Refortalecimiento: Beyond Prevention, Empowerment and Intervention in an Impoverish Community in Puerto Rico / Refortalecimiento: Más allá de la prevención, empoderamiento e intervención en una comunidad empobrecida de Puerto Rico

Abstract Refortalecimiento is a strategy for transformation that started with a debate with the empowerment theory. We have been clarifying the notion of refortalecimiento from experiences at communities and academic's scenarios. As a result, we need to re-imagine some of our concepts to address the consequences of inequalities. In this article, we will present some reflections about three concepts: intervention, prevention model, and empowerment theory based in an Intervention-Investigation (I-I) realized in a community with a group of mothers of children with disabilities (diverse abilities) in an impoverish community in Puerto Rico. We confirmed the need to reevaluate the impact of different concepts/perspectives operating within the project that undermine the implementation process. We learned that the beauty of this process resides on the reciprocity and the fortalezas (strengths) that takes place within all the people involved. But we also find out neoliberal values as: individualism, competition, and everyone for themselves presented great obstacles to overcome discrimination and disparities.

Resumen Refortalecimiento es una estrategia de transformación que inició como un debate con la teoría del empoderamiento. Hemos continuado clarificando la noción de refortalecimiento desde experiencias en escenarios comunitarios y aca-démicos. Como resultado, se entendió que es necesario re-imaginar algunos de nuestros conceptos para abordar las consecuencias de las desigualdades. En este artículo, presentaremos algunas reflexiones acerca de tres conceptos: intervención, modelo de prevención y la teoría del empoderamiento basado en una Intervención-Investigación (I-I) realizada con un grupo de madres de ninos y ninas con impedimentos (habilidades diferentes) en una comunidad empobrecida en Puerto Rico. Se confirmó la necesidad de reevaluar el impacto de los diferentes conceptos/perspectivas operando dentro del proyecto que socaban el proceso de implementación. Aprendimos que la belleza de este proceso reside en la reciprocidad y las fortalezas que tienen lugar en todas las personas involucradas. Pero también identificamos que, valores neoliberales, tales como: individualismo, competencia y cada quien para sí mismo, presentan grandes obstáculos para superar la discriminación y las desigualdades.

Esfuerzos realizados en Puerto Rico hacia la consolidación de políticas públicas para la prevención de cánceres asociados al VPH

[RESUMEN]. El propósito de este informe especial es describir cronológicamente los eventos que contribuyeron al desarrollo y aprobación de la legislación e implementación del requisito escolar de vacunación en Puerto Rico (PR), con el fin de prevenir el VPH y los cánceres asociados a este. A partir del 2010, PR inició las aprobaciones de políticas públicas con el objetivo de mejorar el registro de casos de los cánceres y la cobertura de la vacuna contra el VPH a través de los planes médicos en adolescentes de 11 a 18 años. En el 2014, los esfuerzos científicos y comunitarios lograron documentar la magnitud de las enfermedades causadas por el VPH, y desarrollar en conjunto, estrategias de prevención y promoción de la vacuna contra el VPH. En agosto de 2018, PR logró ser uno de los primeros cuatro territorios de los Estados Unidos de América en implementar la vacuna contra el VPH como requisito escolar con el fin de disminuir la incidencia de cánceres asociados al VPH en la isla. En el 2019 se garantizó por ley que todo proveedor de vacunación debe reportar al Registro de Inmunización. El caso de PR demuestra que el desarrollo de políticas públicas junto con colaboraciones entre coaliciones académicas, científicas y comunitarias, logran cambios poblacionales y resultados medibles dirigidos a la prevención de VPH. Países con una problemática de salud pública similar podrían adoptar esfuerzos similares a los presentados, y alinearlos al objetivo de la Organización Mundial de la Salud: erradicación del cáncer cervical para 2030.

