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1.
Title: Incidence and diagnoses of HIV infection - Puerto Rico, 2006.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Jun 5;58(21):589-91.
Abstract: In 2006, 33 U.S. states and five territories had confidential, name-based, human immunodeficiency virus (HIV) infection reporting; among territories, Puerto Rico had the second highest rate of HIV infection. To characterize the HIV epidemic in Puerto Rico in 2006 (the year with the most recent available data), the Puerto Rico Department of Health and CDC analyzed data on diagnoses of HIV infection (including infections that occurred in 2006 and in previous years) and used a stratified extrapolation approach developed by CDC to generate HIV incidence estimates (the number of persons newly infected with HIV in 2006). The results indicated that, in 2006, an estimated 1,440 persons aged >or=13 years were newly infected with HIV in Puerto Rico, resulting in an estimated incidence rate of 45.0 cases per 100,000 population, twice the rate for the 50 U.S. states and District of Columbia (DC). Males accounted for 65% of new HIV infections in Puerto Rico, and 38% of new HIV infections occurred among persons aged 30-39 years; 39% of new infections were associated with injection-drug use, and 37% with high-risk heterosexual contact. The results provide insight into HIV transmission patterns in Puerto Rico that can help guide allocation of resources and the planning, implementation, and evaluation of HIV prevention programs and other services.
Language: English
Keywords:
PUERTO RICO | SUMMARY REPORT | INCIDENCE | MEN | HISPANICS | IV DRUG USERS | MEN HAVING SEX WITH MEN | HIV INFECTIONS | PROGRAM EVALUATION | Caribbean | Americas | Developed Countries | Measurement | Research Methodology | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Drug Use and Abuse | Behavior | Sex Behavior | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 341589

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Peer Reviewed

Title: Pilot trial of an intervention aimed at modifying drug preparation practices among injection drug users in Puerto Rico.
Author: Colon HM; Finlinson HA; Negron J; Sosa I; Rios-Olivares E; Robles RR
Source: AIDS and Behavior. 2009 Jun;13(3):523-31.
Abstract: Injection drug users (IDUs) contaminate preparation materials with blood-borne pathogens by using syringes as measuring and dispensing devices. In collaboration with IDUs, we developed a preventive intervention consisting of four new preparation practices aimed at avoiding the use of syringes in the preparation, and reducing the contamination of the materials. This report describes the results of a pilot trial introducing the new practices to ascertain their adoption potential and their potential efficacy in reducing contamination. Participants comprised 37 active IDUs among whom the new practices were promoted during 16 weeks. In addition to self-reported behaviors, the study collected cookers and plastic caps from shooting galleries and tested them for the presence of blood residues. Adoption rates were: (1) cleaning of skin area with hand sanitizer--65.6%; (2) directly pouring water with a dropper into the cooker--56.3%; (3) drawing drug solution with a preparation syringe and syringe filter--34.4%; and, (4) backload rinsing syringes--53.1%. Rates of blood residues detected in cookers and plastic caps were 41.7% prior to the trial, 28.6% at week 8, 24.6% at week 14, and 12.0% at week 18. We believe the results of the pilot trial are compelling and suggest that this intervention merits further formal testing.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | PILOT PROJECTS | IV DRUG USERS | CLIENTS | HIV PREVENTION | SANITATION | PARTICIPATION | BEHAVIOR | Caribbean | Americas | Developed Countries | Studies | Research Methodology | Drug Use and Abuse | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Public Health | Health | Social Behavior
Document Number: 342088

Title: Knowledge about breastfeeding among a group of primary care physicians and residents in Puerto Rico.
Author: Leavitt G; Martinez S; Ortiz N; Garcia L
Source: Journal of Community Health. 2009 Feb;34(1):1-5.
Abstract: Physicians have an essential role in promoting, protecting, and supporting breastfeeding as the ideal method of infant feeding. They are in an important position to promote breastfeeding but report difficulty in advising mothers with lactation problems. The purpose of this study is to assess knowledge about breastfeeding among primary care physicians and residents and identify potential barriers to its promotion. One hundred seventy-seven residents and physicians answered an anonymous questionnaire. The participants recognized breastfeeding benefits but 26% did not encourage exclusive breastfeeding. Mastitis, breast abscess, and the use of medications by the mother were considered contraindications to breastfeeding. Temporary breastfeeding discontinuation and bilirubin levels measurement were the preferred recommendations for the jaundiced infant. Most physicians received training in breastfeeding benefits although they report fair knowledge in myths, techniques, and contraindications. Physicians demonstrated to recognize breastfeeding benefits, but formal education is needed to eliminate barriers to breastfeeding promotion and support.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | PHYSICIANS | KNOWLEDGE | PRIMARY HEALTH CARE | HEALTH FACILITIES | BREASTFEEDING | HEALTH EDUCATION | MATERNAL HEALTH | Caribbean | Americas | Developed Countries | Health Personnel | Delivery of Health Care | Health | Sociocultural Factors | Health Services | Infant Nutrition | Nutrition | Education
Document Number: 330862

Peer Reviewed

Title: The effect of sympathy on discriminatory attitudes toward persons living with HIV/AIDS in Puerto Rico: a hierarchical analysis of women living in public housing.
Author: Norman LR; Abreu S; Candelaria E; Sala A
Source: AIDS Care. 2009 Feb;21(2):140-9.
Abstract: As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Puerto Rico, it becomes increasingly important to address the issues of stigma and other discriminatory attitudes. Therefore, the objective of the present study is to examine the attitudes toward PLWHA of a large sample of women living in public housing in Puerto Rico, including sympathy and support for PLWHA in the workplace and in school. A total of 1138 women completed a self-administered 218-item survey made up of questions that measured HIV-related knowledge, attitudes and behaviors. Levels of sympathy varied depending upon the target group, with HIV-infected drug users receiving the least sympathy. Most women reported that HIV-positive teachers should be allowed to teach and that HIV-positive children should be allowed to attend school. However, a significantly lower percentage reported that HIV-infected nurses should be allowed to continue working. Women who were more sympathetic toward PLWHA were more tolerant of PLWHA in the workplace and school, while those with inaccurate knowledge concerning HIV transmission were less tolerant. Also, those who knew a PLWHA were more tolerant. Levels of discriminatory attitudes in Puerto Rico are high and warrant both individual- and societal-level interventions.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | DATA ANALYSIS | WOMEN | PERSONS LIVING WITH HIV/AIDS | LOW INCOME POPULATION | HIV INFECTIONS | AIDS | STIGMA | SOCIAL DISCRIMINATION | ATTITUDES | Caribbean | Americas | Developed Countries | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Social Problems | Sociocultural Factors | Psychological Factors | Behavior
Document Number: 330811

