Cultural and Linguistic Adaptation of a Healthy Diet Text Message Intervention for Hispanic Adults Living in the United States.

Hispanics represent a critical target for culturally adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers in the United States. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. We used survey data to evaluate whether self-determination theory (SDT) factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants desiring to use it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest, suggesting that they could impede program use. In Stage 3, we implemented the mixed-methods findings to finalize HealthyYouTXT en Español. The emergent linguistic principles and multistage, multimethods process can be applied in health communication adaptations.

The Effects of Declining Functional Abilities in Dementia Patients and Increases Psychological Distress on Caregiver Burden Over a One-Year Period.

The degree to which changes in caregiver burden over a one year period can be predicted by functioning of dementia patients and caregiver psychological stress was examined. The Direct Assessment of Functional Status (DAFS) was administered to 44 patients and the Caregiver Burden Inventory and the Brief Symptom Inventory were administered to their next-of-kin caregivers. All patients and caregivers were assessed at baseline and again in approximately one year with the same measures. Hierarchical regression revealed that baseline patient functioning predicted overall changes in caregiver burden, but that increases in psychological symptoms of caregivers such as depression, anxiety and hostility were the best predictors for specific types of increased caregiver burden, such as social, developmental, or physical burden. These results suggest that interventions should target reduction of particular psychological symptoms in order to reduce caregiver burden over time.

Incidence of chemotherapy-induced nausea and vomiting in Mexico: healthcare provider predictions versus observed.

OBJECTIVE: An understanding of the incidence of chemotherapy-induced nausea and vomiting (CINV) may assist healthcare providers (HCP) when making treatment decisions. We investigated the incidence of CINV after highly or moderately emetogenic chemotherapy (HEC or MEC), in comparison with predictions of CINV by HCP. RESEARCH DESIGN AND METHODS: This prospective study was conducted at nine oncology centers in Mexico. Eligible patients were >/=18 years old and scheduled to receive a single, initial cycle of chemotherapy. Patients recorded nausea severity, episodes of emesis, and rescue medication use for the first 5 days after chemotherapy. HCP predicted the general incidence of acute (day 1) and delayed (days 2-5) CINV. RESULTS: A total of 82 patients were enrolled, with complete data available for 73. Mean age was 50 years; 67 (92%) were women; and 57 (78%) received HEC, while 16 (22%) received MEC. HCP predictions were comparable to the incidence of acute CINV after HEC and MEC and of delayed CINV after MEC. However, HCP predictions underestimated delayed CINV after HEC. 75.4% of patients (95% CI: 62.2-85.9) reported delayed nausea and HCP predicted 41.7% (95% CI: 30.2-55.0); 63.2% of patients (95% CI: 49.3-75.6) reported delayed emesis and HCP predicted 31.8% (95% CI: 21.0-44.5). Limitations of the study include the small sample size, possible selection bias and lack of a standardized antiemetic regimen. CONCLUSIONS: Healthcare providers underestimated the incidence of delayed CINV after HEC. There is a need for a better understanding of the incidence of delayed nausea and emesis, which remain common side-effects of chemotherapy.

Stereotactic noninvasive volume measurement compared with geometric measurement for indications and evaluation of gamma knife treatment.

OBJECT: Volume estimation is one of the most important criteria in the evaluation and follow up of radiosurgical treatments and outcomes; however, several limitations are involved in the calculation estimation of target volumes. METHODS: Retrospective and prospective studies were conducted to evaluate the efficacy of a new noninvasive stereotactic method when it is compared with geometric volume calculation of intracranial tumors for planning stereotactic radiosurgery treatment as well as for follow up and outcome evaluation. Two equations were created that permit comparison of the calculated and measured volumes. These equations took linear and quadratic forms, respectively. Volume estimation using the stereotactic approach compared with traditional volume calculation gave more accurate results regardless of the shape and size of the lesion. CONCLUSIONS: The use of stereotactic volume calculation is highly recommended in planning, follow up, and determination of the outcome in patients participating in radiosurgical treatment and should lead to more uniform reports of the response to treatment.

