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PubMed2002

Sector analysis of pH values in the northeastern region of Puerto Rico.

Acid rain precipitation has become a major environmental concern. Many long-range projects in the United States and Europe are devoted to the problems associated with acid rain pollution. In Puerto Rico, there has been no formal study on acid rain. The rainfall pH values and the air-mass trajectory of the northeastern part of the island of Puerto Rico on the surface were analyzed from January 1998 to December 2000. The air-mass trajectory was classified in five different sectors, according to where it originates. The mean pH value measured during that period showed a tendency toward acidity. The 80% of the air-mass trajectory that arrived at the station occurred in Sector I, with a pH value of 4.30. The lowest pH value measured was 4.16, and it occurred in Sector V, where the air mass originates in the northwest part of the island.

Acid Rain↗
PubMed2004

New Year's Eve injuries caused by celebratory gunfire--Puerto Rico, 2003.

Bullets fired into the air during celebrations fall with sufficient force to cause injury and death. However, few data exist regarding the epidemiology of injuries related to celebratory gunfire. In Puerto Rico, where such celebratory actions are common, news media reports have indicated that approximately two persons die and an estimated 25 more are injured each year from celebratory gunfire on New Year's Eve. The Puerto Rico Department of Health (PRDOH) invited CDC and local law enforcement agencies to assist in the investigation of injuries resulting from celebratory gunfire that occurred during December 31, 2003-January 1, 2004. This report summarizes the findings of that investigation, which determined that 1) bullets from probable celebratory gunfire caused 19 injuries, including one death and 2) such injuries affected a higher percentage of women and children aged <15 years than injuries from noncelebratory gunfire, with the majority occurring in certain public housing areas in densely populated, metropolitan San Juan. Education and enforcement of existing laws are needed to prevent these injuries.

Adolescent↗
PubMed2007

A second case of prothrombin Puerto Rico I in the United States.

Prothrombin deficiency is a very rare autosomal recessive bleeding disorder associated with mild to severe bleeding symptoms. We identified this bleeding disorder in a US-born patient as due to prothrombin Puerto Rico I. Unlike other prothrombin deficiencies, prothrombin Puerto Rico I is a series of concordant polymorphisms found in people of Puerto Rican descent with a much higher frequency than those prothrombin deficiencies found in the general population. This case underscores the importance of family history in identifying rare bleeding disorders.

Female↗
PubMed1982

Increased physical activity: a protective factor against heart attacks in Puerto Rico.

The incidence and potential risk factors of coronary heart disease were assessed in 2,585 rural and 6,208 urban men, aged 45 to 64 years, participating in the Puerto Rico Heart Health Program, a prospective epidemiologic study of coronary heart disease initiated in 1965. An index of daily physical activity and a metabolic equivalent of heaviest activity were estimated from each individual history. Rural men had higher mean levels of overall activity as well as higher levels of heavy activity than urban men. An 8 1/4 year follow-up study for coronary heart disease other than angina pectoris was analyzed for relationships with physical activity. Significant inverse associations were found for both urban and rural men. Metabolic equivalent of heaviest activity showed similar results. Although the physical activity index was inversely associated with most known coronary risk factors, multivariate analyses indicated that a significant independent inverse relationship existed with the incidence of coronary heart disease. In Puerto Rico, increased physical activity appears to be a separate protective factor against heart attacks.

Activities of Daily Living↗
PubMed2005

Workforce projections for emergency medicine in Puerto Rico: a five-year follow-up of an evident demand.

In this study, two mathematical equations were used to calculate and establish the actual Emergency Medicine workforce needed in Puerto Rico (PR) and project the time frame to meet the actual demand. 1) Supply equals the number of existing Emergency Physicians (EPs) plus residency-trained graduates in EM per year minus the annual attrition rate (3%); and 2) Demand equals six (6) full time equivalent positions per Emergency Department (ED) times the total number of EDs in PR. Under both scenarios tested, the significant EP shortage in PR will continue until 2044. The actual calculated shortage is 287 EPs. There is an actual significant shortage in the Puerto Rico EP workforce. It will take a long time to make leaders understand the positive impact of having residency-trained EPs in every ED, on quality patient care and the whole health care system.

