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The Puerto Rico (PR) Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk Study (PR-OUTLOOK) is investigating overall and component-specific cardiovascular health (CVH) and cardiovascular disease (CVD) risk factors in a sample of young (age 18-29) Puerto Rican adults in PR (target n=3,000) and examining relationships between individual-, family/social- and neighborhood-level stress and resilience factors and CVH and CVD risk factors. The study is conducting standardized measurements of CVH and CVD risk factors and demographic, behavioral, psychosocial, neighborhood, and contextual variables and establishing a biorepository of blood, saliva, urine, stool, and hair samples. The assessment methods are aligned with other National Heart, Lung, and Blood Institute funded studies: the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) of adults 30-75 years, the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the Boston Puerto Rican Health Study (BPRHS), and the Coronary Artery Risk Development in Young Adults (CARDIA). PR-OUTLOOK data and its biorepository will facilitate future longitudinal studies of the temporality of associations between stress and resilient factors and CVH and CVD risk factors among young Puerto Ricans, with remarkable potential for advancing the scientific understanding of these conditions in a high-risk but understudied young population.
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Mesial temporal lobe epilepsy, one of the most common forms of epilepsy, is often linked with drug resistance. Surgical intervention is a reliable and safe treatment option, though research into postsurgical outcomes in our locality remains limited. We performed a retrospective observational study included 91 patients with mesial temporal lobe epilepsy and hippocampal sclerosis who had undergone anterior temporal lobectomy between 2012 and 2020 at a surgical epilepsy center located in Lima, Peru. Postoperative outcomes were analyzed using bivariate and multivariate analysis based on the Engel classification. We found that after 12 months of follow-up, 78.65% of the 91 patients achieved an Engel IA classification, while 9.09% attained Engel IB classification and 11.24% were designated as Engel II, with only 1.12% classified as Engel IVA. The median QOLIE31 score was 84 (IQR: 7590), with 74.16% of the participants successfully reintegrating into academic or employment activities. After 24 months, only 68 patients completed the follow-up, with 69.12% achieving an Engel IA classification. Individuals with a secondary education or higher were more likely to achieve an Engel IA classification at 12 months (OR: 5.11; P = 0.005; CI: 1.6316.01), after adjusting for sex and age. We concluded that most patients exhibited favorable outcomes after 1 year of follow-up. However, lower educational attainment was linked to worse postsurgical outcomes.
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Esclerose HipocampalRESUMO
AIMS: To assess the level of agreement between point-of-care and laboratory reference glucose values in defining glycaemic status. METHODS: We analysed 1292 overweight/obese, non-institutionalized participants, aged 40-65 years, in the San Juan Overweight Adults Longitudinal Study. Fasting venous blood glucose was determined using a point-of-care Bayer Contour Blood Glucose Meter and by Vitros System 250 instrument (laboratory). American Diabetes Association thresholds were used to classify participants into normoglycaemia (< 5.6 mmol/l), prediabetes (5.6 to 6.9 mmol/l), or diabetes groups (≥ 7 mmol/l). RESULTS: Bland-Altman plot analysis showed a slope of 0.04 (P=0.002) for the regression between the mean difference and the average of the two methods. The slopes were significantly different from zero among people with normoglycaemia (ß=-0.57, P<0.001), and prediabetes (ß=-0.75, P<0.001) but not among people with diabetes (ß=-0.02, P=0.68). When the prediabetes and diabetes groups were merged into one group, the slope was 0.01, and the glucose values remained similar using the two methods (P=0.76). CONCLUSION: Point-of-care blood glucose measurement may be useful to screen people with diabetes, and to assess glucose among individuals with diabetes where blood can be drawn, but laboratory tests are unavailable or untimely.
