Three public health interventions could prevent 94 million premature deaths

Increasing severity of sleep-disordered breathing and sleep disruption are associated with epigenetic age acceleration, according to preliminary results of a new study.

Results show that each standard deviation increase in the apnea-hypopnea index, a measure of sleep-disordered breathing severity, was associated with the equivalent of 215 days of biological age acceleration. Similarly, each standard deviation increase in the arousal index, a measure of sleep disruption, was associated with the equivalent of 321 days of age acceleration.

"People's biological age might not be the same as their chronological age," said lead author Xiaoyu Li, Sc.D., a postdoctoral research fellow in the Division of Sleep and Circadian Disorders in the Department of Medicine at Brigham and Women's Hospital and the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. "Individuals whose biological age is higher than their chronological age exhibit age acceleration or fast aging. In our study, we found that more severe sleep-disordered breathing is associated with epigenetic age acceleration. Our data provide biological evidence supporting adverse physiological and health effects of untreated sleep-disordered breathing."

Sleep-disordered breathing, such as obstructive sleep apnea, is characterized by abnormalities of respiration during sleep. Episodes often result in reductions in blood oxygen saturation and are usually terminated by brief arousals from sleep. Nearly 30 million adults in the U.S. have obstructive sleep apnea. Common warning signs include snoring and excessive daytime sleepiness.

According to the authors, epigenetic age acceleration is a DNA methylation-based marker of fast biological aging, and it is associated with modifiable lifestyle factors. Although sleep-disordered breathing is associated with multiple age-related health disorders, its relationship with epigenetic aging has not been well studied.

The study involved 622 adults with a mean age of 69 years; 53.2% were women. Participants were measured for blood DNA methylation, and their sleep was evaluated at home by polysomnography. Age acceleration measures were calculated as residuals from the regression of each epigenetic age on chronological age. The association of each sleep-disordered breathing trait with age acceleration was estimated using linear regression, controlling for socio-demographics, health behaviors, body mass index, and study site.

Another surprising finding was that the associations were stronger in women than in men, suggesting that women may be particularly vulnerable to the adverse effects of sleep-disordered breathing.

"While women are often considered to be at lower risk for health outcomes related to sleep-disordered breathing, our findings suggest increased biological susceptibility," said Li.

The authors suggested that future work should study whether treatment reduces epigenetic age acceleration among people who have sleep-disordered breathing.

"Since sleep-disordered breathing is not only common and treatable, but often undiagnosed and under-treated, our data highlight the potential for sleep-disordered breathing treatment to improve age-related chronic conditions and longevity," said Li. "Because epigenetic changes are reversible, epigenetic age estimators may be useful for identifying and validating anti-aging interventions."

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Wednesday, June 12, in San Antonio at SLEEP 2019, the 33rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

The study was supported by funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

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Materials provided by American Academy of Sleep Medicine. Note: Content may be edited for style and length.

Declaration of the Ministry of Public Health of Cuba

The Ministry of Public Health of the Republic of Cuba, committed to the solidarity and humanistic principles that have guided Cuba’s medical cooperation for 55 years, has been participating in the Program More Doctors for Brazil since its inception in August 2013.  This initiative launched by Dilma Rousseff, who was at that moment the president of the Federal Republic of Brazil, pursued the double purpose of guaranteeing medical assistance to the majority of the Brazilian people, following the principle of universal health coverage promoted by the World Health Organization.

The program had planned the inclusion of Brazilian and foreign doctors who would go to work in poor and remote areas of that country.

Cuba’s participation in this program was arranged through the Pan-American Health Organization with one distinctive feature, for it was intended to fill the vacancies left by doctors from Brazil and other foreign nations.

During these five years of work, around 20 000 Cuban cooperation workers have assisted 113 359 000 patients in more than 3 600 municipalities.  They managed to provide health coverage to a universe of up to 60 million Brazilians at the moment when they accounted for 80 per cent of all the doctors who were taking part in the program. More than 700 municipalities were able to count on a doctor for the first time ever.

The work of Cuban doctors in areas of extreme poverty, in the favelas of Rio de Janeiro, Sao Paulo, Salvador de Bahia and the 34 Special Indigenous Districts, particularly in Amazonia, was largely recognized by the federal, state and municipal governments of that country and its population, 95 per cent of which expressed their acceptance, according to a survey carried out by the Federal University of Minas Gerais at the request of the Ministry of Health of Brazil.

