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PubMedDate not supplied

Foreign bodies from the upper-aerodigestive tract of children in Puerto Rico.

The objective of this study was to investigate the incidence management, and complications of foreign bodies in the upper aerodigestive tract of children in Puerto Rico. The records of children admitted to the University Pediatric Hospital of Puerto Rico were revised from January 1, 1989 to December 31, 1994. 51 children had foreign body in their airway and 107 children had foreign body in their digestive trac (a total of 158 patients) These records were examined for age, gender, previous medical illness, clinical presentation, radiographic studies, removal technique, complications, and hospital stay. The most common age in both groups was 1 year old children. Of the 51 foreign bodies aspirations, 25 were boys and 26 were girls; and of the 107 ingestion, 67 were boys and 40 were girls. The most common times of the year were during the summer and winter months. The diagnosis of foreign body aspiration or ingestion was made in 6 hours or less in only 68 of the 158 cases. The most common signs were vomiting, coughing, and choking episode (44 cases). X-rays were positive in 146 cases (92.4%). The most common foreign body ingestion was coins and aspiration was peanuts. There were no complications on 129 cases (81.6%). The most common complication was pneumonia with 19 cases. The mean hospital stay was 3 days. In general, foreign body aspiration or ingestion are common events that can be prevented in the pediatric age. Parental education is important at this stage. If the event can't be prevented then a rapid management must be given to those patients with positive history of an adult witness of the event and a high level of suspicion for those patients with no reported event of choking or witness present.

Adolescent↗
PubMed2002

Age, gender and seasonal patterns of asthma in emergency departments of southern Puerto Rico.

We report findings derived from 55,547 emergency department records of asthmatic patients in the city of Ponce, Puerto Rico over a period of six years. The analysis of the data revealed that mean age of the asthmatic cases were 18.7 +/- 17.8 years, with 45% percent of the patients in the 1-9 years age range, and proportionally decreasing with age. In children 1-9 years the percent of males was 1.5 times that of females, and in 10-19 year-old group, admissions to the emergency room for males and females was identical, and between 20-69 years of age, the female ratio ranged from 1.5-2.12. The data also demonstrated that there is a seasonal variation in the asthma attacks reaching its peak in December, and the lowest in June. In conclusion, in the city of Ponce, Puerto Rico, emergency department usage due to asthma attacks show a seasonal variation, and males are more affected by asthma at younger ages while females are more affected at older ages. These findings strongly suggest that emergency department usage due to asthma attacks is highly common and represents an important place where specialized health care delivery is needed. With the implementation of dedicated asthma centers, specialized health care delivery can be easily accomplished. In addition, our data supports the that asthma should be declared a public health problem and a reportable disease.

Adolescent↗
PubMed1991

Comparison of special education and regular students in Puerto Rico on the Eysenck Personality Questionnaire.

The Eysenck Personality Questionnaire and the Eysenck Personality Questionnaire for Children have been standardized for Puerto Rico. In this study the latter test was administered to 24 14-yr.-old boys in special education. No significant differences in scores on Neuroticism or Psychoticism were observed for these boys and 405 12-yr.-old regular students. Results are discussed in terms of the effectiveness of the special education program in Puerto Rico.

Adolescent↗
PubMed1979

Epidemic dengue fever in Puerto Rico, 1977: a cost analysis.

During the period July-December 1977, a widespread epidemic of dengue fever occurred in Puerto Rico. The cost of the epidemic was calculated, using upper and lower limit incidence figures, in terms of direct costs (medical care and epidemic control measures) and indirect costs (lost production of ill workers and parents of ill children). Direct costs were estimated to range between $2.4 and $4.7 million. Indirect costs were calculated by using current (1977) employment and wage data and population extrapolations from the 1970 census, and entailed a loss to the Puerto Rico economy of from $3.7 to $10.9 million. The total cost of this epidemic, therefore, was estimated to be in a range of $6.0 to $15.6 million, of which epidemic control measures comprised 7.8--20.2%.

Adolescent↗
PubMed1999

Epidemiology of pediatric AIDS in Puerto Rico: 1981-1998.

