Scielo RSS <![CDATA[MEDICC Review]]> http://www.scielosp.org/rss.php?pid=1555-796020130004&lang=pt vol. 15 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Mental health</b>: <b>it's not all in your head</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400001&lng=pt&nrm=iso&tlng=pt http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Approaches to Substance Abuse in Cuba</b>: <b>Ricardo A. González MD PhD DrSc. Psychiatrist and consulting professor, Eduardo B. Ordaz Psychiatric Hospital, Havana</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Community mental health services in Cuba</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400004&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Therapeutic clowns bring joy to Cuban patients</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400005&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Tobacco and alcohol consumption among health sciences students in Cuba and Mexico</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400006&lng=pt&nrm=iso&tlng=pt INTRODUCTION: Smoking and alcohol use (beyond social norms) by health sciences students are behaviors contradictory to the social function they will perform as health promoters in their eventual professions. OBJECTIVE: Identify prevalence of tobacco and alcohol use in health sciences students in Mexico and Cuba, in order to support educational interventions to promote healthy lifestyles and development of professional competencies to help reduce the harmful impact of these legal drugs in both countries. METHODS: A descriptive cross-sectional study was conducted using quantitative and qualitative techniques. Data were collected from health sciences students on a voluntary basis in both countries using the same anonymous self-administered questionnaire, followed by an in-depth interview. RESULTS: Prevalence of tobacco use was 56.4% among Mexican students and 37% among Cuban. It was higher among men in both cases, but substantial levels were observed in women as well. The majority of both groups were regularly exposed to environmental tobacco smoke. Prevalence of alcohol use was 76.9% in Mexican students, among whom 44.4% were classified as at-risk users. Prevalence of alcohol use in Cuban students was 74.1%, with 3.7% classified as at risk. CONCLUSIONS: The high prevalence of tobacco and alcohol use in these health sciences students is cause for concern, with consequences not only for their individual health, but also for their professional effectiveness in helping reduce these drugs' impact in both countries. <![CDATA[<b>Psychological, behavioral and familial factors in obese Cuban children and adolescents</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400007&lng=pt&nrm=iso&tlng=pt INTRODUCTION: The global prevalence of obesity has reached alarming proportions. In Cuba, the rise in numbers of children who are overweight or obese, especially preschoolers and adolescents, is similar to that observed in developed countries. Beyond the physical risk factors, there is evidence that obesity has negative psychological, social, academic and economic effects. OBJECTIVE: Describe the psychological, behavioral and familial factors present in a group of obese children and adolescents in Cuba. METHODS: This is a qualitative cross-sectional study of 202 obese children and adolescents aged 3-18 years, with an average age of 9.9 years, seen at the Medical-Surgical Research Center (Havana) psychology service from January 2009 through December 2012. Techniques included interviews of patients and parents, projective drawings and the Rotter Incomplete Sentence Blank. RESULTS: Unhealthy eating habits were reported in 96% of obese children and adolescents, and sedentary lifestyles in 88.1%. Emotional state was affected in 80.2%, and in 72.3% there were family attitudes with potential to produce psychological disturbances in children. CONCLUSIONS: Psychological, behavioral, and familial factors known to foster development and perpetuation of obesity were observed in the majority of cases. This is a first diagnostic stage that will aid in design and implementation of a psychological intervention program for obese and overweight children and their families. <![CDATA[<b>HIV/AIDS among women in Havana, Cuba</b>: <b>l986-2011</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400008&lng=pt&nrm=iso&tlng=pt INTRODUCTION: Women are being diagnosed with HIV infection in increasing numbers, and now account for 50% of cases worldwide. In Cuba, HIV is more frequent in men, but in recent years, a growing number of women have been diagnosed. OBJECTIVE: Describe patterns of HIV among women in Havana, Cuba, 1986-2011. METHODS: Descriptive study of women with HIV aged >14 years, residents of Havana, Cuba, who were diagnosed with HIV from 1 January 1986 through 31 December 2011. Information was obtained from the limited-access HIV/AIDS database of Cuba's Ministry of Public Health. Data were studied from all reported cases, a total of 1274 women. Variables selected were age at diagnosis, education, municipality of residence, screening group, year of HIV diagnosis, late presentation, AIDS-defining condition, year of diagnosis as AIDS case, vital status at the end of 2011, and year of death (if applicable). Incidence of HIV and AIDS, cumulative incidence by municipality of residence, and case fatality rates were calculated. RESULTS: Those aged 20-29 years were most affected by HIV. Almost half (46.7%) the women had completed middle school, and a further 35.4% had completed high school or middle-level technical studies. HIV incidence began to increase more steeply starting in 1998, as did AIDS incidence by year of diagnosis, though to a lesser extent. Central Havana