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Glicemia/análise , Técnicas de Laboratório Clínico/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Idoso , Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/normas , Técnicas de Laboratório Clínico/normas , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Sobrepeso/sangue , Sistemas Automatizados de Assistência Junto ao Leito/normas , Estado Pré-Diabético/sangue , Valor Preditivo dos Testes , Padrões de ReferênciaRESUMO
BACKGROUND: To understand risk factors for HPV exposure in Puerto Rican women, we evaluated HPV 6, 11, 16, and 18 serology in women aged living in the San Juan metropolitan area. METHODS: As part of a cross-sectional study, a population-based sample of 524 HPV unvaccinated Hispanic women ages 16-64 years completed face-to-face and computer assisted interviews and provided blood and self-collected anal and cervical specimens. Serology used multiplex virus-like particle based-IgG ELISA and HPV DNA was detected with L1-consensus PCR. RESULTS: 32% and 47% were seropositive to HPV types included in the bivalent (16/18) and quadrivalent (6/11/16/18) vaccines, respectively. Type-specific seroprevalence was HPV6â¯-â¯29%, HPV11â¯-â¯18%, HPV16â¯-â¯23%, and HPV18 - 17%; seroprevalence was high in the youngest age-group (16-19: 26-37%). HPV seropositivity was associated with having ≥â¯3 lifetime sexual partners (OR=2.5, 95% CI=1.7-3.9) and detection of anogenital HPV DNA (OR=1.8, 95% CI=1.2-2.6). CONCLUSIONS: The high cumulative exposure of HPV vaccine types 6/11/16/18 in this Hispanic population was influenced by factors related to HPV exposure through sexual behavior. High seroprevalence in the youngest age-group indicates early age of exposure to HPV in Puerto Rico, highlighting the need for HPV vaccination starting prior to age 16.
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Anticorpos Antivirais/sangue , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Papillomavirus Humano 11 , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Papillomavirus Humano 6 , Humanos , Pessoa de Meia-Idade , Vacinas contra Papillomavirus , Porto Rico/epidemiologia , Estudos Soroepidemiológicos , Adulto JovemRESUMO
OBJECTIVES: The objective of this study was to investigate the factors associated with HPV awareness among women aged 16 to 64 years, among underserved minority Hispanic women living in Puerto Rico. METHODS: A population-based, cross-sectional sample of 566 women, ages 16 to 64 years, living in the San Juan metropolitan area were surveyed regarding sexual behavior, HPV knowledge, and HPV vaccine uptake. Data was analyzed using descriptive statistics and multivariate logistic regression. RESULTS: Overall, 64.8 % of the women in the sample had heard about the HPV vaccine. Among those in the recommended catch-up vaccination age range (16-26 years, n = 86), 4.7 % had received at least one dose of the HPV vaccine. Of those aware of the availability of the HPV vaccine, most had learned about it through the media, whereas, only 39.6 % had learned about it from a physician. Multivariate logistic regression analysis showed that HPV awareness (OR 8.6; 95 % CI 5.0-14.8) and having had an abnormal Pap smear (OR 2.0; 95 % CI 1.2-3.4) were associated with HPV vaccine awareness (p < 0.05). CONCLUSION: HPV vaccine awareness among Hispanic women in the San Juan metropolitan area of Puerto Rico continues to be low. Strong recommendations from physicians and participation in HPV vaccine educational efforts are essential if the rate of HPV vaccination is to increase in the targeted population. Compared to the USA, and to their US Hispanic counterparts, a health disparity with regard to HPV vaccine awareness and coverage is evident in Puerto Rico; targeted action to deal with this disparity is urgently needed.
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Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Porto Rico , Adulto JovemRESUMO
Magdalena River basin potamodromous fishes have two annual reproductive seasons: the subienda in the first half of the year and the mitaca in the second. Both upstream migrations are c. 30-45 days long; after that, with the onset of the rainy season, fishes spawn and remain in the river (resident individuals) or start a downstream movement (the bajanza) to return to the Magdalena floodplain lakes (nursery, shelter and feeding grounds). Due to their particular gonad development the bocachico Prochilodus magdalenae and probably the comelón Leporinus muyscorum are physiologically able to undertake two annual basin migrations. In the presence of dams or hydropower structures, fishes are able to find alternative migration routes. Some species should be re-classified in their migratory behaviour.
