Heterogeneity of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation based on latent profile analysis / 器官移植

Objective To explore heterogeneous subtypes of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation and the characteristics differences of different types of children after liver transplantation. Methods Seven hundred and forty-one children who underwent living-related liver transplantation were enrolled. The self-designed general information questionnaire, Chinese version of 5-Item World Health Organization Well-Being Index (WHO-5) and the parent-report version of the Strengths and Difficulties Questionnaire (SDQ) were filled out by their guardians. The scores of five dimensions of SDQ were used as the manifest variables of the model. The classification model of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation was constructed by latent profile analysis. The latent categories of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation were analyzed. The influencing factors of latent categories were analyzed by univariate analysis and logistic regression model. Results There were three latent categories of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation, including peer communication problem group (n=302), psychological and behavioral adaptation group (n=145) and psychological and behavioral adjustment difficulty group (n=294). The first two groups were merged into the psychological and behavioral health group (n=447), which had significant differences in the five dimensions and the total score of difficulties of SDQ compared with the psychological and behavioral adjustment difficulty group (n=294) (all P<0.001). Logistic regression analysis showed that age≤5 years old, primary disease of non-cholestatic liver disease, stem family were the risk factors for psychological and behavioral adjustment difficulties in pediatric recipients after liver transplantation. Female gender, high education levels of parents and high WHO-5 score of guardians were the protective factors for psychological and behavioral adjustment difficulties in pediatric recipients after liver transplantation (all P<0.05). Conclusions The psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation are heterogeneous. Medical staff should pay extensive attention to different characteristics of pediatric recipients after liver transplantation with different psychological and behavioral adaptation categories and adopt targeted screening and intervention strategies, aiming to improve psychological and behavioral adaptation outcomes of pediatric recipients after liver transplantation.

Avós que detêm a guarda judicial dos netos: que lugar é esse? / Grandmothers who have judicial custody of grandchildren: what places is it? / Abuelas que detienen la guardia judicial de los nietos: ¿que lugar es éste?

O objetivo geral desta pesquisa foi investigar, na perspectiva das avós, o lugar ocupado por elas nos contextos familiar e social, a partir do deferimento da guarda judicial de seus netos. Participaram cinco avós, de nível socioeconômico médio-baixo, que cuidam integralmente dos netos. Elas responderam a um questionário sociodemográfico e a uma entrevista. Esta foi analisada pela técnica da análise de conteúdo temática. Pode-se constatar que: 1) a solicitação da guarda foi uma consequência natural, uma vez que, em sua maioria, elas já cuidavam dos netos; 2) os motivos que as levaram a assumir os netos foram separação, encarceramento, negligência e morte dos genitores; 3) os ganhos obtidos com a guarda judicial foram a segurança de poder atender às necessidades dos netos, sem o risco de que eles lhes sejam retirados, e união na família; 4) todas se perceberam e são reconhecidas como mães dos netos (AU).

The general objective of this research was to investigate, from the perspective of the grandmothers, the place occupied by them in the family and social contexts, from the deferment of the judicial custody of their grandchildren. Five grandmothers, of medium-low socioeconomic status and fully caring for the grandchildren, participated. They answered a sociodemographic questionnaire and an interview. These were analyzed by the thematic content analysis technique. It can be verified that: 1) the request of the guard was a natural consequence, since, for the majority, they already took care of the grandchildren; 2) the motives that led them to assume the grandchildren were separation, incarceration, negligence and death of genitors 3) the gains obtained with judicial custody were the security of being able to attend the needs of grandchildren, without the risk that they would be taken away, and family union; 4) all perceive themselves and are recognized as mothers of the grandchildren (AU).

El objetivo general de esta investigación fue investigar, en la perspectiva de las abuelas, el lugar ocupado por ellas en los contextos familiar y social, a partir de la aceptación de la custodia judicial de sus nietos. Participaron cinco abuelas, de nivel socioeconómico medio-bajo y que cuidan íntegramente a los nietos. Ellas respondieron a un cuestionario sociodemográfico ya una entrevista. Esta fue analizada por la técnica del análisis de contenido temático. Se puede constatar que: 1) la solicitud de la guardia fue una consecuencia natural, ya que, en su mayoría, ellas ya cuidaban de los nietos; 2) los motivos que las llevaron a asumir los nietos fueron separación, encarcelamiento, negligencia y muerte de genitores; 3) las ganancias obtenidas con la guardia judicial fueron la seguridad de poder atender a las necesidades de los nietos, sin el riesgo de que ellos sean retirados de ellas, y la unión de la familia; 4) todas se percibieron y son reconocidas como madres de los nietos (AU)

What are the boundaries of legal guardianship in Alzheimer's disease? An evidence-based update in the context of the Brazilian Civil Code

The Brazilian Civil Code, which came into force in 2002, established a functional criterion for guardianship proceedings and introduced the concept of “limited guardianship,” applied to cases in which incapacity to exercise civil rights is partial. With population aging and the growth in the number of older people with cognitive impairments, such as Alzheimer’s disease (AD), the need to invoke legal remedies against elder abuse increased; however, difficulties in assessing capacity still lead to a majority of decisions in favor of plenary guardianship. The present article compiled data on capacity in AD subjects. The varying degrees of decision-making impairment at different stages of AD might be compatible with limited guardianship in milder cases of the disease.

