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PubMed2003

Mortality among Hispanic drug users in Puerto Rico.

This paper assesses mortality rate for a cohort of drug users in Puerto Rico compared with that of the Island's general population, examining causes of death and estimating relative risk of death. Date and cause of death were obtained from death certificates during 1998. Vital status was confirmed through contact with subjects, family, and friends. HIV/AIDS was the major cause of death (47.7%), followed by homicide (14.6%), and accidental poisoning (6.3%). Females had higher relative risk of death than males in all age categories. Not living with a sex partner and not receiving drug treatment were related to higher mortality due to HIV/AIDS. Drug injection was the only variable explaining relative risk of death due to overdose. Puerto Rico needs to continue developing programs to prevent HIV/AIDS among drug users. Special attention should be given to young women, who appear to be in greatest need of programs to prevent early mortality.

Adult↗

PubMedDate not supplied

Interventional nephrology in Puerto Rico.

Vascular access is emerging as a critical issue for hemodialysis patients in Puerto Rico. In more than 50% of the hemodialysis patients, tunneled hemodialysis catheters are the sole access for providing dialysis therapy. Most disturbing is the fact that a significant number of these catheters are nontunneled temporary catheters, sometimes placed in the subclavian vein. These facts have contributed significantly to the morbidity and mortality seen in chronic dialysis patients. In addition, many cases of early or late dysfunction of arteriovenous access are not detected and treated in a timely manner due to the lack of a comprehensive vascular access program for end-stage renal disease (ESRD) patients. In fact, monitoring programs to identify and detect vascular access dysfunction are virtually nonexistent in many chronic dialysis units. Even when diagnosed, it is not treated in a timely fashion. Recently literature has shown that procedure-related delays in the treatment of patients with renal disease can be minimized and nephrology care more efficiently delivered by a nephrologist trained in nephrology-related procedures. In an effort to optimize the care of our ESRD patients, we took the initiative to develop an interventional nephrology program that effectively deals with vascular access-related procedures in a timely manner. This approach has minimized delays, decreased hospitalizations and the use of temporary catheters, and improved the medical care of our chronic dialysis patients. So far we have performed more than 400 procedures in the 6 months since the initiation of the program. In this article we describe our initial experience with interventional nephrology in Puerto Rico.

Angioplasty, Balloon↗

PubMed1995

Depressive symptomatology in single women heads of households in Puerto Rico: a comparative analysis.

The present study examines depressive symptomatology among women in Puerto Rico, using data from an island wide population-based sample. We focus on single women heads of households (SWHH) defined as divorced, separated, widowed and never married women with no permanent mate who have the main economic responsibility for their households. The study aims to identify social factors such as family responsibilities, stressful life events, and reduced levels of social support, that may contribute to the risk for depressive symptoms in these women. This is a growing population: the 1990 Census reported that 23% of all households in Puerto Rico were headed by women, an increase from 14% in 1970. The present study was based on a probability sample of adults (17-68 years), interviewed using a structured schedule, from which we analyzed the female subjects. Women were classified in three mutually exclusive groups: single women heads of households (SWHH, n = 138), single women not heads of households (SWNHH, n = 104), and married women not heads of households (MW, n = 275). Our finding that single women heads of households were especially vulnerable to depressive symptomatology is consistent with that of other studies in the United States. Also consistent with previous research, SWHH were found to be older, poorer, have less education and more often lived in urban areas, as compared to other women. Having children at home was associated with more depressive symptoms among both groups of single women, but not among married women. And the availability of emotional supporters had a weaker effect for SWHH. Furthermore, quality of support was found to be more important for these women than number of persons available for emotional support. The study has several implications for family policy and mental health prevention. Since SWHH are vulnerable for depressive symptomatology and their number is increasing, programs should be developed to attend the special needs of these women. These programs could include the provision of child care and the creation of self-help groups to build on their strengths and to combat isolation and loneliness.

Adolescent↗

PubMed2001

Urban expansion and the loss of prime agricultural lands in Puerto Rico.

