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3.
J Youth Adolesc ; 50(4): 628-640, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33606125

RESUMO

Adolescent sleep research has focused heavily on duration and quality with less work examining chronotype, defined as individual differences in sleep-wake timings driven by the circadian rhythm. This study filled a gap in the literature by utilizing actigraphy-based sleep estimates in an accelerated longitudinal design in order to better understand the developmental trajectory and individual stability of chronotype during adolescence, as well as the associations between chronotype with risky behaviors, substance use, and depressive symptoms. A total of 329 adolescents (57% female; 21% Asian American, 31% European American, 41% Latino, 7% other ethnicity) provided actigraphy-based estimates of sleep and completed questionnaires at up to three time points, two years apart, beginning at 14-17 years of age. Multilevel modeling revealed a non-linear developmental trend in chronotype whereby eveningness increased from 14 to 19 years of age followed by a trend toward morningness. Individual differences in chronotype exhibited modest stability during adolescent development. Furthermore, greater evening chronotype was associated with more risky behaviors and substance use among males, and more substance use among older adolescents, whereas depressive symptoms were not associated with chronotype. The findings from this study may have practical implications for adolescent behavioral health interventions targeted at reducing risky behaviors and substance use among youth.


Assuntos
Transtornos do Sono-Vigília , Sono , Adolescente , Desenvolvimento do Adolescente , Ritmo Circadiano , Feminino , Humanos , Masculino , Inquéritos e Questionários
4.
Artigo em Inglês | MEDLINE | ID: mdl-33435327

RESUMO

Secular trends in anthropometric parameters have been documented in most European countries, but no data is available regarding Romanian. The aim of the study was to calculate secular trend in height, body mass and mean menarche age for Romanian children and adolescents. METHODS: A secondary data analysis was performed using ten data sets for urban and eight data sets for rural boys and girls, age 5-15 years, covering 80 years (1936 to 2016). Secular trend in height (cm/decade), body mass(kg/decade) and mean menarche age (years) were calculated. RESULTS: Overall, there was a positive secular trend for height in both genders, which parallels the gross domestic product (GDP)/capita difference, more pronounced in boys, across all age-groups, with a maximum for 15 years-old boys (~3 cm/decade) and 13 years-old girls (~2 cm/decade). Body mass trend was also positive, more accentuated in the rural population. Mean age at menarche was higher in rural compared to urban girls, had a negative trend with the disappearance of the difference in the latest available data set (2013). CONCLUSION: In summary, an overall positive and ongoing secular trend in height and body mass was documented in Romanian children and adolescents, especially for the pubertal age-range, in concordance to other western countries, but out of phase by approximately 20 years.


Assuntos
Estatura , Menarca , Adolescente , Desenvolvimento do Adolescente , Adulto , Criança , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Masculino , Romênia , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-33466291

RESUMO

There is a growing interest in knowing the relationship between biological maturation and sport performance-related variables of young athletes. The objective of this study is to analyze the relationship between biological maturation, physical fitness, and kinanthropometric variables of athletes during their growing period, according to their sex. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and the search protocol was registered in PROSPERO, code: CRD42020208397. A search through the PubMed, Web of Sciences, and EBSCO databases was performed. A total of 423 studies were screened and 13 were included in the meta-analysis. The meta-analysis was completed by using the mean and standard deviation of each variable according to each maturation status (early, on time, or late). Differences depending on maturation were found on physical fitness, with better results in the advanced maturational groups in the male population (standard mean difference (SMD) = 0.17-2.31; p < 0.001-0.05). Differences depending on maturation were found for kinanthropometric variables in males (SMD = 0.37-2.31; p < 0.001-0.002) and height and body mass in females (SMD = 0.96-1.19; p < 0.001). In conclusion, the early maturation group showed higher values in kinanthropometric variables and better results in physical fitness, highlighting the importance of the maturational process in the talent selection programs. Despite that, more research is needed to clarify the relationship of maturation with the other variables on female populations and the changes in the muscle and bone variables during the maturation processes of both sexes.


