Association between maternal diet factors and hemoglobin levels, glucose tolerance, blood pressure and gestational age in a Hispanic population / Asociación entre los factores de la dieta y los niveles de hemoglobina, tolerancia a la glucosa, presión arterial y edad gestacional en una población hispana

The aim of this study was to describe the dietary patterns of pregnant women in northern Puerto Rico and explore associations between diet factors with pregnancy related measurements. This analysis is based on the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT), a prospective cohort that is studying environmental risk factors for preterm births in PR. Participants completed a food frequency questionnaire (FFQ) around 20-28 weeks of gestation. The following pregnancy related measures were collected from the medical records: hemoglobin, blood glucose, blood pressure and gestational age. Potential associations between diet factors and pregnancy measures were assessed using chi square analysis with SPSS. A total of 180 participants completed the FFQ; low hemoglobin levels was found in 19.2%, high blood glucose levels was found in 21.1% by fasting blood glucose test and 24.6%by 1-hour 50 g oral glucose screening test, high blood pressure was found in 2.9% (systolic) and 6.5% (diastolic), and pre-term birth was found in 10.4% of the participants. High consumption of rice, desserts and sweets was associated with higher levels of fasting blood glucose levels (p<0.05), while high consumption of vegetables was associated with higher 1-hour glucose challenge test (p<0.05).No other significant associations were found. In conclusion, consumption of high dense energy food diets in pregnancy, such as rice, sweets and desserts, can lead to high levels of blood glucose and can be a potential predictor of other pregnancy complications during pregnancy in these study participants, such as gestational diabetes.

El objetivo de este estudio fue describir los hábitos alimentarios de mujeres embarazadas en Puerto Rico y explorar la asociación entre factores dietarios y medidas del embarazo. Este fue un análisis de datos basado en un estudio de cohorte prospectivo (PROTECT), que estudia los factores de riesgo ambientales para el embarazo pre-término en mujeres embarazadas. Las participantes completaron un cuestionario de frecuencia alimentaria (FFQ) en las semanas 20-28 de gestación. Los niveles de hemoglobina, glucosa en sangre, presión arterial y edad gestacional se recogieron de expediente médicos. Posibles asociaciones entre factores dietéticos y las medidas del embarazo fueron evaluadas usando Ji cuadrado en SPSS. Un total de 180 participantes completaron el FFQ; 19,2% tuvo bajos niveles de hemoglobina, 21.1% tuvo niveles altos de glucemia por prueba de glucosa en ayunas y 24,6% por prueba de tolerancia a la glucosa de 1 hora; la hipertensión arterial fue encontrada en 2,9% (sistólica) y 6,5% (diastólica) y nacimiento prematuro fue encontrado en 10,4%. Un alto consumo de arroz, postres y dulces se asoció con mayores niveles de glucosa en ayunas (p<0,05), mientras que el alto consumo de vegetales se asoció con mayor nivel de la prueba de tolerancia a la glucosa (p<0,05). No se encontró ninguna otra asociación significativa. En conclusión, el consumo de alimentos de alta densidad energética en el embarazo como arroz, postres y dulces pueden elevar los niveles de glucosa en sangre, lo cual puede ser un predictor potencial de complicaciones en el embarazo en estas participantes, como diabetes gestacional.

Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999

OBJETIVOS: Examinar las asociaciones entre el estado socioeconómico y la aculturación con las características del estilo de vida que podrían constituir factores de riesgo de diabetes y de enfermedades cardiovasculares en mujeres puertorriqueñas de bajos ingresos. MÉTODOS: Este estudio transversal se llevó a cabo entre 1998 y 1999 mediante entrevistas a una muestra de conveniencia compuesta de 200 mujeres puertorriqueñas de bajos ingresos que cuidaban a niños pequeños en Hartford, Connecticut, Estados Unidos de América. Se usaron diversas formas de reclutamiento para conseguir que hubiera una buena representación de la comunidad blanco. Las asociaciones entre la obesidad (índice de masa corporal > 30,0) y factores propios del estilo de vida (actividad física, tabaquismo, consumo de alcohol, alimentación) por un lado y la clase social (escolaridad, empleo, tenencia de un automóvil), aculturación, edad y estado civil por el otro se examinaron mediante la prueba de rho de Spearman, la de ji al cuadrado y la de la U de Mann-Whitney y análisis de regresión logística.RESULTADOS: La edad promedio fue de 29 años. La obesidad (40%), inactividad física (47%) y el tabaquismo (32%) fueron comunes. Las participantes con menos grado de aculturación fueron 57% menos propensas a ser fumadoras y 54% menos propensas a ser obesas que las que estaban más aculturadas. Pertenecer a una clase social más baja (no haber terminado la secundaria o no tener automóvil) se asoció con una mayor probabilidad de ser obesa, pero las mujeres sin trabajo (por oposición a las que sí lo tenían) mostraron menor propensión a ser obesas (P < 0,05). Las mujeres que no tenían automóvil consumían carne, huevos y pescado con menos frecuencia que las que sí lo tenían. Las fumadoras tenían más probabilidad de tener una alimentación malsana que las que no fumaban.CONCLUSIONES: Las asociaciones entre el grado de aculturación y el estado socioeconómico con algunas características del estilo de vida apuntan a la necesidad de crear programas apropiados desde el punto de vista cultural para promover conductas sanas en esta comunidad de bajos ingresos.

