1.  Peer Reviewed Title: The persistence of induced abortion in Cuba: exploring the notion of an "abortion culture". Author: Belanger D; Flynn A Source: Studies in Family Planning. 2009 Mar;40(1):13-26. Abstract: Cuba's annual induced abortion rate persistently ranks among the highest in the world, and abortion plays a prominent role in Cuban fertility regulation despite widespread contraceptive prevalence and state promotion of modern contraceptives. We explore this phenomenon using the concept of an "abortion culture," typically used in reference to Soviet and post-Soviet countries. We synthesize existing literature to provide a historical account of abortion and contraception in Cuba. We also provide a qualitative analysis of abortion and contraceptive use based on in-depth interviews conducted in 2005 in Havana with 24 women who have had an abortion and 10 men whose partners have had an abortion. Information gained from a focus-group discussion with medical professionals also informed the study. Our four principal findings are: (a) longstanding awareness of abortion, (b) the view of abortion as a personal decision, (c) the influence of economic constraints on the decision to induce an abortion, and (d) general skepticism toward contraceptives. We discuss our results on abortion in Cuba in relation to the notion of social diffusion, an approach commonly used to explain the spread of fertility control throughout a population. Language: English Keywords: CUBA | RESEARCH REPORT | KAP SURVEYS | FOCUS GROUPS | WOMEN IN DEVELOPMENT | MEN | ABORTION RATE | CULTURE | COMMUNISM | PERCEPTION | ATTITUDES | KNOWLEDGE | MICROECONOMIC FACTORS | DECISION MAKING | CONTRACEPTIVE USAGE | Caribbean | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Economic Development | Economic Factors | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Sociocultural Factors | Socialism | Political Systems | Political Factors | Psychological Factors | Behavior | Contraception Document Number: 341079 |
| 2. Peer Reviewed Title: The persistence of induced abortion in Cuba: exploring the notion of an "abortion culture". Author: Belanger D; Flynn A Source: Studies In Family Planning. 2009 Mar;40(1):13-26. Abstract: Cuba's annual induced abortion rate persistently ranks among the highest in the world, and abortion plays a prominent role in Cuban fertility regulation despite widespread contraceptive prevalence and state promotion of modern contraceptives. We explore this phenomenon using the concept of an "abortion culture," typically used in reference to Soviet and post-Soviet countries. We synthesize existing literature to provide a historical account of abortion and contraception in Cuba. We also provide a qualitative analysis of abortion and contraceptive use based on in-depth interviews conducted in 2005 in Havana with 24 women who have had an abortion and 10 men whose partners have had an abortion. Information gained from a focus-group discussion with medical professionals also informed the study. Our four principal findings are: (a) longstanding awareness of abortion, (b) the view of abortion as a personal decision, (c) the influence of economic constraints on the decision to induce an abortion, and (d) general skepticism toward contraceptives. We discuss our results on abortion in Cuba in relation to the notion of social diffusion, an approach commonly used to explain the spread of fertility control throughout a population. Language: English Keywords: CUBA | RESEARCH REPORT | ABORTION RATE | CULTURE | CONTRACEPTION | AWARENESS | Caribbean | Americas | Developing Countries | Fertility Control, Postconception | Family Planning | Sociocultural Factors | Knowledge Document Number: 341339 |
| 3. Title: Can we reduce the number of low-birth-weight babies? The Cuban experience. Author: Lopez NB; Choonara I Source: Neonatology. 2009;95(3):193-7. Abstract: Low-birth-weight (LBW) infants have a significantly greater mortality than other babies, not only within the neonatal period but also in infancy and early childhood. Babies are LBW either because they are preterm or they have experienced intrauterine growth retardation. Reducing the prevalence of LBW babies is important in reducing child and infant mortality. Risk factors for prematurity and intrauterine growth retardation are well established. Socioeconomic conditions and nutrition during pregnancy are two key factors. Interventions to reduce the prevalence of LBW infants in developed countries have usually been unsuccessful. A few studies in developing countries have, however, achieved positive results. Cuba has managed to reduce the prevalence of LBW infants and their model of healthcare in relation to achieving this is described. Key features of the Cuban healthcare system are that it is both free and universal, and additionally there is a strong emphasis on primary healthcare. It is likely that a similar approach in both developing countries and disadvantaged communities in developed countries would reduce the prevalence of LBW babies. This would have a major impact in relation to reducing infant mortality rates. Language: English Keywords: CUBA | RESEARCH REPORT | LOW BIRTH WEIGHT | PREMATURE BIRTH | INTRAUTERINE GROWTH RETARDATION | MORTALITY | PREVENTION AND CONTROL | Caribbean | Americas | Developing Countries | Birth Weight | Body Weight | Physiology | Biology | Pregnancy Outcomes | Pregnancy | Reproduction | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Diseases | Population Dynamics | Demographic Factors | Population Document Number: 341366 |
| 4. Peer Reviewed Title: Misoprostol preferable to ethacridine lactate for abortions at 13-20 weeks of pregnancy: Cuban experience. Author: Boza AV; de Leon RG; Castillo LS; Marino DR; Mitchell EM Source: Reproductive Health Matters. 2008 May;16(31 Suppl):189-95. Abstract: Outdated second trimester abortion methods are still being used in some countries, and very few studies have compared them to currently recommended methods. To this end, we studied the efficacy and safety of vaginal misoprostol used alone for abortions in 189 women at 13-20 weeks gestation, in 2004-2006. We also retrospectively collated similar data from an historical cohort of 189 women drawn consecutively and chronologically from hospital records from 2003-2006, also at 13-20 weeks gestation, who had had abortions with a combination of extra-amniotic 0.1% ethacridine lactate solution, oxytocin and sharp curettage. At 24 hours, misoprostol was 92.6% effective in inducing abortion versus 76.2% with the ethacridine lactate regimen (OR 4.2, 95% CI 2.3-8.0). The misoprostol cohort experienced fewer complications than the ethacridine cohort (4 vs. 38 cases, OR 0.086, 95% CI 0.03-0.23). We conclude that in the absence of mifepristone, misoprostol alone is preferable to the ethacridine regimen for the termination of pregnancy in the second trimester, because it works faster, has a higher success rate in a shorter period of time, and fewer complications. Language: English Keywords: CUBA | RESEARCH REPORT | PREGNANCY, SECOND TRIMESTER | ABORTION | MISOPROSTOL | SAFETY | CONTRACEPTIVE METHOD ACCEPTABILITY | Developing Countries | Caribbean | Americas | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Public Health | Health | Contraceptive Usage | Contraception Document Number: 330091 Notification |
