Scielo RSS <![CDATA[MEDICC Review]]> http://www.scielosp.org/rss.php?pid=1555-796020120004&lang=en vol. 14 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Eye on the prize</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400001&lng=en&nrm=iso&tlng=en <![CDATA[<b>SIDATRAT</b>: <b>informatics to improve HIV/AIDS care</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400002&lng=en&nrm=iso&tlng=en AIDS is a major cause of death in the Caribbean, a region with a high prevalence of HIV. However, prevalence in Cuba's population aged 15 to 49 years, despite a slight increase in recent years, is considered extremely low (0.1%). At the close of 2010, 5692 Cuban patients were receiving antiretroviral therapy. SIDATRAT, an informatics system, was developed at the Pedro Kourí Tropical Medicine Institute in Havana to ensure proper monitoring and followup of drug administration. Functioning on a web platform utilizing an Apache server, PHP and MySQL, it records patients' general information, CD4 counts, viral load and data from other laboratory tests, as well as endoscopic and imaging studies. It also compiles information on their AIDS classification, opportunistic infections, HIV subtype and resistance studies, followup consultations, drug regimen, adverse reactions to medications, changes in drug combinations, and survival; and tracks total number of individuals under treatment. SIDATRAT follows the client-server philosophy and enables access by authorized users throughout Cuba via the health informatics network. SIDATRAT has been found effective in supporting quality care for persons living with HIV/AIDS and universal access to antiretroviral therapy, compiling most of the information needed for decisionmaking on patient health and therapies. SIDATRAT has been offered to the UNDP office in Havana for sharing with other developing countries that may wish to adapt or implement it. <![CDATA[<b>PAHO's presence in Cuban health</b>: <b>José Luis Di Fabio PhD PAHO/WHO representative in Cuba</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400003&lng=en&nrm=iso&tlng=en AIDS is a major cause of death in the Caribbean, a region with a high prevalence of HIV. However, prevalence in Cuba's population aged 15 to 49 years, despite a slight increase in recent years, is considered extremely low (0.1%). At the close of 2010, 5692 Cuban patients were receiving antiretroviral therapy. SIDATRAT, an informatics system, was developed at the Pedro Kourí Tropical Medicine Institute in Havana to ensure proper monitoring and followup of drug administration. Functioning on a web platform utilizing an Apache server, PHP and MySQL, it records patients' general information, CD4 counts, viral load and data from other laboratory tests, as well as endoscopic and imaging studies. It also compiles information on their AIDS classification, opportunistic infections, HIV subtype and resistance studies, followup consultations, drug regimen, adverse reactions to medications, changes in drug combinations, and survival; and tracks total number of individuals under treatment. SIDATRAT follows the client-server philosophy and enables access by authorized users throughout Cuba via the health informatics network. SIDATRAT has been found effective in supporting quality care for persons living with HIV/AIDS and universal access to antiretroviral therapy, compiling most of the information needed for decisionmaking on patient health and therapies. SIDATRAT has been offered to the UNDP office in Havana for sharing with other developing countries that may wish to adapt or implement it. <![CDATA[<b>Reducing case fatality from acute myocardial infarction in cienfuegos, Cuba, 1994-2009</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400004&lng=en&nrm=iso&tlng=en Between 1994 and 2009, the Dr Gustavo Aldereguía University Hospital of Cienfuegos, Cuba implemented a series of interventions that reduced acute myocardial infarction case fatality rate from 47% to 15%. These interventions were part of an institutional plan for myocardial infarction included in the hospital's overall quality assurance strategy. Outcomes resulted primarily from organizational changes (from upgrading of the hospital emergency department and provincial emergency system to creation of a comprehensive coronary care unit and a chest pain center); optimizing use of effective drugs (streptokinase, aspirin, ACE inhibitors and beta blockers); adherence to clinical practice guidelines; and continual and participatory evaluation and adjustment. <![CDATA[<b>Acute myocardial infarction mortality in Cuba, 1999-2008</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400005&lng=en&nrm=iso&tlng=en INTRODUCTION: Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years. OBJECTIVE Describe acute myocardial infarction mortality in Cuba from 1999 through 2008. METHODS A descriptive study was conducted of persons aged >25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age- and sex-specific rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two five-year time frames within the study period. RESULTS A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51.8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the first five-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged >75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both five-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively). CONCLUSIONS Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care assessments for these patients. <![CDATA[<b>Audio computer-assisted self