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Objective: The primary aim of this cross-sectional study was to assess, according to previous cancer diagnosis, the knowledge Puerto Rican women have on the link between obesity-endometrial, -breast, and colon cancer, and determine women's most common source for medical information., Methods: In this cross-sectional study, eligible female patients (n=234) from the Gynecology and Gynecology-Oncology Clinics completed a self-administered survey from October 2014 to March 2016. Participants were evaluated on sociodemographic, body mass index, knowledge of the obesity-cancer link, and source of medical information., Results: About 49% and 31% of women in the study were obese and overweight, respectively. Less than 52% of the women knew about the link between obesity-breast,-colon, and/or -endometrial cancers. Women with previous cancer diagnoses were more likely aware of the association between obesity-colon cancer than women without previous cancer diagnoses (58% vs. 44%, p0.05). Higher incomes showed increased odds for the knowledge obesity-cancer link among women with a cancer history, but the odds decreased for women without previous cancer diagnoses (p>0.05). Higher education showed a trend towards a better knowledge of the obesity-cancer association. The most common sources of information were the primary doctor (80%) and the internet (54%)., Conclusion: Counseling about preventable cancer risk factors through primary care to all women must be encouraged especially in young healthy females. Further studies should address qualitative aspects of the odds differences in the obesity-cancer link knowledge observed between income categories for women with/without previous cancer diagnoses.

Objective: Past studies have demonstrated that women with inflammatory bowel disease (IBD) have a higher risk of gynecological conditions than do women without it. We aimed to characterize the gynecological histories of Hispanic Women living in Puerto Rico with IBD., Methods: We identified women, aged 21 to 55 years, with a confirmed IBD diagnosis and receiving follow-up care from the University of Puerto Rico IBD clinics from 2017 through 2020. A questionnaire was administered to acquire sociodemographics, family history, past medical history, IBD diagnosis, and gynecologic aspects., Results: One hundred eighty-six women were recruited. Fifty-three (28%) patients had ulcerative colitis, while 133 (72%) had Crohn's disease. Fifty-six percent of all the participants had a chronic illness in addition to than their IBD. Seventy-four out of 186 patients reported having had at least 1 late period within the last 12 months. Fifty-three (28%) described their period patterns as irregular. Thirty-nine (21%) of the patients reported having been vaccinated against human papillomavirus (HPV), and 8 (4%) had been infected by it. Nine out of 186 (5%) patients reported suffering from infertility., Conclusion: The results showed that our Hispanic patients (living in Puerto Rico) had a prevalence of irregular menstrual cycles that was similar to that observed in other populations. On the other hand, the presence of HPV, infertility, and cervical cancer were lower and the frequency of Papanicolaou smears performed higher than what has been seen in the continental United States, suggesting that this topic should be investigated in future studies.

Objective: To understand the impact of the COVID-19 pandemic on the prenatal care of pregnant Hispanic women living in Puerto Rico., Methods: This was a cross-sectional study. The participants' profiles were determined through an online questionnaire to analyze COVID-19 related behaviors and experiences., Results: Our sample comprised 131 women with an average age of 28 years (±5.3 years). Most of the population was pregnant at the time of the interview (74.8%; n = 98), and the rest were in their post-partum period. Overall, 46.5% (n = 61) of the patients indicated that their prenatal care did not change during the pandemic. In addition, 92.50% (n = 111) reported not altering their plans for breastfeeding their babies. Overall, 77.86% of the participants reported feeling scared or overwhelmed due to the current pandemic, and 97% agreed that COVID testing should be performed as a screening method in all pregnant females., Conclusion: Our findings describe the characteristics of pregnant Hispanic females living in Puerto Rico. The majority reported adhering adequately to their health services, with few or no changes in their prenatal care.

