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Ruiz-Fons F, Acevedo P, Sobrino R, Vicente J, Fierro Y, Fernández-de-Mera IG. Sex-biased differences in the effects of host individual, host population and environmental traits driving tick parasitism in red deer. Front Cell Infect Microbiol 2013; 3:23. [PMID: 23819112 PMCID: PMC3694362 DOI: 10.3389/fcimb.2013.00023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 06/09/2013] [Indexed: 11/13/2022] Open
Abstract
The interactions between host individual, host population, and environmental factors modulate parasite abundance in a given host population. Since adult exophilic ticks are highly aggregated in red deer (Cervus elaphus) and this ungulate exhibits significant sexual size dimorphism, life history traits and segregation, we hypothesized that tick parasitism on males and hinds would be differentially influenced by each of these factors. To test the hypothesis, ticks from 306 red deer-182 males and 124 females-were collected during 7 years in a red deer population in south-central Spain. By using generalized linear models, with a negative binomial error distribution and a logarithmic link function, we modeled tick abundance on deer with 20 potential predictors. Three models were developed: one for red deer males, another for hinds, and one combining data for males and females and including "sex" as factor. Our rationale was that if tick burdens on males and hinds relate to the explanatory factors in a differential way, it is not possible to precisely and accurately predict the tick burden on one sex using the model fitted on the other sex, or with the model that combines data from both sexes. Our results showed that deer males were the primary target for ticks, the weight of each factor differed between sexes, and each sex specific model was not able to accurately predict burdens on the animals of the other sex. That is, results support for sex-biased differences. The higher weight of host individual and population factors in the model for males show that intrinsic deer factors more strongly explain tick burden than environmental host-seeking tick abundance. In contrast, environmental variables predominated in the models explaining tick burdens in hinds.
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Affiliation(s)
- Francisco Ruiz-Fons
- Animal Health and Biotechnology Group (SaBio), Spanish National Wildlife Research Institute (IREC CSIC-UCLM-JCCM) Ciudad Real, Spain.
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Gutiérrez-Guzmán AV, Vicente J, Sobrino R, Perez-Ramírez E, Llorente F, Höfle U. Antibodies to West Nile virus and related flaviviruses in wild boar, red foxes and other mesomammals from Spain. Vet Microbiol 2012; 159:291-7. [DOI: 10.1016/j.vetmic.2012.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/11/2012] [Accepted: 04/12/2012] [Indexed: 11/29/2022]
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Sobrino R, Millán J, Oleaga A, Gortázar C, de la Fuente J, Ruiz-Fons F. Ecological preferences of exophilic and endophilic ticks (Acari: Ixodidae) parasitizing wild carnivores in the Iberian Peninsula. Vet Parasitol 2011; 184:248-57. [PMID: 21968201 DOI: 10.1016/j.vetpar.2011.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/26/2011] [Accepted: 09/05/2011] [Indexed: 11/28/2022]
Abstract
Ticks parasitizing wild carnivores and the tick-borne pathogens (TBPs) that they transmit may affect domestic carnivores and humans. Thus, investigating the role of wild carnivores as tick hosts is of relevance for understanding the life cycle of ticks in natural foci and the epidemiology of TBPs shared with domestic animals and humans. Therefore, the main objective of this study was to determine the ixodid tick fauna of wild carnivores in Peninsular Spain and the environmental factors driving the risk of wild carnivores to be parasitized by ixodid ticks. We hypothesized that the adaptation of tick species to differing climatic conditions may be reflected in a similar parasitization risk of wild carnivores by ticks between bioclimatic regions in our study area. To test this, we surveyed ixodid ticks in wild carnivores in oceanic, continental-Mediterranean, and thermo-Mediterranean bioclimatic regions of Peninsular Spain. We analyzed the influence of environmental factors on the risk of wild carnivores to be parasitized by ticks by performing logistic regression models. Models were separately performed for exophilic and endophilic ticks under the expected differing influence of environmental conditions on their life cycle. We found differences in the composition of the tick community parasitizing wild carnivores from different bioclimatic regions. Modelling results partially confirmed our null hypothesis because bioclimatic region was not a relevant factor influencing the risk of wild carnivores to be parasitized by exophilic ticks. Bioclimatic region was however a factor driving the risk of wild carnivores to be parasitized by endophilic ticks. Spanish wild carnivores are hosts to a relevant number of tick species, some of them being potential vectors of pathogens causing serious animal and human diseases. Information provided herein can be of help to understand tick ecology in Spanish wildlife, the epidemiology of tick-borne diseases, and to prevent the risks of TBPs for wildlife, domestic animals, and humans.
