Determination of antimicrobial sensitivity helps establish adequate treatment and avoids future genital tract diseases in women of fertile age. In Cuba, prevalence of mycoplasma in patients with vaginal discharge is unknown. The objective of this research was to determine frequency and antimicrobial sensitivity of Ureaplasma urealyticum and Mycoplasma hominis in women with vaginal discharge through analysis of laboratory data from vaginal smears from 255 patients referred to the Municipal Hygiene and Epidemiology Center in Güines, Mayabeque Province, Cuba. Mycoplasma System Plus (Italy) was used for detection, identification, count and sensitivity testing. The finding of mycoplasmas in almost two thirds of specimens examined suggests that the sexually active female population should be screened for these bacteria and that barrier contraception methods should be promoted to decrease their spread and prevent longterm sequelae. Such updating of local patterns of antimicrobial resistance supports decision making for best treatment options in patients with these infections. Our results should help clinicians in our area choose an antibiotic, and also confirm the utility of Mycoplasma System Plus for mycoplasma research in resource-scarce settings, to benefit individual and population health.
KEYWORDS Ureaplasma urealyticum, Mycoplasma hominis, vaginal discharge, antimicrobial sensitivity, microbial sensitivity tests, microbiological techniques, Cuba
INTRODUCTION Over the last decade, total cardiovascular risk assessment and management has been recommended by cardiovascular prevention guidelines in most high-income countries and by WHO. Cardiovascular risk prediction charts have been developed based on multivariate equations of values of some well-known risk factors such as age, sex, smoking, systolic blood pressure and diabetes, including or omitting total blood cholesterol.
OBJECTIVE The objectives of this study were: to determine the distribution of cardiovascular risk in a Cuban population using the WHO/International Society of Hypertension risk prediction charts with and without cholesterol; and to assess applicability of the risk prediction tool without cholesterol in a middle-income country, by evaluating concordance between the two approaches and comparing projected drug requirements resulting from each (at risk thresholds of ≥20% and ≥30%) and for the single-risk-factor approach.
METHODS From April through December 2008, a cross-sectional study was conducted in 1287 persons (85.8% of the sample selected), aged 40–80 years living in a polyclinic catchment area of Havana, Cuba, based on the protocol and data from a WHO multinational study. The study used the two sets of the WHO and the International Society of Hypertension (WHO/ISH) risk prediction charts, with and without cholesterol. Percentages and means were calculated, as well as prevalence (%) of risk factors. The chi-square test was used to compare means (p ≤0.05). Concordance between the two prediction charts was calculated for different risk levels, using the chart with cholesterol as a reference.
RESULTS Using the risk assessment tools with and without cholesterol, 97.1% and 95.4% respectively of the study population were in the ten-year cardiovascular risk category of <20%, while 2.9% and 4.6% respectively were in the category of ≥20%. Risk categories were concordant in 88.1% of the population; overestimation was higher among the nonconcordant (136/153). When risk assessment did not include cholesterol, there was 2.6% (34/1287) overestimation of drug requirements and 0.5% (6/1287) underestimation, compared to estimates including cholesterol.
CONCLUSION Total cardiovascular risk assessment using the WHO/ISH charts without cholesterol could be a useful approach to predict cardiovascular risk in settings where cholesterol cannot be measured. This does not introduce overconsumption of drugs, but does enable better targeting of resources to those who are more likely to develop cardiovascular disease.
KEYWORDS Cardiology, risk assessment, health risk appraisal, hypertension, health policy, cost savings, atherosclerosis, Cuba
INTRODUCTION Women are being diagnosed with HIV infection in increasing numbers, and now account for 50% of cases worldwide. In Cuba, HIV is more frequent in men, but in recent years, a growing number of women have been diagnosed.
OBJECTIVE Describe patterns of HIV among women in Havana, Cuba, 1986–2011.
