OBJECTIVE:Psoriasis is a chronic inflammatory autoimmune disease with an increasing burden. Biologic agents are considered a key treatment modality in improving quality of life for psoriasis patients. However, the potential carcinogenic effect of these agents has become a concerning factor due to their immunomodulatory effects. The purpose of this study is to evaluate differences in the incidence of skin and systemic malignancies in biologic-naïve patients vs biologic-treated patients. METHODS:This retrospective study evaluated chart data from the University of Puerto Rico dermatology clinics, from August 2020 through January 2023. The inclusion criteria for biologic-naïve patients were to be 18 years or older, diagnosed with psoriasis, unexposed to previous systemic therapy, and with available baseline clinical characteristics. The biologic-exposed had to meet the same criteria and must have received at least 6 months of biologic therapy. Patients who had a previous history of phototherapy were excluded from the study. RESULTS:A total of 402 patients were evaluated; 172 from the biologic naïve group and 230 from the biologic exposed group. The incidences of NMSC and systemic malignancy for the biologic-naïve group (2.32% and 1.74%) and the biologic-exposed group (2.17% and 2.60%) showed no significant difference (p-value =0.47). In the biologic-exposed group, patients exposed to adalimumab had the highest incidence of both NMSC and systemic malignancy. However, this difference was not statistically significant. The most common systemic malignancies were colorectal and prostate carcinomas. CONCLUSION:There was no significant difference in cancer incidence in patients treated with topical versus biologic therapy for psoriasis.
OBJECTIVE:Improved survival has been described in obese patients with heart failure (HF). However, whether this survival advantage is accompanied by better functional status has not been investigated in depth. Therefore, this study aimed to determine differences in clinical characteristics, functional aerobic capacity, and health-related quality of life among HF patients with different BMIs. METHODS:Cross-sectional descriptive study, 4 groups of patients with HF were compared according to BMI (underweight, normal weight, overweight, and obese). Sociodemographic and clinical variables were assessed using the Duke Activity Status Index, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Patient Health Questionnaire-9 (PHQ-9). Functional aerobic capacity was also assessed. The ethics committee approved the study, and all patients provided written informed consent. RESULTS:A total of 170 patients with HF were admitted; most were men. Arterial hypertension was more frequent in the obese group 33(84.6%) P = .032. Obese patients had higher waist circumference (103.9 ± 10.66 cm) and body fat (34.44 ± 7.33%; P < .05). High-density lipoprotein cholesterol was higher in the normal-weight group (50.72 ± 10.14 mg/dL; P < .05). The underweight group walked the shortest distance (231.5 ± 42.8 m), and the overweight group walked the longest (260.89 ± 45.1 m; P < .05). The obese group had higher MLHFQ scores (P < .05). CONCLUSION:The study population was predominantly male. Obese patients had a higher prevalence of arterial hypertension, greater waist circumference, higher body fat percentage, and higher MLHFQ scores. The overweight group walked the greatest distance.
OBJECTIVE:To investigate female sexual function and its association with sociodemographic factors and comorbidities among Hispanic women in Puerto Rico (PR). METHODS:The study consisted of 2 phases. Phase 1 validated a Spanish version of the Female Sexual Function Index (FSFI) questionnaire with added sections that elicited sociodemographic information and medical history. Phase 2 involved a cross-sectional study in which the validated questionnaire was distributed at multiple gynecology clinics. The domains assessed included Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain and were scored using the FSFI. Descriptive statistics characterized participant profiles, and we analyzed relationships with total FSFI scores using Wilcoxon-Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests. RESULTS:Among 311 participants who completed the questionnaire, the prevalence of female sexual dysfunction (FSD) was 45.34% (n = 141), similar to estimates reported in the US(not including PR). Most of the participants were younger than 40 years (56%, 173) and reported having partners (63%, 195). Desire was the most affected domain. Correlations were observed between FSD and both medical history (particularly ovarian insufficiency) and medication use (particularly beta-blocker use). CONCLUSION:The high FSD prevalence in PR highlights the need for screening to improve characterization and treatment, ultimately enhancing patients' quality of life.
