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PubMed1996

The 1986 dengue and dengue hemorrhagic fever epidemic in Puerto Rico: epidemiologic and clinical observations.

In 1986 Puerto Rico experienced its eleventh dengue outbreak of this century, but the first with simultaneous transmission of three dengue virus serotypes, and the first with significant numbers of severe and fatal hemorrhagic disease. Overall, 10,659 cases were reported; 1,257 cases were laboratory confirmed as having current or recent dengue infection. Dengue 4 (DEN-4) was the predominant serotype (160/363 isolates, 44%) followed by dengue 1 (DEN-1) with 134 isolates (37%) and dengue 2 (DEN-2), 69 isolates (19%). Transmission peaked during September, but large numbers of cases occurred through November. Seventy-one (91%) of Puerto Rico's 78 municipalities had laboratory-confirmed cases. Fifty-one percent of all confirmed cases occurred in metropolitan San Juan. Most cases presented clinically as classical dengue fever, but 37% of all confirmed cases were reported to have developed some type of hemorrhagic manifestation, and 6% reported hematemesis. In addition, 29 laboratory confirmed cases met the WHO case definition for dengue hemorrhagic fever, 3 of which were fatal. Among the 29 laboratory-confirmed cases of dengue hemorrhagic fever/ dengue shook syndrome, virus was isolated from 12; one DEN-1, three DEN-2, and eight DEN-4. Among laboratory confirmed cases, infants less than one year of age were at greater risk of developing dengue hemorrhagic fever/ dengue shook syndrome, hematemesis and any reported hemorrhage than were the other age groups evaluated.

Adolescent↗
PubMed2000

The epidemiology of tuberculosis in patients with AIDS in Puerto Rico: morbidity and survival, 1981-1998.

SETTING: Puerto Rico. OBJECTIVE: To describe the characteristics and survival experience of AIDS patients with tuberculosis (TB) from 1981 through 1998. DESIGN: A population based study using the AIDS Surveillance System, including survival analysis. RESULTS: During the period studied, 1000 AIDS cases were reported with TB, representing 4.3% of total cases. Of these, males accounted for 82.1%, and 84% were diagnosed with pulmonary TB. Approximately 71% of the cases were reported as having died. AIDS cases who were intravenous drug users (IDU) accounted for 63.7% of the cases. The median survival of AIDS/TB cases was 21.4 months, and did not differ by sex or TB site (P > 0.05). IDUs with TB had a longer survival than IDUs with other AIDS-defining conditions; however, AIDS/TB cases with a CD4 count < 200/mm3 had a poorer survival (23.4 months) than those with a count of > or = 200/mm3 (47.9 months). CONCLUSIONS: The overall prevalence of TB in AIDS patients in Puerto Rico is low compared with other countries. As in other studies, the variable that explained poorer survival among AIDS/TB cases was the CD4+ lymphocyte count. Further prospective studies regarding survival in the Hispanic population are needed to confirm these findings.

AIDS-Related Opportunistic Infections↗
PubMed2004

Improving access to liver transplantation: the University of Puerto Rico experience.

Liver transplantation is the only treatment for end-stage liver disease. It is costly, difficult, and not performed in Puerto Rico. For these reasons, it has been a limited option for Puerto Ricans with advanced cirrhosis, especially for those with no medical insurance to cover for the procedure. In an effort to improve access to the procedure and offer this chance of life to more Puerto Ricans facing death from complications of advanced liver disease, the Gastroenterology and Liver Diseases Division of the University of Puerto Rico, in collaboration with LifeLink Transplant Institute in Tampa, Florida and the Office of Catastrophic Funds of the Commonwealth of Puerto Rico, opened a clinic for liver transplant evaluation at the Medical Sciences Campus. The purpose of this clinic is to coordinate the pre-transplant evaluation of candidates for this therapy, provide the evaluation by the transplant surgeon in Puerto Rico, expedite the process in seriously ill patients, and offer post-transplant follow-up upon the patient's return to Puerto Rico. The purpose of this article is to describe the experience in this clinic from 1999 to 2003. One hundred ninety-three patients were seen from September 1999 to January 2003. The most common causes for liver disease were hepatitis C and alcohol, alone or in combination. One hundred thirty four were accepted as candidates for evaluation. Of these, 63 had completed the process, 33 were listed for transplantation and 21 had been transplanted by January 2003. Neither education level, marital status, health insurance nor Child score were associated with successful outcome. This clinic offers Puerto Ricans, especially those with limited resources, with a viable access to liver transplantation.

