Relation between metacognitive strategies, motivation to think, and critical thinking skills.

Critical thinking is a complex reasoning skill, and even though it is hard to reach a consensus on its definition, there is agreement on it being an eminently cognitive skill. It is strongly related with reflective and metacognitive skills, as well as attitudinal or motivational aspects, although no model has yet been able to integrate these three elements. We present herein the preliminary results of a study seeking to establish these relations, in a sample of Chilean university students. 435 students from three universities participated, of which 88 were men, 333 were women, and 14 did not indicate their gender. Their ages ranges between 18 and 51 years old (M = 21, SD = 3.09). Three instruments were applied, one to measure metacognitive strategies, one to measure motivation to critical thinking, and a third to measure critical thinking skills. The relation was analyzed via structural equations. The results show a positive, strong, and significant relation between metacognition and motivation to think. However, only a weak significant relation was observed between motivation to think and critical thinking, and no direct relation was found between metacognition and critical thinking. We hypothesize a significant but moderate relation between the variables, where metacognition influences motivation to think, which in turn influences critical thinking skills. Factors are discussed which could negatively affect the studied relations, as well as the importance of generating integrated models between the three variables, as they would show a theoretical and empirical link.

Critical Thinking, Formation, and Change.

In this paper, we propose an application of critical thinking (CT) to real-world problems, taking into account personal well-being (PB) and lifelong formation (FO). First, we raise a substantial problem with CT, which is that causal explanation is of little importance in solving everyday problems. If we care about everyday problems, we must treat the identification of causal relationships as a fundamental mechanism and action as a form of solution once the origin of the problem is unequivocally known. Decision-making and problem-solving skills should be the execution of the causal explanations reached. By acting this way, we change reality and achieve our goals, which are none other than those imposed by our PB. However, to achieve changes or results, we must have these fundamental competencies in CT, and these are not innate; we must acquire and develop them, that is, we must train ourselves to have CT competencies according to the demands of today's world. Finally, in this paper we propose a causal model that seeks to identify and test the causal relationships that exist between the different factors or variables that determine the CT-PB-FO relationship. We present some results on the relevance of causality and how to effectively form and address real-world problems from causality. However, there are still questions to be clarified that need to be investigated in future studies.

Critical Thinking: The ARDESOS-DIAPROVE Program in Dialogue with the Inference to the Best and Only Explanation.

In our daily lives, we are often faced with the need to explain various phenomena, but we do not always select the most accurate explanation. For example, let us consider a "toxic" relationship with physical and psychological abuse, where one of the partners is reluctant to end it. Explanations for this situation can range from emotional or economic dependency to irrational hypotheses such as witchcraft. Surprisingly, some people may turn to the latter explanation and consequently seek ineffective solutions, such as visiting a witch doctor instead of a psychologist. This choice of an inappropriate explanation can lead to actions that are not only ineffective but potentially harmful. This example underscores the importance of inference to the best explanation (IBE) in everyday decision making. IBE involves selecting the hypothesis that would best explain the available body of data or evidence, a process that is crucial to making sound decisions but is also vulnerable to bias and errors of judgment. Within this context, the purpose of our article is to explore how the IBE process and the selection of appropriate explanations impact decision making and problem solving in real life. To this end, we systematically analyze the role of IBE in the ARDESOS-DIAPROVE program, evaluating how this approach can enhance the teaching and practice of critical thinking.

Assessing higher education students' critical thinking with the PENCRISAL test - Portuguese short version: a psychometric study.

The development of critical thinking in higher education is fundamental, preparing students to think well, find explanations, make decisions and solve problems. Given the importance of its promotion, its assessment is crucial, since the two are inseparable. Moreover, the number of instruments that are validated to assess critical thinking in the Portuguese language and culture are scarce. We present the validation psychometric study of the PENCRISAL test (short version) to the Portuguese language, a critical thinking assessment test for higher education students, designed and validated in Spain (full and short version), which presents adequate reliability and validity psychometric characteristics to assess key-dimensions of critical thinking. A sample of 225 Portuguese higher education students from three universities (two public and one private) performed a reduced version of the PANCRISAL test. The results obtained allowed replicating the Spanish reduced version in Portugal (only changing one of the six items), and the confirmatory factorial analysis permits to identify two factors intercorrelated, legitimizing the combination of the six items in a global score. This short version can be used as a screening test, and its potential is pointed out to assess students critical thinking to support teaching and research in higher education.

