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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.

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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.

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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.

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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.

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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.

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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.

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

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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.

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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.

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

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

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

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

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

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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.

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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.

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El objetivo principal de este estudio fue estudiar, en población peruana, las propiedades psicométricas de la prueba de pensamiento crítico, PENCRISAL, desarrollada y validada originalmente en población española. Participaron respondiendo voluntariamente la prueba 422 estudiantes de Ciencias e Ingeniería de una universidad peruana. Se analizó el nivel de fiabilidad con el alfa de Cronbach; la fiabilidad interjueces con coeficientes de concordancia Kappa de Cohen para cada uno de los ítems; la validez de constructo con Análisis Factorial de Componentes Principales, método Varimax y la validez divergente mediante el estudio de correlaciones con otras pruebas a través del coeficiente de Pearson. Los resultados obtenidos permiten concluir que el test PENCRISAL reúne los requisitos psicométricos necesarios para la evaluación de habilidades de pensamiento crítico en población peruana...

The main objective of this study was to study, in Peruvian population, the psychometric properties of the critical thinking test, PENCRISAL, originally developed and validated in Spanish population. 422 students of Science and Engineering of a Peruvian university participated voluntarily answering the test. Reliability was analyzed with Cronbach's alpha; interrater reliability was studied by mean of Cohen's Kappa coefficients for each of the items; construct validity was analyzed with Factor Analysis of Principal Components, Varimax method. Finally, divergent validity was studied by mean of the correlations with other tests through Pearson coefficient. It is concluded that PENCRISAL test fits with the psychometric requirements for the assessment of critical thinking skills in Peruvian population...

O objetivo principal deste trabalho foi estudar, em população peruana, as propriedades psicométricas do teste de pensamento crítico, PENCRISAL, originalmente desenvolvida e validada na população espanhola. Respondendo o teste participaram voluntariamente 422 estudantes de Ciência e Engenharia de uma universidade peruana. O nível de confiabilidade foi analisada com alfa de Cronbach; a confiabilidade inter-juizes foi analisada com coeficientes Kappa de Cohen para cada um dos itens; a validade do construto foi analisada por meio da análise fatorial de componentes principais, método Varimax. Finalmente, a validade divergente foi analisada por meio do estudo de correlações com outros testes utilizando o coeficiente de Pearson. Concluí-se que o teste PENCRISAL tem os requisitos psicométricos necessários para a avaliação de habilidades de pensamento crítico na população peruana...

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El objetivo principal de este estudio fue estudiar, en población peruana, las propiedades psicométricas de la prueba de pensamiento crítico, PENCRISAL, desarrollada y validada originalmente en población española. Participaron respondiendo voluntariamente la prueba 422 estudiantes de Ciencias e Ingeniería de una universidad peruana. Se analizó el nivel de fiabilidad con el alfa de Cronbach; la fiabilidad interjueces con coeficientes de concordancia Kappa de Cohen para cada uno de los ítems; la validez de constructo con Análisis Factorial de Componentes Principales, método Varimax y la validez divergente mediante el estudio de correlaciones con otras pruebas a través del coeficiente de Pearson. Los resultados obtenidos permiten concluir que el test PENCRISAL reúne los requisitos psicométricos necesarios para la evaluación de habilidades de pensamiento crítico en población peruana.(AU)

The main objective of this study was to study, in Peruvian population, the psychometric properties of the critical thinking test, PENCRISAL, originally developed and validated in Spanish population. 422 students of Science and Engineering of a Peruvian university participated voluntarily answering the test. Reliability was analyzed with Cronbach's alpha; interrater reliability was studied by mean of Cohen's Kappa coefficients for each of the items; construct validity was analyzed with Factor Analysis of Principal Components, Varimax method. Finally, divergent validity was studied by mean of the correlations with other tests through Pearson coefficient. It is concluded that PENCRISAL test fits with the psychometric requirements for the assessment of critical thinking skills in Peruvian population.(AU)

O objetivo principal deste trabalho foi estudar, em população peruana, as propriedades psicométricas do teste de pensamento crítico, PENCRISAL, originalmente desenvolvida e validada na população espanhola. Respondendo o teste participaram voluntariamente 422 estudantes de Ciência e Engenharia de uma universidade peruana. O nível de confiabilidade foi analisada com alfa de Cronbach; a confiabilidade inter-juizes foi analisada com coeficientes Kappa de Cohen para cada um dos itens; a validade do construto foi analisada por meio da análise fatorial de componentes principais, método Varimax. Finalmente, a validade divergente foi analisada por meio do estudo de correlações com outros testes utilizando o coeficiente de Pearson. Concluí-se que o teste PENCRISAL tem os requisitos psicométricos necessários para a avaliação de habilidades de pensamento crítico na população peruana.(AU)

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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.

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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.

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Objetivo.Clasificar las transfusiones sanguíneas efectuadas en Pediatría de un Hospital Nacional como necesarias o innecesarias según recomendaciones internacionales.Diseño. Retrospectivo, descriptivo. Población . 715 expedientes para un total de 8,099 transfusiones efectuadas en 3 años. Metodología. La variable nominal: indicación necesaria o innecesaria de transfusión se difinió en base a protocolos ya establecidos internacionalmente.Resultados. Las principales indicaciones clínicas para transfusión fueron anemia y sepsis m s di tesis hemorr gica y en neonatología para exanguinotransfusión. Los servicios con mayor número de transfusiones innecesarias fueron neurocirugía y traumatología, seguidas por sala de operaciones y cirugía pedi trica II. El 21/100 de los niños requirió dos transfusiones. El grupo et reo m s transfundido fue el de menores de un año (60/100), siendo m s frecuente en el sexo masculino. El derivado sanguíneo mayormente utilizado fue el de glóbulos rojos empacados, seguido por plasma fresco congelado. Se clasificó al 46/100 de las transfusiones sanguíneas como innecesarias.De este porcentaje, el hemoderivado que m s se utilizó incorrectamente fue la sangre completa, seguida por células empacadas.Conclusiones. La mitad de las transfusiones indicadas fueron innecesarias de acuerdo a referencias internacionales de transfusión de hemoderivados

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