METHODS Descriptive study of women with HIV aged >14 years, residents of Havana, Cuba, who were diagnosed with HIV from 1 January 1986 through 31 December 2011. Information was obtained from the limited-access HIV/AIDS database of Cuba’s Ministry of Public Health. Data were studied from all reported cases, a total of 1274 women. Variables selected were age at diagnosis, education, municipality of residence, screening group, year of HIV diagnosis, late presentation, AIDS-defining condition, year of diagnosis as AIDS case, vital status at the end of 2011, and year of death (if applicable). Incidence of HIV and AIDS, cumulative incidence by municipality of residence, and case fatality rates were calculated.
RESULTS Those aged 20–29 years were most affected by HIV. Almost half (46.7%) the women had completed middle school, and a further 35.4% had completed high school or middle-level technical studies. HIV incidence began to increase more steeply starting in 1998, as did AIDS incidence by year of diagnosis, though to a lesser extent. Central Havana and Old Havana municipalities had the highest cumulative incidence. Late presentation was seen in 7.4% of cases; mean age of those diagnosed late was 38.9 years. Wasting syndrome and Pneumocystis jirovecii pneumonia were the most frequent AIDS-defining conditions. Case fatality rates started to decline in 1998.
CONCLUSIONS HIV infection in women is occurring in a predominantly young, relatively well-educated population. Increasing rates of HIV and AIDS in the past decade are a warning sign of the possible expansion of HIV infection in women, even though mortality is declining.
KEYWORDS Human immunodeficiency virus, acquired immunodeficiency syndrome, AIDS, HIV infections, women, delayed diagnosis, Cuba
INTRODUCTION Smoking and alcohol use (beyond social norms) by health sciences students are behaviors contradictory to the social function they will perform as health promoters in their eventual professions.
OBJECTIVES Identify prevalence of tobacco and alcohol use in health sciences students in Mexico and Cuba, in order to support educational interventions to promote healthy lifestyles and development of professional competencies to help reduce the harmful impact of these legal drugs in both countries.
METHODS A descriptive cross-sectional study was conducted using quantitative and qualitative techniques. Data were collected from health sciences students on a voluntary basis in both countries using the same anonymous self-administered questionnaire, followed by an in-depth interview.
RESULTS Prevalence of tobacco use was 56.4% among Mexican students and 37% among Cuban. It was higher among men in both cases, but substantial levels were observed in women as well. The majority of both groups were regularly exposed to environmental tobacco smoke. Prevalence of alcohol use was 76.9% in Mexican students, among whom 44.4% were classified as at-risk users. Prevalence of alcohol use in Cuban students was 74.1%, with 3.7% classified as at risk.
CONCLUSIONS The high prevalence of tobacco and alcohol use in these health sciences students is cause for concern, with consequences not only for their individual health, but also for their professional effectiveness in helping reduce these drugs’ impact in both countries.
KEYWORDS Smoking, tobacco, nicotine dependence, alcohol dependence, substance-related disorders, alcohol-related disorders, addiction, risk behavior, health occupations students, Mexico, Cuba
INTRODUCTION The global prevalence of obesity has reached alarming proportions. In Cuba, the rise in numbers of children who are overweight or obese, especially preschoolers and adolescents, is similar to that observed in developed countries. Beyond the physical risk factors, there is evidence that obesity has negative psychological, social, academic and economic effects.
OBJECTIVES Describe the psychological, behavioral and familial factors present in a group of obese children and adolescents in Cuba.
METHODS This is a qualitative cross-sectional study of 202 obese children and adolescents aged 3–18 years, with an average age of 9.9 years, seen at the Medical–Surgical Research Center (Havana) psychology service from January 2009 through December 2012. Techniques included interviews of patients and parents, projective drawings and the Rotter Incomplete Sentence Blank.
RESULTS Unhealthy eating habits were reported in 96% of obese children and adolescents, and sedentary lifestyles in 88.1%. Emotional state was affected in 80.2%, and in 72.3% there were family attitudes with potential to produce psychological disturbances in children.
