el grau de percepció i diverses variables demogràfiques o clíniques. Conclusions: En general, el grau d'informació percebuda pels tutors és molt bo. Les informacions en relació amb els procediments alternatius, la possibilitat de rebuig i revocació del CI van ser els punts millorables.(AU)

Valoración de la mejoría clínica en niños y adolescentes con trastornos psiquiátricos: una evaluación de múltiples perspectivas con HoNOSCA / Measure of clinical improvement in children and adolescents with psychiatric disorders: an evaluation of multiple perspectives with HoNOSCA

INTRODUCCIÓN La evaluación rutinaria de variables de resultado ayuda en la toma de decisiones, la asignación de recursos y el diseño de políticas en salud. La evaluación rutinaria de variables de resultado en el entorno hospitalario para niños y adolescentes con trastornos psiquiátricos sigue siendo limitada. La Health of the Nation Outcome Scales for Children and Adolescents, HoNOSCA, que recientemente se ha traducido al español y al catalán, permite la evaluación de resultados en esta población desde la perspectiva de pacientes, padres o tutores legales y clínicos. Este instrumento mide 13 áreas de salud y funcionamiento psicosocial. OBJETIVOS Evaluar variables de resultado en salud mental entre pacientes jóvenes de hospital de día de psiquiatría desde estas tres perspectivas usando Health of the Nation Outcome Scales for Children and Adolescents. MÉTODOS Reclutamos pacientes pediátricos (18 años o menos) con cualquier trastorno psiquiátrico en el hospital de día de la unidad de psiquiatría y psicología juvenil del Hospital Salut Mental Parc Taulí (Sabadell, Cataluña, España). Obtuvimos puntuaciones de Health of the Nation Outcome Scales for Children and Adolescents desde la perspectiva de pacientes, sus padres o tutores legales y clínicos, al ingreso y al alta. RESULTADOS Reclutamos 99 pacientes entre enero de 2015 y diciembre de 2017; once se perdieron durante el seguimiento. Entre los 88 restantes, encontramos una mejora significativa en las puntuaciones de Health of the Nation Outcome Scales for Children and Adolescents desde el ingreso hasta el alta. El acuerdo en las puntuaciones de esta escala entre los diferentes evaluadores fue débil al inicio, pero mejor al alta. En general, los pacientes y los padres o tutores legales reportaron puntuaciones más bajas de Health of the Nation Outcome Scales for Children and Adolescents (mejor estado de salud) al ingreso en comparación con los profesionales de la salud. Al alta, las puntuaciones fueron homogéneas desde las tres perspectivas. CONCLUSIONES La Health of the Nation Outcome Scales for Children and Adolescents permite la evaluación rutinaria de variables de resultado en salud mental en el entorno de hospital de día de psiquiatría desde la perspectiva de los pacientes, sus padres o tutores legales y los profesionales de la salud.

INTRODUCTION Routine outcome assessment is helpful to inform decision-making, resource allocation, and health policy design. Routine outcome assessment in the hospital setting for children and adolescents with psychiatric disorders remains limited. The clinical instrument HoNOSCA (Health of the Nation Outcome Scales for Children and Adolescents), which has recently become available in Spanish and Catalan, allows outcome assessment in this population from the perspective of patients, their parents or legal guardians, and clinicians. HoNOSCA measures 13 areas of health and psychosocial functioning. OBJECTIVES The aim of this study was to assess mental health outcomes in psychiatric day hospital pediatric patients from three perspectives (patient, par-ent/legal guardian, clinician), using the Spanish and Catalan versions of HoNOSCA. METHODS We recruited patients up to 18 years old with any psychiatric disorder at the day unit of the Salut Mental Parc Taulí Hospital Universitari (Sabadell, Catalonia, Spain). We obtained admission and discharge HoNOSCA scores for the patients, their parents or legal guardians, and their clinicians. RESULTS We recruited 99 patients over the study period (January 2015 to December 2017), 11 of which were lost to follow-up. Among the remaining 88, we found significant improvement in HoNOSCA scores from admission to discharge. Agreement between the HoNOSCA scores for the three different groups of evaluators (patients, parents/legal guardians, and clinicians) was weak at admission but better at discharge. In general, evaluations from patients and their parents or legal guardians had lower HoNOSCA scores (indicating a better mental health status) at admis-sion compared to those from clinicians. At discharge, however, the scores were more homogenous across the three groups of stakeholders. CONCLUSIONS Use of HoNOSCA allows for routine evaluation of mental health outcomes in the psychiatric day hospital setting from the perspective of pa-tients, their parents or legal guardians, and clinicians.

Conhecimento de responsáveis sobre traumatismo dentário em crianças / Knowledge of parents regarding dental trauma in children

Objetivo: identificar o conhecimento de pais/responsáveis sobre como proceder em caso de traumatismo dentário. Método: pesquisa com desenho observacional descritivo realizada por meio de questionários impressos entregues a 80 pais/responsáveis por crianças atendidas nas disciplinas de Clínica Infantil e Ortodontia I e II da Faculdade Avantis. A análise dos dados foi realizada de forma descritiva e com os testes Qui-Quadrado e Exato de Fisher. Resultados: a prevalência de pais que nunca receberam orientações sobre como porceder perante um traumatismo dentário foi de 75%, associando-se às respostas das perguntas: se saberiam como acondicionar o dente (p=0,001) e se já presenciaram alguma situação de trauma dental (p=0,047). As variáveis socioeconômicas escolaridade e renda e a autopercepção sobre o que fazer em uma situação de traumatismo dentário não se associaram a ter recebido informação sobre como proceder perante um traumatismo dentário, segundo o autorrelato dos responsáveis. A maioria dos pais das crianças nunca receberam informações e não sabem como proceder em caso de um possível traumatismo dentário. Conclusão: ter recebido informação sobre como proceder diante de um traumatismo dentário está associado a já ter presenciado situação de traumatismo dentário e a saber como acondicionar o dente para levar no dentista. (AU)