| 5. Peer Reviewed Title: Second-trimester pregnancy termination with 600-microg vs. 400-microg vaginal misoprostol and systematic curettage postexpulsion: a randomized trial. Author: Carbonell JL; Torres MA; Reyes R; Ortega L; Garcia-Gallego; Sanchez C Source: Contraception. 2008 Jan;77(1):50-55. Abstract: This study was conducted to compare efficacy and safety of 600 mcg of misoprostol vaginally every 6 h up to four doses vs. 400 mcg of misoprostol vaginally every 4 h up to five doses, followed by systematic curettage of the uterine cavity, for pregnancy termination between 12 and 20 weeks' gestation. We used a randomized clinical trial conducted at Hospital Gineco-Obstetrico "Eusebio Hernandez", Havana, Cuba. Subjects were women requesting voluntary termination of pregnancies between 12 and 20 weeks' gestation. Two hundred ten women were randomly assigned to receive 600 mcg of vaginal misoprostol every 6 h up to four doses (Group I) vs. 400 mcg of vaginal misoprostol every 4 h up to five doses (Group II), followed by curettage 1 h after expulsion. The main outcomes measured were successful abortion rate and mean expulsion time. Successful abortion occurred in 103/105 women (98.1%) in Group I and in 99/105 (94.3%) in Group II [p=.279, relative risk (RR)=3.121 and 95% confidence interval for RR=0.615 to 15.833]. Fetus mean expulsion time was 10.7+or-1.3 (SD) h in Group I and 11.5+or-5.0 (SD) h in Group II (p=.209). Six hundred micrograms of misoprostol administered vaginally every 6 h was as effective as 400 mcg of misoprostol every 4 h for second-trimester pregnancy termination. (author's) Language: English Keywords: SPAIN | CUBA | RESEARCH REPORT | CLINICAL TRIALS | PREGNANT WOMEN | PREGNANCY, SECOND TRIMESTER | MISOPROSTOL | CURETTAGE | ADMINISTRATION AND DOSAGE | Europe, Southwestern | Europe | Developed Countries | Developing Countries | Caribbean | Americas | Clinical Research | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs Document Number: 323059 |
| 6. Title: [Change in the survival of Cuban AIDS patients with tuberculosis in the Highly Active Antiretroviral Therapy (HAART) era] Cambios en la supervivencia de enfermos con SIDA y tuberculosis en Cuba en la era Author: Reyes-Corcho A; Capo de Paz V; Diaz-Jidy M; Perez-Avila J; Bouza-Jimenez Y Source: Investigacion Clinica. 2008 Sep;49(3):309-20. Abstract: HIV infection affected 0.06% of the Cuban population and AIDS associated tuberculosis (TB) represented 4.4% of cases in 2004. The objective of this study was to determine the survival of AIDS patients with TB. 167 individuals of both sexes and ages between 15 and 60 years old were studied; all of them were diagnosed in the Havana's Tropical Medicine Institute "Pedro Kouri", Cuba, between January 1st 1997 and May 31st 2005. The Kaplan-Meier's method and the Long-rank test were used for the survival, and the Cox's multivariate method to identify the variables associated with mortality by means of SPSS 9.0. 78 individuals of the total died at the end of study, 71.8% belonged to the pre highly active antiretroviral therapy (HAART) era and 28.2% to the later period. From all deceased cases due to TB, 82.1% were diagnosed in the pre HAART era. The median survival was 41 months (CI=20-62). TB diagnosis in the pre HAART period, TB not being the first disease indicator of AIDS, suffering from candidiasis of esophagus before TB and a LTCD4+ count < 200 at the diagnosis of TB, were all independently associated with mortality. This study demonstrated the positive impact of HAART in the survival of Cuban AIDS patients with TB and also identified advanced immunodepression and opportunistic infections as predictors of mortality. Language: Spanish Keywords: CUBA | RESEARCH REPORT | MULTIVARIATE ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | CANDIDIASIS | MORTALITY | Developing Countries | Caribbean | Americas | Data Analysis | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | HIV | Bacterial and Fungal Diseases | Population Dynamics | Demographic Factors | Population Document Number: 330117 |
| 7. Title: Health promotion: Is it health empowerment? Lessons learnt from Cuba. Author: Bertizzolo F Source: [Unpublished] [2007]. 7 p. Abstract: From 2002 to 2006 the Italian Non Governmental Organisation (NGO) GVC implemented a STDs and HIV/AIDS project in Central Cuba (Provinces of Sancti Spiritus and Santa Clara). Health promotion activities were especially focused on men having sex with men (MSM). The present work aims at analysing the project, labelled as a health promotion activity by the implementing NGO, using the theoretical model of empowerment by Keith Tones. The structure followed in the analysis will include: 1) a description of the political and social environment where the project is run, with major challenges to health promotion activities; 2) a critical review of the empowerment model by Tones; 3) using the framework provided by Tones, the work will evaluate the main actions implemented: is a "true" empowerment action? (excerpt) Language: English Keywords: CUBA | EVALUATION REPORT | PERSONS LIVING WITH HIV/AIDS | NONGOVERNMENTAL ORGANIZATIONS | MEN HAVING SEX WITH MEN | SEXUALLY TRANSMITTED DISEASE PREVENTION | HIV PREVENTION | CAMPAIGNS | STIGMA | CULTURE | HEALTH EDUCATION | HEALTH POLICY | Developing Countries | Caribbean | Americas | Evaluation | HIV Infections | Viral Diseases | Diseases | Organizations | Political Factors | Sociocultural Factors | Sex Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Communication Programs | Communication | Social Problems | Education | Policy Document Number: 325176 |
| 8. Peer Reviewed Title: Sexuality, reproduction, and HIV in women: The impact of antiretroviral therapy in elective pregnancies in Cuba. Author: Castro A; Khawja Y; Gonzalez-Nunez I Source: AIDS. 2007 Oct;21 Suppl 5:S49-S54. Abstract: Since HIV was first diagnosed in Cuba in 1985 to the end of 2006, 246 HIV-positive women have given birth to 266 children; of these, more than half were born after 2001, when antiretroviral therapy (ART) became widely available in Cuba. The objective of the study was to explore how the provision of ART free at point of delivery to all clinically indicated patients might be related to the rapid increase in pregnancies in HIV-positive women. A qualitative instrument was designed to assess how reproductive and sexual histories were affected by a diagnosis of HIV and by the availability of ART. Methods: Data were collected from 55 women, representing 26% of HIV-positive women who are known to have given birth in Cuba. A structured interview was used to collect qualitative information on women's reproductive and sexual histories. Sixty-four per cent of women interviewed reported becoming pregnant aware of their HIV status or that of their partner; of these, all except one became pregnant after ART became widely available in Cuba. The majority said their worries about transmitting HIV subsided after talking to doctors, obtaining information on mother-to-child transmission, learning they could receive ART and deliver by Cesarean section to reduce the risk of vertical transmission significantly, and meeting HIV-positive women who had HIV-negative children. The introduction of effective therapy for HIV, by transforming the social and clinical course of HIV/AIDS and allowing the possibility of having HIV-negative children, contributes to decrease HIV/AIDS-related fear and stigma and reshape reproduction. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | QUALITATIVE RESEARCH | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | SEXUALITY | REPRODUCTIVE BEHAVIOR | ANTIRETROVIRAL THERAPY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | RISK REDUCTION BEHAVIOR | ABORTION | DECISION MAKING | Developing Countries | Caribbean | Americas | Research Methodology | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Personality | Psychological Factors | Behavior | Fertility | Population Dynamics | HIV | Disease Transmission Control | Prevention and Control | Fertility Control, Postconception | Family Planning Document Number: 321757 Notification |
