Legal Guardians Research Articles

Queen Victoria’s ‘Liberated African’: Sarah ‘Sally’ Forbes Bonetta and Her Extraordinary Apprenticeship by the British Royal Family, 1850–1862

ABSTRACT In 1848, Dahomey’s army enslaved a five-year-old Yoruba girl, named Aina, whose fate on the surface was unusual. She was given as a ‘gift’ to a British diplomat who presented her to Queen Victoria in England in 1850. This girl was ‘liberated’ according to anti-slavery law that was applied to Africans taken off slave ships, and she can be identified as a ‘Liberated African’. The Queen’s special interest in Aina was expressed further through her baptism as Sarah Forbes Bonetta (c. 1843–1880), although she was generally known as ‘Sally’. Because of this relationship, British newspapers romanticized her as an ‘African princess’ who symbolized public endorsement of anti-slavery policy. Sally’s apprenticeship centres a fascinating story within the context of the suppression of the slave trade and imperial ambitions in Africa. While not captured on a ship, as 200,000 ‘Liberated Africans’ were, she was enslaved by Dahomey’s army, British diplomats ‘liberated’ her, and the Queen became her legal guardian until the age of 21. The Queen paid for her Christian education in Sierra Leone and England, and in 1862, arranged her marriage to James Pinson Labulo Davies, a wealthy merchant based in Lagos.

Considerations for Alternative Decision-Making When Transitioning to Adulthood for Youth With Intellectual and Developmental Disabilities: Policy Statement.

With advances in medical care, more youth with intellectual and/or developmental disabilities (IDD) are transitioning into adulthood. Patient- and family-centered, integrated care is warranted around this time of transition. Support teams (including the youth, caregivers, teachers, and pediatricians) should engage in transition planning, ideally starting between 12 and 14 years of age, to identify and develop resources to support the maturing youth's capacity for independent decision-making. Care teams should consider the varied levels of alternative decision-making support, which may include supported decision-making, medical proxy decision-making, power of attorney, and/or establishment of legal guardianship arrangements, to support the youth's health and well-being optimally. Ultimately, if independent decision-making is not appropriate, the goal for youth with IDD should be the least restrictive alternative, while preserving human rights and human dignity and promoting their autonomy. These considerations review alternative decision-making support, concepts, and legal requirements available for youth with IDD and their care teams. Pediatricians can support youth with IDD and their families in the transition process and decision-making autonomy by actively engaging the youth in care decisions, supporting needs for augmentative communication, fostering their expression of preferences and understanding of care decisions, and linking them to resources such as the medical-legal partnership model.

Reconstructed Mid-Face Lifting After Tissue Expansion by Suspending the Expander Capsule.

An obvious saggy tendency was observed in the expanded flaps from mid-facial reconstruction and resulted in an unsatisfactory postoperative cosmetic outcome. At the time of this writing, the authors introduced a novel technique of mid-face lifting to correct the phenomenon by suspending the expander capsule. From September 2018 to August 2023, 11 patients who had undergone our mid-face lifting technique were enrolled in our study. The expanded flap was divided into 2 layers during the surgical procedure. The upper layer, which consists of the skin and the subcutaneous layer, was lifted, and the lower layer, consisting of the expander capsule and SMAS system, was left at the base. Then a capsular flap was lifted from the base and folded upward to lift the reconstructed mid-face. The capsular flap was fixed in the temporal or mastoid region when the saggy tendency was corrected, and the mid-facial contour became symmetric. Finally, the upper layer was trimmed and fixed at the base. Facial movements were restricted after the surgery. The saggy tendency of all the expanded flaps was corrected, and the mid-facial symmetry was rebuilt immediately after the surgery. The effect were long-lasting at 3 months to 2 years of follow-ups. No serious postoperative complications occurred. The patients or their legal guardians were satisfied with the esthetic improvement. Reconstructed mid-face lifting with capsular flap was an effective and reliable way to correct the saggy tendency of a mid-facial expanded flap and rebuilt the mid-facial symmetry.

