Search Results (134)

Background/Objectives: The median nerve exhibits clinically relevant anatomical variability, with critical implications for surgical exposure, regional anesthesia, peripheral nerve repair, and diagnostic imaging. Despite extensive descriptive reports, quantitative morphometric analyses incorporating biological sex and donor record population classification remain limited, particularly among Hispanic cadaveric cohorts. Methods: This multi-institutional cadaveric study evaluated median nerve formation and segmental morphometry in 82 anatomical donors, each contributing paired bilateral upper limbs (164 upper limbs total), classified in institutional records as Puerto Rican, Caucasian, or African American. Standardized dissections were performed from the brachial plexus to the distal forearm, and linear measurements were obtained between predefined anatomical landmarks using digital calipers. Results: Mixed-effects modeling was used to evaluate morphometric differences associated with biological sex, donor record population classification, and anatomical location. Male specimens demonstrated localized differences in proximal median nerve formation, including a longer medial cord contribution on the left side. Population group comparisons identified greater measured morphometric distances in the Puerto Rican cohort compared with Caucasian and African American cohorts. Normalized LEH/MEH ratios did not differ between sexes, suggesting that some absolute differences may reflect limb-size scaling rather than proportional shifts in nerve position. Conclusions: These findings provide standardized landmark-based morphometric data and support the value of population-sensitive anatomical reference data for surgical planning and imaging-based interpretations of median nerve morphology. Full article

Background: Overweight and obesity remain major public health challenges in Puerto Rico, affecting over 70% of adults and contributing to cardiovascular, metabolic, and mental health disorders. This study explores the psychosocial and behavioral factors influencing obesity within low-income Puerto Rican communities, emphasizing both biological sex differences and socially defined sex-role influences, along with their respective mental health dimensions. Method: Using a qualitative approach, Community-Based Participatory Research (CBPR), ten focus groups were conducted with 71 participants (37 women and 34 men) from two municipalities in southern Puerto Rico. Discussions were analyzed thematically with the Socioecological and Health Belief Models to identify key determinants. Results: The data collected revealed that women expressed greater emotional vulnerability, frequently citing anxiety, depression, body image concerns, and stress-related eating as contributors to obesity. Men, meanwhile, reported frustration with diet adherence, economic limitations, and healthcare inaccessibility. Across participants, economic hardship, cultural norms, and limited health education emerged as major obstacles. Conclusions: Findings underscore the need for holistic, sex-informed and socially responsive interventions that integrate mental health support with nutritional and physical health strategies. Addressing self-esteem, emotional regulation, and stress management alongside behavioral modification can promote sustainable, culturally tailored obesity prevention in Puerto Rico. Full article

The harms associated with substance use continue to disproportionately affect marginalized populations. This study presents a retrospective program evaluation of a mobile health unit that delivers integrated clinical and harm reduction services to marginalized populations in Eastern Puerto Rico. Methods: A secondary data analysis was conducted using administrative data from a mobile health unit, capturing client encounters, service utilization (e.g., mental health support, health screenings, safe injection counseling, and case management), visit frequency, and demographic characteristics. This study is framed as an implementation-focused program evaluation. Descriptive and exploratory analyses were conducted to assess service delivery, program reach, utilization patterns, and selected program outcomes over a 1.5-year period. Results: Between January 2022 and October 2023, the mobile health unit served 279 participants across eight municipalities. Participants exhibited higher rates of intravenous drug use, mental health disorders, homelessness, and incarceration history compared with previously published estimates for the general Puerto Rican population, although these comparisons are indirect. The program delivered multidisciplinary services and facilitated referrals addressing key social determinants of health, including housing, nutritional assistance, identification services, in-patient treatment, and medication-assisted treatment. Model-based estimates using the Mobile Health Map Impact Tracker tool suggest that, in 2023, mobile health screenings may be associated with a return on investment of approximately 6:1, 259 avoided emergency department visits, 29 life-years saved, and approximately USD 2.4 million in healthcare cost savings. Conclusions: This evaluation demonstrates the feasibility of a mobile health model integrating harm reduction and clinical services to reach highly marginalized populations and facilitate connections to health and social services. Findings reflect program implementation, service reach, and engagement rather than causal effectiveness. Mobile health approaches may represent a feasible and potentially beneficial strategy for expanding access to care, although further research incorporating patient-level outcomes is needed to assess effectiveness. Full article

