Seventeen-year study reveals fluctuations in key ecological indicators on two reef crests in Cuba.

Reef crests in the Caribbean have lost approximately 80% of the foundational habitat-forming coral Acropora palmata (Lamarck, 1816), with declines registered as early as the 1950s mainly from anthropogenic causes. We studied two reef crests in the northwestern region of Cuba over 17 years (2005 to 2021) to evaluate temporal changes in coral cover, dominated by A. palmata, and their potential drivers. The density of A. palmata generally showed a negative trend at both reefs, with the lowest density recorded in 2021 at 0.2 ± 0.05 col. m-2 at Playa Baracoa and 1.0 ± 0.1 col. m-2 at Rincon de Guanabo. The mean size of the colonies in the two reefs also decreased over time. In Playa Baracoa, the mean diameter of A. palmata colonies decreased from 2012 at 67 ± 5.9 cm to 2013 at 34 ± 2.2 cm, whereas in Rincon de Guanabo, a change in diameter was evident from 2015 at 44.3 ± 2.3 to 2021 at 21.6 ± 0.9 cm. Adult colonies (10 cm-50 cm diameter) predominated in most years on both reefs. The populations of A. palmata on both reefs were healthy, with an average of 70% colonies in good condition during the study period. However, A. palmata cover decreased by almost half by 2021, to 8.6% in Playa Baracoa and 16.8% in Rincon de Guanabo. By contrast, macroalgal cover increased two-fold to 87.1% in Playa Baracoa and four-fold to 77.2% in Rincon de Guanabo. The density of the sea urchin Diadema antillarum was higher in Playa Baracoa than in Rincon de Guanabo. The highest densities were 2.8 ± 0.2 ind. m-2 in Playa Baracoa in 2005 and 0.1 ± 0.03 ind. m-2 in Rincon de Guanabo in 2008. Although our results show an overall decline of A. palmata (density and percent cover) and an increase in macroalgae, these two reef crests are in better condition than most reefs in the Caribbean in terms of the density and health of A. palmata populations, and the density of D. antillarum at Playa Baracoa. Our results are important in establishing a management plan to ensure the condition of these reef crests does not degrade further.

[Academic satisfaction in residents of the north zone, Mexico City]. / Satisfacción académica en residentes de la zona norte, ciudad de México.

Background: Resident academic satisfaction has been linked to academic performance and quality of care. Objective: To analyze the perception of academic satisfaction in medical residents of the North Decentralized Administrative Operation Body 2 of the Instituto Mexicano del Seguro Social (IMSS), north of Mexico City. Material and methods: Cross-sectional analytical study. A total of 346 resident physicians of different specialties and academic degrees were found, enrolled in the residence halls in the northern zone of the IMSS, Mexico City from January to February 2022. The dependent variable was the level of academic satisfaction. Descriptive and inferential statistics and p ≤ 0.05 were produced for statistical significance. Results: The level of high satisfaction was 80.6% and the level of poor or low satisfaction was 1.7%. The dimension most affected in the negative bases was that of "Perception of teaching" in which 13% of the doctors surveyed refer to the need for some retraining of teachers. The best qualified dimension was "Perception of the role of autonomies" where 35.3% have an excellent perception of their personal work. The highest degree of satisfaction decreased during the second year. Conclusion: There is a high degree of satisfaction among resident doctors, however it is necessary to work to improve satisfaction in the remaining 20%.

Introducción: la satisfacción académica del residente se ha vinculado con el rendimiento académico y la calidad en la atención. Objetivo: analizar la percepción de la satisfacción académica en médicos residentes del Órgano de Operación Administrativa Desconcentrada 2 Norte del Instituto Mexicano del Seguro Social (IMSS), zona norte de la Ciudad de México. Material y métodos: estudio transversal analítico. Se encuestó a 346 médicos residentes de diferentes especialidades y grados académicos, inscritos en las sedes de residencia de la zona norte del IMSS, en la Ciudad de México de enero a febrero del 2022. La variable dependiente fue el nivel de satisfacción académica. Se utilizó estadística descriptiva, inferencial y p ≤ 0.05 para la significancia estadística. Resultados: el nivel de satisfacción alta fue del 80.6% y el nivel de satisfacción pobre o bajo fue del 1.7%. La dimensión más afectada en las puntuaciones negativas fue la de Percepción de la enseñanza, en la que el 13% de los médicos encuestados refieren la necesidad de algún reentrenamiento en los profesores. La dimensión mejor calificada fue la de Percepción del rol de autonomías, donde el 35.3% tienen una percepción excelente de su trabajo personal. El mayor grado de satisfacción se observó durante el segundo año. Conclusión: existe un alto grado de satisfacción entre médicos residentes; sin embargo, es necesario trabajar para mejorar la satisfacción en el 20% restante.

