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1.
Artigo em Inglês | MEDLINE | ID: mdl-33800269

RESUMO

The HIV-1 integrase viral protein is responsible for incorporating the viral DNA into the genomic DNA. The inhibition of viral integration into host cell DNA is part of recent therapeutic procedures. Combination therapy with protease and reverse transcriptase inhibitors has demonstrated good synergistic results in reducing viral replication. The purpose of this study is to assess the occurrence of integrase drug resistance mutations from the period comprising 2013 through 2018 in Puerto Rico (PR). We analyzed 131 nucleotide sequences available in our HIV genotyping database, and we performed drug resistance mutation analyses using the Stanford HIV Drug Resistance Database. Twenty-one sequences (16.03%) harbored major or resistance-associated mutations. We identified the Q148HKR, G140S, Y143R, N155H, S147G, and E138EA major drug resistance mutations and the D232DN, T97TA, E157Q, G163GART accessory mutations. We detected high-level drug resistance to Elvitegravir and Raltegravir (76.19% and 85.71%). Moreover, we identified sequences harboring drug resistance mutations that could provide resistance to Dolutegravir. The transmission of strains with integrase antiretroviral resistance has been previously documented in treatment naïve patients. Given the increase of patients treated with integrase inhibitors, surveillance of drug resistance mutations is an essential aspect of PR's clinical management of HIV infection.


Assuntos
Infecções por HIV , Inibidores de Integrase de HIV , HIV-1 , Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Inibidores de Integrase de HIV/farmacologia , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/genética , Humanos , Mutação , Porto Rico/epidemiologia , Piridonas
2.
Front Public Health ; 9: 643807, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33898379

RESUMO

Objective: Older adults may struggle with stresses and daily life challenges associated with the Coronavirus Disease 2019 (COVID-19) pandemic. Yet they may also utilize emotional and behavioral coping strategies. This qualitative paper aims to identify ways of coping with worries and stress during the pandemic from the perspectives of older adults in the United States. Methods: The COVID-19 Coping Study recruited 6,938 adults aged ≥55 through online multi-frame sampling from April 2-May 31, 2020 across all 50 US states, the District of Columbia, and Puerto Rico. The online questionnaire focused on the effects of COVID-19 on daily life, mental health, and well-being. This included an open-ended question regarding participants' coping strategies. We used qualitative content analysis to identify and code diverse coping strategies. Our general inductive approach enabled findings to emerge from the most frequent and dominant themes in the raw data. Results: A total of 5,180 adults [74% of the total sample; mean age 67.3 (SD 7.9); 63.8% female] responded to the question about using strategies to cope with living through the COVID-19 pandemic. Frequently-reported strategies included exercising and going outdoors, modifying routines, following public health guidelines, adjusting attitudes, and staying socially connected. Some coping strategies were health-limiting (e.g., overeating), while most strategies encouraged self-improvement, positive adjustment, and wellness. Conclusions: This study provides novel qualitative evidence on coping strategies of older adults early in the COVID-19 pandemic. Findings can inform community and clinical interventions to support older adults that harness positive coping strategies such as exercise, modified routines, and social strategies to improve physical and mental health, foster social support, and encourage meaningful daily activities during times of stress and trauma.


Assuntos
Adaptação Psicológica , Pandemias , Idoso , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico , Inquéritos e Questionários , Estados Unidos/epidemiologia
3.
Environ Sci Technol ; 55(6): 3775-3785, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33645970

RESUMO

Maria made a landfall in Puerto Rico on September 20, 2017 as a category 4 hurricane, causing severe flooding, widespread electricity outages, damage to infrastructure, and interruptions in water and wastewater treatment. Small rural community water systems face unique challenges in providing drinking water, which intensify after natural disasters. The purpose of this study was to evaluate the functionality of six very small rural public water systems and one large regulated system in Puerto Rico six months after Maria and survey a broad sweep of fecal, zoonotic, and opportunistic pathogens from the source to tap. Samples were collected from surface and groundwater sources, after water treatment and after distribution to households. Genes indicative of pathogenic Leptospira spp. were detected by polymerase chain reaction (PCR) in all systems reliant on surface water sources. Salmonella spp. was detected in surface and groundwater sources and some distribution system water both by culture and PCR. Legionella spp. and Mycobacteria spp. gene numbers measured by quantitative PCR were similar to nonoutbreak conditions in the continental U.S. Amplicon sequencing provided a nontarget screen for other potential pathogens of concern. This study aids in improving future preparedness, assessment, and recovery operations for small rural water systems after natural disasters.


