RESUMO
OBJECTIVES: To assess the cognitive capacity of early, middle, and late adolescents and their parents or guardians to provide informed consent to a population-based cohort study. STUDY DESIGN: Adolescent-parent/guardian dyads including 40 early (n = 80; 10-14 years), 20 middle (15-17 years), and 20 late (18-19 years) adolescents were recruited from the Rakai Community Cohort Study, an open demographic cohort in Uganda. Participants were administered the MacArthur Competence Assessment Tool for Clinical Research, a structured open-ended assessment; interviews were recorded and transcribed. Twenty transcripts were scored independently by two coders; the intraclass correlation coefficient was 0.89. The remaining interviews were scored individually. We compared mean scores for early and middle/late adolescents using a one-sided t test and score differences between parent/guardian and adolescent dyads using two-sided paired t tests. RESULTS: Early adolescents (mean score, 28.8; 95% CI, 27.1-30.5) scored significantly lower (P < .01) than middle/late adolescents (32.4; 31.6-33.1). In paired dyad comparisons, we observed no statistically significant difference in scores between parents/guardians and middle/late adolescents (difference, -0.2; 95% CI, -1.0-0.6). We found a statistically significant difference in scores between parents/guardians and early adolescents (difference, 3.0; 95% CI, 1.2-4.8). CONCLUSIONS: The capacity of adolescents-of different ages and in diverse settings-to comprehend risks, benefits, and other elements of informed consent is a critical but understudied area in research ethics. Our findings support the practice of having middle and late adolescents provide independent informed consent for sexual and reproductive health studies. Early adolescents may benefit from supported decision-making approaches.
Assuntos
Consentimento Livre e Esclarecido , Competência Mental , Humanos , Adolescente , Competência Mental/psicologia , Estudos de Coortes , Uganda , Consentimento Livre e Esclarecido/psicologia , Pais , Tomada de DecisõesRESUMO
The aim of this study was to compare gifted, with academic and artistic talent, and non-gifted students regarding overexcitability, as well as to investigate the perceptions of teachers from a specialized educational program for the gifted about their students' emotional development. The study included 150 students and six teachers. As instruments, we used participants characterization questionnaires, an overexcitability scale and a semi-structured interview script. Data were analyzed using inferential statistics and content analysis. The results indicated significant differences between gifted and non-gifted students in the patterns of intellectual and imaginative over-excitability, as well as a tendency for teachers to emotionally characterize gifted students with an emphasis on psychological disorders and weaknesses. To invest in educational strategies that use information derived from overexcitability patterns as facilitating tools for the learning process of the gifted can contribute to increasing student engagement at school, keeping them motivated. (AU)
O objetivo deste estudo foi comparar estudantes superdotados, com talento acadêmico e artístico, e não superdotados em relação às sobre-excitabilidades, bem como investigar a percepção de professores de um atendimento educacional especializado a alunos com altas habilidades/superdotação acerca do desenvolvimento emocional de seus estudantes. Participaram do estudo 150 discentes, além de seis professores. Como instrumentos foram utilizados questionários de caracterização dos participantes, escala de sobre-excitabilidade e roteiro de entrevista semiestruturado. Os dados foram analisados mediante estatística inferencial e análise de conteúdo. Os resultados indicaram diferenças significativas entre estudantes superdotados e não superdotados nos padrões de sobre-excitabilidades intelectual e imaginativa, bem como uma tendência dos professores em caracterizar emocionalmente os alunos superdotados com ênfase em transtornos e fragilidades psicológicas. Investir em estratégias educacionais que utilizem informações decorrentes dos padrões de sobre-excitabilidade como instrumentos facilitadores do processo de aprendizagem dos superdotados pode contribuir para aumentar o envolvimento dos alunos na escola, mantendo-os motivados. (AU)
El objetivo de este estudio fue comparar estudiantes superdotados, con talento académico y artístico, y no-superdotados en relación con la sobreexcitabilidad, así como investigar la percepción de docentes de un servicio educativo especializado para superdotados sobre el desarrollo emocional de sus alumnos. El estudio incluyó a 150 estudiantes y seis profesores. Como instrumentos se utilizaron cuestionarios de caracterización de los participantes, una escala de sobreexcitabilidad y un guión de entrevista semiestructurada. Los datos se analizaron mediante estadística inferencial y análisis de contenido. Los resultados indicaron diferencias significativas entre los superdotados y no-superdotados en las sobreexcitabilidades intelectual e imaginativa, así como una tendencia de los profesores a caracterizar emocionalmente a los superdotados con énfasis en los trastornos psicológicos y las debilidades. Invertir en estrategias educativas que utilicen información derivada de la sobreexcitabilidad como herramientas facilitadoras del proceso de aprendizaje de los superdotados puede contribuir a aumentar la participación de los estudiantes en la escuela, manteniéndolos motivados. (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Competência Mental/psicologia , Inteligência Emocional , Criança Superdotada/psicologia , Inquéritos e Questionários , Estudos de Amostragem , Entrevista , Imaginação , Testes de InteligênciaRESUMO
We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.
