objetivo del trabajo fue identificar relaciones entre contaminantes atmosféricos, variables meteo... more objetivo del trabajo fue identificar relaciones entre contaminantes atmosféricos, variables meteorológicas y consultas de urgencia por asma y enfermedades respiratorias agudas. Durante el período Octubre 1996-Septiembre 1997 se determinaron las medias diarias de dióxido de azufre (SO 2), dióxido de nitrógeno (NO 2), humo y partículas en suspensión menores de 10 µm (PM 10) en la estación de monitoreo de contaminantes atmosféricos del municipio Centro Habana, y las consultas de urgencia por crisis agudas de asma bronquial (CAAB) y enfermedades respiratorias agudas (ERA) en niños y adultos en 2 hospitales del territorio. Se calcularon las correlaciones lineales múltiples entre las medias diarias de las variables meteorológicas seleccionadas, las concentraciones de contaminantes registradas el propio día (sincrónicas) y en el anterior, y las consultas por CAAB y por ERA, en niños y en adultos. Las concentraciones de SO 2 , N0 2 y humo resultaron inferiores a las permisibles por la norma sanitaria cubana; las de PM 10 alcanzaron niveles riesgosos (media anual 61,2 µg/m 3). Fueron observadas relaciones inversas entre los valores sincrónicos de la temperatura y la fuerza del viento y las concentraciones de humo, PM 10 y NO 2 ; así como entre la temperatura y las consultas por CAAB en niños y ERA en adultos; relaciones directas entre las concentraciones de humo y CAAB en niños y ERA en adultos, en tanto que las PM 10 mostraron correlaciones directas con las CAAB y con las ERA, tanto en niños como en adultos. No se observaron relaciones entre las atenciones por estas causas y las concentraciones de contaminantes del día anterior. Al exceso de la media anual de PM 10 con respecto a 50 µg/m 3 se le atribuyó el 2,17 % de las consultas por estas causas.
1. The HIPPOPOC table identifies Inputs, Processes, Outputs, and Impacts; 2. The dynamic model ma... more 1. The HIPPOPOC table identifies Inputs, Processes, Outputs, and Impacts; 2. The dynamic model makes explicit the rationale for the set of activities proposed and how they come together in the proposed outcome, and:
Journal of investigational allergology & clinical immunology, 2013
To determine which common risk factors, including environmental factors, are predictors for the d... more To determine which common risk factors, including environmental factors, are predictors for the development of asthma in Cuban schoolchildren. A longitudinal study was conducted in 1042 schoolchildren without asthma at baseline in 2 Cuban municipalities. Asthma status in 2007, diagnosed using the International Study of Asthma and Allergies in Childhood questionnaire, was related to a set of common risk factors assessed in 2003/2004 in a multivariable logistic regression model. Multiple imputation was used for missing values. The final prediction model was obtained by backward selection (P<.15). The model's prognostic accuracy (R2) and discriminative ability (area under the receiver operating characteristic curve [AUC]) were assessed and internal validation by bootstrapping was performed. A family history of atopic diseases (odds ratio [OR], 2.19; 95% CI, 1.19-4.04), allergic sensitization (OR, 1.83; 95% CI, 0.94-3.55), municipality (OR, 0.34; 95% CI, 0.15-0.74), and use of an...
Background Describing the prevalence and trends of cardiometabolic risk factors that are associat... more Background Describing the prevalence and trends of cardiometabolic risk factors that are associated with noncommunicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014. Methods We did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7•0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas. Findings 389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3•9% (95% CI 2•2-6•3) in 1980, to 18•6% (14•3-23•3) in 2014, in men; and from 12•2% (8•2-17•0) in 1980, to 30•5% (25•7-35•5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5•2% (2•1-10•4) in men and 6•4% (2•6-10•4) in women in 1980, to 11•1% (6•4-17•3) in men and 13•6% (8•2-21•0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27•6% (22•3-33•2) in men and 19•9% (15•8-24•4) in women in 1980, to 15•5% (11•1-20•9) in men and 10•7% (7•7-14•5) in women in 2014. Interpretation Despite the generally high prevalence of cardiometabolic risk factors across the Americas, estimates also showed a high level of heterogeneity in the transition between countries. The increasing prevalence of obesity and diabetes observed over time requires appropriate measures to deal with these public health challenges. Our results support a diversification of health interventions across subregions and countries. Funding Wellcome Trust.
Introduction Smoking is the main preventable cause of death worldwide. The World Health Organizat... more 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.
Objective: To build a national Cuban capacity for training environmental health professionals dir... more Objective: To build a national Cuban capacity for training environmental health professionals directly linked to the needs of policy-makers and communities.
