Drug injection is an increasingly important risk factor in the transmission of blood-borne pathogens, including the hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The purpose of the study was to examine the influence of social network factors on HCV and HIV. The study was grounded in social network theory and sought to determine whether social network characteristics affect high-risk sexual and drug injection behavior as well as self-reported HIV and HCV status. The study design was a quantitative cross-sectional survey. A total of 181 participants in a needle exchange program completed a survey in Spanish assessing individual drug and sex risk practices as well as gathering information to describe the characteristics of participants' personal networks from an egocentric perspective. General estimating equation techniques were used to analyze the data. Results showed that only social network size was related to risky sexual behavior. Injecting risk behaviors were only impacted by personal network exposures, measured by the average number of years network members had injected. HIV self-reported serum status was correlated with trust, closeness, and number of family members named among the closest 5 network members. Last, HCV self-reported serum status was only related to the years that network members had been injecting drugs. This study has implications for positive social change in that public health practitioners may gain a better understanding of the social network characteristics associated with high-risk behaviors of those infected with HCV and HIV in order to develop health promotion programs to lower infections and mortality.

Alzheimer's disease (AD) is associated with substantial healthcare utilization costs, resulting in a public health priority. In this study, the relationship between the demographic characteristics of age, gender, and type of health insurance; the presence of comorbidities of older Puerto Rican residents diagnosed with AD; and their healthcare utilization patterns (i.e., medical office and emergency room visits and hospital admissions) was examined using Andersen's behavioral model. Data from the 2013 Puerto Rico Health Study was used in this retrospective cohort design study. All AD cases aged -?¥ 60 years were extracted using systematic random sampling. One-way ANOVA-WELCH, Mann-Whitney U test, and negative binomial regressions determined if there was a relationship between independent and dependent variables. Results indicated a statistically significant relationship between age, gender, health insurance type, and presence of comorbidities factors and healthcare utilization patterns among older Puerto Ricans with AD. From the results, opportunities were identified for further research and changes in professional practices in order to initiate discussions and action plans to improve services coordination for older Puerto Ricans with AD. Findings might impact social change by inspiring modifications to the public health infrastructure. These modifications may lead to enhanced disease management support, promoted social justice, and increased resources to improve healthcare access and quality of care, and overall enhancement of health outcomes, for Puerto Ricans living with AD.

No description available.

PURPOSE: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. METHOD: Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. RESULTS: Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). CONCLUSIONS: These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.

I determined abundance, movement and activity patterns of the Red-tailed Hawk (Buteo jamaicensis jamaicensis, RTHA) in Río Abajo Forest, Puerto Rico and surrounding lands during 2003-2004. Captive-reared Puerto Rican Parrots (Amazona vittata, PRPA) are scheduled for release in Rio Abajo Forest in 2006. Annual density of RTHAs (0.90 RTHAs/km2) was similar to the Caribbean National Forest (CNF; 1.29 RTHAs/ km2). RTHAs annual survival was high (0.89), and birds maintained compressed territories around the Rio Abajo Forest. Home ranges were 91% smaller than estimates reported for CNF, yet similar to those in North America. Approximately 98.3% of RTHA locations occurred outside the Río Abajo Forest boundaries. RTHAs exhibited random macrohabitat use patterns in north-central Puerto Rico. However, within their home ranges, RTHAs selected fragmented habitats with high patch and edge density, and avoided large tracts of dense closed canopy forest. Encounters between RTHAs and PRPAs may increase as parrots venture beyond the boundaries of Rio Abajo Forest.

No description available.

Puerto Rican adolescent ego identity development was studied within the frameworks of Erikson's psychosocial theory and Heller's conceptualization of familism. Ego identity was measured by the Revised Version of the Extended Objective Measure of Ego Identity Status-2, an instrument based on Erikson's theoretical formulations. The Heller's Familism Scale was utilized to measure familism. It was hypothesized that there is a relationship between familism and the four identity statuses: achievement, moratorium, foreclosure, and diffusion. It was also hypothesized that familism, gender, age, parent's education and occupation, and number of years living in the United States mainland affect an individual's identity status. There were two sample groups; one living in Puerto Rico (n= 180), and one living in Florida (n= 107). Correlations and multiple regression analyses were utilized to test the hypotheses of this study. The regression analysis showed that the independent variables, age, parental level of education, familism, and, for the immigrant group, number of years living in the United States mainland help explain the variance in some of the statuses scores. Some of the variance in the achievement scores can be explained by the independent variables for immigrant male and female adolescents. The independent variables helped explain the variance in the moratorium scores of the male adolescents living in Puerto Rico, and both male and female immigrant adolescents. The variance in foreclosure scores could only be explained by the independent variables when the subjects were female immigrant adolescents. Finally, the independent variables helped explain the variance in the diffusion scores for the female subjects, regardless of sample group. An analysis of variance revealed a main effect for gender in achievement scores, and diffusion scores. ANOVA also revealed a Significant difference among the subject groups diffusion scores. ANOVA identified a significant interaction between gender and sample group for the foreclosure status. Furthermore, ANOVA revealed a significant difference between male and female foreclosure scores. Also, ANOVA revealed a significant difference between sample groups. Because the independent variables explain only a small percentage of the variance in the four ego identity status scores, caution should be exercised in arriving at conclusions about the relative importance of the independent variables on ego identity. / Ph. D.