Assuntos
Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Adolescente , Fatores Etários , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estados UnidosRESUMO
Purpose The purpose of this study is to characterize narrative competence of typically developing bilingual children using Jamaican Creole (JC) and English. Method Story comprehension and fictional storytelling tasks in JC and English were completed by 104 bilingual preschoolers aged 4-6 years. Story comprehension was analyzed using inferential story comprehension questions representing Blank's Question Hierarchy. Fictional storytelling was analyzed using the Monitoring Indicators of Scholarly Language framework for narrative macrostructure and microstructure. Results Story comprehension was significantly correlated within each language, but only questions from Level 4 of Blank's Question Hierarchy showed significant correlations between languages. Fictional storytelling was significantly better in English than in JC for macrostructure (total score, internal response, plan, consequence) and microstructure (total score, adverbs, elaborated noun phrases). Story complexity in JC and English was significantly correlated. In terms of developmental effects, children's macrostructure and story complexity appear to be better at 4 years than 5 years, with English outperforming JC. Furthermore, age correlated with story comprehension in JC. Conclusion Comparison of narrative competence in bilingual children provides much needed insights into language development, with examination of JC and English bilinguals representing an understudied bilingual context.
Assuntos
Linguagem Infantil , Idioma , Competência Mental/psicologia , Multilinguismo , Narração , Negro ou Afro-Americano/psicologia , Criança , Pré-Escolar , Estudos de Coortes , Compreensão , Feminino , Humanos , Desenvolvimento da Linguagem , Testes de Linguagem , MasculinoRESUMO
OBJECTIVES: To examine older people's preferences for self-involvement in end-of-life care decision-making in scenarios of mental capacity (competency) and incapacity, and to identify associated factors. METHODS: A cross-sectional survey was conducted including 400 individuals aged 60+ years living in the city of Belo Horizonte, Brazil. RESULTS: Among 400 respondents, 95.3% preferred self-involvement when capable (due to the high percentage, associated factors were not calculated) and 64.5% preferred self-involvement when incapable through, for example, a living will. Considering that participants could choose multiple answers, the most frequent combinations in the capacity scenario were "yourself" and "other relatives" (76.8%) and "yourself" and "the doctor" (67.8%). In the incapacity scenario, the most frequent combinations were "yourself" and "other relatives" (usually their " children and, less often, their grandchildren) (59.3%) and "yourself" and "the doctor" (48.5%). Three factors were associated with a preference for self-involvement in an incapacity scenario. Those who were married or had a partner (widowed; adjusted odds ratio [AOR] = 0.37; 95% confidence interval [CI] 0.19-0.68) and those who were male (female; AOR = 0.62; 95%CI 0.38-1.00) were less likely to prefer self-involvement. Those who were younger, as in age bands 60-69 years (80+; AOR = 2.35; 95%CI 1.20-4.58) and 70-79 years (80+; AOR = 2.45; 95%CI 1.21-4.94), were more likely to prefer self-involvement. CONCLUSIONS: Most participants preferred self-involvement in both scenarios of capacity and incapacity. Preference for self-involvement was higher in the scenario of capacity, while preference for the involvement of other relatives (usually their children) was greater in the scenario of incapacity.
OBJETIVOS: O objetivo deste estudo foi examinar as preferências de pessoas idosas pelo autoenvolvimento na tomada de decisões nos cuidados de saúde em fim de vida em cenários de capacidade e incapacidade mental (competência), e identificar os fatores associados. METODOLOGIA: Foi realizado um estudo transversal, com 400 indivíduos, com idade 60 anos ou mais, residentes na cidade de Belo Horizonte, Brasil. RESULTADOS: Entre os 400 entrevistados, 95,3% preferiram o autoenvolvimento, quando capazes, na tomada de decisões (devido ao alt percentual, fatores associados não foram caculados); e 64,5% preferiram o autoenvolvimento, quando incapazes de tomar decisões, por meio, por exemplo, de um testamento em vida. Considerando que os participantes puderam escolher mais de uma resposta, as combinações mais frequentes para o cenário de capacidade foram: participantes e outros familiares (76,8%); e participantes e médicos (67,8%). No cenário de incapacidade, as combinações mais frequentes foram: participantes e outros familiares (geralmente filhos e netos) (59,3%); e participantes e médicos (48,5%). Três fatores foram associados à preferência pelo i-r autoenvolvimento em um cenário de incapacidade. Aqueles que eram casados ou com companheiro (viúvo; odds ratio ajustada (AOR) = 0,37; intervalo de confiança (IC) 95% 0,19-0,68) e os homens (mulheres; AOR = 0,62; IC95% 0,38-1,00) foram menos propensos a preferir o autoenvolvimento. Os mais jovens: 60-69 anos (80+; AOR = 2,35; IC95% 1,20-4,58) and 70-79 anos (80+; AOR = 2,45; IC95% 1,214,94) foram mais prováveis de preferir o autoenvolvimento. CONCLUSÕES: A maioria dos participantes preferiu o autoenvolvimento em ambos os cenários de capacidade e incapacidade. A preferência pelo autoenvolvimento foi maior no cenário de capacidade, enquanto a preferência pelo envolvimento de outros familiares (geralmente filhos) foi maior no cenário de incapacidade.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cuidados Paliativos , Saúde do Idoso , Competência Mental/psicologia , Brasil , Estudos Transversais , Tomada de DecisõesRESUMO