Understanding hope at diagnosis: A study among Guatemalan parents of children with cancer.

BACKGROUND: In high-income countries, hope facilitates parental coping and builds the clinical relationship between families of children with cancer and their clinicians. However, the manifestation of hope in low- and middle-income countries (LMICs) remains poorly understood. Our study explores Guatemalan parents' experiences with hope during the pediatric oncology diagnostic process and aims to identify discrete actions clinicians take to support hope. METHODS: This qualitative study utilized audio-recordings of the diagnostic process and an additional semi-structured interview for 20 families of children with cancer at Unidad Nacional de Oncología Pediátrica in Guatemala. Spanish audio-recordings were translated into English, transcribed, and coded using a priori and novel codes. Thematic content analysis using constant comparative methods explored parents' hopes and concerns. RESULTS: At diagnosis, Guatemalan parents expressed both hopes and concerns related to the entire cancer continuum. Throughout the diagnostic process, hope grew as concerns were alleviated. Clinicians supported hope by creating a supportive environment, providing information, affirming religious beliefs, and empowering parents. These strategies helped parents shift their focus from fear and uncertainty toward hope for their child's future. Parents expressed that establishing hope improved mood, promoted acceptance, and enabled them to care for themselves and their children. CONCLUSION: These results confirm the relevance of supporting hope in pediatric oncology settings in LMICs and suggest that culture informs hope-related needs. Supporting hope is critical across cultures and can be integrated into clinical conversation using the four processes identified by our results.

Development and Adaptation of a Patient-Centered Communication Survey for Parents of Children With Cancer in Guatemala.

PURPOSE: Surveys to assess patient and family experiences of pediatric cancer care have been primarily developed and validated in high-income Western settings with English-speaking participants. However, 90% of children with cancer live in low- and middle-income countries. We sought to develop a survey focused on pediatric cancer communication for use in a low-literacy population in Guatemala, including adaptation of many previously validated items. METHODS: A multidisciplinary team developed a quantitative survey on the basis of a theoretical model of important components and influences on pediatric cancer communication. The original survey included established items previously used in high-income settings and novel questions designed for this study. The survey was translated into Spanish and pilot tested with parents of children receiving treatment at Unidad Nacional de Oncologia Pediatrica in Guatemala City, Guatemala, from April-June 2019. Cognitive interviews were used during pilot testing, and the survey was iteratively revised throughout this process. RESULTS: Early in testing, Guatemalan parents tended to choose answers at the extreme ends of response categories and socially desirable responses. Ultimately, a visual aid was developed to accompany three-item Likert scale response options. This allowed for successful administration of the survey instrument, resulting in moderate variation of response options and similar proportions to those generated when the original five-item responses were used in parent populations from the United States. CONCLUSION: Appropriately adapted surveys are necessary to understand patient-centered communication among pediatric oncology populations in low- and middle-income countries. Eventual validation of such tools will enable cross-cultural studies and comparative analysis of results.

Cancer treatment decision-making among parents of paediatric oncology patients in Guatemala: a mixed-methods study.

