Socio-demographic, behavioral, and health correlates of nutrition transition dietary indicators in San Juan, Puerto Rico / Correlatos sociodemográficos, conductuales y de salud de los indicadores alimentarios de transición nutricional en San Juan, Puerto Rico

OBJECTIVE: To identify socio-demographic, behavioral, and health-related correlates of food preferences in Puerto Rico that will help determine Caribbean-region populations vulnerable to nutrition transition. METHODS: Data from a cross-sectional study of a representative sample of 858 adults residing in the San Juan Metropolitan Area of Puerto Rico were analyzed. Multivariable ordinal logistic regressions were used to model the frequency of consumption of 1) fruits and vegetables, 2) tubers/starchy root vegetables, 3) fried foods, and 4) Western-style fast foods as a function of socio-demographic, behavioral, and health-related characteristics. RESULTS: Higher frequency of consumption of fruits and vegetables was associated with being physically active and older and having a medium to high level of education, whereas intake of tubers was associated with being older, having a low income, not using government insurance, and having elevated levels of triglycerides. Frequency of consumption of fast food was associated with younger age, higher income, 12-15 years of formal education, and a higher body mass index (BMI), whereas frequency of consumption of fried food was associated with being younger and male, not being a smoker, and having elevated levels of fasting blood glucose. CONCLUSIONS: The results indicate a nutrition transition in Puerto Rico with health consequences for the Caribbean region. The characteristics of this nutrition transition seem to be determined by income, education, and age, but may also be dictated by access to various food groups. These results set the stage for needed investigation of environmental and individual-level factors that could shape patterns in food consumption.

OBJETIVO: Determinar los correlatos sociodemográficos, conductuales y relacionados con la salud de las preferencias alimentarias en Puerto Rico a fin de ayudar a determinar las poblaciones vulnerables con respecto a la transición nutricional en el Caribe. MÉTODOS: Se analizaron datos procedentes de un estudio transversal de una muestra representativa de 858 adultos que residen en el área metropolitana de San Juan, en Puerto Rico. Se usaron regresiones logísticas ordinales con múltiples variables para modelar la frecuencia de consumo de 1) frutas y verduras, 2) tubérculos feculentos, 3) alimentos fritos y 4) comida rápida de estilo occidental, como una función de las características sociodemográficas, conductuales y relacionadas con la salud. RESULTADOS: Se asoció una mayor frecuencia de consumo de frutas y verduras con un comportamiento físicamente activo y mayor edad, al igual que un nivel de escolaridad de medio a alto, mientras que la ingesta de tubérculos se asoció a una edad mayor, ingresos bajos, no usar el seguro del gobierno y niveles elevados de triglicéridos. La frecuencia de consumo de comida rápida se asoció con una edad menor, ingresos más altos, de 12 a 15 años de educación formal y un índice de masa corporal mayor, mientras que la frecuencia del consumo de alimentos fritos se asoció con una edad más joven y el sexo masculino, no fumar y niveles elevados de glucemia en ayunas. CONCLUSIONES: Los resultados indican una transición nutricional en Puerto Rico con consecuencias para la salud en el Caribe. Las características de esta transición nutricional parecen estar determinadas por los ingresos, la escolaridad y la edad, pero también podrían estar determinadas por el acceso a diversos grupos alimentarios. Estos resultados establecen las condiciones necesarias para la investigación de los factores ambientales e individuales que podrían configurar los modelos de consumo de alimentos.

Prevalence and associated factors of diabetes mellitus in Puerto Rican adults: behavioral risk factor surveillance system, 1999