Diabetes-related mortality among Mexican Americans, Puerto Ricans, and Cuban Americans in the United States

OBJETIVOS: Examinar la mortalidad relacionada con la diabetes entre mexicanoestadounidenses, puertorriqueños y cubanoestadounidenses de más de 35 años de edad en los Estados Unidos durante 1996 y 1997. MÉTODOS: A partir de datos del Sistema Nacional de Estadísticas Vitales de los Estados Unidos y de los censos de 1999 y de 2000, calculamos las tasas de mortalidad relacionadas con la diabetes, ajustadas por edad y para cada grupo de edad específico, en mexicanoestadounidenses, puertorriqueños y cubanoestadounidenses de más de 35 años de edad. Se consideraron muertes relacionadas con la diabetes aquellas en las cuales la diabetes se codificó como causa de muerte subyacente o contribuyente. RESULTADOS: La tasa de mortalidad relacionada con la diabetes en mexicanoestadounidenses (251 muertes por cada 100 000 habitantes) y en puertorriqueños (204 muertes por cada 100 000) fue dos veces mayor que dicha tasa en cubanoestadounidenses (101 muertes por cada 100 000). Los cubanoestadounidenses fallecidos tuvieron la mayor proporción de muertes en que la diabetes se codificó como causa subyacente (44%). Después de la diabetes, las enfermedades cardíacas (31%), seguidas del cáncer (8%) y de los accidentes cerebrovasculares (6%), fueron las principales causas de muerte subyacentes relacionadas con la diabetes en los tres grupos étnicos. CONCLUSIÓN: Los análisis de estos datos revelan diferencias en la mortalidad relacionada con la diabetes entre mexicanoestadounidenses, puertorriqueños y cubanoestadounidenses de más de 35 años de edad en los Estados Unidos. Factores socioeconómicos, tales como un bajo nivel educativo y la escasez de ingresos, posiblemente contribuyan a las discrepancias halladas entre las tasas de mortalidad de los diferentes subgrupos. Es necesario llevar a cabo más estudios para actualizar estos resultados e investigar los factores de riesgo que los explican. Se ha seguido observando gran diversidad entre diferentes subgrupos de hispanos en años recientes, factor que debe tomarse en cuenta en el desarrollo de políticas y servicios dirigidos a estas poblaciones.

Effect of alendronate on bone mineral density in Puerto Rican males with osteoporosis

Osteoporosis in men was not recognized as a major health problem until recently, and increased research in this area resulted in the approval of alendronate for the treatment of osteoporosis in men at the beginning of this decade. Low bone mineral density (BMD) has been demonstrated to be a strong predictor of fracture in men as it is in women. The causes of osteoporosis in men are variable and can be classified as primary or secondary. The aim of these report is to present the response of BMD in 10 Puerto Rican men with secondary causes of osteoporosis treated with alendronate. A significant increase of BMD in spine, total hip, trochanter and intertrochanteric regions were noted. A non-significant increase in femoral neck was observed.

Infliximab in Hispanics: characterization of response to infliximab in an ethnic minority with Crohn's disease

