RESUMO
BACKGROUND AND OBJECTIVES: We examined quality of education, literacy, and years of education in relation to late-life cognitive function and decline in older Puerto Ricans. RESEARCH DESIGN AND METHODS: Our sample consisted of 3,385 community-dwelling adults aged 60 years and older from the Puerto Rican Elderly: Health Conditions study. Quality of education was based on principal component analysis of variables gathered from Department of Education and Census reports. Literacy (yes/no) and years of education were self-reported. Cognitive function was assessed in participants' homes at baseline and 4 years later using a previously validated Spanish-language 20-point global screening measure for dementia, the minimental Cabán. Regression models were adjusted for sociodemographic and life course covariates. RESULTS: Quality of education was positively correlated with both educational attainment and cognitive performance. Independent of years of education, literacy, childhood economic hardship, and adult economic hardship, compared to participants in the lowest quartile of education quality, those in the highest quartile had significantly better baseline cognitive performance (ß = 0.09, p < .001). Quality of education did not consistently show an association with change in cognitive function over 4 years. Literacy and greater educational attainment were each independently associated with better cognitive function at baseline and less cognitive decline. DISCUSSION AND IMPLICATIONS: Quality of education, literacy, and years of education, while interrelated, also show independent associations with cognitive functioning in older Puerto Ricans. The downstream factors of literacy and years of education were more closely related to age-related cognitive decline than quality of education.
RESUMO
BACKGROUND: Older Puerto Rican adults have particularly high risk of diabetes compared to the general US population. Diabetes is associated with both higher depressive symptoms and cognitive decline, but less is known about the longitudinal relationship between cognitive decline and incident depressive symptoms in those with diabetes. This study investigated the association between cognitive decline and incident depressive symptoms in older Puerto Rican adults with diabetes over a four-year period. METHODS: Households across Puerto Rico were visited to identify a population-based sample of adults aged 60 years and over for the Puerto Rican Elderly: Health Conditions study (PREHCO); 680 participants with diabetes at baseline and no baseline cognitive impairment were included in analyses. Cognitive decline and depressive symptoms were measured using the Mini-Mental Cabán (MMC) and Geriatric Depression Scale (GDS), respectively. We examined predictors of incident depressive symptoms (GDS ≥ 5 at follow-up but not baseline) and cognitive decline using regression modeling. RESULTS: In a covariate-adjusted logistic regression model, cognitive decline, female gender, and greater diabetes-related complications were each significantly associated with increased odds of incident depressive symptoms (p < 0.05). In a multiple regression model adjusted for covariates, incident depressive symptoms and older age were associated with greater cognitive decline, and higher education was related to less cognitive decline (p < 0.05). CONCLUSIONS: Incident depressive symptoms were more common for older Puerto Ricans with diabetes who also experienced cognitive decline. Efforts are needed to optimize diabetes management and monitor for depression and cognitive decline in this population.
Assuntos
Disfunção Cognitiva/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus/psicologia , Idoso , Idoso de 80 Anos ou mais , Cognição , Complicações do Diabetes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Porto Rico/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVES: We examined the effects of early life exposure to poor nutrition and infectious diseases on adult heart disease and diabetes using season of birth as an indicator to help disentangle the effects on health of early life exposure from effects associated with other childhood conditions. METHODS: Using data from 60- to 74-year-old Puerto Ricans who lived in rural areas during childhood (n = 1,457), we estimated the effects of seasonal exposure during late gestation on the probability of diabetes and heart disease, controlling for adult obesity and other childhood conditions (health, socioeconomic status, knee height). RESULTS: We found (a) strong associations between exposure and heart disease; (b) weaker associations between exposure and diabetes, although significant negative interaction effects between exposure and having a family member with diabetes suggest the possibility of either strong gene-environment or early adult-environment interactions; (c) virtually no attenuation of effects of self-reported childhood health with controls for exposure. DISCUSSION: Timing of birth may reveal conditions experienced perinatally that affect adult heart disease and diabetes. The results suggest that examination of the effects of season of birth on these chronic conditions among older Puerto Rican adults and among older adults from similar populations deserves deeper scrutiny.
