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Seroprevalence of human T lymphotropic virus type I in Puerto Rico.

Serum specimens from Puerto Rican residents were tested for antibodies to human T lymphotropic virus type I (HTLV-I) using an enzyme immunoassay, Western immunoblot, and radioimmunoprecipitation assays. Of 1,279 specimens obtained during a dengue virus surveillance program in 1986 and 1987, 3 (0.2%) tested positive; an additional 11 were indeterminate. Of 602 specimens obtained from blood donors in Ponce in 1987, 1 (0.2%) was positive; an additional specimen was indeterminate. Of 21 persons hospitalized for problems related to intravenous drug use in 1986 and 1987, 1 (5%) tested positive for HTLV-I antibodies.

Adolescent↗

Analysis of carboxyhemoglobin and cyanide in blood from victims of the Dupont Plaza Hotel fire in Puerto Rico.

Ninety-seven people died from a fire that occurred in the Dupont Plaza Hotel in Puerto Rico on 31 Dec. 1986. All, except four who died later in the hospital, were found dead at the scene. All of the fatalities at the hotel (except for eight) were burned beyond recognition. Blood from seventy-eight of the victims was screened for carboxyhemoglobin at the Institute for Forensic Sciences in Puerto Rico and was then sent to the National Institute of Standards and Technology, Gaithersburg, Maryland, for analysis of carboxyhemoglobin and cyanide concentrations. The blood data indicated that carbon monoxide and hydrogen cyanide, singly or combined, were probably not responsible for the majority of the deaths that occurred in the badly burned victims. On the other hand, the significantly higher carboxyhemoglobin in the nonburned victims indicated that carbon monoxide alone or combined with hydrogen cyanide probably played a major role in the cause of their deaths.

Burns↗

[Description of health status and functional capacity of the 65-year-old and older population residing in the University Region of Health of Puerto Rico].

This study intended to describe the health and functional status of the population 65 years and over resident in the Puerto Rico University Health Region (municipalities of Canóvanas, Loiza, Carolina and Trujillo Alto, Puerto Rico). Four ninety one hundred elderly subjects selected from a random sample of households, were interviewed. A questionnaire was designed to gather data of the following variables: health conditions, functional capacity, health services utilization, social support and preventive measures. Descriptive measures and chi-square were utilized for the statistical analysis. Findings revealed a population composed mostly of women with a higher prevalence of health conditions than their male counterparts. More than half of the sample report visual problems, arthritis or hypertension. Almost a quarter had diabetes mellitus. The prevalence of these conditions was higher in the age group over 75, with the exception of diabetes. Thirty percent of the sample was classified as functionally dependent, condition that increased with the subject's age. Findings evidence the need of an early assessment in this population in order to intervene with potentially modifiable factors to prevent future disability and improve quality of life of the aged.

Activities of Daily Living↗

Prenatal care, infant birthweight and infant mortality in Puerto Rico.

This study purports to analyze selected demographic and socio-economic correlated of prenatal care in Puerto Rico. Also, the relationship between prenatal care and infant birthweight and mortality is examined. The data was obtained from the 1986 live birth and death certificates. Three indicators of adequacy of prenatal care were utilized in the analysis: number of prenatal care visits, trimester in which this care began and the "Kessner Index". The findings of the study revealed that prenatal care in Puerto Rico has improved both in terms of early care and in continuity, since 1980. Great geographical differences in adequacy of prenatal care were observed throughout the Island. Prenatal care varies considerably among different population subgroups. Inadequate prenatal care was more frequent among adolescent, unwed and high parity mothers as well as among those of the lowest socio-economic strata. Furthermore, these groups had the highest proportion of low birthweight babies and their offsprings, the highest mortality rates. The statistical evidence obtained from this study suggests that this is in part due to the inadequate prenatal care received by these mothers.

Adolescent↗

Epidemiology of hepatitis C infection and its public health implications in Puerto Rico.

Hepatitis C infection is the most common chronic blood-borne pathogen in the United States associated with liver cirrhosis and hepatocellular carcinoma and is the leading reason for liver transplantation. It has been estimated that hepatitis C infection may lead to a substantial health and economic burden over the next 10 to 20 years. The prevalence of hepatitis C virus (HCV) infection varies worldwide, with an estimated overall prevalence of 3%. However, the only available data of hepatitis C in the general population of Puerto Rico suggest an elevated prevalence of hepatitis C infection in the municipality of San Juan (6.3%) in comparison with estimates for the adult population residing in the United States (0.9%-3.9%). Much of the inter-region variability in the prevalence of hepatitis C can be attributable to the frequency and extent to which different risk factors have contributed to the transmission of the virus. Established risk factors for infection include injection drug use, transfusion of blood and solid organ transplantation from infected donors prior to July 1992 and blood clotting products before 1987, occupational injury, vertical transmission, sex with an HCV infected partner, and multiple sexual partners. Other potential exposures for infection that have been investigated in epidemiologic studies include history of intranasal cocaine use, sharing of contaminated equipment and personal care items, tattooing, body piercing, imprisonment, acupuncture, and use of contaminated healthcare instruments. The high incidence of AIDS in Puerto Rico and the large prevalence observed in Puerto Rican inmates and in adults residing in the municipality of San Juan indicate that HCV infection is an emerging public health concern. From a public health perspective, potential targets for intervention to decrease the spread of HCV infection, ongoing surveillance, increased clinician awareness of disease reporting systems and the epidemiology and management of hepatitis C, availability of diagnosis and treatment facilities, and recognition of the need for local resources will be of paramount importance to face this silent infection in Puerto Rico.

