This document summarizes a study comparing the profiles of Alzheimer's disease patients in two regions of Puerto Rico with differing socioeconomic characteristics and mortality rates associated with Alzheimer's. The study found that patients in the region with lower socioeconomic status and higher Alzheimer's mortality (Northwest-Central Region) were diagnosed at a younger age and had fewer years of education than those in the higher socioeconomic Metro Region. Despite these differences, both regions showed similar initial cognitive impairment and rates of cognitive decline. The study suggests that socioeconomic factors may contribute to increased Alzheimer's disease risk.
This essay gives the descriptive account of how Paratransit services are in need of better assessment criteria but it also highlights the expense of managing a program that caters to people who are disabled.
American journal of epidemiology www.lizettealvarez.comeVerticeHealthTech
This document describes recruitment methods used in a case-control study of lung cancer among African Americans and Latinos in the San Francisco Bay Area from 1998-2001. Rapid case ascertainment through the tumor registry identified eligible lung cancer cases. Random digit dialing and Health Care Financing Administration records were initially used to recruit controls but failed to yield sufficient numbers. Community-based recruitment methods like churches, health fairs, and physicians' offices were more effective at recruiting African American and Latino controls, requiring less than 1 hour per control recruited on average.
This study examined variations in cost, mortality, and race among hospitalized patients with multiple chronic conditions (MCC) using a dataset of 788 patient cases from 2012. The results showed significantly higher average total charges for patients with 5+ chronic conditions compared to those with 1-4 conditions. There was no significant association found between the number of chronic conditions and mortality or between Hispanic and Black race among patients with 5+ conditions. The findings support the trend of higher healthcare costs for patients with MCC, though inconsistencies in mortality and race results highlight limitations of the small dataset size. Further exploration of factors related to rising MCC prevalence and healthcare costs is recommended.
More young people in Canada are visiting EDs because of drinking alcoholΔρ. Γιώργος K. Κασάπης
More people are visiting emergency departments after drinking alcohol, a new study finds. Researchers looked at more than 765,000 ED visits in Ontario, Canada’s largest province, and found a 175% increase in such visits between 2003 and 2016 among 25- to 29-year-olds. That spiked to a 240% increase in alcohol-related ED visits for young women, who were also more likely than men to be under Canada’s legal drinking age of 19. For both young men and women, visiting the ED for alcohol-related problems also led to more hospital admissions than other types of ED visits. Other countries, including the U.S., have experienced similar increases in alcohol-related visits to the ED, the authors behind the new study write, urging more research into the reasons behind the growing trend.
The rate of alcohol-related deaths has accelerated in recent years, according to a new analysis of U.S. mortality data between 2000-2016. Here's more:
•Overall trends: There were more than 425,000 alcohol-induced deaths during the study period. The annual percentage change in such deaths increased among both men and women, but rose significantly starting in 2012.
•Demographics: Starting in 2012, men experienced a 4.2% annual increase in alcohol-related deaths. From 2013-2016, women experienced an annual percentage increase of around 7%. American Indian and Alaska Native women experienced the highest increases over the 17-year study period.
•Causes: Alcoholic liver disease accounted for the majority of deaths among men and women, followed by mental or physical disorders due to alcohol and accidental poisoning.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes a systematic review of 146 studies on determinants of adherence to antiretroviral therapy (ART) among HIV-positive adults in sub-Saharan Africa. The main findings were:
1) Main determinants of non-adherence included use of alcohol, male gender, use of traditional medicine, dissatisfaction with healthcare, depression, stigma, and poor social support.
2) Promoters of adherence included counseling, education, memory aids, and disclosure of HIV status.
3) Determinants of health status had conflicting effects on adherence.
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This essay gives the descriptive account of how Paratransit services are in need of better assessment criteria but it also highlights the expense of managing a program that caters to people who are disabled.
American journal of epidemiology www.lizettealvarez.comeVerticeHealthTech
This document describes recruitment methods used in a case-control study of lung cancer among African Americans and Latinos in the San Francisco Bay Area from 1998-2001. Rapid case ascertainment through the tumor registry identified eligible lung cancer cases. Random digit dialing and Health Care Financing Administration records were initially used to recruit controls but failed to yield sufficient numbers. Community-based recruitment methods like churches, health fairs, and physicians' offices were more effective at recruiting African American and Latino controls, requiring less than 1 hour per control recruited on average.
This study examined variations in cost, mortality, and race among hospitalized patients with multiple chronic conditions (MCC) using a dataset of 788 patient cases from 2012. The results showed significantly higher average total charges for patients with 5+ chronic conditions compared to those with 1-4 conditions. There was no significant association found between the number of chronic conditions and mortality or between Hispanic and Black race among patients with 5+ conditions. The findings support the trend of higher healthcare costs for patients with MCC, though inconsistencies in mortality and race results highlight limitations of the small dataset size. Further exploration of factors related to rising MCC prevalence and healthcare costs is recommended.
More young people in Canada are visiting EDs because of drinking alcoholΔρ. Γιώργος K. Κασάπης
More people are visiting emergency departments after drinking alcohol, a new study finds. Researchers looked at more than 765,000 ED visits in Ontario, Canada’s largest province, and found a 175% increase in such visits between 2003 and 2016 among 25- to 29-year-olds. That spiked to a 240% increase in alcohol-related ED visits for young women, who were also more likely than men to be under Canada’s legal drinking age of 19. For both young men and women, visiting the ED for alcohol-related problems also led to more hospital admissions than other types of ED visits. Other countries, including the U.S., have experienced similar increases in alcohol-related visits to the ED, the authors behind the new study write, urging more research into the reasons behind the growing trend.
The rate of alcohol-related deaths has accelerated in recent years, according to a new analysis of U.S. mortality data between 2000-2016. Here's more:
•Overall trends: There were more than 425,000 alcohol-induced deaths during the study period. The annual percentage change in such deaths increased among both men and women, but rose significantly starting in 2012.
•Demographics: Starting in 2012, men experienced a 4.2% annual increase in alcohol-related deaths. From 2013-2016, women experienced an annual percentage increase of around 7%. American Indian and Alaska Native women experienced the highest increases over the 17-year study period.
•Causes: Alcoholic liver disease accounted for the majority of deaths among men and women, followed by mental or physical disorders due to alcohol and accidental poisoning.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes a systematic review of 146 studies on determinants of adherence to antiretroviral therapy (ART) among HIV-positive adults in sub-Saharan Africa. The main findings were:
1) Main determinants of non-adherence included use of alcohol, male gender, use of traditional medicine, dissatisfaction with healthcare, depression, stigma, and poor social support.
2) Promoters of adherence included counseling, education, memory aids, and disclosure of HIV status.
3) Determinants of health status had conflicting effects on adherence.
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
This document summarizes that poor health outcomes and lower quality of care are often experienced by patients with limited English proficiency due to language and cultural barriers. It discusses several tragic medical errors that occurred due to communication issues between providers and LEP patients. It outlines the legal obligations of healthcare providers to provide language services based on federal and state laws and regulations, and accreditation standards. Effective identification of LEP populations in need of assistance and data collection on patient race/ethnicity remains a challenge.
Refugee Health, Screening and Data Collection in the Triangle of North Caroli...Courtney Hereford
This document discusses refugee health screening and data collection in North Carolina. It finds that while infectious diseases are still a priority, noncommunicable diseases like diabetes and mental illnesses are increasingly common among refugees and pose growing challenges. The Triangle region of North Carolina receives about 1,000 refugees annually from 40 countries, yet systematic data on noninfectious health issues is lacking. The document calls for standardized, comprehensive health screening and data collection for both infectious and noninfectious refugee health needs in the Triangle to better address their diverse health issues and improve care. This could be achieved through an integrated health center partnership between universities and state/local health programs.
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Bridgin language and cultural barriers between physicians and patientslukamatias
- The study surveyed 301 primary care physicians in Northern California about their experiences communicating with non-English speaking patients.
- On average, physicians reported that 21% of their patient visits were with non-English speaking patients. However, in 73% of encounters with non-English speaking patients, the physician could not speak the patient's language.
- Trained medical interpreters or telephone interpreter services were used in fewer than 6% of encounters with non-English speaking patients. In most encounters, physicians relied on ad hoc methods like using untrained staff or family members of the patient.
