Urinary 2- to 16α-hydroxyestrone ratio did not change with cruciferous vegetable intake in premenopausal women.

The mass ratio of urinary 2-hydroxyestrone to 16-α-hydroxyestrone (2:16) is hypothesized as a biomarker of breast cancer risk in premenopausal women, with higher ratios being theoretically protective. Cruciferous vegetable intake has been associated with higher urinary 2:16 in some studies. We investigated whether a whole-food supplement made from dried Brussels sprouts and kale would increase urinary 2:16 in comparison with placebo or cruciferous vegetables in women. This randomized, parallel arm, placebo-controlled, partly blinded study included 78 healthy premenopausal women (38-50 y) with screening urinary 2:16 ≤3.0. Subjects received either six capsules containing 550 mg dried Brussels sprouts and kale per capsule, 40 g daily alternating broccoli or Brussels sprouts, or placebo for eight weeks. Urinary 2:16 and creatinine were measured at baseline, four, and eight weeks. Intent-to-treat repeated measures-ANOVA with multiple imputation (n=100) for missing values identified no treatment effect (P=0.9) or treatment-by-time interaction (P=0.6); however, a significant time effect was noted (P=0.02). Per-protocol analyses including complete cases found no treatment effect (P=1) or treatment-by-time interaction (P=0.6); however, the significant time effect remained (P=0.03). Restricting analysis to subjects with >80% compliance maintained the time effect (P=0.02). Using Pearson correlations, android-pattern and android:gynoid fat were predictive of change (P≤0.05). In conclusion, neither cruciferous supplements nor an added vegetable serving altered urinary 2:16 in premenopausal women with eight weeks treatment. This ratio did vary with time, which is important for designing future trials.

Assessment of Interpretation Modality and Patient Comprehension in Spanish-speaking Limited English Proficiency (LEP) Patients Presenting to the Emergency Department.

BACKGROUND: Provider-patient language discrepancies with limited English proficiency (LEP) patients can lead to misunderstandings about diagnoses and follow-up care. OBJECTIVES: To assess interpretation modalities used in the emergency department (ED) in terms of patient satisfaction and understanding of discharge diagnosis. METHODS: Spanish-speaking LEP patients completed a survey assessing overall satisfaction and discharge diagnosis comprehension. Modalities included in-person (interpreter or physician/nurse), remote (phone or video), or combination. Differences in proportions with correctly identified diagnoses were compared by modality using Fisher's exact test. RESULTS: Patients preferred a Spanish-speaking staff member (52%) or in-person interpreter (33%) over other modalities. Almost 74% of surveyed patients accurately described their discharge diagnosis. Diagnostic accuracy was increased among patients using remote modalities alone compared with in-person alone or combination (p=.02). CONCLUSION: Taking into account patient preferences and diagnostic accuracy, this study suggests the utility of having different interpreter modalities available for Spanish-speaking LEP ED patients.