Enfoque estratégico para la acreditación de la especialidad de Higiene y Epidemiología en Villa Clara / Strategic approach for the accreditation of the Hygiene and Epidemiology specialty in Villa Clara

La epidemiología es una ciencia básica de la Salud Pública porque sus fundamentos científicos permiten la toma de decisiones en los problemas de salud. Para controlar la calidad de la formación de los profesionales y perfeccionarla, se aplica el sistema de acreditación de escenarios docentes, proceso de gran importancia que garantiza la calidad del pregrado y el posgrado. En la Universidad de Ciencias Médicas de Villa Clara se realizó dicho proceso en la especialidad de Higiene y Epidemiología, fue utilizada la autoevaluación estratégica del escenario laboral como actividad previa. El interés de los autores es exponer el método seguido para cumplir con los requerimientos establecidos. Con la aplicación de esta matriz estratégica para lograr el estado deseado en el proceso docente de la especialidad de Higiene y Epidemiología en la Universidad de Ciencias Médicas de Villa Clara se logró una evaluación de excelente.

Epidemiology is a basic science of Public Health because its scientific foundations make possible decision-making regarding health problems. To control the training quality for professionals and improve it, the accreditation system for teaching scenarios is applied, a very important process that guarantees the quality of undergraduate and postgraduate training. At the University of Medical Sciences of Villa Clara, in the specialty of Hygiene and Epidemiology, this process was carried out; the strategic self-assessment of the work scenario as a prior activity, was used. To expose the method followed to comply with the established requirements, is the aim of the authors. By using this strategic matrix to achieve the desired state in the teaching process of the specialty of Hygiene and Epidemiology at the University of Medical Sciences of Villa Clara, an excellent evaluation was achieved.

Evaluación del Programa de Prevención, Diagnóstico y Control de la Hipertensión Arterial. Santa Clara. 2016 / Evaluation of the Prevention, Diagnosis and Control Program of Arterial Hypertension. Santa Clara. 2016

RESUMEN Introducción: La hipertensión arterial es la más común de las enfermedades que afectan la salud de los individuos en las poblaciones mundiales. Objetivo: Evaluar el cumplimiento del Programa de Prevención, Diagnóstico y Control de la Hipertensión Arterial en el municipio Santa Clara, en el año 2016. Métodos: Se realizó una investigación observacional, descriptiva, de corte transversal en sistemas y servicios de salud. Se definieron criterios y variables, escala de clasificación, descripción operacional con indicadores y estándar, en tres dimensiones. Resultados: La dimensión estructura fue evaluada de no satisfactorio solo en el 30,76 %. En las dimensiones proceso y resultado todos los indicadores examinados resultaron no satisfactorios. Conclusiones: El Programa de Prevención, Diagnóstico y Control de la Hipertensión Arterial en el municipio de Santa Clara fue evaluado de no satisfactorio.

ABSTRACT Introduction: arterial hypertension is the most common of the diseases affecting individuals' health in world populations. Objective: to evaluate compliance with the Prevention, Diagnosis and Control Program of Arterial Hypertension in Santa Clara municipality, in 2016. Methods: an observational, descriptive and cross-sectional study was carried out in health systems and services. Criteria and variables, rating scale, operational description with indicators and standards were defined in three dimensions. Results: the structure dimension was evaluated as unsatisfactory only in 30.76%. All indicators examined in the result and process dimensions were unsatisfactory. Conclusions: the Prevention, Diagnosis and Control Program of Arterial Hypertension in Santa Clara municipality was evaluated as unsatisfactory.

