International Journal of Cuban Heath & Medicine
Medicc Review pública artículos originales de Cuba y otros autores en el área de las investigación y práctica; promoción de la salud; educación médica; estrategias de salud y retrospectivas.
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Original Scientific Articles
Research & Practice
Prevalence of Obesity and its Association with Chronic Kidney Disease, Hypertension and Diabetes Mellitus. Isle of Youth Study (ISYS), Cuba.
Raúl Herrera Valdés, MD, PhD, DrSc, Miguel Almaguer López, MD, José Chipi Cabrera, MD, Xidix Toirac Cabrera, MD, Orquídea Martínez Soto, MD, Osvaldo Castellanos Rabanal, MD, Jorge Bacallao Gallestey, PhD, Rosa M. Licourt Pérez, MD, Pedro Mulet Pineda, MD, Luisa Diéguez Pérez, MD, Israel Velásquez Batista, MD, María C. Hernández Rivero, MD, Walfrido Caballero Odio, BS, Pedro Urra González, MS, Néstor Rodríguez Triana
Introduction Obesity is a social disease constituting a global pandemic. It is present in 90% of diabetic and 65% of hypertensive patients. It is associated with cardiometabolic syndrome and with damaging physiopathological mechanisms, particularly for the vascular system and the kidneys. On Cuba’s Isle of Youth, a community-based epidemiological study of chronic kidney disease (CKD), hypertension (HTN), diabetes mellitus (DM) and cardio-cerebral vascular disease was carried out in total population, including an examination of common risk factors.
Objective Based on the Isle of Youth Study (ISYS) data, determine prevalence of obesity and overweight, and their association with CKD, HTN, DM, and shared risk factors for all these conditions in total population of the Isle of Youth, Cuba.
Methods Phase 1: Population diagnosis (November 2004-April 2006): 96.6% of the Isle of Youth’s total population (80,117) was studied, including all ages and both sexes. Information was offered to the public, and written informed consent obtained. Screening was conducted by participant questionnaire including risk factors, physical measurements (weight, height, blood pressure and body mass index), and a single first-morning urine sample to determine the presence of vascular-renal damage markers - proteinuria and hematuria (Combur 10 Test, Roche), and microalbuminuria (Micral Test, Roche). When results were positive, serum creatinine was determined and glomerular filtration rate (GFR) estimated with Modification of Diet in Renal Disease (MDRD) formula for adults and Schwartz formula for children <15 years. Data obtained were analyzed to determine association of participants’ nutritional status with prevalence of chronic kidney disease, hypertension and diabetes mellitus, as well as a set of common risk factors.
Results Population <20 years: Obesity prevalence 3.2%; positive urine markers in 56.9% of obese and 8.9% of non-obese participants; positive albuminuria in 38% of obese and 3% of non-obese. Obese participants were found to be hyperfiltrating. DM prevalence was 9.5% in obese and 1.1% in non-obese participants.
Population ≥20 years: Overweight, 31.3%; obese, 13.4%. Positive markers in normal-weight, overweight and obese individuals were 18.3%, 21.2% and 32.7%, respectively; microalbuminuria values increased with weight. Obese individuals were found to be hyperfiltrating. HTN prevalence in normalweight, overweight and obese individuals was 18.3%, 31.5%, and 51.0% respectively; DM rates were 2.8%, 5.2% y 11.3%, respectively.
Conclusion In Cuba, obesity poses significant risk for vascular and renal damage and should be the focus of increased prevention efforts.
Keywords: Vascular diseases, chronic kidney disease, CKD, chronic kidney insufficiency, hypertension, diabetes mellitus, risk factors, obesity, overweight, body mass index, glomerular filtration rate
MEDICC Review, Spring 2008, Vol 10, No 2 pp. 14-20
Cardiovascular Risk among Older Women in a Havana Health Area.
Nurys Bárbara Armas Rojas, MD, Yesenia de la Caridad Hernández Álvarez, MD, Alfredo F Dueñas Herrera, MD, Reynaldo de la Noval García, MD, Antonio Castillo Guzmán, MD, MPH
Introduction Cardiovascular morbidity and mortality increase in women after menopause. Various scoring models assess qualitative risk of cardiovascular disease. The Framingham Heart Study global risk score is among the most widely used.
