As the median age of practicing physicians increases, ethical dilemmas due to age-related cognitive decline among clinicians will become ever more pressing. Compelling data show that despite acknowledgement of their duty to protect the public, physicians often fail to report themselves, their colleagues, or their physician-patients when cognitive decline appears to impact medical practice adversely. As such, efforts to educate physicians about ethical obligations and various tactful methodologies to report themselves or others seem ineffective. Illustrated by a case report (...) of age-related cognitive decline in a practicing physician, practical recommendations are made both to develop and validate cognitive screening in middle-aged physicians, presumably before the onset of age-related cognitive decline. (shrink)

This article aims at answering the following questions: What is the influence of age structure on the spread of coronavirus disease 2019? What can be the impact of stringency policy on the spread of COVID-19? What might be the quantitative effect of development levelincome and number of hospital beds on the number of deaths due to the COVID-19 epidemic? By employing the methodologies of generalized linear model, generalized moments method, and quantile regression models, this article reveals that the shares of (...) median age, age 65, and age 70 and older population have significant positive impacts on the spread of COVID-19 and that the share of age 70 and older people in the population has a relatively greater influence on the spread of the pandemic. The second output of this research is the significant impact of stringency policy on diminishing COVID-19 total cases. The third finding of this paper reveals that the number of hospital beds appears to be vital in reducing the total number of COVID-19 deaths, while GDP per capita does not affect much the level of deaths of the COVID-19 pandemic. Finally, this article suggests some governmental health policies to control and decrease the spread of COVID-19. (shrink)

Age‐related and cancer‐related epigenomic modifications have been associated with enhanced cell‐to‐cell gene expression variability that characterizes increased cellular stochasticity. Since gene expression variability appears to be highly reduced by—and epigenetic and phenotypic stability acquired through—direct or long‐range cellular interactions during cell differentiation, we propose a common origin for aging and cancer in the failure to control cellular stochasticity by cell–cell interactions. Tissue‐disruption‐induced cellular stochasticity associated with epigenetic drift would be at the origin of organ dysfunction because of an increase in (...) phenotypic variation among cells, ultimately leading to cell death and organ failure through a loss of coordination in cellular functions, and eventually to cancerization. We propose mechanistic research perspectives to corroborate this hypothesis and explore its evolutionary consequences, highlighting a positive correlation between the median age of mass loss onset (a proxy for the onset of organ aging) and the median age at cancer diagnosis. (shrink)

Autonomous vehicles (AVs) hold considerable promise for maintaining aging adults’ mobility as they develop impairments in driving skill. Nonetheless, attitudes can be a significant barrier to adoption as has been shown for other technologies. We investigated how different introductions to AV, video with a driver in the front seat, the rear seat, and a written description, affected attitudes, as well as how individual difference variables such as age, gender, prior knowledge, and personality traits predict attitudes within a middle-aged (Median (...) age = 34, IQR = 20, n = 441) Amazon Mechanical Turk sample. The 16-item attitude survey uncovered three factors: Concern with AV, Eagerness to Adopt AV technology, and Willingness to Relinquish Driving Control. ANOVAs showed that only age (younger less concerned) and gender, (females more concerned) were significant factors in Concern with AV. Only gender affected Willingness to Relinquish Driving Control, with males more willing. Multiple regressions that included previous knowledge level and personality traits showed a different pattern. Female gender and greater conscientiousness were associated with greater Concern about AV. Prior knowledge of AV was associated with less concern. Emotional stability and openness to experience were positive predictors of Eagerness to Adopt AV, whereas conscientiousness was a negative predictor. Prior knowledge and openness to experience, positively, and extraversion, negatively, were associated wi... (shrink)

IntroductionSimilarities in morphology, physiological function, and neurophysiological findings between median and ulnar nerves are not unequivocal. Our previous study confirmed differences in motor fiber parameters between these nerves in healthy persons. We made an attempt to assess and compare the physiological parameters of different sensation modalities in median and ulnar nerves.MethodsThe study was performed in 31 healthy, right-handed volunteers: 17 women, 14 men, mean age 44.8 ± 15.5 years. Standard sensory conduction tests in the median and ulnar (...) nerves were performed together with the estimation of vibratory, temperature, and warm- and cold-induced pain thresholds in the C7 and C8 dermatomes on the palm, using quantitative sensory testing.ResultsThere were no statistically significant differences in the standard sensory conduction test in the median and ulnar nerves across the whole group: between right and left hands, and between women and men. We revealed differences in the temperature and pain thresholds between these nerves, mainly in low temperature perception. There were no differences in estimated thresholds between sides or in female and male groups. The vibratory limits did not differ significantly between nerves, and subgroups.ConclusionThe study confirmed the differences in the physiological sensory perception between the median and ulnar nerves. The median nerve is more sensitive to temperature stimulation than the ulnar nerve, but simultaneously less sensitive to pain-inducing temperature stimuli. These findings should be considered during the examination of hand nerve pathology. (shrink)

SummaryIntense, sustained nursing lengthens inter-birth intervals and is causally linked with low natural fertility. However, in traditional settings, the effects of such nursing on fertility are difficult to disentangle from those of nutrition. Results from an prospective, direct observational study of reproductive function in well-nourished Amele women who nurse intensively and persistently but who also have high fertility are here presented. Endocrine measures show that ovarian activity resumes by median 11·0 months postpartum. Median duration of postpartum amenorrhoea is (...) 11·3 months, time to next conception is 19·0 months, and the inter-birth interval is 28·0 months. Average life time fertility is 6·8. High fertility in Amele women is due both to refractoriness of reproductive function to suckling stimuli, and to maintenance of equivalent age-specific fertility rates across the reproductive life span. (shrink)

Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Method: Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. Results: The median DUP across (...) the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). Conclusion: These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services. (shrink)

SummaryEarly onset of menarche has been shown to be associated with breast cancer and ischaemic heart disease. Studies on age at menarche of the Malaysian population are poorly documented. This study aimed to determine the influence of anthropometric and socio-demographic factors on the age at menarche of university students in Malaysia. Data were obtained in 2010–11 from 961 students between the ages of 18 and 25 years from the University of Malaya using stratified sampling, and multiple regression analysis was applied. (...) Sixty-three per cent of students reached menarche at the age of 12 or 13 years, with the mean and median of age at menarche being 12.45±1.17 and 12.01 years, respectively. Menarcheal age was positively associated with height and negatively associated with BMI. Students from urban areas attained menarche earlier than those from rural areas. Students from small-sized families attained menarche earlier than those from larger families. First-born students experienced menarche earlier than those who were seventh-born or later. Obese and overweight students reached menarche earlier than students who were underweight or of normal weight. The variations in age at menarche among the Malaysian ethnic groups were statistically insignificant. The results suggest that heavier and first-born students from small families are more likely to attain menarche earlier than their counterparts. (shrink)