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Migração Animal , Caraciformes/fisiologia , Reprodução , Rios , Animais , Colômbia , Peixes , Chuva , Estações do AnoRESUMO
BACKGROUND: Oncogenic HPV infection is associated to anogenital cancer. We estimate the prevalence and correlates of anogenital HPV infection among a population-based sample of women aged 16-64 years living in the metropolitan area of Puerto Rico. METHODS: 564 women completed face-to-face and computer assisted interviews and self-collected anal and cervical specimens. HPV DNA testing used MY09/MY11 consensus HPV L1 primers and beta-globin as an internal control for sample amplification. Positive specimens were typed by dot-blot hybridization. RESULTS: Weighted prevalence of cervical, anal, and cervical/anal co-infection was 29.4%, 38.6%, and 17.1%, respectively. The commonest oncogenic HPV types detected in the cervix and anus were: 68 (8% vs. 7%) and 16 (5.5% vs. 5.1%), correspondingly. Having ≥3 lifetime sexual partners (OR: 2.3; 95% CI: 1.5-3.5) and last year anal intercourse (OR: 1.6; 95% CI: 1.1-2.5) increased the odds of anogenital HPV infection. Cervical infection was independently associated to anal infection (OR: 3.0; 95% CI: 2.0-4.6). CONCLUSIONS: Similar to others, our results confirm the burden of anogenital HPV infection in women and its relationship with sexual behavior. As vaccination increases, future studies should monitor changing trends in HPV infection in this population, and the relationship between anal and cervical HPV-related disease.
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Doenças do Ânus/epidemiologia , Doenças do Ânus/virologia , Genótipo , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções do Sistema Genital/epidemiologia , Infecções do Sistema Genital/virologia , Adolescente , Adulto , Feminino , Técnicas de Genotipagem , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Papillomaviridae/classificação , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Prevalência , Porto Rico/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: This study aimed to estimate the prevalence and correlates of seropositivity to human papillomavirus (HPV)-16 in a subsample of adults who participated in the parent study Epidemiology of Hepatitis C in the adult population of Puerto Rico (PR). SETTING: The parent study was a population-based household survey aimed to estimate the seroprevalence of hepatitis C and other viral infections (hepatitis A, hepatitis B, HIV, and herpes simplex type 2) in PR (n=1654) between 2005 and 2008. PARTICIPANTS: A subsample of the last 450 consecutive adults aged 21-64 years, recruited between February 2007 and January 2008, who participated in the parent study and agreed to participate in HPV testing. PRIMARY AND SECONDARY OUTCOME MEASURES: The samples were tested by ELISA for HPV-16 viral-like particle-specific immunoglobulin G. Information on sociodemographic, health, and lifestyle characteristics was collected. Logistic regression modelling was used to estimate the prevalence odds ratio (POR) to assess factors associated to HPV-16 seropositivity. RESULTS: Prevalence of seropositivity to HPV-16 was 11.3%. Seroprevalence was higher in women (15.8%) than men (5.6%; p=0.001). After adjusting for age and sex, ever smokers (POR 2.06, 95% CI 1.08 to 3.92) and participants with at least five lifetime sexual partners (POR 2.91, 95% CI 1.24 to 6.81) were more likely to be HPV-16 seropositive. CONCLUSIONS: HPV-16 seropositivity is similar to that reported in the USA (10.4%) for NHANES 2003-2004 participants, although different assays were used in these studies. While future studies should evaluate HPV seroprevalence using a larger population-based sample, our results highlight the need to further understand the burden of HPV infection and HPV-related malignancies in PR, population with a low vaccine uptake.
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Hispânico ou Latino , Papillomavirus Humano 16 , Infecções por Papillomavirus/etnologia , Infecções por Papillomavirus/virologia , Adulto , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Estudos Soroepidemiológicos , Viroses/epidemiologia , Viroses/etnologia , Viroses/virologiaRESUMO
Un hábito bucal no fisiológico puede interferir con el desarrollo de la oclusión. El objetivo de este estudio fue describir los hábitos bucales no fisiológicos y maloclusión en niños con dentición mixta que asisten a la consulta de Odontopediatría II área de Pregrado de la Facultad de Odontología de la Universidad de Carabobo en el periodo 2012-2013. El estudio fue epidemiológico descriptivo no experimental transversal, población 190 historias clínicas, muestra no probabilística 110 historias clínicas. La detección de los diferentes hábitos bucales no fisiológicos se realizó en 2 etapas: 1) llenado de la historia clínica de la FOUC y 2) Aplicación de una lista de cotejo con los datos obtenidos en la Historia Clínica. El total de pacientes sanos fue de 29, los pacientes con maloclusión dieron un valor de 81; el hábito bucal de mayor frecuencia fue la onicofagia con un valor de 40 pacientes, con respecto a las maloclusiones se observó mayor frecuencia el apiñamiento con 22 pacientes, clase II subdivisión 2 con 21 pacientes, mordida abierta con 14 pacientes, por último, los pacientes que presentaron hábitos bucales no fisiológicos y maloclusión fue de 51. Se encontró evidencia significativa con respecto a la influencia de los hábitos bucales no fisiológicos sobre la maloclusión, es necesaria la identificación oportuna de estos hábitos, si es posible disminuir o erradicarlos durante el crecimiento y desarrollo de los maxilares, por otra parte, tratar de no anticipar el uso de dispositivos antes de los primeros 6 meses de vida.
