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PubMed1985

[Use of sugar cane harvest residues in cattle fattening in the Republic of Cuba. 1. The physical and chemical composition of the residues and the effect of NaOH treatment on their in vitro and in vivo digestibility].

The harvesting remains of sugar cane (crowns, leaves, sheaths, parts of stalks), which are rich in crude fibre, were investigated. The content of crude nutrients, their digestibility and the energy concentration of the harvesting remains largely correspond to the values of cereal straw. After the treatment with growing amounts of NaOH (0, 4, 6, 8, 10 g/ 100 g DM) a significantly increasing digestibility of the dry matter (31.9, 47.0, 56.1, 61.9, 67.6%) was ascertained in in-vitro experiments. In digestibility experiments with wethers an increased digestibility of the dry matter from 36.6 to 57.6% and of the energy from 39.3 to 56.2% after the treatment with 4 g NaOH/100 g DM could be ascertained in comparison with untreated harvesting remains. Energy concentration increased from 324 to 445 EFU cattle/kg DM and thus approached that of the hay of Bermuda grass (Cynodon dactylon), one of the most important fodder grasses of Cuba. After the feeding of harvesting remains treated with NaOH significant changes in the water and mineral metabolism could be ascertained.

Animal Feed↗

PubMed2005

Ethnicity, education, and blood pressure in Cuba.

The causes of variation in hypertension risk by ethnicity and educational level are not well understood. To gain further insight into this issue in a nonindustrialized country, a population-based sample of 1,667 persons aged 15-74 years was recruited in Cienfuegos, Cuba. In this 2001-2002 study, interviewers classified 29% of participants as Black or mulatto and 71% as White. Educational attainment was stratified at the median number of school years. Compared with White women, non-White women had higher blood pressures (3.0/1.7, systolic blood pressure/diastolic blood pressure) and a higher prevalence of hypertension (24%, 95% confidence interval: 20, 28 vs. 15%, 95% confidence interval: 12, 18). Among men, no differences in blood pressure were observed by ethnicity. Men with a lower level of education had a 14% lower risk of hypertension compared with men above the median. However, women with a lower level of education had a 24% increase in risk. The effect of education was equally strong among Whites alone and when occupation was used for stratification. No variation was observed for body mass index or self-reported health behaviors by ethnicity or education. The narrower ethnic gradient in hypertension prevalence than seen in North America and the gender-specific social status effect, in the context of relatively equal living conditions, suggest that the influence of psychosocial stressors may be specific to cultural contexts.

Adolescent↗

PubMed1993

Family practice in Cuba: evolution into the 1990s.

A group of practising physicians, family practice academicians and medical students visited Cuba in 1991. The purpose of this visit was to assess the current status of the discipline of family medicine in the country. Numerous interviews were conducted with practising family physicians, Cuban medical physicians in other medical specialties, the medical school faculty, patients and officials from the Ministry of Public Health. A summary of the content of these interviews constitutes the following paper. The authors conclude that the Cubans have developed a medical care system that has its basis in family practice, and provides a model which could be emulated not only in less developed, but also in more developed countries.

Cause of Death↗

PubMed2003

Change in health risk perception following community intervention in Central Havana, Cuba.

It is increasingly recognized that individual values, beliefs and behavior operate within a social context. There is growing consensus that local perceptions and indigenous knowledge should be important elements in the evaluation of programs aimed at improving health. Thus, an assessment of changes in health risk perception was included in the evaluation of a multi-component intervention project undertaken between 1996 and 1999 aimed at improving the health and well-being of residents in the inner city community of Cayo Hueso, in Centro Habana, Cuba. The community intervention involved a tremendous mobilization of government and non-governmental organizations, to promote social and cultural activities and address deficiencies in housing, water supply, waste disposal and street illumination. Prior to the interventions, 365 adults were surveyed regarding their perceived health risks regarding 41 health determinants, scored on four-point Likert scales ranging from 'without risk' to 'very risky'. A factor analysis of these data classified perception of risk into five areas: social environment, threats to personal health, lifestyle choices, environmental sanitation and housing conditions. The objective of the current analysis was to determine if there were changes in the level of perceived risk to health over the 5 years pre- versus post-intervention in Cayo Hueso, and if so, whether these changes were significantly different from changes seen during the same 5-year period in Colón, another community in Centro Habana not receiving focused interventions. During the first quarter of 2001, 1703 individuals living in 654 households in Cayo Hueso and Colón were interviewed in their homes using an enhanced version of the 1996 risk perception instrument. Ordinal logistic regression models, adjusted for age, gender and years of education, were fit to assess change in health risk perception between 1996 and 2001. Significant declines in perceived health risk were found in both Cayo Hueso and Colón within all five domains, with significantly greater declines in many areas in Cayo Hueso compared with Colón, particularly with respect to housing-related health risks, indeed the main target of the intervention. Risk perception surveys are useful characterizations of widely held views in a target population. Our findings of decreased perceived health risk following public health, physical and social interventions to improve health suggests that this line of inquiry merits consideration in planning evaluations of multi-sectoral community-based health promotion interventions.