OBJECTIVE:Evidence-based modifications to antineoplastic therapy regimens are common. The reasons for those changes are varied and include dose rounding, adjustments based on organ function or changes in weight of the patient, and adverse reactions. Given this complexity, proper documentation, and use of computerized provider order entry (CPOE) systems are essential in promoting optimal decision making and patient outcomes. The objective of this study is to explore common reasons for therapeutic regimen modification and their documentation. METHODS:This was a descriptive, retrospective study. Patients who received services at the infusion clinics of a specialized oncology hospital during May 2023, and whose regimen was modified between the months of August 2022 and May 2023 were included. Changes were recorded with their explanations, as detailed by physicians. Physical records from the Department of Pharmacy were also verified. RESULTS:The most documented reason for changes in therapeutic regimens of patients, by both physicians and pharmacy, was dose rounding (31.61% and 45.48%, respectively). Adverse effects recorded by physicians included neurotoxicity and gastrointestinal toxicity (5.16% and 3.55%, respectively). In the evaluated documentation, 14.19% of changes showed discrepancies in both records and 2.6% were not justified in either. CONCLUSION:Dose rounding was the most common reason for antineoplastic regimen modifications documented by physicians and pharmacists. Record reviews showed opportunities to improve consistency and clarity of data. Strengthening standardized documentation and interprofessional collaboration may optimize clinical decision-making.
OBJECTIVE:Physical inactivity and sleep disturbances can affect health and quality of life in people with inflammatory bowel disease (IBD). This study aimed to describe physical activity (PA) and sleep characteristics in adults with IBD in Puerto Rico. METHODS:Forty-eight participants (24 women, 24 men; mean age, 42.1 ± 14.1 years), 73% with Crohn's disease (CD) and 27% with ulcerative colitis (UC), completed anthropometric measures and wore an accelerometer on the non-dominant wrist for 7 days to assess PA and sleep characteristics. The Pittsburgh Sleep Quality Index and the Inflammatory Bowel Disease Questionnaire were also used in a subsample(n = 43). RESULTS:On average, patients with IBD met PA recommendations (≥150 min/week) but had short sleep duration. Patients with CD were significantly younger than patients with UC, but no differences were found in PA, body mass index (BMI), or sleep duration. Men were taller and heavier than women, but BMI, PA, and sleep characteristics were similar, except that men had more sleep interruptions. Physical activity peaked in the afternoon and evening. No significant correlations were found between PA and sleep quality. However, sleep duration was inversely correlated with BMI, and PA was positively correlated with BMI. CONCLUSION:Patients with IBD were generally overweight and physically active and had short sleep duration. Monitoring PA, sleep, and BMI may inform targeted health interventions in this population.
OBJECTIVE:Assess home health care (HHC) agency coverage in Puerto Rico (PR), a U.S. territory, and compare PR agencies with those in the U.S. (excluding PR) and in a subset of counties outside of PR with high Puerto Rican populations (CHPRPs). METHODS:PR HHC coverage was mapped using data from 2020 U.S. Census ZIP Code Tabulation Area (ZCTA) and publicly available Centers for Medicare and Medicaid Services (CMS) files. Descriptive statistics on HHC agencies, patients and Medicare beneficiaries were calculated from publicly available CMS data. Pearson's χ2, Fisher's exact, or t tests were used to compare PR agencies with U.S. (excluding PR) and CHPRP agencies. RESULTS:Nearly all PR ZCTAs were served by ≥7 HHC agencies. Compared with U.S. and CHPRP agencies, those in PR have higher nonprofit ownership, higher Medicare Advantage (MA) enrollment, and better fall prevention and quality of patient care, but lower performance in timely HHC initiation, patient influenza vaccination, and patient experience. CONCLUSION:PR HHC agencies excel in patient improvement metrics, with opportunities to strengthen patient experience and preventive care. Future research should examine factors underlying observed differences, and MA enrollee access to and use of HHC.
