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1.
Dis Aquat Organ ; 147: 47-61, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34789587

RESUMO

Sponges are fundamental components of coral reef communities and, unfortunately, like other major benthic members, they too have been impacted by epizootic and panzootic events. We report on the prevalence of disease-like conditions affecting populations of the giant barrel sponge Xestospongia muta across shallow and mesophotic coral reefs off La Parguera Natural Reserve (LPNR) and Mona Island Marine Reserve (MIMR) in Puerto Rico. Four different conditions affecting X. muta were observed during our surveys, of which 3 have been previously reported: cyclic spotted bleaching (CSB; apparently non-lethal), Xestospongia-tissue wasting disease (X-TWD; apparently lethal), and sponge orange band disease (SOB; sparsely associated with X-TWD infected individuals). Additionally, we describe a fourth condition, Xestospongia-tissue hardening condition (X-THC), a previously unreported disease recently observed along the insular shelf margin off LPNR and MIMR. Within LPNR, a total of 764 specimens of X. muta were inspected and measured. Of these, 590 sponges (72.2%) had CSB, 25 (3.27%) had signs of X-TWD, 7 (0.92%) had SOB, and the remaining 142 (18.6%) were apparently healthy. Three colonies inhabiting upper mesophotic depths on the LPNR insular shelf showed signs of CSB and X-TWD. At MIMR, video-transect surveys revealed a total of 514 colonies, of which 40 (7.78%) had signs of CSB and/or XTWD, 14 (2.72%) were affected by X-THC, while the remaining 460 (89.5%) showed no external signs of disease and appeared healthy. The presence of 4 concomitant disease-like conditions in barrel sponges of Puerto Rico is alarming, and indicative of the deteriorating status of Caribbean coral reefs.


Assuntos
Antozoários , Xestospongia , Animais , Recifes de Corais , Ecossistema , Porto Rico/epidemiologia
2.
BMC Health Serv Res ; 21(1): 1239, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34784905

RESUMO

Two category 5 hurricanes, Irma and Maria, arrived in the Caribbean in September 2017 in rapid succession. On September 6, Irma devastated the islands of St. Thomas and St. John, in the Virgin Islands of the United States (USVI). Most medical infrastructure was damaged, including hemodialysis facilities, paralyzing dialysis operations. After Irma's landfall, Puerto Rico served as a safehaven for thousands of displaced and repatriated persons from the impacted islands. These included a cohort of 129 hemodialysis patients evacuated from St. Thomas, USVI to San Juan, Puerto Rico from September 9-11, 2017. The hemodialysis patients arrived first at hotels in San Juan and were then transferred to a Special Needs Shelter, run by the Commonwealth of Puerto Rico and located in the Puerto Rico Convention Center. With the imminent arrival of Hurricane Maria, most patients were evacuated on September 19 to a special needs shelter on the campus of the Florida International University, in Miami, Florida. While in San Juan, hemodialysis treatments were provided by local nephrologists working with local hemodialysis centers. Here, we describe the challenges and the emergency management actions taken to ensure continuity of care, including providing dialysis, general medical care, shelter, food and transportation for USVI dialysis patients during their stay in San Juan, Puerto Rico. We describe here the experiences of federal and host state/territorial officials in the special needs shelter, in the context of the state/territorial and federal response to disasters, in order to provide ideas about challenges, solutions, and approaches to coordinating care for dialysis patients evacuated from a disaster.


Assuntos
Tempestades Ciclônicas , Desastres , Humanos , Porto Rico/epidemiologia , Diálise Renal , Estados Unidos , Ilhas Virgens Americanas
3.
Artigo em Inglês | MEDLINE | ID: mdl-34769708

RESUMO

BACKGROUND: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). OBJECTIVE: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. METHODS: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018-April 2019. RESULTS: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. CONCLUSIONS: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.


Assuntos
Tempestades Ciclônicas , Desastres , Neoplasias dos Genitais Femininos , Atenção à Saúde , Saúde Ambiental , Feminino , Humanos , Porto Rico/epidemiologia
4.
Emerg Infect Dis ; 27(11): 2971-2973, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34670646

RESUMO

We reconstructed the 2016-2017 Zika virus epidemic in Puerto Rico by using complete genomes to uncover the epidemic's origin, spread, and evolutionary dynamics. Our study revealed that the epidemic was propelled by multiple introductions that spread across the island, intricate evolutionary patterns, and ≈10 months of cryptic transmission.


