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INTRODUCTION: Obesity is often labeled as a physical characteristic of a patient rather than a disease and it is subject to obesity bias by health providers, which harms the equality of healthcare in this population. OBJECTIVE: Identifying whether obesity bias interferes in clinical decision-making in the treatment of patients with obesity. METHODS: A systematic review of observational studies published between 1993 and 2023 in MEDLINE, Embase, and Cochrane Library on obesity bias and therapeutic decisions was carried out. The last search was conducted on June 30, 2023. The main outcome was the difference between clinical decisions in the treatment of individuals with and without obesity. The Newcastle-Ottawa scale for observational studies was used to assess for quality. After the selection process, articles were presented in narrative and thematic synthesis categories to better organize the descriptive analysis. RESULTS: Of the 2546 records identified, 13 were included. The findings showed fewer screening exams for cancer in patients with obesity, who were also susceptible to less frequent pharmacological treatment intensification in the management of diabetes. Women with obesity received fewer pelvic exams and evidence of diminished visual contact and physician confidence in treatment adherence was reported. Some studies found no disparities in treatment for abdominal pain and tension headaches between patients presented with and without obesity. CONCLUSION: The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts. (The protocol was registered with the international prospective register of systematic reviews, PROSPERO, under the number CRD42022307567).

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Researchers use public records from deceased individuals to identify trends in manners and causes of death. Errors in the description of race and ethnicity can affect the inferences researchers draw, adversely impacting public health policies designed to eliminate health inequity. Using the New Mexico Decedent Image Database, we examine: 1) the accuracy of death investigator descriptions of race and ethnicity by comparing their reports to those from next of kin (NOK), 2) the impact of decedent age and sex on disagreement between death investigators and NOK, and 3) the relationship between investigators' descriptions of decedent race and ethnicity and cause and manner of death from forensic pathologists (n = 1813). Results demonstrate that investigators frequently describe race and ethnicity incorrectly for Hispanic/Latino decedents, especially regarding homicide manner of death and injury and substance abuse causes of death. Inaccuracies may cause biased misperceptions of violence within specific communities and affect investigative processes.

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Stabled horses often experience negative emotions due to the inappropriate living conditions imposed by humans. However, identifying what emotions horses experience and what can trigger positive and negative emotions in stabled horses can be challenging. In this article we present a brief history of the study of emotions and models that explain emotions from a scientific point of view and the physiological bases and functions of emotions. We then review and discuss physiological and behavioral indicators and cognitive bias tests developed to assess emotions in horses. Hormone concentrations, body temperature, the position of the ears, facial expressions and behaviors, such as approach and avoidance behaviors, can provide valuable information about emotional states in horses. The cognitive bias paradigm is a recent and robust tool to assess emotions in horses. Knowing how to evaluate the intensity and frequency of an individual's emotions can guide horse owners and caretakers to identify practices and activities that should be stimulated, avoided or even banned from the individual's life, in favor of a life worth living. The development and validation of novel indicators of emotions considering positive and negative contexts can help in these actions.

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Judgment bias tests have become an important tool in the assessment of animals' affective states. Subjects are first trained to discriminate between two cues associated with a positive and a less-positive outcome. After successful training, they are confronted with an ambiguous cue, and responses are used for judgment bias assessment. In spatial settings, ambiguous cue presentation is typically linked with novelty, i.e. to yet unexplored areas or areas to which the animal has a low degree of habituation. We hypothesized that in such settings, responses to ambiguity might be biased by the animals' perception of novelty. We conducted judgment bias tests in mound-building mice phenotyped for their exploration tendency. After subjects had learned to distinguish between the positively and less-positively rewarded arms of a maze, a new ambiguous middle-arm was introduced. During the first test trial, more exploratory, less neophobic individuals displayed higher bidirectional locomotion in the ambiguous arm, indicating intensive exploration. Although this resulted in longer latencies to the reward in more exploratory animals, we conclude that this did not reflect a 'more pessimistic judgment of ambiguity'. Indeed, during the following two trials, with increasing habituation to the ambiguous arm, the direction of the association was inversed compared to the first trial, as more exploratory individuals showed relatively shorter approach latencies. We suggest that in spatial test settings associating the ambiguous cue to novel areas, results can be confounded by subjects' personality-dependent motivational conflict between exploration and reaching the reward. Findings obtained under such conditions should be interpreted with care.

