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PubMed1999

Age-specific decrease in seroprevalence of schistosomiasis in Puerto Rico.

In our previous work, we reported the first systematic, island-wide, serologic survey for schistosomiasis in Puerto Rico in 40 years. In that study, approximately 3,000 serum samples from the 76 municipalities comprising the island of Puerto Rico were tested for the detection of antibodies to S. mansoni microsomal antigens by the Falcon assay screening test-enzyme-linked immunosorbent assay (FAST-ELISA) and those positive were confirmed by an enzyme-linked immunoelectrotransfer blot (EITB). The highest EITB positivity was found in 17 municipalities, which comprised 48% of all seropositive samples. An additional finding was that 10% of the 215 EITB-positive samples were from individuals 25 years or younger and were for the most part of residents from the high seroprevalence areas. Thus, for this study we focused on 766 individuals 25 years of age or younger (45.5% males and 54.4% females), two-thirds of which were from 10 municipalities with the highest EITB seropositivity, and one-third from the 10 municipalities with the lowest EITB seropositivity found in our previous study. Of all samples, the results showed an overall FAST-ELISA positivity of 11.6%, with males similar to females (12.6 versus 10.7%, respectively). Confirmation by EITB was only 1.8%, with a males three-fold higher than females (3% versus 0.7%). When seropositivity was measured by age in five-year increments, a clear age-specific decrease in seropositivity was observed. Thus, by FAST-ELISA, 16.7% of the 21-25-year-old age group was positive, decreasing to 14.6%, 9.9%, 7.9%, and 9.3% in the 16-20-, 11-15-, 6-10-, and 1-5-year-old age groups, respectively. Confirmatory EITB showed even more impressive results: 4.7%, 2.6%, 1.2%, 0.7%, and 0% in the same age brackets. With regard to the high prevalence municipalities, only four of 10 (11 of 228 = 4.8%) had confirmatory EITB-positive samples and most were from municipalities of the Rio Grande de Loiza River basin and tributaries. The male to female positivity ratio was 4:1. Of the low prevalence municipalities, only single positive cases (by EITB) were found in three disperse municipalities. These results support the concept that there has been little transmission of S. mansoni in Puerto Rico during the first half of the 1990s and confirms anecdotal comments of local physicians who have seen virtually no new infections during the past three years. This makes the documentation of eradication of schistosomiasis from Puerto Rico feasible, a goal that should be set as being before the 100th anniversary of its discovery on the island by Isaac Gonzalez-Martinez in 1904.

Adolescent↗
PubMed1984

An analysis of poison control center reports of ciguatera toxicity in Puerto Rico for one year.

Forty-five cases of ciguatera poisoning in Puerto Rico (P.R.) are described. These cases represent all those reported to the P.R. Poison Control Center in 1982. Most of the cases were reported in the spring and summer months. The most common fish ingested was the grouper. The clinical presentation of acute and long term symptoms was similar to that reported in other geographical areas, except the incidence of paresthesias. Paresthesias were reported in 11% of the patients reported to the poison center. A companion telephone survey indicated that persons in P.R. that do not eat fish do so because of fear of ingesting the toxin. Our findings indicate an overall familial contact with the ciguatera toxin in Puerto Rico at 7%. This study is the first to document that ciguatera is a common poisoning reported to the Poison Control Center in Puerto Rico. Our findings also support other authors contentions of geographical variations in clinical symptomatology.

Adolescent↗
PubMed1991

Smoking-attributable mortality, years of potential life lost, and direct health care costs for Puerto Rico, 1983.

The authors report the impact of smoking upon health in Puerto Rico for the year 1983. Using a microcomputer spread-sheet program that calculates smoking-attributable disease impact, they estimated that 2,468 deaths were attributable to smoking. This represented 11.5% of all deaths on the island in 1983 and resulted in approximately 19,445 years of potential life lost (YPLL). It appears that cigarette smoking caused US+55.9 million in direct health care expenditures for Puerto Rico in 1983, an amount equal to 10% of the island's yearly expenditures on health. Calculations such as these demonstrate the enormous disease impact of smoking and may assist policy-makers in planning prevention and intervention activities, both in Puerto Rico and elsewhere in Latin America.

Adolescent↗
PubMed2003

Dental caries prevalence of twelve year olds in Puerto Rico.