The study of early parental competences is relevant because such competences are related to children's development; however, most studies have considered competences using a variable-centered approach in which each parental competence is examined in isolation. This paper approaches these competences using a person-centered approach, generating profiles that combine different competences in Chilean mothers assessed when their children were aged 12 months and again at 30 months. The aim of this study was to generate and compare these profiles and to analyze the associations of these profiles with children's language and socioemotional skills. Mother-child interactions in the contexts of storytelling and free play were videotaped at two different times. Ninety mother-child dyads were assessed using the Adult Sensitivity Scale (E.S.A.), the Evaluation of the Mentalization of Significant Caregivers, the Checklist of Observations Linked to Outcomes (PICCOLO), Bayley's language scale and the Functional Emotional Assessment Scale (FEAS). Profiles of mothers' behaviors were identified through person-centered within-group analyses of six aspects: sensitivity, mentalization, affection, responsiveness, encouragement, and teaching. Cluster analyses yielded three similar profiles for mothers at both ages: highly competent, average competent, and poorly competent. The mothers' profiles were related to maternal age, socioeconomic status (SES) and educational level, and the mothers improved their profiles at the 30-month assessment. The mothers' profiles were related to children's language and socioemotional outcomes at both ages. These results and their applicability to promotion and intervention programs are discussed.
Assuntos
Linguagem Infantil , Emoções , Relações Interpessoais , Comportamento Materno/psicologia , Competência Mental/psicologia , Relações Mãe-Filho/psicologia , Adulto , Pré-Escolar , Chile/epidemiologia , Emoções/fisiologia , Feminino , Humanos , Lactente , Masculino , Comportamento Materno/fisiologia , Mães/psicologiaRESUMO
The study investigated, in a longitudinal cohort, predictive models of arithmetic competence (AC) in the 1st year from language and executive functions assessed at preschool age. A total of 71 children were evaluated in oral language skills, preliminary writing abilities and executive functions. In the 1st year, the children were also evaluated in AC. Parents provided information on the socioeconomic level and teachers indicated children with difficulties. Language, oral (phonological awareness and vocabulary) and preliminary writing (knowledge of letters, reading and writing of words) abilities, together with indications of difficulty by the teacher in the ECE, were able to explain a mean of 62% of the variability in AC in the 1st year. The findings reveal predictive variables for the performance in arithmetic in the initial stage of Elementary Education, which can assist in early identification and the design of preventive intervention models.
O estudo investigou, em um recorte longitudinal, modelos preditivos da competência aritmética (CA) no 1º ano a partir de habilidades de linguagem e funções executivas avaliadas em idade pré-escolar. Participaram 71 crianças que foram avaliadas em habilidades de linguagem oral, habilidades preliminares de escrita e funções executivas. No 1º ano, as crianças foram também avaliadas em CA. Pais proveram informações sobre nível socioeconômico e professores indicaram crianças com dificuldades no curso da EI. Habilidades de linguagem, oral (consciência fonológica e vocabulário) e preliminares de escrita (conhecimento de letras, leitura e escrita de palavras), juntamente com indicação de dificuldade pelo professor na EI, foram capazes de explicar média de 62% da variabilidade em CA no 1º ano. Os achados revelam variáveis preditoras do desempenho em aritmética em etapa inicial do Ensino Fundamental e estendem seu impacto para a identificação precoce e delineamento de modelos preventivos de intervenção.
El estudio investigó, en un recorte longitudinal, modelos predictivos de la competencia aritmética (CA) en el primer año a partir de habilidades de lenguaje y funciones ejecutivas evaluadas en edad preescolar. Participaron 71 niños que fueron evaluados en habilidades de lengua oral, habilidades preliminares de escritura y funciones ejecutivas. En el primer año, los niños también se evaluaron en CA. Los padres proporcionaron información sobre NSE y los profesores indicaron a los niños con dificultades en el curso de la EI. Las habilidades de lenguaje, oral (conciencia fonológica y vocabulario) y preliminares de escritura (conocimiento de letras, lectura y escritura de palabras), junto con indicación de dificultad por el profesor en la EI, fueron capaces de explicar media del 62% de la variabilidad en CA en 1er año. Los hallazgos revelan variables predictoras del desempeño en aritmética en etapa inicial de la Enseñanza Fundamental y expiden su impacto para la identificación precoz y delineamiento de modelos preventivos de intervención.
