Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring.

AIMS: Cervical cancer incidence and mortality rates are approximately 55% higher in the Rio Grande Valley (RGV) along the Texas-Mexico border compared with the average rates in the US. Our aim was to improve cervical cancer prevention efforts in the RGV through a comprehensive multilevel intervention initiative focused on community education, patient navigation, and training of local providers. METHODS: We initiated a program in the RGV which consisted of (1) community education, (2) patient navigation, and (3) a training/mentoring program for local medical providers including hands-on training courses coupled with telementoring using Project ECHO® (Extension for Community Health Outcomes). We assessed the number of women undergoing cervical cancer screening, diagnosis, and treatment at three participating clinics caring for underserved women in the region. RESULTS: From November 2014 to October 2018, 14,846 women underwent cervical cancer screening. A total of 2030 (13.7%) women underwent colposcopy for abnormal results (179% increase over baseline) and 453 women underwent loop electrosurgical excision procedures (LEEPs) for treatment of cervical dysplasia. Invasive cancer was diagnosed in 39 women who were navigated to a gynecologic oncologist for treatment. Seven local medical providers were trained to perform colposcopy and/or LEEP. Project ECHO telementoring videoconferences were held every 2 weeks for a total 101 sessions with an average of 22 participants per session and a total of 180 patient cases presented and discussed. CONCLUSIONS: Our program led to a large number of women undergoing diagnosis and treatment of cervical dysplasia in the RGV. If sustained, we anticipate these efforts will decrease cervical cancer rates in the region. The program is currently being expanded to additional underserved areas of Texas and globally to low- and middle-income countries.

A new graph of soil Rn-gas transport: Radon-rose plot.

Soil radon gas movement depends on soil geology, environmental thermodynamic parameters and, micro-seismic telluric activity. Mapping radon time dependent concentration at the relaxation depth in a selected area, provide transport direction in a seismically high-risk region. Nuclear track methodology is employed to determine main gradient vector for radon transport. Applying the gradient definition, a "radon rose" graph is constructed from which prone area can be promptly identified. Results show that short time interval, Rn-transport direction may change unpredictably, however, the length of each "spoke" around the circle provides information on the soil Rn-gas probable shifts towards or from a direction per time interval. The new graph is a novelty and provide improved approach for environmental protection and radon dosimetry.

Perspectives on cervical cancer screening and prevention: challenges faced by providers and patients along the Texas-Mexico border.

BACKGROUND: The Rio Grande Valley (RGV) and Laredo regions located along the Texas-Mexico border consist of seven counties with a population of approximately 1.5 million people and a high uninsured rate (33.5%). Cervical cancer mortality in these border counties is approximately 30% higher than the rest of Texas. The RGV and Laredo areas were studied to better understand the state of access to cervical cancer prevention services along the Texas-Mexico border. METHODS: Data on the population served and the services provided were analyzed to determine the gap between cervical cancer screenings recommended versus those received. Through interviews, we gathered the perspectives of 16 local stakeholders regarding cervical cancer screening for underserved individuals in the region. FINDINGS: It is estimated that 69,139 uninsured women aged 21-64 years in the RGV/Laredo per year are recommended to undergo cervical cancer screening with Papanicolaou (Pap) and/or human papillomavirus (HPV) testing, but only 8941 (12.9%) Pap tests are being performed by the Federally Qualified Health Center (FQHC) serving uninsured women in these regions. Systemic barriers identified include insufficient provider clinical capacity, the high cost of healthcare, and uncertainty about government funding sources. Patient barriers identified include inadequate knowledge on navigating the local healthcare system, low health literacy, lack of money and childcare, an inability to miss work, limited transportation, and fear of deportation. CONCLUSION: Decreasing the disparity between cervical cancer screening services provided and those recommended requires addressing the barriers, identified by local experts, which prevent uninsured women from accessing care. These challenges are being addressed through ongoing programs and collaborations.

