INTRODUCTION To reach the goal of eliminating tuberculosis as a public health problem in Cuba, the epidemiological evolution of the disease and of strategies designed to prevent and manage it to date must be well understood. In this context, in 1970, changes were introduced in Cuba’s National Tuberculosis Control Program.

OBJECTIVE Review background and evolution of Cuba’s strategy for tuberculosis control, the changes implemented in the 1970 revision of the Program, and their impact on the subsequent evolution of the disease in Cuba.

METHODS Published articles on the history of tuberculosis control in Cuba were reviewed, along with archival documents and medical records. Documents concerning the situation of pulmonary tuberculosis in Cuba, including measures adopted to address the disease and its extent, were selected for study, with an emphasis on the period of the Program. Interviews with key informants were conducted.

RESULTS Cuba’s fight against tuberculosis began in Santiago de Cuba, with the creation of a local Anti-Tuberculosis League in 1890. Strategic changes introduced by Cuba’s public health sector, stressing health promotion and disease prevention, led to the 1959 creation of the Tuberculosis Department, which implemented Cuba’s first National Tuberculosis Control Program in 1963. This Program was completely reorganized in 1970. The National Tuberculosis Control Program (1963) covered a network of 27 tuberculosis dispensaries, 8 sanatoriums and 24 bacteriology laboratories. Diagnosis was based on radiographic imaging criteria. Incidence was 52.6/100,000 in 1964 and reached 31.2 in 1970. The Program was updated in 1970 to include two major changes: the requirement for bacteriological confirmation of diagnosis and directly-observed outpatient treatment fully integrated into health services. By 1971, incidence was down to 17.8/100,000, and further reduced to 11.6 in 1979. The decrease is interpreted as the result of the greater specificity of microbiologic diagnosis. Tuberculosis control continued to make progress, reaching an incidence rate of 6.1/100,000 in 2012 and mortality rate of 0.3/100,000 in 2013.

CONCLUSIONS Changes introduced in the National Tuberculosis Control Program in 1970 led to the successful results achieved in later decades, reducing tuberculosis incidence and mortality. These results also allowed health authorities to propose elimination of the disease in Cuba as a current objective.

KEYWORDS History of medicine, tuberculosis, epidemiology, communicable disease control, public health, Cuba

INTRODUCTION Fetal macrosomia is the most important complication in infants of women with diabetes, whether preconceptional or gestational. Its occurrence is related to certain maternal and fetal conditions and negatively affects maternal and perinatal outcomes. The definitive diagnosis is made at birth if a newborn weighs >4000 g.

OBJECTIVE Identify which maternal and fetal conditions could be macrosomia predictors in infants born to Cuban mothers with gestational diabetes.

METHODS A case-control study comprising 236 women with gestational diabetes who bore live infants (118 with macrosomia and 118 without) was conducted in the América Arias University Maternity Hospital, Havana, Cuba, during 2002–2012. The dependent variable was macrosomia (birth weight >4000 g). Independent maternal variables included body mass index at pregnancy onset, overweight or obesity at pregnancy onset, gestational age at diabetes diagnosis, pregnancy weight gain, glycemic control, triglycerides and cholesterol. Fetal variables examined included third-semester fetal abdominal circumference, estimated fetal weight at ≥28 weeks (absolute and percentilized by Campbell and Wilkin, and Usher and McLean curves). Chi square was used to compare continuous variables (proportions) and the student t test (X ± SD) for categorical variables, with significance threshold set at p <0.05. ORs and their 95% CIs were calculated.

RESULTS Significant differences between cases and controls were found in most variables studied, with the exception of late gestational diabetes diagnosis, total fasting cholesterol and hypercholesterolemia. The highest OR for macrosomia were for maternal hypertriglyceridemia (OR 4.80, CI 2.34–9.84), third-trimester fetal abdominal circumference >75th percentile (OR 7.54, CI 4.04–14.06), and estimated fetal weight >90th percentile by Campbell and Wilkin curves (OR 4.75, CI 1.42–15.84) and by Usher and McLean curves (OR 8.81, CI 4.25–18.26).

