Luis Anibal Aviles

Risk factors, prevalence trend, and clustering of hypospadias cases in Puerto Rico

OBJECTIVE The aim was to determine the distribution pattern of hypospadias cases across a well-defined geographic space. MATERIALS AND METHODS The dataset for this study was produced by the Birth Defects Prevention and Surveillance System of the Department of Health of Puerto Rico (BDSS-PR), which linked the information of male newborns of the Puerto Rico Birth Cohort dataset (PRBC; n=92,285) from 2007 to 2010. A population-based case-control study was conducted to determine prevalence trend and to estimate the potential effects of maternal age, paternal age, birth-related variables, and health insurance status on hypospadias. Two types of geographic information systems (GIS) methods (Anselin Local Morans I and Getis-Ord G) were used to determine the spatial distribution of hypospadias prevalence. RESULTS Birthweight (<2500 g), age of mother (40+years), and private health insurance were associated with hypospadias as confirmed with univariate and multivariate analyses at 95% CI. A cluster of hypospadias cases was detected in the north-central region of Puerto Rico with both GIS methods (p≤0.05). CONCLUSIONS The clustering of hypospadias prevalence provides an opportunity to assess the underlying causes of the condition and their relationships with geographical space.

Evidence-Based Public Health: Origins, Assumptions, and Cautions

This chapter presents the origins and assumptions of evidence-based medicine as rooted in the philosophy of science called positivism. The basic principles of the positivist approach to science, empiricism, exclusivity, universality, and autonomy are explained and identified in reproductive and perinatal health outcomes related studies from the systematic reviews of the Cochrane Library, the premier database on evidence-based medicine. A series of articles published in the Evidence-based Public Health Policy and Practice section of the Journal of Epidemiology and Community Health are used to contrast the difference between evidence-based medicine and evidence-based public health. The series of seven articles related to issues of reproductive and perinatal health outcomes demonstrates that evidence-based public health departs from positivism by their incorporation of a diversity of methodological research strategies, by their interest in local and community focus, and by embracing research with clear political implications. As evidence-based public health overcomes the limitations of positivism, researchers should be aware of the limitations of some evidence-based approaches.

Concordance of Expert and Parental Opinion about Hypospadias Surgical Outcome Is Severity Dependent.

Introduction Hypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity. Materials and methods Parents of children who had undergone hypospadias repair were recruited for this study (n = 104). A set of questionnaires that included some items with Likert scale were created to evaluate postsurgical satisfaction by parents and urologists. SAHLSA-50, a validated instrument for adult Spanish-speaking adults, was used to assess health literacy. Cohen’s kappa (κ) coefficient was used to assess interobserver agreement and Chi Square “Goodness of Fit” Test was used to determine probability of satisfaction. Findings Concordance on the level of satisfaction with surgical outcomes for Type cases I was slight (κ = 0.20; CI 95% 0–0.60), for Type II cases was moderate (κ = 0.54; CI 95% 0.13–0.94), and for Type III cases was substantial (κ = 0.62; CI 95% 0–0.56). However, the probability of satisfaction did not change according to severity (Chi Square “Goodness of Fit” Test; parents, p = 0.84; pediatric urologists, p = 0.92). These results cannot be explained by parental health literacy according to SAHLSA-50 test scores. Conclusion The level of concordance of opinion among parents and urologists with regard to their level of satisfaction with surgical outcomes is related to hypospadias severity, whereby the greatest level of concordance of opinion was achieved among most severe cases. This study underscores the need for longer follow-up to properly assess satisfaction with hypospadias repair, especially for the less severe forms of the condition.