Calibrating contentment: the metrics of health and happiness.

This historical note examines Puerto Rico's pioneering role in the development of happiness studies. In 1963-64, the Puerto Health Department's Master Sample Survey included a series of questions on well-being to tap into self-assessed happiness. The study found that happiness was positively correlated with income, education, and health. It also found that women were less happy than men, and that well-being was negatively correlated with age. Since then, the metrics of happiness have gained currency, and several countries have adopted indices to measure their population's self-perceived well-being. Studies have also documented the reciprocal relationship between health and happiness.

Biomedical HIV prevention strategies: state of the art and implications for public health policy in the Caribbean.

Recent advances in the field of biomedical prevention have induced optimism among both the scientific community and the public in general. The discussion of the research evidence is complemented with a discussion of the implications of this evidence for the Caribbean, highlighting the issues and controversies that should be considered in order to encourage and advance the responsible consideration of biomedical strategies. Traditionally, HIV prevention strategies have been characterized as predominantly behavior, social or biomedical. In practice, however, some strategies defy classification: even when they rely on technological or pharmaceutical elements, they have to be adopted by a society and the individuals within it. Moreover, whatever the strategy used, it will have to be distributed, implemented and made available through health care systems or other means. And its cost will be absorbed by specific funders or by society in general. Given the current historical context of the HIV/AIDS epidemic and the array of strategies required to control it, these distinctions (biomedical vs. behavior) can hinder the collaborations required to provide the needed combinations of strategies. The efficacy of the diverse strategies range from: 99% for programs to prevent MTCT, 63% for pre-exposure prophylaxis (PrEP), 96% for treatment as prevention, 39% for vaginal microbicides (54% with good adherence), post exposure prophylaxis (PEP), 31% for a vaccine and 53-60% for medical voluntary adult circumcision. To curtail and eliminate the HIV/AIDS epidemic in the future, expansion and scaled-up implementation of combinations of such strategies will be needed.

Harold W. Brown, Dean-in-a-Pinch.

The creation of the University of Puerto Rico School of Medicine required someone who could recruit faculty, plan the curriculum, set up the admissions process, and insure that the school meet accreditation requirements. Despite setbacks, chancellor Jaime Benitez found in Dr. Harold W. Brown a person with the knowledge and abilities to accomplish these tasks. Although Brown would not accept the deanship of the school, he was detailed by Columbia University to serve as Benitez's special advisor. In this role, he intervened at key points in the school's development and was able to accomplish his mission. Benitez gave credit to Brown for the school's development, and Brown's contributions were duly recognized when the School graduated its first class in 1954.

Medical tourism in the Caribbean.

Although travel for medical reasons has a long history, it has more recently evolved from a cottage industry to a worldwide enterprise. A number of countries are positioning themselves to attract visitors who are willing to travel to obtain health services that are more accessible, less expensive, or more available than in their countries of origin. This has in turn given rise to medical packages that combine tourism with health. Several Caribbean nations - including Cuba, Barbados, Jamaica, and Puerto Rico - hope to expand their revenues in this new market. Each country has selected specific service niches and promotes its services accordingly. While Cuba has been promoting its services to other countries for several decades, medical tourism is just beginning in the other islands. Ultimately, these nations' economic success will hinge on their comparative advantage vis-à-vis other options, while their success in terms of improving their own health care depends on the extent to which the services for tourists are also available to the islands' populations.

Patients without borders: the emergence of medical tourism.

A growing number of patients from the United States and other developed countries are traveling abroad with the express purpose of obtaining health care, including elective surgery and long-term care. This trend is not innocuous. It can lead developing countries to emphasize technology-intensive tertiary care for foreigners at the expense of basic health care for their citizens. Moreover, it can exacerbate the brain drain from the public to the private sector. The examples of Thailand and India suggest the distorting effects of this trend and raise questions of social equity in the distribution of scarce resources.

