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.

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

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.

Epidemiology of pediatric AIDS in Puerto Rico: 1981-1998.

The objective of this study was to describe the AIDS-defining conditions (ADC) and survival experience of pediatric AIDS cases (< 13 years age) reported in Puerto Rico. A descriptive analysis of the data gathered by the Puerto Rico AIDS Surveillance System was performed. Data for the 377 pediatric AIDS cases reported from January 1981 through June 1998 were reviewed. Survival curves following AIDS diagnosis were estimated using the Kaplan--Meier method and differences between curves were assessed by the Wilcoxon test. The majority (61%) of the cases were diagnosed before 2 years of age, and nearly 94% of them acquired the infection through perinatal transmission. The most common ADC were Pneumocystis carinii pneumonia (PCP) (23%), wasting syndrome (19.4%), and esophageal candidiasis (19.1%). The overall median survival time during the study period was 53.5 (95% CI: 38.0-106.2) months. Children < 1 year of age had a significantly shorter median survival time compared with older ages (p < 0.05). The survival experience in children diagnosed with PCP, pulmonary candidiasis, cytomegalovirus, and lymphocytic interstitial pneumonia (LIP) was significantly different (p < 0.05) to those children not diagnosed with these conditions. Although patients diagnosed after 1990 showed a median survival time longer than those diagnosed prior to 1990, the difference did not reach statistical significance (p > 0.05). The frequency of several ADC and median survival time of Puerto Rican children differed from those reported in the United States. This may reflect differences in diagnostic procedures or reporting practices.

Epidemiologic profile of AIDS among Puerto Rican women in the San Juan Standard Metropolitan Statistical Area, 1981-1995.

This article describes the epidemiologic profile of Puerto Rican women affected by AIDS in the San Juan Standard Metropolitan Statistical Area (SMSA). Information from AIDS cases reported to the Puerto Rico (PR) AIDS Surveillance System was analyzed. From July 1981 through June 30 1995, a cumulative total of 15,877 AIDS cases have been reported in PR, 9,838 (62%) of these cases were reported in the San Juan SMSA and 2,044 (20.8%) were women. The male to female ratio was 3.8. The predominant mode of exposure among women was heterosexual contact (48.7%), followed by intravenous drug use (40.4%). The most affected age group among women was 30 to 39 years (43.3%) followed by 20-29 (26.2%). Eighty-one percent of women were in childbearing age. A substantial increase in AIDS cases has been reported for women who revealed heterosexual contact (from 45% in 1993 to 64% in 1995), representing the fastest growing category of AIDS cases in the island. The median survival time after reporting was 16.4 months (95% CI: 15.3-17.7) for males and 22.7 months (95% CI: 19.9 and 26.9) for females. Preventive efforts must be oriented toward education and risk behavior modification primarily directed to young women.