Prevalencia y mortalidad por diabetes en Cuba, decenio 2010-2019 / Prevalence and mortality from diabetes in Cuba during the 2010-2019 decade

Introducción: La diabetes mellitus es una afección grave y crónica que ocurre cuando los niveles de glucosa en la sangre de una persona son altos, porque su cuerpo no puede producir insulina o su cantidad es insuficiente. Constituye un importante e independiente factor de riesgo, para las enfermedades cardiovasculares y otros daños. Objetivo: Describir la prevalencia y mortalidad por diabetes en Cuba, en el decenio 2010- 2019. Material y métodos: Se realizó un estudio ecológico, descriptivo, sobre la diabetes mellitus en Cuba. Se tuvieron en cuenta, la dispensarización, las tasas de mortalidad brutas por la enfermedad, en el decenio 2010- 2019. Los anuarios estadísticos publicados por la Dirección de Registros Médicos y Estadísticas de Salud, del Ministerio de Salud Pública de esos años, fueron la fuente de información. Resultados: La prevalencia de diabetes en Cuba en el decenio, ha tenido tendencia al incremento de 4,04 por ciento en 2010, a 6,67 por ciento en 2019. Fue más frecuente en las personas del sexo femenino. Las tasas brutas de mortalidad, disminuyeron en ese período de 23,9 a 20,6 por 100 000 habitantes. Conclusiones: Las tasas de prevalencia anuales de diabetes reportadas en Cuba, resultaron mayores en el sexo femenino. En el decenio, la prevalencia general de diabetes mostró un incremento, en tanto que la tendencia de la mortalidad bruta por esta enfermedad, fue al descenso. Murieron más mujeres que hombres(AU)

Introduction: Diabetes is a serious and chronic condition that occurs when a person's blood glucose levels are high because the body cannot produce insulin or its amount is insufficient. It is an important and independent risk factor for cardiovascular diseases and other damages. Objective: To describe the prevalence and mortality from diabetes in Cuba during the decade 2010-2019. Material and Methods: A descriptive ecological study on diabetes in Cuba was carried out. Dispensarization and gross mortality rates due to the disease in the 2010-2019 decade were taken into account. The statistical yearbooks published by the Directorate of Medical Records and Health Statistics of the Ministry of Public Health those years were used as a source of information. Results: The prevalence of diabetes in Cuba in the decade tended to increase from 4,04 percent in 2010, to 6,67 percent in 2019. It was more frequent in women. Crude mortality rates decreased in that period from 23,9 to 20,6 per 100 000 inhabitants. Conclusions: The annual prevalence rates of diabetes reported in Cuba were higher in females. In the decade, the general prevalence of diabetes showed an increase, while the trend in gross mortality from this disease was related to the decrease. Women were more likely to die than men(AU)

Vulnerabilidad poblacional a la COVID-19 severa desde los datos de la encuesta nacional de salud

RESUMEN Introducción: Nuevas cepas de SARS-CoV-2 detectadas recientemente provocan aumento de la morbilidad y mortalidad no solo en adultos mayores. Conocer la población vulnerable es un reto. Objetivo: Estimar la prevalencia de adultos vulnerables a la COVID-19 severa y sus factores sociodemográficos asociados. Métodos: Estudio observacional transversal analítico con datos provenientes de la encuesta nacional de salud 2018-2020, que incluye 13 684 personas de 19 y más años de edad. El cuestionario estructurado provee la información de variables sociodemográficas, antecedentes patológicos personales e historia familiar, mediciones de la presión arterial y bioquímicas, entre otras. Vulnerabilidad a COVID-19 severa se construyó según propuesta del CDC de Atlanta, EE. UU y fue la variable dependiente. Resultados: La prevalencia de adultos vulnerables a COVID-19 severa en el país fue de 68,3 %, riesgo superior en el adulto mayor (86,5 %), en los no blancos y en la percepción de condiciones de vida "malas". En adultos mayores ser hombre protege, en tanto, fue riesgo, vivir en la región oriental del país. La hipertensión arterial (39,4 %), seguida del tabaquismo (22,2 %), la obesidad (16,6 %) y las enfermedades respiratorias crónicas (10,6 %) fueron las afecciones médicas más frecuentes. Conclusiones: La vulnerabilidad a la COVID-19 severa en la población adulta cubana es elevada, consecuentemente, constituye un serio problema de salud. Factores no modificables se asocian positivamente a la vulnerabilidad: ser adulto mayor, mujer, color de piel no blanca y padecer hipertensión arterial, en tanto, las "malas" condiciones de vida es el único que puede ser modificado.

ABSTRACT Introduction: New SARS-CoV-2 strains recently detected cause an increase in morbidity and mortality not only in the elderly. Identifying the vulnerable population is a challenge. Objective: To estimate the prevalence of adults vulnerable to severe COVID-19 and its associated sociodemographic factors. Methods: An observational cross-sectional analytic study using data from the 2018-2020 National Health Survey. It included 13 684 individuals aged 19 years and over. The structured questionnaire included information on the sociodemographic variables, personal and family pathological antecedents, and records of blood pressure and biochemistry tests, among others. Vulnerability to severe COVID-19 was developed based on the proposal from the CDC Atlanta, USA and it was the dependable variable. Results: The prevalence of adults vulnerable to severe COVID-19 in the country was 68.3%. At higher risk are the elderly (86.5%), non-white individuals, and those who perceived themselves as having poor living conditions. For the elderly, being male was a protective factor, while living in the western region of the country was a risk factor. High blood pressure (39.4%), smoking (22.2%), obesity (16.6%) and chronic respiratory diseases (10.6%) were the most frequent health problems. Conclusions: Vulnerability to severe COVID-19 in the Cuban adult population is high; consequently, it is considered a serious health problem. Non-modifiable factors are positively associated with vulnerability: being an older adult, female, non-white skin color, and suffering from hypertension; while "poor" living conditions is the only modifiable factor.