Objective: To assess the contraceptive methods used by sexually active Hispanic women living in Puerto Rico., Methods: From October 2016 through February 2018, 518 patients completed a self-administered questionnaire. The inclusion criteria were being over the age of 21 and having visited San Juan City Hospital or University District Hospital. The results were analyzed using descriptive statistics and a 2-sample t test, where P < .05 was considered significant., Results: A total of 518 participants completed the questionnaire. Of the 518, 413 (81.0%) reported having used at least 1 form of contraception; 252 (49.4%) used OCPs, 305 (60.8%) used male condoms, 92 (33.8%) used the rhythm method, 83 (30.6%) undergone female sterilization, 98 (19.9%) used the withdrawal method, 92 (18.9%%) used an implant, 67 (13.5%) received progesterone injections, 41 (8.3%) used female condoms, 13 (4.9%) had partners who undergone male sterilization, 20 (4.1%) used the transdermal patch, 16 (3.2%) used a vaginal ring, and 26 (5.3%) used an intrauterine device., Conclusion: Of the 518 women, 24.2% used LARC, representing an increase in the usage by this population; this increase is likely linked to LARC's being easily accessible and free of charge. Public health interventions should be developed to increase knowledge about sexual health, educate about the effectiveness of different contraceptive methods and the prevention of sexually transmitted diseases, and reduce both the barriers to acquiring contraception and, thereby, the number of unintended pregnancies in this population.

Objective: The aim of this study was to explore the knowledge and attitudes about transgender care in Hispanic medical students at the University of Puerto Rico School of Medicine (UPR SOM)., Methods: Medical students at the UPR SOM were invited to participate in a questionnaire to assess their attitudes and knowledge about the healthcare of transgender patients. The data were analyzed as percentages and averages using Stata version 14., Results: A total of 141 medical students completed the survey. The majority of the students (52.5%) reported that they needed to learn more about transgender health issues. Most of the students (60.3%) were not familiar with the hormonal regimens used for gender reassignment and transition and were not knowledgeable about the requirements an individual must fulfil prior to undergoing gender-reassignment surgery. The Likert scale scores for how comfortable students felt about working with transgender patients and becoming known among peers as a doctor that cares for transgender patients were 4.0 (95% CI: 4.0-4.2) and 4.7 (95% CI: 4.6-4.8), respectively. Almost all the medical students (97.9%) thought that transgender patients deserved the same quality of care from medical institutions as heterosexual patients receive. Most of the medical students (87.3%) believed physicians are responsible for the treatment of transgender patients., Conclusion: Our study revealed that even though UPR SOM medical students tend to be willing to treat transgender patients, there are limitations to their knowledge and training regarding this specific healthcare topic. Strategies to improve medical student knowledge about and training on these topics must be considered.

Objective: Explore influenza and Tdap immunization knowledge, attitudes, and practices among Hispanics patients attending prenatal care in a tertiary hospital in Puerto Rico as well as barriers encountered by patients regarding vaccination practices during pregnancy., Methods: Descriptive study conducted at the University District Hospital prenatal care clinics in the Medical Sciences Campus of Puerto Rico from September 2016 to June 2017., Results: A total of 189 pregnant women were recruited. Regarding Influenza vaccine: 75.6% were offered or oriented about Influenza vaccination, 51.8% had received the vaccine at least once (only 12.2% during current pregnancy) and, 57.1% reported receiving information about influenza infection risks in pregnancy, mainly from health care professionals and media. For Tdap only 20.6% of women were offered or oriented about the vaccine and 7.4% received the vaccine during pregnancy. 55.6% of patients had not been oriented about potential dangers of the pertussis infection; for the few oriented, health professionals were their predominant source. In terms of barriers, lack of information about vaccination and its benefits during pregnancy were the most frequent., Conclusion: Our study identifies the existing gap of information regarding Influenza and Tdap vaccine. Physicians play a pivotal role in preventive care and new strategies are needed to optimize education to our patients.

Objective: Gestational Diabetes Mellitus (GDM) and Type 2 Diabetes Mellitus (DM2) are metabolic disorders characterized by increased insulin resistance. Although insulin is the treatment of choice in pregnant patients with DM, the prescription of oral hypoglycemic agents (OHA) has been increasing among practitioners. This study aimed to evaluate the maternal and neonatal outcomes when oral hypoglycemic agents were used in diabetic pregnant women., Methods: Medical records from the Maternal-Infant Care Unit Clinics SoM-UPR (n=149) were reviewed. Patients that were treated with metformin, sulfonylurea or insulin were included. Maternal and neonatal outcomes were compared between groups., Results: Patient's mean age was 28 ± 6 years. The majority had GDM (91%). The most common comorbidity was hypertension (9.9%). Lifestyle modification was used as treatment in 77% of patients during the second trimester, but its use decreased to 33% during the third trimester. Insulin was the treatment of choice. Among the OHA, sulfonylurea was preferred. Postprandial glucose levels were lower in patients who used insulin as compared to those without medications., Conclusion: No significant differences were found in maternal outcomes such as C-section, induction of labor, episiotomy or preterm labor, or neonatal outcomes such as macrosomia, neonatal hypoglycemia or congenital abnormalities among treatment groups. OHA can be considered as an alternative to insulin for the treatment of DM during pregnancy in selected cases.

