Smoking-attributable mortality in cuba.

Introduction Smoking is the main preventable cause of death worldwide. The World Health Organization estimates that smoking causes 5 million deaths annually, a figure that could double shortly if the present trend in tobacco product consumption continues. Objectives Estimate smoking-attributable mortality in the Cuban population and provide information needed to carry out effective public health actions. Methods This is a descriptive study using smoking prevalence and mortality data in Cuba for 1995 and 2007. Causes of death were grouped in three categories: malignant tumors, cardiovascular diseases and chronic respiratory diseases. Etiological fractions and attributable mortality were calculated by cause and sex. Results Of deaths recorded in 1995 and 2007, 15% and 18% of preventable deaths were attributed to smoking, respectively. In Cuba in 2007, smoking caused 86% of deaths from lung cancer, 78% of deaths from chronic obstructive pulmonary disease, 28% of deaths from ischemic heart disease, and 26% of deaths from cerebrovascular disease. Conclusions Smoking is responsible for high rates of preventable mortality in Cuba. There is willingness on the part of administrative and political authorities to discourage smoking, and more than half of smokers in Cuba wish to quit smoking. Given awareness that reducing smoking is the most effective means of decreasing preventable morbidity and mortality, the country is moving steadily toward concrete, sustainable steps leading to increased life expectancy and quality of life for the Cuban population.

Epidemiology of asthma mortality in cuba and its relation to climate, 1989 to 2003.

Introduction Asthma affects some 300 million people worldwide and causes over 250,000 deaths each year. It is considered a global health problem due to associated high morbidity and mortality rates; disability in inadequately treated patients; years of potential life lost (YPLL); social costs; and impact on the lives of patients, their families and society. Environmental factors, including climatic conditions, are triggers. The 2004 Cuban National Survey on Asthma found a national prevalence of 13% (CI 9.3-16.8). Objective Describe the relationship between climatic factors andasthma mortality in Cuba from 1989 to 2003. Methods Data on deaths from asthma in Cuba were obtained frommedical death certificates. Crude and adjusted mortality rates werecalculated using the 1981 Cuban population as the standard population;the two-parameter exponential smoothing method was used fortrend and prediction analyses, with 95% confidence intervals (CI) forestimating mortality rates by age, sex and YPLL. ArcView softwareversion 3.3 was used to obtain, adjust, and represent models of meteorologicalvariables, and a bioclimatic atlas was included. Results Asthma mortality rates increased in Cuba in the early 90sand then decreased and stabilized in recent years; a rate of 2 per100,000 population was predicted for 2008. For the period understudy, 61% of asthma-related deaths occurred in Cuba's dry wintermonths (November-April). The meteorological variables related to riskof asthma mortality were: atmospheric pressure (997.7-1024.3 hPa),temperature (21.3-24.3oC), number of rainy days in the dry season(15.5-45.2 days), and cloudiness (2.99-5.51%). The provinces withthe highest risk of asthma mortality were: Havana City, Havana, Ciegode Ávila, and Camagüey. Conclusions In Cuba, unfavorable weather conditions in some geographicareas can cause the death of asthmatic patients, althoughthese are not the only factors determining asthma mortality. Theasthma mortality rate is not alarmingly high and is expected to remainstable. Nevertheless, preventive measures must be maintained,particularly for women, who suffer excess mortality from the disease.Implementation of prevention strategies that take into considerationthe seasonal nature of asthma mortality is recommended.

Resultados y experiencias de la vigilancia nacionalde meningitis bacteriana en Cuba / Resultados y experiencias de la vigilancia nacional

Objetivos: Desde 1998 se implementó en Cuba un nuevo sistema de vigilancia nacional de meningitis bacteriana (VNMB) con el objetivo de lograr información en correspondencia con el desarrollo científico actual y las exigencias del programa nacional de prevención y control de estas infecciones. Resultados: Este sistema permitió medir el impacto de la vacuna contra H. influenzae tipo b (Hib) en 1999 sin necesidad de un proyecto y gastos adicionales, demostrando la reducción inmediata de la incidencia (52por ciento). Hasta el 2002 fueron reportados 82 niños < 5 años de los cuales 61(74,4por ciento) no estaban vacunados. Entre los vacunados hubo 14 (66,7por ciento) con una sola dosis aplicada.A partir de esta intervención S. pneumoniae resultó el principal agente causal de meningitis. Los serogrupos/ serotipos más frecuentes han sido 19, 6, 14, 18, 1, 7 y 23, mostrando un 40por ciento de susceptibilidad disminuida a la penicilina. Por primera vez identificamos: - fuerte asociación (RR > 20) de los estudiantes internos de primaria con la enfermedad, - incidencia elevada entre amas de casa (> 2/100 000) y jubilados (> 8/100 000), - fuerte asociación (Razón de disparidad > 20) de la muerte con jubilados y amas de casa en el análisis multivariado. Los resultados microbiológicos posibilitaron la caracterización de agentes y la política antibiótica más adecuada. La letalidad general de la meningitis neumocócica fue > 32 por ciento y fundamentalmente en ancianos. Conclusiones: LaVNMB aportó novedosa información clínico - epidemiológica y microbiológica, permitiendo ampliar el marco integral de los conocimientos y garantizando acciones más efectivas y eficientes en un proyecto multidisciplinario e intersectorial generalizado (AU)