CONCLUSIONS Psychological, behavioral, and familial factors known to foster development and perpetuation of obesity were observed in the majority of cases. This is a first diagnostic stage that will aid in design and implementation of a psychological intervention program for obese and overweight children and their families.
KEYWORDS Obesity, psychosocial factors, childhood, adolescence, projective techniques, Cuba
Education at the community level is indispensable for control of chronic non-communicable diseases and comprehensive patient care, with diabetes mellitus a case in point. The need is even more pronounced for type 1 diabetes, affecting children and adolescents. Families of diabetic adolescents naturally worry about vulnerability to sexually transmitted diseases, which create risks for glycemic control and the adolescent’s health. We felt compelled to explore the issue of sexuality in diabetes education for adolescents, because education can do more than help maintain metabolic control; it can contribute to keeping diabetic children and adolescents on a healthy developmental curve, when combined with the other pillars of diabetes management. Accordingly, we carried out an educational intervention to increase type 1 diabetic adolescents’ knowledge of sexuality and sexually transmitted infections. Participants were 20 adolescents in Camagüey Province’s central clinic for type 1 diabetes patients. A six-session educational program was developed and implemented. Responses to a questionnaire before and after the program revealed that prior to the intervention only 3 of 20 participants (15%) demonstrated satisfactory knowledge of the material covered (≥70%), increasing to 20 (100%) after completion of the program.
KEYWORDS Sex education, adolescents, diabetes mellitus, sexually transmitted infections, Cuba
INTRODUCTION Better prognostic classification of patients who are severely injured or in critical condition has been associated with reduced case fatality from traumatic brain injury.
OBJECTIVE Determine the value of admission results (clinical, laboratory and imaging) and severity scales, for predicting mortality in traumatic brain injury patients.
METHODS A cross-sectional study of traumatic brain injury patients was conducted at the Sancti Spíritus Provincial General Teaching Hospital in 2009 and 2010; the study population included all 16 traumatic brain injury patients who died during the period, plus 31 who survived to discharge. The following independent variables were used: Glasgow Coma Scale, Glasgow Coma Scale motor score, pupil reaction to light, blood glucose, respiratory distress, systolic blood pressure, hemoglobin, and lesions detectable on cranial computed tomography. Associations between independent and dependent variables (death or survival to discharge) were analyzed using the chi-square test and, for cells with expected values of <5, the Fisher exact test. Odds ratios and 95% confidence intervals were calculated.
RESULTS Of 47 patients, 20 (42.6%) were aged >60 years and 32 (68.1%) were male. Parameters associated with higher mortality identified were: Glasgow Coma Scale score ≤8 (OR 47.25, 95% CI 6.26–483.3, p <0.001) and Glasgow Coma Scale motor score ≤3 (OR 28.00, 95% CI 4.20–220.2, p <0.001); absence of pupil reaction (OR = 8.40, 95% CI 1.20–73.35, p <0.001), respiratory distress (OR = 47.25, 95% CI 1.85–85.92, p <0.0014), blood glucose >8.8 mmol/L (OR = 7.26, CI 1.28-46.18, p <0.001), subdural hematoma (OR 20.25, 95% CI 3.55–136.65, p <0.001) and multiple injuries detected by cranial computed tomography (OR = 29.25, 95% CI 4.64–228.43, p <0.001).
CONCLUSIONS The study confirmed value in Sancti Spíritus Province of the following for predicting mortality in head injury patients: Glasgow Coma Scale score ≤8, Glasgow Coma Scale motor score ≤3, blood glucose >8.8 mmol/L, absence of pupil reaction to light, respiratory distress, and presence of multiple injuries detected in cranial computed tomography. No prognostic value was demonstrated for low hemoglobin values or abnormal blood pressure.
