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PubMed1999

Financial aspects of haemophilia care in Puerto Rico and other Latin American countries.

The present cost of optimal care in haemophilia is very high. The paradigm of comprehensive care approach, including the essential elements of continuous integrated multidisciplinary health services and the provision of home care with early use of antihaemophilic products requires abundant economic resources that usually are not readily available in nonaffluent countries. A cost-effective comprehensive paediatric haemophilia programme has been operating in Puerto Rico during the last 15 years that provides quality care to over 90% of paediatric haemophiliacs, and is financed mainly by the local government health system. Efforts are also being made to provide and/or coordinate health care to all adult haemophilic patients through the Puerto Rico Pediatric Hemophilia Treatment Center. Information on the haemophilia care available in Latin American countries is scanty. The data available indicate that with a few exceptions, haemophilia care in this vast region is suboptimal. Apparently, early diagnosis is not common, there is lack of accessibility of services in most countries, comprehensive care is not the rule, safe high-purity AHF concentrates are used infrequently, and home care is used rarely. The main antihaemophilic products used are fresh frozen plasma and cryoprecipitate due to the high cost of modern antihaemophilic factor concentrates. The average per capita income of the main Latin American countries is about one-quarter of that of the USA and Canada. The existing economic situation of most Latin American countries would make it very difficult for them to purchase modern antihaemophilic products regularly and provide quality comprehensive care to their haemophilia patients, unless they make special efforts and get some type of external help. As a result of this study recommendations are made to improve the quality and accessibility of services to haemophilia patients in Latin America and other nonaffluent countries.

Adolescent↗
PubMed2001

The validity of drug use responses in a household survey in Puerto Rico: comparison of survey responses of cocaine and heroin use with hair tests.

BACKGROUND: Despite the widespread use of household surveys to assess the epidemiology of illicit drug use and abuse, there is very little information about the willingness of respondents to disclose their use of drugs in household studies outside the US. METHODS: As part of a household study of substance use disorders in Puerto Rico, we collected hair specimens from a sub-sample of 114 respondents. Hair specimens were screened using a radio immunoassay. Screened-positive specimens were confirmed using gas chromatography/mass spectrometry. RESULTS: Using hair-test results as the standard, specificity of self-reports was 98% or higher for both drugs. The sensitivity of all self-reports was low, although lifetime use reports had somewhat higher sensitivities. The sensitivity of self-reports of recent cocaine use was particularly low, 7.1%. The sensitivity of heroin use reports was somewhat higher, 33.3% for recent use and 66.7% for lifetime use. The estimate of recent cocaine use based on hair tests was 13.7 times the estimate generated from interview reports. For heroin use, the test-based estimate was 2.9 times the rate generated from the interview reports. A shift from the cut-off level of 0.2 ng/mg to 0.5 ng/mg had only a marginal improvement on validity, with sensitivity increasing from 7.1% to 11.1% for self-reported recent cocaine use. CONCLUSIONS: The results suggest that drug users, for the most part, are not willing to disclose their use of drugs in household surveys in Puerto Rico. Methods to increase the willingness of respondents to disclose their use of drugs are needed.

Adult↗
PubMed1989

The La Parguera, Puerto Rico colony: establishment and early studies.

Two islands off the southwest coast of Puerto Rico, La Cueva and Guayacan, were populated with monkeys derived from the Cayo Santiago colony and new imports from India during 1962-1963. This colony became known as the La Parguera Colony due to its proximity to the fishing village of La Parguera. Initial work on the island focused on studies of group formation and dynamics. Later, attention turned to field experiments on the interaction of behavior and hormones in coordinating reproduction and a number of other behavioral studies.

Academies and Institutes↗
PubMed1991

A cross-cultural adaptation of a psychiatric epidemiologic instrument: the diagnostic interview schedule's adaptation in Puerto Rico.

The advent of the use of structured interview schedules that generate psychiatric diagnoses in epidemiologic studies has promoted an intense interest in its cross-cultural use. However, the valid use of these instruments across cultures requires a careful adaptation process which goes beyond mere language translation. In this article the authors illustrate the application of a comprehensive cross-cultural adaptation model to both the translation into Spanish and the adaptation to the population of Puerto Rico of a widely used psychiatric epidemiologic research instrument: the Diagnostic Interview Schedule (DIS). The process aimed to ensure the development of a research instrument that is not only in correct Spanish and comprehensible for most Spanish-speaking people, but also culturally adapted to Puerto Rico's population. Various steps were taken (including bilingual committee, back-translation, instrument testing and diagnostic comparisons) to address cross-cultural validity in five important dimensions (i.e., semantic, technical, content, criterion and conceptual equivalence). The result is an interview schedule that is not only linguistically and culturally adequate for the targeted population but also includes elements which can contribute to the development of the instrument both in its original English language and in its translated versions.

