Neglected Research Articles

Adolescent Medical Decisionmaking Rights: Reconciling Medicine and Law.

Dennis Lindberg came into his aunt's care when he was in the 4th grade because his parents struggled with drug addiction and could not provide for him. At thirteen, he was baptized in his aunt's faith as a Jehovah's Witness. Just days after he turned fourteen, on November 6, he was diagnosed with acute lymphoblastic leukemia.The prognosis was that Dennis had a 75% chance of cure with standard oncology treatment. Consistent with the requirements of his new faith, however, Dennis told his doctors, "I do not want to be treated if the requirement is that I would have to take a blood transfusion." His aunt, whose custodial rights seem not to have included medical decisionmaking, was adamant that "[t]his is Dennis's decision."The hospital social worker assigned to Dennis's case assured his aunt that "having just turned 14, [he] could be considered mature enough to make his own decisions." But hospital psychologists declined to evaluate Dennis's maturity because they did "not have the tools for such an assessment." Established hospital policy described the failure to provide a minor with necessary, life-saving care as medical neglect. Hospital ethicists advised that Dennis's autonomy interests were outweighed by the benefits associated with treatment. And, standard oncology practice norms are that doctors should push back against minors' lifesaving treatment refusals. Still, Dennis's doctor agreed with his social worker and aunt, saying, "We owe respect to a 14-year-old[.]" In this view, he was supported by colleagues on staff and by hospital counsel.A county judge got the case only at the eleventh hour, on an emergency motion filed by Dennis's parents and Child Protective Services for a declaration of dependency and to compel the necessary transfusion. Although Dennis was degrading rapidly, his doctor testified that if a transfusion were ordered that day, Dennis still had a 70% chance of survival. The judge had no background in the applicable law and no time to research the issues; nevertheless, he denied the motion concluding, "It is time to do what Dennis has decided." "Seven hours later, at 6 p.m., on Nov. 28, Dennis died."1.

Factors related to medical neglect recurrence and foster care and adoption services

BackgroundMedical neglect is defined as the failure of a caretaker to heed obvious signs of serious illness, to seek medical care in a timely fashion, or to follow instructions once medical advice is obtained. It is reportable as a form of child maltreatment. Objectives(1) identify factors associated with referrals after medical neglect to adoption and foster care services; (2) describe a cohort of children with first-time cases; and (3) assess whether there were factors associated with recurrence. Participants and settingData from the National Child Abuse and Neglect Data System for 36 U.S. states. MethodsA cohort of children was constructed with first confirmed reports of medical neglect in 2012 with matched confirmed reports during 2012–2017 to describe child, family, offender, and report factors associated with recurrence. These factors were then used in multivariate models, including logistic regression and Cox proportional hazard models, to assess their effects on recurrence and with referral to foster care and adoption services. ResultsComplex family problems were associated with referral for foster care and adoption services, and 8.1% had recurrence within 5 years. Older children with medical problems, Black race, or who were reported by medical or legal personnel had increased risk for recurrence. Only referral to mental health care services was found to decrease this risk. ConclusionsMedical neglect recurs within 5 years despite referrals to most services. Those trying to stop its recurrence should focus on mental health needs and families with children who are older, Black, or have complex medical problems.

The Trauma of Disregard

The Trauma of Disregard

Vaccine Hesitancy Narratives

Vaccine Hesitancy Narratives

The needs of clients coming to counselling following second harm: A Q methodology study

AbstractSecond harm is the added psychological distress from an inadequate response by healthcare providers in response to medical errors or neglect. This inadequate response may require patients to seek counselling. The counselling needs of patients who have experienced second harm have received limited research attention. This Q methodology study addresses this gap in knowledge in order to further inform counselling practice.MethodsParticipants sorted 42 pre‐determined statements online followed by interviews to establish the rationale for the sorting pattern choices. Data from the online sort were analysed using factor analysis to establish the viewpoints expressed. The interview data added to the interpretation of the viewpoints.FindingsThrough a factor analysis, two ‘viewpoints’ and 11 counselling needs were identified. Nine of these needs were generic to the counselling relationship and two specific to second harm. This study concluded that people seeking counselling following second harm have needs beyond those expected from a general counselling relationship. These included not being blamed for what happened and a need for the counsellor to be able to demonstrate that they are able to understand the impact of harm.Implications for practiceThe needs identified in this study as being generic can give counsellors confidence in working with clients that have experienced second harm, knowing that many of the needs identified are not unique. Counsellors can also be confident that those needs that are unique can be understood through extending their knowledge of the topic and listening to those that have been harmed.