Prevalencia y características de la enfermedad pulmonar obstructiva crónica en La Habana (2017-2018)

RESUMEN Introducción: En Cuba la enfermedad pulmonar obstructiva crónica es sexta causa de mortalidad general. Existe insuficiente conocimiento sobre su magnitud. Objetivo: Determinar la prevalencia y características de la enfermedad en La Habana (2017-2018). Métodos: Estudio multicéntrico transversal, coordinado por Iniciative Burden of Lung Disease, incluyó 349 personas no institucionalizadas de 40 años y más de cuatro consultorios médicos (selección aleatoria). Se aplicó cuestionario con variables sociodemográficas relacionadas con diagnóstico médico previo y tabaquismo. Se realizó estudio de espirometría, pre-pos aplicación de salbutamol para determinar limitación del flujo aéreo y clasificó severidad de la enfermedad en leve, moderada, severa y muy severa. Resultados: Prevalencia global 20,9 % (IC 95 %:16,6-25,2); en hombres 25,3 %, en mujeres 17,7 %. Se incrementó con la edad. Formas leves 60 %, más frecuentes en mujeres 67 % vs. severas en hombres, 22 %. Espirometría previa 15 % de encuestados. Catorce encuestados (19,1 %) tenían el diagnóstico médico previo de enfisema pulmonar, bronquitis crónica o enfermedad pulmonar obstructiva crónica. Prevalencia de tabaquismo 36,0 %, mayor porcentaje en formas severas. La tercera parte (31,7 %), expuestos al humo de tabaco ajeno, en hogar o trabajo; media de exposición diaria 5 h. Conclusiones: La alta prevalencia y subdiagnóstico de enfermedad pulmonar obstructiva crónica la convierten en un importante problema de salud en La Habana. Se pronostica incremento de la prevalencia relacionado con la dinámica poblacional en el país y el alto consumo de tabaco en la población. Se requiere un manejo más integral de esta enfermedad prevenible.

ABSTRACT Introduction: In Cuba, chronic obstructive pulmonary disease is the sixth leading cause of death. There is insufficient knowledge concerning its scope. Objective: To determine the prevalence and characteristics of the disease in Havana (2017-2018). Methods: A multicenter, cross-sectional study coordinated by Iniciative Burden of Lung Disease. It included 349 non-hospitalized people aged 40 and over from four family doctor´s offices (random selection). A questionnaire with sociodemographic variables on previous medical diagnosis and smoking was applied. A spirometric study was conducted before and after salbutamol administration to determine airflow limitations, and the disease was classified as mild, moderate, severe, and very severe. Results: Overall prevalence was 20.9% (95 % CI: 16.6-25.2); with males accounting for 25.3%; and females for 17.7%. It increased with age. Mild forms of the disease affected 60% of the population; they were more common in females (67%) than in males (severe forms, 22%). Previous spirometry was performed in 15% of respondents. Fourteen people (19.1%) had previously been diagnosed with pulmonary emphysema, chronic bronchitis, or chronic obstructive pulmonary disease. Smoking prevalence was 36%, with a higher percentage in the severe forms of the disease. One-third (31.7%) were exposed to second-hand tobacco smoke at home or at work, with a daily average exposure of 5 hours. Conclusions: Chronic obstructive pulmonary disease is a major health problem in Havana due to its high prevalence and underdiagnosis. An increase in prevalence is predicted given the demographic dynamics in the country and the high level of tobacco consumption among the population. Therefore, more comprehensive management of this preventable disease is required.

Caracterización de la prevalencia de la hipertensión arterial en Cuba en 2019 / Characterization of Arterial Hypertension Prevalence in Cuba in 2019

Introducción: La hipertensión arterial pudiera ser un elemento clave para la prevención de las enfermedades cardiovasculares, pues constituye su principal denominador común. Es el principal factor de riesgo, para la carga mundial de morbilidad y mortalidad. Objetivo: Caracterizar la prevalencia de hipertensión arterial en Cuba en el año 2019. Métodos: Se realizó un estudio ecológico. Se compararon las prevalencias de hipertensión arterial en las encuestas nacionales de factores de riesgo en los años 1995, 2001 y 2010 respecto a las de la dispensarización de esos años. Se tuvieron en cuenta las prevalencias totales de hipertensión arterial por grupos de edad y sexo, las de cada provincia y del municipio especial Isla de la Juventud. Los datos se procesaron de forma automatizada. Los resultados se expresaron en una tabla y gráficos. Resultados: Las prevalencias de hipertensión arterial encontradas en las encuestas nacionales de factores de riesgo superaron a las de la dispensarización en esos años. La prevalencia de hipertensión arterial se incrementó en la medida que lo hizo la edad. En el grupo de edad de 60 a 64 años, más del 75 por ciento de las personas resultaron hipertensas. En los de 25 a 59, de 65 y más y en el total predominaron las mujeres hipertensas. Conclusiones: Es preciso reducir la brecha entre los pacientes conocidos como hipertensos, dentro del sistema de salud y los que realmente son portadores de la enfermedad, conseguir el manejo adecuado de esta y con eso influir favorablemente en la morbilidad y mortalidad por enfermedades vasculares(AU)