Objective: to identify the knowledge of parents/ guardians on how to proceed in the event of dental trauma. Method: observational descriptive study performed using printed questionnaires applied to 80 parents/guardians of children assisted in the classes of Children's Clinic and Orthodontics I and II at Faculdade Avantis. The data were analyzed descriptively and with chi-square and Fisher's exact tests. Results: the prevalence of parents who had never received instructions on how to deal with dental trauma was 75%, which was associated with the answers to the questions: "Would you know how to prepare the tooth?" (p = 0.001) and "Have you ever experienced any dental trauma situation?" (p = 0.047). Socioeconomic variables including education and income, and the self-perception on the procedures in case of dental trauma were not associated with having received information about how to proceed in a dental trauma situation according to the self-report of parents/guardians. Most parents had never received information and did not know how to deal with a potential dental trauma. Conclusion:having received information on how to deal with dental trauma is associated with having experienced a dental trauma situation and with how to prepare the tooth to take it to the dentist. (AU)

O envelhecer digno como direito fundamental da vida humana / El envejecer digno como derecho fundamental de la vida humana / Decent Aging as a Fundamental Right of Human Life / L'envelliment digne com a dret fonamental de la vida humana

O objeto do artigo volta-se para um exame crítico acerca dos quinze anos de edição do Estatuto do Idoso, sendo seu objetivo discutir a nova tutela da população idosa do Brasil, bem como do enfrentamento do problema social decorrente do envelhecer com dignidade, enquanto direito e garantia fundamental assegurado em nosso ordenamento jurídico. Para tanto, a abordagem teórica fundamenta-se no novo paradigma trazido pelo referido Estatuto, com base na dignidade da pessoa humana do idoso. No mesmo sentido, para se chegar à concretização de tal avanço legislativo em nossa realidade social, deve-se tratar de propiciar uma ressignificação dos papéis do idoso em nossa sociedade; juntamente às formas como socialmente percebe-se a velhice

El artículo es un examen crítico de los quince años de edición del Estatuto del Anciano, para discutir la nueva tutela de la población anciana de Brasil, así como del enfrentamiento del problema social derivado del envejecimiento con dignidad, en cuanto derecho y garantía fundamental asegurada en este ordenamiento jurídico. El enfoque teórico se fundamenta en el nuevo paradigma traído por el Estatuto, con base en la dignidad de la persona humana del anciano. En el mismo sentido, para llegar a la concreción de este avance legislativo en nuestra realidad social, se debe propiciar una resignificación de los papeles del anciano en nuestra sociedad; junto a las formas con que socialmente se percibe la vejez

The article focuses on a critical examination of the fifteen years of the Statute of the Elderly, with the purpose of discussing the new protection of the elderly population in Brazil, as well as addressing the social problem of aging with dignity, as a right guaranteed in our legal system. Therefore, the theoretical approach is based on the new paradigm brought by the Statute, based on the dignity of the human person of the elderly. In the same sense, to arrive at the concretization of such legislative advance in our social reality, we must try to provide a re-signification of the roles of the elderly in our society; together with the ways in which old age is socially perceived

L'article és un examen crític dels quinze anys d'edició de l'Estatut de l'Ancià, a fi de discutir la nova tutela de la població anciana de Brasil, així com de l'enfrontament del problema social derivat de l'envelliment amb dignitat, com a dret i garantia fonamental que garanteix aquest ordenament jurídic. L'enfocament teòric es fonamenta en el nou paradigma generat per l'Estatut, amb base en la dignitat de la persona humana de l'ancià. En el mateix sentit, per arribar a la concreció d'aquest avanç legislatiu en la nostra realitat social, s'ha de propiciar una resignificació del paper de l'ancià en la nostra societat, al costat de les formes amb que socialment es percep la vellesa

Students' dietary habits, food service satisfaction, and attitude toward school meals enhance meal consumption in school food service

BACKGROUND/OBJECTIVES: This study aimed to compare student consumption of school meals by school level, to identify the influencing factors of school meal consumption, and to assess improvement needs of school food service among students. SUBJECTS/METHODS: A total of 1,441 elementary, middle, and high school students attending 58 schools in Gyeonggi-do, South Korea participated in the survey in 2015. A questionnaire and informed consent forms for students and legal guardians were sent home and completed responses were returned to the researcher. RESULTS: Approximately 58% of the students perceived the portion sizes of school meals as appropriate and 76.1% consumed almost all or all of the meals served. More elementary and middle school students than high school students consumed almost all or all of the meals (P < 0.001). A regression analysis revealed that the students with a higher dietary behavior score (P < 0.001), higher satisfaction with food service (P < 0.001), a higher environmental protection practice score (P < 0.05), and more positive attitudes toward school meals (P < 0.01) consumed significantly more meals. The provision of foods that taste good and reflecting student opinions on menus were the most important factors for increasing school meal consumption. CONCLUSIONS: To increase consumption of school meals, food service staff should provide students with quality meals and engage students in school food service. Nutrition education that emphasizes healthy eating behaviors and cafeteria environment modification that applies strategies based on behavioral economics can encourage students to consume more school meals.