Assessing HIV Care Outcomes Among Persons Who Use Drugs in Puerto Rico Before and After Hurricane Maria.

OBJECTIVES: To explore the health impacts of Hurricane Maria (HM) on HIV care outcomes among people living with HIV who use drugs. METHODS: Using data from an ongoing cohort study in San Juan, Puerto Rico (Proyecto PACTo), we measured differences in HIV care outcomes (viral load, viral suppression, and CD4 counts) before and after HM using assessments conducted at 6-month intervals. Generalized estimating equations were used to assess factors associated with HIV care outcomes. RESULTS: All HIV care outcomes showed a deterioration from pre-HM values to post-HM values (mean viral load increased, CD4 counts decreased, and rate of viral suppression decreased) after controlling for pre-HM sociodemographic and health characteristics. In addition to HM, age (aIRR = 1·01), being homeless (aIRR = 0·78) and having health insurance (aIRR = 1·6) were independently associated with viral suppression. PARTICIPANTS: 219 participants completed follow-up visits between April 2017 and January 2018, before and after HM. CONCLUSIONS: People living with HIV who use drugs in Puerto Rico experienced poorer HIV outcomes following HM. Socio-environmental factors contributing to these outcomes is discussed in the context of disaster response, recovery, and program planning.

[Comparison of two types of classification in functional dyspepsia; postprandial distress or epigastric pain vs a multidimensional cluster analysis using unsupervised learning]. / Comparación de dos tipos de clasificación en dispepsia funcional; distrés postprandial o dolor epig ástrico vs un an álisis multidimensional por conglomerados utilizando aprendizaje no supervisado.

Artificial intelligence methods using unsupervised learning tools can support problem solving by establishing unidentified grouping or classification patterns that allow typing subgroups for more individualized management. There are few studies that allow us to know the influence of digestive and extra-digestive symptoms in the classification of functional dyspepsia. This research carried out a cluster unsupervised learning analysis based on these symptoms to discriminate subtypes of dyspepsia and compare with one of the currently most accepted classifications. An exploratory cluster analysis was carried out in adults with functional dyspepsia according to digestive, extra-digestive and emotional symptoms. Grouping patterns were formed in such a way that within each group there was homogeneity in terms of the values adopted by each variable. The cluster analysis method was two-stage and the results of the classification pattern were compared with one of the most accepted classifications of functional dyspepsia. Of 184 cases, 157 met the inclusion criteria. The cluster analysis excluded 34 unclassifiable cases. Patients with type 1 dyspepsia (cluster one) presented improvement after treatment in 100% of cases, only a minority presented depressive symptoms. Patients with type 2 dyspepsia (cluster two) presented a higher probability of failure to treatment with proton pump inhibitor, suffered more frequently from sleep disorders, anxiety, depression, fibromyalgia, physical limitations or chronic pain of a non-digestive nature. This classification of dyspepsia by cluster analysis establishes a more holistic vision of dyspepsia in which extradigestive characteristics, affective symptoms, presence or absence of sleep disorders and chronic pain allow discriminating behavior and response to first-line management.

Social Media and Mobile-App use for Sexual Encounters among Men Who Have Sex With Men in Puerto Rico.

