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PubMed2002

Prognostic factors of severe asthma in Puerto Rico.

Asthma in Puerto Rico is a serious Public Health Problem. This study extends our cross-sectional self-reported asthma prevalence survey of 3,000 volunteers. The purpose of the present study was to analyze the importance of known prognostic factors of asthma severity among 486 self-reported participants. Patients with more than one visit to the emergency room in the previous 12 months due to asthma exacerbations were classified as cases of "severe asthma", and those asthmatic patients who did not visit emergency rooms were classified as "non-severe asthmatic subjects". Severe cases and non-severe asthmatic subjects were compared regarding age, sex, family history of asthma, presence of household pets, and in the previous 12 months: history of hospitalization due to asthma, respiratory infections, tobacco smoking, exposure to passive smoking, and avoidance of passive smoking. Crude and logistic regression adjusted odds ratio was used as a measure of association between each prognostic factor, and the outcome namely severe asthma, while adjusting for all confounders simultaneously. The results clearly showed that previous hospitalizations due to asthma (OR = 7.3, p < 0.0001) and frequent of respiratory infection (OR = 2.5, p = 0.0003) were prognostic factors associated with increased asthma severity. A statistically significant, two percent less likelihood to have severe asthma for each year of age was found. Weak associations were found between asthma severity and male gender, family history of asthma, passive smoking, and presence of household pets. Avoidance of environmental tobacco exposure (passive smoking) was found to be an important and statistically significant protective factor associated with a 47% less likelihood for severe asthma. In conclusion, appropriate management of patients with history of hospitalization due to asthma is very important. The correct management of respiratory infection in asthmatic patients may result in a reduction of up to 60 percent of the odds of having asthma severe enough to require emergency treatment, and may reduced by 86.3 percent hospitalizations.

Adolescent↗
PubMed1991

Presence of human T lymphotropic virus type I in two patients with progressive myelopathy in Puerto Rico.

Two patients from Puerto Rico with progressive paraparesis had serum positive for human T lymphotropic virus type I (HTLV-I) antibodies by ELISA and Western blot, and one patient had HTLV-I antibodies in CSF by the ELISA method. Although the Caribbean basin is considered to be an endemic area for tropical spastic paraparesis, this is the first report of the isolation of HTLV-I antibodies in the serum and CSF of patients with chronic myelopathies in Puerto Rico.

HTLV-I Antibodies↗
PubMed1977

Oral cancer in Puerto Rico.

All cancer cases diagnosed in Puerto Rico are analyzed and registered in the Central Cancer Registry. The incidence of oral cancer in Puerto Rico is fourth-highest in the world. (In 1972 oral cancer accounted 72% of all cancers in males in Puerto Rico.) A review of the data revealed important contrasts with reported statistics from the continental United States (e.g., 75.6% of the cases in Puerto Rico were initially treated by radiation, compared with 15.3% of the cases in Western New York States.

Age Factors↗
PubMed1989

[The effect of cesarean section deliveries on female sterilization in Puerto Rico].

For the last decades Puerto Rico has had the highest rate of female sterilization of the world. However, it was to be expected that the increasing trend will slow down with the appearance of new and effective birth control methods and the increasing educational level of the population. The data obtained from an island-wide sample survey undertaken in 1982 demonstrated that this was not the case and that the rate of female sterilization continued to increase. The authors hypothesis was that this unexpected situation was a result of the remarkable increase observed in cesarean childbirth in the Island. Thus, the main objective of this study was to examine the relationship between cesarean childbirth and female sterilization. Utilizing the 1982 sample survey data the authors demonstrated that surgical deliveries had increased so rapidly during the last decades that Puerto Rico seems to be the leading country of the world, confirming the findings of a 1980 study. These data also showed that there was a very strong association between cesarean childbirth and female sterilization. A partial correlation analysis tend to demonstrate that surgical delivery in Puerto Rico, is at present, a stronger determinant of female sterilization than fertility.

Adolescent↗
PubMed2000

The shape of the HIV/AIDS epidemic in Puerto Rico.

