Satellite-based assessment of electricity restoration efforts in Puerto Rico after Hurricane Maria.

PLoS One. 2019;14(6):e0218883

Authors: Román MO, Stokes EC, Shrestha R, Wang Z, Schultz L, Carlo EAS, Sun Q, Bell J, Molthan A, Kalb V, Ji C, Seto KC, McClain SN, Enenkel M

Abstract
A real-time understanding of the distribution and duration of power outages after a major disaster is a precursor to minimizing their harmful consequences. Here, we develop an approach for using daily satellite nighttime lights data to create spatially disaggregated power outage estimates, tracking electricity restoration efforts after disasters strike. In contrast to existing utility data, these estimates are independent, open, and publicly-available, consistently measured across regions that may be serviced by several different power companies, and inclusive of distributed power supply (off-grid systems). We apply the methodology in Puerto Rico following Hurricane Maria, which caused the longest blackout in US history. Within all of the island's settlements, we track outages and recovery times, and link these measures to census-based demographic characteristics of residents. Our results show an 80% decrease in lights, in total, immediately after Hurricane Maria. During the recovery, a disproportionate share of long-duration power failures (> 120 days) occurred in rural municipalities (41% of rural municipalities vs. 29% of urban municipalities), and in the northern and eastern districts. Unexpectedly, we also identify large disparities in electricity recovery between neighborhoods within the same urban area, based primarily on the density of housing. For many urban areas, poor residents, the most vulnerable to increased mortality and morbidity risks from power losses, shouldered the longest outages because they lived in less dense, detached housing where electricity restoration lagged. The approach developed in this study demonstrates the potential of satellite-based estimates of power recovery to improve the real-time monitoring of disaster impacts, globally, at a spatial resolution that is actionable for the disaster response community.

PMID: 31251791 [PubMed - in process]

Cryptosporidiosis Outbreaks - United States, 2009-2017.

MMWR Morb Mortal Wkly Rep. 2019 Jun 28;68(25):568-572

Authors: Gharpure R, Perez A, Miller AD, Wikswo ME, Silver R, Hlavsa MC

Abstract
Cryptosporidium is a parasite that causes cryptosporidiosis, a profuse, watery diarrhea that can last up to 3 weeks in immunocompetent patients and can lead to life-threatening malnutrition and wasting in immunocompromised patients.* Fecal-oral transmission can occur by ingestion of contaminated recreational water, drinking water, or food, or through contact with infected persons or animals. For the period 2009-2017, public health officials from 40 states and Puerto Rico voluntarily reported 444 cryptosporidiosis outbreaks resulting in 7,465 cases. Exposure to treated recreational water (e.g., in pools and water playgrounds) was associated with 156 (35.1%) outbreaks resulting in 4,232 (56.7%) cases. Other predominant outbreak exposures included contact with cattle (65 outbreaks; 14.6%) and contact with infected persons in child care settings (57; 12.8%). The annual number of reported cryptosporidiosis outbreaks overall increased an average of approximately 13% per year over time. Reversing this trend will require dissemination of prevention messages to discourage swimming or attending child care while ill with diarrhea and encourage hand washing after contact with animals. Prevention and control measures can be optimized by improving understanding of Cryptosporidium transmission through regular analysis of systematically collected epidemiologic and molecular characterization data.

PMID: 31246941 [PubMed - in process]

HIV Testing in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016-2017.

MMWR Morb Mortal Wkly Rep. 2019 Jun 28;68(25):561-567

Authors: Pitasi MA, Delaney KP, Brooks JT, DiNenno EA, Johnson SD, Prejean J

Abstract
Since 2006, CDC has recommended universal screening for human immunodeficiency virus (HIV) infection at least once in health care settings and at least annual rescreening of persons at increased risk for infection (1,2), but data from national surveys and HIV surveillance demonstrate that these recommendations have not been fully implemented (3,4). The national Ending the HIV Epidemic initiative* is intended to reduce the number of new infections by 90% from 2020 to 2030. The initiative focuses first on 50 local jurisdictions (48 counties, the District of Columbia, and San Juan, Puerto Rico) where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and seven states with a disproportionate occurrence of HIV in rural areas relative to other states (i.e., states with at least 75 reported HIV diagnoses in rural areas that accounted for ≥10% of all diagnoses in the state).† This initial geographic focus will be followed by wider implementation of the initiative within the United States. An important goal of the initiative is the timely identification of all persons with HIV infection as soon as possible after infection (5). CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS)§ to assess the percentage of adults tested for HIV in the United States nationwide (38.9%), in the 50 local jurisdictions (46.9%), and in the seven states (35.5%). Testing percentages varied widely by jurisdiction but were suboptimal and generally low in jurisdictions with low rates of diagnosis of HIV infection. To achieve national goals and end the HIV epidemic in the United States, strategies must be tailored to meet local needs. Novel screening approaches might be needed to reach segments of the population that have never been tested for HIV.

PMID: 31246940 [PubMed - in process]

Epidemiologic Trends of Adoption of Do-Not-Resuscitate Status After Pediatric In-Hospital Cardiac Arrest.

