RESUMENES

The implementation of Second Step, a school-based youth violence prevention curriculum with elementary students in PR. B. Mirabal, Dept. of Pediatrics, UPR School of Medicine, Vélez, CN, Dept of Biostatistics and Epidemiology, UPR School of Public Health, Rodríguez-Frau M, Dept. of Undergraduate Health Education, M. Méndez, UPR College of Health Related Professions

Youth violence is a serious public health problem. Homicides are the first cause of death for youth over 15 years of age in PR, particularly in males 20-29 years old; over 90% of these deaths are associated to firearms. Effective, culturally appropriate youth violence prevention interventions are needed which can be implemented early in the child’s development. The UPR Center for Hispanic Youth Violence Prevention culturally adapted Second Step, a Youth Violence Prevention Curriculum found effective in the US. A cognitive-behavioral curricular intervention, it teaches prosocial skills (empathy, impulse control & anger management). Teachers were trained to serve as session facilitators. The instruments were revised and pilot tested prior to the intervention. The intervention was implemented in 4 public elementary schools in a high risk community in PR. It consisted of 35 sessions of 45 minutes duration, during the 2004 - 2005 school year. A total of 143 third grade students participated in the study; 91 were in the experimental group and 52 served as controls. Several measures were used: pre and post tests, observations of student prosocial and antisocial behaviors by trained observers, and teacher interviews. Multivariate analyses were conducted. The pre and post test results, controlling for gender, showed that students in the experimental group (EG) acquired all three prosocial skills. An increase in the empathy score was observed for both males and females, while the impulse control score increased only in males. Anger management scores also increased. The study was supported by funds from the CDC.

Use of the Internet by Physicians in Puerto Rico. J.G. Quijada, F. Hernández, H.A. Monsanto. Merck Sharp and Dohme (I.A.) Corp., Carolina, Puerto Rico.

The objective of this study was to determine the extent of use of the Internet by physicians to support their clinical practice. Personal interviews were conducted between January and February, 2005 among a representative sample of 385 physicians from different specialties and geographical regions in Puerto Rico. Eighty-one percent reported using the Internet. Rheumatologists, Endocrinologists and Cardiologists were the specialties with the highest usage rate. Internet use decreased as age increased. Geographic variations were observed; metropolitan area physicians were more likely to use the Internet when compared to their counterparts from outside the metropolitan area (81% vs. 74%). The top reasons for not using the Internet were “not interested”, “lack of time”, and “too difficult”. The great majority of those who use the Internet do it from home (81%) followed by the office (68%). Almost two-thirds use dial-up to connect to the Internet at home or the office. The main reasons for using the Internet was “professional” (95%), followed by “personal” (89%) and for administrative purposes (46%). Those who use it for professional purposes do it to look for references (92%), to communicate with colleagues (33%) and to obtain continuing education (31%). The principal benefits perceived by the respondents from accessing the Internet were “current information” (47%) and “fast access” (27%). The sites that respondents visit more often for professional purposes are Merck Medicus (73%), JAMA (61%) and WebMD (59%).

Correlation of Aminoglycosides Pharmacokinetics with Severity of Disease in Critically Ill Patients. A. Perez1, D.F. Dexter1, J. Bertran-Pasarell2, H.M. Guiot2, M. Gonzalez-Ramos2, Rafael Garcia MPH3. 1Pulmonary Disease Section, Department of Medicine, UPR School of Medicine; 2Infectious Diseases Section, Department of Medicine, UPR School of Medicine; 3UPR School of Pharmacy.

Introduction: Aminoglycosides still have an important role in the treatment of infections in critically ill patients. Studies suggest that the volume of distribution (Vd) of aminoglycosides in critically ill patients is increased. Therefore, in critically ill patients with increased Vd usual doses may result in sub-therapeutic serum concentrations.

Objective: To evaluate the correlation between pharmacokinetic parameters of aminoglycosides and severity of illness of patients in critical state by analyzing the Sequential Organ Failure Assessment (SOFA) scoring system as a covariant of pharmacokinetic parameters of aminoglycosides. The presumption is that sicker patients (as indicated by higher SOFA score) have higher Vd.

Methods: This is a prospective, on-going, open label study conducted in ICU of UDH. Patients enrolled are 21 years or older, admitted to ICU, and requiring an aminoglycoside. Organ dysfunction is assessed using the SOFA score. A first serum aminoglycoside concentration sample (peak) is collected 30 minutes after the first dose infusion. A second sample is collected at approximately the dosing midpoint interval, while the third sample (through) is collected within 15 minutes prior to the scheduled second dose.

Results: Preliminary results suggest that pharmacokinetics of aminoglycosides in critically ill patients differ from the expected. In the 8 patients enrolled so far, SOFA score has ranged from 2 to 8. Importantly, in 4 of the 8 patients studied (50%), serum concentrations 30 minutes after first dose infusion (peak levels) did not achieve therapeutic levels.

Expectant Management vs. Intervention to Eliminate Macrosomic Fetuses in Diabetic Pregnancies. S. Schwarz, K.Adamsons, Department of Obstetrics and Gynecology, Medical Sciences Campus, University of Puerto Rico.

For 3 decades there has been a continuous search for a substance that accelerates fetal lung maturation as premature delivery has not decreased.In spite of initial conflicting reports, glucocorticoids(GC) has become the gold standard in antenatal treatment of prematurity except in Diabetic patients where it is considered detrimental to metabolic control. The use of thyroxin(T4)was initially seen in European Journals. Its use for 15 yrs. in our institution brought surprising observational results.After intra-amniotic injection of T4 in 98 patients in preterm labor the L/S ratio could be predicted to be mature within one week when it reached 1.6. A double blind random study of T4 and GC demonstrated a better outcome in fetuses given T4 at less then 31 wks. Improved care in NICU assures better outcome after 31 weeks. We present three groups of diabetic patients that were delivered after showing lung maturity at or before 36 wks. No Admissions to NICU,average weight was 1007 gms. less then a similiar group delivered after 37 wks.In this similiar group 44% of fetuses were above 90th percentile growth and one weighed 5028 gms.in spite of good metabolic control.Subsequent reports of 20 patients in 2002 and 34 in 2003 showed similiar results.In 2003 there was one case of shoulder dystocia in a fetus that weighed under 3000 gms at 35.3 wks. And thrombocytopenia in a fetus of 5057 gms. delivered by c/s at 35.3 weeks.

Skin Disease in HIV Positive Persons Living in Puerto Rico. D.M. Freytes, RN, MSN, C.M. Arroyo-Novoa, RN, MSN, M.I. Figueroa-Ramos, RN, MSN, R.B. Ruiz-Lebrón, RN, MSN, N.A. Stotts, RN, EdD, FAAN, and A. Busquets, MD, School of Nursing, SubGraduate Program, UPR-RCM, San Juan, Puerto Rico.