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.

The Impact of Hurricane Maria on Student Pharmacists and Their Perception of Their Academic Performance.

Objective. To assess the self-reported impact of hurricane Maria on the perceived academic performance of student pharmacists at Nova Southeastern University's (NSU) Puerto Rico Regional Campus. Methods. A 37-item electronic instrument, the Hurricane Impact Survey, was created and sent by email to all student pharmacists ≥21 years old enrolled at NSU-COP Puerto Rico Campus during the fall 2017 semester. The electronic survey was available through Redcap platform for four weeks. Descriptive statistics, bivariate analysis, and logistic regression were used to analyze students' responses. Qualitative analysis was used to identify emerging themes in the open-ended comments. Results. A total of 150 student pharmacists completed the survey for a response rate of 69% (150/215). More than 70% of student pharmacists perceived that their academic performance was affected after the hurricane. About one third of students reported not being able to function mentally at the same level as they had prior to the storm (n=53, 35%) and reported having difficulty sleeping (n=54, 36%). Female student pharmacists were more likely than male student pharmacists to report not being able to function at the same level mentally as they had before the hurricane (41% vs 17%). In the multivariate analysis, first- and second-year student pharmacists were more likely to perceive a negative impact on their academic performance compared to third- and fourth-year student pharmacists. Lack of preparedness, gratefulness, and campus management were the themes that emerged from the qualitative analysis. Conclusion. Hurricane Maria had a significant impact on the lives of student pharmacists in Puerto Rico. This led to a perception of diminished academic performance, especially among first- and second-year students. The results can be used to guide preparedness and response to natural disasters in academic settings.

Is Waist-to-Height Ratio a Better Obesity Risk-Factor Indicator for Puerto Rican Children than is BMI or Waist Circumference?

OBJECTIVE: Puerto Rican children could have a higher prevalence of obesity, compared to US children or even to US Hispanic children. Obese youths are more likely to have risk factors for cardiovascular conditions, such as hypertension. Although BMI provides a simple, convenient measurement of obesity, it does not measure body fat distribution, associated with mortality and morbidity. Waist circumference (WC) and waist-to-height ratio (WHtR) have been suggested to estimate obesity health risks. This study aimed to explore the association of a single blood pressure reading with 3 different obesity indicators (WC, BMI, and WHtR). METHODS: A representative sample of students (first to sixth grade) from public and private schools in Puerto Rico was selected. The sample size consisted of 249 students, representing a 63% response rate. According to the sex-specific BMIs, approximately 38.1% of the children were obese or overweight. The prevalence of obesity was slightly higher when determined using WHtR but lower when using WC as the overweight indicator. The prevalence of high blood pressure among students was 12.5%; an additional 11.3% of the students were classified as possible prehypertensive. RESULTS: Regardless of the weight indicator used, overweight children were shown to have a higher risk of pre-hypertension/hypertension (as defined by a single BP measure) than were non-overweight children. The odds for high blood pressure were almost 3 times higher using WHtR. Logistic regression showed a stronger relationship between WHtR and the risk of pre-hypertension/hypertension than that between the former and either BMI or WC. CONCLUSION: This study suggests the possibility of higher prevalence of high blood pressure in obese Puerto Rican children. The waist-to height ratio could be the best indicator to measure obesity and potential hypertension in Puerto Rican children.

Binge drinking as a risk factor for violence among secondary school students in a nationally representative sample in Puerto Rico.