OBJECTIVES: To examine treatment decision-making priorities and experiences among parents of children with cancer in Guatemala. SETTING: This study was conducted at Guatemala's National Pediatric Cancer Center in Guatemala City. PARTICIPANTS: Spanish-speaking parents of paediatric patients (≤18 years of age) diagnosed with any form of cancer within the 8 weeks prior to study enrolment. The quantitative portion of this study included 100 parent participants; the qualitative component included 20 parents. Most participants were Catholic or Evangelical Spanish-speaking mothers. OUTCOMES: Priorities and experiences of cancer treatment decision-making including decision-making role and experienced regret. RESULTS: A range of paediatric ages and cancer diagnoses were included. Most Guatemalan parents surveyed (70%) made decisions about their child's cancer together and almost all (94%) without input from their community. Surveyed parents predominately preferred shared decision-making with their child's oncologist (76%), however 69% agreed it was best not to be provided with many options. Two-thirds of surveyed parents (65%) held their preferred role in decision-making, with fathers more likely to hold their preferred role than mothers (p=0.02). A small number of parents (11%) experienced heightened decisional regret, which did not correlate with socio-demographic characteristics or preferred decision-making role. Qualitative results supported quantitative findings, demonstrating a decision-making process that emphasised trust and honesty. CONCLUSIONS: Guatemalan parents preferred to make decisions with their medical team and appreciated providers who were honest and inclusive, but directive about decisions. This study reinforces the importance of the provider-parent relationship and encourages clinicians in all settings to ask about and honour each parent's desired role in decision-making.

Metacognitive Strategies and Development of Critical Thinking in Higher Education.

More and more often, we hear that higher education should foment critical thinking. The new skills focus for university teaching grants a central role to critical thinking in new study plans; however, using these skills well requires a certain degree of conscientiousness and its regulation. Metacognition therefore plays a crucial role in developing critical thinking and consists of a person being aware of their own thinking processes in order to improve them for better knowledge acquisition. Critical thinking depends on these metacognitive mechanisms functioning well, being conscious of the processes, actions, and emotions in play, and thereby having the chance to understand what has not been done well and correcting it. Even when there is evidence of the relation between metacognitive processes and critical thinking, there are still few initiatives which seek to clarify which process determines which other one, or whether there is interdependence between both. What we present in this study is therefore an intervention proposal to develop critical thinking and meta knowledge skills. In this context, Problem-Based Learning is a useful tool to develop these skills in higher education. The ARDESOS-DIAPROVE program seeks to foment critical thinking via metacognition and Problem-Based Learning methodology. It is known that learning quality improves when students apply metacognition; it is also known that effective problem-solving depends not only on critical thinking, but also on the skill of realization, and of cognitive and non-cognitive regulation. The study presented hereinafter therefore has the fundamental objective of showing whether instruction in critical thinking (ARDESOS-DIAPROVE) influences students' metacognitive processes. One consequence of this is that critical thinking improves with the use of metacognition. The sample was comprised of first-year psychology students at Public University of the North of Spain who were undergoing the aforementioned program; PENCRISAL was used to evaluate critical thinking skills and the Metacognitive Activities Inventory (MAI) for evaluating metacognition. We expected an increase in critical thinking scores and metacognition following this intervention. As a conclusion, we indicate actions to incentivize metacognitive work among participants, both individually via reflective questions and decision diagrams, and at the interactional level with dialogues and reflective debates which strengthen critical thinking.

Communication Priorities and Experiences of Caregivers of Children With Cancer in Guatemala.

PURPOSE: Although > 90% of children with cancer live in low- and middle-income countries, little is known about communication priorities and experiences of families in these settings. We examined communication priorities and the quality of information exchange for Guatemalan caregivers of children with cancer during diagnostic communication. METHODS: A cross-sectional survey including items used in pediatric communication studies from high-income countries and novel questions was verbally administered to 100 caregivers of children with cancer in Guatemala. RESULTS: Guatemalan caregivers prioritized communication functions of exchanging information (99%), fostering healing relationships (98%), decision making (97%), enabling self-management (96%), and managing uncertainty (94%) over responding to emotions (66%) and cultural awareness (48%). Almost all caregivers wanted as many details as possible about their child's diagnosis and treatment (96%), likelihood of cure (99%), and late effects (97%). Only 67% were always given the information they needed without asking for it, and most caregivers sometimes (56%) or always (18%) had questions they wanted to discuss but did not. Approximately half of the caregivers (54%) correctly identified their child's diagnosis, primary site, disease extent (localized v metastatic), proposed treatment length, and treatment intent (curative v palliative). Caregivers of children with leukemia were more likely to correctly identify all attributes than those whose children had solid tumors (P < .001). CONCLUSION: Caregivers in Guatemala prioritize many of the same aspects of diagnostic communication as parents in the United States, and experience similar challenges. Shared communication values offer potential for adaptation of communication interventions across settings with varying resources and diverse cultures.

