Women's lives in times of Zika: mosquito-controlled lives? / A vida das mulheres na era do Zika: vidas controladas por mosquitos? / Las vidas de las mujeres en tiempos de Zika: ¿vidas controladas por mosquitos?

Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies has made governments, national and international agencies issue advices and recommendations to women. There is a clear need to investigate how the Zika outbreak affects the decisions that women take concerning their lives and the life of their families, as well as how women are psychologically and emotionally dealing with the outbreak. We conducted a qualitative study to address the impact of the Zika epidemic on the family life of women living in Brazil, Puerto Rico, and the US, who were affected by it to shed light on the social repercussions of Zika. Women were recruited through the snowball sampling technique and data was collected through semi-structured interviews. We describe the effects in mental health and the coping strategies that women use to deal with the Zika epidemic. Zika is taking a heavy toll on women's emotional well-being. They are coping with feelings of fear, helplessness, and uncertainty by taking drastic precautions to avoid infection that affect all areas of their lives. Coping strategies pose obstacles in professional life, lead to social isolation, including from family and partner, and threaten the emotional and physical well-being of women. Our findings suggest that the impacts of the Zika epidemic on women may be universal and global. Zika infection is a silent and heavy burden on women's shoulders.

A infecção pelo vírus Zika durante a gravidez é causa de anomalias congênitas do sistema nervoso central do feto. As graves consequências gestacionais fizeram com que governos nacionais e agências internacionais emitissem conselhos e recomendações para as mulheres. Existe uma necessidade clara de investigar de que maneira a epidemia de Zika afeta as decisões das mulheres sobre suas próprias vidas e de suas famílias, e de como as mulheres estão lidando psicológica e emocionalmente com a epidemia. Realizamos um estudo qualitativo para avaliar o impacto social da epidemia de Zika na vida familiar das mulheres no Brasil, Porto Rico e Estados Unidos. As mulheres foram recrutadas através da técnica de "bola de neve", e os dados foram coletados com entrevistas semiestruturadas. O artigo descreve os efeitos sobre a saúde mental e as estratégias das mulheres para enfrentar a epidemia do vírus Zika. O vírus está tendo um impacto pesado no bem-estar emocional das mulheres. Elas estão lidando com sentimentos de medo, desamparo e incerteza, ao tomar precauções drásticas para evitar uma infecção que afeta todas as áreas de suas vidas. As estratégias de enfrentamento envolvem obstáculos na vida profissional, levam ao isolamento social, inclusive em relação à família e ao companheiro e ameaçam o bem-estar emocional e físico das mulheres. Nossos achados sugerem que os impactos da epidemia de Zika sobre as mulheres podem ser universais e globais. A infecção pelo vírus Zika põe uma carga pesada e silenciosa nos ombros das mulheres.

La infección por el virus del Zika durante el embarazo es una causa de anormalidades cerebrales congénitas. Sus consecuencias para los embarazos han hecho que los gobiernos, las agencias nacionales e internacionales emitan consejos y recomendaciones para las mujeres. Existe una clara necesidad de investigar cómo el brote de Zika afecta las decisiones que toman las mujeres con respecto a sus vidas y la de sus familias y también cómo las mujeres están lidiando psicológica y emocionalmente con el brote. Llevamos a cabo un estudio cualitativo para abordar el impacto de la epidemia de Zika en la vida familiar de las mujeres que se vieron afectadas por la enfermedad, y que viven en Brasil, Puerto Rico y los EE.UU., para arrojar luz sobre las repercusiones sociales del Zika. Las mujeres fueron reclutadas a través de la técnica de muestreo de bola de nieve y los datos fueron recolectados a través de entrevistas semiestructuradas. Describimos los efectos en la salud mental y las estrategias de afrontamiento que las mujeres usan para lidiar con la epidemia de Zika. La enfermedad está afectando mucho el bienestar emocional de las mujeres. Están enfrentando sentimientos de miedo, impotencia e incertidumbre tomando precauciones drásticas para evitar infecciones que afectan todas las áreas de sus vidas. Las estrategias de afrontamiento representan obstáculos en la vida profesional, conducen al aislamiento social, incluso de la familia y la pareja, y ponen en peligro el bienestar emocional y físico de las mujeres. Nuestros hallazgos sugieren que los impactos de la epidemia de Zika en las mujeres pueden ser universales y globales. La infección por Zika es una carga silenciosa y pesada para los hombros de las mujeres.

Recruitment of Caribbean female commercial sex workers at high risk of HIV infection / Captación de mujeres profesionales del sexo con alto riesgo de infección por VIH en el Caribe

OBJECTIVE: To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS: A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS: HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8-9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS: This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial.