CONCLUSIONS Most variables assessed were predictors of macrosomia in infants of mothers with gestational diabetes. They should therefore be taken into account for future studies and for patient management. Wide confidence intervals indicate uncertainty about the magnitude of predictive power.

KEYWORDS Fetal macrosomia, fetal diseases, gestational diabetes, risk factors, risk prediction, Cuba

INTRODUCTION Death from acute myocardial infarction is due to many factors; influences on risk to the individual include habits, lifestyle and behavior, as well as weather, climate and other environmental components. Changing climate patterns make it especially important to understand how climatic variability may influence acute myocardial infarction mortality.

OBJECTIVES Describe the relationship between climate variability and acute myocardial infarction mortality during the period 2001–2012 in Havana.

METHODS An ecological time-series study was conducted. The universe comprised 23,744 deaths from acute myocardial infarction (ICD-10: I21–I22) in Havana residents from 2001 to 2012. Climate variability and seasonal anomalies were described using the Bultó-1 bioclimatic index (comprising variables of temperature, humidity, precipitation, and atmospheric pressure), along with series analysis to determine different seasonal-to-interannual climate variation signals. The role played by climate variables in acute myocardial infarction mortality was determined using factor analysis. The Mann-Kendall and Pettitt statistical tests were used for trend analysis with a significance level of 5%.

RESULTS The strong association between climate variability conditions described using the Bultó-1 bioclimatic index and acute myocardial infarctions accounts for the marked seasonal pattern in AMI mortality. The highest mortality rate occurred during the dry season, i.e., the winter months in Cuba (November–April), with peak numbers in January, December and March. The lowest mortality coincided with the rainy season, i.e., the summer months (May–October). A downward trend in total number of deaths can be seen starting with the change point in April 2009.

CONCLUSIONS Climate variability is inversely associated with an increase in acute myocardial infarction mortality as is shown by the Bultó-1 index. This inverse relationship accounts for acute myocardial infarction mortality’s seasonal pattern.

KEYWORDS Acute myocardial infarction, climate variability, bioclimatic index, Cuba

Among environmental problems, climate change presents the greatest challenges to developing countries, especially island nations. Changes in climate and the resulting effects on human health call for examination of the interactions between environmental and social factors. Important in Cuba’s case are soil conditions, food availability, disease burden, ecological changes, extreme weather events, water quality and rising sea levels, all in conjunction with a range of social, cultural, economic and demographic conditions.

KEYWORDS Climate change, health, environment, social factors, Cuba

The Cuban population exhibits high prevalence of overweight and associated chronic non-communicable diseases, trends that begin in childhood. In addition to factors related to the mother’s health, factors contributing to excess weight gain in Cuban children are: reduced prevalence of exclusive breastfeeding of infants up to six months of age, full-term low birth weight infants and nutritional mismanagement of this group, incorrect complementary feeding, obesogenic diet, family history and sedentary lifestyles. Thus, it is important to adopt comprehensive, multisectoral strategies that promote adequate nutrition and weight control. This is particularly important for full-term low birth weight infants, predisposed to body fat storage.

KEYWORDS Low birth weight, obesity, diabetes, inflammation, breastfeeding, diet, physical activity, lifestyle, children, adolescents, Cuba

INTRODUCTION Globally, older adults are a population group that often suffers abuse by their caregivers. Along with women and children, they are among those most often reported as victims of abuse of any kind in Cuba.

OBJECTIVE Characterize presence of domestic abuse of older adults in family doctor-and-nurse office No. 28 of the Carlos Manuel Portuondo University Polyclinic in Havana, Cuba, determining the main manifestations of abuse and help-seeking behavior by the older adults identified as victims.