BackgroundWe assessed potential consent bias in a cohort of > 40,000 adult patients asked by mail after hospitalization to consent to the use of past, present and future clinical and biological data in an ongoing ‘general consent’ program at a large tertiary hospital in Switzerland.MethodsIn this retrospective cohort study, all adult patients hospitalized between April 2019 and March 2020 were invited to participate to the general consent program. Demographic and clinical characteristics were extracted from patients’ electronic health records (EHR). Data (...) of those who provided written consent (signatories) and non-responders were compared and analyzed with R studio.ResultsOf 44,819 patients approached, 10,299 (23%) signed the form. Signatories were older (median age 54 [IQR 38–72] vs. 44 years [IQR 32–60], p <.0001), more comorbid (2614/10,299 [25.4%] vs. 4912/28,676 [17.1%] with Charlson comorbidity index ≤ 4, p <.0001), and more often of Swiss nationality (6592/10,299 [64%] vs. 13,813/28,676 [48.2%], p <.0001).ConclusionsOur results suggest that actively seeking consent creates a bias and compromises the external validity of data obtained via ‘general consent’ programs. Other options, such as opt-out consent procedures, should be further assessed. (shrink)

This study examined correlations between moral value judgments on a 17-item Moral Intuition Survey (MIS), and participant scores on the Short-D3 “Dark Triad” Personality Inventory—a measure of three related “dark and socially destructive” personality traits: Machiavellianism, Narcissism, and Psychopathy. Five hundred sixty-seven participants (302 male, 257 female, 2 transgendered; median age 28) were recruited online through Amazon Mechanical Turk and Yale Experiment Month web advertisements. Different responses to MIS items were initially hypothesized to be “conservative” or “liberal” in line (...) with traditional public divides. Our demographic data confirmed all of these hypothesized categorizations. We then tested two broad, exploratory hypotheses: (H1) the hypothesis that there would be “many” significant correlations between conservative MIS judgments and the Dark Triad, and (H2) the hypothesis that there would be no significant correlations between liberal MIS judgments and Machiavellianism or Psychopathy, but “some” significant correlations between liberal MIS judgments and Narcissism. Because our hypotheses were exploratory and we ran a large number of statistical tests (62 total), we utilized a Bonferroni Correction to set a very high threshold for significance (p = .0008). Our results broadly supported our two hypotheses. We found eleven significant correlations between conservative MIS judgments and the Dark Triad—all at significance level of p < .00001—but no significant correlations between the Dark Triad and liberal MIS judgments. We believe that these results raise provocative moral questions about the personality bases of moral judgments. In particular, we propose that because the Short-D3 measures three “dark and antisocial” personality traits, our results raise some prima facie worries about the moral justification of some conservative moral judgments. (shrink)

ObjectiveThe aim of this study was to investigate possible associations between obstructive sleep apnea and fatigue. This naturally led to considering the association between OSA and excessive sleepiness, depression, and anxiety.BackgroundOSA is a highly prevalent sleep disorder, associated with a risk of hypertension, cardiovascular events, daytime sleepiness, poor cognitive function, and sudden death during sleep. Both excessive sleepiness, fatigue, and symptoms of depression are frequently reported.Method5,464 patients referred to a university hospital for obstructive sleep apnea underwent standard respiratory polygraphy. The (...) severity of OSA was defined as either mild, moderate, or severe, using the apnea–hypopnea index. Validated questionnaires were used to assess excessive sleepiness, pathological fatigue, depression, and anxiety.ResultsNearly 70% of the patients were men, and median age was 50 years. One in three had moderate-to-severe OSA. Excessive sleepiness and pathological fatigue were present in 43 and 39%, respectively. The prevalence of possible depression and anxiety was 19 and 28%, respectively. The proportion of patients with male sex, obesity, and excessive sleepiness increased with the severity of OSA. In contrast, the proportion of patients with pathological fatigue did not increase with OSA severity, and there was a decrease in depression and anxiety with increasing OSA severity.ConclusionOur study reports that pathological fatigue, as well as anxiety and depression, did not increase with OSA severity, whereas excessive sleepiness did. Knowledge concerning conditions related to OSA severity may be indicative of pretest probability of OSA and thus change the priority for polygraphy. Furthermore, the high prevalence rates of fatigue, anxiety, and depression among these patients warrant further investigations. (shrink)

BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

Educating young people about how to interact with patients at the end of their lives is challenging. A qualitative study based on Husserl’s phenomenological approach was performed to describe the learning experience of secondary education students after watching, analysing, and reflecting on two videoclips featuring Cameron Duncan, a young man suffering from terminal cancer. Students from three vocational centres providing training in ancillary nursing, pharmacy, and dependent care in the Community of Madrid visited the Palliative Care Hospital. A total of (...) 110 students, with a median age of nineteen years, participated in the study. The students’ learning experience through the videoclips reveals the essential aspects required in palliative care, since the character suffers in every dimension of his being: physically as well as psychologically, socially, and spiritually. Therefore, this requires healthcare professionals to understand their experience, putting themselves in their place, to provide affectionate care and to display communication skills leading to a quality helping relationship. Four comprehensive educational categories were identified in the study. The students learned the importance of: 1) providing comprehensive and affectionate care to patients, 2) the need for communication skills in caring for patients, 3) being aware of the end of life and time left, 4) valuing life and fighting for what one wishes to attain. A visit to a PC hospital and the viewing of videoclips and reflection upon these, represents a useful strategy for secondary education healthcare students. The study indicates that videoclips are an innovative method for becoming aware of the various issues pertaining to palliative care. (shrink)

There is currently a pronounced lack of uniformity in the values placed on a life or a QALY by different New Zealand government entities taking actions designed to save lives or QALYs. With some limited exceptions, equity suggests that all QALYs be equally valued, and therefore likewise for all lives with the same residual life expectancy and quality of life. Prima facie, this is attainable by adopting the best (and only credible) New Zealand estimate of the value of life (the (...) NZTA’s $12.5 m value of the life of a median age person in good health), and using that or its QALY equivalent as a cutoff figure to determine interventions throughout the public sector. This provides opportunities for large welfare gains, from curtailing existing interventions that currently use much larger cutoff values (such as earthquake strengthening regulations) and expanding interventions that currently use much smaller cutoff values (such as public health spending). However, the NZTA’s figure is only applicable to small increases in lives saved, and must decline as the number of additional lives saved increases. This relationship should be estimated. (shrink)

IntroductionResponsive neurostimulation is an evolving therapeutic option for patients with treatment-refractory epilepsy. Open-loop, continuous stimulation of the anterior thalamic nuclei is the only approved modality, yet chronic stimulation rarely induces complete seizure remission and is associated with neuropsychiatric adverse effects. Accounts of off-label responsive stimulation in thalamic nuclei describe significant improvements in patients who have failed multiple drug regimens, vagal nerve stimulation, and other invasive measures. This systematic review surveys the currently available data supporting the use of responsive thalamic neurostimulation (...) in primary and secondary generalized, treatment-refractory epilepsy.Materials and MethodsA systematic review was performed using the following combination of keywords and controlled vocabulary: OR ) OR [responsive neurostimulation AND thalamus AND ]. In addition, a search of the publications listed under the PubMed “cited by” tab was performed for all publications that passed title/abstract screening in addition to manually searching their reference lists.ResultsTen publications were identified describing a total of 29 subjects with a broad range of epilepsy disorders treated with closed-loop thalamic neurostimulation. The median age of subjects was 31 years old. Of the 29 subjects, 15 were stimulated in the anterior, 11 in the centromedian, and 3 in the pulvinar nuclei. Excluding 5 subjects who were treated for 1 month or less, median time on stimulation was 19 months. Of these subjects, 17/24 experienced greater than or equal to 50%, 11/24 least 75%, and 9/24 at least 90% reduction in seizures. Although a minority of patients did not exhibit significant clinical improvement by follow-up, there was a general trend of increasing treatment efficacy with longer periods on closed-loop thalamic stimulation.ConclusionThe data supporting off-label closed-loop thalamic stimulation for refractory epilepsy is limited to 29 adult and pediatric patients, many of whom experienced significant improvement in seizure duration and frequency. This encouraging progress must be verified in larger studies. (shrink)

