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PubMed2001

[Historical recollection Medical School of the University of Puerto Rico 1950-2000].

The School of Medicine of the University of Puerto Rico was founded in 1950 with the mission of educating the much needed physician workforce in order to improve the health of a large portion of the population in Puerto Rico. The main events in its first fifty years of existence are summarized. Emphasis is given to the unique, mutually dependent association between the School of Medicine and the Department of Health of Puerto Rico. Soon after its organization, the school became a principal protagonist in the delivery of specialized medical care to the medically indigent population within the existing Regionalization Program of Health Care services in the island. With the creation and development of various other academic and health services institutions in the island, and the advent of a new system of health care in 1993, based on managed care; the School's interdependence with the Department of Health and its role in the direct care of the medically indigent have waned drastically. The School now faces its greatest challenges as it begins to insert itself into the economically competitive arena of the new health care system; and in redefining its commitments, while searching for new resources, alliances, teaching faculty, hospitals and clinics, enabling it to maintain its leadership in medical education, specialty training and scientific research in Puerto Rico.

History, 20th Century↗
PubMed2006

Risk assessment and community participation model for environmental asthma management in an elementary public school: a case study in Puerto Rico.

Asthma is a rapidly growing chronic disease in the general population of the world, mostly in children. Puerto Ricans have the highest prevalence of children with asthma among the Hispanic community in the US and its territories. Asthma and air quality are becoming a significant and potentially costly public health issue in Puerto Rico. The CDC has reported that in Puerto Rico, 320,350 adults have asthma and this number represents 11.5% of the island adult population. The north east municipality of Carolina, Puerto Rico, has the highest asthma prevalence in the 0 to 17 year old range (2001 data). In this study, we address the potential relationship between anthropogenic and naturally occurring environmental factors, and asthma prevalence in an urban elementary public school in Carolina in an effort to empower and engage communities to work on their environmental health issues. We integrated geographic information systems (GIS) data of anthropogenic activities near the school as well as the natural resources and geomorphology of the region. We found that as Carolina is close by to Caribbean National Forest (El Yunque), this together with the temperature and precipitation cycles in the zone creates the ideal environmental conditions for increased humidity and pollen, mold and fungi development through out the year. We also collected health and socio economic data to generate an asthma profile of the students, employees and parents from the school community, and through a survey we identified perceptions on environmental asthma triggers, and indoor air quality in the school and homes of the students and employees. Finally, we implemented a workshop on indoor air quality designed to engage the school community in managing asthma triggers and the school environment. Our results showed that nearly 30 % of its student's population has asthma, and from this group 58% are males and 42% are female students. Of all asthmatic children, only 43% receive treatment for the disease. The study also showed that most asthmatic children are between 7 and 9 year old, and live in households with an annual income below 10,000 dollars. It also showed that 25 % of the student's parents have the condition, and that 25% of the employees are also affected by this chronic condition. All these numbers are significantly higher than those reported by the CDC for Puerto Rico. The perception component had a response of 83% of school employees, and a 39% response from parents. It showed that people know asthma as a disease but many can't identify most environmental asthma triggers. Pre and post tests of the workshop protocol showed that before the activity only 21% of participants can identify asthma triggers. At the end of the workshop nearly 80% were able to identify and manage environmental asthma triggers. This work validates the fact that Puerto Rico continues to have a significant number of people with asthma, particularly children asthma, and that schools are an important settings to create community based action plans to manage environmental asthma triggers through outreach and training.

Asthma↗
PubMed1989

Evaluation of a regionalized perinatal care system through linked infant birth and death certificates: Puerto Rico 1980-84.

The birth weight-specific neonatal mortality rates for Puerto Rico are among the highest rates reported in the United States. Furthermore, since 1979, Puerto Rico's neonatal mortality rate has been higher than the neonatal mortality rate for blacks in the United States. Since the proportion of births less than 2,500 grams has remained relatively unchanged in the past 10-15 years in Puerto Rico and in the continental United States, those findings suggest problems of either access or quality of the neonatal care in Puerto Rico. Therefore, we used linked infant birth-death certificates from 1980 through 1984 to evaluate the regionalization of perinatal health services operating on the island. We found that 41.6% of all births less than 1,500 grams were delivered at hospitals without Neonatal Intensive Care Units (NICUs). In addition, delivery at hospitals with NICUs did not confer a survival advantage for infants less than 2,500 grams. The lack of survival advantage in most hospitals with NICUs persisted after we adjusted simultaneously for birth weight, Apgar score at 5 minutes, and history of pregnancy complications. We conclude that the regionalization plan operating on the island needs reevaluation and recommend that preventive measures at the primary, secondary, and tertiary levels be implemented.