interview compared to traditional interview in an HIV-related behavioral survey in Vietnam</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400006&lng=en&nrm=iso&tlng=en INTRODUCTION: Globally, population surveys on HIV/AIDS and other sensitive topics have been using audio computer-assisted self interview for many years. This interview technique, however, is still new and little is known about its application and impact in general population surveys in Vietnam. One plausible hypothesis is that residents of Vietnam interviewed using this technique may provide a higher response rate and be more willing to reveal their true behaviors than if interviewed with traditional methods. OBJECTIVE This study aims to compare audio computer-assisted self interview with traditional face-to-face personal interview and self-administered interview with regard to rates of refusal and affirmative responses to questions on sensitive topics related to HIV/AIDS. METHODS In June 2010, a randomized study was conducted in three cities (Ha Noi, Da Nan and Can Tho), using a sample of 4049 residents aged 15 to 49 years. Respondents were randomly assigned to one of three interviewing methods: audio computer-assisted self interview, personal face-to-face interview, and self-administered paper interview. Instead of providing answers directly to interviewer questions as with traditional methods, audio computer-assisted self-interview respondents read the questions displayed on a laptop screen, while listening to the questions through audio headphones, then entered responses using a laptop keyboard. A MySQL database was used for data management and SPSS statistical package version 18 used for data analysis with bivariate and multivariate statistical techniques. Rates of high risk behaviors and mean values of continuous variables were compared for the three data collection methods. RESULTS Audio computer-assisted self interview showed advantages over comparison techniques, achieving lower refusal rates and reporting of higher prevalence of some sensitive and risk behaviors (perhaps indication of more truthful answers). Premarital sex was reported by 20.4% in the audio computer-assisted self-interview survey group, versus 11.4% in the face-to-face group and 11.1% in the self-administered paper questionnaire group. The pattern was consistent for both male and female respondents and in both urban and rural settings. Men in the audio computer-assisted self-interview group also reported higher levels of high-risk sexual behavior-such as sex with sex workers and a higher average number of sexual partners-than did women in the same group. Importantly, item refusal rates on sensitive topics tended to be lower with audio computer-assisted self interview than with the other two methods. CONCLUSIONS Combined with existing data from other countries and previous studies in Vietnam, these findings suggest that researchers should consider using audio computer-assisted self interview for future studies of sensitive and stigmatized topics, especially for men. <![CDATA[<b>Clinical impact of RehaCom Software for cognitive rehabilitation of patients with acquired brain injury</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400007&lng=en&nrm=iso&tlng=en We describe the clinical impact of the RehaCom computerized cognitive training program instituted in the International Neurological Restoration Center for rehabilitation of brain injury patients. Fifty patients admitted from 2008 through 2010 were trained over 60 sessions. Attention and memory functions were assessed with a pre- and post-treatment design, using the Mini-Mental State Examination, Wechsler Memory Scale and Trail Making Test (Parts A and B). Negative effects were assessed, including mental fatigue, headache and eye irritation. The program's clinical usefulness was confirmed, with 100% of patients showing improved performance in trained functions. <![CDATA[<b>An efficient sampling approach to surveillance of non-communicable disease risk factors in Cienfuegos, Cuba</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400008&lng=en&nrm=iso&tlng=en One of the most common shortcomings in non-communicable disease risk factor surveillance, especially in prevalence studies, is sampling procedure, which can and does compromise accuracy and reliability of derived stimates. Moreover, sampling consumes significant time and resources. Since the early 1990s, risk factor surveys in Cienfuegos province, Cuba have paid particular attention to careful sampling methods. The new survey conducted in 2011 was not only statistically rigorous but introduced an innovative, more effi cient method. This article provides a detailed description of the sample design employed to optimize resource use without compromising selection rigor. <![CDATA[<b>New indicators proposed to assess tuberculosis control and elimination in Cuba</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400009&lng=en&nrm=iso&tlng=en Following 48 years of successful operation of the National Tuberculosis Control Program, Cuban health authorities have placed tuberculosis elimination on the agenda. To this end some tuberculosis control processes and their indicators need redesigned and new ones introduced, related to: number and proportion of suspected tuberculosis cases among vulnerable population groups; tuberculosis suspects with sputum microscopy and culture results useful for diagnosis (interpretable); and number of identified contacts of reported tuberculosis cases who were fully investigated. Such new