KEYWORDS Traumatic brain injury, prognosis, coma, Glasgow Coma Scale, brain injuries, head injuries, head trauma, trauma severity indices, injury severity score, Cuba
INTRODUCTION Pre-eclampsia is a major cause of morbidity and mortality during pregnancy worldwide and is among the leading causes of maternal mortality in Cuba. It is a complex, multifactoral disease, in which interaction of genetic and environmental factors should not be overlooked if the goal is proper risk assessment to support personalized preventive genetic counseling and more effective prenatal care to prevent pregnancy complications.
OBJECTIVE Determine the contribution to pre-eclampsia of interaction between a predisposing genome and adverse environmental factors in pregnant women in a Havana maternity hospital.
METHODS This was the exploratory phase of a hospital-based case-control study, using January 2007–December 2009 patient records from the Eusebio Hernández University Hospital, a provincial maternity hospital in Havana. Eighty pregnant women diagnosed with pre-eclampsia and 160 controls were studied. The main variables were age, parity, nutritional status (measured by BMI), alcohol use, tobacco use, and history of pre-eclampsia in relatives of the pregnant woman (proband) or of her partner. Pearson chi square and Fisher exact test were used to assess statistical significance of associations between variables and odds ratio as a measure of association strength. Familial aggregation was studied and a case-control design used to assess gene–environment interaction, using multiplicative and additive models.
RESULTS Among the environmental risk factors studied, alcohol showed the strongest effect on pre-eclampsia risk (OR 3.87, 95% CI 1.64–9.13). Familial pre-eclampsia clustering was observed; risk was increased for both first-degree (OR 2.43, 95% CI 1.62–3.73) and second-degree (OR 1.89, 95% CI 1.34–2.68) relatives as well as for husband’s relatives (OR 2.32, 95% CI 1.40–3.86). There was evidence of interaction between alcohol consumption and family history.
CONCLUSIONS Familial aggregation of the disorder was demonstrated, the first Cuban epidemiological evidence of genetic and enviromental contributions to pre-eclampsia risk. Familial clustering among the husband’s relatives demonstrates the fetal genome’s importance in genesis of pre-eclampsia. The interaction of environmental risk factors with genetic ones produces increased pre-eclampsia risk, compared to expectations based on independent action of these variables.
KEYWORDS Pre-eclampsia, toxemia of pregnancy, pregnancy outcome, environment, genetics, genome–environment interaction, genetic epidemiology, Cuba
INTRODUCTION Cancer has historically been a main cause of death in Cuba, with lung cancer the number one cause of cancer death in both sexes. Cancer morbidity and mortality rates are the basic measures of cancer impact in the community. Cancer mortality has been one of the major applications of geographic analysis and has made important progress in recent decades thanks to access to mortality statistics and to development and availability of geographic information systems. Cuba does not have a strong tradition of etiologic research using spatial analysis. High levels of lung cancer morbidity and mortality in Villa Clara and growing interest in spatial analysis as an epidemiologic tool motivated this study.
OBJECTIVE To identify spatial and/or spatiotemporal clusters of lung cancer morbidity and case fatality in the province of Villa Clara, and to demonstrate the value of cluster analysis as an epidemiologic tool.
METHODS Descriptive observational study based on administrative data, using the technique of space-time scan statistics. The study focused on new cases diagnosed in 2004 and case-fatality for those cases through 2009. Variables used were: cases diagnosed, deaths, date of diagnosis, date of death, municipality and Cartesian geocoding for each municipality.
RESULTS The study identified significant spatial and spatiotemporal clusters of greater than expected lung cancer incidence (municipalities of Encrucijada, Camajuaní, Cifuentes, Sagua la Grande, Caibarién and Santa Clara) and case fatality (Encrucijada, Camajuaní, Cifuentes, Sagua la Grande, Caibarién, Santa Clara, Placetas and Manicaragua).
CONCLUSIONS Although the results are not explanatory, the spatial and spatiotemporal patterns of excess lung cancer risk and case-fatality can support hypothesis generation for research and eventual interventions for targeted prevention and management.