The life expectancy of people with fetal alcohol syndrome (FAS) is estimated to be 34 years, which is significantly lower than the general population's life expectancy of 79 years for men and 83 years for women. The leading causes of death for people with FAS are external causes such as suicide, accidents, and poisoning, which account for 44% of deaths. Diseases of the nervous system, respiratory system, and digestive system are also common causes of death for this group. Their mortality rate is 7.4 to 73 times higher than the general population, depending on age group.
Sarah La Brada was diagnosed with multiple sclerosis and had difficulty accessing timely care through the VA system in Long Beach, with wait times of up to a month to see the sole neurologist. This forced her to exit the VA system and obtain private health insurance. Many veterans using the Los Angeles and Long Beach VA hospitals report wait times of up to 90 days to see primary care physicians and as long as 8 months to see specialists, prompting some to seek outside care. An investigation found VA hospitals, including in Los Angeles, were falsifying records to make wait times appear better, with the Phoenix VA having at least 23 veterans die while waiting for an appointment.
1. The study examined whether racial/ethnic differences exist in the diagnosis of Parkinson's disease (PD) among a Medicaid population in Pennsylvania from 1998-2003.
2. It found that middle-aged black Medicaid enrollees were diagnosed with PD at half the rate of whites, even after controlling for factors like age, gender, location of care, and healthcare utilization.
3. Racial differences in PD diagnosis rates were not fully explained by income, insurance access, or healthcare use, and may be influenced by other factors related to accessing and navigating the healthcare system, as well as potential physician bias.
Estimating HIV prevalence and risk behaviors of transgender persons in the Un...Santé des trans
Cet article, paru en 2008 dans la revue AIDS and Behavior, présente une synthèse des données disponibles dans la littérature scientifique concernant la prévalence du VIH parmi les trans aux Etats-Unis et leurs facteurs de risque comportementaux par rapport à la transmission du virus.
Adherencia al tarv en am latina y caribeRosa Alcayaga
This systematic review and meta-analysis examined adherence to antiretroviral therapy (ART) among people living with HIV in Latin America and the Caribbean. The analysis included 53 studies published between 2005-2016 involving over 22,000 individuals across 25 countries. The overall adherence rate was estimated to be 70%, similar to rates in high-income regions. Adherence was higher with shorter recall periods and in lower income countries. Common barriers to adherence included substance abuse, depression, unemployment and pill burden. The review suggests adherence in the region may be below the level needed for long-term viral suppression.
Ethnicity and Differential Access to Care for Eating Disorder SymptomsDr David Herzog
Dr David Herzog discusses how Ethnicity impacts Differential Access to Care for Eating Disorder Symptoms, and what the reality of the disease is vs. our public perceptions.
This document is a CV for Dr. Sara Michelle Handy that summarizes her education, training, professional experience, licensure, certifications, memberships, awards, publications, and presentations. She received her M.D. and M.P.H. from SUNY Downstate School of Medicine and has worked as an emergency medicine/internal medicine resident at University of Maryland Medical Center from 2006-2012 with a personal leave from 2010-2011. She is board eligible in internal medicine and emergency medicine and maintains several professional memberships and licenses.
Hepatitis C Risk Assessment, Testing and Referral for Treatment in primary Ca...Real Wellness, LLC
Dr. Robert Winn worked with a team to determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
HCS 400 Systems and Policies Minorities Receive lower-quality healthcareMaria Jimenez
The literature review examines research showing that minority patients receive lower quality healthcare than white patients. Several studies found that issues like language barriers, lack of insurance or inadequate insurance, bias among doctors, and too few minority physicians contribute to minorities receiving fewer medical tests and inferior treatment. The report also found disparities persisted even when controlling for insurance, income, age, and medical history. While the Affordable Care Act aims to improve access to healthcare, the literature recommends increasing minority physician representation, improving interpreter access, strengthening doctor-patient relationships, and bolstering enforcement of equity laws.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Comparing local epidemiology of Chlamydia in Miami- Dade County to that of State of Florida and the United States. Highlighting basic description of the disease, surveillance methods, reporting, control measures, epidemiology of the disease and comparison of 5 year trends/incident rates in Miami Dade County to that of State of Florida and the United States.
HIV/AIDS: Hispanic/Latino Disparities and Policy Recommendations
Daniel Santibanez, MPH, Department of Public Health, University of North Florida
Donna T. Jones, MS, RD, LD/N, Medical Nutrition Therapy of Florida, Inc.
July 22, 2005 - UNF Hispanic Health Issues Seminar
This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
This document is a resume for Dr. Sara Michelle Handy that outlines her education, training, professional experience, licensure, certifications, memberships, awards, publications, and presentations. It details that she received her M.D. and M.P.H. from SUNY Downstate School of Medicine and has worked as an emergency medicine/internal medicine resident at University of Maryland Medical Center from 2006 to 2012 with a personal leave from 2010 to 2011. She is board eligible in internal medicine and emergency medicine and maintains BLS, ACLS, and PALS certifications.
This study examined the impact of racism experienced by physicians of color through a mixed-methods survey. 71 physicians of color completed surveys measuring experiences of microaggressions, professional quality of life, and open-ended responses describing instances of racism. Quantitative results found microaggressions were correlated with secondary traumatic stress. Qualitative analysis identified domains of racism experienced from patients, colleagues, and institutions including assumptions of abilities, microaggressions, and exclusion from opportunities. Participants recommended institutions provide spaces to discuss diversity, implement inclusive policies, and promote a diverse workforce. The study suggests physicians of color regularly experience racism which can negatively impact their well-being and career advancement.
UNF Hispanic Health Issues Seminars: Brief Review
Dr. Judith Rodriguez, RD and Daniel Santibanez, MPH, RD, Department of Public Health, University of North Florida
September 23, 2005 - UNF Hispanic Health Issues Seminars
This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.
Tiga kalimat ringkasan dokumen tersebut adalah:
Infrastruktur diperlukan untuk mendorong pertumbuhan ekonomi yang merata di seluruh wilayah Indonesia dan keluar dari jebakan negara berpendapatan menengah. Pemerintah berupaya meningkatkan infrastruktur melalui program-program seperti MP3EI dan Tol Laut untuk meningkatkan konektivitas antarpulau. Peran sivitas akademika dalam pengembangan iptek dan SDM teknik sangat
The document provides guidance on writing a scientific paper like a professional through a six phase process. The phases include outlining the key results, methods, and implications; expanding the outlines into paragraphs for each section; refining the writing; polishing at the sentence and paragraph level for clarity; ensuring the paper presents a cohesive story; and completing elements like the abstract, conclusion, and references. Key advice includes thinking about the reader, using a logical structure, and focusing on presenting results in a clear and convincing manner.
This document summarizes that poor health outcomes and lower quality of care are often experienced by patients with limited English proficiency due to language and cultural barriers. It discusses several tragic medical errors that occurred due to communication issues between providers and LEP patients. It outlines the legal obligations of healthcare providers to provide language services based on federal and state laws and regulations, and accreditation standards. Effective identification of LEP populations in need of assistance and data collection on patient race/ethnicity remains a challenge.
Refugee Health, Screening and Data Collection in the Triangle of North Caroli...Courtney Hereford
This document discusses refugee health screening and data collection in North Carolina. It finds that while infectious diseases are still a priority, noncommunicable diseases like diabetes and mental illnesses are increasingly common among refugees and pose growing challenges. The Triangle region of North Carolina receives about 1,000 refugees annually from 40 countries, yet systematic data on noninfectious health issues is lacking. The document calls for standardized, comprehensive health screening and data collection for both infectious and noninfectious refugee health needs in the Triangle to better address their diverse health issues and improve care. This could be achieved through an integrated health center partnership between universities and state/local health programs.
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Bridgin language and cultural barriers between physicians and patientslukamatias
- The study surveyed 301 primary care physicians in Northern California about their experiences communicating with non-English speaking patients.
- On average, physicians reported that 21% of their patient visits were with non-English speaking patients. However, in 73% of encounters with non-English speaking patients, the physician could not speak the patient's language.
- Trained medical interpreters or telephone interpreter services were used in fewer than 6% of encounters with non-English speaking patients. In most encounters, physicians relied on ad hoc methods like using untrained staff or family members of the patient.
The life expectancy of people with fetal alcohol syndrome (FAS) is estimated to be 34 years, which is significantly lower than the general population's life expectancy of 79 years for men and 83 years for women. The leading causes of death for people with FAS are external causes such as suicide, accidents, and poisoning, which account for 44% of deaths. Diseases of the nervous system, respiratory system, and digestive system are also common causes of death for this group. Their mortality rate is 7.4 to 73 times higher than the general population, depending on age group.