OBJETIVO: Evaluar nuevos criterios de selección y métodos extrainstitucionales encaminados a detectar y captar a las mujeres con alto riesgo de contraer la infección por virus de la inmunodeficiencia humana (VIH) en el Caribe. MÉTODOS: Del 2009 al 2012, se llevó a cabo un estudio prospectivo de cohortes de 799 mujeres profesionales del sexo en la República Dominicana, Haití y Puerto Rico. Los requisitos mínimos de selección fueron el intercambio de relaciones sexuales por bienes, servicios o dinero en los últimos 6 meses y las relaciones sexuales vaginales o anales sin protección con un hombre durante el mismo período. En cada centro se aplicaron criterios de selección y estrategias de captación más restrictivos, en función de las características epidemiológicas locales. Se formularon a las participantes preguntas acerca de la infección por el VIH/sida y su motivación para participar en un estudio clínico sobre la vacuna contra el VIH. Se usó un modelo de regresión logística con el fin de analizar los factores pronósticos de prevalencia de infección por el VIH y la voluntad de participar en un estudio futuro sobre la vacuna contra el virus. RESULTADOS: La prevalencia de infección por el VIH en el momento del tamizaje fue 4,6%. El consumo de crack se asoció con la infección por el VIH (razón de posibilidades [OR]: 4,2; intervalo de confianza [IC] de 95%: 1,8-9,0) y la práctica de relaciones sexuales con clientes en un hotel o un motel se asoció inversamente con esta infección (OR: 0,5; IC 95%: 0,3-1,0). El 88,9% de las mujeres inscritas manifestó una disposición decidida o probable de participar en un estudio futuro sobre la vacuna contra el VIH. CONCLUSIONES: Los resultados del estudio indican que es posible formular criterios de selección e introducir métodos de captación locales con el propósito de detectar y captar a las mujeres profesionales del sexo, que presentan una prevalencia de infección por el VIH mayor que la población general y manifiestan una buena disposición de participar en un ensayo clínico sobre la vacuna contra el VIH.

Small area variation in diabetes prevalence in Puerto Rico / Variación en un área pequeña de la prevalencia de la diabetes en Puerto Rico

OBJECTIVE: To estimate the 2009 prevalence of diagnosed diabetes in Puerto Rico among adults > 20 years of age in order to gain a better understanding of its geographic distribution so that policymakers can more efficiently target prevention and control programs. METHODS: A Bayesian multilevel model was fitted to the combined 2008-2010 Behavioral Risk Factor Surveillance System and 2009 United States Census data to estimate diabetes prevalence for each of the 78 municipios (counties) in Puerto Rico. RESULTS: The mean unadjusted estimate for all counties was 14.3% (range by county, 9.9%-18.0%). The average width of the confidence intervals was 6.2%. Adjusted and unadjusted estimates differed little. CONCLUSIONS: These 78 county estimates are higher on average and showed less variability (i.e., had a smaller range) than the previously published estimates of the 2008 diabetes prevalence for all United States counties (mean, 9.9%; range, 3.0%-18.2%).

OBJETIVO: Calcular la prevalencia en el año 2009 de casos con diagnóstico de diabetes en Puerto Rico en adultos de 20 años de edad o mayores, para conocer mejor su distribución geográfica con objeto de que los responsables políticos puedan encauzar más eficientemente los programas de prevención y control. MÉTODOS: Se ajustó un modelo multinivel bayesiano a la combinación de datos del Sistema de Vigilancia de Factores de Riesgo del Comportamiento 2008-2010 y del Censo de los Estados Unidos del 2009 para calcular la prevalencia de la diabetes en cada uno de los 78 municipios de Puerto Rico. RESULTADOS: El cálculo del valor medio no ajustado para todos los municipios fue de 14,3% (intervalo por municipio de 9,9 a 18,0%). La amplitud promedio de los intervalos de confianza fue de 6,2%. Hubo poca diferencia entre los cálculos ajustados y los no ajustados. CONCLUSIONES: Los valores obtenidos mediante estos cálculos correspondientes a 78 municipios fueron por término medio más elevados y mostraron menor variabilidad (es decir, el intervalo era más pequeño) que los cálculos anteriormente publicados sobre la prevalencia de la diabetes en todos los municipios de los Estados Unidos en el 2008 (media, 9,9%; intervalo de 3,0 a 18,2%).

Penile Cancer Disparities in Puerto Rican Men as compared to the United States Population

This study compares incidence and mortality of penile cancer in Puerto Rico (PR) with other racial/ethnic groups in the United States (US) and evaluates the extent in which socioeconomic position index (SEP) or its components influence incidence and mortality in PR.

Age-standardized rates were calculated for incidence and mortality based on data from the PR Cancer Registry and the US National Cancer Institute's Surveillance, Epidemiology and End Results program, using the direct method.

PR men had approximately 3-fold higher incidence of penile cancer as compared to non-Hispanic white (Standardized rate ratio [SRR]: 3.33; 95%CI=2.80-3.95). A higher incidence of penile cancer was also reported in PR men as compared to non-Hispanic blacks and Hispanics men. Mortality from penile cancer was also higher for PR men as compared to all other ethnic/racial groups. PR men in the lowest SEP index had 70% higher incidence of penile cancer as compared with those PR men in the highest SEP index. However, the association was marginally significant (SRR: 1.70; 95%CI=0.97, 2.87). Only low educational attainment was statistically associated with higher penile cancer incidence (SRR: 2.18; 95%CI=1.42-3.29).

Although penile cancer is relatively uncommon, our results support significant disparities in the incidence and mortality rates among men in PR. Low educational attainment might influence the high incidence of penile cancer among PR men. Further studies are strongly recommended to explore these disparities. .