This work asserts that bureaucratic organization is not only an inevitable part of the modern administrative state, but that a high quality bureaucracy within a strongly empowered executive branch is an ideal mechanism for running government in the modern era. Beginning with a philosophical inquiry into the purpose of American government as we understand it today, this paper responds to criticisms of the role of expanded government and develops a framework for evaluating the quality of differing government structures. Following an evaluation of the current debate surrounding bureaucracies (from both proponents and critics), this thesis outlines the lessons and principles for structuring and managing an efficient bureaucracy. Finally, this paper concludes with two case studies – Puerto Rican bureaucratic failures and Japanese/Chinese national development – to consider the effects of compliance and non-compliance to the lessons outlined in this work. The inquiry finds that principles such as specialization, political autonomy, effective information systems, higher accountability standards, and managerial emphasis on policy implementation are all critical to superior bureaucratic governance.

Active asthma and asthma-related health care utilization are higher among adult females than they are among adult males in Puerto Rico. The purpose of this study was to examine the determinants of the risk of active asthma and associated health care utilization and asthma control among women in Puerto Rico. Guided by the Andersen behavioral model, the study included data from the Asthma Call-Back Survey (ACBS) during 2011 and 2012 in Puerto Rico. The associations between active asthma and behavioral, demographic, and environmental factors were assessed using logistic regression. The relationship between asthma-related health care utilization and predisposing, enabling, and need factors was examined using multiple linear regression. The association between achieved level of asthma control and asthma-related healthcare utilization was investigated using multinomial logistic regression. Results of the logistic regression indicated that being out of work, being in a middle income category, and being obese significantly increased the odds of active asthma. Being self-employed and being in the income category of $15,000-$25,000 significantly predicted the frequency of emergency room visits (ERVs). Results of the multinomial logistic regression indicated that physician urgent visit and ERV were significantly associated with poorly controlled asthma symptoms. The positive social change implication of these findings is that the identified risk factors can be used to develop asthma management plans to prevent and control asthma attacks in at-risk populations and reduce asthma-related health care utilization cost

Juan Francisco Acosta (1890-1968) was a prolific composer, band conductor, and educator from Puerto Rico who created 1,256 original compositions. Even though his activities and influence were integral to the musical life of Puerto Rico in the twentieth century, many details of his life and works remain unknown. This project centers on Acosta’s contribution to the Puerto Rican tradition of the danza—a dance-based genre originating in the nineteenth century—through the study and arrangement of five of Acosta's danzas. Although Acosta composed most danzas for piano, he adapted them for performances by the municipal bands that he led in various towns. This practice of modifying his works for different instruments, as well as the importance of the guitar in Latin America, underpins the author’s choice to arrange his piano music for varied types of guitar combinations, including solo, duo, trio, and quartet. The five works are Bajo la sombra de un pino, Mercedes, Eres una santa, Dulce María, and In memoriam. The guitar arrangements of these five danzas are preceded by important information on the composer within the Puerto Rican music world, with emphasis on the intersections of the band and danza traditions. To enhance the study of these works, this document discusses basic stylistic features, including a comparison of forms, rhythms, and dance characters, and relates Acosta's treatment of the danza puertorriqueña to approaches of his Puerto Rican contemporaries. This document also includes performance guidelines to introduce Acosta's danza style to student and professional players. Based on primary biographical and musical sources, this study presents a foundation for a clearer understanding of the life and works of Acosta upon which further research, analysis, and criticism can be conducted. The arrangements offer a fresh look at new guitar repertoire using the peculiarities of rhythms and traditions of Puerto Rican and Carribean heritage. The arrangements also serve a pedagogical purpose by adding to the existing repertoire of ensemble music for the classical guitar.