Pediatr Crit Care Med. 2019 Jun 21;:

Authors: Gupta P, Rettiganti M, Gossett JM, Nadkarni VM, Berg RA, Raymond TT, Parshuram CS, American Heart Association’s Get With The Guidelines-Resuscitation Investigators

Abstract
OBJECTIVES: To evaluate the prevalence of do-not-resuscitate status, assess the epidemiologic trends of do-not-resuscitate status, and assess the factors associated with do-not-resuscitate status in children after in-hospital cardiac arrest using large, multi-institutional data.
DESIGN: Generalized estimating equations logistic regression model was used to evaluate the trends of do-not-resuscitate status and evaluate the factors associated with do-not-resuscitate status after cardiac arrest.
SETTING: American Heart Association's Get With the Guidelines-Resuscitation Registry.
PATIENTS: Children (< 18 yr old) with an index in-hospital cardiac arrest and greater than or equal to 1 minute of documented chest compressions were included (2006-2015). Patients with no return of spontaneous circulation after cardiac arrest were excluded.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: In total, 8,062 patients qualified for inclusion. Of these, 1,160 patients (14.4%) adopted do-not-resuscitate status after cardiac arrest. We found low rates of survival to hospital discharge among children with do-not-resuscitate status (do-not-resuscitate vs no do-not-resuscitate: 6.0% vs 69.7%). Our study found that rates of do-not-resuscitate status after cardiac arrest are highest in children with Hispanic ethnicity (16.4%), white race (15.0%), and treatment at institutions with larger PICUs (> 50 PICU beds: 17.8%) and at institutions located in North Central (17.6%) and South Atlantic/Puerto Rico (17.1%) regions of the United States. Do-not-resuscitate status was more common among patients with more preexisting conditions, longer duration of cardiac arrest, greater than 1 cardiac arrest, and among patients requiring extracorporeal cardiopulmonary resuscitation. We also found that trends of do-not-resuscitate status after cardiac arrest in children are decreasing in recent years (2013-2015: 13.8%), compared with previous years (2006-2009: 16.0%).
CONCLUSIONS: Patient-, hospital-, and regional-level factors are associated with do-not-resuscitate status after pediatric cardiac arrest. As cardiac arrest might be a signal of terminal chronic illness, a timely discussion of do-not-resuscitate status after cardiac arrest might help families prioritize quality of end-of-life care.

PMID: 31246741 [PubMed - as supplied by publisher]

Research utility of the National Violent Death Reporting System: a scoping review.

Inj Epidemiol. 2019;6:18

Authors: Nazarov O, Guan J, Chihuri S, Li G

Abstract
Background: To better understand and prevent suicide and homicide, the National Center for Injury Prevention and Control of the US Centers for Disease Control and Prevention launched the National Violent Death Reporting System (NVDRS) in six states in 2002. As of 2018, the NVDRS has been expanded to include all 50 states, the District of Columbia and Puerto Rico. The purpose of this review was to assess the research utility of the NVDRS based on studies indexed in major bibliographical databases.
Methods: We performed a scoping review of published studies that were based on data from the NVDRS, identified by searching six electronic databases: PubMed, EMBASE, Google Scholar, OVID, Scopus, and Web of Science. We examined the time trend of annual NVDRS-based research output, generated a word cloud using the keywords listed in the publications, and mapped the knowledge domains covered by NVDRS-based studies.
Results: Our review included a total of 150 studies published between 2005 and 2018. There was a marked increase in the annual number of NVDRS-based publications, with 120 (80.0%) of the 150 studies published between 2011 and 2018. Overall, 104 (69.3%) studies focused on suicide and 39 (26.0%) on homicide. Of the included studies, 100 (66.7%) were descriptive epidemiology, 31 (20.7%) were risk factor analyses, 9 (6.0%) were evaluations, 7 (4.7%) were trend analyses, and 4 (2.7%) were data quality assessments. Knowledge domain mapping identified two major clusters of studies, one on suicide and the other on homicide. The cluster on suicide was commonly linked to "circumstance," "alcohol" and "substance abuse" and the cluster on homicide was commonly linked to "firearm," "injury," and "gang." The two clusters were interlinked to overlapping networks of keywords, such as "firearm" and "mental health problem."
Conclusions: Research utility of the NVDRS has increased considerably in recent years. Studies based on data from the NVDRS are clustered in two knowledge domains - suicide and homicide. The vast potential of the NVDRS for violence research and prevention remains to be fully exploited.

PMID: 31245267 [PubMed]

Improving Cross-Protection against Influenza Virus Using Recombinant Vaccinia Vaccine Expressing NP and M2 Ectodomain Tandem Repeats.