Sarah La Brada was diagnosed with multiple sclerosis and had difficulty accessing timely care through the VA system in Long Beach, with wait times of up to a month to see the sole neurologist. This forced her to exit the VA system and obtain private health insurance. Many veterans using the Los Angeles and Long Beach VA hospitals report wait times of up to 90 days to see primary care physicians and as long as 8 months to see specialists, prompting some to seek outside care. An investigation found VA hospitals, including in Los Angeles, were falsifying records to make wait times appear better, with the Phoenix VA having at least 23 veterans die while waiting for an appointment.
1. The study examined whether racial/ethnic differences exist in the diagnosis of Parkinson's disease (PD) among a Medicaid population in Pennsylvania from 1998-2003.
2. It found that middle-aged black Medicaid enrollees were diagnosed with PD at half the rate of whites, even after controlling for factors like age, gender, location of care, and healthcare utilization.
3. Racial differences in PD diagnosis rates were not fully explained by income, insurance access, or healthcare use, and may be influenced by other factors related to accessing and navigating the healthcare system, as well as potential physician bias.
Estimating HIV prevalence and risk behaviors of transgender persons in the Un...Santé des trans
Cet article, paru en 2008 dans la revue AIDS and Behavior, présente une synthèse des données disponibles dans la littérature scientifique concernant la prévalence du VIH parmi les trans aux Etats-Unis et leurs facteurs de risque comportementaux par rapport à la transmission du virus.
Adherencia al tarv en am latina y caribeRosa Alcayaga
This systematic review and meta-analysis examined adherence to antiretroviral therapy (ART) among people living with HIV in Latin America and the Caribbean. The analysis included 53 studies published between 2005-2016 involving over 22,000 individuals across 25 countries. The overall adherence rate was estimated to be 70%, similar to rates in high-income regions. Adherence was higher with shorter recall periods and in lower income countries. Common barriers to adherence included substance abuse, depression, unemployment and pill burden. The review suggests adherence in the region may be below the level needed for long-term viral suppression.
Ethnicity and Differential Access to Care for Eating Disorder SymptomsDr David Herzog
Dr David Herzog discusses how Ethnicity impacts Differential Access to Care for Eating Disorder Symptoms, and what the reality of the disease is vs. our public perceptions.
This document is a CV for Dr. Sara Michelle Handy that summarizes her education, training, professional experience, licensure, certifications, memberships, awards, publications, and presentations. She received her M.D. and M.P.H. from SUNY Downstate School of Medicine and has worked as an emergency medicine/internal medicine resident at University of Maryland Medical Center from 2006-2012 with a personal leave from 2010-2011. She is board eligible in internal medicine and emergency medicine and maintains several professional memberships and licenses.
Hepatitis C Risk Assessment, Testing and Referral for Treatment in primary Ca...Real Wellness, LLC
Dr. Robert Winn worked with a team to determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
HCS 400 Systems and Policies Minorities Receive lower-quality healthcareMaria Jimenez
The literature review examines research showing that minority patients receive lower quality healthcare than white patients. Several studies found that issues like language barriers, lack of insurance or inadequate insurance, bias among doctors, and too few minority physicians contribute to minorities receiving fewer medical tests and inferior treatment. The report also found disparities persisted even when controlling for insurance, income, age, and medical history. While the Affordable Care Act aims to improve access to healthcare, the literature recommends increasing minority physician representation, improving interpreter access, strengthening doctor-patient relationships, and bolstering enforcement of equity laws.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Comparing local epidemiology of Chlamydia in Miami- Dade County to that of State of Florida and the United States. Highlighting basic description of the disease, surveillance methods, reporting, control measures, epidemiology of the disease and comparison of 5 year trends/incident rates in Miami Dade County to that of State of Florida and the United States.
HIV/AIDS: Hispanic/Latino Disparities and Policy Recommendations
Daniel Santibanez, MPH, Department of Public Health, University of North Florida
Donna T. Jones, MS, RD, LD/N, Medical Nutrition Therapy of Florida, Inc.
July 22, 2005 - UNF Hispanic Health Issues Seminar
This is part 6 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.
This document is a resume for Dr. Sara Michelle Handy that outlines her education, training, professional experience, licensure, certifications, memberships, awards, publications, and presentations. It details that she received her M.D. and M.P.H. from SUNY Downstate School of Medicine and has worked as an emergency medicine/internal medicine resident at University of Maryland Medical Center from 2006 to 2012 with a personal leave from 2010 to 2011. She is board eligible in internal medicine and emergency medicine and maintains BLS, ACLS, and PALS certifications.
This study examined the impact of racism experienced by physicians of color through a mixed-methods survey. 71 physicians of color completed surveys measuring experiences of microaggressions, professional quality of life, and open-ended responses describing instances of racism. Quantitative results found microaggressions were correlated with secondary traumatic stress. Qualitative analysis identified domains of racism experienced from patients, colleagues, and institutions including assumptions of abilities, microaggressions, and exclusion from opportunities. Participants recommended institutions provide spaces to discuss diversity, implement inclusive policies, and promote a diverse workforce. The study suggests physicians of color regularly experience racism which can negatively impact their well-being and career advancement.
UNF Hispanic Health Issues Seminars: Brief Review
Dr. Judith Rodriguez, RD and Daniel Santibanez, MPH, RD, Department of Public Health, University of North Florida
September 23, 2005 - UNF Hispanic Health Issues Seminars
This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.
Tiga kalimat ringkasan dokumen tersebut adalah:
Infrastruktur diperlukan untuk mendorong pertumbuhan ekonomi yang merata di seluruh wilayah Indonesia dan keluar dari jebakan negara berpendapatan menengah. Pemerintah berupaya meningkatkan infrastruktur melalui program-program seperti MP3EI dan Tol Laut untuk meningkatkan konektivitas antarpulau. Peran sivitas akademika dalam pengembangan iptek dan SDM teknik sangat
The document provides guidance on writing a scientific paper like a professional through a six phase process. The phases include outlining the key results, methods, and implications; expanding the outlines into paragraphs for each section; refining the writing; polishing at the sentence and paragraph level for clarity; ensuring the paper presents a cohesive story; and completing elements like the abstract, conclusion, and references. Key advice includes thinking about the reader, using a logical structure, and focusing on presenting results in a clear and convincing manner.
The document describes the rules for a quiz competition between four houses - Quizindor, Quizlepuff, Quizenclaw and Quizerin. Teams from each house will compete in two quiz matches consisting of 10 questions each. Points will be awarded for individual and group scores. The top scoring individual will win regardless of their house. An additional round called "Six Degrees of Wiking" will feature 7 connected questions between the houses, with the house answering all correctly winning 7 goals.
The document describes a proposed student project website where students would work together to solve a concrete problem. The website would allow students to administer a subject area by posting ideas, economic solutions, and approaches to reach a comprehensive solution. Students would collaborate online to make progress on the shared problem.
The document discusses creating a webpage for students to work on concrete problems and administrate solutions. Students would post ideas, economic solutions, and approaches to reach richer solutions for different subjects. The webpage would allow moving between slides on Porter's analysis, SWOT analysis, and a student project example.
The document provides information about dengue fever prevention. It describes how dengue fever is transmitted by the Aedes mosquito, which breeds in stagnant water. Key steps to prevent transmission include removing sources of stagnant water, performing regular 10-minute wipe-outs to remove potential breeding sites, and ensuring homes are sealed before travel to prevent mosquito breeding. Proper prevention methods are needed to control the spread of this mosquito-borne virus.
The document discusses different types of vehicles including gas vehicles, hybrid vehicles, and hydrogen vehicles. For gas vehicles, it notes some get high mpg and are affordable but gas costs are rising. Hybrids have very high mpg, no greenhouse gases or need for gas but cost $2000-5000 more than non-hybrids. Hydrogen vehicles get 360 mpg, emit no pollution but are expensive and mpg drops on highways.
The document provides information about dengue fever prevention. It describes how dengue fever is transmitted by the Aedes mosquito, which breeds in stagnant water. Key steps to prevent transmission include removing sources of stagnant water, covering containers that can collect water, and doing regular 10-minute wipe-outs to check for breeding sites. Performing these prevention measures before going on holiday can help stop the spread of dengue.
Este documento presenta a los principales escultores griegos de los siglos V y IV a.C., incluyendo a Mirón, Policleto y Fidias del siglo V, así como Praxíteles, Escopas y Lisipo del siglo IV. Se mencionan algunas de sus obras más destacadas como la Atenea Parthenos de Fidias y la Afrodita de Cnido de Praxíteles.