Assuntos
Desenvolvimento do Adolescente , Atletas , Desenvolvimento Infantil , Aptidão Física , Adolescente , Antropometria , Aptidão , Criança , Feminino , Humanos , Masculino , Esportes
6.
Neuroimage ; 228: 117684, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33385548

RESUMO

The brain undergoes extensive structural changes during adolescence, concurrent to puberty-related physical and hormonal changes. While animal research suggests these biological processes are related to one another, our knowledge of brain development in humans is largely based on age-related processes. Thus, the current study characterized puberty-related changes in human brain structure, by combining data from two longitudinal neuroimaging cohorts. Beyond normative changes in cortical thickness, we examined whether individual differences in the rate of pubertal maturation (or "pubertal tempo") was associated with variations in cortical trajectories. Participants (N = 192; scans = 366) completed up to three waves of MRI assessments between 8.5 and 14.5 years of age, as well as questionnaire assessments of pubertal stage at each wave. Generalized additive mixture models were used to characterize trajectories of cortical development. Results revealed widespread linear puberty-related changes across much of the cortex. Many of these changes, particularly within the frontal and parietal cortices, were independent of age-related development. Males exhibiting faster pubertal tempo demonstrated greater thinning in the precuneus and frontal cortices than same-aged and -sex peers. Findings suggest that the unique influence of puberty on cortical development may be more extensive than previously identified, and also emphasize important individual differences in the coupling of these developmental processes.


Assuntos
Córtex Cerebral/crescimento & desenvolvimento , Puberdade , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/métodos , Masculino , Neuroimagem/métodos
7.
JAMA Ophthalmol ; 139(3): 293-300, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443542

RESUMO

Importance: Time spent in outdoor activities has decreased owing to home confinement for the coronavirus disease 2019 (COVID-19) pandemic. Concerns have been raised about whether home confinement may have worsened the burden of myopia owing to substantially decreased time spent outdoors and increased screen time at home. Objective: To investigate the refractive changes and prevalence of myopia in school-aged children during the COVID-19 home confinement. Design, Setting, and Participants: A prospective cross-sectional study using school-based photoscreenings in 123 535 children aged 6 to 13 years from 10 elementary schools in Feicheng, China, was conducted. The study was performed during 6 consecutive years (2015-2020). Data were analyzed in July 2020. Exposures: Noncycloplegic photorefraction was examined using a photoscreener device. Main Outcomes and Measures: The spherical equivalent refraction was recorded for each child and the prevalence of myopia for each age group during each year was calculated. The mean spherical equivalent refraction and prevalence of myopia were compared between 2020 (after home confinement) and the previous 5 years for each age group. Results: Of the 123 535 children included in the study, 64 335 (52.1%) were boys. A total of 194 904 test results (389 808 eyes) were included in the analysis. A substantial myopic shift (approximately -0.3 diopters [D]) was found in the 2020 school-based photoscreenings compared with previous years (2015-2019) for younger children aged 6 (-0.32 D), 7 (-0.28 D), and 8 (-0.29 D) years. The prevalence of myopia in the 2020 photoscreenings was higher than the highest prevalence of myopia within 2015-2019 for children aged 6 (21.5% vs 5.7%), 7 (26.2% vs 16.2%), and 8 (37.2% vs 27.7%) years. The differences in spherical equivalent refraction and the prevalence of myopia between 2020 and previous years were minimal in children aged 9 to 13 years. Conclusions and Relevance: Home confinement during the COVID-19 pandemic appeared to be associated with a significant myopic shift for children aged 6 to 8 years according to 2020 school-based photoscreenings. However, numerous limitations warrant caution in the interpretation of these associations, including use of noncycloplegic refractions and lack of orthokeratology history or ocular biometry data. Younger children's refractive status may be more sensitive to environmental changes than older ages, given the younger children are in a critical period for the development of myopia.


