Rafael Ramirez - Academia.edu (original) (raw)
Papers by Rafael Ramirez
Journal of the American College of Cardiology, 2010
Background: Contact mapping with NAVX has not been systematically evaluated in the left ventricle... more Background: Contact mapping with NAVX has not been systematically evaluated in the left ventricle and the accuracy of this system to detail scar substrate has never been compared to CARTO.
Social Psychiatry and Psychiatric Epidemiology, 2003
Journal of Abnormal Child Psychology, 2007
Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivit... more Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.
Neurosurgery, 1995
After the use of Mullan's technique, macroscopic changes take place on the gasserian gang... more After the use of Mullan's technique, macroscopic changes take place on the gasserian ganglion and the surrounding structures. These changes were studied on 20 trigeminal nerves of 10 fresh adult cadavers. Changes took place on the dura as well as in the neural elements. There was compression on the ganglion and on the trigeminal nerve, and there were changes in the position of the trigeminal root, with shortening of its cisternal segment. When the balloon was inflated to capacity (0.75-1.0 ml), dural stretching in an area of 15 x 10 mm took place. This stretching of the dura extended from the lateral wall of the cavernous sinus to the level of the porus trigemini. Despite these important mechanical effects, we never found a rupture or tear on the dura or the trigeminal nerve fibers. We discuss the relationship between mechanical effects and clinical results.
Neurosurgery, 1981
Ten patients with intractable hemifacial spasm were treated by posterior fossa exploration and mi... more Ten patients with intractable hemifacial spasm were treated by posterior fossa exploration and microsurgical technique. These patients have been followed 1 to 5 years. The spasmodic motor disorder was related to compression of the 7th nerve or its exit zone at the brain stem by a dolichoectatic anterior inferior cerebellar artery in eight patients and to kinking and ectasia of the basilar or vertebral artery in two patients. In five patients, there were prominent arachnoidal adhesions in the cerebellopontine angle, and an arachnoid cyst was a component of the lesion in another patient. Additional conditions associated with hemifacial spasm included geniculate neuralgia, facial paresis, vertigo, hearing loss, and trigeminal neuralgia. The surgical morbidity and postoperative results are discussed.
Neurosurgery, 1995
After the use of Mullan's technique, macroscopic changes take place on the gasserian gang... more After the use of Mullan's technique, macroscopic changes take place on the gasserian ganglion and the surrounding structures. These changes were studied on 20 trigeminal nerves of 10 fresh adult cadavers. Changes took place on the dura as well as in the neural elements. There was compression on the ganglion and on the trigeminal nerve, and there were changes in the position of the trigeminal root, with shortening of its cisternal segment. When the balloon was inflated to capacity (0.75-1.0 ml), dural stretching in an area of 15 x 10 mm took place. This stretching of the dura extended from the lateral wall of the cavernous sinus to the level of the porus trigemini. Despite these important mechanical effects, we never found a rupture or tear on the dura or the trigeminal nerve fibers. We discuss the relationship between mechanical effects and clinical results.
The Journal of Nervous and Mental Disease, 2013
There is growing evidence of a positive association between asthma and suicidal ideation and beha... more There is growing evidence of a positive association between asthma and suicidal ideation and behavior in the general community, although information on this potential association is scarce among adolescents and Puerto Ricans, groups at-risk for both conditions. Data came from wave three of the Boricua Youth Study, a longitudinal study of youth in the Bronx and San Juan conducted from 2000-2004. Logistic regressions for correlated data (GEE) were conducted with asthma predicting suicidal ideation and behavior among participants aged 11 years or older. After adjustment for survey design, age, gender, poverty, DSM-IV mental disorders, cigarette smoking, and stressful life events, asthma was positively associated with suicidal ideation and behavior among Puerto Rican adolescents. Public health interventions targeting Puerto Rican adolescents with asthma and future studies investigating potential biological and psychological mechanisms of association are warranted.
Journal of Abnormal Child Psychology, 2001
The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) i... more The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.
Journal of Abnormal Child Psychology, 2001
Using data from the MECA Study, this report examines the prevalence of Conduct Disorder (CD), Opp... more Using data from the MECA Study, this report examines the prevalence of Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), and various levels of antisocial behavior and their correlates among three ethnic groups: Hispanics, subdivided into Island Puerto Ricans and Mainland Hispanics; African Americans; and Mainland Non-Hispanic, Non-African Americans. Correlates considered include stressful life events, birth defects, low birth weight, learning difficulties, teen mothers, family environment, marital adjustment, social competence, parental monitoring, and family relationships. Logistic regression was used to determine the association of outcomes with individual correlates and of interaction terms with ethnicity. Differences between adjusted rates and observed rates of disorders and levels of antisocial behaviors are compared to estimate the extent to which each correlate explains the group differences in rates. Island Puerto Ricans had a lower prevalence of CD, ODD, and various levels of antisocial behavior than mainland Hispanics, African Americans, and non-Hispanic Whites. The lower prevalence appears to be associated with differences in the extent to which a number of these correlates are found on the island, the most salient being better family relations between the target children and their parents and siblings.