OBJECTIVE: To estimate the self-reported weighted prevalence of diabetes mellitus among different population subgroups and determine associated factors in Puerto Rico. METHODS: Data gathered from the Behavioral Risk Factor Surveillance Survey (BRFSS) during 1999 was analyzed. RESULTS: The weighted prevalence in Puerto Rico in 1999 was 9.6 (95 CI: 8.5-10.7), highest than reported nationally. It was higher among individuals with increasing age, female sex, decreasing annual income, decreasing educational attainment, being non-employed, having a health care coverage, high blood pressure, high blood cholesterol, and increasing body mass index. Health behaviors and co-morbid conditions significantly associated with diabetes among individuals aged less than 65 years were high blood pressure, high blood cholesterol, obesity and low educational attainment. However, the only significant characteristic associated with diabetes in individuals aged 65 years or more was female sex. Analysis of the data gathered in the diabetes module revealed that nearly 35 were using insulin, 57.4 were using insulin once a day, 14.4 self-monitored their blood glucose one to three times per day, 18.3 reported they have heard of the glycosylated hemoglobin test, and of these, 71.8 had their test performed between one and six times within the past year. Nearly 42 reported their feet were checked and 54.1 had a dilated eye examination last year. CONCLUSION: The high prevalence of diabetes in Puerto Rico underscores the need for developing integrated management strategies for improving quality of diabetes care.

Prevalence of diabetes and patterns of health services utilization: a comparative analysis between a private and a health reform group of insured, 1997-1998

OBJECTIVE: To compare the prevalence and health services utilization patterns of diabetes mellitus in a group of insured under the Puerto Rico Health Reform Act and the private sector of the same insurance company. METHODS: The medical claims of the public sector insured whose main diagnosis was diabetes mellitus (ICD9-250.0-9) were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: A total of 38,139 diabetic cases were identified during the study period. Overall prevalence was 6.23 (95 CI: 6.17-6.29); 5.22 among males (95 CI: 5.14-5.30) and 7.09 among females (95 CI: 7.00-7.18). The proportion of cases was larger in persons aged 65 years or more (60.3) and females (61.6). Overall, 84.7 of insured diabetics had medical office visits, while 7.8 had emergency room services and 1.3 had hospital admissions. Female cases had more physician office visits (62) and insulin prescriptions (65) compared to males (p < 0.05). The most reported complication was cerebrovascular accident (4.4). The prevalence of diabetes was higher in the public sector (6.23) when compared to the private sector (4.73) (p < 0.01). The mean number of oral hypoglycemic (32.77 +/- 0.40) and insulin (40.99 +/- 0.54) prescriptions were higher in the public sector (p < 0.01). Emergency room utilization rate was larger among males in the younger age groups of the private sector. However, hospital admissions were larger in both sexes of the younger age group of the public sector when compared with the private sector. CONCLUSIONS: A higher prevalence of diabetes and mean service utilization was observed in the public sector. An in-depth analysis of the health care of patients with diabetes in the public sector is needed.

Prevalence of diabetes mellitus among insured of a health insurance company in Puerto Rico: 1997-1998

OBJECTIVE: The purpose of this study was to determine the prevalence of diabetes mellitus in persons covered by a health insurance company. METHODS: The medical claims of persons insured with Triple S Health Insurance Co. of Puerto Rico, whose main diagnosis was diabetes (ICD9-250.0-9), were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: Overall prevalence was 4.73. Prevalence in the male population (5.07) was higher than that of females (4.43) in all age groups, but the difference was not statistically significant (p > 0.05). The proportion of diabetic cases was larger in the > 60 age group. 64 of the cases had 1 or more visits to a physician office, 2 were hospitalized, and almost 3 had emergency room visits. 29 of the cases had insulin prescriptions while 59 had oral prescriptions. The younger age group (< or = 44 years) had a larger utilization rate of emergency room and hospital admissions. Health service utilization varied by age and sex, however, the only significant difference was observed in glucose test services utilization (p < 0.05). CONCLUSIONS: The prevalence of diabetes in this group was lower than the prevalence reported in the Behavioral Risk Factor Surveillance System. This may be partially explained by the fact that the study group did not represent the composition of the Puerto Rican population. Prevalence studies using other groups will be helpful to determine the prevalence of diabetes in Puerto Rico.

The public health burden of diabetes: a comprehensive review

The review of several diabetes epidemiological studies confirms that diabetes is one of the most prevalent non-communicable diseases globally, and it is the fourth or fifth leading cause of death in most developed countries. Diabetes prevalence ranges from nearly 0 in New Guinea to 50 in the Indians of Arizona. No modifiable risk factors have been clearly established in persons with type 1 diabetes, but major environmental determinants have been suggested. Impaired glucose tolerance, gestational diabetes, insulin resistance, obesity and lack of physical activity have been consistently identified as risk factors for type 2 diabetes. The prevalence of diabetes increases with age, but a sex-specific tendency has not been consistent. In addition, the prevalence of diabetes is higher in African-Americans and Hispanics when compared to other ethnic groups. Diabetes affects almost all organs of the body and is the leading cause of blindness and amputations of legs, imposing both clinical and economic costs to patients and society.

