Puerto Rico health sciences journal最新文献

Objective: To evaluate perceived stress and burnout among community pharmacists and to explore their coping mechanisms and perceived contributions.

Methods: A cross-sectional study among pharmacists in Puerto Rico was conducted during the COVID-19 Pandemic using Cohen's 10-item Perceived Stress Scale and the Oldenburg Burnout Inventory. Open-ended questions explored pharmacists' contributions and coping mechanisms. The survey was distributed via the Puerto Rico Pharmacist Association listserv, social media, and professional chats.

Results: A total of 193 pharmacists were included in the analysis. Eighty-five responded to the open-ended questions, and 150 responded to the 2 scales. Most of the participants were women (82%) with a mean age of 45 years. The mean perceived stress score was 22.0 ± 6.6, indicating moderate stress levels. While 46.7% exhibited moderate burnout, 25.3% showed high burnout. Female pharmacists had higher stress than male pharmacists (22.61 vs. 18.56, P < .05). Pharmacists working in chain pharmacies had higher stress and burnout levels compared to those working in independent pharmacies (24.40 vs. 20.48 and 46.87 vs. 40.24, respectively; P < .05). Pharmacists' greatest contributions during the pandemic were ensuring continuity of care and providing pharmaceutical services and education. Although they experienced a sense of underappreciation, coping mechanisms and institutional adaptation strategies helped them overcome the broader challenges of the pandemic.

Conclusion: Community pharmacists, particularly those in chain pharmacies and those who were female, reported moderate stress and moderate-high burnout. It is necessary to explore the reasons for these disparities. This study highlights the importance of allocating resources to improve and protect the wellbeing of pharmacists.

Objective: The objectives of this study were: 1) to describe and evaluate associations between grip strength, and anthropometric characteristics in pediatric patients with obesity and insulin resistance (IR), and 2) to compare IR using the HOMA-IR model and fasting insulin level.

Methods: Secondary data analysis was conducted using results from 41 children and adolescents with obesity and IR (18 boys and 23 girls, mean age: 14.4 ± 3.1 years) enrolled in a clinically supervised weight management program. Independent t-tests were conducted to detect sex differences, and correlation analyses to determine associations between variables.

Results: Mean body mass index (BMI) was above the 99th percentile, with 109.6±19.7 cm waist circumference, 45.6±6.7% body fat, 59.9±15.7 kg lean mass, 91.8±8.9 mg/dL fasting glucose, 36.9±31.5 μU/m fasting insulin, 8.6±1.2 HOMA-IR, and 30.2±9.0 kg grip strength. Boys had greater height, fasting glucose, and lean mass compared to girls. There was a significantly high correlation (r=0.98, P<0.0001) between fasting insulin and HOMA-IR. Grip strength was not associated with insulin and HOMA-IR. However, grip strength relative to lean mass inversely correlated with waist circumference, percent body fat, and BMI percentile.

Conclusion: Fasting insulin and HOMA-IR do not appear to influence grip strength in the group of children and adolescents with obesity and IR in this study. However, grip strength was significantly influenced by anthropometric characteristics. The use of a fasting insulin cutoff at or above 12 μU/mL appears appropriate to detect insulin resistance in this pediatric group.

Previous research has shown that, during both climate and non-climate disasters-such as hurricanes, the COVID-19 pandemic, and other climate-related crises-and despite political control from the mainland United States, mutual aid organizations in Puerto Rico have played a central role in supporting community health and advancing food sovereignty. However, this research has largely focused on urban contexts and post-disaster recovery. The present study examined how mutual aid organizations in rural Puerto Rico contribute to food sovereignty through their everyday practices and beyond periods of disaster. Semistructured interviews were conducted with representatives from 5 mutual aid organizations serving rural municipalities across the island. The study findings identified 3 core themes that reflect how mutual aid organizations in rural Puerto Rico advance food sovereignty. The results suggest that mutual aid serves as a critical mechanism for decolonizing Puerto Rico's food system, emphasizing local leadership and community-based strategies for sustainable self-determination.

Objective: To identify how healthcare workers experienced work related distress during compound disasters in Puerto Rico.

Methods: Over three weeks, a research team composed of ten undergraduate students and three faculty visited eight healthcare sites in Puerto Rico. The team utilized rapid qualitative methods by conducting observations, informal interviews, and two focus groups. Data were documented in notes and analyzed via a shared RREAL table, where the team collaboratively organized, recategorized, and reviewed the findings.

Results: Participants reported symptoms such as physical tiredness, emotional exhaustion and frustration. High levels of compassion were also present. Researchers apply the concepts of burnout and moral injury to understand how eroding conditions and prolonged disasters produce these emotional conflicts. Moral distress arose when professionals could not meet patients' needs due to a lack of providers, limited resources, and a fragmented healthcare system. Additionally, health care workers experienced conflicts between their work and family roles. We argue that strong connections to their communities and patients foster resilience in healthcare workers and protect against the full range of burnout symptoms. However, these strong community connections can also give rise to moral injury.

