Educational inequalities and premature mortality: the Cuba Prospective Study.

BACKGROUND: Although socioeconomic status is a major determinant of premature mortality in many populations, the impact of social inequalities on premature mortality in Cuba, a country with universal education and health care, remains unclear. We aimed to assess the association between educational level and premature adult mortality in Cuba. METHODS: The Cuba Prospective Study (a cohort study) enrolled 146 556 adults aged 30 years and older from the general population in five provinces from Jan 1, 1996, to Nov 24, 2002. Participants were followed up until Jan 1, 2017, for cause-specific mortality. Deaths were identified through linkage to the Cuban Public Health Ministry's national mortality records. Cox regression models yielded rate ratios (RRs) for the effect of educational level (a commonly used measure for social status) on mortality at ages 35-74 years, with assessment for the mediating effects of smoking, alcohol consumption, and BMI. FINDINGS: A total of 127 273 participants aged 35-74 years were included in the analyses. There was a strong inverse association between educational level and premature mortality. Compared with a university education, men who did not complete primary education had an approximately 60% higher risk of premature mortality (RR 1·55, 95% CI 1·40-1·72), while the risk was approximately doubled in women (1·96, 1·81-2·13). Overall, 28% of premature deaths could be attributed to lower education levels. Excess mortality in women was primarily due to vascular disease, while vascular disease and cancer were equally important in men. 31% of the association with education in men and 18% in women could be explained by common modifiable risk factors, with smoking having the largest effect. INTERPRETATION: This study highlights the value of understanding the determinants of health inequalities in different populations. Although many major determinants lie outside the health system in Cuba, this study has identified the diseases and risk factors that require targeted public health interventions, particularly smoking. FUNDING: UK Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).

Alcohol consumption and cause-specific mortality in Cuba: prospective study of 120 623 adults.

BACKGROUND: The associations of cause-specific mortality with alcohol consumption have been studied mainly in higher-income countries. We relate alcohol consumption to mortality in Cuba. METHODS: In 1996-2002, 146 556 adults were recruited into a prospective study from the general population in five areas of Cuba. Participants were interviewed, measured and followed up by electronic linkage to national death registries until January 1, 2017. After excluding all with missing data or chronic disease at recruitment, Cox regression (adjusted for age, sex, province, education, and smoking) was used to relate mortality rate ratios (RRs) at ages 35-79 years to alcohol consumption. RRs were corrected for long-term variability in alcohol consumption using repeat measures among 20 593 participants resurveyed in 2006-08. FINDINGS: After exclusions, there were 120 623 participants aged 35-79 years (mean age 52 [SD 12]; 67 694 [56%] women). At recruitment, 22 670 (43%) men and 9490 (14%) women were current alcohol drinkers, with 15 433 (29%) men and 3054 (5%) women drinking at least weekly; most alcohol consumption was from rum. All-cause mortality was positively and continuously associated with weekly alcohol consumption: each additional 35cl bottle of rum per week (110g of pure alcohol) was associated with ∼10% higher risk of all-cause mortality (RR 1.08 [95%CI 1.05-1.11]). The major causes of excess mortality in weekly drinkers were cancer, vascular disease, and external causes. Non-drinkers had ∼10% higher risk (RR 1.11 [1.09-1.14]) of all-cause mortality than those in the lowest category of weekly alcohol consumption (<1 bottle/week), but this association was almost completely attenuated on exclusion of early follow-up. INTERPRETATION: In this large prospective study in Cuba, weekly alcohol consumption was continuously related to premature mortality. Reverse causality is likely to account for much of the apparent excess risk among non-drinkers. The findings support limits to alcohol consumption that are lower than present recommendations in Cuba. FUNDING: Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).

Implementation of a community-based hypertension control program in Matanzas, Cuba.

Increased blood pressure is a leading risk factor for death worldwide, and improving the control of hypertension is a major health goal to reduce non-communicable disease. Thus, in 2016, as part of a regional effort between the Pan American Health Organization and Cuban Ministry of Public Health to reduce cardiovascular risk and disease, a community demonstration project was implemented to enhance hypertension control. The intervention project was in a population of 25 868 people served by the Carlos Verdugo Martínez Polyclinic in Matanzas, Cuba. The project implemented interventions currently recommended in the World Health Organization HEARTS modules, including a standardized clinical training program with certification for blood pressure measurement, routine screening for hypertension in clinics and in the community, a simple directive pharmacologic treatment algorithm, and a registry with performance reporting and feedback. Qualitative and quantitative program monitoring and evaluation was established. In a 2010 national survey, the prevalence of hypertension and the rate of hypertension control were estimated to be 31% and 36%, respectively. Following less than one year of the full implementation of the program, the prevalence of hypertension, proportion of the hypertensive population registered as having hypertension, proportion of those drug-treated who were controlled, and estimated population rate of control were 30%, 90%, 68%, and 58%, respectively. Based on these positive results, the program has been expanded to include another demonstration program initiated in a second region. In addition, preliminary efforts to disseminate and scale-up aspects of the program to the full Cuban population have started.

Association of childhood smoking and adult mortality: prospective study of 120 000 Cuban adults.