Trends in diabetes mellitus mortality in Puerto Rico: 1980-1997

OBJECTIVE: To determine the characteristics and trends of diabetes mortality among the Puerto Rican population from 1980 through 1997. METHODS: Death certificates for Puerto Rican residents whose underlying cause of death was diabetes mellitus (ICD-9-250.0) were reviewed, and sociodemographic information was abstracted. The proportion mortality ratio (PMR) and 95 confidence intervals were calculated by gender, age group, educational level and period of time. Trend analysis in mortality was performed using a Poisson regression model. RESULTS: A total of 26,193 deaths (5.8) were primarily attributed to diabetes mellitus in the study period. Females accounted for 55.8 of all diabetes related deaths. Diabetes accounted for a higher proportion of deaths among persons aged 60-64 years (8.14), persons aged 65-74 (8.12), females (7.73) and those with 1-6 years of education (7.08). The PMR steadily increased from 4.55 in the 1980-85 period to 6.91 in the 1992-97 period. There was a higher mortality in male diabetic subjects aged < or = 64 than in females during the 18 year period. Between 1980 and 1991, females aged 65-74 had a higher mortality than males, however, mortality increased in males of the same age group during 1992-97. When the oldest age group (> or = 75) was examined, males had a higher mortality between 1986 and 1997, whereas females had a slightly higher rate between 1980 and 1985. CONCLUSIONS: Our results indicate that diabetes mortality has been markedly increasing in the Puerto Rican population, primarily in persons aged 65 years or more. Further analysis is needed to evaluate the determinants of mortality in diabetes.

Natural history and incidence of premature thelarche in Puerto Rican girls aged 6 months to 8 years diagnosed between 1990 and 1995

OBJECTIVE: To describe the natural history and estimate the incidence of premature thelarche in girls aged 6 months to 8 years living in Puerto Rico and diagnosed between 1990 and 1995. BACKGROUND: In the 1970s and 1980s, several pediatric endocrinologists, based on their clinical experience, acknowledged a dramatic increase in the number of cases of precocious sexual development in Puerto Rico. In 1987, the Puerto Rico Health Department developed the Registry of Premature Thelarche and Precocious Sexual Development, which began to operate in 1989. Data regarding the long-term outcomes of girls diagnosed with premature thelarche are insufficient. Knowledge about the natural history of this condition is relevant for predicting the long-term prognosis and therapeutic management of the affected population. METHODS: Of 2,716 cases of precocious sexual development reported to the Premature Thelarche and Precocious Sexual Development Registry, 1,916 (70.5) were premature thelarche. The clinical characteristics and evolution during follow-up of premature thelarche cases were described and compared by age group at diagnosis. RESULTS: Incidences were 6.2 and 1.62 per 1,000 live births for girls aged < 2 years and 2 to 8 years, respectively. These estimates were 10 and 15 times higher than those reported in Olmsted, MN. When the average change in mammary tissue diameter during follow-up was evaluated, a slight reduction in girls aged < 2 years was observed; however, it remained constant for girls aged 2 to 8 years. CONCLUSIONS: The results of this study underscore the need to continue an active search of premature thelarche cases and to perform analytical investigations of precocious sexual development to expand the understanding of the etiology of this important public health problem.