Effect of physical rehabilitation using oromotor stimulation, manual airway clearance technique, positioning, tactile and kinaesthetic stimulation (PROMPT) protocol on respiratory and neuromuscular function in neonatal respiratory distress syndrome (NRDS)- a protocol for randomized controlled trial

Background Neonatal Respiratory Distress Syndrome (NRDS) remains a significant challenge in neonatal care, often leading to respiratory compromise and neuromuscular dysfunction. While advances in medical management have improved outcomes, adjunctive therapies such as physical rehabilitation offer potential benefits yet require further investigation. This protocol outlines a randomized controlled trial aiming to evaluate the effect of Physical Rehabilitation using Oro Motor Stimulation, Manual Airway Clearance Technique, Positioning, Tactile, and Kinesthetic Stimulation (PROMPT) protocol on respiratory and neuromuscular function in neonates with NRDS. Methods The trial will include 38 neonates diagnosed with NRDS, randomly allocated into two groups: the intervention group receiving the PROMPT protocol alongside standard care, and the control group receiving standard care alone. The PROMPT protocol comprises a comprehensive approach targeting oromotor stimulation, manual airway clearance technique, optimal positioning, and tactile/kinesthetic stimulation. Outcome measures Primary outcomes will focus on respiratory parameters such as oxygenation index, ventilatory support requirements, and neuromuscular function assessed through muscle tone and reflexes. Secondary outcomes will encompass length of hospital stay, incidence of complications, and neurodevelopmental outcomes at follow-up. Results Data analysis will employ appropriate statistical methods to compare outcomes between the intervention and control groups, with adjustments for potential confounders. Ethical approval has been obtained, and informed consent will be obtained from parents or legal guardians before enrolment. Conclusion This trial protocol aims to provide valuable insights into the efficacy and safety of the PROMPT protocol as a rehabilitative intervention for NRDS. The findings may inform future clinical practice and contribute to optimizing care strategies for neonates with NRDS, ultimately improving their short- and long-term outcomes. Registration CTRI/2024/03/064911

Specialist nurse's health promotion work with the national childhood immunization programme: A qualitative study.

Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent childhood deaths due to disease. However, global coverage of childhood immunization has decreased throughout the world due to guardians' growing hesitancy towards immunizations. This study aims to describe how specialist nurses promote legal guardians to adhere to national childhood immunization programmes. This study had a qualitative design. Semistructured interviews with 11 specialist nurses, who were paediatric primary care nurses or nurse practitioners, were conducted. Data were analysed using qualitative content analysis. The findings, with four main categories including four subcategories, showed nurses using both local guidelines and national guidelines to promote guardians to adhere to the childhood immunization programme. The main intervention the nurses did to promote childhood immunization coverage was giving legal guardians general information about the programme. With hesitant guardians, adopting a person-centred approach towards the legal guardian improved adherence. Further research should focus on how specialist nurses can respond to guardians who decline immunization for their children, as this study identified difficulties in this area. Furthermore, research on guardians' perspectives towards childhood immunization may also help generate further effective guidance on how to promote immunization coverage among children.

Factors Influencing Willingness to Participate in Clinical Studies in Pediatric Anesthesia (FILIPPA): A vignette-based, structured interview study.