6.
Title: Impact of relationship dynamics and gender roles in the protection of HIV discordant heterosexual couples: an exploratory study in the Puerto Rican context.
Author: Orengo-Aguayo R; Perez-Jimenez D
Source: Puerto Rico Health Sciences Journal. 2009 Mar;28(1):30-9.
Abstract: BACKGROUND: Most of the HIV/AIDS prevention efforts have not taken into consideration the context of the relationship and the gender constructs that influence relationship dynamics. These efforts have failed to view HIV prevention as a collaborative process between partners. Therefore, it is important to explore how relationship dynamics and gender constructs influence how men and women involved in an HIV discordant heterosexual relationship, visualize their role in the protection of their partners in order to design more effective prevention interventions. METHODS: Five Puerto Rican HIV discordant heterosexual couples were interviewed via a qualitative semi-structured interview. The taped interviews were transcribed and analyzed using content analysis according to a set of defined categories. RESULTS: Women visualized their role as one of convincing their partners to use protection as well as being strong and firm in the demand of its use. Men viewed their role as one of being more supportive and willing to use protection, but recognized their resistance towards the use of condoms. Relationship dynamics such as communication and support promoted protection. CONCLUSIONS: Traditional and non-traditional gender roles were assumed by both men and women. Traditional gender roles inhibited protection but were also used in positive ways to promote it. Men showed a greater initiative to break with traditional gender norms. A positive relationship, marked by communication and support could serve as a facilitator in the protection and in the transformation of traditional gender norms. This points out to the need of viewing HIV/AIDS prevention as a collaborative rather than individualistic process.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | COUPLES | SPOUSE | HETEROSEXUALS | GENDER RELATIONS | HIV INFECTIONS | SPOUSAL SUPPORT | SEX FACTORS | CONDOM USE | PARTNER COMMUNICATION | Caribbean | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Family Characteristics | Family and Household | Sociocultural Factors | Family Relationships | Sex Behavior | Behavior | Gender Issues | Microeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population | Risk Reduction Behavior | Interpersonal Relations
Document Number: 341066

Title: Barriers and facilitators of HIV prevention with heterosexual Latino couples: beliefs of four stakeholder groups.
Author: Perez-Jimenez D; Seal DW; Serrano-Garcia I
Source: Cultural Diversity and Ethnic Minority Psychology. 2009 Jan;15(1):11-7.
Abstract: Although HIV prevention interventions for women are efficacious, long-term behavior change maintenance within power-imbalanced heterosexual relationships has been difficult. To explore the feasibility, content, and format of an HIV intervention for Latino couples, the authors conducted 13 focus groups with HIV/AIDS researchers, service providers, and heterosexual men and women in Puerto Rico, the Dominican Republic, and Mexico. Reasons that participants thought that men should be involved in prevention efforts included promotion of shared responsibility, creation of a safe environment for open conversation about sex, and increased sexual negotiation skills. Perceived barriers to men's involvement included cultural taboos, sexual conservatism associated with Catholicism and machismo, and power-imbalanced relationships. Participants stressed the need for recruitment of men within naturally occurring settings or by influential community leaders. Participants indicated that couples-level interventions would be successful if they used strong coed facilitators, included both unigender and mixed-gender discussion opportunities, and addressed personally meaningful topics. Implications of these findings are discussed.
Language: English
Keywords:
DOMINICAN REPUBLIC | PUERTO RICO | MEXICO | RESEARCH REPORT | COUPLES | HETEROSEXUALS | MEN | HIV PREVENTION | BELIEFS | Developing Countries | Caribbean | Americas | Developed Countries | North America | Family Characteristics | Family and Household | Sociocultural Factors | Sex Behavior | Behavior | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Culture
Document Number: 330815

8.
Title: Symptoms and quality of life of people living with HIV infection in Puerto Rico.
Author: Rivero-Mendez M; Portillo C; Solis-Baez SS; Wantland D; Holzemer WL
Source: Puerto Rico Health Sciences Journal. 2009 Mar;28(1):54-9.
Abstract: BACKGROUND: People living with HIV infection are confronted with physical and psychological symptoms that impact their quality of life. This study explored the symptom experience of people living with HIV infection in Puerto Rico and its correlation with quality of life. METHODS: A cross-sectional descriptive design was used to survey 44 men, women, and transgender people living with HIV infection. Measures included a demographic questionnaire, sign and symptom checklist, and a quality of life instrument. RESULTS: The sample was 50% male with a mean age of 42.1 years; the participants had been living with HIV infection an average for 9.8 years. The top five symptoms reported by the sample included: muscle aches (81.8%), depression (77.2%), weakness (70.5%), fear/worries (70.5), and difficulty concentrating (65.9%). Symptom frequency was significantly related to four dimensions of quality of life: overall function (r = -0.58), life satisfaction (r = -0.59), health worries (r = 0.32) and HIV medication worries (r = 0.59). The symptom experience was not related to financial worries, disclosure worries, or sexual functioning. Individuals who reported taking HIV medications reported significantly fewer symptoms than those not taking HIV medications (t = 3.061, df=42, p < 0.01). CONCLUSIONS: These results suggest that people living with HIV infection in Puerto Rico experience a wide array of physical and psychological symptoms and that these symptoms have a correlation with their perceived quality of life. Better management of symptoms may have an impact on perceived quality of life for people living with HIV infection.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | QUALITY OF LIFE | SIGNS AND SYMPTOMS | HIV INFECTIONS | PSYCHOLOGICAL FACTORS | DEMOGRAPHIC FACTORS | HEALTH STATUS INDEXES | DEPRESSION | PAIN | ANTIRETROVIRAL THERAPY | Caribbean | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Viral Diseases | Diseases | Social Welfare | Economic Factors | Behavior | Population | Health | Mental Disorders | HIV
Document Number: 341065