The Women Who Don’t Get Counted

The Women Who Don’t Get Counted

"Do Their Own Thing": Radical Health Care and the Fair Haven Community Health Center.

Radical health reform movements of the 1960s inspired two widely adopted alternative health care models in the United States: free clinics and community health centers. These groundbreaking institutions attempted to realize bold ideals but faced financial, bureaucratic, and political obstacles. This article examines the history of Fair Haven Community Health Care (FHCHC) in New Haven, Connecticut, an organization that spanned both models and typified innovative aspects of each while resisting the forces that tempered many of its contemporaries' progressive practices. Motivated by a tradition of independence and struggling to address medical neglect in their neighborhood, FHCHC leaders chose not to affiliate with the local academic hospital, a decision that led many disaffected community members to embrace the clinic. The FHCHC also prioritized grant funding over fee-for-service revenue, thus retaining freedom to implement creative programs. Furthermore, the center functioned in an egalitarian manner, enthusiastically employing nurse practitioners and whole-staff meetings, and was largely able to avoid the conflicts that strained other community-controlled organizations. The FHCHC proved unusual among free clinics and health centers and demonstrated strategies similar institutions might employ to overcome common challenges. (Am J Public Health. 2021;111(10): 1806-1814. https://doi.org/10.2105/AJPH.2021.306417).

The role of extra lessons on the general administration of urban day high density secondary schools

The current qualitative inquiry aimed at investigating the role of extra lessons on the general administration of the urban day high density secondary schools in Chegutu, Zimbabwe. The researcher adopted the case study design and in-depth interviews, focus group discussions and document analysis were used for data generation. Interviews were held with teachers, school inspectors and parents. Learners were subjected to a focus group discussion. The researcher accessed and analysed documents which included punishment records as well as learner academic reports. The 23 participants from where data were generated consisted of 8 teachers, 6 learners, 6 parents and 3 school inspectors who were sampled through non-probability critical case purposive sampling. From the findings, it emerged that the general administration of the schools was affected by extra lessons. Extra lessons impact positively on school pass rates, ratings and help build and improve a good image for the schools in the community. More learners enroll in the schools. They assist in the reduction of the teachers` workload. Some negative effects were established from the study. For example, extra lessons have created a dent on teacher professionalism as some teachers have been accused of neglecting formal school work so that they create demand for extra lessons among learners. Extra lessons have also contributed indiscipline among learners, while at school. Tension has been created by extra lessons between teachers taking part and those not, given the extra remuneration coming out of the lessons. Relations between learners and teachers also seem to have strained. Despite these challenges, it is recommended that extra lessons should continue to be offered as they reduce the work load for teachers and provide a conducive working environment at the school since teachers are not over worked. However, it is prudent that MOPSE, school heads and parents monitor work that is being given to learners during the normal working hours to avoid instances where teachers work less in the main stream in order to create artificial demand for extra lessons. There is need for guidance and counselling to learners so that other activities expected of them in the formal school, for example, sports are not affected.

Lynne Curry, Religion, Law, and the Medical Neglect of Children in the United States, 1870–2000 (London: Palgrave Macmillan, 2019, £54.99). Pp. ix + 197. isbn 978 3 0302 4688 4.

Lynne Curry, Religion, Law, and the Medical Neglect of Children in the United States, 1870–2000 (London: Palgrave Macmillan, 2019, £54.99). Pp. ix + 197. isbn 978 3 0302 4688 4.

Understanding Medical Neglect on the Frontline of Child Protection

Understanding Medical Neglect on the Frontline of Child Protection

The Keepers: Returning Citizens’ Experiences With Prison Staff Misconduct

Correctional staff play a major role in the incarceration experience for millions of U.S. adults each year. While much research has addressed misconduct perpetrated by incarcerated persons, less has systematically addressed rule-violating behavior by correctional staff and how such conduct is perceived by formerly incarcerated individuals. Using qualitative data gathered from 38 interviews with men and women recently released from prison, we examine their experiences with prison staff misconduct. Respondents shared observations of staff misconduct related to medical neglect, violence, and contraband, but experiences differed for men and women, raising concerns regarding conditions of confinement. We caution that such conduct has the potential to undermine the legitimacy of correctional authority in prison settings, which is troubling because heightened legitimacy is an important aspect of legal socialization that helps to reduce offending. Research and policy development on the frequency and consequences of prison staff misconduct is warranted.

