Scielo RSS <![CDATA[MEDICC Review]]> http://www.scielosp.org/rss.php?pid=1555-796020150002&lang=pt vol. 17 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[Facing Down Climate Change: Now or Never]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200001&lng=pt&nrm=iso&tlng=pt <![CDATA[About the Contributors]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200002&lng=pt&nrm=iso&tlng=pt <![CDATA[Letters]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200003&lng=pt&nrm=iso&tlng=pt <![CDATA[Approaches to Climate Change & Health in Cuba: Guillermo Mesa MD MPhil, Director, Disasters & Health, National School of Public Health Paulo Ortiz MS PhD, Senior Researcher, Climate Center, Cuban Meteorology Institute]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200004&lng=pt&nrm=iso&tlng=pt The US National Institutes of Health predict climate change will cause an additional 250,000 deaths between 2030 and 2050, with damages to health costing US$2–$4 billion by 2030. Although much debate still surrounds climate change, island ecosystems—such as Cuba’s—in the developing world are arguably among the most vulnerable contexts in which to confront climate variability. Beginning in the 1990s, Cuba launched research to develop the evidence base, set policy priorities, and design mitigation and adaptation actions specifically to address climate change and its effects on health. Two researchers at the forefront of this interdisciplinary, intersectoral effort are epidemiologist Dr Guillermo Mesa, who directed design and implementation of the nationwide strategy for disaster risk reduction in the Cuban public health system as founding director of the Latin American Center for Disaster Medicine (CLAMED) and now heads the Disasters and Health department at the National School of Public Health; and Dr Paulo Ortiz, a biostatistician and economist at the Cuban Meteorology Institute’s Climate Center (CEN-CLIM), who leads the research on Cuba’s Climate and Health project and is advisor on climate change and health for the UN Economic Commission for Latin America and the Caribbean (ECLAC). r. to l. Dr Mesa and Dr Ortiz <![CDATA[Cuba Confronts Climate Change]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200005&lng=pt&nrm=iso&tlng=pt Among environmental problems, climate change presents the greatest challenges to developing countries, especially island nations. Changes in climate and the resulting effects on human health call for examination of the interactions between environmental and social factors. Important in Cuba’s case are soil conditions, food availability, disease burden, ecological changes, extreme weather events, water quality and rising sea levels, all in conjunction with a range of social, cultural, economic and demographic conditions. <![CDATA[Influence of Climate Variability on Acute Myocardial Infarction Mortality in Havana, 2001-2012]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200006&lng=pt&nrm=iso&tlng=pt INTRODUCTION Death from acute myocardial infarction is due to many factors; influences on risk to the individual include habits, lifestyle and behavior, as well as weather, climate and other environmental components. Changing climate patterns make it especially important to understand how climatic variability may influence acute myocardial infarction mortality. OBJECTIVES Describe the relationship between climate variability and acute myocardial infarction mortality during the period 2001–2012 in Havana. METHODS An ecological time-series study was conducted. The universe comprised 23,744 deaths from acute myocardial infarction (ICD-10: I21–I22) in Havana residents from 2001 to 2012. Climate variability and seasonal anomalies were described using the Bultó-1 bioclimatic index (comprising variables of temperature, humidity, precipitation, and atmospheric pressure), along with series analysis to determine different seasonal-to-interannual climate variation signals. The role played by climate variables in acute myocardial infarction mortality was determined using factor analysis. The Mann-Kendall and Pettitt statistical tests were used for trend analysis with a significance level of 5%. RESULTS The strong association between climate variability conditions described using the Bultó-1 bioclimatic index and acute myocardial infarctions accounts for the marked seasonal pattern in AMI mortality. The highest mortality rate occurred during the dry season, i.e., the winter months in Cuba (November–April), with peak numbers in January, December and March. The lowest mortality coincided with the rainy season, i.e., the summer months (May–October). A downward trend in total number of deaths can be seen starting with the change point in April 2009. CONCLUSIONS Climate variability is inversely associated with an increase in acute myocardial infarction mortality as is shown by the Bultó-1 index. This inverse relationship accounts for acute myocardial infarction mortality’s seasonal pattern. <![CDATA[Spatial Models for Prediction and Early Warning of Aedes aegypti Proliferation from Data on Climate Change and Variability in Cuba]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200007&lng=pt&nrm=iso&tlng=pt INTRODUCTION Climate variability, the primary expression of climate change, is one of the most important environmental problems affecting human health, particularly vector-borne diseases. Despite research efforts worldwide, there are few studies addressing the use of information on climate variability for prevention and early warning of vector-borne infectious diseases. OBJECTIVES Show the utility of climate information for vector