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Resumen Introduccion En 1997 se realizo un estudio sobre adherencia al tratamiento antibiotico infantil en 6 centros de salud, hallandose que era muy baja. Se decidio realizar en dos de los centros (adherencia 21%) una intervencion educativa basada en el Modelo de Creencias en Salud con el objetivo de valorar si con ello mejoraba la adherencia. Material y metodos La poblacion estaba constituida por los responsables de ninos de 0 a 10 anos con un proceso agudo que recibian tratamiento antibiotico por via oral. El instrumento de medida fue el test de Morisky-Green mediante encuesta telefonica. El estudio fue prospectivo y se estudiaron variables sociodemograficas, el motivo, tipo y duracion del tratamiento antibiotico y la adherencia. Resultados La adherencia global vario de un 21,1% antes, a un 42,6% despues de la intervencion (p = 0,009). En el analisis multivariable resultaron estadisticamente significativas la intervencion (OR, 3,17; IC 95%, 1,5!–6,26) y el centro (OR, 3,18; IC 95%, 1,5!–6,50), no existiendo interaccion entre ellas. Conclusiones A pesar de que incluso las intervenciones mas efectivas no conllevan mejoras sustanciales en la adherencia y los resultados de los tratamientos, la utilizacion de un modelo de intervencion capaz de provocar un cambio de conducta ha confirmado su eficacia en este caso.

BACKGROUND Primary cardiac lymphoma (PCL) is extremely rare in immunocompetent patients. Different definition criteria have been employed in published series. Prognosis is poor due to diagnostic delay and relevance of the site of disease. METHODS Two cases observed at the study institution are reported, with a review of 48 cases published in the literature from 1980 to 1996. Only patients with lymphoma confined to the heart and/or pericardium and those with a single and asymptomatic extracardiac site were considered for analysis. RESULTS Eight patients had minimal extracardiac disease. The most common presentation was unresponsive heart failure. Electrocardiography findings were not specific. PCL usually arose in the right chambers as a mass, with or without pericardial effusion (>80%). Chest X-rays, transthoracic echocardiography, and computed tomography scans are standard in diagnostic workup, but transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) showed a sensitivity > 90%. Cytology of pericardial effusion was diagnostic in 67% of cases. Thoracotomy was diagnostic in all cases, whereas less invasive procedures had high false-negative rates. Gross resection has no role. Early anthracycline-containing chemotherapy appears to improve survival, whereas the role of radiotherapy has not yet been defined. CONCLUSIONS The diagnosis of PCL should be considered in patients with a cardiac mass and/or unexplained refractory pericardial effusion. Adequate diagnostic workup, including TEE and MRI, allows confirmation of the early suspicion of PCL. In the absence of a diagnostic cytology, an open biopsy may be indicated to avoid treatment delay. There is no evidence that PCL should be treated differently from other bulky aggressive lymphomas arising at other anatomic sites. Cancer 1997; 80:1497-506. © 1997 American Cancer Society.