Medical Care, 2004
Latino children have persistent low rates of mental health service use. Understanding the factors... more Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. Data were collected from a random Puerto Rican community sample of caregiver-child dyads. Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. : Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.
American Journal of Community Psychology, 1992
We have illustrated how our “small theory” (Lipsey, 1990) of bereavement guided the development a... more We have illustrated how our “small theory” (Lipsey, 1990) of bereavement guided the development and evaluation of a preventive intervention for bereaved children. Our small theory, based on prior empirical research, enabled us to identify family processes that appeared to mediate the effects of parental death on child mental health. Our intervention was designed to attempt to change these processes. The evaluation of our experimental trial of the intervention assessed changes on these processes as well as the more distal mental health outcomes. The experimental trial showed some-what encouraging results, in terms of the program's ability to modify the warmth of the parent–child relationship and to decrease symptomatology in the adolescent children. We also obtained further empirical support for our underlying theoretical model. Finally, implications for redesign of the program were derived from assessing the adequacy of the program components to change each of the mediators in the theoretical model.
Journal of Nervous and Mental Disease, 2002
Asthma is a serious and vexing problem for many children and their families. Asthma, like most sy... more Asthma is a serious and vexing problem for many children and their families. Asthma, like most syndromes, has many symptoms and potential causes and effects. Studies have shown that pediatric asthma is associated with psychiatric disorders, but the specificity and temporality of these relations is not well known. This study examined the associations between any and specific psychiatric disorders and both childhood asthma and other childhood chronic illnesses. The study used the Methods for the Epidemiology of Child and Adolescent Mental Disorders data, a four-site, community-based study of 1,285 pairs of youths and caretakers. Psychiatric disorders were assessed using the Diagnostic Interview Schedule for Children (DISC 2.3). Methods for the Epidemiology of Child and Adolescent Mental Disorders was also used to assess individual characteristics, parental reports of asthma, and other chronic illnesses. Asthma and 'other' chronic illnesses were associated with different psychiatric disorders. In particular, having a history of asthma was associated with having an anxiety disorder, after adjustment for potential confounding, but was not associated with having an affective disorder. Having a chronic illness other than asthma or cancer was associated with having any affective disorder and dysthymia but not anxiety disorder. These results call for more mechanistic research that explores the specific relations between childhood anxiety disorder and asthma and between affective disorder and other pediatric chronic illnesses.
Archives of General Psychiatry, 2004
Few prevalence studies in which DSM-IV criteria were used in children in representative community... more Few prevalence studies in which DSM-IV criteria were used in children in representative community samples have been reported. We present prevalence data for the child and adolescent population of Puerto Rico and examine the relation of DSM-IV diagnoses to global impairment, demographic correlates, and service use in an island-wide representative sample. We sampled 1886 child-caretaker dyads in Puerto Rico by using a multistage sampling design. Children were aged 4 to 17 years. Response rate was 90.1%. Face-to-face interviews of children and their primary caretakers were performed by trained laypersons who administered the Diagnostic Interview Schedule for Children, version IV (DISC-IV) in Spanish. Global impairment was measured by using the Children's Global Assessment Scale scored by the interviewer of the parent. Reports of service use were obtained by using the Service Assessment for Children and Adolescents. Although 19.8% of the sample met DSM-IV criteria without considering impairment, 16.4% of the population had 1 or more of the DSM-IV disorders when a measure of impairment specific to each diagnosis was considered. The overall prevalence was further reduced to 6.9% when a measure of global impairment was added to that definition. The most prevalent disorders were attention-deficit/hyperactivity disorder (8.0%) and oppositional defiant disorder (5.5%). Children in urban settings had higher rates than those in rural regions. Older age was related to higher rates of major depression and social phobia, and younger age was related to higher rates of attention-deficit/hyperactivity disorder. Both overall rates and rates of specific DSM-IV/DISC-IV disorders were related to service use. Children with impairment without diagnosis were more likely to use school services, whereas children with impairment with diagnosis were more likely to use the specialty mental health sector. Of those with both a diagnosis and global impairment, only half received services from any source. Because we used the DISC-IV to apply DSM-IV criteria, the study yielded prevalence rates that are generally comparable with those found in previous surveys. The inclusion of diagnosis-specific impairment criteria reduced rates slightly. When global impairment criteria were imposed, the rates were reduced by approximately half.