OBJECTIVE: To describe the use and frequency of use of mobile apps (internetand/ or smartphone-based geospatial networking apps) among men who have sex with men (MSM) and how these platforms are used to engage with sexual partners in PR. METHODS: A local module including questions regarding mobile apps and sexual engagement and derived from the 2017 Puerto Rico National HIV Behavioral Surveillance System, fifth MSM cycle, was used for this analysis. A subsample of 127 eligible participants was recruited through venue-based sampling and assented to participate. Univariate analysis was used to evaluate sociodemographic and behavioral characteristics, HIV testing, and the ways in which mobile apps are used to find sexual partners. RESULTS: The participants' median age was 35 years, with a standard deviation of ±11.37 years. Most of our sample (97%) had had anal sex with at least 1 partner in the last 12 months, and 76% of them had had condomless anal sex. Over three fourths (81%) reported using apps for sexual encounters, while 45% stated that the most frequently used app was Grindr. Of the participants who had used apps for sexual encounters, 57% had met 5 or more sexual partners through apps in their lifetime. CONCLUSION: This study shows that there is a need for further research to understand the habits of this population in PR regarding the use of apps to find sexual partners and, also, as a possible way to develop strategies for prevention and health promotion in this group.

Elimination of the Perinatal Transmission of HIV and Syphilis in Puerto Rico and Sustained Success since 2007: Convergence of Science, Women-Centered Care, and Policy.

OBJECTIVE: There have been significant successes in the fight against HIV/AIDS due to the access to rapid HIV testing, interventions to reduce the mother-to-child transmission (MTCT) risk, potent and effective antiviral medications, and other biomedical prevention strategies. The purpose of this work is to demonstrate that Puerto Rico eliminated Mother-to-Child Transmission of HIV (MTCT) following the 2017 World Health Organization (WHO) criteria for validating the elimination of MTCT and Syphilis. METHODS: Existing epidemiological data from Puerto Rico was used to document the elimination of MTCT and Syphilis. Data to calculate the indicators was obtained from the various divisions of the Puerto Rico Department of Health, including vital statistics, surveillance data, and programmatic outcomes. RESULTS: Puerto Rico eliminated MTCT and syphilis, according to the WHO indicators, earlier than other countries. We can trace the outcomes to 1994 using the incidence rate of perinatally-acquired HIV of <50/100,000; to 2007 using HIV perinatal transmission rates for non-breastfeeding countries (<2%), to 2008 using 90% of women receiving ART at delivery, and to 2005 using the incidence rate of congenital syphilis of <50/100,000. CONCLUSION: Not only have we eliminated the MTCT of HIV and syphilis, but the efforts have been sustained since 2000. The elimination of transmission of infectious diseases requires the intersection of scientific feasibility, coordinated interventions, and political will, successfully attained in Puerto Rico.

A brief guide to the science and art of writing manuscripts in biomedicine.

Publishing articles in international scientific journals is the primary method for the communication of validated research findings and ideas. Journal articles are commonly used as a major input for evaluations of researchers and institutions. Few articles have been published previously about the different aspects needed for writing high-quality articles. In this manuscript, we provide an updated and brief guide for the multiple dimensions needed for writing manuscripts in the health and biological sciences, from current, international and interdisciplinary perspectives and from our expertise as authors, peer reviewers and editors. We provide key suggestions for writing major sections of the manuscript (e.g. title, abstract, introduction, methods, results and discussion), for submitting the manuscript and bring an overview of the peer review process and  of the post-publication impact of the articles.

HIV Care Outcomes among Hispanics/Latinos with Diagnosed HIV in the United States by Place of Birth-2015-2018, Medical Monitoring Project.

Relocation from one's birthplace may affect human immunodeficiency virus (HIV) outcomes, but national estimates of HIV outcomes among Hispanics/Latinos by place of birth are limited. We analyzed Medical Monitoring Project data collected in 2015-2018 from 2564 HIV-positive Hispanic/Latino adults and compared clinical outcomes between mainland US-born (referent group), Puerto Rican (PR-born), and those born outside the United States (non-US-born). We reported weighted percentages of characteristics and used logistic regression with predicted marginal means to examine differences between groups (p < 0.05). PR-born Hispanics/Latinos were more likely to be prescribed antiretroviral therapy (ART) (94%) and retained in care (94%) than mainland-US-born (79% and 77%, respectively) and non-US-born (91% and 87%, respectively) Hispanics/Latinos. PR-born Hispanics/Latinos were more likely to have sustained viral suppression (75%) than mainland-US-born Hispanics/Latinos (57%). Non-US-born Hispanics/Latinos were more likely to be prescribed ART (91% vs. 79%), retained in care (87% vs. 77%), and have sustained viral suppression (74% vs. 57%) than mainland-US-born Hispanics/Latinos. Greater Ryan White HIV/AIDS-funded facility usage among PR-born, better mental health among non-US-born, and less drug use among PR-born and non-US-born Hispanics/Latinos may have contributed to better HIV outcomes. Expanding programs with comprehensive HIV/AIDS services, including for mental health and substance use, may reduce HIV outcome disparities among Hispanics/Latinos.