Estado nutricional, factores sociodemográficos y de salud en estudiantes de nuevo ingreso a la UAZ / Nutritional status and social-demographical and health factors among newly enrolled students at UAZ / Estado nutricional, fatores sociodemográficos e de saúde em estudantes de novo ingresso à UAZ

Introducción El sobrepeso y obesidad son factores de riesgo para desarrollar complicaciones a corto y largo plazo. La población de nuevo ingreso a la universidad se considera un colectivo, especialmente, vulnerable desde el punto de vista nutricional. Objetivo Describir el estado nutricional, factores sociodemográficos y de salud en estudiantes de nuevo ingreso a la UAZ. Metodología Estudio de tipo observacional, transversal y descriptivo, que se realizó a 3,972 estudiantes universitarios de nuevo ingreso. Se logró el consentimiento verbal de los alumnos. Se capacitaron y estandarizaron a los pasantes de enfermería, medicina y nutrición, para llevar a cabo las mediciones. Se obtuvo información del estado nutricional, factores sociodemográficos y salud, así como mediciones antropométricas. Resultados Los hombres tienen mayor prevalencia de sobrepeso (24.1%) y obesidad (9.2%) que las mujeres (p < 0.001). Los hombres realizan mayor actividad física (73.6% vs 51.1%), consumen más alcohol (58.3% vs 34.3%) y tabaco (20.8% vs 9.5%) (p < 0.000). Se encontró una asociación positiva en los momios de sobrepeso en relación con los hombres (RM=1.22, IC 95% 1.02-1.45), edad de 19 años (RM=1.36, IC 95% 1.02-1.45), en las áreas de ciencias de la salud (RM=1.88, IC 95% 1.05-3.35), ciencias sociales (RM=1.93, IC 95% 1.06-3.48), humanidades y educativas (RM=1.90, IC 95% 1.01-3.53), ingenierías y tecnologías (RM=1.83, IC 95% 1.01-3.30). Discusión y conclusión Se puede contribuir a reducir las prevalencias de sobrepeso y obesidad de los estudiantes, a través de intervenciones dirigidas a modificar las conductas de riesgo durante la estancia universitaria, mejorar la alimentación y promover estilos de vida saludables.

Introduction Obesity and overweight are risk factors to developing short and long-term health-related complications; and newly enrolled university students are considered a vulnerable group in terms of their nutritional progression status. Objective To describe the nutritional status, and social-demographical and health factors among newly enrolled students at UAZ. Methodology This is an observational, transversal, and descriptive study on a sample of 3,972 newly enrolled university students who verbally consented on their participation. Nursing, medicine, and nutrition intern students were trained to carry out diverse assessments related to the nutritional status, social-demographical and health factors, and anthropometric data on the sample. Results Newly enrolled male students showed a higher prevalence of overweight (24.1%) and obesity (9.2%) in comparison to their female counterparts (p < .001). Male students showed having more physical activity (73.6% vs 51.1%) but also consuming more alcohol (58.3% vs 34.3%) and tobacco (20.8% vs 9.5%) (p < .000). Positive associations were found between the overweight numbers and, being male (RM=1.22, CI 95% 1.02-1.45), being 19 years old (RM = 1.36, CI 95% 1.02-1.45), being in the areas of health sciences (RM=1.88, CI 95% 1.05-3.35), being in the areas of social sciences (RM=1.93, CI 95% 1.06-3.48), being in the areas of humanities and education (RM=1.90, CI 95% 1.01-3.53), and being in the areas of engineering and technology (RM=1.83, CI 95% 1.01-3.30). Discussion and conclusion It is necessary to address to obesity and overweight problems among university students through interventions aimed at modifying risky behaviors during their university stay, improving the quality of nutrition, and promoting healthy life-styles.

Introdução O sobrepeso e a obesidade são fatores de risco para desenvolver complicações a curto e longo prazo. A população de novo ingresso à universidade considera-se um coletivo, especialmente, vulnerável desde o ponto de vista nutricional. Objetivo Descrever o estado nutricional, fatores sociodemográficos e de saúde em estudantes de novo ingresso à UAZ. Metodologia Estudo de tipo observacional, transversal e descritivo, que se realizou a 3,972 estudantes universitários de novo ingresso. Conseguiu-se o consentimento verbal dos alunos. Capacitaram-se e padronizaram os formados de enfermagem, medicina e nutrição, para levar a cabo as medições. Obteve-se informação do estado nutricional, fatores sociodemográficos e saúde, assim como medições antropométricas. Resultados Os homens de novo ingresso têm maior prevalência de sobrepeso (24.1%) e obesidade (9.2%) quanto as mulheres (p < 0.001). Homens realizam mais atividade física que mulheres (73.6% vs. 51.1%), consomem mais álcool (58.3% vs. 34.3%) e tabaco (20.8% vs. 9.5%) (p < 0.000). Encontrou-se uma associação positiva nas chances de sobrepeso em relação com aos homens (RM = 1.22, IC 95% 1.02-1.45), ter 19 anos de idade (RM = 1.36, IC 95% 1.02-1.45) nas áreas de ciências da saúde (RM = 1.88, IC 95% 1.05-3.35), ciências sociais (RM = 1.93, IC 95% 1.06-3.48), humanidades e educativas (RM = 1.90, IC 95% 1.01-3.53), engenharias e tecnologias (RM = 1.83, IC 95% 1.01-3.30). Discussão e conclusão Pode-se contribuir a reduzir as prevalências de sobrepeso e obesidade dos estudantes, a través de intervenções dirigidas a modificar as condutas de risco durante a permanência universitária, melhorar a alimentação e promover estilos de vida saudáveis.

