[Non-communicable diseases: risk factors and actions for their prevention and control in CubaDoenças não transmissíveis: fatores de risco e ações para sua prevenção e controle em Cuba]

Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study

BACKGROUND

Implementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices.

METHODS

We conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention.

RESULTS

Seventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients -51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73-3.22) in the provider and 2.00 (95% CI, 1.68-2.37) in the provider plus patient intervention arm.

CONCLUSIONS

The intervention's patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.

Perfil del estilo de vida en docentes y administrativos de una universidad pública de Colombia

Objetivo: Determinar los comportamientos del estilo de vida en docentes y administrativos de una universidad pública de Colombia. Materiales y métodos: Investigación cuantitativa descriptiva de corte trasversal. El tamaño de la muestra fue de 178 docentes y administrativos, mediante un muestreo aleatorio simple. Se aplicó un cuestionario auto diligenciado compuesto por una ficha sociodemográfica y el instrumento fantástico, diseñado por el Departamento de Medicina Familiar de la Universidad McMaster de Canadá, ajustado por el investigador Pedro Reyes Gaspar, obteniendo un Alfa de Cronbach, de 0,706, y un coeficiente de Spearman Brown r=0,616 y la correlación dos mitades de Guttman r=0,615. Los datos se trabajaron a través del programa SPSS versión 24, mediante análisis estadístico descriptivo univariado de frecuencias y tablas de contingencia. Resultados: El 40% de la población no es activa físicamente, más de la mitad de los docentes y administrativos aseguran que no ingieren una dieta adecuada, el 26% casi nunca duermen bien y se sienten descansados, el 29% algunas veces duerme bien y descansa. El 50% algunas veces es capaz de hacer frente al estrés en sus vidas y 10% casi nunca puede manejar el estrés. Se identificó riesgo en salud en los docentes en las dimensiones de actividad física, nutrición, sueño y estrés (p.000) en comparación con los administrativos. Conclusiones: Se halló que el perfil de estilo de vida en docentes y administrativos de una universidad pública de Colombia se caracteriza por la inactividad física, una mala alimentación, un mal manejo del estrés y trastornos del sueño.

Corruption and its relation to prevalence and death due to noncommunicable diseases and risk factors: a global perspective

Objective.

To describe the relation between corruption indicators and statistics on noncommunicable diseases and their risk factors by continent.

Methods.

An ecological study was conducted to examine the relation of the GINI coefficient, the Country Policy and Institutional Assessment (CPIA), and the Corruption Perception Index (CPI) with noncommunicable diseases, using the Spearman’s rank correlation test.

Results.

There is a moderate and positive correlation between Corruption Perception Index and cause of death due to noncommunicable diseases and risk factors for these diseases (r = 0.532), prevalence of schizophrenia (r = 0.526), bipolar disorder (r = 0.520), and eating disorders (r = 0.677). There is a moderate negative association between the GINI index and cause of death due to noncommunicable diseases (r = –0.571) and smoking prevalence (r = –0.502), and between the Corruption Perception Index and mortality caused by cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases between the exact ages of 30 and 70 years (r = –0.577) and malnutrition prevalence (r = –0.602).

Conclusions.

This study indicates a correlation between corruption and noncommunicable diseases and their risk factors. This suggests that the high prevalence of noncommunicable diseases and risk factors could be related with political practices that negatively impact the population. Further research should study the weight of these associations, to take action on the way corruption is impacting on the health of societies.

Antioxidants in Plants: A Valorization Potential Emphasizing the Need for the Conservation of Plant Biodiversity in Cuba

Plants are phytochemical hubs containing antioxidants, essential for normal plant functioning and adaptation to environmental cues and delivering beneficial properties for human health. Therefore, knowledge on the antioxidant potential of different plant species and their nutraceutical and pharmaceutical properties is of utmost importance. Exploring this scientific research field provides fundamental clues on (1) plant stress responses and their adaptive evolution to harsh environmental conditions and (2) (new) natural antioxidants with a functional versatility to prevent and treat human pathologies. These natural antioxidants can be valorized via plant-derived foods and products. Cuba contains an enormously rich plant biodiversity harboring a great antioxidant potential. Besides opening new avenues for the implementation of sustainable agroecological practices in crop production, it will also contribute to new strategies to preserve plant biodiversity and simultaneously improve nature management policies in Cuba. This review provides an overview on the beneficial properties of antioxidants for plant protection and human health and is directed to the valorization of these plant antioxidants, emphasizing the need for biodiversity conservation.

Dermatoses of the Caribbean: Burden of skin disease and associated socioeconomic status in the Caribbean

Introduction

Dermatologic disease represents a significant burden worldwide, but the regional effect of skin disease in the Caribbean and how it relates to socioeconomic status remain unknown.

Objective

This study aims to measure the burden of skin disease in the Caribbean from epidemiologic and socioeconomic standpoints.

Methods

We selected Global Burden of Disease Study data sets to analyze disability-adjusted life-years (DALYs) and the annual rate of change of dermatoses between 1990 and 2017 in 18 Caribbean countries and the United States. The principal country-level economic factor used was gross domestic product per capita from the World Bank.

Results

Countries with lower gross domestic product per capita had higher DALYs for dermatology-related infectious diseases, urticaria, asthma, and atopic dermatitis. Countries with higher gross domestic product per capita had higher DALYs of cutaneous neoplasms, contact dermatitis, psoriasis, and pruritus. Several Caribbean countries were among the top worldwide for annual increase in DALYs for melanoma, nonmelanoma skin cancers, bacterial skin disease, and total skin and subcutaneous diseases.

Conclusion

Despite promising ongoing interventions in skin disease, better support is needed in both resource-rich and -poor areas of the Caribbean. DALYs can serve as a purposeful measure for directing resources and care to improve the burden of skin disease in the Caribbean.