Assessment of the national school lunch program in a subset of schools in San Juan, Puerto Rico: participants vs. non-participants.

OBJECTIVE: Extensive evaluations of the national school lunch program (NSLP) have been carried out on the U.S. mainland. Puerto Rico, a commonwealth of the U.S. is a participant in this program, but has never been included in assessment studies. Herein, we present assessment information and compare results with comparable mainland studies. METHODS: Multiple 24-hr recall questionnaires were administered to groups of participating (P) and non-participating (NP) children in the lunch program at 3 educational levels. Comparisons were made for children within the study as well as between comparable children in mainland studies for total intake of several macro- and micro-nutrients, contribution of the lunch to the total daily intake and adherence to U.S. Recommended Dietary Allowances (RDA's) or to Dietary Reference Intakes (DRI's) including acceptable macronutrient distribution ranges (AMDR's). RESULTS: Target intakes were met by P for % of the RDA of energy from protein, for all water soluble vitamins, iron, zinc and cholesterol. P did not achieve target intakes for total energy, energy from carbohydrates and fat nor for fat soluble vitamins, calcium, magnesium, phosphorus, potassium and fiber. Recommended levels were exceeded for sodium, total fat and saturated fat. Comparing P vs NP, the vast majority of both groups fell within AMDR recommendations for macronutrients but not all micronutrients. CONCLUSION: For the most part, our results parallel those obtained in the National sample however, results suggest that P in the lunch program in Puerto Rico have a healthier intake of several nutrients than NP students. The unique feature of this study is that it is the first assessment of the NSLP in a completely Hispanic population.

Differences in prevalence of inflammatory bowel disease in Puerto Rico between commercial and government-sponsored managed health care insured individuals.

BACKGROUND: Evaluation of ethnic and racial patterns of Inflammatory Bowel Disease (IBD) has demonstrated a higher incidence of IBD in Jews, and lower rates in blacks and Hispanics when compared to whites. There is limited data describing incidence and prevalence among Hispanics, the fastest growing minority in the United States. METHODS: To estimate the prevalence of IBD computerized records of all physicians billing and hospital discharges classified with ICD-9-CM IBD related codes were searched. Prevalence was estimated by age group, sex, and type of insurance (commercial versus government-sponsored managed care). RESULTS: Of 1,248,993 insured individuals in 2005, 186 had a diagnosis of Crohn's disease and 291 of ulcerative colitis. The estimated prevalence per 100,000 was 14.9 for Crohn's disease, 23.3 for ulcerative colitis, and 38.2 cases for IBD. The most significant difference was found when comparing insurance type, with a total IBD prevalence rate of 61.75 cases among commercial versus 14.36 cases among government-sponsored insured. CONCLUSIONS: The prevalence of IBD in this insured population in Puerto Rico places it among the highest described in a Hispanic population. Given the continued rise in prevalence of IBD and the limited studies describing the epidemiology of IBD in Hispanics, further studies which may provide important clues to the etiology of the disease as well as valuable information for appropriate health care planning are important.

Effectiveness of a back school program in the application of body mechanics principles.

BACKGROUND: Low back pain is one of the most frequent work related injuries in all occupations. Back school programs are therapeutic interventions directed towards treatment, prevention and rehabilitation of backaches. The purpose of this study was to (1) evaluate the test-retest reliability of the modified version of the Body Mechanics Evaluation Checklist (BMEC) and (2) examine the effectiveness of a back school program in terms of application of body mechanics during a lifting task. METHODS: A sample of 12 participants from a public corporation in Puerto Rico was selected to participate in a back school program. The modified and translated version of the American Back School Posttest and the modified version of the Body Mechanics Evaluation Checklist were used to evaluate the theoretical and practical component of the back school program. The test-retest reliability of the BMEC was obtained through the intraclass correlation coefficient (ICC [3,1]). For pre/post assessment, a single factor repeated measures MANOVA was conducted to asses the effect of the intervention. RESULTS: The test-retest reliability of the modified version of the BMEC was 0.84. The single factor repeated measures MANOVA revealed significant differences between pre-test and post-test (p < .0001) scores. CONCLUSIONS: This study demonstrated that the modified version of the BMEC is a reliable instrument to evaluate a lifting activity. It was also demonstrated that the back school program served as an effective educational intervention that promotes short-term changes in the body mechanics of back-injured working adults in Puerto Rico.

Prevalence of obesity and its association with blood pressure, serum lipids and selected lifestyles in a Puerto Rican population of adolescents 12-16 years of age.

OBJECTIVES: To describe the prevalence of obesity and determine its association with blood pressure, serum lipids and lifestyles in adolescents attending a public junior-high school in San Juan, Puerto Rico. METHODS: During the 1999-2000 academic school year, 352 students, ranging in age from 12 years to 16 years, were screened for weight, height, and blood pressure. A sub-sample of voluntary adolescents (n = 26) was screened for serum lipids and lifestyles were assessed using a standardized questionnaire. RESULTS: The prevalence of level I obesity and level II obesity among 12 to 16 years old adolescents were 33.2% and 14.2%, respectively. The mean systolic and diastolic blood pressures were significantly higher in obese than in non-obese adolescents (p < .001). There were no significant differences in serum lipids between the study groups (p > .05). However, the obese group showed higher median levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study group reported engaging in hazardous lifestyles (alcohol intake, smoking, and unhealthy eating patterns), but no real differences in lifestyles were found between obese and non-obese groups (p > .05). CONCLUSIONS: A high prevalence of level I and level II obesity was found in this population. In addition, significant positive correlations between blood pressure and body mass index were observed. This study underscores the need to assess the burden of obesity in Puerto Rico in order to develop community intervention strategies encouraging early detection and conduct modification towards healthier lifestyles.

Landing mechanics during side hopping and crossover hopping maneuvers in noninjured women and women with anterior cruciate ligament reconstruction.

OBJECTIVE: To compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction. DESIGN: A case-control study. SETTING: A 3-dimensional motion analysis laboratory. PARTICIPANTS: Twenty-eight young women (range, 21-35 years) (15 control subjects and 13 subjects with ACL reconstruction). PATIENTS AND METHODS: All participants performed a side-to-side hopping task that consisted of hopping single-legged 10 times consecutively from side to side across 2 lines marked 30 cm apart on 2 individual force plates. The task was designated as a side hopping when the hop was to the opposite side of the stance leg and as crossover hopping when the hop was toward the side of the stance leg. MAIN OUTCOME MEASUREMENTS: Peak hip-/knee-joint angles; peak knee extension/abduction joint moments; electromyographic studies of the gluteus maximus, gluteus medius, rectus femoris, and hamstring muscles; and quadriceps/hamstring co-contraction ratio were compared between the groups by means of 2 × 2 multivariate analysis of variance tests (group × maneuver). RESULTS: Noninjured women and women with ACL reconstruction exhibited similar hip- and knee-joint angles during both types of hopping. Hip-joint angles were greater during the crossover hopping in both groups, and knee-joint angles did not differ between the groups or hops. Knee-joint moments demonstrated a significant group × maneuver interaction. Greater knee extension and valgus moments were noted in the control group during crossover hopping, and greater knee abduction moments were noted in the ACL group during side hopping. Electromyographic data revealed no statistically significantly differences between the groups. CONCLUSIONS: Women with ACL reconstruction exhibited the restoration of functional biomechanical movements such as hip-/knee-joint angles and lower extremity neuromuscular activation during side-to-side athletic tasks. However, not all biomechanical strategies are restored years after surgery, and women who have undergone a procedure such as ACL reconstruction may continue to exhibit knee-joint abduction moments that increase the risk of additional knee injury.