Prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001

OBJECTIVE To study the prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001. METHODS All medical claims for coronary heart disease (ICD-9 410-414), hypertension (ICD-9 401-405), congestive heart failure (ICD-9 428) and cerebrovascular accidents and transient ischemia (ICD-9:430-438.9) submitted for reimbursement purposes to an insurance company (private and public sector) in Puerto Rico in 2001 were identified. Prevalence and medical care utilization concerning cardiovascular conditions was estimated with 95% confidence. RESULTS Overall prevalence of cardiovascular conditions was 13.5% (95% CI: 11.68%-15.44%), being larger in the private sector (16.0%; 95% CI: 15.98%-16.08% vs. 11.7%; 95% CI: 11.62%-11.77%). Although in both sectors prevalence increased with age, at same age groups was two times higher in the private sector. Hypertension was the most prevalent condition (9.7; 95% CI: 8.14%-11.41%) being higher in females (10.4; 95% CI: 10.37%-10.51%) than in males (8.9; 95% CI: 8.81%-8.96%). The health service utilization (physician's office visits, emergency room visits, and hospital admissions) was higher in males. However, it varies by sectors. CONCLUSIONS Significant difference exists in the prevalence of cardiovascular conditions and health services utilization among private and public sectors in Puerto Rico. The observed differences among the private and public populations imply that there are factors such as socioeconomic status, education, lifestyles, environmental hazards in neighborhoods, and health habits that could be involved in the differences

The proportion and characteristics of adolescents who return for anonymous HIV test results.

BACKGROUND: The proportion of adolescents who return for HIV test results varies widely, and knowledge of what characteristics affect their return is limited. GOAL: To quantify the proportion of adolescents who return for results of anonymous HIV tests, and to identify the characteristics that predict their return. STUDY DESIGN: This retrospective study evaluated 285 adolescents consenting to anonymous HIV tests in an urban clinic that provides medical services free of charge without eligibility requirements to a mostly working, uninsured population. RESULTS: Of the adolescents studied, 42% returned for test results. Three characteristics independently predicted their return: (1) coming to the clinic only for HIV testing, (2) having private health insurance, and (3) engaging in unprotected sex while using drugs or alcohol. CONCLUSIONS: Except for having unprotected sex while using drugs or alcohol, the characteristics that placed adolescents at risk for HIV infection did not predict their return for test results. Given the low return rate for anonymous testing in this setting, confidential testing, which permits follow-up evaluation of those failing to return for test results, should be considered.

Connectivity patterns in tuberculosis and leprosy patients are indistinguishable from that of healthy donors.

Connectivity, the self-defined interactions between antigen-recognising molecules in a network system can in part be assessed by measuring the reactivity of a given serum against an ordered set of immunoglobulin (Ig)G F(ab')2 fractions, separated by means of isoelectric focusing so that, the serum reactivity against the whole set of fractions defines a characteristic pattern of connectivity. Deviations from the normal condition (healthy donors) have so far been documented for two autoimmune diseases: systemic lupus erythematosus (SLE) and pemphigus vulgaris, as well as for human immunodeficiency virus (HIV)-1 infection. We tested here if bacterial infections lead to alterations in connectivity. In addition, we wanted to test if two antigenically related bacteria would produce similar or otherwise distinctive connectivity patterns. Connectivity analysis was applied on the sera from tuberculosis and leprosy patients and the sera from healthy donors were used as control. No statistically significant differences between the three groups studied were found. These results have implications for theories that set the origin of autoimmune diseases in microbial infections. To the best of our knowledge, this is the first attempt to analyze the connectivity status in bacterial infections.

Solid waste characterisation study in the Guadalajara Metropolitan Zone, Mexico.

The key findings of a solid waste characterisation study conducted at the Guadalajara Metropolitan Zone, Mexico, are reported. Objectives of the study were to estimate the daily generation rate of household (HSW) and municipal solid waste (MSW), characterise and compare their composition by type of material, determine the proportion that HSW contributes to MSW, explore changes in MSW composition through time after final disposal, and estimate the types and amount of MSW that are sorted out for recycling at final disposal sites. HSW generated during seven days by a sample of 300 households chosen through a two-stage stratified sampling design was collected, weighed and classified. MSW entering the four local disposal sites was recorded for 12 weeks, and materials' sorting was quantified. MSW samples taken by excavating trenches in two final disposal sites were also characterised. The average per capita daily HSW generation rate was 508 g. HSW mainly consisted of putrescible waste (53%), paper (10%) and plastic (9%). The average daily generation rate of MSW was 3119.2 metric tonnes. HSW represented 55.9% of MSW, and the main difference between HSW and MSW was a lower proportion of organic materials (53% vs. 16.5%, respectively). The major changes in MSW composition through time after final disposal, were the result of the quick decomposition of putrescible materials. Only 2.2% of total MSW generated in Guadalajara (mainly package waste) was sorted for recycling.