A nonphysiological oral habit may interfere with the development of the occlusion. The objective of this study was to describe the non-physiologic oral habits and malocclusion in children with mixed dentition attending the consultation area of the Undergraduate Dentistry II, Faculty of Dentistry, University of Carabobo in the period 2012-2013. The study was non-experimental descriptive epidemiological cross-sectional, population 190 medical records, non-probability sample 110 clinical records. The detection of different non- physiological oral habits was conducted in 2 stages: 1) filled by the medical history of FOUC and 2) Implementation of a checklist with the data obtained in the clinical history. A total of 29 patients were healthy, patients with malocclusion gave a value of 81, the most frequent oral habit was nail biting with a value of 40 patients, with regarding crowding malocclusions more frequently observed with 22 patients, class II branch 2 with 21 patients, 14 patients with open bite, finally, patients who had no oral habits and malocclusion physiological was 51. Significant evidence was found regarding the influence of non- physiological oral habits on malocclusion, it is necessary to identify these habits in a timely manner, if possible reduce or eradicate during growth and development of the jaws , on the other hand, try not to anticipate the use of devices before the first 6 months of life.
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Humanos , Masculino , Feminino , Criança , Dentição Mista , Comportamento Alimentar , Má Oclusão , OdontopediatriaRESUMO
Identifying both Human immunodeficiency virus (HIV)-related and co-morbid symptoms experienced by people living with HIV (PLWH) who are receiving antiretroviral therapy (ART) treatment is a major challenge for healthcare providers globally. Yet, little research to date has examined the symptoms of illness experienced by PLWH including patients living in Central and South American. To address this gap, this study was designed to identify symptoms of HIV by socio-demographic and/or clinical characteristics among Chilean patients living with the virus. A convenience sample of 209 Chilean PLWH was recruited from an outpatient clinic in Santiago, Chile. A structured interview was used to elicit socio-demographic information and HIV symptoms status. Additional clinical information was obtained through a review of the participants' medical records. Results show that patients' most commonly reported HIV-related symptoms were fear/worries (66%), anxiety (52%), gas/bloating (50%), and thirst (50%). Multivariate analysis revealed a positive association between the number of reported HIV-related symptoms and number of years living with HIV. Having completed college was negatively associated with number of symptoms. Latent class analysis indicated that PLWH in the sample who had completed college were two times more likely to experience a mild intensity of HIV-related symptoms than their lesser educated counterparts. Similarly, logistic regression revealed that college-educated PLWH were twice as likely to be classified in the subgroup reporting mild intensity of symptoms than those who lacked a college degree. Overall, the study's results reveal that many Chilean PLWH, even those with high CD4 counts and low or undetectable viral loads, are not symptom free. The findings point to the need for clinicians to tailor a plan of care for individuals living with HIV that is based on their symptomatology.
