Predictive Biochemical Model of Frailty and Mortality After Acute Myocardial Infarction.

Frailty, characterized by reduced resistance to stressors, is associated with adverse outcomes in patients with myocardial infarction. The Fried score is commonly used to assess frailty but has several limitations. This study aimed to evaluate the relation between frailty and blood biomarkers and their predictive value for long-term mortality using a biochemical model. A total of 2 cohorts of elderly patients (>65 years old) hospitalized for acute coronary syndrome were included. Geriatric assessments and several blood biomarkers were measured. The predictive models for frailty were developed using logistic regression. The survival models were also developed using Cox regression. Among 466 patients, 9 biomarkers were significantly associated with frailty. Between these biomarkers, white blood cells count, hemoglobin, and fibrinogen showed the highest predictive power. Model 1, without growth differentiation factor 15 (GDF-15), showed a better accuracy in predicting the mortality than the Fried score. Model 2, with GDF-15, had a stronger correlation with frailty but had a lower predictive power for survival. Frailty is associated with dysregulation in the physiological systems and several biomarkers were linked to this fact in our study. However, the inclusion of GDF-15 did not significantly improve the model's predictive ability. Frailty assessment using blood biomarkers can provide valuable prognostic information in elderly patients with acute coronary syndrome.

Polydrug use and attempted suicide among Hispanic adolescents in Puerto Rico.

This study was aimed at examining the relationship between suicidal attempts, polydrug use, and depression in adolescents. A sample of 691 adolescents and their parents were interviewed. Subjects who met the criteria for depression and those who used alcohol were significantly more likely to be suicidal attempters (OR = 6.8, p < 0.001; OR = 7.5, p < 0.001). Polydrug users were significantly more likely to attempt suicide (OR = 8.8, p = 0.032). Adolescents with mothers who met the criteria for depression were more likely to report suicide attempts (OR = 2.4, p = 0.069). Health professionals need to screen for polydrug use and depression to prevent future suicidal behaviors.

Predictors of school dropout among adolescents in Puerto Rico.

OBJECTIVE: This research aims to understand the circumstances associated with school dropout in a cohort of Puerto Rican adolescents. METHODS: The study collected data from adolescents and their parents. Information related to school dropout among adolescents was obtained from the second year follow-up data from the longitudinal study funded by NIDA "Risky Families Embedded in Risky Environments" (Grant No. R01 DA 15301). Data was collected employing a self-administered and a face-to-face interview protocol. Prediction of school dropout was assessed throughout adolescent characteristics, family background, school experiences and behaviors. RESULTS: During the second follow-up, two years after the baseline assessment, approximately 6.2% of the adolescents reported dropping out from school. Logistic regression analysis indicates that older adolescents (OR = 6.6, 1.37-31.67), whose mother used drugs during pregnancy (OR = 4.9, 1.31-17.91), who reported high rates of absenteeism (OR = 4.8, 1.63-14.13), high school grade retention (OR = 3.7, 1.14-12.05), and attended school where teachers were attacked or wounded by students (O R =7.0, 1.44-34.17) were more likely to dropout of school. DISCUSSION: : These findings emphasize the need to further understand the effects of different elements of adolescents' environment such as family and school. It has been posited that dropping out of school is a process whose characteristics can be detected long before it occurs. The fact that students who dropout are more likely to report skip classes and grade retention can be relevant elements in prevention and early intervention for teachers and other school personnel.

Severe anxiety symptomatology and HIV risk behavior among Hispanic injection drug users in Puerto Rico.

Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.

Prevalence and correlates of hepatitis C virus infection among street-recruited injection drug users in San Juan, Puerto Rico.

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.

Factors associated with drug treatment dropout among injection drug users in Puerto Rico.

This study examined factors associated with drug treatment dropout among injection drug users (IDUs) in Puerto Rico, a group that has contributed significantly to the self-sustaining AIDS epidemic in the island since the mid-1980s. A total of 557 IDUs were recruited from communities in a semirural region of Puerto Rico, as part of a longitudinal study testing the efficacy of a two-facet intervention model, based on motivational interviewing. Of 124 IDUs who had entered drug treatment at follow-up, 33 (26.6%) dropped out before completing all recommended sessions. Multiple logistic regression analysis showed that age, homelessness, and speedball use were significantly associated with drug treatment dropout. Conversely, participants who received the two-facet intervention were significantly less likely to drop out of drug treatment. Receiving psychiatric services also reduced the odds of treatment dropout. Improving adherence to drug treatment and reducing dropout rates are complex processes that need to be addressed at the individual behavioral and social support levels, as well as the program process and resource levels.