Emergency Medicine↗
PubMed2003

Identification of the people from whom engorged Aedes aegypti took blood meals in Florida, Puerto Rico, using polymerase chain reaction-based DNA profiling.

We used polymerase chain reaction-based DNA profiling to construct allelic profiles for residents and visitors of 22 houses in Florida, Puerto Rico, and human DNA from blood meals in Aedes aegypti that were collected in those homes. Complete profiles were obtained for < or = 2 days after blood ingestion. Eighteen percent of the meals came from two different people. There was no evidence of meals from > or = 2 people. Eighty percent of the meal sources were identified, > 70% were taken from residents of the collection house, and > 90% were from residents of the study community. Across the community, feeding was non-random with a bias towards young adults and males. Three people accounted for 56% of the meals. Our results confirm that multiple feeding on different people is an important component in the role of Ae. aegypti in dengue virus transmission and help explain the spatial distribution of dengue cases in a previous epidemic in Florida, Puerto Rico.

Adolescent↗
PubMed2003

Differences between patients with non-Hodgkin's lymphomas in a cohort of HIV/AIDS patients in Puerto Rico.

The close association between AIDS and non-Hodgkin's lymphoma (NHL) is well known. Few studies are available that evaluate the profile of NHL in a cohort of HIV-infected patients who reside in Puerto Rico. The present study was performed in a cohort of 2,843 HIV-infected patients followed in the Retrovirus Research Center at Bayamón, Puerto Rico, evaluated between January 1992 until December 2000. NHL prevalence was determined and differences between AIDS defining and non-AIDS defining NHL were evaluated with the Fisher and ANOVA test. NHL prevalence was 0.9%. Nine (33%) were AIDS-defining (AIDS-d) NHL and 18 (67%) were non-AIDS-d NHL. Both groups were similar in gender distribution and mean diagnosis age. The median CD4+ T cell count at diagnosis was below 150/mm3 in both groups. Injecting drug use was higher in AIDS-d NHL patients and Homo-Bisexual contact was higher in non-AIDS-d NHL patients. Death rate in the first year after the NHL was 67% in the AIDS-d group and 56% in the non-AIDS-d group. AIDS-d NHL incidence decreased after the implementation of combined antiretroviral therapy in the cohort, a finding not seen in the non-AIDS-d NHL. In summary the study detected low NHL prevalence, with high degree of immunological damage at the time of the lymphoma diagnosis. Conversely dissimilar response to the antiretroviral therapies was also perceived in the incidence of the two NHL groups.

Adult↗
PubMed1998

[Elderly women in Puerto Rico: a brief summary of gerontological research activities].

Elderly women are a forgotten topic in women's research and in feminist issues. This article presents a concise summary of gerontological research on women's issues in Puerto Rico. Research is divided in two main categories: demographic and health and social issues. A brief account of needed research areas is included. A demographic and health profile of older women in Puerto Rico and their informal support systems is presented. The article concludes with thoughts pertinent to the relevance of conducting research from the perspective of elderly women themselves and not merely that of researchers.

Aged↗
PubMed2003

Infant health among Puerto Ricans--Puerto Rico and U.S. mainland, 1989-2000.