[Challenges in public health for the new century]. / Desafíos de la salud pública para el nuevo siglo.

The history of public health has followed different trends, depending on the prevailing theories of disease causality and the interventions that these suggest. From the concern with miasmas to the germ theory, to the stress on lifestyles and the current interest on the linkages between health, economic welfare, and social status, the proposed policies are contingent on how health and disease are conceptualized and explained. Ironically, now that there is increasing evidence on the socio-economic determinants of health, interventions continue to focus on specific target groups or disease categories, as well as on the medical sector.

Education for public health in Puerto Rico: 1940-1942

Formal training in public health in Puerto Rico began in 1940 when a degree-granting Division of Public Health was established within the existing School of Tropical Medicine. The division was sponsored by five institutions - the Puerto Rico Departament of Health, the U.S. Public Health Service, the Children's Bureau, the University of Puerto Rico, and Columbia University - each with had a different concept of tha aims, scope and character of the training. Conflicts relating to these issues were exacerbated by managerial and budgetary problems, and the program began fitfully and with great difficulties. As a results, the training which was planned in 1940 and launched in 1941 was scrapped or rede-signed the following year

Education for public health in Puerto Rico: 1940-1942

Formal training in public health in Puerto Rico began in 1940 when a degree-granting Division of Public Health was established within the existing School of Tropical Medicine. The division was sponsored by five institutions - the Puerto Rico Departament of Health, the U.S. Public Health Service, the Children's Bureau, the University of Puerto Rico, and Columbia University - each with had a different concept of tha aims, scope and character of the training. Conflicts relating to these issues were exacerbated by managerial and budgetary problems, and the program began fitfully and with great difficulties. As a results, the training which was planned in 1940 and launched in 1941 was scrapped or rede-signed the following year (AU)

Medicina de "cuello rosado": implicaciones de la feminización de la profesión / \"Pink collar\" medicine: implications of the feminization of the profession

El aumento en el número y en la proporción de mujeres dentro de la profesión médica tiene implicaciones para el cuidado a pacientes así como para el sistema de servicios de salud en general. Las mujeres médicos tienden a establecer relaciones de mayor reciprocidad con sus pacientes, y son más propensas a escuchar problemas sicosociales que sus colegas varones. Otras diferencias entre los géneros se evidencian en los tipos de práctica que seleccionan uno y otro sexo. Las mujeres muestran preferencia por determinadas especialidades, ubicaciones urbanas, y práctica asalariada. También muestran una menor productividad, y reciben menores ingresos que los hombres. Estas diferencias a su vez han tendido hacia una jerarquización de los médicos, lo cual sugiere que la feminización de la profesión podría resultar en la creación de una medicina de "cuello rosado"

Años de capacidad potencial perdidos: la mortalidad en Porto Rico, 1986 / Lost years of potential capacity: mortality in Porto Rico, 1986

Este artículo utiliza el indicador denominado "años de capacidad potencial pérdida" para establecer la importancia relativa de las principales causas de muerte prematura en Puerto Rico. El cómputo del ACP destaca la primacía de los accidentes. Cuando los ACP para 1986 se comparan con los indicadores correspondientes para el año 1977, observamos descensos relativos en la mortalidad prematura atribuíble a enfermedades cerebro-vasculares y a la arterioesclerosis, y alzas notables debidas a tres causas: diabetes mellitus, homicidios, y neumonías e influenzas. Estas condiciones están vinculadas a los estilos de vida, pro lo cual su prevención radica en cambios en comportamiento y en medidas ambientales para reducir los factores de riesgo asociados a su etiología

A class A institution: the struggle for the University of Puerto Rico School of Medicine