OBJECTIVE: To assess the prevalence of dental caries amongst twelve-year old Puerto Ricans. DESIGN: Population-based, cross-sectional study. SETTING: Public and private schools in the 11 health regions of Puerto Rico. SUBJECTS: A probabilistic sample of 12-year old school attendees in Puerto Rico. METHOD: One thousand four hundred and thirty-five subjects were evaluated following NIDCR criteria and methodology for DMFS and DMFT indicators from a population of approximately 70,000 12-year olds during April through December 1997. RESULTS: The overall mean DMFS was 6.5 (SE 0.38) and ranged from 9.2 in the Central Region to 5.3 in the Metropolitan and West Regions. The mean DMFT was 3.8 (SE 0.18). The decayed component comprised 42% of the DMFS; caries prevalence for the population was 81%. CONCLUSION: The mean DMFS for twelve year olds is higher than the mean DMFS of 4.2 to 4.7, reported for 12 to 17 years olds in the USA. Dental caries is a highly prevalent disease amongst 12-year olds in Puerto Rico.

Child↗
PubMed1997

Identification of the domestic mite fauna of Puerto Rico.

This study was conducted to identify the domestic mite fauna of Puerto Rico. A total of 57 dust samples were collected from mattresses in homes of 11 cities on the Island. The analysis of the samples revealed that 73.70% of the mattress samples had at least one mite species. The identified species include: Dermatophagoides pteronyssinus (45.6%), Blomia tropicalis (31.6%), Cheyletus sp. (19.3%), Dermatophagoides farinae (17.5%), Euroglyphus maynei (5.3%), Dermatophagoides sibonei (1.8%), Dermatophagoides sp. (1.8%), Suidasia melanensis (1.8%) and mite species that were not identified (5.3%). Differences in the geographical distribution of mites showed that only Blomia tropicalis is more frequently in the northern (43%) than in the southern region (19%) of Puerto Rico (OR 3.36, p, 0.046). This finding can be explained by the fact that in the northern region the relative humidity is significantly higher that in the southern region (p < 0.001). No significant differences were observed for other species or in the total mite counts between the northern and southern regions. The small sample size of this study may explain the lack significance for some of the differences found. Nevertheless, our results indicate that the domestic mite fauna is composed of several clinically important species, their numbers are high enough to be considered in the sensitizing levels, and the diversity of these species is comparable to other observations in the Caribbean areas, and in the southern states in the continental US. Based upon our results, we recommend that when performing the skin test in Puerto Rico, extracts from the identified local domestic mite species be included in the allergen panel. This may prove useful in the aid for the diagnosis and management of atopic conditions.

Animals↗
PubMed1987

Dengue in Puerto Rico: clinical manifestations and management from 1960's to 1987.

Dengue is a viral disease transmitted by the Aedes aegypti mosquito. It is endemic in Puerto Rico and the Caribbean with periodic epidemics occurring at varying intervals. There are three dengue serotypes present in Puerto Rico, at the present time. The clinical manifestations of dengue in Puerto Rico are presented from a historical perspective. Dengue in Puerto Rico has evolved from a clinically mild illness in the 1960's to a devastating disease with hemorrhagic manifestations in the 1980's and dengue shock syndrome in 1987. The approach to clinical diagnosis and management is presented with emphasis on early recognition, performance of tourniquet test, serial hematocrits and aggressive intravenous fluid replacement with crystalloids of colloids in DSS. The best way to treat dengue is eliminating the vector, therefore, prevention.

Dengue↗
PubMed1999

Preliminary results of the Annual Survey of Deaf and Hard of Hearing Children and Youth in Puerto Rico: the first wave.

Preliminary findings are provided from the data collected in Puerto Rico through the Annual Survey of Deaf and Hard of Hearing Children and Youth during the 1997-1998 school year. The study was conducted as a part of an initiative to increase participation in the Annual Survey among the deaf and hard of hearing school-age population in Puerto Rico. Demographic, instructional, etiological, audiological, and communication data on 336 deaf and hard of hearing school age children were collected and summarized. The findings suggest the existence of a heterogeneous deaf community rather than the traditionally conceived homogeneous community. The discussion emphasizes the description of those attributes that suggest heterogeneity and the urgent need to continue to collect the kind of data gathered in the survey. The authors urge that Puerto Rican educators and researchers be stimulated to address the educational and health-related needs of Puerto Rico's deaf and hard of hearing school-age population.

Adolescent↗
PubMed1989

Evaluation of the eradication program for Amblyomma variegatum (Acari:Ixodidae) on Puerto Rico.

A cooperative effort between the United States Department of Agriculture, Animal and Plant Health Inspection Service, Veterinary Services, the Agricultural Research Service, and the Department of Agriculture, Commonwealth Government of Puerto Rico has been successful in eradicating Amblyomma variegatum (Fabricius) from the islands of Puerto Rico and Vieques (an island municipality of Puerto Rico). Application of acaricides to livestock and dogs at 14-day intervals for an 18-month period eliminated foci of tick infestation on 188 farms in four different locations without additional aerial or ground treatment. Reasons for the success and some of the costs associated with the eradication program on Puerto Rico are presented.