Geographic distribution of risk of death due to homicide in Puerto Rico, 2001–2010 / Distribución geográfica del riesgo de muerte por homicidio en Puerto Rico,2001–2010

Objective. To raise awareness of the impact of homicides in Puerto Rico based on the findings of the spatial and temporal distribution of homicides and the use of firearms, by age and gender, using reports of interpersonal violent deaths from the Institute of Forensic Science (IFS) headquartered in San Juan, Puerto Rico. Methods. This was a descriptive study of all homicide incidents in Puerto Rico reported by the IFS for the period 2001–2010. For each of the 8 542 cases, data analyzed included age, sex, municipality of incident, date of death, and mechanism. Crude sex- and age-specific mortality rates for Puerto Rico and for each municipality per year and for the 10-year period were calculated. Cumulative rate and cumulative risks were estimated and defined as lifetime risk. The relative distribution of cumulative rates for each municipality was categorized into quartiles of highest to lowest risk and displayed as a map. Results. The risk of homicide death among males is 13 times greater than among females. The highest rates were observed among males 20–24 years of age (198.4 homicides per 100 000). In any given year, firearms were used in at least 80% of homicides. The average lifetime risk of homicide death for males is 1 in 34. Conclusions. Young adult males with access to firearms are at greatest risk of homicide in Puerto Rico. Also, highly urbanized municipalities are at highest risk; however, certain nonurban municipalities along the coast also have a very high homicide risk. Top priorities should be applying the WHO “ecological model” for violent injury prevention and establishing a surveillance system that will assist in identifying the role that socioeconomics, illegal firearms trade, and drug trafficking are playing.

Objetivo. Concientizar sobre la repercusión de los homicidios en Puerto Rico con base en los resultados de la distribución espacial y temporal de los homicidios y el uso de las armas de fuego, según la edad y el sexo, a partir de los informes del Instituto de Ciencias Forenses (ICF), con sede en San Juan, Puerto Rico, sobre defunciones por violencia interpersonal. Métodos. Estudio descriptivo de todos los incidentes de homicidio ocurridos en Puerto Rico informados por el ICF durante el período del 2001 al 2010. La edad, el sexo, el municipio del incidente, la fecha de muerte y el mecanismo fueron los datos analizados en cada uno de los 8 542 casos. Se calcularon las tasas brutas de mortalidad específicas de cada sexo y edad en Puerto Rico y en cada municipio, por año y durante el período de 10 años. Se calcularon también las tasas y los riesgos acumulados y se definieron como riesgo durante toda la vida. La distribución relativa de las tasas acumuladas para cada municipio se clasificó en cuartiles, del riesgo más alto al más bajo, y se ilustró en un mapa. Resultados. El riesgo de muerte por homicidio en varones es 13 veces mayor que en mujeres. Las tasas más elevadas se observaron en hombres de 20 a 24 años de edad (198,4 homicidios por 100 000). Cualquiera que fuera el año escogido, en al menos 80% de los homicidios se utilizaron armas de fuego. En varones, el riesgo promedio de morir por homicidio durante toda la vida es de 1/34. Conclusiones. Los jóvenes varones adultos con acceso a las armas de fuego están sometidos a un mayor riesgo de homicidio en Puerto Rico. Además, en los municipios muy urbanizados el riesgo es más alto; sin embargo, en ciertos municipios no urbanos de la costa también hay un riesgo de homicidio muy alto. Las máximas prioridades deben ser aplicar el “modelo ecológico” de la OMS para prevenir las lesiones violentas y establecer un sistema de vigilancia que ayude a determinar la función que desempeñan las condiciones socioeconómicas, el comercio ilegal de armas de fuego y el tráfico de drogas.

Spatial variability of disease incidence and mortality in the sea fan Gorgonia ventalina in Puerto Rico (Alcyonacea: Goorgoniidae)

Populations of the common sea fan (Gorgonia ventalina) were decimated by an aspergillosis outbreak throughout the Caribbean two decades ago. Since then, aspergillosis has been considered as the principal cause of mortality in sea fans. However, prevalence and presumably incidence of this disease have been declining in the Caribbean since the mid 1990s. Incidence indicates new cases of disease in previously healthy colonies, while prevalence indicates percent of diseased colonies at a given sample. Most coral disease studies use prevalence rather than incidence to assess the temporal dynamics of diseases. Nevertheless, conclusions based only on prevalence should be handled carefully to avoid misinterpretation. This study was carried out at six reefs in Eastern Puerto Rico. We monitored a total of 448 colonies to (1) obtain estimates of incidence and prevalence of disease and other types of lesions, and (2) to determine causes of sea fan mortality plus their spatial and temporal variation. Three transects (10x1m) were haphazardly placed at each study site. At each transect, every colony was numbered and photographed and its height measured to the nearest cm. Transects were monitored at six months intervals and health status of the colonies was recorded. Also, the colonies were divided into height classes (small, medium and large) for incidence, prevalence and mortality analyses. Incidence and prevalence of disease were low in all reefs, suggesting that disease currently plays a minor role in the regulation of sea fans populations. Detachment was the main cause of mortality, and size structure data suggest that recruitment may compensate for mortality rates in two of the reefs. Spatial differences in size structure and density may be related to environmental and physical characteristics at the reef scale that allow sea fans to reach a safe colony size. Rev. Biol. Trop. 60 (2): 517-526. Epub 2012 June 01.

