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Resumen El tumor maligno de la vaina nerviosa periférica (TMVNP) es un sarcoma de alto grado de malignidad. Es poco frecuente, agresivo y generalmente se localiza en tronco y miembros inferiores. Se presenta mayormente en pacientes con neurofibormatosis tipo 1, aunque no siempre se encuentra esta asociación. Este tumorcomparte características histológicas e inmunohistoquímicas con el melanoma, lo que puede dificultar el diagnóstico. Presentamos el caso de un paciente con TMVNP, en el cual los hallazgos histológicos iniciales condujeron a un diagnósticoerróneode melanoma.

Abstract Malignant peripheral nerve sheath tumor (MPNST) is a high-grade sarcoma. It is rare, aggressive and generally located on the trunk and lower limbs. It occurs in a high percentage of patients with neurofibormatosis type 1, although this association is not always found. This tumor shares histological and immunohistochemical characteristics with melanoma, which can make diagnosis difficult. We present the case of a patient with MPNST, in whom the initial histological findings led to an erroneous diagnosis of melanoma.

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Scorpions are a group of arachnids with great evolutionary success that comprise more than 2,000 described species. Mitochondrial genomes have been little studied in this clade. We describe and compare different scorpion mitochondrial genomes and analyze their architecture and molecular characteristics. We assembled eight new scorpion mitochondrial genomes from transcriptomic datasets, annotated them, predicted the secondary structures of tRNAs, and compared the nucleotide composition, codon usage, and relative synonymous codon usage of 16 complete scorpion mitochondrial genomes. Lastly, we provided a phylogeny based on all mitochondrial protein coding genes. We characterized the mitogenomes in detail and reported particularities such as dissimilar synteny in the family Buthidae compared to other scorpions, unusual tRNA secondary structures, and unconventional start and stop codons in all scorpions. Our comparative analysis revealed that scorpion mitochondrial genomes exhibit different architectures and features depending on taxonomic identity. We highlight the parvorder Buthida, particularly the family Buthidae, as it invariably exhibited different mitogenome features such as synteny, codon usage, and AT-skew compared to the parvorder Iurida that included the rest of the scorpion families we analyzed in this study. Our results provide a better understanding of the evolution of mitogenome features and phylogenetic relationships in scorpions.

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Current available information on reptile genomes provides great potential for the study of unique adaptations from a genomic perspective. We compared differences in base composition and codon usage patterns across 400 reptile mitochondrial genomes assessing AT and GC skew, GC frequency, codon usage, effective number of codons, and codon adaptation index. We identified poor GC content in reptile mitochondrial genomes, with a predominant bias toward Adenine. We determined a compositional asymmetry between different taxonomic groups, which are inversely correlated to the rates of rearrangements in the mitogenome. We found that the most common codons in reptile mitochondrion are CTA (L), ATA (M) and ACA (T), which relates with have been found in birds, meaning that these patterns are shared across sauropsid mitogenomes. Codon usage bias clustering and effective codon number analyses revelated compositional asymmetry based on RSCU as well as that reptile mitogenomes are translationally efficient and are under selection pressure. Codon adaptation index revealed highest values in turtles indicating higher translational efficiency of mitochondrial genes among all reptiles, which could be related to metabolic adaptations (i.e., tolerance to anoxic conditions). This was also seen in other groups such as crocodiles (i.e., acclimation to cold) and snakes (phylogenetic origin of toxin-secreting oral glands and the evolutionary redesign of cytochrome c oxidase complex genes). We discuss our findings in the context of potential adaptations and evolutionary implications that these genomic differences provide to reptiles.

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Vertebrate mitochondrial genomes have been extensively studied for genetic and evolutionary purposes, these are normally believed to be extremely conserved, however, different cases of gene rearrangements have been reported. To verify the level of rearrangement and the mitogenome evolution, we performed a comparative genomic analysis of the 2831 vertebrate mitochondrial genomes representing 12 classes available in the NCBI database. Using a combination of bioinformatics methods, we determined there is a high number of errors in the annotation of mitochondrial genes, especially in tRNAs. We determined there is a large variation in the proportion of rearrangements per gene and per taxonomic class, with higher values observed in Actinopteri, Amphibia and Reptilia. We highlight that these are results for currently available vertebrate sequences, so an increase in sequence representativeness in some groups may alter the rearrangement rates, so in a few years it would be interesting to see if these rates are maintained or altered with the new mitogenome sequences. In addition, within each vertebrate class, different patterns in rearrangement proportion with distinct hotspots in the mitochondrial genome were found. We also determined that there are eleven convergence events in gene rearrangement, nine of which are new reports to the scientific community.

