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1.
Disaster Med Public Health Prep ; 17: e310, 2022 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-36471913

RESUMO

OBJECTIVE: Study the effect of the coronavirus disease (COVID-19) pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints. METHODS: Data from ER encounters in a teaching hospital for years 2019 and 2020 were extracted from an electronic database. The ICD-10-CM codes were used to assign the primary diagnosis. Joinpoint regression was applied to a time-series to detect changes in daily encounters (all-cause and MSK). Total number and median daily encounters were calculated by year, sex, age groups, and diagnostic codes for each year. RESULTS: Overlapping intervals within March 2020 showed drops of 8.1 all-cause encounters per day (95% CI: 4.8-11.5), and 1.2 MSK encounters per day (95% CI: 0.8-1.7), resulting in net losses for the year of 33.2% for all-cause and 35.8% for MSK encounters. Reductions were observed for both sexes and all age groups. MSK codes with largest declines were low back pain, joint pain, and limb pain. CONCLUSION: The COVID-19 pandemic resulted in major reductions in all-cause and MSK encounters in the ER of an academic hospital probably due to governmental restrictions and a change in patients behaviors. Persistence of the observed reduction suggests that patients requiring ER services delayed seeking care for MSK and other health conditions.


Assuntos
COVID-19 , Pandemias , Masculino , Feminino , Humanos , COVID-19/epidemiologia , Serviço Hospitalar de Emergência , Hospitais
2.
P R Health Sci J ; 41(2): 56-62, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35704522

RESUMO

OBJECTIVE: To study the utilization of emergency room (ER) services for health complaints of the musculoskeletal (MSK) system in older men and women. METHODS: Data from all medical encounters at the ER of a teaching hospital for calendar years 2016-2020 were extracted from an electronic database. MSK encounters were defined as those with ICD 10-CM M and S codes in the primary diagnosis field of the database. Frequency distributions were calculated by year, sex, and age group for MSK and all encounters. The most frequent codes used by sex and age groups were assessed. RESULTS: The number of unique patients with medical encounters at the ER during the five-year period was 94,346. There was a total of 220,153 encounters (median:1 encounter per patient; interquartile range:1-3). A 33.2% reduction in the number of encounters occurred in 2020 compared to 2019. The total number of unique patients in the 60 yr. and older group was 24,412 (25.9% of all unique patients). The total number of encounters in the group 60 yr. and older was 56,294 (25.6% of all encounters). Women accounted for 31,488 (56%) encounters in this age group. A total of 12,744 encounters (22.6%) in older adults involved the MSK system and this proportion decreased with increasing age. The most common MSK conditions included low back pain, pain in joints, and femoral fractures. CONCLUSION: Older adults with MSK health conditions represent a substantial portion of ER patients. Many MSK health conditions could be evaluated and treated in other health care settings.


Assuntos
Doenças Musculoesqueléticas , Idoso , Bases de Dados Factuais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Dor
3.
P R Health Sci J ; 40(2): 68-74, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34543564

RESUMO

OBJECTIVE: Assess the potential value of an emergency room (ER) for the teaching of musculoskeletal (MSK) medicine to medical students and residents in training. METHODS: Data from all encounters to the ER of a teaching hospital for calendar years 2016-2019 were extracted from an electronic database. Encounters with ICD-10-CM M codes (MSK system) and S codes (injury) were selected (MSK encounters). Frequency distributions were calculated by year, sex, and age group for all encounters and MSK encounters. Annual distributions of encounters involving the shoulder, hip, knee, and ankle joints were assessed. RESULTS: The number of unique patients seen during the four-year period was 84,094, and the number of encounters was 187,829 (Median: 1 encounter; interquartile range: 1-2). The mean number of encounters per year was 46,957 (range: 45,311- 48,382). There was no seasonal variation. Most patients were women (45,868; 54.6%) and young (20 29 yr.) adults (15,012; 17.8%), and these groups generated the largest numbers of encounters (women: 108,799; 57.9%; young adults: 35,969; 19.1%). A total of 41,353 encounters (22.0% of all encounters) involved the MSK system. The shoulder, hip, knee, and ankle were involved in 2,768 (1.5%), 1,592 (0.8%), 3,082 (1.6%), and 1,718 (0.9%) encounters, respectively. The most common conditions for each joint were shoulder pain, femoral fracture, knee contusion, and ankle sprain. CONCLUSION: Our findings suggest that ER physicians should have broad knowledge of MSK conditions and injuries. An ER is an excellent location for the teaching of MSK medicine to medical students and residents of other training programs.