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Ansiedade/epidemiologia , Infecções por HIV/epidemiologia , Adolescente , Adulto , Idoso , Ansiedade/etiologia , Contagem de Linfócito CD4 , Chile/epidemiologia , Análise por Conglomerados , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Sede , Fatores de Tempo , Carga ViralRESUMO
The study compares the parasitological and productive traits of Criollo lambs native to the central Mexican Plateau (CNCMP) and Suffolk (SU) lambs experimentally infected with Haemonchus contortus. CNCMP lambs (n=20) and SU lambs (n=15) were infected with L3 of H. contortus while five lambs of each genotype were kept as controls. Fecal egg count (FEC), packed cell volume (PCV), blood eosinophil number (BEN), ocular mucous membrane color (as measured by the FAMACHA index), changes in body condition score (BCS) and cumulative live weight gain (CLWG) were measured weekly during a 20-week period. On week 20, all animals were euthanized and the number of adult worms (AW) in the abomasum was counted. Infected SU lambs had higher (p<0.05) FEC and AW mean values compared to CNCMP lambs, which had a higher mean BEN count (p<0.05). Infected lambs had lower PCV values than controls, regardless of genotype, and had a negative correlation (r=-0.84, p<0.05) with the FAMACHA index. BCS tended to decline for infected SU lambs and increased slightly for infected CNCMP lambs. CLWG differed in all groups (p<0.05); infected SU lambs gained 12.1+/-1.9kg, infected CNCMP lambs gained 18.8+/-0.7kg, control SU lambs gained 34.6+/-1.6kg, and control CNCMP lambs gained 26.9+/-0.8kg. In conclusion, CNCMP lambs had a smaller worm burden, a better ability to maintain their productive traits, and were less affected by infection with Haemonchus contortus.
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Hemoncose/veterinária , Doenças dos Ovinos/patologia , Doenças dos Ovinos/parasitologia , Abomaso/parasitologia , Animais , Constituição Corporal/fisiologia , Eosinófilos/citologia , Olho/parasitologia , Fezes/parasitologia , Hemoncose/parasitologia , Hemoncose/patologia , Haemonchus/fisiologia , Hematócrito/veterinária , Contagem de Leucócitos/veterinária , Masculino , México , Contagem de Ovos de Parasitas/veterinária , Ovinos , Aumento de Peso/fisiologiaRESUMO
AIMS: The available evidence suggests that the validity of drug use responses in general population surveys is low. We have conducted a household survey to examine viral infections in the general population of Puerto Rico employing a number of procedures believed to increase the validity of drug use responses, as well as confidentiality and privacy: telling participants of toxicological verification of drug use prior to the interview, ACASI self-interviewing, and interviewing outside households in mobile examination units. METHODS: The study employed a stratified cluster sample of 1654 adults 21 to 64 years old, 532 recruited while urine samples were being collected and 1122 recruited after urinalysis was discontinued due to budgetary reasons. RESULTS: Drug use rates calculated from participants recruited while urinalysis was being conducted did not vary significantly to those derived from participants recruited after urinalysis was discontinued. Sensitivity of responses of drug use during the last three days was 80.0% for marihuana, 76.2% for cocaine, and 40.0% for heroin. The lower validity of heroin reports did not seem to be the result of underreporting as it was reported by more individuals than the test detected. CONCLUSION: We conjecture that the reasonably good validity of the drug use responses might have been the result of the parent study being about a health issue other than drug use, and that interviewing was conducted outside households in mobile units. These findings buttress the value of conducting methodological trials to identify procedures which yield valid responses of drug use.
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Detecção do Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Estudos Transversais , Coleta de Dados , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Análise de Regressão , Reprodutibilidade dos Testes , Autorrevelação , Fatores Socioeconômicos , Urinálise/métodos , Adulto JovemRESUMO
BACKGROUND: Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned. OBJECTIVE: To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations. METHODS: We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points. RESULTS: WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively. CONCLUSION: WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.