Frequency of Neospora caninum infections in beef cow-calf operations under extensive management.

The aim of this study was to evaluate the frequencies of Neospora caninum horizontal and vertical transmissions in beef cow-calf operations under three different extensive management systems: group A: 0.75 head per hectare pasturing on natural grass; group B: 1.1 head per hectare on natural grass and improved cultured pastures; and group C: 2 head per hectare on natural grass, improved cultured pasture and whole corn silage. Serum samples from 72 multiparous cows assigned to each beef cow-calf operations were obtained every 3 months during 2 years. A group of 30 replacement heifers from each group were tested similarly since they were 10-21 months old. Twenty four, 20 and 34 calves from groups A, B and C respectively, were bled before colostrum intake and again 6 months later. The samples were analyzed by indirect fluorescence antibody test (IFAT) for detection of total IgG against N. caninum at a serological titre ≥ 200 for multiparous cows and replacement heifers, and a serological titre ≥ 25 for calves. Serum samples from seropositive cows were assessed by ELISA to evaluate the avidity of their specific antibodies. There were no differences in the proportion of seropositive cows from groups A, B and C at the beginning of the trial (p>0.05). Interestingly, the lowest serological titres in seropositive cows from all groups were observed during the first trimester (p<0.05). Although seropositive cows had medium to high avidity antibodies, suggesting chronic infection; seroconversion associated with low antibody avidity was found in 2, 3 and 3 seropositive cows from groups A, B and C. All replacement heifers remained seronegative. No abortions were recorded but 2, 1, and 2 calves from groups A, B and C were seropositive before colostrum intake, respectively. Seropositive calves born from cows having intermediate or high avidity remained with the same serostatus at 6 months of age. Even under varying extensive management conditions, both N. caninum horizontal and vertical transmission methods do occur in beef cow-calf operations.

Characterization of DNA and MVA vectors expressing Nef from HIV-1 CRF12_BF revealed high immune specificity with low cross-reactivity against subtype B.

The HIV epidemic in Argentina is characterized by the high prevalence of infections caused by subtype B and BF variants. In this study, the Nef protein was used as a tool to study the impact of HIV-1 BF variants in the design of future vaccines. DNA and MVA vectors expressing Nef of the CRF12_BF recombinant form of HIV-1 were generated and characterized. After the administration of single DNAprime/MVAboost immunization schedules in Balb/c mice we found that NefBF delivered from these vectors generated a response of high specificity with low cross-reactivity against subtype B. But, when a more potent response was induced after 3 priming DNA doses and a booster with MVA virus, cross-reactivity against NefB was detected, although of lower magnitude than the NefBF specific. These results will be pivotal for vaccines designs in our region, indicating that antigens from these viral variants must be considered for a future vaccine.

Kinetics of anaerobic degradation of screened dairy manure by upflow fixed bed digesters: effect of natural zeolite addition.

The effect of the hydraulic retention time (HRT) on the performance of two up-flow anaerobic fixed bed digesters (UFAFBDs) packed with waste tire rubber (D1) and waste tire rubber and zeolite (D2) as micro-organism immobilization supports was studied. It was found that a first-order kinetic model described well the experimental results obtained. The kinetic constants for COD, BOD5, total solids (TS) and volatile solids (VS) removal were determined to be higher in digester D2 than in digester D1 or control. Specifically, they were 0.28 +/- 0.01, 0.32 +/- 0.02, 0.16 +/- 0.01 and 0.24 +/- 0.01 d(- 1) respectively for D1 and 0.33 +/- 0.02, 0.40 +/- 0.02, 0.21 +/- 0.01 and 0.28 +/- 0.01 d(- 1) respectively for D2. This was significant at the 95% confidence level. In addition, the first-order model was also adequate for assessing the effect of the HRT on the removal efficiency and methane production. Maximum methane yield and the first-order constant for methane production were determined and the results obtained were comparable with those obtained by other authors but operating at higher HRTs. Maximum methane yields and the kinetic constant for methane production were 11.1% and 29.4% higher in digester D2 than in D1.