OBJECTIVE:Interpersonal violence (IPV) is associated with negative physical, mental, and reproductive health outcomes. This study described the characteristics of Puerto Rican women experiencing IPV before, during, and after the time of pregnancy and explored disparities in their health outcomes, risk factors, and healthcare utilization behaviors. METHODS:We analyzed 2017-2020 data from the Puerto Rico Pregnancy Risk Assessment Monitoring System for 3,893 respondents, calculating weighted prevalence estimates of IPV, 95% CIs, and odds ratios for IPV before, during, and after pregnancy. RESULTS:Overall, 8.0% of Puerto Rican women reported experiencing violence in the 12 months before or during pregnancy. Physical violence, most often perpetrated by a current or former intimate partner, was reported by 4%. Emotional violence during pregnancy was reported by 5.2% of participants, and 1.2% reported being forced to have sex while pregnant. Experiences of violence were significantly associated with age, marital status, type of health insurance at the time of delivery, symptoms of depression or anxiety 3 months before pregnancy, postpartum depressive symptoms, pregnancy intention, smoking 3 months before pregnancy, adequacy of prenatal care, and being asked by a healthcare professional about experiencing violence in the 12 months before pregnancy. CONCLUSION:Puerto Rican women face a significant risk of experiencing violence before, during and after pregnancy; this violence is associated with detrimental physical and mental health outcomes and lower health care utilization. Culturally sensitive interventions and improved health care practices are critical to support affected women and enhance perinatal health outcomes.
OBJECTIVE:The predictive values of the Mini Nutritional Assessment (MNA), along with those of albumin, prealbumin, blood glucose, and body mass index (BMI), for prognosis and mortality in patients with acute ischemic stroke (AIS) are not known. The study aimed to evaluate the association of the MNA score, albumin, prealbumin, blood glucose, and BMI with prognosis and mortality in patients with AIS. METHODS:250 patients diagnosed with AIS and admitted to the emergency department of a tertiary hospital from February 15, 2022, through February 15, 2023 were analysed. The study used hospital records and collected demographic data, as well as albumin, prealbumin, and blood glucose levels. The MNA was used. RESULTS:The mean age of the patients was 70.10 ± 11.28 years; 128 (51.2%) were male, and the mean BMI was 28.20 ± 4.47. The MNA showed 105 (42%) patients at risk of malnutrition and 11 (4.4%) alnourished. There were 21 (8.4%) deaths among patients with AIS. Pearson correlation analysis showed MNA total score significantly positively correlated with BMI (P < .001), albumin (P < .001), and prealbumin (P < .001). Univariate binary logistic regression analysis showed that older age was associated with increased risk of death (P = .003), whereas higher BMI and higher albumin and prealbumin levels were associated with decreased risk of death. Multivariate binary logistic regression analysis showed that higher MNA scores were significantly associated with decreased risk of death (P < .001). CONCLUSION:High MNA scores and albumin and prealbumin levels may predict reduced mortality in AIS patients.
With increasing life expectancy, the elderly population is growing globally and faces unique oral health challenges that impact overall health and quality of life. In the Caribbean, high chronic disease rates prevail, and health care access disparities leave geriatric oral health care underserved. Poor oral health is not inevitable with aging but instead stems from financial constraints, limited specialized services, and poor medical-dental integration. This narrative review synthesizes literature from major databases on the relationships between systemic and oral health in older adults. It identifies geriatric dental barriers, evaluates current strategies, and highlights interdisciplinary collaboration needs. The review presents structured guidelines for the management of older patients in dental clinics and provides evidence-based recommendations, including workforce training, teledentistry, and integration of dental care into general health care. By addressing these gaps, this work aims to guide Caribbean policymakers and health care providers in improving geriatric oral health services, ultimately enhancing quality of life for the region's aging population.