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Within a species, some individuals are better able to cope with threatening environments than others. Paca (Cuniculus paca) appear resilient to over-hunting by humans, which may be related to the behavioural plasticity shown by this species. To investigate this, we submitted captive pacas to temperament tests designed to assess individual responses to short challenges and judgement bias tests (JBT) to evaluate individuals' affective states. Results indicated across-time and context stability in closely correlated "agitated", "fearful" and "tense" responses; this temperament dimension was labelled "restless". Individual "restless" scores predicted responses to novelty, although not to simulated chasing and capture by humans in a separate modified defence test battery (MDTB). Restless animals were more likely to show a greater proportion of positive responses to an ambiguous cue during JBT after the MDTB. Plasticity in defensive behaviour was inferred from changes in behavioural responses and apparently rapid adaptation to challenge in the different phases of the MDTB. The results indicate that both temperament and behavioural plasticity may play a role in influencing paca responses to risky situations. Therefore, our study highlights the importance of understanding the role of individual temperament traits and behavioural plasticity in order to better interpret the animals' conservation status and vulnerabilities.

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Introdução: O viés cognitivo de confirmação diagnóstica é a tendência de lembrar, de interpretar ou de pesquisar por dados clínicos de maneira a confirmar uma hipótese inicialmente aceita mais do que de refutá-la. O uso da estratégia educacional de reflexão estruturada demonstrou em estudos experimentais ser eficaz em tornar o médico menos susceptível a vieses cognitivos e, consequentemente, menos propenso a erros diagnósticos. Objetivos: Avaliar a ocorrência de viés de confirmação diagnóstica em estudantes de medicina do 8º período durante a resolução de casos clínicos, já contendo hipóteses diagnósticas de encaminhamento e verificar o potencial efeito da reflexão estruturada na redução do viés de confirmação diagnóstica. Metodologia: Estudo experimental com estudantes do 8º período do Curso de Medicina - UNIFENAS - Alfenas. Participaram do estudo 107 alunos, divididos em dois grupos, de acordo com a estratégia diagnóstica: grupo reflexão x grupo controle. Cada um desses grupos foi subdividido em dois subgrupos de acordo com a hipótese diagnóstica de encaminhamento dos casos: hipótese correta x hipótese plausível. Sendo hipótese correta (resolução de casos clínicos com hipótese de encaminhamento correta) e hipótese plausível (resolução dos mesmos casos clínicos, mas, com hipótese de encaminhamento plausível, mas incorreta), resultando em quatro condições experimentais. O grupo reflexão utilizou a reflexão estruturada para a resolução dos casos e o grupo controle, a resolução livre. Resultados: O percentual de confirmação diagnóstica em relação à hipótese diagnóstica de encaminhamento encontrado foi de 74,2% de confirmação diagnóstica quando a hipótese diagnóstica de encaminhamento estava correta e 37,8% de confirmação diagnóstica quando a hipótese diagnóstica de encaminhamento era plausível. No grupo reflexão com hipótese diagnóstica de encaminhamento plausível, mas incorreta, a reflexão estruturada melhorou a acurácia diagnóstica tanto nos casos clínicos com grau de dificuldade intermediários (p <0,05) quanto nos casos clínicos difíceis (p <0,001) quando comparados com o grupo controle com hipótese diagnóstica de encaminhamento plausível. Conclusão: Evidenciou-se a ocorrência do viés cognitivo de confirmação diagnóstica em estudantes de medicina e se verificou que o uso do método instrucional de reflexão estruturada enfraquece o viés de confirmação diagnóstica na resolução de casos clínicos contendo hipótese diagnóstica de encaminhamento plausível, mas incorreta, com grau de dificuldade intermediário ou difícil