The document discusses creating a webpage for students to work on concrete problems and post ideas, economic solutions, and approaches to reach better solutions. Students would administer the page for different subjects. The page would allow collaboration to solve problems and share perspectives.
Pusbindiklat Peneliti LIPI memberikan pedoman penulisan karya tulis ilmiah (KTI) bagi peneliti. Pedoman ini mencakup jenis, format, sistematika, komposisi, dan etika penulisan KTI. Pedoman ini bertujuan untuk memberikan acuan baku dalam penyusunan KTI agar tercapai keseragaman persepsi.
El documento describe un viaje de 9 días a Berlín que incluye visitas al Parlamento, la Plaza Sony, el Museo Egipcio, el campo de concentración de Sachsenhausen, los barrios de Friedrichshain y Unterlinden, el Pergamonmuseum y la Gemäldegalerie, así como tiempo libre; el grupo se hospeda en el Hotel Leonardo Berlín West y llega a Berlín desde Lisboa y regresa a Lisboa y Huelva.
Buku ini memberikan panduan lengkap untuk merencanakan dan menghitung biaya pembangunan rumah tinggal sederhana, mulai dari pemilihan lokasi, perizinan, desain konstruksi, instalasi, hingga contoh perhitungan anggaran biaya untuk beberapa tipe rumah. Terdapat pula diskusi dan sarana bertanya kepada penulis.
RunningHead: PICOT Question 1
RunningHead: PICOT Question 7
PICOT Question
Avery Bryan
NRS-433V
Professor Christine Vannelli
May 19, 2019
Clinical Problem
A report from the Center for Disease Control and Prevention in 2015 revealed that (9.4%) 30.3 million Americans are diabetic and 84.1 million have prediabetes. This is a total population of over 100 million is at risk of developing type 2 diabetes which is a growing health problem being the seventh leading cause of death in the U.S. An estimated 1.5 million new cases were among 18-year old bracket and the rates of diagnosed diabetes increased proportionally to age. Below 44 years accounted for 4%, below 64 years at 17 % and 25% for those above 65 years across both genders. One-third of adults in America has prediabetes but sadly, they are unaware despite reports released by The National Diabetes Statistics Report every year. These reports elaborate on prevalence and incidence, prediabetes, long-term complications, risk factors, mortality, and cost. Diabetes poses the risk of serious complications like death, blindness, stroke, kidney disorders, cardiac diseases and health problems that lead to amputation of legs. However, the risks can be mitigated through physical body activities, proper dieting and prescribed use of insulin and other related measures to control the blood sugar levels. Diabetes Prevention Program was funded by NIH to research a yearly evidence-based program to improve healthy weight loss through diet and physical activities. There also efforts to determine the effectiveness of public service campaigns in improving the real-life experience in the diagnosis and treatment of diabetes.
PICOT Question.
The population affected by diabetes cuts across all ages, gender, race, and ethnicity. The prevalence is significantly high from 18 years and it increases with age to about 25% above 65 years. In terms of gender, men are at higher risk accounting for 37% while women are at 30% across races and educational levels. On races, the rates were higher among Indians/Alaska natives at 15%, non-Hispanic blacks at 12.7% and Hispanics at 12%. Among Asians, the rates were lower at 8% and 7.4% for non-Hispanic whites.
Intervention indicator for diabetes shows that individuals who do not observe a healthy diet are more exposed to the disease. Some risk behaviors include lack of exercise and excessive intake of junk foods that lead to obesity and increased blood sugar levels. Diabetes prevalence varied according to education levels were those with less than high school education at 12.6% and 7.2% for those higher than high school education.
Comparison and use of a control group from the popularity of Complementary and Alternative Medicine and Traditional Chinese Medicine showed distinct knowledge of diabetes, blood sugar control, and self-care. The experimental group received education through interactive multimedia for three months while the control group received.
1- Differentiate between primary and secondary sources and provide an.pdfcontact28
1. Differentiate between primary and secondary sources and provide an example for each one. 2.
Describe the similarities and differences between a research paper and a review paper. 4. Is the
following Abstract from a research article? Abstract People of African ancestry (Blacks) have an
increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical
factors. Two variants in the APOL1 gene are now thought to account for much of the racial
disparity associated with hypertensive kidney failure in Blacks. However. this knowledge has not
been translated into clinical care to help improve patient outcomes and address disparities.
GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic
risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African
ancestry. without kidney dysfunction, are recruited from diverse clinical settings and randomized
to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control).
Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff
return APOL1 results to patients and provide low-literacy educational materials. Real-time
clinical decision support ols alert clinicians of their patients' APOL1 results and associated risk
status at the point of care. Our academiccommunity-clinical partnership designed a study to
generate information about the impact of genetic risk information on patient care (blood pressure
and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors.
GUARDD will help establish the effective implementation of APOLL risk-informed
management of hypertensive patients at high risk of CKD, and will provide a robust framework
for future endeavors to implement genomic medicine in diverse clinical practices. It will also add
to the important dialog about factors contributing to and may help eliminate racial disparities in.
kidney disease. True: False 5. Of the 3 titles listed below, which title(s) is suitable for a review
paper: a. Chronic Kidney Disease Diagnosis and Management b. Determining the Effects and
Challenges of Incorporating Genetic Testing into Primary Care Management of Hypertensive
Patients with African Ancestry c. Pharmacist Intervention for Blood Pressure Control in Patients
with Diabetes and/or Chronic Kidney Disease d. all of the above 6. Which reference style is used
for citing electronic journal articles. a. DOI b. APA c. NLM d. MLA e. all of the above f. none of
the above.
Prevalence of fetal alcohol spectrum disorder among special subpopulations: a...BARRY STANLEY 2 fasd
Global subpopulations of children in care, correctional,
special education, specialized clinical and Aboriginal
populations have a significantly higher prevalence of
fetal alcohol spectrum disorder compared with the
general population, which poses a substantial global
health problem.
The document summarizes preliminary data from a community health needs assessment of Latino/Hispanic populations in Mississippi, Louisiana, and Alabama. Key findings include:
1) Obesity is the most commonly diagnosed chronic condition, followed by hypertension and diabetes.
2) Major barriers to healthcare access are lack of health insurance, cost of services, extended time between appointments, and lack of interpreter services.
3) Improved cultural competency training for healthcare providers and more effective outreach programs that address these barriers are needed to improve health outcomes in this population.
When reducing cancer risk in our population, let’s not exacerbate disparitiesGraham Colditz
The document discusses reducing cancer disparities through precision prevention approaches. It highlights that while precision medicine focuses on treating existing disease, precision prevention aims to tailor behavioral interventions to individual characteristics to reduce cancer risk. However, efforts to refine prevention strategies could inadvertently worsen disparities if factors like health literacy levels and access to care are not considered. Priorities for avoiding disparities include collaborating with diverse partners to improve communication and applying implementation research approaches to ensure evidence-based programs reach all groups.
A study on awareness of diabetic complications among type 2 diabetes patientsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
prevalence and correlates bipolar spectrum disorder in the world mental healt...Priscila Navarro
This study examined the prevalence, clinical correlates, and treatment patterns of bipolar spectrum disorder in 61,392 participants across 11 countries. The key findings were:
1. The lifetime prevalence of bipolar I disorder was 0.6%, bipolar II was 0.4%, subthreshold bipolar disorder was 1.4%, and the total bipolar spectrum was 2.4%.
2. Across all countries, severity of symptoms, impairment, and suicidal behavior increased stepwise from subthreshold bipolar disorder to bipolar I disorder. Three-quarters of individuals with bipolar spectrum disorder also met criteria for another mental health condition, most commonly an anxiety disorder.
