Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
1.
Emerg Infect Dis ; 27(11): 2971-2973, 2021 11.
Article in English | MEDLINE | ID: covidwho-1559753

ABSTRACT

We reconstructed the 2016-2017 Zika virus epidemic in Puerto Rico by using complete genomes to uncover the epidemic's origin, spread, and evolutionary dynamics. Our study revealed that the epidemic was propelled by multiple introductions that spread across the island, intricate evolutionary patterns, and ≈10 months of cryptic transmission.


Subject(s)
Epidemics , Zika Virus Infection , Zika Virus , Evolution, Molecular , Humans , Puerto Rico/epidemiology , Zika Virus/genetics , Zika Virus Infection/epidemiology
3.
CA Cancer J Clin ; 71(6): 466-487, 2021 11.
Article in English | MEDLINE | ID: covidwho-1430676

ABSTRACT

The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population-based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73-0.78) in 1995 to 0.91 (95% CI, 0.89-0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection-related cancers, including approximately two-fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized-stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence-based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community-based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID-19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored.


Subject(s)
Early Detection of Cancer/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Neoplasms/ethnology , Adolescent , Adult , Aged , Female , Humans , Incidence , Male , Middle Aged , Neoplasms/mortality , Neoplasms/prevention & control , Puerto Rico/epidemiology , Risk Factors , Survival Rate , United States/epidemiology , Young Adult
4.
Int J Environ Res Public Health ; 18(12)2021 06 12.
Article in English | MEDLINE | ID: covidwho-1282472

ABSTRACT

There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1-3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.


Subject(s)
Electronic Nicotine Delivery Systems , Tobacco Products , Vaping , Adult , Female , Humans , Male , Perception , Puerto Rico/epidemiology , Surveys and Questionnaires
5.
Prehosp Disaster Med ; 36(2): 141-144, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1164743

ABSTRACT

OBJECTIVE: This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with 2020 rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020). METHODS: Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson's correlation coefficient. RESULTS: These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico. CONCLUSION: The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.


Subject(s)
COVID-19/mortality , Disaster Planning , Pneumonia, Viral/mortality , Security Measures , Female , Humans , Male , Pandemics , Pneumonia, Viral/virology , Predictive Value of Tests , Puerto Rico/epidemiology , SARS-CoV-2 , United States/epidemiology
6.
BMC Public Health ; 21(1): 485, 2021 03 11.
Article in English | MEDLINE | ID: covidwho-1133590

ABSTRACT

BACKGROUND: The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning. METHODS: A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n = 1789), school (n = 62) and district administrators (n = 64), nurses (n = 3), and "other" (n = 522). RESULTS: Of 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either "significantly less" or "somewhat less" physically active during the closure. For closed schools, the most frequently cited challenges included "student access to online learning", "teacher/student communication" and "teacher remote work arrangements". For open schools, the most commonly reported challenges included "social distancing", "access to gymnasium/equipment", and "concern for personal health and wellbeing". CONCLUSION: The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.


Subject(s)
COVID-19/prevention & control , Exercise , Physical Education and Training/trends , School Teachers/psychology , Students , Adult , COVID-19/psychology , Child , Curriculum , Education, Distance , Humans , Puerto Rico/epidemiology , Schools/statistics & numerical data , Surveys and Questionnaires , United States/epidemiology
7.
Public Health Rep ; 136(3): 354-360, 2021 05.
Article in English | MEDLINE | ID: covidwho-1088394

ABSTRACT

OBJECTIVES: Using the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)-associated confirmed and probable deaths in Puerto Rico during March-July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period. METHODS: We described data on COVID-19-associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics. RESULTS: During March-July 2020, 225 COVID-19-associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19-associated deaths could have occurred during the study period, up to 413 more COVID-19-associated deaths than originally reported. CONCLUSIONS: Including probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19-associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.


Subject(s)
COVID-19/mortality , Epidemiological Monitoring , Female , Humans , Male , Puerto Rico/epidemiology , SARS-CoV-2
8.
Pediatr Pulmonol ; 55(2): 330-337, 2020 02.
Article in English | MEDLINE | ID: covidwho-1064414