Death Certificates↗
PubMed1989

Evaluation of a regionalized perinatal care system through linked infant birth and death certificates: Puerto Rico, 1980-84.

The birth weight-specific neonatal mortality rates for Puerto Rico are among the highest rates reported in the United States. Furthermore, since 1979, Puerto Rico's neonatal mortality rate has been higher than the neonatal mortality rate for blacks in the United States. Since the proportion of births less than 2,500 grams has remained relatively unchanged in the past 10-15 years in Puerto Rico and in the continental United States, those findings suggest problems of either access or quality of the neonatal care in Puerto Rico. Therefore, we used linked infant birth-death certificates from 1980 through 1984 to evaluate the regionalization of perinatal health services operating on the island. We found that 41.6% of all births less than 1,500 grams were delivered at hospitals without Neonatal Intensive Care Units (NICUs). In addition, delivery at hospitals with NICUs did not confer a survival advantage for infants less than 2,500 grams. The lack of survival advantage in most hospitals with NICUs persisted after we adjusted simultaneously for birth weight, Apgar score at 5 minutes, and history of pregnancy complications. We conclude that the regionalization plan operating on the island needs reevaluation and recommend that preventive measures at the primary, secondary, and tertiary levels be implemented.

Death Certificates↗
PubMed2005

Changes in the AIDS epidemiologic situation in Puerto Rico following health care reform and the introduction of HAART.

OBJECTIVES: To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island's public health care system. METHODS: We compared the incident AIDS cases for two three-year periods, 1992-1994 and 1998-2000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamón Health Region (located in north-central Puerto Rico, it includes 11 of the island's 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamón, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramón Ruíz Arnaú University Hospital), the ambulatory health care facilities (Immunology Clinics) for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamón Health Region. RESULTS: Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. CONCLUSIONS: Further gains in Puerto Rico's fight against AIDS will depend on the island's ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Education for public health in Puerto Rico: 1940-1942.

Formal training in public health in Puerto Rico began in 1940 when a degree-granting Division of Public Health was established within the existing School of Tropical Medicine. The division was sponsored by five institutions--the Puerto Rico Department of Health, the U.S. Public Health Service, the Children's Bureau, the University of Puerto Rico, and Columbia University--each which had a different concept of the aims, scope and character of the training. Conflicts relating to these issues were exacerbated by managerial and budgetary problems, and the program began fitfully and with great difficulties. As a result, the training which was planned in 1940 and launched in 1941 was scrapped or redesigned the following year.

Conflict, Psychological↗
PubMed1997

Geographic clustering and seroprevalence of schistosomiasis in Puerto Rico (1995).