Formula labeling violations to the WHO Code: a quantitative and qualitative analysis

BACKGROUND: The WHO Code on Marketing of Breastmilk Substitutes is intended to be adopted as a minimum requirement by all governments and aims to protect infant health by preventing inappropriate marketing of breastmilk substitutes. Labels need to have correct and clear dispositions since they frequently are the only source of vital information for consumers regarding the content of the product and its uses. OBJECTIVE: The purpose of this study was to determine violations to the provisions of the International Code Article 9 regarding infant formula labeling existing in Puerto Rico. Methods: A quantitative and qualitative evaluation of 34 labels of infant formula was done. Instrument 4-A of the IBFAN Monitoring Project (IMPIII) and the Standard IBFAN Monitoring (SIM) was utilized. This instrument included 14 criteria that identified violations to the International Code of Breastmilk Substitutes on labeling. Descriptive analysis was used for all variables. The 34 labels evaluated represent 77.3% of infant formula labels of the four companies which market them in the island. RESULTS: All the labels (100%) that were evaluated were found to violate the Code in one or more of its dispositions. Most striking violations include: a statement that breastfeeding is best is lacking in 73.5%, as well as a statement that the product should be used only on the advice of a health worker. None of the labels are written in Spanish, the local language. Text which may idealize the use of infant formula or discourage breastfeeding is present in 97.1% of the samples, and the same percentage has a photo or picture idealizing the use of infant formula. CONCLUSIONS: It is vital to produce legislation that implants the WHO Code in Puerto Rico in order to regulate indiscriminate marketing practices and their subsequent ill effects on children's health and breastfeeding practices.

Exploratory study: breastfeeding knowledge, attitudes towards sexuality and breastfeeding, and disposition towards supporting breastfeeding in future Puerto Rican male parents

Identify the breastfeeding knowledge, the attitudes towards sexuality and breastfeeding and the disposition towards supporting breastfeeding in future fathers were the aims of this study. A non-probabilistic sample (n = 100) of future Puerto Rican male parents was used in this study. A self-administered questionnaire was used consisting of four sections. Descriptive statistics were used for data analysis and t-test to the inferential analysis. 88.8of the participants presented a low level of knowledge. However, 81.6had a positive attitude toward sexuality and breastfeeding. Also, 92.0of the participants indicated much/enough willingness to support their partners in exclusively breastfeeding. Disposition to support the breastfeeding was associated with knowledge towards breastfeeding (p = 0.04) and attitudes toward sexuality and breastfeeding (p = 0.00). The knowledge and the attitudes, in this study, are strongly related with the disposition of the father to supporting the breastfeeding in the future.

Effectiveness in the implantation of law 155 of 2002 ordering the designation of spaces for breastfeeding in government agencies

As part of an effort to promote and protect breastfeeding among working mothers in Puerto Rico, Public Law 427 was passed in December 2000. This law grants a paid breastfeeding daily break for milk extraction in the workplace. In support of this initiative Public Law 155 was passed in 2002 ordering Secretaries, Directors, Presidents and Public Administrators of the government of Puerto Rico to designate breastfeeding spaces in the workplaces. OBJECTIVE: Describe the level of compliance with the dispositions of Law 155 in government agencies. METHODOLOGY: A cross sectional descriptive study was carried out. A sample of 28 government agencies was randomly selected, representing 25of the total number of agencies, and a structured telephone interview was administered using an instrument made up of 6 premises. RSEULTS: All (100) of the agencies had knowledge about the existence of this law, but only 50had set up and equipped the spaces. Of these, all had a table, a chair, and an electric outlet, 43had available running water, and 71provided a refrigerator for milk storage. Fifty three percent of the agencies reported having received followup communications to verify whether they were complying with the law, and 61reported having a written public policy in support of breastfeeding for working mothers. Only 54of the agencies stated they had offered some type of orientation to their women employees regarding their breastfeeding rights. CONCLUSIONS: In spite of over two years since the passing of Law 155, the majority of government agencies in Puerto Rico have not complied with its legal dispositions. It is necessary that the responsible entities watch for the satisfactory compliance with this law since working mothers need a secure and accesible place for milk extraction during the working day.