Adult↗

PubMed2001

Persistence of vaccine-derived poliovirus following a mass vaccination campaign in Cuba: implications for stopping polio vaccination after global eradication.

BACKGROUND: With substantial progress made toward polio eradication, developing the appropriate strategy for discontinuing global oral poliovirus vaccine (OPV) after global eradication becomes increasingly important. At issue is the theoretical risk of independent circulation of potentially virulent OPV-derived strains. Because Cuba uses OPV only in mass campaigns, it represents an ideal site to assess vaccine-derived poliovirus persistence. METHODS: Infants born after the 1997 biannual mass campaigns were evaluated for past (neutralizing antibody) or current (virus excretion) evidence of vaccine-derived poliovirus exposure. We obtained sera and/or stool specimens from 861 infants; a second serum from 218 infants. RESULTS: All stool specimens were poliovirus negative. Of 762 infants, 113 (14.8%) had initially detectable poliovirus type 1 antibody, 193 (25.3%) type 2, and 94 (12.3%) type 3. A precipitous antibody decline occurred in initially positive sera. CONCLUSIONS: Our results suggest that in a country with high population immunity, vaccine-derived virus is unlikely to establish ongoing circulation.

Cuba↗

PubMed2003

Poliovirus detection in wastewater and stools following an immunization campaign in Havana, Cuba.

BACKGROUND: Recent outbreaks of poliomyelitis caused by vaccine-derived virus have raised concerns that vaccine-derived poliovirus may continue to circulate after eradication. In these outbreaks, the virus appears to have replicated for > or =2 years before detection. Early detection is critical for an effective response to these outbreaks. Although acute flaccid paralysis (AFP) surveillance will remain the standard for poliovirus detection, wastewater sampling could be a useful supplement. In this study, we evaluated the sensitivity of wastewater sampling by concurrently collecting stools from children aged < 3 years attending two neighbourhood clinics in Havana, Cuba, and wastewater from the same neighbourhoods. METHODS: Sample collection was begun during the third week after the national immunization campaign, continued weekly through the seventh week, and was repeated during weeks 15 and 19. Virus detection and titration were performed using both cell culture and polymerase chain reaction techniques. RESULTS: Wastewater sampling was found to be at least as sensitive as stool sampling under these conditions. Poliovirus was isolated from children through week 7, suggesting that viral shedding reached undetectable levels between weeks 8 and 14. The last virus-positive wastewater sample was collected during week 15. CONCLUSIONS: Wastewater sampling under the conditions studied can be a sensitive supplement to AFP surveillance. Similar studies under different conditions are needed to determine the role of wastewater sampling in post-eradication surveillance.

Child, Preschool↗

PubMed2004

Sexual behaviour, history of sexually transmitted diseases, and the risk of prostate cancer: a case-control study in Cuba.

