Predictors of adverse events after percutaneous transluminal coronary angioplasty in a group of Hispanic patients

OBJECTIVE: To identify predictors of adverse events after PTCA during hospitalization and after hospital discharge in a private hospital in Puerto Rico. BACKGROUND: A review of the literature shows limited information about predictors of adverse events associated to percutaneous transluminal coronary angioplasty (PTCA) in Hispanic patients. METHODS: This is a non-concurrent prospective study. Baseline variables were analyzed using multivariate logistic regression to identify predictors of adverse events. Data were collected from medical charts and telephone reports from referring physicians. RESULTS: Data from 197 subjects undergoing PTCA were analyzed for this study. Median age of patients was 65 years, and 62.9 of patients were male. Angiographic success rate was 81.6. A total of 8.1 of patients had at least one in-hospital adverse event, and 39.8 had at least one adverse event after hospital discharge. After multivariate analysis, a statistically significant association was found between the presence of at least one lesion with residual stenosis of 50 or greater and the risk of developing adverse events in-hospital (RO 11.75; 95 CI 4.32-31.97). A marginally significant association was found between family history of heart disease (RO 2.75; 95 CI 0.93-8.11) and the risk of adverse events during hospitalization. Family history of heart disease (RO 1.41; 95 CI 0.98-2.04) and the presence of at least one lesion with residual stenosis of 50 or greater (RO 2.87; 95 CI 0.82-10.01) showed marginally significant associations with increased risk for adverse events after discharge. CONCLUSIONS: These findings suggest that the presence of at least one lesion with residual stenosis of 50 or greater and family history of heart disease may be risk factors for adverse events after PTCA during hospitalization and after discharge.

Descripción del estado de salud y la capacidad funcional de la población de 65 años o más residente en la Región Universitaria de Salud de Puerto Rico / Description of health status and functional capacity of the 65-years-old and older population residing in the University Region of Health of Puerto Rico

This study intended to describe the health and functional status of the population 65 years and over resident in the Puerto Rico University Health Region (municipalities of Canóvanas, Loiza, Carolina and Trujillo Alto, Puerto Rico). Four ninety one hundred elderly subjects selected from a random sample of households, were interviewed. A questionnaire was designed to gather data of the following variables: health conditions, functional capacity, health services utilization, social support and preventive measures. Descriptive measures and chi-square were utilized for the statistical analysis. Findings revealed a population composed mostly of women with a higher prevalence of health conditions than their male counterparts. More than half of the sample report visual problems, arthritis or hypertension. Almost a quarter had diabetes mellitus. The prevalence of these conditions was higher in the age group over 75, with the exception of diabetes. Thirty percent of the sample was classified as functionally dependent, condition that increased with the subject's age. Findings evidence the need of an early assessment in this population in order to intervene with potentially modifiable factors to prevent future disability and improve quality of life of the aged.

Prevalence of tuberculin reactivity and risk factors for the development of active tuberculosis admission to a nursing home

A total of 118 nursing home admissions were studied to determine the prevalence of M. tuberculosis infection and the prevalence of risk factors for the development of active tuberculosis. The overall prevalence of positive tests was 22.5 per cent. The most prevalent risk factors for development of active tuberculosis were diabetes mellitus (42.4 per cent), being more than 10 per cent below ideal body weight (41.5 per cent), and alcohol abuse (12.7 per cent). Thirty-four percent of admissions had albumin levels below 3.5 g/dl. No associations were found when logistic regression was used to determine the impact of age and poor nutritional status on the prevalence of positive PPD tests on admission. These results show a substantial difference between the prevalence of positive PPD tests found upon nursing home admissions (22.5 per cent) and the prevalence found previously among residents in the same in nursing home (42.9 per cent).

Prevalence of tuberculin reacting and prevalence of risk factors for the development of active tuberculosis in a nursing home in Puerto Rico

A total of 91 nursing home patients were evaluated to determine the prevalence of tuberculous infection and the prevalence of risk factors for active TB in those with positive tuberculin reactions. Overall prevalence rate for positive PPD was 42.9 percent No association was found between revalence of positive PPD and time since admission to the nursing home. The most prevalent risk factors for active TB among PPD positive patients were diabetes mellitus (38.5percent), being 10 percent below ideal body weight (25.6 percent), chest X ray with fibrotic changes (13.2 percent), and carcinoma of oropharynx (5.1 percent). Twenty-one patients (53.8 percent) of patients with positive test) met criteria for prophylactic treatment with isoniazid. This study detected a high prevalence of positive PPD reactions in this nursing home population and a high prevalence of risk factors for the development of active TB in the group with positive reaction to PPD. Due to the high risk for the development of active tuberculosis in this population, aggressive screening and preventive therapy are mandatory

Prevalence of cognitive and functional impairment in an elderly Puerto Rican population

Data from the Gurabo census of the elderly, 1987-1988 (n = 1890)were analyzed to determine the prevalence rates for cognitive and functional impairment in that population. Besides socio-demographic questions, the census questionnaire included the Short Portable Mental Status Questionnaire to determine cognitive dysfunction, and the modified Katz Scale to detect functional impairment. The overall prevalence rates were 18.5 percent and 18.4 percent for cognitive and functional dysfunction respectively. After multiple logistic regression analysis, cognitive impairment was found to be associated with poor education (OR = 4.0, CI = 2.31-6.93), older age (OR = 2.67, C.I. = 2.00-3.58), functional decline (OR = 2.44, C.I. = 1.83-3.25), female sex (OR = 1.82, C.I. = 1.39-2.40) and low income (OR = 1.49, C.I. = 113-1.98). Functional impairment was found to be associated with cognitive dysfunction (OR = 2.45, C.I. = 1.84-3.27) and older age (OR = 2.08, C.I.-1.59 = 2,72). These findings suggest that a substantial proportion of the elderly in Puerto Rico may require assistance to deal with the consequences of these impairments