ABSTRACT

BACKGROUND: Long-term effects of sulfur dioxide (SO2 ) exposure on children, a vulnerable population, are largely unknown. Further, how long-term SO2 affects Puerto Rican children living in the island of Puerto Rico, a group with high asthma prevalence, is unclear. We evaluated the effects of annual average 1-hour daily maximum SO2 average on asthma, atopy, total immunoglobulin E (IgE), and lung function in Puerto Rican children. METHODS: A cohort of 678 children (351 with asthma, 327 without asthma) was recruited in Puerto Rico from 2009 to 2010. Annual average 1-hour daily maximum SO2 exposure was interpolated utilizing publicly available monitoring data. Multivariable logistic and linear regression was used for the analysis of asthma, atopy (defined as an IgE ≥0.35 IU/mL to at least one of five common aero-allergens), total IgE, and lung function measures (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], and FEV1/FVC ratio). RESULTS: Annual SO2 exposure (per 1 ppb) was significantly associated with asthma (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.05-1.91) and atopy (OR = 1.35; 95% CI = 1.02-1.78). Such exposure was also significantly associated with lower FEV1/FVC in all children (ß = -1.42; 95% CI = -2.78 to -0.08) and in children with asthma (ß = -2.39; 95% CI= -4.31 to -0.46). Annual SO2 exposure was not significantly associated with total IgE, FEV1, or FVC. CONCLUSIONS: Among Puerto Rican children in Puerto Rico, long-term SO2 exposure is linked to asthma and atopy. In these children, long-term SO2 exposure is also associated with reduced FEV1/FVC, particularly in those with asthma.


Subject(s)
Air Pollution/statistics & numerical data , Asthma/epidemiology , Inhalation Exposure/statistics & numerical data , Sulfur Dioxide/analysis , Adolescent , Allergens , Asthma/physiopathology , Child , Cohort Studies , Female , Humans , Hypersensitivity, Immediate , Lung/physiopathology , Male , Odds Ratio , Prevalence , Puerto Rico/epidemiology , Respiratory Function Tests , Vital Capacity
9.
J Addict Med ; 15(4): 276-279, 2021.
Article in English | MEDLINE | ID: covidwho-1029787

ABSTRACT

Opioid use disorder (OUD) is an unprecedented medical and public health issue both in Puerto Rico (PR) and the greater US with an increase incidence of opioid use every year. Unprecedented and compounded emergencies in PR such as those caused by hurricanes, earthquakes, and the COVID-19 pandemic coupled with limited national and local governmental support, has forced most clinics in PR to take action to be able to continue providing care. This commentary summarizes the leadership and clinical initiatives of 3 community organizations in PR to maintain services for people with OUD during the COVID-19 pandemic. Local legislation that supported the continuity of OUD care is summarized, along with unique experiences specific to each organization. In addition, the vulnerability of economically disadvantaged people or experiencing homelessness as well as those affected by these compounded events in PR is discussed, with an emphasis on how some challenges were addressed and future directions for continuity of care as our country adjusts to new demands caused by the COVID-19 pandemic.


Subject(s)
COVID-19 , Opioid-Related Disorders , Humans , Leadership , Opioid-Related Disorders/epidemiology , Pandemics , Puerto Rico/epidemiology , SARS-CoV-2
10.
Am J Prev Med ; 60(3): e131-e138, 2021 03.
Article in English | MEDLINE | ID: covidwho-986986

ABSTRACT

INTRODUCTION: Public health and organized medicine have operated somewhat independently of each other since the early 1900s. In the wake of the COVID-19 pandemic, the necessity of healing any divide between organized medicine and state and local health officials seems self-evident. Using the recommendations abstracted from a 2005 article by Dr. Ronald Davis, "Marriage Counseling for Medicine and Public Health," this cross-sectional study explores the formal relationships that existed between state-level public health and medical practice across the U.S. at the end of 2019. METHODS: A questionnaire was distributed to every state's senior public health official and medical society executive (N=104) between August and December 2019 to examine the extent of these entities' partnerships. Analysis was completed in January 2020. RESULTS: Among the respondents, 40%-63.1% (n=65) currently engage in the recommended activities, with 1 exception: state health departments infrequently invite medical society executives to speak at major conferences or meetings (26.2%). The majority of respondents (71.1%-85.9%) judged that each recommended activity would improve the practices of medicine and public health. CONCLUSIONS: Survey results illustrate a desire for reconciliation, but poor implementation of recommended strategies aimed at building a healthy marriage between the 2 sectors. More formal efforts are needed among state medical and public health organizations to capitalize on the current climate of rapprochement. The burden of COVID-19 on the national health system could provide a worthy cause around which these efforts would coalesce.


Subject(s)
COVID-19/prevention & control , Intersectoral Collaboration , Public Health Administration , Societies, Medical/organization & administration , State Government , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Puerto Rico/epidemiology , Societies, Medical/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , United States/epidemiology
11.
J Gerontol B Psychol Sci Soc Sci ; 76(7): e263-e267, 2021 08 13.
Article in English | MEDLINE | ID: covidwho-894590

ABSTRACT

OBJECTIVES: The COVID-19 outbreak has worsened the ongoing economic crisis in Puerto Rico by creating "parallel pandemics" that exacerbate socioeconomic and health inequalities experienced by its most vulnerable residents. Unfortunately, conditions on the island have been largely overlooked by national media outlets and the mainland U.S. population. Thus, this research report aims to draw attention to the disparate burden multiple and compounding disasters have on older island-dwelling Puerto Rican adults' health and well-being. METHODS: We characterize the lived experiences of the older population in Puerto Rico by incorporating data from multiple sources and contextualizing the effects of compounding disasters, the fiscal pandemic, and health care challenges to provide a more nuanced portrait of existing compounding factors that negatively affect the health and well-being of older adults in the era of COVID-19. RESULTS: We highlight 2 main factors that exacerbate pre-pandemic inequities experienced by the older adult population amid the COVID-19 pandemic in Puerto Rico: (a) the impact of multiple and compounding disasters; and (b) health care challenges. DISCUSSION: The human suffering of the Puerto Rican population is compounded by the consequences of fiscal austerity, increasing levels of income and wealth inequality, the debt crisis, significant emigration, and a dysfunctional health care system. Future governmental actions are required to lessen the burden of parallel pandemics on older adults in Puerto Rico.


