SYSTEMS BIOLOGY:
THE SCIENCE OF THE 21ST CENTURY




         Puerto Rican’s Epidemiologic
        Profile: A Systemic Per...
General Objectives
• To describe the social, economic,
  morbidity, and mortality profile of Puerto
  Ricans
• To put on v...
Methodology
• Literature revision.
• National and International organizations.
   – PAHO, WHO, CDC, Others
• Special studi...
About the Systems Theory
• Ludwing von Bertalanffy (1968)




                                                            ...
Social and Economic Indicators




                                                                                       ...
Puerto Rico population, income and education, 2000

                                                                      ...
7
Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
Economic resources, Puerto Rico 2008-2009




Presupuesto del Gobierno de Puerto Rico. (2008-2009). Available at: http://w...
9
Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
Other Faqs
         • For each 100 males      109 females
         • Life expectancy: 77.5 years
                    – Mal...
Population pyramid and age indicator,
                            Puerto Rico 1990 and 2000
                              ...
Social and economic implications
                       of population aging
         • Population aging represents, in one...
Violent deaths by category and
                          age, Puerto Rico 2005




Departamento de Salud (2005). Muertes V...
14
Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
Domestic violence
          • Several reasons                                                                 Entre enero ...
Morbidity and Mortality




                                                                                              ...
Principal causes of death,
                            Puerto Rico, 2004
                                                 ...
Prevalence estimates of the first 15 health
          conditions/diseases Puerto Rico, 2003
                Hypertension  ...
Asthma prevalence at the time of the survey in
          Puerto Rico, BRFSS (2000-2002)




     “…a decreasing tendency i...
Overweight and obesity in the Puerto Rican
             adult population – BRFSS*, 1996–2007

                            ...
Prevalence of diabetes in adults,
     Puerto Rico – BRFSS*, 1996–2007
                                         14        ...
Overweight and obesity in the Puerto Rican
adult population with Diabetes BRFSS*, 2004


                                 ...
Prevalence of diabetes mellitus
                     by age and sex, 2000-2003
                                           ...
Prevalence of the metabolic syndrome and
          its components according, San Juan 2005
                    Prevalence ...
Population aging and chronic diseases
 • Sanitary policies
   must focus on efforts
   to increase the
   expectancy of
  ...
Incidence for vaccine-preventable diseases
          Puerto Rico, 1990 - 2003

                                           ...
AIDS distribution by year of
diagnosis, Puerto Rico, 1981-2009
                        3000
                              ...
Pediatric cases by year of diagnosis,
      Puerto Rico, 1981 – 2008*
                      60


                         ...
Distribución Porcentual de Casos VIH (no-
SIDA) por Modo de Exposición, Puerto Rico
                                      ...
Mental Health




Vincent van Gogh, who himself suffered from depression and committed suicide, painted this picture in 18...
“…un cantante de música religiosa es
  acusado de agresión sexual y actos
 lascivos contra una niña de 11 años”
          ...
Prevalence estimates of one or more psychiatric
           disorders, Puerto Rico versus other countries,
                ...
Depression and lifestyle
• It has been found that people with major
  depression tend to have poorer health
  behaviors, s...
Psychiatric disorders and Diabetes
• Some psychiatric disorders, such as
  depression, anxiety, and schizophrenia,
  have ...
Diabetes and Depression in Puerto
         Rico, 2005        (Disdier & Jiménez, unpublished)


   Diseases           Prev...
Depression and Unemployment
   • Unemployment is a risk factor for
     psychological symptoms of depression
     requirin...
Lifestyles




                                                                                                       37
 ...
Daily Fruits and vegetables consumption
                                                     (5 or more servings),
       ...
Food marketing and health
  • Each year more money is expended in
    unhealthy food advertisement than in
    government ...
40
Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
Physical activity, Puerto Rico 2001

                                     Unknown                                         ...
Physical activity is associated with
             dramatic risk reductions
        quot;We know that diet is important,quo...
“Estudio establece que ejercitarse
  por sólo tres minutos cada día
   protége contra la diabetes”