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Affiliation(s)
- Raquel Sobrino
- Università degli Studio di Torino, Facoltà di Medicina Veterinária, Dipartimento di Produzioni Animali, Epidemiologia ed Ecologia, Vía L. Da Vinci, 44, Grugliasco, Torino, Italy
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Sobrino R, Aurtenetxe O, Carta T, Mamian L, Gerrikagoitia X, Balseiro A, Oleaga A, Sevilla IA, Barral M, Garrido JM, Gortazar C. Lack of evidence of paratuberculosis in wild canids from Southwestern Europe. EUR J WILDLIFE RES 2011; 57:683-688. [PMID: 32214939 PMCID: PMC7088163 DOI: 10.1007/s10344-010-0490-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 12/16/2010] [Accepted: 12/19/2010] [Indexed: 11/04/2022]
Abstract
Wild carnivores are at the top of the trophic chain. They are predators and carrion consumers, and thus, prone to come in contact with disease agents contaminating the environment or infecting live or dead animals. We hypothesized that wild canids could be used as sentinels for the detection of regions with higher Mycobacterium avium paratuberculosis (MAP) prevalence in wild and domestic animals. To test this hypothesis, we set up an ELISA to test 262 wolf (Canis lupus) and fox (Vulpes vulpes) sera for MAP-specific antibodies and processed a subset of samples for culture (n = 61), MAP-specific PCR (15) and histopathology (14). In wolves, the optical density (OD) values in the ELISA were continuously distributed. Ten fox sera (4%) had OD readings of over twice the mean, suggesting contact with mycobacteria. However, all samples tested by PCR were negative for both IS900 and ISMAP02 sequences, and samples cultured for MAP yielded no growth. No visible paratuberculosis or tuberculosis-compatible lesions were recorded. On histopathological examination, no lesions compatible with mycobacterial diseases were observed. These results suggest that wild canids show little or no evidence of paratuberculosis and are unlikely to be useful sentinels for the detection of MAP in Southwestern Europe.
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Affiliation(s)
- Raquel Sobrino
- 1Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo s.n., 13071 Ciudad Real, Spain.,3Department of Animal Production, Epidemiology & Ecology, University of Turin, 10095 Grugliasco, Italy
| | - O Aurtenetxe
- 2Animal Health Department, NEIKER-Tecnalia, 48160 Derio Bizkaia, Spain
| | - Tania Carta
- 1Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo s.n., 13071 Ciudad Real, Spain
| | - L Mamian
- 1Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo s.n., 13071 Ciudad Real, Spain
| | - X Gerrikagoitia
- 2Animal Health Department, NEIKER-Tecnalia, 48160 Derio Bizkaia, Spain
| | - A Balseiro
- 4SERIDA, Centro de Biotecnología Animal, 33394 Deva-Gijón (Asturias), Spain
| | - A Oleaga
- 1Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo s.n., 13071 Ciudad Real, Spain.,4SERIDA, Centro de Biotecnología Animal, 33394 Deva-Gijón (Asturias), Spain
| | - I A Sevilla
- 2Animal Health Department, NEIKER-Tecnalia, 48160 Derio Bizkaia, Spain
| | - M Barral
- 2Animal Health Department, NEIKER-Tecnalia, 48160 Derio Bizkaia, Spain
| | - J M Garrido
- 2Animal Health Department, NEIKER-Tecnalia, 48160 Derio Bizkaia, Spain
| | - Christian Gortazar
- 1Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo s.n., 13071 Ciudad Real, Spain