METHOD This was a descriptive cross-sectional study of adults aged ≥60 years; all those not diagnosed with dementia and who agreed to participate were interviewed. In a universe of 268 older adults, 29 were living outside the area, 24 declined to participate, and 18 had a diagnosis of dementia, leaving a study population of 197 individuals. Variables included: personal experience of abuse, type of abuse, perpetrator, help sought, and reasons for not seeking help. Statistical analysis was based on percentages.

RESULTS Of 197 older adults interviewed, 88 (44.7%) reported that they were victims of domestic abuse; 50 of these were women. The most common types of abuse were psychological abuse and disrespect for personal space, reported by 69 (78.4%) and 54 (61.4%) individuals, respectively. Sons- and daughters-in-law were identified as the abusers by 68 participants and grandchildren by 65. Of the 88 victims, 67 (76.1%) stated that they did not seek help.

CONCLUSIONS The finding that substantial numbers of older adults are victims of domestic abuse brings to light a hitherto insufficiently addressed issue in the community studied. More research is needed to deepen understanding of the scope and causes of the problem to inform prevention and management strategies, not only at the level of the polyclinic catchment area, but in the health system in general.

KEYWORDS Elder abuse, elder neglect, aged abuse, domestic violence, Cuba

INTRODUCTION Heart failure, primarily in the elderly, is a growing epidemic in today’s world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.1/100,000 population.

OBJECTIVES Assess the value of stress–rest protocol gated-SPECT for identifying patients with symptomatic heart failure likely to suffer adverse cardiac events.

METHODS A study was conducted of 52 patients (mean age 59 years, SD 9; 62% women) with functional capacity II/III (New York Heart Association scale) and left ventricular ejection fraction <40%. Patients were divided into two groups based on coronary heart disease diagnosis: those with coronary heart disease (41), labeled ischemic; and those without (11), labeled nonischemic. All underwent gated SPECT myocardial perfusion scintigraphy with technetium-99m-labeled methoxyisobutyl isonitrile, using a two-day stress–rest protocol, including evaluation of intraventricular synchrony by phase analysis. Patients were followed over 36 months for adverse cardiac effects.

RESULTS No significant differences were observed between the two groups during the stress test with regard to exercise time, metabolic equivalents or percentage of maximal heart rate during maximal stress. Summed stress, rest and difference scores, however, were significantly different between the ischemic and nonischemic groups: 16.82 (SD 6.37) vs. 7.54 (SD 5.8), p <0.001; 14.43 (SD 6.28) vs. 6.45 (SD 3.77), p = 0.001; and 2.39 (SD 4.89) vs. 1.09 (SD 3.7), p = 0.034. No differences were found in ventricular function, although stress-minus-rest left ventricular ejection fraction was slightly lower in patients with ischemic heart disease (-1.29, SD 5.8) than in patients without ischemic heart disease (1.27, SD 4.31). Dyssynchrony was greater in patients with ischemic heart disease than in those without, primarily during stress (p <0.01). The only variable that showed a possible association with the occurrence of adverse events was <5 metabolic equivalents on the stress test (p = 0.03), while resting phase SD showed only a tendency toward association (p = 0.05).

CONCLUSIONS Information on myocardial perfusion, functional capacity and intraventricular synchrony obtained from stress–rest gated SPECT may help identify patients with symptomatic heart failure who are likely to develop adverse cardiac events, enabling better management of higher-risk cases and improved allocation of resources.

KEYWORDS Heart failure, congestive heart failure, myocardial ischemia, ischemic heart disease, coronary artery disease, gated SPECT, perfusion, ventricular function, intraventricular synchrony, phase analysis, Cuba

INTRODUCTION Peritoneal dialysis is a maintenance therapy option for patients with end-stage renal disease. Continuous ambulatory peritoneal dialysis in Cuba was introduced in December 2007, and automated peritoneal dialysis one year later. This paper presents the outcomes attained with this blood purification technique, enabling an assessment to decide on scaling up its use in Cuba.