[ABSTRACT]. The purpose of this special report is to describe chronologically the events that contributed to the development and approval of legislation and subsequent implementation of a school vaccination mandate in order to prevent HPV and HPV-associated cancers in Puerto Rico (PR). Starting in 2010, PR initiated public policy approvals aimed at improving cancer registries and HPV vaccine coverage through health insurance for adolescents aged 11 to 18 years. In 2014, scientific and community efforts succeeded in documenting the magnitude of morbidity caused by HPV and jointly developing HPV vaccine prevention and promotion strategies. In August 2018, PR became one of the first four territories of the United States of America to implement the HPV vaccine school entry requirement to decrease the incidence of HPV-associated cancers on the island. In 2019, it was enshrined in law that every immunization provider must submit immunization data to the Puerto Rico Immunization Registry. The case of PR demonstrates that public policy-making alongside collaboration between academic, scientific, and community coalitions can achieve population change and measurable outcomes aimed at HPV prevention. Countries with a similar public health problem could adopt efforts similar to those presented herein and align them with the World Health Organization goal of eradicating cervical cancer by 2030.

[RESUMO]. O propósito deste relatório especial é descrever cronologicamente os eventos que contribuíram para o desenvolvimento e a aprovação de legislação, e a implementação da exigência escolar de vacinação em Porto Rico (PR), a fim de prevenir o HPV e os cânceres associados a ele. A partir de 2010, PR iniciou as aprovações de políticas públicas com o objetivo de aprimorar o registro dos casos de câncer e a cobertura vacinal contra o HPV, por meio de planos de saúde, em adolescentes de 11 a 18 anos. Em 2014, esforços científicos e comunitários permitiram documentar a magnitude das doenças causadas pelo HPV e elaborar conjuntamente estratégias de prevenção e promoção da vacina contra o HPV. Em agosto de 2018, PR foi um dos primeiros quatro territórios dos Estados Unidos da América a implementar a vacina contra o HPV como exigência escolar, a fim de diminuir a incidência de cânceres associados ao HPV na ilha. Em 2019 ficou garantido por lei que todos os vacinadores devem enviar informações ao Registro de Imunização. O caso de PR demonstra que o desenvolvimento de políticas públicas, em conjunto com parcerias entre coalizões acadêmicas, científicas e comunitárias, alcança mudanças populacionais e resultados mensuráveis dirigidos à prevenção do HPV. Países com uma problemática de saúde pública similar poderiam adotar esforços semelhantes aos apresentados e alinhá-los ao objetivo da Organização Mundial da Saúde: a erradicação do câncer cervical até 2030.

Socio-demographic, behavioral, and health correlates of nutrition transition dietary indicators in San Juan, Puerto Rico / Correlatos sociodemográficos, conductuales y de salud de los indicadores alimentarios de transición nutricional en San Juan, Puerto Rico

OBJECTIVE: To identify socio-demographic, behavioral, and health-related correlates of food preferences in Puerto Rico that will help determine Caribbean-region populations vulnerable to nutrition transition. METHODS: Data from a cross-sectional study of a representative sample of 858 adults residing in the San Juan Metropolitan Area of Puerto Rico were analyzed. Multivariable ordinal logistic regressions were used to model the frequency of consumption of 1) fruits and vegetables, 2) tubers/starchy root vegetables, 3) fried foods, and 4) Western-style fast foods as a function of socio-demographic, behavioral, and health-related characteristics. RESULTS: Higher frequency of consumption of fruits and vegetables was associated with being physically active and older and having a medium to high level of education, whereas intake of tubers was associated with being older, having a low income, not using government insurance, and having elevated levels of triglycerides. Frequency of consumption of fast food was associated with younger age, higher income, 12-15 years of formal education, and a higher body mass index (BMI), whereas frequency of consumption of fried food was associated with being younger and male, not being a smoker, and having elevated levels of fasting blood glucose. CONCLUSIONS: The results indicate a nutrition transition in Puerto Rico with health consequences for the Caribbean region. The characteristics of this nutrition transition seem to be determined by income, education, and age, but may also be dictated by access to various food groups. These results set the stage for needed investigation of environmental and individual-level factors that could shape patterns in food consumption.