Assuntos
Tempestades Ciclônicas , Água Potável , Humanos , Porto Rico , População Rural , Qualidade da Água
4.
Environ Int ; 152: 106480, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33740674

RESUMO

BACKGROUND: Infant non-nutritive suck (NNS), or sucking on a pacifier with no nutrients being delivered, has been used as in index of brain function and has been linked to subsequent neurodevelopment. Yet, no data are available connecting NNS to environmental exposures in utero. The goal of this study was to examine the relationship between gestational exposure to phthalates (a group of chemicals found in personal care products, PVC plastics, and other products) and NNS among infants in a birth cohort study in Puerto Rico. METHODS: Urinary phthalate metabolite levels were measured in women at up to three time points in pregnancy as a measure of in utero exposure to the child. We calculated the geometric mean of each metabolite for each woman as a measure of exposure across gestation. Infants had their NNS sampled using our custom research pacifier between 4-6 (± 2 weeks) weeks of age, yielding the following NNS dependent measures: cycles/burst, frequency, amplitude, bursts/min, and cycles/min. RESULTS: Two hundred and eight mother-infant dyads completed this study We used multiple linear regression to assess associations between individual phthalate metabolites and NNS measurements, adjusting for infant sex, birthweight, and urinary specific gravity. An interquartile range (IQR) increase in mono carboxyisononyl phthalate across pregnancy was associated with 3.5% (95%CI: -6.2, -0.8%) lower NNS frequency and 8.9% (0.6, 17.3%) higher NNS amplitude. Similarly, an IQR increase in mono-2-ethylhexyl phthalate was also associated with 3.4% (-6.5, -0.2%) lower NNS frequency, while an IQR increase in di-2-ethylhexyl terephthalate metabolites was associated with 11.2% (2.9, 19.5%) higher NNS amplitude. Gestational exposure to phthalates may alter NNS amplitude and frequency in full-term infants. These findings indicate that the infants may be increasing their NNS amplitude to compensate for their slower NNS frequency. These preliminary findings could have important clinical implications for earlier detection of exposure-related deficits in neurofunction as well as implications for subsequent neurodevelopment and related interventions.


Assuntos
Poluentes Ambientais , Ácidos Ftálicos , Criança , Estudos de Coortes , Exposição Ambiental , Feminino , Humanos , Lactente , Chupetas , Gravidez , Porto Rico
5.
Microbiome ; 9(1): 68, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752735

RESUMO

BACKGROUND: An individual's microbiome changes over the course of its lifetime, especially during infancy, and again in old age. Confounding factors such as diet and healthcare make it difficult to disentangle the interactions between age, health, and microbial changes in humans. Animal models present an excellent opportunity to study age- and sex-linked variation in the microbiome, but captivity is known to influence animal microbial abundance and composition, while studies of free-ranging animals are typically limited to studies of the fecal microbiome using samples collected non-invasively. Here, we analyze a large dataset of oral, rectal, and genital swabs collected from 105 free-ranging rhesus macaques (Macaca mulatta, aged 1 month-26 years), comprising one entire social group, from the island of Cayo Santiago, Puerto Rico. We sequenced 16S V4 rRNA amplicons for all samples. RESULTS: Infant gut microbial communities had significantly higher relative abundances of Bifidobacterium and Bacteroides and lower abundances of Ruminococcus, Fibrobacter, and Treponema compared to older age groups, consistent with a diet high in milk rather than solid foods. The genital microbiome varied widely between males and females in beta-diversity, taxonomic composition, and predicted functional profiles. Interestingly, only penile, but not vaginal, microbiomes exhibited distinct age-related changes in microbial beta-diversity, taxonomic composition, and predicted functions. Oral microbiome composition was associated with age, and was most distinctive between infants and other age classes. CONCLUSIONS: Across all three body regions, with notable exceptions in the penile microbiome, while infants were distinctly different from other age groups, microbiomes of adults were relatively invariant, even in advanced age. While vaginal microbiomes were exceptionally stable, penile microbiomes were quite variable, especially at the onset of reproductive age. Relative invariance among adults, including elderly individuals, is contrary to findings in humans and mice. We discuss potential explanations for this observation, including that age-related microbiome variation seen in humans may be related to changes in diet and lifestyle. Video abstract.