Las poblaciones de abanicos de mar (Gorgonia ventalina) fueron diezmadas por una epidemia de aspergilosis que afectó gran parte del Caribe, hace más de dos décadas. Desde entonces, a la aspergilosis se le ha considerado como la causa principal de mortalidad en los abanicos de mar. Sin embargo, la prevalencia e incidencia de esta enfermedad han disminuido en el Caribe desde mediados de los años 90. La incidencia se mide como la aparición de nuevos casos de la enfermedad en colonias previamente sanas, mientras que, la prevalencia indica el porcentaje de colonias enfermas en una muestra. La mayoría de los estudios en enfermedades de corales utilizan la prevalencia, en lugar de incidencia para evaluar la dinámica temporal de las enfermedades. No obstante, las conclusiones basadas sólo en prevalencia se deben manejar con precaución, para así evitar interpretaciones erróneas al respecto. En este estudio, 448 colonias de abanicos de mar ubicadas en seis arrecifes al este de Puerto Rico fueron examinadas durante un año, con el fin de: (1) estimar la incidencia y prevalencia de aspergilosis y de otros tipos de lesiones, (2) determinar las causas de mortalidad en abanicos de mar, además de su variación espacial y temporal. Las colonias presentes a lo largo de tres transectos establecidos al azar (10x1m) fueron marcadas y fotografiadas en cada arrecife al inicio del estudio. También, se midió la altura para determinar la categoría de tamaño de cada colonia (pequeña, mediana o grande). Las colonias fueron seguidas a lo largo de un año, y en cada visita se registró su condición de salud. Los resultados indicaron que la incidencia y prevalencia de aspergilosis fueron bajas en todos los arrecifes, lo cual sugiere que actualmente la enfermedad desempeña un rol menor en la regulación de las poblaciones de abanicos. El desprendimiento fue la principal causa de mortalidad, y los datos de estructura de tamaño sugieren que el reclutamiento puede compensar por las tasas de mortalidad en dos de los arrecifes. Las diferencias en densidades y estructuras de tamaño de los abanicos entre los sitios de estudio, pueden estar influenciados por características abióticas propias de cada arrecife. Esto puede permitir que los abanicos de mar alcancen un tamaño seguro para la sobrevivencia de la colonia.

A ten-year assessment of anabolic steroid misuse among competitive athletes in Puerto Rico / Valoración por diez años del abuso de esteroides anabólicos entre los atletas de competencia de Puerto Rico

OBJECTIVE: Little is known about anabolic androgenic steroids (AAS) misuse in the Caribbean region in spite of increased popularity among athletes and adolescents. The present study examines the usage of AAS among competitive athletes in Puerto Rico. METHODS: Doping test results of competitive athletes obtained by random sampling out of competition during the 2000-2009 period were analysed. Doping tests were executed by the Centre for Sports, Health and Exercise Sciences (Albergue Olímpico, Salinas, Puerto Rico). A total of 550 athletes were monitored during 2000-2009. Information was collected with regard to competitive sport, gender and AAS compounds whenever a positive test result was encountered. RESULTS: From the total sample of monitored cases during the past decade, 5.4% showed adverse analytical findings. Anabolic androgenic steroids misuse was detected among male (62%) and female (38%) athletes. Weightlifting showed the greatest percentage of positive AAS doping test results (70% of total cases) and stanozolol was the most commonly misused exogenous androgen (60% of abused AAS whether alone or as part of a cocktail). Testosterone was the most common endogenous misused steroid (10% of misused compounds). CONCLUSION: In Puerto Rico, AAS misuse was detected across competitive sports for both genders. Although AAS misuse among Puerto Rican athletes shares some features that are consistent with the international sports community, it is imperative to address AAS misuse in the Caribbean region.

OBJETIVO: Poco se sabe acerca del abuso de los esteroides anabólicos androgénicos (EAA) en la región del Caribe, a pesar de su creciente popularidad entre atletas y adolescentes. El estudio presente examina el uso de EAA entre los atletas de competencia en Puerto Rico. MÉTODOS: Se analizaron los resultados de la prueba de dopaje practicada a atletas de competencia mediante un muestreo aleatorio realizado a partir de competencias celebradas durante el 2000-2009. Las pruebas de dopaje fueron realizadas por el Centro de Deportes, Salud y Ciencias del Ejercicio (Albergue Olímpico, Salinas, Puerto Rico). Se monitorearon un total de 550 atletas durante 2000-2009. Se recogió información en relación con los deportes de competencia, género, y compuestos de EAA, siempre que la prueba arrojara resultados positivos. RESULTADOS: De la muestra total de casos supervisados durante la década pasada, 5.4% mostraron resultados analíticos adversos. Se detectó un uso inapropiado de esteroides anabólicos androgénicos entre los atletas varones (62%) y hembras (38%). El levantamiento de pesas mostró el porcentaje más alto de resultados de dopaje positivos a EAA (70% del total de casos) y el estanozolol fue el andrógeno exógeno más comúnmente mal empleado (60% de los EAA usados inapropiadamente, bien solos o como parte de un cóctel). La testosterona fue el esteroide endógeno más comúnmente abusado (10% de los compuestos mal empleados). CONCLUSIÓN: En Puerto Rico, se detectó uso inapropiado de EAA en los deportes de competencia de ambos géneros. Aunque el abuso de EAA entre los atletas portorriqueños comparte algunas de las características correspondientes a la comunidad internacional de deportes, es absolutamente necesario profundizar en el problema del abuso de los EAA en el área del Caribe.