3. Less than half of individuals with a lifetime
Health Seeking Behaviors following Diabetes Mellitus of Various Ethnic Groups...ijtsrd
The research on Health Seeking Behaviours following Diabetes Mellitus DM of various ethnic groups was conducted because different patients within a given ethnic group or cultural group have different options regarding actions to seek health care services. The purpose of this study was to determine the Health Seeking Behaviours HSB following DM patients from various ethnic groups and the roles of the Health Psychologists HP on the DM patients in Nkwen Health District of Bamenda III Subdivision within Mezam Division of the North West Region of Cameroon. A descriptive survey research design was conducted among 230 sampled DM patients from various ethnic groups in Nkwen Health District. A non probability purposive sampling technique was used to set the population under study. The data was collected using both Focus Groups Discussions FGDs and questionnaire for a period of two months during the period that the DM patients came to Nkwen Health District either to consult or to refill their drugs. The questionnaire were administered to 230 DM patients from the various ethnic groups which were Bali, Bafut, Banso, Bamendankwe, Babanki, Santa, Nkwen and Ndu during this period as well.. The data collected was analysed using both descriptive and inferential statistics with SPSS software tool version 20.0, following the objectives of the study. For HSB, 38.3 agreed that they sought health care from traditional medicine whereas 26.1 remained neutral on traditional medicine. On the other hand, 37.7 disagreed that they used traditional medicine. Cultural believes and distance deterred HSB which were statistically significant with P = 0.001 and P= 0.001 respectively. The options taken to seek health care from the hospital were influenced by family relatives with P=0.001. Therefore, HSB was found to be statistically significant for the first traditional medicine and second line hospital among the different ethnic groups with P = 0.001 and 0.001 respectively. These results showed that poor HSB following DM among the different ethnic groups was statistically significant in Nkwen Health District. Foncham Paul Babila "Health-Seeking Behaviors following Diabetes Mellitus of Various Ethnic Groups in Nkwen Health District of Bamenda III Subdivision, Mezam Division, North West Region of Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-5 , August 2022, URL: https://www.ijtsrd.com/papers/ijtsrd51783.pdf Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/psychology/51783/healthseeking-behaviors-following-diabetes-mellitus-of-various-ethnic-groups-in-nkwen-health-district-of-bamenda-iii-subdivision-mezam-division-north-west-region-of-cameroon/foncham-paul-babila
This document discusses disease surveillance research. It explains that disease surveillance involves the ongoing collection, analysis, interpretation, and dissemination of health data to monitor disease trends and improve public health. A reductionist approach looks at isolating variables to find cause-and-effect relationships, while a complex systems approach considers adaptive and multilevel systems in context. The document also discusses the roles and competencies needed for nurses to participate in surveillance and investigation activities.
We conducted a retrospective study of 178 community dwelling elderly on anemia which was defined as hemoglobin < 13 gm/ dl in males and < 12 gm/dl in females (WHO guidelines).
Methods: This was a retrospective chart review of patients aged ≥ 95 years, who were seen over a two year period at the University of Arkansas for Medical Sciences.
This study aimed to identify risk factors for death in children under 15 years old admitted for treatment of visceral leishmaniasis (VL) in northeast Brazil. The researchers reviewed records of 546 patients and found that 57 died, giving a case fatality rate of 10%. Multivariate analysis identified several independent risk factors for death: presence of mucosal bleeding increased the risk 4 times, jaundice 4 times, dyspnea (fast breathing) 3 times, suspected bacterial infections 3 times, and very low neutrophil and platelet counts 3 times and 12 times, respectively. Based on these factors, the researchers created a prognostic score that classified patients as high or low risk, with 88% sensitivity and 79% specificity.
This document is the Louisiana Comprehensive Cancer Control Plan for 2017-2021. It was created by the Louisiana Comprehensive Cancer Control Program and its partner organizations to serve as a roadmap and reference for existing partners and other stakeholders working to address cancer in Louisiana. The plan emphasizes areas where the biggest impact can be made, such as increasing early detection of certain cancers and reducing cancer risks like tobacco exposure and obesity. It provides data on the cancer burden in Louisiana, outlines goals and strategies for different types of cancer, and includes an evaluation plan to monitor progress.
This study aimed to validate the American Speech-Language-Hearing Association Functional Assessment of Communication Skills (ASHA FACS) for use with Alzheimer's patients in Brazil. The scale was translated into Portuguese and tested on 51 elderly controls without dementia, 32 patients with mild Alzheimer's, and 25 with moderate Alzheimer's. Statistical analysis found the Portuguese version of the ASHA FACS has excellent reliability and validity when compared to established cognitive tests. It can reliably distinguish levels of communication impairment in Alzheimer's patients and provides a standardized way to measure changes in functional communication over time or in response to treatment.
The Effect Race and Income on HIV AIDS infection in African-Americans - Sunil...Sunil Nair
Race and Income has a significant influence on susceptibility to HIV/AIDS infections; Afro-Americans (Blacks) are 1.33 times more likely to be infected than whites. A significant finding is that the income level didn't change race's effect on HIV infections. Race has a significant effect on HIV infections or is an important predictor of incidence of HIV infections independent of the income. In other words, irrespective of the income level being black and poor increases the changes of being infected with HIV/AIDS.
Excess Weight Loss and Cardiometabolic Parameter Reduction Diminished among H...Lindsay Cumella
Bariatric surgery outcomes were analyzed in over 2,000 Hispanic patients at a single institution. Laparoscopic gastric bypass and sleeve gastrectomy resulted in greater excess weight loss and reduction in cardiometabolic parameters than laparoscopic gastric banding over time. However, outcomes were still diminished compared to non-Hispanic populations. Bariatric surgery was found to be highly effective for weight loss and improving health in Hispanic patients, though disparities in outcomes remain when compared to other ethnic groups.
1) A study assessed the prevalence of diagnosed diabetes and diabetes mortality rate in a large Puerto Rican community in Chicago. 2) The prevalence of diabetes was found to be 20.8%, the highest reported for Puerto Ricans and twice as high as rates for Puerto Ricans in New York and Puerto Rico. 3) The diabetes mortality rate of 67.6 per 100,000 population was more than twice the rates for all of Chicago and the US.
Abstract—Prevalence of degenerative dementias and dementias associated with cerebrovascular disease is increasing with the time. Dementia is one of the most significant public health problems. Demographic data, medical history, general biochemical data and serum total homocysteine (tHcy) levels was used in this study to examine the differences between dementia and normal control groups. A cross-sectional study was conducted on 236 individuals who were above the age of 65 years. These participants went through the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), demographic characteristics, biochemical data and tHcy level. Each of the above mentioned factors was assessed. There were significant differences in the history of hypertension, diabetes mellitus, marital status, alcohol consumption (AC), BMI value, and triglyceride (TG) and serum tHcy levels. The logistic regression analysis showed significant differences in marital status, AC and tHcy. So it can be concluded that elevated serum tHcy, no AC and no partner are associated with the risk of dementia in elders of Southern Taiwan. It needs further researches to identify and reduce the risk of dementia.
The document discusses providing fair health to African Americans through community health fairs. It notes that African Americans have higher rates of chronic diseases than Caucasians due to factors like lack of access to healthcare. The purpose is to plan a health fair in East Tampa, where 59% of residents are African American with low income and high poverty/unemployment. A survey found that only 30% had been screened for diabetes, 64% for hypertension, and 27% or less for other diseases. Respondents said they lacked time, insurance, or screening opportunities. The health fair aims to provide free screenings and education to address disparities.
This study examined whether psychosocial factors like depression, anxiety, coping style, and social support influence survival outcomes in young women diagnosed with early-stage breast cancer. The study followed 708 Australian women under age 60 diagnosed with non-metastatic breast cancer for a median of 8.2 years. Psychosocial factors were assessed via questionnaires administered about 11 months after diagnosis. The study found no statistically significant associations between the measured psychosocial factors and distant disease-free survival or overall survival after adjusting for known prognostic factors like tumor characteristics and treatment. One unadjusted analysis found higher anxious preoccupation was linked to poorer outcomes, but this association was explained by its relationship to worse prognostic factors and disappeared after adjustment. The findings do not support
Similar to Profiling of Alzheimer’s disease patients in Puerto Rico - 2016 - CLCM (20)
2. 2 SAGE Open Medicine
available for diagnosis purposes. Mini Mental State
Examination (MMSE) or Folstein test is the most used psy-
chometric test to evaluate memory, attention, language, and
executive function in patients with complains or symptoms of
cognitive impairment.5–7 Due to the simplicity of the ques-
tions and tasks, the MMSE score needs to be adjusted to the
patient’s level of education.6 However, despite adjusting for
the level of education, Hispanics showed significantly lower
MMSE in comparison to African-Americans and white
Caucasians.1 These facts led the scientific community to con-
clude that ethnicity is a risk factor for the development ofAD.
