spuPOR108_inglés
spu06108
Territory and contexts in the field of the population´s health
For the last two decades, advances have been made in the documentation of
social and health problems of the population in the region within the
framework of increased inequalities and inequities, more decentralizing
processes and progressive introduction of data processing and analysis
methods and techniques. The following reflections were aimed at discussing
the few advances made in the inclusion of life environment information in the
population health analyses per territory, and its possible effects on the
comparison among units placed at the same level. The favorable conditions
in which health information had developed and the persistence of some
problems such as lack of integrated data, and likely evolution of data
production and analysis techniques at a pace faster than that of necessary
theoretical and/or methodological reformulations were described. Some
assumptions related to heterogeneity of territorial divisions and of population
distribution in Cuba were stated. The review or clarification of existing
indicators, or the creation of new ones particularly those accounting for the
most recent domestic changes were suggested, with a view to updating the
classification of territories by their living conditions or by type of population.
Also, the proposal of building alternative or supplementary territorial units
characterized by more homogeneous contexts was made in order to improve
the analysis of social production of health problems.
Key words: Territory, contexts, health information, population health
problem distribution, Cuba.
spu08108
Variability and climate change in Cuba: potential impact on the human
health
Estimating the variability of climate changes and the threats derived from the
extension of this event are of vital importance for the impact that this may
have on diseases and on the National Healthcare System as well.
Additionally, identifying the healthcare sector vulnerabilities is gaining today
particular importance for the strategy of the Cuban population adaptation to
climate changes. The main results of research studies conducted in Cuba
about Climate Changes and Human Health were provided. Reflections were
also made on how the relationships that allow describing the potential
impacts on health should be studied and how the vulnerabilities may be
identified using a methodological procedure, that is, the MACVAH/AREEC
model, and three sophisticated indexes devised in Cuba from the general
guidelines and steps submitted for the vulnerability to climate change studies
in the healthcare sector. Costs attributable to climate effects on health and
possible measures to support human adaptation were presented.
Key words: Variability, climate change and health, vulnerability.
spu09108
Biometeorological forecasts: a way of reducing occurrence of health
crises. The Sagua La Grande case
There has been a rise of medical service provision in Cuba and the country
shows health indicators comparable to those of the most developed nations. A
new procedure that will be useful for continuos improvement of the Cuban
population´s health is being worked out. It refers to the biometeorological
forecast method aimed at providing health institutions and emergency
services with early and timely information about the prevention and treatment
of some non-communicable chronic diseases with high incidence in the
country. Such a method can alert to favorable conditions for unleashing
health crisis up to 180 hours in advance on the basis of the changes of partial
air oxygen density within 24 hours, the type of prevailing synoptic situation
and the local effects of the environmental pollution. In order to validate the
results of these forecsts, a pilot study is being conducted from December 1st,
2006 in health centers located in Sagua La Grande municipality, which
monitors daily occurence of several diseases and their association to sudden
weather changes. The diseases under study were bronchial asthma,
cardiovascular diseases, strokes, hypertension, headaches and some types of
acute respiratory diseases. The preliminary satisfactory results of the
operation of this biometeorological forecast service in health centers located
in Sagua la Grande municipality during the little rain period (winter) from
2006 to 2007 were shown.
Key words: Biometeorology, forecasts, human health.
spu10108
Sexual health and aging
The process of changes in the population is continuos and permanent. In
previous times, the evolution of the populational structure was slow, but at
present, very fast movements have occured as a result of the accelerated
impact of decreased fertility and increased life expectancy, which has given
rise to an important population section over 60 years of age existing in many
countries like Cuba. In 1994, a new concept on reproductive health took
shape at international bodies and was accepted by many nations worldwide;
this concept together with the population development calls for new
considerations about the perceptions and behaviors of the elderly´s sexuality.
Consequently, it is necessary to assess the ways of feeling and acting by this
group and also their effects on sexual health, a topic of great significance at
the present time. Some interesting elements on the sexual health of the people
aged 60 years and over were provided; this made it possible to make
reflections on the current sexual behavior of the elders and to contribute to an
accurate assessment of these aspects.