                   ...
http://www.andertoons.com

                                                                                               ...
Education in Deep




                                                                                                    ...
“A primera vista en el país se podría
identificar un alto nivel de ingresos, y se
podría suponer una agenda educativa…”
  ...
“… la lucha político partidista, la
corrupción y la burocracia definen muchos
ámbitos de la política pública y de la
educa...
Educational attainment, for persons 25 years old
   and over, Puerto Rico 1990, 2000, 2005
                               ...
Analphabetism, for persons 10 years old and
             over, Puerto Rico by year
                                  90.0
...
50
Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
Average NAEP scores for mathematics, Puerto
         Rico versus U.S.A. Nation




WWW.ED.GOV


                          ...
Average NAEP scores for mathematics, Puerto
         Rico versus U.S.A. Nation




WWW.ED.GOV


                          ...
Education and Life expectancy
                                           1

                                              ...
Education and Gross Domestic
                      Product (GDP)
                       1
                                ...
Captive kids:
                               $elling obesity at schools
     • quot;More and more companies see school-
  ...
Television violence and children
      (Parents Television Council, 2006)




                                            ...
(Parents Television Council, 2006)

  The results were staggering.
  In the 443.5 hours of children’s
  programming analyz...
Interactions: social problems, economics,
     communication, social forces, and social wellness
                         ...
General recommendations
• Promote lifestyles changes, specially at a
  community level.
  – Improvements in education and ...
Selected references
Avilés LA, Cannino G, Rubio-Stipec M. Proyecciones de diagnósticos
psiquiátricos: Puerto Rico, año 200...
quot;Para que el hombre fuera hombre, es decir,
        digno de realizar los fines de su vida, la
 naturaleza le dio conc...
Información de Contacto
  Prof. Orville M. Disdier-Flores
         Gerente de Proyectos Estadísticos
       Instituto de E...
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Puerto Ricans Epidemiologic Profile A Systemic Perspective (Disdier Om) Final

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Puerto Ricans Epidemiologic Profile A Systemic Perspective (Disdier Om) Final