Cross-Cultural Comparison↗
PubMed1981

Effects of pharmaceutical wastes on microbial populations in surface waters at the puerto rico dump site in the atlantic ocean.

A series of cruises during 1979 and 1980 to the pharmaceutical dump site located 64 km north of Arecibo, Puerto Rico, in the Atlantic Ocean, was carried out to evaluate effects of wastes on the ecology of the microflora of surface waters of the dump site. In addition to bacteriological monitoring of the waste plume created by the release of wastes from the disposal barge, stations along a series of transects, extending north from coastal waters through and beyond the dump site, were sampled. Largest numbers of culturable bacteria on marine agar were found at stations closest to shore and in the vicinity of the dump site. Bacteria recovered on marine agar were predominantly Vibrio and Aeromonas spp., with the relative abundance of these organisms decreasing as gram-positive organisms (staphylococci, micrococci, and bacilli) became dominant in areas immediately affected by waste dumping. Total numbers of bacteria (determined by acridine orange direct counts [AODC]), which were relatively stable throughout the region, and a direct estimate of viable cells (DVC), i.e., those cells responsive to additions of yeast extract and nalidixic acid, were determined by acridine orange staining and epifluorescence microscopy. Heterotrophic bacterial activity, measured by the uptake (V(max)) of C-labeled amino acids, declined relative to distance from land. Increases in specific activity indices (DVC/AODC and V(max)/AODC) were observed near the dump site. The composite results of this study, i.e., increased specific activities (determined by two methods), increased numbers of culturable marine bacteria, and marked alteration of the taxonomic composition of the culturable bacterial community in waters within and surrounding the Puerto Rico dump site, indicate demonstrable changes in the marine microbial community in the region used for waste disposal.

Journal Article↗
PubMed1988

Evaluating ultra-low volume ground applications of malathion against Aedes aegypti using landing counts in Puerto Rico, 1980-84.

Landing counts made in a residential area in San Juan, Puerto Rico during the 5-year period, 1980-84 indicated that malathion ULV applied by LECO Fog Generators was not effective against Aedes aegypti. Of 25 applications only 6 resulted in a decrease on the first day after treatment and only one remained much less than the pretreatment count on the second and third days after treatment. Daily, the number of mosquitoes landing for a 5-minute period at each of 2 stations was recorded. An ideal year created by averaging the monthly data suggested that the seasonal variation of mosquitoes was inverse to that of reported dengue incidence.

Aedes↗
PubMedDate not supplied

Otolaryngology--Head and Neck Surgery training in Puerto Rico.

The Otolaryngology--Head and Neck Surgery training program of the University of Puerto Rico, Medical School, is enjoining a full accreditation by the Residency Review Committee of the Accreditation Council for Graduate Medical Education. Since its foundation 76 Otolaryngologist--Head Neck surgeons have graduated, the first class was in 1962 and the last in June 1998, ten of them moved to the mainland where they practice or teach in renown universities. Our program is five year's durations, and it includes one year of general surgery and four years of progressive education in the specialty. Experience in the surgical sciences will precede the otolaryngology--head and neck surgery education, two residents are accepted each year.

Certification↗
PubMed1984

A clinical and mycologic study of tinea corporis and pedis in Puerto Rico.

A study of the causative agents of tinea corporis and pedis in Puerto Rico in 1982 disclosed four different dermatophytes from a total of 97 cases. Among the total of 49 fungus specimens collected in tinea corporis, the mycologic flora consisted of four different fungus species: Trichophyton rubrum, 42 isolates (85.7%); Epidermophyton floccosum, 4 (8.1%); Trichophyton mentagrophytes, 2 (4%); and Microsporum ferrugineum, 1 (2%). Among the total of 48 fungus specimens collected in tinea pedis, the mycologic flora consisted of 3 different fungus species as follows: T. rubrum, 35 isolates (72.9%); T. mentagrophytes 8 (16.6%); and E. floccosum, 5 (10.4%). Trichophyton rubrum caused 77 of 97 fungal isolates (79.3%). One surprising finding was the isolation of M. ferrugineum in a case of tinea corporis, documenting the first autochtonous case of this species in the island. This dermatophyte had previously been known only in Japan and adjacent areas of the Far East, Southern Europe, and Africa.

Adult↗
PubMed1993

A frequent tyrosinase gene mutation associated with type I-A (tyrosinase-negative) oculocutaneous albinism in Puerto Rico.

