A pilot feasibility study of Conexiones, a telephone-delivered cancer parenting education program for Hispanic mothers.

OBJECTIVE: To test the short-term impact of Conexiones, a culturally adapted cancer parenting education program for diagnosed child-rearing Hispanic mothers. DESIGN: Single group, pre-post-test design. SAMPLE: 18 U.S. Hispanic mothers diagnosed within 2 years with early-stage cancer (0-III) raising a child (5-17 years). METHODS: Participants completed consent, baseline measures, and five telephone-delivered Conexiones sessions at 2-week intervals from trained patient educators in English or Spanish. Outcomes were assessed at baseline and at 3 months. RESULTS: Maternal depressed mood, parenting self-efficacy, and parenting quality significantly improved. Children's anxious/depressed mood tended to significantly improve. Outcomes did not co-vary with mothers' level of acculturation. CONCLUSIONS: Conexiones appears to positively improve Hispanic mothers' distress and parenting competencies; efficacy testing is warranted within a larger randomized control trial. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: A brief, culturally adapted cancer parenting education program has potential to enhance Hispanic mothers' and children's behavioral-emotional adjustment to a mother's cancer.

"I Felt Defeated. I Felt Helpless": Social Determinants of Health Influencing the Cancer Survivorship of a Young Latina Mother.

Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother's cancer survivorship in the U.S.-Mexico border region. The participant's Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant's baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant's cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez's conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.

Inequities in Pain Assessment and Care of Hospitalized Children With Limited English Proficiency.

OBJECTIVES: To examine inequities in pain assessment and management of hospitalized children with limited English proficiency (LEP) as assessed by (1) self-reported pain prevalence and intensity, and (2) nurse-documented pain assessments and analgesia. METHODS: A cross-sectional survey of hospitalized children and parent proxies examined preferred language and pain prevalence, intensity, and etiology; subsequent electronic medical record chart review examined demographics, nurse-documented pain scores, and analgesia prescribed for children aged ≤21 years at a tertiary care children's hospital. The primary outcome was a difference of ≥3 points between self-reported and nurse-documented worst pain scores. Descriptive statistics, Fisher's exact tests, and multivariable logistic regression were used to identify differences in outcomes between children with and without LEP. RESULTS: A total of 155 patients (50% children and 50% parental proxies) were interviewed (96% response rate). Of those, 60% (n = 93) reported pain in the previous 24 hours, most frequently because of acute illnesses. Of patients reporting pain, 65% (n = 60) reported a worst pain score of ≥3 points higher than nurse-documented scores; this discrepancy affected more patients with LEP (82%, n = 27) than English-proficient patients (55%, n = 33) (P = .01) with an adjusted odds ratio of 3.2 (95% confidence interval: 1.13-10.31). Patients with LEP were also less likely than English-proficient patients to receive medications at the time of their worst pain (60% vs 82%, P = .03), particularly opioid analgesia (9% vs 22%, P = .04). CONCLUSIONS: Children with LEP were more likely to self-report pain scores that exceeded nurse-documented scores and received less medications, particularly opiates. This population may be particularly vulnerable to underassessment and inadequate management of pain.

A Latina Community's Evaluation of the Culturally Adapted Conexiones Program.

BACKGROUND: Enhancing Connections (EC) is an evidence-based intervention that promotes communication between cancer-diagnosed mothers and their school-age children. EC was validated with college-educated non-Latina White mothers of privileged socioeconomic status. Latina researchers culturally adapted EC for Latina mothers diagnosed with cancer and renamed it Conexiones. Following cultural adaptation guidelines, the next recommended step was to engage the new consumer group (Latina mothers) in evaluating the newly adapted educational materials. PURPOSE: The purpose of this study was to evaluate the cognitive and cultural fit of the newly adapted Conexiones educational materials for use with Latina mothers diagnosed with cancer. METHOD: Eighteen Latina mothers participated in focus groups evaluating the Conexiones educational materials. An inductive approach was used to identify problem areas and recommendations for corrections to the Conexiones program content. RESULTS: Within the cognitive-informational dimension, recommendations were made to improve the ease of comprehension in the Spanish version of the program. Recommendations within the affective-motivational dimension described the cultural adjustments needed to more effectively engage cancer-diagnosed Latina mothers in the Conexiones program. Implications for Practice. Engagement of the new consumer group in evaluating the initial adaptation of Conexiones served to identify additional cognitive-informational and affective-motivational corrections needed to further refine the cultural adaptation of the Conexiones program. This study reinforced the importance of community engagement in evaluating and refining newly adapted evidence-based interventions.

