INTRODUCTION Cancer is a major public health problem worldwide and in Cuba. Approximately one third of cancer patients develop a brain metastasis. Despite this, epidemiological studies are scarce, internationally and in Cuba; published research is mainly limited to autopsy studies and hospital case series.
OBJECTIVE Characterize patients with brain metastases residing in Habana del Este Municipality, Havana, Cuba, with respect to demographics, metastasis location and primary tumor site.
METHODS A retrospective descriptive study was carried out with data for all patients with histologically confirmed cancer diagnosed in 2014 and registered in primary health care in Habana del Este Municipality. Diagnostic reports from computed tomography and/or magnetic resonance imaging were used to identify patients with brain metastases. Study variables were age, sex, skin color, number and location of brain metastases, control of primary tumor, and presence of extracranial metastases. Percentages were calculated and presented in tables.
RESULTS We identified 832 cancer patients in the Habana del Este population of 181,473 (prevalence 458.5 per 100,000 population). Among patients with cancer, 27.6% (230/832) had brain tumors, among which 83% (191/230) were brain metastases and 17% (39/230) primary tumors, a ratio of 4.9:1. Brain metastases appeared in 23% (191/832) of cancer patients (prevalence 105.2 per 100,000 population). Among patients with brain metastases, 48.2% (92/191) were aged 41–60 years and 61.3% (117/191) were female sex. The majority, 59.7% (114/191) had multiple metastases. The most frequent primary tumor location was the breast (40.8%, 78/191), followed by the lung (31.9%; 61/191); 46.8% (211/451) of brain metastases were in the parietal lobe.
CONCLUSIONS Brain metastases are more prevalent in this Cuban municipality than reported in other countries, but they constitute a higher proportion of cancer cases than seen in other population-based studies. The study’s results underline the importance of detecting brain metastasis early, to permit timely interventions to improve quality of life and survival.
KEYWORDS Cancer, neoplasm metastasis, tumor metastasis/brain, epidemiology, prevalence, Cuba
CONTRIBUTION OF THIS RESEARCH This is the first epidemiological study of brain metastases in Cuba and one of the few carried out internationally.
INTRODUCTION Urinary incontinence is a disorder of considerable significance in older adults. It causes distress and morbidity, yet its true prevalence in the community is likely underestimated, because stigma and other factors may cause underreporting. WHO has developed a 10-minute screening tool to help primary healthcare providers recognize and manage the most common geriatric conditions: falls, memory loss, depression and urinary incontinence.
OBJECTIVE Determine prevalence of urinary incontinence in adults aged ≥60 years in Westmoreland Parish, Jamaica; examine some of the associated risk factors; estimate how much urinary incontinence goes unreported and explore related barriers.
METHODS A cross-sectional study in April 2014 of 454 older adults was conducted in 12 community clusters in Westmoreland. Data collection was done using an interviewer-administered questionnaire. Data were analyzed using SPSS version 17. Chi-square and Fisher exact tests were used to assess significance of associations between dependent and independent variables.
RESULTS The majority (241/454, 53.1%) of respondents were men aged 60–95 years (median age 69 years; interquartile range: 64–77). Prevalence of urinary incontinence was 10.6% (48/453). Statistically significant associations were found between urinary incontinence and hypertension, diabetes mellitus, prostate problems and arthritis, but not with kidney problems, stroke or parity. Among respondents with urinary incontinence, 30.2% had not reported the condition to their doctor (13/43 who answered this question). Reasons cited for nonreporting included belief that urinary incontinence is normal with aging (9 respondents), not being bothered by urinary incontinence (7), inability to pay for treatment (6), feeling ashamed to report the condition (4), not knowing the appropriate doctor to see (2) and lack of awareness of available treatment options (1). Among respondents who had unreported urinary incontinence, 10 indicated a preference for physician-initiated (as opposed to self-initiated) discussion of urinary incontinence.
CONCLUSION The substantial prevalence of urinary incontinence and high rate of nonreporting (almost one in three) underscore the need for systematic screening of older adults by doctors, especially at the primary care level, for early detection and appropriate urinary incontinence management.
