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PubMed1987

Mental health services in Cuba.

Despite its limited resources, Cuba has developed an integrated mental health system that emphasizes prevention and community care. It consists of three distinct organizations: the Committee for the Defense of the Revolution, one of many mass community organizations that strive to protect the revolution; the policlinics, which provide comprehensive health services to geographic areas containing 25,000 to 40,000 people; and the psychiatric hospitals. All three use treatment approaches that are based on a social systems model and that emphasize solving current problems and disturbances. Behavioral and milder psychiatric problems are treated by policlinic psychologists, in the community whenever feasible, and major psychiatric disorders are treated by psychiatrists at the hospitals. Services for children and adolescents, research, and staff training in Cuba are also discussed.

Adolescent↗
PubMed2003

Womens' opinions on antenatal care in developing countries: results of a study in Cuba, Thailand, Saudi Arabia and Argentina.

BACKGROUND: The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina) are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country. METHODS: Through focus groups discussions we were able to assess the concepts and expectations underlying women's evaluation of concepts and experiences of the care received in antenatal care clinics. 164 women participated in 24 focus groups discussion in all countries. RESULTS: Three areas are particularly addressed in this paper: a) concepts about pregnancy and health care, b) experience with health services and health providers, and c) opinions about the modified Antenatal Care (ANC) programme. In all three topics similarities were identified as well as particular opinions related to country specific social and cultural values. In general women have a positive view of the new ANC protocol, particularly regarding the information they receive. However, controversial issues emerged such as the reduction in the number of visits, particularly in Cuba where women are used to have 18 ANC visits in one pregnancy period. CONCLUSION: Recommendations to improve ANC services performance are being proposed. Any country interested in the application of a new ANC protocol should regard the opinion and acceptability of women towards changes.

Adult↗
PubMed2002

Applied ethics in mental health in Cuba: part I--guiding concepts and values.

As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mental health professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by a set of professional values but by a set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America.

Community Participation↗
PubMed2006

Assessment of human health vulnerability to climate variability and change in Cuba.

In this study we assessed the potential effects of climate variability and change on population health in Cuba. We describe the climate of Cuba as well as the patterns of climate-sensitive diseases of primary concern, particularly dengue fever. Analyses of the associations between climatic anomalies and disease patterns highlight current vulnerability to climate variability. We describe current adaptations, including the application of climate predictions to prevent disease outbreaks. Finally, we present the potential economic costs associated with future impacts due to climate change. The tools used in this study can be useful in the development of appropriate and effective adaptation options to address the increased climate variability associated with climate change.

Climate↗
PubMed1990

[Social development and infant mortality, 1977-1986, Cuba. A regional analysis].

In Cuba, the infant mortality rate (IMR) dropped by 65% between 1970 and 1986. The 1986 IMR - 13.6% - has put the country in the lead in Latin American mother and child health care. However, the behavior of the IMR is not homogeneous throughout the country. This paper seeks to identify by multiple regression techniques, those sociodemographic or health care factors which have determined the decline in the IMR and those variables which best explain the inter-regional differences in this indicator. Sociodemographic factors fundamentally explain the evolution of the IMR in Cuba; on the other hand, although in the first instance the proportion of live births of low weight and the crude birth rate explain the inter-regional differences in IMR levels every year, it can be seen that other socioeconomic variables really lie behind these differences.

Cuba↗
PubMed2001

Identification of Biomphalaria havanensis and Biomphalaria obstructa populations from Cuba using polymerase chain reaction and restriction fragment length polymorphism of the ribosomal RNA intergenic spacer.

In Cuba, several Biomphalaria species have been reported such as B. orbignyi, B. schrammi, B. helophila, B. havanensis and B. peregrina; only the latter three are considered as potential hosts of Schistosoma mansoni. The specific identification of Biomphalaria species is based on anatomical and morphological characters of genital organs and shells. The correct identification of these snails is complicated by the high variation in these characters, similarity among species and in some cases by the small size of the snails. In this paper, we reported the classical morphological identification, the use of PCR and RFLP analysis of the internal transcribed spacer region of the ribosomal RNA genes for molecular identification of seven snail populations from different localities in Cuba. Using morphological and molecular analysis, we showed that among the studied Cuban Biomphalaria populations only B. havanensis and B. obstructa species were found.

Animals↗
PubMed2003

Prevalence of Chlamydia trachomatis in human immunodeficiency virus-infected women in Cuba.