Objective Determine level of coronary heart disease risk among women aged ≥60 years in a Havana health catchment area (geographic area whose residents are served by the Mártires del Corynthia Polyclinic, in the Plaza de la Revolución municipality of Havana).
Methods A descriptive, cross-sectional study was conducted in 2006. Universe: all women (3,396) aged ≥60 years in the catchment area, attended at the primary care level by the Polyclinic and 42 neighborhood family doctor-and-nurse offices. Equal probability sample: 1,082 women meeting the inclusion criteria, chosen through single-stage cluster sampling considering a <10% error margin for estimates for this parameter, a 95% confidence interval (CI) and a design effect of 1.5. Absolute frequencies and percentages were calculated to summarize the qualitative data obtained. Results were presented as tables.
Results The most common cardiovascular risk factors found in this study were: physical inactivity, 74.9%; hypertension (HTN), 70.6%; abdominal obesity, 53%; reported family history of coronary heart disease (CHD), 41.8%; diabetes mellitus (DM), 21.8%; and cigarette smoking, 17.2%. Scoring according to number of risk factors present in each individual, 79.3% of these women fell into the high- or moderate-risk categories.
Conclusion The large number of women categorized as high- or moderate-risk for coronary heart disease in this population emphasizes the need for preventive actions aimed at reducing these figures.
Keywords: Cardiovascular diseases, vascular diseases, ischemic heart disease, coronary heart disease, postmenopause, woman, aged, risk factors, risk assessment, hypertension, high blood pressure, lifestyle, diabetes mellitus, obesity, abdominal adipose tissue, body mass index, physical inactivity, tobacco use.
MEDICC Review, Spring 2008, Vol 10, No 2 pp. 21-26
Association between Blood Lipids and Types of Stroke
Sergio González García, MS, Otman Fernández Concepción, MD, MS, Rebeca Fernández Carriera, BS, Caridad Menéndez Saínz, MS, Julia Maza, MD, PhD, Alina González-Quevedo Monteagudo, MD, DrSc, Miguel Ángel Buergo Zuaznábar, MD
Introduction Many studies to date on the link between blood lipid levels and cerebrovascular disease have been hampered by conceptual and methodological limitations, especially failure to separate different types of stroke.
Objective Determine the relationship between serum lipid levels and the occurrence of different types of stroke.
Methods Two case and control studies were undertaken. The first consisted of three groups: subjects with cerebral infarction (CI), subjects with cerebral hemorrhage (CH) and a control group of healthy individuals with no history of cerebrovascular disease. The second study included three groups: those with atheromatous CI, those with CI of other etiology, and the healthy control group. The influence of variables such as age, sex, and presence of risk factors was also assessed.
Results CI patients were found to have higher total cholesterol levels (p<0.01), low-density lipoprotein (LDL) cholesterol (p<0.01), and triglycerides (p<0.01) than those in the control group. CH patients had lower total cholesterol levels (p<0.05), and higher triglycerides levels (p<0.05) than the control group. The second study revealed a link between blood lipid levels and CI only in cases of atheromatous stroke This association was prevalent in women, and was independent of other risk factors.
Conclusions The type of stroke (ischemic or hemorrhagic) and the etiopathogenic subtype of CI must be considered when studying association between blood lipids and occurrence of stroke.
Elevated levels of total cholesterol, LDL and triglycerides are associated with occurrence of atheromatous CI, while low total cholesterol levels and high triglycerides levels are associated with the CH occurrence.
Keywords: cholesterol, HDL, LDL, triglycerides, cerebral hemorrhage, cerebral infarction, atherosclerosis, vascular diseases, cerebrovascular disorders, stroke, cerebrovascular accident, CVA, ischemia, hyperlipidemias
MEDICC Review, Spring 2008, Vol 10, No 2 pp. 27-32
Epidemiology of Cerebrovascular Diseases in Cuba, 1970 to 2006
Miguel Angel Buergo Zuaznábar, MD, Otman Fernández Concepción, MD, Giselle Coutín Marre, MD, Rosa María Torres Vidal, MD
Introduction Cerebrovascular diseases (CD) are a global health problem.
They are the second and third causes of death in the world and in Cuba, respectively. Projections for year 2020 suggest they will continue to be among the main causes of death and disability, both in developed and developing countries. In 2006, the National Health System (NHS) presented its Public Health Projections in Cuba for Year 2015, which set
the following specific goals for CD mortality reduction: overall mortality by 25%, female mortality by 30%, and hospital mortality by 30%.