In many countries where the economy has shifted from mainly agricultural to industrial, abandoned agricultural lands are lost to urbanization. For more than 4 centuries the Puerto Rican economy depended almost entirely on agriculture, but sociopolitical changes early in the 20th century resulted in a shift to industry. This shift in the economy, and an increase in population, has resulted in an increase in urban areas. This study describes the rate and distribution of urban growth on the island of Puerto Rico from 1977 to 1994 and the resulting influence on potential agricultural lands. Urban extent and growth were determined by interpreting aerial photographs and satellite imagery. The 1994 urban coverage was combined with a soil coverage based on agricultural potential to determine the distribution of urban areas relative to potential farmlands. Analyses showed that in 1977, 11.3% of Puerto Rico was classified as urban. After 17 years, urban areas had increased by 27.4% and urban growth on soils suitable for agriculture had increased by 41.6%. This represents a loss of 6% of potential agricultural lands. If this pattern of encroachment by urban growth into potential farmlands continues, Puerto Rico's potential for food production in the future could be greatly limited.

Agriculture↗

PubMed2003

Guidelines on the cost-effectiveness of larval control programs to reduce dengue transmission in Puerto Rico.

OBJECTIVE: In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. DESIGN AND METHODS: Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition, we examined how these guidelines would change with an early warning system that provides information on a possible outbreak of dengue. RESULTS: In Puerto Rico, larval control programs that are expected to reduce dengue transmission by 50% and cost less than US$ 2.50 per person will be cost-effective. Programs that cost more per person but that further reduce transmission are still likely to be cost-effective. Having an early warning system, even one that provides a low level of accuracy, can extend the range of larval control programs that are cost-effective. For example, with an early warning system, a larval control program that reduces dengue transmission by 50% and that costs less than US$ 4.50 per person would be expected to be cost-effective. CONCLUSIONS: Guidelines such as the ones that we developed for Puerto Rico can be useful to public health authorities in helping to decide whether or not to spend resources for a larval control program to reduce dengue transmission. The range of larval control interventions that are cost-effective can be increased by having an early warning system that provides even a small amount of information regarding possible outbreaks.

Aedes↗

PubMed2006

A comparative study of mortality among Puerto Rican injection drug users in East Harlem, New York, and Bayamon, Puerto Rico.

Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY-HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR-HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.

Adult↗

PubMed1989

Isolation of saprophytic Cryptococcus neoformans from Puerto Rico: distribution and variety.

Until the present decade, no studies had been conducted in Puerto Rico on the saprophytic distribution and variety of Cryptococcus neoformans. Samples (522) of pigeon droppings from 14 western towns were tested for the presence of C. neoformans. The yeast was recovered from 24.7% (129 isolates) of the samples, representing 10 of the 14 towns studied. All environmental isolates were identified as C. neoformans var. neoformans using canavanine-glycine-bromthymol blue (CGB) agar. The yeast was isolated from 79.4% of the samples in one town, Isabela. The average number of yeast cells isolated from sites within this municipality was 5.1 x 10(5) per gram of pigeon droppings. This was 2.6 times the average number of yeast cells of C. neoformans isolated from sites in other towns. In addition, the yeast was isolated from four patients with the acquired immune deficiency syndrome (AIDS), each of whom died of cryptococcal meningitis. Each of these poorly encapsulated isolates was identified as C. neoformans var. neoformans using CGB agar. The results of this investigation demonstrate that C. neoformans var. neoformans is prevalent in Puerto Rico.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Mutation of a new gene causes a unique form of Hermansky-Pudlak syndrome in a genetic isolate of central Puerto Rico.

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder characterized by oculocutaneous albinism and a storage pool deficiency due to an absence of platelet dense bodies. Lysosomal ceroid lipofuscinosis, pulmonary fibrosis and granulomatous colitis are occasional manifestations of the disease. HPS occurs with a frequency of one in 1800 in north-west Puerto Rico due to a founder effect. Several non-Puerto Rican patients also have mutations in HPS1, which produces a protein of unknown function. Another gene, ADTB3A, causes HPS in the pearl mouse and in two brothers with HPS-2 (refs. 11,12). ADTB3A encodes a coat protein involved in vesicle formation, implicating HPS as a disorder of membrane trafficking. We sought to identify other HPS-causing genes. Using homozygosity mapping on pooled DNA of 6 families from central Puerto Rico, we localized a new HPS susceptibility gene to a 1.6-cM interval on chromosome 3q24. The gene, HPS3, has 17 exons, and a putative 113.7-kD product expected to reveal how new vesicles form in specialized cells. The homozygous, disease-causing mutation is a large deletion and represents the second example of a founder mutation causing HPS on the small island of Puerto Rico. We also present an allele-specific assay for diagnosing individuals heterozygous or homozygous for this mutation.