Hepatitis C↗

Scores on the eysenck personality questionnaire for a sample of children and adolescents receiving psychological treatment in Puerto Rico.

Personality questionnaire scores obtained by children and adolescents (n = 28) receiving psychological treatment at a health facility in Humacao, Puerto Rico were examined. The scores were compared with those of regular school children of the same age, of Gurabo, Puerto Rico, who were not in treatment (n = 30). The children in treatment obtained higher scores on Psychoticism, lower scores on Extraversion, and similar scores on Neuroticism and Dissimulation by comparison with regular students.

Adolescent↗

Impact of managed care on clinical outcome of systemic lupus erythematosus in Puerto Rico.

This study was designed to explore the impact of a managed care system on the morbidity and mortality rates in a systemic lupus erythematosus (SLE) cohort in Puerto Rico. The clinical manifestations and outcome measures of public SLE patients, before and after implementation of the managed care system, were compared with those of SLE patients treated in a private fee-for-service system. Of the cohort of 171 patients, 103 (60%) were treated in the public system and 68 (40%) in the private sector. Except for higher prevalence of hematuria, renal insufficiency, and serositis in the public group, both groups had a similar prevalence of clinical manifestations, Systemic Lupus Erythematosus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage score, and mortality rate before introduction of the managed care system. Six years after implementation of the managed care system, medically indigent patients were more likely to have photosensitivity (90% vs. 75%), malar rash (85% vs. 65%), hematuria (43% vs. 24%), nephrotic syndrome (17% vs. 6%), and end-stage renal disease (8% vs. 0%). They also had a higher mortality rate (10% vs. 2%) and SLICC/ACR damage index score (1.5 vs. 0.8). In summary, SLE patients treated in the public system of Puerto Rico demonstrated higher morbidity and mortality after being treated in a managed care system compared with patients managed in a private fee-for-service system. Different from the fee-for-service system, the managed care system seeks medical care cost reductions that could affect the management and outcome of SLE patients. These differences could also be related to the higher disease severity before implementation of the managed care system and lower socioeconomic status of the public group. Nevertheless, the public managed care system in Puerto Rico requires continuous evaluation to ensure SLE patients better access to specialty and subspecialty healthcare and optimal pharmacologic treatments.

Journal Article↗

Human schistosomiasis in Puerto Rico: reduced prevalence rate and absence of Biomphalaria glabrata.

A combined epidemiologic and malacologic survey of schistosomiasis in Puerto Rico was carried out in areas where previous surveys had reported the prevalence of the disease. This limited survey, with 495 persons examined, found a low prevalence (0.6%) of Schistosoma mansoni infections. The infections were restricted to three people more than 36 years of age. No infections were detected in children 16 years of age or less, and this cohort comprised 57.8% of the study group. Malacologic surveys of the four streams, 10 rivers, and eight lakes throughout the island revealed the absence of intermediate host Biomphalaria glabrata and the presence of Thiara granifera, a competitive species of B. glabrata and the predatory snail Marisa cornuarietis. We believe that the absence of B. glabrata is the primary reason for the sustained reduction in the prevalence of schistosomiasis in Puerto Rico.

Adult↗

Leprosy in Puerto Rico: a decade later.

A study to evaluate the changes in the incidence and prevalence of leprosy in Puerto Rico was done to include the years 1981-1989. During this period, 75 new cases were diagnosed with an average of 8.3 cases per year. The yearly incidence was 1.9 cases per million which is significantly lower to the 4.6 per million in the previous study. At the present moment 182 cases are been followed at the Tropical Diseases Clinic of the University of Puerto Rico School of Medicine with a prevalence of 5.4 per 100,000 inhabitants. It is important to notice that 16 percent of the patients at the clinic were foreigners, a significant increase from a previous study. The decrease in the incidence of leprosy may be due to advances in the treatment of the disease and the new approach to integrate the patient into the community.

Adolescent↗

Mouthwash in the etiology of oral cancer in Puerto Rico.