Key words: Sexual health, population aging.
spu11108
Fertility in Cuba from the end of the 20th to the beginning of the 21st
century
Fertility in Cuba has had historically low levels, particularly since 1978 when
fertility levels began declining in a permanent way. Since 1970, the fertility
pattern has been characterized by a markedly early structure, mainly
adolescent fertility. From 1990 to 2005, the declining level was kept whereas
the structure or pattern tended to vary. As a result two behaviors were
observed: firstly, a tendency to marked decrease from 1990 to 1995 and
secondly, certain fluctuations with a tendency to stability till 2005. The
highest fertility decrease occurred in the period from 1990 to 1996. On the
other hand, the fertility pattern showed a higher prevalence of older age
groups over 30 years and lower incidence of teenagers (except for
pregnancies). The fertility levels kept slightly higher in non-working women
and in countryside residents, and besides, it was observed that although
education was pretty homogeneous, women graduated from the university
exhibited higher fertility levels. Likewise, the fertility behavior was assessed
in the various regions of the country, noting that there were differences in
terms of structure and level.
Key words: Fertility, tendencies, Cuba.
spu12108
Validation of MBG Questionnaire (Martin-Bayarre-Grau) for the
evaluation of therapy adherence in blood hypertension patients
Introduction A research project aimed at evaluating the levels of adherence
to treatment in hypertensive persons is being conducted in the National
School of Public Health of Cuba; to this end, the construction and validation
of a questionnaire in order to measure this aspect were required.
Objectives To present the process of validation of contents and the logical
construction of the questionnaire as well as the evaluation of its internal
consistency.
Methods Contents validation was carried out using a methodology submitted
by Moriyama. The sample used to evaluate internal reliability and validity of
the internal construction of MBG questionnaire was made up of patients with
essential blood hypertension, aged over 20 years and living in the health area
under Van Troi polyclinics (N: 114) in Centro Habana municipality. Internal
consistency was determined by Cronbach` s alpha coefficient estimation
whereas validity of MBG construction was evaluated by a factor analysis of
main components.
Results Cronbach´s alpha coefficient of internal consistency was 0,889 for
the sample. The contents validation allowed considering that the formulation
of items was reasonable, they were clearly defined and their presence in the
questionnaire was justified; the submitted categories to be included in the
construction of this instrument were adequate. The results indicated the
existence of three factors: active adherence, autonomy in the face of
treatment and adherence complexity, all of which accounted for 68,72% of
accrued variance.
Conclusions The achieved results were favourable.
An instrument
comprising adequate conditions and valid criteria that support its use and
application in the field of research and of medical practice is available.
Key words: Therapy adherence,
questionnaire, blood hypertension.
treatment
adherence,
validation,
spu13108
Marketing in the Cuban healthcare system
Introduction A number of elements on the origin of the social approach to
marketing closely related to health and the reasons why these professionals
are not suitably prepared for using marketing strategies were provided
Objectives To determine the main causes of the non-use of marketing as a
health management tool in the national healthcare system.
Methods A descriptive research based on quantitative and qualitative
techniques and on the methodological triangulation strategy.
Results Little knowledge about marketing and positive attitude towards
marketing implementation in the healthcare field; the great majority of
professionals is interested in acquiring knowledge and delving into this topic
because of its advantages for the work. Particular scenarios and contexts,
training processes and the emphasis given by different formation activities to
social marketing have a great effect on the attitudes of health managers,
officials and professionals. Marketing strategies are applied in specific cases
but not on the basis of knowledge and developed skills. There was a
consensus of the need to implement it in order to achieve better quality and
higher profitability in health programs and services.
Conclusions The scope of research is extended, with results that enrich the
process of formation and qualification in health marketing. There exist
capabilities of response for the formation process in this field at every
managerial level of the national healthcare system, which will be also
supported by positive attitudes to the use of marketing. Adequate information
for the working up of a strategy that positively affects the health management
is available.