New Diagnoses among HIV+ Men and Women in Puerto Rico: Data from the HIV Surveillance System 2003-2014.

OBJECTIVE: Describe the age-standardized rates of new HIV diagnoses and compare sex and time disparities using data from the HIV/AIDS Surveillance System in Puerto Rico (PR). METHODS: The study comprises data of new HIV diagnoses of persons 13 years of age and older in PR reported from 2003-2014. Other variables included were age, sex, and health regions. We computed male to female ratio of new HIV diagnoses and assessed the trends in new HIV diagnoses using the annual percent change (APC) of the age-standardized rates (ASRs). The relative risk (RR) was estimated with 95% confidence intervals using Poisson regression models to assess the risk of new HIV diagnoses. RESULTS: The highest HIV diagnosis rates were observed in the metropolitan area. These rates decreased overall for both sexes for the periods 2007 onward. The risk of getting a new HIV diagnosis was significantly higher among males, ranging from an increased risk of more than 50% to almost 5-fold (p<0.05). Overall, a trend was observed in the 2011-2014 period were the risk increases as the age decreases. For the 13-24 age group, we observed a significant increased risk in new HIV diagnosis of 53% in the 2011-2014 period, when compared to 2003-2006 (p<0.05). CONCLUSION: Our findings suggest a shift in the risk of getting a HIV diagnosis from older to younger males. A possible explanation could be that HIV spread among young men that have sex with men might be increasing. Targeted prevention strategies should be implemented in this age group.

Depressive symptoms are associated with a functional polymorphism in a miR-433 binding site in the FGF20 gene.

Genetic studies of major depressive disorder and its associated endophenotypes are useful for the identification of candidate genes. In recent years, variations in non-coding RNA genes, such as miRNAs, have been explored as novel candidates for psychiatric disorders and related endophenotypes. The aim of the present study was to evaluate the possible association between a functional polymorphism (rs12720208) in the FGF20 gene, which regulates its modulation by miR-433, and depressive symptoms in young adults. A sample of 270 participants from Colombia were evaluated with the Hospital Anxiety and Depression Scale - Depression Subscale (HADS-D) and genotyped for the rs12720208 polymorphism using a TaqMan assay. A lineal regression analysis was used. A statistically significant association of the functional polymorphism in the FGF20 gene (rs12720208) with depressive symptoms was found. It was observed that individuals with the G/A genotype had higher scores for the HADS-D subscale. Our results are the first description in the scientific literature about a significant association between a functional polymorphism in the FGF20 gene, which regulates its modulation by miR-433, and depressive symptoms.

[Survival analysis in people diagnosed with HIV/AIDS in Puerto Rico]. / Perfil de supervivencia, con VIH/SIDA en Puerto Rico.

After the introduction of HAART, the HIV/AIDS epidemiological trends has shown an increasing in the survival rates. HAART has dramatically improved the life expectancy of HIV/AIDS. The objective of this study was to estimate survival in people diagnosed with HIV/AIDS in Puerto Rico (PR) from 2003-2011. A population-based study using the PR HIV Surveillance System was implemented. A total of N = 9,290 people were diagnosed with HIV/AIDS in PR for 2003-2011 period. Cox regression models for survival analysis were assessed. Survival at 6 years after diagnosis in HIV patients was 0.87 (CI95%: 0.09, 0.72) when compare with AIDS patients at same time of diagnosis was 0.57 (CI95%: 0.55, 0.60) p<0.001. Intravenous drug users [IDU] have less probability of survival at 5 years after diagnosis when compare with other transmission modes 0.69 (CI95%: 0.67, 0.71) p<0.001. Assertive prevention strategies must be developed and implemented in PR for IDU's in order to increase their survival rates.