Although the overall U.S. infant mortality rate (IMR) declined dramatically during the 1900s, striking racial/ethnic disparities in infant mortality remain. Infant health disparities associated with maternal place of birth also exist within some racial/ethnic populations. Eliminating disparities in infant health is crucial to achieving the 2010 national health objective of reducing the infant death rate to 4.5 per 1,000 live births (objective 16-1c). Hispanics comprise the largest racial/ethnic minority population in the United States. Among U.S. Hispanics, considerable heterogeneity exists in infant health, with the poorest outcomes reported among Puerto Rican infants. This report compares trends during the previous decade in IMRs and major determinants of these rates such as low birthweight (LBW), preterm delivery (PTD), and selected maternal characteristics among infants born to Puerto Rican women on the U.S. mainland (50 states and the District of Columbia) with corresponding trends among infants born in Puerto Rico. The findings indicate that despite having lower prevalence of selected maternal risk factors, Puerto Rico-born infants are at greater risk for LBW, PTD, and infant death than mainland-born Puerto Rican infants. This report also highlights a persistent disparity in IMRs and an emerging disparity in LBW and PTD rates between Puerto Rico-born infants and mainland-born Puerto Rican infants. Future research should focus on identifying factors responsible for these disparities to improve infant health in Puerto Rico.

Female↗
PubMed1998

Life table study of Aedes aegypti (Diptera: Culicidae) in Puerto Rico fed only human blood versus blood plus sugar.

Life table studies were performed in 1996 with Aedes aegypti (L.) during the low (cool/dry) and high (hot/rainy) dengue virus transmission seasons in Puerto Rico. Mated adult females from field-collected pupae were placed individually in cages and divided into 2 treatment groups: one was fed only human blood and the other human blood plus a 10% sucrose solution. Survival and number of eggs laid were recorded daily for each female. During both seasons, age specific survivorship was higher for the blood plus sugar group, groups fed only human blood had higher reproductive outputs (mx), and net replacement rates (Ro) for blood only groups were higher than for those fed blood plus sugar. Intrinsic rates of growth (r) were the same for both treatments during the low (cool/dry) transmission season, but higher for the blood-only treatment during the high (hot/rainy) transmission season. Our results indicate that feeding on only human blood provides an evolutionary advantage to Ae. aegypti females in Puerto Rico. These results are similar to those from an earlier study carried out with Ae. aegypti in Thailand; the advantage of feeding on human blood does not seem to be restricted to a particular geographic region. We also found that the benefits associated with human feeding persist through epidemiologically different times of the year. We conclude that feeding on human blood is reproductively beneficial for Ae. aegypti, which may increase their contact with human hosts, and therefore may influence their vectorial capacity for dengue viruses through frequent feeding on blood.

Aedes↗
PubMed1990

Varicella outbreaks in Army recruits from Puerto Rico. Varicella susceptibility in a population from the tropics.

Two outbreaks of varicella consisting of a total of 105 cases occurred in a highly varicella-susceptible population of young adult Army recruits from Puerto Rico enrolled in the Defense Language Institute in San Antonio, Tex, between October 1986 and November 1987. Epidemiologic investigation found a significantly higher risk for enlisted recruits housed in open barracks than for officers housed in private rooms. The attack rate in the first outbreak was 30%, with an estimated attack rate of 71% among susceptible persons. Serologic testing of 810 adult recruits from Puerto Rico for varicella-zoster antibody by means of an enzyme-linked immunosorbent assay procedure found 42% to be seronegative, with no significant difference by sex. The enzyme-linked immunosorbent assay test had a positive predictive value for absence of disease development of 95% in the second outbreak. Serologic test results were successfully used as part of the outbreak control strategy, with a resultant decrease in attack rates to 19% overall and 30% among susceptible persons in the second outbreak. Uniquely susceptible adult populations placed in conditions with high likelihood of infection on exposure are potential candidates for the varicella vaccine after its licensure.

Adult↗
PubMed1991

Mercury contamination in Puerto Rico: the Ciudad Cristiana experience.

Mercury contamination constitutes a serious health problem. Several ecological accidents have occurred in the world due to industrial contamination and consumption of mercury contaminated food. This article summarizes the increased absorption levels of mercury among dwellers of Ciudad Cristiana Housing Project in Humacao, Puerto Rico confirming the exposition to the metal as documented by sediment analysis of the area performed by the Puerto Rico Environmental Quality Board. This obliged the local government to remove the dwellers from the area because of the probable health hazard.