This study presents information on AIDS patients in Puerto Rico, including their general sociodemographic profile, some risk-related parameters, characteristics of vulnerable groups, and elements of the clinical spectrum of the disease. Data were analyzed from the Puerto Rico AIDS Surveillance Program and available studies about the HIV/AIDS epidemic in Puerto Rico. A total of 23,089 AIDS cases was reported to the Puerto Rico AIDS Surveillance Program from January 1981 through February 1999. The HIV/AIDS epidemic has affected mostly males and females between the ages of 30 and 49, though cases have also been reported for other age groups. The cumulative proportion of persons with AIDS who are women has increased tremendously, from 11.4% for the 1981-1986 period to 21.6% for the entire 1981-1999 period. In Puerto Rico the category of injecting drug users (IDUs) accounts for the majority of the AIDS cases (52%), followed by heterosexual contact (22%), and men who have sex with men (17%). The three main diagnoses for AIDS on the island are wasting syndrome (30.7%); esophageal, bronchial, and lung candidiasis (29.4%); and Pneumocystis carinii pneumonia (26.8%). According to 1994 vital statistics for Puerto Rico, AIDS was the fourth-leading cause of death. The overall reported AIDS mortality rate was 42.0 per 100,000 persons, with the rate for males, 67.8, much higher than it was for females, 17.4. AIDS is the first cause of death among persons between 30 and 39 years old. Intense efforts are needed to better understand the epidemic in Puerto Rico and its biology, social and family impacts, and financial costs.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

First report of a family with Lynch syndrome type II in Puerto Rico.

Colorectal cancer (CRC) incidence in Puerto Rico has increased prodigiously since incidence figures were first recorded in 1950. Implications for hereditary nonpolyposis colorectal cancer (HNPCC) in concert with this increased CRC incidence are discussed. A family with the Amsterdam-positive criteria of the Lynch syndrome II variant, identified in the eastern area of Puerto Rico, is described. As far as we can determine, this is the first such report of this disorder in Puerto Rico.

Adjuvants, Immunologic↗
PubMed1999

Tobacco and alcohol use and oral cancer in Puerto Rico.

OBJECTIVES: To determine risk for oral cancer in Puerto Rico associated with use of alcohol and tobacco. METHODS: In Puerto Rico, alcohol and tobacco use were compared among nonsalivary gland cancers of the mouth and pharynx (n = 342), cancers of major and minor salivary glands (n = 25) and 521 population-based controls. RESULTS: Alcohol (usual use, Ptrend < 0.0001 for men and Ptrend = 0.02 for women) and tobacco (usual use, Ptrend < 0.0001, for both men and women) were strong independent risk factors for oral cancer in Puerto Rico, with a multiplicative effect from combined exposures. Risks did not vary systematically by use of filter vs. nonfilter cigarettes. Risks with use of other forms of smoked tobacco were about sevenfold among both men and women. Risks decreased only gradually after cessation of tobacco and alcohol use. Tobacco use, but not alcohol, was linked to cancers of the salivary glands. The burden of oral cancer due to alcohol and tobacco use in Puerto Rico (76% for men, 52% for women) agreed closely with earlier estimates for the mainland US population, while about 72% of salivary gland cancer (men and women, combined) was due to tobacco use. CONCLUSIONS: Excess risks for oral cancer in Puerto Rico are largely explained by patterns of alcohol and tobacco use. Smoking filter vs. nonfilter cigarettes does not alter risk, while cessation of alcohol and tobacco use appears to reduce risk only gradually.

Adult↗
PubMed1985

Union Carbide and the community surrounding it: the case of a community in Puerto Rico.

Based on fieldwork in Puerto Rico, this article examines the views on health hazards of residents in a semi-rural community in relation to the influx of industrial development since the early 1970s. It is suggested that "folk" terminology and particular aspects of Puerto Rican culture are less significant in this instance than many studies in medical anthropology suggest. The focus is on the emergence of a protest movement concerned with health problems which community residents and workers attribute to a nearby Union Carbide factory. Residents of El Ingenio, Yabucoa, Puerto Rico, have brought a law suit against Union Carbide and, the management of the plant has attempted to dispel the conflict. The article argues that health concerns of residents, industrial workers, and plant management cannot be interpreted without taking into account problems of unemployment, political affiliations, and company policies and their impact over time.

Adolescent↗
PubMed1996

Hay Bilharzia!, by Klock, Ildefonso, and Mateo-Serrano: medical images of poverty and development in Puerto Rico in the 1950s.