Perfil sociodemográfico y medidas del crecimiento físico en pacientes pediátricos con el síndrome de inmunodeficiencia adquirida seguidos en el Hospital Municipal de San Juan: 1986-1990 / The sociodemographic profile and physical growth patterns of pediatric patients with the acquired immunodeficiency syndrome followed at the the San Juan City Hospital: 1986-1990

Puerto Rico ocupó el tercer lugar en el número de casos diagnosticados de SIDA pediátrico en Estados Unidos entre los meses de septiembre de 1989 y agosto de 1990. El mayor número de casos de SIDA pediátrico ha sido identificado en áreas metropolitanas de alto riesgo. Usualmente el SIDA afecta a niños nacidos a madres drogadictas. Este trabajo pretende describir el perfil sociodemográfico y el crecimiento físico de os casos de SIDA pediátrico al presente atendidos en el Instituto de SIDA de San Juan durante los años de 1986 a 1990. En este estudio de naturaleza descriptiva, la muestra consistió de los 40 pacientes vivos con el diagnóstico de SIDA que constituían el universo al realizar la presente investigación. La fuente principal de transmisión fue por vía perinatal (90.0 por ciento) y el factor de riesgo, la drogadicción endovenosa en la madre (67.5 por ciento). El 42.4 por ciento de las madres sostenían una relación consensual. El 70.0 por ciento de los casos nacieron a término (38 semanas) con un peso promedio de 2,954 gramos y talla promedio de 50.9 centímetros. Al momento de presentar síntomas dentro de alguna categoría P2 según criterios del CDC, el 67.7 por ciento estaban debajo de la 50ma. percentila en peso; y el 86.9 por ciento de los casos estaban por debajo de la 50ma. percentila en talla

Differences in patient mix: a partial explanation for the excessive medicare mortality observed in some Pueto Rican hospitals

Data from a census in a Puerto Rican community were used to retrospectively compare patients admitted to government hospitals in terms of demographic variables, mental status and functional status in the community prior to admission. A total of 268 patients admitted to a hospital at least once during the study period were identified. Patients admitted to government hospitals were poorer, less educated, less functional and had a higher level of mental impairment. However, in comparison to private hospitals, stratified analysis showed consistently higher in-hospital mortality rates among patients admitted to government hospitals when other variables were taken into account

Increased alanine aminotransferase (ALT-SGPT) activity in Puerto Rican blood donors

Se obtuvieron datos de 4,189 expedientes de donaciones de sangre procedentes de dos bancos de sangre en Puerto Rico para determinar si los puertorriqueños tienden a tener niveles en sangre de ALT-SGPT más altos en comparación con donantes de sangre de otros grupos étnicos. El promedio general de ALT-SGPT fue de 36.84 u/l (alcance 1-910, desviación estandard 37.8). El logarítmo de ALT FUE DE 1.47 (alcance 1-2.96, desviación estandard). Analisis de cada banco de sangre en dos períodos de tiempo demostraba promedios de ALT-SGPT consistentemente altos aún cuando excluían donaciones positivas para hepatitis B, H. I. V. y sífilis. Aunque las causas de estos hallazgos no estan claras, factores ambientales como el consumo de alcohol deben considerar-se como posibles explicaciones

Factores asociados a la admisión hospitalaria en una población geriátrica / Factors associated with the hospitalary admission of a geriatric population

El estudio investiga los patrones de utilización hospitalaria en personas mayores de 64 años. La determinación de deficiencia intelectual y discapacidad de 1,353 personas mayores de 64 años y acogidos a Medicare fue obtenida de un censo de la población mayor de 59 año realizado en el municipio de Gurabo, Puerto Rico, entre 1987 y 1988. Examinando los datos de hospitalización del programa Medicare en Puerto Rico se encontró que un total de 105 de estas personas fueron hospitalizadas por lo menos una vez durante ese período de tiempo. Para el grupo con deficiencia intelectual y discapacidad la tasa de hospitalización fue de 13.5%. Los que presentan solamente discapacidad tuvieron una tasa de 9.4%. El grupo con deficiencia intelectual solamente tuvo una tasa de 8.8%. La menor tasa de 6,8%, correspondió a los sujetos sin deficiencia intelectual ni discapacidad. Estos datos sugieren una relación entre la presencia de dichas disfunciones y la probabilidad de ser hospitalizado. No obstante, es necesaria más investigación para dilucidar si dicho efecto es independiente de la edad

El envejeciente de Guarabo: un perfil biosicosocial del envejeciente en una comunidad de Puerto Rico / The aging person in Gurabo: a bio-psychosocial profile of the aging person in a community in Puerto Rico

The Department of Family Medicine of the University of Puerto Rico Medicine School performed a census of the inhabitants 60 years and older in the community of Gurabo. A total of 1,890 elderly were interviewed 51% were female and 49% male. Sixty percent were married and twenty-five percent were widowed. Eighty two percent still lived within a family setting and only seventeen percent lived alone 86% owned their own home despite ninety percent reporting incomes below $400.00 per month. Ninety five percent have access to medical services but 63% receive services in multiples sites. Eighteen percent were functionally impaired, fourteen percent intelectually impaired and five percent had impairment in both areas. Preliminary data show that the latter group had an annual mortality rate of 15% compared to only 3.6% and 1.3% respectively in the other two group. We concluded that: 1) functional and mental impairment are indicators of increased mortality. 2) although access to health care is not a problem this health care is episodic and interrupted being provided in multiple different sites