Puerto Rico health sciences journal最新文献

Extranodal NK/T-cell lymphoma (ENKTL), nasal type and aggressive NK cell leukemia are rare in Western World been less than 1% in USA to 8% in Asia among Non-Hodgkin's lymphomas. It is aggressive, with poor outcome and optimal treatment is unclear. A combination therapy that includes Peg-Asparaginase (SMILE) has been employed in young patients. An 85-year-old Puerto Rican male presented with anorexia, epistaxis, vertigo and involuntary facial movements. He was treated with injectable Onabotulinum toxin A due to suspicion of a hemifacial spasm. However, a CT scan demonstrated a left maxillary sinus lesion extending into the left middle turbinate with biopsy consistent with ENKTL. We adjusted therapy to patient's age and performance receiving Gemcitabine-Oxaliplatin (Gemox) with radiation obtaining a complete response with persistent negative Epstein Barr DNA titers. ENKTL is a rare disease initially misdiagnosed in our elderly patient, who demonstrated adequate response with a modified therapeutic regime.

Objective: There is no Spanish-language instrument for assessing the self-management strategies used by older adults with physical function disabilities to manage the difficulties that can occur in daily living activities. This study aimed to design and test the content validity of a Spanish version of the newly developed Self-Management of Function in Daily Living Activities Questionnaire (SF-DLAQ).

Methods: A methodological study, guided by the Person-Environment-Occupation-Performance (PEOP) model, was conducted to develop the SF-DLAQ. Stage 1 focused on designing the questionnaire, doing so using qualitative data obtained from 24 older adults and obtained from 10 existing scales that measure the self-management of chronic conditions. Stage 2 focused on expert judgement, which consisted of validating the questionnaire with 8 experts in aging using an item-level content validity index (I-CVI), a scale-level CVI (S-CVI), and the kappa statistic.

Results: All the scores that were attained in stage 2 were favorable, with those of the I-CVI for clarity ranging from 0.09 to 1.0 and those of the I-CVI for relevancy, the S-CVI, and the kappa all being 1.0.

Conclusion: The scale and item validity for the SF-DLAQ, Spanish version, has been demonstrated but should be confirmed with further testing.

Objective: The primary aim of this cross-sectional study was to assess, according to previous cancer diagnosis, the knowledge Puerto Rican women have on the link between obesity-endometrial, -breast, and colon cancer, and determine women's most common source for medical information.

Methods: In this cross-sectional study, eligible female patients (n=234) from the Gynecology and Gynecology-Oncology Clinics completed a self-administered survey from October 2014 to March 2016. Participants were evaluated on sociodemographic, body mass index, knowledge of the obesity-cancer link, and source of medical information.

Results: About 49% and 31% of women in the study were obese and overweight, respectively. Less than 52% of the women knew about the link between obesity-breast,-colon, and/or -endometrial cancers. Women with previous cancer diagnoses were more likely aware of the association between obesity-colon cancer than women without previous cancer diagnoses (58% vs. 44%, p0.05). Higher incomes showed increased odds for the knowledge obesity-cancer link among women with a cancer history, but the odds decreased for women without previous cancer diagnoses (p>0.05). Higher education showed a trend towards a better knowledge of the obesity-cancer association. The most common sources of information were the primary doctor (80%) and the internet (54%).

Conclusion: Counseling about preventable cancer risk factors through primary care to all women must be encouraged especially in young healthy females. Further studies should address qualitative aspects of the odds differences in the obesity-cancer link knowledge observed between income categories for women with/without previous cancer diagnoses.

Objective: According to the literature, depression and tobacco use are closely linked. This study's main objectives were to provide the first population-based epidemiological profile of smokers with depression (SWD) who were 18 years and older and living in Puerto Rico (PR) from 2018 to 2020 and identify any statistically significant differences between SWD and smokers without depression (SWOD).