OBJETIVO: Determinar los correlatos sociodemográficos, conductuales y relacionados con la salud de las preferencias alimentarias en Puerto Rico a fin de ayudar a determinar las poblaciones vulnerables con respecto a la transición nutricional en el Caribe. MÉTODOS: Se analizaron datos procedentes de un estudio transversal de una muestra representativa de 858 adultos que residen en el área metropolitana de San Juan, en Puerto Rico. Se usaron regresiones logísticas ordinales con múltiples variables para modelar la frecuencia de consumo de 1) frutas y verduras, 2) tubérculos feculentos, 3) alimentos fritos y 4) comida rápida de estilo occidental, como una función de las características sociodemográficas, conductuales y relacionadas con la salud. RESULTADOS: Se asoció una mayor frecuencia de consumo de frutas y verduras con un comportamiento físicamente activo y mayor edad, al igual que un nivel de escolaridad de medio a alto, mientras que la ingesta de tubérculos se asoció a una edad mayor, ingresos bajos, no usar el seguro del gobierno y niveles elevados de triglicéridos. La frecuencia de consumo de comida rápida se asoció con una edad menor, ingresos más altos, de 12 a 15 años de educación formal y un índice de masa corporal mayor, mientras que la frecuencia del consumo de alimentos fritos se asoció con una edad más joven y el sexo masculino, no fumar y niveles elevados de glucemia en ayunas. CONCLUSIONES: Los resultados indican una transición nutricional en Puerto Rico con consecuencias para la salud en el Caribe. Las características de esta transición nutricional parecen estar determinadas por los ingresos, la escolaridad y la edad, pero también podrían estar determinadas por el acceso a diversos grupos alimentarios. Estos resultados establecen las condiciones necesarias para la investigación de los factores ambientales e individuales que podrían configurar los modelos de consumo de alimentos.

Recruitment of Caribbean female commercial sex workers at high risk of HIV infection / Captación de mujeres profesionales del sexo con alto riesgo de infección por VIH en el Caribe

OBJECTIVE: To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS: A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS: HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8-9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS: This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial.

OBJETIVO: Evaluar nuevos criterios de selección y métodos extrainstitucionales encaminados a detectar y captar a las mujeres con alto riesgo de contraer la infección por virus de la inmunodeficiencia humana (VIH) en el Caribe. MÉTODOS: Del 2009 al 2012, se llevó a cabo un estudio prospectivo de cohortes de 799 mujeres profesionales del sexo en la República Dominicana, Haití y Puerto Rico. Los requisitos mínimos de selección fueron el intercambio de relaciones sexuales por bienes, servicios o dinero en los últimos 6 meses y las relaciones sexuales vaginales o anales sin protección con un hombre durante el mismo período. En cada centro se aplicaron criterios de selección y estrategias de captación más restrictivos, en función de las características epidemiológicas locales. Se formularon a las participantes preguntas acerca de la infección por el VIH/sida y su motivación para participar en un estudio clínico sobre la vacuna contra el VIH. Se usó un modelo de regresión logística con el fin de analizar los factores pronósticos de prevalencia de infección por el VIH y la voluntad de participar en un estudio futuro sobre la vacuna contra el virus. RESULTADOS: La prevalencia de infección por el VIH en el momento del tamizaje fue 4,6%. El consumo de crack se asoció con la infección por el VIH (razón de posibilidades [OR]: 4,2; intervalo de confianza [IC] de 95%: 1,8-9,0) y la práctica de relaciones sexuales con clientes en un hotel o un motel se asoció inversamente con esta infección (OR: 0,5; IC 95%: 0,3-1,0). El 88,9% de las mujeres inscritas manifestó una disposición decidida o probable de participar en un estudio futuro sobre la vacuna contra el VIH. CONCLUSIONES: Los resultados del estudio indican que es posible formular criterios de selección e introducir métodos de captación locales con el propósito de detectar y captar a las mujeres profesionales del sexo, que presentan una prevalencia de infección por el VIH mayor que la población general y manifiestan una buena disposición de participar en un ensayo clínico sobre la vacuna contra el VIH.

Penile Cancer Disparities in Puerto Rican Men as compared to the United States Population

This study compares incidence and mortality of penile cancer in Puerto Rico (PR) with other racial/ethnic groups in the United States (US) and evaluates the extent in which socioeconomic position index (SEP) or its components influence incidence and mortality in PR.

Age-standardized rates were calculated for incidence and mortality based on data from the PR Cancer Registry and the US National Cancer Institute's Surveillance, Epidemiology and End Results program, using the direct method.