Pediatric Oncology Palliative Care Programs in Central America: Pathways to Success.

Palliative care offers children who have life-limiting and life-threatening oncologic illnesses and their families improved quality of life. In some instances, impeccable symptom control can lead to improved survival. Cultural and financial barriers to palliative care in oncology patients occur in all countries, and those located in Central America are no exception. In this article, we summarize how the programs participating in the Asociación de Hemato-Oncólogos Pediatras de Centro America (AHOPCA) have developed dedicated oncology palliative care programs. The experience in Guatemala, El Salvador, Costa Rica, Panama, Dominican Republic and Haiti is detailed, with a focus on history, the barriers that have impeded progress, and achievements. Future directions, which, of course, may be impacted by the COVID-19 pandemic, are described as well.

Blood Toxic Elements and Effects on Plasma Vitamins and Carotenoids in Two Wild Bird Species: Turdus merula and Columba livia.

Birds have historically suffered adverse effects by toxic elements, such as As, Pb, Hg, and Cd. However, reports on exposure to a wide range of elements, including rare earth elements and other minor elements of emerging concern, and the potential consequences for wildlife are still scarce. This study evaluates blood concentrations of 50 elements and their related effects on lutein and vitamin levels in the Eurasian blackbird (Turdus merula) and wild rock pigeon (Columba livia), inhabiting different scenarios of contaminant exposure. Blood concentrations of As, Cd, and Pb (and Mn in T. merula) were increased in both species captured in the mining area, compared to the control site. T. merula also showed increased As, Cd, and Pb concentrations in blood in the agricultural-urban area, as compared to the control area, together with the highest Hg levels, which could be related to agricultural practices and industrial activities. Decreases of 33 and 38% in the plasma retinol levels in T. merula inhabiting the mining and the agricultural-urban areas, respectively, as compared to the control site, were associated with increased Pb, As, and Cd exposure. This could be due to a metal-driven suppressive effect in retinol metabolism and/or its over-use for coping with metal-related oxidative stress.

The evolution of parents' beliefs about childhood cancer during diagnostic communication: a qualitative study in Guatemala.

INTRODUCTION: Fatalistic cancer beliefs may contribute to delayed diagnosis and poor outcomes, including treatment abandonment, for children with cancer. This study explored Guatemalan parents' cancer beliefs during initial paediatric cancer communication, and the sociocultural and contextual factors that influence these beliefs. METHODS: Twenty families of children with cancer were included in this study. We audio-recorded psychosocial conversations with psychologists and diagnostic conversations with oncologists, then conducted semi-structured interviews with parents to explore the evolution of their cancer beliefs. Audio-recordings were transcribed and translated from Spanish into English, with additional review in both languages by bilingual team members. All 60 transcripts were thematically analysed using a priori and novel codes. RESULTS: Guatemalan parents' beliefs evolve as they learn about cancer through various sources. Sources of information external to the cancer centre, including prior experiences with cancer, media exposure, community discussion and clinical encounters, contribute to pre-existing beliefs. Many parents' pre-existing cancer beliefs are fatalistic; some are influenced by Mayan spirituality. Sources internal to the cancer centre include psychologists and oncologists, other providers, other patients and families. Psychologists acknowledge pre-existing beliefs and deliver cancer education using verbal explanations and hand-drawings. Oncologists provide diagnostic information and outline treatment plans. Both support hope by providing a path toward cure. Parents' lived experience is a culmination of sources and simultaneously independent. Ultimately most parents arrive at an understanding of cancer that is consistent with an allopathic medical model and offers optimism about outcomes. CONCLUSION: An interdisciplinary communication process that includes cancer education, is attentive to pre-existing beliefs, and supports hope may encourage acceptance of the allopathic medical model and need for treatment. Providers in settings of all resource levels may be able to use these techniques to support cross-cultural cancer communication, reduce treatment abandonment and improve therapy adherence.