The objective of this study was to describe the AIDS-defining conditions (ADC) and survival experience of pediatric AIDS cases (< 13 years age) reported in Puerto Rico. A descriptive analysis of the data gathered by the Puerto Rico AIDS Surveillance System was performed. Data for the 377 pediatric AIDS cases reported from January 1981 through June 1998 were reviewed. Survival curves following AIDS diagnosis were estimated using the Kaplan--Meier method and differences between curves were assessed by the Wilcoxon test. The majority (61%) of the cases were diagnosed before 2 years of age, and nearly 94% of them acquired the infection through perinatal transmission. The most common ADC were Pneumocystis carinii pneumonia (PCP) (23%), wasting syndrome (19.4%), and esophageal candidiasis (19.1%). The overall median survival time during the study period was 53.5 (95% CI: 38.0-106.2) months. Children < 1 year of age had a significantly shorter median survival time compared with older ages (p < 0.05). The survival experience in children diagnosed with PCP, pulmonary candidiasis, cytomegalovirus, and lymphocytic interstitial pneumonia (LIP) was significantly different (p < 0.05) to those children not diagnosed with these conditions. Although patients diagnosed after 1990 showed a median survival time longer than those diagnosed prior to 1990, the difference did not reach statistical significance (p > 0.05). The frequency of several ADC and median survival time of Puerto Rican children differed from those reported in the United States. This may reflect differences in diagnostic procedures or reporting practices.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Medical negligence in Puerto Rico: 1990-1996].

The purpose of this communication is to present the statistical information of the medical and hospital professional liability situation in Puerto Rico from 1990 to 1996. The Medical Institutional liability is a topic of great relevancy and importance to the people of Puerto Rico and the leaders responsible for establishing policies for the health care services. The Reports on Medical and Hospital Professional Liability from 1991 to the 1996 produced by the Examining Physicians Board were reviewed. The liability claims from 1991 to the 1996 totaled 4054. During the seven years analyzed, 3506 cases were closed against physicians and institutions, a payment was issued in 1272 cases (36.3%), for a total compensation of $56,268,053. The risk of a legal claim is greater for the group of Plastic Surgeons and Emergency Medicine. The probability of a plaintiff receiving a compensation payment in a case of medical malpractice is approximately 36%, usually receiving a third of the total of the award as suggested by the medical literature. A thoughtful analysis of the current medical liability situation and defensive medicine should be done with the purpose of protecting the fiduciary function of the physicians with respect to the health of their patients, this is the function that guarantees a physician-patient relationship that is healthy, righteous and empathic.

Defensive Medicine↗
PubMedDate not supplied

Prevalence of hepatitis C virus infection at three hemodialysis units in the western region of Puerto Rico.

OBJECTIVE: In the United States hepatitis C virus infection (HCV) affects approximately 20 percent of hemodialysis patients but its prevalence in Puerto Rico has not been established. We have sought to determine the prevalence of HCV infection in a homogeneous sample of patients on hemodialysis in the western region of Puerto Rico and to identify its risks factors. METHODS: All patients in the hemodialysis units of Aguadilla, Mayagüez and San Germán, during December 1997 to March 1998, completed a written questionnaire in which they were asked about transfusions, multiple sexual partners, i.v. drugs use, tattooing, occupation, imprisonment, organ transplantation and years on hemodialysis. Serum samples were analysed for HCV antibodies by an enzyme-linked immunoadsorbent assay (ELISA). Sera with positive results for HCV were subjected to a confirmatory test by the polymerase chain reaction (PCR). RESULTS: Thirteen of the 376 (3%) subjects had a positive ELISA (one patient died prior the confirmatory test with PCR). Six out of the twelve patients had a positive PCR. Two had been transfused. Three were illicit i.v. drug users and one had received a renal transplant. The liver biopsies in all patients showed chronic hepatitis and in two there was cirrhosis. CONCLUSIONS: Our prevalence was two percent. As reported elsewhere blood transfusion, organ transplantation and illicit i.v. drug abuse were the major risk factors for HCV infection in our patients. Nosocomial factors were irrelevant in the results.

Hemodialysis Units, Hospital↗
PubMed1995

Paradise lost: an introduction to the geography of water pollution in Puerto Rico.

Rapid industrialization has transformed the agricultural economy of Puerto Rico, creating employment opportunities and raising standards of living. Success, however, is marred by widespread pollution that outstrips the infrastructural capacity necessary for the preservation of environmental quality and of human health. The result today is a landfill crisis, a heritage of toxic dumps, and an advancing tide of pollution. Rivers and reservoirs are nearly ubiquitously affected and groundwaters, long thought to be naturally protected, show evidence of increasing contamination. Limestone aquifers are at particular risk. Public awareness and inter-sectoral political leadership are urgently needed to reverse the trend towards environmental deterioration.

