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

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

[Health status and functional limitations in the elderly population of the University Region of Health of Puerto Rico: methodologic aspects and prevalence estimates]. / Condiciones de salud y limitaciones funcionales en la población de edad avanzada de la Región Universitaria de Salud de Puerto Rico: aspectos metodológicos y estimación de prevalencias.

In order to plan the health services for the elderly population, it is necessary to quantify their health status and their functional capacity. In Puerto Rico, few epidemiological studies have been conducted regarding functional capacity and chronic diseases in the elderly population. One of the difficulties to undertake these studies is the high cost and risks to move this population for clinical exams, in addition to the methodology limitation of self-report in the elderly population. This study shows the use of logistic regression to estimate the prevalence of chronic diseases and functional capacity, when the observed data are not consisted with the planed sampling scheme. Four hundred and eighty-seven elderly persons (65 yr. and over) were interviewed in the municipalities of Canóvanas, Carolina, Loíza and Trujillo Alto in Puerto Rico, using a cross-sectional design. More than half of the elderly had visual problems (IC 95%: 54.8%, 63.8%), arthritis (IC 95%: 52.7%, 61.5%) and hypertension (IC 95%: 47.3%, 56.3%). In the case of hypertension, significant differences (p < 0.05) by sex were observed, where women reported a higher prevalence than men. One of the higher prevalences in the functional capacity status was with urine accidents. More than one-third of the population is estimated to have this problem (IC 95%: 34.7%, 43.4%). One-fourth of the population had limitations with going out for shopping (IC 95%: 23.9%, 31.9%) and using public and private transportation (IC 95%: 19.5%, 26.9%). We conclude that the applied methodology was consistent with the estimation presented in the literature and statistics from the Puerto Rico Health Department. However, it is necessary to continue assessing the design and analytical methodology, in order to undertake consistent and periodic evaluations of the elderly population.

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

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

Functional disability and mental impairment as predictors of mortality in community-dwelling elderly Puerto Ricans.

This is a prospective study that explores the role of functional impairment as predictor of one-year mortality in the elderly of rural Puerto Rico. Between September, 1987 and June 1988, 1901 elderly were interviewed at their place of residence. Besides obtaining social and demographic information, assessment of functional status using a modified Katz scale and determination of mental status using the Short Portable Mental Status questionnaire were performed. During the one-year follow-up period 43 participants died. Multiple logistic regression analysis showed that the presence of functional (OR = 5.31) and mental impairment (OR = 2.22) were independent predictors of mortality when adjusted for age, education, gender and income. These findings are consistent with those of other studies, where the presence of functional and mental impairment, detected on admission to a hospital or while living in the community, were associated to a higher mortality.

Differences in patient mix: a partial explantation for the excessive Medicare mortality observed in some Puerto Rican hospitals.

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

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

Data was obtained from 4189 volunteer blood donation records in two hospital-based blood banks in Puerto Rico to determine whether Hispanics have higher serum alanine aminotransferase (ALT-SGPT) activity than donors from other racial-ethnic groups. The overall mean value of ALT-SGPT in the study population was 36.84 u/l (range 1-910, standard deviation 37.8). When the logarithm of ALT-SGPT (log ALT) was calculated for all subjects, the overall, mean for log ALT was 1.47 (range 1-2.96, standard deviation 0.27). Analysis of each blood bank's donation records at two different time periods showed a consistently high ALT-SGPT activity even when donations positive for hepatitis B surface antigen or other serologic markers were excluded. Though the causal factor of this finding is not clear, non-infectious environmental such as alcohol consumption should be considered as a probable explanation.

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

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

The absence of dengue virus in the skin lesions of dengue fever.

Patients with confirmed dengue infection were studied in an attempt to elucidate the cause of the eruption of dengue fever. Punch biopsies of lesional skin were obtained and processed for the presence of viral antigen and immune globulins by the direct fluorescent antibody test. Another biopsy specimen and the acute sera were processed for virus isolation. Although virus was isolated from the serum of two patients, isolation attempts from the biopsy specimens of all four patients were negative. Fluorescent antibody studies revealed no evidence of either viral antigen or immune globulins in lesional skin. Although limited, the data suggest that the maculopapular rash of dengue fever may be caused by some mechanism other than direct viral infection of the skin or involvement of immune globulins.