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BACKGROUND: Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied. METHODS: Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates. RESULTS: Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes. CONCLUSION: We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.
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Transtornos Relacionados ao Uso de Álcool , Alcoolismo , Consumo Excessivo de Bebidas Alcoólicas , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Estudos de Coortes , Prevalência , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Porto Rico/epidemiologiaRESUMO
Background: Globally, 1.3 billion people were considered food insecure as of 2022. In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3% as of 2020, the highest of all subregions in Latin America. Experienced based measurement scales, like the Latin American and Caribbean Food Security Scale, are efficient measurement tools of food insecurity used globally. The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study is a population-based longitudinal cohort study in the two Caribbean U.S. territories of Puerto Rico and the U.S. Virgin Islands, as well as in Barbados and Trinidad & Tobago. The purpose of this research was to examine the demographic, psychosocial, behavioral, and environmental risk factors associated with household food insecurity (HFI) among adults ≥40 years of age in the ECHORN cohort. Methods: A cross-sectional analysis of baseline ECHORN cohort study data was conducted. The primary outcome was household food insecurity (none, mild, moderate/severe). A total of 16 known and potential risk factors were examined for their association with HFI. The ANOVA and chi-square statistics were used in bivariate analysis. Ordinal logistic regression was used for the multivariable and sex stratified analyses. Results: More than one-quarter of the sample (27.3%) experienced HFI. In bivariate analyses, all risk factors examined except for sex, were significantly associated with HFI status. In the multivariable analysis, all variables except sex, education, marital status, smoking status, and residing in Puerto Rico were significant predictors of HFI in the adjusted model. In sex stratified analysis, depression, food availability, self-rated physical health, and island site were significantly associated with increased odds of worsening HFI for women, but not for men. Source of potable water was an important risk factor for both men and women. Discussion: The prevalence of HFI in the ECHORN cohort study is comparable to other studies conducted in the region. While women did not have an increased risk of HFI compared to men, a different set of risk factors affected their vulnerability to HFI. More research is needed to understand how water and food security are interrelated in the ECHORN cohort.
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Insegurança Alimentar , Abastecimento de Alimentos , Masculino , Adulto , Humanos , Feminino , Fatores Socioeconômicos , Estudos Transversais , Estudos de Coortes , Estudos Longitudinais , Fatores de Risco , Porto Rico/epidemiologiaRESUMO
Resumen La isquemia mesentérica aguda se asocia a una mortalidad de entre el 50 y el 100%, la causa más rara de esta es la trombosis venosa de los vasos mesentéricos (5%) y portal (1%). Las manifestaciones clínicas son diversas, siendo el dolor abdominal el principal síntoma. La tomografía computarizada con contraste intravenoso en fase portal es la imagen más precisa para el diagnóstico. El tratamiento en fase aguda se basa en anticoagulación, fluidos intravenosos, antibióticos profilácticos, descanso intestinal y descompresión. La laparotomía de control de daños, incluida la resección intestinal y el abdomen abierto, pueden estar justificados en última instancia para pacientes con necrosis intestinal y sepsis. Caso clínico: Hombre de 35 años, sin antecedentes de importancia, solo tabaquismo desde hace 15 años. Refirió que 5 días previos comenzó a presentar dolor en el epigastrio tipo cólico, de intensidad moderada, posteriormente refirió que el dolor se generalizó y aumentó de intensidad, acompañado de náusea, vómito, intolerancia a la vía oral y alza térmica. Al examen físico tuvo datos de respuesta inflamatoria sistémica, estaba consciente y orientado, con abdomen doloroso a la palpación superficial y profunda a nivel generalizado, pero acentuado en el flanco derecho, rebote positivo con resistencia, timpanismo generalizado, peristalsis ausente. Se ingresó a quirófano a laparotomía exploradora, encontrando lesión a intestinal isquémica-necrótica a 190-240 cm del ángulo de Treitz, y 400 cc de líquido hemático; se realizó resección de la parte intestinal afectada, con entero-enteroanastomosis término-terminal manual. Se envió pieza a patología, y se reportó un proceso inflamatorio agudo con necrosis transmural y congestión vascular. Ante estos hallazgos se realizó angiotomografía abdominal que reportó defecto de llenado en la vena mesentérica superior, secundario a trombosis que se extendía hasta la confluencia y la vena porta. Conclusión: La trombosis venosa mesentérica y portal es una patología muy infrecuente en pacientes jóvenes sin factores de riesgo en los que se presenta dolor abdominal. El diagnóstico es complejo debido a que los datos clínicos y de laboratorio son poco específicos. Sin embargo, debemos tenerla en cuenta en el diagnóstico diferencial de etiologías de dolor abdominal.