It may be unethical to deny children with cystic fibrosis access to ethically approved clinical trials from which they might benefitDespite advances in nutritional management, aggressive antibiotic usage, and physiotherapy, cystic fibrosis remains a life limiting illness with high morbidity that imposes considerable burdens on children and families.1 Although survival to 40 years is predicted for children born in 1990s, the median age of death in 2003 was 24.2 years .The pathophysiological features of CF are produced by a defective (...) gene on chromosome 7, resulting in the defective production of a protein that regulates cellular ion transport. Defective ion transport is thought to lead to increased mucus viscosity , with poor airway clearance, recurrent bacterial infection, lung damage, and death.Gene therapy , the insertion of a normally functioning gene into deficient host cells using a suitable vector, is a potential treatment or cure for diseases produced by single gene defects—for example, CF. Gene therapy does, however, have potential or actual risks, leading many to suggest that evidence of efficacy in adults should be demonstrated before trials are conducted in children. Many serious diseases in adults such as CF have their onset in childhood. If early treatment provides greater hopes of benefit, children may be more appropriate targets for GT in CF than adults. It may be unethical to deny them access to properly constructed, ethically approved clinical trials from which they might benefit.Since research in children should be scientifically valid, in the child’s best interests, and the subject of valid consent, this article will consider these parameters in relation to trials of GT in children with CF. Because of the importance of consumer participation in the design of research we present the results of a questionnaire about GT trials delivered …. (shrink)

BackgroundPublished data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data on withdrawal of treatment for children in China.MethodsWithdrawal of treatment for children in the pediatric intensive care unit of a regional children’s hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawal of treatment was categorized as medical withdrawal or premature withdrawal. The guardian’s self-reported reasons for abandoning the child’s treatment were recorded from 2011.ResultsThe incidence of withdrawal of treatment for children (...) in the PICU decreased significantly; for premature withdrawal the 3-year average of 15.1% in 2006–2008 decreased to 1.9% in 2015–2017. The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children for whom treatment was withdrawn increased from 14.5 months in 2006 to 40.5 months in 2017. Among the reasons given by guardians of children whose treatment was withdrawn in 2011–2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved”. Only a few guardians ascribed treatment withdrawal to economic reasons.ConclusionsThe frequency of withdrawal of medical therapy has changed over time in this children’s hospital PICU, and parental decision-making has been a large part of the change. (shrink)

Background: It is often claimed that a regulated kidney market would significantly reduce the kidney shortage, thus saving or improving many lives. Data are lacking, however, on how many people would consider selling a kidney in such a market. Methods: A survey instrument, developed to assess behavioural dispositions to and attitudes about a hypothetical regulated kidney market, was given to Swiss third-year medical students. Results: Respondents’ median age was 23 years. Their socioeconomic status was high or middle. 48 considered (...) selling a kidney in a regulated kidney market, of whom 31 would sell only to overcome a particularly difficult financial situation. High social status and male gender was the strongest predictor of a disposition to sell. 32 of all respondents supported legalising a regulated kidney market. This attitude was not associated with a disposition to sell a kidney. 5 respondents endorsed a market and considered providing a kidney to a stranger if and only if paid. 4 of those 5 would sell only under financial duress. Conclusions: Current understanding of a regulated kidney market is insufficient. It is unclear whether a regulated market would result in a net gain of kidneys. Most possible kidney vendors would only sell in a particularly difficult financial situation, raising concerns about the validity of consent and inequities in the provision of organs. Further empirical and normative analysis of these issues is required. Any calls to implement and evaluate a regulated kidney market in pilot studies are therefore premature. (shrink)

Background: Informed consent in clinical research is mandated throughout the world. Both patient subjects and investigators are required to understand and accept the distinction between research and treatment.Aim: To document the extent and to identify factors associated with therapeutic misconception in a population of patient subjects or parent proxies recruited from a variety of multicentre trials .Patients and methods: The study comprised two phases: the development of a questionnaire to assess the quality of informed consent and a survey of patient (...) subjects based on this questionnaire.Results: A total of 303 patient subjects or parent proxies were contacted and 279 questionnaires were analysed. The median age was 49.5 years, sex ratio was 1 and 61% of respondents were professionally active. Overall memorisation of the oral or written communication of informed consent was good , and satisfaction with the process was around 70%. Therapeutic misconception was present in 70% of respondents, who expected to receive better care and ignored the consequence of randomisation and treatment comparisons. This was positively associated with the acuteness and severity of the disease.Conclusion: The authors suggest that the risk of therapeutic misconception be specifically addressed in consent forms as an educational tool for both patients and investigators. (shrink)

In a recent study appearing in Neuroethics, I reported observing 11 significant correlations between the “Dark Triad” personality traits – Machiavellianism, Narcissism, and Psychopathy – and “conservative” judgments on a 17-item Moral Intuition Survey. Surprisingly, I observed no significant correlations between the Dark Triad and “liberal” judgments. In order to determine whether these results were an artifact of the particular issues I selected, I ran a follow-up study testing the Dark Triad against conservative and liberal judgments on 15 additional moral (...) issues. The new issues examined include illegal immigration, abortion, the teaching of “intelligent design” in public schools, the use of waterboarding and other “enhanced interrogation techniques” in the war on terrorism, laws defining marriage as the union of one man and one woman, and environmentalism. 1154 participants (680 male, 472 female; median age 29), recruited online through Amazon Mechanical Turk, completed three surveys: a 15-item Moral Intuition Survey (MIS), the 28-item Short Dark Triad personality inventory, and a five-item demographic survey. The results strongly reinforce my earlier findings. Twenty-two significant correlations were observed between “conservative” judgments and the Dark Triad (all of which were significant past a Bonferonni-corrected significance threshold of p = .0008), compared to seven significant correlations between Dark Triad and “liberal” judgments (only one of which was significant past p = .0008). This article concludes by developing a novel research proposal for determining whether the results of my two studies are “bad news” for conservatives or liberals. (shrink)

The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. We conducted (...) a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions. (shrink)

