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Purpose: Statistical literacy is the ability of a patient to apply basic statistical concepts to their health care. Understanding statistics is a critical component of shared decision making. The purpose of this investigation was to define levels of statistical literacy in an upper-extremity (UE) patient population. We aimed to determine if patient demographics would be associated with statistical literacy. Methods: An electronic survey was administered to a consecutive series of UE patients at a single institution. We recorded baseline demographics, Single Assessment Numeric Evaluation scores, the Berlin Numeracy Test (BNT), and General Health Numeracy Test. We also included a surgical risk question, which asked: "Approximately 3% of patients who get carpal tunnel surgery develop an infection. If 100 patients get this surgery, how many would you expect to develop an infection?" A covariate-controlled adjusted odds ratio reflecting the association between each statistical literacy outcome measure and patient characteristics was reported. Results: A total 254 surveys were administered, 148 of which were completed and included. Fifty percent of respondents had a high-school education or less. For the BNT, 78% scored in the bottom quartile, and 52% incorrectly answered all questions. For the General Health Numeracy Test, 34% answered 0 or 1/6 questions correctly. For the surgical risk question, 24% of respondents answered incorrectly. Respondents who had a college or graduate degree had 2.62 times greater odds (95% confidence interval, 1.09-6.32) of achieving a BNT score in a higher quartile than patients who did not have a college or graduate degree. Conclusions: Overall levels of statistical literacy are low for UE patients. Clinical relevance: When engaging in management discussions and shared decision making, UE surgeons should assume low levels of statistical literacy. Consideration of alternative formats, such as frequencies, video-based materials, and pictographs, may be warranted when discussing outcomes and risks of surgical procedures.

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A better understanding of factors that can affect preferences and choices may contribute to more accurate decision-making. Several studies have investigated the effects of cognitive biases on decision-making and their relationship with cognitive abilities and thinking dispositions. While studies on behaviour, attitude, personality, and health worries have examined their relationship with human values, research on cognitive bias has not investigated its relationship to individual differences in human values. The purpose of this study was to explore individual differences in biased choices, examining the relationships of the human values self-direction, conformity, power, and universalism with the anchoring effect, the framing effect, the certainty effect, and the outcome bias, as well as the mediation of need for cognition and the moderation of numeracy in these relationships. We measured individual differences and within-participant effects with an online questionnaire completed by 409 Brazilian participants, with an age range from 18 to 80 years, 56.7% female, and 43.3% male. The cognitive biases studied consistently influenced choices and preferences. However, the biases showed distinct relationships with the individual differences investigated, indicating the involvement of diverse psychological mechanisms. For example, people who value more self-direction were less affected only by anchoring. Hence, people more susceptible to one bias were not similarly susceptible to another. This can help in research on how to weaken or strengthen cognitive biases and heuristics.

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Fuzzy-trace theory predicts that decisionmakers process numerical information about risk at multiple levels in parallel: the simplest level, nominal (categorical some-none) gist, and at more fine-grained levels, involving relative comparison (ordinal less-more gist) and exact quantities (verbatim representations). However, little is known about how individual differences in these numerical representations relate to judgments and decisions, especially involving health tradeoffs and relative risks. To investigate these differences, we administered measures of categorical and ordinal gist representations of number, objective numeracy, and intelligence in two studies (Ns = 978 and 956). In both studies, categorical and ordinal gist representations of number predicted risk judgments and decisions beyond objective numeracy and intelligence. Participants with higher scores in categorical gist were more likely to choose options to avoid cancer recurrence risks; those who were higher in ordinal gist of numbers were more likely to discriminate relative risk of skin cancer; and those with higher scores in objective numeracy were more likely to choose options that were numerically superior overall in terms of relative risk of skin cancer and of genetic risks of breast cancer (e.g., lower numerical probability of cancer). Results support parallel-processing models that assume multiple representations of numerical information about risk, which vary in precision, and illustrate how individual differences in numerical representations are relevant to tradeoffs and risk comparisons in health decisions. These representations cannot be reduced to one another and explain psychological variations in risk processing that go beyond low versus high levels of objective numeracy.