Abstract Acute Mesenteric Ischemia is associated with a mortality rate between 50% and 100%; the rarest cause of this is venous thrombosis of the mesenteric (5%) and portal (1%) vessels. The clinical manifestations are diverse, with abdominal pain being the main symptom. Computed tomography with intravenous contrast in the portal phase is the most accurate image for diagnosis. Treatment in the acute phase is based on anticoagulation, intravenous fluids, prophylactic antibiotics, intestinal rest, and decompression. Damage control laparotomy, including bowel resection and open abdomen, may ultimately be warranted for patients with bowel necrosis and sepsis. Clinical case: 35-year-old man, with no significant history, only smoking for 15 years. For 5 days before, he reported crampy epigastric pain of moderate intensity. He subsequently reported that the pain became generalized and increased in intensity, accompanied by nausea, vomiting, oral intolerance, and temperature rise. The physical examination showed signs of a systemic inflammatory response, conscious and oriented, abdomen painful on superficial and deep palpation at a generalized level but accentuated on the right flank, positive rebound with resistance, generalized tympanism, absent peristalsis. The operating room was entered for exploratory laparotomy, finding an ischemic-necrotic intestinal lesion at 190 - 240 cm from the angle of Treitz, and 400cc of blood fluid. Resection of the affected intestinal part is performed, with entire manual terminal end anastomosis. The specimen was sent to pathology, reporting an acute inflammatory process with transmural necrosis and vascular congestion. Given these findings, abdominal CT angiography was performed, which reported a filling defect in the superior mesenteric vein, secondary to thrombosis that extended to the confluence and the portal vein. Conclusion: Mesenteric and portal venous thrombosis is a very rare pathology in young patients without risk factors in whom abdominal pain occurs. The diagnosis is complex because the clinical and laboratory data are not very specific. However, we must take it into account in the differential diagnosis of abdominal pain etiologies.
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Resumen El vólvulo de sigmoides ocurre como resultado de una torsión del eje mesentérico colónico, cuenta con una etiología multifactorial y controvertida, de fisiopatología no clara aún. Presenta un cuadro clínico de inicio inespecífico y posteriores signos y síntomas de oclusión intestinal; su diagnóstico se establece mediante tomografía computarizada, con una sensibilidad y especificidad mayor al 90%. El manejo dependerá de la condición clínica del paciente. Caso clínico: Hombre de 29 años con antecedente de síndrome de Asperger. Refirió que desde 7 días previos a su ingreso presentó dolor tipo cólico difuso, asociado a distensión abdominal e intolerancia a la vía oral. Acudió a valoración hospitalaria donde se realizóa tomografía computarizada con niveles hidroaéreos, torsión de arteria mesentérica inferior de aspecto de torbellino. Se realizó laparotomía exploradora a través de la cual se encontró sigmoides dilatado y volvulado, con perforación en la unión rectosigmoidea; se realizó sigmoidectomía con colorectoanastomosis. Al quinto día presentó datos de respuesta inflamatoria con abdomen agudo, por lo que ingresó a laparotomía exploradora donde se encontró dehiscencia de anastomosis; se realizó procedimiento de Hartmann. El paciente presentó choque séptico y falleció a las 24 horas del postquirúrgico. Discusión: La presentación de vólvulo sigmoides generalmente se presenta en personas mayores de 70 años, pocos casos se describen en personas jóvenes y están relacionados con enfermedad de dismotilidad intestinal. El paciente no contaba con factores predisponentes, el diagnóstico se estableció con imágenes características de la enfermedad, como la imagen en torbellino, se decidió manejo quirúrgico con la realización de resección con colorectoanastomosis. Conclusión: La oclusión intestinal por vólvulo sigmoides es una patología infrecuente en jóvenes y de clínica inespecífica. Ante un paciente que presente datos de oclusión intestinal deberá ser abordado de manera apropiada, sobre todo en pacientes en quienes hayan debutado con una clínica insidiosa y persistente de dolor abdominal secundario a oclusión intestinal, sean jóvenes con o sin factores de riesgo.
