Puerto Rico health sciences journal最新文献

Malaria is a parasitic disease common in many regions of the world. Cerebral malaria can cause cortical, cerebellar, and pontine infarctions. Although callosal ischemia (CI) due to diabetes mellitus, hypertension, hyperlipidemia and postoperative factors have been described in the literature, isolated CI due to malaria is very rare. We present a patient with isolated corpus callosum ischemia-an unusual complication of cerebral malaria-a case that we believe will contribute to the literature since the woman is 23 years old and has no comorbidities.

Objective: The aim of this study was to evaluate the effect of foot self massage on peripheral neuropathic pain, peripheral skin temperature and patient comfort in individuals with diabetes.

Methods: The sample of the study consisted of 52 individuals with type 2 diabetes (26 self foot massage group and 26 control group) between August 2021 and July 2022. Individuals in the foot self-massage group performed a foot massage for 30 minutes (15 minutes for each foot) three times a week for four weeks after training. Data were collected using an Individual Description Form, a Visual Analog Scale (VAS), the DN4 Pain Questionnaire and the General Comfort Scale-Short Form and peripheral skin temperature was measured. The data were evaluated using the Independent Sample-t test, Paired Sample-t test, Mann-Whitney U test, and Wilcoxon test. Continuity correction and Pearson-χ2 (chi-square) tests were used to compare categorical variables.

Results: In this study, it was found that foot self-massage did not affect the peripheral neuropathic pain level of the patients, but the mean pain (VAS) scores of the patients in the foot massage group significantly decreased compared to the patients in the control groups. In addition, it was found that foot self-massage did not affect patients' peripheral skin temperature and patient comfort.

Conclusion: It is recommended that foot massage, which can be applied by itself without time and place restrictions, be learned by patients and supported by health professionals because it is easy to apply, practical and economical.

Objective: This study examined how the COVID-19 pandemic contributed to food insecurity in households in Puerto Rico with children with disabilities, compared to households with children without disabilities.

Methods: The present study used a 2-group, cross-sectional design. Participants were interviewed once to describe experiences of food insecurity during the 12 months before the COVID-19 pandemic and again during the pandemic lockdown. In addition, demographic characteristics and mental and physical health were assessed.

Results: Before the COVID-19 pandemic, food insecurity in Puerto Rico was significantly higher in households with children with disabilities (n = 48) than in households with children without disabilities (n = 49) (P < .001). During the COVID-19 pandemic, this difference remained (P = .029). Food insecurity was higher before the pandemic among children in households with children with disabilities (odds ratio [OR]: 3.62; 95% CI:1.19-11.05), and in households overall (OR: 4.72; 95% CI: 1.83 12.14), when assessing adults and children in the same household. This was also true during the pandemic for households overall (OR: 2.54; 95% CI: 1.09-5.96), but to a lesser degree. Food insecurity was not statistically significant in children during the pandemic (OR: 2.56; 95% CI: 0.97-6.74). In both types of households, physical and mental health scores were more than 1 standard deviation below the United States mean.

Conclusion: Both types of households experienced food insecurity during the pandemic. No relationship between food insecurity, disability, and health status was observed in the study sample. All the participants reported low physical and mental health.

This study aimed to evaluate implant outcomes, including success or survival, complications, and marginal bone loss (MBL), in randomized controlled trials (RCTs), comparing short versus long implants with sinus augmentation (SA) after 5 or more years of loading. The objective was to update the qualitative and quantitative evidence on this topic and provide a comprehensive analysis of the previously identified implant outcomes. Electronic searches were conducted in 4 scientific databases from 2016 through 2024. Only RCTs with a minimum follow-up period of 5 years were included (7 studies); these were rated using the revised Cochrane risk-of-bias (RoB 2) tool for main outcomes. The overall risk of bias was "High" in 5 studies, whereas 2 studies were rated as "Some concerns." The risk ratio (RR) and 95% confidence interval (CI) were calculated with Stata software, version 18, for implant success and survival (2.37; 95% CI: 0.83-6.78, P = .11) and for implant complications (0.88; 95% CI: 0.64-1.21, P = .43). The Cohen's d for MBL was -0.41 mm (95% CI: -0.72 to -0.09, P = .01). There was no statistically significant difference in implant success and survival between short and long implants with SA (P = .60). Due to the overall high risk of bias, no definitive conclusions can be drawn regarding the success or survival of short versus long implants. Further RCTs with clear descriptions of implant outcomes, rigorous standardization and calibration protocols, meticulous sample-size calculation, and extended follow-up periods are needed.

