Angel Colon

Risk Factors and Prevalence of Coronary Heart Disease in Puerto Rico

In spite of an apparently increasing mortality rate from coronary heart disease in Puerto Rico, the age-specific mortality rate from this illness is considerably lower in the island than in the U. S. mainland. Examination of 9,814 Puerto Rican urban and rural men in the 45 to 64-year age group revealed sizable and statistically significant differences in monthly income, cigarette smoking, ingestion of fats, blood pressure, heart rate, relative weight, serum cholesterol, serum glycerides, prevalence of diabetes, and prevalence of hypertension (lower in rural dwellers), and also in vital capacity, consumption of calories per unit body weight, and physical activity (higher in rural area). No urban-rural difference in coronary heart disease prevalence was found, but the prevalence of definite myocardial infarction, established on basis of electrocardiographic criteria alone, was significantly higher in the 45 to 54-year urban group. Follow-up of this population to study incidence of disease and the influence of the various factors upon the development of disease is being conducted.

Beliefs and Barriers to Medication Use in Parents of Latino Children With Asthma

Disparities in asthma outcomes exist between Latino and non‐Latino white (NLW) children. We examined rates of medication use, medication beliefs, and perceived barriers to obtaining medication in US and island Puerto Rican parents of children with asthma.

Latino Caregivers' Beliefs about Asthma: Causes, Symptoms, and Practices

Background and objective. This study examined belief systems of Latino caregivers who have children with asthma from Puerto Rican and Dominican backgrounds who resided on the Island of PR and the Mainland. The goal of this study was to document similarities and differences in beliefs about the causes, symptoms, and treatments of asthma across two sites and two Latino ethnic sub-groups of children who remain the most at risk for asthma morbidity. Methods. Participants included 100 primary caregivers of a child with asthma; 50 caregivers from Island PR and 50 caregivers from mainland RI were interviewed (at each site; 25 caregivers were from Puerto Rican backgrounds and 25 caregivers were from Dominican backgrounds). The interview included an assessment of demographic information and beliefs about the causes and symptoms of asthma and asthma practices. Results Results indicated more similarities in beliefs about the causes and symptoms of asthma across site and ethnic group. The majority of differences were among beliefs about asthma practices by site and ethnic group. For example, a higher proportion of caregivers from Island PR, particularly those of Dominican descent, endorsed that a range of home and botanical remedies are effective for treating asthma. Conclusions. Results from this study point to several interesting directions for future research including larger samples of Latino caregivers with children who have asthma. A discussion of the importance of understanding cultural beliefs about asthma and asthma practices is also reviewed.

Ethnic Differences in Perception of Lung Function: A Factor in Pediatric Asthma Disparities?

RATIONALE Disparities in pediatric asthma exist in that Latino children have higher prevalence and greater morbidity from asthma than non-Latino white children. The factors behind these disparities are poorly understood, but ethnic-related variations in childrens ability to accurately recognize and report their pulmonary functioning may be a contributing process. OBJECTIVES To determine (1) if differences exist between Latino and non-Latino white childrens perceptual accuracy and (2) whether these differences are related to asthma outcomes. METHODS Five hundred and twelve children, aged 7-16 years (290 island Puerto Ricans, 115 Rhode Island Latinos, and 107 Rhode Island non-Latino white children) participated in a 5-week home-based protocol in which twice daily they entered subjective estimates of their peak expiratory flow rate into a hand-held, programmable spirometer and then performed spirometry. Their accuracy was summarized as three perceptual accuracy scores. Demographic data, asthma severity, intelligence, emotional expression, and general symptom-reporting tendencies were assessed and covaried in analyses of the relationship of perceptual accuracy to asthma morbidity and health care use. MEASUREMENTS AND MAIN RESULTS Younger age, female sex, lower intelligence, and poverty were associated with lower pulmonary function perception scores. Island Puerto Rican children had the lowest accuracy and highest magnification scores, followed by Rhode Island Latinos; both differed significantly from non-Latino white children. Perceptual accuracy scores were associated with most indices of asthma morbidity. CONCLUSIONS Controlling for other predictive variables, ethnicity was related to pulmonary function perception ability, as Latino children were less accurate than non-Latino white children. This difference in perceptual ability may contribute to recognized asthma disparities.

Conundrums in childhood asthma severity, control, and health care use: Puerto Rico versus Rhode Island.