Objective: Our study sought to evaluate how aware the women attending gynecology clinics at the University of Puerto Rico Medical Sciences Campus (UPRMSC) were of the association between infertility and excess body weight (i.e., overweight and obesity)., Methods: Women 21 years old and older attending gynecology clinics at UPR-MSC were invited to participate in this study (n = 234). A self-administered survey was provided to all the women. Logistic regression models were performed to determine associations., Results: About 56.8% of the women were found to be aware of the effects of obesity on fertility; their main source of medical information was their primary doctor. The odds (adjusted for age and annual income) of being aware of the association between obesity and infertility were about 2.41 (95% CI: 1.07-5.42) times higher in women with a BMI greater than or equal to 25 kg/m2 than they were in those with a BMI of less than 25 kg/m2. An interaction by age group (adjusted for BMI) was found for the association between annual income and knowledge of the obesity-infertility association (OR≥40 years old: 3.51, 95% CI: 1.41-8.72; OR<40 years old: 0.57, 95% CI: 0.15-2.13)., Conclusion: Our study revealed that there is a lack of knowledge regarding the effects of obesity on fertility and identifies characteristics associated with this knowledge. The contents of health-care-provider counseling and the barriers affecting communication between patients and health care providers could be assessed in further studies.

Objective: To describe the level of knowledge about Zika virus exposure, symptoms, complications, and transmission prevention in Hispanic women living in Puerto Rico., Methods: A sample of 168 women aged 21 to 64 at the general community, consented to complete a self-administered questionnaire of 112 questions from October 2016 to July 2017., Results: A univariate analysis showed that the participating women recognized that the Zika virus was transmitted through mosquito bites (95.2%), sexual intercourse (78.0%), and from a mother to her fetus (41.1%); participants also believed that other, incorrect, routes of transmission were plausible. Regarding their knowledge of Zika infection prevention, the participants' correct answers included the following: using mosquito repellent (94.1%), eliminating standing water (83.9%), and using condoms (83.3%). When asked about fetal risks associated with Zika, they believed that the fetus would not develop normally (75.6%), would be born with a disability (69.6%), or would experience nervous system problems (54.2%). Only 22.6% of the participants had taken precautions to prevent pregnancy during the Zika outbreak, of which 65.8% reported that they had used condoms during all sexual relationships., Conclusion: There is a need to educate the general population about the Zika virus to reduce the misconceptions about disease prevention and transmission as well as about the complications associated with Zika during pregnancy. Awareness efforts should emphasize the prevention of infections during pregnancy and the use of available contraceptive methods.

Objective: Peripartum cardiomyopathy is a rare type of heart failure to which only pregnant women are susceptible. In Puerto Rico there is a paucity of information regarding this condition. In this report we describe our experience with peripartum cardiomyopathy., Methods: This was a descriptive retrospective study. We conducted a chart review of all the patients with peripartum cardiomyopathy managed at our institution from January 2006 through December 2012. A total of 12 patients qualified for our analysis., Results: The mean age of our population was 27 (± 8) years. Eight of the twelve (67%) patients were multigravid women, with a mean parity of 2.6 (± 1.6). Most patients (75%) showed clinical evidence of anemia while pregnant, and more than half (58%) delivered prematurely. Six patients (50%) had a prior history of preeclampsia. Cardiac imaging detected a mean ejection fraction of 35% (± 8%) at the time of diagnosis. Only 1 maternal death was documented., Conclusion: Our study cohort was very similar to those in most case series in which the same condition has been studied. In order to better understand the pathophysiology of this entity and, thus, improve treatment for these patients, prospective studies are needed.