Subject(s)
COVID-19/epidemiology , Cyclonic Storms , Natural Disasters , Aged , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Healthcare Disparities/statistics & numerical data , Humans , Puerto Rico/epidemiology , Socioeconomic Factors
12.
Urology ; 147: 50-56, 2021 01.
Article in English | MEDLINE | ID: covidwho-779729

ABSTRACT

OBJECTIVE: To test for an association between surgical delay and overall survival (OS) for patients with T2 renal masses. Many health care systems are balancing resources to manage the current COVID-19 pandemic, which may result in surgical delay for patients with large renal masses. METHODS: Using Cox proportional hazard models, we analyzed data from the National Cancer Database for patients undergoing extirpative surgery for clinical T2N0M0 renal masses between 2004 and 2015. Study outcomes were to assess for an association between surgical delay with OS and pathologic stage. RESULTS: We identified 11,848 patients who underwent extirpative surgery for clinical T2 renal masses. Compared with patients undergoing surgery within 2 months of diagnosis, we found worse OS for patients with a surgical delay of 3-4 months (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.00-1.25) or 5-6 months (HR 1.51, 95% CI 1.19-1.91). Considering only healthy patients with Charlson Comorbidity Index = 0, worse OS was associated with surgical delay of 5-6 months (HR 1.68, 95% CI 1.21-2.34, P= .002) but not 3-4 months (HR 1.08, 95% CI 0.93-1.26, P = 309). Pathologic stage (pT or pN) was not associated with surgical delay. CONCLUSION: Prolonged surgical delay (5-6 months) for patients with T2 renal tumors appears to have a negative impact on OS while shorter surgical delay (3-4 months) was not associated with worse OS in healthy patients. The data presented in this study may help patients and providers to weigh the risk of surgical delay versus the risk of iatrogenic SARS-CoV-2 exposure during resurgent waves of the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Clinical Decision-Making , Kidney Neoplasms/mortality , Nephrectomy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Databases, Factual/statistics & numerical data , Female , Humans , Kaplan-Meier Estimate , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Male , Middle Aged , Mortality/trends , Neoplasm Staging , Nephrectomy/standards , Nephrectomy/trends , Pandemics/prevention & control , Proportional Hazards Models , Puerto Rico/epidemiology , Retrospective Studies , SARS-CoV-2/pathogenicity , Time Factors , Time-to-Treatment/trends , United States/epidemiology
17.
Am J Transplant ; 20(11): 3081-3088, 2020 11.
Article in English | MEDLINE | ID: covidwho-641124

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is a rapidly changing circumstance with dramatic policy changes and universal efforts to deal with the initial crisis and minimize its consequences. To identify changes to organ donation and transplantation during this time, an anonymous web-based survey was distributed to 19 select organ procurement organizations (OPOs) throughout the United States comparing 90-day activity during March-May 2020 and March-May 2019. Seventeen OPOs responded to the survey (response rate of 89.5%). Organ authorization decreased by 11% during the current pandemic (n = 1379 vs n = 1552, P = .0001). Organ recovery for transplantation fell by 17% (P = .0001) with a further 18% decrease in the number of organs transplanted (P = .0001). Donor cause of death demonstrated a 4.5% decline in trauma but a 35% increase in substance abuse cases during the COVID-19 period. All OPOs reported significant modifications in response to the pandemic, limiting the onsite presence of staff and transitioning to telephonic approaches for donor family correspondence. Organ donation during the current climate has seen significant changes and the long-term implications of such shifts remain unclear. These trends during the COVID-19 era warrant further investigation to address unmet needs, plan for a proportionate response to the virus and mitigate the collateral impact.


Subject(s)
COVID-19/epidemiology , Organ Transplantation/statistics & numerical data , Pandemics , SARS-CoV-2 , Tissue Donors/supply & distribution , Tissue and Organ Procurement/organization & administration , Humans , Puerto Rico/epidemiology , Retrospective Studies , United States/epidemiology
18.
Int J Environ Res Public Health ; 17(13)2020 07 05.
Article in English | MEDLINE | ID: covidwho-637646

ABSTRACT

Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.


Subject(s)
Advisory Committees , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Public Health/methods , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Puerto Rico/epidemiology , SARS-CoV-2 , Schools, Medical
SELECTION OF CITATIONS
SEARCH DETAIL
...