Despite improvements in life expectancy, people with HIV (PWH) are at risk of developing HIV-associated comorbidities at a younger age when compared to HIV-uninfected individuals. This premature aging process can be attributed to various factors, such as the prolonged exposure to combination antiretroviral therapy (cART), inflammation, microbial perturbances and oxidative stress. Similarly to the gut, oral dysbiosis occurs in HIV-1 infection, with cART and inflammation playing a crucial role. This gives rise to an enrichment of pathogenic microorganisms that in turn, elicit an immune response tied to chronic inflammation. Consequently, cART exposure, dysbiosis and persistent inflammation in HIV-1 infection have been associated with the production of reactive oxygen species, mitochondrial dysfunction and telomere shortening, which are known hallmarks of aging. Although looking into these factors provides insight into the mechanisms underlying premature aging in PWH, there is still much we do not know about the oral microbiome and its relationship to HIV-1 infection. The objective of this review is to synthetize current evidence to better elucidate the role of the oral microbiome in HIV-1 infection and its contribution to inflammation and oxidative stress. By addressing these gaps, we aim to provide a novel perspective on the premature biological aging process in PWH and ultimately improve overall health in this population.
OBJECTIVE:This retrospective analysis aimed to assess compliance with the diabetes mellitus (DM) treatment guidelines published by the American Diabetes Association and the Centers for Medicare and Medicaid Services (United States) among Puerto Rican patients enrolled in Medicaid. METHODS:In this retrospective analysis of 2019 encounter data, we identified 128,065 patients with a diagnosis of type 1 or type 2 DM. The initial population of patients was assessed based on criteria including sex, age, insurance provider, type of medical provider (primary care or specialist), type of procedures and medical complications. RESULTS:Of the 128, 065 detected patients, only 44.4% had been seen by a primary care provider. Among all these patients, 4,346 (3.4%) were aged 0-18 years and had type 2 DM. Only 4.1% of the patients had been evaluated by an endocrinologist, and 1.3% by a nephrologist. Moreover, only 48% of the patients had an A1C test performed at least once in 2019; 26% had had a test for microalbumin determination; and 44% had undergone an estimated glomerular filtration rate assessment (as part of a comprehensive metabolic panel). Tests for the early detection of eye and kidney complications were very infrequently conducted. Individual health insurers showed similar levels of (low) compliance with the national recommendations for DM management. CONCLUSION:Limited patient and physician engagement are 2 primary factors contributing to poor adherence to national diabetes care guidelines among Medicaid patients in Puerto Rico. This lack of adherence can lead to an increase in patient mortality (diabetes is the third highest cause of mortality in Puerto Rico) and morbidity from both macro- and microvascular complications.
Previous research has shown that, during both climate and non-climate disasters-such as hurricanes, the COVID-19 pandemic, and other climate-related crises-and despite political control from the mainland United States, mutual aid organizations in Puerto Rico have played a central role in supporting community health and advancing food sovereignty. However, this research has largely focused on urban contexts and post-disaster recovery. The present study examined how mutual aid organizations in rural Puerto Rico contribute to food sovereignty through their everyday practices and beyond periods of disaster. Semistructured interviews were conducted with representatives from 5 mutual aid organizations serving rural municipalities across the island. The study findings identified 3 core themes that reflect how mutual aid organizations in rural Puerto Rico advance food sovereignty. The results suggest that mutual aid serves as a critical mechanism for decolonizing Puerto Rico's food system, emphasizing local leadership and community-based strategies for sustainable self-determination.