Menstrual-related hypersomnia (MRH) is a rare disorder consisting of recurrent hypersomnia that is temporally linked with menses. An unusual case of an 18-yearold female with repeated episodes of hypersomnia was referred to a psychiatrist and a neurologist. A review of the literature was done so that an accurate diagnosis could be made, thereby enabling the development of an appropriate treatment plan. Making an effective diagnosis was a challenge because of the similarity of the symptoms of MRH with other psychiatric disorders. As additional clinical features were identified and treatments were ruled ineffective, further diagnoses were proposed. The patient's symptoms ceased with oral contraceptive treatment. Hormones play a role in the menstrual cycle and frequently affect behavior (such as sleep patterns). This case underlines the importance of multidisciplinary evaluation and treatment in unusual cases. The potential role of hormone fluctuation in patients with psychiatric conditions should be considered when diagnosing and treating those who are unresponsive to traditional pharmacological treatments.

This article describes the methodology of the first population-based study of human papillomavirus (HPV) infection among women aged 16-64 years residing in the San Juan Metropolitan Area of Puerto Rico (PR). The sample was identified through a complex sampling design of households. The sampling frame was selected in four stages, using census tracts maps from the Census Bureau. Women completed a face-to-face interview and a computer-assisted self-interview using the Audio CASI system, for the collection of demographic, clinical, and lifestyle variables, and sampling acceptability. Anal, cervical, and oral specimens were collected through self-collection methods for HPV DNA testing using a modified pool of MY09/MY11 consensus HPV L1 and human ß-globin amplification primers. Anthropometric measurements were taken using the Third National Health and Nutrition Examination Survey methodology. Blood samples were collected to create a bio-repository for future HPV-related studies. Fifty census tract blocks were randomly selected. We recruited 566 women, with a response rate of 83.4%. Response rates did not vary by age-group (p>0.05); although they varied by socioeconomic (SES) census block stratums (p<0.05), response rates were good (>75%) in all SES strata. All participants agreed to respond to the surveys and provide the requested anogenital and oral samples. Overall, more than 98% understood and more than 50% felt comfortable with the cervical, anal, and oral self-collection methods used. This article documents the feasibility of performing population-based studies for HPV surveillance in women in PR.

Objective: Cervical cancer is the fifth most common cancer among women in Puerto Rico (PR). Information about which obstetricians and gynecologists in PR are following current cervical cytology guidelines is not available. Our two objectives were to determine whether current guidelines for abnormal cervical cytology management were being followed adequately by OB-GYN residents and faculty at 3 university hospitals and, in addition, to evaluate the knowledge of the current guidelines that is possessed by these individuals., Methods: A retrospective medical record review (records from January 2009 through December 2010) of patients with abnormal cervical cytology results (n=166) to evaluate the management they were given and a cross-sectional survey of OB-GYN residents (n=34) and faculty (n=46) to evaluate their knowledge of cervical cytology guidelines were both performed., Results: One hundred and sixty-six medical records were reviewed. The level of management for 45% of the patients was found to have been optimal."Thirty-three percent were lost to follow-up. Eleven percent of the patients were managed sub optimally and the management of 12% of the patients was considered to have been poor. The survey showed that the faculty were less updated with regard to current guidelines for the management of cervical cytology than were the residents. Study limitations were the lack of electronic medical records in the hospital--which makes access to patient information more difficult--and the low response rate of the faculty., Conclusion: OB-GYN physicians and residents were not consistent with their management, according to current guidelines, of cervical cytological abnormalities. The high-risk nature of the patients and their poor adherence to treatment (loss to follow-up) may have been the cause of this inconsistency. Meetings aimed at addressing the lack of compliance by local OB-GYN physicians with the guidelines for cervical cancer screening have been Better screening strategies are also needed if we are to improve patient compliance in our population.