Abstract Sigmoid volvulus occurs due to a torsion of the colonic mesenteric axis, it has a multifactorial and controversial etiology, and its pathophysiology is not yet clear. Presenting a clinical picture of non-specific onset and later signs and symptoms of intestinal occlusion, its diagnosis is established with computed tomography with a sensitivity and specificity greater than 90%. Management will depend on the clinical condition of the patient. Clinical case: A 29-year-old man with a history of Asperger syndrome. He referred 7 days prior to admission with diffuse cramping pain, associated with abdominal distension and oral intolerance. He went to the hospital for evaluation where a computed tomography was performed with air-fluid levels, torsion of the inferior mesenteric artery with a whirlwind appearance. Exploratory laparotomy was performed, finding a dilated and volvulated sigmoid with perforation at the rectosigmoid junction. A sigmoidectomy with colorectal anastomosis was performed. On the fifth day, he presented data of inflammatory response with acute abdomen, entering exploratory laparotomy finding anastomosis dehiscence, Hartmann procedure was performed. The patient presented septic shock, died 24 hours after surgery. Discussion: The presentation of sigmoid volvulus generally occurs in people older than 70 years, few cases are described in young people and are related to intestinal dysmotility disease, the patient did not have predisposing factors, the diagnosis is established with characteristic images of the disease such as whirlwind image, surgical management is decided by performing resection with colorectal anastomosis. Conclusion: Intestinal occlusion due to sigmoid volvulus is an infrequent pathology in young people and with non-specific symptoms. When faced with a patient presenting evidence of intestinal occlusion, this should be appropriately addressed, especially in patients who have debuted with insidious and persistent symptoms of abdominal pain secondary to intestinal occlusion, whether they are young with or without risk factors.
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OBJECTIVE: Sugar-sweetened beverages (SSB) are implicated in the increasing risk of diabetes in the Caribbean. Few studies have examined associations between SSB consumption and diabetes in the Caribbean. DESIGN: SSB was measured as teaspoon/d using questions from the National Cancer Institute Dietary Screener Questionnaire about intake of soda, juice and coffee/tea during the past month. Diabetes was measured using self-report, HbA1C and use of medication. Logistic regression was used to examine associations. SETTING: Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), collected in Barbados, Puerto Rico, Trinidad and Tobago and US Virgin Islands, were used for analysis. PARTICIPANTS: Participants (n 1701) enrolled in the ECS. RESULTS: Thirty-six percentage of participants were unaware of their diabetes, 33% aware and 31% normoglycaemic. Total mean intake of added sugar from SSB was higher among persons 40-49 (9·4 tsp/d), men (9·2 tsp/d) and persons with low education (7·0 tsp/d). Participants who were unaware (7·4 tsp/d) or did not have diabetes (7·6 tsp/d) had higher mean SSB intake compared to those with known diabetes (5·6 tsp/d). In multivariate analysis, total added sugar from beverages was not significantly associated with diabetes status. Results by beverage type showed consumption of added sugar from soda was associated with greater odds of known (OR = 1·37, 95 % CI (1·03, 1·82)) and unknown diabetes (OR = 1·54, 95 % CI (1·12, 2·13)). CONCLUSIONS: Findings indicate the need for continued implementation and evaluation of policies and interventions to reduce SSB consumption in the Caribbean.
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Diabetes Mellitus Tipo 2 , Bebidas Adoçadas com Açúcar , Masculino , Humanos , Bebidas Adoçadas com Açúcar/efeitos adversos , Estudos de Coortes , Bebidas Gaseificadas , Açúcares , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Porto Rico/epidemiologiaRESUMO
Noncommunicable diseases (NCDs) account for a higher proportion of mortality and morbidity in the Caribbean and US territories-majority-minority communities-than in the United States or Canada. Strategies to address this disparity include enhancing data collection efforts among racial/ethnic communities. The ECHORN Cohort Study (ECS), a regional adult cohort study, estimates prevalence and assesses risk factors for NCDs in two United States territories and two Caribbean islands. Here, we describe the cohort study approach, sampling methods, data components, and demographic makeup for wave one participants. We enrolled ECS participants from each participating island using random and probability sampling frames. Data components include a clinical examination, laboratory tests, a brief clinical questionnaire, and a self-administered health survey. A subset of ECS participants provided a blood sample to biobank for future studies. Approximately 2961 participants were enrolled in wave one of the ECS. On average, participants are 57 years of age, and the majority self-identify as female. Data from the ECS allow for comparisons of NCD outcomes among racial/ethnic populations in the US territories and the US and evaluations of the impact of COVID-19 on NCD management and will help highlight opportunities for new research.