OBJECTIVE:Examining whether gut microbial taxa abundances and predicted functional pathways correlate with dietary quality scores at the end of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer (RC); identifying differentially abundant bacterial species from the pantothenate and acetyl-coenzyme A biosynthesis pathways that differ among dietary quality groups in a subset of participants. METHODS:RC patients (n = 30) provided stool samples for 16S rRNA gene sequencing. To validate pathway predictions from the 16S rRNA gene data, stool samples from a subset of 17 participants underwent shallow shotgun metagenomics sequencing (SMS). Dietary quality was calculated using the Prime Diet Quality Score (PDQS; 24-hour recall). 16S rRNA gene data were analyzed using QIIME2, and SMS data were analyzed using HUMAnN2. RESULTS:At the genus level, Parvimonas, Caproiciproducens, and uncultured Eggerthellaceae abundances positively correlated (Spearman's rho = 0.36 to 0.50) with PDQS scores, whereas abundances of Prevotella, Rothia, Peptostreptococcus, Paeniclostridium, Enterococcus, and Howardella correlated negatively (Spearman's rho = -0.43 to 0.36). Predicted pathways, including those related to B-vitamin biosynthesis and enzyme cofactor biosynthesis (e.g., B5/pantothenate [phosphopantothenate biosynthesis I]), were correlated with higher PDQS scores. Mean abundances of species predicted to encode the vitamin B5-CoA pathway were greater in the high- diet-quality group. CONCLUSION:Findings suggest important associations between the taxa abundances of gut bacteria and the abundances of predicted B-vitamin biosynthesis pathways and dietary quality at the end of nCRT. Three bacterial species encoding vitamin B5-CoA biosynthesis pathways were prominent in high-dietaryquality participants.
OBJECTIVE:To evaluate perceived stress and burnout among community pharmacists and to explore their coping mechanisms and perceived contributions. METHODS:A cross-sectional study among pharmacists in Puerto Rico was conducted during the COVID-19 Pandemic using Cohen's 10-item Perceived Stress Scale and the Oldenburg Burnout Inventory. Open-ended questions explored pharmacists' contributions and coping mechanisms. The survey was distributed via the Puerto Rico Pharmacist Association listserv, social media, and professional chats. RESULTS:A total of 193 pharmacists were included in the analysis. Eighty-five responded to the open-ended questions, and 150 responded to the 2 scales. Most of the participants were women (82%) with a mean age of 45 years. The mean perceived stress score was 22.0 ± 6.6, indicating moderate stress levels. While 46.7% exhibited moderate burnout, 25.3% showed high burnout. Female pharmacists had higher stress than male pharmacists (22.61 vs. 18.56, P < .05). Pharmacists working in chain pharmacies had higher stress and burnout levels compared to those working in independent pharmacies (24.40 vs. 20.48 and 46.87 vs. 40.24, respectively; P < .05). Pharmacists' greatest contributions during the pandemic were ensuring continuity of care and providing pharmaceutical services and education. Although they experienced a sense of underappreciation, coping mechanisms and institutional adaptation strategies helped them overcome the broader challenges of the pandemic. CONCLUSION:Community pharmacists, particularly those in chain pharmacies and those who were female, reported moderate stress and moderate-high burnout. It is necessary to explore the reasons for these disparities. This study highlights the importance of allocating resources to improve and protect the wellbeing of pharmacists.
OBJECTIVE:Infants with Down syndrome present multiple challenges that can affect growth and development, among them feeding, difficulties that arise in the early days after birth. We aimed to describe the sucking patterns of infants with Down syndrome in the neonatal intensive care unit (NICU). METHODS:We reviewed the medical records of infants with Down syndrome admitted (2012-2022) to the University Pediatric Hospital NICU in San Juan, Puerto Rico, who were evaluated with a clinical swallow examination and the Neonatal Oral-Motor Assessment Scale (NOMAS). RESULTS:The study included 29 infants. The median gestational age was 38 weeks, and the median birth weight was 2650 grams. Generalized low muscle tone was identified in 81% of the infants. Sucking patterns were classified as disorganized (41%), dysfunctional (52%), and mature (7%). Only 8% of term infants had mature sucking. The clinical signs of swallow dysfunction included reduced oxygen saturation (20%), mottling (50%), interference with the gag reflex (31%), stridor (40%), and wet or gurgly breathing (75%). CONCLUSION:Mature sucking skills are expected in term infants. However, our sample of term infants with Down syndrome had a high prevalence of dysfunctional sucking. Neonates with congenital anomalies associated with hypotonia require a formal assessment with a clinical tool to determine their readiness for oral feeding and may require a complete evaluation of feeding and swallowing for the diagnosis and monitoring of swallowing dysfunction. These assessments will form the basis for the design of evidence-based interventions and may yield valuable information regarding neurodevelopmental outcomes.