There is an increased focus on, and evidence of, children's capability to both understand and make decisions about issues relating to participation in medical research. At the same time there are divergent ideas of when, how and to what extent children should be allowed to decide for themselves. Furthermore, little is known about parents' views on these matters, an important issue since they often provide the formal consent. In this questionnaire study of 2500 families in south-east Sweden (with and without (...) research experience) we explored parents' views on issues relating to information, consent and research data. We found that parents are generally positive about supplying their child with individual information (93.3%; median age 7) and assuring the child's consent/assent to participation (74.3%; median age 12). However, parents' views vary regarding the extent to which children should influence research data: as many as 47–61% of our sample were opposed to children's rights to decide about the use and storage of biological samples and natural history data. Parents who are opposed to child consent and a wider influence on their research participation argue that parental authority and research quality are two important factors opposing enhanced child influence. Drawing on this, we underline the need to discuss how to balance children's rights against parental autonomy and research interests before implementing any standardized protocols granting children the right to consent and revoke data in long-term research. (shrink)

Medical informed consent stands as an ethical and legal requisite preceding any medical intervention. Hospitalized patients face functional health literacy (FHL) challenges when dealing with informed consent forms (ICFs). The legitimacy of ICFs and informed consent procedures in China remains substantially undisclosed. The study’s aim was to investigate if Chinese patients have adequate FHL to be truly informed before providing medical consent. In this cross-sectional, structured interview-based study, FHL was assessed within the context of the informed consent scenarios in two (...) teaching hospitals (a 1500-bed general tertiary hospital and a 700-bed cancer hospital) affiliated with Shantou University Medical College. Twenty-seven patients admitted across clinical departments, along with their relatives (n = 59), were enrolled in the study after obtaining informed consent. The participants underwent a three-step assessment with two selected ICFs —teach-back skills, perceived understanding (perception), and informed knowledge (cognizance), with each component carrying a maximum score of 10. Data were analyzed with SPSS (version 22.0) for descriptive and inferential statistics, with consideration of significant P values as < 0.05. The median age (IQR and range) of participants was 35.5 (28 – 49 and 13 – 74) years. Most participants had only high school education (24.4%, 21/86) or below high school education (47.7%, 41/86). The median score (IQR) of FHL assessments—teach-back, perception, and cognizance—was 4.0 (2.5, 5.8), 8.0 (6.8, 8.8), and 6.5 (5.5, 8.0) out of 10, respectively. A moderate correlation was observed between the scores of cognizance and teach-back (r = 0.359, P = 0.002) or perception (r = 0.437, P < 0.001). Multivariate linear regression analysis predicted being a patient and having lower education levels as independent risk factors of inadequate FHL (Ps = 0.001). Lack of patient-centeredness in ICFs, time constraints, and poor clinical communication were identified as barriers impeding informed consent. This study demonstrates inadequacy in personal FHL and impaired organizational HL, resulting in compromised informed consent in Chinese teaching hospitals. As a remedy, we propose improving the quality of ICFs and institutionally mandated outcome-focused training on informed consent for all concerned clinicians to enhance medical ethics, ensure quality health care, address patient values, and mitigate potential medical conflicts. (shrink)

This study investigated the effect of non-task language in language switching experiment. Non-task language refers to participants’ language(s) (regardless of proficiency level) that are not used in any trials throughout the experiment. We recruited 60 Tibetan-Chinese-English trilinguals (grade-12 high school students with a median age of 17) to perform a lexical decision (word vs. non-word) task in only two of their languages. We repeated the experiment three times to present each language pair once. In each experiment, the participants were (...) divided into two groups which significantly contrasted with each other in their non-task language while remained comparable in the two task languages. Response time (RT) and error rate (ER) have been examined to evaluate task performance. The interaction between task performance and the participants’ proficiency in the non-task language was also examined. The results showed null effect of language switching. In addition, the effect of the non-task language was not found. These results were interpreted with reference to the main models of bilingual visual word recognition and the role of orthography specificity. (shrink)

Objective: Deep brain stimulation targeted to the ventral intermediate nucleus of the thalamus is effective for motor symptoms in essential tremor, but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients.Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological (...) outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.Results: We identified 50 ET DBS patients; 29 males; the mean age of tremor onset was 35.84 years with a median age of 38 years. The mean age at DBS was 68.18 years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment and age of tremor onset ; F = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment and complications vs. no complications subgroups; F = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.Conclusion: In this large cohort of ET patients with, DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS. (shrink)

Objectives: To quantify the use of do-not-resuscitate orders in a tertiary-care children’s hospital and to characterise the circumstances in which such orders are written.Design: Retrospective study conducted in a 500-bed children’s hospital in Taiwan.Patients: The course of 101 patients who died between January 2002 and December 2005 was reviewed. The following data were collected: age at death, gender, disease and its status, place of death and survival. There were 59 males and 42 females with a median age of 103 (...) months . 50 children had leukaemias, and 51 had malignancies other than leukaemia. The t test and the χ2 test were applied as appropriate.Results: The study found that 44% of patient deaths occurred in the paediatric oncology ward; 29% of patient deaths occurred in the intensive care unit; and 28% of patients died in their home or at another hospital. Other findings included the following: 46 of 101 patients died after attempted cardiopulmonary resuscitation and 55 died with a DNR order in effect. The mean age at death was 9.8 years in both groups with or without DNR orders.Conclusions: From the study of patient deaths in this tertiary-care children’s hospital, it was concluded that an explicit DNR order is now the rule rather than the exception, with more DNR orders being written for patients who have been ill longer, who have solid tumours, who are not in remission and who are in the ward. (shrink)

Introduction: Novel coronavirus is having a devastating psychological impact on patients, especially patients with cancer. This work aims to evaluate mood disorders of cancer patients undergoing radiation therapy during COVID-19 in comparison with cancer patients who underwent radiation therapy in 2019.Materials and Methods: We included all the patients undergoing radiation therapy at our department in two-time points and during the COVID-19 outbreak. All the patients were asked to fulfill a validated questionnaire, the Symptom Distress thermometer, and the Beck Depression Inventory (...) v.2. We took into account the COVID-19 outbreak and also sex, age, week of radiation treatment, and disease.Results: We included 458 patients, with a median age of 64 years. STAI-Y1 median score was 40, whereas the median score of SDT was five and BDI-2 median score was 11. STAI-Y1, SDT, and BDI-2 were significantly correlated with the COVID-19 outbreak, sex, week of treatment, and disease.Conclusions: The prevalence of mood disorders in patients undergoing radiation therapy is higher than expected and even higher during the COVID-19 outbreak. These measurements could be useful as a baseline to start medical humanities programs to decrease these scores. (shrink)

BackgroundThe psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer could be a potential disadvantage of active surveillance, especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significant levels of anxiety after diagnosis. The present study aimed to investigate (...) if demographic, clinical, and psychological variables at the entrance in AS were associated with the risk of developing clinically significant PCa-related anxiety 2 months before the first re-biopsy and to offer psychological support to improve quality of life.Materials and MethodsA total of 236 patients participated in the PCa Research International: AS protocol and in PRIAS-QoL study. Demographic/clinical features, health-related QoL domains, coping with cancer, PCa-related anxiety [Memorial Anxiety Scale for PCa ], personality traits, and decision-making-related factors were assessed at T0. MAX-PC was also administered at T1. PCa-related anxiety at T1 was considered to be of clinical significance if the MAX-PC score was ≥1.5. Multivariable logistic regression coupled to bootstrap was used to detect factors associated with high levels of anxiety.ResultsThe median age was 64.4 years. Fifty-six patients reported MAX-PC total score above the cutoff. Three factors were associated with a high level of PCa anxiety at T1: anxious preoccupation [odds ratio = 4.36], extraversion, and prostate-related symptoms. Physical well-being was associated with a low PCa anxiety subscale ; neuroticism and functional well-being were associated with PSA anxiety. Neuroticism and helplessness/hopelessness were associated with fear of progression.ConclusionOnly a partial portion of the sample experienced significant levels of anxiety after 10 months. Psychological assessment should be routinely conducted to detect risk factors for increased anxiety, offering tailored psychological interventions aimed at promoting interpersonal awareness and emotional well-being. (shrink)