Assuntos
Humanos , Pré-Escolar , Aptidão , Criança , Educação Infantil , Competência Mental/psicologia , Cognição , Matemática , Brasil , Desempenho Acadêmico/psicologiaRESUMO
Even though the Bush Administration opened the Guantánamo Bay detention facility in 2002 in response to the September 11, 2001 attacks in the United States, little remains known about how forensic mental health evaluations relate to the process of detainees who are charged before military commissions. This article discusses the laws governing Guantánamo's military commissions system and mental health evaluations. Notably, the US government initially treated detainees as "unlawful enemy combatants" who were not protected under the US Constitution and the United Nations Convention Against Torture and Other Forms of Cruel, Inhuman or Degrading Treatment, allowing for the use of "enhanced interrogation techniques." In subsequent legal documents, however, the US government has excluded evidence obtained through torture, as defined by the US Constitution and the United Nations Convention Against Torture. Using open-source document analysis, this article describes the reasons and outcomes of all forensic mental health evaluations from Guantánamo's opening to 2018. Only thirty of 779 detainees (~3.85%) have ever had charges referred against them to the military commissions, and only nine detainees (~1.16%) have ever received forensic mental health evaluations pertaining to their case. Of these nine detainees, six have alleged mental torture while in US custody. This paper shows that leaders in the United States and Europe should consider whether counterterrorism policies that supersede traditional health and human rights complicate the ability of future governments to prosecute cases when successive leaders change laws, a pertinent consideration as North American and European states grapple with the return of foreign fighters.
Assuntos
Transtornos Mentais/diagnóstico , Prisioneiros/psicologia , Prisões , Adulto , Cuba , Feminino , Psiquiatria Legal/métodos , Humanos , Masculino , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Pessoa de Meia-Idade , Medicina Militar/métodos , Prisioneiros/estatística & dados numéricos , Terrorismo/legislação & jurisprudência , Terrorismo/psicologia , Tortura/psicologia , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI). DESIGN: Multicenter randomized controlled trial comparing 2 methods of conducting a social competency skills program, an interactive group format versus a classroom lecture. SETTING: Community and veteran rehabilitation centers. PARTICIPANTS: Civilian, military, and veteran adults with TBI and social competence difficulties (N=179), at least 6 months postinjury. INTERVENTIONS: The experimental intervention consisted of 13 weekly group interactive sessions (1.5h) with structured and facilitated group interactions to improve social competence, and the control consisted of 13 traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction. MAIN OUTCOME MEASURES: Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments after TBI. LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale, Posttraumatic Stress Disorder Checklist-C (PCL) civilian version, Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self-Efficacy (PSSE). RESULTS: Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and 2 of the secondary outcomes (LCQ and BSI) were seen immediately posttreatment and at 3 months posttreatment in the alternative treatment arm only; however, these improvements were not significantly different between the group interactive structured treatment and alternative treatment arms. Similar trends were observed for PSSE and PCL-C. CONCLUSIONS: Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study.
Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Competência Mental/psicologia , Reabilitação Psiquiátrica/métodos , Psicoterapia de Grupo/métodos , Transtorno de Comunicação Social/reabilitação , Adulto , Lesões Encefálicas Traumáticas/psicologia , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Centros de Reabilitação , Transtorno de Comunicação Social/psicologia , Habilidades Sociais , Resultado do Tratamento , Veteranos/psicologiaRESUMO
In Chile, more than 180 thousand people (1% of the population) have some form of dementia. The figure should increase to approximately 600,000 (3% of Chileans) by 2050. This disease poses major challenges to the society. One of them is the effective recognition of the autonomy and responsibility of the person living with this condition. This article aims to review the clinical assessment of competence, its agreement with the Chilean legal system and the challenges that the assessment of competence poses in clinical decision-making and the capacity of an individual make decisions, according to the new international obligations subscribed by Chile. It is concluded that inclusion is a pending challenge, reflected among other things, by the non-compliance with binding rules such as Article 12 of the Convention on the Rights of Persons with Disabilities, which affirms that persons with disabilities have the right to be recognized as a person everywhere, before the law.
Assuntos
Humanos , Competência Mental/legislação & jurisprudência , Pessoas com Deficiência Mental/legislação & jurisprudência , Tomada de Decisões , Demência/psicologia , Consentimento Livre e Esclarecido/legislação & jurisprudência , Testes Psicológicos , Chile , Competência Mental/psicologia , Pessoas com Deficiência Mental/psicologia , Autonomia Pessoal , Avaliação da Deficiência , Consentimento Livre e Esclarecido/psicologiaRESUMO
In Chile, more than 180 thousand people (1% of the population) have some form of dementia. The figure should increase to approximately 600,000 (3% of Chileans) by 2050. This disease poses major challenges to the society. One of them is the effective recognition of the autonomy and responsibility of the person living with this condition. This article aims to review the clinical assessment of competence, its agreement with the Chilean legal system and the challenges that the assessment of competence poses in clinical decision-making and the capacity of an individual make decisions, according to the new international obligations subscribed by Chile. It is concluded that inclusion is a pending challenge, reflected among other things, by the non-compliance with binding rules such as Article 12 of the Convention on the Rights of Persons with Disabilities, which affirms that persons with disabilities have the right to be recognized as a person everywhere, before the law.