  1. 1. SYSTEMS BIOLOGY: THE SCIENCE OF THE 21ST CENTURY Puerto Rican’s Epidemiologic Profile: A Systemic Perspective Orville M. Disdier Project Manager, Statistics Instituto de Estadísticas de Puerto Rico
  2. 2. General Objectives • To describe the social, economic, morbidity, and mortality profile of Puerto Ricans • To put on view other related factors – Sociology – Education • To discuss the information presented through the open systems theory • Present some recommendations 2 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  3. 3. Methodology • Literature revision. • National and International organizations. – PAHO, WHO, CDC, Others • Special studies. • Analysis of several databases. – Behavioral Risk Factor Surveillance System (BRFSS). – Local health insurance companies – Department of Health databases – Department of Education • Internet publications. 3 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  4. 4. About the Systems Theory • Ludwing von Bertalanffy (1968) 4 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  5. 5. Social and Economic Indicators 5 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  6. 6. Puerto Rico population, income and education, 2000 Work force participation rate: 40.7% High Percentage Population: school under the graduates: poverty 3,808,610 59.9% level: 48.2% Annual house income (median): $14,511 Pérez CM, Pérez R, Mattei H, Disdier OM, Rodríguez LA. Perfil sociodemográfico y análisis de morbilidad asociada a causas selectas en la población asegurada de Puerto Rico, 2000 – 2003. 2005. 6 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  7. 7. 7 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  8. 8. Economic resources, Puerto Rico 2008-2009 Presupuesto del Gobierno de Puerto Rico. (2008-2009). Available at: http://www.presupuesto.gobierno.pr/Tomo_I/resumenpresupuesto/recursosConsolidados.pdf. 8 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  9. 9. 9 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  10. 10. Other Faqs • For each 100 males 109 females • Life expectancy: 77.5 years – Males: 73 – Females: 81 • In 2005 for each 100 marriage there was 67 divorces. • 30% are single-mom households with small children • 25% of the population has some kind of physical or mental impairment. • Teenage births (15 – 19 years old): 18% • Each morning,13% of Puerto Rico workers spend >1 hour in the traffic jam. Rivas. (2008). Situación presente de la educación de personas jóvenes y adultas en Puerto Rico. Centro de Cooperación Regional para la Educación de Adultos en América Latina y el Caribe. Disponible en: http://www.crefal.edu.mx/novedades/informes_nacionales_confintea.htm. Lobato y Curi. (2005). El tapón de la mañana. Tendenciaspr.com. Disponible en: http://www.tendenciaspr.com/Publicaciones/transporte/tapon.html#anchor_191. 10 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  11. 11. Population pyramid and age indicator, Puerto Rico 1990 and 2000 1990 2000 1980 1990 2000 Aging index* 25 36 47 Age median (years) 24.6 28.5 32.1 *Number of people ≥ 65 years old per 100 people under 15 years old. Pérez CM, Pérez R, Mattei H, Disdier OM, Rodríguez LA. Perfil sociodemográfico y análisis de morbilidad asociada a causas selectas en la población asegurada de Puerto Rico, 2000 – 2003. 2005. 11 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  12. 12. Social and economic implications of population aging • Population aging represents, in one sense, a success story for mankind – But it also poses profound challenges to public institutions that must adapt to a changing age structure. • Increase in the older retired population, decrease in population of working ages, – Creates social and political pressures on social support systems. Gavrilov L.A., Heuveline P. (2003). Aging of Population. In: Paul Demeny and Geoffrey McNicoll (Eds.). The Encyclopedia of Population. New York, Macmillan Reference USA. Available at: http://www.galegroup.com/servlet/ItemDetailServlet?region=9&imprint=000&titleCode=M333&type=4&id=174029 12 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  13. 13. Violent deaths by category and age, Puerto Rico 2005 Departamento de Salud (2005). Muertes Violentas por Grupos de Edad, Sexo, Municipio de Residencia y Año. Secretaría Auxiliar de Planificación y Desarrollo, División de Análisis Estadístico, San Juan, Puerto Rico. Available at: http://www.salud.gov.pr/Datos/InfoSalud/Statistics/GeneralDeath/Pages/MuertesViolentasporGruposdeEdadMunicipiodeResidencia.aspx . 13 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  14. 14. 14 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  15. 15. Domestic violence • Several reasons Entre enero y diciembre – Social de 2001 la Policía de Puerto Rico informó 17,700 – Cultural intervenciones por – Economic violencia doméstica. • Limited essential En el 86% la víctima fue resources una mujer. – Housing – Employment – Education Oficina de la Procuradora de la Mujer. (2008). La violencia doméstica nos toca a todos. 