OBJECTIVE Describe the clinical course of patients in the first five years of the Home Peritoneal Dialysis Program at Havana’s Nephrology Institute.

METHODS An observational, descriptive study with a retrospective cohort was conducted. The universe comprised the 40 Nephrology Institute patients who underwent treatment with home peritoneal dialysis from December 20, 2007 to December 20, 2012. Relative and absolute frequencies were calculated for the study variables and the Kaplan-Meier method was used for survival curves for patients and for the peritoneum as dialysis membrane.

RESULTS Of the 40 patients in the program, 23 were men and 17 were women, primarily aged 40 to 59 years. The most frequent causes of chronic kidney failure were hypertension (42.5%), glomerulopathies (22.5%), and diabetes mellitus (22.5%). A total of 103 complications occurred, both infectious (68, 66%) and non-infectious (35, 34%). The most common infectious complication was peritonitis (45, 66.2%); the most frequent non-infectious complication was catheter displacement (13, 37.1%). Seven patients left the peritoneal dialysis program. Of these, three died, two lost function of the peritoneum as a dialysis membrane, one received a kidney transplant and one recovered kidney function. Survival was 100% at one year, 97% at 2 years, 93.2% at 3 and 4 years, and 92% at 5 years. However, the peritoneal membrane was functional in 100% of patients during the first 2 years, decreasing to 96% at 3 and 4 years and to 88.6% at 5 years.

CONCLUSIONS In our setting, peritoneal dialysis attained outcomes similar to those obtained internationally, which supports its usefulness as a renal replacement therapy method in Cuban patients with end-stage renal disease.

KEYWORDS Peritoneal dialysis, dialysis, renal replacement therapy, end-stage renal disease, ESRD, Cuba

Se revisaron las estrategias de investigación que recomiendan la OMS y otros organismos internacionales para detectar las principales localizaciones del cáncer, así como los requisitos comprendidos en la estrategia para el control del cáncer en Cuba. Universalmente se recomienda la pesquisa del cáncer cervical, de cáncer de mama y del cáncer colorrectal, los que se incluyen también en la estrategia cubana. Adicionalmente, en Cuba se indica el análisis de PSA en los hombres considerados en riesgo (hombres de más de 45 años con antecedentes familiares de cáncer de próstata), y aquellos de más de 50 años que soliciten el estudio; se recomienda el examen anual bucal y la enseñanza del autoexamen bucal para toda la población, así como el examen anual activo para detectar los casos de cáncer bucal en los mayores de 35 años. La pesquisa del cáncer de la piel se realiza mediante el examen físico de los individuos en riesgo. Para maximizar los beneficios de la detección temprana del cáncer se necesita de una mayor cobertura así como de las investigaciones sobre cuán bien se realizan las pesquisas bajo las actuales condiciones cubanas.

PALABRAS CLAVE Cáncer, detección temprana, examen, prevención secundaria, cáncer de mama, cáncer cervical, cáncer colorrectal, cáncer de la piel, cáncer bucal, Cuba

Los recientes avances en la inmunología básica han producido cambios en los paradigmas del manejo del cáncer avanzado, que actualmente se reconoce como una enfermedad crónica con una prevalencia en aumento, y cuya complejidad lo hace difícil de controlar. Como una alternativa, surge la inmunoterapia con nuevos anticuerpos monoclonales, vacunas terapéuticas y una comprensión más profunda de los fenómenos fundamentales involucrados en la interacción entre el tumor y el sistema inmune. Las ideas más novedosas conciernen a los mecanismos de contracción programada de la respuesta inmune, la caracterización de los marcadores moleculares y celulares de inmunosenescencia, el papel dual de la inflamación, la caracterización de células supresoras de estirpe mieloide y las células madre cancerosas, así como los fenómenos de la apoptosis inmunogénica y la adicción oncogénica.