Title: Antiretroviral drugs in development. A report from HIV DART 2008: Frontiers in Drug Development for Antiretroviral Therapies, 9-12 December 2008, Rio Grande, Puerto Rico.
Author: Temesgen Z
Source: Expert Opinion On Investigational Drugs. 2009 Apr;18(4):549-53.
Abstract: HIV DART 2008, Frontiers in Drug Development for Antiretroviral Therapies, was held on 9-12 December 2008 in Puerto Rico. The stated purpose of this biannual international meeting is to assemble clinicians, researchers and basic scientists together to advance the knowledge of the ongoing drug development processes in antiretroviral research. However, there were also presentations of thematic reviews of clinical topics such as prevention and drug resistance; HIV therapy in developing countries; and HIV/hepatitis and other coinfections. This report focuses on the main theme of the conference, the antiretroviral drug development pipeline. The author is solely responsible for the selection of topics and presentations to be included in this report.
Language: English
Keywords:
PUERTO RICO | CONFERENCES AND CONGRESSES | SUMMARY REPORT | RESEARCH AND DEVELOPMENT | CLINICAL TRIALS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | DRUG RESISTANCE | SIDE EFFECTS | TOXICITY | PROTEINS | Caribbean | Americas | Developed Countries | Technology | Economic Factors | Clinical Research | Research Methodology | HIV | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Physiology | Biology
Document Number: 341946

10.
Peer Reviewed

Title: Description of a large island-wide outbreak of dengue in Puerto Rico, 2007.
Author: Tomashek KM; Rivera A; Munoz-Jordan JL; Hunsperger E; Santiago L; Padro O; Garcia E; Sun W
Source: American Journal of Tropical Medicine and Hygiene. 2009 Sep;81(3):467-74.
Abstract: Dengue is a mosquito-borne viral disease that affects 40% of the world's population. Nearly four million U.S. citizens live in dengue-endemic areas; the most affected population resides in Puerto Rico. Data from a dengue surveillance system were used to describe all suspected cases reported in Puerto Rico in 2007. Rates of infection per 10,000 residents were calculated by age, sex, and residence. Rates and clinical outcomes were compared with those from outbreaks in 1994-1995 and 1998. In 2007, 10,508 suspected cases were reported; 52.5% persons were hospitalized, 31.8% reported hemorrhage, 2.2% had dengue hemorrhage fever, and 44 died. A total of 3,293 (33.0%) of processed specimens were laboratory positive for dengue virus (DENV); DENV-3 (1,342, 61.7%) and DENV-2 (677, 31.1%) were detected most often. The overall incidence of laboratory-positive dengue was 8.6 infections per 10,000 population. Rates were highest among persons 10-14 years of age (19.0), followed by persons 15-19 years of age (17.9) and infants (10.9). Higher rates of hospitalization and hemorrhage were reported in 2007 than in 1994-1995 or 1998. United States citizens residing in Puerto Rico are at risk of acquiring dengue. Data suggest that the severity is worsening, and persons 10-19 years of age and infants continue to be most affected.
Language: English
Keywords:
PUERTO RICO | UNITED STATES OF AMERICA | RESEARCH REPORT | DATA ANALYSIS | INCIDENCE | INFANT | DENGUE | FEVER | BLEEDING | LABORATORY EXAMINATIONS AND DIAGNOSES | Caribbean | Americas | Developed Countries | North America | Research Methodology | Measurement | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Body Temperature | Physiology | Biology | Signs and Symptoms | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342872

11.
Title: Profile of Puerto Rican HIV/AIDS patients with early and non-early initiation of injection drug use.
Author: Baez Feliciano DV; Gomez MA; Fernandez-Santos DM; Quintana R; Rios-Olivares E; Hunter-Mellado RF
Source: Ethnicity and Disease. 2008 Spring;18(2 Suppl 2):S2-99-104.
Abstract: BACKGROUND: Early initiation of injection drug use (IDU) increases the risk of HIV infection. METHODS: We compare the sociodemographic, psychosocial, and clinical profiles of HIV-positive IDU patients according to the age at which IDU was initiated. This is a cross-sectional study of 1308 patients seen from 1992 through 2005. We compared the profile of patients with early (age < 13 years) vs non-early (age > 13 years) initiation of IDU. The Fisher and chi2 differences in proportions were performed to assess difference among study groups with earlier IDU. The Mantel-Haenszel test was used to calculate the odds ratio. The Kaplan-Meier and log rank tests were used to assess the median survival. Differences were considered significant at alpha = .05. RESULTS: Early initiation of IDU was reported in 11% of our sample. The early initiation group was more likely to smoke tobacco, use alcohol, attempt suicide, have a history of incarceration, have economic problems, and have episodes of anxiety, confusion, depression, excitation, impulsivity, and violence (P < .05). The general survival time of patients was 36.9 months (95% confidence interval 31.9-42.0). A higher prevalence of candidial esophagitis and Pneumocystis jirovecii pneumonia and a lower prevalence of hepatitis C virus coinfection were seen in the early initiation group (P < .05). No differences in mortality, use of antiretroviral therapy, or CD4 T-cell count were seen. CONCLUSIONS: Differences in terms of lifestyle, stress factors, and history of psychological events were seen in the group of patients with early initiation of IDU seen in our facilities. Differences in the clinical scenario were documented.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | IV DRUG USERS | PERSONS LIVING WITH HIV/AIDS | DEMOGRAPHIC FACTORS | AGE FACTORS | SUICIDE | ANXIETY DISORDERS | VIOLENCE | RISK FACTORS | RISK BEHAVIOR | PERSONALITY | HIV INFECTIONS | Caribbean | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Drug Use and Abuse | Behavior | Viral Diseases | Diseases | Population | Population Characteristics | Mortality | Population Dynamics | Psychological Factors | Biology
Document Number: 328750

12.
Title: Prevalence of drug resistance and associated mutations in HIV-positive Puerto Ricans: sex variations.
Author: Cubano LA; Sepulveda-Torres Ldel C; Sosa G; Boukli N; Robles R; Rodriguez JW
Source: Ethnicity and Disease. 2008 Spring;18(2 Suppl 2):S2-132-6.
Abstract: INTRODUCTION: A cross sectional study was conducted from 2002-2004 to record the evolution of HIV-1 infection in Puerto Rico by monitoring the expression of antiretroviral resistance-associated mutations. METHODS: Samples were analyzed by using the TRUGENE HIV-1 Genotyping Kit and the OpenGene DNA Sequencing System. RESULTS: Mutations in the HIV-1 virus were detected in 92.7% of men and 94.8% of women. Of these, 75.1% of men and 72.4% of women had HIV-1 with resistance to at least one medication. The average number of HIV mutations was 6.1 in men and 5.3 in women. In 2002 and 2003, strains were most frequently resistant to the antiretroviral drugs zalcitabine, lamivudine and didanosine, while in 2004, strains were most frequently resistant to zalcitabine, lamivudine, and efavirenz. The most prevalent mutations in the reverse transcriptase gene were M184V, K103N, T215Y, and M41L. The most prevalent mutations in the protease gene were L63P, M361, L90M, A71V, and L101. CONCLUSIONS: Significant differences between men and women were recorded in the levels of HIV-1 expressed mutations and resistance. When comparing these results with data from 2000 and 2001, results indicate that expression of resistant mutations has remained constant.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | GENETIC TECHNIQUES | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | SEX FACTORS | DRUG RESISTANCE | HIV INFECTIONS | ANTIRETROVIRAL DRUGS | CHROMOSOME ABNORMALITIES | Caribbean | Americas | Developed Countries | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Population Characteristics | Demographic Factors | Population | Treatment | Neonatal Diseases and Abnormalities
Document Number: 328748

13.