Association between calcium intake and colorectal neoplasia in Puerto Rican Hispanics / Asociación entre el consumo de calcio y la neoplasia colorectal en hispanos puertorriqueños

Epidemiological studies show that a high calcium intake reduces the risk of colon cancer. The objective was to study the association between calcium intake and colorectal neoplasia in a clinic-based sample of Hispanics adults from Puerto Rico. As part of this cross-sectional study, a total of 433 subjects were recruited from surgery and gastroenterology clinics at the University of Puerto Rico. Calcium intake was estimated using a food frequency questionnaire (FFQ) of calcium rich foods. Socio-demographics, health history and colonoscopy results were obtained from the primary study. Chi square and odds ratios (OR) for colorectal neoplasia (adenomas and/or adenocarcinoma) were calculated for total calcium, dietary calcium and for calcium supplement use. In total, 312 (72%) from 433 participants completed the FFQ and had available colonoscopy results; from these, 196 (62.5%) were free of neoplasia and 117 (37.5%) had colorectal neoplasia. Colorectal neoplasia subjects were older, a lower proportion were females and less educated than those without neoplasia (p<0.01). Total calcium intake (median 1180 mg/d) was greater in those free of neoplasia compared to colorectal neoplasia subjects (median 1036 mg/d; p<0.05). A high total calcium intake and the use of calcium supplements significantly reduced the OR (crude and age adjusted) for colorectal neoplasia; although these associations lost statistical significance after additionally adjusting for gender and educational level. In conclusion, a high calcium intake and the use of calcium supplements may be protective against colorectal neoplasia, although a greater sample may be required to observe significant associations in a multivariate model.

Los estudios muestran que un alto consumo de calcio reduce el riesgo de cáncer de colon. El objetivo del presente estudio fue estudiar la asociación entre el consumo de calcio y la neoplasia colorrectal en una muestra de hispanos adultos en Puerto Rico. Un total de 433 sujetos fueron reclutados de las clínicas de cirugía y gastroenterología de la Universidad de Puerto Rico. El consumo de calcio fue estimado usando un cuestionario de frecuencia de consumo (CFC) de alimentos ricos en calcio. Los datos socio-demográficos y la colonoscopia se obtuvieron del estudio principal. Se calculó el Ji² y la razón de productos cruzados de neoplasia colorrectal por el consumo total, dietético y uso de suplementos de calcio. Un total de 312 (72%) de 433 participantes completaron el estudio; de éstos, 196 (62.5%) estaban libres de neoplasia y 117 (37.5%) tenían neoplasia colorrectal, los cuales eran de mayor edad, con menor proporción de mujeres y menos educados que aquellos sin neoplasia (p<0.01). El consumo total de calcio (mediana 1180 mg/d) fue mayor en sujetos sin neoplasia que los sujetos con neoplasia (mediana 1036 mg/d; p<0.05). Un alto consumo total de calcio y el uso de suplementos de calcio redujo significativamente la posibilidad (crudo y ajustado por edad) de neoplasia colorrectal; aunque no fue significativo cuando se ajusto también por género y educación. En conclusión, un alto consumo de calcio y el uso de suplementos de calcio pueden proteger contra la neoplasia colorrectal, aunque se requieren más sujetos para ver asociaciones significativas en el modelo multivariado.

Cancer disparities between mainland and island Puerto Ricans / Disparidades en la incidencia de cáncer en puertorriqueños residentes en los Estados Unidos y Puerto Rico

OBJECTIVES: Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans-and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. METHODS: Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). RESULTS: Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p < 0.05) for major cancers-lung (SRRs = 0.36 in males and 0.29 in females), prostate (SRR = 0.71), female breast (SRR = 0.73), and colon-rectum (SRRs = 0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. CONCLUSION: Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.

OBJETIVOS: Se analizaron las tasas de cáncer en un subgrupo de hispanos residentes en los Estados Unidos de América -los puertorriqueños (PRREUA) y se compararon sus tasas de incidencia con las de los puertorriqueños que residen en Puerto Rico (PRRPR) y la población estadounidense blanca sin ascendencia hispana (EUBNH) a fin de encontrar patrones de cáncer y disparidades de orden étnico específicos para los puertorriqueños. MÉTODOS: Se obtuvieron los datos de incidencia de los registros de cáncer de Puerto Rico y tres estados del nordeste de los Estados Unidos (New York, New Jersey y Connecticut) que tienen una elevada densidad de PRREUA. Se compararon las tasas ajustadas por la edad mediante las razones de las tasas estandarizadas (SRR). RESULTADOS: La incidencia total de cáncer fue menor en los PRRPR, intermedia en los PRREUA y mayor en los EUBNH. Los PRRPR presentaron tasas significativamente menores que los PRREUA (P < 0,05) en los principales tipos de cáncer -de pulmón (SRR = 0,36 en hombres; SRR = 0,29 en mujeres), próstata (SRR = 0,71), mama (SRR = 0,73) y colorrectal (SRR = 0,74 en hombres y SRR = 0,65 en mujeres)- así como en algunos tipos de cáncer menos frecuentes (de vejiga, hígado, riñón y pelvis renal, páncreas, tiroides, linfomas no Hodgkin, leucemia y melanoma de piel). En general, las tasas de cáncer en los PRREUA fueron ligeramente menores que las de los EUBNH, aunque de las tres poblaciones los PRREUA tuvieron las mayores tasas de cáncer de estómago, hígado y cervicouterino. CONCLUSIONES: A pesar de las desventajas socioeconómicas, los PRRPR tienen una menor incidencia relativa de cáncer. La identificación de los factores que contribuyen a ello podría ayudar en las investigaciones sobre cáncer, y comprender las razones del mayor riesgo de cáncer en los PRREUA podría facilitar el desarrollo de programas de intervención específicos para esta población.

