Tele-consent using mixed reality glasses (NREAL) in pediatric inguinal herniorrhaphy: a preliminary study.

There is an increasing demand and need for patients and caregivers to actively participate in the treatment process. However, when there are unexpected findings during pediatrics surgery, access restrictions in the operating room may lead to a lack of understanding of the medical condition, as the caregivers are forced to indirectly hear about it. To overcome this, we designed a tele-consent system that operates through a specially constructed mixed reality (MR) environment during surgery. We enrolled 11 patients with unilateral inguinal hernia and their caregivers among the patients undergoing laparoscopic inguinal herniorrhaphy between January through February 2021. The caregivers were informed of the intraoperative findings in real-time through MR glasses outside the operating room. After surgery, we conducted questionnaire surveys to evaluate the satisfaction and usefulness of tele-consent. We identified contralateral patent processus vaginalis in seven out of 11 patients, and then additionally performed surgery on the contralateral side with tele-consent from their caregivers. Most caregivers and surgeons answered positively about the satisfaction and usefulness of tele-consent. This study found that tele-consent with caregivers using MR glasses not only increased the satisfaction of caregivers and surgeons, but also helped to accommodate real-time findings by adapting surgical plan through the tele-consent.

Physical Education and Its Importance to Physical Activity, Vegetable Consumption and Thriving in High School Students in Norway.

Earlier research indicates that physical education (PE) in school is associated with positive outcomes (e.g., healthy lifestyle, psychological well-being, and academic performance). Research assessing associations with resilience and thriving indicators, such as the 5Cs of Positive Youth Development (PYD; competence, confidence, character, caring, and connection) is limited and more so in the Norwegian context. The aim of the present study was to investigate associations between PE grade (reflecting students' effort in theoretical and practical aspects of the subject) and the 5Cs as well as healthy behaviors (physical activity (PA), fruit and vegetable consumption), using cross-sectional data collected from 220 high school students in Norway (Mage = 17.30 years old, SD = 1.12; 52% males). Results from structural equation modelling indicated positive associations between PE grade and four of the 5Cs (competence, confidence, caring, and connection; standardized coefficient: 0.22-0.60, p < 0.05) while in logistic regressions, a unit increase in PE grade was associated with higher likelihood of engaging in PA and vegetable consumption (OR = 1.94; 95% CI = 1.18-3.18 and OR = 1.68; 95% CI = 1.08-2.63, respectively). These significant findings suggest the need for policies and programs that can support effective planning and implementation of PE curriculum. However, further research is needed to probe into the role of PE on youth health and development with representative samples and longitudinal designs.

Emotional development of gifted students: comparative study about overexcitabilities / Desenvolvimento emocional de alunos superdotados: estudo comparativo acerca das sobre-excitabilidades / Desarrollo emocional de estudiantes superdotados: estudio comparativo sobre las sobreexcitabilidades

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)

Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations.

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.

End-of-life decision-making capacity in an elderly patient with schizophrenia and terminal cancer.

Medical practitioners are confronted daily with decisions about patients' capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-of-life decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient's wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient's capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person's psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.

Adolescent Brain Development and Medical Decision-making.

With a few notable exceptions, adolescents do not possess the legal authority to provide consent for or refuse medical interventions. However, in some situations, the question arises regarding whether a mature minor should be permitted to make a life-altering medical decision that would be challenged if made by the minor's parent. In this article, I explore what we currently know about the adolescent brain and how that knowledge should frame our understanding of adolescent decision-making. The prevailing approach to determining when adolescents should have their decisions respected in the medical and legal context, an approach that is focused on establishing capacity under a traditional informed consent model, will be reviewed and critiqued. I will suggest that the traditional model is insufficient and explore the implications for the adolescent role in health care decision-making.

Decisional Capacity Determination In Patients With Cancer.