Además, los nuevos datos conducen a una comprensión más profunda de las cuatro barreras que habrá que vencer para el control del cáncer avanzado: la complejidad de los sistemas biológicos, la heterogeneidad de los tumores, las tasas de mutación de los tumores y la falta de correspondencia entre el genoma y el ambiente. En este nuevo paisaje destacan seis estrategias principales: manejar el cáncer avanzado como una enfermedad crónica, identificar los marcadores moleculares más importantes para la estratificación de los pacientes, desarrollar una base lógica para las combinaciones terapéuticas, dirigir las acciones hacia los lazos de control regulatorio en el sistema inmune, aumentar la capacidad de la modelación matemática y evaluar los paquetes complejos de intervención sanitaria en las condiciones del mundo real.

En este trabajo se ilustran estas transiciones en la investigación de la inmunoterapia del cáncer mediante la descripción de proyectos en ejecución en el Centro de Inmunología Molecular de Cuba.

PALABRAS CLAVE: Inmunoterapia, control del cáncer, inmunología molecular, anticuerpos monoclonales, Cuba

Las enfermedades crónicas no transmisibles se consideran la pandemia del siglo XXI y constituyen un desafío de alta prioridad para la salud pública; de ahí el creciente interés en la vigilancia de los factores de riesgo de las enfermedades crónicas. Cuba desarrolla la vigilancia de los factores de riesgo de forma descentralizada en cada uno de sus municipios como parte de la estrategia para enfrentar las enfermedades no transmisibles. No tiene precedentes en Cuba la vigilancia descentralizada con este nivel de detalle y diseñada expresamente para informar a los decisores en el municipio y la provincia. Se describe la metodología empleada para planificar y realizar la medición de los principales factores de riesgo en 12 municipios de 10 provincias, como parte del sistema nacional de vigilancia de Cuba. Los resultados han facilitado el uso oportuno de la información y la toma de decisiones basadas en pruebas a nivel local.

PALABRAS CLAVE: Sistema de vigilancia, factores de riesgo de enfermedades no transmisibles, encuestas de salud, métodos para la encuesta, Cuba

INTRODUCCIÓN Los años de vida ajustados por discapacidad constituyen una medida compuesta que integra los componentes de morbilidad y mortalidad. Es un indicador útil de la carga global de la enfermedad y es particularmente útil para la evaluación de los resultados de las intervenciones en salud. En los casos de cáncer de mama y del sistema reproductor, estos también pueden afectar negativamente las oportunidades de maternidad en las mujeres jóvenes.

OBJETIVO Determinar los años de vida ajustados por discapacidad por cáncer de mama y del sistema reproductor de la mujer cubana en edades de 15–44 años durante el período 1990-2006.

MÉTODOS Se realizó un estudio epidemiológico nacional, que utilizó las estadísticas de enfermedad en Cuba para 1990, 1995, 2000 y 2006. Los años de vida ajustados por discapacidad en mujeres de 15–44 años se calcularon para el cáncer de mama y tres cánceres del sistema reproductor femenino (cervical, endometrial y de ovario) como la suma de los años de vida perdidos por mortalidad prematura y los años vividos con discapacidad. Los años de vida perdidos por mortalidad prematura se determinaron a partir de las estimaciones específicas de la esperanza de vida por edad. Los años vividos con discapacidad se calcularon como el producto de la severidad (proporcionada por el Estudio Global de Carga de la Enfermedad de la OMS referido al año 1990) y la incidencia y la duración promedio, ambas obtenidas a través del programa DISMOD II. Los datos introducidos en el programa incluyen las estadísticas nacionales de incidencia, prevalencia y mortalidad.