PR men had approximately 3-fold higher incidence of penile cancer as compared to non-Hispanic white (Standardized rate ratio [SRR]: 3.33; 95%CI=2.80-3.95). A higher incidence of penile cancer was also reported in PR men as compared to non-Hispanic blacks and Hispanics men. Mortality from penile cancer was also higher for PR men as compared to all other ethnic/racial groups. PR men in the lowest SEP index had 70% higher incidence of penile cancer as compared with those PR men in the highest SEP index. However, the association was marginally significant (SRR: 1.70; 95%CI=0.97, 2.87). Only low educational attainment was statistically associated with higher penile cancer incidence (SRR: 2.18; 95%CI=1.42-3.29).

Although penile cancer is relatively uncommon, our results support significant disparities in the incidence and mortality rates among men in PR. Low educational attainment might influence the high incidence of penile cancer among PR men. Further studies are strongly recommended to explore these disparities. .

Severity of alcohol use and problem behaviors among school-based youths in Puerto Rico / Magnitud del consumo de alcohol y comportamientos problemáticos en jóvenes escolarizados en Puerto Rico

OBJECTIVE: The present study sought to: (a) categorize youths into groups based on their level of alcohol use and number of symptoms of alcohol abuse and dependence defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and (b) examine whether these categories were associated with other problem behaviors in which youths engage (marijuana use, sexual intercourse, and having been arrested or having trouble with the law). METHODS: The study is based on a cross-sectional survey administered to 972 school-based youths from one middle school and one high school in San Juan, Puerto Rico. Youths were categorized based on their alcohol use and alcohol problems. These categories were then examined for associations with lifetime marijuana use, lifetime sexual intercourse, and having been arrested or having had trouble with the law in the past year. The original eight categories of alcohol use were collapsed into six categories based on the results. RESULTS: For virtually every group characterized by higher severity of alcohol use and alcohol problems, researchers found an increasing prevalence of marijuana use in their lifetimes, increasing odds of sexual intercourse in their lifetimes, and having had trouble with the law in the past year. CONCLUSIONS: Knowing about variations in alcohol use and alcohol problems may be instrumental in measuring the degree to which youths may also be engaging in a range of other elevated risk behaviors and a progression to more serious forms of alcohol and drug use.

OBJETIVOS: Se buscó: a) categorizar a los jóvenes según su nivel de consumo de alcohol y el número de síntomas de abuso y dependencia del alcohol definidos en el Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV); y b) analizar si esas categorías están asociadas con otros comportamientos problemáticos de los jóvenes (consumo de marihuana, relaciones sexuales y arrestos o problemas con la ley). MÉTODOS: Estudio transversal basado en una encuesta aplicada a 972 jóvenes que asistían a una escuela secundaria y una preparatoria en San Juan, Puerto Rico. Los jóvenes se categorizaron según el consumo de bebidas alcohólicas y los problemas del alcoholismo. Se buscaron asociaciones entre esas categorías y el consumo de marihuana y las relaciones sexuales -ambas en toda la vida-, así como con los arrestos o problemas con la ley en el año anterior a la encuesta. A partir de los resultados, las ocho categorías iniciales según el consumo de alcohol se reagruparon en seis. RESULTADOS: Prácticamente en todos los grupos caracterizados por un mayor consumo de bebidas alcohólicas y mayores problemas del alcoholismo se observó un aumento en la prevalencia de consumo de marihuana y la probabilidad de haber tenido relaciones sexuales, ambas en toda la vida, así como de haber tenido problemas con la ley durante el año anterior. CONCLUSIONES: Conocer las variaciones en el consumo de bebidas alcohólicas y los problemas del alcoholismo puede servir para medir el grado en que los jóvenes pueden involucrarse en diversos comportamientos de mayor riesgo y avanzar a formas más peligrosas de consumo de alcohol y drogas.

