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2.
Int J Public Health ; 69: 1606625, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38988503

RESUMO

Objectives: This systematised review aimed to examine European literature reporting data about adaptative skills and global external functioning of unaccompanied minors (UAMs). Methods: We conducted a systematised screening of four databases (APA PsycINFO Ovid, Medline Ovid ALL, Embase.com and Web Of Science Core Collection) using a research strategy including social, scholarly and behavioural abilities as well as externalising problems associated with the target population of UAMs. Thirty articles were included using pre-defined inclusion and exclusion criteria. Results: Our review showed that despite high levels of internalising disorders, socio-behavioural and educational adjustment of UAMs remained positive. It demonstrated how this population displays a strong desire for academic success and prosocial behaviours instead of aggressivity in everyday life. Nevertheless, our review drew attention to the strong tendency of UAMs to internalise their disorders and display chronic distress and problematic behaviours which increased with time spent in the host country. Conclusion: Our study draws attention to the risk of underestimating the real mental health needs of refugees, due to preserved external functioning combined with significant settlement pressures.


Assuntos
Menores de Idade , Humanos , Europa (Continente) , Adolescente , Menores de Idade/psicologia , Refugiados/psicologia , Criança , Adaptação Psicológica , Migrantes/psicologia , Masculino , Feminino
3.
Health Expect ; 27(4): e14128, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38943541

RESUMO

BACKGROUND: Epidermolysis bullosa (EB) comprises a group of rare types of genodermatoses characterized by extreme mucocutaneous fragility, leading to blistering and/or erosions, even with minimal trauma. Continuous care through wound management is an integral part of daily life for the families and individuals affected. The aim of this study was to assess the social reality and impacts on families of having minor members diagnosed with EB in Spain. METHODS: A qualitative methodology was employed, utilizing four focus groups entailing participation by 24 parents (19 mothers and five fathers) of minors diagnosed with EB in Spain. RESULTS: Negative impacts on the family nucleus were evident in four priority areas of analysis: sociorelational, economic-labour, physical and psychoemotional, with significant differences observed based on the severity of the symptoms. CONCLUSION: Impacts on the family nucleus are noticeable from birth, influencing all other daily life routines and complicating family planning and organization. There is an imperative need to enhance the availability of sociohealth resources and to adopt an interdisciplinary approach to address their biopsychosocial needs. PATIENT OR PUBLIC CONTRIBUTION: The active participation of relatives of minors diagnosed with Epidermolysis Bullosa (EB) is invaluable to sociohealth professionals, legislators and researchers. A team member conducts their professional activities at DEBRA España (national patient association dedicated to enhancing the quality of life for individuals with EB and their families), actively engaging in all study phases.


Assuntos
Epidermólise Bolhosa , Grupos Focais , Pesquisa Qualitativa , Humanos , Espanha , Epidermólise Bolhosa/psicologia , Epidermólise Bolhosa/terapia , Feminino , Masculino , Criança , Adolescente , Adulto , Menores de Idade/psicologia , Qualidade de Vida , Pré-Escolar , Família/psicologia , Fatores Socioeconômicos
4.
Ethics Hum Res ; 46(4): 2-16, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38944882

RESUMO

This article examines the ethics of research design and the initiation of a study (e.g., recruitment of participants) involving refugee participants. We aim to equip investigators and members of IRBs with a set of ethical considerations and pragmatic recommendations to address challenges in refugee-focused research as it is developed and prepared for IRB review. We discuss challenges including how refugees are being defined and identified; their vulnerabilities before, during, and following resettlement that impacts their research participation; recruitment; consent practices including assent and unaccompanied minors; and conflicts of interest. Ethical guidance and regulatory oversight provided by international bodies, federal governments, and IRBs are important for enforcing the protection of participants. We describe the need for additional ethical guidance and awareness, if not special protections for refugee populations as guided by the National Institutes of Health (NIH) Guiding Principles for Ethical Research.