Aunque la posibilidad de establecer una escuela de medicina en Puerto Rico había surgido periódicamente entre 1900 y 1940, no fue hasta la segunda guerra mundial que el concepto se consideró seriamente. El reclutamiento militar puso de manifiesto las deficiencias en el estado de salud de la población, a la vez que privó a la isla de muchos médicos. La escasez de médicos aumentó las presiones para la creación de una escuela de medicina, y tanto las autoridades universitarias como la Asociación Médica Americana llevaron a cabo estudios para determinar la viabilidad de la propuesta uan esucela%una escuela. Ambos grupos concluyeron que Puerto Rico ódia sostener uan uan esucela%una escuela de medicina, pero recomendaron sólo la fundación de una institución "Clase A". La discusión entonces enfocó sobre otros temas: los beneficios y objetivos de la escuela, su ubicación, y la relación entre la nueva escuela y la Escuela de Medicina Tropical. El debate sobre estos temas habría de involucrar a distintos intereses académicos y políticos por espacio de cinco años

A class A institution: the struggle for the University of Puerto Rico School of Medicine

Aunque la posibilidad de establecer una escuela de medicina en Puerto Rico había surgido periódicamente entre 1900 y 1940, no fue hasta la segunda guerra mundial que el concepto se consideró seriamente. El reclutamiento militar puso de manifiesto las deficiencias en el estado de salud de la población, a la vez que privó a la isla de muchos médicos. La escasez de médicos aumentó las presiones para la creación de una escuela de medicina, y tanto las autoridades universitarias como la Asociación Médica Americana llevaron a cabo estudios para determinar la viabilidad de la propuesta uan esucela

una escuela. Ambos grupos concluyeron que Puerto Rico ódia sostener uan uan esucela

una escuela de medicina, pero recomendaron sólo la fundación de una institución "Clase A". La discusión entonces enfocó sobre otros temas: los beneficios y objetivos de la escuela, su ubicación, y la relación entre la nueva escuela y la Escuela de Medicina Tropical. El debate sobre estos temas habría de involucrar a distintos intereses académicos y políticos por espacio de cinco años (AU)

Cesarean childbirth in Puerto Rico: a world record

Datos fragmentarios indican que los partos por cesárea aumentaron notablemente en Puerto Rico durante la última década. Este estudio tiene como objetivo el determinar la tasa de incidencia de cesáreas en la Isla y el examinar algunos de los factores provenientes del certificado de nacimiento. A pesar de que esta fuente de información tiende a subestimar los partos por cesárea, todo parece indicar que Puerto Rico tiene la tasa más alta del mundo. En 1980, este procedimiento fue anotado en el 18.2 por ciento de los certificados de nacimientos vivos. Ese año, la tasa para los Estados Unidos fue de 16.5 por ciento. Los nacimientos por cesárea fueron más frecuentes entre madres residentes de las zonas urbanas y metropolitanas así como entre aquellas que utilizaron hospitales privados para dar a luz. La tasa de cesáreas está también asociada de forma positiva con el status socioeconómico de la madre. La incidencia de partos por cesárea aumentaba al aumentar la edad de la madre, pero disminuía al aumentar la paridad. Se observaron relaciones de tipo U entre el por ciento de nacimientos por cesárea y ciertas características del recién nacido tales como edad de gestación, peso y tamaño. En este estudio se encontró una relación directa en la frecuencia de cesáreas y el número de visitas prenatales realizadas por la madre. Además, la tasa variaba inversamente con el trimestre en que comenzó el cuidado prenatal

La regionalización de los servicios de salud: la experiencia de Puerto Rico / Regionalization of health services: the Puerto Rican experience

Analisa o processo de regionalizaçäo e organizaçäo dos serviços de saúde de Porto Rico. Descreve os elementos políticos, administrativos e epidemiológicos que contribuíram para o desenvolvimento dos serviços de saúde naquele país. Apresenta informaçöes gerais da história de Porto Rico, focalizando o desenvolvimento dos recursos na área de saúde. Resume os conceitos básicos de regionalizaçäo, com suas implicaçöes políticas, administrativas e ideológicas dos setores público e privado. (JGC)