Protocolo para la bioseguridad en centros de aislamientos para pacientes positivos a la COVID-19 / Protocol for biosafety in isolation centers for patients positive for COVID-19

RESUMEN Fundamento: los protocolos de bioseguridad resultan ser esenciales para el enfrentamiento a la pandemia de COVID-19, y por tanto, de conocimiento para los profesionales del sistema de salud. Objetivo: diseñar un protocolo de bioseguridad de conocimiento para los trabajadores de la salud que garantice la protección de estos, sus pacientes y el medio ambiente. Métodos: se realizó una investigación de desarrollo en los diferentes centros de aislamiento de pacientes sospechosos y positivos a la COVID-19. Se emplearon métodos teóricos: dialéctico-materialista, modelación, histórico-lógico y de análisis-síntesis; y empíricos: observación epidemiológica y revisión documental de estudios sobre el trabajo con agentes biológicos, incluidos los relacionados con la COVID-19, lo cual permitió establecer las regularidades y contradicciones entre el objeto de estudio y el problema de investigación. La propuesta fue valorada por criterios de especialistas. Resultados: el trabajo realizado permitió el diseño de un protocolo de bioseguridad que fue aplicado en todos los centros de aislamiento con lo cual se garantizó la preparación y bioprotección de los trabajadores, sus pacientes y el medio ambiente, en un esfuerzo por contribuir a la prevención y evitar la propagación de esta enfermedad en Villa Clara. Conclusiones: la implementación de este protocolo en los centros de aislamiento de la provincia permitió que los trabajadores y pacientes se desempeñaran en condiciones de bioseguridad con mínimo riesgo de contagio.

ABSTRACT Background: biosafety protocols turn out to be essential to fight the COVID-19 pandemic, and therefore, a background knowledge for health system professionals. Objective: to design a biosafety protocol of knowledge for health workers that guarantees the protection of them, their patients and the environment. Methods: a development investigation was carried out in the different isolation centers of possible and positive patients for COVID-19. Theoretical methods were used: dialectical-materialist, modeling, historical-logical and analysis-synthesis; and empirical ones: epidemiological observation and documentary review of studies on work with biological agents, including those related to COVID-19, which made it possible to establish the regularities and contradictions between the object of study and the research problem. The proposal was assessed by specialist criteria. Results: the work carried out allowed the design of a biosafety protocol that was applied in all isolation centers, which guaranteed the preparation and bio-protection of workers, their patients and the environment, in an effort to contribute to prevention. and to prevent the spread of this disease in Villa Clara. Conclusions: the implementation of this protocol in the isolation centers of the province allowed workers and patients to perform in biosafety conditions with minimal risk of contagion.

Eficiencia de la actividad de enfermería en policlínicos / Nursing efficiency in polyclinics

Introducción: La actividad de enfermería en los policlínicos es fundamental para alcanzar los resultados de salud que se desean en la población. Brindar estos servicios con eficiencia es un reto y un encargo actual en aras de lograr una mejor utilización de los recursos asignados. Objetivo: Evaluar la eficiencia del trabajo de enfermería en policlínicos de La Habana. Método: Se desarrolló una investigación descriptiva transversal en la totalidad de los policlínicos del municipio Diez de Octubre. Se tomó como base metodológica el algoritmo para el estudio de la eficiencia en unidades del primer nivel de atención de salud en Cuba que emplea el Análisis Envolvente de Datos. Se utilizaron cuatro indicadores de resultados y uno de recursos. Resultados: De los ocho policlínicos, solo cuatro resultaron eficientes. Dos resultaron unidades de mejor práctica y fueron par de referencia para la mayoría de los ineficientes. Las principales reservas de la eficiencia están en el cumplimiento insuficiente de las actividades de seguimiento a pacientes priorizados. Las unidades con mayor nivel de calificación del personal no alcanzaron la eficiencia. Conclusiones: Se determinaron niveles altos de eficiencia técnica pura para la actividad de enfermería en los policlínicos, no obstante, dada la presencia de unidades ineficientes se debe continuar investigando en esta temática. Existen unidades para las cuales hay un nivel de ineficiencia estructuralmente determinada, que para resolverla es necesario un análisis de la distribución y consumo de recursos en el municipio(AU)