Key words: Health marketing, knowledge, attitudes, practice.
spu14108
Direct costs of home-based care in Cuba
Introduction Home-based care is a primary health care option mainly aimed
at improving the patient care and at using available economic resources more
effectively. There have been few studies on this care modality that included
different geographical settings in Cuba.
Objectives To estimate and to characterize the direct cost of home care in the
various geographical areas of the island.
Methods A partial cost study was conducted from 2001 to 2002 in four
Cuban geographical areas. Those costs afforded by the national healthcare
system and part of those paid by the families were analyzed. The considered
items were human resources, waste materials, diagnostic means and drug
therapy. Cost per patient and per cause of home care was estimated. The total
number of patients cared at home was 837.
Results The cost per patient ranged from nearly 10,00 to 20,00 pesos. The
rural setting showed the highest cost in this regard. Items that contributed the
most were salary and drug therapy. The difference between cost per patient in
a rural area and in the other areas was determined by the kind of treatment.
Home-based care accounted for an average family cost, in terms of purchase
of drugs, from 7,00 to 18,00 pesos per patient.
Conclusions Home care generated comparable average costs in both rural
and urban areas. Respiratory diseases were the most costly and the
contribution by the various items was similar regardless of the geographical
area and of the cause of home care. As the condition of the patients became
more critical, differences in terms of costs between urban and rural areas
were observed, and cost increases mainly occurred at the expense of the item
“treatment.”
Key words: Costs, home-based care, primary healthcare.
spu15108
Studies on active screening in Cuba
The Cuban state takes responsibility for the population’s health care, and for
the search of and timely solution of health problems at the primary care level
that constitutes the fundamental pillar of the Cuban healthcare system. At the
same time, it represents the main scenario where big changes are taking place
owing to the introduction of better or new technologies, the opening up of
new services and the wide extension of education, which means that the
health area turns into a medical university to teach medical sciences and into
the place where the improvement of the Comprehensive Medical Care to the
Family and the Community is focused; this Program is aimed at developing
comprehensive medical care of excellence for the people, the families, the
groups and the community at large. The patient classification is closely linked
to the active screening programs that Cuba is conducting at present, and is the
important topic that was reviewed in this paper. Active screening essentially
lies in systematic clinical examination of the population and its final
objective is the reduction of the screened disease-specific mortality rate, so it
detects the highest number of individuals in need of a timely and effective
treatment in order to improve their quality of life. The requirements for a
study of this type and the typical inclusion criteria that a disease should meet
to be accepted for a screening program were explained; additionally, the
Cuban experience in child and adult screening as well as the main challenges
for its implementation in both groups of persons were dealt with.
Key words: Screening, epidemiology, health care service, Cuba.
spu16108
Low birthweight: a look at the influence of social factors
A descriptive study was conducted to show how the social and economic
factors of a country may substantially affect maternal and fetal malnutrition
resulting in low birthweight newborns, all of which is closely related to a
higher incidence of infant mortality. Low birthweighted neonates is a
worldwide problem at present, particularly in the Third World countries
located in Asia, Africa, Latin America and the Caribbean where hunger and
poverty derived from neoliberal globalization prevail, and also the sinister
idea of converting food into fuels is another problem to be faced. It was
proved that economic factors, social and political systems ruling in each
country are decisive to avoid low birthweight children. The Millennium
Development Goals laid out by the different UN organizations were pointed
out.
Key words: Socio-economic
malnutrition, low birthweight.
factors,
agricultural
fuels,
maternal
spu17108
Latin American social and historical references: contribution to the
political fundamentals of health promotion
The present article underlined some contributions by the Latin American
medical and social thinking that have been barely mentioned in the existing
documents about health promotion. However, the theoretical and
methodological contributions made by a number of social scientists from
these countries have achieved significant advances in the fields of medical
sociology, social epidemiology, group health, research-action, just to mention
some areas of knowledge. Likewise, various sociopolitical events that took
place in this continent since the 60`s have significantly influenced several
statements based on the social nature of health, thus enriching the way of
thinking and the way of acting – in the light of counter hegemonic political
positions – for the defense of the public health seen as a fundamental human
right.
Key words: Medical-social thinking, human right, Latin America, health
promotion.