Connectivity and HIV-1 infection: role of CD4(+) T-cell counts and HIV-1 RNA copy number.

Following primary infection with human immunodeficiency virus (HIV)-1, antibodies against specific HIV-1 epitopes are elicited. However, non-HIV-1 specific antibodies, including autoantibodies, also arise. In fact, it has been proposed that such autoantibodies have an important role in the pathogenesis of HIV-1 infection. Because an imbalance in connectivity has been associated with autoimmune processes, we investigated the connectivity status of HIV-1-infected individuals. Moreover, we tested the possible role of viral load and CD4(+) T-cell counts, in connectivity, because these parameters appear to be important in the prognosis of HIV-1 infection. Results show that indeed, there is an alteration in connectivity in these patients, both for immunoglobulin (Ig)G and IgM, which is an immune alteration not previously identified in HIV-1 infection. In addition, our results show that viral load and CD4(+) T-cell counts are both equally important in defining the characteristic pattern of connectivity in HIV-1-infected individuals, and that neither is independently responsible for alterations in patient connectivity status.

Sensation seeking and drug use by adolescents and their friends: models for marijuana and alcohol.

OBJECTIVE: To investigate the prospective influence of individual adolescents' sensation seeking tendency and the sensation seeking tendency of named peers on the use of alcohol and marijuana, controlling for a variety of interpersonal and attitudinal risk and protective factors. METHOD: Data were collected from a cohort of adolescents (N = 428; 60% female) at three points in time, starting in the eighth grade. Respondents provided information about sensation seeking, the positivity of family relations, attitudes toward alcohol and drug use, perceptions of their friends' use of alcohol and marijuana, perceptions of influence by their friends to use alcohol and marijuana, and their own use of alcohol and marijuana. In addition, they named up to three peers, whose sensation seeking and use data were integrated with respondents' data to allow for tests of hypotheses about peer clustering and substance use. RESULTS: Structural equation modeling analyses revealed direct effects of peers' sensation seeking on adolescents' own use of both marijuana and alcohol 2 years later. An unexpected finding was that the individual's own sensation seeking had indirect (not direct) effects on drug use 2 years later. CONCLUSIONS: These findings indicate the potential importance of sensation seeking as a characteristic on which adolescent peers cluster. Furthermore, the findings indicate that, beyond the influence of a variety of other risk factors, peer sensation seeking contributes to adolescents' substance use.

Peer networks and sensation seeking: some implications for primary socialization theory.

This article draws on recent work in sensation seeking and peer influences in drug use prevention and considers some possible implications for primary socialization theory. A particular point of focus is a postulate of the theory that an individual's personal characteristics and personality traits do not directly relate to drug use and deviance but ordinarily influence those outcomes only when they affect interactions between the individual and the primary socialization sources. The article suggests a more broadly encompassing perspective which holds that socialization learning through the primary socialization sources gives people's lives direction; it may be the tugs of activation needs which provide impetus for the actions. The authors cite a recent study in which they developed a structural equation model of influence of individual and peer variables on later alcohol and marijuana use. The model indicates an indirect route from individual sensation seeking through peers to drug and alcohol use, with adolescents picking persons of similar sensation-seeking levels, and the sensation-seeking level of these peers tending to influence alcohol and marijuana use. Although previous studies have suggested causal relationships between sensation seeking and drug use and between peer influence and drug use, the findings in this study suggest that the actual process involves both. [Translations are provided in the International Abstracts Section of this issue.]

Mycoplasma pneumoniae-associated nephritis in children.