Assuntos
Educação a Distância , Olho/fisiopatologia , Miopia/epidemiologia , Refração Ocular , Tempo de Tela , Adolescente , Desenvolvimento do Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Miopia/diagnóstico , Miopia/fisiopatologia , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
8.
Neuroimage ; 227: 117678, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33359342

RESUMO

Myelin development during adolescence is becoming an area of growing interest in view of its potential relationship to cognition, behavior, and learning. While recent investigations suggest that both white matter (WM) and gray matter (GM) undergo protracted myelination during adolescence, quantitative relations between myelin development in WM and GM have not been previously studied. We quantitatively characterized the dependence of cortical GM, WM, and subcortical myelin density across the brain on age, gender, and puberty status during adolescence with the use of a novel macromolecular proton fraction (MPF) mapping method. Whole-brain MPF maps from a cross-sectional sample of 146 adolescents (age range 9-17 years) were collected. Myelin density was calculated from MPF values in GM and WM of all brain lobes, as well as in subcortical structures. In general, myelination of cortical GM was widespread and more significantly correlated with age than that of WM. Myelination of GM in the parietal lobe was found to have a significantly stronger age dependence than that of GM in the frontal, occipital, temporal and insular lobes. Myelination of WM in the temporal lobe had the strongest association with age as compared to WM in other lobes. Myelin density was found to be higher in males as compared to females when averaged across all cortical lobes, as well as in a bilateral subcortical region. Puberty stage was significantly correlated with myelin density in several cortical areas and in the subcortical GM. These findings point to significant differences in the trajectories of myelination of GM and WM across brain regions and suggest that cortical GM myelination plays a dominant role during adolescent development.


Assuntos
Encéfalo/crescimento & desenvolvimento , Substância Cinzenta/crescimento & desenvolvimento , Bainha de Mielina , Substância Branca/crescimento & desenvolvimento , Adolescente , Desenvolvimento do Adolescente , Mapeamento Encefálico/métodos , Criança , Estudos Transversais , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino
9.
Bone Joint J ; 103-B(1): 141-147, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380190

RESUMO

AIMS: The aim of this study was to investigate whether including the stages of ulnar physeal closure in Sanders stage 7 aids in a more accurate assessment for brace weaning in patients with adolescent idiopathic scoliosis (AIS). METHODS: This was a retrospective analysis of patients who were weaned from their brace and reviewed between June 2016 and December 2018. Patients who weaned from their brace at Risser stage ≥ 4, had static standing height and arm span for at least six months, and were ≥ two years post-menarche were included. Skeletal maturity at weaning was assessed using Sanders staging with stage 7 subclassified into 7a, in which all phalangeal physes are fused and only the distal radial physis is open, with narrowing of the medial physeal plate of the distal ulna, and 7b, in which fusion of > 50% of the medial growth plate of distal ulna exists, as well as the distal radius and ulna (DRU) classification, an established skeletal maturity index which assesses skeletal maturation using finer stages of the distal radial and ulnar physes, from open to complete fusion. The grade of maturity at the time of weaning and any progression of the curve were analyzed using Fisher's exact test, with Cramer's V, and Goodman and Kruskal's tau. RESULTS: We studied a total of 179 patients with AIS, of whom 149 (83.2%) were female. Their mean age was 14.8 years (SD 1.1) and the mean Cobb angle was 34.6° (SD 7.7°) at the time of weaning. The mean follow-up was 3.4 years (SD 1.8). At six months after weaning, the rates of progression of the curve for patients weaning at Sanders stage 7a and 7b were 11.4% and 0%, respectively for those with curves of < 40°. Similarly, the rates of progression of the curve for those being weaned at ulnar grade 7 and 8 using the DRU classification were 13.5% and 0%, respectively. The use of Sanders stages 6, 7a, 7b, and 8 for the assessment of maturity at the time of weaning were strongly and significantly associated (Cramer's V 0.326; p = 0.016) with whether the curve progressed at six months after weaning. Weaning at Sanders stage 7 with subclassification allowed 10.6% reduction of error in predicting the progression of the curve. CONCLUSION: The use of Sanders stages 7a and 7b allows the accurate assessment of skeletal maturity for guiding brace weaning in patients with AIS. Weaning at Sanders stage 7b, or at ulnar grade 8 with the DRU classification, is more appropriate as the curve did not progress in any patient with a curve of < 40° immediately post-weaning. Thus, reaching full fusion in both distal radial and ulnar physes (as at Sanders stage 8) is not necessary and this allows weaning from a brace to be initiated about nine months earlier. Cite this article: Bone Joint J 2021;103-B(1):141-147.