Assuntos
Tomada de Decisões , Demência/psicologia , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Pessoas com Deficiência Mental/legislação & jurisprudência , Chile , Avaliação da Deficiência , Humanos , Consentimento Livre e Esclarecido/psicologia , Competência Mental/psicologia , Autonomia Pessoal , Pessoas com Deficiência Mental/psicologia , Testes PsicológicosRESUMO
INTRODUCTION: Schizophrenia and bipolar disorder type I (BD-I) can affect patient autonomy and capacity to consent to participate in research. Other variables associated with the autonomy of patients must be explored in order to improve the quality of the currently available tools. OBJECTIVE: To evaluate the relationship between insight and the capacity to consent to participate in research in patients with BD-I and schizophrenia. METHODS: A cross-sectional and longitudinal study was conducted with 120 subjects (40 subjects with schizophrenia, 40 with BD-I, and 40 healthy controls). The tools used were the Scale Assessment Insight-Expanded (SAI-E) and the MacArthur Competence Assessment Tool-Treatment (MacCAT-CR), which was first adapted culturally, and its validity and reliability assessed. The results obtained on each scale were compared and the association between them were evaluated. RESULTS: There is a direct correlation between the capacity to consent to research, measured using the MacCAT-CR tool, and the degree of insight, measured using the SAI-E scale, with an effect size of 1.3 for BD-I and 2.03 for schizophrenia. CONCLUSIONS: The results suggest that there is a correlation between the degree of insight and the capacity to consent to research in subjects with schizophrenia and BD-I. Insight should therefore be included as a relevant variable to assess the capacity to consent, and future studies should include it when researching on or designing new tools which aim at a greater respect of patient autonomy.
Assuntos
Transtorno Bipolar/psicologia , Compreensão , Consentimento Livre e Esclarecido/psicologia , Competência Mental/psicologia , Psicologia do Esquizofrênico , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Testes Psicológicos , Reprodutibilidade dos TestesRESUMO
Con el aumento de la población de adultos mayores, se plantean importantes retos a nivel internacional. Los estudios se focalizaron en factores demográficos, cognitivos y físicos, en cambio, los emocionales fueron escasamente investigados en esta etapa vital. El objetivo de este estudio es evaluar el patrón de competencias socioemocionales en 53 adultos mayores (M =69; DE =4.2), de ambos sexos, y comparar sus diferencias con 53 jóvenes adultos. A todos los participantes se les administró el Inventario de Competencias Socioemocionales (ICSE; Mikulic, 2013). Los resultados indican que los adultos mayores muestran significativamente mayor optimismo, asertividad, regulación emocional y autonomía, a diferencia de los más jóvenes. Estos hallazgos pueden permitir diseñar intervenciones focalizadas en el aprendizaje de nuevas competencias. Asimismo, permitirían potenciar y mejorar competencias adquiridas pero no desarrolladas aún, con el fin último de que el adulto mayor pueda contar con recursos para afrontar los cambios inherentes a esta etapa vital...
Assuntos
Humanos , Pessoa de Meia-Idade , Competência Mental/psicologia , Emoções , Pessoa de Meia-Idade/psicologia , ArgentinaRESUMO
Realizou-se pesquisa de tese em História Social, sob a vertente da História Oral, com o objetivo de avaliar a política de saúde mental do município de Quixadá, no período de 1993 a 2012. Foram selecionados quatro depoimentos de pessoal diretamente responsável pela construção da política, em sua primeira gestão: o prefeito, o supervisor de serviço, um auxiliar de Enfermagem e um médico. Os depoimentos foram analisados utilizando como referencial teórico a ética da alteridade radical. Consensualmente, os depoimentos apontavam para o entendimento de que, além de o paciente e sua família precisarem de cuidados, intervenções se faziam necessárias no sentido de apresentar a loucura à cidade, como forma de diminuir o preconceito. Sugere-se, a partir dos relatos dessa boa prática, a criação de um novo critério de avaliação dos serviços em saúde mental, qual seja, sua efetividade em gerar, na sociedade, novas formas de lidar com a diferença e com o outro...
We conducted thesis research in Social History, under the aspect of Oral History in order to assess the mental health policy of the city of Quixadá, Brazil, from 1993 to 2012. Testimonials from four directly responsible personnel were selected for the construction of politics in their first term: the mayor, the service supervisor, a nursing assistant and a physician. The interviews were analyzed using as a theoretical ethics of radical otherness. Consensually, the testimonies pointed to the understanding that, in addition to the patient and his family need care, interventions were necessary in order to present to the city madness as a way to reduce prejudice. It is suggested, based on the reports of this good practice, the creation of a new criterion for the evaluation of mental health services, namely, its effectiveness in generating, in society, new ways of dealing with difference and with each other...