Assuntos
Comitês de Ética em Pesquisa , Ética em Pesquisa , Consentimento Livre e Esclarecido , National Institutes of Health (U.S.) , Refugiados , Humanos , Estados Unidos , Consentimento Livre e Esclarecido/ética , América do Norte , Conflito de Interesses , Projetos de Pesquisa , Seleção de Pacientes/ética , Pesquisa Biomédica/ética , Menores de Idade , Guias como Assunto , Populações Vulneráveis
6.
Riv Psichiatr ; 59(3): 87-99, 2024.
Artigo em Italiano | MEDLINE | ID: mdl-38912756

RESUMO

AIM: The Standards of Care (SOC-8) by the World Professional Association for Trans Health provide guidelines for the care of transgender and gender diverse individuals through safe and effective multi-professional interventions for physical and mental well-being. The aim of this work is to summarize the SOC-8 recommendations for childhood and adolescence, highlighting the importance of psychosocial assessment and available medical and surgical therapeutic options, and emphasizing the need for healthcare provider training. METHODS: The SOC-8 recommendations are based on scientific evidence and professional consensus from experts in transgender health, developing classification criteria and access to therapies, based on systematic literature reviews (PubMed and Embase). RESULTS: The SOC-8 underscores the importance of assessing and preserving gender identity, supporting prepubescent individuals from a psychosocial perspective, and ensuring adolescents access to medically and surgically conforming treatments according to local legislation. It is the responsibility of healthcare providers to understand and adapt international guidelines for an inclusive clinical practice of gender diversity. DISCUSSION AND CONCLUSIONS: Gender affirmation therapies in minors require comprehensive evaluation, parental involvement, and consideration of their cognitive and emotional maturity. Treatments should also focus on preserving fertility and accessing medicalized treatments which are beneficial to the well-being of transgender and gender diverse individuals.


Assuntos
Saúde Mental , Pessoas Transgênero , Humanos , Pessoas Transgênero/psicologia , Adolescente , Masculino , Feminino , Criança , Menores de Idade/psicologia , Identidade de Gênero , Acessibilidade aos Serviços de Saúde , Padrão de Cuidado , Procedimentos de Readequação Sexual
7.
Hastings Cent Rep ; 54(3): 57-58, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38842870

RESUMO

What ethically justifies the provision of invasive and irreversible treatments to minors? In this commentary, I examine this question in response to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?," which critiques autonomy-based arguments for justification of gender-affirming care in minors. Minors generally lack sufficient autonomy to make significant medical decisions or major life decisions. For this reason, parents are generally their decision-makers, working with medical professionals to choose treatments that serve the best interests of the minor. Medical care in minors is justified by beneficence, not autonomy, and this should be no different for gender-affirming care. This severely undermines autonomy-based arguments for provision of gender-affirming care to minors. Given the lack of conclusive evidence for benefit, the nature of the treatment, and the fact that gender dysphoria in minors resolves spontaneously in most cases, there is presently insufficient justification for provision of such care to minors.


Assuntos
Disforia de Gênero , Menores de Idade , Autonomia Pessoal , Humanos , Disforia de Gênero/terapia , Pessoas Transgênero , Adolescente , Criança , Feminino , Tomada de Decisões/ética , Masculino , Consentimento Informado por Menores/ética , Assistência à Saúde Afirmativa de Gênero
8.
J Law Med Ethics ; 52(1): 52-61, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38818609

RESUMO

This paper challenges historically preconceived notions surrounding a minor's ability to make medical decisions, arguing that federal health law should be reformed to allow minors with capacity as young as age 12 to consent to their own Centers for Diseases Control and Prevention (CDC)-approved COVID-19 vaccinations. This proposal aligns with and expands upon current exceptions to limitations on adolescent decision-making. This analysis reviews the historic and current anti-vaccination sentiment, examines legal precedence and rationale, outlines supporting ethical arguments regarding adolescent decision-making, and offers rebuttals to anticipated ethical counterarguments.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Consentimento Informado por Menores , Humanos , Adolescente , Estados Unidos , Criança , COVID-19/prevenção & controle , Consentimento Informado por Menores/legislação & jurisprudência , Consentimento Informado por Menores/ética , Vacinação/legislação & jurisprudência , Vacinação/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Centers for Disease Control and Prevention, U.S. , SARS-CoV-2 , Tomada de Decisões
9.
Int J Med Inform ; 187: 105465, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38692233

RESUMO

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.