PURPOSE: The incidence and prevalence of Crohn's disease (CD) varies geographically and with racial/ ethnic background. The highest frequency of occurrence is in North America and Northern Europe. Incidence is highest among Caucasians, lower in blacks and Hispanics, and lowest in Asians. However in the mid-1980s and 1990s, the incidence and prevalence increased in continental Europe, the Middle East, the Pacific Rim, Africa, and Latin America. An increase in the incidence of CD has been noted in Puerto Rico, although our population differs genetically from other described CD populations. A study in our population showed lower prevalence of ASCA and no NOD2 in our CD patients. Infliximab, a TNFa antibody, is effective in refractory inflammatory CD and in fistulizing disease. Since limited data exists regarding CD in Hispanics, the fastest growing minority group in the United States, we designed this retrospective study with patients treated with infliximab at our institution. We wanted to determine if the response to infliximab in genetically admixed Hispanics differed from that previously reported. METHODS: Baseline characteristics, infusion related information and clinical response was abstracted from medical records. Clinical response was classified as complete response, partial response, and nonresponse. RESULTS: The study included 15 patients treated for refractory inflammatory disease, 9 for fistulizing disease, and 11 for both. The positive response rate was 83%(29/35) and the non response rate was 17%(6/35). Overall the patients with complete, partial, and no response were 13/35(37%), 16/35(46%), and 6/ 35(17%), respectively. No statistically significant association was found between response and disease location. Significant association was found between response and fistula type (p = 0.02). Steroid withdrawal was possible in 21/31 patients (68%). In terms of safety, 9/35 patients (26 %) suffered an adverse reaction, 4 patients required therapy discontinuation. CONCLUSION: This study suggests that infliximab has similar global response, allowance of steroid withdrawal and safety in Hispanics as in other populations. Ethnicity does not seem to influence response rate to infliximab.

Predictors of the Utilization of Oral Health Services by Children of Low-income Families in the United States: Beliefs, Cost, or Provider? / 간호학회지

PURPOSE: This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. METHODS: In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. RESULTS: The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on weekends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. CONCLUSION: The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.

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.

Death as a sentinel event: the mortality experience of Puerto Ricans in the United States

The mortality data for 1996 and 1997 reveal that Puerto Ricans in the United States lag behind other Hispanics in terms of age-adjusted death rates. The better health status of Cubans in the United States can be explained by their immigration history and more favorable socio-economic conditions. The greater mortality risks of mainland Puerto Ricans compared to Mexican-Americans is more difficult to explain. While Puerto Ricans have more entitlements, higher incomes, and more education than their Mexican counterparts, the Mexicans have higher levels of employment and more stable families, indicators which apparently affect the relative risk of death. The data also show that, of all the Hispanic subgroups, the Puerto Ricans exhibit the most marked gender differentials, mainland Puerto Rican men being significantly more at risk than females. Finally, the data on infant mortality show that babies born to Puerto Rican women are less likely to survive their first year of life than infants born to women of other Hispanic origins. Each of these indicators suggests the greater vulnerability of mainland Puerto Ricans and confirms the disadvantaged status of this population vis-a-vis other groups

Congenital diaphragmatic hernia: mortality determinants in a Hispanic population

OBJECTIVES: Determine which factors were associated with mortality in our patients, specifically whether ventilatory parameters and arterial blood gas could be used to predict outcome. The role of delaying surgery and the presence of contra lateral pneumothorax were also assessed. BACKGROUND: Mortality among babies born with congenital diaphragmatic hernia remains high. The associated pulmonary hypoplasia and hypertension account for most of the overall mortality. There is no uniform consensus as to which parameters predict outcome. METHOD: Study population consisted of thirty-two patients with CDH managed during a ten-year period. Retrospective data obtained included: perinatal data, postnatal complications, ventilatory parameter data, arterial blood gas, type and age of surgery. Ventilatory index, oxygenation index and arterial to alveolar oxygen difference (A-aDO2) within the first 24 hours of life and after surgical correction were compared among the 23 patients who underwent surgical correction. Timing of surgery and frequency of pneumothorax were compared between survivors and non-survivors. Epi-Info Software Package was used for statistic analysis. RESULTS: Overall survival was 40 per cent. Survival of surgically corrected infants was 61 per cent. Non-survivors had significantly higher A-aDO2 than survivors (p < 0.05). No significant differences in pCO2, ventilatory index, or oxygenation index were identified between survivors and non survivors. Surgical repair performed after the first twenty-four hours of life, was associated with a higher survival rate (p < 0.05). Fourteen patients (39 per cent) developed contralateral pneumothorax, eleven (79 per cent) of these died. CONCLUSIONS: (1) contralateral pneumothorax was associated with higher mortality, 2) A-aDO2 was a better prognostic indicator than pCO2, ventilatory index, or oxygenation index, 3) delaying surgical repair was associated with better survival rate.