Assuntos
Determinação da Idade pelo Esqueleto , Braquetes , Tomada de Decisões , Lâmina de Crescimento/crescimento & desenvolvimento , Escoliose/terapia , Ulna/crescimento & desenvolvimento , Adolescente , Desenvolvimento do Adolescente/fisiologia , Desenvolvimento Ósseo/fisiologia , Feminino , Lâmina de Crescimento/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Ulna/diagnóstico por imagem
10.
Online braz. j. nurs. (Online) ; 19(4)dez. 2020. tab
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1145532

RESUMO

PROBLEMA: A ausência de estímulos facilitadores no ambiente em que o adolescente convive é normalmente atribuída a ocorrência do atraso do desenvolvimento. OBJETIVO: Analisar a associação dos fatores relacionados com a proposta diagnóstica atraso no desenvolvimento em adolescentes no ambiente escolar. MÉTODO: Estudo transversal, realizado com 385 adolescentes em uma cidade no Nordeste do Brasil. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição responsável, sob parecer 1.662.528 e Certificado de Apresentação para Apreciação Ética nº 57945016.4.0000.5537. RESULTADOS: A prevalência da proposição diagnóstica atraso no desenvolvimento foi 18,26%. Os fatores relacionados que apresentaram associação estatística significativa foram: marginalização social, dor crônica, não aceitação às transformações corporais da puberdade e trauma psicológico. DISCUSSÃO: Percebe-se a relação entre as variáveis estudadas e o desenvolvimento humano frente à literatura. CONCLUSÃO: O conhecimento dos fatores associados mais frequentes nessa população, facilita a inferência da proposição diagnóstica pelo enfermeiro. Outrossim, contribui na identificação de aspectos capazes de gerar prejuízos ao adolescente e, consequentemente, sequelas na fase adulta.


PROBLEMA: La ausencia de estímulos facilitadores en el entorno en el que vive el adolescente suele atribuirse al retraso del desarrollo. OBJETIVO: Analizar la asociación de factores relacionados con la Propuesta Diagnóstica Retraso del Desarrollo en adolescentes en el ámbito escolar. MÉTODO: Estudio transversal, realizado con 385 adolescentes de una ciudad del Nordeste de Brasil. El estudio fue aprobado por el Comité de Ética en Investigación de la institución responsable, bajo dictamen 1.662.528 y Certificado de Presentación de Apreciación Ética No. 57945016.4.0000.5537. RESULTADOS: La prevalencia de la Propuesta Diagnóstica Retraso en el Desarrollo fue del 18,26%. Los factores relacionados que mostraron asociación estadísticamente significativa fueron: marginación social, dolor crónico, no aceptación de los cambios corporales de la pubertad y trauma psicológico. DISCUSIÓN: La relación entre las variables estudiadas y el desarrollo humano se percibe en la literatura. CONCLUSIÓN: El conocimiento de los factores asociados más frecuentes en esta población facilita la inferencia de la propuesta diagnóstica por parte del enfermero. Además, contribuye a la identificación de aspectos capaces de generar daño al adolescente y, en consecuencia, secuelas en la edad adulta.


PROBLEM: The absence of facilitating stimuli in the environment in which the adolescent coexists is usually related to a delay in his development. OBJECTIVE: To analyze the association of factors related to the "Development Delay" diagnostic proposal among adolescents in the school environment. METHOD: Transversal study performed with 385 adolescents in a city in Northeastern Brazil. The study was approved by the Ethics in Research Committee of the responsible institution, under opinion nº 1.662.528 and the Certificate of Presentation for Ethical Consideration nº 57945016.4.0000.5537. OUTCOMES: The prevalence of the diagnostic proposition for delay in development was of 18.26%. Related factors that showed significant statistical association were social marginalization, chronic pain, refusal to accept body changes taking place during puberty and psychological trauma. DISCUSSION: One can perceive the relation between the studied variables and human development when considering the literature available. CONCLUSION: The knowledge of the associated factors most present in this population facilitates the understanding of the diagnostic proposal by the nurse. Besides, it contributes to the identification of the different aspects capable of causing harm to the adolescent and, consequently sequels in the adult life.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Diagnóstico de Enfermagem , Saúde do Adolescente , Desenvolvimento do Adolescente , Instituições Acadêmicas , Estudos Transversais
12.
J Youth Adolesc ; 49(11): 2246-2264, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32918664