Title: Medical practices for prevention of perinatal infections in Puerto Rico.
Author: Dayan GH; Caqu�as CR; Garc�a Y; Malik T; Copeland J
Source: Paediatric and Perinatal Epidemiology. 2008 Jan;22(1):31-39.
Abstract: Recommendations for screening for maternal infections and interventions to prevent disease in the fetus or newborn have been in place in Puerto Rico for more than 10 years. However, compliance with these recommendations has not been widely documented. We evaluated compliance with rubella/hepatitis B prenatal screening and vaccination recommendations, assessed hospital screening practices for syphilis and HIV, and determined risk factors for suboptimal prenatal care. Records of a random, stratified sample of 2003 pregnant women delivering in eight maternity hospitals in Puerto Rico in 2002 were reviewed. Obstetric prenatal and postnatal records were also reviewed when rubella/hepatitis B surface antigen (HBsAg) screening was not available at the hospital, and to document rubella postpartum vaccination (PPV). Prenatal screening rates were 98.4% for rubella and 98.8% for HBsAg. Overall, 5.4% [95% CI 4.4, 6.5] of women were susceptible to rubella. No eligible women received rubella PPV at the hospitaland only 1.5% had documented rubella vaccine prescription at the obstetric records. Only one woman was found to be HBsAg positive and her newborn was adequately treated. However, only 0.9% newborns born to mothers with unknown HBsAg status received hepatitis B vaccine. Screening was documented in 85.7% of the hospital records for HIV and 87.9% for syphilis. Suboptimal prenatal care was more likely among teenagers, low-educated women, and women with greater than 3 previous pregnancies. Screening rates for rubella and hepatitis B were high; however, implementation of recommendations for prevention of rubella and hepatitis B needs to be improved. (author's)
Language: English
Keywords:
PUERTO RICO | RECOMMENDATIONS | RESEARCH REPORT | OPERATIONS RESEARCH | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | FETUS | HOSPITAL PERSONNEL | SCREENING | BEST PRACTICES | SYPHILIS | HIV TESTING | RISK FACTORS | ANTENATAL CARE | HOSPITALS | Caribbean | Americas | Developed Countries | Program Evaluation | Programs | Organization and Administration | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Pregnancy | Reproduction | Health Personnel | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Laboratory Examinations and Diagnoses | Biology | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Facilities
Document Number: 323205

14.
Peer Reviewed

Title: Sex risk behaviors of drug users: a dual site study of predictors over time.
Author: Deren S; Strauss S; Kang SY; Colon HM; Robles RR
Source: AIDS Education and Prevention. 2008 Aug;20(4):325-337.
Abstract: Reducing sex risk behaviors among high-risk injection drug users (IDUs) and crack smokers is a continuing challenge for HIV prevention. Based on a longitudinal study of sexually active Puerto Rican IDUs and crack smokers in New York (n = 573) and Puerto Rico (n = 264), baseline predictors of changes in sex risk (number of unprotected sex acts) at 6- and 36-month follow-up interviews were examined. In New York, predictors of higher sex risk were being younger, having primary partners, having more other sex partners, never exchanging sex, having lower self-efficacy for reducing sex risk behaviors and being HIV-negative, and these predictors were significant at both post-baseline periods. In Puerto Rico, short-term predictors included being male, having primary partners, never exchanging sex, lower sex risk norms and lower self-efficacy. However, only having primary partners was significant in longer-term behaviors. Results indicated the need for enhancing self-efficacy and for developing risk reduction strategies related to community differences. (author's)
Language: English
Keywords:
NEW YORK | PUERTO RICO | RESEARCH REPORT | LONGITUDINAL STUDIES | IV DRUG USERS | DRUG USE AND ABUSE | RISK BEHAVIOR | SEX BEHAVIOR | MULTIPLE PARTNERS | HIV INFECTIONS | Developed Countries | United States of America | North America | Americas | Caribbean | Studies | Research Methodology | Behavior | Sexual Partners | Viral Diseases | Diseases
Document Number: 327956

15.
Title: AIDS stigma combinations in a sample of Puerto Rican health professionals: qualitative and quantitative evidence.
Author: Diaz NV; Rivera SM; Bou FC
Source: Puerto Rico Health Sciences Journal. 2008 Jun;27(2):147-57.
Abstract: The HIV/AIDS epidemic continues to impact Puerto Rico and the Caribbean region with growing numbers of cases each year. The stigma that surrounds the epidemic has harmful implications on the health of people living with the disease and public health in general, fostering health deterioration and new infections. When this stigma emanates from health professionals it can severely hinder access to health services, which are crucial for those living with the virus. Still, AIDS stigma has been previously explored among this population as a separate phenomenon from other pre-existing stigmas. This has yielded a limited perspective on the complexity of how AIDS stigma is manifested. In light of this limitation, the main objectives of this study were: 1) to document AIDS stigma among a sample of Puerto Rican health professionals and health professionals in training and 2) to explore the combination of other stigmas (sexism, homophobia, and negative attitudes towards drug users) with that associated to HIV/AIDS. Through an exploratory design, using a mixed method approach (qualitative in-depth interviews and quantitative questionnaires), we explored the objectives in a sample of 501 health professionals and health professionals in training. The results evidenced the combinations of other stigmas with that of HIV/AIDS. Homophobia yielded the strongest correlation and was the best predictor of AIDS stigma. These results evidence the need to develop interventions to reduce AIDS stigma and its combinations among this population.
Language: English
Keywords:
PUERTO RICO | CARIBBEAN | RESEARCH REPORT | QUANTITATIVE RESEARCH | INTERVENTIONS | PERSONS LIVING WITH HIV/AIDS | AIDS | HIV INFECTIONS | STIGMA | SOCIAL DISCRIMINATION | Americas | Developed Countries | Developing Countries | Research Methodology | Programs | Organization and Administration | Viral Diseases | Diseases | Social Problems | Sociocultural Factors
Document Number: 328982

16.

