Differential Diagnosis of Diarrhea in Patients With Neuroendocrine Tumors.

Patients with neuroendocrine tumors (NETs) and carcinoid syndrome experience diarrhea that can have a debilitating effect on quality of life. Diarrhea also may develop in response to other hormonal syndromes associated with NETs, surgical complications, medical comorbidities, medications, or food sensitivities. Limited guidance on the practical approach to the differential diagnosis of diarrhea in these patients can lead to delays in appropriate treatment. This clinical review and commentary underscore the complexity in identifying the etiology of diarrhea in patients with NETs. Based on our collective experience and expertise, we offer a practical algorithm to guide medical oncologists and other care providers to expedite effective management of diarrhea and related symptoms in patients with NETs.

Findings From a Randomized Trial of Weight Gain Prevention Among Overweight Puerto Rican Young Adults.

OBJECTIVE: Assess impact of multimodality weight gain prevention intervention. METHODS: Randomized clinical trial among 39 overweight young Puerto Rico college students using 10 weekly peer-support sessions promoting dietary, physical activity, and other lifestyle changes enhanced by stress-reduction and mindfulness approaches. Body mass index (BMI) and self-reported behaviors were measured at baseline and at 10 weeks and 6 months after baseline. RESULTS: At the completion of the intervention, BMIs in the experimental arm were 0.8 units lower than at baseline (z = -3.0; P = .008) and 1.2 lower at 6 months after baseline (z = -4.1; P < .001); BMIs in the control arm were 0.7 higher (z = 2.7; P = .02) at 10 weeks and 0.8 higher at 6 months (z = 3.1; P = .005). Group × time interaction confirmed that BMI differed significantly over time between arms (χ2 = 26.9; degrees of freedom = 2; P < .001). Analysis of behavioral changes was mostly inconclusive although the experimental arm reported a considerable increase in walking at 10 weeks. Qualitative data suggested that yoga and mindfulness components were particularly useful for motivating participants to maintain healthier lifestyle patterns. CONCLUSIONS: Body mass index in the experimental arm decreased at the end of intervention and was maintained at 6 months' follow-up.

Reintroducción del consumo regular de Quinua en Riobamba, Ecuador: estudio piloto / Reintroucción of regular consumptin of quinoa in Riobamba, Ecuador: a piloy study

En Ecuador la incidencia de obesidad, diabetes y otras afecciones crónicas de salud, que se han asociado parcialmente con cambios en los hábitos alimentarios, está aumentando y muchas veces se acentúa en los centros urbanos más pequeños. El consumo omnipresente de arroz blanco es probablemente una práctica alimentaria presente en esta transición nutricional, mientras que el consumo de alimentos tradicionales saludables como la quinua permanece generalmente bajo. En nuestra encuesta realizada en 2013, el 67% de los 240 residentes encuestados en la pequeña ciudad andina de Riobamba informaron que preferirían comer "arroz de quinua" (quinua preparada como arroz) por lo menos dos veces por semana en lugar de arroz blanco. Con el objetivo de reintroducir el consumo regular de quinua en los hogares de esta población, a finales de 2015 se inició una intervención para promover el consumo de arroz de quinua 3 veces por semana, entre 131 adultos en Riobamba. Entre la línea de base y los datos obtenidos al final de la intervención cuatro meses más tarde, no hubo cambios significativos en el IMC observado. Sin embargo, a los 2, 4 y 7 meses post-basal, el 52%, 40% y 47% de los encuestados, respectivamente, informaron haber disfrutado del consumo de arroz de quinua en lugar de arroz blanco, afirmando que les gustaba "mucho" o "en general", y el 64%, 55% y 68% de los encuestados refirieron que "definitivamente" o "muy probablemente" continuarán consumiendo quinua en lugar de arroz, por lo menos a veces. Estos hallazgos sugieren una aceptación modesta de esta (re)introducción de un alimento tradicional y saludable, aunque otras investigaciones más amplias y extensas podrían evaluar con mayor precisión los posibles impactos en la salud de este tipo de cambio reportado en los hábitos alimentarios de la población.

Abstract: In Ecuador the incidence of obesity, diabetes and other chronic health conditions -- which are partly due to changes in dietary behavior -- has been increasing, often most dramatically in smaller urban centers. The ubiquitous consumption of white rice is likely one important factor in this nutritional transition, while the consumption of traditional healthy foods such as quinoa remains generally low. In a 2013 survey we conducted, 67% of the 240 residents surveyed in the small Andean city of Riobamba reported they would prefer eating quinoa "rice" at least twice weekly instead of white rice. With the objective of encouraging more normative household consumption of quinoa in this population, in late 2015 an intervention was begun to promote consumption of quinoa rice 3 times a week among 131 adults in Riobamba. Between the baseline and the termination of the intervention four months later, no significant change in BMI was observed. However, at 2, 4 and 7 months' post-baseline, 52%, 40% and 47% of respondents, respectively, reported enjoying consumption of quinoa rice instead of white rice either "very much" or "in general," and 64%, 55% and 68% of respondents "definitely" or "very likely" planned to continue doing so. Our findings suggest a modest acceptance of this (re)introduction of a traditional and healthy food, though further and more extensive research could assess with greater precision the potential health impacts of such reported changes in dietary habits. Reintroducción del consumo regular de Quinua en Riobamba, Ecuador: estudio piloto.

Understanding the HIV epidemic in the Dominican Republic: a prevention success story in the Caribbean?

OBJECTIVE: To analyze the general dynamics and trends of the HIV epidemic in the Dominican Republic (DR). METHODS: Thorough review of available HIV seroprevalence and sexual behavioral data from the DR. RESULTS: Multiple sources of data suggest that the DR's HIV epidemic has generally declined. Between the mid-1990s and about 2002, HIV-1 prevalence fell among pregnant women in the capital, Santo Domingo, particularly among young women. Declines in prevalence were also observed over the same period among sexually transmitted infection clinic patients, blood bank donors, US entry visa applicants, and female sex workers. National household surveys found 1.0% (confidence interval: 0.9% to 1.1%) adult prevalence in 2002 and 0.8% (0.6% to 0.9%) in 2007. Among largely Haitian immigrant residents of the impoverished former "sugarcane plantations," prevalence was much higher but declined from 5.0% to 3.2% between 2002 and 2007. The DR's heterogeneous epidemic includes an important men-having-sex-with-men (MSM) and bisexual component. The proportion of reported AIDS cases among men remained constant from 1989 to 2006, accounting for about two thirds of both total cumulative and year 2006 cases. Some survey and qualitative data also suggest a considerable occurrence of MSM-related risk behaviors. HIV prevalence remains relatively high in MSM, with no evidence of significant decrease. CONCLUSIONS: As in several other developing countries that have succeeded in slowing HIV transmission, HIV reductions in the DR seem mainly due to changes in sexual behavior, particularly increased condom use, especially for sex work, and partner reduction in men. Similarly favorable HIV declines and reported behavior change have occurred in some other Caribbean countries, including neighboring Haiti. However, of concern is that anal sex, both male-male and heterosexual, remains a taboo yet apparently common practice largely ignored by existing prevention campaigns. And although the DR epidemic has generally stabilized, there is a danger of complacency, and some recent data suggest that HIV prevalence is no longer declining (and may even be increasing) in some populations.