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Blue Rubber Bleb Nevus Syndrome, is a rare condition characterized by skin lesions caused by vascular malformations most frequently associated with lesions of the gastrointestinal tract, although rare, it can present with lesions in the central nervous system, thyroid, liver, spleen and lungs; common symptoms are: digestive tract bleeding and iron deficiency anemia. The main manifestation are skin lesions that are characterized by being button-like, with a bluish tint, covered by skin, called blue nevus with a rubbery consistency due to its rubber-like consistency. We present a case of Blue Rubber Bleb Nevus Syndrome with involvement in the central nervous and gastrointestinal systems.

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BACKGROUND: Tobacco control policies and other denormalization strategies may reduce tobacco use by stigmatizing smoking. This raises an important question: Does perceived smoking-related stigma contribute to a smoker's decision to quit? The aim of this study was to evaluate if perceived smoking-related stigma was associated with smoking cessation outcomes among smokers in Mexico and Uruguay. METHODS: We analyzed prospective data from a panel of adult smokers who participated in the 2008-2012 administrations of the International Tobacco Control Policy Evaluation Surveys in Mexico and Uruguay. We defined two analytic samples of participants: the quit behavior sample (n = 3896 Mexico; n = 1525 Uruguay) and the relapse sample (n = 596 Mexico). Generalized estimating equations were used to evaluate if different aspects of perceived stigma (ie, discomfort, marginalization, and negative stereotype) at baseline were associated with smoking cessation outcomes at follow-up. RESULTS: We found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico. CONCLUSIONS: This study suggests that perceived smoking-related stigma may be associated with more quit attempts, but less successful quitting among smokers. It is possible that once stigma is internalized by smokers, it may function as a damaging force. Future studies should evaluate the influence of internalized stigma on smoking behavior. IMPLICATIONS: Although perceived smoking-related stigma may prompt smokers to quit smoking, smoking stigma may also serve as a damaging force for some individuals, making quitting more difficult. This study found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico.

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INTRODUCTION: The popularity of electronic cigarettes (e-cigarettes) has increased worldwide among youth, even in countries like Mexico that ban them. This study aimed to assess the correlates of e-cigarette use frequency among Mexican students who currently use ecigarettes, as well as to describe their reasons for use. METHODS: Data were analyzed from a school-based survey of 57 public middle schools from the three largest cities in Mexico. Primary analyses were confined to those who used e-cigarettes in the prior 30 days. Censored binomial models for truncated distributions were estimated, regressing lifetime and past month frequency of use on participant sociodemographics, other substance use (smoking, alcohol, drugs), technophilia (appeal of new technologies), characteristics of e-cigarettes used, and family's and friends' use of nicotine products. RESULTS: Being male (APR = 1.93 95% CI 1.53-2.44), using drugs, (APR = 1.51 95% CI 1.03-2.20), higher technophilia (APR = 1.66 CI 1.21-2.29) and having a family member who uses e-cigarettes and cigarettes were associated with more frequent use in the last month. Students who preferred fruit and combined flavors had used e-cigarettes more often in their lifetime compared to students who preferred mint/menthol flavors. CONCLUSIONS: Some risk factors for more frequent e-cigarette use among Mexican youth are similar to those foudn in other countries (having relatives who use ecigarettes, using drugs, and use of fruit flavors). Additionally, the novel measure of technophilia was positively associated with frequency of e-cigarette use. The appeal of flavors, in particular, suggests the importance of reducing youth access to flavored products to impede product initiation and progression.

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OBJECTIVE: Evaluate the patterns of e-cigarette use andtheir association with smoking behavior. MATERIALS AND METHODS: We analyzed data from a population-based representative cohort of adult smokers who participated in the International Tobacco Control Policy Evaluation Surveys in Mexico. The analytic sample (n=760) was restricted to participants who were followed up from wave 6 (2012) to wave 7 (2014-2015). GEE models regressed e-cigarette use at follow-up and changes in cigarettes per day (CPD) between waves, on baseline sociodemographic variables, smoking status (daily, non-daily, quit), e-cigarette trial, and quit intentions. RESULTS: Smokers who were younger, had a higher income, and had tried e-cigarettes at baseline were more likely to be current e-cigarette users at follow-up. Ecigarette use at follow-up was not associated with a change in CPD over time. CONCLUSIONS: E-cigarette use does not appear to have promoted smoking cessation or reduction in this sample of Mexican smokers.