Informed consent is a relevant backdrop for conducting clinical trials, particularly those involving children. While several factors are known to influence the willingness to consent to pediatric anesthesia studies, the influence of study design on consenting behavior is unknown. To quantify the impact of study complexity on willingness to consent to pediatric anesthesia studies. We conducted a vignette-based interview study by presenting three hypothetical studies to 106 parents or legal guardians whose children were scheduled to undergo anesthesia. These studies differed in level of complexity and included an example of a prospective observational study, a randomized controlled trial, and a phase-II-pharmacological study. Primary outcome was the willingness to consent, using a 5-point Likert scale ranging from "absolutely consent" to "absolutely decline". Secondary outcomes were the effects of child-related (such as sex, age, previous anesthesia, research exposure) and proxy-related factors. Response probabilities for "absolute consent" were 90.9% [95% CI 85.3-96.5] for the observational study, 48.6% [95% CI 38.3-58.9] for the randomized controlled trial, and 32.7% [95% CI 23.9-41.6] for the phase-II-pharmacological study. Response probabilities for "absolutely decline" were 1.6% [95% CI 0.3-2.8], 14.4% [95% CI 8.3-20.5], and 24.7% [95% CI 16.6-32.7], respectively. Significant effects were found for previous research exposure (OR = 0.486 [95% CI 0.256-0.923], p = .027), older age (OR = 0.963 [95% CI 0.927-0.999], p = .045) and the gender of the parent or legal guardian, as mothers were less willing to consent (OR = 0.234 [95% CI 0.107-0.512], p < .001). Willingness to consent decreased with increasing level of study complexity. When conducting more complex studies, greater efforts need to be made to increase the enrollment of pediatric patients.

Clinical manifestations and long-term symptoms associated with SARS-CoV-2 omicron infection in children aged 0-17 years in Beijing: a single-center study.

The study aims to analyze the clinical characteristics of acute phase of SARS-CoV-2 infection in children aged 0-17 years with the Omicron variant, and summarize the persistent symptoms or new-onset clinical manifestations from 4 to 12 weeks after acute COVID. Explore the association between the vaccination status and SARS-CoV-2 neutralizing antibody levels post infection among preschool-aged children. The comprehensive study systematically describes the clinical characteristics of children infected with SARS-CoV-2, providing a foundation for diagnosis and evaluating long-term COVID in pediatric populations. The study enrolled children who were referred to the Children's Hospital, Capital Institute of Pediatrics, (Beijing, China) from January 10, 2023 to March 31, 2023. Participants were classified as infant and toddlers, preschool, school-age, and adolescent groups. Children or their legal guardians completed survey questionnaires to provide information of previous SARS-CoV-2 infection history, as well as clinical presentation during the acute phase and long-term symptoms from 4 to 12 weeks following infection. Furthermore, serum samples were collected from children with confirmed history of SARS-CoV-2 infection for serological testing of neutralizing antibodies. The study recruited a total of 2,001 children aged 0-17 years who had previously tested positive for SARS-CoV-2 through nucleic acid or antigen testing. Fever emerged as the predominant clinical manifestation in 1,902 (95.1%) individuals with body temperature ranging from 37.3 to 40.0°C. Respiratory symptoms were identified as secondary clinical manifestations, with cough being the most common symptom in 777 (38.8%) children, followed by sore throat (22.1%), nasal congestion (17.8%), and runnning nose (17.2%). Fatigue (21.6%), headache (19.8%) and muscle-joint pain (13.5%) were frequently reported systemic symptoms in children. The proportion of children with symptoms of SARS-CoV-2 infection varied across age groups. 1,100 (55.0%) children experienced persistent symptoms from 4 to 12 weeks post the acute phase of infection. Trouble concentrating (22.1%), cough (22.1%), and fatigue (12.1%) were frequently reported across age groups in the extended period. A limited number of children exhibited cardiovascular symptoms with chest tightness, tachycardia, and chest pain reported by 3.5%, 2.5%, and 1.8% of children, respectively. Among 472 children aged 3-5 years, 208 children had received two doses of SARS-CoV-2 vaccine at least 6 months prior to infection, and no association was found between the incidence of long-term COVID and pre-infection vaccination statuses among the 3-5 years age groups (χ2 = 1.136, P = 0.286). In children aged 0-17 years infected with SARS-CoV-2 Omicron variant, fever was the primary clinical manifestation in the acute phase, followed by respiratory symptoms, systemic non-specific and digestive presentations. In particular, respiratory and digestive system symptoms were more frequent in children aged above 6 years. Regarding the long-term symptoms from 4 to 12 weeks post-infection, the most common presentations were concentrating difficulty, cough, and fatigue. The incidence of persistent symptoms of SARS-CoV-2 did not exhibit a significant correlation with vaccination status, which was attributed to the waning efficacy of the vaccine-induced humoral immune response after 6 months.