Virol Sin. 2019 Jun 25;:

Authors: Wang W, Huang B, Wang X, Tan W, Ruan L

Abstract
Conventional influenza vaccines need to be designed and manufactured yearly. However, they occasionally provide poor protection owing to antigenic mismatch. Hence, there is an urgent need to develop universal vaccines against influenza virus. Using nucleoprotein (NP) and extracellular domain of matrix protein 2 (M2e) genes from the influenza A virus A/Beijing/30/95 (H3N2), we constructed four recombinant vaccinia virus-based influenza vaccines carrying NP fused with one or four copies of M2e genes in different orders. The recombinant vaccinia viruses were used to immunize BALB/C mice. Humoral and cellular responses were measured, and then the immunized mice were challenged with the influenza A virus A/Puerto Rico/8/34 (PR8). NP-specific humoral response was elicited in mice immunized with recombinant vaccinia viruses carrying full-length NP, while robust M2e-specific humoral response was elicited only in the mice immunized with recombinant vaccinia viruses carrying multiple copies of M2e. All recombinant viruses elicited NP- and M2e-specific cellular immune responses in mice. Only immunization with RVJ-4M2eNP induced remarkably higher levels of IL-2 and IL-10 cytokines specific to M2e. Furthermore, RVJ-4M2eNP immunization provided the highest cross-protection in mice challenged with 20 MLD50 of PR8. Therefore, the cross-protection potentially correlates with both NP and M2e-specific humoral and cellular immune responses induced by RVJ-4M2eNP, which expresses a fusion antigen of full-length NP preceded by four M2e repeats. These results suggest that the rational fusion of NP and multiple M2e antigens is critical toward inducing protective immune responses, and the 4M2eNP fusion antigen may be employed to develop a universal influenza vaccine.

PMID: 31240620 [PubMed - as supplied by publisher]

Diversity and distribution of Laonice species (Annelida: Spionidae) in the tropical North Atlantic and Puerto Rico Trench.

Sci Rep. 2019 Jun 25;9(1):9260

Authors: Guggolz T, Meißner K, Schwentner M, Brandt A

Abstract
Laonice Malmgren, 1867 (Annelida: Spionidae) is a common polychaete genus in the deep-sea. Although most species are quite well studied morphologically, fragmentation and other damage that occurs during sampling often hampers morphological species identification of deep-sea specimens. In this study, we employ three molecular markers (16S, COI and 18S) to study the biodiversity and the distribution patterns of Laonice from the tropical North Atlantic and the Puerto Rico Trench. Based upon different molecular analyses (Automated Barcode Gap Discovery, pairwise genetic distances, phylogenetics, haplotype networks) we were able to identify and differentiate eight Laonice species. Up to four of these species co-occurred sympatrically at the same station. The majority of species were found at multiple stations and two species in the eastern as well as western Atlantic had ranges of up to 4,000 km. Genetic differentiation across these extensive geographic distances was very low. Surprisingly, one 16S haplotype was shared between individuals 2,776 km apart and individuals from the Caribbean and the abyssal plain in the eastern Atlantic (>3,389 km) differed in only a single mutation in 16S. Our results suggest that members of this genus successfully disperse across large geographic distances and are largely unaffected by topographic barriers.

PMID: 31239511 [PubMed - in process]

Comparative studies of mucosal humoral and cellular immune responses to 2009 pandemic H1N1 influenza virus in mice.

Acta Virol. 2019;63(2):203-210

Authors: Zhang YY, An J, Wang K, Han B, Liu YF, Jia HL, Li YS, Lei L, Jia N, Lv J

Abstract
The nasal-associated lymphoid tissues (NALTs), embedded in the submucosa of murine upper respiratory tract, represents an important site of induction for local mucosal immune responses to airborne pathogens and intranasal vaccines. Here, we systematically investigated the mucosal humoral and cellular immune responses of NALTs in mice infected with A/Beijing/501/2009 (BJ501) and A/Puerto Rico/8/1934 (PR8) viruses. Compared with PR8 infection, BJ501 induced a more rapid increase of virus-specific IgA and IgG antibodies in the nasal lavage fluid and a higher ratio of IgG1/IgG2a, indicating a stronger Th2 response to BJ501 in mucosal immunity. In addition, using virus-specific enzyme-linked immunospot assay (ELISpot assay), we observed higher and earlier responses of virus-specific IgA and IgG antibody-secreting cells (ASCs) and IFN-γ and IL-4 cytokine-secreting cells (CSCs) in NALTs of mice intranasally infected with BJ501 virus. In particular, the frequency of BJ501-specific IFN-γ-CSCs significantly correlated with the kinetics of BJ501 virus load in NALTs, suggesting an important role of IFN-γ-CSCs-associated mucosal cellular immune responses in BJ501 virus clearance. Collectively, BJ501 induced a more comprehensive and rapid mucosal immune responses in NALTs of mice, providing further understanding of the immune responses elicited by 2009 pandemic H1N1 virus in upper respiratory tract. Keywords: nasal-associated lymphoid tissues (NALTs); influenza virus; mucosal immune response; Th1/Th2 response.

PMID: 31230449 [PubMed - in process]

Refining Risk-Adjustment for Bundled Payment Models in Cervical Fusions - An Analysis of Medicare Beneficiaries.