Prevalence of overweight and obesity in a group of children between the ages of 2 to 12 years old in Puerto Rico

BACKGROUND: Obesity in children has been related with co-morbid conditions being an important risk factor in adult morbidity and mortality. The objective of this study was to identify the prevalence of overweight /obesity in a group of children in Puerto Rico. METHODS: Participants included 158 children receiving pediatric care at the San Juan City Hospital and a primary care clinic. Body mass index (BMI) was calculated in children and parents. RESULTS: Fifty-six percent of children were overweight/obese as well as 61% of mothers and 75% of fathers. Using weight-height percentiles graphs, 49% of children were overweight. CONCLUSIONS: This study shows the high prevalence of overweight and obesity in children and their parents. Using the BMI for evaluating weight identified more children at risk than the traditionally used graphs. Identifying risk factors will help health care professionals and parents intervene to improve the health of these families.

Severity of alcohol use and problem behaviors among school-based youths in Puerto Rico / Magnitud del consumo de alcohol y comportamientos problemáticos en jóvenes escolarizados en Puerto Rico

OBJECTIVE: The present study sought to: (a) categorize youths into groups based on their level of alcohol use and number of symptoms of alcohol abuse and dependence defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and (b) examine whether these categories were associated with other problem behaviors in which youths engage (marijuana use, sexual intercourse, and having been arrested or having trouble with the law). METHODS: The study is based on a cross-sectional survey administered to 972 school-based youths from one middle school and one high school in San Juan, Puerto Rico. Youths were categorized based on their alcohol use and alcohol problems. These categories were then examined for associations with lifetime marijuana use, lifetime sexual intercourse, and having been arrested or having had trouble with the law in the past year. The original eight categories of alcohol use were collapsed into six categories based on the results. RESULTS: For virtually every group characterized by higher severity of alcohol use and alcohol problems, researchers found an increasing prevalence of marijuana use in their lifetimes, increasing odds of sexual intercourse in their lifetimes, and having had trouble with the law in the past year. CONCLUSIONS: Knowing about variations in alcohol use and alcohol problems may be instrumental in measuring the degree to which youths may also be engaging in a range of other elevated risk behaviors and a progression to more serious forms of alcohol and drug use.

OBJETIVOS: Se buscó: a) categorizar a los jóvenes según su nivel de consumo de alcohol y el número de síntomas de abuso y dependencia del alcohol definidos en el Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV); y b) analizar si esas categorías están asociadas con otros comportamientos problemáticos de los jóvenes (consumo de marihuana, relaciones sexuales y arrestos o problemas con la ley). MÉTODOS: Estudio transversal basado en una encuesta aplicada a 972 jóvenes que asistían a una escuela secundaria y una preparatoria en San Juan, Puerto Rico. Los jóvenes se categorizaron según el consumo de bebidas alcohólicas y los problemas del alcoholismo. Se buscaron asociaciones entre esas categorías y el consumo de marihuana y las relaciones sexuales -ambas en toda la vida-, así como con los arrestos o problemas con la ley en el año anterior a la encuesta. A partir de los resultados, las ocho categorías iniciales según el consumo de alcohol se reagruparon en seis. RESULTADOS: Prácticamente en todos los grupos caracterizados por un mayor consumo de bebidas alcohólicas y mayores problemas del alcoholismo se observó un aumento en la prevalencia de consumo de marihuana y la probabilidad de haber tenido relaciones sexuales, ambas en toda la vida, así como de haber tenido problemas con la ley durante el año anterior. CONCLUSIONES: Conocer las variaciones en el consumo de bebidas alcohólicas y los problemas del alcoholismo puede servir para medir el grado en que los jóvenes pueden involucrarse en diversos comportamientos de mayor riesgo y avanzar a formas más peligrosas de consumo de alcohol y drogas.

Epidemiology of melanoma in Puerto Rico, 1987-2002

BACKGROUND: The incidence of cutaneous malignant melanoma continues an increasing trend worldwide and has had the highest rise in incidence of all malignancies during the last decades. Mortality rates for melanoma have remained relatively stable in most countries despite the increase in incidence rates. The purpose of this study is to describe the epidemiological trends of malignant melanoma in Puerto Rico from 1987 to 2002 and to compare these findings with those previously reported for Puerto Rico as well as with those reported for other countries. METHODS: All cases of malignant melanoma reported to the Puerto Rico Cancer Registry from 1987 to 2002 were included. Age-adjusted incidence and mortality rates were calculated. Trends were compared by age, gender, anatomical location of the tumor and tumor thickness. RESULTS: There were 1,568 new melanoma cases reported between 1987 and 2002 in Puerto Rico, comprising a 50% overall increase in incidence during this period. Male to female incidence ratio was 1:0.86. The most common anatomical location in women was the lower extremity followed by the head and neck region. In men, the most common anatomical location was the trunk, followed by the head and neck region. Most of the superficial tumors (< 1mm) were located on the trunk followed by the lower limb. The most common specific histologic diagnosis reported was melanoma in situ. In 40.8% of the cases the tumor thickness value was not provided. The number of thinner melanomas (< 1mm) reported increased during the study period. Mortality rates were slightly higher for men than for women, still mortality rates remained stable for both genders and all age groups analyzed. CONCLUSIONS: Melanoma incidence rates continue to increase in Puerto Rico. This, in combination with an increase in the diagnosis of thin melanomas, suggests that the stable mortality rates may be due, in part, to earlier diagnosis and improved overall prognosis.