Animals↗
PubMed1993

Low birthweight and infant mortality in Puerto Rico.

OBJECTIVES: The purpose of this study was to quantify the relative contributions of maternal age, education, marital status, hospital of birth, and use of prenatal care to the high incidence of low birthweight and infant mortality in Puerto Rico. METHODS: An analysis was conducted of 257,537 live births that occurred from 1986 through 1989 among Puerto Rico residents and the 3373 corresponding infant deaths. Binomial multiple regression models were used to calculate the adjusted population attributable risks for each variable. RESULTS: Our estimates indicate that approximately 6 of every 10 infant deaths on the island are potentially preventable if low birthweight were eradicated, regardless of other associated factors. Eliminating risks associated with sociodemographic and socioeconomic factors (including hospital of birth) would potentially decrease the incidence of low birth-weight in Puerto Rico by one third. Specifically, the elimination of risks associated with the socioeconomic disadvantage of women delivering in public hospitals alone would potentially decrease Puerto Rico's low birthweight incidence by 28%, regardless of other factors considered in our study. CONCLUSIONS: Efforts to prevent low birthweight and infant mortality in Puerto Rico should focus on reducing the gap between the private and public sectors.

Adolescent↗
PubMed2006

Adult male height in an American colony: Puerto Rico and the USA mainland compared, 1886-1955.

The links between adult height and socioeconomic-political marginality are controversial. We test hypotheses by comparing secular trends between two groups of USA adult male citizens born during 1886-1930: (a) 9805 men surveyed in Puerto Rico during 1965 and (b) 3064 non-Hispanic Whites surveyed on the mainland during 1971-1975. Puerto Rico provides an apt case study because it is the oldest colony in the world and was the poorest region of the USA during the 20th century. During the period considered the average adult man in Puerto Rico was 164.8 cm tall, 8.3 cm shorter than the average adult man on the mainland (173.1cm). Both groups experienced secular improvements in height, with men on the mainland having higher rates than men in Puerto Rico. In neither case were results statistically significant. The modest changes in Puerto Rico likely reflect the offsetting role of improved health and a stagnant rural economy during the first half of the 20th century.

Body Height↗
PubMed2006

Dengue-related deaths in Puerto Rico, 1992-1996: diagnosis and clinical alarm signals.

BACKGROUND: Dengue, although endemic in Puerto Rico, is often not mentioned in the death certificates of decedents with laboratory results positive for dengue. Because confirmatory results are usually not available during hospitalization, we examined the utility of 2 instruments for diagnosis on the basis of clinical findings: the definition of dengue hemorrhagic fever (DHF) and the publicized (but unevaluated) clinical alarm signals for impending dengue shock. METHODS: We studied data from all patients with laboratory test results positive for dengue who died (23 patients) and from the 8 patients whose death certificates listed dengue as a cause of death but whose laboratory test results were negative for dengue in Puerto Rico from 1992 through 1996. We examined hospital records to determine whether the clinical criteria for DHF were fulfilled and evaluated the incidence and timing of clinical alarm signals (intense, sustained abdominal pain; persistent vomiting; sudden change from fever to hypothermia; and marked restlessness or lethargy) and the hematocrit/hemoglobin ratio as an indicator of hemoconcentration. RESULTS: A similar proportion of patients with laboratory test results positive for dengue (18 [78%] of 23) and negative for dengue (6 [75%] of 8) fulfilled the criteria for DHF. Clinical alarm signals were found only among patients with laboratory test results positive for dengue and were usually noted on the day that the patient's condition deteriorated. The hematocrit/hemoglobin ratio identified 1 (6%) of 16 patients with dengue who had significant hemoconcentration. Important comorbidities were present in 16 (70%) of the patients with laboratory test results positive for dengue and in 4 (50%) of the patients with dengue-related deaths with laboratory test results negative for dengue. CONCLUSIONS: Dengue-related deaths in Puerto Rico often occur in patients with comorbidities. Among such patients, the DHF definition and the hematocrit/hemoglobin ratio were not useful in identifying patients with laboratory test results positive for dengue. In contrast, the clinical alarm signals for shock supported the dengue diagnosis and should alert clinicians to the severity of the disease.

Adolescent↗
PubMed2006

The prevalence of pit and fissure sealants among twelve year olds living in Puerto Rico during 1997.