Idiopathic hemochromatosis: a study in a large Puerto Rican family

We studied 13 first-degree relatives in a large family with an index case of idiopathic hemochromatosis to detect the relatives with evidence of iron overloading. Serum iron, total iron binding capacity (TIBC), and serum ferritin levels were measured in all family members. We also performed HLA typing to identify the relatives who are homozygous with the proband and genetically predisposed to develop the disease. The family was composed of the parents and 12 siblings including the index case. The mean age of the siblings was 25 years. None presented with evidence of iron overload by the iron biochemical tests. HLA typing demonstrated six homozygous siblings with the proband. In separate analysis these siblings did not present abnormalities in any of the iron biochemical tests. These homozygous relatives were followed for one year after initial evaluation and none presented abnormalities in the iron studies during this period. These results are contradictory to other previous studies done in families with idiopathic hemochromatosis. The most feasible explanations for these findings are the young age of these siblings and the predominance of females among them. We consider that these homozygous relatives must be followed for their life-times with iron studies to detect a possible increase in iron stores as expected in later ages

Epidemiological study of tinea capitis in Puerto Rico

Two separate studies were carried out to determine the dermatophytes responsible for tinea capitis in Puerto Rico. A retrospective study to determine those agents during the period between 1979 and 1989 revealed a total of 36 mycologically positive cases. The causative organisms consisted of the following species: M. canis, 14 cases (38.9 per cent ); T. mentagrophytes, 7 cases (19.4 per cent ); T. rubrum, 7 cases (19.4 per cent ); M. gypseum, 5 cases (13.9 per cent ); and T. tonsurans, T. verrucosum, unclassified Microsporum species, 1 case each (2.8 per cent each). In a prospective study, fungal cultures were obtained from the scalps of 95 randomly selected children (45 males, 50 females) seen at the outpatient dermatology clinics of the Medical Sciences Campus of the University of Puerto Rico for a variety of skin problems but with no symptoms or signs of disease. One culture was positive for M. canis. All other cultures were negative. The significance of these findings is discussed as well as their relation to the incidence of T. tonsurans scalp infections in the Unites States

Morbilidad durante los XVI Juegos Deportivos Centroamericanos y del Caribe: Delegación de Puerto Rico, México 1990 / Morbidity during the XVI Central American and Caribbean Games: Puerto Rico delegation, Mexico 1990

The health services offered to the Puerto Rican Delegation during the XVI Central American and Caribbean Sports Games in México in 1990 included: medical, dental and psychological assistance, physical therapy and services on the playing field. From the consultation sheets completed during the Games we obtained information about the use of these services. The 336 members of the Puerto Rico Delegation in the village at México City had 1,838 encounters with the health team. Of these, 991 were medical consults, 55 group therapies, 466 physical therapy sessions and 326 encounters in the sports venues. Among the encounters for medical evaluation the most frequent problems were athletic injuries (318; 32.1 percent), respiratory problems (240; 24.2 percent), gastrointestinal conditions (126; 12.7 percent) and dental services (119; 12.0 percent). The most frequent athletic injuries were first degree strains (83; 26.1 percent), tendinitis (56; 17.6 percent), contusions (42; 13.2 percent), myositis (40; 12.6 percent) and first degree sprains (28; 8.8 percent). The health problems found were diversed and in the majority of cases mild in character, which can be attend by adequately trained on sports health primary health professionals

Menarquia, características menstruales y sociodemográficas de mujeres atletas puertorriqueñas en los XV y XVI Juegos Centroamericanos y del Caribe / Menarche, menstrual and sociodemographic characteristics of Puerto Rican female athletes in the XV and XVI Central American and Caribbean Games

This investigation described maturation, menstrual and socio-demographic characteristics of 65 Puerto Rican women athletes that were interviewed during the XVI Central American and Caribbean Games (CACG), Mexico City in 1990. The results were compared with those of Puerto Rican women athletes (n = 52) at the XV CACG, Santiago Dominican Republic, 1986. The quantitative variables (age, age at initiation of training, years of training, age at menarche, birth order, and family size) were not statistically different (t-independent, p > or = 0.05). The observed frequencies for the qualitative variables (menstrual characteristics, degree of certainty in the recall of age of menarche, use of oral contraceptives, and marital status) were very similar. In conclusion: the women at the XVI CAC in Mexico demonstrated similar maturational, menstrual and socio-demographic characteristics to the those athletes evaluated four years earlier in Santiago and based on their long history of training, both samples were representative of athletically mature athletes. The findings were very similar to those reported for olympic athletes and such data expands the available information on Puerto Rican women athletes

Cardiac transplantation in Puerto Rican patients at the Texas Heart Institute

Cardiac transplantation is the treatment of choice for patients suffering from end-stage cardiac disease unamenable to conventional medical or surgical treatment. More than 390 patients have undergone heart transplantation at the Texas Heart Institute in Houston, and nine were Puerto Rican. Overall survival of these patients is 88%. Our experience with patients from Puerto Rico is described

