There is limited research on whether receiving a dementia diagnosis could prompt later-life migration, particularly among older Medicare beneficiaries in Puerto Rico. Prior research shows older Puerto Ricans are migrating to the mainland United States (U.S.), which may include those with an Alzheimer's Disease and Related Dementias (ADRD) diagnosis. This study examined yearly outmigration trends among older Puerto Ricans by exploring their movement patterns in 2011-2019. We used data from the Medicare Master Beneficiary Summary File and the Puerto Rican Community Survey and focused on Medicare Fee-for-Service enrollees aged 65 and older. The Chronic Conditions Warehouse algorithm was used to ascertain ADRD diagnosis, and migration was defined as the change of (end-of-year) residence from one year to the next. A linear probability model was used to calculate differences in the rate of outmigration between beneficiaries with and without ADRD. Across the study period, the sample averaged 53,294 beneficiaries per year (43,819 [2019] to 66,625 [2012]), with 15% having a previous ADRD diagnosis each year. Overall, older Puerto Ricans previously diagnosed with ADRD were slightly more likely to move to the U.S. mainland compared to those without a diagnosis across the years (adjusted differences of b = 0.14∼0.42%), though differences were statistically significant in some years. For example, outmigration spiked (over 2.5%) among all older adults in the year of Hurricane Maria, regardless of health status. Our results suggest that older Puerto Ricans with ADRD are more likely to migrate as they face challenges in aging in place.
IntroductionAlzheimer's disease and related dementias affect Latino older adults who are living longer with dementia. Puerto Ricans are the second-largest Hispanic group in the United States, and they differ in language, norms, and values from other cultures. As the number of dementia cases increases, the demand for caregivers will rise.MethodThe integrative review was guided by Whittemore and Knafl's framework and aimed to evaluate and synthesize the existing literature regarding the experience, beliefs, and values of Puerto Rican dementia family caregivers. A comprehensive search of PubMed, CINAHL, Embase, PsycInfo, and LILACS databases was performed to examine the literature from 2013 to 2025.ResultsFour key themes emerged: (1) spirituality is essential for caregiving, (2) home is a better place to be, (3) toll of caregiving, and (4) long-established gender roles.ConclusionThe findings demonstrate the scarcity of Puerto Rican caregiver representation in the literature. Further research is needed to determine Puerto Rican values and beliefs regarding caregiving.
ObjectiveTo determine factors associated with hydroxychloroquine (HCQ)-induced retinopathy in Puerto Ricans with systemic lupus erythematosus (SLE) and to evaluate determinants of early HCQ-induced retinopathy.MethodsWe conducted a retrospective study of adult Puerto Ricans with SLE. Patients with ophthalmologist-confirmed HCQ-induced retinopathy were compared with those without retinopathy. A subgroup analysis comparing patients with early-onset (≤5 years) versus late-onset (>5 years) retinopathy was also performed. Demographic factors, clinical manifestations, and pharmacologic treatments were analyzed using bivariate methods and logistic regression models adjusted for SLE duration.ResultsA total of 279 patients were included; 41 had HCQ-induced retinopathy, while 238 did not. Among patients with HCQ-induced retinopathy, the mean age (SD) was 45.2 (13.2) years, and 90.2% were women. The mean (SD) SLE duration and HCQ treatment duration were 10.3 (7.7) years and 9.1 (5.8) years, respectively. Patients with HCQ-induced retinopathy were more likely to have higher daily and weight-adjusted HCQ doses and greater damage accrual, but were less likely to have proteinuria, lymphopenia, anti-dsDNA positivity, low complement levels or exposure to mycophenolate mofetil. Among patients with HCQ-induced retinopathy, 13 (31.7%) discontinued HCQ within 5 years of treatment initiation. In multivariable analysis, early-onset toxicity was associated with corticosteroid exposure.ConclusionsIn this cohort of Puerto Rican Hispanics with SLE, HCQ-induced retinopathy occurred in 14.7% of patients, and nearly 32% of those affected developed early-onset retinopathy. Retinopathy was primarily associated with higher daily and weight-adjusted HCQ doses, while early-onset retinopathy was associated with corticosteroid exposure. These findings provide population-specific data that may help optimize HCQ dosing and underscore the importance of regular ophthalmologic screening, even during the early years of therapy.