Estudio descriptivo sobre ataques y mordeduras de animales en el Município de San Juan, Puerto Rico, 1996-1998 / Descriptive study of animal attacks and bites in the municipality of San Juan, Puerto Rico, 1996-1998

The present study described the frequency of animal bites and attacks in the municipality of San Juan, Puerto Rico between the fiscal years 1996 through 1998. A total of 275 cases were reported to the San Juan Local Office of Environmental Health. The distribution of cases by gender was equal, and persons aged 18 years or older had the highest frequency of animal bites and attacks (52.9 percent). The animal species reported to be involved in the majority of animal bites was the dog (81.1 percent). Upper extremities were involved in 43 percent of these injuries. Animal bites caused by dogs were more often reported among male victims (87.4 percent) (p = 0.031). Approximately 41 percent of dog bites and attacks and 75 percent of bites and attacks caused by other animal species were documented as provoked (p = 0.002). More than 75 percent of the injuries in the head, face or neck involved children < 13 years whereas 65.9 percent of the injuries in the upper extremities involved adults (> 18 years) (p = 0.001). Animal bites and attacks in the upper extremities were more prominent among injuries caused by an animal species different to the dog (71 percent) (p < 0.001). We conclude that animal bites and attacks is a public health concern in light of the increasing pet population. Therefore, educational strategies towards the general population must stress careful supervision of the human-animal interaction as well as the general procedures to follow in case of an injury.

An Epidemiologicaql review of tuberculosis in the Puerto Rican population

Past and recent developments related with tuberculosis (TB) epidemiology in the island were reviewed. Characteristics of the disease such as surveillance, incidence, mortality and the relation of TB with HIV infection were included. TB remains an important public health problem in Puerto Rico and in the Americas, particularly, in HIV-infected patients. From 1981 through 1998, a total of 1,000 AIDS/TB cases has been reported in the island accounting for 4.4 percent of the total of AIDS cases. 82 percent of the AIDS/TB cases were males. The incidence was highest among injecting drug users (IDUs) infected with HIV. The overall incidence of TB in recent years seems to reach a plateau. By the contrary, AIDS/TB cases have been increasing. However, problems of under-reporting must be taken into consideration when analyzing morbidity trends. Adequate and innovative solutions to maintain TB control in the community must be promptly implemented

Componentes básicos para el desarrollo de propuestas de investigación en las ciencias de la salud / Basic components in the development of research proposals in health sciences

Any investigation in the health sciences should have a plan or proposal to answer a specific research question. This document, designed for persons preparing for or already pursuing a research project, describes the conceptual framework related with a research proposal, from the study design until its implementation. The objective of this document is to summarize different theoretical aspects that should be considered in a research project, including pertinent references that might be used to deepen the discussion. First, a series of definitions related to the scientific method are presented and then the processes to carry out a research proposal including common epidemiologic designs are illustrated. In addition, a series of research questions that can serve as a guide to perform a critical analysis of published papers are included. Finally, an interdisciplinary group integrated by health professionals with the clinical expertise and health professionals with the necessary skills in biostatistics and epidemiology to undertake a sound scientific research is recommended.

Clinical findings in patients submitte to cardiac catheterization and coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean: a pilot study

OBJECTIVE: This study examined the demographic characteristics, cardiac risk factors, angiographic findings, and complications of patients undergoing coronary angiography. BACKGROUND: There is growing evidence of coronary angiography safety, however, limited data is available concerning the value of this procedure in the Puerto Rican population. METHODS: We retrospectively reviewed the medical records of 322 patients submitted to this procedure at the Cardiovascular Center of Puerto Rico and the Caribbean over a three-month period during 1995. Comparisons of means were based on Student's t-test; comparisons of proportions were based on Pearson's Chi-Square test. RESULTS: Mean age was 60.4 +/- 10.6 years (Range: 20-86); 57.1 per cent were males. Stable angina (p < 0.001) and atypical chest pain (p = 0.014) were more frequent in females. Smoking history (p < 0.0001), left ventricular dysfunction (p = 0.003), angina post-myocardial infarction (p < 0.001), and myocardial infarction (p < 0.025) were more frequent in males. The most frequent angiographic findings were two-vessel disease (24.2 per cent), normal coronary angiogram (21.2 per cent), and non-obstructive disease (16.9 per cent). In patients with angiographic evidence of coronary artery disease, hypertension (69.8 per cent), diabetes mellitus (41.3 per cent), and hypercholesterolemia (37 per cent) were the predominant risk factors. Thirty-four percent of patients had left ventricular dysfunction. The majority of patients (86 per cent) met American College of Cardiology/American Heart Association Class I.