Introduction: Nursing activity in polyclinics is fundamental to achieve the expected health results in the population. Offering those services with efficiency is both a challenge and a current endeavor aimed at achieving a better use of the resources allocated. Objective: Evaluate nursing efficiency in Havana polyclinics. Method: A cross-sectional descriptive study was conducted of all the polyclinics in the municipality of Diez de Octubre. The methodological foundation of the study was the algorithm for efficiency assessment in Cuban primary health care units, based on data envelopment analysis. Use was made of four indicators for results and one for resources. Results: Of the eight polyclinics, only four were found to be efficient. Two were best practice units and served as reference for most of the inefficient polyclinics. The main efficiency reserves had to do with poor compliance with follow-up activities for priority patients. The units with the most highly qualified personnel did not achieve the desired efficiency. Conclusions: High levels of pure technical efficiency were determined for nursing activity in the polyclinics. However, given the existence of inefficient units, further research should be conducted about the topic. In a number of units there is a structurally determined level of inefficiency to solve which it is necessary to perform an analysis of the distribution and consumption of resources in the municipality(AU)

FOXE1 Polymorphism Interacts with Dietary Iodine Intake in Differentiated Thyroid Cancer Risk in the Cuban Population.

BACKGROUND: The incidence of differentiated thyroid cancer (DTC) is low in Cuba, and the contribution of dietary factors to DTC in this population has not been investigated so far. The aim of this study was to evaluate the relationship between dietary iodine intake and DTC with regard to the interaction with environmental factors or some common single nucleotide polymorphisms (SNPs), based on a case-control study carried out in Cuba. METHODS: A total of 203 cases and 212 controls from the general population were interviewed face-to-face using the dietary intake questionnaire and the photo booklet from the E3N cohort. A specific food composition table was constructed for this study. For each parameter studied, the odds ratio (OR) was stratified on age group and sex, and further adjusted for dietary energy, smoking status, ethnic group, level of education, number of pregnancies, and body surface area. RESULTS: The risk of DTC was significantly reduced with increasing consumption of fish (p = 0.04), but no association between total dietary iodine intake and DTC risk was evident (p = 0.7). This lack of significant association was true whatever the age, the smoking status, the dietary selenium intake, and the ethnicity (p > 0.05). DTC risk was positively and strongly associated with the number of copies in the minor allele (A) for SNP rs965513 near FOXE1 among people who consumed less iodine than the median (p = 0.005). CONCLUSION: Overall, the majority of the studied population had an optimal dietary iodine intake. DTC risk was inversely associated with high fish consumption. Furthermore, DTC risk was positively associated with the number of copies in the minor allele (A) of rs965513 among people who consumed less iodine than the median. Because these findings are based on post-diagnostic measures, studies with pre-diagnostic dietary iodine are needed for confirmation.

Recreational Physical Activity and Differentiated Thyroid Cancer Risk: A Pooled Analysis of Two Case-Control Studies.

PURPOSE: Physical activity has been hypothesized to influence cancer occurrence through several mechanisms. To date, its relation with thyroid cancer risk has been examined in relatively few studies. We pooled 2 case-control studies conducted in Cuba and Eastern France to assess the relationship between self-reported practice of recreational physical activity since childhood and thyroid cancer risk. METHODS: This pooled study included 1,008 cases of differentiated thyroid cancer (DTC) matched with 1,088 controls (age range 9-35 and 17-60 years in the French and Cuban studies, respectively). Risk factors associated with the practice of recreational physical activity were estimated using OR and 95% CI. Logistic regressions were stratified by age class, country, and gender and were adjusted for ethnic group, level of education, number of pregnancies for women, height, BMI, and smoking status. RESULTS: Overall, the risk of thyroid cancer was slightly reduced among subjects who reported recreational physical activity (OR = 0.8; 95% CI 0.5-1.0). The weekly frequency (i.e. h/week) seems to be more relevant than the duration (years). CONCLUSION: Long-term recreational physical activity, practiced since childhood, may reduce the DTC risk. However, the mechanisms whereby the DTC risk decreases are not yet entirely clear.

Thyroid volume and its relation to anthropometric measures in a healthy cuban population.