HIV risk behaviors and alcohol intoxication among injection drug users in Puerto Rico.

This paper reports results of an analysis of the association between alcohol intoxication and injection and sexual HIV risk behaviors among 557 Hispanic heroin and cocaine injectors, not in treatment, who were recruited in poor communities in Puerto Rico. Subjects were part of a longitudinal prevention-intervention study aimed at reducing drug use and HIV risk behaviors. Participants reported a high prevalence of co-occurring conditions, particularly symptoms of severe depression (52%) and severe anxiety (37%), measured by Beck's Depression Index and Beck's Anxiety Index, respectively. Alcohol intoxication during the last 30 days was reported by 18% of participants. Associations were found between alcohol intoxication and both injection and sexual risk behaviors. In the bivariate analysis, subjects reporting alcohol intoxication were more likely to inject three or more times per day, pool money to buy drugs, share needles, and share cotton. They were also significantly more likely to have a casual or paying sex partner and to have unprotected sex with these partners. After adjustment, sharing needles and cotton, having sex with a paying partner or casual partner, and exchanging sex for money or drugs were significantly related to alcohol intoxication. HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors.

Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: a randomized controlled study.

This study examined the effectiveness of a combined counseling and case management behavioral intervention, using motivational interviewing strategies, in engaging Hispanic injection drug users in treatment and reducing drug use and injection-related HIV risk behaviors. Follow up data are presented on 440 (79.0%) of 557 randomized participants, 6 months after the initial interview. Subjects in the experimental arm were significantly less likely to continue drug injection independent of entering drug treatment, and were also more likely to enter drug treatment. Subjects in both arms who entered drug treatment were less likely to continue drug injection. Among subjects who continued drug injection, those in the experimental arm were significantly less likely to share needles. Confirming the outcomes of this study in other Hispanic sites and populations could be a critical step towards reducing factors that contribute to the self-sustaining HIV/AIDS epidemic in Puerto Rico and communities in the U.S. mainland.

Relación de las afecciones rinofaríngeas obstructivas altas con los trastornos del sueño / Relationship of the upper obstructive rhinonasopharyngeal affections with sleep disorders

Con el objetivo de comprobar el efecto que sobre el sueño y el estado de salud tiene la cirugía en pacientes con trastornos del sueño, causados por obstrucciones respiratorias altas, se estudiaron y trataron quirúrgicamente 60 pacientes remitidos de la consulta de trastornos del sueño del Hospital Militar Central "Doctor Carlos J. Finlay", en el período comprendido de enero de 1999 a diciembre de 2001, de los cuales 50 (90 por ciento) eran del sexo masculino y el 10 (por ciento) era femenino. Fue la desviación del septum nasal la afección de otorrinolaringología más frecuente, 36 (60 por ciento), seguida por la desviación del septum nasal, asociada a otra afección de otorrinolaringología, 10 (16,6 por ciento). Presentaron trastornos del sueño asociados con otras afecciones clínicas (cefalea, hipertensión arterial, vértigo, disfunción sexual) 40 (66,7 por ciento) y solo con trastornos del sueño 20 ( 33,3 por ciento). Se realizó tratamiento quirúrgico a los 60 enfermos y se obtuvo que curaron o mejoraron el trastorno del sueño 58 pacientes (96,7 por ciento), las afecciones constructivas curaron o mejoraron en 57 enfermos (95 por ciento), y las afecciones clínicas asociadas curaron o mejoraron en 37 pacientes (92,5 por ciento)(AU)

In order to prove the effect of surgery on sleep and health status in patients with sleep disorders caused by upper respiratory obstructions, 60 patients referred from the sleep disorders consulting room of "Carlos J. Finlay" Military Central Hospital were studied and surgically treated from January, 1991, to December, 2001. Of them, 50 (90 percent) were males and 10 percent were females. The deviation of the nasal septum was the most frequent otorrhinolaryngology affection, 36 (60 percent), followed by the deviation of the nasal septum associated with other otorrhinolaryngology affection, 10 (16.6 percent). 40 patients (66.7 percent) had sleep disorders associated with other clinical affections (headache, arterial hypertension, vertigo, sexual dysfunction), and only 20 (33.3 percent) had sleep disorders. In 58 (96.7 percent) of the 60 patients that underwent surgical treatment, sleep disorders were cured or improved, the constructive affections were cured or improved in 57 patients (95 percent) and the associated clinical affections were cured or improved in 37 patients (92.5 percent)(AU)