KEYWORDS Pulmonary neoplasms, epidemiological methods, spatiotemporal analysis, cluster analysis, space-time clustering, incidence, case fatality, Cuba
INTRODUCTION Knowledge of prognostic factors in end-stage renal disease patients has improved dialysis management and methods for reducing morbidity and mortality, underlining the importance of identification, prevention and control of these factors.
OBJECTIVE Identify factors affecting prognosis (survival or death) in hemodialysis patients at the Medical-Surgical Research Center in Havana over a ten-year period.
METHODS Descriptive, prospective study of 81 end-stage renal disease patients who received hemodialysis at the Medical-Surgical Research Center from 1995 to 2004. Prognostic factors were identified at initiation of and during dialysis treatment, using chi square, t test, McNemar test, Kaplan Meier analysis, log-rank test and Cox regression model, with significance threshold set at p <0.05.
RESULTS Hypertension and diabetes were the leading causes of end-stage renal disease. Six patients were referred late. Mean survival was 4.4 years; with survival of 86.6%, 54.7% and 26.6% at one, three and five years respectively. Factors predictive of decreased survival that were most frequent at initiation of hemodialysis were hypertension and chronic anemia (both present in 95.9% of cases); malnutrition, hypoalbuminemia, cardiovascular disease and chronic liver disease increased during treatment while hypertension decreased. In multivariate analysis, prognostic factors that significantly predicted decreased survival were hypertension, inadequate vascular access and diabetes. Patients aged ≥60 years and those with malnutrition, hypoalbuminemia, anemia, cardiovascular disease or liver disease had lower survival figures at the end of the study period. Leading causes of death were infections (45.2%) and cardiovascular disease (41.9%); the latter was present in 93.5% of deaths, independent of underlying cause of death.
CONCLUSIONS Survival of hemodialysis patients diminished at five years. Some negative predictive factors are present at initiation of hemodialysis, such as diabetes, hypertension and chronic anemia; others increased later, including malnutrition, hypoalbuminemia, cardiovascular disease and liver disease.
KEYWORDS Hemodialysis, prognostic factors, survival, chronic kidney disease, end-stage renal disease, Cuba
Translated from the Spanish and reprinted with permission from the Revista Cubana de Salud Pública, [online] Vol. 38, No. 1, Jan–Mar 2012.
Original available at: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662012000100011&lng=es&nrm=iso&tlng=es
This paper describes the evolution of basic indicators of health services, human resources, and infrastructure, starting with a general account of processes under way since the mid-1990s aimed at health sector recovery and focused on improving quality of service, system efficiency and effectiveness, while maintaining equity. Using this background, a description is provided of objectives and essential elements of transformations currently under way in the national health system, based on processes of reorganization, consolidation and regionalization of services. Finally, implications of territorial redistribution for health system reform are discussed, focusing on tensions between rationalization and equity in real or perceived access.
KEYWORDS Health services, transformations, Cuba
In Cuba, alcohol is an important contributor to morbidity, mortality and social problems. The foundation of Cuba’s universal primary health care coverage, family doctor-and-nurse offices play a critical role in prevention, early detection and treatment of alcohol abuse. Los Palacios Municipality of the westernmost province of Pinar del Río, Cuba, is a socially complex, periurban area where alcohol abuse and alcoholism have been identified as important health problems. Adolescents constitute a population at high risk for alcohol abuse because of their receptivity to social influences, but the precise extent of the problem is unknown. This paper reports baseline findings from a survey and direct observation of alcohol consumption in the catchment area of a primary care center, conducted to inform planning for an educational intervention.