Spine J. 2019 Jun 18;:

Authors: Malik AT, Phillips FM, Retchin S, Xu W, Yu E, Kim J, Khan SN

Abstract
BACKGROUND CONTEXT: The current Bundled Payment for Care Improvement (BPCI) model relies on the use of "Diagnosis Related Groups" (DRGs) to risk-adjust reimbursements associated with a 90-day episode of care. Three distinct DRG groups exist for defining payments associated with cervical fusions: 1) DRG-471 (cervical fusions with major comorbidity/complications), 2) DRG-472 (with co-morbidity/complications) and 3) DRG-473 (without major comorbidity/complications). However, this DRG system may not be entirely suitable in controlling the large amounts of cost variation seen among cervical fusions. For instance, these DRGs do not account for area/location of surgery (upper cervical vs. lower cervical), type of surgery (primary vs. revision), surgical approach (anterior vs. posterior), extent of fusion (1-3 level vs. >3 level) and cause/indication of surgery (fracture vs. degenerative pathology).
PURPOSE: To understand factors responsible for cost variation in a 90-day episode of care following cervical fusions.
STUDY DESIGN: Retrospective study of a 5% national sample of Medicare claims from 2008-2014 (SAF5).
OUTCOME MEASURES: To calculate the independent marginal cost impact of various patient-level, geographic-level and procedure-level characteristics on 90-day reimbursements for patients undergoing cervical fusions under DRG-471, DRG-472 and DRG-473.
METHODS: The 2008-2014 Medicare 5% Standard Analytical Files (SAF5) was queried using DRG codes 471, 472 and 473 to identify patients receiving a cervical fusion. Patients undergoing non-cervical fusions (thoracolumbar), surgery for deformity/malignancy and/or combined anterior-posterior fusions were excluded. Patients with missing data and/or those who died within 90-days of the post-operative follow up period were excluded. Multivariate linear regression modelling was performed to assess the independent marginal cost-impact of DRG, gender, age, state, procedure-level factors (including cause/indication of surgery) and co-morbidities on total 90-day reimbursement.
RESULTS: Following application of inclusion/exclusion criteria, a total of 12,419 cervical fusions were included. The average 90-day reimbursement for each DRG group was as follows: 1) DRG-471= $54,314 ± $32,643, 2) DRG-472 = $28,535 ± $17,271 and 3) DRG-473 = $18,492 ± $10,706. The risk-adjusted 90-day reimbursement of a non-geriatric (age<65) female, with no major co-morbidities, undergoing a primary 1- to 3-level anterior cervical fusion for degenerative cervical spine disease was $14,924 ± $753. Male gender (+$922) and age 70-84 (+$1,007 to +$2,431) was associated with significant marginal increases in 90-day reimbursements. Undergoing upper cervical surgery (-$1,678) had a negative marginal cost-impact. Among other procedure-level factors, posterior approach (+$3,164), >3 level fusion (+$2,561), interbody (+$667), use of intra-operative neuro-monitoring (+$1,018), concurrent decompression/laminectomy (+$1,657) and undergoing fusion for cervical fracture (+$3,530) were associated higher 90-day reimbursements. Severe individual co-morbidities were associated with higher 90-day reimbursements, with malnutrition (+$15,536), CVA/stroke (+$6,982), drug abuse/dependence (+$5,059), hyper-coagulopathy (+$5,436), and chronic kidney disease (+$4,925) having the highest marginal cost-impacts. Significant state-level variation was noted, with Maryland (+$8,790), Alaska (+$6,410), Massachusetts (+$6,389), California (+$5,603) and New Mexico (+$5,530) having the highest reimbursements and Puerto Rico (-$7,492) and Iowa (-$3,393) having the lowest reimbursements, as compared to Michigan.
CONCLUSIONS: The current cervical fusion bundled payment model fails to employ a robust risk adjustment of prices resulting in the large amount of cost-variation seen within 90-day reimbursements. Under the proposed DRG-based risk-adjustment model, providers would be reimbursed the same amount for cervical fusions regardless of the surgical approach (posterior vs. anterior), the extent of fusion, use of adjunct procedures (decompressions) and cause/indication of surgery (fracture vs. degenerative pathology), despite each of these factors having different resource utilization and associated reimbursements. Our findings suggest that defining payments based on DRG codes only is an imperfect way of employing bundled payments for spinal fusions and will only end up creating major financial disincentives and barriers to access of care in the healthcare system.

PMID: 31226386 [PubMed - as supplied by publisher]

Disparities in healthcare services in women with endometriosis with public vs. private health insurance.