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Sobrino R, Martín-Hernando MP, Vicente J, Aurtenetxe O, Garrido JM, Gortázar C. Bovine tuberculosis in a badger (Meles meles
) in Spain. Vet Rec 2008; 163:159-60. [DOI: 10.1136/vr.163.5.159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- R. Sobrino
- Instituto de Investigacíon en Recursos Cinegéticos (CSIC-UCLM-JCCM); Ronda de Toledo s/n 13071 Ciudad Real Spain
| | - M. P. Martín-Hernando
- Instituto de Investigacíon en Recursos Cinegéticos (CSIC-UCLM-JCCM); Ronda de Toledo s/n 13071 Ciudad Real Spain
| | - J. Vicente
- Instituto de Investigacíon en Recursos Cinegéticos (CSIC-UCLM-JCCM); Ronda de Toledo s/n 13071 Ciudad Real Spain
| | - O. Aurtenetxe
- NEIKER Instituto Vasco de I+D Agraria; Berreaga 1 48160 Derio Spain
| | - J. M. Garrido
- NEIKER Instituto Vasco de I+D Agraria; Berreaga 1 48160 Derio Spain
| | - C. Gortázar
- Instituto de Investigacíon en Recursos Cinegéticos (CSIC-UCLM-JCCM); Ronda de Toledo s/n 13071 Ciudad Real Spain
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Sobrino R, Ferroglio E, Oleaga A, Romano A, Millan J, Revilla M, Arnal M, Trisciuoglio A, Gortázar C. Characterization of widespread canine leishmaniasis among wild carnivores from Spain. Vet Parasitol 2008; 155:198-203. [DOI: 10.1016/j.vetpar.2008.05.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 04/19/2008] [Accepted: 05/06/2008] [Indexed: 10/22/2022]
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Affiliation(s)
- R Sobrino
- Instituto de Investigación en Recursos Cinegéticos , Ronda de Toledo, 13071 Ciudad Real, Spain
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Sobrino R, Arnal MC, Luco DF, Gortázar C. Prevalence of antibodies against canine distemper virus and canine parvovirus among foxes and wolves from Spain. Vet Microbiol 2008; 126:251-6. [PMID: 17646060 DOI: 10.1016/j.vetmic.2007.06.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 06/12/2007] [Accepted: 06/18/2007] [Indexed: 10/23/2022]
Abstract
Viral diseases can influence the population dynamics of wild carnivores and can have effects on carnivore conservation. Hence, a serologic survey was conducted in an opportunistic sample of 137 foxes (Vulpes vulpes) and 37 wolves (Canis lupus) in Spain for 1997-2007 to detect antibodies against canine distemper virus (CDV) and against canine parvovirus (CPV) by indirect ELISA. Antibodies against CDV were detected in 18.7% of the analyzed animals and antibodies against CPV in 17.2%. There was no difference in antibody prevalence to CDV between both species, even in the same region (P>0.05), but there was a significant difference in antibody prevalence to CPV between foxes (5.1%) and wolves (62.2%) (P<0.05). In fox populations there was a significant difference in antibody prevalence to CDV between geographic areas (Aragón 26.4%, La Mancha 7.8%, P<0.05). In wolf populations there was significantly higher antibody prevalence against CPV (P<0.05) in Castilla y León (100%) than in the Cantabric region (53.3%). There was no significant sex or age-related difference in the antibody prevalence against CDV or CPV in foxes. These results indicate that contact with CDV is widespread among wild canid populations in Spain and that CPV is endemic in the Iberian wolf population. The implications of these results are briefly discussed.