Twelve percent of older adults in the Hispanic population
are diagnosed with AD, the highest proportion among differ-
ent ethnic groups in the United States.1 The Hispanic popula-
tion living in the United States is very diverse and could be
grouped into three major groups based on their origin of
birth, namely, Central American, South American, and
Caribbean. Geographically, the population of Hispanics
from Caribbean Islands is concentrated in the northeast of
United States. Romas et al.8 adopted the term Caribbean
Hispanics to identify and differentiate AD patients in this
group from Hispanics of other origins. The Caribbean
Hispanic population in the northeast of United States is com-
posed of people from Puerto Rico, Dominican Republic, and
Cuba. Previous studies indicated that Caribbean Hispanics
have fewer years of education, lower age-of-onset, and lower
MMSE score in comparison to African-Americans and white
Caucasians.9–12 Livney et al.11 showed that a Hispanic cohort
in Philadelphia has a more severe symptomatology associ-
ated with AD than any other ethnic group studied, with sig-
nificant lower age-of-onset and MMSE score. This Hispanic
cohort is primarily composed (85%) of Puerto Ricans.13
Further studies of Puerto Ricans within the Philadelphia
cohort identified a dominant mutation in the amyloid-β pro-
tein precursor (AβPP) gene associated with familial AD.13
The Gly206A mutation in AβPP was also identified, about
10 years earlier, in a cohort of families of Puerto Rico descent
in the Washington Heights/Hamilton Heights Aging
Project.14 Taken together, genetic and social factors may
contribute to the distinct symptomatology of Caribbean
Hispanics AD patients.
Our previous studies of Puerto Ricans, living in the island
of Puerto Rico, indicated that the mortality rate associated
with AD is significantly higher than the one registered in the
United States.15 Moreover, the mortality associated with AD
of Puerto Ricans in Puerto Rico is higher than that for Puerto
Ricans living in the United States.15 However, geographical
analysis of mortality rate in Puerto Rico identified some
regions with lower or comparable rate to the one reported in
the United States, while other regions showed significantly
higher mortality rate associated with AD.15 The underlying
cause(s) of the differential mortality rate and the clinical pro-
file of AD patients in Puerto Rico are still unknown. Here,
we conducted a retrospective study to profile AD patients in
two regions of Puerto Rico, based on their previously
determined mortality associated with AD. We compared
demographic variables, MMSE score, rate of change, and
comorbidities among patients from both regions. The results
are discussed and contrasted, taking into consideration the
differences in socioeconomic status and healthcare facilities
among the two studied regions.
Methods
Subjects and diagnostic criteria
To develop a clinical profile of the progression of AD, we
collected data related to AD patients from two private prac-
tices, one in San Juan (Metro) and the other in Manati
(Northwest-Central), that encompass areas of high and low
mortality associated with AD, respectively.15 We identified
one clinical practice at each area with similar diagnostic pro-
tocols that included brain imaging, psychometric analyses,
and serological tests (in some instances, patients were tested
for sexually transmitted diseases). In addition, the selected
clinical practices serve a broad and representative population
within the regions of interest and are recognized in Puerto
Rico due to their expertise in the diagnosis and treatment of
AD patients. The physicians at these clinics are American
Board of Neurology certified with over 20 years of experi-
ence, dedicating most of their clinical practice to cognitive
impaired patients. The municipalities represented in the
Metro Region were Carolina, Guaynabo, Trujillo Alto, and
San Juan. The municipalities represented in the Northwest-
Central Region were Aguadilla, Aibonito, Arecibo,
Barceloneta, Barranquitas, Bayamon, Caguas, Camuy,
Ciales, Corozal, Hatillo, Isabela, Lares, Manati, Naranjito,
Orocovis, Quebradillas, Toa Alta, Utuado, Vega Alta, and
Vega Baja. The primary residence was determined from the
clinical record. Even though other psychometric analyses
were registered (e.g. clock drawing, Montreal Cognitive
Assessment) in the patients’ record, MMSE score was
selected because it was the common diagnostic psychomet-
ric tool used for all patients at both clinical practices. Brain
imaging results were not recorded and exclusively used as
the criterion for diagnosis of possible or probable AD by the
clinician. The inclusion criteria were as follows: patients
diagnosed with probable or possible AD, serological tests,
and cognitive impairment measured by MMSE.5–7 The cases
included had at least one MMSE (first or last) with score of
26 or less, taking into consideration that a normal MMSE
score is 27 or more. The exclusion criteria were as follows:
MMSE score of 27 or more, diagnosis of mixed dementia,
for example,AD, and vascular dementia. The total amount of
records included in this study was 485. The absence of infor-
mation about specific parameters in some of the records con-
tributed to the variability of the reported N value per analyzed
parameter. The record review was conducted in accordance
with the University of Puerto Rico Institutional Review
Board–approved protocol (#1011–208).
3. Camacho-Mercado et al. 3
Record review
The information from the medical record was collected on a
profile template using Epi Info™ (version 3.5.3), a program
developed by the Centers for Disease Control and Prevention
(CDC) as a data collection and analysis instrument.16 The
parameters evaluated were demographic information (age,
gender, education, and primary residency), metabolic profile
(levels of B12, glucose, cholesterol, and triglycerides),
comorbidities (diabetes, hyperlipidemia, hypertension,
hypothyroidism, and depression), and general information
about caregivers. The age at initial evaluation and years of
education were collected from the medical record, as reported
by the patient or a family member. The score of the initial
MMSE was the score obtained in the first cognitive test per-
formed on the patient. The last MMSE was the last score
recorded in the clinical record. Only those cases with two
MMSE scores and the date when the test was performed
(more than 3 months apart) were used to estimate the rate of
change in cognitive function. In terms of comorbidities, it is
important to mention that we included only those conditions
recognized as risk factors of AD.15
Socioeconomic and healthcare facilities
The Controller’s Office is the governmental agency respon-
sible for collecting and reporting socioeconomic data in
Puerto Rico. Thus, the socioeconomic data from represented
municipalities in the records reviewed were extracted from
the Puerto Rico Controller’s Report, based on the 2010 cen-
sus. The reported income per capita, percentage of popula-
tion under poverty level, unemployment rate, and percentage
of 25 years or older with high school education or more, for
each municipality, were averaged within a specific region.
The inclusion of municipalities within a region was based on
the Department of Health of Puerto Rico established distri-
bution of Health Regions in Puerto Rico, as previously used
to assess the geographical distribution of mortality rate asso-
ciated with AD.15 The number of healthcare facilities within
a specific Region was extracted from the 2014 Health Report
of Puerto Rico (http://www.salud.gov.pr/Estadisticas-
Registros-y-Publicaciones/EstadisticasVitales/Informe de la
Salud en Puerto Rico 2014.pdf).
Data analysis
The data were recorded using the Epi Info software and
downloaded to Microsoft Excel program. Data analysis was
carried out using JMP 9.0 (SAS, Cary, NC, USA) and
GraphPad Prism (version 6.05) statistical software. The
study used descriptive statistics, focusing on the measures
of central tendency. For each quantitative parameter, we cal-
culated the mean and the standard deviation (SD), followed
by non-parametric two-tailed Mann–Whitney test of
unpaired t-test data to determine statistical difference at
p-value lower than 0.05 at 95% confidence interval. The
rate of change in the MMSE score was calculated by sub-
tracting the last MMSE score with the first MMSE score
and dividing by the number of years between these two
tests. A Z-test for two population proportions (two-tailed;
p 0.05) was performed to determine significance of the
percentage of AD patients’ caregivers and comorbidities
between the two populations studied. Pearson’s correlation
coefficient was determined for age-at-diagnosis and income
per capita for each municipality in both regions studied
(p-value: two-tailed, 95% confidence interval).
Results
Demographic profile
Previous studies indicated that age-of-onset and age-at-
diagnosis of AD are earlier among Caribbean Hispanics
than other ethnic groups living in the mainland United
States.9–12 However, there is no information about those liv-
ing in Puerto Rico. The Metro Region includes municipali-
ties within the San Juan metropolitan area that have shown
lower mortality rate associated with AD in comparison to
Northwest-Central Region in Puerto Rico.15 Thus, we
recorded the age-at-diagnosis using the information reported
in the clinical records of patients within these two regions.
The average age-at-diagnosis for all cases evaluated was
77.9 years (Table 1). However, the age-at-diagnosis of AD
cases in the Metro Region was 79.3 years of age, signifi-
cantly higher (p 0.0001) than the 75.8 years of age regis-
tered in a representative cohort from the Northwest-Central
Region in Puerto Rico (Table 1). Since we noticed that in
most cases evaluated patients were diagnosed as probable or
possible AD within the first visits, it is very likely that the
age-of-onset was earlier than the age registered at diagnosis.
