Mitochondrial disease: Needs and problems of children, their parents and family. A systematic review and pilot study into the need for information of parents during the diagnostic phase

Contains fulltext : 51979.pdf (publisher's version ) (Closed access)OBJECTIVE: Firstly, this paper aims to systematically review the mitochondrial disease literature to identify studies assessing the needs and problems in the daily life of children with a mitochondrial disease and of their parents and family. The second aim is to provide more insight into the need for information by the parents of these children during the diagnostic process while in hospital. DESIGN: A systematic review and a pilot study, using a qualitative (focus group interviews; n = 7) and a quantitative (questionnaire; n = 37) design. RESULTS: Mothers reported great socioeconomic and psychoaffective strain and showed psychopathological symptoms in the two studies published with respect to this topic. The pilot study showed that parents considered an honest and interested attitude of the person who is giving the information as most important. Furthermore they wanted oral and written information and a central point where they could go with their questions at any time they felt the need. The need for information increased during the four phases of the diagnostic process and was highest in the fourth phase. CONCLUSIONS: The few studies found in the review, combined with expectations that having a mitochondrial disease must have a great impact on these children and their parents and family, call for more research in their needs and problems. Furthermore, there are gaps in the current information provision to parents of these children. A better understanding of the needs and problems of these children and their family is essential for effective care planning and might result in an improved quality of life

Deliberating Animal Values: a Pragmatic-Pluralistic Approach to Animal Ethics.

Debates in animal ethics are largely characterized by ethical monism, the search for a single, timeless, and essential trait in which the moral standing of animals can be grounded. In this paper, we argue that a monistic approach towards animal ethics hampers and oversimplifies the moral debate. The value pluralism present in our contemporary societies requires a more open and flexible approach to moral inquiry. This paper advocates the turn to a pragmatic, pluralistic approach to animal ethics. It contributes to the development of such an approach in two ways. It offers a pragmatist critique of ethical monism in animal ethics and presents the results of a qualitative study into the value diversity present in the different ways of thinking about animals in the Netherlands. Carefully arranged group discussions resulted in the reconstruction of four distinctive moral value frameworks that may serve as instruments in the future process of moral inquiry and deliberation in the reflection on animal use. © 2010 The Author(s)

Explaining variation in Down's syndrome screening uptake: comparing the Netherlands with England and Denmark using documentary analysis and expert stakeholder interviews.

Background: The offer of prenatal Down’s syndrome screening is part of routine antenatal care in most of Europe; however screening uptake varies significantly across countries. Although a decision to accept or reject screening is a personal choice, it is unlikely that the widely differing uptake rates across countries can be explained by variation in individual values alone. The aim of this study was to compare Down’s syndrome screening policies and programmes in the Netherlands, where uptake is relatively low ( 90% respectively), in an attempt to explain the observed variation in national uptake rates. Methods: We used a mixed methods approach with an embedded design: a) documentary analysis and b) expert stakeholder analysis. National central statistical offices and legal documents were studied first to gain insight in demographic characteristics, cultural background, organization and structure of healthcare followed by documentary analysis of primary and secondary sources on relevant documents on DSS policies and programme. To enhance interpretation of these findings we performed in-depth interviews with relevant expert stakeholders. Results: There were many similarities in the demographics, healthcare systems, government abortion legislation and Down’s syndrome screening policy across the studied countries. However, the additional cost for Down’s syndrome screening over and above standard antenatal care in the Netherlands and an emphasis on the ‘right not to know’ about screening in this country were identified as potential explanations for the ‘low’ uptake rates of Down’s syndrome screening in the Netherlands. The social context and positive framing of the offer at the service delivery level may play a role in the relatively high uptake rates in Denmark. Conclusions: This paper makes an important contribution to understanding how macro-level demographic, social and healthcare delivery factors may have an impact on national uptake rates for Down’s syndrome screening. It has suggested a number of policy level and system characteristics that may go some way to explaining the relatively low uptake rates of Down’s syndrome screening in the Netherlands when compared to England and Denmark

A 3/2 algorithm for two-machine open shop with route-dependent processing times

This paper considers the problem of minimizing the schedule length of a two-machine shop in which not only can a job be assigned any of the two possible routes, but also the processing times depend on the chosen route. This problem is known to be NP-hard. We describe a simple approximation algorithm that guarantees a worst-case performance ratio of 2. We also present some modifications to this algorithm that improve its performance and guarantee a worst-case performance ratio of 3=2