The Puerto Rico Healthcare Crisis.

Ann Am Thorac Soc. 2015 Nov 9;

Authors: Roman J

Abstract
The Commonwealth of Puerto Rico is a U.S. organized non-incorporated territory with a population of over 3.5 million U.S. citizens. The island has been the focus of much attention due to the recent default on its debt (estimated at over $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy and this crisis affects reimbursement rates for physicians, while promoting the disintegration of the island's healthcare infrastructure. A major contributor of this crisis relates to a disparity in federal funding provided to support the island's healthcare system when compared to that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare. To make matters worse, the U.S. Center for Medicaid and Medicare Services (CMS) is planning to soon implement another 11 percent cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ~$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, while quality care will suffer leading to serious implications for those with chronic medical disorders including respiratory disease.

PMID: 26551268 [PubMed - as supplied by publisher]

A comparative cross-cultural study of the prevalence of late life depression in low and middle income countries.

J Affect Disord. 2015 Oct 23;190:362-368

Authors: Guerra M, Prina AM, Ferri CP, Acosta D, Gallardo S, Huang Y, Jacob KS, Jimenez-Velazquez IZ, Llibre Rodriguez JJ, Liu Z, Salas A, Sosa AL, Williams JD, Uwakwe R, Prince M

Abstract
BACKGROUND: Current estimates of the prevalence of depression in later life mostly arise from studies carried out in Europe, North America and Asia. In this study we aimed to measure the prevalence of depression using a standardised method in a number of low and middle income countries (LMIC).
METHODS: A one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was assessed and compared using ICD-10 and EURO-D criteria.
RESULTS: Depression prevalence varied across sites according to diagnostic criteria. The lowest prevalence was observed for ICD-10 depressive episode (0.3 to 13.8%). When using the EURO-D depression scale, the prevalence was higher and ranged from 1.0% to 38.6%. The crude prevalence was particularly high in the Dominican Republic and in rural India. ICD-10 depression was also associated with increased age and being female.
LIMITATIONS: Generalisability of findings outside of catchment areas is difficult to assess.
CONCLUSIONS: Late life depression is burdensome, and common in LMIC. However its prevalence varies from culture to culture; its diagnosis poses a significant challenge and requires proper recognition of its expression.

PMID: 26544620 [PubMed - as supplied by publisher]

Late Diagnosis of HIV Infection in Metropolitan Areas of the United States and Puerto Rico.

AIDS Behav. 2015 Nov 5;

Authors: Hall HI, Tang T, Espinoza L

Abstract
The majority of persons infected with HIV live in large metropolitan areas and many such areas have implemented intensified HIV testing programs. A national indicator of HIV testing outcomes is late diagnosis of HIV infection (stage 3, AIDS). Based on National HIV Surveillance System data, 23.3 % of persons with HIV diagnosed in 2012 had a late diagnosis in large MSAs, 26.3 % in smaller MSAs, and 29.6 % in non-metropolitan areas. In the 105 large MSAs, the percentage diagnosed late ranged from 13.2 to 47.4 %. During 2003-2012, the percentage diagnosed late decreased in large MSAs (32.2-23.3 %), with significant decreases in 41 of 105 MSAs overall and among men who have sex with men. Sustained testing efforts may help to continue the decreasing trend in late-stage HIV diagnosis and provide opportunities for early care and treatment and potential reduction in HIV transmission.

PMID: 26542730 [PubMed - as supplied by publisher]

Change In The Demographic Profile And Impact In The Mortality Of Melanoma And Lung Cancer In Puerto Rico 2000-2010.

Value Health. 2015 Nov;18(7):A827

Authors: Orengo JC, Arbalaez F, Lutz M, Baker-Ivey T, Marques-Goyco C, Monsanto H, Green VS

PMID: 26534416 [PubMed - in process]