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This is the first national study of breast-cancer knowledge, beliefs, and early detection practices among elderly women (65+) in Puerto Rico. Cancer breast examination (CBE) was the most common early detection practice, followed by the mammogram, with breast self exam (BSE) a distant third. The primary reasons most often cited for never having a mammogram related to both personal and external factors: not having symptoms, negligence or forgetfulness, and not having a physician's referral. No statistically significant difference (p0.05) was found between knowledge and early detection practices. Conversely, beliefs had an impact on preventive behavior. Those who had less misconceptions were most likely to have had a CBE or a mammogram. Bivariate analysis demonstrated that age was associated with performing a BSE once or twice monthly, ever having a mammogram, and having a mammogram in the past two years. A higher socioeconomic status was associated to performing BSE and ever having had a mammogram. Education correlated positively to ever having a mammogram or having a mammogram in the two years prior to the interview. Factors that explained compliance with a mammogram in the last two years included referral from a physician, owning a car, and receiving information after menopause on breast cancer from a health care provider. A gynecological visit increased the probability of having had a mammogram during the last two years. Logistic regression determined that a referral from a physician was the most important factor for mammogram compliance when a combination of variables were considered.

In order to plan the health services for the elderly population, it is necessary to quantify their health status and their functional capacity. In Puerto Rico, few epidemiological studies have been conducted regarding functional capacity and chronic diseases in the elderly population. One of the difficulties to undertake these studies is the high cost and risks to move this population for clinical exams, in addition to the methodology limitation of self-report in the elderly population. This study shows the use of logistic regression to estimate the prevalence of chronic diseases and functional capacity, when the observed data are not consisted with the planed sampling scheme. Four hundred and eighty-seven elderly persons (65 yr. and over) were interviewed in the municipalities of Canóvanas, Carolina, Loíza and Trujillo Alto in Puerto Rico, using a cross-sectional design. More than half of the elderly had visual problems (IC 95%: 54.8%, 63.8%), arthritis (IC 95%: 52.7%, 61.5%) and hypertension (IC 95%: 47.3%, 56.3%). In the case of hypertension, significant differences (p0.05) by sex were observed, where women reported a higher prevalence than men. One of the higher prevalences in the functional capacity status was with urine accidents. More than one-third of the population is estimated to have this problem (IC 95%: 34.7%, 43.4%). One-fourth of the population had limitations with going out for shopping (IC 95%: 23.9%, 31.9%) and using public and private transportation (IC 95%: 19.5%, 26.9%). We conclude that the applied methodology was consistent with the estimation presented in the literature and statistics from the Puerto Rico Health Department. However, it is necessary to continue assessing the design and analytical methodology, in order to undertake consistent and periodic evaluations of the elderly population.

This paper presents the results of the validation process to determine the concepts for knowledge and beliefs about breast cancer early detection practices among Puerto Rican elderly women. An initial questionnaire was designed based on the scientific literature review and focus group experiences. To determine its reliability and validity, 50 elderly women, stratified by type of profession and place of residence, were interviewed twice. Consistency of the questionnaire was analyzed using binomial test, matched t-test, Pearson correlation coefficient, and Cronbach's coefficient effect. Factor analysis (FA) was the statistical technique used to analyze the grouping of the knowledge and beliefs statements. FA indicated that three scales for knowledge and one for beliefs can be constructed. The purpose of the scales was to identify differences among groups, according to breast cancer early detection practices. Construct validity was performed to determine the number of statistical associations between the scales and these practices. The results showed that beliefs scales was associated with practice of mammogram (p0.05), and visit to the gynecologist (p0.05) while the knowledge scale for early-detection was associated with the clinical breast examination (p0.05). The beliefs scale had better consistency than the knowledge scale. The Cronbach's alpha was 0.75 for the beliefs' scale and 0.30, 0.41 and 0.43 for each defined knowledge scale, respectively.

Twenty five cases of onychomycosis due to filamentous saprophytic agents were diagnosed within the period 1981-1982 in two mycology laboratories in Medellín, Colombia. These cases represented 4.5% and 9.5% respectively of the total fungal nail lesions (FNL) seen at those institutions. No explanation was found for the high frequencies, which sharply contrast with the previous local experience with the disease (0.4% of FNL). The responsible agents belonged to the following genera in decreasing order of frequency: Fusarium, Aspergillus, Scopulariopsis, Penicillium and Lasiodiplodia; two patients were infected with unidentified dematiaceous fungi and two more had the association of a saprophyte and a dermatophyte. In every case direct KOH preparations revealed septate hyphae, associated in 14 patients (56%) with chlamydoconidia. The only predisposing factors that were common to all these patients were age above 20 years and the use of footwear.

Serum electrophoresis patterns and various measures of specific and non-specific immune competence were determined in 16 patients with paracoccidioidomycosis, at time of diagnosis and 6 months after therapy. The results were compared with those furnished by the study of 16 control subjects, matched by age and sex. Once treated, the patients approached normality in some parameters. Untreated patients had significantly diminished albumin levels with increased alpha 1, alpha 2 and gamma fractions. Immune gamma globulin G (IgG) was elevated and remained so during therapy. Both before and after treatment patients had diminished total numbers and decreased percentages of E rosettes; they also had depressed lymphocyte transformation with phytohemagglutinin (PHA) and paracoccidioidin (P). Also, untreated patients exhibited the lowest skin test responses to PHA, purified protein derivative (PPD), P and candidin (C); significant differences, however, were limited to the former 2 antigens. All untreated patients had detectable antibody titers against P. brasiliensis; these titers had a tendency to drop during treatment. No direct correlation was found between elevated serum fractions, presence of antibodies and depressed cellular immunity.