Assuntos
Microbioma Gastrointestinal , Microbiota , Animais , Feminino , Microbioma Gastrointestinal/genética , Macaca mulatta , Camundongos , Microbiota/genética , Porto Rico , RNA Ribossômico 16S/genética
6.
BMC Public Health ; 21(1): 485, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33706744

RESUMO

BACKGROUND: The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning. METHODS: A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n = 1789), school (n = 62) and district administrators (n = 64), nurses (n = 3), and "other" (n = 522). RESULTS: Of 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either "significantly less" or "somewhat less" physically active during the closure. For closed schools, the most frequently cited challenges included "student access to online learning", "teacher/student communication" and "teacher remote work arrangements". For open schools, the most commonly reported challenges included "social distancing", "access to gymnasium/equipment", and "concern for personal health and wellbeing". CONCLUSION: The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.


Assuntos
/prevenção & controle , Exercício Físico , Educação Física e Treinamento/tendências , Professores Escolares/psicologia , Estudantes , Adulto , Criança , Currículo , Educação a Distância , Humanos , Porto Rico/epidemiologia , Instituições Acadêmicas/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia
7.
Am J Bot ; 108(2): 200-215, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33598914

RESUMO

PREMISE: The Caribbean islands are in the top five biodiversity hotspots on the planet; however, the biogeographic history of the seasonally dry tropical forest (SDTF) there is poorly studied. Consolea consists of nine species of dioecious, hummingbird-pollinated tree cacti endemic to the West Indies, which form a conspicuous element of the SDTF. Several species are threatened by anthropogenic disturbance, disease, sea-level rise, and invasive species and are of conservation concern. However, no comprehensive phylogeny yet exists for the clade. METHODS: We reconstructed the phylogeny of Consolea, sampling all species using plastomic data to determine relationships, understand the evolution of key morphological characters, and test their biogeographic history. We estimated divergence times to determine the role climate change may have played in shaping the current diversity of the clade. RESULTS: Consolea appears to have evolved very recently during the latter part of the Pleistocene on Cuba/Hispaniola likely from a South American ancestor and, from there, moved into the Bahamas, Jamaica, Puerto Rico, Florida, and the Lesser Antilles. The tree growth form is a synapomorphy of Consolea and likely aided in the establishment and diversification of the clade. CONCLUSIONS: Pleistocene aridification associated with glaciation likely played a role in shaping the current diversity of Consolea, and insular gigantism may have been a key innovation leading to the success of these species to invade the often-dense SDTF. This in-situ Caribbean radiation provides a window into the generation of species diversity and the complexity of the SDTF community within the Antilles.


Assuntos
Filogenia , Animais , Bahamas , Região do Caribe , Florida , Porto Rico , Índias Ocidentais
8.
Artigo em Inglês | MEDLINE | ID: mdl-33578762

RESUMO

Patients with psychiatric disorders often have cognitive impairment. Several deficits have been recognized in patients with mood and/or psychotic disorders. We hypothesized that differences in the levels of deterioration exist between patients with bipolar disorder (BD), major depressive disorder (MDD), and schizoaffective disorder (SAD). The mini-mental state examination, version 2 (MMSE-2), was used with a sample of 160 psychiatric patients to measure cognitive impairment. The aims of this studyssss were as follows: (1) To characterize the differences in cognitive deterioration among patients diagnosed with BD, MDD, or SAD; (2) to explore item difficulty and cutoff points based on the educational level and other variables which are significant for our psychiatric population. Descriptive statistics were used for categorical variables. In addition, a Bonferroni post hoc test and an analysis of covariance (ANCOVA) for the continuous dependent variable were performed. Psychiatric diagnosis and years of education adjusted by several covariates proved to be significant. The 25th percentile were obtained to establish the cutoff points. Each item's difficulty was analyzed using means and chi-square tests. Cognitive deterioration was found in 51% of the patients with SAD, in 31% with BD, and in 18% with MDD.