Complications while awaiting elective inguinal hernia repair in infants: Not as common as you thought.

BACKGROUND: The dogma of early inguinal hernia repair in infants, especially those born prematurely, has dominated clinical practice owing to reports of a high frequency of incarceration and significant complications associated with untreated inguinal hernias. We aim to evaluate the frequency of complications after discharge with delayed surgery for inguinal hernia repair. METHODS: The Nationwide Readmissions Database (2010-2014) was queried to identify infants diagnosed with inguinal hernia. We compared the frequency and characteristics of inguinal hernia repair performed during the index admission, discharge from the index admission without hernia repair, and unplanned readmissions. RESULTS: We identified 33,530 infants (16,624 preterm and 16,906 full-term) diagnosed with an inguinal hernia during an index admission. For those infants diagnosed with an inguinal hernia at birth, inguinal hernia repair was performed during the birth admission for only a minority of both preterm (35%) and full-term infants (18%; P < .001). Of the infants discharged without hernia repair, 15% required nonelective readmission up to 1 year later, but only 2% of preterm and 1% of full-term infants actually underwent inguinal hernia repair during these unplanned readmissions. None of the readmitted infants underwent additional procedures suggestive of a strangulated hernia. CONCLUSION: Complications among infants awaiting inguinal hernia repair may be substantially less common than previously reported, and the occurrence of significant associated morbidity is quite rare.

Young Child-Rearing Latina Cancer Survivors Living in the US-Mexico Border Region: A Qualitative Study.

BACKGROUND: Despite increasing cancer incidence among young Latinas (<50 yrs.) in the US, little is known about how young, child-rearing Latinas cope with cancer in the US-Mexico border region. OBJECTIVE: The purpose of this study was to explore how young, child-rearing Latinas described their challenges, strengths, and social support sources for coping with cancer in the US-Mexico border region. METHODS: Nine Latinas that had been diagnosed with cancer, had at least one child 5 to 13 years old, and lived in one of two targeted border counties participated in audio-recorded, semi-structured focus groups (n = 6) or interviews (n = 3) in their preferred language (i.e., English or Spanish). Interview recordings were transcribed and inductively coded using methods based on grounded theory. RESULTS: Three major themes emerged. First, in reporting their physical and emotional struggles with cancer as the most difficult time of their lives, participants described feeling alone as they navigated treatment side effects and continued fear of cancer. Second, they explained figuring out how to live day-by-day, reporting the negative impact of cancer on their families and on their ability to maintain their roles as mothers. Third, they highlighted factors that gave them the strength to fight and carry on, emphasizing their children and their inner strength. CONCLUSIONS: Even with a supportive family, young Latina mothers felt alone as they navigated cancer (i.e., treatment, fear, and impact on their families) and as they worked to garner the strength to overcome the stress of cancer. Interventions for young Latina survivors should be designed to address their needs, build on their fighting spirit, incorporate the family, and connect them with other survivors for personalized support. Further research is warranted to better understand cancer survivorship among child-rearing Latina mothers experiencing a cancer diagnosis in under-resourced communities like the US-Mexico border region.

Understanding a Diverse Cancer Center Catchment Area: A Qualitative Needs Assessment Built on a Theoretical Framework.

INTRODUCTION: Quantitative approaches to the cancer incidence and mortality of a geographic region may lack understanding of the human context in the region thereby affecting how relevant cancer prevention and control activities can best be targeted to a cancer center's catchment area. OBJECTIVES: The objective of this study was to obtain and analyze qualitative data that described the barriers and facilitators in a cancer center's catchment area. A further objective was to use the assessment to plan a comprehensive approach to cancer prevention and control activities in the region. METHODS: Extensive qualitative data were gathered from 32 key informants in the 13 county catchment area. We used the Warnecke Model for Analysis of Population Health and Health Disparities to analyze the qualitative data. We coded factors affecting cancer prevention and control using a directed content analysis approach guided by the Warnecke Model. RESULTS: Four outcome types included fundamental barriers such as political environment and discrimination, gaps in resources, and lack of coordinated activities. Social and physical barriers included distrust, diverse language and cultures, and geographic distance. Individual barriers included lack of system negotiation, health literacy, and poverty. Biological barriers were disparate disease rates in specific groups. CONCLUSION: The analysis and assessment led to the creation of a catchment area wide coalition that used the results to formulate a comprehensive strategic plan to address the barriers in the region.

Interface fluid syndrome in routine cataract surgery 10 years after laser in situ keratomileusis.