Background/Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. Full article

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. Full article

This qualitative study examines the language ideologies surrounding code-switching and Puerto Rican Spanish among Puerto Rican bilingual speakers in Massachusetts, focusing on how these ideologies interact with identity construction in the diaspora. Participants in this study commonly described their own language use as Spanglish, emphasizing both its practical role in everyday communication and its significance as a marker of cultural and linguistic identity. Drawing on data collected through sociolinguistic interviews and focus groups, this research explores how participants perceive code-switching not only as a communicative strategy but also as a meaningful expression of Puerto Rican identity. Although negative ideologies persist–framing code-switching as linguistic inadequacy–this study centers on how speakers actively negotiate and redefine these views within their communities. Puerto Rican Spanish, shaped by historical contact with English and sociopolitical ties to the U.S., offers a unique lens through which to explore these dynamics. The findings also suggest that media representations, particularly through music genres such as reggaetón, contribute to shaping and reflecting language ideologies. By centering on speakers’ voices, this paper contributes to understanding how language ideologies form and are shaped by bilingual practices, and how code-switching functions as a form of linguistic citizenship in the Puerto Rican diaspora. Full article

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. Full article

Background: Cardiometabolic risk (CMR), including obesity, dyslipidemia, hypertension, and impaired glucose regulation, disproportionately affects Hispanic/Latinx adults in the United States (U.S.). Although plant-forward dietary patterns are established as cardioprotective, less is known about how dietary patterns within Hispanic/Latinx subgroups relate to CMR. Methods: A narrative review was conducted of observational studies among U.S. Hispanic/Latinx adults (≥18 years) examining defined dietary patterns (a priori, a posteriori, or hybrid) in relation to CMR outcomes (e.g., BMI, waist circumference, blood pressure, glucose, lipids). Risk of bias was assessed using an adapted version of the Newcastle–Ottawa Scale. Results: Ten studies met the inclusion criteria, including Seventh-day Adventist Latinx, Puerto Rican adults, Mexican American adults, Hispanic women, and a national Hispanic cohort. Plant-forward dietary patterns were associated with lower BMI and waist circumference, lower triglycerides and fasting glucose, and higher HDL-C. In contrast, energy-dense patterns characterized by refined grains, added sugars, processed meats, fried foods, solid fats, and sugar-sweetened beverages were associated with greater adiposity, poorer lipid profiles, and higher blood pressure. Traditional rice-and-beans–based patterns observed in Puerto Rican and Mexican American groups were associated with central adiposity and higher metabolic syndrome prevalence, despite modestly higher intakes of fruits, vegetables, and fiber. Study quality ranged from good (n = 4) to very good (n = 6). Conclusions: Across Hispanic/Latinx subgroups, plant-forward dietary patterns were associated with favorable cardiometabolic profiles, whereas refined and animal-based patterns aligned with higher CMR. Given the predominance of cross-sectional evidence, these findings should be interpreted as associative rather than causal. Culturally grounded dietary counseling, along with additional longitudinal and intervention studies, is needed to support cardiometabolic health in these populations. Full article

Background/Objective: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) lacking targeted therapies and characterized by high tumor heterogeneity. In this study, we evaluated the anticancer activity and mechanistic profile of Simalikalactone D (SKD), a quassinoid compound derived from the endemic Puerto Rican tree Simarouba tulae, in three TNBC cell lines, MDA-MB-468, MDA-MB-231, and SUM-149. Methods: MDA-MB-468, MDA-MB-231 and SUM-149 TNBC cells were evaluated for cell viability, proliferation and migration following SKD treatment. Phospho-antibody array, proteomics, and Western blot analyses were used to explore the SKD mechanism of action in MDA-MB-468 and MDA-MB-231 cell lines. Molecular docking was performed to assess SKD’s interaction with potential intracellular targets. Results: SKD exerted a concentration-dependent effect on the three cell lines. However, MDA-MB-468 cells exhibited an IC₅₀ of 67 nM, while the IC₅₀ values for MDA-MB-231 and SUM-149 were 422 nM and 598 nM, respectively. In MDA-MB-468 cells, 100 nM of SKD induced apoptosis, evidenced by the activated caspase-3 activity, PARP-1 cleavage and decrease in Bcl-2 and survivin protein levels. Sublethal SKD (25 nM) impaired migration in MDA-MB-231 cells and reduced proliferation and motility in SUM149 cells. A 6 h SKD treatment markedly reduced phosphorylation of apoptosis-related proteins (p53, BAD, DAXX, AKT1, JUN) and Jak/STAT pathway components, indicating early disruption of intracellular signaling prior to phenotypic changes. Proteomic profiling showed distinct pathway alterations in both MDA-MB-468 and MDA-MB-231 cells, with reduced Integrin β1 (ITGB1) levels emerging as a shared effector. This suggests that SKD broadly disrupts cell adhesion and migration independently of apoptosis-driven cell death. Western blot validation confirmed reduced ITGB1 protein levels across all three TNBC cell lines examined. In silico docking confirmed favorable binding affinities of SKD to both EGFR (ΔG = −6.718 kcal/mol) and STAT4 (ΔG = −8.481 kcal/mol). Conclusions: Overall, our findings suggest that SKD is a potent anticancer agent in a subgroup of TNBC cells. Full article