15 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  16. 16. Morbidity and Mortality 16 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  17. 17. Principal causes of death, Puerto Rico, 2004 4.2 Alzheimer 5.3 Hypertension 8.8 Diabetes 16.6 Cancer 17.3 Heart disease Porcentaje (%) Estado Libre Asociado de Puerto Rico. Informe Anual de Estadísticas Vitales, 2004. Secretaría Auxiliar de Planificación, Evaluación, Estadísticas, y Sistemas de Información. División de Estadísticas 17 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  18. 18. Prevalence estimates of the first 15 health conditions/diseases Puerto Rico, 2003 Hypertension #1 14.76 Asthm a 12.23 Diabetes #3 7.73 Arthritis 7.27 Sinusitis (chronic) 7.12 Allergic rhinitis 5.39 Lipoproteins problem s 5.28 Migraine 4.29 #9 Circulatory problem s 3.67 Myopia and astigm atism 3.29 Intervertebral discs problem s 2.98 #12 Depressive episode 2.88 Acute rinofaringitis 2.79 Gastritis 2.50 Back disability 2.43 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 Prevalence (%) 18 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  19. 19. Asthma prevalence at the time of the survey in Puerto Rico, BRFSS (2000-2002) “…a decreasing tendency in the asthma prevalence as income reported increases. A statistically significant difference was observed during year 2000 between income groups of less than $15,000 and $50,000 or more.” Bartolomei-Diaz, 2007 Bartolomei-Diaz, J. (2006-2007). Epidemiological Profile of Asthma in Puerto Rico . Puerto Rico Asthma Project. Puerto Rico Department of Health. Available at: http://www.salud.gov.pr/OficEpidemiologia/Documents/AsthmaEpiProfile.pdf. 19 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  20. 20. Overweight and obesity in the Puerto Rican adult population – BRFSS*, 1996–2007 45 40.70 40.60 39.00 39.00 39.60 39.30 38.00 Prevalence (%) 39.40 40 37.20 37.20 38.30 36.80 35 30 26.60 25 24.30 24.70 20 23.70 22.90 21.70 22.20 22.00 21.30 19.30 19.00 15 16.80 Normal (BMI < 24.9) 10 Overweight Obese Overweight (25 < BMI < 29.9) 5 Obese (BMI > 30) 0 Year * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2007. Atlanta, GA: United States, Department of Health and Human Services. 20 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  21. 21. Prevalence of diabetes in adults, Puerto Rico – BRFSS*, 1996–2007 14 12.5 12.5 Prevalence (%) 11.9 12 10.7 11.0 10.8 10.5 10.5 9.8 9.6 9.6 10 8.5 8 6 4 1.9 2 Diabetes Pre-Diabetes 1.5 1.3 1.1 0 Year * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2007. Atlanta, GA: United States, Department of Health and Human Services. 21 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  22. 22. Overweight and obesity in the Puerto Rican adult population with Diabetes BRFSS*, 2004 35.7 Obe se 43.9 Ove rwe ight 20.4 Normal 0 5 10 15 20 25 30 35 40 45 50 Percent (% ) Normal (BMI < 24.9) Overweight (25 < BMI < 29.9) Obese (BMI > 30) * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2003. Atlanta, GA: United States, Department of Health and Human Services. 22 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  23. 23. Prevalence of diabetes mellitus by age and sex, 2000-2003 40.3 35.9 32.1 31.1 30.0 27.6 Prevalence (%) 24.4 22.2 Female Male 14.3 12.4 8.3 8.0 6.2 4.9 2.4 3.1 <18 18-24 25-34 35-44 45-54 55-64 65-74 >74 Age (in years) Pérez CM, Pérez R, Mattei H, Disdier OM, Rodríguez LA. Perfil sociodemográfico y análisis de morbilidad asociada a causas selectas en la población asegurada de Puerto Rico, 2000 – 2003. 2005. 23 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  24. 24. Prevalence of the metabolic syndrome and its components according, San Juan 2005 Prevalence (%) 49.0 48.7 45.6 38.2 31.2 30.8 MS Abdominal Ele vate d Low HDL-C Ele vated Hype rtension O besity Glucose Triglyceride s Prevalence of the metabolic syndrome and its individual components in the adult population of the San Juan metropolitan Area. C. Pérez, PhD*, A. Ortiz, PhD*, M. Estrella, MPH*, N. Pérez, MS*, Y. Valle, MPH*, M. Guzmán, MD†, L. Haddock, MD†, E. Suárez, PhD*, Graduate School of Public Health* and School of Medicine†, University of Puerto Rico. 24 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  25. 25. Population aging and chronic diseases • Sanitary policies must focus on efforts to increase the expectancy of incapacity-free years. – Instead of just the simple life expectancy . Organización Mundial de la Salud. (2007). Panorama de la Salud en la Región. Salud en las Américas 2007. 25 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  26. 