Peer Reviewed

Title: Disparities in access to behavioral health services for Puerto Rican - descended adolescents.
Author: Duke MR; Mateo W
Source: Human Organization. 2008 Spring;67(1):68-76.
Abstract: This article discusses the unique behavioral health issues facing Puerto Rican-descended adolescents in the mainland United States, and their particular challenges in accessing behavioral health services. Utilizing interview data with in-treatment and not-in-treatment youth, and with behavioral health providers who work with this population, this paper elucidates that range and scope of behavioral health needs for youth of Puerto Rican descent, and documents the social, cultural, and economic barriers faced by Puerto Rican youth and their families in accessing culturally and linguistically appropriate treatment. The paper concludes with a set of recommendations for addressing the behavioral health disparities and barriers to treatment that this population faces. (author's)
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | INTERVIEWS | ADOLESCENTS | ADOLESCENT HEALTH | MIGRATION | HEALTH SERVICES | BEHAVIOR | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | Caribbean | Americas | Developed Countries | Data Collection | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Population Dynamics | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 326534

17.
Title: Changes in HIV/AIDS knowledge among early adolescents in Puerto Rico.
Author: Fernandez DM; Figueroa WI; Gomez Mde L; Maysonet J; Olivares ER; Hunter RF
Source: Ethnicity and Disease. 2008 Spring;18(2 Suppl 2):S2-146-50.
Abstract: INTRODUCTION: One of the factors that influences HIV risk behavior among early adolescents is their HIV/AIDS knowledge. The objectives of this study were 1) to describe the sociodemographic features and HIV/AIDS knowledge among Puerto Rican early adolescents participating in the ASUMA (A Supportive Model for HIV Risk Reduction in Early Adolescents) project; and 2) to assess changes in the knowledge of HIV/AIDS within the intervention and nonintervention groups after the first year of the study. METHODS: This is a prospective cohort study of 173 early adolescents after 12 months of participation in the ASUMA project. The setting of the study was four junior high schools. Baseline and follow-up self-administered questionnaires were issued to the entire study group. The first workshop was developed directed to increase HIV/AIDS knowledge and decrease vulnerability in the group assigned to the intervention. Descriptive and inferential analyses were performed. RESULTS: 47% of adolescents were cases and 52.6% controls. Most adolescents were 12 years old; 50.3% were boys and 49.7% were girls; 78.6% believe that they could have a good conversation with their parents; and 26.3% reported alcohol use at any time in their lives. A significant increase in HIV/AIDS knowledge was found among adolescents from the intervention group (P < .001), while a nonsignificant increase was found among control adolescents. CONCLUSIONS: An increase in HIV/AIDS knowledge was observed among adolescents who participated in the first year of the ASUMA project. This study illustrates the importance of the creation of culturally appropriate instruments and interventions to reduce HIV infection in adolescents.
Language: English
Keywords:
PUERTO RICO | EVALUATION REPORT | KAP SURVEYS | PROSPECTIVE STUDIES | COHORT ANALYSIS | CASE CONTROL STUDIES | ADOLESCENTS | KNOWLEDGE | HIV PREVENTION | SOCIOECONOMIC FACTORS | WORKSHOPS | PARENTAL INVOLVEMENT | PROGRAM EFFECTIVENESS | Caribbean | Americas | Developed Countries | Evaluation | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Economic Factors | Education | Child Rearing | Behavior | Program Evaluation | Programs | Organization and Administration
Document Number: 328747

18.

Peer Reviewed

Title: Self-reported prevalence of endometriosis and its symptoms among Puerto Rican women.
Author: Flores I; Abreu S; Abac S; Fourquet J; Laboy J
Source: International Journal of Gynecology and Obstetrics. 2008 Mar;100(3):257-261.
Abstract: The objective was to determine the prevalence of endometriosis and its symptoms in a Puerto Rican cohort, and to describe the menstrual, obstetric, and clinical profiles of the women. A self-administered questionnaire was given to 1285 Puerto Rican women. Categorical variables were compared using x/2 analysis or Fisher exact test. There were 57 self-reported cases of endometriosis (48 surgically confirmed) among 1193 valid questionnaires, for a point prevalence of 4.0%. A diagnosis of endometriosis was significantly associated with dysmenorrhea, dyspareunia, and chronic pelvic pain, but not with menstrual cycle characteristics. Undiagnosed women commonly reported signs and symptoms of endometriosis. The estimated prevalence of endometriosis in Puerto Rico is 4.0%, comparable to what has been reported in other populations. Endometriosis symptoms were common in the population surveyed, indicating the need for increased awareness and development of public health policies leading to early diagnosis and appropriate management. (author's)
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | QUESTIONNAIRES | WOMEN | ENDOMETRIOSIS | SIGNS AND SYMPTOMS | PREVALENCE | EPIDEMIOLOGY | Caribbean | Americas | Developed Countries | Demographic Factors | Population | Diseases | Measurement | Research Methodology | Public Health | Health
Document Number: 324206

19.

Title: Male gender identity in an XX individual with congenital adrenal hyperplasia.
Author: Jorge JC; Echeverri C; Medina Y; Acevedo P
Source: Journal of Sexual Medicine. 2008 Jan;5(1):122-131.
Abstract: In spite of significant changes in the management policies of intersexuality, clinical evidence show that not all pubertal or adult individuals live according to the assigned sex during infancy. The purpose of this study was to analyze the clinical management of an individual diagnosed as a female pseudohermaphrodite with congenital adrenal hyperplasia (CAH) simple virilizing form four decades ago but who currently lives as a monogamous heterosexual male. We studied the clinical files spanning from 1965 to 1991 of an intersex individual. In addition, we conducted a magnetic resonance imaging (MRI) study of the abdominoplevic cavity and a series of interviews using the oral history method. Our analysis is based on the clinical evidence that led to the CAH diagnosis in the 1960s in light of recent clinical testing to confirm such diagnosis. Analysis of reported values for 17-ketosteroids, 17-hydroxycorticosteroids, from 24-hour urine samples during an 8-year period showed poor adrenal suppression inspite of adherence to treatment. A recent MRI study confirmed the presence of hyperplastic adrenal glands as well as the presence of a prepubertal uterus. Semistructured interviews with the individual confirmed a life history consistent with a male gender identity. Although the American Academy of Pediatrics recommends that XX intersex individuals with CAH should be assigned to the female sex, this practice harms some individuals as they may self-identify as males. In the absence of comorbid psychiatric factors, the discrepancy between infant sex assignment and gender identity later in life underlines the need for a reexamination of current standards of care for individuals diagnosed with CAH. (author's)
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN | MEN | CONGENITAL ABNORMALITIES | ADRENAL CORTEX EFFECTS | SEXUALITY | PHYSICAL EXAMINATIONS AND DIAGNOSES | Caribbean | Americas | Developed Countries | Research Methodology | Studies | Demographic Factors | Population | Neonatal Diseases and Abnormalities | Diseases | Endocrine Effects | Endocrine System | Physiology | Biology | Personality | Psychological Factors | Behavior | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 323234

20.