Major histocompatibility complex class II polymorphisms and risk of cervical cancer in Puerto Rican women

Association between HLA antigens and cervical squamous cell carcinoma has been described in several populations. To verify whether HLA-DRB1 and DQB1 diversity is related to cervical cancer in Puerto Rican women, 40 cases and 50 controls were HLA typed. DRB1*16 (POR=2.89) and DRB1*11 (POR=1.74) were positively associated with cervical cancer. A negative association was found with DRB1*01 (POR=0.52), DRB1*04 (POR=0.60), DRB1*14 (POR=0.33), DRB1*15 (POR=0.65), DQB1*04 (POR=0.33), DQB1*05 (POR=0.64) and DQB1*06 (POR=0.65). We suggest that HLA Class H polymorphisms are involved in genetic susceptibility to cervical cancer in Puerto Rican women. These results should be confirmed in studies with larger sample size to preclude the possibility of false positive observations.

Coronary artery abnormalities in Puerto Rico

A retrospective study was done to determine the frequency of coronary artery anomalies in terms of their origin, course, and structure. The clinical history, catheterization data and surgical reports of patients undergoing coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean, from 1999 to 2004, were analyzed. Thirty-eight patients were identified with a coronary artery anomaly in this population. These anomalies were classified according to their clinical consequences and the need for surgical intervention.

Review of clinical characteristics and management of patients with ST segment elevation myocardial infarction at atertiary care center

BACKGROUND: Information from recent multiple trials on the pathophysiology and outcome of ST-segment elevation myocardial infarction (STEMI) has changed its clinical perspective and strategic management, leading to a revision of the 1999 ACC/AHA practice guidelines for that condition. OBJECTIVE: Analyze the clinical characteristics, management strategies, the timing of therapeutic interventions and outcome of patients with STEMI referred to the Cardiovascular Center of Puerto Rico (CVCPR). METHODS: Retrospective review of medical records of all patients admitted to the CVCPR with a diagnosis of STEMI from January 1, 2003 to December 31, 2003. RESULTS: A total of 184 medical records were reviewed. Seventy-six percent of patients were men, mean age was 62.1 +/- 11.8 years. A high prevalence of coronary risk factors was present: systemic hypertension (64), diabetes mellitus (40), dyslipidemia (35), smoking (33) and previous CAD (32). Less than 1/4 of referral forms contained data indicative of whether patients had received antiplatelet therapy, beta-blockers, ACE inhibitors or statins. Fifty percent of patients arrived to the CVCPR more than 48 hours after diagnosis. Only forty-two patients (23) arrived within 12 hours. Thrombolytic therapy had been used in 27of them. 179 (97) patients underwent coronary angiography, 69.2of which had multivessel disease. 114 (62) patients underwent percutaneous coronary interventions (PCI) with stenting. Patients submitted to PCI and stenting of the culprit lesion had a better outcome and survival than the ones not exposed to those procedures (p = 0.02). Approximately two-third of patients received secondary prevention medications upon discharge. CONCLUSIONS: Relevant findings of this review were that in spite of high prevalence of CAD major risk factors, the use of medications of proven benefit for prevention and treatment of CAD at referral centers was less than that recommended by current guidelines, a significant delay in the transfer of patients to the tertiary care facility (in most cases that period exceeded more than 48 hours after diagnosis) and a reduced utilization of thrombolytic therapy. Intensification of the education of physicians throughout the island regarding these matters is to be encouraged. Additional measures should include, development of written protocols at referral centers to assure a more expedite clinical assessment of patients, an enhancement of their capability for utilizing fib

The economic burden of prescription drug use among elderly patients in Ponce, Puerto Rico

OBJECTIVE: To examine the economic impact of prescription drug use on the personal income of elderly individuals in Ponce, Puerto Rico. METHODS: One-hundred elderly individuals who attend five care centers were interviewed using a four-page structured questionnaire. The interview collected information about the source and amount of income of participants, the type of insurance coverage for prescription drugs, the amount of expenditures for prescription drugs that are paid out-of-pocket and the barriers they face to use or obtain prescription drugs. RESULTS: Participants were mostly female (69) and the average age was 77 years. The average monthly income reported was 476 dollars, 79of which was derived from Social Security. The average monthly expenditure was 364.00 dollars of which 117.00 dollars (32) was spent on health related expenditures: 70.00 dollars (19) on prescription drugs, 31.00 dollars (8) on health insurance premiums, 10.00 dollars (3) on medical expenditures not related to prescription drugs, and 6.00 dollars (2) on over-the-counter drugs. The great majority reported having health insurance but one-third pay out-of-pocket for their prescription drugs. Nearly two-thirds expressed they have experienced problems to obtain or use medications in the past six months. Thirty-eight percent reported that the problem was that the cost of medications was too high. CONCLUSION: In spite of insurance coverage, the cost of prescription drugs places a substantial economic burden on elderly individuals. On average, prescription drug expenditures comprise nearly 20of the personal expenditures of respondents, second only to groceries. This accounts for 15of their personal income. The economic burden of prescription drugs on the elderly may affect access to needed drugs and may adversely impact health outcomes.