From 1940 to 1970 Puerto Rico underwent a dramatic change in its economic, social, political, and medical characteristics. Schistosomiasis (known locally as bilharzia) persisted throughout this period as a nearly intractable problem. In 1954, staff from the Puerto Rico Department of Health, and the Puerto Rico Field Station of the U.S. Communicable Disease Center (now San Juan Laboratories, Centers for Disease Control and Prevention) created a set of black and white 35 mm slides as a tool for community education. The presentation, titled "Hay Bilharzia!" ("There is schistosomiasis here!") is organized in four major sections (Introduction, Disease Cycle, Disease Prevention, Treatment). Each section consists of two to four sub-themes, with three to eight slides each. The slides were used extensively in public schools and community lectures. This set of slides is worthy of preservation as evidence of the bilharzia control efforts and the dismal living conditions widely prevalent in Puerto Rico in the 1950s. It is also an example of the educational programs that were produced at the time to stimulate community development and health.

Adult↗
PubMed1997

Puerto Rican patients travel to Puerto Rico: assessing the effect on clinical care.

OBJECTIVE: To examine travel habits of Puerto Rican patients and assess the potential effect of this travel on their health care. DESIGN: Interview and survey of patients. SETTING: Urban medical clinic. PATIENTS: Two hundred consecutive, self-identified Puerto Rican patients presenting for follow-up care. INTERVENTION: Immediately prior to a follow-up office visit, patients were interviewed in either Spanish or English. MEASUREMENTS: The patients' age, sex, education level, employment status, and place of birth were recorded. The patients were asked questions concerning the principle place of residence of their family members, their ability to speak English, and their preferences in television and radio programs. Patients who had visited Puerto Rico were asked about the duration and purpose of their most recent trip and about the health care they received in Puerto Rico. Chi-square testing was applied to categorical data and t tests for continuous data; P values were calculated using the SPSS statistical analysis program. RESULTS: Of the 200 subjects, 110 (55%) had traveled to Puerto Rico in the last five years and 90 (45%) had not. The patients who traveled were more likely to have been born in Puerto Rico, less likely to speak English, and less likely to listen to English-language programs. A majority of the patients who traveled to Puerto Rico visited for a month or less (80%) and did not experience a change in health care (78%). In comparison, however, a majority (59%) of the patients who visited for longer than a month did experience a major change in their health care status (P < .00001). CONCLUSIONS: Puerto Rican patients, particularly those born in Puerto Rico with stronger cultural "ties" to the island, frequently return to Puerto Rico. Patients who visit for longer than a month often experience changes in care which are likely to have significant effect on their health. Clinicians caring for Puerto Rican patients should ask about upcoming visits to Puerto Rico and take steps to assure continuous and coordinated medical care.

Aged↗
PubMed1961

Resistance of Aedes aegypti to certain chlorinated hydrocarbon and organophosphorus insecticides in Puerto Rico.

Failure to control Aëdes aegypti in Puerto Rico has suggested resistance to the insecticides, particularly DDT. A laboratory colony (named Isla Verde strain) was established from material obtained near the International Airport. This strain proved highly resistant to DDT and dieldrin as well as various other insecticides. The scientific and practical significance of this is far-reaching. Heretofore, it was thought that populations of Aëdes aegypti could be resistant to the DDT group of insecticides or to the dieldrin group but not to both, and that one type of resistance involved biochemical, toxicological and genetic characteristics different from the other. This theory must now be modified or even abandoned. From the practical point of view, it is clear that the continued use of DDT or dieldrin for Aëdes aegypti control in Puerto Rico is questionable, for it is not wise to attempt to overcome high resistance by increasing the concentration or rate of application. Further, the situation demonstrated for Puerto Rico may also obtain in other islands of the Caribbean where Aëdes aegypti is known to be DDT-resistant.

Aedes↗
PubMed1983

The Medicaid program in Puerto Rico: description, context, and trends.

The Medicaid program in Puerto Rico differs from United States Medicaid programs in several important ways. First, it operates within a larger, centrally administered health care delivery system. Approximately half of Puerto Rico's 3.2 million inhabitants are poor and depend upon the public health system for their medical care. Second, recipients are not free to choose their own provider, but are referred to the proper level of care by public health care system professionals. Third, this system has a low average recipient cost. Fourth, Congress has "capped" the Federal financial participation since 1968. Finally, despite the economic constraints and large Medicaid population, health status in Puerto Rico compares favorably with that in the United States. This study describes the organization and operation of Puerto Rico's Medicaid program in terms of basic expenditures and utilization data. The Puerto Rican program is an important example of an alternative health care delivery system for the poor. It is interesting in the contrast it provides to United States Medicaid programs and as a case study of how such a program operates when Federal financing is "capped" over a period of time.