Assuntos
Humanos , Comportamento Social/história , Avaliação em Saúde , Pessoas Mentalmente Doentes , Marginalização Social/história , Política de Saúde , Serviços de Saúde Mental/tendências , Brasil , Competência Mental/psicologiaRESUMO
OBJECTIVES: To assess the views of physicians in training regarding the informed consent as autonomous authorization in pediatrics and to discuss the limiting effects of the competence norm in this field. METHODS: We conducted a multi-institutional survey with 158 medical residents in order to assess the views of physicians in training regarding the informed consent as autonomous authorization in pediatrics. The study was conducted with volunteer participants, from a limited geographical area (Bucharest and surrounding areas). RESULTS: Most respondents strongly agreed that a patient aged 16-18 years should make informed medical decisions regarding any type of procedures (including reproductive choices), whilst those aged 14-16 should be allowed to take informed medical decisions regarding minor procedures only. Most participants agreed that transplant procedures involving bone marrow should be allowed between siblings if they approve, whilst most disagreed allowing solid organ transplantation. The involvement of children in clinical studies should only be allowed if the children agree. CONCLUSIONS: The responses obtained in our study regarding the informed consent put it closer to the autonomic authorization sense than the effective authorization sense. Therefore, respondents' moral intuition is more bioethical and less legal, which, even if maximizing the patient's benefit, is associated with an increased liability risk. However, since the newer generations become more and more precocious, a reanalysis of the classical competence dogmas should be conducted.
Assuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/psicologia , Médicos/psicologia , Criança , Tomada de Decisões , Humanos , Consentimento Livre e Esclarecido/ética , Relações Pais-Filho , Pais , Participação do Paciente , Pediatria , Relações Médico-Paciente , RomêniaRESUMO
OBJETIVOS: Analisar o ponto de vista de médicos em treinamento a respeito do consentimento informado como autorização autônoma em pediatria e discutir os efeitos limitantes da norma de competência nesse campo. MÉTODOS: Foi realizado um estudo multi-institucional com 158 residentes de medicina com o intuito de analisar o ponto de vista de médicos em treinamento a respeito do consentimento informado como autorização autônoma em pediatria. A participação no estudo foi voluntária, e os participantes eram provenientes de uma área geográfica limitada (Bucareste e arredores). RESULTADOS: A maioria dos respondentes concordou totalmente que um paciente entre 16 e 18 anos deve tomar decisões médicas informadas sobre qualquer tipo de procedimento (inclusive os referentes a escolhas reprodutivas); enquanto que pacientes entre 14 e 16 anos devem ser autorizados a tomar decisões médicas informadas apenas a respeito de procedimentos menores. A maioria concordou que transplantes de medula óssea devem ser permitidos entre irmãos se aprovados por ambos, enquanto que a maioria não concorda com o transplante de órgãos sólidos. A participação de crianças em estudos clínicos deve ser permitida apenas se a criança concordar. CONCLUSÕES: As respostas obtidas em nosso estudo sobre o consentimento informado aproximam-no mais do sentido de autorização autônoma do que do sentido de autorização efetiva. Portanto, a intuição moral dos participantes é mais bioética e menos jurídica, o que, embora maximize os benefícios do paciente, está associado a um aumento no risco de responsabilidade. No entanto, visto que as gerações mais novas tornam-se cada vez mais precoces, é preciso reavaliar os dogmas tradicionais a respeito da competência.
OBJECTIVES: To assess the views of physicians in training regarding the informed consent as autonomous authorization in pediatrics and to discuss the limiting effects of the competence norm in this field. METHODS: We conducted a multi-institutional survey with 158 medical residents in order to assess the views of physicians in training regarding the informed consent as autonomous authorization in pediatrics. The study was conducted with volunteer participants, from a limited geographical area (Bucharest and surrounding areas). RESULTS: Most respondents strongly agreed that a patient aged 16-18 years should make informed medical decisions regarding any type of procedures (including reproductive choices), whilst those aged 14-16 should be allowed to take informed medical decisions regarding minor procedures only. Most participants agreed that transplant procedures involving bone marrow should be allowed between siblings if they approve, whilst most disagreed allowing solid organ transplantation. The involvement of children in clinical studies should only be allowed if the children agree. CONCLUSIONS: The responses obtained in our study regarding the informed consent put it closer to the autonomic authorization sense than the effective authorization sense. Therefore, respondents' moral intuition is more bioethical and less legal, which, even if maximizing the patient's benefit, is associated with an increased liability risk. However, since the newer generations become more and more precocious, a reanalysis of the classical competence dogmas should be conducted.
Assuntos
Criança , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/psicologia , Médicos/psicologia , Tomada de Decisões , Consentimento Livre e Esclarecido , Relações Pais-Filho , Pais , Participação do Paciente , Pediatria , Relações Médico-Paciente , RomêniaRESUMO
A large proportion of human social neuroscience research has focused on the issue of decision-making. Impaired decision-making is a symptomatic feature of a number of neurodegenerative diseases, but the nature of these decision-making deficits depends on the particular disease. Thus, examining the qualitative differences in decision-making impairments associated with different neurodegenerative diseases could provide valuable information regarding the underlying neural basis of decision-making. Nevertheless, few comparative reports of decision-making across patient groups exist. In this Review, we examine the neuroanatomical substrates of decision-making in relation to the neuropathological changes that occur in Alzheimer disease, frontotemporal dementia, Parkinson disease and Huntington disease. We then examine the main findings from studies of decision-making in these neurodegenerative diseases. Finally, we suggest a number of recommendations that future studies could adopt to aid our understanding of decision-making cognition.