OBJECTIVE: to estimate the prevalence of pit and fissure sealants on first permanent molars in twelve year olds living in Puerto Rico and to further evaluate dental sealant prevalence by (1) urban/rural and public/private school status as well as (2) gender; DESIGN: population-based, cross-sectional study. SETTING: public and private schools encompassing the 11 health regions of Puerto Rico. SUBJECTS: a probabilistic sample of 12-year old school attendees in Puerto Rico representing a population of approximately 70,000. METHOD: during April through December 1997, the first permanent molars of 1435 subjects were evaluated by visual and tactile methods for the presence of dental sealants. RESULTS: the data collected revealed that 4.3% of 12 years olds presented at least one permanent first molar sealed. A statistically significant difference (p = 0.01) between urban-public (2.5%), rural-public (3.39%) and urban-private (11.0%) schools was observed. The prevalence of sealants was higher in males (5.5%) than females (2.9%); (p = 0.02). CONCLUSIONS: the prevalence of dental sealants in the first permanent molars of 12-year olds living in Puerto Rico during 1997 (4.3%) is lower than that reported in the United States (18.5%). Sealant prevalence was higher in males and students attending (urban) private schools.

Age Factors↗
PubMed1999

[Breast feeding in Puerto Rico: traditional patterns, national trends and future strategies].

The Puerto Rican society has gone through profound transformations during the past 50 years. Industrialization and the incorporation of women into the labor force have been accompanied by medicalization of the reproductive process and a progressive reduction in the prevalence of breastfeeding as the cultural norm for nutrition of infants. The data base for 1990 places Puerto Rico significantly below Latin America and the United States in the percentage of breastfed infants. The authors report their experience in the promotion of breastfeeding during the last 5 years. The principal negative factors which hinder the beginning and maintenance of successful breastfeeding are of a social nature. The orientation of physicians towards technology underrates the benefits of breastfeeding. The marketing strategies of the corporations which manufacture artificial milk continuously violate the International Code for Marketing of Breast Milk Substitutes and disfigure the community's perception on the benefits of breastfeeding. The lack of social and legal support for the breastfeeding working mother frequently prevents her from carrying out successful breastfeeding for the recommended period of time. Strategies are presented for the overturn of the existent barriers which have reduced breastfeeding in Puerto Rico to the present precarious levels.

Breast Feeding↗
PubMed2004

Prevalence of chronic hepatitis C virus genotypes among patients between 21 to 65 years old in Puerto Rico.

OBJECTIVES: This is the first study done in Puerto Rico to estimate the prevalence of hepatitis C virus (HCV) genotype distribution in patients with chronic infection and to determine the statistical association between the genotype and variables such as age, sex, HCV risk factors, and viral load. METHODS: Chronic HCV infected patients diagnosed with ELISA, RIBA or PCR from 1990 to 2002 who were under follow up with members of the Puerto Rico Gastroenterological Association were asked to participate. Eligible patients were those without evidence of HIV or other viral hepatic infection; had no previous antiviral treatment or if previously treated, therapy ended at least six months prior to their participation in the study; had no history of organ transplant and were willing to participate. All study subjects completed a study questionnaire and had blood samples taken to determine HCV genotype and viral load. RESULTS: 500 patients were recruited. Most of the study subjects were males (68%); 70% were 45 to 65 years old. The principal reported risk factors were: surgeries (75.5%), drug use (46.8%), sexual relationships with intravenous/intranasal drug users (30.3%), blood transfusions (30.2%), multiple sex partners (28.9%), tattoos (22.0%), needle accidents (12.7%), and sexual relationships with an HCV infected partner (9.0%). Most patients had multiple risks factors for infection, only 3.4% (17/500) reported a single risk factor whereas 2.0% (10/500) reported none. 33% of the patients were previously treated (non-responders or relapsers) while 67% were naive. In general, 82% of the HCV patients had genotype 1, while 18% had non-1 genotypes. Among genotype 1 subtypes, genotype la (39.8 %) was more common than 1b (27%). The most common non-1 genotype was genotype 2 of which 2b represented 9.8% of the study population. Similar distribution was observed within the categories of the HCV risk factors, with the exception of those who reported sex with an infected partner (p=0.018), sex with multiple sexual partners (p=0.049) and IVDU (p=0.006). For patients in which the viral load was 2 million IU/ml or less, the genotype la (41%) predominates, followed by 1b (29%) and 1a/1b (9%); patients with viral load was greater than 2 million IU/ml, the genotypes distribution was 1a (38%), 1b (24%), and 2b (12%). After adjusting by type of patients (naive and treated), age and gender, no significant association (p<0.05) were found between two-categories of genotype (1 vs. non-1) and HCV risk factors. CONCLUSION: This cross-sectional epidemiological study demonstrated that the most frequent genotype found in Puerto Rican HCV infected patients is genotype 1. The principal risk factors associated in our population were: surgeries, drug use, blood transfusions, sexual relationships with IVDU, and multiple sex partners. The statistical evidence showed that the genotype distribution is not affected by the HCV risk factor, after adjusting by type of patients (naive and treated), age, gender or geographical area.