Assuntos
Internato e Residência , Doenças Musculoesqueléticas , Estudantes de Medicina , Ensino , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino
4.
J Neuromuscul Dis ; 3(2): 261-266, 2016 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-27854217

RESUMO

BACKGROUND: Duchenne and Becker Muscular Dystrophy (DMD and BMD, respectively), are common forms of inherited muscle disease. Information regarding the epidemiology of these conditions, including genotype, is still sparse. OBJECTIVE: To establish the prevalence and genetic profile of DMD and BMD in Puerto Rico. METHODS: We collected data from medical records in all Muscular Dystrophy Association (MDA) clinics in Puerto Rico in order to estimate the prevalence of DMD and BMD and to describe the genotypic profile of these patients. Patients selected for data analysis matched "definite", "probable" and "possible" case definitions as established by MD STARnet. RESULTS: A total of 141 patients matched the inclusion criteria, with 64.5% and 35.5% being categorized into DMD and BMD, respectively. DMD and BMD prevalence in Puerto Rico was estimated at 5.18 and 2.84 per 100,000 males, respectively. Deletion was the most common form of mutation (66.7%) in the dystrophin gene, with exons in segment 45 to 47 being the most frequently affected. CONCLUSIONS: This is the first report of the prevalence and genetic profile characteristics of DMD and BMD in Puerto Rico. Prevalence of DMD was similar to that reported worldwide, while prevalence of BMD was higher. Genetic profile was consistent with that reported in the literature.


Assuntos
Distrofina/genética , Distrofia Muscular de Duchenne/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Éxons , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Distrofia Muscular de Duchenne/genética , Mutação , Prevalência , Porto Rico/epidemiologia , Deleção de Sequência , Adulto Jovem
5.
Int J Environ Res Public Health ; 13(1): ijerph13010018, 2015 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-26703677

RESUMO

PURPOSE: This paper describes SalHUD, a prototype web-based application for visualizing health data from Puerto Rico. Our initial focus was to provide interactive maps displaying years of potential life lost (YPLL). METHODS: The public-use mortality file for year 2008 was downloaded from the Puerto Rico Institute of Statistics website. Data was processed with R, Python and EpiInfo to calculate years of potential life lost for the leading causes of death on each of the 78 municipalities in the island. Death records were classified according to ICD-10 codes. YPLL for each municipality was integrated into AtlasPR, a D3 Javascript map library. Additional Javascript, HTML and CSS programing was required to display maps as a web-based interface. RESULTS: YPLL for all municipalities are displayed on a map of Puerto Rico for each of the ten leading causes of death and for all causes combined, so users may dynamically explore the impact of premature mortality. DISCUSSION: This work is the first step in providing the general public in Puerto Rico with user-friendly, interactive, visual access to public health data that is usually published in numerical, text-based media.


Assuntos
Causas de Morte , Internet , Mortalidade , Saúde Pública/estatística & dados numéricos , Humanos , Porto Rico , Software
6.
Telemed J E Health ; 16(1): 103-6, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20155874

RESUMO

Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences.