| 9. Peer Reviewed Title: Emergency contraception in Cuba with 10 mg of mifepristone. Author: Esteve JL; Garcia R; Breto A; Llorente M Source: European Journal of Contraception and Reproductive Health Care. 2007 Jun;12(2):162-167. Abstract: Mifepristone in a dose of 10 mg is an effective emergency contraceptive when administered up to 120 hours after unprotected coitus. Between May 2003 and February 2005, we conducted in Cuba a single-arm trial to evaluate the effectiveness of 10 mg mifepristone for emergency contraception up to 6 days after unprotected coitus. A total of 635 women who requested emergency contraception after a single act of unprotected intercourse were included in the study. After treatment there were 7/635 (1.1%) pregnancies (95% CI 0.4-2.3%). Pregnancy that might have occurred was prevented in 88.0% of the cases (95% CI 77.1-95.1%). The most common side effects reported by participants were fatigue (10.7%), dizziness (6.1%) and nausea (4.9%); vomiting was only reported by 0.6%. In 38/635 (6.0%) women menstruation was delayed more than 7 days. Mifepristone 10 mg administered is an effective emergency contraceptive with an acceptable profile of side effects up to five days, but greater studies are necessary to verifyits efficacy up to 6 days after unprotected intercourse. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | FAMILY PLANNING ACCEPTORS | EMERGENCY CONTRACEPTION | RU-486 | ADMINISTRATION AND DOSAGE | SIDE EFFECTS | Developing Countries | Caribbean | Americas | Clinical Research | Research Methodology | Demographic Factors | Population | Family Planning Programs | Family Planning | Contraception | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 317565 |
| 10. Title: Progress towards tuberculosis elimination in Cuba. Author: Gonzalez E; Armas L; Llanes MJ Source: International Journal of Tuberculosis and Lung Disease. 2007 Apr;11(4):405-411. Abstract: The Cuban National Tuberculosis Control Programme (NTCP) was implemented in 1962, and has included directly observed treatment since 1971 and DOTS since 1982. The objective was to assess the short-term trends of major indicators of tuberculosis (TB) elimination. A surveillance system has been created on treatment and case finding. Data from the National TB Registry of the Ministry of Public Health were reviewed. The incidence of TB declined from 1965 to 1991 from 65.0 to 4.7 per 100 000 population, then reversed in the period 1992-1994. The implementation of a re-intervention package recovered the increase from 1995 to 1998. From 1999 to 2003, 97.5% of TB suspects identified underwent sputum smear microscopy. The incidence rate declined from 10.0 to 7.2/100 000. In 2003 the case detection rate was 92.2%; the overall TB cure rate was 92% and TB human immunodeficiency virus (HIV) co-infection was 3%. Two of Cuba's 15 provinces reached incidence rates of < 5/100 000, eliminating TB as a public healthproblem. Low incidence, high detection and cure rates, along with low rates of TB-HIV co-infection, are evidence of progress towards the elimination of TB as a public health problem in Cuba, using DOTS in a context of good socio-cultural and technological interaction. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | INCIDENCE | TUBERCULOSIS | DIRECTLY OBSERVED THERAPY SHORT-COURSE (DOTS) | SCREENING | COMMUNICABLE DISEASE CONTROL | Developing Countries | Caribbean | Americas | Measurement | Research Methodology | Infections | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses Document Number: 320038 |
| 11. Title: Cuban intervention in South African health care service provision. Author: Hammett D Source: Journal of Southern African Studies. 2007 Mar;33(1):63-81. Abstract: This article considers the reasons for, and implications of, Cuban development assistance being provided to the South African health care system. The provision of skilled Cuban doctors to South Africa has been a feature of post-apartheid health care services. Under a series of bilateral agreements, over 450 Cuban doctors have taken placements in South Africa and over 250 South African medical students have undergone training in Cuba. The economic, political and symbolic incentives for this co-operation for both parties are considered against the costs incurred. Drawing upon historical links between the ANC and the Communist government in Cuba, this agreement provides both states with much-needed resources. It is shown that whilst short- to medium-term benefits outweigh the costs to both parties, questions remain over its sustainability. South Africa is drawing upon Cuban expertise in health care services to mitigate its shortage of health care staff whilst providing financial and symbolic capital to an anti-apartheid ally. In the long term, concerns exist over the sustainability of this agreement in a post-Castro Cuba, as well as restrictions on families accompanying doctors traveling to South Africa, and recent rulings over the possibility for Cuban doctors to remain in South Africa beyond their initial contract. (author's) Language: English Keywords: SOUTH AFRICA | CUBA | SUMMARY REPORT | PHYSICIANS | BRAIN DRAIN | PRIMARY HEALTH CARE | HEALTH SERVICES | INTERNATIONAL MIGRATION | COMMUNISM | INTERVENTIONS | GOVERNMENT PROGRAMS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Caribbean | Americas | Health Personnel | Delivery of Health Care | Health | Migration | Population Dynamics | Demographic Factors | Population | Socialism | Political Systems | Political Factors | Sociocultural Factors | Programs | Organization and Administration Document Number: 317108 |
| 12. Title: Vitamin A status in Cuban children aged 6 -- 11 years. Author: Macias-Matos C; Pita-Rodriguez G; Monterrey-Gutierrez P; Reboso-Perez J Source: Public Health Nutrition. 2007;11(1):95-101. Abstract: A nationwide study was performed in Cuba to assess vitamin A status and the intake of vitamin-A-providing foods in children aged 6-11 years. The sample comprised 1191 schoolchildren from first to sixth grade, both sexes, from municipalities randomly selected from the five eastern provinces of Cuba in 2002 (first semester) and from the four western and four central provinces in 2003 (first semester). A food-frequency questionnaire was completed by 2038 mother-and-child pairs. Mean (+or- standard deviation) plasma retinol concentrations were 1.77 +or- 0.48micromol l/-1 in the western, 2.01 +or- 0.56 micromol l/-1 in the central and 1.40 +or- 0.41micromol l/-1 in the eastern region. No child had plasma retinol concentration below 0.35mmol l/-1, indicative of a high risk of clinical deficiency. Subclinical deficiency, plasma retinol concentration of 0.35-0.7 micromol l/-1, was seen in < 2% of subjects in all three regions and was < 5% even in the two provinces with the worst vitamin A status (Guantanamo, 4.6%; Las Tunas, 3.0%). Adequate status (> 1.05 micromol l/-1) was present in > 90% of subjects in all western and central provinces, and in one of the eastern provinces (Holguin), whereas in the four remaining eastern provinces, adequate status was present in > 75%. Only nine fruits and vegetables were consumed frequently (> 3 times per week) by > 50% of children. Thirty-seven per cent regularly consumed a supplement containing vitamin A. Most Cuban children aged 6-11 years had adequate vitamin A status. Consumption of foods rich in vitamin and provitamin A, especially vegetables, was frequent but limited to a small variety of foods. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | QUESTIONNAIRES | CHILD | PRIMARY SCHOOLS | VITAMIN A | RISK FACTORS | DEFICIENCY DISEASES | DIET | FOOD SUPPLEMENTATION | Developing Countries | Caribbean | Americas | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Schools | Education | Vitamins and Minerals | Physiology | Biology | Nutrition Disorders | Diseases | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care Document Number: 323537 |