Assuntos
Tomada de Decisões/fisiologia , Demência/psicologia , Competência Mental/psicologia , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/psicologia , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Demência/diagnóstico , Função Executiva/fisiologia , Demência Frontotemporal/diagnóstico , Demência Frontotemporal/patologia , Demência Frontotemporal/fisiopatologia , Demência Frontotemporal/psicologia , Humanos , Doença de Huntington/diagnóstico , Doença de Huntington/patologia , Doença de Huntington/fisiopatologia , Doença de Huntington/psicologia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/patologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/patologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologiaRESUMO
BACKGROUND: In clinical tests, the Informed Consent is critical to preserve the ethics, but due to its high complexity level, it cannot be fully understood. This study assesses the Informed Consent as viewed by patients. OBJECTIVE: We addressed the issue of what do patients understand about the studies based on the IC. METHODS: We invited participants of outpatient clinical drug trials phase II, III and IV to answer a questionnaire with 29 questions, such as: why have you accepted to participate? Did you read the Informed Consent before signing it? By signing it, were you sure you have fully understood it? Eighty individuals (20 women and 60 men) showed up, from 106 patients. The variables of each question were considered as often as they appeared. The comparison of the averages among the groups was made by t tests of Student or Wilcoxon; and for associations, Chi-square or Likelihood Ratio, or Fisher's exact test. RESULTS: Ages averaged 58.7 +/- 9.3 years. Concerning their reasons to taking part in the survey, 66.2% pointed out their own benefit; 42.5%, for science's sake; 25.0% claimed they were doing so at their doctor's request; 50% did not understand the Informed Consent properly; and 32.9% did not read it, but signed it. Among those who were administered placebo after randomization (n = 47), 66.7% did not understand the meaning of the informed consent. A strong correlation between failure to understand the meaning of placebo with literacy level (p = 0,02) was verified, which is an evidence that the smaller is the literacy level, the smaller is the understanding level. CONCLUSION: The Informed Consent is poorly understood by patients and for some of them, trusting a doctor affected their decision in taking part in the clinical trial with drugs. Their literacy level also influenced their understanding of the term 'placebo'.
Assuntos
Ensaios Clínicos como Assunto , Compreensão , Consentimento Livre e Esclarecido/psicologia , Competência Mental/psicologia , Cardiologia , Distribuição de Qui-Quadrado , Escolaridade , Feminino , Humanos , Consentimento Livre e Esclarecido/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Motivação , Estatísticas não ParamétricasRESUMO
Fundamento: Em ensaios clínicos, o Termo de Consentimento Livre e Esclarecido (TCLE) é fundamental para preservar a ética, mas pela sua complexidade ele pode não ser entendido completamente. Neste estudo, avaliamos o entendimento do TCLE pelo paciente. Objetivo: Abordamos a questão sobre o nível de compreensão dos pacientes em relação aos estudos baseados no Consentimento Informado. Métodos: Convidamos participantes de pesquisa ambulatorial fases II, III e IV, com fármacos, para responder um questionário estruturado com 29 questões, tais como: por que aceitou participar? Leu o TCLE antes de assinar? Ao assiná-lo, estava certo de tê-lo entendido? Oitenta indivíduos (20 mulheres e 60 homens) compareceram, num universo de 106 pacientes. As variáveis de cada questão foram consideradas por frequência de ocorrência. A comparação entre as médias entre os grupos foi realizada pelos testes t de Student ou Wilcoxon; e para associações, o Qui-quadrado ou Razão de Verossimilhança, ou teste exato de Fisher. Resultados: A média das idades foi de 58,7 ± 9,3 anos. Das motivações para participar da pesquisa, 66,2 por cento apontaram seu próprio benefício; 42,5 por cento, o bem da ciência; 25,0 por cento alegaram atender a um pedido de seu médico; 50 por cento não entenderam corretamente o TCLE; e 32,9 por cento sequer o leram, mas o assinaram. Dentre os que receberam placebo após a randomização (n = 47), 66,7 por cento não entenderam o significado deste termo. Houve forte correlação entre o não entender o significado de placebo com a escolaridade (p = 0,02), evidenciando que quanto menor o nível de instrução, menor este entendimento. Conclusão: O TCLE é pouco compreendido pelos pacientes e para alguns deles a confiança no médico teve impacto na decisão de participar do ensaio clínico com fármaco, havendo também influência do nível de instrução dos sujeitos no entendimento do termo "placebo".