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Abstract A better understanding of factors that can affect preferences and choices may contribute to more accurate decision-making. Several studies have investigated the effects of cognitive biases on decision-making and their relationship with cognitive abilities and thinking dispositions. While studies on behaviour, attitude, personality, and health worries have examined their relationship with human values, research on cognitive bias has not investigated its relationship to individual differences in human values. The purpose of this study was to explore individual differences in biased choices, examining the relationships of the human values self-direction, conformity, power, and universalism with the anchoring effect, the framing effect, the certainty effect, and the outcome bias, as well as the mediation of need for cognition and the moderation of numeracy in these relationships. We measured individual differences and within-participant effects with an online questionnaire completed by 409 Brazilian participants, with an age range from 18 to 80 years, 56.7% female, and 43.3% male. The cognitive biases studied consistently influenced choices and preferences. However, the biases showed distinct relationships with the individual differences investigated, indicating the involvement of diverse psychological mechanisms. For example, people who value more self-direction were less affected only by anchoring. Hence, people more susceptible to one bias were not similarly susceptible to another. This can help in research on how to weaken or strengthen cognitive biases and heuristics.

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Resumen (analítico) Las y los estudiantes carecen de espacios para valorar sus experiencias de inclusión/exclusión escolar. La crisis sanitaria obligó a vincularnos virtualmente, sin conocer las posibilidades para el intercambio de significados digitales, representación de experiencias y movilización de relaciones interpersonales. Desde una perspectiva pedagógica, semiótica y social, este estudio analiza una sesión de un taller virtual con nueve estudiantes secundarios de tres escuelas chilenas, preguntándose sobre cómo se materializó la participación de las y los jóvenes. Con herramientas de la multimodalidad se analiza un corpus audiovisual de una cartografía virtual de espacios educativos. Se visibilizan los recursos disponibles para la participación virtual y las maneras en que fueron usados para compartir significados individuales y generar solidaridad co-construyendo relatos de inclusión/exclusión escolar.

Abstract (analytical) Students lack spaces that evaluate their experiences of inclusion/exclusion in school. The health cri-sis forced us to interact online and at first we were not aware of the resources available for the ex-change of digital meanings, representation of experiences and formation of interpersonal relation-ships. Using a pedagogical, semiotic and social approach, this study analyzes the results of an online workshop attended by nine secondary students from three Chilean schools. The aim was to identify the means and resources that facilitated student participation in online environments. Using multi-modal tools, an audiovisual corpus consisting of an Online Cartography of Educational Spaces is explored by the authors. The resources available for online participation were shared by participants. In addition, the article describes semiotic mechanisms for sharing individual meanings and developing solidarity by co-constructing stories about inclusion/exclusion in the classroom.

Resumo (analítico) Os alunos e alunas não têm espaços para avaliar suas experiências de inclusão/exclusão escolar. A crise de saúde pela Covid-19 obrigou as pessoas a termos uma interação virtual, sem conhecer os recursos disponíveis para a troca de significados digitais, a representação de experiências e o desenvolvimento das relações interpessoais. Do ponto de vista pedagógico, semiótico e social, este estudo analisa uma sessão de oficina virtual com nove alunos e alunas do ensino médio de três es-colas chilenas. A pesquisa foca em identificar os significados y recursos que auxiliam a participação dos e das estudantes. Utilizando ferramentas multimodais, foi analisado um corpus audiovisual de uma Cartografia Virtual de Espaços Educacionais. Assim, este estudo mostra os recursos disponíveis para a participação virtual e as formas como foram utilizados para compartilhar significados desde a experiência pessoal, além de promover a solidariedade através da co-construção de relatos de inclusão/exclusão escolar.

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Resumen (analítico) Essa pesquisa identificou se os jovens e as jovens rurais que residem no Rio Grande do Sul/Brasil estão projetando seu futuro profissional no campo, pretendem ser sucessores nos estabelecimentos agropecuários familiares, além de apontar os fatores condicionantes para a tomada destas decisões. A pesquisa foi realizada a partir de questionário aplicado em 2018 e 2019. A amostra foi composta por 743 jovens, com idades de 13 a 21 anos, filhos de agricultores e estudantes do ensino médio. Constatouse que 47.9% dos e das jovens querem permanecer no campo e 45.2% querem ser sucessores. O processo sucessório tem sido comprometido pela limitação da participação dos e das jovens rurais nos processos gerenciais e na tomada de decisões nas propriedades. Conclui-se que o jovem valoriza significativamente o fato de ser sujeito atuante e autônomo na propriedade.