Diverging medical and legal perceptions of the need for legal guardianship in people with dementia: A qualitative study.

Dementia is assumed to alter mental capacity, which may necessitate legal guardianship. However, only limited research exists on how dementia affects mental capacity, and most studies have focused solely on a medical perspective and concentrate on memory functions. The aim of this qualitative study was to investigate physicians' and legal experts' perceptions on a broad range of cognitive and neuropsychiatric domains potentially affecting mental capacity and the need for guardianship in people with dementia. Physicians (N = 30) and legal experts (N = 20) participated in semi-structured individual interviews. The data were analyzed by using content analysis and further semi-quantified according to the cognitive and neuropsychiatric domains. Physicians considered neuropsychiatric symptoms and executive dysfunction to be the most important deficits in the legal context, while legal experts highlighted episodic memory impairment and dyscalculia. Perceptions regarding the importance of several cognitive and neuropsychiatric symptoms varied between and within the professional groups. Physicians and legal experts diverged in their perceptions of cognitive and neuropsychiatric domains affecting mental capacity and the need for guardianship. The evaluation and influence of medical evidence among legal experts heavily rely on subjective opinions. Given the substantial potential impact on patients' equal access to their rights, developing standardized guidelines is essential.

Apilot study evaluating stress factors during and after the COVID-19 pandemic in Viennese families who have the suspicion of child maltreatment or abuse.

The global population was affected by the unprecedented coronavirus COVID-19 pandemic. The impact of the pandemic on children who suffer child maltreatment has not been explored sufficiently. Child abuse is known to increase in stressful circumstances, and therefore potentially during this pandemic.We aimed to identify and measure the impact of pandemic-related stress in families with asuspicion or confirmed child maltreatment. In addition, other parameters were determined, including resilience factors and family dynamics.We conducted apilot study at the Medical University of Vienna, Forensic Examination Centre for Children and Adolescents (FOKUS Safeguarding team). Parents, carers and legal guardians of children who were referred for potential child abuse (study group) participated by completing two questionnaires, one year apart, covering the following periods: pre-COVID, during-COVID and post-COVID. Simultaneously, acontrol group was devised with patients who presented to the Paediatric Emergency Department with unrelated conditions (other than child maltreatment concerns). The questionnaires addressed psychological stress factors and were completed face-to-face and/or via telephone. Atotal of 35carers participated, with almost equal numbers in both intervention and control groups.Results show that there was statistically significantly higher stress level perception before and during the pandemic period in the study group. Several families in this group commented on the positive effect of support received from health professionals, especially after the pandemic.

Health Care for Unaccompanied Immigrant Children in US Communities: A Guide for Pediatric Practitioners.

Children who arrived at the United States border without a parent or legal guardian (ie, unaccompanied children) are present in communities throughout the country in growing numbers. For them to receive the highest-quality medical and mental services available, pediatric practitioners should have a foundational understanding of their unique set of circumstances and experiences. However, formal education on how to care for this specific immigrant subpopulation is not routinely incorporated into pediatric training programs, and limited clinical guidance is available in the published literature. This article provides best-practice recommendations for pediatric practitioners caring for unaccompanied children after their release from government custody, incorporating guidance for clinical encounters as well as suggestions of processes to meet their health-related social needs and advocacy actions to improve their well-being. [Pediatr Ann. 2024;53(5):e178-e182.].