Assuntos
Transtorno Bipolar , Transtornos Cognitivos , Transtorno Depressivo Maior , Cognição , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Humanos , Porto Rico/epidemiologia
9.
Environ Int ; 149: 106418, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33548848

RESUMO

BACKGROUND: Metal exposure and psychosocial stress in pregnancy have each been associated with adverse birth outcomes, including preterm birth and low birth weight, but no study has examined the potential interaction between them. OBJECTIVES: We examined the modifying effect of psychosocial stress on the association between metals and birth outcomes among pregnant women in Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) birth cohort study. METHODS: In our analysis of 682 women from the PROTECT study, we measured 16 essential and non-essential metals in blood samples at two time points. We administered questionnaires to collect information on depression, perceived stress, social support, and life experience during pregnancy. Using K-means clustering, we categorized pregnant women into one of two groups: "good" and "poor" psychosocial status. We then evaluated whether the effect of blood metals (geometric average) on adverse birth outcomes (gestational age, preterm birth [overall and spontaneous], birth weight z-score, small for gestation [SGA], large for gestation [LGA]) vary between two clusters of women, adjusting for maternal age, maternal education, pre-pregnancy body mass index (BMI), and second-hand smoke exposure. RESULTS: Blood manganese (Mn) was associated with an increased odds ratio (OR) of overall preterm birth (OR/interquartile range [IQR] = 2.76, 95% confidence interval [CI] = 1.25, 6.12) and spontaneous preterm birth (OR/IQR: 3.68, 95% CI: 1.20, 6.57) only among women with "poor" psychosocial status. The association between copper (Cu) and SGA was also statistically significant only among women having "poor" psychosocial status (OR/IQR: 2.81, 95% CI: 1.20, 6.57). We also observed associations between nickel (Ni) and preterm birth and SGA that were modified by psychosocial status during pregnancy. CONCLUSIONS: Presence of "poor" psychosocial status intensified the adverse associations between Mn and preterm birth, Cu and SGA, and protective effects of Ni on preterm. This provides evidence that prenatal psychosocial stress may modify vulnerability to metal exposure.


Assuntos
Exposição Materna/efeitos adversos , Metaloides/sangue , Metais/sangue , Nascimento Prematuro , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Gestantes , Nascimento Prematuro/epidemiologia , Porto Rico
10.
Artigo em Inglês | MEDLINE | ID: mdl-33546156

RESUMO

The purpose of this pilot study was to assess the feasibility and acceptability of a mobile smoking cessation intervention in Puerto Rico. This was a single-arm pilot study with 26 smokers in Puerto Rico who were enrolled in Decídetexto, a mobile smoking cessation intervention. Decídetexto incorporates three integrated components: (1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, (2) a 24-week text messaging counseling program with interactive capabilities, and (3) pharmacotherapy support. Outcome measures included self-reported 7-day point prevalence abstinence at Months 3 and 6, pharmacotherapy adherence, satisfaction with the intervention, and changes in self-efficacy. The average age of the participants was 46.8 years (SD 12.7), half of them (53.8%) were female. Most participants (92.3%) smoked daily and half of them (53.8%) used menthol cigarettes. All participants requested nicotine patches at baseline. However, only 13.0% of participants used the patch >75% of days. At Month 3, 10 participants (38.4%) self-reported 7-day point prevalence abstinence (88.5% follow-up rate). At Month 6, 16 participants (61.5%) self-reported 7-day point prevalence abstinence (76.9% follow-up rate). Most participants (90%, 18/20) reported being satisfied/extremely satisfied with the intervention at Month 6. Self-efficacy mean scores significantly increased from 40.4 (SD 12.1) at baseline to 57.9 (SD 11.3) at Month 3 (p < 0.01). The study suggests that Decídetexto holds promise for further testing among Puerto Rican smokers.