To determine the prevalence rates and serovar distribution of Chlamydia trachomatis cervical infections in Cuban women, two different groups were selected. Group I consisted of 60 human immunodeficiency virus (HIV-1) seropositive women from different regions of Cuba and group II of 60 randomly selected women HIV seronegative and apparently healthy. C. trachomatis was detected in cervical scrapes by mean of nested polymerase chain reaction (PCR) specific for major out membrane protein. The overall prevalence rate of C. trachomatis in cervical scrapes determined by nested PCR was 10% in group I and the estimated prevalence was 6.6% for group II; 83.3% of HIV seropositive women with C. trachomatis infection reported history of pelvic inflammatory disease followed by cervicitis (50%). The control group C. trachomatis-infected women referred a history of cervicitis in 75% of cases. Other reports in the latter group included infertility and pelvic inflamatory disease in 50%. The present study is the first report of C. trachomatis prevalence in Cuba. It showed that there was not significantly difference in the prevalence rate of C. trachomatis between both groups.

Adolescent↗
PubMed2004

Evaluation of four methods for detecting the beta-lactamase activity in Neisseria gonorrhoeae isolated in Cuba.

Four methods (chromogenic, acidimetric, inhibition, and iodometric) for demonstration of the beta-lactamase production by 70 isolates of Neisseria gonorrhoeae, were evaluated in Cuba. There was 100% correlation between all beta-lactamase methods and the standardized penicillin dilution susceptibility test for penicillinase-non-producing N. gonorrhoeae. For penicillinase-producing N. gonorrhoeae strains, there was a perfect correlation between the chromogenic method and penicillin susceptibility testing, but one and two strains failed to give a positive result for beta-lactamase with the inhibition/acidimetric and the iodometric methods, respectively. There was a high concordance between the chromogenic method, considered as gold standard and the rest of penicillinase tests evaluated: Kappa Index (KI) = 0.98 for inhibition/acidimetric methods and KI = 0.97 for the iodometric method. The four methods evaluated were accurate, reproducible, easily readable, economical, and ease to use for screening primary isolates of N. gonorrhoeae in Cuba. We recommended the use of the inhibition method, when testing the penicillinase activity in gonococcal isolates in provincial and municipal reference laboratories.

Bacteriological Techniques↗
PubMed2004

Population dynamics of intermediate snail hosts of Fasciola hepatica and some environmental factors in San Juan y Martinez municipality, Cuba.

The variation of abundances of intermediate snail hosts of Fasciola hepatica in Cuba (Fossaria cubensis and Pseudosuccinea columella) was studied during one year under natural conditions at five sampling sites in San Juan y Martinez municipality, Pinar del Rio province, Cuba. The effect of some environmental variables on the lymnaeid abundances was also studied. A canonical correspondence analysis showed that both species do not generally occur together in the same habitat and that most factors affect them in an opposite fashion, although both of them correlate positively through time to the diversity of the habitats. F. cubensis prefers the sites that are in or closer to the city whereas P. columella is more abundant in rural sites. Lymnaeid abundances are mainly affected by nitrite and nitrate concentrations as well as by the abundance of the thiarid Tarebia granifera. F. cubensis is more abundant in polluted habitats with low densities (or absence) of T. granifera whereas P. columella prefers cleaner habitats and can coexist with the thiarid, even at its higher densities. The implications of divergent preferences of the two lymnaeids for the control of fasciolosis are discussed.

Animals↗
PubMed1999

[Epidemiology of dengue and hemorrhagic dengue in Santiago, Cuba 1997].

A dengue epidemic that Cuba reported in 1997 registered more than 500,000 cases of dengue fever produced by viral serotype 1. In 1981, there was an epidemic of dengue hemorrhagic fever produced by serotype 2 of the virus. This time 344,203 clinical cases were reported, 10,312 of which were severe cases of hemorrhagic fever that led to 158 fatalities (101 of them among children). The reintroduction of dengue, and specifically of dengue viral serotype 2 (Jamaica genotype), was quickly detected in January 1997 through an active surveillance system with laboratory confirmation of cases in the municipality of Santiago de Cuba, in the province of the same name. The main epidemiological features of this outbreak are reported in this paper. A total of 3,012 cases were reported and serologically confirmed. These included 205 cases classified as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), 12 of which were case fatalities (all among adults). Secondary infection with dengue virus was one of the most important risk factors for DHF/DSS. Ninety-eight percent of the DHF/DSS cases and 92% of the fatal cases had contracted a secondary infection. It was the first time dengue hemorrhagic fever was documented as a secondary infection 16 to 20 years after initial infection. Belonging to the white racial group was another important risk factor for DHF/DSS, as had been observed during the 1981 epidemic. During the most recent epidemic it was demonstrated that the so called "fever alert" is not useful for early detection of an epidemic. Measures taken by the country's public health officials prevented spread of the epidemic to other municipalities plagued by Aedes aegypti.