Assuntos
Educação em Saúde , Internet , Telemedicina/organização & administração , Inteligência Artificial , Comportamento Cooperativo , Humanos , Capacitação em Serviço , Pesquisa , Interface Usuário-Computador
7.
P R Health Sci J ; 22(2): 111-8, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12866133

RESUMO

OBJECTIVES: We describe hospitalization rates among Medicare beneficiaries resident in Puerto Rico compared to beneficiaries in the mainland U.S., in 1999. METHODS: A cross-sectional analysis using Medicare Denominator and hospitalization files. RESULTS: The rate ratio (PR/U.S.) of age, gender-adjusted hospitalizations among elderly Medicare beneficiaries with Part A coverage was 0.78, compared with 0.92 among beneficiaries with both Part A and Part B coverage. Among the latter, the rate ratios were 0.78 for surgical admissions, 1.08 for low-variation medical conditions, and 0.97 for high variation medical conditions. They were higher for younger elderly beneficiaries. CONCLUSIONS: Rates of hospitalization in Puerto Rico may be lower, the same or exceed those of the mainland U.S. depending on the age of the beneficiary and the type of hospitalization.


Assuntos
Serviços de Saúde para Idosos/estatística & dados numéricos , Medicare/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Grupos Diagnósticos Relacionados , Feminino , Humanos , Masculino , Porto Rico/epidemiologia
8.
P. R. health sci. j ; P. R. health sci. j;20(1): 5-11, Mar. 2001.
Artigo em Inglês | LILACS | ID: lil-334074

RESUMO

OBJECTIVE: To identify predictors of adverse events after PTCA during hospitalization and after hospital discharge in a private hospital in Puerto Rico. BACKGROUND: A review of the literature shows limited information about predictors of adverse events associated to percutaneous transluminal coronary angioplasty (PTCA) in Hispanic patients. METHODS: This is a non-concurrent prospective study. Baseline variables were analyzed using multivariate logistic regression to identify predictors of adverse events. Data were collected from medical charts and telephone reports from referring physicians. RESULTS: Data from 197 subjects undergoing PTCA were analyzed for this study. Median age of patients was 65 years, and 62.9 of patients were male. Angiographic success rate was 81.6. A total of 8.1 of patients had at least one in-hospital adverse event, and 39.8 had at least one adverse event after hospital discharge. After multivariate analysis, a statistically significant association was found between the presence of at least one lesion with residual stenosis of 50 or greater and the risk of developing adverse events in-hospital (RO 11.75; 95 CI 4.32-31.97). A marginally significant association was found between family history of heart disease (RO 2.75; 95 CI 0.93-8.11) and the risk of adverse events during hospitalization. Family history of heart disease (RO 1.41; 95 CI 0.98-2.04) and the presence of at least one lesion with residual stenosis of 50 or greater (RO 2.87; 95 CI 0.82-10.01) showed marginally significant associations with increased risk for adverse events after discharge. CONCLUSIONS: These findings suggest that the presence of at least one lesion with residual stenosis of 50 or greater and family history of heart disease may be risk factors for adverse events after PTCA during hospitalization and after discharge.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Angioplastia Coronária com Balão/efeitos adversos , Doença das Coronárias , Idoso de 80 Anos ou mais , Doença das Coronárias , Hispânico ou Latino , Análise Multivariada , Estudos Prospectivos , Porto Rico , Recidiva
9.
P. R. health sci. j ; P. R. health sci. j;18(4): 369-76, dez. 1999. tab
Artigo em Espanhol | LILACS | ID: lil-260830

RESUMO

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.


Assuntos
Humanos , Masculino , Feminino , Idoso , Atividades Cotidianas , Nível de Saúde , Fatores Etários , Área Programática de Saúde , Porto Rico , Universidades
10.
P. R. health sci. j ; P. R. health sci. j;15(4): 275-7, dec. 1996.
Artigo em Inglês | LILACS | ID: lil-212518

RESUMO

A total of 118 nursing home admissions were studied to determine the prevalence of M. tuberculosis infection and the prevalence of risk factors for the development of active tuberculosis. The overall prevalence of positive tests was 22.5 per cent. The most prevalent risk factors for development of active tuberculosis were diabetes mellitus (42.4 per cent), being more than 10 per cent below ideal body weight (41.5 per cent), and alcohol abuse (12.7 per cent). Thirty-four percent of admissions had albumin levels below 3.5 g/dl. No associations were found when logistic regression was used to determine the impact of age and poor nutritional status on the prevalence of positive PPD tests on admission. These results show a substantial difference between the prevalence of positive PPD tests found upon nursing home admissions (22.5 per cent) and the prevalence found previously among residents in the same in nursing home (42.9 per cent).