A comparative analysis to depict underlying attributes that might determine successful implementation of local adaptation plans.

Current trends in climate change indicate that the impact on the most vulnerable systems will increase. Urban areas, which concentrate population, economic activity and infrastructures, are sometimes at high-risk locations. Yet they are to be considered as vulnerable systems in need of harmonized structures supporting their efforts towards mitigating climate effects and/or adapting their territories to them. One current structure is the Covenant of Mayors for Climate and Energy (CoM) initiative, tackling in a global and harmonized way local adaptation to climate change. Do CoM cities that developed acceptable climate change adaptation plans have similar characteristics? It is still unclear which might be the drivers or key attributes potentially leading to successful planning within the initiative. In this paper, we explore attributes of the first 51 cities that have submitted their adaptation plans to CoM, in order to identify common elements among accepted plans. Therefore, our hypothesis is that there must be attributes determining the acceptance of adaptation plans. In order to do so, the cities were classified as compliant and non-compliant with the CoM principles. Fisher's and Kolmogorov-Smirnov tests were applied to identify attributes that are statistically different between both groups. Results show that the engagement of multiple stakeholders and citizens, particularly at the local level, might significantly facilitate the acceptance of adaptation plans in the initiative. We also found that the benefits of stakeholder and citizen engagement could be greater in small municipalities because citizens and stakeholders have more opportunities to participate.

¿Puede ser evaluado el pensamiento crítico de forma breve? / Pode o pensamento crítico ser avaliado de forma breve? / Can critical thinking be briefly assessed?

El objetivo de la investigación ha sido validar una versión breve de la prueba completa de pensamiento crítico (PC) PENCRISAL, en español y portugués. Aquí se presenta la primera. Esta versión breve consta de 2 factores, con 3 ítems cada uno. Un factor evalúa argumentación general, y el otro las formas de razonamiento más empleadas a diario. Además, ambos factores evalúan indirectamente la toma de decisiones y la solución de problemas, gracias a la naturaleza de los ítems, en los que se plantean problemas cotidianos que se deben resolver y, en ocasiones, hay que tomar decisiones. El análisis factorial confirmatorio nos ofrece índices de ajuste adecuados que avalan la estructura de la versión breve del test presentado. Los coeficientes de fiabilidad y validez son razonablemente robustos, lo que hace que esta prueba sirva a los objetivos de investigación establecidos (AU).

O objetivo do nosso estudo foi validar uma versão breve do Teste Completo de Pensamento Crítico (PC) PENCRISAL, em espanhol e português. Aqui apresentamos o primeiro. Esta versão resumida consiste em 2 fatores, com 3 itens cada. Um fator avalia a argumentação geral e o outro as formas de raciocínio mais utilizadas no dia a dia. Além disso, ambos os fatores avaliam indiretamente a tomada de decisão e a resolução de problemas, graças à natureza dos itens, nos quais se levantam problemas diários que devem ser resolvidos e para os quais, às vezes, devem ser tomadas decisões. A análise fatorial confirmatória nos oferece índices adequados de ajustamento que sustentam a estrutura da versão resumida do teste apresentado. Os coeficientes de confiabilidade e validade são razoavelmente robustos, o que faz com que este teste sirva para os objetivos de investigação declarados (AU).

The aim of our study was to validate a short version of the PENCRISAL complete critical thinking test, in Spanish and Portuguese. Here we present the first. This short version consists of 2 factors, with 3 items each. One factor assesses general argumentation, and the other the forms of reasoning most used on a daily basis. In addition, both factors indirectly evaluate decision-making and problem solving, thanks to the nature of the items, in which daily problems are raised that must be solved and for which decisions must sometimes be made. The confirmatory factor analysis offers us solid and consistent indices that support the structure of the short version of the test presented. The reliability and validity coefficients are reasonably robust, as to make this test serve very well for the stated objectives (AU).