Introduction: Hypertension could be a key element for the prevention of cardiovascular diseases, since it constitutes its main common denominator. It is the main risk factor for the global burden of morbidity and mortality. Objective: To characterize the prevalence of arterial hypertension in Cuba in 2019. Methods: An ecological study was carried out. The prevalence rates of arterial hypertension in the national surveys of risk factors in the years 1995, 2001 and 2010 were compared to those of the dispensarization carried out in those years. The total prevalence rates of arterial hypertension were taken into account by age groups and sex, considering also those of each province and of the special municipality of Isla de la Juventud. The data was processed automatically. The results were expressed in a table and in graphs. Results: The prevalence rates of arterial hypertension found in the national surveys of risk factors exceeded those of dispensarization in those years. The prevalence of hypertension increased with age. In the age group 60-64 years, more than 75 percent of people were hypertensive. In those aged 25-59, 65 and over, as well as in the total, hypertensive women predominated. Conclusions: It is necessary to reduce, within the health system, the gap between patients known as hypertensive and those who really are carriers of the disease, to achieve proper management of this and, thus, to have a favorable influence on morbidity and mortality from vascular diseases(AU)

Fungal populations in the bedroom dust of children in Havana, Cuba, and its relationship with environmental conditions.

The study of the fungal community composition in house dust is useful to assess the accumulative exposure to fungi in indoor environments. The objective of this research was to characterize the fungal diversity of house dust and its association with the environmental conditions of bedrooms. For this, the dust was collected from 41 bedrooms of children between the ages of 8 and 9 with a family history of asthma, residents of Havana, Cuba. The fungal content of each sample was determined by two methods: plate culture with malt extract agar and by direct microscopy. An ecological analysis was carried out from the fungal diversity detected. To describe the factors associated with the fungi detected, bivariate logistic regression was used. Through direct microscopy, between 10 and 2311 fragments of hyphae and spores corresponding mainly to Cladosporium, Coprinus, Curvularia, Aspergillus/Penicillium, Xylariaceae, and Periconia were identified. Through the culture, 0-208 CFU were quantified, where Aspergillus, Cladosporium, and Penicillium predominated. The culturability evidenced the differences between the quantification determined by both methods. A positive relationship was found between the type of cleaning of the furniture, the presence of trees in front of the bedroom, indoor relative humidity, indoor temperature, the presence of air conditioning, and natural ventilation with specific spore types and genera. The use of two different identification methods allowed to detect a greater fungal diversity in the residences evaluated. Monitoring the exposure to these fungal allergens in childhood can help to prevent sensitization in the allergic child, the development of asthma, and other respiratory diseases.

Caracterización de la mortalidad por enfermedades cardiovasculares: Cuba, 2009-2018 / Characterization of mortality from cardiovascular diseases: Cuba, 2009-2018

RESUMEN Fundamento: un tercio del total de muertes que ocurren en el mundo, por enfermedades no transmisibles, se deben a las enfermedades cardiovasculares que constituyen la primera causa de muerte a nivel mundial y en Cuba. Objetivo: caracterizar la mortalidad por enfermedades cardiovasculares en Cuba ocurridas en el período 2009-2018. Métodos: se realizó un estudio ecológico. Se utilizaron los anuarios estadísticos, publicados por el Ministerio de Salud Pública de Cuba y la Clasificación Internacional de Enfermedades (CIE-10). Se consideraron las tasas de mortalidad por enfermedades del corazón y su comportamiento por provincias, así como, las tasas de mortalidad por enfermedades del sistema circulatorio y su distribución por grupo de edades. Las tasas usadas fueron las brutas. Resultados: en Cuba las enfermedades del sistema circulatorio aportan una tasa de mortalidad entre 299,4 y 360,0 por 100 000 habitantes con tendencia al incremento. Las tasas de mortalidad para las enfermedades del corazón y de las arterias, arteriolas y vasos capilares, desde el año 2009 hasta el 2018, fueron superiores en los hombres. En cuanto a las enfermedades cerebrovasculares excedieron en las mujeres, excepto en los años 2014, 2016-2018. En el año 2013 y 2015 fueron muy similares para ambos sexos. Dentro de las enfermedades cardiovasculares las del corazón aportaron más años de vida perdidos, secundadas por las cerebrovasculares y en menor magnitud las de las arterias, arteriolas y vasos capilares. Conclusiones: las enfermedades cardiovasculares son un grave problema de salud por lo cual se hace necesario accionar sobre las causas que las originan, para ganar en la percepción de riesgo cardiovascular, en la responsabilidad de cada persona y en el auto cuidado de la salud.

ABSTRACT Background: a third of the total deaths that occur in the world, due to non-transmissible diseases, are due to cardiovascular diseases. They constitute the first cause of death worldwide and in Cuba. Objective: to characterize the mortality from cardiovascular diseases in Cuba that occurred in the period 2009-2018. Methods: an ecological study was carried out. Statistical yearbooks published by the Cuban Ministry of Public Health and the International Classification of Diseases (ICD-10) were used. Mortality rates from heart diseases and their behavior by provinces were considered, as well as mortality rates from diseases of the circulatory system and their distribution by age group. The rates used were gross. Results: in Cuba, diseases of the circulatory system provide a mortality rate between 299.4 and 360.0 per 100 000 inhabitants with a tendency to increase. Mortality rates for diseases of the heart and arteries, arterioles, and capillaries, from 2009 to 2018, were higher in men. Regarding stroke diseases, they exceeded in women, except in the years 2014, 2016-2018. In 2013 and 2015 they were very similar for both sexes. Within cardiovascular diseases, heart diseases contributed more potentially lost years of life, supported by stroke diseases and to a lesser extent those of arteries, arterioles and capillaries. Conclusions: cardiovascular diseases continue to be a serious health problem, which is why it is necessary to act on the causes that cause them, gaining in the perception of cardiovascular risk and in the responsibility, of each person, in the self-care of the health.