Warfarin is one of the most used oral anticoagulants, even after the arrival of non-vitamin K oral anticoagulants. Warfarin has been implicated in approximately one-third of emergency hospitalizations for adverse drug events among older adults in national U.S. data. Warfarin dose has been shown to vary between patients with up to 10 times the standard dose. This variability is due to multiple factors such as age, gender, diet, body size, co-medications, and the genetic background of the patient, where the genetic background accounts for 50% of warfarin dose variability among Europeans. Sadly, these findings do not apply to Caribbean Hispanic populations such as Puerto Ricans due to them having an admixed genetic profile. In the field of pharmacogenomics (PGx), the utility of machine learning (ML) has been used to predict individual drug responses by analyzing complex genetic and clinical data, which helps personalize medicine by tailoring treatments to a patient's genetic makeup. Inclusion of ethno-specific variants has demonstrated improvement on the application of ML to a specific population. This study compares eight ML methods to predict warfarin sensitivity in Puerto Rican Caribbean Hispanics. This study is a secondary analysis of genetic and clinical data from 217 Puerto Rican patients treated with warfarin for thromboembolic disorders. After quality control filtering and exclusion of participant records with incomplete genetic and clinical data, 146 participants are retained for analysis. Data are divided into 65% and 35% to be used as training and test sets. Model performance is determined by comparing the precision and accuracy metrics, computed through the corresponding confusion matrixes. A gradient boosting classifier (GDB) achieves the highest overall accuracy (0.7500) and weighted precision of (0.7642); however, sensitivity for detecting warfarin-sensitive patients remains low. Feature importance analysis suggests that rs202201137 could contribute to model predictions, although overall detection of warfarin-sensitive individuals remains limited.
Interpersonal violence (IPV) is associated with negative physical, mental, and reproductive health outcomes. This study described the characteristics of Puerto Rican women experiencing IPV before, during, and after the time of pregnancy and explored disparities in their health outcomes, risk factors, and healthcare utilization behaviors. We analyzed 2017-2020 data from the Puerto Rico Pregnancy Risk Assessment Monitoring System for 3,893 respondents, calculating weighted prevalence estimates of IPV, 95% CIs, and odds ratios for IPV before, during, and after pregnancy. Overall, 8.0% of Puerto Rican women reported experiencing violence in the 12 months before or during pregnancy. Physical violence, most often perpetrated by a current or former intimate partner, was reported by 4%. Emotional violence during pregnancy was reported by 5.2% of participants, and 1.2% reported being forced to have sex while pregnant. Experiences of violence were significantly associated with age, marital status, type of health insurance at the time of delivery, symptoms of depression or anxiety 3 months before pregnancy, postpartum depressive symptoms, pregnancy intention, smoking 3 months before pregnancy, adequacy of prenatal care, and being asked by a healthcare professional about experiencing violence in the 12 months before pregnancy. Puerto Rican women face a significant risk of experiencing violence before, during and after pregnancy; this violence is associated with detrimental physical and mental health outcomes and lower health care utilization. Culturally sensitive interventions and improved health care practices are critical to support affected women and enhance perinatal health outcomes.