Improvement of legal institutions of hospitalization of mentally disabled patients / 中国卫生政策研究

The institution of voluntary hospitalization should be improved by establishing the concept of prece-dent autonomy and surrogate decision-making. The institution of advance directives should also be established to pro-tect rights of autonomy for mentally disabled patients. The decision by the guardian provided by China’s Mental Health Law is one situation of surrogate decision-making rather than involuntary hospitalization. The provision of in-voluntary hospitalization, especially“damage”,“safety”, and“danger”, should be properly interpreted on the basis of balancing patient autonomy and social security. Serious mental disorders shall return to the essence of pure medical problems, and the determination of decision-making capacity should be a separate question. Unified criteria for the judgment of decision-making capacity should be established.

Research of immunization coverage of left-behind children and their guardians′immunization knowledge,attitudes and practice in rural areas of Chongqing / 重庆医学

Objective To investigate the immunization knowledge ,attitudes ,practice and requirements of the custodians of left‐behind/non‐left‐behind children in rural areas of Chongqing and to explore intervening measures .Methods Totally 1 441 com‐plete questionnaires were obtained by surveying the custodians of 1 year old left‐behind/non left‐behind children in 3 counties .Im‐munization records were checked to acquire vaccination information .Results Custodians of left‐behind children had poorer educa‐tion ,immunization knowledge and less comply with immunization behaviors than custodians of non‐left‐behind children .Village doc‐tors were essential to immunization work in rural areas .Conclusion We suggest pulling peer education in publicity and education for families with left‐behind children .It is important to mobilize the enthusiasm of village doctors ,and pay more attentions to the immunization work of left‐behind children .

Avós guardiões de baixa renda / Low income guardian grandparents

Esta pesquisa teve como objetivo geral investigar as vivências e percepções de avós que criam os netos. Participaram 10 avós (nove mulheres e um homem), com média de idade de 48 anos, de padrão socioeconômico baixo, que criavam entre um a cinco netos. Eles responderam a uma entrevista semi-estruturada que foi analisada por temas. Os principais resultados apontam que: os motivos que levaram os avós a criar os netos foram variados, destacando-se a gravidez na adolescência por parte de um filhoe sua separação; a iniciativa da criação, em geral, partiu dos próprios avós; os sentimentos experimentados são de satisfação e felicidade, em que pese a difícil situação financeira e a dificuldade para colocar limites nos netos; a relação com os pais das crianças se caracteriza por um distanciamento e não intromissão na criação dos avós; os filhos ajudam esporadicamente, e a criação deve continuar com os próprios avós.

This study had as a general goal to investigate about experiences and perceptions of grandparents who raise their grandchildren. The participants were ten grandparents (nine women and one man) whose average age was 48 years old, all them had low socioeconomic pattern and raised from one to five grandchildren. They answered questions of a semi-structured interview that was analyzed through themes. The main results point out that: the reasons that led grandparents to raise their grandchildren adolescence and the breakup of their relationships; the initiative of the upbringing, in general, came from the grandparents themselves; the feelings experienced by these are happiness and satisfaction, despite the burden of their difficult financial situation and the difficulties to set limits to their grandchildren; the relationship with the chilupbringing; parents help sporadically and the upbringing must be carried on by the grandparents.

P53: la historia sin final de un polifacético guardián / P53: the never-ending story of a multifaceted guardian

El gen p53 ha sido muy estudiado en los últimos años. Inicialmente su producto fue considerado como promotor tumoral; pero hoy en día no sólo se le reconocen sus bondades como un represor tumoral, sino que también juega un papel protagónico en otros procesos celulares como el mantenimiento de la integridad del genoma, la apoptosis, la senescencia y el desarrollo, entre otros. Pero, aún no se conoce los límites de sus alcances; sin embargo la información obtenida ha logrado transcender a las aplicaciones clínicas y probablemente falta mucho más por explorar y aplicar acerca de éste polifacético guardián.

The p53 gene has been extensively studied in recent years, with initial results considering it a tumor promoter. However, currently it is notonly recognized for being a tumor repressor, but also for playing a leading role in other cellular processes such as maintaining the integrity of the genome, apoptosis, senescence and development, among others. The limits of its scope are still unknown; however, the information obtained has transcended clinical applications and there is probably much more to explore and implement regarding this multifaceted guardian.

Age of consent in medical profession: A food for thought.

The concept of ‘consent’ comes from the ethical issue of respect for individual dignity as well as right to self determination. Indian Constitution covers issue of consent under Article 21 dealing with right to life with dignity. In law, the tort of battery is defined as ‘Application of force to the person of another without lawful justification’ and there in lies the essence of requirement of consent for any medical treatment. Consent has been defined to mean “voluntary agreement, compliance, or permission for a specified act or purpose”. [1] This paper deals with review of literature on the issue of ‘age of consent’ in medical profession, Civil and Criminal Laws in India, judicial pronouncements, medical literature, etc. some textbooks mentioned age of consent as 12 years and others 18 years, while others used the words like: major, adult, minor, child and guardian, etc. author has made a sincere effort to reach at a consensus about the age of consent in medical profession.

Dementia : Patient's right and physician's role.

An elderly Thai widow with progressive dementia was transferred to Siriraj Hospital for properly continued supportive treatment. Due to the course of the disease, she lacked the ability to make any valid decision related to giving consent to medical treatment and to manage her own affairs. Giving medical consent was a critical issue confronting the treating physician whereas the patient\'s relatives might face with the issue of administering her personal affairs and property. In order to establish the patient's lawful substitute decision maker and administration for the patient's best interest, a declaration of the patient\'s incompetency and the appointment of suitable guardian were needed. The legal proceedings would inevitably be undertaken by filing a petition to the court. This would also have profound implications for the patient's rights and the physician's roles under the justice system.