OBJECTIVES: The aim of this study was to describe the thyroid volume in healthy adults by ultrasound and to correlate this volume with some anthropometric measures and other differentiated thyroid cancer risk factors. STUDY DESIGN: Thyroid volume and anthropometric measures were recorded in a sample of 100 healthy adults, including 21 men and 79 women aged 18-50 years, living in a non-iodine-deficient area of Havana city. RESULTS: The average thyroid volume was 6.6 ± 0.26 ml; it was higher in men (7.3 ml) than in women (6.4 ml; p = 0.15). In the univariate analysis, thyroid volume was correlated with all anthropometric measures, but in the multivariate analysis, body surface area was found to be the only significant anthropometric parameter. Thyroid volume was also higher in current or former smokers and in persons with blood group AB or B. CONCLUSION: Specific reference values of thyroid volume as a function of body surface area could be used for evaluating thyroid volume in clinical practice. The relation between body surface area and thyroid volume is coherent with what is known about the relation of thyroid volume to thyroid cancer risk, but the same is not true about the relation between thyroid volume and smoking habit.

Common variants at the 9q22.33, 14q13.3 and ATM loci, and risk of differentiated thyroid cancer in the Cuban population.

BACKGROUND: The incidence of differentiated thyroid carcinoma (DTC) in Cuba is low and the contribution of host genetic factors to DTC in this population has not been investigated so far. Our goal was to assess the role of known risk polymorphisms in DTC cases living in Havana. We genotyped five polymorphisms located at the DTC susceptibility loci on chromosome 14q13.3 near NK2 homeobox 1 (NKX2-1), on chromosome 9q22.33 near Forkhead factor E1 (FOXE1) and within the DNA repair gene Ataxia-Telangiectasia Mutated (ATM) in 203 cases and 212 age- and sex- matched controls. Potential interactions between these polymorphisms and other DTC risk factors such as body surface area, body mass index, size, ethnicity, and, for women, the parity were also examined. RESULTS: Significant association with DTC risk was found for rs944289 near NKX2-1 (OR per A allele = 1.6, 95% CI: 1.2-2.1), and three polymorphisms near or within FOXE1, namely rs965513 (OR per A allele = 1.7, 95% CI: 1.2-2.3), rs1867277 in the promoter region of the gene (OR per A allele = 1.5, 95% CI: 1.1-1.9) and the poly-alanine tract expansion polymorphism rs71369530 (OR per Long Allele = 1.8, 95% CI: 1.3-2.5), only the 2 latter remaining significant when correcting for multiple tests. Overall, no association between DTC and the coding SNP D1853N (rs1801516) in ATM (OR per A Allele = 1.1, 95% CI: 0.7-1.7) was seen. Nevertheless women who had 2 or more pregnancies had a 3.5-fold increase in risk of DTC if they carried the A allele (OR 3.5, 95% CI: 3.2-9.8) as compared to 0.8 (OR 0.8, 95% CI: 0.4-1.6) in those who had fewer than 2. CONCLUSIONS: We confirmed in the Cuban population the role of the loci previously associated with DTC susceptibility in European and Japanese populations through genome-wide association studies. Our results on ATM and the number of pregnancies raise interesting questions on the mechanisms by which oestrogens, or other hormones, alter the DNA damage response and DNA repair through the regulation of key effector proteins such as ATM. Due to the small size of our study and to multiple tests, all these results warrant further investigation.

Environmental, lifestyle, and anthropometric risk factors for differentiated thyroid cancer in cuba: a case-control study.

BACKGROUND: The incidence of differentiated thyroid carcinoma (DTC) is low in people of African origin and higher in populations living on islands, but there is no well-established explanation for these differences. Cuba is a multiethnic nation with people of African and Spanish descent. Until now, no study on the risk factors of DTC has focused on the Cuban population. Our aim is to establish the role of environmental and lifestyle factors and to relate anthropometric measurements to the risk of developing DTC in Cuba. METHODS: We performed a case-control study of 203 DTC patients treated in two hospitals in Havana and 212 controls living in the area covered by these hospitals (i.e. parts of Havana and the municipality of Jaruco). Risk factors were analyzed using conditional logistic regression. RESULTS: As has been shown by other studies, we found that non-African ethnicity, never smoking, parity, and high body mass index are risk factors significantly associated with DTC, whereas a history of exposure to ionizing radiation and level of education were not significantly related with disease development. Being rhesus factor-positive, having a personal history of benign thyroid disorder, agricultural occupation, and consumption of artesian well water were also associated with a significantly increased risk of developing DTC. CONCLUSIONS: The original findings reported here concern the risk of DTC that was associated with non-African ethnicity, positive rhesus factor, farming, and drinking water from an artesian well.