The Philippines has a young population with an estimated median age of 22.9 years in 2010. About 19.8 million or are 15–24 years old. About 48 % of these young people are adolescents aged 15–19. Studies in local settings provide varied information on the prevalence of adolescent pregnancy in the Philippines, depending on source and time of survey as well as age of respondents. The Cordillera Administrative Region has the highest teen pregnancy rate based on the 2013 Young Adult (...) Fertility and Sexuality Study. In the YAFS survey, the region registered 18.4% for teen fertility, making the Cordillera top all other regions. Likewise, a dramatic increase of teenage pregnancy is also evident in Barangay Irisan, Baguio City. Barangay Irisan is the biggest and most populated barangay in Baguio City. It had a population of 28,357 as of the 2010 Census, which accounts for about seven percent of the city's total populace. The barangay is located at the northwestern tip of the city, and is primarily accessible via the Naguilian Road. It is widely known for the dumpsite in the area. The Philippines is a signatory to numerous international agreements related to women in general, with implications for teenage pregnancy. These include the International Conference on Population and Development Programme of Action signed in Cairo, Egypt, in 1994; the Beijing Declaration and Platform for Action, developed during the Fourth World Conference on Women in Beijing, China, in September 1995; the Fourth World Summit on Social Development, the World Conference on Human Rights Programme of Action; and the Convention on the Elimination of all forms of Discrimination Against Women. The country is not lacking in laws nor policies and programs that could protect and empower women of all ages. Political bickering, religious interference, and the population’s ambivalent attitudes toward sex and reproductive health have, however, negatively affected the effective implementation of adolescent reproductive health programs in the Philippines. Adolescents having unprotected heterosexual intercourse are at risk of both HIV infection and unwanted pregnancy. (shrink)

In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) (...) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country. (shrink)

Introduction: Parental postpartum bonding has been studied by many researchers focusing on maternal bonding. The objective of this study was to examine the psychological and socio-demographic predictors of paternal postpartum bonding in the early postpartum period.Methods: In this cross-sectional study, 131 couples (fathers median age of 32.37 years,SD= 4.59; mothers median age of 30.23 years,SD= 3.90) of newborns from full-term pregnancies were recruited from November 2019 until March 2020. The primary outcome was paternal postpartum bonding as measured by (...) the Postpartum Bonding Questionnaire (PBQ). Secondary outcomes included: maternal and paternal anxiety [with the Generalized Anxiety Disorder (GAD) Assessment]; maternal and paternal stress [with the Parental Stress Scale (PSS)]; maternal depressive symptoms [with the Edinburgh Postpartum Depression Scale (EPDS)]; and maternal and paternal socio-demographic variables as fathers’ presence at childbirth, education level, age, and parental experience.Results: Paternal postpartum bonding was significantly correlated with paternal anxiety (moderate strength), maternal stress (strong correlation), and maternal postpartum bonding. No significant correlations between paternal postpartum bonding, maternal depression symptoms, and maternal anxiety were found. The mediating role of paternal stress in paternal postpartum bonding was proven. Paternal anxiety strengthens paternal stress (b= 0.98). Further, a high level of paternal stress disrupts paternal postpartum bonding (b= 0.41). Results of regression analyses have revelated that maternal infant bonding (p< 0.01) and paternal stress (p< 0.01) are the only predictors of parental postpartum bonding across all included variables. None of investigated socio-demographic variables were associated with paternal postpartum bonding.Conclusion: Notwithstanding limitations, the current findings add to a growing body of literature on paternal postpartum bonding. The results have shown that paternal mental health is related to parental postpartum bonding directly after delivery.Clinical Trial Registration:ClinicalTrials.govIdentifier: NCT04118751. (shrink)

BackgroundCommunity engagement is a key component in health research. One of the ways health researchers ensure community engagement is through Community Advisory Boards (CABs). The capacity of CABs to properly perform their role in clinical research has not been well described in many resource limited settings. In this study, we assessed the capacity of CABs for effective community engagement in Uganda.MethodsWe conducted a cross sectional study with mixed methods. We used structured questionnaires and key informant interviews (KII) to collect data (...) from CAB members, trial investigators, and community liaison officers. For quantitative data, we used descriptive statistics while for qualitative data we used content analysis.ResultsSeventy three CAB members were interviewed using structured questionnaires; 58.9% males, median age 49 years (IQR 24–70), 71.2% had attained tertiary education, 42.5% never attended any research ethics training, only 26% had a training in human subject protection, 30.1% had training in health research, 50.7% never attended any training about the role of CABs, and 72.6% had no guidelines for their operation. On the qualitative aspect, 24 KIIs cited CAB members to have some skills and ability to understand and review study documents, offer guidance on community norms and expectations and give valuable feedback to the investigators. However, challenges like limited resources, lack of independence and guidelines, and knowledge gaps about research ethics were cited as hindrances of CABs capacity.ConclusionThough CABs have some capacity to perform their role in the Ugandan setting, their functionality is limited by lack of resources to facilitate their work, lack of independence, lack of guidelines for their operations and limited knowledge regarding issues of research ethics and protection of the rights of trial participants. (shrink)

Despite the classic patriarchy of the Roman Catholic church, American Catholic nuns entered into patriarchal bargains that latently gained them access to resources and status within the system. By means of educational advancement and professional careers, encouraged by the male hierarchy as necessary to performing the works of the church, nuns gained both informal power in the system and an awareness of their disadvantaged position. This article analyzes the shifts that have occurred in these bargains during the past 40 years (...) in terms of the submerged networks of feminist consciousness that have existed in Catholic convents for decades. The article concludes with a description of the current crisis occurring within religious orders as they experience a decline in membership and rapidly increasing median ages of members. (shrink)

According to Aristotle, wisdom orchestrates all other virtues and therefore leads to eudaimonia, which can be translated as flourishing or psychological well-being. Wisdom guides people to take the morally right course of action in concrete situations to benefit themselves and others. If Aristotle’s theory is correct, then wisdom should be related to different moral virtues and wisdom, rather than individual virtues, should predict eudaimonic well-being, establishing wisdom as the driving force behind human flourishing. Survey data were collected from 230 undergraduate (...) students (M = 21 years, median age = 20 years) attending five different classes in the social sciences at a university in the Southeast of the United States at the beginning and end of the fall semester in 2016. Bivariate correlations, regression analyses, and a structural equation model were utilized to analyze the data. Three-dimensional wisdom (3D-WS) at the beginning of the semester (T1), consisting of the average of cognitive, reflective, and compassionate personality qualities, was significantly positively related to gratitude, forgiveness, morality/fairness, modesty, greed avoidance, and sincerity at T1. Wisdom at T1 predicted flourishing at the end of the semester (T2), assessed by self-acceptance, mastery, purpose in life, and orientation toward personal growth. Among the virtues, only gratitude at T1 significantly predicted flourishing at T2. It appears that Aristotle was correct! Wisdom, at least as measured by the 3D-WS, seems to orchestrate moral virtues and result in human flourishing. This implies that cultivating the development of wisdom will lead to a better and more flourishing life. (shrink)