indicators have been validated and successfully implemented in all provinces (2011-12) and are in the approval pipeline for generalized use in the National Tuberculosis Control Program. These indicators complement existing criteria for quality of case detection and support more comprehensive program performance assessment. <![CDATA[<b>Community engagement, personal responsibility and self help in cuba's health system reform</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400010&lng=en&nrm=iso&tlng=en In 2011 the Cuban health system began a process of sectoral reform to maintain and improve the health of Cuba's population, in response to new challenges and demands in the health sector and population health status. The main actions involved are reorganization, consolidation and regionalization of services and resources. Although community engagement and personal responsibility are not explicitly mentioned in the strategy document, it is advisable to use this opportunity to revitalize both topics and encourage appropriate and full incorporation into the Cuban health system. Both are consistent with the objectives and actions of system reforms proposed, in that they allow the various social actors to assume shared responsibility in working toward social goals-in this case, health gains. This approach also recognizes that reaching such goals is a collective endeavor, to be pursued according to ethical principles (beneficence as responsibility and justice as solidarity), with community involvement and personal responsibility emerging as two important factors subject to reorientation in the context of the health system reform under way. <![CDATA[<b>Cuban research in current international journals</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400011&lng=en&nrm=iso&tlng=en In 2011 the Cuban health system began a process of sectoral reform to maintain and improve the health of Cuba's population, in response to new challenges and demands in the health sector and population health status. The main actions involved are reorganization, consolidation and regionalization of services and resources. Although community engagement and personal responsibility are not explicitly mentioned in the strategy document, it is advisable to use this opportunity to revitalize both topics and encourage appropriate and full incorporation into the Cuban health system. Both are consistent with the objectives and actions of system reforms proposed, in that they allow the various social actors to assume shared responsibility in working toward social goals-in this case, health gains. This approach also recognizes that reaching such goals is a collective endeavor, to be pursued according to ethical principles (beneficence as responsibility and justice as solidarity), with community involvement and personal responsibility emerging as two important factors subject to reorientation in the context of the health system reform under way. <![CDATA[<b>Banishing biases to save lives</b>: <b>introducing genetic testing for familial cancers</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400012&lng=en&nrm=iso&tlng=en In 2011 the Cuban health system began a process of sectoral reform to maintain and improve the health of Cuba's population, in response to new challenges and demands in the health sector and population health status. The main actions involved are reorganization, consolidation and regionalization of services and resources. Although community engagement and personal responsibility are not explicitly mentioned in the strategy document, it is advisable to use this opportunity to revitalize both topics and encourage appropriate and full incorporation into the Cuban health system. Both are consistent with the objectives and actions of system reforms proposed, in that they allow the various social actors to assume shared responsibility in working toward social goals-in this case, health gains. This approach also recognizes that reaching such goals is a collective endeavor, to be pursued according to ethical principles (beneficence as responsibility and justice as solidarity), with community involvement and personal responsibility emerging as two important factors subject to reorientation in the context of the health system reform under way. <![CDATA[<b>Erratum</b>;]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1555-79602012000400013&lng=en&nrm=iso&tlng=en In 2011 the Cuban health system began a process of sectoral reform to maintain and improve the health of Cuba's population, in response to new challenges and demands in the health sector and population health status. The main actions involved are reorganization, consolidation and regionalization of services and resources. Although community engagement and personal responsibility are not explicitly mentioned in the strategy document, it is advisable to use this opportunity to revitalize both topics and encourage appropriate and full incorporation into the Cuban health system. Both are consistent with the objectives and actions of system reforms proposed, in that they allow the various social actors to assume shared responsibility in working toward social goals-in this case, health gains. This approach also recognizes that reaching such goals is a collective endeavor, to be pursued according to ethical principles (beneficence as responsibility and justice as solidarity), with community involvement and personal responsibility emerging as two important factors subject to reorientation in the context of the health system reform under way.