Assuntos
Abandono do Hábito de Fumar , Envio de Mensagens de Texto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Porto Rico , Fumar
11.
Endocr Pract ; 27(3): 241-244, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33618848

RESUMO

OBJECTIVE: Iodine deficiency is a worldwide public health problem and a preventable cause of neurodevelopmental delay in children. There are no data regarding iodine sufficiency and knowledge on iodine nutrition among pregnant women in Puerto Rico. The objective of this study was to assess iodine status, potential factors influencing iodine status, and knowledge regarding iodine nutrition among Puerto Rican pregnant women. METHODS: This was a cross-sectional study of 125 pregnant women recruited from an ambulatory high-risk obstetric clinic in San Juan, Puerto Rico. The participants completed a survey and provided spot urine samples. We excluded women on thyroid medications or those who had undergone iodinated contrast studies in the last 6 months. Spot urine iodine concentrations (UICs) were measured spectrophotometrically. RESULTS: The median UIC was 182 µg/L. Only 3 (2%) of the participants were aware that pregnant women need increased iodine intake, and 78% reported taking prenatal vitamins, 77% of which were prescription products. The participants who reported taking prescription prenatal vitamins had a median (range) UIC of 148.6 (15.3-1188.6) µg/L compared to those who were not taking prescription prenatal vitamins, who had a median UIC of 249.7 (47.8-2179.0) µg/L (P = .05). The iodine content of the prenatal vitamins was unknown. CONCLUSIONS: The World Health Organization has defined iodine deficiency as a median UIC of <150 µg/L in populations of pregnant women. Our sample of pregnant Puerto Rican women had an adequate iodine status. Most women used prescribed prenatal vitamins with unknown iodine content. The majority of participants reported not receiving any education by health care providers regarding dietary iodine needs.


Assuntos
Iodo , Criança , Estudos Transversais , Feminino , Humanos , Iodo/análise , Estado Nutricional , Gravidez , Gestantes , Porto Rico/epidemiologia
12.
BMJ Open ; 11(2): e044965, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568377

RESUMO

PURPOSE: The COVID-19 pandemic, beginning in early 2020, has resulted in massive social, economic, political and public health upheaval around the world. We established a national longitudinal cohort study, the COVID-19 Coping Study, to investigate the effects of pandemic-related stressors and changes in life circumstances on mental health and well-being among middle-aged and older adults in the USA. PARTICIPANTS: From 2 April to 31 May 2020, 6938 adults aged ≥55 years were recruited from all 50 US states, the District of Columbia and Puerto Rico using online, multi-frame non-probability-based sampling. FINDINGS TO DATE: Mean age of the baseline sample was 67.3 years (SD: 7.9 years) and 64% were women. Two in three adults reported leaving home only for essential purposes in the past week (population-weighted proportion: 69%; 95% CI: 68% to 71%). Nearly one in five workers aged 55-64 years was placed on a leave of absence or furloughed since the start of the pandemic (17%; 95% CI: 14% to 20%), compared with one in three workers aged ≥75 years (31%; 95% CI: 21% to 44%). Nearly one-third of adults screened positive for each of depression (32%; 95% CI: 30% to 34%), anxiety (29%; 28% to 31%) and loneliness (29%; 95% CI: 27% to 31%), with decreasing prevalence of each with increasing age. FUTURE PLANS: Monthly and annual follow-ups of the COVID-19 Coping Study cohort will assess longitudinal changes to mental health, cognitive health and well-being in relation to social, behavioural, economic and other COVID-19-related changes to life circumstances. Quantitative and in-depth qualitative interview data will be collected through online questionnaires and telephone interviews. Cohort data will be archived for public use.


Assuntos
Adaptação Psicológica , Saúde Mental , Pandemias , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , District of Columbia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Porto Rico , Estados Unidos/epidemiologia
13.
PLoS One ; 16(1): e0244512, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503036

RESUMO

Understanding how perceptions around motivation, capacity, and climate change's impacts relate to the adoption of adaptation practices in light of experiences with extreme weather events is important in assessing farmers' adaptive capacity. However, very little of this work has occurred in islands, which may have different vulnerabilities and capacities for adaptation. Data of surveyed farmers throughout Puerto Rico after Hurricane Maria (n = 405, 87% response rate) were used in a structural equation model to explore the extent to which their adoption of agricultural practices and management strategies was driven by perceptions of motivation, vulnerability, and capacity as a function of their psychological distance of climate change. Our results show that half of farmers did not adopt any practice or strategy, even though the majority perceived themselves capable and motivated to adapt to climate change, and understood their farms to be vulnerable to future extreme events. Furthermore, adoption was neither linked to these adaptation perceptions, nor to their psychological distance of climate change, which we found to be both near and far. Puerto Rican farmers' showed a broad awareness of climate change's impacts both locally and globally in different dimensions (temporal, spatial, and social), and climate distance was not linked to reported damages from Hurricane Maria or to previous extreme weather events. These results suggest that we may be reaching a tipping point for extreme events as a driver for climate belief and action, especially in places where there is a high level of climate change awareness and continued experience of compounded impacts. Further, high perceived capacity and motivation are not linked to actual adaptation behaviors, suggesting that broadening adaptation analyses beyond individual perceptions and capacities as drivers of climate adaptation may give us a better understanding of the determinants to strengthen farmers' adaptive capacity.