26. Incidence for vaccine-preventable diseases Puerto Rico, 1990 - 2003 AÑO DE INCIDENCIA ENFERMEDAD 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Tétano 4 1 1 2 2 0 2 1 1 2 0 0 3 0 Tosferina 26 57 14 11 3 3 3 2 1 9 2 0 0 1 Paperas 8 13 3 3 2 3 2 7 1 0 0 1` 2 0 Meningitis XH FLU 35 15 8 3 3 3 2 0 2 2 4 1 2 4 Hepatitis B 610 580 393 422 415 689 1,073 843 278 303 313 258 219 143 Hepatitis B Perinatal N/A N/A 35 75 108 98 126 117 96 89 95 51 63 17 Sarampión Común 1,817 160 577 356 46* 3 3 0 0 1 3 1 2 0 Sarampión Alemán 0 0 1 0 0 0 0 0 0 2 0 3 0 0 Difteria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Polio 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rabia Humana 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Varicela** 1,332 5,233 8,524 8,240 9,193 5,678 5,942 8,854 4,348 5,019 5,200 2,186 1,141 * * Incluidos los falsos positivos por método de Clark **Obligatorio a partir del 1997 Fuente: Departamento de Salud, Programa de Epidemiología, 1990-2003. 26 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  27. 27. AIDS distribution by year of diagnosis, Puerto Rico, 1981-2009 3000 2,669 2,526 2500 2,348 2,306 2,133 2,053 2000 1,851 Number of cases 1,735 1,598 1,447 1500 1,283 1,279 1,177 1,177 1039 1050 1000 898 917 813 750 672 455 500 441 268 184 5 0 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 5 98 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20 <1 Year of diagnosis N = 33,074 Casos reportados hasta el 01/30/2009. 27 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  28. 28. Pediatric cases by year of diagnosis, Puerto Rico, 1981 – 2008* 60 48 45 42 41 37 37 40 Number of cases 32 25 21 17 20 15 13 12 65 4 3 2 2 1 1 10 1 0 0 0 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 Year of diagnosis Fuente: Programa Vigilancia de SIDA, División de Epidemiología, Departamento de Salud de Puerto Rico N =411 *Casos pediátricos reportados hasta el 1/30/2009. 28 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  29. 29. Distribución Porcentual de Casos VIH (no- SIDA) por Modo de Exposición, Puerto Rico Sexo H/H y UDI 3% No Ident. 12% Uso Drogas Inyectables (UDI) 36.1 Sexo Hom bre/Hom bre 38% 14% Contacto Heterosexual 33% N = 7,346 Casos reportados adults/adolesc. hasta el 1/30/2008 29 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  30. 30. Mental Health Vincent van Gogh, who himself suffered from depression and committed suicide, painted this picture in 1890 of a man that can symbolize the desperation and hopelessness felt in depression. 30 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  31. 31. “…un cantante de música religiosa es acusado de agresión sexual y actos lascivos contra una niña de 11 años” 31 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  32. 32. Prevalence estimates of one or more psychiatric disorders, Puerto Rico versus other countries, 2000 - 2003 4.3 China (Shangai) 8.8 Japón 9.1 China (Beijin) 12.2 Mexico 17.8 Colombia 26.4 Estados Unidos 27. 5 Puerto Rico Prevalencia (%) Avilés LA, Cannino G, Rubio-Stipec M. Proyecciones de diagnósticos psiquiátricos: Puerto Rico, año 2000. Puerto Rico Health Sciences Journal 1990; 9(3):235-243. World Mental Health Organization. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291(21): 2581-2590. 32 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  33. 33. Depression and lifestyle • It has been found that people with major depression tend to have poorer health behaviors, specially those which are risk factors for obesity and diabetes (Talbot F, & Nouwen, 2000; Knol, Twisk, & Beekman, 2006). – Unhealthy diet – Smoking – Sedentary lifestyles 33 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  34. 34. Psychiatric disorders and Diabetes • Some psychiatric disorders, such as depression, anxiety, and schizophrenia, have been associated with diabetes (Lean, & Pajonk, 2003; Anderson, Freedland, & Clouse, 2001; Lustman, Anderson, & Freedland, 2000; Lustman, 1988). • Individuals with diabetes have twice the risk of suffering from depression than people without diabetes (Anderson, Freedland, & Clouse, 2001) 34 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  35. 35. Diabetes and Depression in Puerto Rico, 2005 (Disdier & Jiménez, unpublished) Diseases Prevalence Diabetes 9.8 % (96% CI: 9.7% - 10.1%) Major depression 3.1% (95% CI: 3.2% - 3.3%) Diabetes in 14.6% subjects with POR (95% CI: 14.2% - 15.0%) major depression 1.6 Diabetes in 9.7% subjects without (95% CI: 9.5% - 9.9%) (95% CI: 1.5 – 1.6) major depression Pvalue < 0.001 35 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  36. 36. Depression and Unemployment • Unemployment is a risk factor for psychological symptoms of depression requiring medical attention – Even in those men without previous psychological vulnerability. • Adjusted RR = 2.10 (95% CI: 1.21 - 3.63). Montgomery, S., Cook, D., Bartley, M., & Wadsworth, M. (1999, February). Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men. International Journal Of Epidemiology, 28(1), 95-100. Retrieved January 13, 2009, from MEDLINE with Full Text database. 