surveillance by developing spatial models using an entomological indicator and information on predicted climate variability in Cuba to provide early warning of danger of increased risk of dengue transmission. METHODS An ecological study was carried out using retrospective and prospective analyses of time series combined with spatial statistics. Several entomological and climatic indicators were considered using complex Bultó indices -1 and -2. Moran’s I spatial autocorrelation coefficient specified for a matrix of neighbors with a radius of 20 km, was used to identify the spatial structure. Spatial structure simulation was based on simultaneous autoregressive and conditional autore-gressive models; agreement between predicted and observed values for number of Aedes aegypti foci was determined by the concordance index Di and skill factor Bi. RESULTS Spatial and temporal distributions of populations of Aedes aegypti were obtained. Models for describing, simulating and predicting spatial patterns of Aedes aegypti populations associated with climate variability patterns were put forward. The ranges of climate variability affecting Aedes aegypti populations were identified. Forecast maps were generated for the municipal level. CONCLUSIONS Using the Bultó indices of climate variability, it is possible to construct spatial models for predicting increased Aedes aegypti populations in Cuba. At 20 × 20 km resolution, the models are able to provide warning of potential changes in vector populations in rainy and dry seasons and by month, thus demonstrating the usefulness of climate information for epidemiological surveillance. <![CDATA[Use of Home Peritoneal Dialysis by Cuba's Nephrology Institute, 2007-2012]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200008&lng=pt&nrm=iso&tlng=pt INTRODUCTION Peritoneal dialysis is a maintenance therapy option for patients with end-stage renal disease. Continuous ambulatory peritoneal dialysis in Cuba was introduced in December 2007, and automated peritoneal dialysis one year later. This paper presents the outcomes attained with this blood purification technique, enabling an assessment to decide on scaling up its use in Cuba. OBJECTIVES Describe the clinical course of patients in the first five years of the Home Peritoneal Dialysis Program at Havana’s Nephrology Institute. METHODS An observational, descriptive study with a retrospective cohort was conducted. The universe comprised the 40 Nephrology Institute patients who underwent treatment with home peritoneal dialysis from December 20, 2007 to December 20, 2012. Relative and absolute frequencies were calculated for the study variables and the Kaplan-Meier method was used for survival curves for patients and for the peritoneum as dialysis membrane. RESULTS Of the 40 patients in the program, 23 were men and 17 were women, primarily aged 40 to 59 years. The most frequent causes of chronic kidney failure were hypertension (42.5%), glomerulopathies (22.5%), and diabetes mellitus (22.5%). A total of 103 complications occurred, both infectious (68, 66%) and non-infectious (35, 34%). The most common infectious complication was peritonitis (45, 66.2%); the most frequent non-infectious complication was catheter displacement (13, 37.1%). Seven patients left the peritoneal dialysis program. Of these, three died, two lost function of the peritoneum as a dialysis membrane, one received a kidney transplant and one recovered kidney function. Survival was 100% at one year, 97% at 2 years, 93.2% at 3 and 4 years, and 92% at 5 years. However, the peritoneal membrane was functional in 100% of patients during the first 2 years, decreasing to 96% at 3 and 4 years and to 88.6% at 5 years. CONCLUSIONS In our setting, peritoneal dialysis attained outcomes similar to those obtained internationally, which supports its usefulness as a renal replacement therapy method in Cuban patients with endstage renal disease. <![CDATA[Stress-Rest Myocardial Perfusion Scintigraphy and Adverse Cardiac Events in Heart Failure Patients]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200009&lng=pt&nrm=iso&tlng=pt INTRODUCTION Heart failure, primarily in the elderly, is a growing epidemic in today's world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.1/100,000 population. OBJECTIVES Assess the value of stress-rest protocol gated-SPECT for identifying patients with symptomatic heart failure likely to suffer adverse cardiac events. METHODS A study was conducted of 52 patients (mean age 59 years, SD 9; 62% women) with functional capacity II/III (New York Heart Association scale) and left ventricular ejection fraction &lt;40%. Patients were divided into two groups based on coronary heart disease diagnosis: those with coronary heart disease (41), labeled ischemic; and those without (11), labeled nonischemic. All underwent gated SPECT myocardial perfusion scintigraphy with technetium-99m-labeled methoxyisobutyl isonitrile, using a two-day stress–rest protocol, including evaluation of intraventricular synchrony by phase analysis. Patients were followed over 36 months for adverse cardiac effects. RESULTS No significant differences were observed between the two groups during the stress test with regard to exercise time, metabolic equivalents or percentage of maximal heart rate during maximal stress. Summed stress, rest and difference scores, however, were significantly different between the ischemic and nonischemic groups: 16.82 (SD 6.37) vs. 7.54 (SD 5.8), p &lt;0.001; 14.43 (SD 6.28) vs. 6.45 (SD 3.77), p = 0.001; and 2.39 (SD 4.89) vs. 1.09 (SD 3.7), p = 0.034. No differences were found in ventricular