KEYWORDS Urinary incontinence, prevalence, risk factors, cross-sectional studies, aged, elderly, Jamaica
INTRODUCTION Neurofibromatosis 1 is one of the most common heritable genetic disorders in humans. It is characterized by formation of neurofibromas, with marked variability in expression. Half the cases are due to autosomal dominant inheritance; the rest arise from de novo mutations. Prevalence varies by population, and prevalence in Cuba is unknown.
OBJECTIVE Determine the prevalence of neurofibromatosis 1 in a population of Cuban children aged 9–11 years old in Pinar del Río Province, Cuba.
METHODS A descriptive cross-sectional study was carried out in Pinar del Río Province in 2004, in which 19,392 children were assessed for neurofibromatosis 1. The study was conducted in two phases: the first, a survey of the entire population aged 9–11 years by genetic counselors in the province’s schools; the second, assessment by clinical geneticists of children who met criteria for referral to the Provincial Medical Genetics Center. Neurofibromatosis 1 cases and first-degree relatives were examined to identify the origin of the mutation (de novo or inherited). Neurofibromatosis 1 prevalence was calculated, as well as history of a first-degree relative with the disease and frequency of several principal clinical signs—café au lait spots, freckles in places unexposed to sunlight, presence of neurofibromas, Lisch nodules and characteristic bone lesions.
RESULTS Of the eligible population, 99.3% was screened (10,034 boys and 9358 girls). Active case finding resulted in referral of 200 children to medical geneticists and the disease was confirmed in 17, for a prevalence of one case per 1141 children aged 9–11 years old. Café au lait spots were the most frequent sign (100%), followed by freckles in areas unexposed to sunlight (82.4%) and characteristic bone lesions (41.2%). Only 4 of the 17 cases were previously being treated for the disease.
CONCLUSIONS Neurofibromatosis 1 has high prevalence in the group studied in Pinar del Rio Province and most cases are not detected in primary health care settings.
KEYWORDS Neurofibromatosis 1, von Recklinghausen disease, prevalence, café au lait spots, Lisch nodules, genetic diseases, hereditary disease, medical genetics, genetic epidemiology, Cuba
INTRODUCTION Over the last 40 years, high smoking prevalence has been reported throughout Cuba, including in Cienfuegos city in the central part of the island.
OBJECTIVES Determine smoking prevalence and potential associated risk factors in Cienfuegos city for 2010–2011.
METHODS A descriptive cross-sectional study was conducted in Cienfuegos city in the context of CARMEN (Collaborative Action for Risk Factor Prevention & Effective Management of Non-communicable Diseases), a PAHO multi-country initiative for a multidimensional approach to chronic non-communicable diseases. Participants totaled 2193 (aged 15–74 years), randomly selected through complex probabilistic three-stage sampling. Variables examined in relation to smoking included age, sex, skin color, civil status and educational level.
RESULTS Approximately 25% of those surveyed were smokers (30.3% of men and 21.0% of women). For men, prevalence was highest in the groups aged 25–34 and 55–64 years; for women, in the group aged 45–54 years. Concerning skin color, smoking rates were higher among black and mestizo persons (29.5%); and concerning civil status, higher among those who were separated, widowed or divorced (30.0%). Smoking prevalence fell with higher educational level; in keeping with that trend, the university-educated group had the lowest prevalence (16.2%).
CONCLUSIONS Although one in four Cienfuegos residents aged ≥15 years smoked in 2010–2011, prevalence there is lower than in previous surveys. Knowledge of differences observed in age, sex, skin color, civil status and educational level can be useful for planning future smoking prevention and control actions.
KEYWORDS Tobacco, smoking, prevalence, health surveys, risk factor surveillance, Cuba
INTRODUCTION This manuscript updates a review previously published in a local journal in 2012, about a new form of chronic kidney disease that has emerged over the past two decades in the north-central dry zone of Sri Lanka, where the underlying causes remain undetermined. Disease burden is higher in this area, particularly North Central Province, and affects a rural and disadvantaged population involved in rice-paddy farming. Over the last decade several studies have been carried out to estimate prevalence and identify determinants of this chronic kidney disease of uncertain etiology.