Diet may influence the pathogenesis of asthma, a heterogeneous syndrome comprising unique mechanisms or endotypes. Little is known about the relation between diet and asthma endotypes in children and adolescents. Are dietary patterns associated with T-helper 17 (T17)-high asthma? Cross-sectional (n = 465) and longitudinal (n = 358) analyses of dietary patterns and asthma endotypes in Puerto Rican populations with (cases) and without (control patients) asthma who completed a baseline study visit at 6 to 14 years of age and a second visit at 9 to 20 years of age, with a mean interval of 5.3 years between visits. A dietary score, ranging from -2 (unhealthiest diet) to 2 (healthiest diet) was developed using data from a food frequency questionnaire. An unhealthy diet was defined as a nonpositive dietary score (-2 to 0). Based on nasal epithelial expression of 8 signature genes for T-helper 2 (T2) and T17 immunity, 3 asthma endotypes were identified at the second visit: T2-high, T17-high, and T2-low/T17-low. Multinomial regression was used for the multivariable analysis of dietary patterns and asthma endotypes. In a cross-sectional analysis including 465 participants at the second visit, with control patients as the reference group, each 1-point increment in dietary score was associated with decreased odds of T17-high asthma (OR, 0.72; 95% CI, 0.55-0.95; P = .02), whereas an unhealthy diet was associated with increased odds of T17-high asthma (OR, 2.31; 95% CI, 1.31-4.08; P < .01). In a prospective analysis including 356 youths who completed both visits, an unhealthy diet at both visits was associated with increased odds of T17-high (OR, 4.30; 95% CI, 1.77-10.47; P < .01) and T2-low/T17-low asthma (OR, 2.48; 95% CI, 0.99-6.20; P = .05). Our results show that in a study of Puerto Rican youths, an unhealthy diet was associated with T17-high asthma in cross-sectional and prospective analyses, suggesting that T17 pathways may potentially mediate dietary effects on asthma.
BackgroundThe Subscales Vestibular Activities and Participation Measure Questionnaire (SVAP) measures limitations in activities and restrictions in participation in patients with vestibular conditions. This questionnaire has undergone a translation and cultural adaptation process from English to several languages.ObjectivesThe objectives of the study were to translate and culturally adapt the SVAP from English to Puerto Rican Spanish and to administer the translated instrument to a sample of patients with vestibular disorders in Puerto Rico to determine its reliability.MethodA quantitative methodological study was conducted to translate and culturally adapt the SVAP to a Spanish version following a 7-stage process, obtaining as a result a translated questionnaire into Spanish (SVAP-E). The psychometric evaluation was carried out through internal consistency, where 30 participants of both sexes, from 21 to 85 years old, with vestibular disorders were recruited.ResultsA Cronbach's alpha coefficient of 0.90 was obtained for the SVAP-E. Subscale A analysis showed a Cronbach's alpha coefficient of 0.81 and 0.84 for subscale B.ConclusionThis study supports the Puerto Rican Spanish version of the SVAP as a questionnaire with excellent reliability that could be used to identify activity limitations and restrictions in participation of patients with vestibular conditions.
The present study explores the personal narratives of bullying victimization among Costa Rican college students, examining how cultural factors shape bullying. Thirteen participants aged 18 to 23 recounted their experiences being victims of bullying in elementary and high school through semi-structured interviews. Thematic analysis revealed three themes and subthemes: (1) Helplessness (Inward and Outward), (2) Negative Emotions (Internalization and Maladaptive Responses), and (3) Sense-Making (Normalization/Rationalization, Positive Gains, and Outsider Status). These themes capture the emotional impacts and the ways participants interpreted their victimization, often with feelings of powerlessness, frustration, and self-doubt. This study contributes to understanding the cultural dimensions of bullying in Latin American contexts, providing insights for tailored interventions that support youth resilience and address unique societal factors, particularly by bolstering family involvement and bystander intervention.
Puerto Rico has been severely impacted by climate-related issues and natural hazards, which have damaged water infrastructure and compromised overall water quality. This has led residents to mistrust water from municipal utility suppliers. As a result, Puerto Ricans have adopted alternative drinking sources and filtration methods, including reliance on bottled water and home water filtration methods. Although there is a good understanding that many residents mistrust tap water, there is limited understanding regarding whether and how users rely on home water filtration methods. We collected survey data from 506 residents in Puerto Rico in 2024. Logistic regression analysis shows that users typically filter their water due to a combination of demographic factors. For instance, income was a significant predictor (p-value <0.001), along with concerns about water quality, color, the perceived presence of per- and polyfluoroalkyl substances (PFAS), overall dissatisfaction with their water quality, and perceived health risks associated with consuming tap water. This is the first study in Puerto Rico on household filtration and extends our knowledge about specific factors that influence public trust in water quality, ultimately supporting future evidence-based approaches to enhancing trust in tap water.