RESUMO

Loneliness, social anxiety symptoms, and depressive symptoms are internalizing problems that are highly intertwined and often co-occur during adolescence. This overlap and co-occurrence raises the question whether three different labels are used for the same underlying phenomenon. The present study adopts a comprehensive approach to this issue by investigating the development of the three phenomena simultaneously. Specifically, this study aimed to investigate (1) the developmental trend for all three internalizing problems separately, (2) whether they are best described by a single developmental trend, (3) how they co-develop across adolescence, and (4) gender differences in this co-development. The analyses were run in three three-wave longitudinal samples of adolescents with one-year intervals in order to verify the robustness of the findings. Sample 1 (roughly ages 15, 16, and 17) comprised 549 adolescents (63% girls), and Samples 2 and 3 (roughly ages 13, 14, and 15) comprised 811 adolescents (46% girls) and 1101 adolescents (52% girls), respectively. Latent growth curve modeling for the three phenomena separately showed either small increases or stable patterns. A comparison of a Multiple Indicator Latent Growth Model (MILGM) with a Parallel Process Latent Growth Curve Modeling (PPLGCM) showed that the three internalizing problems followed unique, but related, developmental trends across adolescence. The intercepts of the three phenomena were positively correlated with one another in all samples and increases in loneliness were associated consistently with increases in social anxiety symptoms. Only in Sample 3 evidence was found for a similar association between loneliness and depressive symptoms and between social anxiety symptoms and depressive symptoms. Except for differences in initial levels, gender differences in the development of the three problems were limited. Overall, the results of the present study clearly indicate that the three internalizing problems are longitudinally distinct from one another, but co-develop across adolescence.


Assuntos
Depressão , Solidão , Adolescente , Desenvolvimento do Adolescente , Ansiedade , Feminino , Humanos , Estudos Longitudinais
14.
PLoS One ; 15(8): e0233244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797080

RESUMO

The role of white matter in reading has been established by diffusion tensor imaging (DTI), but DTI cannot identify specific microstructural features driving these relationships. Neurite orientation dispersion and density imaging (NODDI), inhomogeneous magnetization transfer (ihMT) and multicomponent driven equilibrium single-pulse observation of T1/T2 (mcDESPOT) can be used to link more specific aspects of white matter microstructure and reading due to their sensitivity to axonal packing and fiber coherence (NODDI) and myelin (ihMT and mcDESPOT). We applied principal component analysis (PCA) to combine DTI, NODDI, ihMT and mcDESPOT measures (10 in total), identify major features of white matter structure, and link these features to both reading and age. Analysis was performed for nine reading-related tracts in 46 neurotypical 6-16 year olds. We identified three principal components (PCs) which explained 79.5% of variance in our dataset. PC1 probed tissue complexity, PC2 described myelin and axonal packing, while PC3 was related to axonal diameter. Mixed effects regression models did not identify any significant relationships between principal components and reading skill. Bayes factor analysis revealed that the absence of relationships was not due to low power. Increasing PC1 in the left arcuate fasciculus with age suggest increases in tissue complexity, while increases of PC2 in the bilateral arcuate, inferior longitudinal, inferior fronto-occipital fasciculi, and splenium suggest increases in myelin and axonal packing with age. Multimodal white matter imaging and PCA provide microstructurally informative, powerful principal components which can be used by future studies of development and cognition. Our findings suggest major features of white matter undergo development during childhood and adolescence, but changes are not linked to reading during this period in our typically-developing sample.