Abstract (analytical) This research focused on whether rural youths living in Rio Grande do Sul in Brazil are projecting their futures in agriculture and intend to be successors of family farming establishments, in addition to highlighting the conditioning factors that are used to make these decisions. The research involved the application of a questionnaire applied in 2018 and 2019. The sample consisted of 743 young people aged 13 to 21 years who are children of farmers and high school students at the time. It was found that 47.9% of the surveyed young people want to stay in the countryside and 45.2% want to be successors. The succession process has been compromised by limits on the participation of rural youth in management and decision-making processes on their family's properties. The authors conclude that these young people significantly value being active and autonomous subjects on their families' properties.

Resumo (analítico) Esta investigación identificó si los jóvenes rurales residentes en Rio Grande do Sul/Brasil están proyectando su futuro profesional en el campo, pretenden ser sucesores en los establecimientos de agricultura familiar, además de señalar los condicionantes para la toma de estas decisiones. La encuesta se realizó con base en un cuestionario aplicado en 2018 y 2019. La muestra estuvo conformada por 743 jóvenes, de 13 a 21 años, hijos de agricultores y estudiantes de secundaria. Se encontró que el 47.9 % de los jóvenes quiere quedarse en el campo y el 45.2 % quiere ser sucesor. El proceso de sucesión se ha visto comprometido al limitar la participación de la juventud rural en los procesos de gestión y en la toma de decisiones sobre las propiedades. Se concluye que el joven valora significativamente el hecho de ser un sujeto activo y autónomo en la propiedad.

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This article traces inequality and numeracy development in the regions of Chile during the 19th and early 20th century. Inequality, measured with anthropometric methods, was associated with a lower speed of human capital formation. Not all talents received the necessary education to make full use of their talent for the regional economy, especially in the south in the early period. However, Chile became slightly less unequal over time and more numerate during the late 19th century. In addition, we study the correlates of low-intensity immigration in Chile. Regions with a relatively high share of North European migrants developed faster in terms of numeracy.

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We explored the home learning environments of 173 Mexican preschool children (aged 3-6 years) in relation to their numeracy performance. Parents indicated the frequency of their formal home numeracy and literacy activities, and their academic expectations for children's numeracy and literacy performance. Children completed measures of early numeracy skills. Mexican parent-child dyads from families with either high- or low-socioeconomic status (SES) participated. Low-SES parents (n = 99) reported higher numeracy expectations than high-SES parents (n = 74), but similar frequency of home numeracy activities. In contrast, high-SES parents reported higher frequency of literacy activities. Path analyses showed that operational (i.e., advanced) numeracy activities were positively related to children's numeracy skills in the high- but not in the low-SES group. These findings improve the understanding of the role of the home environment in different contexts and provide some insights into the sources of the variable patterns of relations between home learning activities and children's numeracy outcomes. They also suggest that SES is a critical factor to consider in research on children's home numeracy experiences.

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Children's performance on number line tasks reflects their developing number system knowledge. Before 5 years of age, most children perform poorly on even the simplest number lines (i.e., 0-10). Our goal was to understand how number line skills develop before formal schooling. Chilean preschoolers attempted a 0-10 number line task three times over 2 years: at the beginning of pre-kindergarten (M = 4:7 [years;months]; Time 1), at the end of pre-kindergarten (M = 5:0; Time 2), and at the end of kindergarten (M = 5:10; Time 3). We used latent class analysis to group children according to their patterns of performance across number targets. At Time 1, 86% of children had error patterns indicating that they randomly placed estimates on the line. At Time 2, 56% of children continued to respond randomly. At Time 3, 56% of children showed competent performance across the number line, 23% were accurate only near the endpoints, and 21% were accurate only for low target numbers near the origin. Latent transition analyses showed that the transition from less to more proficient estimation classes was predicted by children's number identification skills. Thus, number line performance changed dramatically from 4 to 6 years of age as children began to develop the cognitive and numerical skills necessary to accurately estimate numbers on a number line.