We have determined the mutations in the tyrosinase gene from 12 unrelated Puerto Rican individuals who have type I-A (tyrosinase-negative) oculocutaneous albinism (OCA). All but one individual are of Hispanic descent. Nine individuals were homozygous for a missense mutation (G47D) in exon I at codon 47. Two individuals were heterozygous for the G47D mutation, with one having a missense mutation at codon 373 (T373K) in the homologous allele and the other having an undetermined mutation in the homologous allele. One individual with negroid features was homozygous for a nonsense mutation (W236X). The population migration between Puerto Rico and the Canary Islands is well recognized. Analysis of three individuals with OCA from the Canary Islands showed that one was a compound heterozygote for the G47D mutation and for a novel missense mutation (L216M), one was homozygous for a missense mutation (P81L), and one was heterozygous for the missense mutation P81L. The G47D and P81L missense mutations have been previously described in extended families in the United States. Haplotypes were determined using four polymorphisms linked to the tyrosinase locus. Haplotype analysis showed that the G47D mutation occurred on a single haplotype, consistent with a common founder for all individuals having this mutation. Two different haplotypes were found associated with the P81L mutation, suggesting that this may be either a recurring mutation for the tyrosinase gene or a recombination between haplotypes.

Albinism, Oculocutaneous↗
PubMed1992

Risk factors associated with severe measles in Puerto Rico.

From January to April, 1990, 695 measles cases were reported to the Puerto Rico Health Department; there were 12 measles-associated deaths (case fatality ratio, 17/1000), more than in any year since 1967. We conducted a case-control study of risk factors for severe measles. We identified 16 children (ages 5 to 34 months) with severe measles and selected children with nonsevere measles as controls (39 hospitalized and 38 nonhospitalized). Controls were frequency matched to severe measles cases by region of residence. One case and two controls had been vaccinated. An underlying illness was present in 50% of cases and 16% of nonhospitalized controls (Mantel-Haenszel weighted odds ratio 5.3; 95% confidence interval 1.4, 20.2). In a multivariate analysis cases were significantly more likely than hospitalized controls to be from families with an annual income of < $5000 (odds ratio (OR), 26.9), to have a mother without a high school degree (OR 11.1), to be anemic (hemoglobin < 10 g/dl) (OR 15.9) and have an underlying illness (OR 18.3). During measles outbreaks preventing severe illness requires aggressive control measures and strategies to increase vaccine coverage of children with underlying illnesses and of low socioeconomic status.

Child, Preschool↗
PubMed1994

Deaths due to flash floods in Puerto Rico, January 1992: implications for prevention.

BACKGROUND: In January 1992, the Commonwealth of Puerto Rico sustained unusually heavy rainfall, which caused flash floods and deaths. METHODS: We conducted a descriptive study and a case-control study to determine the circumstances of these deaths and to identify mortality-prevention strategies. We describe the time, place, and circumstances of each death, and compare this information with water-level and rainfall data and the timing of warnings. Using controls selected from the affected population, we estimated the risk of death by age, sex, and vehicle occupancy during the flood. RESULTS: Within 7 hours, 23 people died in 17 incidents; 20 of the decedents (87%) were occupants of motor vehicles. The estimated risk of mortality was significantly elevated for motorists (odds ratio = 16, 95% confidence interval: 3.5-144). Being in a vehicle to evacuate a flash flood area was protective; however, being in a vehicle during the flood for other reasons further increased the risk of mortality. Deaths occurred early during the rapid rise of water and before official warnings were issued. CONCLUSION: We recommend improving the sensitivity of the warning system and its ability to disseminate appropriate information rapidly. We also recommend educating officials and the public about the risks of driving on flooded roads and in potential flash flood conditions; and about the unique flash flood risks associated with specific topographical features in their region.

Adolescent↗
PubMed1984

Demographic consequences of migration trends in Puerto Rico: 1950-1980.

"This paper examines the evolution and changes in migration patterns [in Puerto Rico] through the 1970's based on data from the 1980 census. The focus is on demographic consequences of migration, particularly with regard to population growth, redistribution and changing age structure." A final section is concerned with the socioeconomic implications of migration. (summary in FRE, SPA)

Age Distribution↗
PubMed1993

Endemic plants of Puerto Rico: brine shrimp lethality and antibacterial activity.

A total of 49 endemic plants of Puerto Rico were evaluated for their toxicological and antibacterial activities. The toxicological analysis was conducted with brine shrimp (Artemia salina Leach) lethality bioassay and the antibacterial screening was carried out by means of the agar diffusion test. In the toxicological bioassay, six plant extracts showed LC-50 values below 200 g/ml., indicating the potential presence of bioactive compounds. In the antibacterial screening, over 80% of the plant extracts displayed activity against gram positive bacteria, whereas only 6% of the extracts inhibited the growth of the gram negative bacteria.

Animals↗
PubMed1984

Incidence of Kaposi's sarcoma and mycosis fungoides in the United States including Puerto Rico, 1973-81.