Patients with cancer face many difficult decisions and encounter many clinical situations that undermine decisional capacity. For this reason, assessing decision-making capacity should be thought of at every medical encounter. The culmination of variable disease trajectories, following patients to the end of life, use of high-risk treatments, and other weighty personal decisions require attention to patients' ability to engage in decisions. Oncologists develop meaningful relationships with their patients. This familiarity may lead to forgoing the process of diligently assessing a patient's cognitive ability and/or decisional capacity when important decisions need to be made. While the process may feel like it takes place spontaneously, many subtle and overt details are involved with the decisions around cancer care that require pointed questioning and probing. Thus, there are many ways to fall short in determining decisional capacity. Clinicians are inconsistent in their decisional capacity determinations and generally assume more decisional capacity than the patient has. Consult and referral services such as ethics and psychiatry can help with treatment decisions and with assessing underlying psychosocial and psychiatric conditions. Decisional capacity may fluctuate and requires a variable amount of decisional ability depending on the clinical situation; hence, it is time-specific and decision-specific. This review is intended to provide a summary of key components of decisional capacity while highlighting areas in need of clinical refinement.

Decision-making in cancer care for people living with dementia.

OBJECTIVE: Increasing numbers of people are expected to live with comorbid cancer and dementia. Cancer treatment decision-making for these individuals is complex, particularly for those lacking capacity, requiring support across the cancer care pathway. There is little research to inform practice in this area. This ethnographic study reports on the cancer decision-making experiences of people with cancer and dementia, their families, and healthcare staff. METHODS: Participant observations, informal conversations, semi-structured interviews, and medical note review, in two NHS trusts. Seventeen people with dementia and cancer, 22 relatives and 19 staff members participated. RESULTS: Decision-making raised complex ethical dilemmas and challenges and raised concerns for families and staff around whether correct decisions had been made. Whose decision it was and to what extent a person with dementia and cancer was able to make decisions was complex, requiring careful and ongoing consultation and close involvement of relatives. The potential impact dementia might have on treatment understanding and toleration required additional consideration by clinicians when evaluating treatment options. CONCLUSIONS: Cancer treatment decision-making for people with dementia is challenging, should be an ongoing process and has emotional impacts for the individual, relatives, and staff. Longer, flexible, and additional appointments may be required to support decision-making by people with cancer and dementia. Evidence-based decision-making guidance on how dementia impacts cancer prognosis, treatment adherence and efficacy is required.

Is Mental Health Competence in Childhood Associated With Health Risk Behaviors in Adolescence? Findings From the UK Millennium Cohort Study.

PURPOSE: Promoting positive mental health, particularly through enhancing competencies (such as prosocial behaviors and learning skills), may help prevent the development of health risk behaviors in adolescence and thus support future well-being. Few studies have examined how mental health competencies in childhood are associated with adolescent health risk behaviors, which could inform preventative approaches. METHODS: Using UK Millennium Cohort Study data (n = 10,142), we examined how mental health competence (MHC) measured at the end of elementary school (11 years) is associated with self-reported use of cigarettes, e-cigarettes, alcohol, illegal drugs, antisocial behavior, and sexual contact with another young person at age 14 years. A latent measure of MHC was used, capturing aspects of prosocial behavior and learning skills, categorized as high MHC, high-moderate MHC, moderate MHC, and low MHC. Logistic and multinomial regression estimated odds ratios and relative risk ratios for binary and categorical outcomes, respectively, before and after adjusting for confounders. Weights accounted for sample design and attrition and multiple imputation for item missingness. RESULTS: Those with low, moderate, or high-moderate MHC at age 11 years were more likely to have taken part in health risk behaviors at age 14 years compared with those with high MHC. The largest associations were seen for low MHC with binge drinking (relative risk ratio: 1.6 [95% confidence interval: 1.1-2.4]), having tried cigarettes (odds ratio: 2.2 [95% confidence interval: 1.6-3.1]) and tried illegal drugs (odds ratio: 2.0 [95% confidence interval: 1.3-3.1) after adjusting for confounders (which attenuated results but largely maintained significant findings). CONCLUSIONS: MHC in late childhood is associated with health risk behaviors in midadolescence. Interventions that increase children's MHC may support healthy development during adolescence, with the potential to improve health and well-being through to adulthood.

Older people's preferences for self-involvement in decision-making if faced with serious illness / As preferências de pessoas idosas pelo autoenvolvimento na tomada de decisão numa situação de doença grave

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.

Are physical and mental abilities of older people related to gonadotropins and steroid hormones levels?