Relación de las afecciones rinofaríngeas obstructivas altas con los trastornos del sueño / Relationship of the upper obstructive rhinonasopharyngeal affections with sleep disorders

Con el objetivo de comprobar el efecto que sobre el sueño y el estado de salud tiene la cirugía en pacientes con trastornos del sueño, causados por obstrucciones respiratorias altas, se estudiaron y trataron quirúrgicamente 60 pacientes remitidos de la consulta de trastornos del sueño del Hospital Militar Central "Doctor Carlos J. Finlay", en el período comprendido de enero de 1999 a diciembre de 2001, de los cuales 50 (90 (por ciento) eran del sexo masculino y el 10 (por ciento) era femenino. Fue la desviación del septum nasal la afección de otorrinolaringología más frecuente, 36 (60 (por ciento), seguida por la desviación del septum nasal, asociada a otra afección de otorrinolaringología, 10 (16,6 (por ciento). Presentaron trastornos del sueño asociados con otras afecciones clínicas (cefalea, hipertensión arterial, vértigo, disfunción sexual) 40 (66,7 (por ciento) y solo con trastornos del sueño 20 ( 33,3 (por ciento). Se realizó tratamiento quirúrgico a los 60 enfermos y se obtuvo que curaron o mejoraron el trastorno del sueño 58 pacientes (96,7 (por ciento), las afecciones constructivas curaron o mejoraron en 57 enfermos (95 (por ciento), y las afecciones clínicas asociadas curaron o mejoraron en 37 pacientes (92,5 (por ciento)(AU)

Mortality among Hispanic drug users in Puerto Rico.

This paper assesses mortality rate for a cohort of drug users in Puerto Rico compared with that of the Island's general population, examining causes of death and estimating relative risk of death. Date and cause of death were obtained from death certificates during 1998. Vital status was confirmed through contact with subjects, family, and friends. HIV/AIDS was the major cause of death (47.7%), followed by homicide (14.6%), and accidental poisoning (6.3%). Females had higher relative risk of death than males in all age categories. Not living with a sex partner and not receiving drug treatment were related to higher mortality due to HIV/AIDS. Drug injection was the only variable explaining relative risk of death due to overdose. Puerto Rico needs to continue developing programs to prevent HIV/AIDS among drug users. Special attention should be given to young women, who appear to be in greatest need of programs to prevent early mortality.

Dosis óptimas para la inducción del bostezo con apomorfina en el humano sano / Optimal doses for the induction of vawning with apomorphine in the healthy human

Se estudió el efecto de la administración subcutánea de 4, 6, 8, 10, 12, 14 m g de apo-morfina en 16 hombres voluntarios sanos, con el objetivo de encontrar las dosis óptimas para la inducción del bostezo en el humano sano. Se dividieron en 2 subgrupos de 8 para administrarles a cada grupo sólo 3 dosis. A todos se les administró suero fisiológico para estudiar el bostezo espontáneo (situación control). Los resultados demuestran que el rango de 8 a 10 m g es el más adecuado para la inducción del bostezo. Las dosis inferiores tuvieron poco efecto inductor, las dosis superiores produjeron efectos indeseables(AU)

Dosis óptimas para la inducción del bostezo con apomorfina en el humano sano / Optimal doses for the induction of vawning with apomorphine in the healthy human

Se estudió el efecto de la administración subcutánea de 4, 6, 8, 10, 12, 14 m g de apo-morfina en 16 hombres voluntarios sanos, con el objetivo de encontrar las dosis óptimas para la inducción del bostezo en el humano sano. Se dividieron en 2 subgrupos de 8 para administrarles a cada grupo sólo 3 dosis. A todos se les administró suero fisiológico para estudiar el bostezo espontáneo (situación control). Los resultados demuestran que el rango de 8 a 10 m g es el más adecuado para la inducción del bostezo. Las dosis inferiores tuvieron poco efecto inductor, las dosis superiores produjeron efectos indeseables