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Resumen (analítico) Este estudio examina los conocimientos sobre las propiedades formales y la función referencial del dibujo, la escritura y los numerales desplegados por madres y sus niños y niñas (2 ½ años y 4 años) en una tarea de producción conjunta. Se construyó un sistema de codificación mediante el método comparativo constante; se analizó mediante pruebas no paramétricas. Las díadas del grupo de 2 ½ años conversaron sobre la función referencial de los tres sistemas, especialmente del dibujo. A los 4 años se incrementó el interés en la escritura, la consideración de las propiedades formales de la escritura y los numerales; así como las producciones infantiles independientes de dibujo y escritura. El estudio mostró a la producción gráfica como una interacción educativa en la familia que estimula la apropiación temprana de las representaciones externas.

Abstract (analytical) This study examines the knowledge of formal properties and referential function of drawing, writing and numerals displayed by mothers and their children (2 and a half years old and 4 years old) in a joint production task. A coding system was constructed using the constant comparative method and was analyzed using non-parametric tests. The results of the group with 2 and half year old children demonstrated the referential function of the three systems, especially the drawing. At the age of 4 children's interest in writing increased, as well as the consideration of the formal properties of writing and numerals and the children's independent production of drawing and writing. The study demonstrated that graphic production is an educational interaction in the family that stimulates the early appropriation of external representations.

Resumo (analítico) Este estudo examina o conhecimento sobre as propriedades formais e a função referencial de desenho, escrita e numerais que mães, filhos e filhas (2 anos e meio e 4 anos) apresentados em tarefa de produção conjunta. O método comparativo constante foi utilizado para a construção do sistema de codificação; se analisou mediante provas não paramétricas. As duplas do grupo de 2 anos e meio conversaram sobre a função referencial dos três sistemas, especialmente do desenho. No grupo de 4 anos aumentaram o interesse pela escrita, a consideração das propriedades formais da escrita e dos numerais e as produções independentes de desenho e escrita. O estudo mostrou a produção gráfica conjunta como uma interação educacional na família que estimula a apropriação precoce de sistemas de representação externa.

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Introduction: Physicians and medical students need to understand numerical and graphical health data in order to provide patients with correct information. Objective: The graphical and numerical skills of medical students and residents from a private university in Lima, Peru, were determined in this investigation. Method: Cross-sectional, descriptive study. The Objective Numeracy, Subjective Numeracy and Graph Literacy Scales were applied to medical students at their two final years of medical school and to medical residents. Results: Of 169 participants, 52.07% were sixth-year and 18.34% were seventh-year students and 29.58% were residents. Mean objective numeracy score was 7.34, mean subjective numeracy was 34.12 and mean graph literacy was 10.35. A multiple linear regression analysis showed that Subjective and Objective Numeracy Scales highest means were associated with the male gender and training on research methodology (p < 0.05). Graph Literacy Scale highest means were associated with the male gender and younger age (p-value < 0.05). Conclusion: Numeracy and Graph Literacy Scales mean scores were high in medical students.

Introducción: Los médicos y estudiantes de medicina necesitan comprender los datos numéricos y gráficos sobre salud para proveer información correcta a los pacientes. Objetivo: Determinar las habilidades gráficas y numéricas en estudiantes y residentes de medicina de una universidad privada de Lima, Perú. Método: Estudio descriptivo, transversal. Se aplicaron las escalas de Habilidad Numérica Objetiva, de Habilidad Numérica Subjetiva y de Habilidad Gráfica a estudiantes de medicina de los dos últimos años de la carrera de medicina y a residentes de medicina. Resultados: De 169 participantes, 52.07 % fueron estudiantes de sexto año, 18.34 % de séptimo y 29.58 % residentes. La media en la habilidad numérica objetiva fue de 7.34, en la subjetiva de 34.12 y en la habilidad gráfica de 10.35. De la regresión lineal múltiple se obtuvo que las medias más altas en las escalas de Habilidad Numérica Subjetiva y Objetiva estuvieron asociadas con el sexo masculino y la capacitación sobre metodología en investigación (p < 0.05). En la Escala de Habilidad Gráfica, las medias más altas estuvieron asociadas con el sexo masculino y menor edad (p < 0.05). Conclusión: Las medias de las escalas de Habilidad Gráfica y Habilidad Numérica en estudiantes de medicina fueron altas.