Mycoplasma pneumoniae infection is a rare cause of acute nephritis. Six children (2 girls) aged 5-10 years, admitted for nephritis, had serological tests showing recent Mycoplasma pneumoniae infection. The diagnosis of Mycoplasma pneumoniae infection was based on the presence of serum IgM, detected either by immunofluorescence (IF) (n = 1) or enzyme-linked immunosorbent assay (n = 5). Four children had a renal biopsy, with analysis of parenchymal Mycoplasma pneumoniae components by indirect IF and polymerase chain reaction. Extrarenal symptoms were: respiratory (n = 3), ear, nose and throat (n = 2), gastrointestinal (n = 3), hepatic (n = 1), neurological (n = 1), articular (n = 1), and hematological (n = 3). The patients presented with acute nephritis (1 had a nephrotic syndrome) or with acute renal failure and proteinuria. Pathological findings included type 1 membranoproliferative glomerulonephritis (MPGN, n = 1), proliferative endocapillary glomerulonephritis (n = 2) and minimal change disease (n = 1). The patient with type 1 MPGN progressed rapidly towards end-stage renal failure because of a congenital solitary kidney. Among the patients with endocapillary glomerulonephritis, 1 relapsed 6 months later and remained proteinuric, while the other recovered, as did the child with minimal change disease. The search for Mycoplasma pneumoniae antigens and nucleic acids in renal tissue was negative. However, the absence of the microorganism in the kidney is a common feature of post-streptococcal glomerulonephritis. We conclude that Mycoplasma pneumoniae is a rare yet potential cause of acute glomerulonephritis.

Altered pattern of connectivity in serum immunoglobulins from pemphigus vulgaris patients.

Pemphigus vulgaris is a cutaneous autoimmune disease in which the occurrence of autoantibodies directed against desmoglein-3 and other self-antigens has been well established in patient sera. However, V-region interactions (connectivity) of serum IgG and IgM have not been analysed to date. In this report, it has been demonstrated that IgG and IgM in the sera of pemphigus vulgaris patients bind a preparation of F(ab')2 fragments fractionated according to their isoelectric points, and that a pattern of connectivity distinguishable from that of healthy donor sera arises when the sera are tested against 20 individual isoelectric-focusing-separated F(ab')2-containing fractions. This suggests that there are alterations in regulatory networks. In spite of the fact that prednisolone-based treatment of pemphigus patients has proved to be effective in controlling the disease, some undesirable effects associated with this form of treatment have prompted investigation into other therapeutic approaches. One possible approach to the treatment of this autoimmune disease is the use of high doses of normal polyclonal immunoglobulins. In fact there are a few reports of the empirical intravenous administration of immunoglobulins to pemphigus vulgaris patients. The results presented here provide the rational basis for using such a treatment, since it is demonstrated that a deviation from healthy V-region interactions can be attributed to pemphigus patients and that such a condition is considered to be modified by this type of immunotherapy.

Indice de láminas positivas de Malaria de la Región VI de Salud, junio 1998 / Incidence of positive malaria slides in Sanitary Region VI, June 1998

Se realizó un estudio descriptivo con el objetivo de determinar el índice de láminas positivas de malaria en 71,615 pruebas de gotas gruesas realizadas en la Región 6 de salud, cita en la ciudad de San Juan de la Maguana, durante el mes de junio de 1998. Encontrándose un índice de láminas positivas de 0.64//; el 57.5// de los afectados tenía más de 15 años; el 53.6// correspondieron al sexo masculino; Elías Piña fue la provincia más afectada y la tasa de mortalidad regional fue de cero

Incidencia de apendicitis en el Hospital Padre Billini - Enero 1990 - diciembre 1995 / Incidence of apendicitis of the \"Padre Billini\" Hospital, January 1990-December 1995

Se realizó un estudio descriptivo con el objetivo de determinar la incidencia de apendicitis aguda en 33,863 pacientes admitidos en el Hospital Padre Billini durante el período enero de 1990 a diciembre de 1995. Encontrándose una tasa de incidencia de 1.4 por cada 1,000 ingresos; el 41.6// estaban comprendido entre los 20-29 años; el 53.9// correspondieron al sexo masculino; el 57.5// se debieron a cuerpo extraño y el 1.8// de los pacientes fallecieron

[Glomerulopathy and hypomelanosis of Ito]. / Glomérulopathie et hypomélanose de Ito.

Hypomelanosis of Ito is a rare neuroectodermal syndrome characterized by specific cutaneous lesions and frequent musculoskeletal or visceral involvement. We report on a child with an original nephritis with major segmental abnormalities of the glomerular basement membrane. Such an association might not be fortuitous and glomerular involvement might be underestimated in hypomelanosis of Ito.

Recurrence of membranous nephropathy after renal transplantation. Incidence and risk factors in 1614 patients.