OBJECTIVE Summarize the available evidence on prevalence, clinical profile and risk factors of chronic kidney disease of uncertain etiology in the north-central region of Sri Lanka.
METHODS PubMed search located 16 manuscripts published in peer-reviewed journals. Three peer-reviewed abstracts of presentations at national scientific conferences were also included in the review.
RESULTS Disease prevalence was 5.1%–16.9% with more severe disease seen in men than in women. Patients with mild to moderate stages of disease were asymptomatic or had nonspecific symptoms; urinary sediments were bland; 24-hour urine protein excretion was <1 g; and ultrasound demonstrated bilateral small kidneys. Interstitial fibrosis was the main pathological feature on renal biopsy. The possibility of environmental toxins affecting vulnerable population groups in a specific geographic area was considered in evaluating etiological factors. Pesticide residues were detected in affected patients’ urine, and mycotoxins detected in foods were below maximum statutory limits. Calcium-bicarbonate–type water with high levels of fluoride was predominant in endemic regions. Significantly high levels of cadmium in urine of cases compared to controls, as well as the disease’s dose-related response to these levels, has drawn attention to this element as a possible contributing factor. Familial clustering of patients is suggestive of a polygenic inheritance pattern comparable to that associated with diseases of multifactorial etiology.
CONCLUSIONS Available data suggest that chronic kidney disease of uncertain etiology is an environmentally acquired disease, but to date no definitive causal factor has been identified. Geographic distribution and research findings suggest a multifactorial etiology.
KEYWORDS Chronic kidney disease, uncertain etiology, prevalence, clinical profile, risk factors, rural communities, paddy farming, environmentally acquired disease, Sri Lanka
In recent years, Central America, Egypt, India and Sri Lanka have reported a high prevalence of chronic kidney disease of unknown etiology in agricultural communities, predominantly among male farmworkers. This essay examines the disease’s case definitions, epidemiology (disease burden, demographics, associated risk factors) and causal hypotheses, by reviewing published findings from El Salvador, Nicaragua, Costa Rica, Sri Lanka, Egypt and India. The range of confirmed chronic kidney disease prevalence was 17.9%–21.1%. Prevalence of reduced glomerular filtration (<60 mL/min/1.73 m2 body surface area) based on a single serum creatinine measurement was 0%–67% men and 0%–57% women. Prevalence was generally higher in male farmworkers aged 20–50 years, and varied by community economic activity and altitude. Cause was unknown in 57.4%–66.7% of patients. The dominant histopathological diagnosis was chronic tubulointerstitial nephritis. Associations were reported with agricultural work, agrochemical exposure, dehydration, hypertension, homemade alcohol use and family history of chronic kidney disease. There is no strong evidence for a single cause, and multiple environmental, occupational and social factors are probably involved. Further etiological research is needed, plus interventions to reduce preventable risk factors.
KEYWORDS: Chronic kidney disease, prevalence, risk factors
INTRODUCTION Upper gastrointestinal endoscopy, traditionally performed in Cuba in specialized hospitals, was decentralized to the primary health care level in 2004 to make it more patient-accessible.
OBJECTIVES Describe frequency and distribution of the principal symptomatic diseases of the upper gastrointestinal tract and their relation to the main risk factors associated with each in a sample of urban adults who underwent upper gastrointestinal endoscopy in primary care facilities in Havana in selected months of 2007.
METHODS A multicenter cross-sectional study was conducted, including 3556 patients seen in the primary health care network of Havana from May through November 2007. The endoscopies were performed at the 22 polyclinics (community health centers) providing this service. Diagnostic quality and accuracy were assessed by experienced gastroenterologists using a validated tool. Patients responded to a questionnaire with clinical, epidemiologic, and sociodemographic variables. Univariate and multivariate analyses (unconditional logistical regression) were used to identify associated risk factors. The significance level was set at p < 0.05 (or confidence interval excluding 1.0).