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Affiliation(s)
- R Sobrino
- IREC (CSIC, UCLM, JCCM), Ronda de Toledo s.n., 50013 Ciudad Real, Spain
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Sobrino R, Cabezón O, Millán J, Pabón M, Arnal MC, Luco DF, Gortázar C, Dubey JP, Almeria S. Seroprevalence of Toxoplasma gondii antibodies in wild carnivores from Spain. Vet Parasitol 2007; 148:187-92. [PMID: 17689869 DOI: 10.1016/j.vetpar.2007.06.038] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 06/12/2007] [Accepted: 06/27/2007] [Indexed: 11/18/2022]
Abstract
Serum samples from 282 wild carnivores from different regions of Spain were tested for antibodies to Toxoplasma gondii by the modified agglutination test using a cut-off value of 1:25. Antibodies to T. gondii were found in 22 of 27 (81.5%) of Iberian lynx (Lynx pardinus), 3 of 6 European wildcats (Felis silvestris), 66 of 102 (64.7%) red foxes (Vulpes vulpes), 15 of 32 (46.9%) wolves (Canis lupus), 26 of 37 (70.3%) Eurasian badgers (Meles meles), 17 of 20 (85.0%) stone martens (Martes foina), 4 of 4 pine martens (Martes martes), 6 of 6 Eurasian otters (Lutra lutra), 4 of 4 polecats (Mustela putorius), 1 of 1 ferret (Mustela putorius furo), 13 of 21 (61.9%) European genets (Genetta genetta), and 13 of 22 (59.1%) Egyptian mongooses (Herpestes ichneumon). Serological results indicated a widespread exposure to T. gondii among wild carnivores in Spain. The high T. gondii seroprevalence in Iberian lynx and the European wildcat reported here may be of epidemiologic significance because seropositive cats might have shed oocysts.
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Affiliation(s)
- R Sobrino
- Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo s/n, 13071 Ciudad Real, Spain
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Sobrino R, Gonzalez LM, Vicente J, Fernández de Luco D, Garate T, Gortázar C. Echinococcus granulosus (Cestoda, Taeniidae) in the Iberian wolf. Parasitol Res 2006; 99:753-6. [PMID: 16752157 DOI: 10.1007/s00436-006-0229-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 04/26/2006] [Indexed: 10/24/2022]
Abstract
The intestinal contents of 27 Iberian wolves (Canis lupus signatus) from Spain were screened for the presence of the taenid cestode Echinococcus granulosus. Four animals were found positive (15% prevalence). The intensity of parasitation was variable (mean 71, range 1-147 E. granulosus per host). Gravid individuals were found in all wolves positive with the parasite. Molecular characterization of the parasite material showed that the wolf strain belongs to the G1 genotype. According to the results, we conclude that the Iberian wolf takes part in the maintenance of the life cycle of this zoonotic parasite in Spain and that this fact could have public health relevance.
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Affiliation(s)
- R Sobrino
- Instituto de Investigación en Recursos Cinegéticos IREC, (CSIC-UCLM-JCCM), Ronda de Toledo sn, 13071 Ciudad Real, Spain
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Benetó A, Gómez E, Rubio P, Sobrino R, Esparza A, Gil M, Entrambasaguas M, Valdivieso R. [Periodical EEG pattern modifications in herpetic encephalitis treated with acyclovir]. Rev Neurol 1996; 24:829-32. [PMID: 8681195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The presence of PLED or localized or lateralized periodic activity in encephalitis strongly suggests that the encephalitis is due to the herpes simplex virus. Nevertheless, there has been controversy over its clinical significance. In addition, since the introduction of antiviral drugs in the treatment of herpes encephalitis in its initial stages, the prognosis of the disease has improved. We studied nine patients all diagnosed as having herpes encephalitis and treated with acyclovir. The presence or absence of periodic activity and its characteristics were analyzed. It was seen that either there was no such activity, or if there was, it was not exactly as classically described.
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Affiliation(s)
- A Benetó
- Servicio de Neurofisiología Clínica, Hospital Universitario La Fe, Valencia
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Rubio P, Burguera JA, Sobrino R, Ameabe Y, Fenollosa B. [Sleep disorders and Parkinson disease: study of a series]. Rev Neurol 1995; 23:265-8. [PMID: 7497172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Disturbances of sleep are frequent and varied in patients with Parkinson's disease. In an attempt to find out about these disturbances, we carried out interviews using the Vanna and Mazzuia questionnaire, modified for forty-five sufferers of Parkinson's disease, and forty healthy adults. We researched sleep habits and disturbances, as well as the consumption of hypnotics. We found that both groups had similar habits, although those with PD altered according to the stage of development of the disease, thus difficulty in staying sleep and parasomnia were more frequent in PD sufferers and worsened in the most advanced cases. On the other hand the quality of night sleep and the consumption of hypnotics interfered in the daytime efficiency of those suffering from Parkinson's Disease.