BACKGROUND: The average age at which people start smoking has been decreasing in many countries, but insufficient evidence exists on the adult hazards of having started smoking in childhood and, especially, in early childhood. We aimed to investigate the association between smoking habits (focusing on the age when smokers started) and cause-specific premature mortality in a cohort of adults in Cuba. METHODS: For this prospective study, adults were recruited from five provinces in Cuba. Participants were interviewed (data collected included socioeconomic status, medical history, alcohol consumption, and smoking habits) and had their height, weight, and blood pressure measured. Participants were followed up until Jan 1, 2017 for cause-specific mortality; a subset was resurveyed in 2006-08. We used Cox regression to calculate adjusted rate ratios (RRs) for mortality at ages 30-69 years, comparing never-smokers with current smokers by age they started smoking and number of cigarettes smoked per day and with ex-smokers by the age at which they had quit. FINDINGS: Between Jan 1, 1996, and Nov 24, 2002, 146 556 adults were recruited into the study, of whom 118 840 participants aged 30-69 years at recruitment contributed to the main analyses. 27 264 (52%) of 52 524 men and 19 313 (29%) of 66 316 women were current smokers. Most participants reported smoking cigarettes; few smoked only cigars. About a third of current cigarette smokers had started before age 15 years. Compared with never-smokers, the all-cause mortality RR was highest in participants who had started smoking at ages 5-9 years (RR 2·51, 95% CI 2·21-2·85), followed by ages 10-14 years (1·83, 1·72-1·95), 15-19 years (1·56, 1·46-1·65), and ages 20 years or older (1·50, 1·39-1·62). Smoking accounted for a quarter of all premature deaths in this population, but quitting before about age 40 years avoided almost all of the excess mortality due to smoking. INTERPRETATION: In this cohort of adults in Cuba, starting to smoke in childhood was common and quitting was not. Starting in childhood approximately doubled the rate of premature death (ie, before age 70 years). If this 2-fold mortality RR continues into old age, about half of participants who start smoking before age 15 years and do not stop will eventually die of complications from their habit. The greatest risks were found among adults who began smoking before age 10 years. FUNDING: UK Medical Research Council, Cancer Research UK, British Heart Foundation, US Centers for Disease Control and Prevention (CDC) Foundation (with support from Amgen).

Burden of hypertension and associated risks for cardiovascular mortality in Cuba: a prospective cohort study.

BACKGROUND: In Cuba, hypertension control in primary care has been prioritised as a cost-effective means of addressing premature death from cardiovascular disease. However, there is little evidence from large-scale studies on the prevalence and management of hypertension in Cuba, and no direct evidence of the expected benefit of such efforts on cardiovascular mortality. METHODS: In a prospective cohort study, adults in the general population identified via local family medical practices were interviewed between Jan 1, 1996, and Nov 24, 2002, in five areas of Cuba, and a subset of participants were resurveyed between July 14, 2006, and Oct 19, 2008, in one area. During household visits, blood pressure was measured and information obtained on diagnosis and treatment of hypertension. We calculated the prevalence of hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or receiving treatment for hypertension) and the proportion of people with hypertension in whom it was diagnosed, treated, and controlled (systolic blood pressure <140 mm Hg, diastolic blood pressure <90 mm Hg). Deaths were identified through linkage by national identification numbers to the Cuban Public Health Ministry records, to Dec 31, 2016. We used Cox regression analysis to compare cardiovascular mortality between participants with versus without uncontrolled hypertension. Rate ratios (RRs) were used to estimate the fraction of cardiovascular deaths attributable to hypertension. FINDINGS: 146 556 participants were interviewed in the baseline survey in 1996-2002 and 24 345 were interviewed in the resurvey in 2006-08. After exclusion for incomplete data and age outside the range of interest, 136 111 respondents aged 35-79 years (mean age 54 [SD 12] years; 75 947 [56%] women, 60 164 [44%] men) were eligible for inclusion in the analyses. 34% of participants had hypertension. Among these, 67% had a diagnosis of hypertension. 76% of participants with diagnosed hypertension were receiving treatment and blood pressure was controlled in 36% of those people. During 1·7 million person-years of follow-up there were 5707 cardiovascular deaths. In the age groups 35-59, 60-69, and 70-79 years, uncontrolled hypertension at baseline was associated with RRs of 2·15 (95% CI 1·88-2·46), 1·86 (1·69-2·05), and 1·41 (1·32-1·52), respectively, and accounted for around 20% of premature cardiovascular deaths. INTERPRETATION: In this Cuban population, a third of people had hypertension. Although levels of hypertension diagnosis and treatment were commensurate with those in some high-income countries, the proportion of participants whose blood pressure was controlled was low. As well as reducing hypertension prevalence, improvement in blood pressure control among people with diagnosed hypertension is required to prevent premature cardiovascular deaths in Cuba. FUNDING: Medical Research Council, British Heart Foundation, Cancer Research UK.