RESULTS The diagnoses were: gastritis (91.6%), duodenitis (57.8%), hiatal hernia (46.5%), esophagitis (25.2%), duodenal ulcer (15.8%), gastric ulcer (6.2%) and malignant-appearing lesions (0.4%). Overall prevalence of Helicobacter pylori infection was 58.4%. The main risk factors for duodenal ulcer were H. pylori infection (OR 2.70, CI 2.17–3.36) and smoking (OR 2.08, CI 1.68–2.58); and for gastric ulcer, H. pylori (OR 1.58, CI 1.17–2.15) and age ≥60 years (OR 1.78, CI 1.28–2.47). H. pylori infection was the main risk factor for gastritis (OR 2.29, CI 1.79–2.95) and duodenitis (OR 1.58, CI 1.38–1.82); and age ≥40 years for hiatal hernia (OR 1.57, CI 1.33–1.84). External evaluation was “very good” or “good” for 99.3% of endoscopic procedures and 97.9% of reports issued.
CONCLUSIONS Gastrointestinal endoscopy performed in primary care yielded high quality results and important information about prevalence of the most common diseases of the upper GI tract and associated risk factors. This study provides a reference for new research and can inform objective recommendations for community-based interventions to prevent and control these diseases. The existence of a network of universally accessible diagnostic endoscopy services at the primary care level, will contribute to conducting further research.
KEYWORDS Endoscopy, gastrointestinal diseases, upper GI tract, prevalence, risk factors, primary care, Cuba
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INTRODUCTION Tobacco and alcohol are currently the most widely consumed legal psychoactive substances in the world. They represent a heavy burden for health and society in almost all populations. Increasing consumption of both substances is a trend observed in women.
OBJECTIVE Describe the profile of women aged ≥15 years residing in urban areas of Cuba with respect to tobacco and alcohol consumption.
METHOD Basic information on tobacco and alcohol consumption by Cubans aged ≥15 years in urban areas was obtained from the Second National Survey on Risk Factors and Chronic Diseases (2001), a national descriptive cross-sectional study, the objective of which was to determine the frequency and epidemiological characteristics of the urban population’s main chronic disease risk factors. Sampling design was complex stratified multi-stage cluster. Of a sample of 23,743 individuals, 22,851 were surveyed, representative of 6.8 million Cubans. A questionnaire and structured interview were used. Variables were tobacco and alcohol use, as well as sociodemographic factors: sex, age, educational level, skin color, marital status, type of full-time employment and perceived economic situation. Prevalence, with 95% confidence intervals, and male:female prevalence ratios were estimated.
RESULTS Women who smoked were predominantlyaged 40–59 years; had completed less than university education; of black skin color; divorced; laborers, service workers or managers, and with a perceived economic situation as very poor. Women who consumed alcohol were predominantly aged 15–59 years, had at least middle school education, of mestizo or black skin color, of marital status other than widowed; there was no typical profile for occupation or perceived economic situation. Women who were both smokers and alcohol consumers were predominantly 20–59 years, of black or mestizo skin color, of marital status other than widowed; with no typical profile for educational level, occupation or perceived economic situation.
CONCLUSIONS The first nationwide socioeconomic profile of Cuban women using tobacco, alcohol or both constitutes a baseline for comparison to results of a new national study now under way, permitting evaluation of trends over time and effectiveness of prevention and control efforts.
KEYWORDS Risk behavior, risk factors, behavioral risk factor surveillance system, smoking, tobacco smoking, alcohol, alcohol consumption, psychoactive agents, prevalence, women’s health, Cuba
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In El Salvador, end-stage renal disease is the leading cause of hospital deaths in adults, the second cause of death in men and the fifth leading cause of death in adults of both sexes in the general population.
Introduction: Cerebrovascular disease (CVD) is the third cause of death and second cause of disability and dementia in adults aged ≥65 years worldwide. The few epidemiological studies of stroke in Latin America generally report lower prevalence and different patterns than developed countries.
Objective: Estimate the prevalence of stroke and associated risk factors in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba.