Assuntos
Menores de Idade , Portais do Paciente , Humanos , Finlândia , Suécia , Estudos Retrospectivos , Adolescente , Portais do Paciente/estatística & dados numéricos , Masculino , Feminino , Confidencialidade , Criança , Registros Eletrônicos de Saúde/estatística & dados numéricos , Acesso dos Pacientes aos Registros , Tutores Legais
10.
J Law Med Ethics ; 52(1): 62-64, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38818597

RESUMO

Policies allowing some minors to consent to receive recommended vaccines are ethically defensible. However, a policy change at the federal level expanding minor consent for vaccinations nationwide risks triggering a political backlash. Such a move may be perceived as infringing on the rights of parents to make decisions about their children's health care. In the current post-COVID environment of heightened anti-vaccination activism, changes to minor consent laws may be unadvisable, and policy makers should proceed with caution.


Assuntos
Vacinação , Adolescente , Criança , Humanos , Movimento contra Vacinação , COVID-19/prevenção & controle , Política de Saúde/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/ética , Consentimento Informado por Menores/legislação & jurisprudência , Consentimento Informado por Menores/ética , Menores de Idade/legislação & jurisprudência , Política , Estados Unidos , Vacinação/ética , Vacinação/legislação & jurisprudência
11.
Cuad Bioet ; 35(113): 27-40, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38734921

RESUMO

The consumption of pornography over the Internet by minors has been increasing exponentially in recent years. The use of digital technologies and the ease of access to these contents are causes that explain this event. Simultaneously, there is concern about the increase in sexual violence, associated with discriminatory behavior, despite the efforts of laws and programs that promote sexual reproductive health (SRH) and the principle of equality. From a bioethical point of view, it is urgent to address this issue, which affects the physical and psychological health of minors and their affective-sexual education. The study addresses whether it is possible to relate the consumption of online pornography by minors and sexual violence. To do this, legal sources, reports from associations, audiovisual councils and scientific studies are consulted. In all of them, the relationship between the consumption of online pornography by adolescents and risky behavior in emotional-sexual matters and gender inequality is evident. In the legal and fiscal sphere, it is alerted to the damage that is occurring and points out the need to propose lines of action that reverse this situation. We propose measures to technically regulate access to content. These measures are based on the precautionary principle, a tool that has been applied in fields such as health and the environment. More studies and political actions are needed to make the Internet a safe place for minors.


Assuntos
Literatura Erótica , Internet , Literatura Erótica/legislação & jurisprudência , Literatura Erótica/psicologia , Humanos , Adolescente , Menores de Idade/legislação & jurisprudência , Menores de Idade/psicologia , Feminino , Masculino , Criança , Delitos Sexuais/legislação & jurisprudência , Delitos Sexuais/psicologia
14.
Eur J Pediatr ; 183(7): 2871-2880, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38589580

RESUMO

To explore the needs, expectations, and experiences of asylum-seeking parents and unaccompanied minors under the age of 18 years on the initial health assessment for children and adolescents and access to care upon entry in the Netherlands, We conducted five semi-structured focus group discussions with asylum-seeking parents and unaccompanied minors, from Syria, Eritrea, Afghanistan, and other Middle-East and African countries, supported by professional interpreters. To triangulate findings, semi-structured interviews with health care professionals involved in care for refugee children were conducted. Transcripts of focus group discussions were inductively and deductively coded and content analyzed; transcripts of interviews were deductively coded and content analyzed. In total, 31 asylum-seeking participants: 23 parents of 101 children (between 0 and 18 years old), 8 unaccompanied minors (between 15 and 17 years), and 6 healthcare professionals participated. Parents and minors expressed that upon entry, their needs were met for vaccinations, but not for screening or care for physical and mental health problems. Parents, minors, and health professionals emphasized the necessity of appropriate information and education about health, diseases, and the health system. Cultural change was mentioned as stressful for the parent-child interaction and parental well-being.     Conclusion: The perspectives of refugee parents and unaccompanied minors revealed opportunities to improve the experience of and access to health care of refugees entering the Netherlands, especially risk-specific screening and more adequate education about health, diseases, and the Dutch health care system. What is Known: •  Refugees have specific health needs due to pre-flight, flight, and resettlement conditions. Health assessment upon entry was non-obligatory in the Netherlands, except for the tuberculosis screening. Health needs were not always met, and refugees experienced barriers in access to care. What is New: • The initial health assessment met the needs concerning vaccinations but mismatched the needs regarding physical and mental health assessment. Screening for specific risk-related diseases and mental health could enable refugee parents and minors to engage better with the health system.