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BACKGROUND: Self-management of moderate-to-severe asthma depends on the patient's ability to (1) navigate (access health care to obtain diagnoses and treatment), (2) use inhaled corticosteroids (ICSs) properly, and (3) understand ICS function. OBJECTIVE: We sought to test whether navigation skills (medication recall, knowledge of copay requirements, and ability to provide information needed for a medical visit about a persistent cough unresponsive to medication) are related to other self-management skills and health literacy. METHODS: A 21-item Navigating Ability (NAV2) questionnaire was developed, validated, and then read to adults with moderate-to-severe asthma. ICS technique was evaluated by using scales derived from instructions in national guidelines; knowledge of ICS function was evaluated by using a validated 10-item questionnaire. Spearman correlation was computed between NAV2 score and these questionnaires and with numeracy (Asthma Numeracy Questionnaire) and print literacy (Short Test of Functional Health Literacy in Adults). RESULTS: Two hundred fifty adults participated: age, 51 ± 13 years; 72% female; 65% African American; 10% Latino; 50% with household income of less than $30,000/y; 47% with no more than a 12th-grade education; and 29% experienced hospitalizations for asthma in the prior year. A higher NAV2 score was associated with correct ICS technique (ρ = 0.24, P = .0002), knowledge of ICSs (ρ = 0.35, P < .001), better print literacy (ρ = 0.44, P < .001), and numeracy (ρ = 0.41, P < .001). CONCLUSIONS: Patients with poor navigational ability are likely to have poor inhaler technique and limited understanding of ICS function, as well as limited numeracy and print literacy. Clinicians should consider these elements of self-management for their effect on asthma care and as a marker of more general health literacy deficits.

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A la hora de realizar juicios y tomar decisiones sobre la salud, debemos procesar y comprender información numérica. Por ejemplo, habitualmente recibimos información sobre el riesgo de padecer una enfermedad en probabilidades, porcentajes o fracciones. Sin embargo, muchas personas presentan deficiencias a la hora de comprender esta información. En este trabajo, presentamos una revisión crítica de la evidencia empírica sobre los efectos que tienen las habilidades numéricas en diversos aspectos del proceso que acontece cuando un paciente acude al médico, más concretamente en la percepción de los riesgos médicos y la eficacia de los tratamientos. También describimos los distintos marcos teóricos que pretenden explicar estos efectos y resaltamos algunas de sus limitaciones. Por último, discutimos las ventajas y los inconvenientes de los instrumentos de medida de las habilidades numéricas, y destacamos entre ellos el Berlin Numeracy Test. Concluimos que este test puede evaluar las habilidades numéricas satisfactoriamente en diversos contextos, y planteamos diversas cuestiones que permanecen abiertas, como la relación entre las habilidades numéricas y diversos constructos psicológicos como la inteligencia o la reflexión cognitiva.

When we make judgments and decisions about our health, we are frequently faced with numerical information. For example, we often receive information concerning the risk of suffering an illness in terms of probabilities, percentages or fractions. However, many people have difficulties in understanding this type of information. In this paper, we present a critical review of the existing empirical evidence that documents the influence of numeracy on various aspects of the process that occurs when patients visit their doctor, focusing on perceptions of medical risks and treatment efficacy. We also outline different theoretical frameworks that have attempted to explain the impact of numeracy, highlighting some of their limitations. Finally, we discuss the advantages and disadvantages of existing tools for measuring numeracy, drawing attention to the Berlin Numeracy Test. We concluded that this test can satisfactorily assess numeracy in a wide range of contexts. We also discuss a number of open questions, including the relationship between numeracy and other psychological constructs, such as intelligence or cognitive reflection.

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Pacientes com diabetes mellitus requerem um autocuidado extenso, com tratamentos complexos e comportamentos de saúde adequados, sendo, essas habilidades, fator chave. Frente a tal complexidade surge a importância do letramento funcional em saúde. O objetivo do estudo foi analisar fatores associados ao letramento em saúde e sua relação com controle glicêmico em pacientes diabéticos. Este estudo foi realizado com 82 pacientes diabéticos tipo 2, atendidos em um ambulatório de endocrinologia de um hospital público, de ambos os sexos e com idade entre 19 e 59 anos, que responderam à versão abreviada e traduzida do Test of Functional Health Literacy in Adults (b-TOFHLA). Valores de glicemia de jejum e hemoglobina glicada foram coletados dos prontuários dos participantes. Foram realizadas correlações, comparações de médias e modelos de regressão linear. O letramento inadequado foi encontrado em 65,9% dos pacientes. Foram fatores associados à pontuação do b-TOFHLA, a idade e os anos de estudos. O letramento global não explicou o controle glicêmico, mas o numeramento apresentou associação com tal controle. Nossos resultados apontam para a necessidade de melhorar o numeramento em saúde dos pacientes para obter seu melhor controle glicêmico, principalmente naqueles com maior idade e menos anos de estudo.