Alleles↗

PubMed1991

The Puerto Rico and New York State tumor registries: problems associated with the use of cancer incidence data in migrant studies.

This paper discusses specific problems pertaining to compatibility of data between the Puerto Rico and New York State tumor registries, which is applicable to other studies comparing cancer incidence rates from two distinct tumor registries. Discrepancies in the data between the two tumor registries were due to differences in quality control, under and overreporting of cancer cases, reliability indicators, and case criteria. A study comparing stomach cancer incidence rates between Puerto Rico and Puerto Rican migrants to New York City provided the foundation for this investigation.

Emigration and Immigration↗

PubMed2005

Respiratory syncytial virus-related bronchiolitis in Puerto Rico.

BACKGROUND: Respiratory syncytial virus (RSV) is an important cause of respiratory tract disease in infants and young children. Immunoprophylaxis is available for high-risk infants. This study reviews infants with bronchiolitis at three primary care hospitals to describe the epidemiology of RSV infection in Puerto Rico. METHODS: We analyzed data from 2 hospitals by obtaining the number of infants diagnosed with bronchiolitis and estimating the percentage of cases due to RSV. A third hospital included patients with confirmed RSV infection. RESULTS: There were 4,557 patients in the study. RSV infection occurred throughout the year. Data shows a progressive decrease in RSV-positive infections. CONCLUSIONS: Data confirms year-round incidence of RSV in Puerto Rico. A standardized surveillance system in Puerto Rico is imperative to determine RSV epidemiology. The decrease in positive RSV infections may be due to the introduction of immunoprophylaxis to high-risk patients.

Bronchiolitis↗

PubMed2005

Isla evangelista-a story of church and state: Puerto Rico's faith-based initiatives in drug treatment.

This article describes the debates leading to Puerto Rico's Mental Health Law of 2000, which defined addiction as a spiritual and social problem rather than a mental disorder, in order to trace three competing approaches to addiction in Puerto Rico: evangelist, biomedical, and harm-reductionist. Highlighting the ways in which the evangelist approach of Puerto Rican street ministries challenges the individualism underlying US faith-based initiatives and the punitive approach of the US War on Drugs, this article concludes that the virtues of the evangelist approach to addiction would be best supported by public funding for biomedical and harm-reduction approaches within a pluralistic system of treatment for addiction.

Christianity↗

PubMed1990

AIDS risk behavior patterns among intravenous drug users in Puerto Rico and the United States.

We interviewed 385 IV drug users recruited in the streets of the San Juan metropolitan area and compared our findings with comparable results from projects in the United States. As expected, intravenous (IV) drug users, irrespectively of the race or ethnic group they belong to or the geographical setting in which they live, are still practicing HIV risk behaviors. Overall, IV drug users in this analysis are young, however, both Puerto Rican and Hispanic groups have completed less years of school than Blacks and Whites in the United States. The fact that almost half of Puerto Rican IV drug users in the United States reported illegal activities as a source of income surprised investigators. However, as hypothesized by investigators, almost half of the Island's IV drug users reported to live with parents. Puerto Rican IV drug users are still practicing HIV risk behaviors, they inject drugs and use shooting galleries to inject drugs more frequently, and are less likely to clean needles and use condoms than Puerto Ricans in the U.S., Blacks and Whites. It is a well known fact that intravenous drug users are the largest group at risk for the acquired immunodeficiency syndrome (AIDS) in Puerto Rico and among Puerto Ricans in the United States. IV drug users are also the major risk for heterosexual transmission and main source of perinatal transmission of the disease. Thus, resources for preventing AIDS in Puerto Rico are needed most among IV drug users, where 44.5 of the subjects in this study are HIV positive.