Assuntos
Mudança Climática , Fazendeiros/psicologia , Adaptação Psicológica , Adulto , Idoso , Agricultura , Tempestades Ciclônicas , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Motivação , Porto Rico , Inquéritos e Questionários
14.
Prehosp Disaster Med ; 36(2): 141-144, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33397547

RESUMO

OBJECTIVE: This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with 2020 rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020). METHODS: Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson's correlation coefficient. RESULTS: These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico. CONCLUSION: The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.


Assuntos
/mortalidade , Planejamento em Desastres , Pneumonia Viral/mortalidade , Medidas de Segurança , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Porto Rico/epidemiologia , Estados Unidos/epidemiologia
15.
Environ Sci Pollut Res Int ; 28(13): 16504-16516, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33389579

RESUMO

The exposure to airborne particulate matter (PM) and its constituents is an important factor to be considered when evaluating their potential health risk. Transition metals found in PM are known to contribute significantly to the exacerbation of respiratory ailments. Exposure to these constituents results in the induction of oxidative stress in the bronchial epithelium, thus promoting the secretion of inflammatory mediators. Therefore, it is important to know the contributions of PM2.5 constituents to further investigate their relationship with toxic responses and associated health risks. PM2.5 samples from three rural (Humacao, Guayama, and Guayanilla) and two urban (more populated) sites (Bayamón and Ponce) from Puerto Rico were analyzed for various inorganic constituents. A total of 59 trace elements were analyzed, of which eight were considered with the greatest toxic potential. The highest annual average concentration of PM2.5 was reported at the urban site of Ponce (5.82 ± 1.40 µg m-3), while Bayamón's average concentration was not as high (4.69 ± 1.30 µg m-3) compared to concentrations at the rural sites Humacao, Guayama, and Guayanilla (4.33 ± 1.20 µg m-3, 4.93 ± 1.50 µg m-3, and 4.88 ± 1.20 µg m-3 respectively. The concentration at the Ponce site exhibited the highest summer value (7.57 µg m-3) compared to that of all the rural sites (~ 6.40 µg m-3). The lowest summer PM2.5 values were obtained at the Humacao site with an average of 5.76 µg m-3. Average Cu and Zn concentrations were 3- and 2-fold higher at the urban sites (0.68 ng m-3 and 6.74 ng m-3 respectively) compared to the rural sites (0.17 ng m-3 and 4.11 ng m-3). Relative toxicity of inorganic PM extract indicates Bayamón (urban) and Guayama with similar low LC50 followed by Humacao, Guayanilla, and finally Ponce (urban) with the highest LC50. Of the eight potential toxic metals considered, only Fe was found to be higher at the rural sites. To our understanding, there are different sources of emission for these metals which potentially indicate main anthropogenic sources, together with the trade winds adding periodically volcanic and African Dust Storm particulates that affect Puerto Rico. These results are the first of their kind to be reported in Puerto Rico.


Assuntos
Poluentes Atmosféricos , Material Particulado , Poluentes Atmosféricos/análise , Monitoramento Ambiental , Material Particulado/análise , Porto Rico , Estações do Ano
16.
Int J Mol Sci ; 22(2)2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33450964