In vitro antifungal evaluation and structure-activity relationships of a new series of chalcone derivatives and synthetic analogues, with inhibitory properties against polymers of the fungal cell wall.

Here we report the synthesis, in vitro antifungal evaluation and SAR study of 41 chalcones and analogues. In addition, all active structures were tested for their capacity of inhibiting Saccharomyces cerevisiae beta(1,3)-glucan synthase and chitin synthase, enzymes that catalyze the synthesis of the major polymers of the fungal cell wall.

Intralesional isotype profiles in human localized cutaneous leishmaniasis lesions.

This immunocytochemical study evaluates the presence of IgG1-4, IgA and IgE immunoglobulins in active lesions of 25 localized cutaneous leishmaniasis patients from three bioclimatic areas (Awa, Afa and Bsha) in Mérida State, Venezuela. All immunoglobulin isotypes except IgE were detected, with variable intensity, in one or more of the epidermal or dermal components of skin lesions. IgG1 and IgG2 were detected significantly more frequently than IgG3, IgG4 and IgA. The ranking of the isotypes according to frequency of detection was the same in all areas: IgG1 = IgG2 > IgG3 = IgG4 = IgA, but considered as whole, all isotypes were detected significantly more frequently in patients from the Awa area than in those from the Bsha area. The predominant expression of isotypes IgG1 and IgG2 suggests a preferential Th1 like immune response. Anti-Leishmania immunoserum stained only parasites and their debris, suggesting that most of the immunostaining was nonspecific.

Puerto Rican health teachers: attitudes towards breastfeeding.

OBJECTIVE: The purpose of the study was to identify attitudes towards breastfeeding and support for breastfeeding in public in a group of health teachers in the Department of Education. METHOD: The study design was correlational descriptive. A self-administered questionnaire was used (Cronbach's alpha = 0.83) for 125 health teachers. Descriptive and inferential statistics (chi square and t test) were used for data analysis. RESULTS: 89.6% were women, 47.1% had 39 years of age or less, 76.4% were married, the median of years in the profession was 12.5. Only 8.8% had breastfed exclusively, 46.1% used artificial feedings exclusively, and 45.1% combined artificial milk and breast milk. A moderate/negative attitude towards breastfeeding was shown by 53.1%. 60.3% stated they agreed or totally agreed that in order to breastfeed the mother must follow a specific diet, 36.0% agreed or totally agreed that breast milk should alternate with artificial milk, and 100% of participants do not support breastfeeding in public. No significant difference was found in the attitude scale towards breastfeeding and the gender, the age, years in the profession, and the type of milk given their children. CONCLUSIONS: We must train teachers in the Department of Education, on a priority basis, in the field of human lactation in view of their importance for health promotion.

Profile of calls to a breastfeeding clinic information and help telephone line.

Breastfeeding mothers need orientation and help in order to succeed with breastfeeding. Lack of support from health professionals and societal barriers result in a median duration of breastfeeding in Puerto Rico of only 3 weeks. A telephone warm line at our breastfeeding clinic tries to provide some much-needed support and orientation. The purpose of this study was to determine the principal reasons for calls to the warm line and the action taken by the counselor. Five hundred and thirty three calls were received in a 4-month period. They were handled by certified lactation educators who gathered demographic and feeding information from the mother and registered the action taken. Descriptive analysis was used with crosstabs tables and multi-response analysis; chi-square test was used to establish the association between variables. 78.7% of callers were breastfeeding fully, while 21.3% were breastfeeding partially or formula feeding, 62.8% of the babies were 2 months old or less. 68.8% of the calls originated in the metropolitan San Juan area. The source of the referral was family/friend in 64.2% of calls, while only 9.8% of the callers were referred by a physician, 3.0% by hospital personnel and 2.0% by other health care providers. Significant differences between full breastfeeders and partial or artificial feeders were found in calls related to position (p = 0.01), engorgement (p = 0.04), breast refusal (p = 0.001), product information (p = 0.02), medications (p = 0.009), breastmilk management and storage (p = 0.001), and relactation (p = 0.02). Actions taken by the counselor included orientation, referral to breastfeeding specialist physician and referral to breastfeeding support groups or classes. Results indicate that more active promotion of referral to breastfeeding support groups or classes is warranted since this action was taken in only 14.5% of fully breastfeeding mothers and 12.6% of partial breastfeeding or formula users. Promotion of the warm line among physicians, hospitals and other health care professionals is also needed.