Conclusion: Burnout and moral injury coexist in healthcare professionals when they cannot provide the best patient care due to obstacles created by prolonged compound disasters and a broken healthcare system.

Objective: This retrospective analysis aimed to assess compliance with the diabetes mellitus (DM) treatment guidelines published by the American Diabetes Association and the Centers for Medicare and Medicaid Services (United States) among Puerto Rican patients enrolled in Medicaid.

Methods: In this retrospective analysis of 2019 encounter data, we identified 128,065 patients with a diagnosis of type 1 or type 2 DM. The initial population of patients was assessed based on criteria including sex, age, insurance provider, type of medical provider (primary care or specialist), type of procedures and medical complications.

Results: Of the 128, 065 detected patients, only 44.4% had been seen by a primary care provider. Among all these patients, 4,346 (3.4%) were aged 0-18 years and had type 2 DM. Only 4.1% of the patients had been evaluated by an endocrinologist, and 1.3% by a nephrologist. Moreover, only 48% of the patients had an A1C test performed at least once in 2019; 26% had had a test for microalbumin determination; and 44% had undergone an estimated glomerular filtration rate assessment (as part of a comprehensive metabolic panel). Tests for the early detection of eye and kidney complications were very infrequently conducted. Individual health insurers showed similar levels of (low) compliance with the national recommendations for DM management.

Conclusion: Limited patient and physician engagement are 2 primary factors contributing to poor adherence to national diabetes care guidelines among Medicaid patients in Puerto Rico. This lack of adherence can lead to an increase in patient mortality (diabetes is the third highest cause of mortality in Puerto Rico) and morbidity from both macro- and microvascular complications.

Objective: S. pneumoniae infections remain a significant cause of morbidity and mortality despite vaccine availability. Limited information exists about current pneumococcal serotypes transmission in Puerto Rico. Our study aimed to describe the serotype distribution of S. pneumoniae isolates in Puerto Rico and its patients' demographic characteristics.

Methods: This prospective laboratory-based observational study from 25 hospitals in Puerto Rico (April 2021-July 2023) collected specimens positive for S. pneumoniae and serotyped them using the Pneumotest-Latex assay and the Quellung reaction tests. A summary of the distribution of S. pneumoniae isolates is presented.

Results: Nineteen specimens were received from sterile (8/19, 42.1%), and non-sterile sites (11/19, 57.9%). All sterile specimens were isolated from blood samples. Most specimens came from male patients (16/19, 84.2%), the median age was 67 years (range: 8 months to 87 years) and came from different geographic regions. Thirteen serotypes were identified: 3 ( two patients), 6A (two patients), 11C, 11D, 15A, 15C, 19A (two patients), 19B, 19C (two patients ), 19F (two patients ), 22A, 34 (two patients ), and 35. Of these, nine (69.2%) were not covered in PPSV23 and PCV13 (available vaccines being used prior and by the time of specimen collection period), three (23%) were covered by both PPSV23, and PCV13, and one (8%) by PCV13 only.

Conclusion: Our findings highlight the importance of continuous surveillance to detect early serotype changes, ongoing vaccination to avoid preventable infections and complications, and pursuing new higher-valency vaccines with broad serotype coverage to address the evolving pneumococcal disease epidemiology.

Objective: Examining whether gut microbial taxa abundances and predicted functional pathways correlate with dietary quality scores at the end of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer (RC); identifying differentially abundant bacterial species from the pantothenate and acetyl-coenzyme A biosynthesis pathways that differ among dietary quality groups in a subset of participants.

Methods: RC patients (n = 30) provided stool samples for 16S rRNA gene sequencing. To validate pathway predictions from the 16S rRNA gene data, stool samples from a subset of 17 participants underwent shallow shotgun metagenomics sequencing (SMS). Dietary quality was calculated using the Prime Diet Quality Score (PDQS; 24-hour recall). 16S rRNA gene data were analyzed using QIIME2, and SMS data were analyzed using HUMAnN2.

Results: At the genus level, Parvimonas, Caproiciproducens, and uncultured Eggerthellaceae abundances positively correlated (Spearman's rho = 0.36 to 0.50) with PDQS scores, whereas abundances of Prevotella, Rothia, Peptostreptococcus, Paeniclostridium, Enterococcus, and Howardella correlated negatively (Spearman's rho = -0.43 to 0.36). Predicted pathways, including those related to B-vitamin biosynthesis and enzyme cofactor biosynthesis (e.g., B5/pantothenate [phosphopantothenate biosynthesis I]), were correlated with higher PDQS scores. Mean abundances of species predicted to encode the vitamin B5-CoA pathway were greater in the high- diet-quality group.