Academic Medical Centers↗
PubMed1992

[The use of silicone breast prosthesis in Puerto Rico].

To obtain data on the use of gel-filled silicone breast implants in Puerto Rico, a study was undertaken by the Division of Plastic Surgery of the University of Puerto Rico. Questionnaires, designed to obtain information about their breast implant patients, were mailed to the 22 plastic surgeons in Puerto Rico. Sixty-eight percent of the plastic surgeons responded. The collected data showed that 1,682 patients received gel-filled silicone breast implants, of whom breast augmentation accounted for 82%, and post-mastectomy reconstruction for 18%. Capsular contracture occurred in 16% and early complications in 2.5% of the patients. Autoimmune disease was rare (.0006%), as was breast cancer (.0002%). Very few patients in Puerto Rico received polyurethane foam covered breast implants (.005%). The risk of problems associated with breast implants in our Island appears to be very low.

Breast↗
PubMed2003

Migration and HIV risk behaviors: Puerto Rican drug injectors in New York City and Puerto Rico.

OBJECTIVES: We compared injection-related HIV risk behaviors of Puerto Rican current injection drug users (IDUs) living in New York City and in Puerto Rico who also had injected in the other location with those who had not. METHODS: We recruited Puerto Rican IDUs in New York City (n = 561) and in Puerto Rico (n = 312). Of the former, 39% were "newcomers," having previously injected in Puerto Rico; of the latter, 14% were "returnees," having previously injected in New York. We compared risk behaviors within each sample between those with and without experience injecting in the other location. RESULTS: Newcomers reported higher levels of risk behaviors than other New York IDUs. Newcomer status (adjusted odds ratio [OR] = 1.62) and homelessness (adjusted OR = 2.52) were significant predictors of "shooting gallery" use; newcomer status also predicted paraphernalia sharing (adjusted OR = 1.67). Returnee status was not related to these variables. CONCLUSIONS: Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.

Adolescent↗
PubMed1998

[Legal secrecy: abortion in Puerto Rico from 1937 to 1970].

The essay discusses abortion in Puerto Rico from 1937 to 1970, concentrating in its legal status as well as its social practice. The research documents the contradictions between the legality of the procedure and a social practice characterized by secrecy. The essay discusses the role of the Clergy Consultation Service on Abortion in promoting the legal practice of absortion in Puerto Rico. It also discusses the ambivalent role of medical doctors who, despite being legally authorized to perform abortions to protect the life and health of women, refused to perform the procedure arguing abortion was illegal. The essay concludes with a brief discussion on perceptions of illegality regarding abortion, emphasizing the contradictions between the practice of abortion and that of sterilization in Puerto Rico.

Abortion, Illegal↗
PubMed2005

Egocentric HIV risk networks among Puerto Rican crack users in New York and in Puerto Rico: impact on sex risk behaviors over time.

This study examined risk network characteristics of Puerto Rican crack users and the relationship between the network and HIV-related sex risk behavior over time. The participants (N = 383 in New York; N = 165 in Puerto Rico), recruited through street outreach, were interviewed at both baseline and 6-month follow-up. The majority of crack users (88%, New York; 92%, Puerto Rico) in the sample named one or more personal risk network members. As compared with New York participants, crack users in Puerto Rico reported larger risk networks and were more likely to engage in sex risk behaviors with strangers or acquaintances. In multivariate analyses, a significant variable in predicting sex risk behaviors at follow-up in both sites was the baseline measure of the dependent variable. Significant network variables were: having any known crack use member less than 6 months and having acquaintance/stranger in network in New York; communicating with network members about using condoms in Puerto Rico. More attention to sex risk behaviors are needed in HIV/AIDS prevention and education programs.