| 13. Title: "Obvious gays" and the state gaze: Cuban gay visibility and U.S. immigration policy during the 1980 Mariel boatlift. Author: Pena S Source: Journal of the History of Sexuality. 2007 Sep;16(3):482-514. Abstract: During the cold war relations between the United States and Cuba were tense. Because of this political acrimony, Cubans as a group had been accorded preferential treatment for their symbolic value as people fleeing communism. However, in the same era homosexuals were formally and categorically excluded by U.S. immigration policy. Even as Armando and other gay-identified Mariel Cubans were traveling by boat to the United States, the country of their destination was recodifying a long-standing immigration policy that explicitly excluded homosexuals. Because of its massive scale, the Mariel migration also posed procedural challenges to any systematic identification of immigrant characteristics. Finally, given the national media attention focused on the boatlift, the identification of homosexuals posed a public relations dilemma for the U.S. government. These complications are clearly seen when focusing on the ways in which homosexual Cuban men entering the United States were seen and not seen by the U.S. state gaze. During the boatlift conflicting immigration policies and procedures clashed as men who were both Cuban and visibly gay entered the country under the glare of the media spotlight. (excerpt) Language: English Keywords: CUBA | UNITED STATES OF AMERICA | HISTORICAL REVIEW | CASE STUDIES | HOMOSEXUALS | REFUGEES | MIGRATION POLICY | INTERNATIONAL MIGRATION | SEXUALITY | SETTLEMENT AND RESETTLEMENT | Developing Countries | Caribbean | Americas | Developed Countries | North America | Studies | Research Methodology | Sex Behavior | Behavior | Migrants | Migration | Population Dynamics | Demographic Factors | Population | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors | Personality | Psychological Factors Document Number: 323720 |
| 14. Peer Reviewed Title: Genotypic resistance to antiretroviral drugs in patients infected with several HIV type 1 genetic forms in Cuba. Author: Perez L; Alvarez LP; Carmona R; Aragones C; Delgado E Source: AIDS Research and Human Retroviruses. 2007 Mar;23(3):407-414. Abstract: The main objective of this study is to evaluate the prevalence of resistance-associated mutations to reverse transcriptase (RT) and protease (PR) inhibitors (I) 2 years after the introduction of antiretroviral treatment in Cuba, analyzing the mutations corresponding to different HIV-1 genetic forms circulating in Cuba. A total of 425 plasma samples were collected in 2003, corresponding to 175 (41.2%) subtype B and 250 (58.8%) non-B genetic forms, including 56 (22.4 %) non-B subtypes, 112 (44.8%) circulating recombinant forms (CRFs), and 82 (32.8%) unique RFs (URFs). Of these, 175 (41.2%) patients were under highly active antirretroviral therapy (HAART) and 250 (58.8%) were treatment-naive. The presence of RT and PR resistance-associated mutations was established by sequencing. Levels of resistance were evaluated according to the Stanford Database program (http://hivdb.stanford.edu). The prevalence of resistance to RTI was 52.2% among RTI-treated patients, 51.5% for subtype B, and 53.2% for non-B genetic forms, including CRF18_cpx, CRF19_cpx, subtype C, and BG URF. In treatment-naive patients it was 6.4% in subtype B and 4.2% in non-B subtypes and RFs. The prevalence of resistance to PRI was 30% among PRI-treated patients, 28% in subtype B and 31% in non-B genetic forms, and 3.2% among treatment-naive subjects, mostly BG recombinants. In conclusion, significant differences in the prevalence of resistance to RTI and PRI were not detected among the most frequent genetic forms from treated patients, suggesting that the genetic diversity of HIV-1 in Cuba does not play a main role in the development of resistance to antiretroviral drugs. The presence of transmitted resistance mutations supports the study of resistance at baseline of treatment. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | GENETICS | LABORATORY PROCEDURES | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | PREVALENCE | Developing Countries | Caribbean | Americas | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Measurement | Research Methodology Document Number: 317457 |
| 15. Title: Tackling infectious disease in Cuba. Author: Sansom C Source: Lancet Infectious Diseases. 2007 Jun;7(6):376. Abstract: Cuban doctors often make bold claims about the efficacy of their country's health-care system. Gustavo Kouri, director of a Havana institute of tropical medicine, Instituto de Medicina Tropical "Pedro Kouri" (IPK), recently told TLID that "infectious diseases are no longer a public-health problem in Cuba". To some extent these claims are borne out by the statistics. The last recorded case of measles in Cuba, according to WHO, occurred in 1995, and in 2005 no cases of diphtheria, polio, tetanus, rubella, or yellow fever were recorded. HIV infections are extremely low, at less than 0.05% of the population, and all Cuban adults in need of antiretroviral treatment now receive it. All this has been achieved, however, with very limited resources. According to WHO, Cuba's miniscule yearly health expenditure of US$251 per capita is only slightly more than 10% of the UK's. It is, no doubt, easier to control infectious disease on an island, with a relatively small, isolated population. However, Cuba also benefits from an extensive vaccination programme. Pedro Lopez Saura of the Centre for Genetic Engineering and Biotechnology (CIGB) in Havana, described Cuban children as being "among the most vaccinated in the world". He told TLID that they are offered 13 different vaccines, including a tetravalent vaccine against diphtheria, tetanus, pertussis, and hepatitis B that was only registered in 2004; compliance is almost 100%. (excerpt) Language: English Keywords: CUBA | UNITED STATES OF AMERICA | CRITIQUE | POLICYMAKERS | COMMUNICABLE DISEASE CONTROL | VACCINATION | VACCINES | RESEARCH AND DEVELOPMENT | GOVERNMENT PROGRAMS | COMMUNISM | HEALTH POLICY | POLITICAL FACTORS | PUBLIC HEALTH | Developing Countries | Caribbean | Americas | Developed Countries | North America | Administrative Personnel | Organization and Administration | Health Services | Delivery of Health Care | Health | Immunization | Primary Health Care | Medical Procedures | Medicine | Technology | Economic Factors | Programs | Socialism | Political Systems | Sociocultural Factors | Policy Document Number: 317196 |