Adolescent↗
PubMedDate not supplied

The dengue and dengue hemorrhagic fever epidemic in Puerto Rico, 1994-1995.

From June 1, 1994 to May 31, 1995 a total of 24,700 cases of dengue (7.01/1,000 population) were reported to the laboratory-based surveillance system in Puerto Rico (1991-1994, annual average: 2.55/1,000). Dengue virus 2 predominated. The earliest indicator of epidemic activity was the virus isolation rate in May 1994 (14.0% versus 5.7% average). The male-to-female ratio among cases was 1:1.1; 65.4% were younger than 30 years (the 10 to 19 year age group had the highest incidence, 11.8/1,000). At least 5,687 cases (23.0%) showed a hemorrhagic manifestation; 4,662 (18.9%) were hospitalized, and 40 died (0.2%; 10 laboratory-positive). Two cases documented by laboratory were transmitted by unusual routes--intrapartum and through a bone marrow transplant. Among 2,004 hospitalized cases reported by infection control nurses, 139 (6.9%) fulfilled the criteria for dengue hemorrhagic fever (DHF) and another 13 cases (0.6%) had dengue shock syndrome. This epidemic produced the largest number of hospitalizations, DHF cases, and deaths from any dengue epidemic in Puerto Rico. Severity did not change throughout the year. Surveillance capabilities were maintained by temporary, simplified reporting methods, none of which could be recommended as the single method of choice for surveillance; each must be used (on site, or as a service available from a reference laboratory) at the right time in the epidemic cycle. The utility of comparisons of current and previous data underscores the value of long-term surveillance. Our analysis was unable to document whether significantly increased transmission occurred more often in cities where the water supply was rationed or where the local landfill was closed.

Adolescent↗
PubMed1984

Disease rate as an artifact of the health care system: tuberculosis in Puerto Rico.

It is demonstrated that the reported rates of tuberculosis in Puerto Rico comprise a direct, positive measurement of location, infrastructure and numbers of personnel in the health care system. The disease map does not reflect true geographic prevalence, but it is a measurable artifact of the health care system. Areas of high and low reporting and zones of minimum patient contact, are identified in the interests of program management.

Delivery of Health Care↗
PubMedDate not supplied

Quality of care provided to patients with diabetes mellitus in Puerto Rico; managed care versus fee-for-service experience.

OBJECTIVE: To evaluate and compare the quality of diabetes care in a large managed care system and fee-for-service payment system in Puerto Rico. METHODS: This retrospective cross-sectional study assessed the adherence to standards of diabetes care in 1,687,202 subjects--226,210 from a fee-for-service population and 1,460,992 from a managed care group. Patients with diabetes mellitus were identified from insurance claims reports. Type of health-care provider, service location, number of visits, and laboratory utilization were also assessed. RESULTS: From the analysis, we identified 90,616 patients with diabetes (5.4% of the overall study group). Of these, 66,587 (73.5%) were found to have at least one encounter with a physician in a medical visit. Of the 66,586 patients with diabetes who visited a physician, only 4% were treated by an endocrinologist. General laboratory utilization was 34% for the entire population of patients with diabetes studied. In the group of patients with documented laboratory tests, 93% had a documented fasting blood glucose test; in contrast, hemoglobin A lc testing was performed in only 9% of the patients. The fee-for-service group had a higher rate of visits to medical specialists and general laboratory utilization, whereas the managed care group had a higher rate of hospital admissions and emergency department visits. CONCLUSION: The quality of diabetes management and the subsequent outcomes are related to patient and health-care provider adherence to standards of care. In this analysis, we found that patients and physicians are responsible for low compliance with recognized standards of diabetes care in Puerto Rico. The lack of adequate management will lead to increased mortality, development and severity of chronic complications, and increased emergency department utilization. Therefore, health-care providers and payers should find ways to achieve more effective promotion of adherence to accepted standards of care for patients with diabetes.