Acquired Immunodeficiency Syndrome↗

PubMed1999

[Health status and functional limitations in the elderly population of the University Region of Health of Puerto Rico: methodologic aspects and prevalence estimates].

In order to plan the health services for the elderly population, it is necessary to quantify their health status and their functional capacity. In Puerto Rico, few epidemiological studies have been conducted regarding functional capacity and chronic diseases in the elderly population. One of the difficulties to undertake these studies is the high cost and risks to move this population for clinical exams, in addition to the methodology limitation of self-report in the elderly population. This study shows the use of logistic regression to estimate the prevalence of chronic diseases and functional capacity, when the observed data are not consisted with the planed sampling scheme. Four hundred and eighty-seven elderly persons (65 yr. and over) were interviewed in the municipalities of Canóvanas, Carolina, Loíza and Trujillo Alto in Puerto Rico, using a cross-sectional design. More than half of the elderly had visual problems (IC 95%: 54.8%, 63.8%), arthritis (IC 95%: 52.7%, 61.5%) and hypertension (IC 95%: 47.3%, 56.3%). In the case of hypertension, significant differences (p < 0.05) by sex were observed, where women reported a higher prevalence than men. One of the higher prevalences in the functional capacity status was with urine accidents. More than one-third of the population is estimated to have this problem (IC 95%: 34.7%, 43.4%). One-fourth of the population had limitations with going out for shopping (IC 95%: 23.9%, 31.9%) and using public and private transportation (IC 95%: 19.5%, 26.9%). We conclude that the applied methodology was consistent with the estimation presented in the literature and statistics from the Puerto Rico Health Department. However, it is necessary to continue assessing the design and analytical methodology, in order to undertake consistent and periodic evaluations of the elderly population.

Activities of Daily Living↗

PubMed2002

Prevalence of steroid receptors and HER 2/neu in breast cancer biopsies of women living in Puerto Rico.

OBJECTIVE: The purpose of this study is to determine the prevalence rate of estrogen and progesterone receptors and HER 2/neu in the breast cancer biopsies analyzed in the Laboratory of Immunohistochemistry of the University of Puerto Rico School of Medicine in the year 2000. This data may serve as a reference point for future studies of the epidemiological aspects of breast cancer among women living in Puerto Rico. BACKGROUND: Determination of estrogen receptor (ER) and progesterone receptor (PR) on biopsy specimens of breast carcinoma prior to treatment is standard practice in the management of breast carcinoma. ER and PR are used to identify patients who are likely to respond to endocrine therapy. The prevalence of ER, PR and Her2/neu among USA women is 77%, 55% and 10-34%, respectively. One of the major clinical roles for testing HER 2/neu expression is to determine eligibility for treatment with Trastuzumab. METHODS: Retrospective analysis of 309 breast cancer biopsies was done. Paraffin embedded blocks of breast cancer tissue biopsies were received from different hospitals and Pathology Laboratories located throughout the island specifically for routine analysis of steroid receptor (ER/PR) and/or HER 2/neu expression. Immunostaining was performed in a Ventana Medical Systems automated instrument. RESULTS: Positive nuclear staining for ER and PR were seen in 65.9% (203/308) and 51.8% (159/307), respectively. In the HER2/neu test, 27.8% (46/165) gave a strong and complete membranous staining (score 3+). CONCLUSIONS: There is a lower prevalence of estrogen receptor in the breast cancer biopsies of women living in Puerto Rico than their USA counterparts, but similar prevalence of progesterone receptor status and HER 2/neu protein over expression.

Adult↗

PubMed2002

Virologic risk factors for vertical transmission of HIV type 1 in Puerto Rico.