BACKGROUND The lifetime prevalence of self-reported asthma among Puerto Ricans is very high, with increased asthma hospitalizations, emergency department visits, and mortality rates. Differences in asthma severity between the mainland and island, however, remain largely unknown. OBJECTIVE We sought to characterize differences in asthma severity and control among 4 groups: (1) Island Puerto Ricans, (2) Rhode Island (RI) Puerto Ricans, (3) RI Dominicans, and (4) RI whites. METHODS Eight hundred five children aged 7 to 15 years completed a diagnostic clinic session, including a formal interview, physical examination, spirometry, and allergy testing. Using a visual grid adapted from the Global Initiative for Asthma, asthma specialists practicing in each site determined an asthma severity rating. A corresponding level of asthma control was determined by using a computer algorithm. RESULTS Island Puerto Ricans had significantly milder asthma severity compared with RI Puerto Ricans, Dominicans, and whites (P < .001). Island Puerto Ricans were not significantly different from RI whites in asthma control. RI Puerto Ricans showed a trend toward less control compared with island Puerto Ricans (P = .061). RI Dominicans had the lowest rate of controlled asthma. Paradoxically, island Puerto Ricans had more emergency department visits in the past 12 months (P < .001) compared with the 3 RI groups. CONCLUSIONS Potential explanations for the paradoxic finding of milder asthma in island Puerto Ricans in the face of high health care use are discussed. Difficulties in determining guideline-based composite ratings for severity versus control are explored in the context of disparate groups.

Issues and methods in disparities research: the Rhode Island-Puerto Rico asthma center.

Epidemiologic studies have documented higher rates of asthma prevalence and morbidity in minority children compared to non‐Latino white (NLW) children. Few studies focus on the mechanisms involved in explaining this disparity, and fewer still on the methodological challenges involved in rigorous disparities research.

Interrelationship of Serum Lipids with Relative Weight, Blood Glucose, and Physical Activity

Serum cholesterol, serum glyceride, blood glucose, relative weight, physical activity, percent calories from fat, percent calories from carbohydrate, and polyunsaturated/saturated fatty acid (P/S) ratio were determined in 1780 rural and 4023 urban fasting men aged 45-64 years being followed prospectively to ascertain reasons for the low prevalence of coronary heart disease mortality in Puerto Rico as compared to other countries. Lipid and glucose levels and relative weight were higher and physical activity lower in urban men. Glyceride was positively correlated with cholesterol, glucose, and relative weight, and negatively correlated with physical activity. Cholesterol was positively correlated with glyceride, glucose, and relative weight, and not correlated with physical activity. Percent calories from fat and P/S ratio were significantly higher and percent carbohydrates from starch significantly lower in urban men. These variables taken together were not significant in predicting the differences between urban and rural serum cholesterol or glyceride values. Relative weight was the most significant variable in explaining urban-rural differences in serum glyceride and cholesterol levels. These findings confirm the importance of weight control in dietary management for reduction of serum lipids.

Plasma glutathione concentrations in children infected with human immunodeficiency virus

BACKGROUND Glutathione (GSH) is the principal intracellular defense against oxidants, and HIV-infected individuals tend to have subnormal concentrations in plasma. This GSH deficiency may contribute to the pathogenesis of disease progression. In the pediatric population correlations between GSH concentrations with clinical, immunologic and virologic disease profiles are scarce. OBJECTIVES The main objectives of this study were (1) to compare plasma GSH concentrations of HIV-infected children and healthy controls and (2) to correlate GSH values with clinical, immunologic and virologic disease indices. METHODS Twenty-four HIV-infected and 24 healthy control children entered the study. Plasma concentrations of total glutathione and related thiols were determined. RESULTS The difference in mean plasma GSH concentrations between HIV-infected (2.96 +/- 0.31 microM) and control (6.62 +/- 0.58 microM) groups was highly significant (P < 0.0001). Linear regression analyses in HIV-infected patients revealed significant correlations between GSH and both absolute CD4+ cell counts (r = 0.56, P = 0.004) and viral load measured as log HIV-RNA PCR (r = -0.49, P = 0.018). GSH concentrations did not significantly correlate with CDC clinical stage but were lower in HIV-infected patients with growth failure (1.60 +/- 0.54 microM) vs. non-growth failure (3.23 +/- 0.33 microM); P = 0.05. CONCLUSIONS This study confirmed that HIV-infected children are deficient in plasma GSH concentrations compared with healthy controls. We documented that low GSH concentrations in HIV-infected children are directly correlated with CD4+ cell counts and inversely correlated with viral loads. These findings support a possible role of GSH in the pathogenesis of HIV disease progression.