International medical graduates (IMGs) and Puerto Rican medical graduates (PRMGs) are integral to the United States (U.S.) physician workforce yet face unique immigration-related and professional challenges. We conducted a study to investigate reasons for migration, perceived barriers, discrimination, satisfaction, and factors influencing IMGs' and PRMGs' decisions to remain in the U.S. versus return to their home countries. We conducted a cross-sectional, online survey of foreign-born physicians who obtained their medical degrees outside the continental United States and were currently training or practicing in the U.S. The survey captured demographic and professional characteristics, migration history, cultural adaptation, discrimination, and overall professional experiences. Descriptive statistics summarized responses. Among physicians who completed training and were practicing independently in the U.S., we compared overall experience ratings and discrimination-related distress between the training and independent practice phases using the Wilcoxon signed-rank test and McNemar's test. Of 352 respondents, most were IMGs (82.1%) and 16.8% were PRMGs. Nearly half reported racial and/or ethnic discrimination (49.6%) and language discrimination (37.8%) during training. In paired analyses among those currently in independent practice, overall experience ratings shifted from the training to independent practice phase, with "excellent" ratings more common during training than independent practice. Among participants who experienced language discrimination in both phases, distress levels decreased over time. Despite high rates of discrimination and pressure to assimilate, most participants reported excellent (63.6%) or good (52.9%) overall experiences during training and practice, respectively. Only 9.3% had returned to their home country, most of whom reported extreme happiness after returning. High rates of racial, ethnic, gender, and language discrimination, along with pressures to assimilate, characterize IMGs' and PRMGs' journeys in the U.S. healthcare system. Nevertheless, most report high professional satisfaction. Interventions are needed to address discrimination, support cultural identity, and promote sustainable careers for this essential segment of the U.S. workforce.
Plant-based diets have been associated with favourable health outcomes; however, not all plant-based diets are of the same quality. This study aimed to investigate the associations between three plant-based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI) and unhealthy PDI (uPDI) and measures of adiposity: wrist circumference, waist circumference, waist:hip ratio and BMI. This study used data from 2027 controls in the Costa Rica Heart Study, a case-control study. A validated FFQ was used to create the plant-based diet indices. Multivariable linear regression was used to examine associations between quintiles of the plant-based diet indices and adiposity indicators. Higher hPDI scores were associated with lower adiposity, with waist circumference showing the strongest association. Participants in the highest hPDI quintile had a β = -1·90 cm (95 % CI: -3·32, -0·49) lower waist circumference and a β = -0·72 kg/m2 (95 % CI: -1·33, -0·10) lower BMI compared with participants in the lowest quintile. Significant linear trends were observed with waist circumference (P-trend = 0·0037), waist:hip ratio (P-trend = 0·0064) and BMI (P-trend = 0·0171). Subjects in the 5th quintile of the overall PDI had significantly lower waist circumference (β = -1·75 cm (95 % CI: -3·14, -0·36)), waist-to-hip ratio (β = -0·010 (95 % CI: -0·019, -0·001)) and BMI (β = -0·62 kg/m2 (95 % CI: -1·22, -0·02)). In general, uPDI showed no significant associations with adiposity indicators. Among Costa Rican adults, adherence to hPDI is associated with lower adiposity, whereas uPDI showed no association, indicating the quality of plant-based diets plays a role in body composition.