The prevalence of pit and fissure sealants among twelve year olds living in Puerto Rico during 1997

OBJECTIVE: to estimate the prevalence of pit and fissure sealants on first permanent molars in twelve year olds living in Puerto Rico and to further evaluate dental sealant prevalence by (1) urban/rural and public/private school status as well as (2) gender; DESIGN: population-based, cross-sectional study. SETTING: public and private schools encompassing the 11 health regions of Puerto Rico. Subjects: a probabilistic sample of 12-year old school attendees in Puerto Rico representing a population of approximately 70,000. METHOD: during April through December 1997, the first permanent molars of 1435 subjects were evaluated by visual and tactile methods for the presence of dental sealants. RESULTS: the data collected revealed that 4.3of 12 years olds presented at least one permanent first molar sealed. A statistically significant difference (p = 0.01) between urban-public (2.5), rural-public (3.39) and urban-private (11.0) schools was observed. The prevalence of sealants was higher in males (5.5) than females (2.9); (p = 0.02). CONCLUSIONS: the prevalence of dental sealants in the first permanent molars of 12-year olds living in Puerto Rico during 1997 (4.3) is lower than that reported in the United States (18.5). Sealant prevalence was higher in males and students attending (urban) private schools.

Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) with Puerto Rican elderly

The Beck Depression Inventory-Second Edition (BDI-II; (1) is one of the most useful measures for depressive symptomatology in many countries (2). The psychometric properties of this inventory, however, have not been reported with Puerto Rican elderly. This paper reports, exploratory psychometric results with a sample of 410 elderly Puerto Rican (65 years and older; men=94, women=316). The assessment of the construct validity of the BDI-II yielded four factors accounting for 52of total variance and an internal reliability coefficient (alpha Cronbach) of .89. A factor analysis with the 21 items of the BDI-II was performed using principal component analysis as the extraction method and Varimax rotation. This analysis revealed that the BDI-II was a good measure of the dimensions of depressive symptomatology in the present sample, which resembled prior findings reported with the general Puerto Rican Population (3). This study also reports further data supporting the reliability, validity, and practical utility of the BDI-II for the Puerto Rican population including elders. Implications for potential research with minorities and clinical uses of the BDI-II are also discussed.

Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999

OBJETIVOS: Examinar las asociaciones entre el estado socioeconómico y la aculturación con las características del estilo de vida que podrían constituir factores de riesgo de diabetes y de enfermedades cardiovasculares en mujeres puertorriqueñas de bajos ingresos. MÉTODOS: Este estudio transversal se llevó a cabo entre 1998 y 1999 mediante entrevistas a una muestra de conveniencia compuesta de 200 mujeres puertorriqueñas de bajos ingresos que cuidaban a niños pequeños en Hartford, Connecticut, Estados Unidos de América. Se usaron diversas formas de reclutamiento para conseguir que hubiera una buena representación de la comunidad blanco. Las asociaciones entre la obesidad (índice de masa corporal > 30,0) y factores propios del estilo de vida (actividad física, tabaquismo, consumo de alcohol, alimentación) por un lado y la clase social (escolaridad, empleo, tenencia de un automóvil), aculturación, edad y estado civil por el otro se examinaron mediante la prueba de rho de Spearman, la de ji al cuadrado y la de la U de Mann-Whitney y análisis de regresión logística.RESULTADOS: La edad promedio fue de 29 años. La obesidad (40%), inactividad física (47%) y el tabaquismo (32%) fueron comunes. Las participantes con menos grado de aculturación fueron 57% menos propensas a ser fumadoras y 54% menos propensas a ser obesas que las que estaban más aculturadas. Pertenecer a una clase social más baja (no haber terminado la secundaria o no tener automóvil) se asoció con una mayor probabilidad de ser obesa, pero las mujeres sin trabajo (por oposición a las que sí lo tenían) mostraron menor propensión a ser obesas (P < 0,05). Las mujeres que no tenían automóvil consumían carne, huevos y pescado con menos frecuencia que las que sí lo tenían. Las fumadoras tenían más probabilidad de tener una alimentación malsana que las que no fumaban.CONCLUSIONES: Las asociaciones entre el grado de aculturación y el estado socioeconómico con algunas características del estilo de vida apuntan a la necesidad de crear programas apropiados desde el punto de vista cultural para promover conductas sanas en esta comunidad de bajos ingresos.