Objective: To describe the general knowledge and choices of postpartum contraception among pregnant teens who, at the time of the study, ranged in age from 13 to 19 years old and were receiving prenatal care at a hospital-based prenatal clinic., Methods: Questionnaires to obtain information regarding demographic characteristics and to explore contraception knowledge and choices were voluntarily completed by 44 pregnant teens, ranging in age from 13 to 19 years old. The frequency and distribution of the variables under study were analyzed and are presented herein., Results: Forty-four teens participated in the study. They had a mean age of 17.5 years. A significant proportion of the participants, 20 (45.5%), claimed not to know where to find information about contraception. All the participants acknowledged knowing about the male condom; as to other methods of contraception, 41 (93.2%) knew about oral contraceptive pills (OCPs), 31 (70.5%) knew about the patch, 30 (68.2%) knew about Depo-Provera, and 25 (56.8%) knew about intrauterine devices (IUD). The contraception methods about which the participants reported having the least knowledge were the sponge, the diaphragm, implants, the vaginal ring, and various natural methods. The majority (90.0%) of the participants agreed that they would prefer to use postpartum contraception. The contraceptive method of choice for postpartum contraception was the IUD (40%), which was followed in terms of preference by OCPs (17.5%), the patch (12.5%), and Depo-Provera (12.5%)., Conclusion: The majority of the pregnant teens who participated in the study professed the desire to use some sort of contraceptive method to ensure that they would not become pregnant again in the near future. To that end, most of them expressed a preference for the IUD, one of the most effective contraceptive methods available today. Nevertheless, they need more access to and information about available contraceptive methods.

Alport syndrome with diffuse leiomyomatosis (ASDL) is a complex combination that doesn't have a specific course of treatment. In this case report, we present a 44-year-old woman with ASDL and detail her treatment. The patient presented at the emergency room (ER) with symptoms of anemia, bronchial asthma, and abnormal uterine bleeding (AUB). The patient had diffuse myomas in different areas of her body, including the esophagus and genital tract. She was treated by a multidisciplinary team that included members from the hematology/oncology, pulmonary, interventional radiology, anesthesia, surgery, and gynecology services. A physician from interventional radiology performed an embolization of the uterine arteries to treat the patient's AUB. Surgery was done in May 2011 to remove the esophageal leiomyomas to improve her pulmonary function. Surgery included a distal esophagectomy, a proximal gastrostomy, and the resection of the leiomyomatous mass. In order to shrink the tumor in her genito pelvic region so that it could be extirpated with the highest likelihood of success, the patient was treated with gonadotropin-releasing hormone agonist (leuprolide acetate, 3.75 mg/month for 4 months). In May 2012, the patient had a total abdominal hysterectomy (TAH), with a bilateral salpingo-ophorectomy (BSO), the excision of a leiomyoma, and a posterior colporrhaphy.

Objective: Persistent infection with high-risk (HR) HPV is a necessary risk factor for the development of cervical cancer. Information on HPV infection is limited in Puerto Rico. This study determined the distribution of HPV types and the association of HR-HPV types with cervical pathology in a clinic-based sample of women in PR., Methods: Data from 92 female participants aged 18 to 34 years and recruited from the University of Puerto Rico-Gynecology Clinic, were analyzed. Cervical cytology was performed. HPV testing was performed using L1 consensus primer PCR with MY09/ MY11 primers and typed by dot-blot hybridization. Logistic regression modeling was used to determine the crude and covariate adjusted association between HR-HPV and cervical pathology., Results: Twenty percent (n = 18) of the patients had abnormal cytology, 45.7% (n = 42) were HPV positive, and 30.4% (n = 28) were HR HPV-positive. Women infected with HR-risk HPV types were 7.9 (95% CI = 2.5-25.5) times more likely to have abnormal cytology as compared to women without HR infection when adjusted by age and age at first sexual intercourse., Conclusion: The burden of HPV infection was high, and, as expected, HR HPVs were strongly associated with dysplasia. A population-based study is needed to estimate HPV prevalence and its association with related malignancies in our population. This will be of great value in determining disease burden and will increase awareness of the HPV vaccination in our population.