Efecto de la privación de agua sobre el bostezo espontáneo en la rata / Effect of water deprivation on spontaneous yawing in rats

Con el objetivo de comprobar si la hormona arginina-vasopresina (AVP) tiene alguna influencia sobre el bostezo espontáneo en ratas adultas de la cepa Wistar se efectuaron 2 series experimentales: a) estudio del efecto de la privación de agua (WD) sobre el bostezo y b) estudio del efecto de la WD sobre el bostezo en animales en ayuno durante 96 h (el ayuno suprime el bostezo espontáneo a las 24 h en los animales estudiados). Se observó que la WD no afecta de manera significativa el bostezo en los animales con alimentación normal. En los animales en ayuno se observó la supresión del bostezo en el grupo control (ayuno y agua ad libitum) mientras que en el grupo experimental (WD y ayuno) se evitó la supresión que sobre el bostezo provoca el ayuno. Se infiere de estos resultados que la AVP participa en la regulación del bostezo en las condiciones estudiadas; la forma en que lo hace queda fuera del alcance de este estudio(AU)

Efecto de la privación de agua sobre el bostezo espontáneo en la rata / Effect of water deprivation on spontaneous yawing in rats

Con el objetivo de comprobar si la hormona arginina-vasopresina (AVP) tiene alguna influencia sobre el bostezo espontáneo en ratas adultas de la cepa Wistar se efectuaron 2 series experimentales: a) estudio del efecto de la privación de agua (WD) sobre el bostezo y b) estudio del efecto de la WD sobre el bostezo en animales en ayuno durante 96 h (el ayuno suprime el bostezo espontáneo a las 24 h en los animales estudiados). Se observó que la WD no afecta de manera significativa el bostezo en los animales con alimentación normal. En los animales en ayuno se observó la supresión del bostezo en el grupo control (ayuno y agua ad libitum) mientras que en el grupo experimental (WD y ayuno) se evitó la supresión que sobre el bostezo provoca el ayuno. Se infiere de estos resultados que la AVP participa en la regulación del bostezo en las condiciones estudiadas; la forma en que lo hace queda fuera del alcance de este estudio

Consumo de Sangre en Operaciones Electivas de Cirugia General / Blood consumption in elective operations of general surgery

Se presenta un estudio del consumo de sangre en operaciones electivas de cirugia general. Se transfundieron el 7,7 por ciento de los pacientes operados. El mayor numero de unidades transfundidas correspondio a las operaciones ginecologicas con 63 y de ellas fueron las histerectomias abdominales las que requirieron mayor cantidad con 58 en 184 operaciones, para el 31,5 por ciento. Son importantes tambien por el numero de unidades consumidas y el porcentaje de enfermos transfundidos las lobectomias pulmonares, colectomias parciales, operacion de Miles, resecciones hepaticas y gastrectomias subtotales. El mayor promedio de unidades usadas en pacientes transfundidos ocurrio en esofagectomias totales con 9; operacion de Whipple 5; resecciones hepaticas 4,5; pleurectomia y decorticacion 3; gastrectomias subtotales 2,9 y la histerectomia abdominal 2,03. Los principales criterios de indicacion de la transfusion fueron el sangramiento transoperatorio y la anemia preoperatoria

Consumo de Sangre en Operaciones Electivas de Cirugía General / Blood consumption in elective operations of general surgery

Se presenta un estudio del consumo de sangre en operaciones electivas de cirugía general. Se transfundieron el 7,7 por ciento de los pacientes operados. El mayor número de unidades transfundidas correspondió a las operaciones ginecológicas con 63 y de ellas fueron las histerectomías abdominales las que requirieron mayor cantidad con 58 en 184 operaciones, para el 31,5 por ciento. Son importantes también por el número de unidades consumidas y el porcentaje de enfermos transfundidos las lobectomías pulmonares, colectomías parciales, operación de Miles, resecciones hepáticas y gastrectomías subtotales. El mayor promedio de unidades usadas en pacientes transfundidos ocurrió en esofagectomías totales con 9; operación de Whipple 5; resecciones hepáticas 4,5; pleurectomía y decorticación 3; gastrectomías subtotales 2,9 y la histerectomía abdominal 2,03. Los principales criterios de indicación de la transfusión fueron el sangramiento transoperatorio y la anemia preoperatoria (AU)