OBJECTIVE:To identify how healthcare workers experienced work related distress during compound disasters in Puerto Rico. METHODS:Over three weeks, a research team composed of ten undergraduate students and three faculty visited eight healthcare sites in Puerto Rico. The team utilized rapid qualitative methods by conducting observations, informal interviews, and two focus groups. Data were documented in notes and analyzed via a shared RREAL table, where the team collaboratively organized, recategorized, and reviewed the findings. RESULTS:Participants reported symptoms such as physical tiredness, emotional exhaustion and frustration. High levels of compassion were also present. Researchers apply the concepts of burnout and moral injury to understand how eroding conditions and prolonged disasters produce these emotional conflicts. Moral distress arose when professionals could not meet patients' needs due to a lack of providers, limited resources, and a fragmented healthcare system. Additionally, health care workers experienced conflicts between their work and family roles. We argue that strong connections to their communities and patients foster resilience in healthcare workers and protect against the full range of burnout symptoms. However, these strong community connections can also give rise to moral injury. CONCLUSION:Burnout and moral injury coexist in healthcare professionals when they cannot provide the best patient care due to obstacles created by prolonged compound disasters and a broken healthcare system.
OBJECTIVE:S. pneumoniae infections remain a significant cause of morbidity and mortality despite vaccine availability. Limited information exists about current pneumococcal serotypes transmission in Puerto Rico. Our study aimed to describe the serotype distribution of S. pneumoniae isolates in Puerto Rico and its patients' demographic characteristics. METHODS:This prospective laboratory-based observational study from 25 hospitals in Puerto Rico (April 2021-July 2023) collected specimens positive for S. pneumoniae and serotyped them using the Pneumotest-Latex assay and the Quellung reaction tests. A summary of the distribution of S. pneumoniae isolates is presented. RESULTS:Nineteen specimens were received from sterile (8/19, 42.1%), and non-sterile sites (11/19, 57.9%). All sterile specimens were isolated from blood samples. Most specimens came from male patients (16/19, 84.2%), the median age was 67 years (range: 8 months to 87 years) and came from different geographic regions. Thirteen serotypes were identified: 3 ( two patients), 6A (two patients), 11C, 11D, 15A, 15C, 19A (two patients), 19B, 19C (two patients ), 19F (two patients ), 22A, 34 (two patients ), and 35. Of these, nine (69.2%) were not covered in PPSV23 and PCV13 (available vaccines being used prior and by the time of specimen collection period), three (23%) were covered by both PPSV23, and PCV13, and one (8%) by PCV13 only. CONCLUSION:Our findings highlight the importance of continuous surveillance to detect early serotype changes, ongoing vaccination to avoid preventable infections and complications, and pursuing new higher-valency vaccines with broad serotype coverage to address the evolving pneumococcal disease epidemiology.