Adult↗
PubMed1993

Eradication of a new focus of Amblyomma variegatum in Puerto Rico.

In May 1992 an infestation with the tropical bont tick appeared in a small dairy heifer replacement herd in Camuy, Puerto Rico, a completely new site located near Puerto Rico's northwest coast. This finding occurred after some three years of no infestation in either Puerto Rico or the U.S. Virgin Islands and is not suspected of being associated with any previous infestations. The methods used to eradicate this tick include spray treatment at a two-week interval of all domestic livestock, with amitraz at 0.025% and permethrin at 0.055%. Dogs and chickens are also inspected. Owners are encouraged to reduce numbers of these species. All livestock on adjoining farms are inspected and treated on a frequent basis. There has been no evidence of any spread and the infestation is expected to be eliminated within 18 months.

Animals↗
PubMed1976

Dengue outbreaks in Guánica-Ensenada and Villalba, Puerto Rico, 1972-1973.

Epidemics of dengue fever occurring in Puerto Rico in 1963 to 1964 and 1969 were caused by dengue-3 and dengue-2 (DN-2) viruses, respectively, but endemic dengue transmission has never been documented on the Island. Since the 1969 epidemic, a surveillance system has detected DN-2 activity on the Island during each of the years 1970 through 1973, which suggests endemic persistence of the virus. This report describes the investigation of localized outbreaks of DN-2 in Guanica-Ensenada (1972) and Villalba (1973), and presents epidemiological, serological, and virological data from the outbreaks. Analysis of geographic distribution of dengue activity in Puerto Rico in recent years indicates that the DN-2 transmission in 1970 to 1973 may represent a long tail-off of the 1969 epidemic rather than the emergence of a truly endemic situation.

Adolescent↗
PubMed1985

Field testing along a disease gradient: some geographical dimensions of tuberculosis in Puerto Rico.

The spatial pattern of reported tuberculosis incidence in Puerto Rico is characterized by numerous high-low gradients among continguous municipios. Tuberculin testing of some 1500 subjects along one such gradient reveals that there is no difference in sensitivity and suggests that the gradients are artifacts of reporting. Correlative associations with tuberculin conversion were generally weak, except for age-dependency. Collected personal histories demonstrated that the web of familial and intergenerational relationships is a major force in perpetuating the disease. Concealment of infection, denial and poor compliance in chemotherapy regimens compound the difficulties of case-discovery and case-control. Interviews in a sample of twelve health centers confirmed that, without the presence of trained and assigned tuberculosis nurses, the health care providers' 'index of suspicion' for tuberculosis is generally low. Absence of a tuberculosis clinic virtually dictates serious under-reporting of incidence in that municipio. Despite the success of Puerto Rico's control program over past decades, a reservoir of tuberculosis persists. The level of endemicity is relatively low but unsatisfactory in the context of public health aspirations.

Adolescent↗
PubMed1997

The epidemiology of mental disorders in the adult population of Puerto Rico.

OBJECTIVES: The main objective of the manuscript is to present a review of the literature of the psychiatric epidemiological studies carried out in Puerto Rico in the last decade. BACKGROUND: Data from three major epidemiological surveys carried out in the last decade is presented which provide evidence against prior long standing observations that Puerto Ricans reported higher levels of psychiatric symptomatology as compared to other populations and ethnic groups in the United States. METHODS: The studies selected for review were the universe of population epidemiological studies carried out in Puerto Rico in the last decade. All studies used island wide probability sampling procedures to select the study population. RESULTS: Rates of psychiatric disorders in Puerto Rico were found to be significantly different from those obtained in United States communities. Exceptions were somatization disorder and symptoms which were found to be significantly more common in Puerto Rico and drug abuse/dependence which was found to be considerably less common in the island as compared to the Unites States adults in the age range of 17 to 67 years old. CONCLUSION: In spite of several indicators of social disruption in the island, the prevalence of most psychiatric disorders does not appear to be more prevalent than in other communities in the United States and other parts of the world. Risk factors for mental disorders are also similar, although sex ratios for gender linked disorders are more marked in the island.

Adolescent↗