Assuntos
Epidemias , Infecção por Zika virus , Zika virus , Evolução Molecular , Humanos , Porto Rico/epidemiologia , Zika virus/genética , Infecção por Zika virus/epidemiologia
6.
CA Cancer J Clin ; 71(6): 466-487, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34545941

RESUMO

The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population-based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73-0.78) in 1995 to 0.91 (95% CI, 0.89-0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection-related cancers, including approximately two-fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized-stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence-based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community-based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID-19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Neoplasias/etnologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/prevenção & controle , Porto Rico/epidemiologia , Fatores de Risco , Taxa de Sobrevida , Estados Unidos/epidemiologia , Adulto Jovem
7.
PLoS Negl Trop Dis ; 15(7): e0009606, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34310614

RESUMO

An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prior dengue virus infection. However, in vaccinees who had no prior dengue virus infection, the vaccine had a modestly elevated risk of hospitalization and severe disease. The WHO therefore recommended a strategy of pre-vaccination screening and vaccination of seropositive persons. To estimate the cost-effectiveness and benefits of this intervention (i.e., screening and vaccination of seropositive persons) in Puerto Rico, we simulated 10 years of the intervention in 9-year-olds using an agent-based model. Across the entire population, we found that 5.5% (4.6%-6.3%) of dengue hospitalizations could be averted. However, we also found that 0.057 (0.045-0.073) additional hospitalizations could occur for every 1,000 people in Puerto Rico due to DENV-naïve children who were vaccinated following a false-positive test results for prior exposure. The ratio of the averted hospitalizations among all vaccinees to additional hospitalizations among DENV-naïve vaccinees was estimated to be 19 (13-24). At a base case cost of vaccination of 382 USD, we found an incremental cost-effectiveness ratio of 122,000 USD per QALY gained. Our estimates can provide information for considerations to introduce the CYD-TDV vaccine in Puerto Rico.


Assuntos
Análise Custo-Benefício , Vacinas contra Dengue/economia , Vacinas contra Dengue/imunologia , Dengue/epidemiologia , Dengue/prevenção & controle , Vacinação/economia , Humanos , Porto Rico/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-34204687

RESUMO

There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1-3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Vaping , Adulto , Feminino , Humanos , Masculino , Percepção , Porto Rico/epidemiologia , Inquéritos e Questionários
9.
Environ Health Perspect ; 129(5): 57011, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34009015

RESUMO

BACKGROUND: Glyphosate (GLY) is the most heavily used herbicide in the world. Despite nearly ubiquitous exposure, few studies have examined prenatal GLY exposure and potentially adverse pregnancy outcomes. Preterm birth (PTB) is a risk factor for neonatal mortality and adverse health effects in childhood. OBJECTIVES: We examined prenatal exposure to GLY and a highly persistent environmental degradate of GLY, aminomethylphosphonic acid (AMPA), and odds of PTB in a nested case-control study within the ongoing Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) pregnancy cohort in northern Puerto Rico. METHODS: GLY and AMPA in urine samples collected at 18±2 (Visit 1) and 26±2 (Visit 3) wk gestation (53 cases/194 randomly selected controls) were measured using gas chromatography tandem mass spectrometry. Multivariable logistic regression was used to estimate associations with PTB (delivery <37wk completed gestation). RESULTS: Detection rates in controls were 77.4% and 77.5% for GLY and 52.8% and 47.7% for AMPA, and geometric means (geometric standard deviations) were 0.44 (2.50) and 0.41 (2.56) µg/L for GLY and 0.25 (3.06) and 0.20 (2.87) µg/L for AMPA, for Visits 1 and 3, respectively. PTB was significantly associated with specific gravity-corrected urinary GLY and AMPA at Visit 3, whereas associations with levels at Visit 1 and the Visits 1-3 average were largely null or inconsistent. Adjusted odds ratios (ORs) for an interquartile range increase in exposure at Visit 3 were 1.35 (95% CI: 0.99, 1.83) and 1.67 (95% CI: 1.26, 2.20) for GLY and AMPA, respectively. ORs for Visit 1 and the visit average were closer to the null. DISCUSSION: Urine GLY and AMPA levels in samples collected near the 26th week of pregnancy were associated with increased odds of PTB in this modestly sized nested case-control study. Given the widespread use of GLY, multiple potential sources of AMPA, and AMPA's persistence in the environment, as well as the potential for long-term adverse health effects in preterm infants, further investigation in other populations is warranted. https://doi.org/10.1289/EHP7295.