Introduction: The cognitive bias of diagnostic confirmation is the tendency to remember, to interpret or to search for clinical data in order to confirm an initially accepted hypothesis rather than to refute it. The use of the educational strategy of structured reflection has shown in experimental studies to be effective in making the physician less susceptible to cognitive bias and, consequently, less prone to diagnostic errors. Objectives: To evaluate the occurrence of diagnostic confirmation bias in medical students of the 8th period during the resolution of clinical cases, already using diagnostic hypotheses for referral and to verify the potential effect of structured reflection in reducing diagnostic verification bias. Methodology: Experimental study with students from the 8th period of the Medical Course - UNIFENAS - Alfenas. 107 students participated in the study, divided into two groups, according to a diagnostic strategy: reflection x control group. Each of these groups was subdivided into two subgroups according to a diagnostic hypothesis of referral cases: correct hypothesis x plausible hypothesis. Being the correct hypothesis (resolution of clinical cases with the hypothesis of correct referral) and the plausible hypothesis (resolution of the same clinical cases, but with diagnostic hypothesis of plausible referral, but incorrect), resulting in four experimental conditions. The reflection group used structured reflection to solve cases and the control group used free resolution. Results: The percentage of diagnostic confirmation in relation to the diagnostic referral hypothesis found was 74,2% of diagnostic confirmation when the diagnostic hypothesis of referral was correct and 37,8% of diagnostic confirmation when the diagnostic hypothesis of referral was plausible. In the reflection group with a plausible but incorrect diagnostic hypothesis, the structured reflection improved the diagnostic accuracy both in clinical cases with intermediate degree of difficulty (p <0,05) and in difficult clinical cases (p <0,001) when compared with control group with diagnostic hypothesis of plausible referral. Conclusion: It became evident the occurrence of the cognitive bias of diagnostic confirmation in medical students and it was found that the use of the instructional method of structured reflection weakens the diagnostic confirmation bias in the resolution of clinical cases containing a plausible but incorrect diagnostic hypothesis of referral with intermediate or difficult degree of difficulty

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Resumen: Un concepto que ha causado atención en los últimos años es el de los sesgos cognitivos y su influencia en las decisiones y comportamientos diarios de los seres humanos. Los equipos de trabajo en sala de operaciones se forman de diferentes áreas de especialidad y con distintos niveles de experiencia, todos tienen una función y pueden tomar decisiones que afectan al paciente. Este proceso de toma de decisiones se puede basar en experiencia previa, razonamiento clínico y el contexto; la necesidad de realizar diagnósticos y tratamiento rápido en algunas situaciones hace al anestesiólogo particularmente vulnerable a sesgos cognitivos. Presentamos diferentes ejemplos de sesgos cognitivos que se pueden llegar a presentar en sala de operaciones, como puede ser el sesgo de atención, en el cual un estímulo relevante como la necesidad de asegurar la vía aérea puede hacer que el estado hemodinámico del paciente pase desapercibido. El objetivo de este trabajo es crear conciencia particularmente en los anestesiólogos sobre estos sesgos cognitivos, su presencia en el proceso de toma de decisiones en la sala de operaciones y compartimos un par de formas para ayudar a prevenirlos.

Abstract: A concept that has gained attention in the last years is the existance of cognitive biases and their influence in decision making and behaviour of human beings. Teams in the operating room are formed by different medical specialities with varied levels of experience, everyone has a role and every one can make decisions that have an impact in the patient. This decision making process might be based in previous experience, clinical reasoning, and context; the need to make a rapid diagnosis and treatment in some situations makes the anesthesiologist especially vulnerable to cognitive bias. We present different types of cognitive bias that might be present in the operating room for example the attention bias in which a relevant stimulus like the airway management could make the hemodynamic aspect go unnoticed. The goal of this paper is to aware anesthesiologists in particular about this cognitive biases, their presence in the decision making process in the operating room and to share a couple of ways to prevent them.