Self-sampling techniques have been shown to be reliable in determining human papillomavirus (HPV) infection, although the acceptability of this method of sampling has not been studied in Puerto Rico (PR). The objective of this study was to determine the acceptability of cervicovaginal and anal self-sampling for HPV DNA testing among women in PR. One hundred women aged 18-34 years old and undergoing routine Pap smears in an OBGYN clinic in PR were recruited. Interviewer-administered and computer-based questionnaires were used to collect information on relevant risk factors. To assess acceptability, four-item acceptability Likert scales were used that measured comfort, pain, privacy, and embarrassment. Overall acceptability indexes were calculated as the sum of the Likert scores. Clinician-collected and self-collected cervicovaginal and anal samples for HPV-DNA testing were obtained from the participating women. Although the acceptability of both sampling methods was high, it was higher for self- rather than clinician-sampling of the cervix (difference in mean score = -0.71, p<0.05); contrarily, it was higher for clinician-sampling of the anus (difference in mean score = 0.64). When analyzing individual items within the scale, less embarrassment was observed with respect to the self-collection of cervical and anal samples. Nevertheless, most women reported that they preferred having a clinician collect cervical and anal samples (67% and 61%, respectively); and most of these women (86% for cervical samples and 92% for anal samples) felt more confident that this sample would be properly taken. Despite this, in this population, the high level of acceptability with regard to self-collected samples and the previously documented concordance between self- and clinician-collected samples support the use of cervical and anal HPV DNA self-sampling techniques in future HPV-related population-based studies and screening programs in PR.

Objective: Approximately 30% of women diagnosed with cervical cancer are in their childbearing years, and 5-8% of pregnant women seeking prenatal care are found to have an abnormal Papanicolaou smear. Prenatal visits are an excellent opportunity for cervical cytology testing and patient education because of close follow-up. The objective of this study is to examine the overall prevalence of cervical dysplasia and associated risk factors in pregnant women aged 15 to 30 years attending the high-risk obstetrics clinics at the University Hospital in San Juan, Puerto Rico between December 2005 and May 2007., Methods: We performed a systematic review of 237 prenatal charts from patients attending the high-risk obstetrics clinics at the University Hospital in San Juan. The variables studied were age, place of birth, gestational age at first visit, gravidity, age at first coitus, number of sexual partners, tobacco use, Papanicolaou smear results, and cervical gonorrhea and Chlamydia test results. The relationship between cervical cytology results and the aforementioned variables was statistically assessed., Results: Abnormal cervical cytology was found in 16 (6.8%) of the patients. Of these, 75% were atypical squamous cells of unknown significance (ASCUS), 19% low-grade squamous intraepithelial lesion (LGSIL), and 6% high-grade squamous intraepithelial lesion (HGSIL). Gravidity > 3 was observed in 16.5% of the patients, and 48.7% were in their second trimester of gestation. Their first coitus was at age 17 or earlier (66.5%), and 78% had between 1 and 3 sexual partners. Having a positive Chlamydia test was significantly (p < 0.05) associated with the risk of having an abnormal cervical cytology. Other variables such as gravidity, age at first coitus, number of sexual partners, and tobacco use were not statistically associated with an abnormal cervical cytology test., Conclusion: The overall prevalence of cervical dysplasia among pregnant women who attend the high-risk obstetrics clinic at the University Hospital in San Juan, Puerto Rico is similar to what has been reported elsewhere. Among all variables studied, only a positive Chlamydia test was found to be associated with an abnormal cervical cytology test. Given the high number of women seeking prenatal care and the close follow-up provided during this period, prenatal care is an excellent opportunity for cervical cytology testing and patient education.

Objective: The knowledge of medical students in Puerto Rico with regard to the Chlamydia trachomatis infection has not been formally assessed. The purpose of this study was to make such an assessment as it is the members of this group who will eventually educate and inform patients about this and other health-care issues., Methods: The sample was drawn from a population of students enrolled in a four-year medical school program in Puerto Rico. Data were collected via a self-administered one-page questionnaire and took approximately 5 minutes to complete. The questionnaire was a 9-item inventory composed mostly of knowledge items. A frequency count for each item was calculated. The SPSS program was used for the statistical analysis., Results: A final response rate of 76% (338/455) was obtained for the analysis. The sources of chlamydial information were college (73.4%), high school (59.8%), friends (28.1%), press media (21.6%), and family members (15.4%). Asked to identify the etiology of the infection, participants responded that it was bacterial (78.1%), viral (16.9%), parasitic (3.8%), or fungal (1.2%). Knowledge about the existence of a cure for the infection resulted in 85.5% of the respondents answering in the affirmative, that a cure exists; the rest either did not know or were uncertain about the existence of a cure for Chlamydia. Knowledge regarding the mode of transmission resulted in 98.2% stating that it is transmitted sexually, while public bathrooms as a source of infection accounted for 2.4%; kissing (1.5%) was also identified as a method of transmission. Statistics for the symptoms and the consequences of chlamydia resulted in pelvic inflammatory disease (PID) (81.1%), infertility (75.1%), abnormal vaginal secretions (79.6%), burning sensation upon urination (49.6%), ectopic pregnancies (44.9%), abnormal vaginal bleeding (13.9%), and cervical cancer (8.9%)., Conclusion: Our data suggest that members of this population understand this infection only partially and that there is indeed a lack of knowledge regarding infection of sexually transmitted Chlamydia trachomatis. Without accurate knowledge of chlamydial infection, medical students and physicians are unable to identify its presence and, subsequently, educate their patients regarding both the management and the serious complications of this infection. There are serious implications for women's health, and thus knowledge is important to reduce the burden of chlamydial infection.

