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
Popular belief has it that alcohol, particularly red wine, protects against atherosclerosis and associated cardio- and cerebrovascular conditions. That presumption motivates this paper, which describes the mechanisms underlying the J-shaped risk curve for alcohol use, with benefits for vascular disease risk at low consumption levels and harmful effects—both directly on the user and indirectly on the bystander—at higher levels. The importance of further exploring alcohol use in patients with cardiovascular risk factors and of intervening to modify non-social use of alcohol to prevent serious adverse health consequences is also addressed.
KEYWORDS Alcohol-related disorders, burden of illness, atherosclerosis, atherogenesis, vascular disease, risk factors, 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 Violent acts in young people constitute one of the most serious forms of violence in any society. Violence by young people in schools, on the streets, and in their families has been documented in many studies worldwide. Homicide and non-fatal assaults involving young people have been reported as a great global burden of premature death, injury and disability. Adolescents and young people are both the main victims and perpetrators of such violence. In Vietnam, an emerging pattern of health problems in adolescents related to intentional injury and violence is drawing increasingly more attention from government and the public.
OBJECTIVE Describe the situation of intentional injury among Vietnamese youth, including risk and protective factors, in order to suggest policy implications.
METHODS The 2003 Survey Assessment of Vietnamese Youth was used as a data source, providing a nationally representative sample of 7584 youth aged 14–25 years, resident in 42 of the country’s 61 provinces. This sample was drawn from the 45,000 households in the 2002 Vietnam Living Standards Survey, with a multi-staged and stratified design, using the probability-proportional-to-size method to maintain representativity. Data were analyzed using bivariate and multivariate statistical techniques.
RESULTS Of the sample of young people, 2.2% reported injury resulting from violent behavior by a family member and 8.0% by non-family members, the latter demonstrating a significantly higher rate among males than females (13.6% vs. 2.4%). Characteristics of youth most likely to hurt others included: male sex, inebriation at some point, victims of intentional injury, group riot participants and carriers of weapons. Youth who had been members of mass social organizations or clubs in the community were half as likely to hurt other people as those who were unaffiliated with such groups. Females were almost four times more likely than males to attempt suicide. Other risk factors for suicide attempts were past inebriation (OR 2.7, 95% CI 1.3–5.4), ever having been a victim of intentional injury by a family member (OR 3.3, 95% CI 1.1–11.5) or ever having had feelings of hopelessness (OR 6.5, 95% CI 3.3–13.6).
CONCLUSIONS Prevalence of violence and self-harm among Vietnamese youth is comparatively less than in Western and other Asian countries. Risk and protective factors appear similar to those found in most populations. In particular, this study indicated a possible protective effect of membership in social groups. National policy for injury prevention should include strategies to reduce violence and self-harm within this population group.
KEYWORDS Adolescent, youth; adolescent behavior, risk factors, violence, domestic violence, suicide, suicide, attempted, suicidal ideation, Vietnam
INTRODUCTION Diabetes in pregnancy threatens both maternal and neonatal health, with risks of lung immaturity, fetal macrosomia, dystocia and impaired maternal kidney function. Before insulin, diabetes resulted in maternal mortality rates of 30–50% and perinatal mortality rates of 50–60%. Global prevalence estimates vary by population, geographical area and diagnostic criteria. Diabetes accounts for some 90% of endocrine complications in pregnancy.
OBJECTIVES Determine diabetes mellitus prevalence in pregnancy and characterize the population of diabetic women who gave birth in the Isle of Youth Special Municipality in 2008.
METHODS A descriptive retrospective study was carried out from January to December 2008. Clinical records were reviewed of 180 diabetic women who gave birth on the Isle of Youth in 2008, their diagnosis based on WHO criteria modified by municipal health authorities. Study variables were: maternal age, nutritional status, glucose tolerance, gestational age at diagnosis, history of diabetes, and pregnancy outcome; as well as risk factors such as diabetes family history, pregnancy weight gain and comorbidities.
RESULTS Overall prevalence (pregestational and gestational diabetes) among these cases was 17.3%; highest in the group aged ≥35 years. Gestational diabetes was more frequent (96.1% of cases) than pre-gestational diabetes. Multiparity (62.1%), a first-degree family history of diabetes mellitus (26.1%), excess weight before pregnancy (50%) and adequate weight gain during pregnancy (54.4%) were the most frequent conditions found. Among gestational diabetics, diabetes was most frequently detected at 20–28 weeks gestation (31.8%). Fetal macrosomia appeared in 4.4% of cases and a high percentage of deliveries were by Cesarean section (30%). There were no low Apgar scores or congenital abnormalities among neonates.
CONCLUSIONS Despite using modified, more inclusive, WHO diagnostic criteria, the clinical and demographic characteristics of the population studied were comparable to those in other studies of diabetes in pregnancy, except for the low frequency of fetal macrosomia and absence of birth defects present in our study.
KEYWORDS diabetes mellitus, pregnancy, risk factors, diabetes, gestational
INTRODUCTION The disease complex comprised of atherosclerosis, chronic kidney disease (CKD) and other associated chronic vascular diseases is the leading cause of mortality worldwide. Microalbuminuria is a marker for vascular damage in the heart, kidney and brain. This paper presents selected findings of the clinical-epidemiological Isle of Youth Study (ISYS) of markers for kidney and vascular damage from chronic vascular diseases and their common risk factors in total population, focusing on Phase 2 reassessment (in 2010) of Phase 1 (2004 to 2006) results.
OBJECTIVES (1) Update the prevalence of risk factors in the study population aged ≥20 years (adult population). (2) Confirm presence of microalbuminuria in at-risk adults diagnosed as presumptive positives in Phase I. (3) Evaluate association between microalbuminuria and selected risk factors.
METHODS Of 3779 adults positive for microalbuminuria in ISYS Phase 1, 73.1% were reevaluated. The risk-factor questionnaire was re-administered and blood pressure, weight and height were measured. Blood was tested for creatinine, glycemia, cholesterol and triglycerides. Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Albuminuria was measured in urine using Micral-Test (Germany) and albumin/creatinine ratio (ACR) by nephelometry. This paper uses ACR as the reference for analyzing risk factor associations. Double-entry tables were developed to analyze association among microalbuminuria, risk factors and co-morbidities.
RESULTS Most prevalent risks were hypertension, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), excess weight and hypertriglyceridemia. Microalbuminuria was confirmed in 18% of cases, using the same test. Elevated prevalence of microalbuminuria was positively associated with advancing age, male sex, underweight, smoking, NSAID use, dyslipidemia, hypertension, diabetes, heart disease and stroke.
CONCLUSIONS The at-risk cohort studied presented low levels of confirmation for positive microalbuminuria. Positive microalbuminuria stratified individuals at greatest risk, except for obesity.
KEYWORDS Chronic kidney disease, cardiovascular disease, risk factors, damage markers, albuminuria, microalbuminuria, Cuba
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 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 normal-weight, 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