OBJETIVO: Evaluar los patrones de uso de cigarros electrónicos y su asociación con el uso de tabaco. MATERIAL Y MÉTODOS: Se usaron datos de una cohorte de fumadores adultos mexicanos de la Encuesta Internacional de Evaluación de Políticas del Control del Tabaco (n=760) con seguimiento de la ronda 6 (2012) a la 7 (2014-2015). Se usaron modelos GEE para evaluar el uso de cigarros electrónicos y el cambio en el número de cigarros por día (CPD) en variables de la basal sobre características sociodemográficas, consumo del cigarro (diario, no diario, haber dejado de fumar), prueba de cigarros electrónicos e intención de dejar de fumar. RESULTADOS: umadores jóvenes, con ingresos altos y que probaron cigarros electrónicos en la medición basal tenían más posibilidad de usar cigarros electrónicos. No se encontró relación entre uso de cigarros electrónicos y cambio en CPD. CONCLUSIONES: Los cigarros electrónicos no parecen promover el abandono ni la reducción del consumo de cigarros en esta muestra de fumadores mexicanos.

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Abstract: Objective: Evaluate the patterns of e-cigarette use and their association with smoking behavior. Materials and methods: We analyzed data from a population-based representative cohort of adult smokers who participated in the International Tobacco Control Policy Evaluation Surveys in Mexico. The analytic sample (n=760) was restricted to participants who were followed up from wave 6 (2012) to wave 7 (2014-2015). GEE models regressed e-cigarette use at follow-up and changes in cigarettes per day (CPD) between waves, on baseline sociodemographic variables, smoking status (daily, non-daily, quit), e-cigarette trial, and quit intentions. Results: Smokers who were younger, had a higher income, and had tried e-cigarettes at baseline were more likely to be current e-cigarette users at follow-up. E-cigarette use at follow-up was not associated with a change in CPD over time. Conclusions: E-cigarette use does not appear to have promoted smoking cessation or reduction in this sample of Mexican smokers.

Resumen: Objetivo: Evaluar los patrones de uso de cigarros electrónicos y su asociación con el uso de tabaco. Material y métodos: Se usaron datos de una cohorte de fumadores adultos mexicanos de la Encuesta Internacional de Evaluación de Políticas del Control del Tabaco (n=760) con seguimiento de la ronda 6 (2012) a la 7 (2014-2015). Se usaron modelos GEE para evaluar el uso de cigarros electrónicos y el cambio en el número de cigarros por día (CPD) en variables de la basal sobre características sociodemográficas, consumo del cigarro (diario, no diario, haber dejado de fumar), prueba de cigarros electrónicos e intención de dejar de fumar. Resultados: Fumadores jóvenes, con ingresos altos y que probaron cigarros electrónicos en la medición basal tenían más posibilidad de usar cigarros electrónicos. No se encontró relación entre uso de cigarros electrónicos y cambio en CPD. Conclusiones: Los cigarros electrónicos no parecen promover el abandono ni la reducción del consumo de cigarros en esta muestra de fumadores mexicanos.

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BACKGROUND: This study examined how risk perceptions and social norms around e-cigarettes are associated with susceptibility (i.e., openness to using the product in the next 12 months) of e-cigarettes and smoking among adolescents. METHODS: We analyzed data from a 2016 representative survey of 8,718 middle school students in Mexico. The study sample was restricted to students who had tried neither e-cigarettes nor cigarettes, ( N = 4471). Students reported on the risks of e-cigarettes compared with those of cigarettes, and product-specific norms were measured by assessing current use by family members, at least one close friend, and, for e-cigarettes, by perceived societal acceptability of use (i.e., acceptability among people in general). Adjusted prevalence ratios (APR) were estimated using generalized estimating equation models that regressed e-cigarette societal acceptability on study variables. Adjusted generalized estimating equation models also regressed susceptibility for each product on study variables. RESULTS: Susceptibility to both e-cigarettes and smoking was higher among students who reported that their family and friends used only cigarettes or both products when compared with students whose family and friends did not use either of these products. Friend use of e-cigarettes was associated with e-cigarette susceptibility (APR = 1.33) but not smoking susceptibility. Students who perceived that e-cigarettes were less risky than smoking were more susceptible to e-cigarette use (APR = 1.45). The association between e-cigarette susceptibility and friend or family use was not mediated by societal acceptability. CONCLUSIONS: E-cigarette use among family and peers appears associated with susceptibility to use e-cigarettes in a way that is similar to the patterns found for cigarettes. However, the influences appear somewhat specific to the type of product that network members use.