Clinical Ethics Consultations (CECs) are used by healthcare systems to offer healthcare practitioners a structured level of support to approach ethical questions. The objective of this study was to detail the elements of surveyed CECs and offer guidance in the approach to future ethics consultations at a regional healthcare system. This cohort study has a qualitative and quantitative retrospective approach, surveying ethics consultations through the dates of 4/27/22 to 4/26/24. A documentary sheet was created, and information was entered via online (...) data-gathering forms. The cases are from a range of specialties within a regional healthcare system servicing Minnesota, Wisconsin, and North Dakota. 103 CECs were performed within the study period across the regional healthcare system. Consultations were identified through retrospective review of the internal CEC database, and patient information was collected through the medical record. Decision-making was often performed by a substitute decision-maker (N = 54), occurring in 70.1% of cases with known decision makers. CECs were documented in an ethics-specific note in the patient medical record in 37 of 82 (45.1%) documented patient cases. It was common for physicians to mention the ethics consultation in their patient notes, occuring in 51 of 82 (62.2%) of documented patient cases. Age was recorded in 92.0% (N = 91) of unique patient cases; the median age was 62 years. Ethical questions concerning end-of-life care were the most common cause for consultation (N = 35, 34%), and CECs were most commonly requested in general medicine or hospitalist departments (N = 38, 45.2%). Most consultations resulted in resolution at time of initial consultation with the ethics call team. Recommendations for increased frequency and timing of policy review are given based on the results of the data presented. Using interpretation of the CECs in this study, we offer recommendations towards the use and documentation of ethics consultations in the era of open notes, open the door towards areas of future research, and ultimately promote use of CECs for more favorable patient outcomes. (shrink)

IntroductionIn highly developed countries, as many as 16 percent of children are physically abused each year. Traumatic brain injury (TBI) is the most common injury in non-accidental trauma (NAT) and is responsible for 80 percent of fatal NAT cases, with most deaths occurring in children younger than three years old. Cases of abusers who refuse withdrawal of life-sustaining medical treatment (LSMT) to avoid criminal charges have previously been reported. Therefore, we hypothesized that NAT is associated with a lower risk for (...) withdrawal LSMT in pediatric TBI.MethodsThe pediatric Trauma Quality Improvement Program database was analyzed (2014 to 2016) for patients aged 16 and younger with TBI and Glasgow Coma Scale (GCS) of 8 and lower on admission. Patients with a head Abbreviated Injury Scale (AIS) of 2 or less or who died within 48 hours were excluded. A multivariable logistic regression model was used for analysis.ResultsOf 2,209 TBI patients, 92 (4.2 percent) had withdrawal of LSMT. Compared to those without withdrawal of LMST, those with LMST had statistically similar median age (three years of age versus seven years, p = 0.07) and a higher rate of NAT (33.7 percent versus 13.5 percent, p < 0.001). The most common specified perpetrator was a father/stepfather/ male partner (70 percent). After adjusting for covariates, factors associated with higher risk for withdrawal of LSMT included age of less than three years (OR 2.38, CI 1.34-4.23, p < 0.05) and NAT (OR 1.86, CI 1.02-3.41, p < 0.05).ConclusionNAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized. (shrink)

Callous unemotional (CU) traits (i.e., a lack of empathy/remorse and poverty of emotion) that co-occur with childhood antisocial behaviour are believed to be the developmental precursor to psychopathy in adulthood. An increasing volume of evidence supports two distinct variants of CU traits/psychopathy, known as primary and secondary. Primary variants are thought to show core deficits in emotional reactivity (e.g., attenuated autonomic activity), whereas secondary variants present with high levels of anxiety and this may be reflected in increased emotional sensitivity to (...) negative stimuli. -/- Aims: The current study is the first of its kind to examine the role of anxiety in modulating emotional processing as indexed by heart rate (HR) in incarcerated boys with CU traits. -/- Methods: HR was recorded continuously while 205 adolescents (aged 14 to 18 years) completed an emotional pictures dot-probe task. The task consisted of four blocks of 18 trials, beginning with a 500 ms central fixation cross, a 250 ms picture pair presentation (i.e., neutral, positive, negative valence), followed by a probe appearing in either the top or bottom picture location until response, and lastly a 2000 ms inter-trial interval recovery period. Four groups were formed on the basis of median-split scores on the Revised Children's Manifest Anxiety Scale and the Inventory of Callous Unemotional Traits, reflecting a primary variant (high CU/low anxiety), secondary variant (high CU/high anxiety), and two nonpsychopathic groups (low CU/high anxiety and low CU/low anxiety). -/- Results: The HR data indicated relative HR deceleration during the picture-probe period, regardless of group. Additionally, compared to all other groups, HR deceleration was greatest for the high CU/high anxiety secondary group and smallest for the high CU/low anxiety primary group during negative stimuli. Conclusions: This result is thought to reflect differences between CU/psychopathy variants in attentional orienting to distressing stimuli, consistent with theory. (shrink)

Background: The prevalence of diabetes is rising worldwide, especially in poorer nations. It is anticipated to emerge as the sixth main cause of mortality globally by 2030. The factors linked to self-awareness in diabetes patients are still debated.Aim: To identify factors associated with self-awareness among diabetic patients attending Al-Zaher primary health care center (PHCC), Makkah Almukaramah City, Saudi Arabia 2024Methods: A cross-sectional study was performed using a randomized sample of diabetes patients visiting Al-Zaher Primary Health Care Center in Makkah AlMukarramah (...) city. The used questionnaire included demographic information and data on the patient's beliefs and attitudes toward diabetes mellitus (DM). The statistical analysis was conducted using SPSS. A P-value below 0.05 was deemed significant.Results: The study included 523 patients with T2DM in different genders, age categories from 20 to 70 years and education levels. The majority of respondents were married (79.3%). 53.5% of respondents were fully informed of their health conditions, however 52% were not confident in managing their diabetes. 60% of patients stated that regular diabetic follow-up every one to two months would assist in maintaining their health. 50.7% of respondents said there is a significant likelihood of getting diabetic issues in the future. While 50.9% of respondents felt that diabetes may be remedied with medicine, 47% of them thought that those with diabetes would have a shorter lifespan compared to those without the condition. 48% of patients selected meals optimal for their health, whereas 51.6% engaged in exercise at least three times weekly to enhance blood glucose regulation. Nonetheless, 51.1% of them sometimes missed doses of diabetic medicine. The average total score of patients' self-awareness about diabetes mellitus was 6.8±3.9, with a median of 8 (range 1-13).Conclusion: The study found inadequate self- awareness among diabetic patients. Male gender, younger age and high education level are the significant factors associated with high self-awareness toward DM. The study highlights the need for educational programs to improve self-awareness and empower patients, especially females, older individuals, and those with lower education levels, in Saudi Arabia. (shrink)