and Old Havana municipalities had the highest cumulative incidence. Late presentation was seen in 7.4% of cases; mean age of those diagnosed late was 38.9 years. Wasting syndrome and Pneumocystis jirovecii pneumonia were the most frequent AIDS-defining conditions. Case fatality rates started to decline in 1998. CONCLUSIONS: HIV infection in women is occurring in a predominantly young, relatively well-educated population. Increasing rates of HIV and AIDS in the past decade are a warning sign of the possible expansion of HIV infection in women, even though mortality is declining. <![CDATA[<b>Total cardiovascular risk assessment and management using two prediction tools, with and without blood cholesterol</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400009&lng=pt&nrm=iso&tlng=pt INTRODUCTION: Over the last decade, total cardiovascular risk assessment and management has been recommended by cardiovascular prevention guidelines in most high-income countries and by WHO. Cardiovascular risk prediction charts have been developed based on multivariate equations of values of some well-known risk factors such as age, sex, smoking, systolic blood pressure and diabetes, including or omitting total blood cholesterol. OBJECTIVE: The objectives of this study were: to determine the distribution of cardiovascular risk in a Cuban population using the WHO/International Society of Hypertension risk prediction charts with and without cholesterol; and to assess applicability of the risk prediction tool without cholesterol in a middle-income country, by evaluating concordance between the two approaches and comparing projected drug requirements resulting from each (at risk thresholds of ≥20% and ≥30%) and for the single-risk-factor approach. METHODS: From April through December 2008, a cross-sectional study was conducted in 1287 persons (85.8% of the sample selected), aged 40-80 years living in a polyclinic catchment area of Havana, Cuba, based on the protocol and data from a WHO multinational study. The study used the two sets of the WHO and the International Society of Hypertension (WHO/ISH) risk prediction charts, with and without cholesterol. Percentages and means were calculated, as well as prevalence (%) of risk factors. The chi-square test was used to compare means (p ≤0.05). Concordance between the two prediction charts was calculated for different risk levels, using the chart with cholesterol as a reference. RESULTS: Using the risk assessment tools with and without cholesterol, 97.1% and 95.4% respectively of the study population were in the ten-year cardiovascular risk category of <20%, while 2.9% and 4.6% respectively were in the category of ≥20%. Risk categories were concordant in 88.1% of the population; overestimation was higher among the nonconcordant (136/153). When risk assessment did not include cholesterol, there was 2.6% (34/1287) overestimation of drug requirements and 0.5% (6/1287) underestimation, compared to estimates including cholesterol. CONCLUSION: Total cardiovascular risk assessment using the WHO/ISH charts without cholesterol could be a useful approach to predict cardiovascular risk in settings where cholesterol cannot be measured. This does not introduce overconsumption of drugs, but does enable better targeting of resources to those who are more likely to develop cardiovascular disease. http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400010&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Depression in an older adult rural population in India</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400011&lng=pt&nrm=iso&tlng=pt INTRODUCTION: With a rapidly aging society, geriatric mental health is emerging as an important public health concern. According to the WHO, prevalence of depression in adults aged ≥60 years in developed and developing countries was 0.5 million and 4.8 million respectively in 2004. In India, increased life expectancy led to a rise in the older adult population between 2001 and 2011, expected to reach 324 million by 2050. OBJECTIVES: To estimate the prevalence of depression and assess association between sociodemographic parameters and depression among older adults in a rural Indian community. METHODS: A cross-sectional descriptive study was conducted in February and March 2012 in the rural village of Sembakkam, Kancheepuram District in the state of Tamil Nadu, India; the village has a population of 5948, 3.1% of whom are aged ≥60 years. Universal sampling technique was employed, in which every household in the community was visited and all elderly persons were selected. After obtaining written informed consent (a thumbprint was taken if the person was illiterate), participants were assessed face to face for depression using the Short Form Geriatric Depression Scale. The inclusion criterion was a score >24 on the mini-mental state examination. Final sample size was 103. Study variables included sociodemographic parameters such as age, sex, education, occupation, socioeconomic status, and marital status. Data entry and statistical analysis used SPSS version 17. RESULTS: Of 103 respondents interviewed, 73 (70.9%) were aged 60-69 years and 58 (56.3%) were male. Forty-four (42.7%) individuals (17 males, 27 females) were found to be depressed; 23 (22.3%) with mild depression, 14 (13.6%) moderate depression and 7 (6.8%) severe depression. Female sex and widowhood were significantly associated with depression. CONCLUSIONS: Depression, particularly mild depression, is common in this rural population of older adults, particularly among women and widowed elderly. These study findings can help program managers implement a more comprehensive strategy in this community for timely interventions to promote mental health and