[Public policy for the promotion of maternal lactation in hospitals]. / Política pública para la promoción de la lactancia materna en las instituciones hospitalarias.

The policy for Breastfeeding Promotion in Puerto Rico includes as one of its goals, that all hospital in the island become Baby Friendly Hospitals. The authors present a hospital policy model which can be adopted and recommendations for the implementation of this policy are given.

Interaction of Leishmania mexicana promastigotes with the plasminogen-plasmin system.

The binding of human plasminogen and plasmin to the promastigote form of Leishmania mexicana was investigated. L. mexicana was capable to bind both molecules, the binding being inhibited by epsilon-aminocaproic acid. Scatchard plot analysis revealed a dissociation constant (Kd) value of 2.4+/-0.8 microM and 0.9+/-0.1 x 10(4) binding sites per cell for plasminogen and a Kd value of 1.2+/-0.4 microM and 1.6+/-0.2 x 10(5) binding sites per cell for plasmin. C-terminal lysine residues are involved in plasminogen binding to cells, since carboxypeptidase B treatment reduced this binding by 34%. Ligand blotting analysis showed a group of proteins, with molecular masses between 105 and 115 kDa, capable to interact with plasminogen. Zymogram analysis showed that the protease activity acquired by L. mexicana, due to the interaction with either plasminogen or plasmin, comprises an important fraction of the total protease activity at pH 7.7. Plasminogen activation by tissue-type plasminogen activator (t-PA) was enhanced by the presence of L. mexicana promastigotes. These results raise the question whether the interaction of L. mexicana with components of the fibrinolytic system is involved in the virulence of the parasite.

[Ethical aspects of human lactation and breastfeeding]. / Aspectos éticos en la promoción de la lactancia humana y el amamantamiento.

Breastfeeding has experienced a surge in Puerto Rico thanks to the efforts of many women, as well as governmental, non-governmental and private organizations. Among the aspects which can affect the initiation, establishment and maintenance of successful breastfeeding one finds potential ethical conflicts among health professionals as well as the financial interests of the companies which produce and market artificial milks. These companies dedicate great marketing efforts and enormous sums of money in the sale of their products, in detriment of breastfeeding. The profit motive of these companies is in open contradiction to public health and to breastfeeding promotion. The international community has carried out efforts for more than two decades in the creation of structures which protect the rights of women and their children to ideal nutrition practices, free from commercial pressures, through breastfeeding. Possible ethical conflicts related to the new industry of breastfeeding paraphernalia are discussed, especially when these are marketed exclusively for profit. Recommendations are presented for health professionals in order for them to be able to face and respond to the unethical strategies practiced by the manufacturers of artificial milks in utilizing these professionals for legitimating and marketing their products.

The management of labor and delivery and its implications for breastfeeding.

The main professional organizations of obstetrical and pediatric care providers in the United States and Puerto Rico have issued official position papers in favor of breastfeeding. Routine labor and delivery practices, however, constitute frequent barriers for the initiation, type and duration of breastfeeding. Many of these practices, moreover, lack the scientific basis to justify their routine use. We analyze in this article some of the most common obstetrical practices and their impact on breastfeeding.

[Breast feeding in Puerto Rico: traditional patterns, national trends and future strategies]. / La lactancia materna en Puerto Rico: patrones tradicionales, tendencias nacionales y estrategias para el futuro.

The Puerto Rican society has gone through profound transformations during the past 50 years. Industrialization and the incorporation of women into the labor force have been accompanied by medicalization of the reproductive process and a progressive reduction in the prevalence of breastfeeding as the cultural norm for nutrition of infants. The data base for 1990 places Puerto Rico significantly below Latin America and the United States in the percentage of breastfed infants. The authors report their experience in the promotion of breastfeeding during the last 5 years. The principal negative factors which hinder the beginning and maintenance of successful breastfeeding are of a social nature. The orientation of physicians towards technology underrates the benefits of breastfeeding. The marketing strategies of the corporations which manufacture artificial milk continuously violate the International Code for Marketing of Breast Milk Substitutes and disfigure the community's perception on the benefits of breastfeeding. The lack of social and legal support for the breastfeeding working mother frequently prevents her from carrying out successful breastfeeding for the recommended period of time. Strategies are presented for the overturn of the existent barriers which have reduced breastfeeding in Puerto Rico to the present precarious levels.