Risky decision-taking task: A novel paradigm to assess the risk-taking behaviour in rats predisposed to early-life stress.

One of the characteristic features of adolescence is risk-taking behavioural traits. Uncontrolled risk-taking without proper assessment may have harmful impact on mental health later in life. Therefore, it is essential to identify it early for the preventable health problems. In the present study, we have designed a novel paradigm, viz. Risky Decision-taking Task (RDTT), to evaluate the spontaneous risk-taking behavioural repertoire in adolescent rodents. The task was designed based on both risk and cognitive factors. To validate and compare the risk-taking tendency, we have used early maternal separation and isolation (MS) stress model, as it is known to increase anxiety and curiosity-like behaviour at adolescence. We have used Sprague-Dawley rats of both sexes. Rats were exposed to MS stress for 10 days daily for six hours during stress hyporesponsive period (SHRP) from postnatal day 4-13. These rats were subjected to RDTT during adolescence. This task is a reward-based task where the latency to collect reward in the presence or absence of a risk factor is assessed. It consists of habituation, training to find the location of small and large rewards, reward preference for small and large reward and testing period under risky situation. Rats were trained individually to retrieve the valuation-based rewards under the risky, but innate aversive environments. The results from RDTT showed that as compared to controls, MS rats from both sexes showed reduced latency to collect large reward in the presence of a risk element and a reduced risk-index which is indicative of a higher risk-taking tendency in these rats. In addition, MS rats showed a trend towards anxiety-like behaviour as compared to controls in the Light-Dark Test. These results together show decreased risk latency for the large reward and reduced risk assessment in MS rats which is suggestive of more risk-taking tendency in these rats. Thus, we propose that RDTT paradigm can be used to evaluate the spontaneous risk-taking behavioural repertoire based on innate, spontaneous aversion and cognitive factors in rats.

Boris Johnson: the moral case for government resignations in July 2022.

Although comparatively rare, political resignations are essential for the health of democracy and political institutions. Protagonists risk their political careers when resigning but can hold governments to account and make real the Nolan principles of public life. In July 2022, an unprecedented 62 resignations ended Boris Johnson's time as British prime minister to be replaced first by Liz Truss and then, 44 days later, by Rishi Sunak, the second minister to resign. An inductive, qualitative, content analysis of the resignation letters elucidates the reasons for the resignations and highlights the ethical dilemmas that confronted would be resignees. Events lessened the effectiveness of government, triggered fears for the electoral prospects of the Conservative Party and separately challenged individuals' personal integrity. Considerations that prevented resignees acting earlier-promises that things would change, competing loyalties, fear of reprisal, love of job, attachment to status and allegiance to ideological faction-may partially explain why much of government remained in post in July.

Risky Decision-Making and Hazard Prediction are Negatively Related and Could Be Assessed Independently Using Driving Footage.

INTRODUCTION: Traffic collisions are a principal cause of death in Europe, disproportionately affecting young drivers. Driving safety depends not only on our ability to anticipate and respond to dangers on the road but also on the level of risk we are willing to engage within our own driving behaviour. METHODS: Hazard prediction (HPr) and risky decision-making (RDM) tests were given to three groups of young Spaniards (169 participants): 54 non-drivers (M=20), 65 novice (M=21) and, 50 experienced drivers (M=26 years old). Both tests presented participants with video clips of driving recorded from the driver's perspective. The HPr test contained hazardous situations caused by the actions of another road user (eg, a pedestrian crossing the road). Each HPr clip was occluded as a hazard began to unfold and participants were asked to predict "what happens next?" They selected their answer from four on-screen options. The RDM test used clips where any imminent danger would be provoked by the film-car driver's risky behaviour (eg, overtaking illegally). Participants were asked to report the probability of following certain types of risky behaviour (eg, "Would you go forward with the lights on amber?" or "Would you overtake the cyclist/lorry/bus at this point?"). In addition, the effect of the locality of the driving scenarios was manipulated: they could take place in the participant's native country (Spain) or in a different country (UK). RESULTS: Non-drivers and novice drivers were less able to predict upcoming hazards and more likely to make risky decisions. Driving scenarios from another country (UK) provoked riskier decisions than those from the participants' home country (Spain). CONCLUSION: Improvement in HPr skills among novice or new drivers poses a huge challenge as far as driver training is concerned, though it is only part of the solution. Young inexperienced drivers' willingness to engage in risky behaviour also needs to be tackled. Our results suggest that such RDM can be assessed in a similar way to HPr skill, using a naturalistic approach, which raises the possibility of assessing and training drivers on a wider range of safety-related behaviours.