HIV-1 vertical transmission in Puerto Rico has decreased significantly due to the implementation of antiviral therapy. Several studies have shown that the phenotype of the HIV-1 isolates initially recovered from infected infants has generally been one that replicates rapidly, infects macrophages, and preferentially use the CCR5 coreceptor. Our hypothesis is that viral genotypic and phenotypic differences exist between HIV-1 nontransmitter and transmitter mothers. Viral DNA samples and virus isolates were analyzed from a Puerto Rican perinatal population. Heteroduplex tracking assay (HTA) was performed on DNA samples to detect env V3 evolutionary variants and the extent of heterogeneity within each sample. HIV-1 C2-V3 variants were cloned from each patient to study sequence variation among the groups. Differences in replication kinetics of viral isolates in macrophage and GHOST CCR5 cells were analyzed by use of repeated measures linear regression analysis. HTA analysis showed that only two nontransmitter patient samples showed the presence of evolutionary variants. Phylogenetic analysis between maternal-infant pairs showed that transmission of a single maternal variant occurred, with the exception of one sample pair. When evaluating amino acid sequences from cloned PCR products, nontransmitting mothers appear to have a higher number of distinct sequences than both the transmitting mothers (p = 0.0410) and the infected infants (p = 0.0315). Analysis of replication kinetics indicated that transmitters showed faster replication kinetics in GHOST CCR5 cell cultures at 12 days postinfection (p = 0.0434) and 15 days postinfection (p = 0.0181). In conclusion, viral homogeneity and rapid replication kinetics were correlated with vertical transmission.

Acquired Immunodeficiency Syndrome↗

PubMed1970

Control of schistosomiasis in Guayama and Arroyo, Puerto Rico.

In 1953, a programme to control schistosomiasis mansoni was started in Guayama and Arroyo, Puerto Rico, employing, first, chemical and, later, both biological and chemical methods to control Biomphalaria glabrata, the snail host of Schistosoma mansoni. Sodium pentachlorophenate was the molluscicide, and an ampullarid snail, Marisa cornuarietis, was used for biological control in ponds and reservoirs. In addition some chemotherapy was given to infected persons. The prevalence of intestinal schistosomiasis was measured annually, sampling about one-third of the 6-year-old population in Guayama and Arroyo and in Caguas, an untreated area. Costs of the programme and the results are discussed in relation to similar projects in other parts of Puerto Rico. In Guayama and Arroyo the prevalence of schistosomiasis reached zero in 6-year-olds by 1966 despite the persistence of the disease in a nearby untreated area. Although this decline appeared related to the control effort, it is noted that a large decline also occurred in the untreated area, suggesting the influence of other factors such as economic development or improvements in sanitation.

Child↗

PubMed1988

Left ventricular hypertrophy among dark- and light-skinned Puerto Rican men: the Puerto Rico Heart Health Program.

Racial groups were assessed by determinations of skin color in 3366 urban men in the Puerto Rico Heart Health Program, an epidemiologic study of coronary heart disease in Puerto Rico. These men participated in a comprehensive cardiovascular examination that included assessment of blood pressure, relative weight, physical activity, cigarette smoking, left ventricular hypertrophy (LVH) as determined by ECG, and measurements of skinfold thickness. They were followed for mortality over the next 6 years. Dark-skinned Puerto Rican men had a higher prevalence of both definite and possible LVH-ECG after stratifying by levels of hypertension, relative weight, physical activity, number of cigarettes smoked, and subscapular skinfold thickness. After multivariate adjustment of these factors, the dark-skinned men had approximately twice the prevalence of both definite and possible LVH-ECG as the lighter skinned men. Definite LVH-ECG carries a high mortality risk over the next 6 years as compared to men without definite LVH (fivefold increased risk in lighter skinned and sevenfold increased risk in darker skinned Puerto Rican men).

Adult↗

PubMed1998

Syringe and needle exchange as HIV/AIDS prevention for injection drug users in Puerto Rico.

This study evaluated the effectiveness of the first needle exchange program (NEP) established in Puerto Rico. The data for this study were collected during the first months of the NEP from July 1995 to March 1996 in 13 communities of the San Juan metropolitan area. Subjects were the participants of two modalities of the NEP: a mobile team and a community-based drug treatment program. During the 3-week evaluation period, 2401 injection drug users (IDUs) were recruited, resulting in a total of 19,195 exchange contacts and 146,323 syringes exchanged. No significant change in drug injection was observed. However, the program was effective in reducing sharing of syringes and cookers. The study suggests that the NEP did help in reducing needle sharing in Puerto Rico. However, the HIV seropositivity in returned syringes suggests the need to continue aggressive prevention programs to arrest the epidemic among IDUs. However, factors related to the socio-cultural environment as well as cultural norms and traditions need to be considered when planning and expanding NEPs.

HIV Infections↗