Hepatic Echinococcus granulosus. A case report.

A 32-year-old woman was admitted to hospital complaining of right upper quadrant and epigastrium abdominal pain, and nausea. On routine physical examination an abdominal mass was discovered on the right upper quadrant. Liver tests were normal. Magnetic resonance imaging of the abdomen revealed a low-density cystic mass. A cystectomy was performed. Hydatid sand containing a protoscolex of Echinococcus granulosus was seen on microscopical examination. Specific antiparasitic treatment was given and after two months the patient is asymptomatic

Síndrome de Klippel-Feil. Imágenes por tomografía en tercera dimensión / Klipper-Feil syndrome three-dimensional computed tomography images by computed tomography

El síndrome de Klippel-Feil se caracteriza por la fusión congénita de las vértebras cervicales que resulta de una falta de segmentación en el esqueleto axial del embrión. Es una enfermedad heterogénea que se asocia también a malformaciones craneofaciales. El fenotipo característico tiene una tríada que se presenta en menos de 50 por ciento de los casos caractetizada por implantación baja del cabello, cuello corto y limitación de la movilidad del cuello. La presencia de alteraciones sistémicas y esqueléticas es común, entre las más importantes se encuentran; elevación de la escápula, escoliosis y malformaciones cardiacas y renales. En este artículo pre-sentamos imágenes tridimensionales de fusiones verte-brales múltiples por tomografía computada en un niño de nueve años de edad.

Interferón alfa 2-b adyuvante a la cirugía en melanoma / Adjuvant interferon alpha-2b in the surgery of melanoma

A pesar de la identificación de los factores pronósticos en melanoma, sólo el diagnóstico temprano puede ofrecer altas probabilidades de curación, ya que, hasta fecha reciente, la cirugía era el único tratamiento curativo. Desde mediados de los 80, en todo el mundo se iniciaron protocolos de terapia con interferón adyuvante a la cirugía. Este trabajo fue realizado con el objetivo de evaluar si el interferon adyuvante mejoraba la supervivencia y el intervalo libre de enfermedad en sujetos con melanoma. Se incluyeron 31 pacientes menores de 70 años con melanoma del mal pronóstico y estado funcional de 0, 1 o 2 (de acuerdo a la clasificación del Eastern Cooperative Oncology Group). Todos fueron tratados quirúrgicamente con excisión amplia y disección ganglionar regional electiva o terapéutica. Quince recibieron interferón alta 2-b por seis meses. Los 16 pacientes restantes sólo fueron tratados con cirugía. El análisis comparativo de edad, sexo, localización, nivel de invasión, grosor tumoral, satelitosis y metástasis ganglionares mostró que ambos grupos tenían características similares. A ocho sujetos del grupo con interferón se les administraron tres millones de unidades; a otros seis, cinco millones y al enfermo restante, 10 millones; en todos ellos se aplicaron tres veces a la semana. El tratamiento se administró durante seis meses en 11 casos; y durante tres, cuatro, cinco y 12 meses en un caso, respectivamente. Los tres pacientes que recibieron el interferón por menos de seis meses desarrollaron recurrencia y se consideraron fallas al tratamiento adyuvante. La tolerancia fue adecuada y no hubo toxicidad importante. La supervivencia a cinco años fue de 35.7 por ciento en el grupo tratado y de 36.5 por ciento en el grupo control (p= 0.98). El intervalo libre de enfermedad fue de 28.7 y 37.8 meses, respectivamente (p = 0.67). Nueve de 16 sujetos del grupo control fallecieron, así como 11 de los 15 enfermos del grupo tratado; en éstos el tiempo medio de vida fue de 15.4 y de 28.6 meses, respectivamente (p= 0.3). Los resultados de este estudio muestran que con la dosis y tiempo utilizado no hay ningún beneficio sobre el intervalo libre de enfermedad ni en la supervivencia global. Esto confirma los resultados informados por otros autores. Es indispensable diseñar nuevas estrategias de tratamiento para los pacientes con melanoma de mal pronóstico, los cuales representan más del 50 por ciento de los casos con esta neoplasia en nuestro medio