Características epidemiológicas de la COVID-19 en La Habana, epicentro de Cuba

RESUMEN Introducción: En Cuba, La Habana es declarada el epicentro de la pandemia y se desconocen sus particularidades. Objetivo: Examinar las características epidemiológicas de la COVID-19 en La Habana. Métodos: Estudio epidemiológico observacional descriptivo de todos los casos con COVID-19 confirmados entre el 17 de marzo-30 de junio de 2020 en La Habana. Información procedente de la investigación epidemiológica realizada a cada caso positivo. Análisis estadístico realizado con el paquete estadístico R versión 4.0.1 y el análisis espacial con el software libre QGIS 3.0. Resultados: El pico epidémico se alcanzó con 64 casos y brotes institucionales pasados 30 días del inicio de la epidemia. Existió variabilidad de las incidencias entre los municipios y un tránsito favorable de la incidencia, recuperados y fallecidos a partir de los 45 días de la pandemia. Los estadios clínicos de la enfermedad difieren respecto a la edad y los municipios de procedencia. El mayor riesgo de morir es proporcional a la edad. Los enfermeros y las mujeres son más vulnerables al contagio. Conclusiones: El máximo aumento de casos a nivel poblacional y los brotes institucionales son importantes en la dinámica de una epidemia. La incidencia y la mortalidad difieren entre los municipios. Los estadios clínicos de la enfermedad están influidos por la edad y las comorbilidades. El personal de enfermería es frecuentemente enfermado. Tener un plan nacional para el enfrentamiento de esta contingencia junto a la voluntad política del estado es una fortaleza en la evolución satisfactoria de la pandemia. Profundizar en la epidemiología e impactos de las estrategias salubristas es necesario.

ABSTRACT Introduction: Havana has been declared the COVID-19 pandemic epicenter in Cuba, but its specific features are not known. Objective: Examine the epidemiological characteristics of COVID-19 in Havana. Methods: An observational descriptive epidemiological study was conducted of all the COVID-19 cases confirmed in Havana from 17 March to 30 June 2020. Data were obtained from the epidemiological study of each positive case. Statistical analysis was based on the statistical package R, version 4.0.1, whereas the free software QGIS 3.0 was used for spatial analysis. Results: The epidemic peak was reached with 64 cases and institutional outbreaks 30 days after the start of the epidemic. Variability was found between the incidence values for the different municipalities, and a favorable transit was observed of the incidence of the disease and the number of recoveries and deaths as of 45 days of the pandemic. Clinical stages of the disease vary with age and the municipality of residence. Risk of death is proportional to age. Nurses and women are more vulnerable to contagion. Conclusions: Maximum increase in the number of cases on a population level and institutional outbreaks are important elements in the dynamic of an epidemic. Incidence and mortality differ between municipalities. The clinical stages of the disease are influenced by age and comorbidities. The nursing personnel are at greater risk of becoming ill. A national contingency plan and the political will of the state are strengths in the successful combat against the pandemic. It is necessary to gain further insight into the epidemiology of the disease and the impact of the health strategies implemented.

Prevalence and risk factors for wheeze, decreased forced expiratory volume in 1 s and bronchoconstriction in young children living in Havana, Cuba: a population-based cohort study.

OBJECTIVES: Asthma has not been extensively studied in low-income and middle-income countries, where risk factors and access to treatment may differ from more affluent countries. We aimed to identify the prevalence of asthma and local risk factors in Havana, Cuba. SETTING: Four municipalities in Havana, Cuba. PARTICIPANTS: A population-based cohort study design of young children living in Havana, Cuba. Children were recruited from primary care centres at age 12-15 months. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on wheeze in the past 12 months, asthma treatment and environmental exposures collected regularly until the age of 6 years, when forced expiratory volume in 1 s (FEV1) and reversibility to aerosolised salbutamol were also measured. RESULTS: 1106 children provided data at the age of 6 years old. The prevalence of wheeze in the previous 12 months was 422 (38%), and 294 (33%) of the study population had bronchodilatation of 12% or more in FEV1 after administration of inhaled salbutamol. In the previous 12 months, 182 (16%) of the children had received inhaled corticosteroids, 416 (38%) salbutamol inhalers and 283 (26%) a course of systemic steroids.Wheeze in the first year and a family history of asthma were both positively associated with bronchodilatation to inhaled salbutamol (1.94%; 95% CI 0.81 to 3.08 and 1.85%; CI 0.14 to 3.57, respectively), while paracetamol use in the first year was associated with wheeze at 6 years (OR 1.64, 95% CI 1.14 to 2.35). There were large differences in FEV1, bronchodilatation and risk of wheeze across different geographical areas. CONCLUSIONS: Asthma is common in young children living in Havana, and the high prevalence of systemic steroids administrated is likely to reflect the underuse of regular inhaled corticosteroids. If replicated in other comparable low-income and middle-income countries, this represents an important global public health issue.

The prevalence, clinical status and genotype of cystic fibrosis patients living in Cuba using national registry data.

BACKGROUND: We aimed to establish a national cystic fibrosis (CF) registry for Cuba, a developing country. METHODS: Regional centres that deliver care for all CF patients provided information for a national database. FINDINGS: The prevalence of CF in Cuba is 26.3 cases per 1,000,000 population. The median age at diagnosis is 2 years, and the median age of the total population was 15 years. Of those aged 16 years or older, the prevalence of Pseudomonas aeruginosa infection was 46%, the prevalence of Staphylococcus aureus infection was 36%, and 80% of individuals were receiving oral azithromycin. The commonest gene mutation was F508del which was observed in 50% of patients. INTERPRETATION: These data demonstrate that it is possible to establish a national CF registry in a developing country such as Cuba. This provides baseline data to permit evaluation of health care delivery enable the spread of good clinical practice nationally.