Am J Obstet Gynecol. 2019 Jun 18;:

Authors: Fourquet J, Zavala DE, Missmer S, Bracero N, Romaguera J, Flores I

Abstract
BACKGROUND: Health disparities research's goals are to identify facilitators and barriers to health care utilization to help eliminate health inequalities. There are few studies on disparities in health care access and utilization trends for endometriosis patients that may lead to differences in appropriate care based on socioeconomic status.
OBJECTIVE: This retrospective cross-sectional study was conducted to compare health services utilization patterns and prevalence of co-morbidities of women with endometriosis with public (government-based) vs. private (purchased or provided by employer) health insurance.
STUDY DESIGN: A total of 342 de-identified datasets (171 randomly-selected cases per study group) from women with endometriosis 14-50 years-old, members of one health insurance company that provides both public and private health insurance coverage in Puerto Rico were analyzed. Patients were defined as having at least one endometriosis-related medical claim (ICD-9-617.xx; International Classification of Diseases, Ninth Revision, Clinical Modification) during the three-year study period.
RESULTS: Medical service (e.g., hospital, laboratory, pathology and radiology) utilization trends were 3 times lower in the public vs. the private sector. Women in the public sector were 3.5 less likely to have a laparoscopy, 2.7 times more likely to be prescribed opioid/narcotics, and were the only study subjects reporting emergency room use. Ob/Gyn services were utilized >2-fold less by women in the public (29.5%) vs. the private sector (70.5%) (p=0.087).
CONCLUSION: We report significant differences in the utilization trends of endometriosis-related medical services and prescriptions, indicating differences in health care access based on socioeconomic parameters. Our results support development of public health programs to promote access to health care for endometriosis patients irrespective of socioeconomic status and promote health disparity research in other health care systems.

PMID: 31226295 [PubMed - as supplied by publisher]

Factors Associated with Self-Perceived Diet Quality Among Puerto Rican Adults (P04-092-19).

Curr Dev Nutr. 2019 Jun;3(Suppl 1):

Authors: Amaro-Rivera K, Carbone E

Abstract
Objectives: Self-perceived diet quality is an important psychosocial factor that can influence dietary patterns. Several studies have found an association between this variable and health-related behaviors, such as eating fruits and vegetables and exercising regularly. However, this relationship has not been well studied among minority groups. The aim of this research was to examine the associations between sociodemographic and health-related variables and self-perception of diet quality among adults living in Puerto Rico.
Methods: This was a cross-sectional study. A researcher-designed questionnaire was distributed within a particular community. One questionnaire was given per household to be answered by everyone living in the house. A multivariable logistic regression was used to examine the association between the dependent variable, self-perceived diet quality (specified as excellent/very good/good or fair/poor), and the following independent variables: age groups, sex, education, poverty level estimate, self-rated health, intake of fruits or vegetables, sugar-sweetened beverages and fast-food, physical activity, recreational screen time (as a proxy for sedentary time), and BMI categories.
Results: A total of 106 questionnaires were distributed and 93 were returned, with data collected for 254 individuals. Children (n = 57) and adults with missing data (n = 5) were excluded from the analysis. The final sample consisted of 192 adults aged ≥18 years. Among these, 53.1% were females, 52.0% completed more than high school, 41.7% were below the poverty level estimate, and 61.5% were either overweight or obese. A total of 26.6% of the participants described their diet as fair/poor. Fair/poor self-perceived diet quality was associated with higher odds of reporting fair/poor self-rated health, consuming less than one cup of fruits or vegetables per day, eating at fast-food one or more times per week, and spending three hours or more per day using a screen for recreational purposes.
Conclusions: Self-perception of diet quality was associated with certain health-related behaviors in our sample. Future research should examine the association between self-perceived and objective diet quality, as previous research has shown that Puerto Ricans have poor knowledge of dietary recommendation.
Funding Sources: N/A.
Supporting Tables Images and/or Graphs:

PMID: 31224708 [PubMed]

Should Protocols for Weight Change During Pregnancy Include Information About the Previous Weight History of the Woman Who Is Pregnant? (P22-015-19).

Curr Dev Nutr. 2019 Jun;3(Suppl 1):

Authors: Macpherson-Sanchez A

Abstract
Objectives: Recent research has indicated that an increase in weight is frequently caused by prior famine or Self-Induced Weight Loss (SIWL). The purpose of the literature search was to evaluate if famine or SIWL, in a woman who is contemplating pregnancy or who is currently pregnant, could have long term effects on the child to be born.
Methods: Pub Med was searched using the key phrases "Pregnancy and Famine or Starvation", and "Gestational Weight Gain", both limited to Humans, with no limit as to dates of publication.
Results: The earliest famine study found was published in 1976 and indicated that men born during the Dutch Famine (1944-45) had higher obesity rates if they were exposed to famine during the first half of pregnancy and lower rates if they experienced famine in the third trimester or the first few months of life. Other publications report results of pregnancy outcomes before, during, and after the Holocaust (1940-45), the Dutch Famine and famines in China (1959-61), Biafra (1968-70), and Bangladesh (1974-75). Long-term famine related problems include increased risk of overweight, obesity, Type 2 Diabetes, coronary heart disease, hypertension, and metabolic syndrome. Additional studies extend this observation to those who live in poverty with corresponding uncertainty about food resources. The most complete studies were published after 2004. Studies less than 18 months indicate that SIWL may be effective. However, with individuals followed 6 years or more either long-term weight gain occurs, or additional SIWL.Pregnancy protocols advocate specific limits to weight gain during pregnancy based on pre-pregnancy or early pregnancy BMI and recommend total weight gain ranges using usual BMI classifications. They do not ask about the weight history of the woman or if she has ever engaged in SIWL. BMI is based on height and weight and does not take into consideration the relative contribution of bone and muscle mass differentiated from fat mass. The size of the baby at birth is not an adequate indicator of actual health status.
Conclusions: An individual is conceived, lives in utero, and then is born. Caloric undernutrition in utero and during childhood can produce increased body fat and result in non-communicable diseases that are commonly related to obesity.
Funding Sources: Pension, University of Puerto Rico.
Supporting Tables Images and/or Graphs:

PMID: 31224646 [PubMed]

Association Between Intentional Purchase of Local Food Products and Diet Quality Among Adults in Puerto Rico (P04-148-19).

Curr Dev Nutr. 2019 Jun;3(Suppl 1):

Authors: Marrero-Hernandez A, Tamez M, Mattei J

Abstract
Objectives: Adults in Puerto Rico have a high prevalence of poor diet quality, behavior that, in other United States territories, has previously been associated with increased access to imported food products. These trends raise the question of whether consumption of local food, which accounts for only 15% of the Puerto Rican food environment, may contribute to healthy dietary intake. We aimed to investigate the association between purposefully purchasing local foods (PPLF) and diet quality in Puerto Rico.
Methods: The Puerto Rico Assessment of Diet, Lifestyle, and Diseases (PRADLAD) is a 2015 cross-sectional study of 380 adults (35-75y) sampled in San Juan. To assess PPLF, participants were asked, 'How often do you purposely purchase foods from Puerto Rico (like fruits, vegetables, meat and other products that are produced here rather than being imported)? ' Diet was assessed through a culturally-adapted food frequency questionnaire, and diet quality was defined using the Alternative Healthy Eating Index-2010 (AHEI). Statistical analysis was conducted among participants with valid dietary data (n = 248). Multivariable generalized linear models tested the association between PPLF and AHEI, adjusted for relevant sociodemographic and behavioral factors.
Results: Nearly a third (33.9%) of participants reported never/sometimes, 33.5% reported often, and 30.6% reported always PPLF. As compared to never/sometimes PPLF, fully-adjusted mean AHEI scores were 3.56 (P = 0.0383) points higher among those often PPLF and 9.34 (P < 0.0001) points higher among those always PPLF. Compared to never/sometimes PPLF, those who always PPLF had higher fully-adjusted mean component scores for vegetables (P < 0.0001), fruits (P = 0.0002), whole grain (P = 0.0391), nuts and legumes (P = 0.034), trans fat (P = 0.0003), and long-chain (Ω-3) fats (P = 0.002).
Conclusions: Adults in Puerto Rico who intentionally purchase local products had significantly higher diet quality, especially regarding plant-based foods and healthy fats intake. These findings point to possible dietary benefits associated with improving local food availability. Further research on the Puerto Rican food environment is needed, including potential poor diet quality associated with imported products.
Funding Sources: Private anonymous donations, Dry Bean Health Research Program Incentive Award, and institutional funds.
Supporting Tables Images and/or Graphs:

PMID: 31224486 [PubMed]

Cultural Sensitivity and Global Pharmacy Engagement in the Caribbean: Dominica, Jamaica, Puerto Rico, and St. Kitts.

Am J Pharm Educ. 2019 May;83(4):7219

Authors: Abrons JP, Andreas E, Jolly O, Parisi-Mercado M, Daly A, Carr I

Abstract
Sustainable and reciprocal partnerships in pharmacy education and practice exist between schools and colleges of pharmacy in the United States and Caribbean countries and territories. This paper discusses the cultural considerations for such partnerships to flourish. First, general information on Caribbean countries and territories is covered. Next, the paper transitions into how to ensure culturally sensitive engagements when traveling to or hosting visitors from the Caribbean. This paper is intended to assist practitioners with integrating culturally sensitive considerations into the development of partnerships in this region.

PMID: 31223164 [PubMed - in process]

Lessons from the reestablishment of Public Health Laboratory activities in Puerto Rico after Hurricane Maria.

Nat Commun. 2019 Jun 20;10(1):2720

Authors: Hardy MC, Stinnett RC, Kines KJ, Rivera-Nazario DM, Lowe DE, Mercante AM, Gonzalez Jimenez N, Cuevas Ruiz RI, Rivera Arbolay HI, Gonzalez Peña RL, Toro M, Trujillo AA, Pappas CL, Llewellyn AC, Candal F, Burgos Garay M, Gomez GA, Concepcion Acevedo J, Ansbro M, Moura H, Shaw MW, Muehlenbachs A, Romanoff LC, Sunshine BJ, Rose DA, Patel A, Shapiro CN, Luna-Pinto SC, Pillai SK, O'Neill E

Abstract
Public Health Laboratories (PHLs) in Puerto Rico did not escape the devastation caused by Hurricane Maria. We implemented a quality management system (QMS) approach to systematically reestablish laboratory testing, after evaluating structural and functional damage. PHLs were inoperable immediately after the storm. Our QMS-based approach began in October 2017, ended in May 2018, and resulted in the reestablishment of 92% of baseline laboratory testing capacity. Here, we share lessons learned from the historic recovery of the largest United States' jurisdiction to lose its PHL capacity, and provide broadly applicable tools for other jurisdictions to enhance preparedness for public health emergencies.

