Optometric manpower needs in Puerto Rico

We report an intradiploic epidermoid cyst of the skull responsible for transverse sinus compression and presenting with nonpulsatile tinnitus. Plain films and CT both demonstrated the tumour. Cerebral angiography showed best the degree of narrowing of the right transverse sinus, accompanied with turbulent flow probably leading to tinnitus. MRI demonstrated accurately both the tumour and the dural sinus compression. The tumour was totally removed, cranioplasty was performed, and the patient was discharged free of symptoms.     

Puerto Rican patients travel to Puerto Rico: assessing the effect on clinical care

OBJECTIVE: To examine travel habits of Puerto Rican patients and assess the potential effect of this travel on their health care. DESIGN: Interview and survey of patients. SETTING: Urban medical clinic. PATIENTS: Two hundred consecutive, self-identified Puerto Rican patients presenting for follow-up care. INTERVENTION: Immediately prior to a follow-up office visit, patients were interviewed in either Spanish or English. MEASUREMENTS: The patients' age, sex, education level, employment status, and place of birth were recorded. The patients were asked questions concerning the principle place of residence of their family members, their ability to speak English, and their preferences in television and radio programs. Patients who had visited Puerto Rico were asked about the duration and purpose of their most recent trip and about the health care they received in Puerto Rico. Chi-square testing was applied to categorical data and t tests for continuous data; P values were calculated using the SPSS statistical analysis program. RESULTS: Of the 200 subjects, 110 (55%) had traveled to Puerto Rico in the last five years and 90 (45%) had not. The patients who traveled were more likely to have been born in Puerto Rico, less likely to speak English, and less likely to listen to English-language programs. A majority of the patients who traveled to Puerto Rico visited for a month or less (80%) and did not experience a change in health care (78%). In comparison, however, a majority (59%) of the patients who visited for longer than a month did experience a major change in their health care status (P < .00001). CONCLUSIONS: Puerto Rican patients, particularly those born in Puerto Rico with stronger cultural "ties" to the island, frequently return to Puerto Rico. Patients who visit for longer than a month often experience changes in care which are likely to have significant effect on their health. Clinicians caring for Puerto Rican patients should ask about upcoming visits to Puerto Rico and take steps to assure continuous and coordinated medical care.     

Ethnic conflict and the psychology of liberation in Guatemala, Peru, and Puerto Rico

Ethnic identity and conflict in Guatemala, Peru, and Puerto Rico are complexly embedded within dynamic systems of class- and race-based geopolitics. Whereas overt violence and terror have permeated both Guatemalan and Peruvian societies, overt conflict has undermined Puerto Rican nationhood. Despite similarities among these 3 countries of Hispano-America, there are important particularities that inform psychological theory and practice. This article explores selected contributions of a psychology of liberation informed by indigenous psychologies and reflexive praxis. The challenges these conflicts and their consequences pose to psychologists seeking to work with populations most deeply affected by these social inequalities are analyzed. It concludes with suggestions of how psychology can move toward the development of community-based responses to psychosocial oppression that foster enhanced individual and collective development in a context of social change.     

Surgical manpower: past and present reality, estimates for 2000

The growth in the number of board-certified surgeons in the 1970s, projections of the need for surgeons in the year 2000, and possible factors softening the impact of surgical expansion are discussed in detail. The best index for the optimal supply of surgeons in the United States is related to the phenomenon of local community needs.     

Incidence of IDDM in children living in Puerto Rico. Puerto Rican IDDM Coalition

OBJECTIVE: To determine incidence, geographic distribution, and seasonal variation of IDDM in children 0-14 years of age living in Puerto Rico. Because these data have been collected through the infrastructure of the World Health Organization's DiaMond project, these results are directly comparable with incidence data from other population worldwide involved in this study. RESEARCH DESIGN AND METHODS: Beginning in 1990, new cases of IDDM were registered retrospectively from 1985 and prospectively to 1994 by review of medical records from island hospitals. Included in the hospital registry are 1,527 cases of IDDM. Validation of the primary source was by three secondary lists of cases obtained through diabetic camps, surveys of schools, and a government registry. Long linear modeling (capture-recapture) was used to correct incidence. RESULTS: Mean incidence of IDDM from 1985-1994 was 18.0 cases/100,000 children per year (95% CI 17.6-18.3). There was a slight female rather than male predominance: 51% of the cases were girls, and 49% were boys. Although Puerto Rico has marked variation in rainfall, altitude, and genetic markers, no significant differences are found in the incidence rates of different areas or seasons of the island. CONCLUSIONS: This registry of Puerto Rican children is the largest IDDM registry of minority children in the U.S. The results of this study indicate that the annual incidence of IDDM of children living in Puerto Rico is higher than the incidence of other multiracial ethnic groups living in the U.S.     