KEYWORDS Alcohol, alcoholism, alcohol abuse, alcohol dependence, adolescence, primary health care, Cuba
INTRODUCTION Polio was first detected in Cuba in the late 19th century among residents of the US community on the Isla de Pinos (Isle of Pines, now Isle of Youth), apparently introduced through migration from the USA. The first outbreak was reported in 1906 on the Isle, with the first epidemic reported in the former province of Las Villas in 1909. The epidemics subsequently intensified, by 1934 becoming periodic every four to five years, and accompanied by high morbidity, mortality and crippling sequelae, primarily among children.
OBJECTIVE To review and analyze the history of polio and its control in Cuba, from the disease’s first appearance in 1898 until WHO/PAHO certification of elimination in 1994.
METHODS The historiological method was used; archival documents, medical records, and available polio morbidity and mortality statistics from the Ministry of Public Health’s National Statistics Division before 1959 and from 1959 through 2000 were reviewed. Crude morbidity and mortality rates were calculated using population estimates at mid-period. Reports and scientific publications describing polio vaccination campaigns and their results were also reviewed, and key informants were interviewed.
RESULTS After initial introduction of polio in Cuba, five major epidemics occurred between 1932 and 1958: in 1934 (434 cases, 82 deaths); 1942 (494 cases, 58 deaths); 1946 (239 cases, 33 deaths), 1952 (492 cases, 15 deaths) and 1955 (267 cases, 8 deaths). Between 1957 and 1961 the disease’s endemicity reached epidemic levels, with the last outbreak occurring in 1961, with 342 cases, 30% of them in children aged >4 years.
In 1962, Cuba launched a nationwide polio vaccination campaign, the first of annual campaigns thereafter carried out in the framework of a coherent national program aimed at polio elimination. Using the Sabin oral vaccine and targeting the entire pediatric population in a single time period, five million doses were administered in the first campaign, reaching 87.5% of the target population aged 1 month through 14 years, constituting 109.4% of planned coverage. Since that year, no deaths from polio have been recorded (there were ten cases between 1963 and 1989) and WHO/PAHO certified polio elimination in Cuba in 1994.
CONCLUSIONS Cuba controlled polio with effective vaccination strategies and appropriate epidemiological measures, in the context of social, financial and political support.
KEYWORDS History, poliomyelitis, epidemiology, disease control, vaccination, Sabin vaccine, Cuba
INTRODUCTION Nosocomial pneumonia associated with use of mechanical ventilators is one of the greatest challenges confronted by intensivists worldwide. The literature associates several bacteria with this type of infection; most common in intensive care units are Acinetobacter baumannii, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and some of the Enterobacteriaceae family.
OBJECTIVES To identify the causal agents of nosocomial ventilator-associated pneumonia in patients receiving mechanical ventilation in the intensive care units of Havana’s Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in 2011, and to characterize their antibiotic resistance.
METHODS A cross-sectional descriptive study was conducted using hospital administrative data of quantitative cultures from positive tracheal aspirates for January through December, 2011. Records were analyzed from 77 intensive care unit patients who developed nosocomial ventilator-associated pneumonia. Variables examined were age and sex, and pathogens identified from culture of tracheal aspirate and related antibiotic susceptibility.
RESULTS Species most frequently isolated were: Acinetobacter baumannii in 53 patients (68.8%), Pseudomonas aeruginosa in 34 patients (44.2%), other species of Pseudomonas in 15 patients (19.5%), and Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli in 12 patients each (15.6%). Some patients presented more than one pathogen in concurrent or successive infections. Antimicrobial susceptibility testing found high percentages of resistance to antibiotics in all these pathogens. Least resistance was found to colistin.
CONCLUSIONS The prevalence of antibiotic resistance in bacteria causing nosocomial ventilator-associated pneumonia is of concern. Colistin is the drug of choice among the antibiotics reviewed, but sensitivity to other antibiotics should be assessed to search for more appropriate broad-spectrum antibiotics for treating nosocomial ventilator-associated pneumonia. Our results also suggest the need to strengthen infection control efforts, particularly in intensive care units, and to reassess compliance with quality control procedures. Multidisciplinary research involving microbiologists, epidemiologists, internists and intensivists is needed to fully understand the etiological and resistance patterns observed.