Nevertheless, this result indicates that AD patients in the
Northwest-Central region are diagnosed at a younger age
than those in the Metro Region in Puerto Rico.
Next, we determine the sex ratio and level of education of
the cohort of AD patients in Puerto Rico. In the cohort stud-
ied, 65% of the AD patients were female, which is consistent
with the higher reported proportion of females with AD in
the general population.13,15 The data also indicate that there
are significantly more female diagnosed with AD in the
Metro Region than Northwest-Central Region of Puerto
Rico. However, it is important to mention that, based on the
2010 census, the percentage of females 65 years of age or
older is higher in the Metro Region (58.7%) than in the
Northwest-Central Region (54.9%). In terms of education,
the average year of education was significantly higher (13.0;
p 0.01) in the Metro Region than that registered from AD
patients in the Northwest-Central Region (12.0) of Puerto
Rico (Table 1). Consistently, the percentage of the popula-
tion 25 years of age or older with high school or more
is higher in the Metro Region (76%) than in the
4. 4 SAGE Open Medicine
Northwest-Central Region (63%; Table 5). Taken together,
the results suggest that the significant differences in the per-
centage of females and years of education among the cohort
of AD patients may be influenced by sociodemographic dif-
ferences between the Metro and Northwest-Central Regions.
Cognitive profile
The MMSE score was used to determine cognitive function
at the time of initial evaluation (first MMSE) and to assess
the progression or rate of cognitive change. The average
score of the first MMSE was 19.9 for all AD patients regis-
tered in this study (Table 1). The average of the first MMSE
in the Metro Region (20.1) was slightly higher than the one
from Northwest-Central Region (19.5) in Puerto Rico, but
not significantly different (Table 1). No all recorded AD
cases included in the study had more than one MMSE regis-
tered in the clinical record, but for those cases that had two
or more, the average of the last MMSE registered was 18.4.
Even though the average MMSE score from the region with
high mortality rate associated with AD (Northwest-Central)
was slightly lower (17.8), no significant difference was
detected between the Metro Region (18.4) and Northwest-
Central Region in Puerto Rico (Table 1). To determine the
rate of change per year, we only used those cases that had
two or more MMSE scores and the date when the score was
recorded. Consistently, no significant difference was detected
in the rate of change per year of MMSE score, which was
calculated to be a decline of 1.4 points per year (Table 1).
The effect that the level of education has on MMSE scores
has been previously documented.6 Consistently, an analysis
of the MMSE score taking into consideration the years of
education revealed a significant difference between AD
patients when grouped based on their years of education and
their respective MMSE scores (data not shown). These
results suggest that the small, but significant, difference in
years of education of AD cases reported in the Metro versus
Northwest-Central Regions may account for the slightly
higher MMSE score in the Metro Region but did not have an
effect on the rate of cognitive decline.
Comorbidities and metabolites’ level
AD has been associated with metabolic disorders such as dia-
betes and hyperlipidemia.17 These two metabolic disorders are
prevalent among Hispanics, especially in the Caribbean
Hispanic population.11,13,14 In the cohort studied here, we found
that 48% of the AD patients were hyperlipidemic and 69%
were hypertensive (Table 2). The Metro Region had a slight but
significant higher percentage (p 0.0151, Z-score −2.427) of
hypertensive AD patients than the Northwest-Central Region
in Puerto Rico (Table 2). In contrast, the percentage of diabetic
AD patients was significantly higher (p 0.000072, Z-score
−3.383) in the Northwest-Central Region than in the Metro
Region (Table 2). Interestingly, glucose was the only metabo-
lite in which the average level was higher than normal in both
regions (Table 3). All other metabolites recorded were within
the normal range (Table 3). Depression is another comorbidity
associated with AD, especially among Caribbean Hispanics.11
We found that almost one in every two AD patients in the
cohort studied in Puerto Rico was diagnosed with depression.
When comparing both regions, the percentage of AD patients
diagnosed with depression was significantly (p 0.00386,
Z-score −2.893) higher in the Metro Region than in the
Northwest-Central Region of Puerto Rico. The results indicate
that there are significant differences in the occurrence of
comorbidities, which suggests a distinct profile of AD patients
between these two regions studied.
Primary caregiver of AD patients per region
We also determined the primary caregiver of AD patients from
both regions in this study (Table 4). The primary caregiver for
most AD patients was the husband or wife followed by other
Table 1. Demographic and cognitive profile of Puerto Rican AD patients in Metro versus Northwest-Central regions.
Variables All regions Metro Region Northwest-
Central Region
Difference between
regions, p-valuea
Age at diagnosis, in years (SD, N) 77.9 (7.2, 468) 79.3 (6.9, 287) 75.8 (7.16, 181) p 0.0001
Sex, % female 65% (314/484) 66% (195/295) 63% (119/189) p 0.0078
Z-score −2.6606
Education in mean years (SD, N) 12.7 (3.4, 406) 13.0 (3.4, 279) 12.0 (2.8, 127) p 0.01
Initial MMSE (SD, N) 19.9 (5.4, 485) 20.1 (5.3, 295) 19.5 (5.2, 190) p 0.4396
Last MMSE (SD, N) 18.4 5.4,354) 18.6 (5.2, 244) 17.8 (5.8,110) p 0.2868
Initial MMSE (SD, N) 21.8 (4.48, 198) 21.8 (4.2, 139) 21.8 (5.15, 59) p 0.6756
Last MMSE (STD, N) 18.24 (5.38, 198) 18.4 (5.2, 139) 17.83 (6.09, 59) p 0.5827
Rate of change (first MMSE − last
MMSE/year), mean (SD, N)
1.4 (2.0, 198) 1.4 (2.0, 139) 1.4 (2.0, 59) p 0.8228
AD: Alzheimer’s disease; SD: standard deviation; MMSE: Mini Mental State Examination.
A total of 485 clinical records were reviewed. The N value per parameter is based on the total amount of records that contained the reported informa-
tion. The rate of change was used only for those records that have two or more MMSE scores and specific date.
aNon-parametric two-tailed Mann–Whitney test of unpaired t-test data, except for gender that used Z-test for two population proportions.
5. Camacho-Mercado et al. 5
family members. Interestingly, the percentage of husband or
wife caregivers was significantly higher (p 0.00001, Z-score
−7.530) in the Northwest-Central Region than in the Metro
Region (Table 4). In contrast, the category of other family mem-
ber (siblings) was significantly higher (p 0.0041, Z-score
−2.873) in the Metro Region than in the Northwest-Central
Region (Table 4). AD patients who reported living alone were
significantly higher (p 0.0214, Z-score −2.299) in the Metro
Region than in Northwest-Central Region; close to one in every
fourAD patients in the Metro Region are living alone (Table 4).
There was no significant difference in the amount of
institutionalized (non-family caregivers; p 0.5222) AD
patients among the two Regions (Table 4). Sociodemographic
characteristics that differentiate the two studied Regions in
Puerto Rico may explain the identified differences in caregiver.
Socioeconomic and healthcare facilities per
region
In order to define the sociodemographic differences
between the Metro and Northwest-Central Region, we
extracted public data from two governmental offices in
Table 2. Comparison of comorbidities of Puerto Rican AD patients in Metro and other health regions.
Comorbidities All regions, %
(N = 485)
Percent of AD patients in
Metro Region (N = 295)
Percent of AD patients in
Northwest-Central-Region (N = 190)
Difference between
regions, p-valuea
Diabetes mellitus 29 24 35 p 0.000072
Z-score −3.383
Hypertension 69 71 65 p 0.0151
Z-score −2.427
Hyperlipidemia 48 57 46 p 0.19914
Z-score −1.284
Hypothyroidism 15 15 15 p 0.20982
Z-score −1.254
Depression 48 46 50 p 0.00386
Z-score −2.893
AD: Alzheimer’s disease.
aZ-test for two population proportions.
Table 3. Blood metabolite values in AD Puerto Rican patients in Metro versus other health regions.
Metabolite levels (normal value) All regions—mean
of metabolite levels
(SD, N)
Metro Region—
mean of metabolite
levels (SD, N)
Northwest-Central
Region—mean of
metabolite levels (SD, N)
Difference between
regions, p-valuea
B12 (110–1500 pg/mL) 611.28 (480.00, 281) 602.38 (445.35, 195) 631.44 (552.89, 86) p 0.6680
Glucose (70–99 mg/dL) 106.44 (33.55, 246) 105.16 (34.39, 166) 109.09 (31.77, 80) p 0.3777
Total cholesterol (less than 200 mg/dL) 185.17 (41.10, 321) 179.37 (39.49, 214) 196.76 (42.08, 107) p 0.0005
Triglycerides (less than 150 mg/dL) 131.48 (72.42, 303) 129.15 (69.28, 213) 137.01 (78.48, 90) p 0.4112
AD: Alzheimer’s disease; SD: standard deviation.