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PURPOSE: Develop and validate a scale that measures Technophilia (positive orientation toward new technology) and use it to address orientation toward new technologies to explain e-cigarette trial and adoption, especially in relatively low risk adolescents. METHODS: Survey data were obtained from students of the three largest cities in Mexico (n = 8123). We developed eight questions involving access, use and pleasure from different electronic media to measure technophilia. Exploratory factor analysis (EFA) was conducted. Linear GEE models were used when regressing technophilia on covariates. When regressing e-cigarette and conventional cigarette trial and use, logistic GEE models were used. Finally, we used multinomial logistic regression to evaluate the associations between technophilia and e-cigarettes as the first tobacco product. RESULTS: Technophilia were correlated with theoretically-related variables. Unadjusted and adjusted models regressing e-cigarette trial and use indicated that students in the highest quartile for technophilia were more likely to have tried e-cigarettes compared with the lowest quartile (AORQ4 vs Q1 = 1.36, 95% CI 1.14-1.62). Technophilia was not independently associated with current e-cigarette use in adjusted models. Students with higher technophilia were more likely to have first tried e-cigarettes in both crude and adjusted models (AORQ4vQ1 = 1.66, 95% CI 1.20-2.31; AORQ3vQ1 = 1.43, 95% CI 1.02-2.01). Technophilia did not have a statistically significant, independent association with first use of other tobacco products. CONCLUSION: This study suggests that technophilia is associated with trial of e-cigarettes among youth. The measure we developed appears useful for understanding why some youth are open to trying novel, technologically oriented ways to consume nicotine.

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Among high-income countries, awareness and use of e-cigarettes is lower in countries with more restrictive e-cigarette regulations. Little is known about e-cigarettes in middle-income countries, many of which like Mexico, ban e-cigarette sales and marketing. The current study determined the national-level prevalence and correlates of e-cigarette awareness and consumption in Mexico. Data were analyzed from a 2016 nationally representative survey. Prevalence of e-cigarette awareness, trial and current use was estimated separately for adolescents (n = 12,436), adult nonsmokers (n = 36,966), and adult smokers (n = 7347). For each group, crude and adjusted logistic models regressed e-cigarette outcomes on sociodemographic and smoking-related variables, adjusting for the sampling design and weights. Prevalence varied across subgroups for e-cigarette awareness (adolescents = 45.3%; adult nonsmokers = 33.9%; adult smokers = 54.3%), e-cigarette trial (adolescents = 6.5%; adult nonsmokers = 2.6%; adult smokers = 18.2%) and current use of electronic cigarettes (adolescents = 1.1%; adult nonsmokers = 0.3%; adult smokers = 4.5%). Among adolescents and adults, current smoking and higher smoking frequency were significantly associated with e-cigarette awareness, trial and use. Among adolescents and nonsmokers, awareness, trial and use of e-cigarette were significantly lower among females than males. Among adult smokers, however, females were more likely to use e-cigarettes than males (AOR = 1.80; 95% CI = 1.08-3.02). Higher education and greater wealth increased the likelihood of trial of e-cigarettes among adult nonsmokers and smokers. Despite the ban on the distribution and sales of e-cigarettes, a substantial number of Mexicans, have access to e-cigarettes. Decision makers and advocates should consider e-cigarette regulations as recommended by the WHO, at the same time Mexico must invest in the infrastructure needed to enforce these regulations.