OBJECTIVE:The objectives of this study were: 1) to describe and evaluate associations between grip strength, and anthropometric characteristics in pediatric patients with obesity and insulin resistance (IR), and 2) to compare IR using the HOMA-IR model and fasting insulin level. METHODS:Secondary data analysis was conducted using results from 41 children and adolescents with obesity and IR (18 boys and 23 girls, mean age: 14.4 ± 3.1 years) enrolled in a clinically supervised weight management program. Independent t-tests were conducted to detect sex differences, and correlation analyses to determine associations between variables. RESULTS:Mean body mass index (BMI) was above the 99th percentile, with 109.6±19.7 cm waist circumference, 45.6±6.7% body fat, 59.9±15.7 kg lean mass, 91.8±8.9 mg/dL fasting glucose, 36.9±31.5 μU/m fasting insulin, 8.6±1.2 HOMA-IR, and 30.2±9.0 kg grip strength. Boys had greater height, fasting glucose, and lean mass compared to girls. There was a significantly high correlation (r=0.98, P<0.0001) between fasting insulin and HOMA-IR. Grip strength was not associated with insulin and HOMA-IR. However, grip strength relative to lean mass inversely correlated with waist circumference, percent body fat, and BMI percentile. CONCLUSION:Fasting insulin and HOMA-IR do not appear to influence grip strength in the group of children and adolescents with obesity and IR in this study. However, grip strength was significantly influenced by anthropometric characteristics. The use of a fasting insulin cutoff at or above 12 μU/mL appears appropriate to detect insulin resistance in this pediatric group.
OBJECTIVE:The fecal immunochemical test (FIT) is indicated for colon cancer screening in asymptomatic average-risk patients. However, the inclusion of orders for non-indication-based FITs in medical records has led to increased inappropriate use in emergency department (ED) and inpatient settings. This study aimed to evaluate the clinical impact of FIT results when the test is used for purposes other than routine screening. METHODS:We conducted a single-center, retrospective chart review using electronic medical records, analyzing patients who underwent the FIT in the ED or while admitted to the VA Hospital from September 2013 through December 2016. The collected data included demographics; clinical symptoms and signs; medications; and information on digital rectal examinations, gastroenterology consultations, and endoscopic procedures. RESULTS:Of the 1,354 patients included, most were men. Among FIT-positive patients, the mean age was 73.7 years. The majority of FITs were done in the ED. Positive FIT results were statistically significantly associated with rectal bleeding, weakness, and diarrhea. Anticoagulants were associated with positive FIT results. Patients with positive tests often received gastroenterology consultations and were more likely to undergo endoscopic procedures. CONCLUSION:None of the evaluated FITs were used for screening, confirming that they had been ordered inappropriately. This indiscriminate use can lead to unnecessary interventions and prolonged hospitalizations. Additionally, negative tests may lead to underestimate worrisome symptoms or features that require further investigation. In conclusion, our study does not support the indiscriminate use of the FIT in inpatient or ED settings.
OBJECTIVE:This study aimed to understand the visual and medical characteristics and their associated social determinants of health in Hispanic older adults in Puerto Rico attending senior centers. It provides essential information on visual impairment and factors that can contribute to older adults' well-being. METHODS:A cross-sectional study of individuals attending 16 senior centers in the island's metropolitan area was performed. Information on demographic, medical, visual, and social determinants was gathered. On-site visual screening, including visual acuity and refraction, was performed. Visual impairment was defined as a best-corrected visual acuity worse than 20/40 (>0.30 logMAR) in the better-seeing eye. RESULTS:A total of 304 participants were included. The mean age was 72.9 ± 9.1 years, with 37.8% being male and 62.2% female. Most of the participants lived alone, had not completed 12th grade, and lived below the poverty line. The average number of chronic conditions was 3.04 ± 1.78. Participants used an average of 4.07 ± 3.1 prescribed medications and 1.16 ± 1.45 over-the-counter. The mean presenting uncorrected visual acuity was 0.5 ± 0.46 logMAR, and the best corrected visual acuity was 0.26 ± 0.44 logMAR. The mean difference in best-corrected visual acuity showed a significant improvement of 0.03 ± 0.32 logMAR. Of the participants, 29.9% had visual impairment, with cataracts the most common self-reported cause (16.5%). CONCLUSION:These findings highlight the need for interventions and prevention to reduce visual impairment in Puerto Rico's older population. Comprehensive healthcare for the elderly is critical to improving the island's overall health outcomes.