A systematic, island-wide survey for schistosomiasis in Puerto Rico has not been conducted for more than 40 years. In 1974, a thorough survey of Boqueron de Las Piedras, a small community, showed a prevalence of 40%. No additional information on prevalence in Puerto Rico has been obtained during the ensuing 21 years. Concern for the public health of residents and visitors prompted the formation of the Bilharzia Commission in 1994 and the systematic serosurvey reported herein. Two thousand nine hundred fifty-five plasma samples from healthy donors were obtained randomly from the Red Cross in March and April 1995. Sex, resident municipalities, and age of the donors were recorded. The donors were from all but three of 79 municipalities in Puerto Rico. No sample was available from the three out island municipalities of Mona, Vieques, and Culebra. Male donors (n = 2,027) outnumbered females (n = 928) by more than 2:1, ages ranged from nine to 76 years with most (85.3%) between 19 and 51 years of age. All samples were tested with the Falcon assay screening test:enzyme-linked immunosorbent assay (FAST:ELISA) with microsomal antigens of Schistosoma mansoni. All FAST:ELISA+ samples were confirmed by enzyme-linked immunoelectrotransfer blot (EITB). Our data showed that 15.4% were FAST:ELISA+, and 10.6% were confirmed by EITB; 13.5% of the males and 4.1% of the females were EITB+. If we exclude those municipalities with fewer than five samples, the prevalence of EITB+ ranged from 0% to 38.5%, with the highest seroprevalence rates (21.1-38.5%) concentrated in 17 municipalities, which accounted for 48% of all seropositive samples. These 17 municipalities, however, contain only 18% of the total population of Puerto Rico. Two areas of high seroprevalence rates center around Jayuya (38.5%) and Naguabo (36.4%). The previously surveyed area of Boqueron is located in Las Piedras (35.3%), adjacent to Naguabo. In addition, we found 10% (21) of our total 215 donors less than 25 years of age to be EITB+ and all but two are residents of the high prevalence districts. These data strongly support the contention that schistosomiasis has been transmitted in a focal fashion during the past approximately 20 years.

Adolescent↗
PubMed2001

Trends in HIV seroprevalence and needle sharing among Puerto Rican drug injectors in Puerto Rico and New York: 1992-1999.

This study assessed trends in HIV seroprevalence and needle-sharing behaviors among Puerto Rican injection drug users (IDUs) in Puerto Rico and New York. Data from two studies of IDUs conducted from 1992 through 1995 and 1998 through 1999 in Bayamón, Puerto Rico, and East Harlem, New York, were examined to assess trends over this period. Separate analyses were conducted for IDUs who were current crack smokers. Significant decreasing trends in seroprevalence were found among IDUs in the New York and Puerto Rico samples (p <.001). Significant decreasing trends in receptive and distributive needle sharing were found in the New York sample, and a significant decline in receptive sharing was found in the Puerto Rico sample. Overall, higher levels of needle-sharing behaviors were reported in Puerto Rico compared with New York. Decreasing trends in needle sharing and seroprevalence in both communities are an encouraging finding. Ongoing epidemiologic studies to monitor the epidemic and continued prevention efforts to help maintain or further these declines are needed, particularly to address the higher rates of needle sharing in Puerto Rico.

Adolescent↗
PubMed2007

Severe anxiety symptomatology and HIV risk behavior among Hispanic injection drug users in Puerto Rico.

Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.

Adult↗
PubMed1990

[Malignant melanoma in Puerto Rico].

An epidemiological study of malignant melanoma in Puerto Rico was done by reviewing the Puerto Rico Cancer Registry for all melanoma cases reported between the years 1981 to 1987. A total of 367 new cases were documented with the annual incidence ranging from 1.20 to 2.12 per 100,000 inhabitants with a mean of 1.59. Most of the patients were between 40 and 80 years of age with a peak in the sixties. Nearly one half of the tumors were located on the extremities, most notably on the feet, sharing this predilection with Blacks and Japanese. The most frequently recognized clinico-histologic type was the superficial spreading melanoma followed by the acral lentiginous, the nodular and the lentigo maligna melanoma. Nearly one third of the total cases were not classified according to the histologic type, while Clark's levels and Breslow's thickness were not reported in 44 and 84% of the cases, respectively. When compared to a previous study during 1977 to 1980, the average annual incidence of new cases increased from 0.92 to 1.59 per 100,000 documenting an increased incidence of the condition in our population, but not as significant as that registered in the United States.

Adolescent↗
PubMed1985

Turtle-associated salmonellosis in Puerto Rico. Hazards of the global turtle trade.

After the Puerto Rico Department of Health received a report of salmonellosis in an infant who had contact with a pet turtle, we conducted a case-control study in two urban areas in Puerto Rico to measure the extent of pet turtle-associated salmonellosis there. Ten (17%) of 60 infants with salmonellosis but none of their matched controls had a history of exposure to a pet turtle in the two weeks before onset of illness. Two other case patients were also exposed to a pet turtle--an 8-year-old child and an adult with acquired immunodeficiency syndrome and Salmonella bacteremia. A variety of Salmonella serogroups were represented in the turtle-associated cases. All turtle lots collected from pet shops in Puerto Rico were culture-positive for Salmonella; 89% yielded Salmonella pomona. Contamination of the turtles probably occurred at the farm before distribution, since S pomona was also isolated from turtles exported from the same farm to Guam and to Yugoslavia. The estimated 3 to 4 million turtles exported annually from the United States are an important potential route for global dissemination of human salmonellosis.