Methods: Single phase, cross-sectional, door-to-door study of 3015 adults aged ≥65 years in selected municipalities of Havana City and Matanzas provinces. Variables studied were age, sex, educational level, and self-report and description of chronic disease (stroke, heart attack, angina, and diabetes mellitus), substance use (alcohol, tobacco), and dietary habits. Respondents were given a structured physical and neurological exam, and blood pressure was measured. Laboratory tests comprised complete blood count, fasting glucose, total cholesterol and fractions, triglycerides, and apolipoprotein E (APOE) genotype. Diagnosis of stroke was based on the World Health Organization’s definition. Stroke prevalence ratios (crude and adjusted), with 95% confidence intervals (CI), were calculated for the variables studied using a Poisson regression model. Risk association was analyzed using multiple logistic regression for dichotomous responses.
Results: Assessments were made of 2944 older adults (97.6% response rate). Prevalence of stroke was 7.8% (95% CI 6.9–8.8), and was higher in men. The risk profile for this population group included history of hypertension (OR 2.8; 95% CI 2.0–4.0), low HDL cholesterol (OR 2.6; 95% CI 1.7–3.9), male sex (OR 1.7; 95% CI 1.2–2.5), anemia (OR 1.6; 95% CI 1.1–2.5), history of ischemic heart disease (OR 1.5; 95% CI 1.0–2.3), carrier of one or two apolipoprotein E4 genotype (APOE ε4) alleles (OR 1.4; 95% CI 1.0–2.0), and advanced age (OR 1.3; 95% CI 1.1–1.9).
Conclusions: Stroke prevalence in this study is similar to that reported for Europe and North America, and higher than that observed in other Latin American countries. The risk profile identified includes classic risk factors plus anemia and APOE ε4 genotype.
Keywords: Apolipoprotein E4, population-based study, epidemiology, risk factors, stroke, prevalence, Cuba
Introduction Prevalence of overweight and obesity is increasing worldwide in parallel with the growing burden of noncommunicable chronic diseases. According to the World Health Organization, in 2005 approximately 1.6 billion individuals aged ≥15 years were overweight and at least 400 million were obese; by 2015 these figures will almost double. Central distribution of adiposity has also been associated with higher rates of cardiovascular diseases and other conditions.
Objective Determine the prevalence of overweight, obesity and central adiposity, and their association with noncommunicable chronic diseases and related lifestyle risk factors in Cuban adults.
Methods The Second National Survey on Risk Factors and Chronic Diseases (ENFRENT II), conducted in 2000–2001, surveyed a representative sample of males and females aged ≥15 years using a stratified, multi-stage cluster sampling design. Data from a sub-sample of 19,519 individuals aged ≥20 years were analyzed and prevalence calculated for diabetes, hypertension, cardiovascular and cerebrovascular diseases, and for each of these variables in association with overweight, obesity and central distribution of adiposity, and with the presence of sedentary lifestyle, smoking, alcohol consumption, eating regular daily meals and daily breakfast.
Results Estimated prevalence of overweight and obesity in the adult population was 30.8% (CI: 30.1–31.5) and 11.8% (CI: 11.2–12.4), respectively. Obesity prevalence was twice as high in women (15.4%; CI: 14.5–16.3) as in men (7.9%; CI: 7.3–8.6). Obesity was significantly more frequent in diabetics, hypertensives and people with heart disease, while central adiposity was significantly associated with a higher prevalence of diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, obesity and overweight. Smoking and alcohol consumption were low among overweight and obese subjects, who exhibited a higher prevalence of irregular and inadequate eating patterns.
Conclusions Prevalence of overweight, obesity and central adiposity, and comorbidity with diabetes mellitus, hypertension and heart disease, are growing public health problems in Cuba. A multi-sector strategy is needed to develop comprehensive food and nutrition policies and programs aimed at halting these trends, including interventions that encourage healthy eating patterns and regular physical activity in adults and children.
Keywords: Overweight, obesity, comorbidity, chronic disease, prevalence, nutrition disorders