BACKGROUND: Aging is characterized by deep alterations of hormone secretion. In majority, hormone secretion, except gonadotropins, undergoes a pronounced decrease which is thought to contribute to the progression of aging. The recent data indicate that gonadotropin excess may also by itself influence the aging process. The aim of the present study was to investigate the relations between gonadotropins and steroid hormones with physical and mental abilities of older people. MATERIAL AND METHODS: In a group of patients aged over 75 years, concentrations of FSH, LH, estradiol, testosterone, DHEAs and cortisol were measured. The mental ability was estimated by MMSE and CDT and the physical ability by TUG and SPPB tests. RESULTS AND CONCLUSIONS: The positive correlation between SPPB scores and FSH and the negative correlations of SPPB with LH/FSH ratio were observed in men. The correlation of TUG scores and estradiol levels was also noted in men. The positive correlation between CDT scores and FSH in women and the negative correlation between CDT and LH/FSH ratio in men were found. The correlation between the results of CDT and cortisol levels in men was also observed. Thus, we did not confirm the simple deleterious effect of gonadotropins on cognitive abilities. FSH and LH seem exert different (antagonistic?) effects on cognitive functions, but this hypothesis needs further studies.

Sinako, a study on HIV competent households in South Africa: a cluster-randomised controlled trial protocol.

BACKGROUND: With 7.7 million South Africans currently infected with human immunodeficiency virus (HIV) and 4.8 million currently receiving antiretroviral treatment (ART), the epidemic represents a considerable burden for the country's resource-limited health system. In response to the health and human resource shortages, task shifting to community health workers (CHWs) and empowering people living with HIV (PLWH) are integral parts of a sustainable ART strategy. Despite the success of the ART programme, South Africa still faces both prevention and treatment challenges. To tackle these challenges, future endeavours need to focus on the role played by the households of PLWH in mediating between the community and PLWH themselves. Building health-enabling "HIV competent" households with the capacity to actively stimulate lifestyles that foster health, offers a potential strategy to tackle South Africa's HIV-related challenges. The aim of the "Sinako: Households and HIV" study is to investigate to what extent and how an intervention can increase HIV competence in PLWH and their households, and subsequently optimise the impact of CHW support on individual ART outcomes. METHODS: The "Sinako" study is a cluster-randomised controlled trial with two arms. In the control arm, CHWs offer a standard package of support to PLWH during home visits, focused on the individual. The intervention arm includes both a focus on the individual and the household to enable the patient to self-manage their treatment within an HIV competent household. A longitudinal mixed methods design is adopted to analyse the data. For the quantitative data analysis, methods including latent cross-lagged modelling, multilevel modelling and logistic regression will be used. To assess the acceptability and feasibility of the intervention and to construct a comprehensive picture of the mechanisms underlying the impact on the household and the PLWH, qualitative data (in-depth interviews and focus group discussions) will be collected and analysed. DISCUSSION: Stimulating HIV competence in households could be a feasible and sustainable strategy to optimise the outcomes of CHW interventions and thus be important for HIV treatment interventions in resource-limited settings. TRIAL REGISTRATION: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.

Clinical correlates of the ability to consent to research participation in brain metastasis.

OBJECTIVE: Impairment in the ability to provide informed consent is common in persons with brain metastasis. However, little is known about what factors contribute to this impairment in the patient group. Our objective is to determine if the associations between demographic, cognitive, and clinical variables correlate with the ability to provide informed consent in persons with brain metastasis. METHODS: We administered a comprehensive neuropsychological battery to a group of 61 persons with brain metastasis. Demographic and clinical information was also collected. All diagnoses were made by board-certified oncologists and were verified histologically. Statistical analyses included Pearson's product-moment correlations, point biserial correlations, and linear regression. RESULTS: Results indicated that combinations of education, verbal memory, executive function, whole brain radiation therapy, and chemotherapy affected various aspects of the ability to provide informed consent. Subsequent regression models demonstrated that these variables contributed a significant amount of shared variance to the ability to provide informed consent. CONCLUSION: We found that the ability of persons with brain metastasis to provide informed consent is a cognitively complex ability that is also affected by education and treatment variables. This information can help clinical researchers in identifying persons with brain metastasis at risk of an impaired ability to provide informed consent and aid in the consenting process.

Using cognition to predict the ability to understand medical treatment in brain and metastatic cancer.

