Medicine In Cuba Research Articles

Use Of Natural And Traditional Medicine In Cuba: Results From The National Health Survey 2018-2019.

Objective: To analyze the prevalence of Natural and Traditional Medicine (NTM) use in the last 12 months as per as the report from the National Health Survey (NHS), Cuba 2018-2019. Material-Method: It was an observational, descriptive cross-sectional study that was part of the referred NHS. Socio-demographic characteristics of the survey respondents were collected (living area, gender, age, skin color, marital status, educational level and occupation). The main variable selected for this study was the prevalence of NTM use by the Cuban population in the previous 12 months. Results: More than one out of five Cubans used NTM therapies in the previous 12 months to the NHS, Cuba 2018-2019, with a higher prevalence of use by people living in rural areas, females, the age group of 65-74 years old, a co-habited marital status, university educational level and those in retirement. Phytotherapy was the most reported NTM therapy. Conclusion: This study analyzed for the first time the prevalence of NTM use by the Cuban population. It demonstrated that more than one out of five Cubans used NTM therapies in the previous 12 months to the NHS, Cuba 2018-2019. The characteristics of the CNHS ensure the conditions to facilitate the development of NTM and the information from this study would contribute to strengthen the integration of these treatments with conventional medicine in Cuba.

Prevalence of single-nucleotide variants in twenty-five pharmacogenes from a Cuban sample cohort.

The Cuban population is genetically diverse, and information on the prevalence of genetic variants is still limited. As complex admixture processes have occurred, we hypothesized that the frequency of pharmacogenetic variants and drug responses may vary within the country. The aims of the study were to describe the frequency distribution of 43 single-nucleotide variants (SNVs) from 25 genes of pharmacogenetic interest within the Cuba population and in relation to other populations, while taking into consideration some descriptive variables such as place of birth and skin color. SNVs were analyzed in 357 unrelated healthy Cuban volunteers. Genotype, allele frequencies, and ancestry proportions were determined, and the pairwise fixation index (FST ) was evaluated. Hardy-Weinberg equilibrium (HWE) deviations in six loci (rs11572103, rs2740574, rs776746, rs3025039, rs861539, and rs1762429) were identified. Minor allele frequencies (MAFs) ranged from 0.00 to 0.15 for variants in genes encoding xenobiotic metabolizing enzymes. They also ranged from 0.01 to 0.21 for variants in DNA repair, growth factors, methyltransferase, and methyl-binding proteins, while they ranged from 0.04 to 0.27 for variants in the O-6-methylguanine-DNA methyltransferase enzyme. Moderate genetic divergence was observed upon comparison to Africans (FST = 0.071 and SD 0.079), with 19 markers exhibiting moderate-to-large genetic differentiation. The average European, African, and Amerindian ancestry proportions were 67.8%, 27.2%, and 5.3%, respectively. Ancestry proportions differed by skin color and birthplace for both African and European components, with the exception of the European component, which showed no significant difference between individuals from Western and Eastern regions. Meanwhile, the statistical significance varied in comparisons by skin color and birthplace within the Amerindian component. Low genetic divergence was observed across geographical regions. We identified 12 variants showing moderate-to-large differentiation between White/Black individuals. Altogether, our results may support national strategies for the introduction of pharmacogenetic tools in clinical practice, contributing to the development of precision medicine in Cuba.