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PURPOSE: This study evaluated whether e-cigarette trial among Mexican adolescents increased the likelihood of trial and use of conventional cigarettes or marijuana use at follow-up. METHOD: A school-based longitudinal survey was conducted in 60 public middle schools from the three largest cities in Mexico. Students (12-13years old) were surveyed in 2015 and followed up 20 months later (n=6574). Generalized estimating equations models were used to evaluate the association between e-cigarette trial at baseline and conventional cigarettes smoking and marijuana use at follow-up. RESULT: Adolescents who had tried e-cigarettes (but not cigarettes) at baseline were more likely to have tried conventional cigarettes at followup compared to adolescents who had tried neither e-cigarettes nor cigarettes (43% vs. 24%, respectively; RR 1.41, 95% CI 1.18-1.70). We also found that adolescents who had tried both conventional cigarettes and e-cigarettes at baseline were more likely to have tried marijuana at follow-up compared to adolescents who had tried neither tobacco product (20% vs. 4%, respectively; RR 2.67, 95% CI 1.78-4.02). Trial of only e-cigarettes was not independently associated with marijuana use at followup. CONCLUSIONS: Adolescents who had tried e-cigarettes were more likely to have tried conventional cigarettes and marijuana 20 months later. Although e-cigarettes have been banned in Mexico, it is likely that additional policies and public health campaigns are needed to reduce adolescent use of e-cigarettes and its consequences.

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The aim of this study was to examine the separate and combined relationships of neighborhood social norms and neighborhood social cohesion with smoking behavior in a cohort of adult Mexican smokers. Neighborhood anti-smoking norms were measured as the proportion of residents in each neighborhood who believed that society disapproves of smoking. Perceived social cohesion was measured using a 5-item cohesion scale and aggregated to the neighborhood level. Higher neighborhood anti-smoking norms were associated with less successful quitting. Neighborhood social cohesion modified the relationship between neighborhood social norms and two smoking behaviors: smoking intensity and quit attempts. Residents of neighborhoods with weaker anti-smoking norms and higher social cohesion had lower smoking intensity and more quit attempts than residents living in other areas. Social cohesion may help buffer smoking behavior in areas with weak social norms.

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INTRODUCTION: Over the last few years, the increasing use of electronic cigarettes has become a new public health problem. Since 2011, Argentina has had a complete ban on marketing and sale of e-cigarettes. However, e-cigarettes are marketed online and can be easily bought in stores. We conducted a longitudinal study to evaluate the determinants of e-cigarette trial among Argentinean early adolescents. METHODS: A school-based longitudinal study was conducted in 2014-15, in 3 large cities in Argentina. Among students who reported never smoking an e-cigarette at baseline, we assessed demographics, media use, sensation seeking, smoking behavior, network member smoking, use of other substances, and perception of e-cigarette risk as potential risk factors for e-cigarette trial at follow up (mean between-wave interval 17.1 months) using multilevel logistic regression models with random intercepts for schools. RESULTS: E-cigarette trial prevalence increased from baseline (1.8%; n=57) to follow up (7.1%; n=139). Independent predictors of e-cigarette use at follow up included: higher sensation seeking (OR: 1.49 95% CI 1.21-1.84); being a current smoker (OR: 2.58 95% CI 1.38-4.83); having close friends that smoke cigarettes (OR: 1.93 95% CI 1.25-2.99) and being highly exposed to tobacco product ads online (OR: 1.87 95% CI 1.04-3.36). Attending a public school was the only protective factor (OR: 0.40 95% CI 0.22-0.73). CONCLUSION: In Argentina, illicit trial of e-cigarettes among early adolescents is low but appears to be rapidly increasing. Identifying students at risk could help identify policies and programs to prevent increasing use in this population.

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BACKGROUND: Recent increases in violent crime may impact a variety of health outcomes in Mexico. We examined relationships between neighbourhood-level violence and smoking behaviours in a cohort of Mexican smokers from 2011 to 2012, and whether neighbourhood-level social cohesion modified these relationships. METHODS: Data were analysed from adult smokers and recent ex-smokers who participated in waves 5 and 6 of the International Tobacco Control Mexico survey. Self-reported neighbourhood violence and social cohesion were asked of wave 6 survey participants (n=2129 current and former smokers, n=150 neighbourhoods). Neighbourhood-level averages for violence and social cohesion (ranges 4-14 and 10-25, respectively) were assigned to individuals. We used generalised estimating equations to determine associations between neighbourhood indicators and individual-level smoking intensity, quit behaviours and relapse. RESULTS: Higher neighbourhood violence was associated with higher smoking intensity (risk ratio (RR)=1.17, 95% CI 1.02 to 1.33), and fewer quit attempts (RR=0.72, 95% CI 0.61 to 0.85). Neighbourhood violence was not associated with successful quitting or relapse. Higher neighbourhood social cohesion was associated with more quit attempts and more successful quitting. Neighbourhood social cohesion modified the association between neighbourhood violence and smoking intensity: in neighbourhoods with higher social cohesion, as violence increased, smoking intensity decreased and in neighbourhoods with lower social cohesion, as violence increased, so did smoking intensity. CONCLUSIONS: In the context of recent increased violence in Mexico, smokers living in neighbourhoods with more violence may smoke more cigarettes per day and make fewer quit attempts than their counterparts in less violent neighbourhoods. Neighbourhood social cohesion may buffer the impact of violence on smoking intensity.