Medical or surgical management of fibroids? An internet survey of gynecologists' views.

AIM: To assess the attitudes of gynecologists toward symptomatic fibroids and analyze which factors influence their choice of treatment. MATERIAL AND METHOD: We surveyed the attitude of Belgian gynecologists toward patients' cases. We used a vignette of a woman with symptomatic fibroids and modified 3 factors: her age, her parity and her desire for pregnancy, thereby establishing 12 different cases. We ensured that each gynecologist (n=1437) received one case, chosen randomly, by email. The gynecologists were asked whether and how they would treat the patient. RESULTS: Replies were received from 337 gynecologists (a 23% response rate). Of the 337, 116 (34%) would prescribe a medical treatment only; in this group, 29% specified acetate ulipristal a selective progesterone receptor modulator (SPRM) and 27% indicated progestins. Of the sample of 337 responders, another 116 (34%) would begin with medical treatment (70% an SPRM) and then proceed to surgery. Of the 337 gynecologists, 75 (22%) would perform surgery only. The preferred surgical treatments were myomectomy (53/75; 71%) and hysterectomy (19/75; 25%) when surgery was suggested as a first step, and myomectomy (91/115; 79%) and hysterectomy (18/115; 16%) when it was preceded by medical treatment. The choice of treatment varied significantly in relation to the 12 vignettes (p<0.01). When we grouped the vignettes there was no significant variation in relation to age or parity, but a there was significant variation (p<0.001) in relation to desire to achieve pregnancy. CONCLUSION: We observed that, in women with symptomatic fibroids, the desire retain fertility is respected. Moreover, SPRM is increasingly used for symptomatic patients.

[Spinal muscular atrophy and respiratory failure. How do primary care pediatricians act in a simulated scenario?]. / Atrofia muscular espinal y fracaso respiratorio. ¿Cómo actúan los pediatras de atención primaria en un escenario simulado?

INTRODUCTION: Spinal muscular atrophy type 1 (SMA-1) tends to be fatal in the first year of life if there is no ventilatory support. The decision whether to start such support is an ethical conflict for healthcare professionals. MATERIAL AND METHODS: A scenario of acute respiratory failure in an infant with SMA-1 has been included in a training program using advanced simulation for Primary Care pediatricians (PCP). The performances of 34 groups of 4 pediatricians, who participated in 17 courses, were systematically analyzed. Clinical, ethical and communication aspects with parents were evaluated. RESULTS: The initial technical assistance (Administration of oxygen and immediate ventilatory support) was correctly performed by 94% of the teams. However, the PCP had problems in dealing with the ethical aspects of the case. Of the 85% of the teams that raised the ethical conflict with parents, 29% did so on their own initiative, 23% actively excluded them, and only 6% involved them and took their opinion into account in making decisions. Only 11.7% asked about the quality of life of children and 12% for their knowledge of the prognosis of the disease. None explained treatment alternatives, nor tried to contact the pediatrician responsible for the child. CONCLUSIONS: When faced with a simulated SMA-1 infant with respiratory failure, PCP have difficulties in interacting with the family, and to involve it in the decision making process. Practical training of all pediatricians should include case scenarios with an ethical clinical problem.