function, although stress-minus-rest left ventricular ejection fraction was slightly lower in patients with ischemic heart disease (−1.29, SD 5.8) than in patients without ischemic heart disease (1.27, SD 4.31). Dyssynchrony was greater in patients with ischemic heart disease than in those without, primarily during stress (p &lt;0.01). The only variable that showed a possible association with the occurrence of adverse events was &lt;5 metabolic equivalents on the stress test (p = 0.03), while resting phase SD showed only a tendency toward association (p = 0.05). CONCLUSIONS Information on myocardial perfusion, functional capacity and intraventricular synchrony obtained from stress-rest gated SPECT may help identify patients with symptomatic heart failure who are likely to develop adverse cardiac events, enabling better management of higher-risk cases and improved allocation of resources. <![CDATA[Psychological the Most Common Elder Abuse in a Havana Neighborhood]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200010&lng=pt&nrm=iso&tlng=pt INTRODUCTION Globally, older adults are a population group that often suffers abuse by their caregivers. Along with women and children, they are among those most often reported as victims of abuse of any kind in Cuba. OBJECTIVES Characterize presence of domestic abuse of older adults in family doctor-and-nurse office No. 28 of the Carlos Manuel Portuondo University Polyclinic in Havana, Cuba, determining the main manifestations of abuse and help-seeking behavior by the older adults identified as victims. METHODS This was a descriptive cross-sectional study of adults aged ≥60 years; all those not diagnosed with dementia and who agreed to participate were interviewed. In a universe of 268 older adults, 29 were living outside the area, 24 declined to participate, and 18 had a diagnosis of dementia, leaving a study population of 197 individuals. Variables included: personal experience of abuse, type of abuse, perpetrator, help sought, and reasons for not seeking help. Statistical analysis was based on percentages. RESULTS Of 197 older adults interviewed, 88 (44.7%) reported that they were victims of domestic abuse; 50 of these were women. The most common types of abuse were psychological abuse and disrespect for personal space, reported by 69 (78.4%) and 54 (61.4%) individuals, respectively. Sons- and daughters-in-law were identified as the abusers by 68 participants and grandchildren by 65. Of the 88 victims, 67 (76.1%) stated that they did not seek help. CONCLUSIONS The finding that substantial numbers of older adults are victims of domestic abuse brings to light a hitherto insufficiently addressed issue in the community studied. More research is needed to deepen understanding of the scope and causes of the problem to inform prevention and management strategies, not only at the level of the polyclinic catchment area, but in the health system in general. <![CDATA[Poor Management of Low Birth Weight Compounds Obesity and Chronic Diseases in Cuba]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200011&lng=pt&nrm=iso&tlng=pt The Cuban population exhibits high prevalence of overweight and associated chronic non-communicable diseases, trends that begin in childhood. In addition to factors related to the mother’s health, factors contributing to excess weight gain in Cuban children are: reduced prevalence of exclusive breastfeeding of infants up to six months of age, full-term low birth weight infants and nutritional mismanagement of this group, incorrect complementary feeding, obesogenic diet, family history and sedentary lifestyles. Thus, it is important to adopt comprehensive, multisectoral strategies that promote adequate nutrition and weight control. This is particularly important for full-term low birth weight infants, predisposed to body fat storage. <![CDATA[Cuba-USA: Environmental Protection Knows No Borders]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200012&lng=pt&nrm=iso&tlng=pt The Cuban population exhibits high prevalence of overweight and associated chronic non-communicable diseases, trends that begin in childhood. In addition to factors related to the mother’s health, factors contributing to excess weight gain in Cuban children are: reduced prevalence of exclusive breastfeeding of infants up to six months of age, full-term low birth weight infants and nutritional mismanagement of this group, incorrect complementary feeding, obesogenic diet, family history and sedentary lifestyles. Thus, it is important to adopt comprehensive, multisectoral strategies that promote adequate nutrition and weight control. This is particularly important for full-term low birth weight infants, predisposed to body fat storage. <![CDATA[Climate Change Highlights a Potentially Dangerous Trade-off]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602015000200013&lng=pt&nrm=iso&tlng=pt The Cuban population exhibits high prevalence of overweight and associated chronic non-communicable diseases, trends that begin in childhood. In addition to factors related to the mother’s health, factors contributing to excess weight gain in Cuban children are: reduced prevalence of exclusive breastfeeding of infants up to six months of age, full-term low birth weight infants and nutritional mismanagement of this group, incorrect complementary feeding, obesogenic diet, family history and sedentary lifestyles. Thus, it is important to adopt comprehensive, multisectoral strategies that promote adequate nutrition and weight control. This is particularly important for full-term low birth weight infants, predisposed to body fat storage.