Background: Obesity is an established risk factor for endometrial cancer (EC). This association, however, has not been studied in Puerto Rico, where overweight and obesity have reached epidemic levels (38% and 26%, respectively)., Methods: A hospital based case-control study was designed to evaluate the association between body mass index (BMI) and EC in women older than 21 years of age. Seventy-four prevalent EC cases diagnosed between January 2004 and August 2007 and a random sample of 88 healthy controls were recruited from gynecology clinics of the Medical Sciences Campus, University of Puerto Rico. Demographic, reproductive, lifestyle, and clinical information was obtained via structured telephone interviews and medical chart review. Unconditional logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI)., Results: A significant trend was observed between BMI and EC in bivariate analyses (p < 0.05). Results showed that overweight (25.0 > BMI < 29.9 kg/m2) (OR = 4.4, 95% CI = 1.6-12.3) and obese (BMI < or = 30 kg/m2) (OR = 9.9, 95% CI = 3.6-26.9) women were more likely to have EC when compared to non-obese women. In multivariate analysis, obese women had a 4-fold greater possibility of EC (OR = 4.1; 95% CI: 1.8-8.6) than nonobese women, after adjusting for age, education, employment status, hypertension and diabetes diagnosis, use of oral contraceptives and consumption of poultry., Conclusion: Consistent with previous studies worldwide, adult obesity was a strong predictor for EC in this sample of Puerto Rican women. Thus, cancer control strategies should promote weight reduction strategies to reduce disease risk in this population.

Female sexual dysfunction is a multi-causal and multidimensional problem combining sexual, physiological, physical, psychological, and interpersonal determinants. Loss of libido or loss of sexual desire, as a symptom of one of the primary sexual dysfunctions described in females, is highly prevalent in the general female population. Research on the psychological aspect associated with loss of libido among Hispanic female populations is limited. The objective of this study was to determine how the loss of libido is affected by signs and symptoms of depression, once potential confounders are controlled. Nine-hundred and nineteen Puerto Rican women ages 40 to 59 years living in Puerto Rico participated in health-fairs conducted in twenty-two municipalities between May 2000 and November 2001. Contingency tables and chi-square statistics were used to evaluate the bivariate associations of loss of libido with demographic and lifestyle characteristics, symptom experience and obstetric and gynecologic histories. A logistic regression model was used to estimate the magnitude of the association between loss of libido and signs and symptoms of depression, after controlling for confounders. The overall prevalence of loss of libido in this population was 40.8%. Loss of libido was significantly associated with depressive symptoms (p < 0.05) after adjusting for age, educational attainment, employment status, physical activity, menopausal status/ hormone therapy use and genitourinary symptoms. Women reporting 1-2 depressive symptoms were 67% (95% CI = 1.08-2.60) more likely than women reporting no symptomatology to report loss of libido. The odds of loss of libido increased as the number of depressive symptoms increased [(3-4 symptoms: POR = 3.67, 95% CI = 2.16-5.56); (5-6 symptoms: POR = 5.52, 95% CI = 3.16-9.66)]. Consistent with previous studies, signs and symptoms of depression were significantly associated with loss of libido. Future longitudinal studies should further elucidate the temporal sequence between depression and sexual dysfunctions in this population.