Diagnosis of animal abuse: A Brazilian study

Due to their intimate relationship with human beings, animals can experience abuse, especially in the family environment. Research on the variables involved in this topic is scarce in Latin America. The objective of this study was to identify the main types of animal abuse in Brazilian municipalities and to characterize animals and perpetrators in addition to identifying the socioeconomic factors associated with the incidents. The occurrences of animal abuse were analyzed from the records of the Police Station Specialized in Fauna Crimes Investigation Department of the Civil Police of Minas Gerais operating in Belo Horizonte, Brazil, from September 2016 to September 2018. Events involving cruelty to animals were categorized as active maltreatment, while acts of omission, which refer to neglected animals, were categorized as passive maltreatment, defined according to sets of nutritional, health, behavioral, and comfort indicators. Cruel crimes were the most frequently registered (45.7 %, 101/221), with intoxication and aggression being the most common types. Active maltreatment generated more deaths compared to passive maltreatment (OR: 3.900, 95 % CI: 1.873–8.588, p<0.05). Regarding abuse, dogs were the most affected animals (59.7 %, 132/221), followed by felines (14.9 %, 33/221), equine (5.4 %, 12/221), birds (5.8 %, 13/221), poultry (2.7 %, 6/221), reptiles (2.2 %, 5/221), and other groups of animals (9.0 %, 20/221). Adults were the most frequently reported (55.2 %, 122/221) age of abused animals. Cats were the main cruelty victims, with the highest chance of death (OR: 6.829, 95 %CI: 2.916–16.696, p<0.05) and were those who suffered most from intoxication abuse (OR: 4.72, 95 % CI 1.585–14.996, p=0.001). The perpetrators of abuse were predominantly males (66.8 %, 137/205) aged between 40 and 59 years (38.6 %, 53/137). Perpetrators of committing animal cruelty were 3.57 times more likely to be male and 2.5 times more likely to have no college education. The perpetrators of animal abandonment had a 25 times greater chance of being between 18 and 24 years old compared to the category between 40 and 59 years old and perpetrators of animal intoxication had 5 times greater chance of being also between 18 and 24 years old.Among all victimized animals, dogs and cats were the most affected, probably due to their close relationships with humans. Understanding the profile of victims and suspects involved in neglect maltreatment and cruelty to animals is fundamental to the establishment of policies and strategies to prevent and restrain these activities.

Reassessing overlooked information about the diagnosis of Brachycephalus atelopoide (Anura: Brachycephalidae), a neglected problem for the taxonomy of the genus

Reassessing overlooked information about the diagnosis of Brachycephalus atelopoide (Anura: Brachycephalidae), a neglected problem for the taxonomy of the genus

What About the Victim? Neglected Dimensions of the Standing to Blame

What About the Victim? Neglected Dimensions of the Standing to Blame

Medical neglect in Ontario: Implications for health care provision.

This study explores child welfare investigations for medical neglect in Ontario, Canada, focusing on household, family and child characteristics of such investigations and factors associated with substantiated victimization. This analysis used data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018. Bivariate analyses compared medical neglect with other neglect investigations to create a profile of medical neglect investigations in Ontario, and a binary logistic regression determined which case characteristics were associated with substantiation of medical neglect. Compared with other neglect investigations, medical neglect investigations were more likely to involve children less than 1 year old and caregivers under 21 years old, households that had run out of money in the past 6 months for basic necessities, primary caregivers with few social supports, mental health issues or drug/solvent abuse concerns, and children with at least one functioning concern. Medical neglect investigations in which the primary caregiver had few social supports were almost four times more likely to be substantiated (OR=3.698, P<0.05). While the public's perception of medical neglect tends to focus on parental refusal of treatment due to philosophical/religious beliefs, this Ontario sample indicates that medical neglect is often driven by financial constraints and a lack of social support. Implications for health care providers within a universal health care system are discussed.

Az élelmezésbiztonság és a gazdasági növekedés kapcsolata jövedelemszintenként

Food security is a fundamental but often neglected aspect of economic growth and sustainable development. This paper examines the effect of food security on productivity (GDP/capita) over time, while taking the income level of various countries into account. Dynamic panel regression analyses suggest that food security is positively related to productivity, but this effect is stronger in more developed countries. The study highlights the complexity of the economic problems faced by the least developed countries, where increasing the consumption and supply of food is insufficient for significantly increasing economic performance.