prevent geriatric depression. <![CDATA[<b>Frequency and antimicrobial sensitivity of <i>Ureaplasma urealyticum</i> and <i>Mycoplasma hominis</i> in patients with vaginal discharge</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400012&lng=pt&nrm=iso&tlng=pt Determination of antimicrobial sensitivity helps establish adequate treatment and avoids future genital tract diseases in women of fertile age. In Cuba, prevalence of mycoplasma in patients with vaginal discharge is unknown. The objective of this research was to determine frequency and antimicrobial sensitivity of Ureaplasma urealyticum and Mycoplasma hominis in women with vaginal discharge through analysis of laboratory data from vaginal smears from 255 patients referred to the Municipal Hygiene and Epidemiology Center in Güines, Mayabeque Province, Cuba. Mycoplasma System Plus (Italy) was used for detection, identification, count and sensitivity testing. The finding of mycoplasmas in almost two thirds of specimens examined suggests that the sexually active female population should be screened for these bacteria and that barrier contraception methods should be promoted to decrease their spread and prevent longterm sequelae. Such updating of local patterns of antimicrobial resistance supports decision making for best treatment options in patients with these infections. Our results should help clinicians in our area choose an antibiotic, and also confirm the utility of Mycoplasma System Plus for mycoplasma research in resource-scarce settings, to benefit individual and population health. <![CDATA[<b>Cuban research in current international journals</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400013&lng=pt&nrm=iso&tlng=pt Determination of antimicrobial sensitivity helps establish adequate treatment and avoids future genital tract diseases in women of fertile age. In Cuba, prevalence of mycoplasma in patients with vaginal discharge is unknown. The objective of this research was to determine frequency and antimicrobial sensitivity of Ureaplasma urealyticum and Mycoplasma hominis in women with vaginal discharge through analysis of laboratory data from vaginal smears from 255 patients referred to the Municipal Hygiene and Epidemiology Center in Güines, Mayabeque Province, Cuba. Mycoplasma System Plus (Italy) was used for detection, identification, count and sensitivity testing. The finding of mycoplasmas in almost two thirds of specimens examined suggests that the sexually active female population should be screened for these bacteria and that barrier contraception methods should be promoted to decrease their spread and prevent longterm sequelae. Such updating of local patterns of antimicrobial resistance supports decision making for best treatment options in patients with these infections. Our results should help clinicians in our area choose an antibiotic, and also confirm the utility of Mycoplasma System Plus for mycoplasma research in resource-scarce settings, to benefit individual and population health. <![CDATA[<b>Aging and dementia</b>: <b>implications for Cuba's research community, public health and society</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400014&lng=pt&nrm=iso&tlng=pt Dementia is a syndrome that has great repercussions for quality of life of patients and their families, as well as a high social cost. A [2009] systematic review of research evidence and consensus of expert opinions showed that 36 million people live with dementia worldwide, with 4.6 million new cases every year (similar to the global incidence of nonfatal stroke). The prevalence of dementia in older Cubans is high, with rates ranging from 6.4% to 10.2%, or about 130,000 persons (1.1% of the total population). This number is expected to rise to 260,000 by 2030. The age-standardized annual incidence of dementia is also high: 21 per 1000 population, with 28,750 new cases annually. Dementia is the leading cause of disability among older adults and is the main cause of dependency, financial burden and caregiver stress. In this review, we highlight the importance of epidemiological research to obtain greater knowledge of the disease, improve health services, promote actions for prevention and early diagnosis, and implement a national strategy to address dementia in the Cuban population, itself now immersed in two processes: accelerated demographic aging and epidemiologic transition. <![CDATA[<b>Burnout among Cuban nurses</b>: <b>out of the shadows</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602013000400015&lng=pt&nrm=iso&tlng=pt Dementia is a syndrome that has great repercussions for quality of life of patients and their families, as well as a high social cost. A [2009] systematic review of research evidence and consensus of expert opinions showed that 36 million people live with dementia worldwide, with 4.6 million new cases every year (similar to the global incidence of nonfatal stroke). The prevalence of dementia in older Cubans is high, with rates ranging from 6.4% to 10.2%, or about 130,000 persons (1.1% of the total population). This number is expected to rise to 260,000 by 2030. The age-standardized annual incidence of dementia is also high: 21 per 1000 population, with 28,750 new cases annually. Dementia is the leading cause of disability among older adults and is the main cause of dependency, financial burden and caregiver stress. In this review, we highlight the importance of epidemiological research to obtain greater knowledge of the disease, improve health services, promote actions for prevention and early diagnosis, and implement a national strategy to address dementia in the Cuban population, itself now immersed in two processes: accelerated demographic aging and epidemiologic transition.