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Background There has been little research published on the adaptation of diabetic exchange list diet approaches for the design of intervention diets in health research despite their clinical utility. The exchange list approach can provide clear and precise guidance on multiple dietary changes simultaneously. The objective of this study was to develop exchange list diets for Mediterranean and Healthy Eating, and to evaluate adherence, dietary intakes and markers of health risks with each counselling approach in 120 subjects at increased risk for developing colon cancer. Methodology A randomized clinical trial was implemented in the USA involving telephone counselling. The Mediterranean diet had ten dietary goals targeting increases in monounsaturated fats, n3 fats, whole grains and the amount and variety of fruits and vegetables. The Healthy Eating diet had five dietary goals that were based on the U.S. Healthy People 2010 recommendations. Results Dietary compliance was similar in both diet arms with 82–88% of goals being met at 6 months, but subjects took more time to achieve the Mediterranean goals than the Healthy Eating goals. The relatively modest fruit and vegetable goals in the Healthy Eating arm were exceeded, resulting in fruit and vegetable intakes of about 8 servings/day in each arm after six months. A significant (P<0.05) weight loss and a decrease in serum C-reactive protein concentrations were observed in the overweight/obese subgroup of subjects in the Mediterranean arm in the absence of weight loss goals. Conclusions Counselling for the Mediterranean diet may be useful for both improving diet quality and for achieving a modest weight loss in overweight or obese individuals.

When using instruments written originally in a different language, the accuracy of translation is a crucial issue. The language and cultural interpretations can be barriers to healthcare access. Despite the need for a robust translation process, the existing literature offers little information about best practices for translation. Therefore, the purpose of this qualitative research was to illustrate a systematic approach to developing an accurate translation. We describe the process of developing an accurate and culturally relevant translation of the Connor-Davidson Resilience Scale (CD-RISC) from English to Arabic. The CD-RISC is a healthcare instrument to measure resilience and comprises 25 items rated on a 5-point scale, with higher scores reflecting increased resilience. Resilience is an important healthcare construct that can be applied to research on mental illness and adaptation ability. For instance, increased resilience appears to protect against diminished mental health. The translation process began as two individuals independently translated the CD-RISC into Arabic. A third person combined the two translations to produce a reconciled version. A fourth individual then back-translated the reconciled Arabic version to English. To resolve difficult-to-translate segments, the research team consulted with the instrument developer and then conducted cognitive testing with six individuals. A cultural research methodologist participated throughout the process. Among the 28 text segments in the CD-RISC (the title, instructions, scoring, and 25 items), the best equivalency in Arabic came from eight segments of each forward-translation. The remaining 12 segments were similar. Each the back-translation and cognitive testing contributed to seven revisions. The robust translation procedures detailed can be used by researchers to develop best-quality translations.

ObjectiveAssessing risk of adverse outcomes among patients with chronic liver disease has been challenging due to non-linear disease progression. We previously developed accurate prediction models for fibrosis progression and clinical outcomes among patients with advanced chronic hepatitis C (CHC). The primary aim of this study was to validate fibrosis progression and clinical outcomes models among a heterogeneous patient cohort.DesignAdults with CHC with ≥3 years follow-up and without hepatic decompensation, hepatocellular carcinoma (HCC), liver transplant (LT), HBV or HIV co-infection at presentation were analyzed (N = 1007). Outcomes included: 1) fibrosis progression 2) hepatic decompensation 3) HCC and 4) LT-free survival. Predictors included longitudinal clinical and laboratory data. Machine learning methods were used to predict outcomes in 1 and 3 years.ResultsThe external cohort had a median age of 49.4 years (IQR 44.3–54.3); 61% were male, 80% white, and 79% had genotype 1. At presentation, 73% were treatment naïve and 31% had cirrhosis. Fibrosis progression occurred in 34% over a median of 4.9 years (IQR 3.2–7.6). Clinical outcomes occurred in 22% over a median of 4.4 years (IQR 3.2–7.6). Model performance for fibrosis progression was limited due to small sample size. The area under the receiver operating characteristic curve (AUROC) for 1 and 3-year risk of clinical outcomes was 0.78 (95% CI 0.73–0.83) and 0.76 (95% CI 0.69–0.81).ConclusionAccurate assessments for risk of clinical outcomes can be obtained using routinely collected data across a heterogeneous cohort of patients with CHC. These methods can be applied to predict risk of progression in other chronic liver diseases.