RESULTADOS El cáncer de mama y el cáncer de cuello uterino mostraron las mayores tasas de años potenciales de vida perdidos por muerte prematura, con los mayores incrementos en el período (de 139 a 206.5 y de 114.7 a 215.2 por 100 000, respectivamente). Las neoplasias de endometrio y ovario aumentaron más discretamente. Se observó un aumento en años vividos con discapacidad en tres de estos cuatro tipos de cáncer; solamente se produjo una disminución en el cáncer de cuello uterino (de 12.7 a 9 por 100 000). El cáncer de mama y el cáncer de cuello uterino presentaron los más altos niveles de años de vida ajustados por discapacidad en los cuatro años estudiados, con un aumento de 146.9 a 227.8 y de 127.4 a 224.2 por 100 000, respectivamente, entre 1990 y 2006 en mujeres en edad reproductiva.

CONCLUSIONES Se observó una tendencia desfavorable en los años de vida ajustados por discapacidad por cáncer de mama y de cuello uterino en mujeres cubanas en edad fértil entre 1990 y 2006.

PALABRAS CLAVE Años de vida ajustados por discapacidad, AVAD, DALY, años de vida perdidos por mortalidad prematura, años vividos con discapacidad, cáncer, mama, sistema reproductor femenino, fertilidad, Cuba

A review/analysis of current literature on exemplary multicenter registries of clinical dementias was conducted as a comparative basis for a proposed Cuban registry on cognitive impairment and dementia.

The study of mental health disorders has been predominantly based on clinical concepts and criteria, and only in recent years a public health approach has been applied. Traditional epidemiological studies do not reveal patterns of cognitive impairment and behavioral disorders (particularly dementias) in routine clinical practice in a defined geographic area, which would provide essential information for long-term planning and allocation of health and social resources. Thus, multicenter clinical registries have become an important source of clinical and epidemiological data on dementias in recent decades. This article addresses the Cuban proposal for an automated national dementia registry, comparing it to others internationally. The registry would be housed in the Neurology and Neurosurgery Institute, and would include a duly protected surveillance network hosted on the Institute’s website.

Such a multicenter dementia registry based on epidemiological surveillance methods and limited to a defined area would provide new, valid, representative and current data on dementia occurrence patterns by subtype, flow of case identification and referral from primary care, as well as the main clinical features of patients at the time of their first contact with health services. This information would support development of health planning policies for implementation of programs aimed at improved distribution of social and health resources in the affected population, monitoring of the disorder’s natural evolution and identification of preventive measures. The scientific benefits would be equally important: production of new knowledge, generation of hypotheses for clinical research projects, standardization of diagnostic criteria, and promotion of multicenter research in both national and multinational centers.

KEYWORDS Dementia, Alzheimer disease, cognitive impairment, disease registries, public health, surveillance, Cuba

INTRODUCTION Cytomegalovirus and herpes simplex virus are associated with congenital or perinatal infection, causing potential damage to the newborn.

OBJECTIVES Determine the prevalence of active or latent infection by cytomegalovirus and herpes simplex virus in a population of mothers, congenital infection by these agents in their infants, and association between prevalence of virus infection in mothers and in their newborns.

METHODS A cross-sectional study was conducted from June to September 2012 in a population of 95 pregnant women admitted to the Dr Ramón González Coro University Maternity Hospital during the third trimester of pregnancy, and their infants (98). Patients were tested for antibodies specific to these viruses; vaginal swabs and urine from the women and serum and urine from the newborns were tested for viral genome. The Fisher exact test with 95% confidence interval was used for comparisons.

RESULTS Of the women studied, 89.5% tested positive for cytomegalovirus and 83.2% for herpes simplex. Active infection from cytomegalovirus was detected in 16.7%, and from herpes simplex in 3.2%. Congenital cytomegalovirus infection was detected in 4.1% of newborns; no herpes simplex virus infection was found in this group. Two newborns of women with active cytomegalovirus infection were congenitally infected.

CONCLUSIONS Serology demonstrated that most of the women were immune to both viruses. Active cytomegalovirus infections are common in this population, and newborns of women with active cytomegalovirus infection during pregnancy are at increased risk of congenital infection.