Adult↗
PubMed1998

Abortion in Puerto Rico: the limits of a colonial legality.

This paper situates the current abortion practice and policy in Puerto Rico within the historical, political, and economic context of the colonial domination of the United States (US) over Puerto Rico. In particular, we pay attention to the hurdles that women face to obtain abortion services in Puerto Rico as a result of its colonial legality. Of particular significance is the overall low abortion ratio, and differential abortion ratio and access issues faced by women when grouped by an age-ethnicity category: unmarried teenagers, adult Puerto Rican women and, adult immigrant women from the Dominican Republic. The present hurdles to abortion access--related to information, abortion providers, economic situation, and government policies--are discussed within the colonial legality of abortion based on the US Supreme Court decision Roe v. Wade. Puerto Rico's case is situated within its broader history of population policies developed by the State since the 1930's. Of particular relevance is the antagonism that State managers have had towards abortion in spite of its legality. In this sense, abortion in Puerto Rico continues to be an unfinished business, in spite of its legality.

Abortion, Legal↗
PubMedDate not supplied

Hereditary colorectal carcinoma syndromes and their implications for colorectal carcinoma in Puerto Rico.

During the last 41 years cancer of the colon in Puerto Rico has markedly increased as reported by the Puerto Rico Cancer Registry. The etiology of this increase remains elusive, but possibilities include an increase in reporting new cases, dietary modifications, exposure to carcinogens, as well as an hereditary predisposition. The importance of Hereditary Nonpolyposis Colorectal Cancer (HNPCC) in Puerto Rico, its molecular genetics, diagnostic criteria, and management will be discussed.

Adult↗
PubMed2000

Longitudinal studies of Aedes aegypti (Diptera: Culicidae) in Thailand and Puerto Rico: blood feeding frequency.

We used a histologic technique to study multiple blood feeding in a single gonotrophic cycle by engorged Aedes aegypti (L.) that were collected weekly for 2 yr from houses in a rural village in Thailand (n = 1,891) and a residential section of San Juan, Puerto Rico (n = 1,675). Overall, mosquitoes from Thailand contained significantly more multiple meals (n = 1,300, 42% double meals, 5% triple meals) than mosquitoes collected in Puerto Rico (n = 1,156, 32% double meals, 2% triple meals). The portion of specimens for which frequency of feeding could not be determined was 31% at both sites. We estimated that on average Ae. aegypti take 0.76 and 0.63 human blood meals per day in Thailand and Puerto Rico, respectively. However, frequency of multiple feeding varied among houses and, in Puerto Rico, the neighborhoods from which mosquitoes were collected. In Thailand 65% of the mosquitoes fed twice on the same day, whereas in Puerto Rico 57% took multiple meals separated by > or = 1 d. At both sites, the majority of engorged specimens were collected inside houses (Thailand 86%, Puerto Rico 95%). The number of blood meals detected was independent of where mosquitoes were collected (inside versus outside of the house) at both sites and the time of day collections were made in Puerto Rico. Feeding rates were slightly higher for mosquitoes collected in the afternoon in Thailand. Temperatures were significantly higher and mosquitoes significantly smaller in Thailand than in Puerto Rico. At both sites female size was negatively associated with temperature. Rates of multiple feeding were associated positively with temperature and negatively with mosquito size in Thailand, but not in Puerto Rico. Multiple feeding during a single gonotrophic cycle is a regular part of Ae. aegypti biology, can vary geographically and under different climate conditions, and may be associated with variation in patterns of dengue virus transmission.

Aedes↗
PubMed1978

Dengue fever with hemorrhagic manifestations: a report of three cases from Puerto Rico.