The association between dengue immunoglobulin G titres with previous clinical dengue infection and white cell counts in Cuban children: A population-based study.

BACKGROUND: The prevalence of dengue infection is increasing globally. There are few prospective population-based surveillance studies of the immunological and inflammatory consequences of exposure to dengue virus in young children. OBJECTIVE: To study the association between serologically confirmed prior medical diagnosis of dengue infection and blood measures of systemic inflammation with dengue virus immunoglobulin G levels. METHODS: A population-based study of healthy three-year old children living in Havana, Cuba. RESULTS: 865 individuals provided a blood sample. Fourteen (1.6%) had a prior medical diagnosis of dengue infection, and 851 individuals had no prior medical diagnosis. There was no difference in the serum immunoglobulin G titres between these groups (Mann-Whitney test, p = 0.49). Total white cell count, blood neutrophil and eosinophil counts were linearly associated with a dengue immunoglobulin G value above the median value. CONCLUSIONS: There was no difference between the dengue immunoglobulin G titres in young children who had previously had clinically proven dengue infection compared to those who had no diagnosis of prior infection. This may be a consequence of a relatively high prevalence of sub-clinical infection. A higher dengue immunoglobulin G level was positively associated with a range of inflammatory biomarkers, although these data cannot demonstrate a causal association.

[Prevalence, incidence and factors associated with adverse reactions to foods in Cuban infants. A population-based cohort study]. / Prevalencia, incidencia y factores asociados con reacción adversa a alimentos en infantes cubanos. Estudio de cohorte de base poblacional.

BACKGROUND: The prevalence of asthma and allergic diseases in Cuban children is high, but little is known about adverse reactions to foods. OBJECTIVE: To determine the prevalence, incidence and risk factors for adverse reaction to foods in children. METHODS: Population-based cohort study carried out in Havana, Cuba, in a three-year period. Parents of 1543 children provided medical and lifestyle information from the first to the third year of age, which was collected using a questionnaire. An adverse reaction to foods was defined by medical diagnosis reported by the parents or caregivers. RESULTS: Annual cumulative incidence was 5.7%, 1.9% and 0.8%, whereas annual prevalence was 5.7%, 4% and 2.5% at 1, 2 and 3 years of age, respectively; 8% of infants had experienced an adverse reaction to foods when they turned 3 years of age. Cow milk was the most commonly implicated food. Main risk factors were allergenic food consumption, use of antibiotics, factors related to the presence of allergens, maternal history of overweight during pregnancy and allergy to insect bites. CONCLUSIONS: Adverse reaction to food is a significant clinical problem in children from Havana. Modifiable risk factors were identified, the understanding of which will help to direct effective intervention strategies.

Antecedentes: Aunque la prevalencia del asma y enfermedades alérgicas en niños cubanos es alta, se conoce poco de las reacciones adversas a alimentos. Objetivo: Determinar prevalencia, incidencia y factores de riesgo para reacciones adversas a alimentos en niños. Métodos: Estudio de cohorte de base poblacional de La Habana, Cuba, en un periodo de tres años. Los padres de 1543 niños proveyeron datos médicos y de estilos de vida del primer al tercer año de edad, colectados con un cuestionario. La reacción adversa a alimentos fue definida por diagnóstico médico reportado por los padres o cuidadores. Resultados: La incidencia acumulada anual fue 5.7, 1.9 y 0.8 % y la prevalencia anual de 5.7, 4 y 2.5 % al uno, dos y tres años, respectivamente; 8 % de los infantes a los tres años tuvo una reacción adversa a alimentos. La leche de vaca fue el alimento más implicado. Los principales factores de riesgo fueron consumo de alimentos alergénicos, uso de antibióticos, factores relacionados con la presencia de alérgenos, historia materna de sobrepeso durante el embarazo y alergia a picaduras de insectos. Conclusiones: La reacción adversa al alimento es un problema significativo en los niños de La Habana. Se identificaron factores de riesgo modificables, cuya comprensión puede dirigir las intervenciones.

Epilepsy mortality trends in Cuba compared with England and Wales: 1987-2010.

There are limited epilepsy mortality data from developing countries and Latin America in particular. We examined national epilepsy mortality data from Cuba and contrasted them with comparable data from England and Wales. National epilepsy mortality data for Cuba between the years 1987 and 2010 were obtained from the Medical Records and Health Statistics Bureau of the Cuban Public Health Ministry (www.sld.cu/sitios/dne/) with the corresponding mortality data from England and Wales obtained from the UK Office of National Statistics (ONS, www.ons.gov.uk). Indirect standardization with calculation of a standardized mortality ratio (SMR) was used to compare trends. The overall trend was of a slight decrease in mortality rates over the 23 years in Cuba, with higher mortality rates primarily occurring in young people. Annual age-adjusted rates were consistently lower in Cuba than those seen in England and Wales, with the SMR ranging from 0.35 (95% confidence interval (CI): 0.30 to 0.48) in 2007 to 1.00 (95% CI: 0.85 to 1.15) in 1994. Cuban epilepsy mortality rates are consistently lower than those of England and Wales. Reasons for this disparity in mortality rates are not immediately apparent but are likely to be multifactorial.