Diagnóstico y seguimiento de pacientes con sangre oculta positiva en heces fecales / Diagnosis and follow-up of patients with positive hidden blood in fecal feces

Introducción: la hemorragia digestiva se define como toda pérdida de sangre procedente de cualquier sitio del tubo digestivo, desde la boca hasta el ano, incluyendo las hemorragias digestivas originadas en órganos que drenan en la luz intestinal. Objetivo: realizar el diagnóstico y seguimiento de pacientes con sangre oculta positiva en heces fecales. Materiales y métodos: se realizó un estudio epidemiológico descriptivo en el municipio de Unión de Reyes, provincia de Matanzas, entre los años 2014-2015. El universo y muestra estuvo constituida por 130 pacientes a los cuales el test de sangre oculta en heces fecales fue positivo, teniendo entre las variables características sociodemográficas de los pacientes, diagnóstico y seguimiento. Resultados: dentro de los resultados obtenidos las edades comprendidas entre 50-69 años fueron las más frecuentes, así como el sexo femenino donde la positividad del test fue mayor al igual que en negros y mestizos. Los medicamentos que más incidencia tuvieron fueron los antiinflamatorios no esteroideos y la aspirina. El test le fue indicado a 115 pacientes por atención primaria siendo 76 por pesquisa. A 80 pacientes no se les comunicó con que intensión se indicaba el examen. Del total de pacientes 43 tuvieron enfermedades relacionadas con el tracto digestivo alto y 44 del bajo. Conclusiones: uno de cada cinco pacientes presentó alguna tumoración del tracto digestivo. Se consideró que el trabajo de los equipos de salud fue deficiente en el diagnóstico y seguimiento de los pacientes (AU).

Introduction: digestive hemorrhage is defined as any blood loss that stems from any site of the alimentary canal, from the mouth to the anus, including digestive hemorrhages occurring in organs draining in the intestinal lumen. Objective: to diagnose and follow-up patients with positive hidden blood in fecal feces. Materials and methods: a descriptive epidemiologic study was carried out in the municipality of Unión de Reyes, province of Matanzas, in the period 2014-2015. The universe and sample were formed by 130 patients whose test of hidden blood in fecal feces was positive, taking as variables the socio-demographic characteristics of the patients, their diagnosis and follow-up. Results: some of the obtained results were the predominance of ages between 50 and 69 years, and also the female sex with higher test positivity like in black and mestizo patients. The medications having more incidence were the non-steroidal antiinflammatory ones and aspirin. The test was indicated to 115 patient in the primary health care, being 76 in the screening. 80 patients were no informed of the intentionality when the test was indicated. From the total of the patients, 43 had diseases related with the upper digestive tract, and 44 with the low one. Conclusions: one form each five patients showed any tumor of vthe digestive tract. The work of the health teams was considered deficient in relation with the patients' diagnosis and follow-up...(AU)

Homicidio en la provincia de Matanzas. 1989 al 2016 / Homicide in the province of Matanzas. From 1989 to 2016

Introducción: el homicidio, es la forma más extrema de resolución de los conflictos sociales entre las personas y los colectivos. En Cuba no constituye un problema de salud, pero por su importancia humana, social y judicial, se lleva una vigilancia sobre el tema. Objetivo: describir las principales características epidemiológicas en tiempo, espacio y personas, de los fallecidos por homicidio en la provincia de Matanzas. Materiales y Métodos: se realizó un estudio descriptivo para caracterizar en tiempo, espacio y algunos aspectos personales, a los fallecidos por homicidio en la provincia de Matanzas durante los años 1989 al 2016. El universo y muestra estuvo conformado por los 802 fallecidos por esta causa durante el periodo analizado. Para el análisis de las variables se utilizaron tasas crudas por 100000 hab. Resultados: las tasas de mortalidad estuvieron entre 1,75 y 7,2 por 100000 habitantes. La mayor cantidad de fallecidos fue en edades jóvenes, entre varones, personas sin pareja estable y de color de la piel negra. Las las tasas resultaron ser más bajas que en otros países aunque con una ligera tendencia al incremento. Se comparan los resultados con otros países y se destaca la necesidad de mejorar el trabajo sobre todo a partir de la atención primaria Conclusiones: el homicidio aunque no constituye un problema de salud por sus cifras, requiere de un trabajo multidisciplinario e intersectorial para disminuir su incidencia sobre todo en aquellos grupos y municipios más vulnerables (AU).

Summary: homicide is the most extreme form of solving social conflicts among individuals and collectives. It is not a health problem in Cuba, but because of its human, social and judicial importance, vigilance is carried out on the theme. Objective: to describe the main epidemiological characteristics in time, space and persons, of the individuals deceased by homicide in the province of Matanzas. Materials and Methods: a descriptive study was carried out to characterize in time, space and several personal aspects, the people deceased by homicide in the province of Matanzas during the period 1989-2016. The universe and the sample were formed by the 802 people who died by homicide during the analyzed period. Gross rates per 100 000 inhabitants were used for the analyses of the variables. Results: the mortality rates ranged between 1.75 and 7.2 per 100 000 inhabitants. The highest quantity of deceased people were young, male, black skinned persons without stable couple. The rates were lower than in other countries, thought with a slight tendency to increase. The results were compared with other countries. It is highlighted the necessity of improving the work, beginning from the primary health care level. Conclusions: although homicide is not a health problem because of its amount, it requires a multidiscipline and inter-sectorial work to decrease its incidence mainly in those more vulnerable groups and municipalities (AU).