Objective: The objectives of this report were to 1) describe the 2015 and 2020 physical activity (PA) Country Cards of Puerto Rico (PR), including data beyond the 2020 Country Card, and 2) propose recommendations for promoting PA research, surveillance, and policy development.

Methods: A comparison of the 2015 and 2020 data from the PR Country Cards provided by the Global Observatory for Physical Activity (GoPA!) was conducted. Country Card data were collected from the World Bank, the United Nations, PubMed, and the Behavioral Risk Factor Surveillance Survey (BRFSS). This ensured that data indicators were standardized for global comparability. Local representatives facilitated data collection through a collaborative review process with GoPA! Country Card data included demographic characteristics, mortality rates, PA prevalence, surveillance data, policy, and research indicators.

Results: In 2015, the BRFSS data indicated a PA prevalence of 34% in PR, decreasing to 20% in 2020. No data on inactivity-related mortality or a national standalone plan focused on PA was available. From 2015 to 2020, research output in PR increased slightly, improving its global ranking from the 61st to the 58th position.

Conclusion: The PR Country Card is a tool to raise awareness and identify surveillance, research, and policy gaps. Recommendations include establishing a dedicated PR health monitoring system, integrating PA into PR national public health plans, and establishing an interinstitutional coalition for PA research (in PR). Multi-sector efforts from policymakers, researchers, and stakeholders are essential for meaningful progress in improving PA levels and public health in PR.

Objective: To investigate the relationships between pediatric neuroblastoma outcomes, tumor ploidy, and ethnicity, focusing on disparities in overall survival (OS) while also accounting for race and ethnicity.

Methods: Clinical and tumor ploidy data for 63 Hispanic White, 561 non-Hispanic White, and 86 non-Hispanic Black patients were obtained from cBioPortal for Cancer Genomics (TARGET [Therapeutically Applicable Research to Generate Effective Treatments], 2018). Kaplan Meier survival curves were analyzed using log-rank and Gehan-Breslow Wilcoxon tests. Hazard ratios (HR) with 95% CIs were calculated using the Mantel-Haenszel method. Associations between ethnicity and tumor ploidy were assessed using the chi-square test.

Results: Significant differences in overall survival (OS) were observed between White patients who self-identified as Hispanic and those who identified as non Hispanic, with Hispanic patients exhibiting worse outcomes. (P = .0076, HR = 1.907, 95% CI: 1.187-3.062). Median survival for Hispanic patients was 94 months but was undefined for non-Hispanic patients. Diploid tumors were associated with worse outcomes than hyperdiploid tumors were (P < .0001, HR = 2.291, 95% CI: 1.689-3.109). The chi square test revealed a significant association between ethnicity and tumor ploidy (χ2 = 4.220, P = .0400), with non-Hispanic patients having a higher proportion of hyperdiploid tumors (66.99%) than Hispanic patients (53.97%).

Conclusion: Hispanic White patients with neuroblastoma had lower OS than did non-Hispanic White patients, partly due to the former having a higher proportion of diploid tumors. These findings highlight the importance of considering ethnicity and tumor ploidy in risk stratification and treatment strategies.

Objective: A study was conducted to evaluate the mental health status and access to essential resources in a sample of schoolteachers impacted by earthquakes and the COVID-19 pandemic in Southwestern Puerto Rico.

Methods: From November 2020 through September 2021, an online survey was administered to schoolteachers working in municipalities listed in the Federal Emergency Management Agency earthquake disaster declaration. The prevalences of post-traumatic stress disorder (PTSD), anxiety, and depression were calculated based on scores from the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) (PCL-5), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the Center for Epidemiologic Studies-Depression (CES-D-7) scale, respectively.

Results: Most of the teachers in the sample (N = 58) reported serving students of low socioeconomic status (93.1%). Forty-eight percent (48.3%) reported having trouble making necessary home repairs, and 32.8%, accessing medical care. Twenty-one percent (20.7%) of the teachers met the clinical cutoff for PTSD, and 12.1% scored within the range of severe anxiety. Twenty-four percent (24.1%) of the teachers obtained scores indicative of depression.

Conclusion: The survey findings highlight the need to provide mental health services to schoolteachers in the aftermath of a natural disaster in Puerto Rico.