36 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  37. 37. Lifestyles 37 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  38. 38. Daily Fruits and vegetables consumption (5 or more servings), BRFSS, Puerto Rico, 2007 Yes 14% No 86% * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 2007. Atlanta, GA: United States, Department of Health and Human Services. 38 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  39. 39. Food marketing and health • Each year more money is expended in unhealthy food advertisement than in government publicity and efforts aimed to promote health lifestyles (US Department of Health and Human Services. Nutrition and Overweight. Healthy People 2010. January 21, 2004) US Department of Health and Human Services. Nutrition and Overweight. Healthy People 2010. January 21, 2004. 39 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  40. 40. 40 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  41. 41. Physical activity, Puerto Rico 2001 Unknown Yes 14% 17% No 69% Estudio Continuo de Salud. Departamento de Salud de Puerto Rico. Universidad de Puerto Rico, Escuela Graduada de Salud Pública, 2001. 41 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  42. 42. Physical activity is associated with dramatic risk reductions quot;We know that diet is important,quot; said co- author Chris Riddoch, Ph.D., of Bath University, quot;but what this research tells us is that we mustn't forget about activity.“ quot;It's been really surprising to us how even small amounts of exercise appear to have dramatic results,quot; he said in a statement. Online in the open-access journal PLoS Medicine. Just 15 Minutes of Physical Activity Lowers Kids@Risk of Obesity and Diabetes. http://www.diabetesincontrol.com/results.php?storyarticle=4665. 42 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  43. 43. “Estudio establece que ejercitarse por sólo tres minutos cada día protége contra la diabetes” 43 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  44. 44. http://www.andertoons.com 44 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  45. 45. Education in Deep 45 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  46. 46. “A primera vista en el país se podría identificar un alto nivel de ingresos, y se podría suponer una agenda educativa…” “…una segunda mirada nos revela… casi la mitad de la población vive en la pobreza, el país tiene un coeficiente de desigualdad social alto...” Myrna Rivas Nina, 2008. 46 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  47. 47. “… la lucha político partidista, la corrupción y la burocracia definen muchos ámbitos de la política pública y de la educación.” Myrna Rivas Nina, 2008. 47 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  48. 48. Educational attainment, for persons 25 years old and over, Puerto Rico 1990, 2000, 2005 60.0 Puerto Rico está en la posición #48 (de 51) en 50.3 50.0 cuanto al total de personas con bachillerato o más 40.0 40.0 Percent (%) 33.6 20.7% 1990 30.0 24.2 2000 22.3 21.0 20.0 2005 15.5 13.6 12.2 11.9 10.7 9.5 10.0 8.8 7.2 5.6 4.7 5.3 3.6 0.0 Less than High Some Associate Bachelor Graduate High School College, no Degree Degree School School Graduate degree Degree Negociado del Censo. Censo 1990, Censo 2000, Encuesta de la Comunidad 2005. 48 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  49. 49. Analphabetism, for persons 10 years old and over, Puerto Rico by year 90.0 79.6 80.0 78.4 70.0 65.5 60.0 Percent (%) 55.0 50.0 40.0 41.4 31.5 30.0 24.7 20.0 16.6 13.1 11.5 10.0 10.7 10.6 0.0 Negociado del Censo. Censo 1890-1990. 49 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  50. 50. 50 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  51. 51. Average NAEP scores for mathematics, Puerto Rico versus U.S.A. Nation WWW.ED.GOV 51 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  52. 52. Average NAEP scores for mathematics, Puerto Rico versus U.S.A. Nation WWW.ED.GOV 52 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  53. 53. Education and Life expectancy 1 y = 0.732x + 0.1319 Iceland 0.9 r = 0.74 0.8 R=55% 0.7 Life Expectancy Index 0.6 0.5 0.4 0.3 Africa 0.2 0.1 0 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Education Index Raw data from: United Nations Development Programme. (2008). Human Development Reports 2007-2008. Available at http://hdr.undp.org/en/terms/. 53 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  54. 54. Education and Gross Domestic Product (GDP) 1 United States 0.9 y = 0.807x + 0.0488 0.8 r = 0.78 0.7 R=61% 0.6 GDP 0.5 0.4 0.3 Africa 0.2 0.1 0 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Education Index Raw data from: United Nations Development Programme. (2008). Human Development Reports 2007-2008. Available at http://hdr.undp.org/en/terms/. 54 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  55. 