Background/Objectives: Prostate cancer (PCa) has the highest incidence and mortality rates among men in Puerto Rico. However, screening and early detection programs remain limited and fragmented. This study presents the design and implementation of a community-based educational program to increase PCa screening and knowledge in three southeastern rural communities with high African ancestry and elevated PCa mortality. Methods: Conducted between 2021 and 2025, this mixed-method study followed Community Engagement principles and was guided by the Intervention Mapping framework. A Community Advisory Committee informed each step of the intervention, which included PSA and digital rectal examination (DRE) testing via a mobile clinic staffed by urologists. Pre- and post-tests measured knowledge gains and willingness to screen, while satisfaction surveys evaluated the program’s impact. Results: After the intervention, knowledge scores increased significantly (t = −5.5, p < 0.001), and 76% of participants reported greater confidence in making health decisions. In total, 95 men accessed screening services through a mobile clinic, 33 were referred for follow-up, and 4 PCa cases were detected. Conclusions: Combining culturally tailored education with accessible screening helped overcome sociocultural and structural barriers, showing promise for reducing PCa disparities in underserved Puerto Rican populations. Full article

Background: Obesity is a leading cause of type 2 diabetes (T2D), with particularly high prevalence in Hispanic populations residing in the USA. However, how genetic variation influences obesity-related blood metabolite levels which, in turn, contribute to T2D progression, is not well understood. Our goal was to identify and understand genetic and dietary connections between obesity and T2D in a Hispanic cohort of older adults. Materials and Methods: We conducted a genome-wide association study on 13 specific metabolites previously associated with T2D and characteristic of individuals with abdominal obesity within the Boston Puerto Rican Health Study cohort. We further examined associations of identified metabolite quantitative trait loci (mQTLs) and their interactions with targeted dietary factors on T2D prevalence and related traits. We used gene set and pathway analysis with protein–protein interaction networks to explore the molecular mechanisms underlying the metabolic connections between obesity and T2D. Results: We identified 30 single-nucleotide polymorphisms (SNPs) acting as mQTLs for these 13 metabolites. These mQTLs were located within 19 gene regions, associated with processes such as linoleic acid metabolism, alpha-linolenic acid metabolism, and glycerophospholipid biosynthesis. Although no mQTLs were directly associated with T2D or related traits, 12 demonstrated interactions with certain food groups that affect T2D risk. Moreover, gene set and pathway analysis with protein–protein interaction networks indicated that alpha-linolenic acid metabolism, lipid metabolism, and glycerophospholipid biosynthesis and metabolism among other pathways are potential connections between T2D and obesity. Conclusions: This study identifies biochemical relationships between genetic susceptibility and dietary influences, contributing to our understanding of T2D progression in Hispanic people with obesity. Full article

Background/Objectives: Laboratory tests are a cornerstone of modern medicine, and their interpretation depends on reference intervals (RIs) that define expected values in healthy populations. Standard RIs are obtained in cohort studies that are costly and time-consuming and typically do not account for demographic factors such as age, sex, and ethnicity that strongly influence biomarker distributions. This study establishes a data-driven approach for deriving RIs directly from routinely collected laboratory results. Methods: Multidimensional joint distributions of lipid biomarkers were estimated from large-scale real-world laboratory data from the Puerto Rican population using a Gaussian Mixture Model (GMM). GMM and additional statistical analyses were used to enable separation of healthy and pathological subpopulations and exclude the influence of comorbidities all without the use of diagnostic codes. Selective mortality patterns were examined to explain counterintuitive age trends in lipid values while comorbidity implication networks were constructed to characterize interdependencies between conditions. Results: The approach yielded sex- and age-stratified RIs for lipid panel biomarkers estimated from the inferred distributions (total cholesterol, LDL, HDL, triglycerides). Apparent improvements in biomarker profiles after midlife were explained by selective survival. Comorbidities exerted pronounced effects on the 95% ranges, with their broader influence captured through network analysis. Beyond fixed limits, the method yields full distributions, allowing each individual result to be mapped to a percentile and interpreted as a continuous measure of risk. Conclusions: Population-specific and sex- and age-segmented RIs can be derived from real-world laboratory data without recruiting healthy cohorts. Incorporating selective mortality effects and comorbidity networks provides additional insight into population health dynamics. Full article