Child Protective Services Referral in a Cleft Lip and/or Palate Population: Assessment of Prevalence, Indications, and Outcomes.

To determine the prevalence of, reasons for, and outcomes related to Child Protective Services (CPS) referral in an isolated and syndromic cleft lip/palate population. Retrospective cohort study. Tertiary Children's Hospital. Any patient <18 years of age attending the multidisciplinary cleft team for care at our institution with a history of referral to CPS by the cleft team during the study period 2009 to 2014. The number of children with CPS referrals, reasons for CPS referrals, outcomes of CPS referrals, associated psychosocial risk factors potentially predictive of CPS referral; demographics and cleft-related surgical history was also reviewed for each patient. Of 1392 patients, 25 (1.8%) were identified with a history of referral to CPS. Average age at referral was 11 months; 76.0% of patients were <1 year of age. Most referrals (64.0%) were directly associated with issues related to cleft care. Identified psychosocial risk factors included financial strain, mental illness/cognitive disability, transportation issues, and inadequate social support. Nine families ultimately lost custody of their children temporarily (n = 5) or permanently (n = 4). Cleft team family referral to CPS involves long-term patient care challenges requiring maximal medical and social support. Families are most commonly referred for issues related to medical neglect, which can lead to failure to thrive, delays in care, and ultimate removal from the home. Identifying families with known psychosocial risk factors and providing increased support may potentially help avoid referrals to CPS.

Reproductive Injustice at the Southern Border and Beyond: An Analysis of Current Events and Hope for the Future.

Reproductive Injustice at the Southern Border and Beyond: An Analysis of Current Events and Hope for the Future.

Hematological parameters and globulin profile of Bothrops asper and Crotalus simus snakes (Serpentes: Viperidae), after the main venom gland removal

Snakebite accidents are a neglected tropical disease worldwide recognized, and in Costa Rica the snakes Bothrops asper and Crotalus simus causes more than the 60% of the snakebite accidents reported. To fight this neglected disease, institutions need to establish and keep a venomous snake collection in order to extract the venom and produce the antivenom. The welfare of the snakes in captivity must be guaranteed, specially to old animals with defective venom production, which is the case of the Clodomiro Picado Institute. A surgical removal of the main venom gland was performed in five animals of B . asper and C . simus with none or low venom production, and the hematological parameters and plasma proteins were analyzed pre-surgery and for 90 days post-surgery. As result of the surgical procedure, the animals did not show anemia post-surgery, a heterophilia was found in respond to the invasive method, a relative monocytosis and lymphopenia at day one to three was also found, meaning that the surgical removal of the main venom gland is a safe procedure and did not affect the snake’s health. Additionally, the electrophoretic determination of the albumin:globulin ratio, is a good test to assess the body health condition in the snakes studied. Finally, the relative monocytosis and lymphopenia seems to be directly linked to a continuously handling of the snakes during consecutive days. with monocytes playing a key role in a stress respond, therefore, these relative monocytosis and lymphopenia values should be considered in the interpretation of stress leukogram reports.

Profiles of trauma histories as predictors of depression among women living with HIV

ABSTRACT This study examined co-occurring psychosocial problems among 120 women living with HIV (WLWH) in Washington, DC, USA. Participants completed a demographic survey, PHQ-9 (depressive symptoms), the Life Stressor Checklist (stressful events) and the PCL-C (PTSD symptoms in civilian populations). We calculated descriptive statistics and chi-square solutions for participant demographics. Classes of trauma history were established using latent class analysis (LCA). Latent indicators were extracted from participant self-reported traumatic histories on the LSC-R. Traumatic events have been found to be predictive of both depression. Latent class solution selection was guided by utility in evaluating and discriminating between classes as predictors of scales measuring depression or trauma exposure. Three distinct classes of trauma histories were identified: a high trauma (HT) class, an abuse/neglect (AN) class and a childhood trauma (CT) class. Binary logistic regression analyses determined whether trauma profiles predicted depression or PTSD after controlling for age, marital status, race and education. Participants in both the AN and CT class were over five times more likely than those in the HT class to endorse depressive symptoms. Classes differed significantly on whether they endorse depressive symptoms (p = .008) and marital status (p = .009), while PTSD appeared to trend toward significance (p = .085).