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Índice de Massa Corporal , Doença das Coronárias/etnologia , Obesidade/etnologia , Circunferência da Cintura/etnologia , Relação Cintura-Quadril/estatística & dados numéricos , Adulto , Idoso , Antropometria/métodos , População Negra , Chile/etnologia , Colômbia/etnologia , República Dominicana/etnologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Peru/etnologia , Valor Preditivo dos Testes , Porto Rico/etnologia , Medição de Risco , Fatores Sexuais , Estados Unidos , Venezuela/etnologia , População BrancaRESUMO
UNLABELLED: In the first population-based study of vertebral fractures in Latin America, we found a 11.18 (95% CI 9.23-13.4) prevalence of radiographically ascertained vertebral fractures in a random sample of 1,922 women from cities within five different countries. These figures are similar to findings from studies in Beijing, China, some regions of Europe, and slightly lower than those found in the USA using the same standardized methodology. INTRODUCTION: We report the first study of radiographic vertebral fractures in Latin America. METHODS: An age-stratified random sample of 1,922 women aged 50 years and older from Argentina, Brazil, Colombia, Mexico, and Puerto Rico were included. In all cases a standardized questionnaire and lateral X-rays of the lumbar and thoracic spine were obtained after informed consent. RESULTS: A standardized prevalence of 11.18 (95% CI 9.23-13.4) was found. The prevalence was similar in all five countries, increasing from 6.9% (95% CI 4.6-9.1) in women aged 50-59 years to 27.8% (95% CI 23.1-32.4) in those 80 years and older (p for trend < 0.001). Among different risk factors, self-reported height loss OR = 1.63 (95% CI: 1.18-2.25), and previous history of fracture OR = 1.52 (95% CI: 1.14-2.03) were significantly (p < 0.003 and p < 0.04 respectably) associated with the presence of radiographic vertebral fractures in the multivariate analysis. In the bivariate analyses HRT was associated with a 35% lower risk OR = 0.65 (95% CI: 0.46-0.93) and physical activity with a 27% lower risk of having a vertebral fracture OR = 0.73 (95% CI: 0.55-0.98), but were not statistically significant in multivariate analyses CONCLUSION: We conclude that radiographically ascertained vertebral fractures are common in Latin America. Health authorities in the region should be aware and consider implementing measures to prevent vertebral fractures.
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Vértebras Lombares/lesões , Osteoporose Pós-Menopausa/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Vértebras Torácicas/lesões , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Estatura , Brasil/epidemiologia , Colômbia/epidemiologia , Terapia de Reposição de Estrogênios , Exercício Físico , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/diagnóstico por imagem , Prevalência , Porto Rico/epidemiologia , Radiografia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagemRESUMO
Consumers increasingly use bottled water and home water treatment systems to avoid direct tap water. According to the International Bottled Water Association (IBWA), an industry trade group, 5 billion gallons of bottled water were consumed by North Americans in 2001. The principal aim of this study was to assess the microbial quality of in-house and imported bottled water for human consumption, by measurement and comparison of the concentration of bacterial endotoxin and standard cultivable methods of indicator microorganisms, specifically, heterotrophic and fecal coliform plate counts. A total of 21 brands of commercial bottled water, consisting of 10 imported and 11 in-house brands, selected at random from 96 brands that are consumed in Puerto Rico, were tested at three different time intervals. The Standard Limulus Amebocyte Lysate test, gel clot method, was used to measure the endotoxin concentrations. The minimum endotoxin concentration in 63 water samples was less than 0.0625 EU/mL, while the maximum was 32 EU/mL. The minimum bacterial count showed no growth, while the maximum was 7,500 CFU/mL. Bacterial isolates like P. fluorescens, Corynebacterium sp. J-K, S. paucimobilis, P. versicularis, A. baumannii, P. chlororaphis, F. indologenes, A. faecalis and P. cepacia were identified. Repeated measures analysis of variance demonstrated that endotoxin concentration did not change over time, while there was a statistically significant (p < 0.05) decrease in bacterial count over time. In addition, multiple linear regression analysis demonstrated that a unit change in the concentration of endotoxin across time was associated with a significant (p < 0.05) reduction in the bacteriological cell count. This analysis evidenced a significant time effect in the average log bacteriological cell count. Although bacterial growth was not detected in some water samples, endotoxin was present. Measurement of Gram-negative bacterial endotoxins is one of the methods that have...
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Abastecimento de Água/análise , Endotoxinas/análise , Enterobacteriaceae/isolamento & purificação , Microbiologia da Água , Contagem de Colônia Microbiana , Fezes/microbiologiaRESUMO
Studies investigating the seroprevalence of HCV infection have been carried out in diverse populations, showing an estimated worldwide prevalence of 3%. A seroprevalence survey conducted among randomly selected non-institutionalized adults aged 21-64 years in San Juan, Puerto Rico in 2001-2002 revealed that 6.3% were positive for HCV antibodies. These data suggest that Puerto Ricans are burdened with a significantly greater prevalence of HCV infection compared to the general United States population aged 20-69 years (0.9%-4.3%). This article illustrates data from different sources that taken together establish the need to start addressing HCV infection in Puerto Rico with prompt and decisive public health actions. Some of these include (1) establish hepatitis C prevention as a priority for state and municipal public health authorities, (2) raise awareness and educate target populations about HCV transmission and prevention, (3) increase clinician awareness of the HCV reporting system and the epidemiology and management of hepatitis C, (4) increase availability of diagnosis and treatment facilities, (5) increase access to effective drug treatment services, and (6) develop appropriate control measures to help reduce continued transmission in correctional settings.