Prevalencia del alcoholismo y factores asociados. Municipio Matanzas. 2011-2012 / Alcoholism prevalence and associated factors. Municipality of Matanzas. 2011-2012

El alcoholismo es un trastorno conductual crónico, manifestado por excesiva ingestión de alcohol, respecto a normas sociales y dietéticas de la comunidad, y que acaban interfiriendo la salud o las funciones económicas y sociales del bebedor, constituyendo hoy uno de los principales problemas de salud a escala mundial. Se realizó un estudio analítico de tipo transversal, con el objetivo de cuantificar la prevalencia del consumo de bebidas alcohólicas en personas de 15 y más años de edad, y factores asociados al mismo en el municipio de Matanzas, durante los años 2011-2012. El universo estuvo constituido por los 112 348 habitantes del municipio, en las edades entre 15 y 74 años de edad. Para la selección de la muestra se tuvo en cuenta el protocolo del proyecto Conjunto de Acciones Multifactoriales para el Control de las Enfermedades no Transmisibles, de la Organización Panamericana de la Salud. En cada estrato se incluyeron 220 personas, por lo que la muestra quedó constituida por 2 640. Las variables estudiadas como posibles factores asociadas al alcoholismo fueron: edad, sexo, ocupación, tabaquismo, hipertensión arterial, diabetes mellitus, colesterol, perímetro de cintura, el hábito de no desayunar y el estado nutricional inadecuado. Para el análisis estadístico se utilizó el enfoque de riesgo en análisis bivariado, con cálculo del Odds Ratio (OR) y sus intervalos de confianza a un 95 %, y también el valor de p, considerando una asociación estadística significativa cuando el mismo fuera p<0,05 y el intervalo de confianza del OR no incluyera el valor 1. Posteriormente, estas variables significativas fueron sometidas a un análisis multivariado para obtener las verdaderas variables asociadas, así como las variables confusoras. Los principales resultados obtenidos fueron que la prevalencia de alcoholismo fue de 4,1 por cada 100 personas, encontrando mayor prevalencia (7,7) en el grupo de 45 a 54 años, y en el sexo masculino con 7,6. Los principales factores asociados al alcoholismo fueron: el sexo masculino, el tabaquismo, no desayunar y el índice de cintura inadecuada.

Alcoholism is a chronic behavioral disorder, characterized by excessive alcohol intake with respect to the community social and dietetic standards. Nowadays it is one of the main health problems at the world level. We carried out a cross-sectional analytical study, with the aim of quantifying the prevalence of alcoholic beverages consumption in persons aged 15 years and more, and its associated factors in the municipality of Matanzas, during 2011-2012. The universe was formed by the 112 348 inhabitants of Matanzas municipality in the age brackets from 15 to 74 years old. For choosing the sample we took into account the protocol of the Pan-American Health Organization project Group of Multifactor Actions for the Control of Non-transmissible Diseases. In each layer we included 220 persons, so the sample was formed by 2 640 persons. The variables studied as possible alcoholism-associated factors were: age, gender, occupation, smoking, arterial hypertension, diabetes mellitus, cholesterol, waist perimeter, the habit of not having breakfast and the inadequate nutritional status. For the statistical analysis we used the risk approach in bivariate analysis, calculating the Odds ratio and confidence intervals in 95 %, and also the p- value, considering a significant statistical association when p<0,05 and the OR confidence interval did not included value 1. Then, these significant variables were object of a multivariate analysis for obtaining the true associated variables, and also the confusing variables. The main obtained results were that alcoholism prevalence was 4,1 per each 100 persons, finding the higher prevalence (7,7) in the age group 45-54 years, and in male gender with 7,6. The main alcoholism-associated factors were: male gender, smoking, not having breakfast and inadequate waist index.

Intervención integral educativa en hipertensión arterial. Policlínico Héroes del Moncada. Municipio de Cárdenas, 2013 / Integral educative intervention in arterial hypertension. Policlinic Heroes del Moncada. Cardenas Municipality, 2013

Se realizó la descripción de una intervención integral dirigida a médicos de familias y grupos básicos de trabajo, en consulta externa, a la comunidad y a los hipertensos del Policlínico Héroes del Moncada, del 1 de enero al 31 de diciembre de 2013. Se consignaron los temas que se impartirán a los médicos de familia y a los grupos básicos de trabajo, según la guía del Programa de Hipertensión Arterial. Se señalaron los acápites que deben ser llenados en la historia clínica y las acciones a desarrollar por el médico de familia en la consulta externa del hipertenso. Se expresaron las actividades y el procedimiento de intervención en la comunidad, así como la metodología y el programa para llevar a cabo en las escuelas de hipertensos.

We described an integral intervention directed to family physicians and basic work groups in external consultation, to the community and hypertensive patients of the Policlinic Heroes del Moncada, carried out from January 1st to December 31st 2013. The themes taught to family physicians and basic work groups were identified taking into account the Arterial Hypertension Program guidelines. We indicated the items of the clinical record that should be filled out and the actions the family physician should develop in the hypertensive patient external consultation. We explained the activities and the intervention procedure in the community, and also the methodology and program to develop in the hypertensive patients’ schools.