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Doenças não Transmissíveis , Adulto , Feminino , Humanos , Região do Caribe/epidemiologia , Estudos de Coortes , Avaliação de Resultados em Cuidados de Saúde , Inquéritos e Questionários , Estados Unidos , Índias Ocidentais , Masculino , Pessoa de Meia-IdadeRESUMO
Improving public health initiative requires an accurate anthropometric index that is better suited to a specific community. In this study, the anthropometric grouping index is proposed as a more efficient and discriminatory alternative to the popular BMI for the Eastern Caribbean population. A completely distribution-free cluster analysis was performed to obtain the 11 categories, leading to AGI-11. Further, we studied these groups using novel non-parametric clustering summaries. Finally, two generalized linear mixed models were fitted to assess the association between elevated blood sugar, AGI-11 and BMI. Our results showed that AGI-11 tends to be more sensitive in predicting levels of elevated blood sugar compared to BMI. For instance, individuals identified as obese III according to BMI are (POR: 2.57; 95% CI: (1.68, 3.74)) more likely to have elevated blood sugar levels, while, according to AGI, individuals with similar characteristics are (POR: 3.73; 95% CI: (2.02, 6.86)) more likely to have elevated blood sugar levels. In conclusion, the findings of the current study suggest that AGI-11 could be used as a predictor of high blood sugar levels in this population group. Overall, higher values of anthropometric measures correlated with a higher likelihood of high blood sugar levels after adjusting by sex, age, and family history of diabetes.
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Glicemia , Grupos Populacionais , Índice de Massa Corporal , Estudos de Coortes , Humanos , Avaliação de Resultados em Cuidados de Saúde , Fatores de RiscoRESUMO
PURPOSE: There is increasing evidence that exposures in utero and in infancy impact breast cancer risk. No previous studies have evaluated these associations among women in Puerto Rico. METHODS: In a population-based case-control study of breast cancer epidemiology in the San Juan metropolitan area in Puerto Rico, we examined the association of early life factors with breast cancer risk and breast cancer risk factors. Both cases (n = 315) and controls (n = 348) completed interviewer-administered questionnaires, including self-reported birth country, birthweight, and history of having been breastfed. Comparisons of characteristics of those with and without the early life factors were made with t-tests or chi-squared tests; associations between early life factors and breast cancer risk were estimated with unconditional logistic regression adjusting for age, education, body mass index (BMI), age at menarche, parity, and menopausal status. RESULTS: Women who had been breastfed tended to have higher adult body mass index (BMI), higher education, and lower parity (p < 0.05). Higher birthweight was associated with higher adult BMI and lower educational attainment (p < 0.05). Those born outside of Puerto Rico or the US were more likely to have higher educational attainment and earlier age at menarche than those born within Puerto Rico or the US (p < 0.05). We found no significant associations between any of the early life factors and breast cancer risk. CONCLUSION: We did not find evidence of an association of early life factors with breast cancer risk among women in Puerto Rico.
