Mortalidad por cáncer bucal en La Habana, 2001-2010 / Oral cancer mortality- Havana, 2001-2010

Introducción: el cáncer bucal está asociado con una morbilidad y mortalidad significativas. Objetivo: determinar los niveles de mortalidad en la provincia La Habana en el periodo 2001-2010. Método: se realizó un estudio descriptivo sobre la mortalidad por cáncer bucal en la población de La Habana desde 2001 hasta 2010. Se incluyeron las defunciones por cáncer como causa básica de muerte, según el Centro de Estudios de Población y Desarrollo de la Oficina Nacional de Estadísticas de la República de Cuba y la dirección sectorial de salud de la provincia La Habana. Variables: años, edad, sexo, localización y municipios. Indicadores: Tasa cruda y ajustada; Tasa específica por sexo; Tasa específica por grupos de edades, Variación porcentual de la mortalidad, Tasa bruta de mortalidad y Razón estandarizada de mortalidad. Resultados: el porcentaje de mortalidad por cáncer bucal aumentó, la tasa en el sexo femenino fue mayor en 2001 respecto al 2010. La localización más frecuente fue la base de lengua. El mayor decrecimiento en la tasa lo tuvo el municipio Habana Vieja con -3,73 por ciento. Conclusiones: el aumento de las tasas brutas de mortalidad por cáncer bucal en general y por sexo puede estar asociado a los cambios ocurridos en la estructura de la población de la provincia; la localización no difiere de lo reportado en el país y en la literatura consultada; la variación de la estructura poblacional, la cantidad de población y sus modificaciones influyen en el comportamiento de las tasas de mortalidad de los municipios(AU)

Introduction: Oral cancer is associated with a significant morbidity and mortality. Objective: Determine the levels of mortality in Havana province from 2001 to 2010. Method: A descriptive study on oral cancer mortality was carried out in the population of Havana from 2001 to 2010. Deaths caused by cancer were included as the basic cause, according to the Center for Population and Development Studies of the National Bureau of Statistics of the Republic of Cuba and the health directing office in Havana. Variables: years, age, sex, localization and municipalities. Indicators: crude rate and adjusted rate; specific rate per sex; per groups of ages, variation of mortality percentage, crude rate of mortality and standard reason of mortality. Results: The oral cancer mortality percentage increased, the female rate was higher in 2001 compared to 2010. The most common site was the base of the tongue. The largest rate decrease was in Habana Vieja municipality (-3.73 percent). Conclusions: In general increased crude mortality rates per oral cancer and sex may be associated with changes in the structure of the province population; the location does not differ from that reported in the country and in the reviewed literature; the change in population structure, population size and its changes affect the behavior of mortality rates in municipalities(AU)

The impact of freedom on fertility decline.

Although fertility decline often correlates with improvements in socioeconomic conditions, many demographers have found flaws in demographic transition theories that depend on changes in distal factors such as increased wealth or education. Human beings worldwide engage in sexual intercourse much more frequently than is needed to conceive the number of children they want, and for women who do not have access to the information and means they need to separate sex from childbearing, the default position is a large family. In many societies, male patriarchal drives to control female reproduction give rise to unnecessary medical rules constraining family planning (including safe abortion) or justifying child marriage. Widespread misinformation about contraception makes women afraid to adopt modern family planning. The barriers to family planning can be so deeply infused that for many women the idea of managing their fertility is not considered an option. Conversely, there is evidence that once family planning is introduced into a society, then it is normal consumer behaviour for individuals to welcome a new technology they had not wanted until it became realistically available. We contend that in societies free from child marriage, wherever women have access to a range of contraceptive methods, along with correct information and backed up by safe abortion, family size will always fall. Education and wealth can make the adoption of family planning easier, but they are not prerequisites for fertility decline. By contrast, access to family planning itself can accelerate economic development and the spread of education.

The impact of vouchers on the use and quality of health care in developing countries: a systematic review.

One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. Using inclusion/exclusion criteria, a search of databases, key journals and websites review was conducted in October 2010. A narrative synthesis approach was taken to summarise and analyse five outcome categories: targeting, utilisation, cost efficiency, quality and health outcomes. Sub-group and sensitivity analyses were also performed. A total of 24 studies evaluating 16 health voucher programmes were identified. The findings from 64 outcome variables indicates: modest evidence that vouchers effectively target specific populations; insufficient evidence to determine whether vouchers deliver healthcare efficiently; robust evidence that vouchers increase utilisation; modest evidence that vouchers improve quality; no evidence that vouchers have an impact on health outcomes; however, this last conclusion was found to be unstable in a sensitivity analysis. The results in the areas of targeting, utilisation and quality indicate that vouchers have a positive effect on health service delivery. The subsequent link that they improve health was found to be unstable from the data analysed; another finding of a positive effect would result in robust evidence. Vouchers are still new and the number of published studies is limiting.