Developing Countries↗
PubMedDate not supplied

Virus characterization and sequence of the fusion protein gene cleavage site of recent Newcastle disease virus field isolates from the southeastern United States and Puerto Rico.

Nine Newcastle disease virus (NDV) isolates obtained from Puerto Rico, Georgia, Alabama, Mississippi, and Texas were analyzed for in vivo pathogenicity, biological properties (hemagglutination of mammalian erythrocytes), and for sequence variation at the amino acid and sense RNA level of the fusion protein cleavage site. Intracerebral pathogenicity index values ranged from 0 to 0.3 and the intravenous pathogenicity index obtained for all isolates was 0. Four isolates hemagglutinated bovine erythrocytes, whereas no hemagglutination was observed using equine erythrocytes. By direct sequencing of reverse transcription polymerase chain reaction products, all the isolates had a predicted fusion cleavage sequence comparable to lentogenic NDV strains. Based on nucleotide sequence, the viruses could be grouped phylogenetically with the B1 vaccine-type virus. However, nucleotide sequences were not 100% similar to the B1 or La Sota NDV strains, indicating that minor genetic heterogeneity occurs among lentogenic field isolates of NDV.

Amino Acid Sequence↗
PubMed1996

Pneumocystis carinii pneumonia versus wasting syndrome among AIDS cases in Puerto Rico: a survival analysis.

OBJECTIVE: To compare mortality of wasting syndrome (WS) versus Pneumocystis carinii pneumonia (PCP) in AIDS patients reported in Puerto Rico after controlling for gender, age, and CD4 levels. METHODS: AIDS patients for which a diagnosis of WS (n = 1,180) or PCP (n = 765), who were reported to the AIDS Surveillance System of Puerto Rico between 1989 and 1992, were used to analyze the mortality risk among these diagnoses using a Cox's proportional hazard regression model. RESULTS: Cox model showed that WS patients had a 14% to 33% reduction in mortality risk compared with PCP patients after adjusting for gender and age (95% confidence level). Mortality risks for males were 18% (95% CI: 1%, 39%) higher than females risk after adjusting for AIDS defining condition and age. It was shown that a decrease in 100 CD4 cells increased the mortality by 37% (95% CI: 16%, 62%) after adjusting for AIDS defining conditions, gender, and age.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Premature thelarche in Puerto Rico. A search for environmental factors.

Pediatric endocrinologists in Puerto Rico reported a threefold increase in the number of patients with premature thelarche seen between 1978 and 1981. A matched-pairs case-control study was conducted to evaluate associations with potential environmental exposures to substances with estrogenic activity, as well as with familial factors. Analysis was performed on 120 pairs, the case subjects of which were selected from those diagnosed between 1978 and 1982. In subjects 2 years of age or older at the onset of thelarche, no significant associations were found. In subjects with onset before 2 years of age, significant positive associations were found with a maternal history of ovarian cysts, consumption of soy-based formula, and consumption of various meat products. A statistically significant negative association was found with consumption of corn products. These statistical associations are probably not sufficient to explain the reported increase because in over 50% of the case subjects there was no exposure to any of the risk factors for which statistical associations were found. Exposure to other substances with possible estrogenic effect, such as waste products from pharmaceutical factories and pesticides, was also excluded as a possible cause. These findings suggest that better diagnosis and reporting, or conceivably the presence of entirely new, unsuspected factors, could account for the reported increase.

Animals↗
PubMed1993

Salt and gastric cancer: a case-control study in Puerto Rico.

A total of 136 incident intestinal type gastric cancer cases and 151 age-comparable population controls were interviewed in Puerto Rico about their dietary habits with special emphasis on dietary salt consumption. All interviews were conducted at home using a quantitative dietary frequency instrument. The weekly intake of foods was estimated from the reported frequency of consumption and portion size according to a food model. The dietary salt exposure was estimated from the intake of nine selected food items which are highly salted food items commonly consumed in Puerto Rico. A strong (odds ratio [OR] = 3.34) and statistically significant (P < 0.001) unadjusted difference was found between cases and controls regarding dietary salt exposure. A statistically significant dose response for the index of salt exposure and gastric cancer was also found. The association remained positive and statistically significant after simultaneously adjusting for the confounding effects of sex, education and cigarette smoking.

Adenocarcinoma↗
PubMedDate not supplied

Spirometric nomograms for normal children and adolescents in Puerto Rico.

