Background Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. Methods We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. Results A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). Conclusions Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

Background Helicobacter pylori is an important etiologic factor for peptic ulcers and gastric cancer, one of the top ten leading causes of cancer death in Puerto Rico. However, the prevalence of H. pylori infections in this population was previously unknown. The aim of this study was to examine the seroprevalence of H. pylori and its associated risk factors in Puerto Rico.Materials and MethodsA cross‐sectional study was designed using an existing population‐based biorepository. Seropositivity was determined using the Premier™ H. pylori immunoassay. Helicobacter pylori seroprevalence was estimated with 95% confidence using marginal standardization following logistic regression. To assess the risk factors associated with H. pylori seropositivity, a multivariable log‐binomial model was fitted to estimate the prevalence ratio (PR) and its 95% confidence interval (95% CI).ResultsA total of 528 population‐based serum samples were analyzed. The mean age of the study population was 41 ± 12 years, of whom 55.3% were females. The overall seroprevalence of H. pylori was 33.0% (95% CI = 28.3%‐38.1%). Increasing age and having <12 years of education were significantly (P < .05) associated with H. pylori seropositivity in the multivariable model; however, residing in counties with low population density reached marginal significance (P = .085).ConclusionsWe report that H. pylori infection is common among Hispanics living in Puerto Rico. The H. pylori seroprevalence observed in Puerto Rico is similar to the seroprevalence reported in the overall population of the United States. The association between H. pylori seroprevalence and the risk factors analyzed offers insight into the epidemiology of gastric cancer in Puerto Rico and warrants further investigation.

Despite unfavorable demographic characteristics, records for patients with hypertension who used IUSOC as a regular provider of primary care compared favorably with national data.

The academic community must replicate and strengthen existing models for interprofessional education (IPE) to meet widespread calls for team-based patient-centered care. One effective but under-explored possibility for IPE is through student-led clinics, which now exist in the majority of medical schools. This short report presents the Indiana University Student Outreach Clinic (IU-SOC), which involves seven different professional programs across three institutions, as a model for how IPE can be delivered formally through service learning. Lessons learned, such as nurturing an intentional interprofessional program, structured orientation and reflection, and resource and knowledge sharing between the clinic and academic institutions, can be applied to all student-led clinics, but also can inform other IPE initiatives in health professional curricula.

No abstract

No abstract

Background and Objectives: Accumulating evidence supports that colorectal cancer (CRC) is comprised of different genetic diseases affecting the same organ. The molecular classification of CRC is evolving as we gain a comprehensive knowledge about the mechanisms and processes resulting in colorectal carcinogenesis. Tumors display distinct characteristics depending on the molecular subtype, which may affect response to treatment, prognosis, and survival. CRC is the leading cause of cancer deaths among Puerto Rican Hispanics (PRH). The aim of this study was to characterize colorectal tumors at a molecular level in a cohort of PRH in order to determine the prevalence of molecular markers. Methods: The molecular markers evaluated were microsatellite instability (MSI), CpG island methylation phenotype (CIMP), and mutations in KRAS and BRAF oncogenes. In addition, HPV infection status was assessed, as it has been associated with CRC. Sociodemographic and clinicopathological characteristics were evaluated according to MSI, CIMP, KRAS/BRAF mutation and HPV-status using Pearson's Chi-Square and Mann-Whitney U-test. Results: A total of 201 CRC tumors were included in our study. Of the evaluated tumors 2.6% (n=3) showed MSI and 1.8% of the studied tumors had CIMP high phenotype (n=2). The incidence of KRAS and BRAF mutations for our study was 30.6% (n= 38) and 9.2% (n=11), respectively. Furthermore, KRAS positive individuals were more likely to have private or Medicare insurance (p=0.017). In addition, BRAF mutation-positive tumor were more likely to be poorly differentiated when compared to BRAF mutation-negative tumors (p=0.009). HPV infection was not associated with any molecular characteristics examined. Conclusions: We present for the first time the molecular characterization of CRC tumors in PRH. The observation of a different molecular signature for the CRC tumors (low MSI, CIMP Zero and mainly wild-type for KRAS and BRAF) suggests that CRC in this population might be driven by additional genetic, epigenetic and environmental factors than other racial/ethnic groups. Citation Format: Yaritza Díaz-Algorri, Julyann Pérez-Mayoral, Maria González-Pons, Natalia Rodríguez, Belisa Suárez, Giancarlo Colón, Javier Sevilla, Daphne L. Jorge, Xavier Llor, Rosa Xicola, Luis Tous, José S. Reyes, Marla Torres, Ajay Goel, Segundo Rodriguez, Marcia Cruz-Correa. Molecular characterization of colorectal tumors from Puerto Rican Hispanic patients. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B35.

