Puerto Rico health sciences journal最新文献

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.

Objective: Despite the high volume of admissions to the Puerto Rico Trauma Hospital (PRTH), there is no evidence of any recent trends related to pediatric trauma. Therefore, we aimed to update, describe, and compare the epidemiology of the pediatric (≤21 years) trauma population in PR according to age group (≤15 years and 16-21 years).

Methods: This was a retrospective cohort study of 853 PRTH pediatric admissions from January 2015 through June 2019. A comparison between age groups was done using Pearson's chi-square test. The association between age and study outcomes was evaluated with multivariate analyses.

Results: Of the admissions, 220 (25.8%) were patients aged 15 years and younger and 633 (74.2%) were patients aged 16 to 21 years; the percentage of males was higher in the latter group (65.5% vs. 79.0%; P < .01). Motor vehicle accidents were the primary injury mechanism. Major trauma (Injury Severity Score >15) incidence was higher in the under 15 group (40.8% vs. 24.5%; P < .01). After adjusting for confounders, 16- to 21-year-old trauma patients were less likely to be admitted to the intensive care unit (ICU) than were their younger counterparts but were more prone to having longer ICU and hospital stays. However, age was not associated with the need for mechanical ventilation (MV), days of MV, or in-hospital mortality.

Conclusion: Understanding the specific characteristics of our pediatric patient population can help us guide treatment and elucidate these patients' needs to improve their outcomes.

Objective: Evaluate the relationship between diabetes and hypertension and COVID-19 booster uptake.

Methods: Members of the Community Outreach Group of the Puerto Rico Community Engagement Alliance Against COVID-19 Disparities (PR-CEAL) administered a survey at 229 community events between November 2021 and May 2023. Information on 2,145 participants' sociodemographic information and chronic disease diagnoses was gathered. Characteristics distributions were described using frequency and percentages. The associations between demographic factors and booster uptake were assessed using chi-squared analysis for categorical variables. Multivariate logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI), adjusting for age, sex, education, and medical insurance, to investigate the relationship between hypertension and diabetes and booster uptake.

Results: Participants' mean age was 43.8 years. Most (80%) were women and had received a COVID-19 booster (84%). A high prevalence of hypertension (43%) and diabetes (33%) was observed in this study sample. Bivariate analyses showed a statistically significant association between receiving the booster and having hypertension or diabetes (p<0.05). Adjusted multivariate analysis showed that participants with diabetes were 3% more likely to have the booster than those without diabetes (OR=1.03, 95% CI: (1.01-1.05), p<0.05). No significant association was found between hypertension and booster uptake in the adjusted multivariate analysis (OR=1.01, 95% CI: (0.99-1.03), p=0.13).

Conclusion: Insights from this study can inform future vaccination campaigns through improved awareness and prevention strategies by targeting vulnerable populations in Puerto Rico.

Objective: This meta-analysis explored genes in common between breast cancer (BC) and colorectal cancer (CRC) in women. Breast cancer and CRC are causes of significant morbidity and mortality in women worldwide. Research has shown that women are underrepresented in clinical trials, especially in oncology; studying sex differences in cancer addresses this lack.

Methods: Ten GEO (Gene Expression Omnibus) dataset (5 BC and 5 CRC) were used to identify genes in common. Correlated networks were constructed and analyzed using BioOptimatics methodologies, including multiple criteria optimization and minimum spanning tree.

Results: Eighteen differentially expressed genes were identified, with such core genes as B3GNT3, CALU, CD46, DCN, DLX4, and others showing high frequencies. The study also identified 289 diseases related to core genes, further narrowed down to 37, including BC and CRC. Direct associations with BC and CRC were found for 5 genes, while 7 were linked to other cancer types.

Conclusion: The results of this study underscore the importance of sex differences in cancer biology and indicate that this methodology, BioOptimatics, can help in the discovery of new pathways and biomarkers for BC and CRC in women.

The abuse of psychoactive substances poses a critical public health challenge in Puerto Rico, with far-reaching implications for both individuals and society as a whole. This article provides a comprehensive overview of the patterns and trends associated with drug abuse in Puerto Rico, focusing on alcohol, tobacco, cannabis, benzodiazepines, opioids, and methadone. Recent statistics reveal a concerning increase in substance abuse, particularly among young adults. Long-standing problems with alcohol and tobacco continue to drive chronic health conditions, while the legalization of medical cannabis has influenced its usage patterns. The abuse of prescription medications, especially benzodiazepines and opioids, has intensified, contributing to an expanding opioid crisis on the island. This review critically examines the current scientific literature, highlighting the urgent need for comprehensive, evidence-based strategies for prevention, intervention, and regulation. It also underlines the importance of continued research efforts and the development of tailored approaches to effectively address drug abuse in Puerto Rico. By shedding light on these complex challenges, the article provides valuable insights that can inform future initiatives aimed at curbing substance abuse and promoting the well-being of Puerto Rico's population.

Objective: In this study, the localization of tumor necrosis factor alpha (TNF-α) and interleukin (IL) -6 in the umbilical cord tissue of pregnant women with preeclampsia who smoke and in those who do not smoke was investigated using immunohistochemical methods.

Methods: The sample groups consisted of a control group, cigarette smokers, preeclampsia, and cigarette smokers with preeclampsia. Histological and immunohistochemical methods were applied to the tissue samples.

Results: It was determined that there were varying degrees of edemato s change in the layers of arteries and veins in the preeclampsia and the cigarette smokers with preeclampsia groups, with a statistically significant level of difference in thickness compared to the other groups. In addition, different levels of TNF α and IL-6 immunoreactivity were detected in the umbilical cord tissue across all the groups. In the preeclampsia group, TNF-α immunoreactivity was found to increase in the arterial muscle layer. Moreover, IL-6 immunoreactivity was found to decrease in the arterial endothelium and muscle layers in the cigarette smokers, preeclampsia, and cigarette smokers with preeclampsia groups and increase in the venous endothelium and muscle layers. In addition, immunoreactivity increased in the amniotic epithelium in the cigarette smokers with preeclampsia group.

Discussion: In conclusion, the differences in cytokine levels between the cigarette smokers, preeclampsia, and cigarette smokers with preeclampsia groups were thought to be caused by responses of the maternal immune system and histopathological changes in the umbilical cord tissue.

This is the case of a 22-year-old female who arrived at our institution after experiencing refractory insomnia, disorganized behavior, inappropriate laughter, and anorexia. Upon admission, a physical examination revealed mutism, irritability, and visual hallucinations. Infectious, metabolic, and other, alternative, causes for the presenting symptoms were excluded. Brain magnetic resonance imaging and chest and abdominopelvic computed tomography scan results showed no evidence of pathology. Due to there being a high clinical suspicion of paraneoplastic encephalitis, treatment was initiated with intravenous (IV) high-dose steroids and IV immunoglobulins. An endovaginal ultrasound was performed, which revealed a small atypical intraovarian dermoid cyst. The patient's laboratory tests were positive for anti-N-methyl-D-aspartate antibodies within her cerebrospinal fluid. A laparoscopic right partial salpingectomy and an oophorectomy were performed on day 25, after the symptoms developed further. Histopathology confirmed the presence of a mature teratoma within the right ovary. After surgery, she returned to her baseline mental status, with no further complications.