Background Seeking assent from children for participation in medical research is an ethical imperative of numerous institutions globally. However, none of these organizations provide specific guidance on the criteria or process to be used when obtaining assent. The primary objective of this scoping review was to determine the descriptions of assent discussed in the literature and the reported criteria used for seeking assent for research participation in pre-adolescent children. Methods Medline and Embase databases were searched until November 2020 using the (...) term “assent” in the title or abstract. Inclusion criteria were (1) studies enrolling children which specifically described operationalization of the assent process and (2) studies of the assent process which provided a description of assent. Data collected included participant information, patient criteria for seeking assent, guidelines referenced, description of assent reported, how assent was obtained and assent information presented, and reported assent rate. For qualitative articles focusing on the assent process, important themes were identified. Results A total of 116 articles were included of which 79 (68.9%) operationalized assent and 57 studies (%) described the assent process. The most commonly reported criterion used to determine the ability of a child to assent was age (35.4%, 28/79). The reported minimal age for obtaining pediatric assent varied considerably across and within jurisdictions (5–13 years; median 7.5 years, IQR 7.0, 9.75). Cognitive ability was reported as a criterion for obtaining assent in 5.1% (4/79) of studies. Assent rates were only reported in 17.7% (14/79) of citations and ranged from 32.0 to 100%. Analysis of the 57 studies describing the assent process identified several themes, including age thresholds, assessment of capacity, variable knowledge of pediatric assent and parental roles. Conclusion We found significant variation in criteria used for assessment of patient capacity, delivery of information used to obtain assent and documentation of the assent process. While we acknowledge that individual children, settings and jurisdictions may require different approaches to obtaining assent, there should be agreement on important principles to be followed with resulting common guidance on assessing capacity, delivering information and documentation of the assent process for publication. (shrink)

The characterization of the world of the ancient Greek city states as relatively poor and economically static has been refuted by recent advances in Greek economic history. The Greek world grew dramatically, compared to other premodern societies, both in population and per capita consumption from the age of Homer to that of Aristotle. By the fourth century BCE the city-state ecology was densely populated, and median consumption was well above bare subsistence. Athenian income inequality can be roughly measured using (...) income and population estimates from late fourth century BCE. This paper argues that, at least in Athens, economic growth was accompanied by historically low levels of income inequality. Both economic growth and low inequality are explained by the development of citizen-centered political institutions. Growth, inequality, and institutions were important parts of the historical context in which Plato and Aristotle wrote. Attending to that context may elucidate some aspects of Greek political philosophy. (shrink)

Background: Despite a gradual shift in the focus of medical care among terminally ill patients to a palliative model, studies suggest that many children with life-limiting chronic illnesses continue to die in hospital after prolonged periods of inpatient admission and mechanical ventilation.Objectives: To examine the characteristics and location of death among hospitalised children, investigate yearwise trends in these characteristics and test the hypothesis that professional ethical guidance from the UK Royal College of Paediatrics and Child Health would lead to significant (...) changes in the characteristics of death among hospitalised children.Methods: Routine administrative data from one large tertiary-level UK children’s hospital was examined over a 7-year period for children aged 0–18 years. Demographic details, location of deaths, source of admission , length of stay and final diagnoses were studied. Statistical significance was tested by the Kruskal–Wallis analysis of ranks and median test , χ2 test and Cochran–Armitage test .Results: Of the 1127 deaths occurring in hospital over the 7-year period, the majority were among infants. The main diagnoses at death included congenital malformations , perinatal diseases , cardiovascular disorders and neoplasms . Most deaths occurred in an intensive care unit environment , with a significant increase over the years . There was a clear increase in the proportion of admissions from in-hospital among the ICU cohort . Infants with congenital malformations and perinatal conditions were more likely to die in an ICU , and older children with malignancy outside the ICU . Children stayed for a median of 13 days on a hospital ward before being admitted to an ICU where they died.Conclusions: A greater proportion of hospitalised children are dying in an ICU environment. Our experience indicates that professional ethical guidance by itself may be inadequate in reversing the trends observed in this study. (shrink)

Impaired performance in verbal fluency tasks is a frequent observation in Parkinson’s disease. As to the nature of the underlying cognitive deficit, it is commonly attributed to a frontal-type dysexecutive syndrome due to nigrostriatal dopamine depletion. Whereas dopaminergic medication typically improves VF performance in PD, e.g., by ameliorating impaired lexical switching, its effect on semantic network activation is unclear. Data from priming studies suggest that dopamine causes a faster decay of semantic activation spread. The aim of the current study was (...) to examine the impact of dopaminergic medication on the dynamic change of word frequency during VF performance as a measure of semantic spreading activation. To this end, we performed a median split analysis of word frequency during phonemic and semantic VF task performance in a PD group tested while receiving dopaminergic medication as well as after drug withdrawal, and in a sample of age-matched healthy volunteers. Dopaminergic medication in the PD group significantly affected phonemic VF with improved word production as well as increased error-rates. The expected decrease of word frequency during VF task performance was significantly smaller in the PD group ON medication than in healthy volunteers across semantic and phonemic VF. No significant group-difference emerged between controls and the PD group in the OFF condition. The comparison between both treatment conditions within the PD group did not reach statistical significance. The observed pattern of results indicates a faster decay of semantic network activation during lexical access in PD patients on dopaminergic medication. In view of improved word generation, this finding is consistent with a concept of more focused neural activity by an increased signal-to-noise ratio due to dopaminergic neuromodulation. However, the effect of dopaminergic stimulation on VF output suggests a trade-off between these beneficial effects and increased error-rates. (shrink)

BackgroundAccurate reporting on sex and gender in health research is integral to ensuring that health interventions are safe and effective. In Canada and internationally, governments, research organizations, journal editors, and health agencies have called for more inclusive research, provision of sex-disaggregated data, and the integration of sex and gender analysis throughout the research process. Sex and gender analysis is generally defined as an approach for considering how and why different subpopulations (e.g., of diverse genders, ages, and social locations) may experience (...) health conditions and interventions in different or similar ways.The objective of this study was to assess the extent and nature of reporting about sex and/or gender, including whether sex and gender analysis (SGA) was carried out in a sample of Canadian randomized controlled trials (RCTs) with human participants.MethodsWe searched MEDLINE from 01 January 2013 to 23 July 2014 using a validated filter for identification of RCTs, combined with terms related to Canada. Two reviewers screened the search results to identify the first 100 RCTs that were either identified in the trial publication as funded by a Canadian organization or which had a first or last author based in Canada. Data were independently extracted by two people from 10% of the RCTs during an initial training period; once agreement was reached on this sample, the remainder of the data extraction was completed by one person and verified by a second.ResultsThe search yielded 1433 records. We screened 256 records to identify 100 RCTs which met our eligibility criteria. The median sample size of the RCTs was 107 participants (range 12–6085). While 98% of studies described the demographic composition of their participants by sex, only 6% conducted a subgroup analysis across sex and 4% reported sex-disaggregated data. No article defined “sex” and/or “gender.” No publication carried out a comprehensive sex and gender analysis.ConclusionsFindings highlight poor uptake of sex and gender considerations in the Canadian RCT context and underscore the need for better articulated guidance on sex and gender analysis to improve reporting of evidence, inform policy development, and guide future research. (shrink)