OBJECTIVE: The use of spirometric reference values specific to the population being tested is preferable. A study carried out in Puerto Rico is used here to develop nomograms for normal children and adolescents based on age and height, two variables that have been found to be good predictors of pulmonary function. MATERIAL AND METHODS: The data for healthy individuals aged 5 to 18 were extracted (108 girls and 107 boys) from a larger study of spirometric measurements collected on 4527 individuals attending medical services in Puerto Rico. Several models were tested for the prediction of FEV1, FVC and the ratio FEV1/FVC. The best models were selected for each gender, and nomograms were developed showing the fifth, twenty-fifth, fiftieth, seventy-fifth, and ninety-fifth percentile of the predicted values according to age and height separately. RESULTS: The best models were those using the logarithm of the pulmonary function and the cube of height (R2 = 0.79-0.81), and age without transformation (R2 = 0.73-0.77). Corresponding nomograms were developed based on these models. The ratio showed little variation for different ages and heights. CONCLUSIONS: Pulmonary function can be efficiently predicted by age and height. Nomograms provide a simple way to use spirometric references that can be incorporated to clinical practice.

Adolescent↗
PubMed1980

Malathion resistance in Aedes aegypti of Puerto Rico induced by selection pressure on larvae.

A high level of tolerance to malathion occurred in Aedes aegypti larvae of San Juan, Puerto Rico in 1978. The tolerance was 7-fold when compared with a susceptible strain. Malathion selection pressure in the laboratory on this tolerant strain resulted in resistance after only six filial generations. The resistance of the F6 generation as 10-fold when compared with the strain as it was in the field in 1969, and 19-fold when compared with a susceptible laboratory strain. The results, together with those of previous studies suggest that resistance may be a major factor in situations in Puerto Rico in which malathion failed to control Ae. aegypti.

Aedes↗
PubMed2001

Residential status and HIV risk behaviors among Puerto Rican drug injectors in New York and Puerto Rico.

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p < .001), and more New York IDUs lived in their own home (30% vs. 14%, p < .001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

Adult↗
PubMed2004

Substance use among school-based youths in Puerto Rico: differences between gender and grade levels.

The present study examined substance use rates among adolescents in Grades 7-12 in Puerto Rico. Nine hundred eighty-nine students completed the Spanish version of the International Survey of Adolescent Health. More than 50% of middle school youths and 75% of high-school youths reported lifetime alcohol use. Female gender was associated with tobacco use in middle school while male gender was associated with marijuana use in high school. High-school females reported lower rates of tobacco use and marijuana use than middle-school females. High-school males exhibited substantially higher drug-use rates than middle-school males for each substance. These findings may suggest that universal drug prevention interventions may be needed for females in Puerto Rico before they enter middle school, while targeted interventions aimed at high-risk females who continue to smoke tobacco or marijuana may be more effective during high school. In contrast, targeted drug prevention interventions for males probably need to begin in middle school and be maintained if not increased in intensity throughout the high-school years.

Adolescent↗
PubMed1989

[Lost years of potential capacity: mortality in Puerto Rico, 1986].

This article uses the indicator "Years of Potential Life Lost" (YPLL) to rank the major causes of premature death in Puerto Rico. This highlights the importance of accidents. When the YPLL computed for 1986 are compared to those for 1977, we can detect reductions in premature mortality due to cerebrovascular diseases and arteriosclerosis, and marked increases due to diabetes, homicides, and pneumonias and influenzas. The latter three causes are highly associated with lifestyles; the prevention of premature mortality in Puerto Rico therefore requires behavioral changes and environmental measures to reduce the risk factors linked with the etiology of these conditions.

Adolescent↗
PubMed1991

[Environmental epidemiology of cancer in Puerto Rico: 1987-1988].

An epidemiological analysis on cancer was run for the years 1987 and 1988 and for each municipal jurisdiction in Puerto Rico. Areas of pronounced incidence were examined on the basis of possible environmental cause-and-effect relationships. The cancer data examined were based on first diagnoses for cancer of all types, respiratory cancer and leukemia. The municipality of Cataño was salient in most incidences. Cataño lies downwind from the largest metropolitan urban center in Puerto Rico (population density 9,559 inhabitants per square mile), from the largest number of industries for the island, from past and present uncontrolled non-compliance air emissions, from the largest number of vehicles, and is surrounded by wetlands. Also salient were other municipalities of historical or current heavy industrial emission activity with lenient or non-existent environmental controls.

Environment↗