Prevalencia de sobrepeso y factores asociados. Municipio Matanzas 2009-2010 / Overweight prevalence and associated factors. Matanzas Municipality 2009-2010

La obesidad constituye uno de los problemas más comunes asociado al estilo de vida. Desde 1998 la Organización Mundial de la Salud (OMS) considera la obesidad una epidemia global. En la infancia y adolescencia constituye el trastorno metabólico más frecuente, así como la principal enfermedad no declarable. En Cuba la prevalencia ha variado de 32% aun 42.6% según investigaciones nacionales. El municipio Matanzas en la última encuesta nacional de factores de riesgo en el 2001, la prevalencia fue de 40.4 por 100 habitantes. La presente investigación se realizó con el objetivo de determinar la prevalencia de sobrepeso e identificar los factores asociados al mismo en personas de 15 y más años de edad en la población del municipio Matanzas en el período 2009-2010. Para esto se realizó un estudio observacional analítico de tipo transversal. La muestra fue aleatoria estratificada por grupos de edad decenales por sexo, 2640 personas dieron su consentimiento para participar en el estudio y fueron encuestados. El análisis fue por la metodología para muestras complejas. Se utilizó el enfoque de riesgo en análisis bivariado, con cálculo de Odds Ratio con intervalos de confianza del 95%. Dentro de los principales resultados encontrados fueron: la prevalencia de sobrepeso fue de 54.9% por 100 personas, los factores asociados fueron: no practicar ejercicios físicos sistemáticos, el sexo, la escolaridad, edad, ocupación, antecedentes de hipertensión arterial, antecedentes de colesterol elevado y los antecedentes de diabetes mellitus.

Obesity is one of the most common problems associated to life style. Since 1998, the World Health Organization considers obesity a global epidemic. It is the most frequent metabolic disorder in childhood and adolescence, and also the main non-declarable disease. According to national research, its prevalence have changed from 32 % to 42,6 %. In the last risk factors national enquiry of 2001, the municipality of Matanzas presented 40.4 % prevalence per 100 inhabitants. This research was carried out with the aim of to determine overweight prevalence and identifying the associated factors in persons aged 15 and more years among the population of the municipality of Matanzas in the period 2009-2010. For that we developed a cross-sectional analytic observational study. The analysis was made using the methodology for complex samples. The sample was randomized, stratified for every decennial age bracket per gender; 2 640 persons gave their consent for participating and were questioned. We used the risk approach and bi-variable analysis, calculating the odd ratio with 95 % confidence intervals. Among the main results was 54.9 % overweight prevalence per 100 persons; the associated factors found were: lack of systematical physical exercising, gender, scholarship, age, occupation, arterial hypertension, high cholesterol and diabetes mellitus antecedents.

Prevalencia del hábito de fumar y factores asociados. Municipio Matanzas 2009-2010 / Prevalence of smoking habit and associated factors. Municipality of Matanzas. 2009-2010

La Organización Mundial de la Salud considera al tabaquismo como una epidemia, constituyendo uno de los principales problemas de la salud pública mundial, además de las enfermedades, la pérdida de años de vida, las muertes que indiscutiblemente provoca y los gastos sanitarios que ocasiona, el tabaco representan una carga asistencial adicional para la salud pública. Cuba se sitúa entre los primeros países en el consumo per cápita de cigarrillos y tabaco, por lo que se le atribuye al tabaquismo carácter de epidemia. El municipio Matanzas en la última encuesta nacional de factores de riesgo en el 2001, presentaba una prevalencia de 29,1%. Esta problemática conllevó a la presente investigación. Los objetivos de la misma fueron cuantificar la prevalencia de tabaquismo e identificar los factores asociados al mismo en personas de 15 y más años en el municipio Matanzas de 2009-2010. Para esto se realizó un estudio observacional analítico de tipo transversal. Para la selección de la muestra se tuvo en cuenta el protocolo de la Iniciativa de la OPS conocida por las siglas de CARMEN. Se realizó el análisis para muestras complejas utilizando el enfoque de riesgo con cálculo de Odds Ratio y con intervalos de confianza del 95%. Dentro de los principales resultados, se obtuvo una prevalencia de tabaquismo de 24,3, más frecuente en el sexo masculino y con otras enfermedades asociadas como el alcoholismo, la hipertensión, diabetes mellitus e hipercolesterolemia. El inicio del hábito de fumar se destaca en edades tempranas de la vida. La mayoría de los fumadores quieren dejar de fumar y lo han intentado con anterioridad. Pocos fumadores solicitaron ayuda para dejar de fumar. Los profesionales de la salud no siempre recomiendan dejar el hábito, ni prestan ayuda cuando se les solicita.

The World Health Organization considers smoking an epidemics, being one of the main problems of the world´s public health; besides the diseases, life year lost, the deceases unquestionably provoked and the sanitary expenses caused, smoking represents an additional charge for the public health care. Cuba is among the first countries in the consumption of cigarettes and cigars per capita, so in our country an epidemic character is attributed to smoking. In the last risk factors national enquiry in 2001, the municipality of Matanzas presented a 29,1 % prevalence. This problem led us to this research. Its aims were quantifying smoking prevalence and identifying smoking associated factors in persons aged 15 years and more in the municipality of Matanzas in 2001-2010. For that we carried out a cross-sectional analytical observational study. For the selection of the sample we took into account the protocol of the Pan-American Heath Organization known as CARMEN. We developed the analysis for complex samples using the risk approach with Odd ratio and confidence intervals of 95 %. Among the main results obtained were 24,3 % prevalence of smoking, more frequent in male gender and associated to other diseases like alcoholism, hypertension, diabetes mellitus and hypercholesterolemia. The beginning of the smoking habit stood out in early ages. Most of the smokers want to quit smoking and had intended it before. Few smokers ask for help to quit smoking. Health care professionals do not always recommend quitting smoking nor help the people asking for it.