Health disparities between island and mainland Puerto Ricans

OBJETIVO: Detectar disparidades de salud entre tres poblaciones: puertorriqueños que viven en Puerto Rico, así como puertorriqueños y personas no hispanas de raza blanca que viven en tierra firme estadounidense. MÉTODOS: Se analizaron los datos obtenidos mediante dos encuestas de similar diseño que se realizaron en 1999–2000. El Sistema de Vigilancia de Factores de Riesgo Conductuales proporcionó datos acerca de los puertorriqueños radicados en la isla y de residentes de Estados Unidos de raza blanca que no son hispanos. Otra encuesta de puertorriqueños radicados en la Ciudad de Nueva York aportó datos acerca de los puertorriqueños que residían en tierra firme estadounidense. Se usaron las razones de las tasas estandarizadas (standardized rate ratios, SRR) para hacer las comparaciones interpoblacionales de las prevalencias ponderadas, estandarizadas por edad y sexo, de varios parámetros (obesidad, diabetes, tabaquismo y dolencias físicas) y de indicadores de acceso a la atención sanitaria (frecuencia de los exámenes de rutina y de la atención de la diabetes). RESULTADOS: Los puertorriqueños que vivían en tierra firme estadounidense y los que vivían en la isla tuvieron una prevalencia de obesidad parecida (21% a 22%). Comparados con los habitantes de la isla, los puertorriqueños radicados en tierra firme tuvieron una prevalencia de diabetes más alta (SRR = 1,4; intervalo de confianza de 95% [IC95%]: 1,01 a 2,0); los que tenían diabetes también mostraron una mayor prevalencia de tabaquismo (SRR = 4,2; IC 95%: 2,3 a 7,7) y de dolencias físicas (SRR = 1,5%; IC95%: 1,1 a 2,0) que los puertorriqueños que vivían en la isla. Mientras que los puertorriqueños en tierra firme se asemejaron a los blancos que no eran hispanos en cuanto a la utilización de servicios de prevención primaria y de atención de la diabetes, los puertorriqueños en la isla tenían cifras de utilización mucho más bajas...

Programa de inmunización contra la influenza para adultos de 65 años o más en una farmacia de comunidad en Puerto Rico / Immunization program against influenza for adults 65 years or older at a community pharmacy in Puerto Rico

Evaluate the educational needs of adults over 65 years or more with regards to the vaccine, vaccination and immunization against the influenza, design strategies to assist the educational needs and implant and evaluate an immunization program at an independent community pharmacy. A study divided into three phases: Phase I--evaluation of the educational needs related to the vaccine, vaccination and immunization. Phase II--designing of strategies to assist the needs. Phase III--a random longitudinal controlled study to evaluate an immunization program against the influenza implanted at an independent community pharmacy. One hundred (100) patients participated, randomly assigned to a controlled and experimental group. Three months into the study's Phase III, a 68of the experimental group had been vaccinated and showed a tendency to improvement in knowledge; in the controlled group, a 32had been vaccinated and did not show a tendency in improvement of knowledge. A year into the study's Phase III, a 76of the experimental group had been vaccinated and 24of the controlled group was vaccinated. The satisfaction average of the experimental group towards the pharmacist was 3.94 +/- 0.18 and, in the controlled group was 3.98 +/- 0.20, whiting a scale of 0-04. People who participated in an educational activity offered by a pharmacist showed: more knowledge, remembered what they learned and an increase in influenza vaccination.