Title: Severity of alcohol use and problem behaviors among school-based youths in Puerto Rico.
Author: Latimer WW; Rojas VC; Mancha BE
Source: Revista Panamericana de Salud P�blica / Pan American Journal of Public Health. 2008 May 20;23(5):325-332.
Abstract: The present study sought to: 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 examine whether these categorizes were associated with other problem behaviors in which youths engage (marijuana use, sexual intercourse, and having been arrested of having trouble with the law). 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 of 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. 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. 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. (author's)
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | SURVEYS | CROSS SECTIONAL ANALYSIS | ADOLESCENTS | ALCOHOL USE AND ABUSE | RISK BEHAVIOR | PREVALENCE | DRUG USE AND ABUSE | SEX BEHAVIOR | Caribbean | Americas | Developed Countries | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Measurement
Document Number: 326882

21.

22.
Title: AIDS-defining neoplasm prevalence in a cohort of HIV-infected patients, before and after highly active antiretroviral therapy.
Author: Mayor AM; Gomez MA; Rios-Olivares E; Hunter-Mellado RF
Source: Ethnicity and Disease. 2008 Spring;18(2 Suppl 2):S2-189-94.
Abstract: INTRODUCTION: Malignant disorders have been linked to the HIV epidemic from its onset. Implementation of highly active antiretroviral therapy (HAART) has resulted in a dramatic reduction in the HIV/AIDS morbidity and mortality. The present study evaluates the neoplasm prevalence before and after the implementation of HAART. METHODS: A cross-sectional study was conducted in 171 HIV-infected adults who were followed in Puerto Rico from May 1992 through December 2005. Neoplasm prevalence was measured, and the difference in AIDS- and non-AIDS-defining neoplasms was analyzed before and after the HAART era. Between-group differences were explored by using chi2, Fisher exact test, analysis of variance, and student t test. RESULTS: Malignant neoplasms were detected in 171 patients (4.8%). Of these, 51.5% were AIDS-defining neoplasms, and 68% were established before HAART. AIDS-defining neoplasms accounted for 62.4% of those detected before the availability of HAART and 25.9% of those detected after HAART. Except for cervical carcinoma, the prevalence of AIDS-defining neoplasms decreased after HAART. Non-AIDS lymphomas and prostate neoplasms were more frequent after HAART. DISCUSSION: Our study found a significant reduction of Kaposi sarcoma and AIDS-related lymphoma in the HAART era of the AIDS epidemic. A higher prevalence of non-AIDS-defining lymphomas, prostate carcinoma, and cervical carcinoma was seen in the HAART era. These findings suggest that factors other than severe immunosuppression are involved in the neoplasms' pathogenesis. Preventive strategies that include screening tests, vaccination, and lifestyle modification should be routinely applied in HIV-infected patients.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COMPARATIVE STUDIES | CROSS SECTIONAL ANALYSIS | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ADULTS | PREVALENCE | CANCER | AIDS | COMPLICATIONS | ANTIRETROVIRAL THERAPY | Caribbean | Americas | Developed Countries | Research Methodology | Studies | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Neoplasms | HIV
Document Number: 328745

23.
Title: The feasibility and acceptability of a multimedia hepatitis C prevention program for Hispanic HIV-infected persons.
Author: Mayor AM; Fernandez DM; Colon HM; Thomas JC; Hunter-Mellado RF
Source: Ethnicity and Disease. 2008 Spring;18(2 Suppl 2):S2-195-9.
Abstract: INTRODUCTION: Hepatitis C (HCV) and HIV coinfection has emerged as a major health problem in Puerto Rico, particularly among injection drug users (IDUs). We developed and implemented a multimedia educational intervention for HIV-infected IDUs, based on the Health Belief Model and social cognitive theory. METHODS: To evaluate the program's acceptability, a group of 42 participants completed a written questionnaire immediately after each intervention component. RESULTS: Participants were 85% male, the mean age was 41.6 years (standard deviation 9.2 years), and mean educational level was ninth grade. More than 73% of respondents reported that the computer-based program was very easy to operate. More than 83% agreed that the audio and video tools highly facilitated their learning process, and > 71% agreed that the sessions were long enough. Additionally, they reported a high incremental increase in perceived knowledge regarding HIV/HCV co-infection, HCV infection risk behaviors, HCV complications, HCV preventive measures, and HCV diagnosis and therapy. Most of the participants favored the dissemination of this intervention. CONCLUSIONS: The study found a very good acceptability and feasibility of the computerized intervention in the study group. This new technology that includes audiovisual tools in its design kept the participants' attention and interest, while increasing HIV/HCV co-infection knowledge. Subsequent studies will evaluate the efficacy of this intervention, investigating changes in knowledge and risk behaviors among HIV-infected persons.
Language: English
Keywords:
PUERTO RICO | EVALUATION REPORT | KAP SURVEYS | THEORETICAL MODELS | PERSONS LIVING WITH HIV/AIDS | IV DRUG USERS | PROGRAM ACCEPTABILITY | HEPATITIS | COMMUNICABLE DISEASE CONTROL | HIV INFECTIONS | COMPLICATIONS | COMPUTER PROGRAMS AND PROGRAMMING | SATISFACTION | KNOWLEDGE | AUDIOVISUAL AIDS | Caribbean | Americas | Developed Countries | Evaluation | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Drug Use and Abuse | Behavior | Program Evaluation | Programs | Organization and Administration | Health Services | Delivery of Health Care | Health | Information Processing | Information | Psychological Factors | Sociocultural Factors | Educational Methods | Educational Activities | Education
Document Number: 328744