Enfermedades no transmisibles: factores de riesgo y acciones para su prevención y control en Cuba

[RESUMEN]. Las enfermedades no transmisibles (ENT) representan uno de los mayores desafíos para el desarrollo en el siglo XXI, debido al devastador impacto social, económico y de la salud pública que provocan. El propósito de este artículo es describir la evolución y los factores de riesgo de las ENT en Cuba, principalmente en el período 1990–2015, reseñar las acciones emprendidas por el Ministerio de Salud Pública y destacar los desafíos más importantes para su prevención y control. La información contenida proviene de los datos colectados y publicados por la Dirección de Registros Médicos y Estadísticas de Salud, investigaciones sobre los factores de riesgo, otros estudios fundamentados y la documentación de acciones integrales. La mortalidad en Cuba está determinada por cuatro grandes problemas de salud: enfermedades cardiovasculares, tumores malignos, enfermedades crónicas de las vías respiratorias inferiores y diabetes mellitus, que en conjunto causan el 68,0% de los fallecimientos. La tendencia del cáncer es al ascenso y la enfermedad renal crónica emerge como un grave problema de salud. Cuba cuenta con una línea de base conocida sobre los factores de riesgo, de ellos la hipertensión y el consumo de tabaco son los principales relacionados con la mortalidad por ENT. En consonancia con la importancia de estas enfermedades se aprecian hitos e intervenciones de impacto positivo, así como brechas y desafíos en el marco del Plan de Acción Mundial de la Organización Mundial de la Salud para el enfrentamiento a las ENT.

[ABSTRACT]. Non-communicable diseases (NCDs) represent one of the greatest challenges for development of the 21st century due to their devastating social, economic and public health impact. The objective of this article are to describe the evolution and risk factors for NCDs in Cuba, mainly in the period 1990–2015, to outline actions undertaken by the Ministry of Public Health of Cuba, and to highlight the most important challenges with a focus on their prevention and control. The information is based on data collected and published by the Directorate of Medical Records and Health Statistics, research on risk factors, other studies and documentation of comprehensive actions. Mortality in Cuba is determined by four major health problems: cardiovascular diseases, malignant tumors, chronic diseases of the lower respiratory tract and diabetes mellitus, which together cause 68.0% of deaths. Cancer presents a growing trend, and chronic kidney disease emerges as a serious health problem. Cuba has a known baseline on risk factors, and hypertension and tobacco consumption are the main factors related to NCDs mortality. In line with the importance of these diseases, there are milestones and interventions with a positive impact, as well as gaps and challenges within the framework of the World Health Organization’s Global Action Plan for the Prevention and Control of NCDs.

[RESUMO]. As doenças não transmissíveis (DNT) representam um dos maiores desafios do século 21 para o desenvolvimento devido ao desvastador impacto social, econômico e de saúde pública que elas causam. O objetivo deste artigo é descrever a evolução e os fatores de risco das doenças não transmissíveis em Cuba, principalmente no período de 1990–2015, para delinear as ações realizadas pelo Ministério da Saúde Pública de Cuba e destacar os desafios mais importantes para sua prevenção e controle. A informação vem dos dados coletados e publicados pela Diretoria de Registros Médicos e Estatísticas de Saúde, pesquisa sobre fatores de risco, outros estudos fundamentados e documentação de ações abrangentes. A mortalidade em Cuba é determinada por quatro principais problemas de saúde: doenças cardiovasculares, tumores malignos, doenças crônicas do trato respiratório inferior e diabetes mellitus, que em conjunto causam 68,0% das mortes. O câncer tem uma tendência crescente, e a doença renal crônica surge como um grave problema de saúde. Cuba tem uma linha de base conhecida sobre os fatores de risco, dos quais a hipertensão e o consumo de tabaco são os principais relacionados à mortalidade por DNT. Em consonância com a importância dessas doenças, há marcos e intervenções com impacto positivo, bem como lacunas e desafios no âmbito do Plano de Ação Mundial da Organização Mundial da Saúde para enfrentar as doenças não transmissíveis.

[Non-communicable diseases: risk factors and actions for their prevention and control in CubaDoenças não transmissíveis: fatores de risco e ações para sua prevenção e controle em Cuba]. / Enfermedades no transmisibles: factores de riesgo y acciones para su prevención y control en Cuba.

Non-communicable diseases (NCDs) represent one of the greatest challenges for development of the 21st century due to their devastating social, economic and public health impact. The objective of this article are to describe the evolution and risk factors for NCDs in Cuba, mainly in the period 1990-2015, to outline actions undertaken by the Ministry of Public Health of Cuba, and to highlight the most important challenges with a focus on their prevention and control. The information is based on data collected and published by the Directorate of Medical Records and Health Statistics, research on risk factors, other studies and documentation of comprehensive actions. Mortality in Cuba is determined by four major health problems: cardiovascular diseases, malignant tumors, chronic diseases of the lower respiratory tract and diabetes mellitus, which together cause 68.0% of deaths. Cancer presents a growing trend, and chronic kidney disease emerges as a serious health problem. Cuba has a known baseline on risk factors, and hypertension and tobacco consumption are the main factors related to NCDs mortality. In line with the importance of these diseases, there are milestones and interventions with a positive impact, as well as gaps and challenges within the framework of the World Health Organization's Global Action Plan for the Prevention and Control of NCDs.