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Affiliation(s)
- P Rubio
- Servicio de Neurofisiología Clínica, Hospital Universitario La Fe de Valencia
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Goldstein S, Friedman L, Hutchinson R, Canner P, Romhilt D, Schlant R, Sobrino R, Verter J, Wasserman A. Timing, mechanism and clinical setting of witnessed deaths in postmyocardial infarction patients. J Am Coll Cardiol 1984; 3:1111-7. [PMID: 6423716 DOI: 10.1016/s0735-1097(84)80167-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The temporal distribution and mechanism of death were studied in a large multicenter secondary prevention trial (Aspirin Myocardial Infarction Study) in which acute witnessed death represented 72% (270 of 376) of the deaths due to arteriosclerotic heart disease. Instantaneous deaths represented 28.9% (78 of 270) of the acute witnessed deaths; 45.2% (122 of 270) occurred in the first hour after the onset of symptoms and were defined as sudden deaths. In the subsequent 23 hours, an additional 113 deaths (41.8%) occurred and were defined as intermediate deaths; 29 late deaths (10.7%) occurred after 24 hours. Cardiac arrhythmia was the mechanism of death in 83% (194 of 235) of deaths within 24 hours. Univariate analysis of baseline clinical and electrocardiographic characteristics indicates that a history of congestive heart failure, cardiomegaly, angina pectoris, multiple myocardial infarctions and therapy with digitalis and nitroglycerin were more common in those who died than in survivors, regardless of the timing of death.
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Capone N, Urbanetti S, Sobrino R, Sobrino S. [Histological peculiarities of the placenta in materno-fetal isoimmunization due to Rh factors]. Minerva Ginecol 1982; 34:151-154. [PMID: 6806722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Capone N, Carafa M, Urbanetti S, Sobrino R, Sobrino S. [Cervico-vaginitis and sterility]. Minerva Ginecol 1982; 34:165-9. [PMID: 7088410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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García-Palmieri MR, Costas R, Cruz-Vidal M, Cortés-Alicea M, Colón AA, Feliberti M, Ayala AM, Patterne D, Sobrino R, Torres R, Nazario E. Risk factors and prevalence of coronary heart disease in Puerta Rico. Circulation 1970; 42:541-9. [PMID: 5451238 DOI: 10.1161/01.cir.42.3.541] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In spite of an apparently increasing mortality rate from coronary heart disease in Puerto Rico, the age-specific mortality rate from this illness is considerably lower in the island than in the U. S. mainland. Examination of 9,814 Puerto Rican urban and rural men in the 45 to 64-year age group revealed sizable and statistically significant differences in monthly income, cigarette smoking, ingestion of fats, blood pressure, heart rate, relative weight, serum cholesterol, serum glycerides, prevalence of diabetes, and prevalence of hypertension (lower in rural dwellers), and also in vital capacity, consumption of calories per unit body weight, and physical activity (higher in rural area). No urban-rural difference in coronary heart disease prevalence was found, but the prevalence of definite myocardial infarction, established on basis of electrocardiographic criteria alone, was significantly higher in the 45 to 54-year urban group. Follow-up of this population to study incidence of disease and the influence of the various factors upon the development of disease is being conducted.
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Costas R, Feliberti M, García-Palmieri MR, Colón AA, Cruz-Vidal M, Cortés-Alicea M, Ayala AM, Sobrino R. Operational procedures at the Puerto Rico Heart Health Program Clinic. Bol Asoc Med P R 1969; 61:180-3. [PMID: 5257819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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García-Palmieri MR, Feliberti M, Costas R, Colón AA, Cruz-Vidal M, Cortés-Alicea M, Ayala AM, Sobrino R, Torres R. An epidemiological study on coronary heart disease in Puerto Rico: The Puerto Rico Heart Health Program. Bol Asoc Med P R 1969; 61:174-9. [PMID: 5257818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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