OBJECTIVES: To determine if the risk of cancers of the mouth and pharynx is associated with mouthwash use in Puerto Rico, an area of relatively high risk. METHODS: Interviews were conducted with 342 cases of oral and pharyngeal cancer registered in Puerto Rico and diagnosed between 1992 and 1995 and with 521 population-based controls regarding mouthwash use and other factors. Mouthwash-related risks were estimated using unconditional logistic regression controlling for potential confounders. RESULTS: The adjusted odds ratio associated with using mouthwash with an alcohol content of 25% or greater was 1.0. Risks were not higher with greater frequency, years of use, or lifetime mouthwash exposure. Among tobacco and alcohol abstainers the odds ratio associated with mouthwash use was 2.8 (CI = 0.8-9.9), in contrast to 0.8 (CI = 0.4-1.7) and 0.9 (CI = 0.6-1.3) among those with light and heavy cigarette smoking/alcohol drinking behaviors, respectively. CONCLUSIONS: There was no overall increased risk of oral cancer associated with mouthwash use. An elevated, but not statistically significant, risk was observed among the small number of subjects who neither smoked cigarettes nor drank alcohol, among whom an effect of alcohol-containing mouthwash would be most likely evident. Our findings indicate the need to clarify the mechanisms of oral carcinogenesis, including the possible role of alcohol-containing mouthwash.

Adult↗

Brief report: self-care behaviors of children with type 1 diabetes living in Puerto Rico.

OBJECTIVE: To examine self-care behaviors among children and adolescents with type 1 diabetes living in Puerto Rico, to determine the relationship between self-care and demographic variables, and to investigate the utility of the 24-hour recall interview within a Hispanic population. METHOD: Forty-one children (M age = 12.6 years) with type 1 diabetes, and their mothers, were administered the 24-hour recall interview on three separate occasions to assess diabetes-related self-care behaviors. RESULTS: Children reported self-care behaviors that included daily administration of an average of two insulin injections and two blood glucose tests, and consumption of 5.5 meals a day comprised of 52% carbohydrates and 29% fat. Younger age, female gender, longer illness duration, and better metabolic control were associated with higher rates of several self-care behaviors. CONCLUSIONS: Data provide a first look at self-care behaviors of children with type 1 diabetes living in Puerto Rico and suggest the utility of the 24-hour recall interview within this population.

Adolescent↗

Between-city variation in frequency of injection among Puerto Rican injection drug users: East Harlem, New York, and Bayamon, Puerto Rico.

Frequency of injection has been consistently found to be higher among Puerto Rican Injection drug users (IDUs) than among other groups of IDUs. Several explanations have been suggested, but an empirical explanation has yet to be presented. This study compares the frequency of injection of Puerto Rican IDUs in East Harlem, New York, with that of IDUs in Bayamon, Puerto Rico. Study subjects comprised 521 Puerto Rican IDUs from East Harlem and 303 IDUs from Bayamon. The mean frequency of injection among IDUs in East Harlem was 2.8, the corresponding mean in Bayamon was 5.4. Younger IDUs reported a higher number of daily injection episodes than older IDUs, and the IDU group in Bayamon was 5 years younger than the group in East Harlem. The drug use variables accounted for a greater portion of the between-city difference than the demographic and psychosocial variables. Use of noninjected drugs, as well as the use of prescribed methadone, were found to be associated with a lower number of daily injections. Conversely, injection of cocaine, injection of cocaine mixed with heroin ("speedball"), and injection of larger amounts of drug solution were found to be associated with a higher number of daily injections.

Adult↗

Drug treatment disparities among Hispanic drug-using women in Puerto Rico and New York City.

This paper reports findings on 334 out-of-treatment drug users in Puerto Rico and 617 in New York City, at the 6-month follow-up interview of a Longitudinal Survey. Main outcomes were health care and drug treatment utilization since baseline, assessed by asking participants if they had received physical or mental health services (including HIV medications), and if they had been in methadone maintenance, inpatient or outpatient drug treatment, or drug treatment while incarcerated. Chi-square tests were used to evaluate associations between gender and the various correlates. Logistic regression was used to calculate the contribution of each variable in predicting use of drug treatment. The analysis suggests that women in both sites were likely to suffer from disparities in both health care and drug treatment utilization when compared with men, albeit women in New York utilized more drug treatment resources and were more embedded in the immediate family than their female peers in Puerto Rico. Further research to specify the impact of contextual factors at the organizational and community levels, among members of the same ethnic group residing in different sites, may prove valuable in identifying the health needs and the factors that impede or facilitate drug-using women in obtaining the most appropriate treatment. Findings from these studies can help in developing appropriate public health policy and science-based drug treatment programs to eliminate disparities such as the ones detected in this study.

Adolescent↗

Eradication of Boophilus microplus (Acari: Ixodidae) in Puerto Rico.