As doenças não transmissíveis (DNT) representam um dos maiores desafios do século 21 para o desenvolvimento devido ao desvastador impacto social, econômico e de saúde pública que elas causam. O objetivo deste artigo é descrever a evolução e os fatores de risco das doenças não transmissíveis em Cuba, principalmente no período de 1990­2015, para delinear as ações realizadas pelo Ministério da Saúde Pública de Cuba e destacar os desafios mais importantes para sua prevenção e controle. A informação vem dos dados coletados e publicados pela Diretoria de Registros Médicos e Estatísticas de Saúde, pesquisa sobre fatores de risco, outros estudos fundamentados e documentação de ações abrangentes. A mortalidade em Cuba é determinada por quatro principais problemas de saúde: doenças cardiovasculares, tumores malignos, doenças crônicas do trato respiratório inferior e diabetes mellitus, que em conjunto causam 68,0% das mortes. O câncer tem uma tendência crescente, e a doença renal crônica surge como um grave problema de saúde. Cuba tem uma linha de base conhecida sobre os fatores de risco, dos quais a hipertensão e o consumo de tabaco são os principais relacionados à mortalidade por DNT. Em consonância com a importância dessas doenças, há marcos e intervenções com impacto positivo, bem como lacunas e desafios no âmbito do Plano de Ação Mundial da Organização Mundial da Saúde para enfrentar as doenças não transmissíveis.

Enfermedades no transmisibles: factores de riesgo y acciones para su prevención y control en Cuba / Non-communicable diseases: risk factors and actions for their prevention and control in Cuba / Doenças não transmissíveis: fatores de risco e ações para sua prevenção e controle em Cuba

RESUMEN Las enfermedades no transmisibles (ENT) representan uno de los mayores desafíos para el desarrollo en el siglo XXI, debido al devastador impacto social, económico y de la salud pública que provocan. El propósito de este artículo es describir la evolución y los factores de riesgo de las ENT en Cuba, principalmente en el período 1990-2015, reseñar las acciones emprendidas por el Ministerio de Salud Pública y destacar los desafíos más importantes para su prevención y control. La información contenida proviene de los datos colectados y publicados por la Dirección de Registros Médicos y Estadísticas de Salud, investigaciones sobre los factores de riesgo, otros estudios fundamentados y la documentación de acciones integrales. La mortalidad en Cuba está determinada por cuatro grandes problemas de salud: enfermedades cardiovasculares, tumores malignos, enfermedades crónicas de las vías respiratorias inferiores y diabetes mellitus, que en conjunto causan el 68,0% de los fallecimientos. La tendencia del cáncer es al ascenso y la enfermedad renal crónica emerge como un grave problema de salud. Cuba cuenta con una línea de base conocida sobre los factores de riesgo, de ellos la hipertensión y el consumo de tabaco son los principales relacionados con la mortalidad por ENT. En consonancia con la importancia de estas enfermedades se aprecian hitos e intervenciones de impacto positivo, así como brechas y desafíos en el marco del Plan de Acción Mundial de la Organización Mundial de la Salud para el enfrentamiento a las ENT.

ABSTRACT Non-communicable diseases (NCDs) represent one of the greatest challenges for development of the 21st century due to their devastating social, economic and public health impact. The objective of this article are to describe the evolution and risk factors for NCDs in Cuba, mainly in the period 1990-2015, to outline actions undertaken by the Ministry of Public Health of Cuba, and to highlight the most important challenges with a focus on their prevention and control. The information is based on data collected and published by the Directorate of Medical Records and Health Statistics, research on risk factors, other studies and documentation of comprehensive actions. Mortality in Cuba is determined by four major health problems: cardiovascular diseases, malignant tumors, chronic diseases of the lower respiratory tract and diabetes mellitus, which together cause 68.0% of deaths. Cancer presents a growing trend, and chronic kidney disease emerges as a serious health problem. Cuba has a known baseline on risk factors, and hypertension and tobacco consumption are the main factors related to NCDs mortality. In line with the importance of these diseases, there are milestones and interventions with a positive impact, as well as gaps and challenges within the framework of the World Health Organization's Global Action Plan for the Prevention and Control of NCDs.

RESUMO As doenças não transmissíveis (DNT) representam um dos maiores desafios do século 21 para o desenvolvimento devido ao desvastador impacto social, econômico e de saúde pública que elas causam. O objetivo deste artigo é descrever a evolução e os fatores de risco das doenças não transmissíveis em Cuba, principalmente no período de 1990-2015, para delinear as ações realizadas pelo Ministério da Saúde Pública de Cuba e destacar os desafios mais importantes para sua prevenção e controle. A informação vem dos dados coletados e publicados pela Diretoria de Registros Médicos e Estatísticas de Saúde, pesquisa sobre fatores de risco, outros estudos fundamentados e documentação de ações abrangentes. A mortalidade em Cuba é determinada por quatro principais problemas de saúde: doenças cardiovasculares, tumores malignos, doenças crônicas do trato respiratório inferior e diabetes mellitus, que em conjunto causam 68,0% das mortes. O câncer tem uma tendência crescente, e a doença renal crônica surge como um grave problema de saúde. Cuba tem uma linha de base conhecida sobre os fatores de risco, dos quais a hipertensão e o consumo de tabaco são os principais relacionados à mortalidade por DNT. Em consonância com a importância dessas doenças, há marcos e intervenções com impacto positivo, bem como lacunas e desafios no âmbito do Plano de Ação Mundial da Organização Mundial da Saúde para enfrentar as doenças não transmissíveis.

The association of low birth weight with serum C reactive protein in 3-year-old children living in Cuba: A population-based prospective study.