OBJECTIVE: The objective of this study was to determine the association between binge drinking and violence in a representative sample of secondary-school students in Puerto Rico. METHODS: Consulta Juvenil VII (a biennial survey of school-aged youths in Puerto Rico) has a representative sample of adolescent students in Puerto Rico. A multi-stage stratified cluster sampling design was used. The sampling frame of Consulta Juvenil VII includes all the public and private schools registered with the Department of Education and the Council of General Education in Puerto Rico. The study utilizes a self-administered questionnaire that was translated and adapted from the "Student Survey of Risk and Protective Factors and Prevalence of Alcohol, Tobacco, and Other Drug Use". "Binge drinking" was defined as having 5 or more alcoholic drinks in a row during the 30 days preceding the survey. RESULTS: Almost 20% of the sample members reported that at least 1 instance of binge drinking had taken place during the 2 weeks prior to the survey (17.7%). After controlling for gender, age, school level, the type of system, and the parents' educational levels, the odds of a given binge drinker reporting violent behaviors were 5 times greater than the odds among non-binge drinkers (OR: 5.6; 95% CI: 4.7-6.7). CONCLUSION: The study shows an association between binge drinking and violence in Puerto Rican adolescents, indicating that Hispanic youths who abuse alcohol may be at increased risk of violence. These findings suggest that violence prevention programs should be integrated with substance use prevention programs. [PR Health

Video games use patterns and parenteral supervision in a clinical sample of Hispanic adolescents 13-17 years old.

Video games have become a popular entertainment among adolescents. Although some video games are educational, there are others with high content of violence and the potential for other harmful effects. Lack of appropriate supervision of video games use during adolescence, a crucial stage of development, may lead to serious behavioral consequences in some adolescents. There is also concern about time spent playing video games and the subsequent neglect of more developmentally appropriate activities, such as completing academic tasks. Self-administered questionnaires were used to assess video game use patterns and parental supervision among 55 adolescent patients 13-17 years old (mean age 14.4 years; 56.4% males) and their parents. Parental supervision /monitoring of the adolescents video games use was not consistent and gender related differences were found regarding their video game use. Close to one third (32%) of the participants reported video game playing had interfered with their academic performance. Parents who understood video games rating system were more likely to prohibit their use due to rating. These findings underscore the need for clear and consistently enforced rules and monitoring of video games use by adolescents. Parents need to be educated about the relevance of their supervision, video games content and rating system; so they will decrease time playing and exposure to potentially harmful video games. It also supports the relevance of addressing supervision, gender-based parental supervisory styles, and patterns of video games use in the evaluation and treatment of adolescents.

Childhood obesity among Puerto Rican children: discrepancies between child's and parent's perception of weight status.

Public concern about childhood obesity and associated health problems calls for the identification of modifiable factors that could halt this epidemic. Parental perceptions of their children's weight status could be associated to how parents influence children's eating patterns. We aimed to identify the perceptions Puerto Rican parents have of their children's weight and children's own perceptions of weight status as compared to real weight. A cross sectional survey was performed in a representative sample of 1st-6th grade students. Only half of the children correctly identified their weight, and only 62.4% of the parents correctly classified their children's weight. Most obese/overweight children did not perceive themselves as such. Almost half of obese/overweight children were identified by the parents as normal weight while over half of the underweight children were perceived by their parents at normal weight. More girls than boys perceived themselves as obese/overweight and more parents of girls than of boys perceived them as such. Higher-educated parents were better at recognizing overweight/obesity among their children compared to less-educated parents. This study suggests an influence of parents' SES characteristics on their perceptions of children's weight status as well as on children's own perceptions of their weight status.

Prevalence of childhood obesity in a representative sample of elementary school children in Puerto Rico by socio-demographic characteristics, 2008.