Adult↗
PubMed1998

Optometric manpower in the Commonwealth of Puerto Rico: estimates and projections, 1982-2025.

BACKGROUND: The 1982 study investigated the potential impact of the IAUPR School of Optometry on the adequacy of supply of optometrists in Puerto Rico for the years of 1980-2000. This article is designed to: (1) update the 1982 study; (2) appraise the accuracy of the 1982 projections; (3) re-evaluate the status of optometric manpower in Puerto Rico through the year 2025; and (4) provide the School of Optometry with information necessary to make informed judgments about future enrollments. METHODS: Estimates of supply are based on data from the Colegio de Optometras de Puerto Rico, the Sección de Oftalmología de la Asociación Médica de Puerto Rico, and the enrollment and graduation registries from the School of Optometry. Requirements are based on estimates of annual effective demand, provider-to-population ratios, per capita demand, and optometric productivity. RESULTS: Optometrists comprised 52.2% of Puerto Rico's actively practicing vision care manpower in 1995, with a mean optometrist-to-population ratio of 8.2 per 100,000. The number ranged from 28 in Mayagüez to 107 in San Juan. Under different assumptions regarding supply, productivity, and demand, surpluses and deficits are estimated and projected for the years 1995 to 2025. CONCLUSIONS: Depending on the assumptions used, an undersupply or an oversupply of optometrists may be found in Puerto Rico, currently and in the future. Projections of supply and demand predict a considerable range--from a surplus of 961 optometrists to a deficit of 2,085 optometrists in the year 2025.

Adolescent↗
PubMed1998

[Women and health in numbers. Puerto Rico, 1994].

The purpose of this study was to explore the health situation of women in Puerto Rico through the analysis of the causes of deaths in medical certification contained in death certificates. The data source used was the computer tape containing the data on deaths occurred in Puerto Rico during 1994. This tape was produced by the Puerto Rico Department of Health. The analysis of the main causes of deaths in women showed a trend associated with chronic and degenerative diseases. This trend is compatible with the one found in women over 65 years old. In women under 65 years of age, this trend was also observed, although other causes were also relevant, like deaths by external causes and AIDS. For the age groups of under 15, 15 to 44, 45 to 64 and 65 and over, the principal causes of deaths were: conditions related to the perinatal period, AIDS, cancer and heart and heart related diseases respectively. The degree of vulnerability to death from certain causes of mortality which changes in importance from one age range to another in the female population of Puerto Rico is shown by the results of this research project.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Acute hemorrhagic conjunctivitis in Puerto Rico, 1981-1982.

In late 1981, the Western Hemisphere's pandemic of acute hemorrhagic conjunctivitis spread to Puerto Rico. Over 6,000 cases of conjunctivitis were reported to the Puerto Rico Department of Health from November 1981 to March 1982. Enterovirus 70 was isolated from one of 19 eye-swab specimens tested, and 10 of 13 (77%) individuals with acute hemorrhagic conjunctivitis had neutralizing antibody titers to enterovirus 70 of greater than or equal to 1:4. These data suggest that enterovirus 70 was the etiologic agent of the acute hemorrhagic conjunctivitis outbreak in Puerto Rico. In a study of a lower middle socioeconomic sector with relatively intense transmission, 152 of 670 (23%) persons reported illness consistent with acute hemorrhagic conjunctivitis. The highest attack rate was in the 5- to 14-year-old group (30%), and a disproportionate number of household index cases were in the predominantly school age group (5-19 years old). Twelve per cent (3/25) of asymptomatic household contacts of acute hemorrhagic conjunctivitis cases had sera with neutralizing antibody to enterovirus 70. Retrospective surveillance through ophthalmologists and neurologists identified one patient with a neurologic complication, a seventh nerve palsy temporally associated with recent enterovirus 70 infection. Household transmission was significantly associated with crowding and sharing of beds (p less than 0.05). This and other recent studies in Florida suggest that school age children play an important role in the transmission of acute hemorrhagic conjunctivitis. This study also suggests that asymptomatic enterovirus 70 infection is uncommon, and that in Puerto Rico, neurologic complications associated with acute hemorrhagic conjunctivitis were quite rare.