Methods: A descriptive cross-sectional study was carried out using PR Behavioral Risk Factor Surveillance System (PRBRFSS) data (2018-2020). Univariate analysis was performed to obtain an epidemiological profile of smokers who had depression. Likewise, using bivariate analysis, SWD and SWOD were compared to identify statistically significant differences in terms of chronic conditions, risk factors, and quit attempts.

Results: Depression prevalence among smokers 18 years and over in PR from 2018-2020 was 23.7%. Smokers with depression were more likely to be physically inactive (P < .001), overweight or obese (P < .001), have arthritis (P < .001), chronic obstructive pulmonary disease (P < .001), asthma (P < .001), high cholesterol (P < .001), hypertension (P < .001), coronary heart disease (P < .001), diabetes (P < .001), stroke (P < .001), and heart attack (P < .001) compared with SWOD. Likewise, SWD made more quitting attempts in the past year than did SWOD (P < .001).

Conclusion: Our results indicate that SWD should be targeted in any health-based tobacco-control efforts to develop evidence-based strategies to reduce or eliminate tobacco use in this same population.

Enterocutaneous fistulas can present with significant morbidity and mortality for affected patients, as the abnormal connection can result in exorbitant loss of enteral fluids, electrolyte disturbances, and sepsis, among other complications. We present a patient with a chronic complex enterocutaneous fistula who underwent several surgeries, resulting in a considerable amount of bowel resection. Based on history and findings of high output fistula with diverting transverse colostomy, the fistula was closed with a left rectus myocutaneous pedicle flap to avoid entering the abdominal cavity and prevent the possibility of short bowel syndrome. This case contributes to the growing body of literature supporting the use of rectus myocutaneous flaps for the closure of intractable complex enterocutaneous fistulas in patients unable to undergo resection of the affected bowel.

Objective: Migration of physicians in Puerto Rico makes it difficult to obtain specialized care for Alzheimer's disease and related dementias (ADRD). Primary care physicians (PCPs) can fill this gap, but there is limited information on how their beliefs and behaviors towards ADRD affect early diagnostic practices. Using the Theory of Planned Behavior (TPB), we addressed salient beliefs of PCPs that affect their intention to diagnose ADRD early, defined as "performing the recommended clinical testing to diagnose ADRD within 3 months from the patient's first subjective memory complaint".

Methods: This cross-sectional study included 103 Puerto Rican PCPs, surveyed at CME activities and online. We measured PCPs salient beliefs in terms of attitudes, pressure they feel from others, self-perception of ability to diagnose ADRD early, and intention to perform early diagnosis. Questionnaire measures were psychometrically acceptable.

Results: Structural equation modeling (PLS-SEM) analysis showed that, combined, framework constructs explained 35.7% of the variance, reflecting a moderate-to-strong intention of PCPs to diagnose early (R2 = 0.357, p < 0.001). Self-perception of skills was the strongest predictor of intention (ß= 0.378, p < 0.001). Hours in ADRD training and years of experience in medical practice were strongly correlated with the percentage of total diagnoses performed by PCPs.

Conclusion: Training and years of experience may be key for PCPs to have a positive outlook of their skills for early ADRD diagnosis. Findings could be useful to design interventions to dispel myths about ADRD, reduce stigma, and reduce diagnostic hesitancy toward ADRD among PCPs.

The lack of a classification system addressing the size of pelvic masses challenges their evaluation. The American College of Obstetricians and Gynecologists recommends using an ultrasound (US) as the first-line modality, followed by magnetic resonance imaging (MRI). However, these do not guarantee optimal assessment. We present a case of a 36-year-old woman with a large pelvic mass of unknown etiology, after being evaluated with US, a computed tomography scan, and MRI. A reassessment by a US-specialized radiologist found a stalk (≥2.0 cm) with internal bridging vessels at the uterine fundus. The mass was identified as a pedunculated myoma and removed en bloc during a total abdominal hysterectomy with a bilateral salpingectomy and an oophoropexy. A reassessment by a US-specialized radiologist could be beneficial for cases of pelvic masses with unknown etiology after an evaluation with multiple imagining studies. These specialists possess extensive knowledge and vast expertise, potentially allowing US evaluations to be more effective than MRIs.

