Parent-provider communication dynamics during the pediatric oncology diagnostic process in Guatemala: A qualitative study.

BACKGROUND: Effective communication is founded on bidirectional participation from families and healthcare providers. In adult medicine, bidirectional communication promotes treatment adherence and builds the family-provider relationship. However, the relationship between communication styles in pediatrics remains poorly understood, particularly in culturally diverse settings. This study aims to investigate parent-provider communication dynamics and parental involvement during diagnostic cancer communication in Guatemala. PROCEDURE: This qualitative study included 20 families of children with cancer and 10 providers at Unidad Nacional de Oncología Pediátrica in Guatemala. Psychoeducation and diagnostic conversations between parents, psychologists, and oncologists were recorded and thematically analyzed using a priori and novel codes exploring communication behaviors, parental engagement, and interpersonal dynamics. RESULTS: Participating parents had children with various diagnoses. Only 15% of fathers and 5% of mothers reported education beyond primary school. Providers spoke 68% of words during psychoeducation and 85% of words during diagnosis conversations. Providers used supportive communication behaviors providing explanations, demonstrating verbal attentiveness, and soliciting questions and non-supportive behaviors including paternalistic talk. Parental participation was considered active when they asked questions, expressed hopes or concerns, or asserted their opinions, and non-active when participation was limited to brief responses to closed-ended questions. Supportive provider communication often encouraged active participation; non-supportive communication did not. Furthermore, active parental participation prompted supportive communication from providers, while non-active participation did not. CONCLUSIONS: Our findings highlight the bidirectional nature of effective communication, establishing that provider communication styles both influence and are influenced by parental participation, and emphasizing the importance of supportive provider communication for patient-centered care.

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.

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.

Improvement in treatment abandonment in pediatric patients with cancer in Guatemala.

BACKGROUND: Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. METHODS: This was a retrospective study of Guatemalan children (0-18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001-2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan-Meier analysis estimated the survival. RESULTS: Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. CONCLUSION: This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.

Improving our understanding of the use of traditional complementary/alternative medicine in children with cancer.

BACKGROUND: Children with cancer in high-income and low-income countries often use traditional complementary/alternative medicine (TCAM). With efforts by the World Health Organization and international twinning programs improving access to conventional care for patients with childhood cancer, understanding the global use of TCAM is important because reliance on TCAM may affect time to presentation, adherence, and abandonment of care. In the current study, the authors describe the process and validation of an international survey documenting the use of TCAM among children with cancer. METHODS: The survey was designed to collect information on TCAM use and associated factors through both open-ended and close-ended questions. During the period between June 2012 and December 2013, the survey was administered to 300 children and adolescents (or their parents) who were undergoing treatment for cancer at a collaborating institution located in Mexico, Uruguay, and Nicaragua. RESULTS: For the majority of constructs, the survey demonstrated strong test-retest reliability as evidenced by an intraclass correlation of at least ≥0.79 in each of the participating countries. The survey demonstrated good internal consistency and reliability across countries (α range from. 77 to. 85 for the belief scale; and an α range from. 60 to. 86 for the cause scale) and convergent validity between TCAM beliefs and behavior constructs (adjusted correlation range, 0.35-0.60). CONCLUSIONS: The results of the current study demonstrate the successful development of a cross-cultural survey that produced results that were reliable and valid. These findings will aid investigators in providing guidelines concerning TCAM, support the development of education and research priorities, and identify variables associated with TCAM that are region-specific.

Use of traditional and complementary/alternative medicine (TCAM) in children with cancer in Guatemala.

BACKGROUND: International surveys have demonstrated that use of traditional and complementary/alternative medicine (TCAM) is highly prevalent among children with cancer; however, little is known about its use among children with cancer in Latin America. As part of a regional initiative, we present the results of the first survey exploring use of TCAM among children with cancer residing in Latin America. PROCEDURE: A cross-sectional sample of 100 parents whose children received treatment in Guatemala City were interviewed from May 2008 to February 2010. Upon consent, an in-person interview was performed during a routine clinical visit. Information on the form, duration, cost, and satisfaction of TCAM was collected. Approval from the institutional review board was obtained. RESULTS: The median age of patients was 9.2 years with 63% undergoing treatment. Use of TCAM was reported by 90% of parents. Most often, more than one type of therapy was utilized. Most patients (67%) relied on TCAM for supportive care indications; however, a significant percentage (34%) used TCAM for curative purposes. The most commonly reported form was the use of oral supplements with the majority perceiving TCAM as effective for the intended purpose. CONCLUSIONS: Use of TCAM was highly prevalent among children with cancer residing in Guatemala. Most importantly, TCAM was used alongside conventional therapy for supportive care indications. These findings underscoring the need for open lines of communication between clinicians and families. Future research may consider exploring the role of TCAM within the scope of supportive care and its effect on existing supportive care interventions.

Changes in the solubility of corn proteins through interaction with the arabinoxylans in extruded nixtamalized corn flour treated with xylanase.

The extrusion process allows the production of nixtamalized corn flour rich in arabinoxylans, which help to prevent cardiovascular and intestinal diseases. During extrusion, physiochemical properties of nixtamalized corn flour are negatively modified. The use of enzymes such as xylanase in order to obtain nixtamalized corn flour using extrusion has been studied as an alternative to reduce these changes in corn flour tortilla. The aim of this research was to evaluate changes in protein solubility of extruded nixtamalized corn flour with and without different concentrations of xylanase enzyme (0.05, 0.075, and 0.1%, w/w). Soluble proteins of each corn flour were extracted and analyzed by SE-HPLC, while insoluble proteins were determined by the combustion method. In addition, each corn flour was analyzed by scanning electron microscopy (SEM). Results showed that the extruded nixtamalized corn flour, with and without xylanase, increased the protein solubility, and this effect was lower in extruded nixtamalized corn flour with xylanase. Insoluble protein diminished in corn flours either with or without xylanase enzyme. The addition of xylanase reduces the effect that the extrusion process has on the solubility proteins of extruded nixtamalized corn flour.

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.

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: 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.

An interactive way of learning about cancer and healthy living in a multicultural setting (part one)?

Health education is essential not only for preventing illnesses but also for knowing how to act when disease comes. In countries where the education system is inefficient for most of the population and where health issues are often ignored or mistreated because of ignorance or well-intended but ineffective belief in nature's energy and magic, it is important that people have access to truthful information about health issues. Such access allows them to act adequate knowledge and also to learn ways to avoid illness by changing their daily habits into a "healthy way of living." Approaching the young population is a way to achieve this objective. The program described here considers the education of both majority (indigenous) and minority (non indigenous) populations. It approaches the communication of information in such a way that it involves the participants in the "making" of the education. The participants actively interact with didactic material that allows them to experience "hands on" the issues about cancer and healthy living. It is intended to have a profound impact on the participant, so that he/she will remember the "education" not only as information but also as an experience. The program includes specific material for the indigenous population, which is based on their idiosyncrasy (corn plants) so that they can more easily understand the concepts. In Guatemala, UNOP (Unidad Nacional de Oncologia Pediatrica) is the only institution that provides a quality integral service for the majority of the entire children-with-cancer population. UNOP and the Psychology Department are interested in the development and implementation of education programs such as this where the participant not only learns but also experiences information about this disease and its prevention.

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.

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.

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.

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.

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.