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Neoplasias da Mama , Adulto , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Paridade , Gravidez , Porto Rico/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND: Though inconsistent, there is evidence that sun exposure is associated with reduced breast cancer risk. Previous studies have been conducted in geographical regions with seasonal variation in UV radiation, including periods of low to no exposure, and among participants mostly of European descent. Puerto Rico has no significant seasonal fluctuation, with continuous exposure to very high UV radiation. METHODS: We conducted a population-based case-control study of breast cancer among women in metropolitan San Juan, Puerto Rico, examining a cumulative sun exposure index (SEI) based on a comparison of reflectance of sun-exposed and non-exposed skin. A chromameter was used to measure skin reflectance and estimate the difference between constitutive (unexposed) and facultative (exposed) skin pigmentation in 307 cases and 328 controls. Breast cancer risk factors were ascertained with interviewer-administered questionnaires. OR and 95% confidence intervals (CI) were estimated with unconditional logistic regression. RESULTS: Adjusted breast cancer odds were lower for the highest tertile of the SEI (ORadj = 0.47; 95% CI, 0.29-0.74). Results were similar within strata of estrogen receptor status. In analyses stratified by constitutive skin pigmentation, among participants with darker skin color, breast cancer risk was lower with more sun exposure (ORadj = 0.33; 95% CI, 0.16-0.70). CONCLUSIONS: We found lower risk of breast cancer associated with greater sun exposure in a population living with high, continuous sun exposure. This beneficial finding should be placed in the context of other effects of sun exposure. IMPACT: Sun exposure is a modifiable factor that may contribute, directly or indirectly, to lower breast cancer risk.
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Neoplasias da Mama/epidemiologia , Luz Solar , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Medição de RiscoRESUMO
AIMS: To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. METHODS: Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. RESULTS: Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. CONCLUSION: There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.
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Doenças Cardiovasculares , Diabetes Mellitus , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Controle Glicêmico , Fatores de Risco de Doenças Cardíacas , Humanos , Avaliação de Resultados em Cuidados de Saúde , Porto Rico , Fatores de RiscoRESUMO
BACKGROUND: Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean. METHODS: Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk. RESULTS: Mean age (SD) of participants (n = 1617) was 56.6 years (±10.2), 64% were women, 74% were overweight/obese, and 24% had an ASCVD risk score above 10%. Elevated body mass index (BMI, > 30 kg/m2) and waist circumference were not associated with CVD risk. Elevated waist-to-hip ratio (WHR, > 0.9 men, > 0.85 women) and elevated waist-to-height ratio (> 0.5) were associated with all three categories of CVD risk. Area under the receiver curve was highest for WHR for each category of CVD risk. Elevated WHR demonstrated odds of 2.39, 2.58, and 3.32 (p < 0.0001) for CVD risk of > 7.5, > 10 and > 20% respectively. CONCLUSION: Findings suggest that WHR is a better indicator than BMI of obesity-related CVD risk and should be used to target adults in the Caribbean, and of Caribbean-descent, for interventions.
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Doenças Cardiovasculares , Adulto , Barbados , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Porto Rico , Fatores de Risco , Trinidad e Tobago , Circunferência da Cintura , Relação Cintura-QuadrilRESUMO
Global breast cancer incidence varies considerably, particularly in comparisons of low- and high-income countries; rates may vary even within regions. Breast cancer rates for Caribbean countries are generally lower than for North America and Europe. Rates in Puerto Rico are in the middle of the range between the highest and the lowest Caribbean countries. Populations in transition, with greater variability in risk factor exposures, provide an important opportunity to better understand breast cancer etiology and as potential sources of variation in rates. Understanding of exposures across the life span can potentially contribute to understanding regional differences in rates. We describe here the design and implementation of a population-based, case-control study in the San Juan Metropolitan Area (SJMA) of Puerto Rico, the Atabey Epidemiology of Breast Cancer Study. We describe steps taken to ensure that the study was culturally appropriate, leveraging the Atabey researchers' understanding of the culture, local health system, and other required resources to effectively recruit participants. A standardized, in-person interview was developed, with attention to life course events customized to the study population. In order to understand variation in global breast cancer rates, studies customized to the populations outside of North America and Europe are required.
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Neoplasias da Mama , Neoplasias da Mama/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Porto Rico/epidemiologia , Fatores de RiscoRESUMO
Studies show an inverse association between onion and garlic intake and risk of cancers of the lung, prostate, and stomach. There is limited evidence on the association between onion and garlic intake and breast cancer. We assessed this association in a population-based, case-control study in Puerto Rico. Incident, primary breast cancer cases (n = 314) were identified among women aged 30-79 from hospital and clinic records. Controls (n = 346) were women with no history of cancer other than nonmelanoma skin cancer, residents of the same area. Dietary intake was estimated using a food frequency questionnaire. Total onion and garlic intake included sofrito (a popular garlic- and onion-based condiment) intake frequency. Unconditional logistic regression assessed the association between onion and garlic consumption and breast cancer adjusting for age, education, parity, family history, body mass index, age at menarche, total energy, and smoking. Inverse associations with breast cancer were observed for moderate (OR (odds ratio) = 0.59, 95% CI (confidence interval): 0.35, 1.01) and high consumption (OR = 0.51, 95% CI: 0.30, 0.87) compared to low consumption of onion and garlic (Ptrend = 0.02). Results were similar when stratified by menopausal status. Study results suggest that high onion and garlic consumption is protective against breast cancer in this population.