Effects of presenting risk information in different formats to cardiologists. A Latin American survey / Encuesta sobre los efectos de la presentación de los riesgos y beneficios en distintos formatos a cardiólogos latinoamericanos

Objective: Previous publications demonstrated that the presentation of treatment benefits in terms of relative risk reduction (RRR) rather than in terms of absolute risk reduction (ARR) or number of patients to treat (NNT) might favor the perception of outcome effectiveness. The objective was to perform a cognitive evaluation to assess how the manner in which risks and benefits of screening methods and treatments are presented can affect medical care decision-taking in a sample of cardiologists. Methods: Four-hundred and six Latin American cardiologists answered a questionnaire reporting the results of clinical trials presented as RRR, ARR or NNT, associated or not to biased graphs. Results: Cardiologists' decision-taking was different when comparing treatment benefits presented as RRR (62.2%) vs. ARR (40.4%) (p = 0.000000), and as RRR vs. NNT (44.4%) (p = 0.000000). However, their decision-taking was similar when information was presented as NNT or ARR (p = 0.073). The inclusion of biased graphs was misinterpreted as an actual data difference (RRR: 61.6% vs. ARR: 14.0%, p = 0.000000). Conclusions: This study demonstrated that Latin American cardiologists could misinterpret statistical data when information of clinical trials is presented in terms of RRR. We emphasize the need to enhance cardiologists' training in quantitative techniques, to improve medical care decision-making.

Objetivo: Publicaciones previas demostraron que la presentación de los beneficios terapéuticos en términos de reducción del riesgo relativo (RRR) en lugar de en términos de reducción del riesgo absoluto (RRA) o número necesario a tratar (NNT) favorecería la percepción de que los resultados son más efectivos. El objetivo fue realizar una evaluación en una muestra de cardiólogos para determinar cómo afecta a la decisión médica la manera como se presentan los riesgos y beneficios de métodos diagnósticos y terapéuticos. Métodos: Cuatrocientos seis cardiólogos latinoamericanos respondieron a un cuestionario que contenía los resultados de ensayos clínicos como RRR, RRA y/o NNT, asociados o no a gráficos sesgados. Resultados: La toma de decisión de los cardiólogos fue diferente al comparar los beneficios terapéuticos presentados como RRR (62.2%) vs. RRA (40.4%) (p = 0.000000), y como RRR vs. NNT (44.4%) (p = 0.000000); sin embargo, fue similar cuando la información se presentó como NNT o RRA (p = 0.073). La inclusión de gráficos sesgados fue malinterpretada como una diferencia real (RRR: 61.6% vs. RRA: 14.0%, p = 0.000000). Conclusiones: Se demostró que los cardiólogos latinoamericanos podrían confundir resultados estadísticos cuando la información de los ensayos clínicos se presenta como RRR. Hacemos hincapié en la necesidad de entrenar a los cardiólogos en las técnicas cuantitativas para mejorar la toma de decisiones.

Effects of presenting risk information in different formats to cardiologists. A Latin American survey.

OBJECTIVE: Previous publications demonstrated that the presentation of treatment benefits in terms of relative risk reduction (RRR) rather than in terms of absolute risk reduction (ARR) or number of patients to treat (NNT) might favor the perception of outcome effectiveness. The objective was to perform a cognitive evaluation to assess how the manner in which risks and benefits of screening methods and treatments are presented can affect medical care decision-taking in a sample of cardiologists. METHODS: Four-hundred and six Latin American cardiologists answered a questionnaire reporting the results of clinical trials presented as RRR, ARR or NNT, associated or not to biased graphs. RESULTS: Cardiologists' decision-taking was different when comparing treatment benefits presented as RRR (62.2%) vs. ARR (40.4%) (p=0.000000), and as RRR vs. NNT (44.4%) (p=0.000000). However, their decision-taking was similar when information was presented as NNT or ARR (p=0.073). The inclusion of biased graphs was misinterpreted as an actual data difference (RRR: 61.6% vs. ARR: 14.0%, p=0.000000). CONCLUSIONS: This study demonstrated that Latin American cardiologists could misinterpret statistical data when information of clinical trials is presented in terms of RRR. We emphasize the need to enhance cardiologists' training in quantitative techniques, to improve medical care decision-making.