Assuntos
Humanos , Idoso , Casas de Saúde , Teste Tuberculínico , Tuberculose , Fatores Etários , Alcoolismo/complicações , Peso Corporal , Diabetes Mellitus/complicações , Modelos Logísticos , Estado Nutricional , Prevalência , Porto Rico , Fatores de Risco
11.
P. R. health sci. j ; P. R. health sci. j;15(1): 27-31, mar. 1996. tab
Artigo em Inglês | LILACS | ID: lil-212511

RESUMO

A total of 91 nursing home patients were evaluated to determine the prevalence of tuberculous infection and the prevalence of risk factors for active TB in those with positive tuberculin reactions. Overall prevalence rate for positive PPD was 42.9 percent No association was found between revalence of positive PPD and time since admission to the nursing home. The most prevalent risk factors for active TB among PPD positive patients were diabetes mellitus (38.5percent), being 10 percent below ideal body weight (25.6 percent), chest X ray with fibrotic changes (13.2 percent), and carcinoma of oropharynx (5.1 percent). Twenty-one patients (53.8 percent) of patients with positive test) met criteria for prophylactic treatment with isoniazid. This study detected a high prevalence of positive PPD reactions in this nursing home population and a high prevalence of risk factors for the development of active TB in the group with positive reaction to PPD. Due to the high risk for the development of active tuberculosis in this population, aggressive screening and preventive therapy are mandatory


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Casas de Saúde/normas , Programas de Rastreamento , Teste Tuberculínico/normas , Tuberculose Pulmonar , Idoso de 80 Anos ou mais , Antituberculosos , Estudos Transversais , Avaliação Geriátrica , Incidência , Isoniazida , Porto Rico , Fatores de Risco , Tuberculose Pulmonar
12.
P. R. health sci. j ; P. R. health sci. j;14(4): 279-83, Dec. 1995. tab
Artigo em Inglês | LILACS | ID: lil-212086

RESUMO

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 percent and 18.4 percent 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


Assuntos
Humanos , Feminino , Idoso , Masculino , Pessoa de Meia-Idade , Atividades Cotidianas , Transtornos Cognitivos , Avaliação Geriátrica , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Modelos Logísticos , Entrevista Psiquiátrica Padronizada , Vigilância da População , Prevalência , Porto Rico , Inquéritos e Questionários , Razão de Chances , Fatores de Risco , Saúde da População Rural , Fatores Socioeconômicos
13.
Bol. Asoc. Méd. P. R ; Bol. Asoc. Méd. P. R;83(11): 479-84, nov. 1991. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-117757

RESUMO

Puerto Rico ocupó el tercer lugar en el número de casos diagnosticados de SIDA pediátrico en Estados Unidos entre los meses de septiembre de 1989 y agosto de 1990. El mayor número de casos de SIDA pediátrico ha sido identificado en áreas metropolitanas de alto riesgo. Usualmente el SIDA afecta a niños nacidos a madres drogadictas. Este trabajo pretende describir el perfil sociodemográfico y el crecimiento físico de os casos de SIDA pediátrico al presente atendidos en el Instituto de SIDA de San Juan durante los años de 1986 a 1990. En este estudio de naturaleza descriptiva, la muestra consistió de los 40 pacientes vivos con el diagnóstico de SIDA que constituían el universo al realizar la presente investigación. La fuente principal de transmisión fue por vía perinatal (90.0 por ciento) y el factor de riesgo, la drogadicción endovenosa en la madre (67.5 por ciento). El 42.4 por ciento de las madres sostenían una relación consensual. El 70.0 por ciento de los casos nacieron a término (38 semanas) con un peso promedio de 2,954 gramos y talla promedio de 50.9 centímetros. Al momento de presentar síntomas dentro de alguna categoría P2 según criterios del CDC, el 67.7 por ciento estaban debajo de la 50ma. percentila en peso; y el 86.9 por ciento de los casos estaban por debajo de la 50ma. percentila en talla