Assuntos
Grupos Focais , Acessibilidade aos Serviços de Saúde , Menores de Idade , Pais , Refugiados , Humanos , Refugiados/psicologia , Adolescente , Feminino , Masculino , Criança , Países Baixos , Pais/psicologia , Pré-Escolar , Lactente , Menores de Idade/psicologia , Adulto , Recém-Nascido , Pesquisa Qualitativa , Necessidades e Demandas de Serviços de Saúde , Avaliação das Necessidades , Serviços de Saúde da Criança
16.
Clin Child Psychol Psychiatry ; 29(3): 833-849, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38520182

RESUMO

BACKGROUND: Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. METHODS: The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. RESULTS: Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. CONCLUSIONS: Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures.


Staff who support refugee children without parents come from different backgrounds, and often have limited mental health knowledge and skills. To address this gap, a national programme was established for 17 organisations hosting accommodation centres across Greece. Selected professionals were upskilled as trainers to cascade knowledge to their staff group. Training was based on the understanding of the impact of trauma and children's cultural needs and was provided to interdisciplinary staff groups. In total, 199 staff attended pilot training. Experiences of the training were shared by a sub-group of 33 trained staff, nine managers and six trainers through focus group discussions. These were analysed through a qualitative thematic approach. Key findings included the relevance of new knowledge to children's needs and staff roles, training as a team, using learning methods based on real issues, and supports that should be put in place to ensure that benefits are maintained. Such a model of cascading knowledge and skills can be useful for large numbers of organisations and staff supporting refugee and other vulnerable children. Training should include staff such as caregivers, who may have had limited educational opportunities, while balancing between different staff roles. Training should be integral to all functions of accommodation centres.


Assuntos
Menores de Idade , Humanos , Grécia , Criança , Menores de Idade/psicologia , Adolescente , Serviços de Saúde Mental , Pessoal de Saúde/educação , Masculino , Feminino , Adulto
18.
Artigo em Alemão | MEDLINE | ID: mdl-38410090

RESUMO

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.


Assuntos
Disforia de Gênero , Puberdade , Humanos , Disforia de Gênero/tratamento farmacológico , Disforia de Gênero/psicologia , Adolescente , Criança , Feminino , Masculino , Puberdade/efeitos dos fármacos , Puberdade/psicologia , Menores de Idade/psicologia , Hormônios Esteroides Gonadais/uso terapêutico , Supressão da Puberdade
19.
Int J Legal Med ; 138(3): 983-995, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38279991

RESUMO

Age assessment of migrants is crucial, particularly for unaccompanied foreign minors, a population facing legal, social, and humanitarian challenges. Despite existing guidelines, there is no unified protocol in Europe for age assessment.The Forensic Anthropology Society of Europe (FASE) conducted a comprehensive questionnaire to understand age estimation practices in Europe. The questionnaire had sections focusing on the professional background of respondents, annual assessment numbers, requesting parties and reasons, types of examinations conducted (e.g., physical, radiological), followed protocols, age estimation methods, and questions on how age estimates are reported.The questionnaire's findings reveal extensive engagement of the forensic community in age assessment in the living, emphasizing multidisciplinary approaches. However, there seems to be an incomplete appreciation of AGFAD guidelines. Commonalities exist in examination methodologies and imaging tests. However, discrepancies emerged among respondents regarding sexual maturity assessment and reporting assessment results. Given the increasing importance of age assessment, especially for migrant child protection, the study stresses the need for a unified protocol across European countries. This can only be achieved if EU Member States wholeheartedly embrace the fundamental principles outlined in EU Directives and conduct medical age assessments aligned with recognized standards such as the AGFAD guidelines.


Assuntos
Refugiados , Migrantes , Criança , Humanos , Menores de Idade , Europa (Continente) , Antropologia Forense , Determinação da Idade pelo Esqueleto
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