Alternative and complementary medicine: A look at the general culture

This paper explores the world of traditional medicine and complementary and alternative medicine from a multicultural perspective. It begins by highlighting the importance of traditional medicine in various cultures and its vital link to the cultural identity of ethnic groups. It then differentiates between traditional medicine and complementary/alternative medicine, explaining that the former is part of a specific culture, while the latter is used in conjunction with or in place of conventional medicine. The paper highlights how traditional and complementary medicine often seek to balance the physical, spiritual and experiential aspects of health and how these practices are rooted in culture and nature. Numerous alternative and complementary therapies, such as herbal medicine, acupuncture, reflexology, yoga, and aromatherapy, are mentioned, and it is emphasized that these therapies are based on natural and noninvasive approaches. In addition, the relationship between traditional medicine and Western medicine is discussed, and how in some places they are being harmoniously combined to provide holistic health care. The example of intercultural medicine in Cuba is mentioned, where scientific medicine, traditional Chinese medicine and natural and traditional medicine are integrated. The importance of preserving and respecting the traditions and practices of traditional medicine of indigenous cultures, such as Mapuche medicine in South America, is emphasized. It is mentioned that these traditions not only treat individual diseases, but also seek to maintain balance with nature and culture. In conclusion, it is emphasized that traditional and complementary medicine offer a different perspective on health and wellness, and it is important to approach them critically and with proper medical guidance. These practices can offer holistic approaches to health care and are an integral part of cultural diversity in health care.

Origin of Traditional Chinese Medicine in Cuba in the 19th Century from Its Main Exponents and Some Notable Medical Descendants in the 20th Century

The Cuban people are made up of three major migratory currents, the Chinese are one of them. They brought their culture, the methods, and procedures of traditional Chinese medicine (TCM) in the 19th century. Few were able to return and so they created families in Cuba; some of their descendants dedicated themselves to medicine. In order to investigate the practices that were predecessors of TCM in Cuba in the 19th century, a qualitative phenomenological research was carried out, reviewing what was published by various sources, applying documentary analysis, logical historical analysis, abstraction, synthesis, and systematization of the results on the regularities of the work and human behavior of Chinese doctors in the Cuban 19th and 20th centuries. This made it possible to identify six Chinese doctors in the 19th century in Cuba who gave rise to the beginning of some practices of TCM in Cuba, and five from the 20th century, descendants of coolies who dedicated themselves to other specialties of medicine. It was found that despite their geographical and time disperse, they were all notorious for their outstanding professional and human behavior, with a trail of accumulated successes in achieving “almost the impossible” with the patient. They have left their mark on Cuban culture.

The gift of health: Cuba’s development assistance in the Pacific

Since 2006, 50 Cuban doctors have worked in Pacific Island countries (PICs), while 250 Pacific islanders have studied medicine at the Latin American School of Medicine in Cuba, nearly doubling the medical workforce in some countries. Although Cuba has pursued an extensive South-South Cooperation (SSC) programme in health around the globe for 60 years, the relatively recent presence of Cuba in the Pacific is intriguing. The programme is based on what Cuba has called the “multiple coincidences” and shared experiences between Cuba and PICs as Small Island Developing States facing common challenges. Proponents argue Cuba’s expertise in providing community-based and human-capital oriented care health care in low-resource environments could provide a suitable model for meeting the health goals and needs of PICs. Moreover, Cuba’s medical cooperation is grounded in an ethics of solidarity and offers a clear example of social justice-oriented south-south cooperation which aims to both address immediate humanitarian need and to transform power structures that limit the accessibility and availability of sustainable health care within partner countries. Yet despite this there has been little research on Cuba’s approach to medical cooperation in the Pacific. This paper addresses this gap, drawing on Maussian gift theory to argue that the Cuban ‘gift of health’ provides much needed capacity in health while building the dignity of both partners. As a theory of solidarity with distinct Pacific roots and which links clearly to the solidarity-based model of Cuban cooperation based on egalitarianism and relationship, gift theory provides an explanation for the presence of Cuba in the Pacific and highlights the importance of equitable relationships and dignity in development partnerships, providing theoretical roots to the idea that there might an alternative to traditional models of aid and development in the region.