Di Sebalik Isu Perkahwinan Nadrah: Tumpuan Terhadap Pandangan Ahmad Luthfi dalam Majalah Qalam (1950–1963)

The issue of Nadrah began to draw the attention of the world community in the early 1950s due to the trial of custody rights between her Malay adoptive mother and her Dutch biological parents. This event sparked a major polemic since it touched the sensitivities of the Malays and Muslims. Among the dominant issues in the Nadrah tragedy was the issue of Nadrah’s marriage, which had become the main topic in the newspapers and magazines at that time, including the Qalam magazine. Compared to other print media, the Qalam magazine seemed to emphasise more on reports that were based on Islamic beliefs and morals in relation to the issue of Nadrah. In relation to this, the current study examined the perception of Ahmad Luthfi, as a founder, publisher, and author of the Qalam magazine, on the issue of Nadrah’s marriage from the aspects of age limit for marriage, Islamisation and faith, women’s freedom, the role of kadi (a judge)/wali (Islamic legal guardian) and Islamic administrative law. The resources and materials in this article were obtained from the National Archives of Malaysia, Tun Sri Lanang Universiti Kebangsaan Malaysia Library, Universiti Malaya (UM) Main Library, UM Za’ba Memorial Library, UM Ahmad Ibrahim Library, UM Academy of Islamic Studies Library, and other sources. The findings of the study show that Ahmad Luthfi had a clear perception of the Islamic law based on the Al-Quran and Hadith. He would not compromise with those who undermined Islamic law. His views had invited positive and negative reactions from various parties.

Conflicting Expectations of Interpreters’ Roles in the Interaction between Guardians and Unaccompanied Minors

Abstract Public service interpreters assume a key role in rendering accessible social services to newcomer clients. They could even be considered inherent to social work settings that are multilingual in nature, such as the interactional context of unaccompanied minors and their legal guardians. However, despite the intrinsic linguistic diversity and the unique position of interpreters in this setting, guardian–minor encounters remain unexplored in research. The current study therefore aims to provide insight into the multilingual needs and challenges in these encounters, focussing particularly on the roles interpreters play in this setting and how they are perceived to affect the interaction. To this end, the study draws on twelve semi-structured interviews with guardians of unaccompanied minors, collected as part of a research project examining the impact of multilingual strategies on the communication and relationship between guardians and minors in Belgium. Through thematic analysis, the study explores guardians’ insecurities, revealing confusion about the professional status of interpreters, concerns about interpretation quality and conflicting expectations of what interpreters should (not) do. The study provides recommendations with a view to improving both the confidence of guardians and the efficiency of guardian–minor interactions, and highlights the relevance of the findings for various other social work settings.

Parental burnout during COVID-19: The moderating role of anxiety and family functioning.

Parental burnout (PB) is characterised by parental exhaustion resulting from exposure to chronic parental stress. Due to the social and economic changes resulting from the COVID-19 pandemic that impacted families, there is a significant scientific interest in identifying factors related to PB within the pandemic context. This study aimed to analyse the relationships between parental stress (parental concerns, parental satisfaction, lack of control, and fears and anxieties), family functioning, psychological morbidity (anxiety and depression), and burnout in parents. The sample consisted of 253 parents, legal guardians or primary caregivers of children aged between 0 and 6years. Results revealed that the child's age, psychological morbidity (depression), and parental stress were significant predictors of PB. Anxiety and family functioning played a moderating role in the relationship between parental satisfaction and PB. According to the results, intervention programs should focus on anxiety symptoms and family functioning to mitigate the effects of parental stress on PB.

Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

The Accreditation Council for Graduate Medical Education (ACGME) requires that all graduate medical education (GME) programs provide at least 6 paid weeks off for medical, parental, and caregiver leave to residents. However, it is unclear whether all orthopaedic residency programs have adapted to making specific parental leave policies web-accessible since the ACGME's mandate in 2022. This gap in policy knowledge leaves both prospective and current residents in the dark when it comes to choosing residency programs, and knowing what leave benefits they are entitled to when having children during training via birth, surrogacy, adoption, or legal guardianship. (1) What percentage of ACGME-accredited orthopaedic surgery residency programs provide accessible parental leave policies on their program's website, their GME website, and through direct contact with their program's administration? (2) What percentage of programs offer specific parental leave policies, generic leave policies, or defer to the Family and Medical Leave Act (FMLA)? As indicated in the American Medical Association's 2022 Freida Specialty Guide, 207 ACGME-accredited orthopaedic residency programs were listed. After further evaluation using previous literature's exclusion criteria, 37 programs were excluded based on osteopathic graduate rates. In all, 170 ACGME-accredited allopathic orthopaedic surgery residency programs were identified and included in this study. Three independent reviewers assessed each program website for the presence of an accessible parental leave policy. Each reviewer accessed the program's public webpage initially, and if no parental leave policy was available, they searched the institution's GME webpage. If no policy was found online, the program administrator was contacted directly via email and phone. Available leave policies were further classified into five categories by reviewers: parental leave, generic leave, deferred to FMLA, combination of parental and FMLA, and combination of parental and generic leave. Our results demonstrated that 6% (10 of 170) of orthopaedic residency programs had policy information available on their program's main orthopaedic web page. Fifty nine-percent (101 of 170) of orthopaedic residency programs had a clearly stated policy on their institution's GME website. The remaining 35% (59 of 170) had no information on their public website and required direct communication with program administration to obtain policy information. After directly contacting program administration, 12% (21 of 170) of programs responded to researchers request with a PDF explicitly outlining their policy. Twenty-two percent (38 of 170) of programs did not have an accessible policy available. Of the programs that had available policies, a total of 53% (70 of 132) of programs were categorized as offering explicit parental leave policies, 9% (12 of 132) were categorized as offering general leave policies, and 27% (36 of 132) deferred to FMLA. Seven percent (9 of 132) offered combined parental leave policies with FMLA, and 4% (5 of 132) offered combined general leave policies with FMLA. Although most ACGME-accredited allopathic orthopaedic surgery residency programs met the ACGME requirement of written parental leave policies in 2023, a small minority of programs have clear, accessible parental leave policies provided on their webpage. Parental leave policies should be easily accessible to prospective and current trainees and should clearly state compensation and length of leave. Ensuring orthopaedic surgery residency programs provide accessible and transparent parental leave policies is important for maintaining diversity in prospective applicants and supporting the work-life balance of current residents.

Co-infection of Helicobacter pylori and intestinal parasites in children of selected low-income communities in Lagos State, Nigeria

Helicobacter pylori and intestinal parasites cause gastrointestinal diseases with a high prevalence in children in resource limited developing countries. There is paucity of information in Nigeria on co-infection of H. pylori and intestinal parasites. The study was conducted to determine the prevalence of H. pylori and parasite co-infection in children from selected low-income communities in Lagos, Nigeria. Fecal samples were collected from 151 healthy children aged ≤11 years across six low-income communities in Lagos. H. pylori was detected using stool antigen test and conventional PCR assay, intestinal parasites were detected using formol-ether concentration and nested PCR assay. Structured questionnaires were administered to parents and legal guardians of the children by an interviewer to collect relevant data on demographic and lifestyle factors. The prevalence of H. pylori was 31.79% (48), with a higher prevalence in children aged 2–3 years. The prevalence of intestinal parasites was 21.19% (32) with the lowest frequency found in children aged 8–9 years. The parasites detected include: A. lumbricoides (10.6%), G. intestinalis (7.3%), hookworm (1.99%), E. histolytica (0.66%), S. mansoni (0.66%). There was co-infection prevalence of 10.6% (16) which was associated with the parasites: G. intestinalis (7.3%) and A. lumbricoides (3.97%). Polyparasitism with G. intestinalis and A. lumbricoides was reported in 2 children infected with H. pylori. This study which is the first reported in Lagos established a low prevalence of H. pylori and intestinal parasite co-infection in children and provides better understanding of the epidemiology of H. pylori infection associated with intestinal parasites in Nigeria.