Structural stressors (SS) or mutually reinforcing systems that prevent groups of individuals from accessing opportunities and resources, can impact one's health. Indicators of SS include area-level group differences in income, education and exposure to violence. SS are fundamental causes of health disparities and can be indexed by area-level measures. Area-level SS may influence substance use risk in adolescents and future substance use disorders (SUDs). SUDs often start during adolescence, a critical risk period and an ideal time for prevention and intervention efforts. Since SUD risk can be influenced by the experience of the prior generation, it is important to take into account familial risk when trying to understand the role of SS on substance use risk. Improved understanding of the relationship between SS and neurocognitive mechanisms of substance use risk could inform novel approaches to prevention and intervention. We will enroll participants who are part of the Boricua Youth Study (BYS), an intergenerational, representatively sampled cohort of Puerto Rican families living in the South Bronx, New York and San Juan, Puerto Rico that has been followed for 20+ years. Working with BYS will allow us to control for familial SUD risk with prospectively captured parental SUD data and examine the how SS is related to substance use risk in two disadvantaged contexts. This article describes a pilot study focused on providing proof of the concept that specific area-level indicators of SS, including measures of income, education and exposure to violence, relate to neurocognitive mechanisms of substance use risk, including steeper delay discounting and reduced reward-related neural activity in reward-sensitive brain regions. Analyses will test a relationship between SS and neurocognitive mechanisms of substance use risk. Results will reflect associations between area-level, substance use-relevant SS and neurocognitive mechanisms of substance use risk in adolescents. If proof of concept is obtained, the next phase of the study will examine structural and family-level factors that may buffer the negative impact of SS. The goal of this research is to guide novel approaches to structural-, family- and individual-level prevention of SUD. https://clinicaltrials.gov/study/NCT06221839, identifier: NCT06221839.
Background/Objectives: Puerto Rican Hispanic/Latino (PR H/L) men experience a heightened incidence and mortality rate of aggressive forms of prostate cancer. The underlying causes of this increased disease burden likely include a complex interplay of socio-economic and biological factors. This pilot study leveraged the first cancer tissue biobank at a Hispanic-Serving Institution (Puerto Rico BioBank) and aimed to provide an initial description of the genomic features of prostate cancer in 35 PR H/L men. Methods: Whole-exome and RNA sequencing were performed on prostate adenocarcinoma tumor samples to investigate the genomic features associated with prostate cancer. Results: Our analysis suggests that mutation profiles and gene expression pattern differences are observed in this population and may be associated with disease aggressiveness and progression. Notably, mutations in TP53 and TMPRSS2-ERG gene fusions, which are common in broader populations, were less prevalent in the PR H/L cohort. Conclusions: While this study contributes to the understanding of ethnicity-specific genetic factors in prostate cancer, underscoring the need for inclusive genomic studies, continued expansion to larger cohorts of patients under-represented in large genomic studies will be needed to more robustly characterize the full range of genomic features of prostate cancer. A broader understanding of the genomic features of prostate cancer in PR H/L men may lead to future opportunities for delivering more personalized prognoses and treatment options, helping to ensure that treatment advances and better outcomes are available to all patients.
We report the discovery of arboreal multi-species mammal latrines in montane cloud forests of Costa Rica. We surveyed 169 trees from 29 species. Canopy multi-species latrines were only found in 11 individuals of a single tree species, Ficus tuerckheimii. Camera traps recorded 17 mammal species and a total of 181 visits over 60 days, indicating that some vertebrates frequently visit canopy latrines. Among the most notable visitors was the two-toed sloth (Choloepus hoffmanni), a species long documented to descend to the ground exclusively to defecate. Our findings suggest that sloths may also use arboreal latrines, challenging a long-standing assumption in sloth ecology and raising new questions about the drivers of their defecation behavior. As with terrestrial latrines, canopy latrines may also play a role in interspecific communication, provide spatial cues, and affect nutrient dynamics in forest canopies. All these aspects highlight the potentially important role that Ficus tuerckheimii might have in these interaction points. Reportamos el descubrimiento de letrinas arbóreas de mamíferos de múltiples especies en los bosques nubosos montanos de Costa Rica. Se censaron 169 árboles de 29 especies. Las letrinas multi‐especie de dosel solo se encontraron en 11 individuos de una única especie de árbol, Ficus tuerckheimii. Las cámaras trampa registraron 17 especies de mamíferos y un total de 181 visitas en 60 días, lo que muestra que algunos vertebrados visitan frecuentemente las letrinas del dosel. Entre los visitantes más notables está el oso perezoso de dos dedos (Choloepus hoffmanni), una especie que durante mucho tiempo se ha documentado que desciende al suelo exclusivamente para defecar. Nuestros hallazgos sugieren que los perezosos también podrían utilizar letrinas arbóreas, lo que desafía una suposición de larga data en la ecología de la especie y plantea nuevas preguntas sobre los factores que impulsan su comportamiento de defecación. Al igual que las letrinas terrestres, las letrinas del dosel también pueden desempeñar un papel en la comunicación interespecífica, en las señales espaciales y, además, en la dinámica de nutrientes en los doseles forestales. Todos estos aspectos resaltan la importancia del rol que puede tener Ficus tuerckheimii en estos puntos de interacción.
