"Treated me like I was family": Qualitative Evaluation of a Culturally-Adapted Health Care Manager Intervention for Latinos with Serious Mental Illness and at Risk for Cardiovascular Disease.

Latinos with serious mental illness (SMI) experience health and health care disparities and may benefit from interventions that improve access to, coordination of, and receipt of primary care services. The aim of this qualitative study was to examine the experiences of Latinos with SMI and at risk for cardiovascular disease participating in Bridges to Better Health and Wellness (B2BHW), a culturally-adapted health care manager intervention delivered in a public outpatient mental health clinic. A total of 29 Latino participants completed a post-intervention survey that included an open-ended question about the three things they liked most about B2BHW; a subset of 16 participants participated in one of three post-intervention focus groups. Results indicate that what mattered most to participants was the health education they received, the positive relationships they formed with their health care managers, the care coordination assistance they obtained, and the motivation and activation they gained from this intervention. Study findings suggest that key elements of the health care manager intervention (e.g., care coordination, and patient activation) shaped participants' experiences with B2BHW and were perceived as beneficial.

Bridges to Better Health and Wellness: An Adapted Health Care Manager Intervention for Hispanics with Serious Mental Illness.

This study examined the feasibility, acceptability, and initial impact of bridges to better health and wellness (B2BHW), a culturally-adapted health care manager intervention for Hispanics with serious mental illness (SMI). Thirty-four Hispanics with SMI and at risk for cardiovascular disease were enrolled. Mixed-linear models were used to examine changes over 12-months on patient activation, self-efficacy, patient-rated quality of care, receipt of preventive primary care services, and quality of life. The majority of participants completed the intervention (85%) with high satisfaction. Significant improvements were found for patient activation, self-efficacy, patients' ratings of quality of care, and receipt of preventive primary care.

Relationship between HMF intake and SMF formation in vivo: An animal and human study.

SCOPE: 5-Hydroxymethylfurfural (HMF) is a furanic compound produced in heat-processed foods by nonenzymatic browning reactions. HMF has been demonstrated to be hepato- and nephrotoxic in animals with a link to its metabolite 5-sulfooxymethylfurfural (SMF). To date little is known about either the formation of SMF from ingested HMF or the formation of DNA adducts in animals or human beings. METHODS AND RESULTS: To assess SMF in vivo formation, we first performed a study in mice treated with high/low doses of oral HMF. We found increased concentrations of SMF in plasma and DNA SMF-adducts in leukocytes, hepatic tissue, and kidneys by means of LC-MS/MS, but no spatial formation in such tissues was observed by MALDI-MS imaging technology due to low sensitivity. In a second experiment, we measured the exposure to HMF in a Spanish preadolescent population. We analyzed the concentration of HMF metabolites (plasma, urine) and measured, for the first time, the presence of SMF in plasma and DNA SMF-adducts in leukocytes. CONCLUSION: This study provides the first evidence that oral HMF is readily transformed into SMF in vivo, giving rise to the formation of DNA adducts in a direct relation with HMF intake, both in animals and human beings.

Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness.

BACKGROUND: Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community. METHODS: The study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic clients. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations. RESULTS: The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. The application of this approach enabled the CAB to identify a series of cultural and provider level-adaptations without compromising the core elements of the original health-care manager intervention. CONCLUSIONS: Reducing health disparities in people with SMI requires community engagement, particularly when preparing existing interventions to be used with new communities, provider groups, and practice settings. Our study illustrates one approach that can be used to involve community stakeholders in the intervention adaptation process from the very beginning to enhance the transportability of a health-care manager intervention in order to improve the health of people with SMI.

Primary health care experiences of hispanics with serious mental illness: a mixed-methods study.