The ongoing cooperative effort between the United States Department of Agriculture, Animal and Plant Health Inspection Service and the Puerto Rico Department of Agriculture to eradicate the southern cattle tick, Boophilus microplus (Canestrini), is reviewed. Epidemiological and biological aspects of the tick that influence efficient control and/or eradication in Puerto Rico are discussed. The differences between the current eradication methodology and that initially utilized by the program are emphasized. The status and possible future adaptations of the program, as well as its applicability to other areas in the Caribbean, are also addressed.

Animals↗

Ethnic conflict and the psychology of liberation in Guatemala, Peru, and Puerto Rico.

Ethnic identity and conflict in Guatemala, Peru, and Puerto Rico are complexly embedded within dynamic systems of class- and race-based geopolitics. Whereas overt violence and terror have permeated both Guatemalan and Peruvian societies, overt conflict has undermined Puerto Rican nationhood. Despite similarities among these 3 countries of Hispano-America, there are important particularities that inform psychological theory and practice. This article explores selected contributions of a psychology of liberation informed by indigenous psychologies and reflexive praxis. The challenges these conflicts and their consequences pose to psychologists seeking to work with populations most deeply affected by these social inequalities are analyzed. It concludes with suggestions of how psychology can move toward the development of community-based responses to psychosocial oppression that foster enhanced individual and collective development in a context of social change.

Colonialism↗

Incidence of insulin dependent diabetes mellitus in Puerto Rico: the University Pediatric Hospital experience.

The incidence of newly-diagnosed Insulin-dependent diabetes mellitus (IDDM) in a pediatric population has been found to increase with colder seasons in countries at latitudes where a marked weather change presumably triggers a higher prevalence of viral infections (especially respiratory), that may induce an insulitis which could be etiologically related with IDDM. In order to assess whether the opposite is true for a country with rather uniform climate, like Puerto Rico, we have studied the seasonal pattern of newly diagnosed IDDM seen at our institution during a 10 year period (1973-1982). Also, recent reports on a higher mortality from diabetes in Puerto Rico going from 16.6 in 1977 to 31.0 in 1983, prompted us to look at a possible secular trend of increasing incidence of IDDM. There were a total of 269 new cases of IDDM or 27 cases/year, with standard deviation (SD) of +/- 5.3, range 18 to 33, and no secular trend at all. Sex distribution was quite variable, having male:female (m/f) ratios from 1:2 to 3:1, and an over-all m/f of 13.3/13.6. Incidence of IDDM per month of year went from a low of 1.7 for April and November to a high of 3.0 for March and 2.9 for September, 2.8 for October, with a mean of 2.24 +/- 0.48 cases/month. Again, no significant seasonal differences were noted. Mean incidence for our "cold" months (November to April was 2.25/month; for our "hot" season (May to October) was 2.3/month; for our "rainy" season (July to December) 2.3 and for our "dry" season (January to April) 2.3/month. Thus, it appears that there are no such seasonal trends of IDDM In Puerto Rico.

Age Factors↗

Pseudo-outbreak of infectious mononucleosis--Puerto Rico, 1990.

From September 11 through October 7, 1990, 57 persons (including outpatients, inpatients, and staff) at a community hospital in Puerto Rico had laboratory-confirmed infectious mononucleosis; however, investigation determined that test results may have been misinterpreted. This report describes the investigation of this pseudo-outbreak by the Puerto Rico Department of Health (PRDH) in October 1990.

Adolescent↗

Heavy metal and selenium levels in young cattle egrets from nesting colonies in the northeastern United States, Puerto Rico, and Egypt.

Colonially-nesting species of herons and egrets breed mainly in coastal areas, along rivers or near other large bodies of water. Such areas are also preferred for human development, exposing nesting birds to various pollutants. From 1989-1991, the concentrations of heavy metals and selenium were studied in the feathers of fledgling cattle egrets Bubulcus ibis, a terrestrially-feeding insectivore, from New York and Delaware in the northeastern United States, from Puerto Rico, and from Egypt. There were geographic differences in the concentrations of lead, mercury, cadmium, manganese, selenium, and chromium in the feathers of these egrets. Lead levels were 41 times higher in the feathers of cattle egrets from Cairo compared to the other sites. This difference was attributed to the continuing use of leaded gasoline and the dense automobile traffic in Cairo. However, other differences remain unexplained. Similarly, levels of chromium and manganese were also higher in Cairo than at any other sites. Cadmium levels were similar at all places except for higher levels in eastern Puerto Rico. Mercury concentrations were twelve times higher in the feathers of cattle egrets at Aswan compared to Cairo. In Puerto Rico, we also compared levels in adult cattle egrets with young and found higher concentrations of mercury and manganese, but lower concentrations of selenium in the adults. Using feathers from young cattle egrets is a potentially sensitive tool for biomonitoring for metals, especially lead, since they reflect the local area surrounding the breeding colony.

Animals↗