The N value per parameter is based on the total amount of records that contained the reported information.
aNon-parametric two-tailed Mann–Whitney test of unpaired t-test data.
Table 4. AD patients’ caregivers in Puerto Rico.
Caregiver All regions, %
(N = 362)
Metro Region, %
(N = 261)
Northwest-Central
Region, % (N = 101)
Difference between
regions, p-valuea
Husband/wife or partner 48 44 57 p 0.00001
Z-score −7.530
Other family members 23 25 21 p 0.0041
Z-score −2.873
Non-family caregiver 6 7 4 p 0.5222
Z-score −0.6356
Alone 22 24 18 p 0.0214
Z-score −2.299
AD: Alzheimer’s disease.
aZ-test for two population proportions.
6. 6 SAGE Open Medicine
PuertoRico,namely,theController’sOfficeandDepartment
of Health. In terms of population density, the Metro Region
is five times more populated than the Northwest-Central
Region (Table 5). This high population density is also
reflected in the quantity of healthcare facilities and hos-
pices. For example, the distribution of hospitals and hos-
pices per square mile in the Metro Region is about five
times that of the Northwest-Central Region (Table 5). The
two regions are also markedly different in terms of income
per capita and population under the poverty level (Table 5).
The average income per capita of the municipalities
included in the Metro Region (US$16,192) is more than
double of the one reported for the municipalities in the
Northwest-Central Region (US$7991). This socioeconomic
difference is reflected in the fact that almost half (48%) of
the population in the Northwest-Central Region lives under
the poverty level, in contrast to 29% in the Metro Region.
Thus, in comparison to the income per capita (US$10,355)
and the percentage of the population living under the pov-
erty level (34.7%) in Puerto Rico, the Metro Region repre-
sents an area of high socioeconomic status where the
Northwest-Central Region is one of lower socioeconomic
status (Table 5). Consistently, the unemployment rate in the
Metro Region (8%) is half of that reported last year (2014)
for the Northwest-Central Region (16.1%) and considera-
bly lower than that for the entire island of Puerto Rico
(14%). Pearson’s correlation of income per capita versus
age-at-diagnosis of AD indicated a positive correlation
(r = 0.6496; R2 = 0.4420; degree of freedom (df) = 12;
p 0.0119), suggesting that earlier age-at-diagnosis corre-
lates with lower socioeconomic status (Figure 1). Taken
together, these data indicate that the region with higher
mortality rate associated with AD, earlier age-at-diagnosis,
and less years of formal education in Puerto Rico has lower
socioeconomic status and less healthcare facilities per
square mile than the region with significantly lower mortal-
ity associated with AD.15
Discussion
The high prevalence of AD among Hispanics and African-
Americans suggests that these two ethnic groups are at higher
risk of developing this devastating disease than white
Caucasian.1 Among Hispanics, Caribbean Hispanics showed a
more severe presentation and progression of AD. For
Caribbean Hispanics, the MMSE scores are significantly
lower (even after correcting for their level of education), the
rate of change in cognition is more accelerated, and the age-
of-onset is significantly earlier than any other ethnic group.9–11
However, socioeconomic status and healthcare access as
covariant in relation to the ethnic background are rarely taken
into consideration. Here, we showed the clinical profile of AD
patients in a Caribbean Hispanic population (Puerto Ricans)
from two distinct socioeconomic areas with previously
reported differential mortality rate associated with AD.15 The
Northwest-Central Region encompasses a low socioeconomic
level and high mortality rate associated with AD in Puerto
Rico whereas the Metro Region represents a high socioeco-
nomic status and low mortality rate associated with AD.
Even though a significant difference in the age-at-diagno-
sis between the two regions studied was detected, no differ-
ence was detected in MMSE score and rate of cognitive
decline in AD patients living in Puerto Rico. In contrast, the
initial MMSE score average in Puerto Rico was 19.9, which
is significantly higher than those previously reported for
Puerto Ricans living in the United States.9–14 Furthermore,
the average year of education (12.7) of AD patients from
both regions in Puerto Rico was also higher than the one
reported for Puerto Ricans living in the mainland United
States.9–14 Although education had an effect on the MMSE
score, the first MMSE score (17.6), for those living in Puerto
Rico with 0–9 years of education was higher than the one
reported for Caribbean Hispanic in the mainland United
States.9–13 Thus, in this case, education level may not be the
main factor contributing to the difference in MMSE score
Table 5. Socioeconomic and healthcare facilities in municipalities that comprise the Metro versus Northwest-Central regions.
Puerto Rico Metro Region Northwest-Central Region
Total surface area of the region (sq. mile) 3421 141 1043
Total population in the regiona 3,725,789 744,854 1,129,537
Population density (people/sq. mile) 1089 5283 1083
Income per capita in the region (SD)a US$10,355 US$16,192 (2966) US$7,991 (1813)
% Population under poverty level in the regiona 34.7 29 48
% Population 25 years or older with high school
or more in the regiona
67.6 76 63
% Unemployment rate in the region (2014) 14 8.1 16.1
Total number of hospital and healthcare facilities
in the region (as of 2013) (per sq. mile)
250 (0.073) 59 (0.418) 79 (0.076)
Total hospice facilities in the region (per sq. mile) 43 (0.013) 13 (0.071) 15 (0.016)
SD: standard deviation.
The reported values are based on the municipalities represented in each region.
aBased on the 2010 Census.
7. Camacho-Mercado et al. 7
between Caribbean Hispanics in Puerto Rico versus the
United States. Interestingly, however, the Caribbean
Hispanics studied in North Philadelphia live in a socioeco-
nomic area similar to the Northwest-Central Region in
Puerto Rico. These results further support the hypothesis that
factors associated with low socioeconomic status may con-
tribute to increase the risk of developing AD.
Socioeconomic status and education level have been
shown to effect cognitive function.17 In addition, inherent
cultural characteristics and healthy lifestyle differences
among ethnic groups may contribute to differences in the
prevalence of AD.17,18 Thus, the access to or social influ-
ences to maintain a healthy diet could be different in every
ethnic group due to socioeconomic differences or traditional
customs. Coincidentally, the blood glucose level was higher
than normal among AD patients from both regions studied in
Puerto Rico, suggesting a high degree of insulin resistance
within the cohort studied that may be related to the diet or
genetic risk factors.19 Additionally, a diagnosis of depression
was found in almost one of two AD patients in Puerto Rico.
Interestingly, while diabetes and depression were found
largely in a region of low socioeconomic status, hyperten-
sion was prominent in the region of high socioeconomic sta-
tus in Puerto Rico. These results suggest that socioeconomic
status of a distinct population may influence the detection of
specific risk factors or comorbidities associated with AD.
Taken together, the profile of AD patients living in Puerto
Rico differed based on the socioeconomic status of the stud-
ied region. Thus, this study brings forward an alternative
hypothesis to explain the higher prevalence of AD among
Caribbean Hispanics in the United States and Puerto Rico.
We hypothesize that socioeconomic status and healthcare
access should be taken into consideration as covariant to
determine factors that increase the risk of AD among a
specific ethnic group. Prevention strategies leading to halt
the high AD prevalence among ethnic minorities should be
based on cultural sensitive education programs and reduc-
tion in healthcare disparities to facilitate the early detection
of abnormal memory problems in the elder population within
the Caribbean Hispanic population.17,18 Thus, further studies
are needed to determine those socioeconomic factors that
contribute to health disparities and differences in prevalence
of AD among different ethnic groups.18
Acknowledgements
The authors are grateful to the staff at Caribbean Center for the
Study of Memory and Cognition and the Institute of Neuroscience
at the Manati Medical Center for their contribution to this study.
The authors also thank Dr. María-Egleé Perez for her assistance
with biostatistics and Dr. Roberto Marrero for his contribution as
medical liaison.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Ethical approval
Ethical approval for this study was obtained from University of Puerto
Rico Institutional Review Board–approved protocol (#1011-208).
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
research is financially supported by the College of Human
Medicine, Michigan State University.
Informed consent
Informed consent was not sought for this study because this is a
retrospective study that does not include information that can serve
as identifier, as approved by the UPR-IACUC.
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