Objective: This article aims to provide an evaluation of the psychometric properties of the instruments of oral health literacy in adults.

Methods: An electronic search for instrument studies was performed in the PubMed, PubMed Central, ScienceDirect, Scopus, EMBASE, and PsycINFO databases to find articles published up to June 2021. The risk of bias of the included studies was assessed using the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk of Bias checklist for systematic review.

Results: From an initial sample of 2617 articles, 14 instrument studies were included in the present review. Their sample sizes ranged from 177 to 1405 adults, and the number of items per measurement instrument ranged from 14 to 99. For structural validity, statistical techniques were performed using the classical test theory (exploratory and confirmatory factor analysis) and the item response theory (dichotomous and polytomous models). The Rapid Estimate of Adult Literacy in Dentistry 30, elaborated in the USA, was the measurement instrument that had the greatest number of cultural adaptations, having been validated in such countries as Saudi Arabia, Brazil, Turkey, and Romania. The evaluation of the risk of bias, undertaken using the COSMIN Risk of Bias checklist, showed that 6 of the 10 parameters had been evaluated.

Conclusion: The psychometric properties that were evaluated in the present systematic review were structural validity, internal consistency, reliability (test-retest), and hypothesis testing for construct validity. To date, there is no gold standard measuring instrument to evaluate the criterion validity parameter.

Objective: To evaluate a website for an educational intervention among participants of the Baby-Act Trial. Baby-Act is a community-based intervention to prevent infant obesity by promoting physical activity, sleep, and healthy eating behaviors in Women, Infants, and Children (WIC) program participants in Puerto Rico. The intervention was designed to be delivered through a mobile application, but after the study was launched, participants reported many difficulties, and an alternative educational platform was developed.

Methods: Participants of the WIC program completed a face-to-face structured interview consisting of several open-ended questions. After completing the interview, they were instructed on how to access the newly developed webpage and completed the lessons found therein. Then followed a survey that explored the overall experience.

Results: Nine participants were interviewed; they all agreed that the website was easy to access, registration was simple, and the webpage was clear; 8 were able to complete at least 1 lesson (1 participant had a very poor signal), and all 9 reported being confident in using the webpage and stated they would use it again.

Conclusion: The study participants found this website to be user-friendly and a viable alternative for future educational intervention delivery to WIC participants.

Objective: From May 2016 through September 2017, the Zika Contraception Access Network (Z-CAN) program increased access to contraception during the Zika virus outbreak in Puerto Rico by providing no-cost client-centered contraceptive counseling and (same-day) access to the full range of US Food and Drug Administration-approved reversible contraceptives to women desirous of not becoming pregnant. The purpose of this study was to identify areas for programmatic improvement and enhance the sustainability of services from the perspectives of participating Z-CAN physicians and other staff.

Methods: From April through July 2017, 49 in-depth key-informant interviews were conducted with Z-CAN physicians and clinic staff. Twenty-five clinics participating in the Z-CAN program were selected through a cluster randomization process. A semi-structured interview guide was developed to explore the participants' perceptions of the Z-CAN program and examine facilitators of and barriers to said implementation. A thematic analysis of the emerging topics was conducted.

Results: Our analysis encountered 4 common overarching themes: facilitators of the Z-CAN program; barriers to Z-CAN implementation; the perceived impact of Z-CAN on providers and communities; and the sustainability of contraception access after the Z-CAN program ended. The key findings were that provider training, mentor support, and communication campaigns facilitated program implementation and that delays in the acquisition and distribution of contraceptives were obstacles.

Conclusion: Lessons learned from the implementation of Z-CAN from the perspective of physicians and other staff can be used to work towards sustainable contraceptive services in Puerto Rico and inform other contraception-access programs' design and implementation strategies.