PURPOSE: Interface fluid syndrome is an unusual complication after laser in situ keratomileusis (LASIK). We present a case of interface fluid syndrome after cataract surgery in a patient who had previous LASIK surgery. METHODS: A 62-year-old man underwent routine cataract surgery on the left eye 10 years after LASIK on both eyes. The day after surgery, the intraocular pressure (IOP) was 21 mm Hg and a pocket of fluid was present in the interface LASIK wound. The patient was treated with 0.50% timolol eye drops twice daily. RESULTS: The problem resolved within 1.5 months. Two months later, the patient underwent routine cataract surgery of the right eye. The next day, the IOP was 11 mm Hg and LASIK interface fluid was present. The patient was treated with 0.5% timolol eye drops twice daily. Two months after the surgery, the problem had completely resolved. CONCLUSIONS: Ocular hypertension and traumatic endothelial cell damage could have been the causes of the syndrome. Although the IOP was not very high, previous LASIK could have led us to underestimate the IOP.

Hígado graso no alcohólico como marcador de calidad de vida en mujeres de edad mediana / Non-alcoholic fatty liver as a marker of quality of life in middle age women

Introducción: en la mujer de edad mediana coexisten múltiples enfermedades crónicas en detrimento de su calidad de vida, es frecuente la presencia de hígado graso no alcohólico (HGNA). Objetivo: identificar las variables de riesgo en mujeres de edad mediana con hígado graso no alcohólico (HGNA). Métodos: se realizó un estudio casos control desde enero 2008 a 2011 en San Antonio de los Baños, Artemisa, donde se analizaron variables como: edad, índice de masa corporal (IMC) según relación cintura cadera (ICC), presencia de hipertensión y su control, severidad y duración del síndrome climatérico más edad de presentación de la menopausia espontánea. Aleatoriamente se seleccionaron 60 pacientes con criterios ultrasonográficos de HGNA (Grupo A), de otras 60 con ultrasonido negativo (Grupo B o control) seleccionadas por pareamiento. Resultados: en A un 44,4 por ciento tenían menor edad respecto a la media global (47,5 años IC: 45,7-48,2), en ese mismo grupo un 51,6 por ciento presentó aumento del IMC e ICC con coeficiente de correlación de 0,94. La mayor cantidad de hipertensas estaban en el Grupo A, con un 81,6 por ciento de ellas descontroladas (OR: 0,25 IC: 95 por ciento). Un 55 por ciento de las pacientes con HGNA presentó síntomas climatéricos muy molestos por más de 12 meses. De las estudiadas, 64,1 por ciento refirió la menopausia entre 46-49 años, con 33,3 por ciento del grupo A por debajo de la media global (47,5). Conclusiones: el HGNA marca tempranamente mal control clínico-metabólico de la mujer en edad mediana con síntomas climatéricos más tempranos intensos y duraderos, en detrimento de su calidad de vida

Objective: To identify the risk variables in mean age women presenting with non-alcoholic fatty liver (NAFL). Methods: A control-case study was conducted from January, 2008 to 2011 in San Antonio de los Baños, Artemisa province to analyze variable including: age, body mass index (BMI) according to the waist-hip relation (WHR), presence of high blood pressure and its control, severity and length of climateric syndrome plus age of presentation of spontaneous menopause. In a random way 60 patients with ultrasonography criteria of NAFL (Group A), another 60 patients with negative ultrasound (US) (Group B or control) selected according matching. Results: In A group the 44.4 percent was smaller than the global mean (47.5 years, 95 percent CI: 45.7 48.2) in that same group the 51.6 percent had al increase of the BMI and WHR, with a correlation coefficient of 0.94. Most of hypertensive patients were in the A group with a 81.6 percent of them non-controlled (RO: 0.25 CI: 95 percent. The 55 percent of patients with NAFL had climateric symptoms very annoying for more than 12 months. From the study patients, the 64.1 percent had menopause between 46-49 years old where the 33.3 percent of the A group was under the global mean (47.5). Conclusions: The NAFL marks early a poor clinical-metabolic control of woman in mean age with earlier, intensive and lasting and climateric symptoms to the detriment of life

Myopic LASIK and LASEK in patients with preoperative mean central keratometry ≥47.50 D.