24.
Title: Early life exposure and its effects on health in the Puerto Rican elderly population.
Author: McEniry M; Palloni A; Davila AL; Garcia Gurucharri A
Source: Madison, Wisconsin, University of Wisconsin-Madison, Center for Demography and Ecology, 2008. 49 p. (CDE Working Paper No. 2008-01)
Abstract: Season of birth may help disentangle the effects on health of early life exposure to poor nutrition and infectious diseases from effects associated with other childhood conditions. Using data from 60 to 74 year old Puerto Ricans who lived in rural areas during childhood (n=1459), we estimated effects of exposure to poor nutrition and infectious diseases during late gestation on the probability of (a) chronic conditions (diabetes, heart disease, obesity), (b) decreased functionality (limitation in at least one ADL and IADL), and (c) poor self-reported health controlling for childhood health and SES and knee height. Findings: (1) strong associations between exposure and heart disease; (2) virtually no attenuation of effects of self-reported childhood health with controls for exposure; (3) no association between exposure and diabetes, obesity, functionality, poor health. Conclusions: timing of birth may reveal conditions experienced perinatally which affect adult heart disease, but there is little evidence of similar effects on adult diabetes and obesity. (author's)
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | OLDER ADULTS | FETUS | SEASONAL VARIATION | CHILDBIRTH | INFANT NUTRITION | COMMUNICABLE DISEASES | CHILD HEALTH | CHRONIC DISEASES | HEALTH | HEART DISEASES | OBESITY | DIABETES | Caribbean | Americas | Developed Countries | Research Methodology | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Population Dynamics | Pregnancy Outcomes | Nutrition | Infections | Diseases | Body Weight | Physiology | Biology
Document Number: 325667

25.

Title: HIV testing practices among women living in public housing in Puerto Rico.
Author: Norman LR; Abreu S; Candelaria E; Sala A
Source: Journal of Women's Health. 2008 May;17(4):641-655.
Abstract: The objective of our study was to examine HIV testing practices among a large sample of women living in public housing in Puerto Rico and the relationships among HIV testing, sociodemographic variables, and HIV-related behaviors. A total of 1138 women were surveyed between April and August 2006 using a self-administered survey instrument. Eighty-two percent of the women in the sample group reported a history of HIV testing. Hierarchical logistic regression analyses revealed that those adults who were at least 25 years of age and those who perceived some risk of HIV were more likely to report previous HIV testing. Also, those who had attended an HIV/AIDS education workshop or discussion and those who reported knowing persons living with HIV/AIDS were more likely to report previous testing. A large percentage of the women in our study have been tested for HIV; it is imperative, however, that appropriate HIV education and prevention messages be given to them when they receive their results. Client-initiated HIV testing to learn HIV status provided through counseling and testing remains critical to the effectiveness of HIV prevention. It is unwise to underestimate the importance of being tested. One of the first steps in self-protection from HIV is to be informed of one's HIV status, which allows one to make appropriate and responsible sexual decisions. Future success in decreasing the number of new infections among women will result from targeting women who may be at high risk, although not because of sex work or drug use. Increasing knowledge of HIV serostatus and the implications of these results, especially among those who are infected, can serve as a gateway to sustained behavioral risk reduction intervention, as well as to care and treatment. Considering the fact that both the actual and estimated numbers of HIV/AIDS cases among women in Puerto Rico continue to increase, it is clear that effective, targeted, and aggressive strategies are urgently needed to prevent both primary and secondary HIV transmission. (author's)
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | DATA ANALYSIS | WOMEN | HIV TESTING | KNOWLEDGE | BEHAVIOR | RISK REDUCTION BEHAVIOR | INTERVENTIONS | Caribbean | Americas | Developed Countries | Research Methodology | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sociocultural Factors | Programs | Organization and Administration
Document Number: 326653

26.

Title: Cesarean delivery as a barrier for breastfeeding initiation: the Puerto Rican experience.
Author: Perez-Rios N; Ramos-Valencia G; Ortiz AP
Source: Journal of Human Lactation. 2008 Aug;24(3):293-302.
Abstract: The study's objective was to examine the relationship between cesarean section delivery and the initiation of breastfeeding in a representative sample of 1695 Puerto Rican women aged 15 to 49 years, who delivered their last healthy singleton child in Puerto Rico between 1990 and 1996. Secondary analysis of data collected in the population-based cross-sectional study Puerto Rico Reproductive Health Survey was performed. Bivariate and multivariate logistic regression analyses were used to examine the crude and covariate adjusted association between type of childbirth and initiation of breastfeeding. Overall, 36% of all births were performed by cesarean section, while initiation of breastfeeding was achieved by 61.5% of the women. Cesarean section was negatively related to breastfeeding initiation in multivariable logistic regression models (odds ratio = .64; 95% CI = 0.51-0.81) after controlling for confounding variables. Intervention programs that aim to promote breastfeeding and that provide special assistance to women undergoing this procedure should be developed.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | MULTIVARIATE ANALYSIS | RETROSPECTIVE STUDIES | MOTHERS | WOMEN IN DEVELOPMENT | CESAREAN SECTION | BREASTFEEDING | PREVALENCE | Caribbean | Americas | Developed Countries | Research Methodology | Data Analysis | Studies | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Economic Development | Economic Factors | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Nutrition | Nutrition | Measurement
Document Number: 308026

27.
Title: Suicide attempts among Puerto Rican men and women with HIV/AIDS: a study of prevalence and risk factors.
Author: Quintana-Ortiz RA; Gomez MA; Baez Feliciano DV; Hunter-Mellado RF
Source: Ethnicity and Disease. 2008 Spring;18(2 Suppl 2):S2-219-24.
Abstract: INTRODUCTION: Epidemiologic studies in the United States have estimated that 1.1%-4.3% of the general population attempt suicide at some time in their lives, but limited information is available on suicidal attempts within the HIV-positive population after the introduction of effective antiretroviral therapy. In this study, we evaluate the profile and trends of attempted suicide in a sample of HIV patients in Bayamon, Puerto Rico. METHODS: A retrospective cohort study design was employed to analyze data from the HIV/AIDS longitudinal data bank generated in the Retrovirus Research Center at the Universidad Central del Caribe, Puerto Rico, from 2000 through 2004. We analyzed cumulative self-reported suicide attempts from 714 individuals. Annual percentage changes were assessed by using general linear model with Poisson distribution. Adjusted odds ratios were estimated by using logistic regression. RESULTS: The prevalence of suicide attempts increased in the five-year period examined, from 9.0% to 22.0%. In our study, men were more likely to attempt suicide than were women. In addition, the risk factors most strongly related to suicide attempts after adjusting for age, sex, HIV/AIDS status at study entry, and injection drug use were stress factors related to filial relationships, use of psychoactive substance, and isolation. Changes in conducts related to depression, confusion and anxiety were positively associated with suicide attempts. CONCLUSIONS: Prevention and intervention programs should embrace a more comprehensive approach to care for HIV/AIDS. This approach should recognize the psychological needs and provide the support these patients desperately need.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | KAP SURVEYS | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | RETROSPECTIVE STUDIES | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | PERSONS LIVING WITH HIV/AIDS | SUICIDE | PREVALENCE | RISK FACTORS | SEX FACTORS | STRESS | Caribbean | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Measurement | Biology | Population Characteristics | Psychological Factors | Behavior
Document Number: 328743

28.