PMID: 31221973 [PubMed - in process]

The Correlation of English Language Proficiency and Indices of Stress and Anxiety in Migrants from Puerto Rico after Hurricane Maria: A Preliminary Study.

Disaster Med Public Health Prep. 2019 Jun 21;:1-5

Authors: Carl Y, Frias RL, Kurtevski S, González Copo T, Mustafa AR, Font CM, Blundell AR, Rodriguez EC, Sacasa R

Abstract
ABSTRACTObjective:Using validated psychological assessment instruments, this study examined the psychological distress associated with potential language barriers experienced by over 135 000 Puerto Rican residents who either temporarily or permanently migrated to the continental United States with the landfall of Hurricane Maria in 2017.
METHODS: Participants were Puerto Rican residents (n = 107) who remained in Puerto Rico (control) or left the island for at least 3 months because of Hurricane Maria (migrants). Participants completed an online survey in their preferred language (Spanish or English), which assessed self-reported English language proficiency, Kessler Psychological Distress Scale (K6), Posttraumatic Stress Disorder Checklist for DSM 5, Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. It was hypothesized that migrants with lower self-reported English proficiency would have comparatively higher indices of post-disaster distress than those with a higher proficiency.
RESULTS: Dividing the migrant group by preferred language for questionnaire completion, the Fisher's exact test showed significant differences in prevalence of severe mental distress, as defined by K6 scores above 13, between the Spanish-preferring migrants (30.4%), English-preferring migrants (0%), and controls (9.6%).
CONCLUSION: Our results support a possible correlation between decreased language proficiency in post-disaster migrants and a higher risk factor for severe mental distress.

PMID: 31221231 [PubMed - as supplied by publisher]

Clinical replicability of rehabilitation interventions in Randomized Controlled Trials reported in main journals is inadequate.

J Clin Epidemiol. 2019 Jun 17;:

Authors: Negrini S, Arienti C, Pollet J, Engkasan JP, Francisco GE, Frontera WR, Galeri S, Gworys K, Kujawa J, Mazlan M, Rathore FA, Schillebeeckx F, Kiekens C, REREP study participants, IRCCS Don Gnocchi Foundation

Abstract
OBJECTIVE: To study if Randomized Controlled Trials (RCTs) in rehabilitation (a field where complex interventions prevail) published in main journals include all the details needed to replicate the intervention in clinical practice (clinical replicability).
STUDY DESIGN AND SETTING: Forty-seven rehabilitation clinicians of 5 professions from 7 teams (Belgium, Italy, Malaysia, Pakistan, Poland, Puerto Rico, USA). reviewed 76 RCTs published by main rehabilitation journals exploring 14 domains chosen through consensus and piloting.
RESULTS: The response rate was 99%. Inter-rater agreement was moderate/good. All clinicians considered unanimously 12 (16%) RCTs clinically replicable and none not replicable. At least one "absent" information was found by all participants in 60 RCTs (79%), and by a minimum of 85% in the remaining 16 (21%). Information considered to be less well described (8-19% "perfect" information) included two providers (skills, experience) and two delivery (cautions, relationships) items. The best described (50-79% "perfect") were the classic methodological items included in CONSORT (descending order: participants, materials, procedures, setting and intervention).
CONCLUSION: Clinical replicability must be considered in RCTs reporting, particularly for complex interventions. Classical methodological checklists like CONSORT are not enough, and also TIDieR do not cover all the requirement . This study supports the need for field-specific checklists.

PMID: 31220570 [PubMed - as supplied by publisher]

Zika virus infection of pregnant rats and associated neurological consequences in the offspring.

PLoS One. 2019;14(6):e0218539

Authors: Sherer ML, Khanal P, Talham G, Brannick EM, Parcells MS, Schwarz JM

Abstract
Zika virus (ZIKV) is a mosquito-borne flavivirus associated with microcephaly and other neurological disorders in infants born to infected mothers. Despite being declared an international emergency by the World Health Organization, very little is known about the mechanisms of ZIKV pathogenesis or the long-term consequences of maternal ZIKV infection in the affected offspring, largely due to the lack of appropriate rodent models. To address this issue, our lab has developed a working model of prenatal ZIKV infection in rats. In this study, we infected immune competent pregnant female rats with 105-107 PFU of ZIKV (PRVABC59, Puerto Rico/Human/Dec 2015) in order to examine its pathogenesis in the dams and pups. We examined the febrile response and sickness behavior in the dams, in addition to neonatal mortality, microglia morphology, cortical organization, apoptosis, and brain region-specific volumes in the offspring. Here, we demonstrate that pregnant and non-pregnant female rats have a distinct febrile response to ZIKV infection. Moreover, prenatal ZIKV infection increased cell death and reduced tissue volume in the hippocampus and cortex in the neonatal offspring. For the first time, we demonstrate the efficacy and validity of an immunocompetent rat model for maternal ZIKV infection that results in significant brain malformations in the neonatal offspring.