Adolescent↗
PubMed2002

Tetanus--Puerto Rico, 2002.

During February-May 2002, the Puerto Rico Department of Health (PRDOH) received reports of three tetanus cases, two of which were fatal. The last reported case of tetanus in Puerto Rico had occurred in 1999. This report summarizes the investigations of these three cases, which underscore that health-care providers should ensure that all patients have been vaccinated fully against tetanus.

Aged↗
PubMed1993

Drug-resistant tuberculosis in Puerto Rico, 1987-1990.

We conducted a proportional morbidity study to determine the factors associated with, patterns of, and proportion of cases of tuberculosis with drug resistance in Puerto Rico. We abstracted data from 279 report forms of new cases of tuberculoses reported to the Puerto Rico Health Department between 1987 and 1990 in which isolates had been tested for drug susceptibility. Overall, 55 (19.7%) of the 279 cases of tuberculosis were resistant to at least one drug, and 27 (9.7%) were resistant to more than one drug. Among the 59 patients with previous tuberculosis therapy, 20 (33.9%) had isolates that were drug-resistant. Among the 220 without previous therapy, 35 (15.9%) had isolates that were drug-resistant. For all 279, resistance to isoniazid (INH) was most common (11.1%) followed by streptomycin (SM) (10%), rifampin (RIF) (4.3%), ethambutol (EMB) (2.2%), and pyrazidimide (PZA) (1.1%). A history of previous tuberculosis therapy (odds ratio [OR] = 2.71, 95% confidence interval [CI] = 1.34-5.48) and being born outside the United States and Puerto Rico (OR = 4.76, CI = 1.69-13.39) were independently associated with drug resistance. Because of the high proportion of drug-resistant tuberculosis in Puerto Rico we recommend (1) that all persons in Puerto Rico in whom tuberculosis is diagnosed should initially receive four-drug therapy (INH, RIF, EMB, and PZA), (2) that susceptibility testing be done on initial Mycobacterium tuberculosis isolates from all patients, and (3) that those with a history of previous tuberculosis therapy or those who are foreign-born have very careful clinical and microbiologic follow-up.

Antitubercular Agents↗
PubMed1999

Malignant melanoma in Puerto Rico: an update.

A study about the incidence of malignant melanoma in Puerto Rico during the calendar year 1996 was carried out compiling the information submitted by pathological reports to the Puerto Rico Cancer Registry and identifying similar reports at other pathology laboratories. A total of 107 new cases were documented in 1996, resulting in an incidence of 3.03 (+/- 17.9) per 100,000 persons for that particular year. The age of the patients fluctuated between 19 and 88 years with a mean of 61.3 years, most of them being between 50 and 80 years. More than half of the cases (54.2%) were located in the head and neck, and the extremities. Thickness measurement of the neoplasm was reported in only 42% of the cases. In 60% of those cases in which the tumor thickness was reported, it was found to be less than 1.49 mm. Previous data in Puerto Rico from the years 1981 to 1986 had shown a tendency to an increase in the incidence of melanoma per 100,000 inhabitants rising 1.20 to 1.52 respectively. The present study reflects a continuation of the same pattern, with a two-fold increase in the last 10 years (from 1.52 to 3.03).

Adult↗
PubMed1993

Consequences of return migrant status for employment in Puerto Rico.

"At the aggregate level, return migrants in Puerto Rico in 1970 and 1980 faced greater employment-related difficulties, as compared with nonmigrants. This article explores the individual-level relationship of return migrant status to employment outcomes. The conceptual framework takes into consideration local and regional contextual factors, particularly the employment conditions prevailing in Puerto Rico during this period. Within this framework, specific hypotheses suggest a negative influence of return migrant status.... The findings substantiate the hypotheses for both census years and indicate the importance of the duration of residence in the United States and the timing of the return move as mediating factors."