Objective: Effective coping with the physical and mental changes experienced after traumatic injury decreases stress, reduces complications, and promotes healing. Although there are many studies of coping in medical patients, there is little research concerning the coping styles of patients hospitalized in trauma units. This study aimed to achieve two main objectives: (1) adapt the Vignette Similarity Rating Method for implementation in a Puerto Rican trauma unit, and (2) describe the coping styles of patients admitted to the unit, exploring their association with sociodemographic, clinical, and situational factors.

Methods: Patients hospitalized in a trauma unit were recruited. Nine patients participated in the adaptation process (33% women, 67% men; mean age 37.75), while in the coping assessment phase 43 patients were included (41.9% women, 58.1% men; mean age 39.5). The culturally and contextually adapted Vignette Similarity Rating Method was employed to depict and evaluate coping strategies. Associations between two adaptive coping styles, three less adaptive coping styles, sociodemographic and clinical characteristics of the participants, and length of hospital stay were determined.

Results: Participants reported a higher level of similarity with adaptive coping vignettes (median=18.0), followed by active coping vignettes (median=14.0). Individuals living with diabetes (p = .006) and those experiencing longer hospital stays (p = .018) reported a greater similarity to less effective Type A coping vignettes.

Conclusion: These findings emphasize the importance of considering the effectiveness of coping styles within specific contexts and to developing interventions that promote adaptive coping strategies, especially for patients facing prolonged hospitalization.

Objective: Acute kidney injury (AKI) is a complication following heart surgery that is associated with increased morbidity and mortality. Fenoldopam is a dopaminergic receptor agonist that has been successful in the prevention of cardiac surgery-associated AKI. We hypothesized that fenoldopam started preoperatively would reduce the risk of AKI in patients with chronic kidney disease (CKD), stage 3 or higher.

Methods: We conducted a retrospective study of adult patients admitted from 2015 to 2019 for cardiac surgery requiring cardiopulmonary bypass (CPB). Fenoldopam was started in the operating room 1 to 2 hours before the procedure and continued for up to 16 hours post-CPB at a rate of 0.3 mcg/kg/min. The primary outcome was the incidence of postoperative AKI with or without fenoldopam.

Discussion: A total of 203 patients with CKD stage 3 or higher were examined in this study, 35.5% of whom received fenoldopam. Of the patients who received fenoldopam, 41.67% developed AKI compared to 38.17% of those without fenoldopam. Being female had a small protective effect against AKI (OR 0.233, CI 0.108-0.502), as did having an adequate hematocrit level prior to surgery (OR 0.921, CI 0.871-0.974). Analysis revealed that a hematocrit level of 37.18% indicated anemia in the study population.

Conclusions: While the administration of fenoldopam prior to CPB in patients with CKD stage 3 or higher did not significantly reduce AKI after cardiac surgery or significantly reduce length of stay, possible renal protective properties were identified. Being female and having an adequate preoperative hematocrit level were identified as possible investigative points for future studies.

Objective: This study aimed to explore the stressors faced by breast and colorectal cancer patients following Hurricanes Irma and María in Puerto Rico and to evaluate their association with post-hurricane psychological distress.

Methods: A telephone-based survey was conducted with 241 cancer patients (140 with breast cancer and 101 with colorectal cancer) aged ≥40 years, diagnosed at least six months before September 2017, and undergoing treatment at the time of the hurricanes. Data on traumatic stressors (e.g., experiences directly related to life-threatening situations), non-traumatic stressors (e.g., difficulties accessing basic needs), and psychological distress (measured using the Kessler 6-item Psychological Distress Scale) were collected. Poisson regression estimated the prevalence ratio (PR, 95% CI) for psychological distress according to hurricane-related stressors, adjusting for age, cancer type, pre-hurricane preparedness, and social support.

Results: Nearly 25% of participants faced traumatic stressors, 57.5% were exposed to nontraumatic stressors, and 45.6% presented elevated psychological distress. Those who faced traumatic and nontraumatic stressors demonstrated elevated psychological distress compared to their counterparts (PR=1.73, 95% CI=1.36, 2.20; PR=1.69, 95% CI=1.21, 2.35; respectively) after adjusting for age, cancer type, pre-hurricane preparedness, and social support.

Conclusion: Breast and colorectal cancer patients experienced heightened psychological distress due to exposure to various hurricane-related stressors. It is crucial to prioritize an action plan that addresses disaster preparedness, response, and the mental well-being of vulnerable populations like cancer patients to enhance their overall health and resilience.