Adaptation and validation of the Spanish-language Trauma Symptom Inventory in Puerto Rico.

Objective: This research was conducted to assess the Spanish-language Trauma Symptom Inventory's (Briere, 1995) suitability for use with a Puerto Rican sample. Minor revisions were made to the original instrument following a comprehensive appraisal involving a bilingual committee and pilot focus group. The present study outlines the review and adaptation process and examines the psychometric properties of the revised instrument, the Inventario de Síntomas de Trauma-Revisado (IST–R). Method: A sample of 225 students (155 women, 70 men) at the University of Puerto Rico, age 20 to 59 (M = 23.24, SD = 4.69), participated in the validation study. Participants completed a demographic questionnaire; a self-report trauma exposure instrument; and measures of psychological distress, including Spanish-language versions of the Beck Depression Inventory, Symptom Checklist—36, and the Dissociative Experiences Scale. Results: Reliability coefficients for the IST–R clinical scales ranged from .69 to .91 (mean α = .84), and correlation coefficients were strongest for scales measuring the same constructs. Factor loadings obtained were consistent with those reported in the literature. Results support the internal consistency and construct validity of the IST–R. Conclusions: Culturally and linguistically appropriate assessment instruments are needed to address the mental health needs of diverse populations. Results from this study provide evidence for the clinical and research promise of the IST–R as a screening tool for trauma-related symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV/AIDS risk factors among adolescent students in Puerto Rico, 1994

PURPOSE: Identify several HIV risk behaviors among adolescent students. METHODS: The sample (n = 3,648) was selected using a two-staged stratified cluster sampling design, and weighted to represent all junior high and high school students. RESULTS: About 28.8% of the students reported ever having sexual activity. Less than half of the sexually active (44.5%) used condoms during their last sexual activity; 27.6% used them always. Only 54.7% knew correctly > 75% of the HIV knowledge questions. A HIV risk scale was constructed using five risk factors. About 15.9% of the students did not have any risk factor, 36.2% had one, 47.9% had two or more. Males and high school students had significantly more risk factors. Half of the students will abstain from having sex next year because they don't want to get HIV/AIDS. CONCLUSIONS: It is important to implement effective HIV prevention programs for adolescents in order to change their attitudes and behaviors.     

A cross-cultural comparison of alcohol expectancies in Puerto Rico and the United States.

This study compared the alcohol expectancies of 211 (62 men, 149 women) native Puerto Rican and 167 (54 men, 113 women) U.S. college students. Respondents completed a back-translated alcohol expectancy questionnaire. Results were factor analyzed separately by ethnicity. Comparison of factor structures indicated similarities and differences in expectancy structures. Puerto Rican respondents showed a tendency to associate positive aspects of alcohol effects with an expectancy for increased sociability, whereas for U.S. respondents these dimensions appeared to be independent. Puerto Ricans also had expectations of concurrent positive and negative alcohol effects on sexual behavior. A strong relationship between alcohol expectancies and alcohol consumption patterns was observed in both samples. Positive expectancies were better predictors of drinking than negative expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eradication of a new focus of Amblyomma variegatum in Puerto Rico

In May 1992 an infestation with the tropical bont tick appeared in a small dairy heifer replacement herd in Camuy, Puerto Rico, a completely new site located near Puerto Rico's northwest coast. This finding occurred after some three years of no infestation in either Puerto Rico or the U.S. Virgin Islands and is not suspected of being associated with any previous infestations. The methods used to eradicate this tick include spray treatment at a two-week interval of all domestic livestock, with amitraz at 0.025% and permethrin at 0.055%. Dogs and chickens are also inspected. Owners are encouraged to reduce numbers of these species. All livestock on adjoining farms are inspected and treated on a frequent basis. There has been no evidence of any spread and the infestation is expected to be eliminated within 18 months.     

Risk factors for dengue infection during an outbreak in Yanes, Puerto Rico in 1991

In November 1991, during a five-month dengue outbreak, we performed epidemiologic and serologic surveys linked to an earlier entomologic study in a community of 425 houses in Yanes (Florida), Puerto Rico. We obtained a household response rate of 95% (98 of 103) and blood samples from 84% (345 of 410) of the participants. Dengue incidence, as volunteered by the respondents, was 5% (21 of 410), but serologic diagnosis (immunoglobulin M and IgG-enzyme-linked immunosorbent assays [ELISA]) indicated a recent infection rate of 18% (59 of 331). The presence of anti-dengue antibodies was detected in 277 (84%) of 331 persons tested. In our final sample of 65 households and 112 persons, we analyzed (by univariate and multivariate logistic regression methods) the association of 12 entomologic, environmental, and behavioral variables with the proportion of household members with laboratory-confirmed recent dengue. The number of female Aedes aegypti per person was the only significant (P = 0.02) household risk factor. The results of our study underscore the importance of intradomiciliary mosquito populations in dengue transmission, and may serve as a guide for mosquito control efforts.     