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Antioxidantes/uso terapêutico , Neoplasias da Mama/dietoterapia , Dieta , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Estudos de Casos e Controles , Feminino , Alho , Humanos , Pessoa de Meia-Idade , Cebolas , Porto Rico , Fatores de Risco , VerdurasRESUMO
On April 19, 2017, the 37th Medical Sciences Campus Annual Research and Education Forum opened with the discussion panel The role of research in policy and practice: The Zika phenomena in Puerto Rico, with Dr. Cruz M. Nazario Delgado, Dr. Carmen D. Zorrilla and Dr. Luis A. Bonilla Soto. In this article, we critically examine the public policy process of the Zika epidemic in Puerto Rico, as presented by authors Nazario and Bonilla. We argue that policymaking and the public health responses to confront the Zika epidemic in Puerto Rico took place in a political environment where different US and local actors operated to advance their goals and vision, undermining the role of knowledge, evidence and past experiences. We propose a bottom to top preventive and community empowerment approach to control the vector. This model must be built on successful policy implementation experiences with epidemics in the Island and strengthened by evidence, international guidelines and ethical principles.
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Pesquisa Biomédica/organização & administração , Saúde Pública , Política Pública , Infecção por Zika virus/epidemiologia , Epidemias , Guias como Assunto , Humanos , Formulação de Políticas , Política , Porto Rico/epidemiologiaRESUMO
BACKGROUND: Hurricane Maria struck Puerto Rico on Sept 20, 2017, devastating the island. Controversy surrounded the official death toll, fuelled by estimates of excess mortality from academics and investigative journalists. We analysed all-cause excess mortality following the storm. METHODS: We did a time-series analysis in Puerto Rico from September, 2017, to February, 2018. Mortality data were from the Puerto Rico Vital Statistics System. We developed two counterfactual scenarios to establish the population at risk. In the first scenario, the island's population was assumed to track the most recent census estimates. In the second scenario, we accounted for the large-scale population displacement. Expected mortality was projected for each scenario through over-dispersed log-linear regression from July, 2010, to August, 2017, taking into account changing distributions of age, sex, and municipal socioeconomic development, as well as both long-term and seasonal trends in mortality. Excess mortality was calculated as the difference between observed and expected deaths. FINDINGS: Between September, 2017, and February, 2018, we estimated that 1191 excess deaths (95% CI 836-1544) occurred under the census scenario. Under the preferred displacement scenario, we estimated that 2975 excess deaths (95% CI 2658-3290) occurred during the same observation period. The ratio of observed to expected mortality was highest for individuals living in municipalities with the lowest socioeconomic development (1·43, 95% CI 1·39-1·46), and for men aged 65 years or older (1·33, 95% CI 1·30-1·37). Excess risk persisted in these groups throughout the observation period. INTERPRETATION: Analysis of all-cause mortality with vital registration data allows for unbiased estimation of the impact of disasters associated with natural hazards and is useful for public health surveillance. It does not depend on certified cause of death, the basis for the official death toll in Puerto Rico. Although all sectors of Puerto Rican society were affected, recovery varied by municipal socioeconomic development and age groups. This finding calls for equitable disaster preparedness and response to protect vulnerable populations in disasters. FUNDING: Forensic Science Bureau, Department of Public Safety, and Milken Institute School of Public Health of The George Washington University (Washington, DC, USA).