OBJECTIVE: Childhood obesity is a worldwide epidemic; its prevalence has quadrupled in the US among children from 6-11 y/o. In the US, Hispanic children have a higher prevalence of obesity compared to non-Hispanic whites. No representative data was available for Puerto Rican children from first to sixth grades in Puerto Rico or the US. The aim of this study was to measure the prevalence of childhood obesity among Puerto Rican children from first to sixth grade by different socio-demographic characteristics in a sub-urban municipality in Puerto Rico. METHODS: A two-stage stratified cluster sampling design was used (n = 250). Weights and heights were measured twice to the nearest 0.1 kg and 0.1 cm, respectively. Weight status of children was determined based on the CDC criteria. Chi-square and Fisher tests were used to compare proportions. Simple logistic regressions were used to assess associations with socio-demographic variables. RESULTS: Nearly half of the students (51.0%) were boys; mean age was 9.5 + 1.9 years. Almost 40% of the children had family monthly incomes under $1,000. Overall childhood obesity prevalence (BMI > 95th percentile) was 26.8%. Prevalence of having some type of overweight (BMI for age > 85%) was statistically similar by gender and school grade. Low family-income children had 76% higher odds of having some type of overweight compared with those with higher income. CONCLUSION: This study documents a high prevalence of Puerto Rican childhood obesity among first to sixth grade regardless of grade level and gender, which is higher than the prevalence among Hispanics in the US. A higher probability of overweight was seen among the poorer children. This is the first study conducted among first to sixth graders. Thus, it calls for attention towards Puerto Rican children in the island and the US.

Job satisfaction of a group of surgical and non-surgical physicians at a Hispanic academic medical center, 2006-2007.

BACKGROUND: Job satisfaction has been associated with motivation, job involvement, job commitment, patient's satisfaction, and quality of care. Physician's job satisfaction may improve retention and performance in clinical practice, and maximize quality of services. METHODS: Job satisfaction was assessed in a group of non-resident surgical and non-surgical married physicians of the UPR SOM during the 2006-2007 academic year. Job satisfaction was measured using an 18-item scale. RESULTS: Ninety-two (n=92) physicians completed a self-administered questionnaire for a response rate of 34.8%. Almost all (90.0%) reported being satisfied or very satisfied with their job. Satisfaction was very high in both surgical and non-surgical physicians, and similar in both males and females. The physicians who were most satisfied with their jobs were those aged 35 or less, those who had completed their residency/fellowship in the previous 10 years, those whose spouse was not a physician, those who reported being previously married, and those who were not active in their religion. CONCLUSIONS: In this study, almost all the physicians in both genders reported being satisfied or very satisfied with their job. The younger physicians, who are also probably the same that completed their residency/fellowship in the previous 10 years, were the most satisfied with their jobs. Satisfaction was very high in both the surgical and the non-surgical group. The findings in this population differ from other groups, particularly in the high level of satisfaction among younger doctors and the similar satisfaction levels among genders.

Characteristics of cancer patients under age 20at a population-based registry, Puerto Rico, 1980-1991

OBJECTIVES: To evaluate and describe the characteristics and incidence of pediatric (< 20 years) cancer in Puerto Rico between 1980-1991. METHODS: A descriptive study of all new childhood cancer cases among residents of Puerto Rico reported to the Cancer Registry between the years 1980 and 1991 was conducted. The distribution of cases was described by age, gender, place of residence, histology, last date known to be alive, and stage of disease. Incidence rates and standardized incidence rates by age were calculated. RESULTS: A total of 1,823 new pediatric cases were reported from 1980 through 1991. Over half were males, and 52.2 percent were aged < 10 years. Most cases resided in urban areas. The most frequent histologic types were leukemia (31.0 percent), lymphomas and other reticulo-endothelial neoplasms (16.2 percent), and brain, central nervous system, and intracranial and intraspinal neoplasms (16.0 percent). The most frequent type of tumor was acute lymphocytic leukemia (22.0 percent). Although the overall distribution of most neoplasms was similar between genders, a higher proportion of lymphomas was reported among males, and there were significantly more carcinomas among girls. The largest increase in the age-adjusted incidence rate between periods (1980-84 and 1985-89) occurred in the 5-9 age group. CONCLUSIONS: Overall, these findings are consistent with previous studies in USA. However, there were some differences in the distribution of histologic types when compared with similar studies in other countries, and with the results of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Factors such as differences in diagnostic capabilities among countries must be taken into consideration.