Social networks and patterns of use among the poor with mental health problems in Puerto Rico

OBJECTIVES: This study uses the recently developed Network-Episode Model (NEM) to examine the nature and correlates of utilization among Puerto Ricans reporting mental health problems. The NEM highlights two issues: (1) examining the patterns or combinations of lay and formal use that individuals employ and (2) reformulating how the availability and content of social networks influences patterns of care. METHODS: Using data from the 1989 Mental Health Care Utilization Among Puerto Ricans Study (probability sample of 1,777 individuals living in low-income areas of the island), the authors focus on the patterns and correlates of use for 365 Puerto Ricans reporting service use for mental health problems in the previous year. RESULTS: A combination of clustering and multinomial logit techniques indicates that there are six unique care patterns. Two patterns include the use of mental health providers and are associated with different contingencies. CONCLUSIONS: In general, patterns of use are shaped by age, education, gender, and illness severity. Larger, more supportive networks decrease the use of patterns of care that include formal health care providers, and decrease direct entry into the mental health sector. These results are in line with NEM's predictions for lower class populations and help clarify inconsistencies in previous research on social networks. The implications of this perspective for health services research and treatment are discussed.     

Profile of a population using a primary health care center in Puerto Rico

PURPOSE: To describe the services delivered by the Family Medicine Physicians at a Community Health Center. METHODS: All information from patient visits during the natural year 1996 were registered using a commercialized computer program. The information was gathered by different means: initial interview, physician's report, records, and personal interviews. RESULTS: A total of 13,203 visits were registered; this represent a total of 4,493 patients. Most of the patients were women, and with a mean age of 38. As expected, most of the patients have Medicaid. The most common conditions seen were hypertension, diabetes, and respiratory diseases. The mean number of visits during the year for almost all conditions was three. Most of the children and adolescents visit the Center due to respiratory conditions, while adults come due to hypertension, diabetes, and musculoskeletal conditions.     

Short report: A case of ectopic schistosomiasis in Puerto Rico with some observations on the biology of the parasite

A recently acquired Schistosoma mansoni infection that resulted in a cervical polyp containing a pair of adult worms is reported in a Puerto Rican woman. Active schistosome transmission is not commonly reported in Puerto Rico at the present time and the ectopic location of the worms is rare in very light infections. Observations on the biology of the parasite recovered from the patient are described.     

American Psychological Foundation Awards for 1980: Gold Medal, Distinguished Teaching in Psychology, Development of Psychology Education in Puerto Rico and the Caribbean, and the National Media.

On September 2, 1980, at the annual meeting of the APA in Montreal, the American Psychological Foundation announced the recipients of the Gold Medal Award (Pauline Snedden Sears and Robert Richardson Sears), the Distinguished Teaching in Psychology Award (Elliot Aronson), the Award for the Development of Psychology Education in Puerto Rico and the Caribbean (Carlos Albizu-Miranda), and the National Media Awards (Marlene Cimons, Zick Rubin, Ellen Frank, Daniel Goleman, and Richard J. Trotter). A citation and brief biography for each award recipient is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute dissection of the thoracic aorta: experience at the Puerto Rico Medical Center (1991 through 1995)

BACKGROUND: Acute dissection of the thoracic aorta has a very poor prognosis unless promptly diagnosed and treated. The clinical presentation, diagnosis and management of 16 patients was reviewed. METHODS: We identified 12 patients from the Puerto Rico Medical Center and 4 patients from the "Centro Cardiovascular de Puerto Rico y del Caribe" whose diagnosis was made from January 1991 to December 1995. Medical records and autopsy reports were reviewed. RESULTS: Of the 16 patients, 10 [62%] were males, 10 [62%] were 60 years old or older [range 25 to 85 years], and 15 [93%] had a past history of hypertension although only 6 [38%] were found with an initial blood pressure of 140/90 or higher. Chest pain was the initial symptom in 13 [81%]. Of these 46% [6/13] described it as oppressive, with radiation to back or neck in 38% [5/13]. In none a neurological abnormality was the initial presentation. No physical sign was present in more than 40% of patients. One patient had a diastolic murmur suggestive of aortic regurgitation but none had a pericardial rub or a neurologic deficit. The electrocardiogram showed left ventricular hypertrophy in 35% but none had changes compatible with an acute Q wave infarction. The chest radiography was compatible with dissection in all in whom it was done [8/8]. Computerized tomography of the chest was diagnostic in 6 of 8 patients [sensitivity 75%]. Aortography had a sensitivity of 80% [4/5]. Trans-thoracic echocardiogram was diagnostic in 3 of 4 patients [75% sensitivity]. Transesophageal echocardiogram had a 100% sensitivity [2/2]. In 8 patients [50%] the correct diagnosis was made by postmortem examination, all of whom died within 24 hours of Emergency Room's evaluation. Of those properly diagnosed 5 died without being surgically intervened. Only one survived surgery [1/3] Overall mortality was 93%. The most common pathological finding was Type A dissection in 14 [88%]. Cardiac tamponade was found in 9 [56%]. Hemothorax was found in 6 [38%]. Aortic valve insufficiency was reported in 20% and coronary artery involvement in 28%. CONCLUSIONS: The dismal prognosis traditionally associated with acute dissection of the thoracic aorta remains unchanged. Prompt diagnosis based on high clinical suspicion. followed by expeditious medical and surgical treatment are fundamental to change the natural course of this condition.     