Descripción del manejo de la información en la primera infancia en dieciséis municipios colombianos / Description of Information Management in Early Childhood in Sixteen Colombian Municipalities / Descriçã o do manuseio da informação na primeira infância em dezesseis municipios colombianos

Los objetivos de este trabajo fueron identificar los temas de mayor interés, las principales necesidades de información y los aspectos o sugerencias para la construcción de un sistema de información sobre el cuidado de la salud de la población infantil en los municipios. Se realizaron siete talleres en siete municipios, con la participación de 71 representantes de 19 entidades relacionadas con el cuidado de la salud de la población infantil. Se encontró que la falta de articulación, unificación y consolidación de la información ocasiona que la toma de decisiones se realice a partir de resultados desactualizados, incompletos o inexistentes. Por tanto, en los territorios se necesita un espacio donde se presente un panorama completo de la población infantil, articulando las diferentes instituciones y consolidando periódicamente los temas de interés.

The objectives of this work were to identify the most important topics, the main information needs and the aspects or suggestions for the construction of an information system regarding health care of child population in the municipalities. We carried out seven workshops in seven municipalities, with the participation of 71 representatives from 19 entities related to the health care of child population. We found that the lack of coordination, unification and consolidation of information causes decision taking to be performed based on outdated, incomplete or non-existent results. So, territories need a space to show the complete picture of the child population, to coordinate the different institutions and periodically consolidate topics of interest.

Os objetivos deste trabalho foram identificar os temas de maior interesse, as principais necessidades de informacao e os aspectos ou sugestoes para a construcao de um sistema de informacao sobre o cuidado da saúde da populacao infantil nos municipios. Realizaram-se sete oficinas em sete municipios, com a participacao de 71 representantes de 19 entidades relacionadas com o cuidado da saúde da populacao infantil. Encontrou-se que a falta de articulacao, unificacao e consolidacao da informacao ocasiona que a tomada de decisoes seja realizada a partir de resultados desatualizados, incompletos ou inexistentes. Por tanto, nos territórios é preciso um espaco onde apresentar um panorama completo da populacao infantil, articulando as diferentes instituicoes e consolidando periodicamente os temas de interesse.

Bioética e o fim da vida: o debate sobre a tomada de decisão, às portas do infinito / Bioethics and the end of life: discussions on taking decisions at the gates of the infinite

Neste trabalho pretendeu-se investigaros principais aspectos envolvidos no debate moral sobre os problemas bioéticos atinentes aos cuidados de fim de vida, enfatizando especialmente o processo de tomada de decisão frente à morte e ao morrer. Justifica-se a importância da temática em virtude, especialmente, (a) das transições demográfica e epidemiológica que vêm ocorrendo no Brasil e (b) do expressivo avanço das biotecnociências na saúde, no tocante à manutenção da vida e ao prolongamento da sobrevida. Com efeito, delineia-se um cenário no qual há crescente demanda por tratamentos e serviços de saúde, propiciando o surgimento de situações nas quais se torna necessário deliberar sobre os cuidados de fim de vida, do ponto de vista técnico e bioético. Para a abordagem bioética dessa questão foi elaborada revisão da literatura com estratégia de busca definida, utilizando-se as bases LILACS, PUBMED e SCIELO. Os textos obtidos foram lidos e as considerações advindas da leitura organizadas em dois artigos. O primeiro artigo cujo objetivo é discutir, criticamente, aspectos atuais dos problemas bioéticos atinentes à finitude assinala a importância da construção,pelos profissionais que cuidam,de uma mínima caixa de ferramentas bioéticas, para a abordagem das questões morais atinentes aos cuidados ao fim de vida. O segundo artigo que tem por escopo ponderar sobre o processo de tomada de decisões em bioética clínica aplicado ao processo de morrer, acena para a relevância da participação dos enfermos, dos familiares e dos profissionais da saúde no processo decisório. Com efeito, conclui-se que a Bioética fornece ferramentas teóricas para a análise dos problemas éticos do final da vida, tornando-os mais claros, facilitando a construção das melhores decisões morais na prática clínica, o que para a temática em tela poderá perfeitamente significar a possibilidade de uma boa morte, respeitando – acima de tudo– a vontade do titular em processo de morrer, às portas do infinito...