Mental Health and Sociodemographic Correlates of Child Sexual Abuse

Abstract Background: Child sexual abuse (CSA) has long-term deleterious effects on mental health. The prevalence of CSA is more in females than males. A lifetime diagnosis of anxiety, depression, eating disorders, posttraumatic stress disorder (PTSD), sleep disorders, and suicide attempts has been associated with a history of sexual abuse. Few studies have focused on the role of temperament and the relationship between psychiatric morbidity and sociodemographic variables. Aim: This study aimed to assess the relationship between psychiatric morbidity and sociodemographic variables in cases of CSA. Methodology: After ethical approval, 168 consecutive survivors of an alleged history of child sexual assault brought by the police were enrolled after informed consent from legal guardians and assent from survivors. A specially designed semi-structured pro forma was used to collect data. Psychiatric morbidity was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-5. Scales assessing temperament, perceived social support and global functioning, were used. Results: Seventy-seven percent of survivors in this study had psychiatric morbidity. Adjustment problems were more in children with slow-to-warm temperament. A positive family history of mental illness was significant in major depressive disorder (MDD) but not in PTSD. Those with a history of being assaulted multiple times (36 out of 42) had a higher chance of developing MDD. Conclusion: This study highlights that the adjustment problems were more in children with slow-to-warm temperament, highlighting the need for targeted and timely intervention in this subgroup of CSA survivors. This study shows an association between childhood environmental adverse event and development of psychiatric morbidity.

Preschool children's asthma medication: parental knowledge, attitudes, practices, and adherence.

Introduction: As parents or legal guardians primarily care for children with asthma, understanding their knowledge, attitudes, and practices (KAP) barriers to treatment and medication adherence is of essential importance. This study aimed to analyze the KAP toward asthma medication and adherence among preschool-aged asthmatic children's parents and explore the factors influencing adherence. Methods: This cross-sectional study was conducted between February 2023 and April 2023. Parents of preschool children with asthma were asked to complete the questionnaire containing knowledge, attitude, practice dimensions, and demographic characteristics. The Morisky Medication Adherence Scale (MMAS) was used to investigate adherence. Results: A total of 632 valid questionnaires (154 male and 478 female) were included. Parents showed moderate knowledge (9.49 ± 2.86, 63.27%, possible range: 0-15) and moderate attitudes (26.18 ± 2.51, 74.80%, possible range: 7-35) towards asthma medication, while their practices (27.46 ± 5.26, 91.53%, possible range: 6-30) were proactive; however, medication adherence was low (4.84 ± 1.78, total score: 8). The attitude scores (OR = 1.10, 95% CI: 1.01-1.19, P=0.020), practice scores (OR = 1.16, 95%CI: 1.12-1.21, p < 0.001), and smoking (OR = 1.64, 95%CI: 1.14-2.37, p = 0.008) were associated with medication adherence. Discussion: Preschool-aged asthmatic children's parents showed moderate knowledge, attitudes, and proactive practice toward asthma medication. Continuous training and education programs should be provided for parents to improve asthma medication management in preschool children.

Prevalence of psychiatric disorders in patients with craniofacial malformations - a statistical analysis

IntroductionCraniofacial malformations have long been associated with a heightened risk of psychiatric disorders. Understanding this link is crucial, as it can inform early intervention and support for affected individuals, enhancing their overall well-being. Research in this area aims to shed light on the prevalence and nature of these disorders within the craniofacial population, ultimately improving healthcare and quality of life for affected individuals.ObjectivesThis study aims to establish a comprehensive understanding of the relationship between craniofacial malformations and psychiatric disorders. Specifically, our objectives include: assessing prevalence, identifying risk factors, evaluating impact and informing clinical practice. This research aims to improve the holistic care and mental well-being of individuals with craniofacial malformations, contributing to a more comprehensive approach in the field of psychiatry.MethodsThis cross-sectional study was conducted at a prominent referral hospital named Hospital de Clínicas de Porto Alegre during the month of August 2023.Participant Selection: Patients with craniofacial malformations of all ages and both genders.Data Collection: We conducted structured interviews with participants to gather demographic information, medical history, and details of their craniofacial conditions.Medical Records Review: Medical records were reviewed to corroborate craniofacial diagnoses and identify any comorbid conditions.Statistical Analysis: Data were analyzed using appropriate statistical techniques to assess the association between craniofacial malformations and psychiatric disorders.Ethical Considerations: The study adhered to all ethical guidelines, with informed consent obtained from participants or their legal guardians. Ethical approval was obtained from the hospital’s Institutional Review Board.Data Handling: Confidentiality and data security were ensured throughout the study, with all data anonymized to protect participant privacy.ResultsIn our study, we assessed 132 different patients, comprising 62 females and 70 males. The youngest patient was 2 months old, while the oldest was 56 years old. The mean age of the patients was 16.22 years, with a median of 9 years, a harmonic mean of 18 years, and a standard deviation of 15.23 years.Among the patients, 24 exhibited psychiatric disorders, evenly split between 12 males and 12 females. Their average age was 16.21 years, with a median of 10 years, a harmonic mean of 6.13, and a standard deviation of 14.57. The youngest patient with evidence of a psychiatric disorder was 2 years old.Image:Image 2:ConclusionsOur study underscores the prevalence of psychiatric disorders among craniofacial patients, which seems to be greater than the general population, emphasizing the need for integrated care that considers both medical and psychological aspects, thus enhancing the overall well-being of these individuals.Disclosure of InterestNone Declared