Prevalencia de insuficiencia renal crónica mediante las fórmulas de Cockcroft-Gault y Modificación de Dieta en la Enfermedad Renal: Matanzas, 2010 / Prevalence of the chronic renal insufficiency by means of the Cockcroft-Gault and Diet modification in the renal disease formulas: Matanzas, 2010

Fundamento: la insuficiencia renal crónica es la pérdida gradual, progresiva e irreversible de las funciones renales. Las fórmulas más empleadas para su diagnóstico son las de Cockcroft-Gault y la Modificación de Dieta en la Enfermedad Renal. En Matanzas se habían utilizado en estudios poblacionales.Objetivos: calcular la prevalencia de la insuficiencia renal crónica en el municipio de Matanzas y comparar ambas fórmulas. Métodos: se realizó un estudio descriptivo de tipo transversal. Muestra 2 326 personas. Las variables utilizadas fueron edad, sexo, peso, talla, color de la piel y creatinina sérica. Se utilizaron los intervalos de confianza del 95 por ciento para comparar las prevalencias por ambos métodos. Resultados: la prevalencia fue de 6,4 por 100 personas por Cockcroft-Gault y 5,0 por Modificación de Dieta en la Enfermedad Renal. Se incrementó directamente proporcional a la edad, el sexo femenino fue el más afectado, al igual que el color de piel blanca. No hubo diferencias significativas entre los datos de ambos métodos en el análisis de estas variables. La media de filtrado glomerular fue superior por la fórmula de Cockcroft-Gault. Igualmente por esta ecuación, fue superior la prevalencia en el grupo de 65 a 74 y en las personas con peso saludable. Conclusiones: se considera que ambos métodos son válidos para el cálculo de FG y por tanto para el diagnóstico de insuficiencia renal crónica, por su sencillez, y bajo costo, cuando se trabaja con grupos poblacionales grandes.

Fundament: the chronic renal insufficiency is the gradual, progressive and irreversible lost of the renal functions. The Cockcroft-Gault and the Diet Modification in the renal disease formulas are the most used ones for its diagnosis. In Matanzas they had been used in population studies. Objectives: calculating the prevalence of the chronic renal insufficiency in the municipality of Matanzas and comparing both formulas. Methods: we carried out a cross-sectional descriptive research. The sample was composed by 2 326 persons. The used variables were age, genre, weight, size, skin color, and serum creatinine. We used the confidence intervals of 95 percent to compare the prevalence of both methods. Results: the prevalence was 6,4 per 100 people for the Cockcroft-Gault, and 5,0 for the Diet Modification in the Renal Disease. There it was a direct increase in relation with age; the female genre was the most affected, and also the white skin color. There were not significant differences between the data of both methods in the analysis of these variables. The average of the glomerular filtrate was higher by means of the Cockcroft-Gault. Also the prevalence in the 65-74 age group and in the persons with healthy weight was higher for this equation.Conclusions: we consider that both methods are valid for calculating the glomerular filtrate and therefore for the diagnosis of the chronic renal insufficiency, because of its easiness and low cost, when working with big population groups.

Prevalencia del hábito de fumar en estudiantes de profesiones de la saludMatanzas: 2008-2009 / Prevalence of smoking habit in students of health professions Matanzas: 2008-2009

El tabaquismo es un problema mundial con alta prevalencia, no sólo en la población, sino también entre los trabajadores de la salud que deben servir de ejemplo en la lucha contra esta adicción. Se realizó un estudio de prevalencia para cuantificar la proporción de fumadores entre estudiantes de la salud de tercer año de las carreras de Medicina, Estomatología y Enfermería, en la Universidad de Ciencias Médica de Matanzas. Se aplicó una encuesta a 440 estudiantes y se encontró una prevalencia de 22 por ciento de fumadores, con predominio del hábito en el sexo masculino y los estudiantes de las carreras de enfermería. Al medir la exposición al humo ambiental, se encontraron alta prevalencia de fumadores pasivos tanto dentro de las viviendas como fueras de ellas, incluido las áreas de estudio (71,8 por ciento y el 62,9 por ciento de estudiantes, respectivamente). La edad de comienzo del hábito de fumar fue entre 16 y 19 años, y el grupo que probó por primera vez el cigarro entre 20 y 29 años fue el que más mantuvo el hábito. Entre los fumadores y no fumadores, los segundos fueron más partidarios de prohibir fumar en restaurantes, discotecas, bares, clubes y espacios públicos en relación a los fumadores. La alta prevalencia identificada de fumadores entre estudiantes de la salud hace necesario reforzar la labor educativa entre este grupo de futuros profesionales para que puedan realmente cumplir con su rol educativo...

Smoking is a world problem with a high prevalence, not only among the population, but also among the health professionals that should be an example in the struggle against this addiction. We carried out a prevalence study to quantify the proportion of smokers among the 3rd year students of Medicine, Stomatology, and Nursery, at the Medical Sciences University of Matanzas. We applied a survey to 440 students and found a prevalence of 22 % of smokers, with predominance of the male students and the students of Nursery. When assessing the exposition to the environmental smoke, there was a high prevalence of passive smokers both in the houses and out of them, including the studying areas (71,8 percent and 62,9 percent of students, respectively). The smoking habit began at the age between 16 and 19 years old, and the group that smoked for the first time when they were from 20 to 29 years old, was the group that more maintained the habit. Between the smokers and non-smokers, the second ones were more inclined to forbid smoking in restaurants, discotheques, bars, clubs and public places than smokers. The identified high prevalence of smokers among health students makes necessary to reinforce the educative work in this group of future professionals for they could really play their educative role...