Assuntos
Neuroimagem Funcional/métodos , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Leitura , Substância Branca/anatomia & histologia , Adolescente , Desenvolvimento do Adolescente/fisiologia , Axônios/ultraestrutura , Teorema de Bayes , Criança , Desenvolvimento Infantil/fisiologia , Imagem de Tensor de Difusão/estatística & dados numéricos , Feminino , Neuroimagem Funcional/estatística & dados numéricos , Voluntários Saudáveis , Humanos , Imageamento Tridimensional , Masculino , Modelos Anatômicos , Modelos Neurológicos , Imageamento por Ressonância Magnética Multiparamétrica/estatística & dados numéricos , Bainha de Mielina/metabolismo , Análise de Componente Principal/métodos , Análise de Regressão , Substância Branca/crescimento & desenvolvimento , Substância Branca/fisiologia
15.
PLoS One ; 15(8): e0235781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760096

RESUMO

BACKGROUND: An association between education and dementia is well-established but it is unclear whether education is associated with dementia after accounting for early life cognitive ability and whether there is a joint effect, such that the risk associated with one of the exposures depends on the value of the other. We examined separate and joint associations of adolescent cognitive ability and educational attainment with risk of dementia among Danish men born between 1939 and 1959. METHODS: Men (N = 477,421) from the Danish Conscription Database were followed for dementia from the age 60 for up to 17 years via patient and prescription registry linkages. Exposure measures included cognitive ability assessed at the conscript board examination around age 18 and highest educational level (low: 0-10 year, medium: 10-13 years, high: ≥13 years) at age 30 from registry records. Associations with dementia diagnosis were estimated in Cox proportional hazards models adjusted for birth year and age at conscript board examination. Interaction was assessed on the multiplicative scale by including a product term between the two exposure measures and on the additive scale by calculating relative excess risk due to interaction (RERI) between different levels of the exposure measures. RESULTS: Compared to men in the high education group hazard ratio [HR] for men in the medium and low group were 1.21 (95% confidence interval [CI]: 1.13, 1.30) and 1.34 (95% CI: 1.24, 1.45), respectively when not adjusting for cognitive ability. Additional adjustment for cognitive ability attenuated the magnitude of the associations, but they remained significant (education medium: HR = 1.10, 95% CI: 1.02, 1.19 and education low: HR = 1.12, 95% CI: 1.02, 1.22). A 10% higher cognitive ability score was associated with a 3.8% lower hazard of dementia (HR = 0.962; 95% CI: 0.957, 0.967), and the magnitude of the association only changed marginally after adjustment for education. Men in the low education group with relatively low cognitive ability were identified as a high-risk subgroup for dementia. The increased risk associated with exposure to both risk factors did, however, not significantly depart from the sum of risk experienced by men only exposed to one of the risk factors (estimates of RERI were not significantly different from 0) and no significant evidence of either additive or multiplicative interactions was found. CONCLUSIONS: In conclusion, the results suggest that education and cognitive ability protect against the risk of dementia independently of one another and that increases in educational attainment may at least partially offset dementia risk due to low cognitive ability.


Assuntos
Desenvolvimento do Adolescente/fisiologia , Cognição/fisiologia , Demência/epidemiologia , Escolaridade , Adolescente , Idoso , Demência/fisiopatologia , Dinamarca/epidemiologia , Seguimentos , Humanos , Testes de Inteligência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Fatores de Risco
16.
Pediatrics ; 146(Suppl 1): S18-S24, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737228

RESUMO

With a few notable exceptions, adolescents do not possess the legal authority to provide consent for or refuse medical interventions. However, in some situations, the question arises regarding whether a mature minor should be permitted to make a life-altering medical decision that would be challenged if made by the minor's parent. In this article, I explore what we currently know about the adolescent brain and how that knowledge should frame our understanding of adolescent decision-making. The prevailing approach to determining when adolescents should have their decisions respected in the medical and legal context, an approach that is focused on establishing capacity under a traditional informed consent model, will be reviewed and critiqued. I will suggest that the traditional model is insufficient and explore the implications for the adolescent role in health care decision-making.