On September 27, 2016, the Ministry of Public Health, in an official statement issued on a day close to the expiration date of the agreement and amidst the events associated to the legislative and judicial coup d’ etat against president Dilma Rousseff, announced that Cuba “would continue to honor its agreement with the Pan-American Health Organization for the implementation of the Program More Doctors, provided that the guarantees offered by local authorities were maintained”, something that has been so far respected.

Jair Bolsonaro, president elect of Brazil, who has made direct, contemptuous and threatening comments against the presence of our doctors, has declared and reiterated that he will modify the terms and conditions of the Program More Doctors, in full disregard of the Pan-American Health Organization and the agreement reached by this organization with Cuba, since he has questioned the qualification of our doctors and has conditioned their permanence in the program to a process of validation of their titles and established that contracts will only be signed on an individual basis.

The announced modifications impose conditions that are unacceptable and fail to ensure the guarantees that had been previously agreed upon since the beginning of the Program, which were ratified in 2016 with the re-negotiation of the Terms of Cooperation between The Pan-American Health Organization and the Ministry of Health of Brazil and the Cooperation Agreement between the Pan-American Health Organization and the Ministry of Public Health of Cuba.  These unacceptable conditions make it impossible to maintain the presence of Cuban professionals in the Program.

Consequently, in the light of this unfortunate reality, the Ministry of Public Health of Cuba has decided to discontinue its participation in the Program More Doctors and has informed so to the Director of the Pan-American Health Organization and the political leaders of Brazil who founded and defended this initiative.

The decision to bring into question the dignity, professionalism and altruism of Cuban cooperation workers who, with the support of their families, are currently offering their services in 67 countries is unacceptable. During the last 55 years, a total of 600 000 internationalist missions have been accomplished in 164 nations, with the participation of 400 000 health workers who, in quite a few cases, have fulfilled this honorable task more than once. Their feats in the struggle against the Ebola virus in Africa, blindness in Latin America and the Caribbean and cholera in Haiti as well as the participation of 26 brigades of the International Contingent of Doctors Specialized in Disaster Situations and Great Epidemics “Henry Reeve” in Pakistan, Indonesia, Mexico, Ecuador, Peru, Chile and Venezuela, among other countries, are worthy of praise.

In the overwhelming majority of the missions that have been accomplished, all expenses have been covered by the Cuban government.

Likewise, 35 613 health professionals from 138 countries have been trained in Cuba at absolutely no cost as an expression of our solidarity and internationalist vocation.

All Cuban cooperation workers have preserved their posts and their full salary in Cuba, together with all due labor and social benefits, just as the rest of the workers of the National Health System.

The experience of the Program More Doctors for Brazil and Cuba’s participation in it show that it is indeed possible to structure a South-South Cooperation Program under the auspices of the Pan-American Health Organization in order to promote the achievement of its goals in our region.  The United Nations Development Program and the World Health Organization have described it as the main example of good practices in triangular cooperation and the implementation of the 2030 Agenda and its Sustainable Development Goals.

The peoples from Our America and from all over the world know that they will always be able to count on the solidarity and humanistic vocation of our professionals.

The Brazilian people, who turned the Program More Doctors into a social achievement and, from the very beginning, has trusted Cuban doctors, recognized their virtues and appreciated the respect, sensitivity and professionalism with which they have assisted them, will understand who are to be held responsible for our doctors’ not being able to continue offering their fraternal contribution in that country.

Havana, November 14, 2018.

  • Published in Specials

Cuba Elected as Head of Continental Medical Organization

Cuba was elected by acclamation as president and secretary general of the Alliance of Public Health Associations in the Americas (AASPAL), in the framework of the first International Conference of the sector that concludes today in this capital.

Interviewed by the news agency Prensa Latina, Doctor Alcides Ochoa, elected as president, said this election was acknowledgment to the contribution and collaboration by the Caribbean country in this field, in personnel training and stating the need to create an organization as AASPAL.

