Effectiveness of peer-delivered sleep health education and social support in increasing OSA evaluation among at-risk blacks.

To assess the effectiveness of culturally and linguistically tailored, peer-delivered obstructive sleep apnea education and of social support to increase adherence to physician-recommended obstructive sleep apnea evaluation among blacks. In a two-arm randomised controlled trial, we ascertained the effectiveness of peer-delivered obstructive sleep apnea education in increasing obstructive sleep apnea evaluation among 319 blacks at risk of obstructive sleep apnea (intervention = 159 and control = 160); their average age was 47 ± 12.9 years, and 41% were male. Obstructive sleep apnea risk was assessed with the Apnea Risk Evaluation System questionnaire, administered in community venues. Participants in the intervention arm received tailored obstructive sleep apnea education during a 6 month period; those in the control arm received standard sleep and healthy lifestyle information. Analysis focussed on the effectiveness of peer-delivered obstructive sleep apnea education on adherence to obstructive sleep apnea evaluation, but also considered the role of psychosocial factors. The results showed no significant differences in baseline demographic and clinical measures when contrasting participants in the study arms. The adherence rates for home-based obstructive sleep apnea evaluation in the intervention and control arms were 45.9% and 45.6%, respectively. Overall, participants in both study arms (adherers) who underwent obstructive sleep apnea evaluations were likely to experience a greater level of social support (8.2 ± 2.4 vs. 7.3 ± 2.4; p = 0.06). Moreover, adherers showed greater psychosocial scores (i.e., Dysfunctional Beliefs and Attitudes about Sleep scale, Apnea Beliefs Scale (ABS) (and Apnea Knowledge) compared with non-adherers (6.0 ± 1.8 vs. 4.9 ± 2.2; p = 0.02; 77.0 ± 7.1 vs. 73.2 ± 7.4; p = 0.04, and 6.4 ± 3.1 vs. 7.6 ± 2.4; p = 0.06, respectively). The results of the present randomised controlled trial favoured a potential role of peer-based social support and psychosocial factors, associated with obstructive sleep apnea adherence behaviour.

[Primary adenosquamous carcinoma of the stomach]. / Carcinoma adenoescamoso primário do estômago.

BACKGROUND: Primary adenosquamous carcinoma of the stomach is a rare tumour, the incidence of which does not exceed 1% of gastric tumours. This tumour shows two different cell components: one squamous and the other adenomatous. MATERIAL AND METHODS: The authors report a case of a primary adenosquamous carcinoma of the stomach in a 55-year-old Caucasian (white) man, whose pathology and immunohistochemistry show the presence of both types of cells: adenomatous and squamous. CONCLUSION: The authors show an interesting and rare case of adenosquamous tumour, discuss its pathogenesis, diagnosis, clinics and pathologic features.

Carcinoma adenoescamoso primário do estômago / Primary adenosquamous carcinoma of the stomach

O carcinoma adenoescamoso primário do estômago é um tumor raro, cuja incidência nao excede 1 por cento dos tumores gástricos. Esse tumor mostra dois tipos celulares distintos: um escamoso e outro adenocarcinomatoso. Material e Método. Os autores reportam um caso de carcinoma adenoescamoso primário do estômago em um paciente branco de 55 anos, cuja patologia e imuno-histoquímica mostram a presença dos dois tipos celulares: adenocarcinomatoso e escamoso. Conclusao. É discutido um caso de um tumor raro e interessante do estômago, com relaçao à sua patogênese, diagnóstico e aspectos clínico-patológicos.