Conclusion: Findings suggest important associations between the taxa abundances of gut bacteria and the abundances of predicted B-vitamin biosynthesis pathways and dietary quality at the end of nCRT. Three bacterial species encoding vitamin B5-CoA biosynthesis pathways were prominent in high-dietaryquality participants.

Objective: Infants with Down syndrome present multiple challenges that can affect growth and development, among them feeding, difficulties that arise in the early days after birth. We aimed to describe the sucking patterns of infants with Down syndrome in the neonatal intensive care unit (NICU).

Methods: We reviewed the medical records of infants with Down syndrome admitted (2012-2022) to the University Pediatric Hospital NICU in San Juan, Puerto Rico, who were evaluated with a clinical swallow examination and the Neonatal Oral-Motor Assessment Scale (NOMAS).

Results: The study included 29 infants. The median gestational age was 38 weeks, and the median birth weight was 2650 grams. Generalized low muscle tone was identified in 81% of the infants. Sucking patterns were classified as disorganized (41%), dysfunctional (52%), and mature (7%). Only 8% of term infants had mature sucking. The clinical signs of swallow dysfunction included reduced oxygen saturation (20%), mottling (50%), interference with the gag reflex (31%), stridor (40%), and wet or gurgly breathing (75%).

Conclusion: Mature sucking skills are expected in term infants. However, our sample of term infants with Down syndrome had a high prevalence of dysfunctional sucking. Neonates with congenital anomalies associated with hypotonia require a formal assessment with a clinical tool to determine their readiness for oral feeding and may require a complete evaluation of feeding and swallowing for the diagnosis and monitoring of swallowing dysfunction. These assessments will form the basis for the design of evidence-based interventions and may yield valuable information regarding neurodevelopmental outcomes.

Objective: Puerto Rico has had an alarming increase in opioid distribution, overdose, and opioid-related deaths in the last 2 decades. It is crucial to analyze both the effects of naloxone on mortality in opioidoverdose cases and the current trends in naloxone administration to implement strategies to reduce deaths from opioid-related overdoses.

Methods: This retrospective study analyzed opioid overdoses and naloxone administration in Puerto Rico from 2019 to 2023. The data was obtained from the Puerto Rico Mental Health and Anti-Addiction Services Administration and included findings on the spatial and temporal patterns of naloxone administration and a demographic description of the affected populations. Additionally, the study provided an overview of naloxone's role in fatality reduction in cases of opioid overdose.

Results: The key findings indicate a higher prevalence of naloxone administration in public spaces, with peaks occurring during afternoon hours; middle-aged men were the predominant group experiencing opioid overdoses. Additionally, the results demonstrated significantly higher mortality among individuals who did not receive naloxone. Those who received a single dose had a survival rate of 76%, compared to 56% for those who received no naloxone. Furthermore, individuals who received multiple doses of naloxone had an even higher probability of survival.

Conclusion: The findings present an effective approach to enhance the targeted geographic distribution of naloxone. Our findings indicated that increasing access to naloxone and strengthening overall community engagement could contribute to mitigating the ongoing public health crisis in Puerto Rico.

Objective: To estimate the prevalence of skeletal anteroposterior malocclusions and their associated components in orthodontic patients living in Puerto Rico.

Methods: A cross-sectional study was conducted with 50 normodivergent patients (cervical vertebral maturation stages 4-6) from the Orthodontic Graduate Program (2012-2014) of the University of Puerto Rico, Medical Sciences Campus. A calibrated examiner obtained five measurements (Frankfort Horizontal-Sella-Nasion, Sella-Nasion-Gonion-Gnathion, Sella-Nasion-A point, Sella-Nasion-B point, and A point-Nasion-B point) from patients' initial cephalometric x-rays using Dolphin Imaging software, version 11.7, to determine the presence and distribution of skeletal jaw discrepancies. Sex-based differences were explored using the Mann-Whitney and Fisher's exact tests. P < .05 was considered statistically significant.

Results: The prevalence of skeletal discrepancies was 78%. The most common skeletal malocclusion was Class II (54%), followed by Class I (34%) and Class III (12%). Class II malocclusions were associated with maxillary prognathism (59%), whereas Class III malocclusions were attributed to mandibular prognathism (83%). Most Class I patients did not present a discrepancy (65%); however, we observed bimaxillary prognathism in 24% of Class I patients, and a low position of Sella was detected in 54% of the sample. No significant sex-based differences were observed in the five cephalometric x-ray measurements (P > .05).

Conclusion: A high percentage of patients presented with a skeletal malocclusion. Class II skeletal malocclusions due to maxillary prognathism predominated; no sex-based differences were found for skeletal jaw discrepancies; a low Sella position was frequently observed.