The Journal of Pacific History, 2014
Journal of the American College of Cardiology, 2010
Background: Contact mapping with NAVX has not been systematically evaluated in the left ventricle... more Background: Contact mapping with NAVX has not been systematically evaluated in the left ventricle and the accuracy of this system to detail scar substrate has never been compared to CARTO.
Social Psychiatry and Psychiatric Epidemiology, 2003
Journal of Abnormal Child Psychology, 2007
Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivit... more Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.
Neurosurgery, 1995
After the use of Mullan's technique, macroscopic changes take place on the gasserian gang... more After the use of Mullan's technique, macroscopic changes take place on the gasserian ganglion and the surrounding structures. These changes were studied on 20 trigeminal nerves of 10 fresh adult cadavers. Changes took place on the dura as well as in the neural elements. There was compression on the ganglion and on the trigeminal nerve, and there were changes in the position of the trigeminal root, with shortening of its cisternal segment. When the balloon was inflated to capacity (0.75-1.0 ml), dural stretching in an area of 15 x 10 mm took place. This stretching of the dura extended from the lateral wall of the cavernous sinus to the level of the porus trigemini. Despite these important mechanical effects, we never found a rupture or tear on the dura or the trigeminal nerve fibers. We discuss the relationship between mechanical effects and clinical results.
Neurosurgery, 1981
Ten patients with intractable hemifacial spasm were treated by posterior fossa exploration and mi... more Ten patients with intractable hemifacial spasm were treated by posterior fossa exploration and microsurgical technique. These patients have been followed 1 to 5 years. The spasmodic motor disorder was related to compression of the 7th nerve or its exit zone at the brain stem by a dolichoectatic anterior inferior cerebellar artery in eight patients and to kinking and ectasia of the basilar or vertebral artery in two patients. In five patients, there were prominent arachnoidal adhesions in the cerebellopontine angle, and an arachnoid cyst was a component of the lesion in another patient. Additional conditions associated with hemifacial spasm included geniculate neuralgia, facial paresis, vertigo, hearing loss, and trigeminal neuralgia. The surgical morbidity and postoperative results are discussed.
Neurosurgery, 1995
After the use of Mullan's technique, macroscopic changes take place on the gasserian gang... more After the use of Mullan's technique, macroscopic changes take place on the gasserian ganglion and the surrounding structures. These changes were studied on 20 trigeminal nerves of 10 fresh adult cadavers. Changes took place on the dura as well as in the neural elements. There was compression on the ganglion and on the trigeminal nerve, and there were changes in the position of the trigeminal root, with shortening of its cisternal segment. When the balloon was inflated to capacity (0.75-1.0 ml), dural stretching in an area of 15 x 10 mm took place. This stretching of the dura extended from the lateral wall of the cavernous sinus to the level of the porus trigemini. Despite these important mechanical effects, we never found a rupture or tear on the dura or the trigeminal nerve fibers. We discuss the relationship between mechanical effects and clinical results.
The Journal of Nervous and Mental Disease, 2013
There is growing evidence of a positive association between asthma and suicidal ideation and beha... more There is growing evidence of a positive association between asthma and suicidal ideation and behavior in the general community, although information on this potential association is scarce among adolescents and Puerto Ricans, groups at-risk for both conditions. Data came from wave three of the Boricua Youth Study, a longitudinal study of youth in the Bronx and San Juan conducted from 2000-2004. Logistic regressions for correlated data (GEE) were conducted with asthma predicting suicidal ideation and behavior among participants aged 11 years or older. After adjustment for survey design, age, gender, poverty, DSM-IV mental disorders, cigarette smoking, and stressful life events, asthma was positively associated with suicidal ideation and behavior among Puerto Rican adolescents. Public health interventions targeting Puerto Rican adolescents with asthma and future studies investigating potential biological and psychological mechanisms of association are warranted.
Journal of Abnormal Child Psychology, 2001
The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) i... more The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.
Journal of Abnormal Child Psychology, 2001
Using data from the MECA Study, this report examines the prevalence of Conduct Disorder (CD), Opp... more Using data from the MECA Study, this report examines the prevalence of Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), and various levels of antisocial behavior and their correlates among three ethnic groups: Hispanics, subdivided into Island Puerto Ricans and Mainland Hispanics; African Americans; and Mainland Non-Hispanic, Non-African Americans. Correlates considered include stressful life events, birth defects, low birth weight, learning difficulties, teen mothers, family environment, marital adjustment, social competence, parental monitoring, and family relationships. Logistic regression was used to determine the association of outcomes with individual correlates and of interaction terms with ethnicity. Differences between adjusted rates and observed rates of disorders and levels of antisocial behaviors are compared to estimate the extent to which each correlate explains the group differences in rates. Island Puerto Ricans had a lower prevalence of CD, ODD, and various levels of antisocial behavior than mainland Hispanics, African Americans, and non-Hispanic Whites. The lower prevalence appears to be associated with differences in the extent to which a number of these correlates are found on the island, the most salient being better family relations between the target children and their parents and siblings.