OBJECTIVE: Low birthweight is associated with a decreased risk of childhood leukemia and an increased risk of both cardiovascular disease and all-cause mortality in adult life. Possible biological mediators include systemic innate immunity and inflammation. We tested the hypothesis that birthweight was inversely associated with serum high sensitivity C reactive protein assay (hsCRP), a measure of both innate immunity and systemic inflammation. METHODS: Data on birthweight and current anthropometric measures along with a range of exposures were collected at 1 and 3 years of age in a population-based cohort study of young children living in Havana, Cuba. A total of 986 children aged 3-years-old provided blood samples that were analyzed for serum hsCRP levels. RESULTS: Nearly 49% of children had detectable hsCRP levels in their serum. Lower birthweight was linearly associated with the natural log of hsCRP levels (beta coefficient -0.70 mg L-1 per kg increase in birthweight, 95% CI: -1.34 to -0.06). This was attenuated but still present after adjustment for the child's sex and municipality (-0.65 mg L-1 per kg birthweight; 95% CI: -1.38 to +0.08). There were no associations between growth from birth or anthropometric measures at 3 years and systemic inflammation. CONCLUSIONS: Birthweight was inversely associated with serum hsCRP levels in children aged 3 years living in Cuba. These observations provide a potential mechanism that is present at the age of 3 years to explain the association between low birthweight and both decreased childhood leukemia and increased cardiovascular disease in adults.

Population-based weight loss and gain do not explain trends in asthma mortality in Cuba: A prospective study from 1964 to 2014.

BACKGROUND: The increase in prevalence of obesity is a possible risk factor for asthma in developed countries. As the people of Cuba experienced an acute population-based decrease in weight in the 1990s, we tested the hypothesis that national weight loss and subsequent weight gain was associated a reciprocal changes in asthma mortality. METHODS: Data were obtained on mortality rates from asthma and COPD in Cuba from 1964 to 2014, along with data on prevalence of obesity for this period. Joinpoint analysis was used to identify inflexion points in the data. RESULTS: Although the prevalence of obesity from 1990 to 1995 decreased from 14% to 7%, over the same time period the rate of asthma mortality increased from 4.5 deaths per 100,000 population to 5.4 deaths per 100,000 population. In 2010, the obesity prevalence subsequently increased to 15% in 2010, while the asthma mortality rate dropped to 2.3 deaths per 100,000 population. The optimal model for fit of asthma mortality over time gave an increasing linear association from 1964 to 1995 (95% confidence interval for inflexion point: 1993 to 1997), followed by a decrease in asthma mortality rates from 1995 to 1999 (95% confidence interval for inflexion point: 1997 to 2002). CONCLUSIONS: These national data do not support the hypothesis that population-based changes in weight are associated with asthma mortality. Other possible explanations for the large decreases in asthma mortality rates include changes in pollution or better delivery of medical care over the same time period.

Saharan Dust Effects on Human Health: A Challenge for Cuba's Researchers.

WHO considers the effects of air pollution one of the most pressing global health priorities. Several years ago, scientists began noting a link between Saharan dust (a meteorological phenomenon that diminishes air quality as it spreads over the globe) and some diseases, but the few studies to date have been inconsistent. Cuba has the human and material resources to study the association between Saharan dust and health. It is important to encourage creation of multidisciplinary research teams to do so. KEYWORDS Health, airborne particulate matter, dust, air pollutants, environmental health, climate, Cuba.

Comparación entre los criterios de la global initiative for chronic obstructive lung disease y el límite inferior de la normalidad para el diagnóstico de enfermedad pulmonar obstructiva crónica / Comparison between global initiative for chronic obstructive lung disease" criterion and "lower limit of normal criterion for the diagnosis of chronic obstructive pulmonary disease

Introducción: existe evidencia de limitaciones que presentan los métodos utilizados para interpretar la función pulmonar como obstructiva.Objetivo: analizar las ventajas y las desventajas del método recomendado por la Global Initiative for Chronic Obstructive Lung Disease (GOLD) y las del límite inferior de la normalidad (LIN).Métodos: se realizó un estudio de evaluación de estas tecnologías biomédicas. Se incluyeron 732 pacientes con criterio clínico de EPOC con disnea (grupo 1) y 2 grupos controles constituidos por 100 individuos sanos de 18 a 30 años (grupo 2) y otro de 100 individuos sanos de 60 años o más (grupo 3). A todos los grupos se les aplicó ambos métodos de interpretación espirométrica y se compararon los resultados.Resultados: fueron negativos por los criterios de la GOLD 26 pacientes (3,5 por ciento) y por el LIN, 79 (10,8 por ciento). El método de la GOLD reflejó 4 por ciento de casos con función pulmonar obstructiva en el grupo 3 y el LIN evidenció 25 por ciento de negativas en el grupo 2. Cuando se aplicaron los dos métodos combinados el 100 por ciento de los pacientes con EPOC clínica fueron positivos de obstrucción bronquial.Conclusiones: el método de la GOLD es más exacto que el LIN para el diagnóstico de EPOC. Sin embargo, el LIN es más efectivo en hombres mayores de 60 años. Al utilizar ambos métodos a la vez se evidencia que se logra el diagnóstico de EPOC en el 100 por ciento de los casos(AU)

Introduction: there is evidence of the limitations of the methods used to interpret pulmonary function such as obstructive.Objective: compare the advantages and disadvantages of the method recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the lower limit of normal (LLN).Methods: an evaluation study of these biomedical technologies was conducted. 732 patients were included with clinical criteria of chronic obstructive pulmonary disease (COPD) with dyspnea (group 1) and 2 control groups of 100 healthy individuals of 18-30 years (group 2) and another 100 healthy individuals aged 60 or more (group 3). All groups were applied both spirometric interpretation methods and the results compared.Results: 26 patients (3.5 percent) were negative according to GOLD criteria and 79 (10.8 percent) according to LIN. The GOLD method reflected 4 percent of cases with obstructive lung function in group 3 and LIN showed 25 percent negative in group 2. When the two combined methods were applied to 100 percent of COPD patients were positive for clinic bronchial obstruction.Conclusions: GOLD method is more accurate than LIN for the diagnosis of COPD. However, LIN is most effective in men older 60 years. By using both methods at a time, COPD diagnosis is achieved in 100 percent of cases(AU)