Aplicación de farmacopuntura en afecciones dolorosas del hombro / Application pharmacopuncture in painful affections of the shoulder

Se realizó un estudio experimental, tipo ensayo clínico controlado, en el período comprendido entre enero del 2007 hasta enero del 2008, con el fin de comparar la respuesta al tratamiento con farmacopuntura en el hombro doloroso con respecto al bloqueo del nervio supraescapular y proponer un algoritmo de tratamiento. La muestra quedó constituida por 60 pacientes, los cuales fueron aleatorizados y divididos en dos grupos, a uno se le realizó bloqueo del nervio supraescapular con betametasona y lidocaína al 2 por ciento en dosis habituales y al otro grupo se les aplicó farmacopuntura con pequeñas dosis de betametasona diluida con agua para inyección. El tratamiento fue aplicado dos veces por semana y hasta seis sesiones como máximo. Se evaluaron semanalmente por un equipo de trabajo teniendo en cuenta el criterio del paciente según la escala visual análoga, según criterio médico basado en el examen clínico, explorándose el dolor, la limitación de la movilidad articular y el balance funcional . Se observó una evolución satisfactoria más rápida en los pacientes tratados con farmacopuntura. El tratamiento con farmacopuntura en el hombro doloroso es de alta eficacia frente al bloqueo del nervio supraescapular.

We carried out an experimental, longitudinal and prospective study, at the Provincial Centre for the Development of Natural and Traditional Medicine Dr Mario E Dihigo, during the period from January 2007 to January 2008, with the objective of treating the increased incidence of patients with painful affections of the shoulder, requiring in many cases the usage of long, risk treatments, with results not always satisfactory. The sample was formed by 60 patients who were randomized and divided in two groups. A blockade of the supraescapular nerve with betamethasone and lidocain 2 per cent in habitual doses was applied to one group; the second one received pharmacopuncture with low doses of betamethasone diluted in water for injection. The treatment was applied 2 times a week and up to the maximum of 6 sessions. They were evaluated weakly for a working group, taking into account the patient's criteria according to the visual analogous scale, according to the medical criteria based on the clinical examination looking for pain, joint mobility limitation and functional balance. Among the studied patients there was a predominance of the female sex beginning from the third and fourth decades of life. Tendinitis of the rotator cuff was the most frequent diagnosis. There was a faster satisfactory recovery in patients treated with pharmacopuncture. Pharmacopuncture therapy in painful shoulder is of higher efficacy than the blockade of the supraescapular nerve.

Hipertenso controlado: ¿Socialismo o capitalismo? / Controlled hypertense patient: Socialism or capitalism?

La hipertensión arterial es una enfermedad de gran importancia social por su alta frecuencia en la población y ser además el principal factor de riesgo de las enfermedades vasculares (cerebro y cardiovascular), que se encuentran dentro de las primeras causas de muerte de países desarrollados y subdesarrollados. Nos propusimos recopilar datos sobre las características de la hipertensión y la búsqueda de datos económico-sociales como el desempleo, el nivel de pobreza, la educación, la diferencia de ingresos y la brecha entre pobres y ricos, los sistemas de salud y los sistemas de seguridad social con su cobertura a la población y la equidad en salud, que constituyen determinantes del estado de salud de una población. Al comparar los datos de países capitalistas con los de Cuba y de la provincia de Matanzas, se demuestra con resultados la superioridad del sistema socialista sobre el capitalista.

The arterial hypertension is a disease of great social importance because of its high frequency among the population and for being the main risk fact of vascular diseases (cerebral and cardiovascular), located among the first causes of death in developed and underdeveloped countries. Our objective was compiling data on hypertension characteristics and socio-economic data like unemployment, poverty level, education, incomes difference and the gap between the poor and the rich, the health systems and the social security systems with their population covering and health care equity, all of them constituting determinants of the population's health status. When comparing the data from the capitalist countries with those from Cuba and the province of Matanzas , the results show a superiority of the socialist system on the capitalist.

Intervención educativa en diabéticos tipo 2 / Educational intervention in type II diabetes

Se realizó un estudio cuasiexperimental para valorar la influencia de una intervención educativa en el desarrollo de conocimientos, habilidades y destrezas en pacientes con diabetes mellitus 2, en Cárdenas, ingresados en el Centro de Atención a Pacientes Diabéticos, durante el segundo semestre de 2007 y el primero de 2008. La muestra estuvo conformada por 90 pacientes que asistieron al centro durante los meses de julio a diciembre del año 2007 (grupo de intervención) y 90 pacientes diabéticos de la Atención Primaria (grupo control). La intervención educativa constó de 2 etapas. Para ambos grupos al finalizar la primera etapa se aplicó un cuestionario, mientras que la segunda etapa consistió en actividades de profundización de conocimientos e integración del grupo de intervención, y al mismo tiempo se buscó igual información en el grupo control. Al final de la intervención los participantes en el Curso de Información Básica aumentaron sus conocimientos sobre diabetes mellitus, y mostraron diferencias significativas en cuanto a conocimientos sobre la enfermedad con relación al control. El Curso de Información Básica resulta efectivo para el desarrollo de conocimientos sobre diabetes mellitus. Los pacientes del grupo de intervención mostraron un adecuado control metabólico a los 6 meses de la intervención.