Background: In clinical tests, the Informed Consent is critical to preserve the ethics, but due to its high complexity level, it cannot be fully understood. This study assesses the Informed Consent as viewed by patients. Objective: We addressed the issue of what do patients understand about the studies based on the IC. Methods: We invited participants of outpatient clinical drug trials phase II, III and IV to answer a questionnaire with 29 questions, such as: why have you accepted to participate? Did you read the Informed Consent before signing it? By signing it, were you sure you have fully understood it? Eighty individuals (20 women and 60 men) showed up, from 106 patients. The variables of each question were considered as often as they appeared. The comparison of the averages among the groups was made by t tests of Student or Wilcoxon; and for associations, Chi-square or Likelihood Ratio, or Fisher's exact test. Results: Ages averaged 58.7 ± 9.3 years. Concerning their reasons to taking part in the survey, 66.2 percent pointed out their own benefit; 42.5 percent, for science's sake; 25.0 percent claimed they were doing so at their doctor's request; 50 percent did not understand the Informed Consent properly; and 32.9 percent did not read it, but signed it. Among those who were administered placebo after randomization (n = 47), 66.7 percent did not understand the meaning of the informed consent. A strong correlation between failure to understand the meaning of placebo with literacy level (p = 0,02) was verified, which is an evidence that the smaller is the literacy level, the smaller is the understanding level. Conclusion: The Informed Consent is poorly understood by patients and for some of them, trusting a doctor affected their decision in taking part in the clinical trial with drugs. Their literacy level also influenced their understanding of the term "placebo".
Fundamento: En ensayos clínicos, el Formulario de Consentimiento Informado (FCI) es fundamental para que se preserve la ética, sin embargo por su complexidad él puede no comprenderse completamente. En este estudio, evaluamos la comprensión del FCI por parte del paciente. Objetivo: Abordamos la cuestión sobre el nivel de comprensión de los pacientes respecto a los estudios basados en el Consentimiento Informado. Métodos: Invitamos a los participantes de investigación clínica fase II, III y IV con fármacos para responder un cuestionario estructurado con 29 cuestiones, tales como: ¿Por qué aceptó participar?¿Leyó el FCI antes de firmarlo?¿Al firmarlo estaba seguro de haberlo entendido? Ochenta individuos (20 mujeres y 60 varones) comparecieron, en un total de 106 pacientes. Las variables de cada cuestión se llevaron a cabo por frecuencia de ocurrencia. La comparación entre los promedios entre los grupos se realizó mediante las pruebas t de Student o Wilcoxon; y para asociaciones, el Chi-cuadrado o Razón de Verosimilitud, o prueba exacta de Fisher. Resultados: El promedio de las edades fue de 58,7 ± 9,3 años. De las motivaciones para participar en la investigación, el 66,2 por ciento señaló su propio beneficio; un 42,5 por ciento, el bien de la ciencia; un 25,0 por ciento alegó atender a una petición de su médico; el 50 por ciento no comprendió correctamente el FCI; y un 32,9 por ciento tampoco leyó el formulario, pero lo firmó. Entre los que recibieron placebo tras la randomización (n = 47), un 66,7 por ciento no entendió el significado de este término. Hubo una fuerte correlación entre las personas que no entendían el significado de placebo con la escolaridad (p = 0,02), evidenciando que cuanto menor era el nivel de instrucción, menor era la comprensión. Conclusión: EL FCI es poco comprendido por los pacientes y para algunos de ellos la confianza en el médico tuvo impacto en la decisión de participar en el ensayo clínico con fármaco, habiendo...
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos como Assunto , Compreensão , Consentimento Livre e Esclarecido/psicologia , Competência Mental/psicologia , Cardiologia , Distribuição de Qui-Quadrado , Escolaridade , Consentimento Livre e Esclarecido/estatística & dados numéricos , Motivação , Estatísticas não ParamétricasRESUMO
Este trabalho explora as possibilidades de contribuição da psicanálise para a compreensão do processo de construção de identidade e busca de autonomia de adultos com limitação intelectual moderada. Parte da idéia de que estas pessoas apresentam formas diversas de subjetivação e que, como todos, ao longo da vida são passíveis de encontros e desencontros provocadores dos mais diversos sentimentos. Reconhece a importância dos aspectos orgânicos, e afastando-se dos mesmos, desenvolve a idéia de que, para além do substrato orgânico, os aspectos emocionais são fatores fundamentais para a construção da autonomia. A hipótese básica é a de que os limites e as possibilidades de aquisição da autonomia são variáveis e que os aspectos emocionais são importantes neste processo. Há aspectos da dependência ambiental que são insuperáveis nestes casos, o que não quer dizer que sejam fixos ou imutáveis. Mesmo levando-se em consideração as restrições impostas pela base orgânica dos quadros estudados, as ligações familiares, primordialmente representadas pela relação da mãe com seu filho, colocam-se como fator importante quando se propõe a compreender e trabalhar com estas pessoas. O trabalho aborda a articulação possível entre a dependência e a autonomia levantando algumas conseqüências: nas práticas sociais, na construção da subjetividade e nos tratamentos. Pretende desenvolver a idéia de que a teoria do desenvolvimento emocional primitivo de Winnicott traz uma importante contribuição para a compreensão deste processo.