This mixed-methods study examines the primary health care experiences of Hispanic patients with serious mental illness. Forty patients were recruited from an outpatient mental health clinic. Participants reported a combination of perceived discrimination and stigmatization when receiving medical care. They rated the quality of chronic illness care as poor and reported low levels of self-efficacy and patient activation. These indicators were positively associated with how patients viewed their relationships with primary care providers. A grounded model was developed to describe the structural, social, and interpersonal processes that shaped participants' primary care experiences.

Neutropenia febril en niños con leucemia linfoblástica agudaasistidos en el Hospital pediátrico Juan Pablo II desde el 2004 al 2012 / Febrile Neutropenia in infants with acute lymphoblastic leukemia nursed in pediatric hospital Juan Pablo II from 2004 to 2012

La leucemia linfoblástica aguda (LLA) es la patología oncológica más frecuente en la infancia. El tratamiento con quimioterapia intensiva es la inducción, donde la complicación precoz es la neutropenia febril(NF). El presente trabajo tuvo por objetivo establecer la relación entre sexo del niño, qrupo etario y la instrucción materna con la aparición de NF en niños con LLA durante el período de inducción del del tratamiento quimioterápeutico, asistidos en el Hospital Pediátrico "Juan Pablo II" entre 2004 y 2012. Se planteó un estudio cuantitativo y analítico de casos y controles. Los casos fueron niños con LLA que padecieron NF y los controles aquellos que no la presentaron. La muestra se conformó con 60 unidades de análisis seleccionadas de historias clínicas de niños con LLA; 20 casoso y 40 controles. Los resultados mostraron que el 65 per cent de casos eran niñas, que bajó a 38 per cent en los controles, tras la asociación de variables presentaron tres veces más probabilidades de padecer NF que los niños (p<0,04). En el grupo etario, la NF afectó al 65 per cent de niños de 1 a 5 años y los controles fueron de 57 per cent de esas edades. Al relacionar grupo etario y NF, la franja de 1 a 5 años presentó 1,37 más posibilidades de presentar el suceso (p<0,57). Analizando la instrucción materna, se halló en los casos que el 75 per cent tenía instrucción incompleta, sobre el 68 per cent de controles. Al correlacionar las variables, los casos mostraron 1,4 más probabilidades de padecer NF que los de madres con instrucción completa(p<0,55). En conclusión, ser niño y tener una madre con escolaridad incompleta aumenta los riesgos de NF en niño con LLA en fase de inducción del tratamiento...

Abstract: The acute lymphoblastic leukemia(ALL) is the most frequent pathology of the oncology during the childhood. The treatment with induced chemotherapy is the induction in which the premature complication is the febrile neutropenia (FN). The objetive of this assigment was to establish the relationship that exists between chidrem's gender, age group, instruction of mothers and the emergence of FN in infants with ALL during the period of induction of the treatment of chemotherapy nursed in peadiatric hospital Juan Pablo II from 2004 to 2012. A quantitative and analytic research of cases and controls was proposed. Considering the cases, they were infants with ALL that suffered from FN. The controls, however, were those that did not presented it. The test was based on 60 units of analysis selected from the medical record of children with ALL, 20 cases and 40 controls...

Successful treatment with etanercept in a patient with hepatotoxicity closely related to infliximab.

To date, hepatotoxicity with anti-TNF therapy has been associated with concomitant liver-toxicity drugs, infection or malignant diseases. We report the case of one patient with spondyloarthropathty who presented severe liver dysfunction related to infliximab. After the second infusion serum controls showed an slightly increase of transaminases. Before the administration of fifth infusion, infliximab therapy was stopped due to severe liver damage (AST 327 mU/ml, ALT 656 mU/mL, GGT 140 mU/mL, alkaline phosphate 227 mU/mL). Ten weeks after infliximab discontinuation serum concentrations of liver blood tests were normal but ankylosing spondylitis symptoms had relapsed. Therefore, he was treated with etanercept with a rapid and sustained improvement. Serum concentrations of albumin, AST, ALT, GGT and alkaline phosphate were followed and did not change for five months.