Assuntos
Doenças Transmissíveis/epidemiologia , Diabetes Mellitus/epidemiologia , Transtornos da Nutrição Fetal/epidemiologia , Cardiopatias/epidemiologia , Desenvolvimento Humano , Idoso , Idoso de 80 Anos ou mais , Agricultura/estatística & dados numéricos , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus/etiologia , Feminino , Cardiopatias/etiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pobreza , Porto Rico/epidemiologia , Fatores de Risco , População Rural , Estações do AnoRESUMO
The demographic origins of aging in Puerto Rican and other Latin American and Caribbean (LAC) countries may have important implications for the profile of health status and mortality of elderly people. For this article we tested a general conjecture about the relation between early childhood conditions and adult health status among Puerto Rican elderly using a rich data set recently collected through an island-wide survey (N = 4,293). We examined the association between markers of early nutritional status, self-reports of health and on socioeconomic conditions during early childhood, and the prevalence of 3 conditions during adult ages: obesity, diabetes, and cardiovascular diseases. Although we found that obesity and diabetes are associated with markers of early malnutrition, that heart disease is associated with early deprivations and selected early childhood conditions, the evidence we were able to tease out from the data provides only fragile support for the conjecture.
Assuntos
Nível de Saúde , Mortalidade , Estado Nutricional , Classe Social , Adolescente , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Mammography for low-income women is an important intervention issue as it is still under utilized in these sectors. Despite evidence in favor of breast cancer screening with mammograms, research indicates that mammogram compliance among low-income females and women over 50 years of age has been slow. This article revolves around the factors that affect compliance with screening mammograms among low-income women ages 40 to 64 in Puerto Rico once they receive a referral from a physician. Although the multivariate analysis demonstrated that only age, work outside of the home and performing breast self-exams significantly increased the probability for middle-aged, low-income women in Puerto Rico to comply with referrals and have mammograms, this research illustrated that certain factors such as knowledge about the disease and screening practices, a satisfactory perception of the patient-physician relationship, and the performance of a clinical breast exam by a physician influence mammogram compliance.
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Neoplasias da Mama/prevenção & controle , Mamografia/estatística & dados numéricos , Cooperação do Paciente , Adulto , Autoexame de Mama/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mamografia/economia , Programas de Rastreamento/economia , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Relações Médico-Paciente , Porto Rico , Fatores SocioeconômicosRESUMO
Screening mammogram utilization is a critical issue in early detection of breast cancer. However, it is underutilized by different sectors, particularly low-income women. The objective of this study was to utilize the method known as focus group to probe into obstacles to screening mammogram among low-income women in the ages 40 to 64 in Puerto Rico once they had a physician's referral. The women in the study had knowledge of breast self-examination, clinical breast exam and mammogram as tests to detect breast cancer. Yet, they had no adequate knowledge about current screening guidelines. Attitudes toward pain or discomfort related to the mammogram and fear of a breast cancer diagnosis were the personal reasons most often cited for non-compliance in the focus group discussions. In the case of external or systemic barriers, the most prevalent reasons offered were: cost of the mammogram, transportation, and negative factors associated to the doctor-patient relationship.
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Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Adulto , Fatores Etários , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Autoexame de Mama/estatística & dados numéricos , Feminino , Doença da Mama Fibrocística/diagnóstico , Humanos , Mamografia/economia , Pessoa de Meia-Idade , Relações Médico-Paciente , Fatores de Risco , Meios de Transporte , VocabulárioRESUMO
Screening mammogram utilization is a critical issue in early detection of breast cancer. However, it is underutilized by different sectors, particularly low-income women. The objective of this study was to utilize the method known as focus group to probe into obstacles to screening mammogram among low-income women in the ages 40 to 64 in Puerto Rico once they had a physician's referral. The women in the study had knowledge of breast self-examination, clinical breast exam and mammogram as tests to detect breast cancer. Yet, they had no adequate knowledge about current screening guidelines. Attitudes toward pain or discomfort related to the mammogram and fear of a breast cancer diagnosis were the personal reasons most often cited for non-compliance in the focus group discussions. In the case of external or systemic barriers, the most prevalent reasons offered were: cost of the mammogram, transportation, and negative factors associated to the doctor-patient relationship.
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Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Mamografia , Programas de Rastreamento , Pobreza , Fatores Etários , Neoplasias da Mama , Autoexame de Mama , Doença da Mama Fibrocística/diagnóstico , Mamografia , Relações Médico-Paciente , Fatores de Risco , Meios de Transporte , VocabulárioRESUMO
Analysis of the access to abortion in Puerto Rico is important because, together with Cuba, they are the only countries where abortion is legal in Latin America. This article analyzes the socio-political trends of the debate and discourses through which the discussion of the pro-option and antiabortion sectors have developed in the current situation of Puertorican law and their links with the arguments of those sectors in the United States. Even in this framework of legality, the right to abortion in Puerto Rico has been the object of a process of attacks by the antiabortion sectors that has limited its exercise, and it continues to be a taboo and polemical matter; maybe tolerated, but questioned and undermined as a right, and as a result, delegitimized. The Island situation makes it possible to consider that eradicating the legal prohibition of the practice is not a sufficient element for abortion to become a social need and a right of women in their own conscience, in public opinion and in state interventions.