Assuntos
Desenvolvimento do Adolescente , Encéfalo/crescimento & desenvolvimento , Tomada de Decisão Clínica , Doença de Hodgkin/tratamento farmacológico , Consentimento Livre e Esclarecido/psicologia , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Fatores Etários , Feminino , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Mães , Patient Self-Determination Act , Autonomia Pessoal , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
17.
Pediatrics ; 146(Suppl 1): S25-S32, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737229

RESUMO

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.


Assuntos
Tomada de Decisão Clínica , Competência Mental/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/legislação & jurisprudência , Educação Infantil , Bem-Estar da Criança/legislação & jurisprudência , Direitos Civis , Tomada de Decisão Clínica/ética , Família , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Competência Mental/normas , Menores de Idade/psicologia , Relações Pais-Filho , Consentimento dos Pais/ética , Patient Self-Determination Act , Autonomia Pessoal , Procurador/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
18.
Arch. argent. pediatr ; 118(4): s130-s141, agosto 2020. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1118606

RESUMO

Los padres que deciden cambiar la dieta habitual de sus hijos por otra más restrictiva deben conocer los riesgos y las ventajas de la alimentación escogida y recibir información que les ayude a ofrecerles una alimentación suficiente. Las dietas vegetarianas pueden realizarse siempre que sean planificadas por especialistas con la inclusión de una amplia variedad de alimentos vegetales y fortificados, y con el suplemento adecuado indicado en cada etapa.El objetivo de este documento es dar a conocer la postura del Comité de Nutrición de la Sociedad Argentina de Pediatría y brindar a los profesionales de la salud información adecuada que permita responder a las inquietudes de los padres y los pacientes que deciden escoger una dieta vegetariana como modalidad de alimentación. Se identifican los desafíos para tener en cuenta y se destaca que, sin dichas consideraciones y un seguimiento adecuado, estas dietas no pueden realizarse de manera segura en la infancia


Parents who decide to change the usual diet of their children for a more restrictive one should know the risks and advantages of the chosen diet and receive information that helps them to offer their children a sufficient diet. Vegetarian diets can be adopted as long as they are planned by specialists with the inclusion of a wide variety of plant foods and fortified foods with the appropriate supplementation indicated at each stage. The objective of this document is to present the position of the Nutrition Committee of the Argentine Society of Pediatrics and to provide health professionals with adequate information to respond to the concerns of parents and patients who decide to choose a vegetarian diet as a modality of feeding. The challenges to be taken into account are identified, highlighting that without these considerations and proper monitoring these diets cannot be carried out safely in childhood


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Dieta Vegetariana , Pediatria , Nutrientes/administração & dosagem , Desenvolvimento Infantil , Risco , Monitoramento , Desenvolvimento do Adolescente , Dietoterapia
20.
Artigo em Inglês | MEDLINE | ID: mdl-32722060

RESUMO

The study examined the moral competence levels in adolescents participating in individual/team sports compared with those not undertaking sports at all. In total, 827 students aged 15-17 years old (45.4% boys, 54.6% girls) from randomly selected secondary schools in the Wielkopolska region in Poland participated in the study. The moral competences were assessed using the Lind's Moral Competence Test. The students also answered questions concerning their statues of involvement in sport (not involved; amateur; professional), years of involvement, and the type of sport they partook in (individual/team). The results highlight that the moral competence level in most of the examined adolescents (71.6% girls, 76.8% boys) was low. Those who presented a high moral competence level were 10.4% in girls, 8% in boys. There was no interaction between modes of involvement in sport and moral competence when comparing adolescents. The moral competence levels were not correlated with years of training in either mode of involvement or with type of sports. Therefore, we assume that, at this age, the type of sport and the level of engagement do not differentiate moral competence level and that there must be more factors contributing to this. This opens new directions for further research on the role of external factors stimulating the socio-moral growth of youth.


Assuntos
Desenvolvimento do Adolescente , Princípios Morais , Esportes , Adolescente , Feminino , Humanos , Masculino , Polônia , Instituições Acadêmicas
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