Implementation of chronic disease risk factor surveillance in 12 Cuban municipalities.

Chronic non-communicable diseases have been called the pandemic of the 21st century and constitute a high-priority public health challenge; hence growing interest in chronic disease risk factor surveillance. Cuba is implementing decentralized risk factor surveillance in each of its municipalities as part of a strategy to address non-communicable diseases. Decentralized surveillance with this level of detail and explicitly designed to inform municipal and provincial decisionmaking is unprecedented in Cuba. We describe the methodology for planning and implementing measurement of major risk factors in 12 municipalities in 10 provinces, as part of Cuba's National Surveillance System. The results have facilitated timely use of information and evidence-based decisionmaking at the local level.

Tobacco and alcohol use in Cuban women.

INTRODUCTION: Tobacco and alcohol are currently the most widely consumed legal psychoactive substances in the world. They represent a heavy burden for health and society in almost all populations. Increasing consumption of both substances is a trend observed in women. OBJECTIVE: Describe the profile of women aged ≥15 years residing in urban areas of Cuba with respect to tobacco and alcohol consumption. METHOD: Basic information on tobacco and alcohol consumption by Cubans aged ≥15 years in urban areas was obtained from the Second National Survey on Risk Factors and Chronic Diseases (2001), a national descriptive cross-sectional study, the objective of which was to determine the frequency and epidemiological characteristics of the urban population's main chronic disease risk factors. Sampling design was complex stratified multi-stage cluster. Of a sample of 23,743 individuals, 22,851 were surveyed, representative of 6.8 million Cubans. A questionnaire and structured interview were used. Variables were tobacco and alcohol use, as well as sociodemographic factors: sex, age, educational level, skin color, marital status, type of full-time employment and perceived economic situation. Prevalence, with 95% confidence intervals, and male:female prevalence ratios were estimated. RESULTS: Women who smoked were predominantly aged 40-59 years; had completed less than university education; of black skin color; divorced; laborers, service workers or managers, and with a perceived economic situation as very poor. Women who consumed alcohol were predominantly aged 15-59 years, had at least middle school education, of mestizo or black skin color, of marital status other than widowed; there was no typical profile for occupation or perceived economic situation. Women who were both smokers and alcohol consumers were predominantly 20-59 years, of black or mestizo skin color, of marital status other than widowed; with no typical profile for educational level, occupation or perceived economic situation. CONCLUSIONS: The first nationwide socioeconomic profile of Cuban women using tobacco, alcohol or both constitutes a baseline for comparison to results of a new national study now under way, permitting evaluation of trends over time and effectiveness of prevention and control efforts.

Equilibrium-based sampler for determining Cu2+ concentrations in aquatic ecosystems.

The bioavailability of potentially toxic metals in aquatic systems is frequently related to the dissolved free metal ion (M2+) concentration. However, typical methods used to determine M2+ are labor intensive or require sophisticated equipment. We developed an inexpensive, in situ sampling device--the "gellyfish"--that simplifies Cu2+ determinations in seawater. The gellyfish is a thin disk of polyacrylamide gel embedded with iminodiacetate (Id) groups bound to immobile beads. The sampler operates on the principle that the immobilized Id groups equilibrate with the Cu2+ concentration of the surrounding solution. Cu is then back-extracted into a known volume of 10% HNO3 and measured by inductively coupled plasma mass spectrometry (ICP-MS). In laboratory tests, we varied Cu2+ concentrations between 10(-12) and 10(-8) M and salinity between 5 and 35 ppt. Id-bound Cu (CuId(measured)) did not respond to changes in total Cu. However, CuId(measured) does increase in a predictable manner with increasing Cu2+, and prototype gellyfish precision (average coefficient of variation = 10%) is sufficient to resolve small differences in Cu2+ (+/-30%). Modeled Cu uptake, based on thermodynamic equilibrium speciation of Id within gellyfish, is a good predictor of CuId(measured) (r2 = 0.96 and n = 45).