Prevalence of hemochromatosis in the Puerto Rico veteran population

BACKGROUND: Hereditary hemochromatosis (HH) is a disorder of iron storage that results in iron overload. It's prevalence in Puerto Rico (PR) is unknown and the condition frequently undiagnosed. PURPOSE: Determine the prevalence of HH in the PR Veteran population. METHODS: Patients attending the San Juan VA Medical Center Laboratory for routine tests were invited to participate. Basic demographic data, symptoms related questionnaire, fasting samples for unbound iron binding capacity (UIBC) and serum iron were obtained. Transferrin saturation (TS) > or =45% was considered as iron overload. Patients with elevated TS had a second test done to confirm iron overload. Genetic testing was performed to patients with sustained elevated TS. RESULTS: Data from 521 of the 559 recruited patients was available for analysis. 59 patients had TS > or =45%. Iron overload was confirmed in eleven patients. Two patients were lost to follow up; one had secondary causes for iron overload. Eight patients underwent genetic testing. Genetic mutations associated with hemochromatosis were found in four patients. CONCLUSION: The estimated prevalence of confirmed iron overload in our population is 2%, similar to one in the United States, while the prevalence of genetic mutations associated to hemochromatosis is 0.76%, which is slightly higher. Both genetic mutations (C282Y, H63D) are equally seen in the evaluated population which is different from reports elsewhere. Physician awareness of the prevalence of HH in PR may result in increased screening and early identification of the condition.

The prevalence of atopic dermatitis in Puerto Rican school children

BACKGROUND: Atopic dermatitis is a common inflammatory disease of the skin that usually begins in childhood and its diagnosis depends on clinical criteria. Recent reports have indicated that the worldwide prevalence of atopic dermatitis is increasing. The objective of this study was to determine the prevalence of atopic dermatitis in schoolchildren between the ages of six and seven in two school districts in Puerto Rico. METHODS: The Laughter questionnaire, developed to determine the prevalence of atopic dermatitis in schoolchildren was translated and validated in Spanish. A population-based prevalence survey was conducted among second grade students in the districts of Guaynabo and Humacao, Puerto Rico. The prevalence of atopic dermatitis was determined by sex, school type (private or public), and geographical location (urban or rural) using the questionnaire. RESULTS: Ninety-two percent (92 %) of the eligible schools participated in the study. A total of 2,393 questionnaires were distributed with a response rate of 53 %. The prevalence of atopic dermatitis among the population surveyed was 24.8%. The prevalence of atopic dermatitis by sex or geographic location was not significantly different (p>0.05). An excess of atopic dermatitis was observed in private schools (31.0%) when compared to public schools (19.9%). The effect remained after controlling potential confounders (POR Mantel-Haenszel = 1.37; 95%CI: 1.07 - 1.42). CONCLUSION: This study presents evidence of a significant public health problem in Puerto Rico. The prevalence of atopic dermatitis in Puerto Rico is high and possibly a large percentage (70%) of the patients is not been diagnosed.

Major histocompatibility complex class II polymorphisms and risk of cervical cancer in Puerto Rican women

Association between HLA antigens and cervical squamous cell carcinoma has been described in several populations. To verify whether HLA-DRB1 and DQB1 diversity is related to cervical cancer in Puerto Rican women, 40 cases and 50 controls were HLA typed. DRB1*16 (POR=2.89) and DRB1*11 (POR=1.74) were positively associated with cervical cancer. A negative association was found with DRB1*01 (POR=0.52), DRB1*04 (POR=0.60), DRB1*14 (POR=0.33), DRB1*15 (POR=0.65), DQB1*04 (POR=0.33), DQB1*05 (POR=0.64) and DQB1*06 (POR=0.65). We suggest that HLA Class H polymorphisms are involved in genetic susceptibility to cervical cancer in Puerto Rican women. These results should be confirmed in studies with larger sample size to preclude the possibility of false positive observations.

Características del abuso y maltrato de personas ancianas en Puerto Rico / Features of elder abuse and mistreatment in Puerto Rico

PURPOSE OF THE STUDY: This descriptive study seeks to understand the prevalence and the phenomenon of abuse and mistreatment among the elderly (60+) in Puerto Rico. The various forms of elder abuse are defined, including socio demographic characteristics, recurrence of abuse, characteristics of perpetrators (abusers), risk factors, and history of health conditions, among others. METHODS: A random sample group was selected among the cases filed with the Protective Services Unit of the Family Department Adults Services during 1999 throughout 2000 (fiscal year). The study included the regions of Aguadilla, Arecibo, Bayamón, Caguas, Carolina, Guayama, Humacao, Mayagüez, Ponce and San Juan. A total of 255 cases were evaluated of which 246 fulfilled the pre-established criteria. The procedures followed were in accordance with privacy and ethical standards. FINDINGS: The most common type of abuse identified is neglect, followed by emotional or psychological abuse, physical abuse, financial exploitation and sexual abuse. Cognitive and social impairment and the need for assistance are important risk factors for elder abuse. Most abusers are family members (especially the elders' offspring). Mitigating factors that explain or increase the risk of elderly abuse are physical or psychological illness of family members or caregiver and/or lack of access to resources. RECOMMENDATIONS: A systematic approach to appropriately report and document patient abuse is recommended. It is necessary to educate the public about the rights of the elderly. Educating professionals, caregivers, and the public on abuse is critical to prevention. The lack of awareness about elder abuse can lead to the public not being able to detect and/or denounce the elderly abuse and may result in death of the victim or aggressors.