PURPOSE: To evaluate whether patients who undergo myopic LASIK or laser epithelial keratomileusis (LASEK) with preoperative central keratometry ≥47.50 diopters (D) are at higher risk for developing corneal ectasia postoperatively. METHODS: Records of 32 patients (54 eyes) who underwent myopic LASIK or LASEK between May 2002 and July 2005 with preoperative mean central keratometry ≥47.50 D were retrospectively reviewed. Patients eligible for the study were offered free follow-up. Last follow-up was at least 3 years after surgery. All procedures were performed with the Technolas Keracor 217z excimer laser (Bausch & Lomb). RESULTS: Twenty-four patients (40 eyes) had LASIK and 8 patients (14 eyes) had LASEK. At last follow-up, no patient had developed ectasia. CONCLUSIONS: This study suggests that patients with preoperative central keratometry ≥47.50 D as the only parameter evaluated should not be excluded from corneal refractive surgery due to increased risk of postoperative ectasia. However, when this preoperative finding is accompanied by other topographic abnormalities, treatment options should be carefully evaluated.

Effect of preoperative keratometric power on intraoperative complications in LASIK in 34,099 eyes.

PURPOSE: To evaluate the effect of preoperative keratometric power on the intraoperative complications in LASIK for myopia, hyperopia, and astigmatism. METHODS: In this retrospective study, the records of 34,099 eyes of 17,388 patients who underwent LASIK for myopia, hyperopia, and astigmatism using the Moria LSK One manual microkeratome and the Bausch & Lomb Technolas 217 Z excimer laser were reviewed. RESULTS: One thousand three hundred thirty-eight (3.92%) intraoperative microkeratome complications were identified in the total number of eyes: 571 (1.67%) free caps, 320 (0.93%) epithelial abrasions, 282 (0.82%) thin/irregular flaps, 126 (0.36%) incomplete flaps, and 39 (0.11%) flap buttonholes. When eyes were stratified according to preoperative keratometric power, eyes with flatter corneas usually had more free caps and incomplete flaps than eyes with steeper corneas (P < .05), whereas eyes with steeper corneas usually had more epithelial abrasions and thin/irregular flaps than eyes with flatter corneas (P < .05). The risk of free caps, incomplete flaps, and epithelial abrasions was greater when bigger keratome rings (H) were used than when smaller rings (-1) were used (P < .05). The incidence of buttonholes was independent of the preoperative keratometric power, keratome plate (100 or 130 microm), and keratome ring (-1, -2, or H). CONCLUSIONS: No statistically significant relationship was found between preoperative keratometric power and incidence of flap buttonholes in this series. Eyes with flatter corneas tended to have more free caps and incomplete flaps, whereas eyes with steeper corneas tended to have more epithelial abrasions and thin/irregular flaps.

Atención psicosocial integral en enfermedad catastrófica (Atinar) / Integrative Psychosocial Care in Catastrophic Illness

La enfermedad médico-quirúrgica catastrófica (EMQ-C) se define como una enfermedad aguda o prolongada, usualmente considerada como amenazante para la vida o con el riesgo de dejar discapacidad residual importante. La EMQ-C , a menudo, conlleva trastornos psicosociales que afectan de manera importante su evolución, porque alteran el proceso de rehabilitación, los hábitos saludables y la calidad de vida y, además, limitan la adherencia al tratamiento. Por lo tanto, para ofrecer un tratamiento a la persona quien la padece, es necesario desarrollar modelos que permitan identificar y tratar integralmente todos los aspectos médicos, psicológicos y sociales. La legislación colombiana, desde la aprobación de la Ley 100 de 1993, reglamentó la atención integral de la EMQ-C. No obstante, el desarrollo de programas de atención integral que incluyan lo psicosocial ha sido lento. Se presenta un modelo teórico de atención psicosocial integral en EMQ-C, que sigue los lineamientos de la medicina biopsicosocial de Ángel, junto a un modelo denominado medicina cognitiva , desarrollado previamente por uno de los autores (HR). El modelo incluye aspectos y procedimientos necesarios para su funcionamiento ajustado a la ley colombiana.

Medical Surgical Catastrophic Illness (MSIC) is defined as an acute or chronic lifethreatening disease or with risk of important disability. MSI-C is frequently associated with Psychosocial Disorders influencing the outcome due to effects on the rehabilitation process, quality of life and compliance. The development of integrative models of care that cover medical, psychological and social aspects is necessary in order to offer treatment to the person with MSI-C. Since Law 100 of 1993 was passed, Colombia ruled an integrative model of care for catastrophic illness. Noteworthy, implementation of these programs has been slow. In this article a theoretical model of integrative psychosocial care that follows recommendations of Engel's Biopsychosocial Model and the Cognitive Medicine model developed by one of the authors (HR). The model includes necessary aspects and procedures for its implementation according to Colombian Law.