BACKGROUND: The relationship between the risk of prostate cancer and sexual activity and history of sexually transmitted diseases was investigated in a case-control study conducted in Cuba aimed at assessing the effect of lifestyle and environmental factors, as well as hormonal and genetic factors, on the occurrence of this disease. METHODS: During the period 1998-2000, all men up to 84 yr old with newly diagnosed, cytologically and/or histologically confirmed prostatic cancer who were resident in Havana City were identified in nine major hospitals in the area. Controls were resident in the same city, frequency-matched by age (+/-5 years) and hospital. The study included 273 cases and 254 controls. Information was obtained through an interview. RESULTS: The risk of prostate cancer was increased among men with a history of venereal disease (odds ratio = 1.7, 95% CI = 1.1-2.5). A higher frequency of cases reported having had sex with prostitutes, although the estimate of relative risk did not reach statistical significance. Similarly, a nonsignificant positive association was found with the number of female sexual partners. A significant increased risk was observed in subjects who reported having sexual intercourse more than 7 times per week compared with those who reported a weekly frequency of 3 times or fewer (odds ratio = 2.1, 95% CI = 1.2-3.7). Moreover, a significant trend was demonstrated. CONCLUSIONS: The study supports the hypothesis that an infectious factor related to sexual behaviour could be involved in the occurrence of prostate cancer. A role for hormonal factors related to sexual activity cannot be ruled out.

Aged↗

PubMed1997

Reduction of mosquito larval densities in natural sites after introduction of Romanomermis culicivorax (Nematoda:Mermithidae) in Cuba.

Romanomermis culicivorax Ross & Smith became established in 4 of 6 treated sites and produced high levels of infection in Anopheles albimanus Wiedemann, Culex atratus Theobald, Psorophora confinnis Lynch-Arribálzaga, and Uranotaenia sapphirina Oster-Sacken mosquitoes for 9 wk in 1993. Mean levels of southern house mosquito parasitism ranged from 82 to 83% for Culex quinquefasciatus Say, at 2 sites, from 89 to 95% for An. albimanus at 4 sites, and from 78 to 80% at 2 sites for Cx. atratus, Ps. confinnis, and Un. sapphirina. Results indicated that R. culicivorax has potential use as biological control agent against mosquitoes in several different habitats in Cuba.

Animals↗

PubMed1997

Cross-resistance to pyrethroid and organophosphorus insecticides in the southern house mosquito (Diptera:Culicidae) from Cuba.

A sample of the southern house mosquito, Culex pipiens quinquefasciatus Say, from Cuba was subjected to lambda-cyhalothrin selection to evaluate the usefulness of this pyrethroid insecticide for mosquito control. High resistance developed after 6 generations of selection. Little or no cross-resistance was observed to other pyrethroids (deltamethrin and cypermethrin), to a carbamate (propoxur) and to some organophosphates (chlorpyrifos and pirimiphos-methyl), but high cross-resistance was found to malathion (organophosphate). Possible resistance mechanisms responsible for this phenomenon are discussed.

Animals↗

PubMed2004

Natural radioactivity in some building materials in Cuba and their contribution to the indoor gamma dose rate.

The natural radioactivity of some building materials commonly used in Cuba was measured by gamma spectrometry. Typical concentrations encountered so far encountered are in the ranges: 47-2511 Bq kg(-1) for (40)K; 9-71 Bq kg(-1) for (226)Ra; and 2-38 Bq kg(-1) for (232)Th. The external gamma ray absorbed doses in indoor air and the corresponding effective dose-equivalents in a typical dwelling are presented in this paper.

Air Pollution, Indoor↗

PubMed2006

Population effective collective dose from nuclear medicine examination in Cuba.

In an attempt to estimate the effective collective dose imparted to the population of Camagüey-Ciego de Avila territory, Cuba, we have made use of the statistics from nuclear medicine examinations given to a population of 1.1 million inhabitants for the years 1995-1999. The average annual frequency of examinations was estimated to be 3.82 per 1000 population. The results show that nuclear medicine techniques of thyroid imaging with 43.73% and thyroid uptake with 43.36% are the main techniques implicated in the relative contribution to the total annual effective collective dose, which averaged 54.43 man Sv for the studied period. Radiation risks for the Camagüey-Ciego de Avila population caused by nuclear medicine examinations in the period studied were calculated: the total number of fatal and non-fatal cancers was 16.33 and the number of serious hereditary disturbance was 3.54 as a result of 21,073 nuclear medicine procedures, corresponding to a total detriment of one case per thousand examinations.

Body Burden↗

PubMed2005

'Candidatus Phytoplasma graminis' and 'Candidatus Phytoplasma caricae', two novel phytoplasmas associated with diseases of sugarcane, weeds and papaya in Cuba.