KEYWORDS Acinetobacter baumannii, nosocomial infections, mechanical ventilation, ventilator-associated pneumonia, bacterial resistance, microbial sensitivity tests, bacterial sensitivity tests, Cuba
INTRODUCTION Myocardial reperfusion during the course of an acute myocardial infarction improves patients’ short- and long-term prognosis; coronary blood flow is successfully re-established while preserving a large amount of at-risk muscle. Clinical evolution, however, varies. Presence of residual ischemia or viable myocardial tissue affects a patient’s prognosis. Assessment by noninvasive methods allows better prognostic stratification. Cardiac-gated SPECT provides appropriate parameters to support treatment selection and monitoring of these patients.
OBJECTIVES Assess the prognostic value—ability to predict occurrence of major cardiac events—of perfusion and cardiac function obtained by myocardial perfusion scintigraphy in myocardial infarction patients treated by any myocardial reperfusion method, whether pharmacological or surgical.
MEDTHODS Forty patients were included, mean age 58.8±9 years, diagnosed with myocardial infarction. Participants were divided into two groups: primary percutaneous transluminal coronary angioplasty (15) or thrombolysis (25). All received myocardial perfusion scintigraphy with cardiac-gated SPECT to assess perfusion and left ventricular function, and were followed for six months with telephone interviews and review of clinical records.
RESULTS In the 11 patients who had major cardiac events within six months of followup, a nonsignificant increase in perfusion defect extent was seen post reperfusion. Six (54.5%) of those with major cardiac events had anterior perfusion defects. In functional parameters, a significant increase in end-diastolic and end-systolic volumes and decrease in left ventricular ejection fraction were observed post stress (p = 0.006) and at rest (p = 0.001). Post-stress end-diastolic volume of ≥70 mL had a higher prognostic value for major cardiac events [sensitivity 100%; specificity 89%, area under ROC curve 0.835 (CI 0.702–0.969), p = 0.001].
CONCLUSIONS Cardiac-gated SPECT is useful to identify variables (including left ventricular systolic dysfunction and dilation of left cavities, particularly left end-systolic volume of >70 mL) predictive of major cardiac events in reperfused patients, independent of treatment modality.
KEYWORDS Scintigraphy, cardiac-gated SPECT, single-photon emission computer-assisted tomography, myocardial infarction, myocardial reperfusion, percutaneous transluminal coronary angioplasty, thrombolysis, prognosis, Cuba
INTRODUCTION With 333 million cases worldwide predicted for 2015, type 2 diabetes mellitus presents an important global health challenge. Its rising tide calls for health policies emphasizing prevention at the primary care level, including public education as well as early risk identification and intervention.
OBJECTIVES Estimate risk of developing type 2 diabetes in persons with no known glucose abnormalities, registered in a primary care setting in Pinar del Río city, Cuba, using FINDRISK.
METHODS A descriptive, cross-sectional study applied FINDRISK to 620 persons aged ≥18 years randomly selected from a universe of 1058 patients with no known glucose abnormalities, registered in family-doctor-and-nurse office No. 23 in the Turcios Lima Teaching Polyclinic health area, Pinar del Río city.
RESULTS The study population was predominantly aged ≤45 years (53.5%) and 80.2% was overweight or obese. At least moderate risk of diabetes was found in 74.4% of the sample, and 10.5% was at very high risk, meaning an estimated 120 patients in the sample could be expected to develop type 2 diabetes within the next 10 years.
CONCLUSIONS Type 2 diabetes prevalence can be expected to increase substantially in this population over the next decade. We recommend design and timely implementation of intensive lifestyle change programs to eliminate or slow development of type 2 diabetes in at-risk individuals. We propose following cohorts identified by FINDRISK to assess its prognostic value in the Cuban population.
KEYWORDS Diabetes mellitus, risk factors, risk prediction, prevention, Cuba