The exact incidence of recurrence of membranous nephropathy (MN) after renal transplantation is not well documented because of the limited number of series involving a small number of patients. The aim of this study was to assess the incidence of MN recurrence in our population of renal transplant patients, to identify the risk factors associated with the recurrence, and to analyze the influence of the recurrence on graft and patient survival rates. The recurrence was defined as biopsy-proven MN on the renal graft in a patient whose original disease was MN. Among 1614 consecutive renal transplantations performed from January 1, 1980, to June 1, 1993, the incidence of recurrence was 26.3%, i.e., 5 recurrences out of 19 transplantations. We were unable to show pretransplant epidemiological, immunological, and therapeutic factors associated with recurrence. The HLA DR3 allele was present in 2 patients with recurrence (40%), compared with 3 patients without recurrence (21.4%). The early use of cyclosporine was not associated with a decreased prevalence of MN recurrence. Graft survival was not influenced by the recurrence. Three lymphomas were observed in the 19 transplanted patients with MN as causal nephropathy.

Thrombospondin in human glomerulopathies. A marker of inflammation and early fibrosis.

Extensive damage is thought to occur to endothelial cells in renal vasculitis and other glomerulopathies. The state of inflammation of these endothelial cells was investigated through the use of a panel of monoclonal antibodies (MAb) directed against thrombospondin (TSP), von Willebrand factor (vWF), integrins (alpha IIb beta 3, alpha v beta 3), CD36, and classical markers of inflammation (P-selectin, E-selectin, ICAM-1, VCAM). Results show that the anti-TSP MAb (LYP10) stains large areas of interstitium in focal sclerosis, vasculitis, membranous glomerulonephritis (GN), and diabetic GN but does not in normal kidney. In contrast, very limited areas are stained by LYP10 in minimal change nephropathy and Berger's disease. On paraffin-embedded specimens these areas stained by LYP10 appear edematous and early fibrous. Up-regulation of vWF and ICAM-1 is matched by an increased binding of LYP10 to the interstitium. In addition, fibrous crescents in injured glomeruli are stained by LYP10. This study reports for the first time an increased TSP secretion in glomerulopathies. Such TSP secretion may be part of physiological adaptive changes associated with inflammation and early fibrosis.

[Can hydroxyethylamidon be used during intensive care of brain-dead organ donors?]. / L'hydroxyéthylamidon peut-il être utilisé lors de la réanimation des sujets en état de mort cérébrale pour don d'organe?

In France, most of the kidney grafts are obtained from brain dead organ donors. Brain death induces numerous changes, especially in haemodynamic status, requiring the infusion of large volumes of fluid. The aim of this study was to evaluate the effect of hydroxyethyl starch (HES) on the organ donors and the kidney graft function in recipients. We compared two groups of brain dead organ donors and the kidney grafts, differing by the infused solutions: either a combination of HES (Elohes, Biosedra) and 4% human albumin solutions (HES group), or albumin alone in the control group (Albumin group). In the two groups, sex-ratio, age, cause of brain death and duration of therapy were similar. Fluid requirements were identical in the two groups: respectively 2,211 +/- 1,512 mL in the Albumin group vs 2,452 +/- 1,094 mL in the HES group (p = 0.17). However, the volume of albumin was significantly decreased in the HES group: 711 +/- 822 mL (p = 0.0001). Therefore the cost was lower in the latter: 638 +/- 633 vs 1766 +/- 788 FF. The coagulation status was not significantly different between the two groups. Amylasemia was higher in the HES group, but the difference was not significant. In the Albumin group, urinary output increased, but not significantly and creatinemia was decreased: 113.9 +/- 62 vs 131.5 +/- 44 mumol.L-1 (p < 0.05). The two groups of recipients were also similar for sex-ratio, age, kind of graft, cause of the chronic renal failure and ischaemia times.(ABSTRACT TRUNCATED AT 250 WORDS)

[Triple association: extramembranous glomerulonephritis, renal adenocarcinoma and splenic hamartoma. Apropos of a case]. / Triple association: glomérulonéphrite extramembraneuse, adénocarcinome rénal et hamartome splénique. A propos d'un cas.

We report the case of a 36 year old woman who presented a renal cell carcinoma, associated to a membranous nephropathy as a paraneoplastic syndrome. The concomitant association with a splenic hamartoma was probably fortuitous. Five years after nephrectomy, the patient was asymptomatic and her proteinuria was very low. We studied in the literature 93 cases which reported a such association between cancer, nephrotic syndrome and membranous nephropathy. Carcinoma of the lung and adenocarcinoma of the gastrointestinal tract are the most frequently implicated. This association can occur at every age and more often in men (75%) than in women. The survival is directly linked to the evolution of the cancer. Proteinuria and membranous nephropathy can totally disappear after surgical resection of the carcinoma. The glomerular injury is mediated by immune complexes composed at least in part of tumour associated antigens. The development of several types of glomerular injury in patients with carcinoma have been described but membranous glomerulonephritis is the most commonly observed.