Americas↗
PubMed1993

[Possible origins of the gene of Hermansky-Pudlak in Puerto Rico].

Five out of six albino persons in Puerto Rico suffer from the Hermansky-Pudlak syndrome. This syndrome has been reported also in other countries such as Great Britain, the Netherlands, Belgium, and Mexico, among others. Due to the geographical isolation of the island it is likely that these patients share a common ancestor. In explaining how the gene may have arrived to Puerto Rico the following possibilities are considered: (1) British soldiers attacking the island since 1595. (2) Dutch attackers in 1625. (3) aboriginal tribes. (4) slave traders.

Albinism, Oculocutaneous↗
PubMed2005

A marked increase in organ donation in Puerto Rico.

During its first years of existence, the Puerto Rico Transplant Program barely reached 18 to 20 renal transplants per year. A brain death amendment to the law improved the numbers but only to a stable thirty/year. Polls and studies showed that, although people knew about transplantation and expressed willingness to donate, the powerful emotional grief reaction, as well as a peculiar decision-making process, all militated against effective donation. In 1995, LifeLink of Puerto Rico was created as part of the very successful LifeLink Foundation of Tampa, staffed by local professionals. Cadaveric donation increased exponentially by 1227% and in 2004, 22.4 donors per million population were recovered, up from 1.5, one of the steepest growth curves in the United States. As a result, kidney transplantation increased, a cardiac transplant program was inaugurated, a pancreas transplant program has started, and liver will follow. The success is the result of well-trained, culturally sensitive coordinators and requestors; continuous education to the public, hospitals, administrators, neurospecialists, and critical care units; hospital development; implementation of federal law; and a sensitive approach the deceased donor family, and not only to the waiting list patients. The results demonstrate that organizational and educational factors can override cultural obstacles.

Brain Death↗
PubMed1998

[Intents to delegitimatize the right to abortion in Puerto Rico].

Analysis of the access to abortion in Puerto Rico is important because, together with Cuba, they are the only countries where abortion is legal in Latin America. This article analyzes the socio-political trends of the debate and discourses through which the discussion of the pro-option and antiabortion sectors have developed in the current situation of Puertorican law and their links with the arguments of those sectors in the United States. Even in this framework of legality, the right to abortion in Puerto Rico has been the object of a process of attacks by the antiabortion sectors that has limited its exercise, and it continues to be a taboo and polemical matter; maybe tolerated, but questioned and undermined as a right, and as a result, delegitimized. The Island situation makes it possible to consider that eradicating the legal prohibition of the practice is not a sufficient element for abortion to become a social need and a right of women in their own conscience, in public opinion and in state interventions.

Abortion, Legal↗
PubMedDate not supplied

Prevalence of headache in Puerto Rico.

BACKGROUND: Headache is one of the most frequently reported disorders in the general adult population. Despite the fact that this disorder is common, no official estimate of the prevalence of headache exists in Puerto Rico. PURPOSE: To examine the prevalence of headache and migraine, specifically, in Puerto Rico. METHODS: A telephone survey of 1610 individuals was conducted. The telephone calls were distributed using the 1990 census adjusted to the population of Puerto Rico in 1998, and according to gender, geographical area, and age. RESULTS: The prevalence of headache in Puerto Rico was 35.9% and migraine, in particular, 13.0%. When prevalence was fractionated by age, gender, and geographical areas, the prevalence of headache was similar for all ages, with females exhibiting a 2:1 preponderance over males. In the younger population (between 20 and 50 years of age), the female-male ratio for migraine was 3:1, and the prevalence for migraine was lower in the Metropolitan area. CONCLUSION: This study, the first of its type in Puerto Rico, demonstrates that headache (and migraine specifically) is a common disorder in this country.

Adult↗