Hispanic populations in the U.S. have a high prevalence of type 2 diabetes and its complications. It has been proposed that interventions targeting multiple levels and domains of influence are needed to address health disparities, but more evidence is needed regarding the most effective approaches. We aimed to review the effects of non-pharmacological interventions on glycemic control among Hispanic persons with diabetes, overall and by level and domain of intervention. A systematic review (PubMed, Scopus, PsycInfo, CINAHL; 1985–2019) identified randomized trials reporting HbA1c outcomes for Hispanic populations. Article review, data extraction, and risk of bias assessment were completed by independent reviewers. Level and domain of intervention were assigned based on the National Institute on Minority Health and Health Disparities Research Framework. Random-effects meta-analyses estimated pooled effect sizes. Quality of evidence was rated based on the GRADE framework. Forty-eight trials met inclusion criteria, representing various Hispanic populations (n = 18 Mexican, n = 5 Puerto Rican, n = 1 Dominican, n = 4 multiple, n = 20 unspecified) and enrolling 9185 total participants. Overall, interventions decreased HbA1c by −0.32% (95% CI: −0.44% to −0.20%, I² = 68%, strength of evidence: moderate). Multi-level, multi-domain interventions decreased HbA1c by −0.41% (−0.61% to −0.21%, I² = 74%, strength of evidence: moderate). Few interventions addressed community (n = 3), society (n = 0), or physical/built environment (n = 1). Non-pharmacological interventions have modestly decreased HbA1c among Hispanic persons with diabetes. Multi-level, multi-domain interventions are promising, but more research is needed on interventions that target social and environmental structures. Full article

Infants born to mothers who self-identify as Hispanic account for a substantial and growing share of births in the United States, yet limited research has examined disparities in birth outcomes across Hispanic origin subgroups. This study aims to document trends and identify important factors associated with Cesarean section (C-section), low birthweight, and prematurity within the Hispanic population. We use data from the National Vital Statistics System (2011–2021), covering nearly all U.S. births. We compare outcomes across Hispanic, non-Hispanic White, and non-Hispanic Black mothers and further disaggregate by Hispanic origin (Mexican, Puerto Rican, Cuban, Central/South American, and Other/Unknown). We use logistic regression and classification tree models to assess associations between maternal, infant, and clinical factors and birth outcomes. We find that Hispanic mothers have birth outcomes similar to non-Hispanic Whites and better than non-Hispanic Blacks. However, prematurity rates among Hispanics have slightly increased over time. Mexican mothers exhibit the most favorable outcomes, while Cuban mothers show higher rates of C-section, and Puerto Rican mothers show higher rates of low birthweight and prematurity. Logistic regression results highlight multiple births, breech presentation, and hypertensive conditions as important factors associated with adverse birth outcomes. Our biomedical approach emphasizes physiological and clinical risk factors such as multiple births, breech presentation, hypertensive conditions, and obesity. In parallel, our biosocial analysis incorporates demographic, socioeconomic, and behavioral variables to contextualize how social determinants interact with biology to influence outcomes. Complementing these findings, our classification tree analysis identifies inadequate gestational weight gain (less than 15 pounds) as a prominent risk factor for both low birthweight and prematurity. Additionally, obesity emerges as a significant factor linked to an increased likelihood of C-section. While birth outcomes among Hispanic mothers are generally favorable, subgroup differences and emerging disparities highlight the need for disaggregated research and culturally tailored public health interventions. Full article

This study investigates how second language (L2) learners of Spanish identify the regional origin of native Spanish speakers and whether specific phonetic cues predict dialect identification accuracy across proficiency levels. Situated within a growing body of work on sociolinguistic competence, this research addresses the development of learners’ ability to use linguistic forms not only for communication but also for social interpretation. A dialect identification task was administered to 111 American English-speaking learners of Spanish and 19 native Spanish speakers. Participants heard sentence-length stimuli targeting regional phonetic features and selected the speaker’s country of origin. While L2 learners were able to identify regional dialects above chance, accuracy was low and significantly below that of native speakers. Higher-proficiency learners demonstrated improved identification, especially for speakers from Spain and Argentina, and relied more on salient phonetic cues (e.g., [θ], [ʃ]). No significant development was found for identification of Mexican or Puerto Rican varieties. Unlike native speakers, L2 learners did not show sensitivity to broader macrodialect groupings; instead, they frequently defaulted to high-exposure varieties (e.g., Spain, Mexico) regardless of the phonetic cues present. Findings suggest that sociophonetic perception in L2 Spanish develops gradually and unevenly, shaped by cue salience and exposure. Full article