The incidence of Kaposi's sarcoma (KS) was examined with the use of data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. KS is a manifestation of the recent epidemic of acquired immunodeficiency syndrome (AIDS) that has occurred particularly among homosexual men. The incidence of KS in 1973-79 was found to be higher (0.29 male and 0.07 female cases/100,000/yr) than is usually cited for the pre-AIDS KS incidence rates. Collectively, the 9 SEER registries in the United States showed only a slight increase in the incidence of KS between 1973-79 and 1980-81. However, the SEER registry covering San Francisco, which is a high-risk area for AIDS, showed a marked excess of KS in 1981. The KS case rate among never-married men younger than 50 years old, a surrogate index of homosexuality, was found to be markedly elevated in the post-AIDS period, compared with the case rate of a reference disease, mycosis fungoides. Never-married men younger than 50 years old, therefore, constitute a SEER-identifiable population who can be monitored for risk of KS and other neoplasms that might be related to AIDS. In addition, the incidence rate of KS in the SEER registry of Puerto Rico was generally higher than that in the U.S. SEER registries, despite data that suggested that KS may be underreported. The demographic characteristics of patients diagnosed as having KS in Puerto Rico suggested the classical rather than the AIDS-related form of KS.

Acquired Immunodeficiency Syndrome↗
PubMed1980

Gapeworm infection of domestic cats in Puerto Rico.

In a survey of 40 adult cats in Puerto Rico, 13 (33%) were found to be infected with the gapeworm Synagamus (Mammomonogamus) ierei. Direct fecal smear and necropsy were the methods used to detect the infection. Fourteen adult worm pairs were collected in one cat; the average was four. Histologically, evidence of chronic inflammation was observed in the nasopharynx of infected cats. The parasite occurs widely in the Caribbean region. It was concluded that the similarity of the gapeworm egg with those of hookworms and the recondite location of the adult gapeworm probably explain the lack of reports on the infection.

Animals↗
PubMed1976

ABO hemolytic disease in Puerto Rico and North Carolina.

A prospective study was carried out at the University of Puerto Rico Hospital (UPRH) and at the North Carolina Baptist Hospital (NCBH) in order to establish the incidence of ABO hemolytic disease (ABO HD) in the two populations and to determine the relationship of intestinal parasitic infection of the mother to ABO HD in the infant. The incidence of ABO HD among UPRH at risk pregnancies (type O mother with type A or B infant) was 28.3% or 1 in 3.5 as compared with 18.4% or 1 in 5.4 of NCBH at risk pregnancies (P less than .05). Indirect Coombs' tests in cord sera, representing the passive transfer from mother to fetus of antibodies directed toward antigens on the infants' erythrocytes, were positive in 58.8% of UPRH at risk infants as opposed to 40.4% of NCBH at risk infants (P less than .001). Maternal isohemagglutinin titers at term were higher in type O UPRH mothers than in type O NCBH mothers (P less than .01). A relationship between helminth parasitic infection of the mother and ABO HD in the infant was suspected but not proved.

ABO Blood-Group System↗
PubMed1990

Misreporting of maternal mortality in Puerto Rico.

Maternal mortality (MM) continues to be a problem that plagues many developed and underdeveloped countries around the world. It has been estimated that the minimum amount of underreporting in the U.S. to be 20%, resulting in MM rates that may be substantially higher than reported. The national goal for the MM for the year 1990 has been set at 5/100,000, and at the present trend it is expected that this may be achieved among the white population, but not among minorities. P.R. reported a maternal mortality rate of 5/100,000 in 1975. It was suspected that such a low rate was due to underreporting, a study was undertaken to investigate that possibility. The results indicated that there was severe underreporting of maternal deaths during 1978 = 79. Recently, there has been a growing concern that the level of underreporting in PR continues to be high. Since there has been no evidence that the surveillance has improved, the Dept. of Health requested from the Dept. of Ob-Gyn of the University of Puerto Rico Medical School and the Dept. of Maternal and Child Health to conduct a study to find out if the previous findings held true for recent years. The study was based on the review of selected medical records corresponding to deaths of women of childbearing age whose causes of death, as coded in the death certificate, were considered as having a high probability of masking a misreported maternal death. It was decided to investigate those deaths occurring in 1982, to see if the results of the previous study had caused any impact on the surveillance of maternal deaths in Puerto Rico.

Death Certificates↗
PubMed1990

[Birth spacing in Puerto Rico].

This paper uses life table methods to analyze the process of family formation in Puerto Rico. Despite a continuing decline in fertility, the pattern of birth spacing is very rapid with a big proportion of short intergenesic intervals. This indicates a clear distinction between spacing and stopping behavior. Some possible health implications are discussed.

Age Factors↗