This paper presents a structured investigation of the key aspects involved in moral debates over bioethical problems arising from end-of-life care, with particular stress on decision-taking processes related to death and dying. The importance of this topic is justified especially by: (a) demographic and epidemiological transitions under way in Brazil and (b) significant progress in the health-related bio-techno-sciences, in terms of maintaining life and prolonging survival. This shapes a context where rising demands for healthcare treatments and services are leading to situations in which thought must be given to end-of-life care, from the technical and bioethical standpoints. In order to approach this issue through bioethics, a review of the literature was prepared, following a clearly defined search strategy and using the LILACS, PUBMED and SCIELO databases. The obtained texts were read and the resulting observations were organized into two papers. The first paper – whose purpose is to conduct a critical discussion of current aspects of bioethical problems related to finitude – underscores the importance of the construction of a basic bioethical toolbox by attending practitioners, for exploring moral issues related to end-of-life care. Exploring decision-taking processes in clinical bioethics applied to the dying process, the second paper underscores the relevance of the participation of patients, family members and healthcare practitioners in decision-taking processes, reaching the conclusion that Bioethics provides theoretical tools for analyzing and clarifying end-of-life ethical problems. This streamlines the construction of more valid moral decisions in clinical practice which, for the topic under examination, may enhance the possibilities of decent deaths, above all respecting the wishes of persons engaged in the process of dying, at the gates of the infinite...

Gerência de enfermagem em unidades básicas: a informação como instrumento para a tomada de decisão / Nursing management in basic units: information as a decision-taking tool

Os Sistemas de Informação em Saúde (SIS) constituem-se em um suporte essencial à organização e gestão dos serviços, visto que oferecem subsídios para as funções de administração das unidades de saúde e, como consequência, podem contribuir para uma melhor assistência/cuidado ao indivíduo e/ou acoletividade. Este artigo discute sobre os SIS enquanto ferramenta gerencial, para a tomada de decisão e tem por objetivo analisar como as enfermeiras gerentes de Unidades Básicas de Saúde (UBS) utilizam as informações geradas pelo serviço no processo de tomada de decisão no município de Itabuna-BA. Nesse sentido, foi realizada uma pesquisa descritiva, com abordagem qualitativa, desenvolvida em 08 UBS situadas na zona urbana daquele município, envolvendo a realização de entrevista semi-estruturada aplicada a 12 enfermeiras gerentes. Para a análise, foi adotada a técnica da análise temática das informações coletadas e utilizado o referencial da Teoria Geral dos Sistemas e a concepção simoniana de administrar. Os resultados demonstraram que há falta de retroalimentação das informações para os serviços por parte da Secretaria Municipal de Saúde (SMS), expressando a importância dos SIS na tomada de decisão. Revelaram, ainda, que a coleta de dados envolve o preenchimento de grande quantidade de formulários, além da exiguidade de tempo, pois há o acúmulo das funções gerenciais e assistenciais por parte das enfermeiras. Com estas constatações, pode-se concluir que a gerência de UBS, em geral, incorpora pouco ou não incorpora os resultados das informações no processo de tomada de decisão. Assim, sugerese que as enfermeiras devam criar condições para o exercício de uma prática gerencial mais autônoma e responsável; buscar aperfeiçoamento em cursos específicos sobre os SIS e que a SMS promova um ambiente organizacional propício ao melhor desempenho destas gerentes.

Information health systems (IHS) are an essential supportto the organization and management of services, as theyprovide managerial information that may contribute to betterindividual and collective care.This discussion of IHS asmanagement tools for decision-taking aimed to analyze hownurses managing Basic Health Units (BHU) use informationthus provided in the municipality of Itabuna, BA, Brazil.Adescriptive, qualitative research of 8 urban BHU involvedthe assessment of 12 nurses through a semi-structuredinterview.Thematic analysis of collected information wasmade according to the general system theory and the Simonianadministrative concept. The results showed a lack ofinformation feedback from the Municipal Health Authority(MHA) to the services, highlighting the importance of IHSin decision-taking.Because of the large number of forms,data collection is time-consuming, especially when it istaken into account that these professionals also accumulatepatient care tasks.BHU management incorporates little, ifany, information in decision-taking.Nurses should developmore autonomous and responsible management practices.Continuing nurse education about the possibilities of IHSand provision of adequate managerial environments shouldbe targeted by the MHA.