Population-Based Study of Tobacco Use Among People Living With HIV in Puerto Rico.

BACKGROUND: Despite substantial advances in the era of highly active antiretroviral therapy, HIV-positive persons are at high risk of tobacco-related disease and mortality. This study describes the prevalence and sociodemographic factors associated with current tobacco use among HIV-positive men and women 18 years and older receiving HIV care in Puerto Rico. METHODS: Data from the 2009 Medical Monitoring Project (MMP) was used. A three-stage sampling design was conducted to obtain annual cross-sectional probability samples of HIV-infected adults in care. Factors associated with current tobacco use were identified using logistic regression models. All analyses were performed using STATA version 11.0. RESULTS: The estimated prevalence of current cigarette use among the population was 29.0% (95%CI: 23.5%-35.2%), daily smoking was reported in 76.7% of them. Multivariate logistic regression models, showed that male drug users (injected and noninjected) were up to nine times more likely to be current smokers (OR = 9.9; 95%CI = 3.1, 31.5) as compared to nonusers. CONCLUSION: Findings highlight the need for smoking cessation strategies in this population, particularly among male HIV+ drug users.

APOE gene and neuropsychiatric disorders and endophenotypes: A comprehensive review.

The Apolipoprotein E (APOE) gene is one of the main candidates in neuropsychiatric genetics, with hundreds of studies carried out in order to explore the possible role of polymorphisms in the APOE gene in a large number of neurological diseases, psychiatric disorders, and related endophenotypes. In the current article, we provide a comprehensive review of the structural and functional aspects of the APOE gene and its relationship with brain disorders. Evidence from genome-wide association studies and meta-analyses shows that the APOE gene has been significantly associated with several neurodegenerative disorders. Cellular and animal models show growing evidence of the key role of APOE in mechanisms of brain plasticity and behavior. Future analyses of the APOE gene might find a possible role in other neurological diseases and psychiatric disorders and related endophenotypes. © 2016 Wiley Periodicals, Inc.

Rural and urban injection drug use in Puerto Rico: Network implications for human immunodeficiency virus and hepatitis C virus infection.

Understanding the short- and long-term transmission dynamics of blood-borne illnesses in network contexts represents an important public health priority for people who inject drugs and the general population that surrounds them. The purpose of this article is to compare the risk networks of urban and rural people who inject drugs in Puerto Rico. In the current study, network characteristics are drawn from the sampling "trees" used to recruit participants to the study. We found that injection frequency is the only factor significantly related to clustering behavior among both urban and rural people who inject drugs.

Mobile phone text messaging improves antihypertensive drug adherence in the community.

Antihypertensive drug adherence (ADA) is a mainstay in blood pressure control. Education through mobile phone short message system (SMS) text messaging could improve ADA. The authors conducted a randomized study involving 314 patients with hypertension with <6 months of antihypertensive treatment from the Preventive Health Program of 12 different primary care centers in Santiago, Chile. Patients were randomly assigned to receive or not receive SMS related to ADA and healthy lifestyle. Adherence was assessed by the self-reported four-item scale Morisky-Green-Levine questionnaire at baseline and after 6 months of follow-up, with four of four positive questions classified as good adherence. Group comparison for adherence was performed by means of a logistic regression model, adjusting by baseline adherence, age older than 60 years, and sex. A total of 163 patients were randomized to receive and 151 to not receive SMS. After 6 months of follow-up, ADA in the non-SMS group decreased from 59.3% to 51.4% (P=.1). By contrast, adherence increased from 49% to 62.3% (P=.01) in the SMS group. Text messaging intervention improved ADA (risk ratio, 1.3; 95% confidence interval, 1.0-1.6 [P<.05]). At 6-month follow-up, text messaging resulted in an increase in reporting ADA in this hypertensive Latino population. This approach could become an effective tool to overcome poor medication adherence in the community.

When "the Cure" Is the Risk: Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico.