KEYWORDS Congenital infection, perinatal infection, cytomegalovirus, herpes simplex virus, pregnant women, newborns, Cuba

INTRODUCTION Birth weight is considered to be the best predictor of an infant’s health status in the neonatal phase. In the Americas, several studies have set the foundation for determining references birth weights. In Cuba there is a report on anthropometric patterns in neonates in 1990 from a maternity ward in Havana, but there are no updated neonatal weight distribution curves by gestational age and sex, as suggested by WHO.

OBJECTIVE Create birth weight percentile distribution tables and curves for neonates by gestational age and sex in Holguín Municipality, capital of the eastern Cuban province of the same name.

METHODS A retrospective longitudinal study was designed in a universe of 16,018 neonates born alive, delivered within a gestational range of 30 to 42 weeks in the maternity unit of the V.I. Lenin University General Hospital in Holguín Municipality between January 2008 and December 2012. Included were neonates born in the study hospital living in Holguín Municipality; neonates from multiple births were excluded. Variables included gestational age, sex, and birth weight. Gestational age- and sex-specific weight percentile distribution tables and curves were constructed based on observed values. A third-degree polynomial was applied via weighted least squares regression to smooth distribution curves. Analysis of variance was conducted to compare four years (2008, 2009, 2010 and 2011) and the coefficient of variation was calculated for each week of gestation.

RESULTS The average weight of neonates of both sexes rose from week 30 to week 42. The coefficient of variation between weeks 34 and 42 was 11.6%–19% in girls and 12.1%–21.3% in boys. The 10th percentile value at 36 weeks of gestation was 2140 g for girls and 2200 g for boys. For girls, cutoff points for the 10th percentile (small for gestational age infant) were higher at 34–42 weeks and for boys at 36–42 weeks. Applying our cutoff points to this population identified 47% more low birth weight infants than did previously applied standards.

CONCLUSIONS Marked differences were found when comparing our tables with tables from other countries. The higher references values for the 10th percentile (compared to previous ones in Cuba) in mean more neonates fall in the low birth weight category, providing greater opportunities to reduce morbidity and mortality in this high-risk group.

KEYWORDS Birth weight, gestational age, chronologic fetal maturity, low birth weight infant, small for gestational age infant, reference growth curves, growth tables, Cuba

INTRODUCTION Lung cancer is one of the leading causes of death worldwide and in Cuba, where its incidence and mortality are on the rise. Diagnostic delay is a variable linked to survival and prognosis. Quantifying this delay and comparing it with data from other national and international sources may lead to planning actions to reduce its impact.

OBJECTIVE Assess diagnostic delay of lung cancer in patients at the Joaquín Albarrán Clinical-Surgical Teaching Hospital, Havana, Cuba, from 2007 to 2010.

METHODS A retrospective descriptive study was conducted based on administrative data from patients diagnosed with lung cancer. The length of overall diagnostic delay was determined, as well delay between symptom onset and the patient’s first contact with the health system, and delay at the primary and secondary levels of the national health system. Descriptive statistics were used to summarize the different time intervals.

RESULTS The study comprised a total of 54 patients; 74.1% were men; the largest age group was 51–60 years. Of the total, 61.1% sought care first at the primary level. Total diagnostic delay for these patients was 67.4 days: 24.3 days due to patient delay (SD 32.8), 16.2 days due to primary care delay (SD 5.2), and 26.9 days due to secondary care delay (SD 20.1). The total delay for patients first seen at the secondary care level was 79.1 days (SD 81.8): 47.8 days due to patient delay (SD 25.6), and 31.3 days due to secondary level delay (SD 14.4).

CONCLUSIONS Diagnostic delay in lung cancer is high. Patients who went directly to hospital did not benefit from shorter delay in diagnosis.

KEYWORDS Lung cancer, diagnostic delay, primary level, risk perception, Cuba