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Causas de Morte , Tempestades Ciclônicas/mortalidade , Desastres Naturais/mortalidade , Fatores Etários , Humanos , Porto Rico , Fatores SexuaisRESUMO
Lack of variability in dietary intake within a population makes identification of relationships between diet and disease difficult. Studies in populations with greater interindividual variation can provide important insights. The Puerto Rican diet is in transition from a traditional to a more Western-type diet, resulting in greater interindividual variability. We identified foods contributing to absolute intake and variability in the intake of macronutrients among Puerto Rican women. One hundred women, aged 30â»79, residents of San Juan, Puerto Rico, completed three, interviewer-administered, 24-h dietary recalls from which foods contributing to absolute intake and intake variability in intake of energy, fat, protein, carbohydrate and dietary fiber were determined. The overall prevalence of intake of foods was also calculated. Traditional Puerto Rican foods such as legumes, rice, and plantains were important contributors to the intake of calories and macronutrients as were foods more typical of Western diets including white bread and sweetened carbonated beverages. Identification of food sources of nutrients for this population with a diet in transition can contribute to the development of instruments to measure dietary intake and to understand the contribution of diet to the etiology of chronic disease among Puerto Rican women.
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Dieta Ocidental/etnologia , Dieta/etnologia , Ingestão de Energia/etnologia , Hispânico ou Latino , Estado Nutricional/etnologia , Valor Nutritivo/etnologia , Recomendações Nutricionais , Adulto , Idoso , Variação Biológica Individual , Inquéritos sobre Dietas , Comportamento Alimentar/etnologia , Feminino , Hispânico ou Latino/psicologia , Humanos , Pessoa de Meia-Idade , Avaliação Nutricional , Porto Rico , Fatores SexuaisRESUMO
OBJECTIVE: Routine Progesterone and Estrogen hormone receptor proteins and human epidermal growth factor receptor 2 (HER-2) analysis on invasive breast carcinomas provide therapeutic and prognostic values, revealing significant subgroups: luminal A, luminal B, HER-2 and the "triple negative" tumors. The aim of this study was to determine the expression of basal cytokeratins and Epidermal Growth Factor Receptor in "triple negative" invasive breast carcinomas in Puerto Rico women. METHODS: All invasive breast carcinoma cases received from 2008 to 2010 were included. Assessment of tumoral expression of Estrogen Receptor, Progesterone Receptor and HER-2 was performed. The cases were divided into groups based on their molecular categories and analyzed according to the age. "Triple negative" tumors were further analyzed according to their expression of Epidermal Growth Factor Receptor and cytokeratins 5/6 and 14. RESULTS: From 717 cases reviewed, 487 cases of invasive breast carcinoma were included. The molecular categories were 66%, 10%, 9% and 15% for the luminal A, luminal B, Her-2 and "triple negative" groups, respectively. No significant difference (p= 0.64) was observed between the molecular categories and the age of the patients. Assessment of basal cytokeratins and Epidermal Growth Factor Receptor expression was performed on 41 "triple negative" tumors; 71% expressed at least one basal cytokeratin or Epidermal Growth Factor Receptor and 29% were negative to all markers. CONCLUSION: Prevalence and relation between the molecular categories and the expression of basal cytokeratins in "triple negative" tumors in our population is comparable to other published data.
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Biomarcadores Tumorais/biossíntese , Receptores ErbB/biossíntese , Queratinas/biossíntese , Neoplasias de Mama Triplo Negativas/metabolismo , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Porto Rico , Estudos Retrospectivos , Neoplasias de Mama Triplo Negativas/patologiaRESUMO
OBJECTIVE: Breathlessness is a common and disabling symptom of pulmonary disease. Measuring its severity is recommended as such measurements can be helpful in both clinical and research settings. The oxygen-cost diagram (OCD) and the Medical Research Council (MRC) dyspnea scale were developed in English to measure severity of dyspnea. These scales were previously translated to Spanish and adapted for use in a Hispanic population. The objective of this study is to assess the psychometric properties of these scales. We propose the scales correlate well with measures of physiological impairment. METHODS: Subjects having pulmonary disease rated their perceptions of dyspnea using the scales, performed a spirometry test, and did a 6-min walk. Spearman correlation coefficients (p) were used to correlate dyspnea scores with spirometric parameters and distance walked (6MWD). RESULTS: Sixty-six patients having stable asthma (n = 36), chronic obstructive pulmonary disease (n = 19), or interstitial lung disease (n = 11) participated in the study. OCD scores showed a significant correlation with FEV1 (p = 0.41; p < 0.01), FEV1% (p = 0.36; p < 0.01), FVC (p = 0.44; p < 0.01), and FVC% (p = 0.37; p < 0.01) in the study population. The OCD scores were highly correlated with 6MWD (p = 0.59, p < 0.01). The MRC dyspnea scale showed significant inverse correlation with FEV1 (p = -0.34; p < 0.01) and 6MWD (p = -0.33; p < 0.05), but the correlations were weaker compared to the correlations with the OCD scale. CONCLUSION: The severity of breathlessness as measured by the adapted Spanish OCD showed a moderate to high correlation with spirometric parameters and 6MWD; therefore, the adapted OCD should prove to be useful in Puerto Rico.