Background: Several studies indicate that approximately 4.6% of the Puerto Rican Population has been affected by depression at some time in their life. Perimenopausal women have been one of the most frequently mentioned population in scientific literature prone to develop depression. Sociodemographic factors along with medical history have been hypothesized to be associated with the development of depression. This study has the purpose to know the prevalence of depressive symptoms in a sample of women age 40 to 55 years attending a gynecological outpatient clinic in the Medical Sciences Campus of the University of Puerto Rico. We also want to identify sociodemographic risk factors that can predispose these women to develop depressive symptoms., Method: A cross sectional study was done during the months of June 2000 thru December 2000. Female subjects age 40 to 55 selected by availability. The Zung Self-Rating Depression Scale (1995 Spanish Version) and a questionnaire were administered to each subject. Results. The overall prevalence of depressive symptoms in this sample of 64 women was 39.1%. Among the variables considered as possible associated risk factors for the development of depressive symptoms, educational level, prior visit to a mental health professional or a spiritual guide, and prior diagnosis of depression and antidepressant use were of statistical significance., Discussion: A high prevalence of depressive symptoms was found in this sample. As reported in other studies, higher educational level is a protective factor against depression. Contrary of other studies, no association is found between depression and other sociodemographic and medial factors.

Objectives: To characterize the distribution of age at menopause in a sample of Puerto Rican women and to evaluate the differences in demographic, health and lifestyle factors associated with menopausal state., Background: Age at natural menopause may be an important marker of a woman's long-term risk of chronic disease. Understanding which factors influence the timing of menopause remains limited and while ethnic differences in age at menopause have been reported, little data are available for Puerto Rican women., Methods: In 2000, a self-administered questionnaire was completed by a sample of 300 women aged 30-59 attending health fairs in the cities of Carolina, Aguadilla and Yauco, Puerto Rico (PR). Data from this interview was used to determine age at menopause which was described with probit analysis. Women from different menopausal status groups were compared with respect to demographic, lifestyle and health characteristics by using contingency table analysis and chi-square statistics., Results: In a sample where 53% of women were menopausal, the median age of natural menopause was 51.4 years (95% confidence intervals 50.3-52.5). Compared to premenopausal women, naturally and surgically postmenopausal women had lower educational attainment, increased parity and were more likely to be obese (p < 0.05)., Conclusion: This analysis provides the first estimate of age at natural menopause among women living in PR and the age is similar to that reported in other populations. Determining whether this population tends to have an early or late menopause will facilitate a better understanding of the potential chronic disease profile of Puerto Rican women as they age.

We report our experience with the use of intra-amniotic thyroxine to accelerate fetal maturation in preterm delivered infants. One hundred and fourteen infants who had received 500 micrograms of thyroxine weekly prenatally until an L/S ratio greater or equal to 2.0 was achieved, were compared to 113 premature infants who had not been given thyroxine or steroids prenatally. After stratification by weight, the relative incidence of respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH) were compared. A decrease in the incidence of RDS was observed in the infants with birth weight between 1000 and 1500 g who had received more than one dose of intra-amniotic thyroxine. No difference in the incidence of RDS was observed in infants with birth weight of less than 1000 g or over 1500 g. One dose of thyroxine had no effect in decreasing the incidence of RDS, PDA, NEC, and IVH in any of the groups. We conclude intra-amniotic thyroxine seems to decreases the incidence of RDS in very low birth weight infants.

During the second decade of AIDS the spread of this disease has encompassed most areas of the world. In Puerto Rico the epidemic has been different than in the mainland USA. Our initial cases were mostly associated to intravenous drug use and subsequently heterosexual transmission. Sexual transmission of HIV is the principal cause of AIDS for women in Puerto Rico. AIDS is also the principal cause of death in young women in Puerto Rico (ages 25-40). Therefore the counselling to women has to include the universality of the risk. Data from seroprevalence studies show a high prenatal seroprevalence (1%) in the San Juan Metropolitan Health Region. In view of the high prenatal seroprevalence, universal offering of HIV counselling and testing is recommended. Gynecologic evaluation is essential in the follow-up of women with HIV infection and should include frequent evaluations to determine the frequent occurrence of premalignant lesions in the cervix that may be associated to immunosuppression.