RESUMO

In 2020, approximately 191,930 new prostate cancer (PCa) cases are estimated in the United States (US). Hispanic/Latinos (H/L) are the second largest racial/ethnic group in the US. This study aims to assess methylation patterns between aggressive and indolent PCa including DNA repair genes along with ancestry proportions. Prostate tumors classified as aggressive (n = 11) and indolent (n = 13) on the basis of the Gleason score were collected. Tumor and adjacent normal tissue were annotated on H&E (Haemotoxylin and Eosin) slides and extracted by macro-dissection. Methylation patterns were assessed using the Illumina 850K DNA methylation platform. Raw data were processed using the Bioconductor package. Global ancestry proportions were estimated using ADMIXTURE (k = 3). One hundred eight genes including AOX1 were differentially methylated in tumor samples. Regarding the PCa aggressiveness, six hypermethylated genes (RREB1, FAM71F2, JMJD1C, COL5A3, RAE1, and GABRQ) and 11 hypomethylated genes (COL9A2, FAM179A, SLC17A2, PDE10A, PLEKHS1, TNNI2, OR51A4, RNF169, SPNS2, ADAMTSL5, and CYP4F12) were identified. Two significant differentially methylated DNA repair genes, JMJD1C and RNF169, were found. Ancestry proportion results for African, European, and Indigenous American were 24.1%, 64.2%, and 11.7%, respectively. The identification of DNA methylation patterns related to PCa in H/L men along with specific patterns related to aggressiveness and DNA repair constitutes a pivotal effort for the understanding of PCa in this population.


Assuntos
Metilação de DNA , Epigênese Genética , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/genética , Idoso , Ilhas de CpG , Reparo do DNA , Progressão da Doença , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Porto Rico
17.
Mil Med ; 186(Suppl 1): 82-90, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33499489

RESUMO

INTRODUCTION: Zika virus (ZIKV) is a mild febrile illness generally transmitted via the bite of infected Aedes species mosquitoes, including Aedes aegypti, with the potential to cause neurological complications. Nearly 200 U.S. military installations are located within areas where Aedes mosquitos are found, putting thousands of personnel at risk for infection with ZIKV. This analysis aims to quantify the benefits of interventions, including vaccination, to decrease the risk of ZIKV on U.S. military installations. METHODS: The authors developed a dynamic transmission model to test the "effectiveness" of vaccination, personal protective measures (PPM), and mosquito control at reducing morbidity within U.S. military populations. ZIKV transmission was modeled as a compartmental susceptible-exposed-infected-recovered model tracking interactions between humans and mosquitos and incorporating seasonality of mosquito populations and the potential for herd immunity. The model included two-dose vaccination as well as symptomatic and asymptomatic infection. The model was calibrated against 2016 public health data in Puerto Rico; sensitivity analyses were performed on model parameters and interventions. RESULTS: The greatest reduction in total modeled ZIKV cases resulted from vaccination combined with mosquito control and PPM. All three interventions at their highest estimated level of efficiency reduced ZIKV cases by 99.9% over the baseline case of low-level adherence to PPM. The addition of vaccination had limited additional benefit over effective vector control and PPM since the significant lag to vaccine-induced protection limited effectiveness of vaccination. CONCLUSIONS: Given the current vaccine, the model predicted that up to 92.8% of Zika cases occurring in deployment settings over a 10-year period could be prevented by adding vaccination to current low-level PPM. Combining vaccination with other interventions can reduce cases further. A location-specific cost-benefit analysis would be a valuable contribution to outbreak control policy as it could evaluate the economic impact of the interventions versus the reduced level of illness and downtime in this setting.


Assuntos
Infecção por Zika virus , Zika virus , Aedes , Animais , Humanos , Mosquitos Vetores , Porto Rico , Vacinação , Vacinas Virais , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controle
18.
Mar Pollut Bull ; 164: 112010, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33485022

RESUMO

Caribbean islands, including Puerto Rico, are biodiversity hotspots threatened by microplastics (<5 mm). Little is known about the extent of microplastic pollution in coastal sandy beaches of Puerto Rico. Sand from six northern beaches was collected in the high tide line to determine microplastic abundance (0.3-4.75 mm). Península La Esperanza, the most polluted beach, exhibited higher average abundance (17 items/kg dw) and diversity. High urbanization, industrial/port activities, and riverine input are likely sources of plastic debris on this beach. The other beaches showed lower and similar average abundance (3 to 7 items/kg dw) despite having distinct potential point and non-point sources. Overall, fibers (40%), fragments (28%) and foams (27%) predominated (n = 102 particles). Results showed comparable levels to other world beaches, some classified as highly contaminated, but only when transforming units to items/m2. Preliminary ATR-FTIR analysis identified mainly polyethylene. It is imperative to have plastics source reduction through waste management.