Assuntos
Humanos , Hepatite C/epidemiologia , Saúde Pública , Anticorpos Anti-Hepatite C/sangue , Hepatite C/sangue , Hepatite C/complicações , Infecções por HIV/complicações , Porto Rico , Estudos SoroepidemiológicosRESUMO
The naturally derived insecticide spinosad is a reduced-risk material that is neurotoxic to Diptera. The 24-h 50% lethal concentration by laboratory bioassay in third instars of Aedes aegypti (L.) (Diptera: Culicidae) (Rockefeller strain) was estimated at 0.026 ppm. Two identical field trials were performed in an urban cemetery in southern Mexico during the dry and wet seasons. Water containers treated with 1 or 5 ppm spinosad suspension concentrate (Tracer, Dow Agrosciences) were as effective in preventing the development of Aedes spp. (mostly Ae. aegypti) as temephos granules during both trials, whereas the bacterial insecticide VectoBac 12AS performed poorly. The half-life of aqueous solutions of spinosad (10 ppm) placed in a warm sunny location was 2.1 d, compared with 24.5 d for solutions in a shaded location. Spinosad, temephos, and VectoBac were not repellent to gravid Ae. aegypti at the concentrations tested, and no ovicidal properties were observed. The 24-h survival of neonate larvae but was reduced by 94-100% in the presence of residues carried over from the spinosad treatments, but it was not affected by residues of temephos or VectoBac. The toxicological properties of spinosad, combined with its favorable environmental profile, should encourage the detailed evaluation of spinosad as a mosquito larvicide in domestic and urban environments.
Assuntos
Aedes/efeitos dos fármacos , Inseticidas/uso terapêutico , Macrolídeos/uso terapêutico , Controle de Mosquitos/métodos , Oviposição/efeitos dos fármacos , Animais , Combinação de Medicamentos , Estabilidade de Medicamentos , Feminino , Óvulo/efeitos dos fármacos , Temefós/uso terapêuticoRESUMO
BACKGROUND: Information from recent multiple trials on the pathophysiology and outcome of ST-segment elevation myocardial infarction (STEMI) has changed its clinical perspective and strategic management, leading to a revision of the 1999 ACC/AHA practice guidelines for that condition. OBJECTIVE: Analyze the clinical characteristics, management strategies, the timing of therapeutic interventions and outcome of patients with STEMI referred to the Cardiovascular Center of Puerto Rico (CVCPR). METHODS: Retrospective review of medical records of all patients admitted to the CVCPR with a diagnosis of STEMI from January 1, 2003 to December 31, 2003. RESULTS: A total of 184 medical records were reviewed. Seventy-six percent of patients were men, mean age was 62.1 +/- 11.8 years. A high prevalence of coronary risk factors was present: systemic hypertension (64), diabetes mellitus (40), dyslipidemia (35), smoking (33) and previous CAD (32). Less than 1/4 of referral forms contained data indicative of whether patients had received antiplatelet therapy, beta-blockers, ACE inhibitors or statins. Fifty percent of patients arrived to the CVCPR more than 48 hours after diagnosis. Only forty-two patients (23) arrived within 12 hours. Thrombolytic therapy had been used in 27of them. 179 (97) patients underwent coronary angiography, 69.2of which had multivessel disease. 114 (62) patients underwent percutaneous coronary interventions (PCI) with stenting. Patients submitted to PCI and stenting of the culprit lesion had a better outcome and survival than the ones not exposed to those procedures (p = 0.02). Approximately two-third of patients received secondary prevention medications upon discharge. CONCLUSIONS: Relevant findings of this review were that in spite of high prevalence of CAD major risk factors, the use of medications of proven benefit for prevention and treatment of CAD at referral centers was less than that recommended by current guidelines, a significant delay in the transfer of patients to the tertiary care facility (in most cases that period exceeded more than 48 hours after diagnosis) and a reduced utilization of thrombolytic therapy. Intensification of the education of physicians throughout the island regarding these matters is to be encouraged. Additional measures should include, development of written protocols at referral centers to assure a more expedite clinical assessment of patients, an enhancement of their capability for utilizing fib
