|
||||||||||
|
||||||||||
CUBAN MEDICAL LITERATURE Abstracts Origin, Present Situation and Prospects for the National Network of Pediatric Surgery This paper presents the strategies and results attained in informatics during the development of the National Network of Pediatric Surgery and its headquarters, the "Octavio de la Concepción de la Pedraja" Pediatric Teaching Hospital in Holguín. This hospital was chosen in 2003 as the venue for the telecommuncations network project that will support the management of pediatric surgery throughout the country. It created six main areas of work, namely, the institution's internal network, the national network, software and websites, theoretical informatics projects, knowledge management, as well maximum exploitation of the best equipment in every territory. The results in the telecommunications development of the National Network of Pediatric Surgery and its headquarters show that it is possible to achieve gradual computerization in a hospital, with limited material resources, if human resources are developed to the best of their capacities. Keywords : networks, telecommunication, pediatric surgery, Cuba Source: ACIMED, 12:3; May-Jun, 2004. Costs of Prenatal Care for Women - Havana, 2000 A partial economic assessment is presented in the form of cost analysis of the "pocket expenses" group. The sample included 340 women who were split into two groups: a control group and an intervention group. This research was carried out in 10 polyclinics in three municipalities in Havana City, the women of which generally give birth in "América Arias" hospital. During this research, the polyclinics were also part of a wider study which included economic assessment; this was classified as a controlled multi-centric random trial, and carried out under the auspices of the World Health Organization, to validate a care protocol in four prenatal visits in relation to the regular program. The sample was calculated with a reasonable extent for the average value reliability interval. The basic source of information was the questionnaire applied to all women in the sample. The main results highlight the peculiarities of the costs under study not only between the two groups, but also between polyclinics. These results are rendered in absolute frequencies and percentages, with calculations of mean, standard deviation and significance tests. The total number of visits was slightly higher than that established in the care protocol. The time used for transportation and the actual visit was similar for both groups. As regards the opportunity cost, the pregnant women preferred not to combine their visits to the doctor with other activities. There were no statistically significant variations between the two groups in relation to pocket expenses associated with prenatal care visits. Keywords: PRENATAL CARE/ECONOMY; ECONOMIC ANALISIS; HEALTH ECONOMY: HEALTH CARE COSTS; COSTS AND COST ANALISIS; PREGNANCY; FEMALE. Source: Rev. Cubana Salud Pública, 30:1; Jan-Mar, 2004. Bacterial Meningoencephalitis in Cuba's Child Population: 1998-2000 A description is made of some epidemiological features of Bacterial Meningoencephalitis (BME) in Cuba between 1998 and 2000, according to available data recorded by the National Bacterial Meningoencephalitis Surveillance. Five hundred and thirty cases were reported in children under 15 years of age in the whole country during this period. The age group that was most affected was that of children under 5 years old. The most frequently identified agents were Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (Spn), and Neisseria meningitidis (Nm). The incidence of Hib was four times lower as a result of massive vaccination, especially in children under 5. Spn has been the main BME-causing and most lethal agent in Cuba since 2000. Overall lethality increased from 10.6% to 20.4%, the under-one-year age group being most severely affected. Future studies will make it possible to go deeper into the epidemiology of these affections and to monitor the changes resulting from intervention. Keywords: MENINGOENCEPHALITIS/EPIDEMIOLOGY; MENINGOENCEPHALITIS/IMMUNOLOGY; EPIDEMIOLOGICAL SURVEILLANCE; BACTERIAL VACCINES; CHILDREN; BACTERIAL MENINGITIS/EPIDEMIOLOGY; BACTERIAL MENINGITIS/IMMUNOLOGY. Source: Revista Cubana de Pediatria, 74:2. Fats in Maternal Diet, Gestational Age and Birth Weight Fats in maternal diet play determining roles in the development of a normal pregnancy, the structure of an adequate uterus-placenta flow, the formation of cellular membranes, intrauterine fetus growth and the development of the central nervous system. This paper aims to measure the relationship between the fatty acids in maternal diet according to gestational age and the newborn child's birth weight. A transversal study was conducted in 156 pregnant women and 160 babies carried full term as a result of normal deliveries in Havana between February 2000 and January 2001. Food ingestion was measured by means of semi-quantitative frequency surveys on food consumption during the final trimester of pregnancy. Birth weight of the newborn child and mother gestational age were recorded at the time of delivery. Birth weight, the contribution of saturated fatty acids and the saturated/polyunsaturated fatty acids ratio in diet for all children (between 34 and 37 weeks of pregnancy) were negatively associated regardless of birth weight. This significance was lost when a separate analysis was made of children born with normal weight. Gestational age and the total amount of fat ingested (more than 34 weeks of pregnancy) were negatively correlated in all children, but significance was also lost for this correlation when the children with normal birth weight were assessed separately. Gestational age was negatively correlated with the essential and polyunsaturated fatty acids (more than 34 weeks of pregnancy) for all children - including those with normal birth weight. In the future, the fatty acids