Adolescent↗
PubMed1999

[Risk factors of low birth weight. Provincial Gynecologic-Obstetric Hospital of Sancti Spíritus, Cuba].

The objective of this work was to identify some risk factors that women could present during pregnancy and that are associated with low birthweight (less than 2,500 g). A study was performed during 1994 with 378 cases and 649 controls at the Provincial Obstetric-Gynecologic Hospital of Sancti Spíritus, Cuba. The data were obtained from clinical histories, the registry of births, and personal interviews with mothers. A bivariate analysis was carried out and possible confounding factors were controlled utilizing dichotomous logistic regression, using the Epi Info 5 and SPSS software programs. With the final multivariate model, the following risk factors for low birthweight were identified as significant: hypertension during pregnancy, infrequent checkups during pregnancy, previous abortions, a period of less than 2 years since the last birth, and a maternal weight increase of less than 8 kg. Priority should be given to these last three variables in order to maintain the high standards of the maternal and child health program of Sancti Spíritus Province, Cuba.

Cuba↗
PubMed2001

[Impact of vaccination against Haemophilus influenzae type b in Cuba].

OBJECTIVE: To assess the effectiveness of mass vaccination in Cuba of children under 2 years of age against Haemophilus influenzae type b (Hib), the most common causative pathogen of bacterial meningitis. METHODS: The availability of effective Hib conjugate vaccines led to a nationwide vaccination program in 1999 targeting all children under 2 years of age, with a 97% coverage rate achieved. To assess the program's impact, data from 1998 and 1999 from the National Bacterial Meningitis Reporting System were used. RESULTS: Vaccination efficacy was estimated at 99%. The overall incidence of Hib meningitis declined 46.1%, from 1.3 to 0.6 cases per 100,000 population. The greatest overall reduction, of 56.1%, occurred among children under 5 years of age. Among children under 1 year of age, the reduction was 70.5%, and among the rest of the age groups of children under 5, incidence decreased between 25.9% and 49.6%. In the group targeted for vaccination, incidence decreased 61.1%. Among children in the target group who contracted Hib meningitis, only 8 cases (24.2%) had been vaccinated, most with a single dose applied 1 month before becoming ill. CONCLUSIONS: Hib vaccination of all children under 2 years of age in Cuba greatly reduced the incidence of Hib meningitis, as measured by the National Bacterial Meningitis Reporting System.

Cuba↗
PubMed2006

[Ecological factors linked to the presence of Aedes aegypti larvae in highly infested areas of Playa, a municipality belonging to Ciudad de La Habana, Cuba].

OBJECTIVES: To identify local ecological factors that might have had an impact on the higher infestation rates by the vector mosquito Aedes aegypti seen in four urban health districts of Ciudad de La Habana, Cuba, and to determine the type of containers with the highest number of larvae. METHODS: This is a descriptive study that was carried out in four health areas (Docente, 28 de Enero, 26 de Julio, and 1. degrees de Enero) within Playa, a municipality belonging to Ciudad de La Habana, Cuba. These areas were chosen because of the persistent presence of the dengue vector throughout 2003. All buildings on the selected blocks were inspected between April 2004 and March 2005, and note was taken of existing water deposits (type, number, and location) and of surrounding ecological factors (existence of a patio and shade, the way tanks were covered, the presence of organic matter inside them, and the overall cleanliness of the dwelling). Using filtration, the mosquito larvae and pupae in each deposit were counted. Pupae were typified as to their taxonomic species under a stereoscopic microscope. RESULTS: The types of deposits where larvae and pupae of A. aegypti were most often found in all areas were low tanks and small artificial containers. In three of the study areas the greatest numbers of pupae were found in low tanks (88.6%, 100%, and 56.6%), 90.9% of which were uncovered or only partially covered. On the other hand, in the fourth study area small artificial deposits were the most commonly infested (85.7%). A correlation was noted between the number of deposits in infested houses and the presence of a patio (chi(2) = 29.59; P = 0.0001), partial shade (chi(2) = 4.108; P = 0.0001), shrubbery (chi(2) = 43.59; P = 0.0001) and trees (chi(2) = 101.459; P = 0.0001), as well as poor hygiene (chi(2) = 53.76; P = 0.0001). CONCLUSIONS: Artificial deposits, especially low tanks and small containers, are the most frequent breeding sites for A. aegypti and are therefore risk factors for infestation with this vector species. Uncovered tanks containing organic matter and located in the shade on the outside of homes were found to present the highest risk in this respect.