Carlos Albizu-Miranda: American Psychological Foundation Awards for 1980: Award for the Development of Psychology Education in Puerto Rico and the Caribbean.

Provides the biography of Carlos Albizu-Miranda and announces that he has received the American Psychological Foundation Award for the Development of Psychology Education in Puerto Rico and the Caribbean (1980). A selected bibliography is also provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predation on Aedes aegypti (Diptera: Culicidae) by Theridion rufipes (Araneae: Theridiidae) in Puerto Rico

A total of 110 total knee replacements (TKRs) was randomised to receive either a cemented or an uncemented prosthesis. Postoperative venography at five to seven days was used to compare the prevalence, site and size of deep-vein thrombosis (DVT). We also compared the findings with those of postoperative venography in a group of patients with cemented total hip replacements (THRs). The total prevalence of DVT was significantly greater after uncemented (81%) than after cemented TKR (55%). Both knee groups had a significantly higher prevalence of DVT than in cemented hip replacements (32%). We found no difference in the proportion with proximal DVT in the three groups (14%, 15% and 16%). The median length of the thrombi was significantly greater after cemented (26.5 cm) than after uncemented TKR (11 cm) or after cemented THR (7 cm). This difference was mainly due to greater lengths of distal rather than proximal thrombi. We conclude that the use of cement may affect the formation of DVT after joint replacement, but does not appear to lead to an increased incidence.     

Projected needs of health manpower in Saudi Arabia, 1974-90

Although our projections are not completely accurate, due to inadequate data and crude methods of approximation, three conclusions are inescapable: 1. The nation should give priority to planning new schools for health administrators and rural health workers, and to generally expanding present schools for paramedicals. 2. Plans should proceed rapidly for the two new medical schools. 3. A Health Manpower plan based on census information and special studies should be developed over the next 2 years. This plan should have input from all concerned ministries. (The Ministry of Health has regarded a proposal from University Associate "a group of Harvard, Johns Hopkins and A.U.B. professors" for technical cooperation in health services planning.)     

Male pseudohermaphroditism caused by enzymatic deficiency of 17-alpha-hydroxylase. 1st case reported in Puerto Rico

A 36 year old white female came to our service after having been evaluated on repetitive occasions in the past for a workup of gigantism and acromegalic features. Since childhood she had developed tall stature, frontal bossing, prominence of zygomatic bones, separated teeth, large hands and size 14 shoes. Human growth hormone and somatomedin serum levels had been normal on all occasions tested. Her past history was significant for primary amenorrhea and a 12 year history of hypertension. On physical examination BP was 140/100, height 6' 2", weight 2571 bs. Her phenotype was truly acromegalic. There was absence of axillary and pubic hair with no breast development. External genitalia was of female appearance. Laboratory evaluation showed increased FSH of 88 mlU/ml, increase LH of 65.6 mlU/ml and decreased E2 of 12.6 pg/ml. Other findings were low serum cortisol of 0.2 mg/dl, high ACTH of 344 pg/ml, low 17-Ketosteroids, high pregnenolone levels of 595 mg/dl, low 17-hydroxypregnenolone less than 10 ng/dl, very high aldosterone of 31 ng/dl and suppressed PRA of less than 0.1 ng/ml. A pelvic sonogram showed a right ovoid structure which could represent a gonad and failed to identify the uterus and left gonad. A bone densitometry showed a decrease bone mineral density compatible with osteoporosis. Chromosome study showed a karyotype of 46-XY. A diagnosis was made of congenital adrenal hyperplasia secondary to 17-alpha-hydroxylase deficiency in a genotypic male. Our patient was referred to the department of gynecology for surgical removal of the gonads. It is amazing how a patient with severe adrenal insufficiency can withstand 36 years of her life undiagnosed without going into an adrenal crisis. Her tall stature and acromegalic features were the striking signs confusing all physicians and delaying the correct diagnosis and appropriate treatment. There has been reported worldwide, nearly 120 cases with documented severe 17-alpha-hydroxylase deficiency. To our knowledge this is the first case identified in Puerto Rico of male pseudohermaphroditism secondary to 17-alpha-hydroxylase enzyme deficiency.