During 2003, surveys of sugarcane yellow leaf disease and papaya bunchy top-like disease were carried out on plantations in Havana province, Cuba, to determine the roles of weeds and Auchenorrhyncha insects in the epidemiology of these diseases. More than 250 plant and insect samples were collected and indexed by using a nested PCR for phytoplasma 16S rDNA with the generic primer pairs P1/P7 and R16F2n/R16R2. The PCR products were further characterized by restriction fragment length polymorphism using HaeIII, AluI, Sau3AI, Tru9I, HhaI, HpaII and TaqI endonucleases, giving patterns that distinguished them from those of the other reference phytoplasmas analysed. Phylogenetic analysis of 16S rRNA gene sequences identified the phytoplasmas present in sugarcane (Saccharum officinarum L.), Cynodon dactylon L., Conyza canadensis L. Cronq., Sorghum halepense L. Pers., Macroptilium lathyroides L. Urb., Saccharosydne saccharivora (Westwood) and Cedusa spp., and those in papaya (Carica papaya L.) and Empoasca papayae, as two novel provisional phytoplasma species. We propose that these phytoplasmas should be given Candidatus status, as 'Candidatus Phytoplasma graminis' and 'Candidatus Phytoplasma caricae', respectively.

Base Sequence↗

PubMed1991

Malathion and pyrethroid resistance in Culex quinquefasciatus from Cuba: efficacy of pirimiphos-methyl in the presence of at least three resistance mechanisms.

Use of malathion for mosquito control in Cuba for 7 years up to 1986 has selected for elevated non-specific esterase and altered acetylcholinesterase (AChE) resistance mechanisms in populations of the pest mosquito Culex quinquefasciatus Say. These mechanisms are still present in relatively high frequencies in the Havana area, despite the replacement of malathion by pyrethroid insecticides for the last 3 years in the mosquito control programme. Samples of Culex quinquefasciatus populations from within a 100 km radius of Havana had high levels of resistance to malathion and lower levels of resistance to propoxur, but there was little or no cross-resistance to the organophosphorus insecticide pirimiphos-methyl. Selection with malathion for twenty-two consecutive generations in the laboratory increased the level of malathion resistance to 1208-fold and propoxur level to 1002-fold, but the maximum level of pirimiphos-methyl resistance was only 11-fold. Pirimiphos-methyl is still operationally effective, despite the resistance mechanisms segregating, so this insecticide if used for control is unlikely to select either of the known resistance factors directly in the field population. Since 1986, pyrethroids have been used extensively, and low levels of pyrethroid resistance were detected in two of five field population samples tested. Malathion selection did not increase the level of pyrethroid resistance, which indicates that one or more distinct pyrethroid resistance factors are now being selected in the field populations of Culex quinquefasciatus.

Aerosols↗

PubMed1993

Changes in malathion and pyrethroid resistance after cypermethrin selection of Culex quinquefasciatus field populations of Cuba.

Use of the organophosphorus insecticide malathion for mosquito control in Cuba, for 7 years up to 1986, selected elevated non-specific esterase and altered acetylcholinesterase (AChE) resistance mechanisms in Culex quinquefasciatus. In central Havana space-spraying of malathion was replaced by the pyrethroid cypermethrin in 1987: alternate cycles of malathion and cypermethrin were applied in some of the more rural areas of Havana district during 1987-91. Consequently, populations of Cx quinquefasciatus in the central area of Havana developed resistance to cypermethrin, but there is no evidence of pyrethroid resistance in the outlying areas. Malathion resistance levels declined significantly after 1986, measured both by bioassay and the frequency of the elevated esterase resistance mechanism, and then stabilized with no measurable decline during 1990 in any of the populations tested. These populations had less than 10% frequency of susceptible homozygotes for both the esterase and AChE resistance mechanisms, indicating that organophosphate resistance is still prevalent in Cuban Cx quinquefasciatus. These two mechanisms appear to be in linkage equilibrium, suggesting that current selection for double resistance is not strong. In the central Havana region, pirimiphos-methyl, an organophosphorus insecticide unaffected by the two common malathion resistance mechanisms, is now being used in a resistance management strategy designed to avoid pyrethroid resistance spreading.

Animals↗

PubMed2005

Intersectoral coordination in Aedes aegypti control. A pilot project in Havana City, Cuba.