Aedes↗
PubMed2001

Detection of insecticide resistance in Aedes aegypti (Diptera: Culicidae) from Cuba and Venezuela.

Four strains of Aedes aegypti (L.), one from Cuba and three from Venezuela, were bioassayed for susceptibility to eight insecticides, including the organophosphates, temephos, malathion, fenthion, pirimiphos methyl, and chlorpyrifos, and the pyrethroids, deltamethrin, lambda cyhalothrin and cypermethrin, S, S, S,-tributyl phosphorotrithioate and piperonyl butoxide were used as synergists to assess the involvement of esterases and monooxygenases in organophosphate resistance. Venezuelan strains had low levels of resistance to fenthion and malathion, and moderate to high resistance to temephos, pyrimphos methyl, and chlorpiriphos. All strains were susceptible to the pyrethroids, except the Cuban strain, which had moderate levels of resistance to cypermethrin. Organophosphate resistance in Ae. aegypti is a serious threat to control operations. Integrated strategies for Ae. aegypti control to prevent or delay pyrethroid resistance in Venezuela and Cuba are discussed.

Aedes↗
PubMed2002

Cross-resistance to pyrethroid and organophosphorus insecticides induced by selection with temephos in Aedes aegypti (Diptera: Culicidae) from Cuba.

A sample of Aedes aegypti (L.) from Santiago de Cuba, Cuba, with a high level of temephos resistance (19.58x at the 50% lethal concentration [LC50]), was subjected to temephos selection to evaluate the utility of this organophosphate insecticide for mosquito control. High resistance developed after six generations of selection (200.00x). Little or no cross-resistance was observed to the organophosphates, malathion and fenitrothion, but high cross-resistance was observed for the pyrethroid deltamethrin (337.5x) and the organophosphate fenthion (12.74x). Synergism tests implicated detoxifying esterases in temephos and fenthion resistance and deltamethrin resistance was associated with a cytochrome P450 monooxygenasa. Biochemical tests, polyacrylamide gel electrophoresis (PAGE), and inhibition studies confirmed the presence of elevated esterase activity associated with temephos resistance. Pyrethroid resistance could be associated with a glutathione-S-transferase mechanism but not the esterases. The cross-resistance to deltamethrin from temephos selection could limit the use of both insecticides for Ae. aegypti control.

Aedes↗
PubMed1981

Occupational health in Cuba.

Health and safety regulation, training, and research were practically non-existent in Cuba before the Revolution in 1959. Since that time important advances have been made. Specialized inspectors, occupational physicians, and other such personnel are now trained in Cuba. An Occupational Health Institute, founded in 1976, provides training and specialized technical services, and conducts research. In 1978, a far reaching "Work Safety and Health Law" was enacted which defines the rights and responsibility of government agencies, workplace administrators, unions, and workers. Comprehensive control of toxic substances in workplaces, still at an early stage, is likely to increase in light of the new law, the growing availability of qualified personnel, and the mounting concern of public health authorities with the increasingly "developed" health profile of the population.

Cuba↗
PubMed2005

Economic crisis and access to care: Cuba's health care system since the collapse of the Soviet Union.

This article explores the effects on access to health care in Cuba of the severe economic crisis that followed the collapse of the Soviet Union and the monetary and market reforms adopted to confront it. Economic crises undermine health and well-being. Widespread scarcities and self-seeking attitudes fostered by monetary and market relations could result in differential access to health services and resources, but the authors found no evidence of such differential access in Cuba. While Cubans generally complain about many shortages, including shortages of health services and resources before the economic recovery began in 1995, no interviewees reported systemic shortages or unequal access to health care services or resources; interviewees were particularly happy with their primary care services. These findings are consistent with official health care statistics, which show that, while secondary and tertiary care suffered in the early years of the crisis because of interruptions in access to medical technologies, primary care services expanded unabated, resulting in improved health outcomes. The combined effects of the well-functioning universal and equitable health care system in place before the crisis, the government's steadfast support for the system, and the network of social solidarity based on grassroots organizations mitigated the corrosive effects of monetary and market relations in the context of severe scarcities and an intensified U.S. embargo against the Cuban people.

Adolescent↗