For parents of children who die of cancer, doctor-patient communication is the principal determinant of high-quality physician care. In contrast, physicians' care ratings depend on biomedical rather than relational aspects of care.

Objectives: xMany Africans were brought to Brazil as slaves. The runaway or abandoned slaves founded isolated communities named quilombos. There are many quilombo remnants in Vale do Ribeira region in the southern part of São Paulo State. The aim of our study was to contribute to understanding the origins of these populations, through admixture studies. Methods: We genotyped 307 unrelated DNA samples obtained from ten quilombo populations from Vale do Ribeira region, using a panel of 48 INDEL polymorphisms. We estimated genetic differentiation between populations (FST) and genomic ancestry from these populations. Our data were compared to a similar study performed in quilombo remnants from the Brazilian Amazon region. Results: Population admixture estimates showed high degree of miscegenation in the quilombo remnants from Vale do Ribeira (average admixture estimates at 39.7% of African, 39.0% of European and 21.3% of Amerindian contribution). The proportions of ancestral genes varied greatly among individuals, ranging from 7.3 to 69.5%, 12.9 to 68.3%, and 7.3 to 58.5% (African, European, and Amerindian, respectively). Genetic differentiation between these populations was low (all FST values <5%), indicating gene flow between them. Both groups of quilombos, from Vale do Ribeira and Amazon, presented similar patterns of admixture. Conclusions: INDEL markers were useful to evidence the triple interbreeding among African, European, and Amerindian in the formation of quilombo populations. The low FST values suggested gene flow among quilombos from Vale do Ribeira. Our data highlight the important role of Amerindians in the formation of quilombo populations. Am. J. Hum. Biol., 2013. © 2012 Wiley Periodicals, Inc.

While dying at home may be the choice of many, where people die may be less important than argued. We examined factors associated with parental planning of a child's location of death (LOD) and its effects on patterns of care and parent's experience. In a cross-sectional study of 140 parents who lost a child to cancer at one of two tertiary level U.S. pediatric hospitals, 88 (63%) planned the child's LOD and 97% accomplished their plan. After adjusting for disease and family characteristics, families whose primary oncologist clearly explained treatment options during the child's end of life (EOL) and who had home care involved were more likely to plan LOD. Planning LOD was associated with more home deaths (72% versus 8% among those who did not plan, P<0.001) and fewer hospital admissions (54% versus 98%, P<0.001). Parents who planned were more likely to feel very prepared for the child's EOL (33% versus 12%, P=0.007) and very comfortable with LOD (84% versus 40%, P<0.001), and less likely to have preferred a different LOD (2% versus 46%, P<0.001). Among the 73 non-home deaths, planning was associated with more deaths occurring in the ward than in the intensive care unit or other hospital (92% versus 33%, P<0.001), and fewer children being intubated (21% versus 48%, P=0.029). Comprehensive physician communication and home care involvement increase the likelihood of planning a child's LOD. Opportunity to plan LOD is associated with outcomes consistent with high quality palliative care, even among non-home deaths, and thus may represent a more relevant outcome than actual LOD.

Although conventional wisdom may view BCS as the preferred treatment, a notable proportion of well informed women choose mastectomy. Whereas prior studies have linked objective factors to treatment choice, this study reveals subjective preferences that underlie decision making. The systematic use of a decision aid before the surgical consultation may help women make informed, values-based decisions, while clearly reducing decisional conflict.