Delivery of Health Care↗
PubMed2006

Using a multisectoral approach to assess HIV/AIDS services in the western region of Puerto Rico.

The Enhancing Care Initiative of Puerto Rico assessed services available to people living with HIV/AIDS in the western region of Puerto Rico. Participants were 212 people living with HIV/AIDS and 116 employees from 6 agencies providing HIV/AIDS services in the region. Two main findings were that depression symptoms were present in 98.1% of people living with HIV/AIDS, and 7 of the 15 municipalities in the region did not provide any specific services to this population. Most urgent needs identified by people living with HIV/AIDS were economic support, housing, mental and psychological services, medicines, medical treatment, and transportation. The Enhancing Care Initiative provides an example of a successful multisectoral, multidimensional volunteer team effectively overcoming challenges while translating research into interventions to enhance HIV/AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Fertility determinants in Puerto Rico.

This paper examines the proximate determinants of fertility in Puerto Rico using data from a 1982 island-wide study. Contraceptive use was found to be the primary direct determinant of fertility in Puerto Rico, both for the total population and for each level of education studied. Female sterilization is the most prevalent method of contraception used in Puerto Rico at each educational level. Marriage is also important in Puerto Rico and is the only proximate determinant that varies across education groups. Late age at first marriage, in addition to high contraceptive use, accounts for the below-replacement fertility of women who have more than a high school education. In contrast, women who have not completed high school tend to marry early and not practice contraception for birth-spacing purposes. This study shows the advantages of analyzing fertility determinants at the population subgroup level (i.e., women of various educational attainment levels) so that the fertility of the total population can be better understood.

Adolescent↗
PubMed1992

[Prevalence of smoking among women in reproductive age in Puerto Rico].

The prevalence of smoking in Puerto Rican women was estimated on the basis of data from 3,157 women 15 to 49 years of age who had been surveyed in the 1982 Evaluation of Fertility and Family Planning in Puerto Rico. The weighted prevalence was 15.5%, with a 95% confidence interval of 13.8 to 17.1. The prevalence varied by age group, education, marital status, place of residence at age 15, and consumption of alcohol. The prevalence of smoking increased in successive birth cohorts while the mean age at initiation of the habit tended to decline. The data suggest that in Puerto Rico smoking is on the rise among younger women.

Adolescent↗
PubMed1982

Canine leptospirosis in Puerto Rico.

Among 116 stray dogs in Puerto Rico surveyed for leptospiral agglutinins, 73 (62.9%) has significant titers to one or more leptospiral serotypes. The most common serogroup identified serologically was icterohaemorrhagiae accounting for 53 (72.6%) of the infections. Although the infection rates were comparable for male and female dogs the older were found to be more frequently infected. The significance of the canine in the epidemiology of leptospirosis in Puerto Rico is probably of paramount importance due to the extensive direct and indirect contact dogs have with rats and the human population.

Agglutination Tests↗
PubMedDate not supplied

Contraceptive use and the need for family planning in Puerto Rico.

In 1982, 69 percent of Puerto Rican women in union were practicing contraception. Forty-five percent relied on contraceptive sterilization (40 percent, female, and five percent, male), eight percent were using the pill, four percent each, the IUD and the condom, five percent relied on rhythm, and three percent were using other methods. Thus, sterilization is the dominant form of fertility regulation in Puerto Rico, and there is relatively little use of reversible methods for childspacing. Reliance on female sterilization peaks among women in union in the age-group 35-44 (54 percent), whereas pill use is highest among those aged 15-24 (approximately 23 percent). Overall, eight percent of all women aged 15-49 are at risk of unintended pregnancy because they are fecund, sexually active, not pregnant or seeking pregnancy and not using any kind of contraceptive method. However, among women in union, this risk ranges from nine percent among those aged 30-39 to 22 percent among women aged 15-19. Reliance on sterilization rather than reversible methods of contraception is strongly influenced by socio-demographic variables. Women with less than a high school education, the wives of blue-collar workers, women living outside of the major cities and those born in Puerto Rico depend upon sterilization more than do women with a college education, the wives of white-collar employees, women living in cities and those born outside of the country. These findings point to the need for improved availability of reversible family planning services, especially for young women, and those whose childbearing is incomplete.

Adolescent↗
PubMed2006

Prevalence and correlates of hepatitis C virus infection among street-recruited injection drug users in San Juan, Puerto Rico.

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.

Adult↗