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Infarto do Miocárdio/terapia , Fármacos Cardiovasculares/uso terapêutico , Angioplastia Coronária com Balão/efeitos adversos , Angiografia Coronária , Eletrocardiografia , Fibrinolíticos/uso terapêutico , Hospitais Universitários/estatística & dados numéricos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Porto Rico/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Terapia Trombolítica/efeitos adversosRESUMO
OBJECTIVES: Describe the perioperative characteristics of the patients undergoing coronary artery bypass grafting (CABG) in San Juan, Veterans Affairs Medical Center (SJ-VAMC). Determine the in-hospital and 30-day morbidity and mortality following CABG and identify adverse predictors for postoperative complications. BACKGROUND: Preoperative risk factors for complications post-CABG have been identified; however limited data is available regarding the value of these predictors in the Puerto Rican Population. METHODS: Perioperative characteristics and 30-day complications were gathered from all patients undergoing CABG (n = 252) at the SJ-VAMC (2001-2003). Logistic regression analysis was performed to determine factors associated with the occurrence of complications. RESULTS: The population's mean age was 66.9 +/- 8.1 years. Associated illnesses included: hypertension (95.6), diabetes (57), past smoking (61), COPD (26), chronic renal insufficiency (CRI-11.5), cerebrovascular disease (CVD-20.6), disabling angina (78), 3-vessel coronary disease (75.8), significant left main stenosis (20), and non-elective surgical intervention (54). The most frequent primary complications were postoperative myocardial infarction (MI-4.8) and congestive heart failure (4.8). The 30-day mortality was 1.2. Upon multivariate analysis PRBC transfusions > 3 units was associated to increased risks of primary complications, in patients with prior history of CVD. CRI and LVEF < or = 40were independently associated to development of primary complications, in patients with prior MI and CVD. CONCLUSION: The preoperative characteristics are suggestive of an older and sicker patient that is undergoing CABG at the SJ-VAMC. Despite this, the death rate was low and the frequency of other complications comparable to the Society of Thoracic Surgeons (STS) National Adult Cardiac Database.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias/epidemiologia , Doença das Coronárias/cirurgia , Hospitais de Veteranos/estatística & dados numéricos , Complicações Pós-Operatórias , Ponte de Artéria Coronária/estatística & dados numéricos , Porto Rico/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Hepatitis C infection is the most common chronic blood-borne pathogen in the United States associated with liver cirrhosis and hepatocellular carcinoma and is the leading reason for liver transplantation. It has been estimated that hepatitis C infection may lead to a substantial health and economic burden over the next 10 to 20 years. The prevalence of hepatitis C virus (HCV) infection varies worldwide, with an estimated overall prevalence of 3%. However, the only available data of hepatitis C in the general population of Puerto Rico suggest an elevated prevalence of hepatitis C infection in the municipality of San Juan (6.3%) in comparison with estimates for the adult population residing in the United States (0.9%-3.9%). Much of the inter-region variability in the prevalence of hepatitis C can be attributable to the frequency and extent to which different risk factors have contributed to the transmission of the virus. Established risk factors for infection include injection drug use, transfusion of blood and solid organ transplantation from infected donors prior to July 1992 and blood clotting products before 1987, occupational injury, vertical transmission, sex with an HCV infected partner, and multiple sexual partners. Other potential exposures for infection that have been investigated in epidemiologic studies include history of intranasal cocaine use, sharing of contaminated equipment and personal care items, tattooing, body piercing, imprisonment, acupuncture, and use of contaminated healthcare instruments. The high incidence of AIDS in Puerto Rico and the large prevalence observed in Puerto Rican inmates and in adults residing in the municipality of San Juan indicate that HCV infection is an emerging public health concern. From a public health perspective, potential targets for intervention to decrease the spread of HCV infection, ongoing surveillance, increased clinician awareness of disease reporting systems and the epidemiology and management...