Diabetes mellitus patients must concentrate on self-care, with complex treatments and adequate health behavior in which such habits are a key factor. Due to the complexity of this issue, the importance of literacy in health arises. The goal of the study was to analyze factors associated with literacy in health and its relation with glycemic control in diabetic patients. It involved a study with 82 type 2 diabetic patients of both sexes and aged between 19 and 59 attended in the outpatient endocrinology ward of a public hospital, who filled out an abbreviated and translated version of the Test of Functional Health Literacy in Adults (b-TOFHLA). Fasting glycaemia values and glycated hemoglobin were collected from the clinical history of the participants. Correlations, mean comparisons and linear regression models were tested. Inadequate literacy in health was encountered in 65.9% of the patients. The issues involved factors associated with the b-TOFHLA point scores were age and years of schooling. Global literacy did not explain the glycemic control, but the level of numeracy presented an association with this control. The results point to the need to improve the numeracy in health of the patients to obtain enhanced glycemic control, mainly in those with more advanced age and less years of schooling.

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Is there a sense of chance shared by all individuals, regardless of their schooling or culture? To test whether the ability to make correct probabilistic evaluations depends on educational and cultural guidance, we investigated probabilistic cognition in preliterate and prenumerate Kaqchikel and K'iche', two indigenous Mayan groups, living in remote areas of Guatemala. Although the tested individuals had no formal education, they performed correctly in tasks in which they had to consider prior and posterior information, proportions and combinations of possibilities. Their performance was indistinguishable from that of Mayan school children and Western controls. Our results provide evidence for the universal nature of probabilistic cognition.

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Although the study of brain development in non-human animals is an old one, recent imaging methods have allowed non-invasive studies of the gray and white matter of the human brain over the lifespan. Classic animal studies show clearly that impoverished environments reduce cortical gray matter in relation to complex environments and cognitive and imaging studies in humans suggest which networks may be most influenced by poverty. Studies have been clear in showing the plasticity of many brain systems, but whether sensitivity to learning differs over the lifespan and for which networks is still unclear. A major task for current research is a successful integration of these methods to understand how development and learning shape the neural networks underlying achievements in literacy, numeracy, and attention. This paper seeks to foster further integration by reviewing the current state of knowledge relating brain changes to behavior and indicating possible future directions.

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Despite evidence that individual differences in numeracy affect judgment and decision making, the precise mechanisms underlying how such differences produce biases and fallacies remain unclear. Numeracy scales have been developed without sufficient theoretical grounding, and their relation to other cognitive tasks that assess numerical reasoning, such as the Cognitive Reflection Test (CRT), has been debated. In studies conducted in Brazil and in the USA, we administered an objective Numeracy Scale (NS), Subjective Numeracy Scale (SNS), and the CRT to assess whether they measured similar constructs. The Rational-Experiential Inventory, inhibition (go/no-go task), and intelligence were also investigated. By examining factor solutions along with frequent errors for questions that loaded on each factor, we characterized different types of processing captured by different items on these scales. We also tested the predictive power of these factors to account for biases and fallacies in probability judgments. In the first study, 259 Brazilian undergraduates were tested on the conjunction and disjunction fallacies. In the second study, 190 American undergraduates responded to a ratio-bias task. Across the different samples, the results were remarkably similar. The results indicated that the CRT is not just another numeracy scale, that objective and subjective numeracy scales do not measure an identical construct, and that different aspects of numeracy predict different biases and fallacies. Dimensions of numeracy included computational skills such as multiplying, proportional reasoning, mindless or verbatim matching, metacognitive monitoring, and understanding the gist of relative magnitude, consistent with dual-process theories such as fuzzy-trace theory.