| 16. Peer Reviewed Title: Human papillomavirus infections in Cuban women with cervical intraepithelial neoplasia. Author: Soto Y; Mune M; Morales E; Goicolea A; Mora J Source: Sexually Transmitted Diseases. 2007 Dec;34(12):974-976. Abstract: The aims of the current study were to detect different HPV types in Cuban patients with different grades of cervical intraepithelial neoplasia (CIN) and to assess the association between HPV infection and other risk factors involved in the development of cervical cancer in Cuban women. We analyzed 60 samples from women with a previous diagnosis of abnormal cytology (15 CIN-1, 36 CIN-2, and 9 CIN-3), who were referred to the Gynecology and Obstetrics Department at Eusebio Hernandez Maternity Hospital in Havana, Cuba, by their primary clinics. Epidemiologic data were obtained from standardized questionnaires. The questionnaire was designed to provide information on sexual and reproductive behavior (reproductive and gynecological history, sexual history, and the age of the first intercourse), socioeconomic conditions, cigarette smoking, and oral contraceptive use. During the first visit to the hospital an informed consent was obtained from each patient. For HPV detection, ectocervical and endocervical scrapings were used; Pap smears were also analyzed. Every patient underwent colposcopic examination, which included two schematic drawings of the reactions of the acetic acid and Lugol solution. This method allowed the detection of leucoplastic lesions, atypical transformation zones, cervicitis, colpitis, and condylomatous lesions. (excerpt) Language: English Keywords: CUBA | RESEARCH REPORT | CLINICAL RESEARCH | GENETIC TECHNIQUES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | HPV | CERVICAL CANCER | RISK BEHAVIOR | SEX BEHAVIOR | CERVICAL MUCUS | PREVALENCE | AGE FACTORS | FIRST INTERCOURSE | Developing Countries | Caribbean | Americas | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Development | Economic Factors | Viral Diseases | Diseases | Cancer | Neoplasms | Behavior | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Measurement | Population Characteristics | Demographic Factors | Population Document Number: 313976 |
| 17. Peer Reviewed Title: Achieving sustainability of community-based dengue control in Santiago de Cuba. Author: Toledo Romani ME; Vanlerberghe V; Perez D; Lefevre P; Ceballos E Source: Social Science and Medicine. 2007 Feb;64(4):976-988. Abstract: Achieving sustainability is one of the major current challenges in disease control programmes. In 2001-2002, a community-based dengue control intervention was developed in three health zones of Santiago de Cuba. New structures (heterogeneous community working groups and provincial/municipal coordination groups inserted in the vertical programme) were formed and constituted a key element to achieve social mobilization. In three control zones, routine programme activities were intensified. We evaluated the sustainability of the intervention strategy over a period of 2 years after the withdrawal of external support. Data on maintenance of effects, level of institutionalization and continuity of activities through capacity building were collected via documental review, direct observation, questionnaires, key informant and group interviews and routine entomological surveys. The intervention effects, evaluated through larval indices and behavioural change indicators, were maintained during the 2 years of follow-up. In the intervention area, 87.5% of the water storage containers remained well covered in 2004 and 90.5% of the families continued to correctly use a larvicide, against 21.5% and 63.5%, respectively in the control area. The house indices further declined from 0.35% in 2002 to 0.17% in 2004 in the intervention area, while in the control area they increased from 0.52% to 2.25%. Institutionalization of the intervention, assessed in terms of degrees of intensiveness (passage, routine, niche saturation), was reaching saturation by the end of the study. Key elements of the intervention had lost their separate identity and became part of the control programme's regular activities. The host organization adapted its structures and procedures accordingly. Continuous capacity building in the community led to participatory planning, implementation and evaluation of the Aedes control activities. It is concluded that, in contrast to intensified routine control activities, a community-based intervention approach promises to be sustainable. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | COMMUNITY-BASED DISTRIBUTION | DENGUE | PREVENTION AND CONTROL | CAPACITY BUILDING | VECTOR CONTROL | BEHAVIOR CHANGE COMMUNICATION | IMPLEMENTATION | PROGRAM SUSTAINABILITY | Caribbean | Americas | Developing Countries | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Disease Transmission Control | Behavior Change | Behavior | Communication Programs | Communication Document Number: 312038 |
| 18. Peer Reviewed Title: Efficacy of two intervals and two routes of administration of misoprostol for termination of early pregnancy: A randomised controlled equivalence trial. Author: von Hertzen H; Piaggio G; Huong NT; Arustamyan K; Cabezas E Source: Lancet. 2007 Jun 9;369(9577):1938-1946. Abstract: The most effective route and best interval between several doses of misoprostol to induce abortion have not been defined. Our aim was to assess the effects of the interval between multiple doses of misoprostol and the route of administration to terminate pregnancy. 2066 healthy pregnant women requesting medical abortion with 63 days or less of gestation were randomly assigned within 11 gynaecological centres in six countries to the four treatment groups (three doses of 0.8 mg misoprostol given sublingually at 3-h intervals, vaginally 3 h, sublingually 12 h, and vaginally 12 h), stratifying by gestational age. This was an equivalence trial with a 5% margin of equivalence. The primary endpoints were efficacy of treatment to achieve complete abortion and to terminate pregnancy. The main efficacy analysis excluded women lost to follow-up. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN10531821. Efficacy outcomes were analysed for 2046 women (99%), excluding 20 lost to follow-up. Complete abortion rates at 2-week follow-up were recorded for 431 (84%) in the sublingual and for 434 (85%) women in the vaginal group when misoprostol was given at 3-h intervals (difference 0.4%, 95% CI -4.0 to 4.9, p=0.85 equivalence shown), and for 399 (78%) in the sublingual and for 425 (83%) in the vaginal 12-h groups (4.6%, -0.2 to 9.5, p=0.06, equivalence not shown). In the 3-h groups, pregnancy continued in 29 (6%) women after sublingual and in 20 (4%) women after vaginal administration (difference 1.8%, 95% CI -0.8 to 4.4, p=0.19, equivalence shown); in the 12-h groups it continued in 47 (9%) after sublingual and in 25 (5%) after vaginal administration (4.4%, 1.2-7.5, p=0.01, vaginal better than sublingual). Differences for complete abortion between intervals for sublingual and vaginal routes were 6% (95% CI 1.0-10.6, p=0.02, 3 h better than 12 h) and 2% (-2.9 to 6.1, p=0.49, equivalence not shown), respectively; for continuing pregnancies they were 4% (0.4-6.8, p=0.03, 3 hbetter than 12 h) and 1% (-1.5 to 3.5, p=0.44, equivalence shown), respectively. Administration interval can be chosen between 3 h and 12 h when misoprostol is given vaginally. If administration is sublingual, the intervals between misoprostol doses need to be short, but side-effects are then increased. With 12-h intervals, vaginal route should be used, whereas with 3-h intervals either route could be chosen. (author's) Language: English Keywords: ARMENIA | CUBA | GEORGIA | INDIA | MONGOLIA | VIETNAM | RESEARCH REPORT | CLINICAL TRIALS | ABORTION | MISOPROSTOL | ADMINISTRATION AND DOSAGE | Developing Countries | Asia, Southwestern | Asia | Caribbean | Americas | Asia, Southern | Asia, Northern | Asia, Southeastern | Clinical Research | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 317555 Notification |