A quasi experimental study was conducted to value the influence of an educational intervention in knowledges, abilities and dexterities development in patients presenting with typo II diabetes mellitus in Cárdenas municipality, admitted in Care Center for Diabetes Patients during the second semester of 2007 and during the first one of 2008. Sample included 90 patients seen in such center from July to December, 2007 (intervention group), and 90 diabetic patients from Primary Care (control group). Educational intervention had 2 stages. In both groups at the end of the first stage we applied a questionnaire, whereas the second one included knowledge deepening activities and group intervention, and at the same time we search for information in control group. At the end of intervention, participants in Basic Information Course increased their knowledges on diabetes mellitus and showed significant differences as regards the knowledges on the disease in relation to control group. The above mentioned course is effective to develop the knowledges on diabetes mellitus. Patients of intervention group showed a appropriate metabolic control at 6 months from the intervention.

Mortalidad por cáncer y condición de género / Cancer mortality and sexual condition

La mortalidad por cáncer ha mantenido una tendencia al incremento en la mayor parte de los países. Se hizo un estudio descriptivo de la mortalidad por cáncer según condición de género desde el año 1990 al año 2007 en la provincia de Matanzas, que abarcó 14,294 fallecidos por cáncer de los 90,908 fallecidos por todas las causas. Se encontró un aumento sostenido de las tasas crudas y ajustadas de mortalidad en relación directa con la edad, mayor en el sexo masculino, estadísticamente significativa. La menor razón masculino/femenino (1.5) se evidenció en el período del 2002 al 2007. La media de la edad fue superior entre los hombres: 69.7 vs. 65.1. Ambos sexos con tendencia al incremento, pero los hombres con mayor peso en la mortalidad proporcional (17.5 vs. 13.5). La razón de sexo fue ligeramente mayor en los fallecidos por cáncer que entre los fallecidos por todas las causas (1.6 vs 1.3), así como en los de 70 años y más. La mayor cantidad de fallecidos la aportaron los cánceres de pulmón, próstata, colon y la mama femenina.

Cancer mortality has maintained an increasing tendency in most of the countries. We carried out a descriptive study of the cancer mortality according to the sex condition from 1990 to 2007 in the province of Matanzas, covering 14 294 deceased for cancer from the total of 90 908 deceased due to different causes. We found a steady increase of the crude and adjusted rates in direct relation with age, being higher and statistically significant in the male sex. The lowest male/female ratio (1.5) was evident in the period from 2002 to 2007. Mean age was higher among men: 69.7 vs. 65.1. There was a tendency to increase in both sexes, but there was a bigger proportional mortality in men (17.5 vs. 13.5). Sex ratio was slightly higher among those died by cancer than among those who died by other causes (1.6 vs. 1.3), and also among those who were 70 years old and more. The bigger quantity of diseases was due to lung, prostate, colon and female breast cancer.

Promedio de años de vida vividos y perdidos por fallecido de cáncer / Average of life years lost and gained for cancer deceased

Se realizó un estudio descriptivo y retrospectivo del Promedio de Años de Vida vividos (PAVV/F) y perdidos (PAVP/F) de los 14075 fallecidos por cáncer en la Provincia de Matanzas desde 1990 al año 2007. Se encontró que la diferencia en el PAVV/F entre el cáncer y otras causas descendió, mientras el PAVP/F se elevó en igual período. En los municipios el PAVV/F osciló entre 65.3 y 69.9 años y el PAVP/F entre 15.2 hasta 18.5. Los fallecidos por cáncer de próstata tuvieron el mayor PAVV/F y el menor fue el cáncer de cuello uterino. Los fallecidos de próstata tuvieron el menor Promedio de Años de Vida Vidos PAVP/F y el de Cuello uterino resultó el mayor.

We carried out a retrospective, descriptive study on the average of gained and lost life years of the 14 075 deceased by cancer in the province of Matanzas from 1990 to 2007. We found that the difference in the average of gained life years between cancer and other causes decreased, while the average of lost life years increased during the same period. In the municipalities, the average of gained life years ranged between 65.3 and 69.9 years, and the average of lost life years between 15.2 and 18.5. The deceased by prostate cancer showed the highest average of gained life years, and the the deceased by uterine neck cancer showed the lowest. The deceased by prostate cancer showed the lowest average of lost life years and the deceased by uterine neck cancer showed the highest.

Evaluación de los indicadores epidemiológicos del programa de la tuberculosis, Matanzas: años 2002- 2006 / Evaluating the epidemiological indicators of the tuberculosis program, Matanzas: years 2002-2006

Se realizó una Investigación en Sistemas y Servicios de Salud (ISSS) con un diseño epidemiológico observacional de tipo descriptivo transversal en la provincia de Matanzas en el período 2000-2006.Se tomaron el 100 por ciento de los casos de tuberculosis diagnosticados, llegándose a la conclusión de que se cumplieron adecuadamente los indicadores Epidemiológicos a nivel provincial y de Áreas.

We carried out an investigation on Health Services and Systems with an observational epidemiologic design of transversal descriptive type in the province of Matanzas during the period 2000-2006. We covered 100 percent of the tuberculosis diagnosed cases, arriving to the conclusion that the Epidemiologic Indicators were fulfilled adequately at the provincial and health areas levels.