About this historic alliance, the secretary general, Doctor Juan Manuel Diego Cobelo, asserted that apart from the ideological diversity and the different governmental systems, Latin America achieved an unprecedented unity, motivated by progress of public health for its people.

Ochoa highlighted the role played by the American Public Health Association, with traditional friendship with its Cuban counterpart, for Cuba to occupy this post, adding the support from the Pan-American Health Organization, among others.

He explained that this support answered to the respect from members of that association for the Cuban health system.

The executive committee is also composed of Mexico, Puerto Rico, Brazil, Colombia and Panama.

  • Published in Now

South Africa Highlights Cuba Collaboration in Public Health

South Africa lacks about 20,000 health specialists in the public sector, shortage it tries to counteract through the contribution of the medical cooperation program with Cuba.

An article in the Sowetan newspaper quoted Professor Yusuf Veriava, from the ministerial committee of academic review of medical collaboration Nelson Mandela-Fidel Castro, who explained that through the agreement 'are sent South Africans to Cuba for medical training'.

And in turn -he emphasized- 'Cuban doctors counterparts' travel to the African nation to serve in the public sector.

Veriava, former head of Internal Medicine at the University of Witwatersrand (Johannesburg), asserted that 80 percent of all specialists in South Africa are concentrated in the private area of the provinces of Western Cape and Gauteng.

The Health Department spokesman, Joe Maila Health, told the same source that at least 508 South African graduates trained in Cuba are working in this moment in the national territory.

In addition, "we have 2,967 youngsters studying at this moment 'in the Caribbean nation.

This cooperation program, born on the initiative of the leaders Nelson Mandela and Fidel Castro celebrates its 20thanniversary in 2016.

It was on February 27, 1996 that the first group of doctors reached the South African soil to work, specially in rural areas.

At present there are 460 Cuban collaborators in South Africa, of which 276 are health professionals.

  • Published in Cuba

Miami-Health: Its "Secret" World

A New Herald journalist wrote a suggestive articulate entitled "The Dark Paths of Medicine in Miami."

It appeared this weekend, signed by Rui Ferreira and it approached the existence of a dark environment in medicine in that town.

Ferreira begins his writing speaking about a clinic where several patients make line.

The line disappears and a bit later a long wait begins for those gathered there.

The first condition is to be examined by a doctor or a nurse that will have them take the mandatory assays.

Rui Ferreira writes that they would spend hours talking about how they arrived in the United States escaping from a miserable life “so perhaps later they would face an even worse future."

In such circumstance they found out to have the same characteristic, they are people without medical insurance or illegal immigrants.

The article also mentions a large amount of needed moving in the underground world of Miami and who, like every human being, also get sick.

  

It mentions the case of a Honduran woman, Mariana: "I have no choice. My employer doesn't pay us medical insurance. I work half time and my back hurts a lot."

It added that she visits that sanitary institution because their prices are cheaper.

Ferreira says that their owners take into account a low-revenue clientele forced to pay for the service.

It also notifies that the first visit costs 40 dollars, the second and third 25 and so forth.

The journalist from the Herald informs that the realization of several clinical analyses at once is more than 100 dollars.

What about the places for people who have medical insurance? It could be trice higher.

Rui Ferreira manifested that next to that underground industry there’s another one, the drug stores selling medications without prescription.

One of the main causes of everything exposed about what happens involving this issue in Miami?

The high price of health insurance imposed many to their inhabitants when the effects of economic crisis jump to the eye.

Statistics show that 21% of them don't have medical insurance, as well the fact that nobody knows how many of them are illegal and have no documents.

That’s how life goes by, for many, in the so called City of Sun.

  • Published in Now

Cuban Doctor: First and Foremost Love the Profession

The greatest satisfaction for a doctor in Cuba is not watching many people suffer like one sees suffering in some places. In all these missions there’s great suffering, seeing people without solutions

Julio Cardenal is a through and through Cuban, like cut down by the book of stereotypes: mulatto, funny, outgoing, great people, he likes sharing, even better among friends. All of this when it’s not a work day or has any activity with Communist Party to which he belongs proudly even though he is retired. "I am from the breed of Maceo" he says everywhere and he is a doctor, internationalist to complete the perfect description of Cubans who make great the everyday life on this island.

Where does the calling for medicine and pediatrics specifically come from?