| 19. Title: Treatment of rectovaginal fistula: a 5-year review. Author: Casadesus D; Villasana L; Sanchez IM; Diaz H; Chavez M Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2006 Feb;46(1):49-51. Abstract: This paper presents a chart review of 17 patients who had been treated for rectovaginal fistula (RVF) from 1996 to 2000. In most cases (13; 76.5%), the fistula was the result of post-surgical complications. Following vaginal mucosa advancement flap repair or repair after conversion to a fourth-degree perineal laceration, 16 (94%) of the rectovaginal fistulae (during the first attempted repair or after failed treatment) were successfully treated. In all patients but one, faecal diversion was avoided. In two patients, fistulography was both a diagnostic procedure and the method of treatment. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | FISTULA | VAGINA | TREATMENT | SURGERY | COMPLICATIONS | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 310367 |
| 20. Peer Reviewed Title: Health in Cuba. Author: Cooper RS; Kennelly JF; Ordunez-Garcia P Source: International Journal of Epidemiology. 2006 Aug;35(4):817-824. Abstract: The poorer countries of the world continue to struggle with an enormous health burden from diseases that we have long had the capacity to eliminate. Similarly, the health systems of some countries, rich and poor alike, are fragmented and inefficient, leaving many population groups underserved and often without health care access entirely. Cuba represents an important alternative example where modest infrastructure investments combined with a well-developed public health strategy have generated health status measures comparable with those of industrialized countries. Areas of success include control of infectious diseases, reduction in infant mortality, establishment of a research and biotechnology industry, and progress in control of chronic diseases, among others. If the Cuban experience were generalized to other poor and middle-income countries human health would be transformed. Given current political alignments, however, the major public health advances in Cuba, and the underlying strategy that has guided its health gains, have been systematically ignored. Scientists make claims to objectivity and empiricism that are often used to support an argument that they make unique contributions to social welfare. To justify those claims in the arena of international health, an open discussion should take place on the potential lessons to be learned from the Cuban experience. (author's) Language: English Keywords: CUBA | DEVELOPING COUNTRIES | CRITIQUE | PUBLIC HEALTH | FOREIGN AID | INTERNATIONAL AGENCIES | Caribbean | Americas | Health | Financial Activities | Economic Factors | Organizations | Political Factors | Sociocultural Factors Document Number: 304966 |
| 21. Peer Reviewed Title: Mensuration, Mendel, and a 19th century public health justification for US imperialism. Author: Davey Smith G Source: International Journal of Epidemiology. 2006 Aug;35(4):811-813. Abstract: Measurement is a key issue in epidemiology and rightly receives considerable attention in most textbooks. In this issue of the IJE many of the key issues regarding measurement get an outing. A first concern is with validity of measurement, and this might be a particular issue with respect to somewhat fuzzy categories, such as socioeconomic position. Laura Kauhanen et al. revisit the association of childhood social circumstances with mortality and morbidity in middle age in the Kuopio Ischemic Heart Disease (KIHD) study. Many studies have found that deprivation in childhood is related to increased cardiovascular disease (CVD) risk in later life, but KIHD was an exception, with one of Kauhanen's current co-authors having shown that childhood social conditions as reported in adulthood were not independently associated with CVD risk. With longer follow-up they replicate the earlier null finding with adulthood recall of childhood social circumstances but show considerably more evidence of increased risk of CVD when childhood conditions were indexed by historical data from school health records. Adulthood recall of childhood social circumstances may simply be too inaccurate to demonstrate an effect in this context. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | CUBA | CRITIQUE | CHILD | NUTRITION | DIET | MEASUREMENT | PUBLIC HEALTH | VALIDITY | SANITATION | North America | Americas | Developed Countries | Developing Countries | Caribbean | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Research Methodology Document Number: 304964 |
| 22. Title: Drug-resistant tuberculosis in Cuba. Results of the three global projects. Author: Montoro E; Lemus D; Echemendia M; Armas L; Gonzalez-Ochoa E Source: Tuberculosis. 2006 May-Jul;86(3-4):319-323. Abstract: The spread of multidrug-resistant tuberculosis (MDR TB) in the world remains a major public health problem. Surveillance of anti-TB drug resistance is therefore an essential tool for monitoring the effectiveness of TB control program and, through policy development, for improving national and global TB control. The objective was to determine the prevalence of anti-TB drug resistance in Cuba during the execution of the three global projects. Drug-resistance was determined using the proportion method in 1528 Mycobacterium tuberculosis strains to first line anti-TB drugs. Resistance in new cases was 8.3%, 4.6% and 5.0%; MDR was 0.7%, 0% and 0.3% in the first (1997), second (2000) and third (2004) global projects, respectively. In new cases, none showed resistance to the four drugs. There were among previously treated cases statistically significant decreases in the prevalence of resistance to at least one drug when comparing the results obtained in the three global projects. The contributed data through Cuba demonstrated that our country is relatively free of MDR strains, reflecting the good National Control Program and the possibility of TB elimination in Cuba. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGY | TARGET POPULATION | TUBERCULOSIS | DRUG RESISTANCE | PREVALENCE | Caribbean | Americas | Developing Countries | Research Methodology | Public Health | Health | Program Design | Programs | Organization and Administration | Infections | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Measurement Document Number: 311142 |