Background: Gastric cancer (GC) is the 4th most common incident cancer and the 2nd leading cause of cancer death worldwide. Approximately 990,000 people are diagnosed with GC worldwide, of whom close to 75% die from this disease. Despite the overall decrease in the global incidence of GC since the 1930s, GC disease is one of the top ten most diagnosed cancers and leading cause of cancer death in Puerto Rico. Risk factors for the development of gastric cancer include: male sex, older age, Helicobacter pylori status, tobacco smoking, diet, living in places with high altitude, low socioeconomic status, and being part of the Asian, Hispanic, and African American communities. However, the prevalence of H. pylori, one of the main risk factors for GC, is unknown in the Puerto Rican Hispanic population. Prevalence of H. pylori infection is influenced by socioeconomic, demographic, and ethnic factors. Thus, this study aimed to determine the seroprevalence and associated risk factors for H. pylori infection among a sub-sample of Puerto Rican Hispanics. Methods: A cross sectional study was designed using an existing population-based biobank that comprised of 1,645 serum samples collected in the parent study “Epidemiology of hepatitis C in the household population of Puerto Rico”. The Premier™ H. pylori enzyme immunoassay (Meridian Bioscience, Inc.) was used to determine the seroprevalence according to the manufacturer's specifications. A prevalence estimate of H. pylori was estimated using logistic regression models according to sociodemographic characteristics. Differences between groups according to H. pylori status were assessed using Student's t-test or Mann-Whitney test for continuous variables, and χ² test or Fisher's exact test, when appropriate, for categorical variables. Multivariable logistic regression models were fitted to estimate the prevalence ratio (PR) with 95% CIs for H. pylori seropositivity. All data was analyzed using Stata for Windows release 13.0 (Stata Corporation, College Station, Texas, USA). Results: A total of 528 representative serum samples (by age, gender, population density, and years of education) from the 1654 were analyzed. The majority of participants were females (55.3%), aged 30-49 years (50.2%), born in PR (89.6%), had ≥ 12 years of education (76.3%), had an annual family income &lt; $20,000 (64.1%), and had health insurance (88.8%). The overall seroprevalence of H. pylori was 35.2% (95% CI=31.2-39.5; females 54.8%). Statistically significant differences in terms of age, place of birth, marital status, years of education, annual family income, type of health insurance, place of residence, and population density were observed when comparing individuals with seropositive to H. pylori and individuals without (p&lt;0.05). Seroprevalence of H. pylori increased according to age-strata; where those ages 30-49 had prevalence of 1.49 (95% CI 1.01-2.18), while those ages 50-64 had higher prevalence of 2.28 (95% CI 1.57-3.33). Individuals born in Puerto Rico had higher seropositive prevalence of H. pylori, compared to individuals not born on the island (PR=2.29; 95% CI=1.24-4.20). The prevalence of H. pylori among individuals living in high-density population areas was higher than those living in low-density areas (PR=0.71, 95% CI=0.56-0.90, p-value=0.005). Conclusions: This is the first report of the seroprevalence of H. pylori in the Puerto Rican Hispanic population. The observed prevalence of H. pylori in Puerto Rican Hispanics is lower than rates reported for US Hispanics and similar to US non-Hispanics. The lower prevalence of H. pylori among individuals living in high-density population areas may be a surrogate for wealth and/or environmental exposures. In summary, the observed health disparities among the Puerto Rican population with regards to H. pylori seroprevalence may impact the incidence of gastric neoplasia and warrant further investigation. Citation Format: Maria del Mar Gonzalez-Pons, Marievelisse Soto-Salgado, Javier Sevilla, Erick L. Suarez, Cynthia M. Perez, Juan M. Marquez-Lespier, Marcia Cruz-Correa. Seroprevalence of H. pylori in Puerto Rico. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B45.