"I think I was interested since I was a boy, and I was operating lizards since I was six. Pediatrician because children are unique... in my childhood in the poor Havana neighborhood where I lived I witnessed a lot of tragedy with children, there was no solution for children like there is today, many kids polishing shoes, sick, working and unable to work problems out, as I grew I went to the clinic and met a pediatrician, I saw him take care with so love, and devotion that I thought this is what I want, help children heal, I'll become a pediatrician. "

What led you to Matanzas?

"I fell in love and married a girl from Matanzas, Edda, doctor also, besides she was a student leader and I was sent to head the hospital of Colon, I worked in the department of gastroenterology there, head of Perico, and I got entangled in Matanzas and I stayed here".

After that came many other responsibilities, among them running for a rough time the pediatric hospital of that city and several internationalist missions.

What motivated the unconditional availability?

"I was a Fidel follower since I was a kid, since always, and wherever Fidel sent I went. I harvested coffee in Oriente province; I participated in the literacy campaign, many things. Among the many tasks I performed was taking leaderships in very difficult moments of the country and accomplishing missions regardless the place in year 1976, for example, I left for Yemen with barely twenty-odds. I think this availability depends on each person’s personal love, the love to the country, the profession, it’s not just talk, it's real, that's how I see it, you can’t leave the territory where you were born and who gave you everything you are for money or out of a whim. "

What’s the greatest satisfaction for a Cuban Doctor?

"The greatest satisfaction for a doctor in Cuba is not to see suffering so many people, in all those missions I suffer a lot watching people without solutions, where governments can’t afford or do not have the possibility of giving enough to solve the problem to the people, that's really shocking, what you see, what you feel, I have photos of children in countries I have been, they are very strong. Cuban doctors have saved many of those kids, that's priceless. Not seeing that here is the greatest satisfaction for a Cuban doctor. "

Have you ever thought of retiring from your profession? Not even in the worst moments of this country?

"Never. The first thing is the calling, most processes of people leaving their jobs is not because of economic reasons but by lack of calling, because they find easier and new paths, they don’t put their soul and feeling that takes to be a doctor. Those should have never been doctors, they didn’t have vocation of doctors, but as waiters or artisans and I don’t blame them. Everyone has in their heads what they believe, but they should have never begun med school, because it’s a waste of time for them and an economic loss for the country that trains an individual that when it is almost ripe shifts to a more profitable activity. That is related with their political, ideological, but also human formation, because the doctor is the representation of humanity, our job is to save lives, is the most human vocation, it’s very nice to build a bridge, a building and very necessary but it’s essential to take care of the human beings and that is true since the tribal healers.

Many justify the abuse or indifference that we sometimes regret at health institutions with the economic limitations suffered by the professionals of the field. How do you see?

"No, that is unjustifiable, is lack of professionalism, dishonesty to yourself. How often we go to work with a thousand problems in our heads, without transport, walking to the hospital, walk in the early morning in the neighborhood, where people know me and love me, because in the time of harsh economic crisis I had lunch at some house and someone else gave me a sandwich, we went through more difficult times than these, no salary raise, for example, and I say nothing justifies the mistreatment to people, regardless if the food is bad, which at some other times it has been worse than now. Most importantly, I repeat, is to have a calling, a sense of what is being a doctor and human being, there some who have great knowledge of medicine, but is a savage; he has no reasoning and heart. Those are the ones who mistreat patients, abandon the ER and when you look deep into it for the reasons why this happen you realize that doing things massively has helped us to help many people, but also hurt us. "

You have taught for most of your 40 years of service and you said you enjoy a lot. Why?

"I had to pay what my teachers did for me. I love teaching is one of the things I still do whenever I can, or need, to deliver a lecture, a conference ... •

What piece of advice would you give to young doctors?

"Choose well what specialty you’ll do, because there are some who got it wrong and later they are mad about quitting everything, because I have patients whom I treated and their children. This is a life profession when you are at a pediatric room and hear the screaming of children, the cries or see little children suffering and you know you have to be there, be patient, be polite and stay there because that's your job, you need a lot of love for the profession. The main thing is to love the profession you chose, and give yourself fully to it, because it’s about saving lives, the life of your neighbor, your family, your neighbor's life ...”

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