[Ethics and giving bad news to a patient with Alzheimer's]. / Éthique et mauvaise nouvelle à un patient Alzheimer.

Breaking bad news to a patient with Alzheimer's often raises ethical questions: should the person be informed or not when there is a risk he or she will not understand or retain the explanations provided? While on the face of it the truth seems desirable, it is important to carefully analyse what is at stake as this truth can potentially harm a vulnerable patient. The person making the disclosure can find themselves at the centre of a conflict: on the one hand loyalty and a moral duty to inform, on the other a compassionate lie to protect the patient from upsetting news. Being aware of the ethical issues at the heart of this dilemma can help to indicate the best path to take for the benefit of the patient, the family and the nurses.

Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak.

OBJECTIVES: This study aimed to identify demographic, clinical and medical care factors associated with mortality in three nursing homes in France. METHODS: Two nursing homes were hospital-dependent, had connections with infection prevention and control departments, and had permanent physicians. A third nursing home had no direct connection with a general hospital, no infection control practitioner, and no permanent physician. The main outcome was death. RESULTS: During the first 3 months of the outbreak, 224 of 375 (59.7%) residents were classified as COVID-19 cases and 57 of 375 (15.2%) died. The hospital-dependent nursing homes had lower COVID-19 case fatality rates in comparison with the non-hospital-dependent nursing home (15 [6.6%] vs 38 [25.8%], OR 0.20 [0.11-0.38], p = 0.001). During the first 3 weeks of the outbreak, mortality in COVID-19 patients decreased if they had a daily clinical examination (OR: 0.09 [0.03-0.35], p = 0.01), three vital signs measurement per day (OR: 0.06 [0.01-0.30], p = 0.001) and prophylactic anticoagulation (OR: 0 [0.00-0.24], p = 0.001). CONCLUSIONS: This study suggested that high mortality rates in some nursing homes during the COVID-19 outbreak might have been contributed by a lack of medical care management. Increasing human and material resources, encouraging presence of nursing home physicians and establishing a connection with general hospitals should be considered to deal with present and future health disasters in nursing homes.

Cyberbullying definition among adolescents: a comparison across six European countries.

Several criteria have been proposed for defining cyberbullying to young people, but no studies have proved their relevance. There are also variations across different countries in the meaning and the definition of this behavior. We systematically investigated the role of five definitional criteria for cyberbullying, in six European countries. These criteria (intentionality, imbalance of power, repetition, anonymity, and public vs. private) were combined through a set of 32 scenarios, covering a range of four types of behaviors (written-verbal, visual, exclusion, and impersonation). For each scenario, participants were asked whether it was cyberbullying or not. A randomized version of the questionnaire was shown to 295 Italian, 610 Spanish, 365 German, 320 Sweden, 336 Estonian, and 331 French adolescents aged 11-17 years. Results from multidimensional scaling across country and type of behavior suggested a clear first dimension characterized by imbalance of power and a clear second dimension characterized by intentionality and, at a lower level, by anonymity. In terms of differences across types of behaviors, descriptive frequencies showed a more ambiguous role for exclusion as a form of cyberbullying, but general support was given to the relevance of the two dimensions across all the types of behavior. In terms of country differences, French participants more often perceived the scenarios as cyberbullying as compared with those in other countries, but general support was found for the relevance of the two dimensions across countries.

Gene flow scenarios with transgenic maize in Mexico.

Maize diversity is widespread in Mexico and it has been stewarded by campesinos in small communities until the present. With the arrival of transgenic maize, the objective of this study is to analyze possible scenarios that could result if genetically modified maize were not regulated and openly available in Mexico. By applying a simple logistic model based on the conditions of maize production in Mexico, the dispersion of transgenic maize in different situations within fields of farmers is described. In traditional open systems of freely exchanged seed within communities it is concluded that the most likely outcome of GM maize release is the incorporation of transgenes in the genome of Mexican germplasm and possibly in that of teosinte.