Medical Care, 2004
Latino children have persistent low rates of mental health service use. Understanding the factors... more Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. Data were collected from a random Puerto Rican community sample of caregiver-child dyads. Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. : Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.
American Journal of Community Psychology, 1992
We have illustrated how our “small theory” (Lipsey, 1990) of bereavement guided the development a... more We have illustrated how our “small theory” (Lipsey, 1990) of bereavement guided the development and evaluation of a preventive intervention for bereaved children. Our small theory, based on prior empirical research, enabled us to identify family processes that appeared to mediate the effects of parental death on child mental health. Our intervention was designed to attempt to change these processes. The evaluation of our experimental trial of the intervention assessed changes on these processes as well as the more distal mental health outcomes. The experimental trial showed some-what encouraging results, in terms of the program's ability to modify the warmth of the parent–child relationship and to decrease symptomatology in the adolescent children. We also obtained further empirical support for our underlying theoretical model. Finally, implications for redesign of the program were derived from assessing the adequacy of the program components to change each of the mediators in the theoretical model.
Journal of Nervous and Mental Disease, 2002
Asthma is a serious and vexing problem for many children and their families. Asthma, like most sy... more Asthma is a serious and vexing problem for many children and their families. Asthma, like most syndromes, has many symptoms and potential causes and effects. Studies have shown that pediatric asthma is associated with psychiatric disorders, but the specificity and temporality of these relations is not well known. This study examined the associations between any and specific psychiatric disorders and both childhood asthma and other childhood chronic illnesses. The study used the Methods for the Epidemiology of Child and Adolescent Mental Disorders data, a four-site, community-based study of 1,285 pairs of youths and caretakers. Psychiatric disorders were assessed using the Diagnostic Interview Schedule for Children (DISC 2.3). Methods for the Epidemiology of Child and Adolescent Mental Disorders was also used to assess individual characteristics, parental reports of asthma, and other chronic illnesses. Asthma and 'other' chronic illnesses were associated with different psychiatric disorders. In particular, having a history of asthma was associated with having an anxiety disorder, after adjustment for potential confounding, but was not associated with having an affective disorder. Having a chronic illness other than asthma or cancer was associated with having any affective disorder and dysthymia but not anxiety disorder. These results call for more mechanistic research that explores the specific relations between childhood anxiety disorder and asthma and between affective disorder and other pediatric chronic illnesses.
Archives of General Psychiatry, 2004
Few prevalence studies in which DSM-IV criteria were used in children in representative community... more Few prevalence studies in which DSM-IV criteria were used in children in representative community samples have been reported. We present prevalence data for the child and adolescent population of Puerto Rico and examine the relation of DSM-IV diagnoses to global impairment, demographic correlates, and service use in an island-wide representative sample. We sampled 1886 child-caretaker dyads in Puerto Rico by using a multistage sampling design. Children were aged 4 to 17 years. Response rate was 90.1%. Face-to-face interviews of children and their primary caretakers were performed by trained laypersons who administered the Diagnostic Interview Schedule for Children, version IV (DISC-IV) in Spanish. Global impairment was measured by using the Children's Global Assessment Scale scored by the interviewer of the parent. Reports of service use were obtained by using the Service Assessment for Children and Adolescents. Although 19.8% of the sample met DSM-IV criteria without considering impairment, 16.4% of the population had 1 or more of the DSM-IV disorders when a measure of impairment specific to each diagnosis was considered. The overall prevalence was further reduced to 6.9% when a measure of global impairment was added to that definition. The most prevalent disorders were attention-deficit/hyperactivity disorder (8.0%) and oppositional defiant disorder (5.5%). Children in urban settings had higher rates than those in rural regions. Older age was related to higher rates of major depression and social phobia, and younger age was related to higher rates of attention-deficit/hyperactivity disorder. Both overall rates and rates of specific DSM-IV/DISC-IV disorders were related to service use. Children with impairment without diagnosis were more likely to use school services, whereas children with impairment with diagnosis were more likely to use the specialty mental health sector. Of those with both a diagnosis and global impairment, only half received services from any source. Because we used the DISC-IV to apply DSM-IV criteria, the study yielded prevalence rates that are generally comparable with those found in previous surveys. The inclusion of diagnosis-specific impairment criteria reduced rates slightly. When global impairment criteria were imposed, the rates were reduced by approximately half.
The Journal of Pacific History, 2014