Incendiary: Fire setting behaviors in youth

A 12‐year‐old boy presented for psychiatric assessment with a chief complaint of “fire setting.” The patient was reluctant to speak, however, his caregiver stated that he had set a fire in the basement of his home while the rest of the family were asleep. They were alerted due to the smoke alarm going off and were able to hurriedly contain the situation. The patient had a history of physical and emotional abuse from parents and was residing with his legal guardian, his maternal aunt.

Prevalence of psychiatric and cognitive disorders in patients with Pierre-Robin sequence - a statistical analysis

IntroductionThe Pierre-Robin sequence (PRS), characterized by micrognathia, glossoptosis, and cleft palate, has long been a subject of clinical interest. Recent research suggests a potential association between PRS and cognitive or psychiatric disorders. This study explores this intriguing connection, shedding light on the complex interplay between craniofacial anomalies and mental health.ObjectivesThis study aims to establish a comprehensive understanding of the relationship between Pierre-Robin Sequence and psychiatric disorders. Specifically, our objectives include: assessing prevalence, evaluating impact and informing clinical practice. This research aims to improve the holistic care and mental well-being of individuals with craniofacial malformations, contributing to a more comprehensive approach in the field of psychiatry.MethodsThis cross-sectional study was conducted at a prominent referral hospital named Hospital de Clínicas de Porto Alegre, an international reference in Pierre-Robin Sequence, during the month of August 2023.Participant Selection: Patients with PRS. Inclusion criteria encompassed individuals of all ages and both genders.Data Collection: Trained medical personnel conducted structured interviews with participants to gather demographic information, medical history, and details of their craniofacial conditions.Medical Records Review: Medical records were reviewed to corroborate craniofacial diagnoses and identify any comorbid conditions.Statistical Analysis: Data were analyzed using appropriate statistical techniques to assess the association between PRS and psychiatric disorders.Ethical Considerations: The study adhered to all ethical guidelines, with informed consent obtained from participants or their legal guardians. Ethical approval was obtained from the hospital’s Institutional Review Board.Data Handling: Confidentiality and data security were ensured throughout the study, with all data anonymized to protect participant privacy.ResultsIn our study, we assessed 28 different patients with Pierre-Robin Sequence, comprising 13 females and 15 males. The youngest patient was 2 months old, while the oldest was 22 years old. The mean age of the patients was 4.75 years, with a median of 3 years and a standard deviation of 5.36 years.Among the patients, 6 exhibited psychiatric disorders, split between 4 males and 2 females. Their average age was 10 years, with a median of 9 years and a standard deviation of 4.2. The youngest patient with evidence of a psychiatric disorder was 5 years old.ConclusionsThis study underscores a concerning reality within the Pierre-Robin population, pointing to a high prevalence of psychiatric disorders. These findings highlight the urgent need for integrated care, emphasizing the importance of early psychiatric assessment and tailored interventions to enhance the overall well-being of individuals facing the challenges of PRS.Disclosure of InterestNone Declared