International Journal of Occupational and Environmental Health, 2000
Perceptions of health risks were surveyed in the inner city of Centro Habana, Cuba. A questionnai... more Perceptions of health risks were surveyed in the inner city of Centro Habana, Cuba. A questionnaire developed by community leaders and experts was administered to 348 residents to determine the level of perceived risk for each of 41 risk items. Ecologic-level data on morbidity, mortality, and environmental indicators were also gathered. Using factor analysis to reduce the dimensionality of the data, five factor groupings accounted for 60% of the variance, as follows: social environment (40.8%); infectious agents and other health-risk factors of immediate concern (6.1%); lifestyle risks (4. 9%); environmental sanitation (4.1%); and living conditions (3.3%). A relationship between the perception of risk and the ecologic data was found, with inconsistencies largely attributable to factors known to influence risk perception. The greatest concern identified throughout the municipality was housing conditions, highest in the neighborhood that had already begun to address this problem. The analysis was useful in planning targeted health promotion campaigns and prioritizing further interventions. Repeat evaluation of risk perception will be conducted following the completion of interventions.
International journal of occupational and environmental health
The ecosystem approach to human health was applied to guide an evaluation of the effectiveness of... more The ecosystem approach to human health was applied to guide an evaluation of the effectiveness of a multi-component intervention to improve quality of life and health in an inner-city Havana community. A pre- versus post-intervention analysis was carried out in the study community of Cayo Hueso, and Colon, a concurrent comparison community. A household survey of 1,703 individuals was conducted in 30 neighborhoods, equally divided between the two areas. Greater improvements in housing, local infrastructure, and exposure to risk were perceived to have occurred in the targeted community, more so from the perspective of benefit to the community rather than with regard to the residents' own households. Improvements in some lifestyle-related risk factors and self-rated health in the most vulnerable subgroups (elderly and adolescents) were also achieved. Overall, the Cayo Hueso Plan was considered highly successful in improving the quality of life amid difficult circumstances. Its less...
International journal of occupational and environmental health
The authors developed and evaluated a comprehensive participatory ecosystem health approach for p... more The authors developed and evaluated a comprehensive participatory ecosystem health approach for preventing the transmission of dengue, the most prevalent vector-borne disease in Cuba and the Latin America-Caribbean region. The integrated surveillance system central to this initiative encompassed three main subsystems (environmental; entomological; clinical-epidemiologic), relying on extensive community involvement. The study was conducted in Central Havana, Cuba. Indicators from each subsystem were selected and mapped using a GIS procedure providing instant visualization by city block in the municipality. To elucidate the factors affecting control and prevention efforts, perceived needs and risks, as well as knowledge, attitudes, and behaviors related to dengue, were assessed. Specific factors associated with the presence of mosquito breeding sites and risks of dengue were examined in a case-control study.
objetivo del trabajo fue identificar relaciones entre contaminantes atmosféricos, variables meteo... more objetivo del trabajo fue identificar relaciones entre contaminantes atmosféricos, variables meteorológicas y consultas de urgencia por asma y enfermedades respiratorias agudas. Durante el período Octubre 1996-Septiembre 1997 se determinaron las medias diarias de dióxido de azufre (SO 2), dióxido de nitrógeno (NO 2), humo y partículas en suspensión menores de 10 µm (PM 10) en la estación de monitoreo de contaminantes atmosféricos del municipio Centro Habana, y las consultas de urgencia por crisis agudas de asma bronquial (CAAB) y enfermedades respiratorias agudas (ERA) en niños y adultos en 2 hospitales del territorio. Se calcularon las correlaciones lineales múltiples entre las medias diarias de las variables meteorológicas seleccionadas, las concentraciones de contaminantes registradas el propio día (sincrónicas) y en el anterior, y las consultas por CAAB y por ERA, en niños y en adultos. Las concentraciones de SO 2 , N0 2 y humo resultaron inferiores a las permisibles por la norma sanitaria cubana; las de PM 10 alcanzaron niveles riesgosos (media anual 61,2 µg/m 3). Fueron observadas relaciones inversas entre los valores sincrónicos de la temperatura y la fuerza del viento y las concentraciones de humo, PM 10 y NO 2 ; así como entre la temperatura y las consultas por CAAB en niños y ERA en adultos; relaciones directas entre las concentraciones de humo y CAAB en niños y ERA en adultos, en tanto que las PM 10 mostraron correlaciones directas con las CAAB y con las ERA, tanto en niños como en adultos. No se observaron relaciones entre las atenciones por estas causas y las concentraciones de contaminantes del día anterior. Al exceso de la media anual de PM 10 con respecto a 50 µg/m 3 se le atribuyó el 2,17 % de las consultas por estas causas.