Data on mitigation policies at local level within the Covenant of Mayors' monitoring emission inventories.

This data article relates to and complement the research paper: "Assessment of climate change mitigation policies in 315 cities in the Covenant of Mayors initiative" [1]. The reported data has been collected and elaborated within the framework of the Covenant of Mayors (CoM) initiative. The dataset is extracted from the overall database of the initiative reported through the platform MyCovenant. The data deals with the Monitoring Emission Inventories submitted by local authorities by 2016. Data has been processed and elaborated to highlights specific features of signatories and the policies they have adopted in the development of their Sustainable Energy Action Plans (SEAP). Available data relates to the mitigation policies in the SEAPs and includes their carbon reduction potential, the status of implementation and the class of governance. The CoM gathers together thousands of local authorities who voluntary committed to decarbonisation and increase resilience in their territory. Therefore, this data can be of interest for local policy makers and urban planners to identify successful examples in cities with comparable contexts and to identify possible measures in several sectors for climate change mitigation.

Removal of Cadmium from Aqueous Solutions by Saccharomyces cerevisiae-Alginate System.

The aim of this study was to determine the Cd2+ removal capacity of a biosorbent system formed by Saccharomyces cerevisiae in calcium alginate beads. The adsorption of Cd2+ by a S. cerevisiae-alginate system was tested either by batch or fixed-bed column experiments. The S. cerevisiae-alginate system was characterized using dynamic light scattering (DLS, zeta potential), size, hardness, scanning electron microscopy (SEM), and Fourier-transform infrared spectroscopy. Beads of the S. cerevisiae-alginate system showed a spherical-elliptical morphology, diameter of 1.62 ± 0.02 mm, 96% moisture, negative surface charge (-29.3 ± 2.57 mV), and texture stability during storage at 4 °C for 20 days. In batch conditions, the system adsorbed 4.3 µg of Cd2+/g of yeast-alginate beads, using a Cd2+ initial concentration of 5 mg/L. Adsorption capacity increased to 15.4 µg/g in a fixed-bed column system, removing 83% of total Cd2+. In conclusion, the yeast-alginate system is an efficient option for the removal of cadmium at low concentrations in drinking water.

Osteopontin expression and its relationship with prognostic factors in diffuse large B-cell lymphoma.

The aim of this study is to explore the expression of osteopontin (OPN) and its relationship with prognostic factors and survival in diffuse large B cell lymphoma (DLBCL). A tissue microarray was performed for immunohistochemical evaluation. Contingency tables were analyzed for trends; chi-square test was used to determine differences between groups. Univariate and multivariate Cox proportional hazards-regression analyses were performed to evaluate the impact of prognostic factors on survival. Expression of OPN was observed in 28%. It was different in non-germinal center DLBCL (P=0.04). The mean overall survival (OS) was lower in patients with positive OPN expression (19.762; CI 95% 14.269-25.255) it was not significant (P=0.123). It is not possible to establish a clear relationship between the expression by immunohistochemistry of osteopontin and a poor prognosis but it would be important to complement the analysis with other techniques as PCR or NGS that allow us to assess the influence of the isoforms and post-translational modifications of OPN on the biological behavior of DLBCL. Our findings indicate that OPN expression could be associated with a more aggressive variant of lymphoma: non-germinal center DLBCL.

Prognostic factors for overall survival in patients with chronic myeloid leukemia treated with imatinib at the National Cancer Institute - Mexico, from 2000 to 2016.