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OBJECTIVE: To assess preschoolers' cumulative daily screen time, measure the contributions of the home and the child care setting to this total, and characterize children that are most at risk for excessive screen time. STUDY DESIGN: We used data from the Early Childhood Longitudinal Study-Birth Cohort, to calculate daily screen time based on reports by preschooler's parents and care providers. RESULTS: The sample size of 8950 represented approximately 4 million children. By preschool age, >80% of children were in some child care. On average, children in this study were exposed to 4.1 hours of screen time daily, including 3.6 hours at home and 0.4 hours in child care. Children in centers had the lowest screen time (3.2 hours) compared with children in parental care only (4.4 hours), home-based care (5.5 hours), and Head Start (4.2 hours). Even when adjusted for relevant covariates, these differences remained significant (P < .001). CONCLUSIONS: Preschoolers' cumulative screen time exceeds recommendations and most previous estimates. Pediatric clinicians are uniquely positioned to encourage families to discuss screen time with their children's caregivers and to advocate for high quality child care. Efforts to decrease screen time in homes and home-based child care settings are needed.

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Las ciencias de la conducta comprenden diferentes disciplinas tales como la biología, la antropología, la economía, la psicología y las ciencias políticas. Sin embargo, para abordar sus problemáticas, cada una de ellas apela a un modelo teórico distinto, algunos incompatibles entre sí. Superar este estado de cosas es una necesidad urgente ara estas ciencias, si se quiere tener entre ellas una relación científicamente más productiva. Actualmente, los desarrollos conceptuales y empíricos, representan una oportunidad para su redefinición conceptual teniendo como marco de referencia y la teoría de la evolución, como una lógica explicativa aplicable a las ciencias de la conducta. Tal reconceptualización, está relacionada con el papel que tiene la conducta en la evolución biológica y en la evolución cultural y que será el objeto de análisis aquí. Se discutirán las implicaciones teórico-empíricas que tiene la conducta en la construcción del nicho de los organismos. Se señala la importancia de la conducta, resaltando como su variabilidad funcional la convierte en un sistema de amortiguación y ajuste de las relaciones dadas entre organismo y medio, relevantes para la supervivencia de los organismos y cómo a su vez esto se constituye en un factor influyente en la evolución de las especies.

The sciences of the behavior include different disciplines such as biology, anthropology, economy, psychology and political science. However, to deal with their problems, each one of them will appeal to a different theoretical model, some of which are incompatible between them. To remedy this state of things is an urgent need in the sciences of the behavior, if we want to have a scientifically more productive relationship. Currently, the conceptual and empirical developments represent an opportunity to be redefined the problem in the conceptual way, having as a reference framework the theory of evolution, as applicable explicatory logic to behavior. Such reconceptualization is related to the role that behavior has in the biological evolution and in the cultural evolution, which will be the object of analysis herein. It will be discussed what theoretical and empirical implications has the behavior in the construction of the niche. It can be concluded, pointing to the importance of the behavior, highlighting as its variability functional to serve a system damping for the survival of the organisms and in the same way in an influential factor in the evolution of species.

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OBJECTIVES: To determine parental participation in medical decision-making (MDM) during hospitalization and its association with parental self-efficacy and to explore other factors associated with participation. STUDY DESIGN: We surveyed parents of children admitted to a pediatric medical unit to measure parental report of participation in MDM during hospitalization and self-efficacy with physician interactions (categorized into tertiles). We performed multivariate logistic regression to evaluate the association between self-efficacy and parental participation, controlling for potential confounders. RESULTS: One hundred thirty of 278 eligible parents completed surveys and 86% reported participating in MDM about their child's care. After adjusting for covariates, parents with scores in the middle and highest self-efficacy tertiles had higher odds of participating in MDM compared with parents in the lowest tertile. Younger parents and parents of previously hospitalized children were also more likely to participate although parents with a high school education or less were less likely. CONCLUSIONS: Self-efficacy was significantly associated with parental participation in MDM during hospitalization after adjusting for confounding factors. Interventions to increase self-efficacy may also improve parental participation in MDM.

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