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

Este artículo discute los problemas relacionados con la compatibilidad de información entre los registros de cáncer de Puerto Rico y de el estado de New York. Estos problemas pueden aplicar-se a investigaciones que comparan la tasa de la incidencia de cáncer entre los registros de cáncer. Las discrepancias en información entre los dos registros de cáncer se deben a diferencias en el control de calidad de cada registro, reportaje excesivo o incompleto, los indicadores de confianza, y los criterios usados para definir los casos. Un estudio comparando las tasas de incidencia de cáncer de estómago entre Puerto Rico y puertorriqueños residentes en la ciudad de New York proveyeron la base necesaria para el estudio

Health conditions among elderly Puerto Ricans: gender differences

The health conditions of 466 free-living elderly Puerto Ricans were surveyed islandwide between September 1984 ans September 1985. the questions pertaining to this topic are made up of 17 itms: seven questions about background information and a list of ten of the most frquently reported health conditions among the elderly. It is part of a larger study of the socio-demographic characteristics of this papulation, comprised of 173 questions. The statistical tests of significance utlized were those of Kendall's Tau B and Cramer'sV. The structural variables of sex, age, and marital status were found to be the most statistically significant for the presence of health conditions at the time of the interview. The implications of this for the elderly, social and public policy planners, formal and informal care givers and the health cara establishment are discussed

AIDS prevention program for Puerto Rican women

Históricamente, las mujeres han sido las principales proveedores de cuidados primario; biológicamente, também son el eslabón esencial en la cadena de transmisión del SIDA a sus hijos. Como resultado de esta realidade de esta realidad dual, las mujeres requieren programas culturalmente apropriados que les ayuden a comprender la enfermedad, protegerse a sí mismas y a sus familias y a cuidar de los miembros de sus familias contagiados con el SIDA. A través de entrevistas y revisión de la literatura se hizo un examen de los servicios disponibles en la lucha contra el SIDA. También se realizó un análisis de la aplicabilidad disponibilidad, e idoneidad cultural de la información educativa en la campaña contra la enfermedad. Para asegurar la efectividad de los programas preventivos y que éstos lleguen a las mujeres puertorriqueñas es necesario que estos sean culturalmente idóneos, reconozcan los roles de los dos sexos, y la importancia del rol materno a la mujer latina. Programas efectivos ayudan a las mujeres a poner en práctica la información adquirida y toman en consideración los valores culturales en cuanto a respeto y modestia a la vez que proveen información e instrucción acertada y entendible

Mortalidad por SIDA en mujeres puertorriqueñas en la ciudad de Nueva York, 1981-87 / AIDS - related mortality among Puerto Rican women in New York City, 1981-87

Este estudio analiza el imapcto del SIDA en la mortalidad de la mujer puertorriqueña en la ciudad de Nueva York y la compara a la experiencia de otros grupos de mujeres residentes de dicha ciudad durante los años 1981 al 1987. Esta investigación indica que las puertorriqueñas en la ciudad de Nueva York son las mujeres más afectadas por el SIDA en relación a cualquier otro grupo nacional o étnico. Factores relacionados con este patrón incluyen aspectos económicos y socio-culturales relacionados con el uso de drogas intravenosas, además de patrones de migración y de nupcias. Estos datos tienen una relevancia especial para Puerto Rico dados los patrones de migración entre la población que reside en la ciudad de Nueva York con los de la Isla

Trends and differentials in dietary patterns and nutrient intake among migrant Puerto Rican families

La presente investigación la motivó la preocupación por definir el estado nutricional de familias puertorriqueñas que migran los Estados Unidos de América. Con esta finalidad, se estudió un total de 526 familias residentes en el Sur del Bronx, Nueva York, y cuatro comunidades en Puerto Rico. Los resultados referentes a la ingesta de nutrientes sugieren que la dietas de las madres son bastante adecuadas, en el Sur del Bronx y en Puerto Rico, salvo en lo concerniente al consumo de hirro, en Puerto Rico. Más aún, los datos muestran una aparente tendencia al alto consumo de alimentos, particularmente de tipo proteínico en ambos lugares; revelan, asimismo, un alto consumo de azúcar y bebidas carvonatadas en Puero Rico. Estos datos dietarios fueron corroborados mediante antropometría nutricional, confirmando cierta tendencia al sobrepeso y obesidad en las madres estudiadas. Se informan en detalle cambios ocurridos en la dieta en el trasncurso de los últimos cinco años. Los programas educativos como el de EFNEP, la disponibilidad de nuevos alimentos y la influencia de los niños en el hogar a traves de sus propias preferencias, figuran como factores influyentes en a dinámica de cambios alimentarios de sociedades en transición