Assuntos
Glicina/análogos & derivados , Organofosfonatos , Nascimento Prematuro , Efeitos Tardios da Exposição Pré-Natal , Estudos de Casos e Controles , Feminino , Glicina/toxicidade , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Organofosfonatos/toxicidade , Gravidez , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Porto Rico/epidemiologia
10.
Am J Prev Med ; 61(3): e149-e155, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33952412

RESUMO

INTRODUCTION: Zika virus is primarily transmitted through mosquito bites. Because Zika virus infection during pregnancy can cause serious birth defects, reproductive-aged women need protection from Zika virus infection. This report describes Zika virus prevention behaviors among women aged 18-49 years and assesses whether pregnancy status and healthcare provider counseling increases Zika virus prevention behaviors. METHODS: A population-based cell phone survey of women aged 18-49 years living in Puerto Rico was conducted in July-November 2016. Data were analyzed in 2018-2019. Prevalence estimates and 95% CIs were calculated for Zika virus prevention behaviors. Adjusted prevalence ratios were estimated to examine the association of pregnancy status with healthcare provider counseling on Zika virus prevention behaviors, controlling for age, education, and health insurance status. RESULTS: Most women reported using screens on open doors/windows (87.7%) and eliminating standing water in/around their homes (92.3%). Other Zika virus prevention behaviors were less common (<33%). In adjusted analysis, pregnant women were more likely than women not at risk for unintended pregnancy to report using mosquito repellent every/most days (adjusted prevalence ratio=1.44, 95% CI=1.13, 1.85). Healthcare provider counseling was associated with receiving professional spraying/larvicide treatment (adjusted prevalence ratio=1.42, 95% CI=1.17, 1.74), sleeping under a bed net (adjusted prevalence ratio=2.37, 95% CI=1.33, 4.24), using mosquito repellent (adjusted prevalence ratio=1.57, 95% CI=1.40, 1.77), and wearing long sleeves/pants (adjusted prevalence ratio=1.32, 95% CI=1.12, 1.55). CONCLUSIONS: Receipt of healthcare provider counseling was more consistently associated with Zika virus prevention behaviors than pregnancy status. Healthcare provider counseling is an important strategy for increasing the uptake of Zika virus prevention behaviors among women aged 18-49 years.


Assuntos
Complicações Infecciosas na Gravidez , Infecção por Zika virus , Zika virus , Adulto , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Gravidez não Planejada , Porto Rico/epidemiologia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controle
11.
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
12.
Ann Allergy Asthma Immunol ; 127(2): 236-242.e1, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33892162

RESUMO

BACKGROUND: Age- and sex-related differences in asthma may be due to changes in sex hormone levels. OBJECTIVE: To evaluate whether a change in free testosterone or free testosterone-to-estradiol ratio is associated with changes in lung function and eosinophils in the Puerto Rican youth. METHODS: We tested for the association between the change in sex hormone levels and change in lung function or change in eosinophils in a prospective study of 317 children (with and without asthma) followed up from ages 6 to 14 years to ages 10 to 20 years (146 females, 171 males) in San Juan, Puerto Rico. Serum levels of testosterone, estradiol, sex hormone-binding globulin, and progesterone were measured at 2 study visits, approximately 4.9 years apart. Using testosterone and sex hormone-binding globulin levels, we derived free testosterone and the free testosterone-to-estradiol ratio. Multivariable linear regression was used for the analysis of change in lung function and eosinophils, conducted separately by sex. RESULTS: In girls, each quartile increment in the free testosterone-to-estradiol ratio was associated with a 2.03% increment in percent predicted forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) between study visits. In males, each quartile increment in the free testosterone-to-estradiol ratio was associated with a 3.27% increment in percent predicted FEV1 and a 1.81% increment in percent predicted FEV1/FVC between study visits. In girls with asthma, an increased free testosterone-to-estradiol ratio was significantly associated with decreased eosinophils between visits (P=0.03). CONCLUSION: In Puerto Rican youth, increased free testosterone-to-estradiol ratio over time was associated with an increased FEV1/FVC in both sexes, and with an increased FEV1 in males.