Introduction Human immunodeficiency virus (HIV) remains a pressing global public health challenge, particularly in Puerto Rico, where prevalence rates outpace most U.S. jurisdictions. Despite advances in antiretroviral therapy (ART) and the availability of biomedical prevention strategies, such as pre-exposure prophylaxis (PrEP) and the Undetectable = Untransmittable (U=U) campaign, gaps in local knowledge persist among future healthcare providers. Methods A cross-sectional study was conducted at San Juan Bautista School of Medicine, Caguas, Puerto Rico, among first-year medical students. Participants completed a three-part anonymous online survey via REDCap, capturing demographics, general HIV knowledge using the validated HIV-KQ-18, and awareness of recent prevention concepts. Descriptive statistics were used to summarize sociodemographic variables and HIV knowledge. Sociodemographic predictors of HIV knowledge were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Results Eighty-two students participated, with a mean age of 23.4 years and 59.8% female. The mean HIV-KQ-18 score was 14.5 out of 18, reflecting moderate knowledge. Key deficits included awareness of PrEP (40.2% answered correctly) and understanding of the U=U campaign (53.7% answered correctly). Sociodemographic predictors of HIV knowledge included political views, gender, highest education level before beginning the MD program, location raised, religious beliefs, family household income, and living status. Conclusions Significant gaps in HIV prevention and transmission knowledge were identified among first-year medical students in Puerto Rico, underscoring a need for enhanced, culturally responsive educational initiatives focused on biomedical prevention and combating misinformation. These findings should inform targeted curricular reforms and public health outreach in similar high-prevalence regions.
This study updates the lethality (LD50) and venom yield data for Costa Rican snakes, including both Elapidae and Viperidae families, endemic species, and juveniles. Using CD-1 mice, the venom yields and LD50 values reveal notable differences from previous studies and highlights the impact of sex, age, and geographic origin on venom characteristics. These updated metrics are crucial for antivenom manufacturing, dosing algorithms, and understanding ontogenetic shifts in venom composition.
This study describes the epidemiological and clinical profile of ICU patients undergoing percutaneous tracheostomy in Costa Rica and identifies predictors of acute complications, addressing ongoing debates on timing, technique, and risk stratification. We performed a prospective multicenter cohort study in eight CCSS hospitals (2019-2022), including adult ICU patients undergoing percutaneous tracheostomy. Demographic, clinical, and procedural data were collected, and multivariable logistic regression identified predictors of complications. A total of 516 patients were analyzed (mean age 53.2 ± 16.3 years; 68.2% male). The main indications were anticipated prolonged ventilation (32.4%), neurological deficits (26.7%), and ventilation >10 days (21.8%). The Ciaglia and Griggs techniques were used in 51.0% and 48.3% of cases, respectively. Capnography was applied in 74.2%, ultrasound in 17.7%, and bronchoscopy in 3.1%. First-pass success was achieved in 85.1%. Acute complications occurred in 28.3% of patients, predominantly minor bleeding (25.4%), while serious complications (airway loss, false passage, or bleeding requiring surgery) were rare (3.9%). No procedure-related deaths were observed. Independent predictors of complications included anticoagulation (OR 2.82), obesity (OR 2.10), coagulopathy (OR 2.29), prior neck surgery (OR 3.49), cervical immobilization (OR 4.68), and technical difficulty (OR 4.15 for any complication; OR 2.00 for serious complications). Airway management by physicians, compared with respiratory therapists, was also associated with higher risk (OR 1.52). Percutaneous tracheostomy was feasible in multiple ICUs of the CCSS with complication rates comparable to international cohorts. Risk factors for complications included anticoagulation and prior neck surgery. Wider adoption of adjunctive monitoring tools and structured multidisciplinary training may further enhance procedural safety. These findings should be interpreted in the context of an observational design and a broad definition of complications.