Retinitis pigmentosa in Puerto Rico

INTRODUCTION: Previous studies have reported that the prevalence of retinitis pigmentosa (RP) varies between one per 3,000 to one in per 5,000 in the general population. PURPOSE: To study the incidence and ocular findings of RP in a sub-urban community in Puerto Rico. METHODS: We conducted a non-concurrent prospective study of 10,100 patients in a sub-urban San Juan community. RESULTS: 44 out of the 10,100 patients had RP (0.44). Eight out of the 44 patients (18) had nystagmus, twenty-eight (31.8) had microcornea, 3 patients (6.8) had sluggish papillary reaction. Six patients (13.6) had mild cataracts, 27 (65.9)had attenuated retinal vessels and thirty five patients (81.4) had bony spicules. Fifteen patients (34.1) out of the 44 had retinitis pigmentosa as part of the Bardet-Biedl syndrome. CONCLUSION: Incidence of RP in Puerto Rico is higher when compared to Maine and Spain (p < 0.001). Autosomal recessive pattern of inheritance is the most common in Puerto Rico. These findings could be due to the island's geographic isolation, and inbreeding.

Coronary artery abnormalities in Puerto Rico

A retrospective study was done to determine the frequency of coronary artery anomalies in terms of their origin, course, and structure. The clinical history, catheterization data and surgical reports of patients undergoing coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean, from 1999 to 2004, were analyzed. Thirty-eight patients were identified with a coronary artery anomaly in this population. These anomalies were classified according to their clinical consequences and the need for surgical intervention.

Review of clinical characteristics and management of patients with ST segment elevation myocardial infarction at atertiary care center

BACKGROUND: Information from recent multiple trials on the pathophysiology and outcome of ST-segment elevation myocardial infarction (STEMI) has changed its clinical perspective and strategic management, leading to a revision of the 1999 ACC/AHA practice guidelines for that condition. OBJECTIVE: Analyze the clinical characteristics, management strategies, the timing of therapeutic interventions and outcome of patients with STEMI referred to the Cardiovascular Center of Puerto Rico (CVCPR). METHODS: Retrospective review of medical records of all patients admitted to the CVCPR with a diagnosis of STEMI from January 1, 2003 to December 31, 2003. RESULTS: A total of 184 medical records were reviewed. Seventy-six percent of patients were men, mean age was 62.1 +/- 11.8 years. A high prevalence of coronary risk factors was present: systemic hypertension (64), diabetes mellitus (40), dyslipidemia (35), smoking (33) and previous CAD (32). Less than 1/4 of referral forms contained data indicative of whether patients had received antiplatelet therapy, beta-blockers, ACE inhibitors or statins. Fifty percent of patients arrived to the CVCPR more than 48 hours after diagnosis. Only forty-two patients (23) arrived within 12 hours. Thrombolytic therapy had been used in 27of them. 179 (97) patients underwent coronary angiography, 69.2of which had multivessel disease. 114 (62) patients underwent percutaneous coronary interventions (PCI) with stenting. Patients submitted to PCI and stenting of the culprit lesion had a better outcome and survival than the ones not exposed to those procedures (p = 0.02). Approximately two-third of patients received secondary prevention medications upon discharge. CONCLUSIONS: Relevant findings of this review were that in spite of high prevalence of CAD major risk factors, the use of medications of proven benefit for prevention and treatment of CAD at referral centers was less than that recommended by current guidelines, a significant delay in the transfer of patients to the tertiary care facility (in most cases that period exceeded more than 48 hours after diagnosis) and a reduced utilization of thrombolytic therapy. Intensification of the education of physicians throughout the island regarding these matters is to be encouraged. Additional measures should include, development of written protocols at referral centers to assure a more expedite clinical assessment of patients, an enhancement of their capability for utilizing fib

Alfa 1 antitrypsin and protease levels in Puerto Rican asthmatics: a pilot study

A cross-sectional pilot study was conducted on a population of 119 asthmatics who had been recruited from the Emergency Room Department of a major hospital in Ponce, Puerto Rico. The purpose of the study was to determine the frequency of the MM, MS, and SS a-i-antiprotease variants. Also, we analyzed the serum levels of the alpha-1-antiprotease inhibitor, quantified the levels of serine proteases in homes of the asthmatic volunteers, and determined whether environmental levels of proteases, regardless of their sources, had any association with either asthma symptoms or alpha-1-antiprotease inhibitor phenotypes. Our results do not support the role of the alpha-1-antiprotease as a risk factor for asthma in the study population as previously reported. Patients who had visited the ED due to asthma on 3 or more occasions had significantly higher trypsin levels than those who had done so 2 or fewer times. Of those asthmatic patients who had daily symptoms, 40had been exposed to high levels of elastase, and 33.3to trypsin. Similarly, 52.9of the patients with 2 or more hospitalizations a year had been exposed to high elastase levels, and 40.5of asthma patients who had nocturnal asthma more than 3 times a week had been exposed to high levels of elastase.