23.  Title: [Epidemiology and risk strata from violent death. Villa Clara province, 1993 - 2002] Epidemiologia y estratos de riesgo de las muertes violentas. Villa Clara, 1993-2002. Author: Rodriguez Gonzalez B; Rodriguez Lopez J Source: Revista Cubana de Higiene y Epidemiologia. 2006 May-Aug;44(2):[9] p.. Abstract: Every year, millions of people worldwide lose their lives or suffer injures as a result of violent deaths. Cuba is one of the first countries in the mortality picture by this cause, which prompted us to conduct a retrospective, longitudinal descriptive study aimed at characterizing from the epidemiological viewpoint violent deaths and determining priority areas for action in Villa Clara province from 1993 to 2002. It was observed that the risk of dying was higher in over 64 years age group and in males, and that the fundamental cause had been occurrence of accidents with a rate of 52.9 per 100 000 pop. In reference to risk strata, nine of the municipalities in this province were included in high risk strata because of their high mortality rates from this reason and the number of years of potential life lost, this is why they were classified as priority areas for action. (author's) Spanish Abstract: Cada año millones de personas en el mundo pierden la vida o sufren lesiones como consecuencia de las muertes violentas, y en Cuba estas se encuentran dentro de las primeras causas del cuadro de mortalidad, lo que motivó la realización de un estudio descriptivo retrospectivo y longitudinal, con el propósito de caracterizar epidemiológicamente las muertes violentas y determinar las áreas prioritarias de acción en Villa Clara, en el período comprendido entre 1993 y 2002. Se observó que el riesgo de morir fue mayor en el grupo de más de 64 años y en el sexo masculino, y que la causa fundamental fue la ocurrencia de accidentes, con una tasa de 52,9 por cada 100 000 habitantes. Al identificar los estratos de riesgo, se determinó que 9 de los municipios se encontraban en los estratos de alto riesgo, no solo por presentar altas tasas de mortalidad por este motivo, sino también por el aporte a los años de vida potencialmente perdidos, por lo que se consideraron áreas prioritarias para la acción. (del autor) Language: Spanish Keywords: CUBA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | LONGITUDINAL STUDIES | TARGET POPULATION | HOMICIDE | RISK FACTORS | DEATH RATE | PREVENTION AND CONTROL | Developing Countries | Caribbean | Americas | Geographic Factors | Population | Research Methodology | Studies | Program Design | Programs | Organization and Administration | Crime | Social Problems | Sociocultural Factors | Biology | Mortality | Population Dynamics | Demographic Factors | Diseases Document Number: 316403 |
| 24. Peer Reviewed Title: Commentary: Daring to learn from a good example and break the ‘Cuba taboo'. Author: Spiegel JM Source: International Journal of Epidemiology. 2006 Aug;35(4):825-826. Abstract: When confronted by observations of unusually positive or negative outliers, epidemiologists and other scientists are typically drawn to better understand what could be producing such results. Recognition of diminishing HIV/AIDS prevalence in Uganda, for example, appropriately triggered activity to examine and learn from associated policies and practices that could be accounting for this. So when a low-income country can be seen to be systematically producing excellent health indicators, one would think that this would attract considerable scientific attention. Think again. Despite the remarkable health achievements that the small island nation of Cuba has registered, there has been limited discussion of this in scientific circles. (excerpt) Language: English Keywords: CUBA | UGANDA | CRITIQUE | HEALTH POLICY | OBSTACLES | DISEASE PREVENTION | PROGRAM EFFECTIVENESS | Developing Countries | Caribbean | Americas | Africa, Eastern | Africa, Sub Saharan | Africa | Policy | Political Factors | Sociocultural Factors | Organization and Administration | Prevention and Control | Diseases | Program Evaluation | Programs Document Number: 304967 |
| 25. Peer Reviewed Title: Prevalence and risk factors of intestinal parasites in Cuban children. Author: Wordemann M; Polman K; Heredia LT; Diaz RJ; Madurga AM Source: Tropical Medicine and International Health. 2006 Dec;11(12):1813-1820. Abstract: The objectives were to determine the prevalence of intestinal parasite infections and their risk factors in children in urban and rural settings in two Cuban municipalities. A total of 1320 Cuban schoolchildren aged 4-14 were tested by stool examination for intestinal parasite infections and evaluated by parental questionnaire for a number of common environmental, sanitary, socioeconomic and behavioural risk factors. Multivariate regression was applied to examine the relationship between the respective parasite infections and the risk factors. Prevalences of intestinal parasite infections were 58% in Fomento and 45% in San Juan y Martinez; for helminth infections, these were 18% and 24% and for protozoa infections, 50% and 29%, respectively. Helminth infections were associated with high parental education (maternal: OR 0.68, CI 0.50-0.93; paternal: OR 0.71, CI 0.52-0.96), absence of toilet (OR 1.57, CI 1.12-2.19), consumption of water from a well or river (OR 0.56, CI 0.41-0.77) and eating unpeeled/unwashed fruit (OR 1.37, CI 1.01-1.87); protozoa infections were only associated with high maternal education (OR 0.72, CI 0.57- 0.91). Paediatric intestinal parasite infections are still prevalent in certain areas in Cuba and associated with a number of common environmental, socioeconomic and sanitary risk factors. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | PREVALENCE | CHILD | STUDENTS | PRIMARY SCHOOLS | EXAMINATIONS AND DIAGNOSES | GASTROINTESTINAL EFFECTS | PARASITIC DISEASES | RISK FACTORS | Caribbean | Americas | Developing Countries | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Education | Schools | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Diseases Document Number: 310925 |
| 26. Title: State of malnutrition in Cuban hospitals. [Estado de desnutrición en los hospitales cubanos] Author: Barreto Penié J Source: Nutrition. 2005;21:487-497. Abstract: We assessed the current state of undernutrition as observed in 1905 patients hospitalized in 12 Cuban health care institutions, as part of a Latin American, multinational survey similar in design and goals. We surveyed 1905 randomly selected patients from 12 Cuban hospitals in a two-phase study. Patients’ clinical charts were audited in phase 1, the Subjective Global Assessment was used to assess patients’ nutritional status in phase 2. The study was locally conducted by a properly trained team. The frequency of undernutrition in Cuban hospitals was 41.2% (95% confidence interval = 38.9 to 43.4), and 11.1% of patients were considered severely undernourished. Statistically significant (P < 0.05) univariate relations were identified between undernutrition and patient’s age and sex. Nutritional status was a dependent of the patient’s instruction level (P < 0.05). Patients’ nutritional status was statistically associated with the presence of cancer and infection. Undernutrition was highly prevalent among cancer patients, no matter the stage of medical or surgical treatment. Undernutrition became extremely frequent after surgical treatment in non-cancer patients. High nutritional risks hospital services/specialties were identified: geriatrics (56.3%), critical care (54.8%), nephrology (54.3%), internal medicine (48.6%), gastroenterology (46.5%), and cardiovascular surgery (44.8%). Malnutrition rates increased progressively with prolonged length of stay. A high malnutrition rate was observed among participating hospitals. The design and inception of policies that foster intervention programs focusing on early identification of hospital malnutrition and its timely management is suggested to decrease its deleterious effects on outcomes of health care in the participating hospitals. (author's) Spanish Abstract: Se evaluó el estado actual de la desnutrición según se lo observó en 1905 pacientes hospitalizados en 12 instituciones cubanas de atención médica, como parte de una encuesta multinacional latinoamericana similar en diseño y objetivos. Se encuestaron 1905 pacientes seleccionados aleatoriamente de 12 hospitales cubanos en un estudio de dos fases. En la fase 1, se auditaron los cuadros clínicos de los pacientes y, en la