Objective Analyze CD mortality in Cuba from 1970 to 2006, before and after implementation of the National Program for Cerebrovascular Disease Prevention and Control (NPCD-PC) to obtain a better understanding of the current situation, which may serve as the basis to meet the goals set for year 2015.
Methods CD mortality databases from the National Statistical Division of the Cuban Ministry of Public Health were used. The following variables were applied: sex, CD-related causes, and place of death.
Crude and age-adjusted mortality rates were determined. Overall mortality, mortality by sex, years of potential life lost, hospital mortality, incidence, and prevalence were calculated.
Results Crude mortality rates showed a sustained increase within the time series under study; conversely, age-adjusted rates showed a decrease in mortality during the 1970s, were stable in the 1980s and 1990s and, finally, decreased since year 2000, when the NPCDPC program was started in the country. The male/female ratio increased slightly from the late 1990s until 2005; yet female mortality has shown a tendency to increase. Between 1993 and 2002, cerebral hemorrhage caused more deaths than the cerebral infarction; since then, this profile has reversed. CD-related years of potential life lost (YPLL) showed a decrease from 1970 to 1975, followed by a sustained increase through 1985, and a gradual decrease since 1990. Hospital mortality diminished steadily from 1990 to 1999 and has remained stable since year 2000. Even though there was greater CD incidence from 2000 to 2001, it has decreased since then.
However, prevalence has increased slightly every year from 2000 to 2005.
Conclusion Although overall mortality and female mortality rates, in particular, increased following implementation of the NPCD-PC program, age-adjusted mortality, hospital mortality, and incidence diminished during the same period. Further study is recommended to determine specific actions required to achieve CD mortality reduction goals by 2015.
Keywords: Vascular diseases, stroke, cerebrovascular accident, CVA, intracranial hemorrhage, brain ischemia, cerebral infarction, cerebral hemorrhage, epidemiology, hospital mortality, mortality
MEDICC Review, Spring 2008, Vol 10, No 2 pp. 33-38
Introduction of Information and Communication Technologies
in Havana Polyclinics: Phase One Evaluation
Susana B. Llanusa Ruiz, MPH, Nereida Rojo Pérez, PhD, Magali Caraballoso Hernández, MD, MPH, Julia S. Pérez Piñero, MD, PhD
Introduction Information and communication technologies were introduced in community-based polyclinics as a result of a Cuban health system policy to make information more readily accessible to health professionals and other health workers at the primary health care level.
Objective Assess phase one of the Program to Introduce Information and Communication Technologies in Primary Health Care (PICTPHC), as implemented in Havana, and in particular to determine the aspects of structure, process and outcomes with the greatest impact on this phase’s effectiveness.
Methods From May to October 2003, an assessment was carried out in all Havana community-based polyclinics where phase one of the Program was underway. Study dimensions, criteria, and standards were established through consultation with experts and considering the level of performance expected by program directors, thus providing
timely analysis to the directors concerning problem areas in need of attention. This paper concentrates on the five dimensions which were thought to have the most bearing on effectiveness of information and communication technologies (ICTs) installed in the polyclinics’ libraries:
librarians’ competencies in IT skills, training received by librarians, training received by users, Program monitoring and follow-up, and exploitation of the technologies. Six data collection instruments were devised. Participants in the study included 41 librarians and 544 users. Data were processed to obtain indicators corresponding to study criteria. Each indicator was then compared with the established standard. Validity of results was established through analysis and comparison.
Results Overall, the first phase of the PICT-PHC in Havana succeeded in making online information resources more readily available to health professionals and technicians. Some librarians had insufficient basic IT competencies, which had an impact on the quality of their work. Moreover, it was found that monitoring and follow-up activities were focused chiefly on implementation process rather than outcomes. There was consistency between the achievements and problems found for some criteria and dimensions, and their impact on related ones.
Conclusion This study furnished evidence of the need for greater emphasis on human resources training (particularly of librarians) in the use of ICTs in the primary health care system.
Keywords: Information and communication technologies, ICTs, primary health care, public health informatics, medical informatics applications, library science, access to information, public health, health systems, informatics, Health Information Technologies, HIT
MEDICC Review, Spring 2008, Vol 10, No 2 pp. 38-45
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