To determine potential predictors of long-term survival in a large set of Hispanic (Mexican) patients with chronic myeloid leukemia (CML) treated with imatinib. We conducted an analysis with data from 411 patients with CML treated at the National Cancer Institute - Mexico, between January 2000 and December 2016. We found a median age at diagnosis of 40 years (range: 18-84 years). The survival rate at 150 months was 82.02%, and we found that phase at diagnosis (ß: 0.447, 95% Confidence Interval [95% CI]: 0.088, 0.806; P = 0.015), prognostic scales (Sokal [P = 0.021] and Hasford [ß: 0.369, 95% CI: 0.049, 0.688; P = 0.024]) and hematological response at 3 months (ß: 0.717, 95% CI: 0.443, 0.991; P < 0.001), but not molecular response (P = 0.834 for 6 months, P = 0.927 for 12 months, P = 0.250 for 18 months), were independently associated with overall survival. Survival analysis in subsets, according to the initial phase (chronic, accelerated and blastic phase) did not show any effect according to prognostic scales (P > 0.05). Mexican patients with CML have repeatedly been diagnosed at earlier ages. Prognostic factors in CML may differ according to the ethnic or geographical context. We found that phase at diagnosis, prognostic scale and hematological response at 3 months were independent predictors of survival.

Nutritional status at diagnosis of cancer in children and adolescents in Guatemala and its relationship to socioeconomic disadvantage: A retrospective cohort study.

BACKGROUND: At least 80% of children with cancer live in low- and middle-income countries where the prevalence of malnutrition and socioeconomic disadvantage is high. We examined the relationship between nutritional status (NS), assessed by arm anthropometry, and socioeconomic status (SES) in children diagnosed with cancer at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala over a three-year period. METHOD: Patients aged 0 to 18 years of age diagnosed between January 2015 and December 2017 were included. NS was evaluated by mid-upper arm circumference, triceps skin fold thickness, and serum albumin level, and subjects were classified as adequately nourished, moderately depleted, and severely depleted nutritionally. SES was measured by a 15-item instrument developed at UNOP. RESULTS: Of 1365 patients diagnosed in the study period, 1060 (78%) fulfilled the eligibility criteria. Only 6% of patients were classified as medium to high, the remainder as medium-low to extremely low SES. Almost 47% were severely depleted at diagnosis, 19% moderately depleted, and 34% adequately nourished. SES was shown to be a determinant of NS; with progressively lower SES, the probability of a decline in NS increased by a factor of 1.04 points (P < 0.0001). Leukemia and lymphoma were also important predictors of nutritional depletion with odds ratios of 6.08 (95% CI, 1.74-28.28; P = 0.008) for leukemias and 4.83 (95% CI, 1.33-23.03; P = 0.03) for lymphomas. CONCLUSION: Both low SES and a diagnosis of leukemia or lymphoma are strong predictors of poor NS at diagnosis in children with cancer in Guatemala.

An institutional analysis to address climate change adaptation in Tenerife (Canary Islands).

Heat waves and Saharan dust outbreaks have been acquiring more frequency and intensity in the Canary Islands during the last decades. Both climatic hazards are known to produce impacts on human health such as mortality (due to heat waves) and morbidity (due to dusty weather). This work addresses possible climate adaptation policies in Tenerife assuming the increasing impact of heat waves and Saharan dust outbreaks in the island under a climate change scenario. It explores the institutional setting of climate change adaptation planning in Tenerife and evaluates the statu quo of adaptation planning in the island through the engagement of key social actors. An historical review of the local and regional press articles and legislation, an in-depth round of interviews, together with questionnaires to the main social actors allows framing the social and political context in which climate change adaptation in Tenerife is embedded. Key social actors were engaged, including international organisations, atmospheric research centres, local Universities, regional and insular governments, trade unions, and environmental NGOs, among others. The main obstacles mentioned by the social actors that hinder the development of an effective climate adaptation policy address scientific knowledge, data collection and policy making, focusing on the uncertainty of climate models, the lack of epidemiological data and contrasting opinions regarding the existing climate adaptation policies. Public participation, mainstreaming of climate policies and an integrated approach between mitigation and adaptation plans were identified as key policy issues. The outcomes of this study could be meaningful for climate adaptation initiatives at local or regional level, such as the Global Covenant of Mayors, that intend to promote climate resilience through the setup of climate adaptation strategies and plans at municipality level.