Assuntos
Microplásticos , Poluentes Químicos da Água , Praias , Monitoramento Ambiental , Plásticos , Porto Rico , Resíduos/análise , Poluentes Químicos da Água/análise , Índias Ocidentais
19.
Ann Hematol ; 100(3): 735-741, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33438047

RESUMO

Plasma cell disorders including plasmacytomas and multiple myeloma (MM) are exquisitely radiosensitive, and thus, radiation therapy (XRT) is used effectively in their management. The role of XRT in the setting of novel MM therapeutics has not been explored. The 2016 National Cancer Database (NCDB) for MM with patients diagnosed between 2004 and 2013 was studied. Association between utilization of XRT as part of initial therapy and patient, disease, or treating facility characteristics was studied. A total of 111,281 cases with 91.6% MM, 7% osseous plasmacytoma (PLA-O), and 1.4% extramedullary plasmacytoma (PLA-E) were identified. XRT was utilized as part of initial therapy in 25.4% cases, including 69.3% of PLA-O, 60% of PLA-E, and 21.5% of MM patients. Patients with PLA-E and MM were significantly less likely to receive XRT as compared to PLA-O (p < 0.001). A significantly decreased use of XRT was noted over time (p < 0.001), and for advancing patient age (p < 0.001), women (p < 0.001), and blacks (p < 0.001), and with increasing income (p = 0.015). Patients with Medicare were less likely to receive XRT (OR 0.86, 95% CI 0.78, 0.94) as compared to uninsured as were those with initial treatment at academic or high-volume facilities and facilities performing stem cell transplant. There was overall decreased utilization of XRT in recent years, possibly due to advent of efficacious systemic agents for MM therapy, with a higher XRT utilization for plasmacytomas. Patterns of XRT use need to be explored prospectively, so that uniform standards of healthcare delivery can be maintained and treatment heterogeneity can be minimized.


Assuntos
Oncologia/tendências , Mieloma Múltiplo/radioterapia , Padrões de Prática Médica/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Mieloma Múltiplo/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Porto Rico/epidemiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
20.
Environ Int ; 147: 106310, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33321388

RESUMO

BACKGROUND: Metal(loid)s have been associated to adverse birth outcomes in experimental and epidemiological studies, but the underlying mechanism(s) are not well understood. Endocrine disruption may be a mechanism by which the metal(loid)s impact birth outcomes. METHODS: Pregnant women were recruited through the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT). Urine, blood, demographic and pregnancy-related data were collected at recruitment and subsequent visits. Sixteen metal(loid)s were analyzed in urine and blood samples, while nine maternal hormones (corticotropin-releasing hormone (CRH), sex-hormone binding globulin (SHBG), estriol (E3), progesterone, testosterone, thyroid-stimulating hormone (TSH), total triiodothyronine (T3), total thyroxine (T4), and free thyroxine (fT4)) were measured in serum samples from 815 singleton pregnancies. Linear mixed models with random intercepts were used to examine associations between metal(loid)s in blood and urine with hormone concentrations. RESULTS: Arsenic blood concentrations were significantly associated with increased levels in CRH (%Δ: 23.0, 95%CI: 8.4-39.6) and decreased levels in testosterone (%Δ: -16.3, 95%CI: -26.2--5.1). Cobalt, manganese, and lead blood concentrations were associated with small increases in SHBG (%Δ range: 3.3-4.2), E3 (%Δ range: 3.9-8.7) and progesterone (%Δ range: 4.1-6.3) levels, respectively. Nickel blood concentration was inversely associated with testosterone levels (%Δ -13.3, 95%CI: -18.7--7.6). Significant interactions were detected for the association between nickel and study visit in relation to CRH (p < 0.02) and testosterone levels (p < 0.01). CONCLUSION: Our analysis suggests that metal(loid)s may act as endocrine disruptors by altering prenatal hormone levels. This disruption may depend on specific windows of exposure during pregnancy. Additionally, some essential metal(loid)s such as managense and cobalt may be contributors to adverse maternal and fetal outcomes. The study of metal(loid)s as endocrine disruptors is in the early stages of epidemiological research and future studies are needed to further investigate these associations.


Assuntos
Metaloides , Biomarcadores , Feminino , Humanos , Exposição Materna , Metais , Gravidez , Gestantes , Porto Rico
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