Determinants of small for gestational age birth at term.

BACKGROUND: Being born small for gestational age (SGA) is an indicator of intrauterine growth restriction (IUGR) and later health risks. This study investigated determinants of severe and moderate SGA (respectively, birthweight <3rd percentile and 3rd to <10th percentile for gestational age and sex). METHODS: A total of 2195 term pregnancies from a prospective cohort were studied. Prenatal data arose from maternal interview at 10-22 weeks of gestation and perinatal data were collected from hospital charts. Severe and moderate SGA were classified by Canadian population standards. Risk factors for SGA were identified from fitting multivariable logistic regression models. RESULTS: Multivariable associations with severe SGA were: maternal age ≥ 35 [odds ratio (OR) 3.2 [95% confidence interval (CI) 1.4, 6.9]], maternal smoking during pregnancy (OR 5.3 [95% CI 2.4, 11.7]), preeclampsia (OR 4.6 [95% CI 1.6, 13.2]) and threatened preterm labour (OR 3.9 [95% CI 1.3, 11.4]). Primiparity was associated with both severe and moderate SGA with OR 2.4 [95% CI 1.1, 5.1] and OR 1.9 [95% CI 1.3, 2.9] respectively. Underweight pre-pregnancy body mass index was associated with moderate SGA (OR 2.4 [95% CI 1.2, 5.0]). Inclusion of placental weight, in the final model attenuated the associations. CONCLUSIONS: This study demonstrated different determinants for severe and moderate SGA. We speculate that the majority of severe SGA infants are IUGR while moderate SGA infants may be a mixture of IUGR and constitutionally small newborns. This study has also contributed evidence linking preterm labour and SGA as two, potentially related, outcomes of overlapping causal mechanisms reflective of ischaemic placental disease.

Misinformation and fear of side-effects of family planning.

Fears about the side-effects from family planning are well-documented barriers to use. Many fears are misinformation, while others reflect real experience, and understanding of these is not complete. Using qualitative interviews with women in three countries, this study examines what women feared, how they acquired this knowledge, and how it impacted on decision-making. We aimed to understand whether women would be more likely to use family planning if they were counselled that the side-effects they feared were inaccurate. Across all countries, respondents had a similar host of fears and misinformation about family planning, which were comprised of a mixture of personal experience and rumour. Most fears were method-specific and respondents overwhelmingly stated that they would be more likely to use the family planning method they feared if counselled that there were no side-effects. This suggests programmes should focus on education about family planning methods and method mix.

The theoretical and political framing of the population factor in development.

The silence about population growth in recent decades has hindered the ability of those concerned with ecological change, resource scarcity, health and educational systems, national security, and other global challenges to look with maximum objectivity at the problems they confront. Two central questions about population--(1) is population growth a problem? and (2) what causes fertility decline?--are often intertwined; if people think the second question implies possible coercion, or fear of upsetting cultures, they can be reluctant to talk about the first. The classic and economic theories explaining the demographic transition assume that couples want many children and they make decisions to have a smaller family when some socio-economic change occurs. However, there are numerous anomalies to this explanation. This paper suggests that the societal changes are neither necessary nor sufficient for family size to fall. Many barriers of non-evidence-based restrictive medical rules, cost, misinformation and social traditions exist between women and the fertility regulation methods and correct information they need to manage their family size. When these barriers are reduced, birth rates tend to decline. Many of the barriers reflect a patriarchal desire to control women, which can be largely explained by evolutionary biology. The theoretical explanations of fertility should (i) attach more weight to the many barriers to voluntary fertility regulation, (ii) recognize that a latent desire to control fertility may be far more prevalent among women than previously understood, and (iii) appreciate that women implicitly and rationally make benefit-cost analyses based on the information they have, wanting modern family planning only after they understand it is a safe option. Once it is understood that fertility can be lowered by purely voluntary means, comfort with talking about the population factor in development will rise.

Barriers to fertility regulation: a review of the literature.

The evidence in the demographic and family planning literature of the range and diversity of the barriers to fertility regulation in many developing countries is reviewed in this article from a consumer perspective. Barriers are defined as the constraining factors standing between women and the realistic availability of the technologies and correct information they need in order to decide whether and when to have a child. The barriers include limited method choice, financial costs, the status of women, medical and legal restrictions, provider bias, and misinformation. The presence or absence of barriers to fertility regulation is likely an important determinant of the pace of fertility decline or its delay in many countries. At the same time, barriers inhibit women's ability to avoid unintended pregnancy. Problems of quantifying barriers limit understanding of their importance. New ways to quantify them and to identify misinformation, which is often concealed in survey data, are needed for future research.