Abstract in English: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.
Abstract in English: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.
Abstract in English: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.
Abstract in English: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.
Abstract in English: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.
Abstract in English:Establishment, progressive development, expansion and organization of Cuba's National Comprehensive Diabetes and Pregnancy Program is described, including changes in related health services since 1959. Currently implemented throughout the country, the Program is supervised by a working group and addresses diabetic women's reproductive health and care during pregnancy. The importance of preconception care for diabetic women is emphasized, as well as the need to increase Program uptake nationally, including screening for gestational diabetes in primary care.