Title: GC-MS confirmation of xylazine (Rompun), a veterinary sedative, in exchanged needles.
Author: Rodriguez N; Vargas Vidot J; Panelli J; Colon H; Ritchie B
Source: Drug and Alcohol Dependence. 2008 Aug 1;96(3):290-3.
Abstract: In order to assess the extent of xylazine (Xyz) injection in Puerto Rico, two waves of used-syringe collections were performed. In the first, syringes were gathered, anonymously and without additional information; in the second, a short interview, also anonymous, was administered. We found Xyz in 37.6% of the collected syringes; the majority of the Xyz-containing syringes came from ranching communities. Syringes containing Xyz more frequently also contained "speedball" than those without (90.6% and 66.7%, respectively). Self-reports of Xyz injection deviated markedly from actual detection: only 50% (self-described users) and 22% (self-described non-users) of the collected syringes contained the drug. With a high prevalence of skin ulcers (38.5% vs. 6.8%; p<0.001), Xyz users were more likely to be in poor health compared to non-users. Surprisingly, though a higher percentage of Xyz users than non-users had college-level educations (23.1% vs. 5.5%), they were more likely to be homeless (64.1% vs. 37%).
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | CLINICAL RESEARCH | KAP SURVEYS | IV DRUG USERS | ANALGESIA | SYRINGE | DRUG USE AND ABUSE | Caribbean | Americas | Developed Countries | Research Methodology | Surveys | Sampling Studies | Studies | Behavior | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Equipment and Supplies
Document Number: 329125

29.
Title: Concerns about HIV and sexually transmitted infection among low-risk and high-risk women, Puerto Rico.
Author: Torres R; Hilerio CM; Silva G; Ortiz NY; Zorrilla CD; Santiago LE
Source: Ethnicity and Disease. 2008 Spring;18(2 Suppl 2):S2-238-41.
Abstract: In this study, the RESPECT-2, an HIV risk reduction intervention developed by the Centers for Disease Control and Prevention, was translated into Spanish and culturally adapted to the Puerto Rican population. A new intervention emerged called the RReduC-PR (Risk Reduction Counseling-Puerto Rico). This instrument allows the assessment of sexual behaviors and development of risk reduction plans. Women from three distinct risk behavior groups participated: women recruited from a community-based organization (CBO), which includes street sex workers, crack users, and sexual partners of intravenous drug users; participants from a sexually transmitted infection (STI) clinic; and participants from a family planning clinic (FPC) in Puerto Rico. As part of the RReduC-PR, participants were provided counseling before and after a rapid HIV test to explore their attitudes about sexual behaviors. At baseline, all participants from the FPC reported having monogamous relationships (100%), as compared with the participants from the STI clinic (70%) and those from the CBO (20%). STI risk-reduction behaviors varied by site. Most of the participants acknowledged risk behaviors that may have exposed them to HIV. They did not use condoms, or used them inconsistently, even though acquiring HIV was a great concern for them. Most regarded a positive HIV diagnosis as a negative event. Their attitudes toward an HIV diagnosis varied by site. The groups varied in the perception of risk behaviors, knowledge, and concerns. These findings provide useful information for future risk-reduction interventions with these women.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | KAP SURVEYS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | SEX WORKERS | IV DRUG USERS | SEXUAL PARTNERS | SEXUALLY TRANSMITTED DISEASES | HIV PREVENTION | SEX BEHAVIOR | BEHAVIOR CHANGE COMMUNICATION | ATTITUDES | RISK ASSESSMENT | PERCEPTION | Caribbean | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Behavior | Drug Use and Abuse | Reproductive Tract Infections | Infections | Diseases | HIV Infections | Viral Diseases | Communication Programs | Communication | Behavior Change | Psychological Factors | Evaluation
Document Number: 328742

30.

Peer Reviewed

Title: A novel estrogen-free oral contraceptive pill for women: Multicentre, double-blind, randomized controlled trial of mifepristone and progestogen-only pill (levonorgestrel).
Author: Lakha F; Ho PC; Van der Spuy ZM; Dada K; Elton R
Source: Human Reproduction. 2007 Sep;22(9):2428-2436.
Abstract: The acceptability and continuation rate of oral contraceptive steroids are limited by unpredictable bleeding and the fear of long-term risks such as breast cancer. By inhibiting ovulation and by altering the receptivity of the endometrium, antagonists of progesterone, such as mifepristone, could be developed as estrogen-free novel contraceptives. Multicentre, double-blind, randomized controlled trial comparing frequency of amenorrhoea (primary outcome), bleeding patterns, side effects and efficacy in women taking daily 5 mg mifepristone (n = 73) or 0.03 mg levonorgestrel (progestogen-only pill; POP, n = 23) for 24 weeks. More women were amenorrhoeic while taking mifepristone than POP (49 versus 0% P < 0.001), and fewer women bled or spotted for >5 days per month (4 versus 39% P < 0.001). Forty-eight percent of women who took mifepristone for 6 months had cystic glandular dilatation of the endometrium but none showed hyperplasia or atypia. There were no pregnancies in 356 months of exposure in women who used only mifepristone for contraception. Two pregnancies occurred in women taking mifepristone who were also using condoms for dual protection. Daily mifepristone (5 mg) is an effective oral contraceptive pill which has a better pattern of menstrual bleeding than an existing POP (levonorgestrel). (author's)
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, PROGESTIN | RU-486 | LEVONORGESTREL | CONTRACEPTIVE METHOD ACCEPTABILITY | Caribbean | Americas | Developed Countries | Clinical Research | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Female | Contraceptive Agents | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Usage
Document Number: 319383


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