BACKGROUND: Substance use, particularly injection drug use, continues to fuel the HIV/HCV (hepatitis C virus) epidemics in San Juan, Puerto Rico (PR). AIM: This article examines individual and sociostructural factors that affect HIV/HCV risk among people who use drugs (PWUD) living with or at risk for HIV/HCV in San Juan, PR. Findings were used to inform a community-level intervention to enhance HIV care access and retention for this population. METHOD: A rapid ethnographic assessment in collaboration with a community-based organization was conducted. Data collection took place between June and December 2013 and included field observations, 49 unstructured interviews with PWUD, and 19 key informant interviews with community stakeholders. Fieldnotes, photographs, and interview transcripts were analyzed for recurrent themes and to address the intervention-planning needs. Study results are presented as fieldnote excerpts, direct quotes from interviews, and photographs. RESULTS: Findings suggest that PWUD in PR face myriad challenges that affect HIV/HCV risk and hinder linkage to and retention in care. Results describe a layered risk environment where PWUD encounter many barriers to prevention, care, and treatment such as transience, social isolation, stigma, limited housing options, and inadequate medical and substance use disorder treatment services. DISCUSSION: These observed circumstances provide an empirical basis for the development and evaluation of comprehensive interventions that may serve to reduce barriers to care and link individuals to other supportive services. CONCLUSION: New approaches and comprehensive interventions are needed to break the structures that perpetuate risk and lack of engagement and retention in HIV care and substance use disorder treatment in San Juan.

Original title: HIV infection and unawareness among men who have sex with men in Puerto Rico: data from The National HIV behavioral surveillance system 2011-2014.

BACKGROUND: Unawareness of HIV infection is a public health challenge that needs to be addressed, particularly in the case of men who have sex with men (MSM), since recent data are reporting increasing rates of HIV in this population in Puerto Rico. OBJECTIVES: We examined differences in the prevalence of HIV infection and unawareness among MSM in 2011 and 2014 using data from the National HIV Behavioral Surveillance System, 2011 and 2014. METHODS: Bivariate analyses was used to compare demographical and behavioral characteristics in both cycles (2011 and 2014). Prevalence ratio (PR) was assessed with Poisson regression models to determine changes in HIV prevalence and unawareness across cycles, using the 2011 NHBS-MSM cycle as reference group. RESULTS: A stable rate in HIV prevalence was observed in 2011 and 2014. There was a higher prevalence in 2014 than in 2011 in multiple behavioral characteristics such as age at sexual initiation, the number of sexual partners in the 12 months prior to being interviewed, HIV testing in the year prior to being interview, and the disclosure of sexual orientation to a healthcare provider. A significant decrease in HIV unawareness was reported (76.67%, 2011; 46.51%, 2014). Age-adjusted regression models showed a marginal reduction of 55% in HIV unawareness for men who disclosed their sexual orientation to their healthcare providers. CONCLUSION: Behavioral surveillance systems in groups such as MSM in on the island will aid to monitor prospectively the effectiveness of HIV testing outreach and engagement, as well as capacity capacity-building strategies targeted towards health care providers, aimed to increase HIV testing and awareness among this group.

The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico.

BACKGROUND: HIV prevalence in Puerto Rico is nearly twice that of the mainland United States, a level that was substantially fueled by injection drug use. Puerto Rico has a longstanding history of health provision by the public sector that directly affects how HIV and substance use disorder (SUD) treatment services are provided and funded. As part of pre-implementation research for a randomized trial of a community-level intervention to enhance HIV care access for substance users in San Juan, Puerto Rico, we sought to understand the structural and health policy environment for providing HIV and SUD treatments. METHODS: We conducted semi-structured qualitative interviews (n = 8) with government and program administrators in English and Spanish. Data were analyzed to identify dominant and recurrent themes. RESULTS: Participants discussed how lack of integration among medical and mental health service providers, lack of public transportation, and turnover in appointed government officials were barriers to integrated HIV and SUD treatment. Federal funding for support services for HIV patients was a facilitator. The Affordable Care Act has limited impact in Puerto Rico because provisions related to health insurance reform do not apply to U.S. territories. DISCUSSION AND CONCLUSIONS: Implications for intervention design include the need to provide care coordination for services from multiple providers, who are often physically separated and working in different reimbursement systems, and the potential for mobile and patient transportation services to bridge these gaps. Continuous interaction with political leaders is needed to maintain current facilitators. These findings are relevant as the current economic crisis in Puerto Rico affects funding, and may be relevant for other settings with substance use-driven epidemics.