Assuntos
Asma/diagnóstico , Dispneia/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/fisiopatologia , Estudos Transversais , Dispneia/etiologia , Feminino , Volume Expiratório Forçado , Humanos , Idioma , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Psicometria , Porto Rico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Índice de Gravidade de Doença , Espirometria/métodos , Estatísticas não Paramétricas , Caminhada/fisiologia , Adulto JovemRESUMO
OBJECTIVE: The objectives of this study were to identify cancer-related health care services and to explore the presence of inter-organizational interactions among clinical and support oncology services in southern Puerto Rico. METHODS: From January through July of 2010, a survey was completed by 54 health care organizations offering clinical, supportive, or both services to cancer patients/survivors (CPS) in southern PR. Survey data were compiled and descriptive analyses performed using the software Statistical Package for a Social Science (SPSS), version 18.0. RESULTS: The distribution of the primary services provided by the participating organizations was the following: 26 had clinical services, 16 had support services, and 12 offered a combination of clinical and support services. Only 24 % of the surveyed organizations offered their services exclusively to patients diagnosed with cancer. In terms of referral practices, 61 % of the responses were for medical specialists, 43 % were for mental health services, and 37 % were referrals for primary care services. The most common reason for interacting (n = 27) was to provide a given patient both a referral and information. CONCLUSION: Findings suggest gaps in both the availability of oncology services and the delivery of integrated health care. Lack of communication among clinical and support organizations (for cancer patients, specifically) could negatively impact the quality of the services that they offer. Further network analysis studies are needed to confirm these gaps. Until systemic, structural changes occur, more efforts are needed to facilitate communication and collaboration among these kinds of organization.
Assuntos
Redes Comunitárias/organização & administração , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/organização & administração , Neoplasias/terapia , Apoio Social , Sobreviventes/estatística & dados numéricos , Adulto , Idoso , Redes Comunitárias/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Porto Rico/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricosRESUMO
The various toxic effects associated with inorganic arsenic (iAs) warrants that exposure sources be identified. This pilot study evaluated if greater seafood consumption from Vieques-Puerto Rico is associated with increased exposure to iAs. Nail, hair, and urine samples were used as biomarkers of iAs exposure in adult women and men from Vieques classified as high (n = 31) and low (n = 21) seafood consumers, who reported eating fish and/or shellfish ≥1 time per week and once per month or less, respectively. The sum of urinary iAs (As III + As V), monomethylarsonic acid (MA[V]), and dimethylarsinic acid (DMA[V]), denoted as SumAs, fluctuated from 3.3 µg/g Cr (1.2 µg/L) to 42.7 µg/g Cr (42 µg/L) (n = 52). Levels of As in nail samples (n = 49) varied from 0.04 to 0.82 µg/g dry weight (dw), whereas in hair (n = 49) As was only detected in 49 % of the samples with a maximum value of 0.95 µg/g dw. None of the biomarkers of exposure to As exceeded exposure reference values for urine (50 µg/g Cr or 50 µg/L), nails (1 µg/g), or hair (1 µg/g). However, median (10.0 µg/g Cr; 10.6 µg/L) and 95th percentile (31.9 µg/g Cr; 40.4 µg/L) of urinary SumAs were higher in Vieques samples than in the those from the general population of other countries. Among the three biomarkers of exposure, nail samples reflected better the exposure to iAs from seafood consumption with significantly higher average As concentrations in high (0.24 µg/g) than low (0.12 µg/g) seafood consumers. Multivariate results for As in nail samples (R(2) = 0.55, p < 0.0001) showed a positive association with fish consumption, particularly for men, with levels increasing with years of residency in Vieques.