In Puerto Rico (PR), lung cancer mortality remains high because diagnoses frequently occur at advanced stages. Although low-dose computed tomography (LDCT) lowers lung cancer-specific mortality, this screening is difficult to operationalize locally due to high false-positive rates, radiology capacity constraints, payer limitations, and geographic barriers affecting rural populations. We performed a narrative review on the literature from 2001-2026 of established and emerging detection strategies-LDCT; serum biomarkers (CEA, CYFRA-21-1, NSE, ProGRP, SCC-Ag, HE4, Hp, TAAb); breath analysis (FeNO and VOCs); and liquid biopsy (ctDNAs/CTCs/miRNAs). We assessed technical performance, feasibility, and health-system fit in PR and then synthesized these findings into an implementable biomarker-first triage workflow for are. Multiplex serum panels analyzed with machine learning outperform single markers and TAAb provide high specificity with biological lead time, supporting their use as a triage gateway before LDCT. Breathomics is also feasible at the point of care. Liquid biopsy has modest sensitivity in very-early disease yet provides molecular adjudication for indeterminate nodules. A stepwise pathway-expanded risk assessment, integrated multi-panel testing in primary care, LDCT reserved for biomarker-positive individuals, and liquid biopsy when imaging is inconclusive-can enrich pre-test probability, reduce unnecessary scans, align with capitation, and protect limited radiology capacity. An integrated, non-invasive, biomarker-first triage model offers a pragmatic, equitable route to earlier lung cancer detection in PR and resource stewardship, while reducing disparities.
Increased waist-hip ratio (WHR) increases free fatty acid (FFA) flux, contributing to dysglycemia and dyslipidemia in Europeans. We examined these phenomena in non-Europeans, a group with higher prevalence of metabolic disease. We undertook sex-stratified analyses of WHR, body composition, HbA1c, lipids and total FFA in people without diabetes (Males: 153,613, Females: 193,574) of European (E, N = 333,465), African (A, N = 2040), African American (AA, N = 2808), South Asian (SA, N = 5121), East Asian (EA, N = 1374), Asian-Pacific Islander (API, N = 570) and Latin American 1 (LA-1, Puerto Rican and Dominican, N = 1400) and Latin American 2 (LA-2, Mexican and Mexican American, N = 409) ancestry as defined by genetic data in the UK Biobank. Sex-matched Es were the comparator group for all analyses. After adjustment for WHR, socioeconomic status, smoking, alcohol use, physical activity and menopause status in females, all groups except LA-2 males had significantly higher HbA1c (p < 2E - 3). Increased FFA and dyslipidemia was only seen in EA and API males but not females. SA males and females had dyslipidemia with no increase in FFA. A and AA males and females had lower FFA and improved lipids, while no significant differences were seen in lipid parameters amongst LA-1 males and females and LA-2 females compared to Es. Dysglycemia is seen in most non-E ancestries after adjustment for WHR and does not always associate with increased FFA and dyslipidemia. This indicates that factors beyond body composition and lipid flux may contribute to metabolic disease in non-Es.
Because cultural values are believed to shape the identities, attitudes, and behaviors of societies, the study of Latine cultural values holds a prominent place in Latine psychology. However, it is important to examine how the cultural values ascribed to Latine communities reflect their interaction with the sociohistorical and sociopolitical contexts Latines inhabit. Guided by a critical consciousness lens, the present study analyzed the values that recent Puerto Rican immigrants identified and deemed representative of Puerto Rican culture and society. Results from a reflexive thematic analysis with 19 Puerto Rican immigrants living in Florida and Arizona showed that participants ascribed a different set of cultural values to Puerto Ricans in the archipelago and Puerto Ricans in the U.S. diaspora. While the values of alegría, lucha, hospitalidad, and respeto were assigned to Puerto Ricans in Puerto Rico and those who have migrated to the United States, the values of dependencia and conformismo were attributed to Puerto Ricans in the archipelago. We then used a critical consciousness lens to examine how these cultural values are (a) influenced by colonial dynamics or (b) reflect resistance to or survival of those dynamics. These findings highlight the need to examine how cultural values should be understood and interpreted as responses to sociopolitical and historical processes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).