Assuntos
Humanos , Criança , Crescimento , Hospitalização/estatística & dados numéricos , Síndrome da Imunodeficiência Adquirida/epidemiologia , Fatores Etários , Análise de Variância , Idade Gestacional , HIV-1 , Hospitais Municipais , Porto Rico/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos
14.
Bol. Asoc. Méd. P. R ; Bol. Asoc. Méd. P. R;83(8): 329-32, ago. 1991. tab
Artigo em Inglês | LILACS | ID: lil-108081

RESUMO

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


Assuntos
Grupos Diagnósticos Relacionados , Hospitais Federais , Hospitais Privados , Medicare , Mortalidade , Fatores Etários , Grupos Diagnósticos Relacionados , Hospitais Federais , Hospitais Privados , Medicare , Porto Rico , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
15.
Bol. Asoc. Méd. P. R ; Bol. Asoc. Méd. P. R;83(5): 189-91, Mayo 1991. tab
Artigo em Inglês | LILACS | ID: lil-105532

RESUMO

Se obtuvieron datos de 4,189 expedientes de donaciones de sangre procedentes de dos bancos de sangre en Puerto Rico para determinar si los puertorriqueños tienden a tener niveles en sangre de ALT-SGPT más altos en comparación con donantes de sangre de otros grupos étnicos. El promedio general de ALT-SGPT fue de 36.84 u/l (alcance 1-910, desviación estandard 37.8). El logarítmo de ALT FUE DE 1.47 (alcance 1-2.96, desviación estandard). Analisis de cada banco de sangre en dos períodos de tiempo demostraba promedios de ALT-SGPT consistentemente altos aún cuando excluían donaciones positivas para hepatitis B, H. I. V. y sífilis. Aunque las causas de estos hallazgos no estan claras, factores ambientales como el consumo de alcohol deben considerar-se como posibles explicaciones


Assuntos
Humanos , Alanina Transaminase/sangue , Doadores de Sangue , Etnologia , Porto Rico
16.
Bol. Asoc. Méd. P. R ; Bol. Asoc. Méd. P. R;82(3): 115-8, mar. 1990. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-83267

RESUMO

El estudio investiga los patrones de utilización hospitalaria en personas mayores de 64 años. La determinación de deficiencia intelectual y discapacidad de 1,353 personas mayores de 64 años y acogidos a Medicare fue obtenida de un censo de la población mayor de 59 año realizado en el municipio de Gurabo, Puerto Rico, entre 1987 y 1988. Examinando los datos de hospitalización del programa Medicare en Puerto Rico se encontró que un total de 105 de estas personas fueron hospitalizadas por lo menos una vez durante ese período de tiempo. Para el grupo con deficiencia intelectual y discapacidad la tasa de hospitalización fue de 13.5%. Los que presentan solamente discapacidad tuvieron una tasa de 9.4%. El grupo con deficiencia intelectual solamente tuvo una tasa de 8.8%. La menor tasa de 6,8%, correspondió a los sujetos sin deficiencia intelectual ni discapacidad. Estos datos sugieren una relación entre la presencia de dichas disfunciones y la probabilidad de ser hospitalizado. No obstante, es necesaria más investigación para dilucidar si dicho efecto es independiente de la edad


Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Fatores Etários , Pessoas com Deficiência , Hospitalização/tendências , Deficiência Intelectual/epidemiologia , Idoso de 80 Anos ou mais
17.
Bol. Asoc. Méd. P. R ; Bol. Asoc. Méd. P. R;81(9): 345-50, sept. 1989. ilus
Artigo em Espanhol | LILACS | ID: lil-103668

RESUMO

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 intelectually 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


Assuntos
Envelhecimento , Serviços de Saúde para Idosos , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Acessibilidade aos Serviços de Saúde , Serviços de Saúde para Idosos/provisão & distribuição , Indicadores Básicos de Saúde , Morbidade , Mortalidade , Porto Rico/epidemiologia , População Rural , Fatores Socioeconômicos
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