1. The HIPPOPOC table identifies Inputs, Processes, Outputs, and Impacts; 2. The dynamic model ma... more 1. The HIPPOPOC table identifies Inputs, Processes, Outputs, and Impacts; 2. The dynamic model makes explicit the rationale for the set of activities proposed and how they come together in the proposed outcome, and:
Journal of investigational allergology & clinical immunology, 2013
To determine which common risk factors, including environmental factors, are predictors for the d... more To determine which common risk factors, including environmental factors, are predictors for the development of asthma in Cuban schoolchildren. A longitudinal study was conducted in 1042 schoolchildren without asthma at baseline in 2 Cuban municipalities. Asthma status in 2007, diagnosed using the International Study of Asthma and Allergies in Childhood questionnaire, was related to a set of common risk factors assessed in 2003/2004 in a multivariable logistic regression model. Multiple imputation was used for missing values. The final prediction model was obtained by backward selection (P<.15). The model's prognostic accuracy (R2) and discriminative ability (area under the receiver operating characteristic curve [AUC]) were assessed and internal validation by bootstrapping was performed. A family history of atopic diseases (odds ratio [OR], 2.19; 95% CI, 1.19-4.04), allergic sensitization (OR, 1.83; 95% CI, 0.94-3.55), municipality (OR, 0.34; 95% CI, 0.15-0.74), and use of an...
Background Describing the prevalence and trends of cardiometabolic risk factors that are associat... more Background Describing the prevalence and trends of cardiometabolic risk factors that are associated with noncommunicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014. Methods We did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7•0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas. Findings 389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3•9% (95% CI 2•2-6•3) in 1980, to 18•6% (14•3-23•3) in 2014, in men; and from 12•2% (8•2-17•0) in 1980, to 30•5% (25•7-35•5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5•2% (2•1-10•4) in men and 6•4% (2•6-10•4) in women in 1980, to 11•1% (6•4-17•3) in men and 13•6% (8•2-21•0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27•6% (22•3-33•2) in men and 19•9% (15•8-24•4) in women in 1980, to 15•5% (11•1-20•9) in men and 10•7% (7•7-14•5) in women in 2014. Interpretation Despite the generally high prevalence of cardiometabolic risk factors across the Americas, estimates also showed a high level of heterogeneity in the transition between countries. The increasing prevalence of obesity and diabetes observed over time requires appropriate measures to deal with these public health challenges. Our results support a diversification of health interventions across subregions and countries. Funding Wellcome Trust.
Introduction Smoking is the main preventable cause of death worldwide. The World Health Organizat... more 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.
Objective: To build a national Cuban capacity for training environmental health professionals dir... more Objective: To build a national Cuban capacity for training environmental health professionals directly linked to the needs of policy-makers and communities.
International Journal of Occupational and Environmental Health, 2000
Perceptions of health risks were surveyed in the inner city of Centro Habana, Cuba. A questionnai... more Perceptions of health risks were surveyed in the inner city of Centro Habana, Cuba. A questionnaire developed by community leaders and experts was administered to 348 residents to determine the level of perceived risk for each of 41 risk items. Ecologic-level data on morbidity, mortality, and environmental indicators were also gathered. Using factor analysis to reduce the dimensionality of the data, five factor groupings accounted for 60% of the variance, as follows: social environment (40.8%); infectious agents and other health-risk factors of immediate concern (6.1%); lifestyle risks (4. 9%); environmental sanitation (4.1%); and living conditions (3.3%). A relationship between the perception of risk and the ecologic data was found, with inconsistencies largely attributable to factors known to influence risk perception. The greatest concern identified throughout the municipality was housing conditions, highest in the neighborhood that had already begun to address this problem. The analysis was useful in planning targeted health promotion campaigns and prioritizing further interventions. Repeat evaluation of risk perception will be conducted following the completion of interventions.
International journal of occupational and environmental health
The ecosystem approach to human health was applied to guide an evaluation of the effectiveness of... more The ecosystem approach to human health was applied to guide an evaluation of the effectiveness of a multi-component intervention to improve quality of life and health in an inner-city Havana community. A pre- versus post-intervention analysis was carried out in the study community of Cayo Hueso, and Colon, a concurrent comparison community. A household survey of 1,703 individuals was conducted in 30 neighborhoods, equally divided between the two areas. Greater improvements in housing, local infrastructure, and exposure to risk were perceived to have occurred in the targeted community, more so from the perspective of benefit to the community rather than with regard to the residents' own households. Improvements in some lifestyle-related risk factors and self-rated health in the most vulnerable subgroups (elderly and adolescents) were also achieved. Overall, the Cayo Hueso Plan was considered highly successful in improving the quality of life amid difficult circumstances. Its less...
International journal of occupational and environmental health
The authors developed and evaluated a comprehensive participatory ecosystem health approach for p... more The authors developed and evaluated a comprehensive participatory ecosystem health approach for preventing the transmission of dengue, the most prevalent vector-borne disease in Cuba and the Latin America-Caribbean region. The integrated surveillance system central to this initiative encompassed three main subsystems (environmental; entomological; clinical-epidemiologic), relying on extensive community involvement. The study was conducted in Central Havana, Cuba. Indicators from each subsystem were selected and mapped using a GIS procedure providing instant visualization by city block in the municipality. To elucidate the factors affecting control and prevention efforts, perceived needs and risks, as well as knowledge, attitudes, and behaviors related to dengue, were assessed. Specific factors associated with the presence of mosquito breeding sites and risks of dengue were examined in a case-control study.
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Papers by Mariano Bonet