Rehabilitation for disabled children requires long-term programmeswhich are expensive to the family. This study aimed to estimate the costincurred by caregivers’ children with disabilities from Pahang, Terengganu andKelantan participating in Community-Based Rehabilitation and cost of seeking alternative rehabilitation. Costanalysis using the Activity-Based Costing method was used to estimatetwelve-months’ expenditure in 2014 institutional year on 297 caregivers ofchildren with disability, aged 0 to 18 years who attended CBR. Data werecollected using a self-administered costing questionnaire and presentedin median. Results showed that (...) the median direct and indirect costs,excluding medications and alternative care were nearly four times as highin Home-Based compared to Centre-Based vs. RM608. Both groups of caregivers spent a significant amount ofresources on alternative rehabilitation. The high costs incurred for alternativerehabilitation is a major economic burden to the family. (shrink)

Validated self-report measures of post-stroke fatigue are lacking. The Dutch Multifactor Fatigue Scale (DMFS) was translated into Danish, and response process evidence of validity was evaluated. DMFS consists of 38 Likert-rated items distributed on five subscales: Impact of fatigue (11 items), Signs and direct consequences of fatigue (9), Mental fatigue (7), Physical fatigue (6), and Coping with fatigue (5). Response processes to DMFS were investigated using a Three-Step Test-Interview (TSTI) protocol, and data were analyzed using Framework Analysis. Response processes were (...) indexed on the following categories: (i) “congruent,” response processes were related to the subscale construct; (ii) “incongruent,” response processes were not related to the subscale construct; (iii) “ambiguous,” response processes were both congruent and incongruent or insufficient to evaluate congruency; and (iv) “confused,” participants did not understand the item. Nine adults were recruited consecutively 10–34 months post-stroke (median = 26.5) at an outpatient brain injury rehabilitation center in 2019 [five females, mean age = 55 years (SD= 6.3)]. Problematic items were defined as <50% of response processes being congruent with the intended construct. Of the 38 items, five problematic items were identified, including four items of Physical fatigue and one of Mental fatigue. In addition, seven items posed various response difficulties to some participants due to syntactic complexity, vague terms, a presupposition, and a double-barrelled statement. In conclusion, findings elucidate the interpretative processes involved in responding to DMFS post-stroke, strengthen the evidence base of validity, and guide revisions to mitigate potential problems in item performance. (shrink)

Sacred Science is one of the traditionalists' principles among them some philosophers like Sayyed Hossein Nasr, Frithjof Schuon, and Rene Guenon can be noted. Having this principle, a theory of science, and a religious theory in general an Islamic one in particular, can be explained and reconstructed. This reconstruction reveals that traditionalists can be considered as advocates of religious science. In this paper, concepts like sacred science, and tradition and traditionalism are explained, criteria of classification of religious science's theories are (...) mentioned, and theories of religious scienceare analyzed as minimal, maximal, and median ones, and also as reductive, established, and mixed theories. Reconstruction of traditionalists' account shows despite of differences among scholars' view, it is possible to accept religious science in a reductive approach based on sacred science, and traditional sciences can be shown as examples of religious science. Particularly, it can be said, in Sayyed Hossein Nasr's view, sciences with Islamic attributes are realized, and they have to be recognized in contemporary age; in other words, Islamic sciences must be revived. (shrink)

« Dem Namenlosen fühl ich mich vertrauter… »R. M. Rilke : Fortschritt Bien que les fragments des Âges du monde, promesses pour toujours inaccomplies d’un chef-d’œuvre de la période médiane de F. W. J. von Schelling, comptent parmi les écrits les plus populaires du philosophe de Leonberg, leur puissance philosophique et, par suite, leur importance dans la formation de la pensée schellingienne sont souvent sous-estimées par l’historiographie philosophique en général et par la réception francoph...

Clearance phase at signalized crosswalks is an important parameter of pedestrians’ safety because it helps them to complete the crossing before the green signal for vehicles. However, there is the issue of pedestrian decision as to whether to cross if they arrive at the crosswalk during the clearance phase, which represents a violation in many countries. Due to the proof that pedestrian violations multiply the risk of traffic accidents, in this study, the tendency of pedestrians to commit violations during the (...) clearance time has been researched. With the aim of proposing the design of the pedestrian traffic lights, which could decrease the frequency of pedestrian violations, the comparison of pedestrians behaviour at crosswalks with and without a countdown timer during the clearance time was made, based on the data collected in the video recording. Chi square independency test showed that there is a statistically significant difference in the behaviour of pedestrians during the clearance time, depending on the existence of the timer, as well as the fact that pedestrians behave in a safer manner if there is no clearance time shown on the timer. The total delay rate on the roadway during the red signal, which was the consequence of starting the crossing during the clearance time or subsequent violations, was 1.3 times higher at the crosswalks with the countdown timer. This research was unique because for the first time, two-phase pedestrian crossings on the roadway with the median refuge island in the sense of clearance time were analysed, in spite of the previous proof that pedestrians are more likely to commit violations during the red signal in that kind of roadway. Another novelty in the research was pedestrians following till the end of crossing, due to the possibility of subsequent violations. With the means of binary logistic regression, different factors which affect pedestrians’ behaviour during the clearance time have been determined and they differ depending on the existence of the timer. At the pedestrian crosswalks with the timer, contributing factors have been determined, such as gender, the number of waiting pedestrians, distractions, arrival time, and age. If there is no timer, the contributing factors are the following: the number of crossing pedestrians, distractions, group, position of pedestrians in relation to the vehicle, the number of traffic lanes, and age. Based on the obtained results, a new design of the pedestrian traffic lights was proposed. (shrink)

Musical performance requires the ability to master a complex integration of highly specialized motor, cognitive and perceptual skills developed over years of practice. It often means also being able to deal with a large amount of pressure within dynamic environments. Consequently, many musicians suffer from health-related problems and have a large number of physical and psychological complaints. Research has shown that making music can present challenges for musicians’ wellbeing. Therefore, our research aims to evaluate and analyze the wellbeing of two (...) distinct groups of respondents, college music students compared with amateur musicians in the French-speaking part of Switzerland, this second group serving as our comparison group. This article presents the results of a sample of 126 musicians (mean age ± SD = 22.4 ± 4.5 years, 71 male). The wellbeing was assessed through the World Health Organization Quality of Life-BREF questionnaire evaluating two general measures, Quality of Life and General health, and four specific dimensions, Physical health, Psychological health, Social relationships and Environment. The respondents’ Quality of Life was high on each measure: median scores were higher than 4 for the first two measures and higher than 70 for the four specific dimensions. Among the dimensions, respondents had the highest mean score for Social relationships and Physical health (74.0 and 73.8, respectively) and, finally, on Psychological health (70.3). Our overview of musicians’ wellbeing in Western Switzerland underlines the importance of helping musicians to be aware of their health in order to take care of themselves. This research offers an important insight into musicians’ health and point out the importance of involving different actors (teachers, administrators or support staff) to promote their wellbeing and empower musicians. (shrink)