UNLABELLED: Background The 55th World Health Assembly declared dengue prevention and control a priority and urged Member States to develop sustainable intersectoral strategies to this end. To provide evidence for the reorientation of the dengue prevention policy in Cuba, we launched an intervention study to document the effectiveness of a local-level intersectoral approach. METHODS: We used a quasi-experimental design. Social scientists introduced participatory methods to facilitate dialogue in the biweekly meetings of the intersectoral Health Council of the intervention area. This council subsequently developed an intersectoral plan for dengue prevention, of which the core objective was to design and implement activities for communication and social mobilization. In the control area, routine dengue control activities continued without additional input. Knowledge, attitudes and perceptions of dengue, and entomological indices were compared inside and between the areas before and after the 1-year intervention period. RESULTS: In the intervention area the Health Council elaborated an intersectoral plan for dengue prevention focused on source reduction. The Aedes aegypti control methods consisted in eliminating useless containers in the houses and surroundings, covering tanks, and cleaning public and inhabited areas. It was implemented through communication and social mobilization. The Health Council in the control area occasionally discussed dengue issues but did not develop a coordinated action plan. Good knowledge about breeding sites and disease symptoms increased significantly (by 49.7% and 17.1% respectively) in the intervention area as well as the proportion of respondents eliminating containers in and around their houses (by 44%). No changes were observed in the control area. The House Index in the intervention area was 3.72% at baseline and decreased to 0.61% after 1 year. In the control area it remained stable throughout the study period (1.31% and 1.65% respectively). CONCLUSION: The introduction of a participatory approach by social scientists promotes changes in intersectoral management. This facilitates social mobilization which, in its turn, leads to significant changes in knowledge, attitudes and dengue-related practices in the population and eventually to more effective control of Ae. aegypti.

Aedes↗

PubMed2006

Colombia and Cuba, contrasting models in Latin America's health sector reform.

Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far-reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful--and radical--example of 'market-oriented' health care reform, and Cuba, which followed a highly 'conservative' path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign--especially North American--corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.

Colombia↗

PubMed2005

Strategies for national health care systems and centers in the emerging world: Central America and the Caribbean--the case of Cuba.

Over 40% of the 76 million people in Central America and the Caribbean live in poverty with no safety net. Communicable and noncommunicable diseases significantly impact morbidity and mortality, and a tendency toward aging suggests increasing prevalence of chronic conditions. Among factors related to renal diseases: obesity is an epidemic among the near-poor; prevalence of diabetes mellitus is 6% to 8%; and hypertension is 8% to 30%. The region's racial-ethnic composition--associated with depressed socioeconomic conditions--is comparable to US minorities showing greater chronic renal disease (CRD) rates than those registered in Central America and the Caribbean, which suggests that this region may be among the world's most seriously affected by CRD. This is a reality masked by lack of health care coverage. Health policies generally have not prioritized human resource development, and training is biased toward curative care instead of prevention. Nephrologists are less than 20 per million population in most countries. Health care infrastructures are poor, lacking the primary care facilities charged with prevention. Cuba shares economic limitations with its neighbors but is one of the region's least socially stratified countries, with a universal, free, and public health care system emphasizing primary health care and prevention. Human resource development has resulted in 59.6 physicians per 10,000 inhabitants and a family physician program covering the whole population. A national renal diseases program incorporates preventive strategies at all care levels. Nevertheless, early detection of patients with CRD remains a challenge in the Cuban context. In Central America and the Caribbean, prevention is the key to reducing medical, social, and economic costs of renal disease.

Aged↗

PubMed1983

Prevalence of oral leukoplakia in Havana City, Cuba.

A survey related to the detection of precancerous lesions of the oral cavity has been done in Cuba for the first time. The sample comprised 749 randomly selected workers from Havana City Province, taking into account the census records of the Cuban population up to 1979. Prevalence of lesions and their relation to age, sex and predisposing factors, such as smoking, alcohol habits and mechanical trauma were studied. 4.4% of leukoplakia and preleukoplakia considered together and 2.1% leukoplakia alone, and two cases of oral lichen planus and leukokeratosis nicotina palati (0.1% of each) were found. The former lesions were more frequently encountered in people above 50 years old, specially in males and specifically among those who had smoked for more than 10 years. Sites of location most frequently encountered were the buccal mucosa and the labial commissures.

Adult↗