Riesgo cardiovascular y marcadores electrocardiográficos de arritmiasen pacientes hipertensos sin cardiopatía isquémica / Cardiovascular risk and arrhythmias electrocardiographic markers in hypertensive patients without coronary artery disease

Los factores de riesgo (FR) cardiovascular se asocian con los marcadores electrocardiográficospredictivos de arritmias, sin embargo la relación entre estos marcadores y el riesgo cardio-vascular global (RCVG) ha sido poco estudiada. El objetivo fue analizar la relación de los FR y el RCVG con marcadores electrocardiográficos, en hipertensos sin cardiopatía isquémica(AU)

Aspectos medicolegales de reclusos encausados por delitos relacionados con drogas ilícitas / Forensic aspects on prisoners prosecuted for crimes related to illicit drugs

Se realizó un estudio descriptivo y transversal para caracterizar a 163 reclusos encausados por delitos relacionados con drogas ilícitas en la Prisión Nacional de Boniato de la provincia de Santiago de Cuba desde julio del 2006 hasta igual mes del 2007. Entre los principales resultados sobresalieron que la droga más consumida fue la marihuana (74,4 por ciento) y que los consumidores de narcóticos delinquieron mucho más que los no adictos a esas sustancias tóxicas(AU)

descriptive and cross-sectional study was carried out to characterize 163 prisoners prosecuted for crimes related to illicit drugs in the Boniato National Prison of Santiago de Cuba province from July, 2006 to July, 2007. The main results revealed that the most used drug was the marijuana (74,4 percent) and drug users offended much more than people who did not use these substances(AU)

Aspectos medicolegales de reclusos encausados por delitos relacionados con drogas ilícitas / Forensic aspects on prisoners prosecuted for crimes related to illicit drugs

Se realizó un estudio descriptivo y transversal para caracterizar a 163 reclusos encausados por delitos relacionados con drogas ilícitas en la Prisión Nacional de Boniato de la provincia de Santiago de Cuba desde julio del 2006 hasta igual mes del 2007. Entre los principales resultados sobresalieron que la droga más consumida fue la marihuana (74,4 por ciento) y que los consumidores de narcóticos delinquieron mucho más que los no adictos a esas sustancias tóxicas.

A descriptive and cross-sectional study was carried out to characterize 163 prisoners prosecuted for crimes related to illicit drugs in the Boniato National Prison of Santiago de Cuba province from July, 2006 to July, 2007. The main results revealed that the most used drug was the marijuana (74,4 percent) and drug users offended much more than people who did not use these substances.

El internado rural: Una revolución en la docencia médica / Rural intership: A revolution in medical teaching

Se hace un estudio de la situación actual que presenta el Internado Rural en la provincia de Villa Clara. Se hace una comparación, de cómo se encontraba la atención de la población rural antes y después de la introducción de la docencia. Se destaca como aspecto fundamental la preparación de los médicos de las unidades con fines docentes. Se enfatiza en la repercusión positiva de la docencia en estas unidades sobre la elevación de la calidad de los servicios médicos que se brindan ÿ en las mismas. Finalmente se recomienda que se considere al Internado Rural como el precedente del médico de la familia en las zonas rurales de la provincia

El internado rural: Una revolución en la docencia médica / Rural intership: A revolution in medical teaching

Se hace un estudio de la situación actual que presenta el Internado Rural en la provincia de Villa Clara. Se hace una comparación, de cómo se encontraba la atención de la población rural antes y después de la introducción de la docencia. Se destaca como aspecto fundamental la preparación de los médicos de las unidades con fines docentes. Se enfatiza en la repercusión positiva de la docencia en estas unidades sobre la elevación de la calidad de los servicios médicos que se brindan ÿ en las mismas. Finalmente se recomienda que se considere al Internado Rural como el precedente del médico de la familia en las zonas rurales de la provincia(AU)