55. Captive kids: $elling obesity at schools • quot;More and more companies see school- based marketing as the most compelling, memorable and cost effective way to build share of mind and market into the 21st Century”. • “Candy and snack food manufacturers, soft drink bottlers, and fast food restaurants are among the companies that market most heavily in schools” California Project LEAN . (2006). Captive kids: $elling obesity at schools- An action guide to stop the marketing of unhealthy foods and beverages in school. Available from: http://www.californiaprojectlean.org/Assets/1019/files/CK2007.pdf. 55 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  56. 56. Television violence and children (Parents Television Council, 2006) 56 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  57. 57. (Parents Television Council, 2006) The results were staggering. In the 443.5 hours of children’s programming analyzed by the PTC there were: •3,488 instances of violence – an average of 7.86 violent incidents per hour. •There is more violence aimed directly at young children than at adults on television today. •858 incidents of verbal aggression •250 incidents of offensive language •662 incidents of disruptive, disrespectful or otherwise problematic attitudes and behaviors •275 incidents of sexual content 57 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  58. 58. Interactions: social problems, economics, communication, social forces, and social wellness Interacción entre Problemas Sociales, Metas y Procesos y Fuerzas Inhibidoras y Facilitadoras del Ambiente Social Sano. RESULTADOS PROCESOS ESTRUCTURA Metas y Procesos Problemas Sociales Fuerzas Inhibidoras y Facilitadoras de Ambiente Sano J P U O Empleo S Optimo L CRIMEN T I I I Comunicación T DROGADICCION C N M Social Sana I I E T R ALCOHOLISMO C A E C A MODELO ECONOMICO A R DESERCION D AUTOSUSTENTABLE N ESCOLAR O A P C U C MATERNIDAD A B I P PRECOZ I L O P CULTURA T Familia I A A N Sana I VIOLENCIA L Z A C DOMÉSTICA L T A I E CORRUPCIÓN C Z DEL GOBIERNO N DEMOCRACIA A O PARTICIPATIVA L S C CIVISMO O A SIDA E I G L Nivel de I Q O Soberanía A U U N Optima D I A Comunidad D Empoderada B A y L Organizada D E US Department of Health and Human Services. Nutrition and Overweight. Healthy People 2010. January 21, 2004. 58 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  59. 59. General recommendations • Promote lifestyles changes, specially at a community level. – Improvements in education and socioeconomics • Innovations in effective prevention programs. • Keep the developing of new medical and technologic advances. • Conscientious rejection or acceptance of our new and future culture. 59 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  60. 60. Selected references Avilés LA, Cannino G, Rubio-Stipec M. Proyecciones de diagnósticos psiquiátricos: Puerto Rico, año 2000. Puerto Rico Health Sciences Journal 1990; 9(3):235-243. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2007. Atlanta, GA: United States, Department of Health and Human Services. Montgomery, S., Cook, D., Bartley, M., & Wadsworth, M. (1999, February). Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men. International Journal Of Epidemiology, 28(1), 95-100. Retrieved January 13, 2009, from MEDLINE with Full Text database Pérez CM, Pérez R, Mattei H, Disdier OM, Rodríguez LA. Perfil sociodemográfico y análisis de morbilidad asociada a causas selectas en la población asegurada de Puerto Rico, 2000 – 2003, 2005. Rivas. (2008). Situación presente de la educación de personas jóvenes y adultas en Puerto Rico. Centro de Cooperación Regional para la Educación de Adultos en América Latina y el Caribe. Disponible en: http://www.crefal.edu.mx/novedades/informes_nacionales_confintea.htm. World Mental Health Organization. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291(21): 2581-2590. 60 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  61. 61. quot;Para que el hombre fuera hombre, es decir, digno de realizar los fines de su vida, la naturaleza le dio conciencia de ella, capacidad de conocer su origen, sus elementos favorables y contrarios, su trascendencia y relaciones, su deber y su derecho, su libertad y su responsabilidad, capacidad de perfecciones y de mejorar por si mismo las condiciones de su ser y por sí mismo elevar el ideal de su existenciaquot; Eugenio María de Hostos 61 Puerto Rican’s Epidemiologic Profile – A Systemic Perspective ©Prof. Orville M. Disdier
  62. 62. Información de Contacto Prof. Orville M. Disdier-Flores Gerente de Proyectos Estadísticos Instituto de Estadísticas de Puerto Rico Calle Quisqueya #57, 2do piso, San Juan, PR 00917 P.O. Box 195484, San Juan, PR 00919-5484 Teléfono: (787) 993-3342 Fax: (787) 993-3346 Email: Orville.Disdier@estadisticas.gobierno.pr Página de Internet: www.estadisticas.gobierno.pr http://disdier.blogspot.com

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