Aged↗
PubMed2005

Luis Llorens Torres and the impossible return: identity, conflict and hope in the national poem of Puerto Rico.

The psychodynamic exploration of the content of literary words and of the personal lives of their authors oftentimes reveals how they can be mutually reflective of the other. Such is the case of the poem, "Valle de Collores" (The Valley of Collores), considered by many to be the national poem of Puerto Rico and of the author Luis Llorens Torres (1876-1944), regarded as the "Poet Laureate of Puerto Rico." The timelessness and wide appeal of certain literary works has been attributed, among other reasons, to the fact that they address universal inner conflicts that affect all human beings. The poem "Valle de Collores" is the narrative of a country boy who leaves home to face the larger world and, as he reaches adulthood, he looks back and expresses his impossible longing to return to the rural home of his childhood. It is a description of the universal struggles of human development and of separation-individuation, loss and mourning and a longing to return, and a wish to merge with the early parental objects of childhood. The poem also parallels the history of the Puerto Rican people, in their transition from a rural society under Spanish rule to an industrialized society as an American Commonwealth. This difficult transition resulted in a massive immigration of Puerto Ricans to the United States that continues to this day. The poem also represents the longing of many Puerto Rican immigrants to return to their island home, and to a simpler time of more fundamental values. The land that is left behind and longed for becomes a metaphor for the early maternal imago.

Conflict, Psychological↗
PubMed2005

Luis Llorens Torres and the impossible return: identity, conflict and hope in the national poem of Puerto Rico.

The psychodynamic exploration of the content of literary works and of the personal lives of their authors oftentimes reveals how they can be mutually reflective of the other. Such is the case of the poem, "Valle de Collores" (The Valley of Collares), considered by many to be the national poem of Puerto Rico and of the author Luis Llorens Torres (1876-1944), regarded as the "Poet Laureate of Puerto Rico." The timelessness and wide appeal of certain literary works has been attributed, among other reasons, to the fact that they address universal inner conflicts that affect all human beings. The poem "Valle de Collores" is the narrative of a country boy who leaves home to face the larger world and, as he reaches adulthood, he looks back and expresses his impossible longing to return to the rural home of his childhood. It is a description of the universal struggles of human development and of separation-indi-viduation, loss and mourning and a longing to return, and a wish to merge with the early parental objects of childhood. The poem also parallels the history of the Puerto Rican people, in their transition from a rural society under Spanish rule to an industrialized society as an American Commonwealth. This difficult transition resulted in a massive immigration of Puerto Ricans to the United States that continues to this day. The poem also represents the longing of many Puerto Rican immigrants to return to their island home, and to a simpler time of more fundamental values. The land that is left behind and longed for becomes a metaphor for the early maternal imago.

History, 19th Century↗
PubMed1993

Immunodiagnosis of human dirofilariasis in Puerto Rico.

A seroepidemiologic study was carried out in humans inhabiting southeastern Puerto Rico, the area on this island with highest prevalence of canine heartworm, to detect the presence of antibodies to Dirofilaria immitis. Three hundred serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) using somatic antigens of the adult worm. Serum samples from eight patients were positive for anti-dirofilarial IgG. These patients had a mean age of 54 years. Although the study population had a female: male of 2.5:1, six out of the eight positive sera were from males. The minimum prevalence of human dirofilariasis was conservatively estimated to be 2.66%. After Western blot analysis of positive sera, four polypeptide markers with M(r) values of 15, 33, 42, and 69 kD were selected as potential immunologic markers for this human infection. Three of them (15, 33, and 69 kD) were specifically reactive only with ELISA-positive sera. The 42-kD polypeptide reacted strongly with ELISA-positive sera, although it reacted weakly with some of the ELISA-negative controls. The 15-, 33-, and 69-kD polypeptides were recognized by positive sera in several combinations, but only those sera with the highest ELISA optical density values reacted with all three polypeptides.

Adolescent↗