OBJECTIVE: To determine if cognition can be used to identify persons with cancer at high risk for the impaired ability to understand treatment decisions. METHODS: The association between understanding treatment decisions and cognition was examined using data from 181 participants across four groups: 67 with brain metastasis, 41 with metastatic cancer that has not spread to the brain, 27 with malignant glioma, and 46 healthy controls. All diagnoses were made by board-certified oncologists and were verified histologically. RESULTS: Results indicated that numerous cognitive functions were associated with the ability to understand treatment decisions in persons with cancer. The following proportion of participants demonstrated impaired understanding of treatment decisions in our three patient groups: approximately 51% malignant glioma, approximately 46% brain metastasis, and approximately 24% metastatic cancer. In a combined brain cancer group, we were able to use cognitive performance to predict the impaired ability to understand treatment decisions. CONCLUSIONS: An impaired ability to understand treatment decisions is prevalent in persons with brain cancer and persons with metastatic cancer. Performance on a brief cognitive battery can be used to help clinicians identify patients at particular risk for impaired medical decision making.

Prediction of arithmetic competence: role of cognitive abilities, socioeconomic variables and the perception of the teacher in Early Childhood Education / Predição da competência aritmética: papel das habilidades cognitivas, variáveis socioeconômicas e percepção do professor na Educação infantil / Predicción de la competencia aritmética: papel de las habilidades cognitivas, variables socioeconómicas y percepción del profesor en la Educación infantil

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.

Speaking genomics to parents offered germline testing for cancer predisposition: Use of a 2-visit consent model.

BACKGROUND: Patients with cancer are increasingly offered genomic sequencing, including germline testing for cancer predisposition or other disorders. Such testing is unfamiliar to patients and families, and clear communication is needed to introduce genomic concepts and convey risk and benefit information. METHODS: Parents of children with cancer were offered the opportunity to have their children's tumor and germline examined with clinical genomic sequencing. Families were introduced to the study with a 2-visit informed consent model. Baseline genetic knowledge and self-reported literacy/numeracy were collected before a study introduction visit, during which basic concepts related to genomic sequencing were discussed. Information was reinforced during a second visit, during which informed consent was obtained and a posttest was administered. RESULTS: As reflected by the percentage of correct answers on the pretest and posttest assessments, this model increased genetic knowledge by 11.1% (from 77.8% to 88.9%; P < .0001) in 121 parents participating in both the study introduction and consent visits. The percentage of parents correctly identifying the meaning of somatic and germline mutations increased significantly (from 18% to 59% [somatic] and from 31% to 64% [germline]; P < .0001). Nevertheless, these concepts remained unfamiliar to one-third of the parents. No relation was identified between the change in the overall percentage of correct answers and self-reported literacy, numeracy, or demographics. CONCLUSIONS: The use of a 2-visit communication model improved knowledge of concepts relevant to genomic sequencing, particularly differences between somatic and germline testing; however, these areas remained confusing to many participants, and reinforcement may be necessary to achieve complete understanding.

Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer.

BACKGROUND: The objective of this study was to assess decision-making capacity in patients newly diagnosed with lung cancer, clinical factors associated with impaired capacity, and physicians' perceptions of patients' decision-making capacity. MATERIALS AND METHODS: We recruited 122 patients newly diagnosed with lung cancer. One hundred fourteen completed the assessment. All patients were receiving a combination of treatments (e.g., chemotherapy, chemo-radiotherapy, or targeted therapy). Decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Cognitive impairment, depressive symptoms, and frailty were also evaluated. Physicians' perceptions were compared with the ascertainments. RESULTS: Twenty-seven (24%, 95% confidence interval [CI], 16-31) patients were judged to have incapacity. Clinical teams had difficulty in judging six (22.2%) patients for incapacity. Logistic regression identified frailty (odds ratio, 3.51; 95% CI, 1.13-10.8) and cognitive impairment (odds ratio, 5.45; 95% CI, 1.26-23.6) as the factors associated with decision-making incapacity. Brain metastasis, emphysema, and depression were not associated with decision-making incapacity. CONCLUSION: A substantial proportion of patients diagnosed with lung cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. IMPLICATIONS FOR PRACTICE: Decision-making capacity is the cornerstone of clinical practice. A substantial proportion of patients with cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients.

¿Sé y puedo? Toma de decisión y consentimiento informado en los trastornos demenciantes: dilemas diagnósticos y jurídicos en Chile / Decision making and consents given by demented patients. Are they valid?

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.