PMID: 31220154 [PubMed - in process]

Trends in Diagnostic Flexible Laryngoscopy and Videolaryngostroboscopy Utilization in the US Medicare Population.

JAMA Otolaryngol Head Neck Surg. 2019 Jun 20;:

Authors: Itamura K, Hur K, Kokot NC, Johns MM

Abstract
Importance: Diagnostic flexible laryngoscopy (DFL) is the second-most reimbursed procedure by Medicare in otolaryngology. However, the economic trends of this procedure on a population level are unknown.
Objective: To describe national- and state-level DFL and videolaryngostroboscopy (VLS) utilization and payment trends from 2000 to 2016 in the Medicare population.
Design, Setting, and Participants: This population-based, cross-sectional study of all Medicare beneficiaries from 2000 through 2016 found that at the national level the total absolute number of DFLs performed in the US Medicare population increased by 87% from 344 183 to 645 172 services, whereas total absolute payments for DFLs made by Medicare concurrently increased by 41% from $38 720 243 to $54 499 071. Rates of DLS and VLS categorized as Current Procedural Terminology (CPT) code 31575 and 31579, respectively. Analysis was carried out between November 18, 2018 and December 18, 2018.
Exposures: Diagnostic flexible laryngoscopy and VLS.
Main Outcomes and Measures: The DFL and VLS utilization rates, payments, and reimbursement rate trends were analyzed by year and state. Utilization was assessed for physician characteristics, including specialty and credentials.
Results: Nationally from 2000 to 2016 in the Medicare population, DFL utilization per Medicare enrollee increased 30% from 0.0087 to 0.0110 and payment per enrollee decreased 2% from $0.98 to $0.96, whereas VLS utilization and payment per enrollee both increased at least 300% during the same time period, with VLS procedure per enrollee and payment per enrollee increasing by 382% from 0.00028 to 0.0013 and 301% from $0.05 to $0.22, respectively. There was a weak correlation between reimbursement and utilization per enrollee for both DFL (r = 0.23; 95% CI, 0.12-0.34) and VLS (r = 0.26; 95% CI, 0.14-0.37) performed from 2012 to 2016. In 2016, the mean (SD) payment per DFL was $85.14 ($7.95), ranging from $65.45 in Puerto Rico to $104.82 in Washington, DC, a 1.6-fold difference. For VLS, there was a 2-fold difference between the lowest-reimbursing state, Maine ($92.20) and the highest, New York ($182.96). All US dollar values were uniformly adjusted for inflation to 2018 dollar values. Most DFLs in 2016 were performed by otolaryngologists (93.6%).
Conclusions and Relevance: The DFL utilization rates remained stable compared with VLS in the Medicare population from 2000 to 2016. There was a decrease in both DFL and VLS payments per procedure in the same time period and also weak correlations between reimbursement and utilization. Practice patterns and reimbursement varied geographically across the United States, though VLS exhibited significantly higher variation than DFL at the state level.

PMID: 31219508 [PubMed - as supplied by publisher]

What the Puerto Rican hurricanes make visible: Chronicle of a public health disaster foretold.

Soc Sci Med. 2019 Jun 12;:112367

Authors: Benach J, Díaz MR, Muñoz NJ, Martínez-Herrera E, Pericàs JM

Abstract
García Márquez's novel, "Chronicle of a Death Foretold", narrates the multiple strands of a story leading up to a murder in a small Caribbean village. The novel shows both the incredulity of those who do not believe it possible that this tragic death could occur, and the impotence of those who see it coming but can do nothing to prevent it. Something akin to this double incapacity seems to be occurring today in Puerto Rico. In September 2017, the passage of Hurricanes Irma and María caused a public health disaster with large-scale death and destruction. Paradoxically, this catastrophe has made visible the need to evaluate the critical socio-environmental situation of this country, and to analyse the underlying social factors contributing to the problems caused by the hurricanes. Why did neither the US nor the Puerto Rican government react as expected when faced with such a serious situation? For decades, this country has been suppressed by colonial domination, exploitation of the workforce, and health discrimination. It has been a "laboratory", where colonial practices have institutionalized social control, racism, and inequality, with profound negative effects on society, quality of life and health equality. Poverty and unemployment have always been very high, and thousands of families live in precarious housing situations. Additionally, current labour reforms imposed as part of a neoliberal agenda, are eroding the job security and protections of the working population, while education, health, housing, pensions, energy, and land are being progressively privatized. What are the root causes of this situation? What future does the country await? To answer these questions, critical and comprehensive scrutiny of history showing what the hurricanes have helped to make visible is required. This shows that neoliberal colonialism has shaped the social features behind the principle health and inequality problems of the Puerto-Rican population.

PMID: 31213368 [PubMed - as supplied by publisher]