During the 1975 dengue epidemic in Puerto Rico, we studied three patients who had serologically confirmed dengue with hemorrhagic manifestations. None of the patients went into shock and none died. Only one of the patients had disease that resembled dengue hemorrhagic fever (DHF) as observed in Southeast Asia. This patient was a 14-year-old boy who had epistaxis, a positive tourniquet test, moderate thrombocytopenia, and significant hemoconcentration. The other two patients had hemorrhagic disease which was of clinical importance, but was not typical of DHF. These cases of dengue with hemorrhagic manifestations are the only ones known to have been documented in Puerto Rico.

Adolescent↗
PubMed1991

Acaricide susceptibility of Amblyomma variegatum (Acari:Ixodidae) from Puerto Rico and Guadeloupe.

Base-line data on acaricide susceptibility of larvae and of larvae and nymphs of the tropical bont tick, Amblyomma variegatum (Fabricius), from Puerto Rico and Guadeloupe were collected on 14 and six compounds, respectively. Nymphs 7-8 weeks old from Puerto Rico and Guadeloupe, and larvae 3-4 weeks old from Guadeloupe, were exposed for 24 or 48 h to residues of acetone dilutions of technical-grade or commercial formulations of acaricides on disposable glass pipettes. Effectiveness of the acaricides in killing nymphs (LC50) from Guadeloupe and Puerto Rico ranged from 0.0001% for deltamethrin2 to 0.269% for malathion. For Puerto Rico, the susceptibility to toxaphene and amitraz, but not to dioxathion, increased with increasing age of nymphs. Nymphs from Guadeloupe were 9.5 times more susceptible to chlorpyrifos than nymphs from Puerto Rico. The susceptibility of larvae from Guadeloupe to acaricides tested ranged from LC50 0.000012% for deltamethrin to 0.0141% for ethion. There was no evidence of development of acaricide resistance in ticks from Guadeloupe or Puerto Rico.

Animals↗
PubMed2006

Rates of cesarean delivery among Puerto Rican women--Puerto Rico and the U.S. mainland, 1992-2002.

Cesarean delivery has been associated with greater risks for maternal morbidity, longer hospital stays, and rehospitalization after childbirth than vaginal delivery. On the U.S. mainland (i.e., 50 states and District of Columbia), rates of total cesarean delivery and primary cesarean delivery (i.e., for women without a previous cesarean) per 100 live births decreased from 1992 to 1996 before increasing from 1996 to 2002. During 2002, among all U.S. mainland births (approximately 4 million), 26% were by cesarean delivery; among all mainland births to women without a previous cesarean delivery, 18% were by primary cesarean. Cesarean delivery rates for Puerto Rican women who delivered on the U.S. mainland were similar to those for all women on the mainland. By contrast, among all 52,747 births in Puerto Rico in 2002, 45% were by cesarean delivery; among births in Puerto Rico to women without a previous cesarean delivery, 33% were primary cesarean deliveries. In addition, during 1996-2002, annual rates of vaginal births after cesarean delivery (VBAC) (i.e., per 100 live births to women who had a previous cesarean delivery) were lower in Puerto Rico than on the U.S. mainland. To compare trends in cesarean delivery during 1992-2002 among Puerto Rican women who delivered in Puerto Rico and on the U.S. mainland, CDC and the Puerto Rico Department of Health analyzed birth certificate data from the National Vital Statistics System (NVSS). This report summarizes the results of that analysis, which determined that, during 1992-2002, total and primary cesarean rates were consistently higher in Puerto Rico than among Puerto Rican women on the mainland. From 1996 to 2002, total and primary cesarean rates increased for Puerto Rican women in both places of delivery, but rates increased more sharply for women in Puerto Rico than on the mainland. The results suggest that measures to reduce the number of cesarean deliveries in Puerto Rico should focus on lowering the rate of primary cesarean deliveries, especially among women at low risk for a cesarean delivery.

Adult↗
PubMed1994

Measles--Puerto Rico, 1993, and the measles elimination program.

In the Commonwealth of Puerto Rico, a resurgence of measles peaked in 1990 when 1805 cases (51.3 cases per 100,000 population) and 12 measles-related deaths were reported. This report summarizes the persistence of measles transmission in Puerto Rico in 1993 and describes the Puerto Rico Measles Elimination Program.

Adolescent↗