fase 2 se utilizó la Evaluación Global Subjetiva para evaluar el estado nutricional de los pacientes. El estudio estuvo dirigido localmente por un equipo adecuadamente capacitado. La frecuencia de desnutrición en los hospitales cubanos fue del 41,2% (Intervalo de confianza [IC] 95%: 38,9 a 43,4), y se consideró que el 11,1% de los pacientes tenía desnutrición grave. Se identificaron relaciones univariadas estadísticamente significativas (P < 0,05) entre la desnutrición y la edad y sexo de los pacientes. El estado nutricional de los pacientes dependía del nivel de instrucción (P < 0,05), y se lo asoció estadísticamente con la presencia de cáncer e infección. Se registró una elevada prevalencia de desnutrición entre los pacientes con cáncer, independientemente del estadío o del tratamiento médico o quirúrgico. En los pacientes que no tenían cáncer, la frecuencia de la desnutrición aumentó marcadamente después del tratamiento quirúrgico. Se identificaron especialidades/servicios hospitalarios de alto riesgo nutricional: geriatría (56.3%), cuidados críticos (54.8%), nefrología (54.3%), medicina interna (48.6%), gastroenterología (46.5%), y cirugía cardiovascular (44.8%). Las tasas de desnutrición aumentaron progresivamente si se prolongaba la internación. Se observó una elevada tasa de desnutrición entre los hospitales participantes. Se sugiere que el diseño y el inicio de políticas que promuevan los programas de intervención enfocados a la identificación temprana de desnutrición hospitalaria y el manejo oportuno disminuirán los efectos perjudiciales sobre los resultados de la atención médica en los hospitales participantes. (del autor) Language: English Keywords: CUBA | LATIN AMERICA | RESEARCH REPORT | HEALTH SURVEYS | CLIENTS | HOSPITALS | NUTRITION INDEXES | MALNUTRITION | Caribbean | Americas | Developing Countries | Health | Program Activities | Programs | Organization and Administration | Health Facilities | Delivery of Health Care | Nutrition | Nutrition Disorders | Diseases Document Number: 286580 |
| 27. Peer Reviewed Title: Sexual behaviour, history of sexually transmitted diseases, and the risk of prostate cancer: a case-control study in Cuba. Author: Fernández L; Galán Y; Jiménez R; Gutiérrez A; Guerra M Source: International Journal of Epidemiology. 2005;34(1):193-197. Abstract: 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. 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. 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. 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. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | CASE CONTROL STUDIES | MEN | SEX BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | PROSTATE CANCER | RISK FACTORS | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Demographic Factors | Population | Behavior | Reproductive Tract Infections | Infections | Diseases | Cancer | Neoplasms | Biology Document Number: 279203 |
| 28. Title: Classical dengue hemorrhagic fever resulting from two dengue infections spaced 20 years or more apart: Havana, Dengue 3 epidemic, 2001-2002. Author: González D; Castro OE; Kourí G; Perez J; Martinez E Source: International Journal of Infectious Diseases. 2005 Sep;9(5):280-285. Abstract: The objective was to report the clinical, laboratory and sonographic findings in 76 adult cases of dengue hemorrhagic fever (DHF). A dengue 3 epidemic occurred in Havana City from June 2001 to March 2002. 12,889 cases were reported, with 81 DHF cases. From this, 76 serologically confirmed cases were studied descriptively. Bronchial asthma and white race were important risk factors for the severe form of the disease. Fever (100%), headache (92.1%), myalgia (76.3%), arthralgia (73.7%) and retro-orbital pain (57.7%) were the most frequent general symptoms. Vomiting and abdominal pain were observed in 59.2% and 48.6% of cases, respectively. The most common bleeding site was the vagina (64%), followed by the skin (55.2%). Eighteen patients (23.6%) had shock syndrome. Laboratory findings included thrombocytopenia (100%), hemoconcentration (93.4%), an increase in liver enzymes (82.8%), and leukopenia (71%). Ultrasound detected thickening of the gallbladder wall in 35.1%, pleural effusion in 20.3%, and splenomegaly in 12.9% of cases. These findings contribute to a better understanding of the clinical aspects of DHF in adult patients due to the dengue 3 virus. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | CLINICAL RESEARCH | CLIENTS | DENGUE | RISK FACTORS | SIGNS AND SYMPTOMS | EPIDEMIOLOGY | Developing Countries | Caribbean | Americas | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Biology | Public Health | Health Document Number: 290623 |
| 29. Peer Reviewed Title: Molecular epidemiology and KSHV K1 subtypes in a Cuban AIDS-Kaposi's sarcoma population. Author: Kouri V; Liang X; Rodriguez ME; Capo V; Resik S Source: AIDS. 2005;19(9):984-987. Abstract: A patch test (PT) may be useful in defining true abacavir hypersensitivity syndrome (AHS). Seven previously PT-positive patients remote from the original AHS were shown to have robust 24 h responses, supporting PT durability. HLA-B+5701 was present in all seven PT-positive versus one of 11 controls tolerating abacavir (P < 0.001). Five of seven PT (71%) versus one of 11 controls (9%) (P = 0.005) showed significant abacavir-specific CD8 proliferation, suggesting a direct role for HLA-B+5701-restricted CD8 cells in the pathophysiology of AHS. (author's) Language: English Keywords: CUBA | RESEARCH REPORT | CLIENTS | AIDS | EPIDEMIOLOGY | NEOPLASMS | PROTEINS | GENETICS | VIRAL DISEASES | CLASSIFICATION | Caribbean | Americas | Developing Countries | Program Activities | Programs | Organization and Administration | HIV Infections | Diseases | Public Health | Health | Physiology | Biology | Research Methodology Document Number: 306922 |
| 30. Title: Acute hepatitis E virus infection in a Cuban patient [letter] Author: Montalvo Villalba MC; Trujillo Aválos A; Rodríguez Lay LD; Goyenechea Hernández AD; Corredor MB Source: International Journal of Infectious Diseases. 2005 Sep;9(5):286-287. Abstract: Hepatitis E virus (HEV) is an important cause of jaundice in developing countries in tropical and subtropical regions. The virus is transmitted via the fecal-oral route, although the possibility for zoonotic acquisition of HEV infection has been suggested by several studies. Lemos et al., in a seroprevalence survey, demonstrated that HEV could have been responsible for a considerable number of sporadic viral hepatitis episodes in Cuban patients. In August 2003 a 22-year-old man living in a suburb of Havana City was admitted to the gastroenterology service of the Pedro Kouri Institute. He had not previously traveled abroad and had had no contact with people who had recently arrived from other countries. The patient did not have a history of jaundice, blood transfusion, tattoos or intravenous drug use. He reported 14 days of anorexia and general malaise before progressively developing jaundice, dark urine and pale feces. A blood sample was negative for hepatitis A virus IgM antibodies; hepatitis B surface antigen; hepatitis B core antibody and hepatitis C virus antibodies using commercially available kits. (excerpt) Language: English Keywords: CUBA | RESEARCH REPORT | CASE STUDIES | CLIENTS | HEPATITIS | JAUNDICE | EXAMINATIONS AND DIAGNOSES | EPIDEMIOLOGY | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Signs and Symptoms | Public Health | Health Document Number: 290624 |
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