Atoms
Oh, that summer! The memories are cascading back now. Yes, that’s right, the turn of the 1970s, a time when the world seemed to your schoolchild eyes to be in chaos, but a chaos into which you didn’t yourself feel drawn. You’d leave your home, the avant-garde, for-the-time beige brick—complete with conservatory at the end of the avenue, the chords of drawn Gimme Shelter (played hourly on the crackly transistor), encapsulating the esprit corps to a tee, chiming in your ears. A sharp left-turn down the alley (the one your parents wouldn’t let you take after dark), through the meadow where you would plunge into the darkness of the forest foliage. If you’d had time, you might have tucked into an en courant bowl of cornflakes and a lashing of demerara, but, as often as not, you’d have been out of the blue gate before your mum had registered...
>> Read More

Factors associated with teenage preterm birth in the USA, a call for structural interventions
We read with interest the research letter by Douglas and colleagues, ‘Disparities in health outcomes of infants born to teenage birthing individuals: a cross-sectional study’.1 The investigators analysed 2019 data from the US Centers for Disease Control and Prevention’s (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) database to describe birth outcomes among 1395 teenaged individuals representing 72 795 in the weighted sample. They specifically analysed associations of race with preterm birth (PTB, <37 weeks’ gestation), early PTB (<34 weeks) and low birth weight (<2500 g). Non-Hispanic black individuals had significantly higher odds of early PTB compared with non-Hispanic white individuals, but the association with all PTBs was not significant (adjusted OR 1.14, 95% CI 0.58, 2.23). They also looked for protective factors and found, somewhat surprisingly, that public insurance, typically a proxy for lower socioeconomic status, was associated with lower odds of each outcome compared with private insurance. They...
>> Read More

Parents ability to provide consent: the zone of parental responsibility
Can the principles underlying the ‘zone’ (or ‘scope’) of parental responsibility promote parents’ participation in providing consent for their children? In a judgement relating to parental consent for puberty blockers, Lieven J noted1 that there were few circumstances where a child’s treatment could not be authorised solely by parental consent: In fact, the only case where...(a judge) has found a legal requirement to come to Court in respect of treatment of a child, where both parents consent....is the case of a non-therapeutic sterilisation of an 11-year-old. In all other contexts, including where the parental decision will lead to a child’s life ending, the Court has imposed no such requirement. Naturally, there are a range of circumstances where the Court’s approval is necessary, but this is in the context of a clinical disagreement (either between doctors or with the family’s view); or disagreement between those with parental...
>> Read More

Perceptions of consent for a paediatric telehealth trial during emergency transport in Pakistan
Introduction Childhood mortality in the emergency setting is disproportionately high in low-income and middle-income countries (LMIC), with limited research dedicated to improving timely interventions, especially for critically ill children during transport. To perform essential prehospital paediatric research, there is a need for a tailored consent process, which reflects the specific needs and concerns of participants in this challenging research context. Objective The objective is to prospectively investigate stakeholder perceptions and preferences regarding consent processes for a specific paediatric ambulance-based telemedicine trial. Methods Exploratory qualitative study design using face-to-face semistructured interviews and focus group discussions. Data were analysed using thematic analysis. Participants included healthcare providers (paediatric telemedicine physicians and emergency medical technicians) and parents of children who required emergency transportation in Karachi, Pakistan. Results 47 participants, ranging from 19 to 47 years old, were involved in in-depth interviews or focus group discussions. The participants comprised 29 healthcare workers and 18 parents. Among them, 9 were women and 38 were men. Expressing diverse attitudes towards different consent methods, the majority recommended a prospective written informed consent approach to build trust and provide legal protection. Participants understood the situational incapacity that occurs in emergency settings, emphasised the importance of keeping the consent brief and recommended a subsequent contact in 2–3 days after the emergency transport to reconfirm consent and answer any questions. Conclusion Our interpretation of the findings revealed that participants preferred a staged consent process for telemedicine trials in LMIC paediatric emergency settings.
>> Read More