profile should be studied directly in the newborn children's blood, in order to minimize estimation errors inherent to dietetic information. Keywords: DIET IN PREGNANCY; FATTY ACIDS; GESTATIONAL AGE; BIRTH WEIGHT. Source: Rev Cubana Salud Pública 2004;30(2) Clinical, Psychological and Laboratory Assessment of Children with Benign Hyperphenylalaninemia at Birth Hyperphenylalaninemias, alterations in phenylalanine metabolism, hold genetic, clinical and biochemical heterogeneity with in-plasma phenylalanine higher than 120 µmol/L (2 mg/dL). Benign hyperphenylalaninemia ranges from 240 to 600 µmol/L (4 to 10 mg/dL) with higher enzymatic activity and does not require dietetic treatment. A clinical and laboratory assessment was made on 32 children with this alteration at birth between 1989 and 1999, in order to identify variations in serial concentration with time, the appearance of symptoms or clinical signs of the disease, and the intelligence quotient of these children. The 32 children in the study showed diminished amino acid levels, as compared with their birth, between 90 and 287 µmol/L (1, 5 mg/dL to 5, 52 mg/dL). Most of them showed no clinical symptoms or signs of phenylketonuria. The average intelligence quotient was 100.6 points. Recommendations are made to study all children suffering from this alteration in Cuba and to undertake mutation studies to demonstrate the allelic heterogeneity that will explain variable expressiveness in these children's biochemical and clinical phenotype. Keywords : PHENYLKETONURIA; PHENYLALANINE/ANALYSIS; CLINICAL DIAGNOSIS; CHILD; CHILD PSYCHOLOGY; CHILD DEVELOPMENT . Source: Rev. Cubana de Pediatría, 2002;74(4) Benefits of Using Epicutaneous Catheters in the Newborn Child A transversal and retrospective descriptive study was carried out in order to demonstrate the benefits of using epicutaneous catheters in intensive neonatology care at the "América Arias" Gyno-Obstetric Teaching Hospital. The study focused on the most important features of the epicutaneous catheter procedure and technique in a sample of 37 newborns. The universe included all the newborns hospitalized in the neonatology service. The methods used were documental and directed observation, based on collection of data registered in the medical histories. The following data were collected for the study: gestational age, catheter permanence, the duration of the newborn in neonatology care, reason for catheter prescription, place of insertion, catheter-associated complications, and reasons for removal. The epicutaneous catheter was most frequently prescribed to newborns who showed acquired sepsis, congenital bronchopneumonia and severe perinatal asphyxia. The right upper limb was the most common puncture site for catheterization. Of all the newborns in the study, 83.7% did not show complications. Phlebitis was the most common complication detected, with three cases or 8.1%. The main reason for removal was the elective mode, in 59.5% of the cases. The average durability of the catheter was 12 days, and the average stay of the newborns in neonatology was 18 days. This study intends to contribute to a better diffusion of this procedure, and to extend to other neonatology services in the country the experiences achieved regarding the benefits of using epicutaneous catheters in newborns. Keywords : EPICUTANEOUS CATHETER; NEWBORN Source: Rev Cubana Enfermeria, 2004;20(2) Molecular Characterization of Cuban Phenylketonuric Patients More than 500 mutations of the human phenylalanine hydroxilasa gene have been described so far for its 13 exons; of these, number 7 contains the highest number. The fact that phenylketonuria is caused by punctual mutations makes it necessary to use a method that allows a quick analysis of each individual. This study included the analysis of the genomic deoxyribonucleic acid (DNA) of 28 phenylketonuric (PKU) patients and their parents, coming from different parts of Cuba. An amplification was made by means of polymerase chain reaction (PCR) in the 13 exons, before using the method of denaturalizing gradient gel electrophoresis (DGGE) and sequencing. Sixteen different mutations were found in 91% of the independent chromosomes in these patients, E280K and R261Q (originally from Galicia), being the most frequent mutations. Mendelian inheritance was tested in the parents. The most frequent mutations in Cuba do not coincide with those in Spain and Latin America. Keywords : PHENYLKETONURIA/DIAGNOSIS; PHENYLALANINE HYDROXILASA/ANALYSIS; PHENYLALANINE HYDROXILASA/GENETICS; MUTATION; ADN; POLYMERASE CHAIN REACTION; HEREDITARY DISEASES; MOLECULAR BIOLOGY . Source: Rev Cubana Pediatria 2002;74(2) Cuban Maternity Homes: A Comprehensive Study Cuba is known throughout the world as an advanced public health state. Its international reputation is immediately confirmed by an analysis of the maternal and infant health indicators of countries in Latin America and the Caribbean, and beyond. Cuba's exceptional maternal and infant health indicators are associated with one of the country's most unique and under-documented public health programs, hogares maternos, or maternity homes. Maternity homes reveal that attention to social risk factors during pregnancy can have an impressive effect on maternal and infant health indicators. Cuban maternity homes demonstrate to the international health and development community an innovative way to make pregnancy and childbirth safer. Using qualitative methodology, this report examines: (1) evolution of maternity homes in Cuba from 1962 to present, (2) structure and function of maternity homes, as well as their health effects, (3) management and financing of maternity homes, and (4) best practices to be potentially utilized by other country's public health programs. Amanda Peréz was a student at the George Washington University School of Public Health when this paper was completed in October 2001; she can be reached at amandaperez@rcn.com |
||||||||||
|
||||||||||