Assuntos
Asma/epidemiologia , Estradiol/sangue , Testes de Função Respiratória , Testosterona/sangue , Adolescente , Asma/imunologia , Asma/patologia , Criança , Eosinófilos/citologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Progesterona/sangue , Estudos Prospectivos , Porto Rico/epidemiologia , Globulina de Ligação a Hormônio Sexual/análise , Adulto Jovem
13.
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
COVID-19/prevenção & controle , Exercício Físico , Educação Física e Treinamento/tendências , Professores Escolares/psicologia , Estudantes , Adulto , COVID-19/psicologia , Criança , Currículo , Educação à Distância , Humanos , Porto Rico/epidemiologia , Instituições Acadêmicas/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia
14.
PLoS One ; 16(2): e0247481, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33606839

RESUMO

BACKGROUND: Acute febrile illness (AFI) is an important cause for seeking health care among children. Knowledge of the most common etiologic agents of AFI and its seasonality is limited in most tropical regions. METHODOLOGY/PRINCIPAL FINDINGS: To describe the viral etiology of AFI in pediatric patients (≤18 years) recruited through a sentinel enhanced dengue surveillance system (SEDSS) in Southern Puerto Rico, we analyzed data for patients enrolled from 2012 to May 2018. To identify seasonal patterns, we applied time-series analyses to monthly arboviral and respiratory infection case data. We calculated coherence and phase differences for paired time-series to quantify the association between each time series. A viral pathogen was found in 47% of the 14,738 patients. Influenza A virus was the most common pathogen detected (26%). The incidence of Zika and dengue virus etiologies increased with age. Arboviral infections peaked between June and September throughout the times-series. Respiratory infections have seasonal peaks occurring in the fall and winter months of each year, though patterns vary by individual respiratory pathogen. CONCLUSIONS/SIGNIFICANCE: Distinct seasonal patterns and differences in relative frequency by age groups seen in this study can guide clinical and laboratory assessment in pediatric patients with AFI in Puerto Rico.


Assuntos
Dengue/epidemiologia , Febre/epidemiologia , Influenza Humana/epidemiologia , Infecção por Zika virus/epidemiologia , Adolescente , Criança , Pré-Escolar , Dengue/complicações , Febre/virologia , Humanos , Incidência , Lactente , Recém-Nascido , Influenza Humana/complicações , Prevalência , Porto Rico/epidemiologia , Estações do Ano , Infecção por Zika virus/complicações
15.
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
16.
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
17.
JCO Oncol Pract ; 17(2): e168-e177, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33567240

RESUMO

PURPOSE: High-intensity care with undue suffering among patients with cancer at the end of life (EoL) is associated with poor quality of life. We examined the pattern and predictors of high-intensity care among patients with GI cancer in Puerto Rico. METHODS: This population-based study of data from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database examined patients with GI cancer who died between 2009 and 2017. EoL care intensity indicators include the following services in the last month before death: emergency room (ER) visits, hospitalizations, intensive care unit (ICU) admissions, life-extending procedures, death in an acute care setting, and the use of chemotherapy in the last 14 days. We used logistic regression models to examine factors associated with EoL care. RESULTS: Four thousand six hundred twenty-nine patients with GI cancer were included in the analysis. We found that 11.0% of patients received chemotherapy, 17.3% had > 1 hospitalization, 9.3% were in the ICU, 18.0% had > 1 ER visit, 39.3% died in an acute care setting, and 8.6% received life-extending procedures. A compound indicator of the aggressiveness of care showed that 54.5% of patients had at least one of the selected aggressive indicators. The multivariable model showed that female patients, patients ≥ 60 years of age, patients enrolled in Medicaid, patients dually eligible for both Medicare and Medicaid, and patients who survived > 1 year were less likely to receive aggressive EoL care. CONCLUSION: Our findings support the urgent need to improve EoL care in Puerto Rico. Further studies are warranted to fully understand EoL care in patients with cancer in Puerto Rico.


Assuntos
Neoplasias , Assistência Terminal , Idoso , Feminino , Hospitalização , Humanos , Medicare , Neoplasias/terapia , Porto Rico/epidemiologia , Qualidade de Vida , Estados Unidos
18.
Public Health Rep ; 136(3): 354-360, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33596136

RESUMO

OBJECTIVES: Using the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)-associated confirmed and probable deaths in Puerto Rico during March-July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period. METHODS: We described data on COVID-19-associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics. RESULTS: During March-July 2020, 225 COVID-19-associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19-associated deaths could have occurred during the study period, up to 413 more COVID-19-associated deaths than originally reported. CONCLUSIONS: Including probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19-associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.


Assuntos
COVID-19/mortalidade , Monitoramento Epidemiológico , Feminino , Humanos , Masculino , Porto Rico/epidemiologia , SARS-CoV-2
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.
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
COVID-19/mortalidade , Planejamento em Desastres , Pneumonia Viral/mortalidade , Medidas de Segurança , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Porto Rico/epidemiologia , SARS-CoV-2 , Estados Unidos/epidemiologia
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