Antiurolithiatic activity of Boldoa purpurascens aqueous extract: An in vitro and in vivo study

Ethnopharmacological relevanceBoldoa purpurascens Cav. (Nyctaginaceae) is a plant species used in traditional medicine in Cuba as antiurolithiatic. Aim of the studyThe aim of the present investigation was to evaluate the in vitro and in vivo antiurolothiatic activity of an aqueous extract from the leaves of Boldoa purpurascens. Materials and methodsThe aqueous extract from leaves of Boldoa purpurascens was evaluated for antiurolithiatic activity in vitro and in vivo. In vitro crystallization of calcium oxalate (CaOx) was assessed using a nucleation, aggregation and growth assay. The effects of the extract and of Cystone®, used as a positive control, on the slope of nucleation and aggregation, as well as on the growth of CaOx crystals, were evaluated spectrophotometrically. The densities of the formed crystals were compared microscopically. In vivo activity was evaluated in an urolithiasis model in rats, in which kidney stones are induced by ethylene glycol (0.75%) and ammonium chloride (2%) in drinking water for 10 days. Three different experimental doses (100, 200 and 400 mg/kg, p.o.) of the extract and Cystone® were administered for 10 days. After 10 days, various biochemical parameters were measured in urine and serum, and histopathological analysis of the kidneys was carried out. ResultsThe aqueous extract of Boldoa purpurascens inhibited the slope of nucleation and aggregation of CaOx crystallization, and decreased the crystal density. It also inhibited the growth and caused the dissolution of CaOx crystals. Cystone® exhibited similar effects. At a dose of 400 mg/kg the extract reduced the concentration of uric acid in urine, as well as the serum concentration of uric acid and creatinine. Histopathologic analysis of the kidneys of the same treatment group revealed reduced tissue damage; the results were almost similar to the untreated healthy control group. ConclusionThis study indicates that an aqueous leaf extract of Boldoa purpurascens may be effective in the prevention of urinary stone formation, and substantiates the traditional claim.

Hereditary Ataxias in Cuba: Results and Impact of a Comprehensive, Multidisciplinary Project.

Spinocerebellar ataxia type 2 is a degenerative disease that causes physical disability and, ultimately, prostration and death. Globally, reported prevalence is around 3 cases per 100,000 population and Cuba has the world's highest rates of the disease, affecting both patients and their at-risk descendants. In Holguín Province, which has the country's highest concentration of cases, incidence is 4.4 per 100,000 population and prevalence is 40.2 per 100,000 population. In 2000, a specialized research center was established in that province. Supplied with the necessary equipment and human resources, the center conducted national multidisciplinary studies involving molecular biology, clinical care, epidemiology, psychology, clinical neurophysiology, imaging, clinical genetics and community medicine, among others. A training and continuing education program also raised scientific capacity. Priority was given to developing international collaborations for academic exchange and training of Cuban researchers.Multiple results from research involving clinical and epidemiologic characterization of the disease, identification of biomarkers and therapeutic targets, genetic association studies, clinical trials and characterization of the disease's preclinical stages have been introduced in care of patients and their at-risk descendants. This has been accomplished through various programs including personalized rehabilitation, predictive diagnosis and social services. These results have also been published in high-impact scientific journals and received national and international awards. Such an experience in the context of Cuba's national health system-which is universal, free, accessible, comprehensive, prevention-oriented and with a record of international cooperation-demonstrates the possibility of providing quality care to affected families. Incorporating research findings into medical practice, with the resulting impact on patients' health and wellbeing, is a practical example of translational medicine in Cuba. KEYWORDS Spinocerebellar ataxia type 2, health services research, biomedical research. health care delivery, translational medicine, translational research, health equity, Cuba.

The Family Doctor and Nurse Program: development of the health care model in CubaO Programa de Médicos e Enfermeiras da Família: desenvolvimento do modelo de saúde em Cuba

RESUMENEl modelo de medicina familiar cubano se desarrolla, desde hace más de tres décadas, como el tercer modelo de atención médica del período revolucionario en Cuba. Es la expresión más acabada de la aplicación de la estrategia de atención primaria de salud. Aún muestra potencial para la mejora en la organización, la calidad y la eficiencia de los servicios de salud en el primer nivel de atención de salud. El objetivo esencial de este trabajo es describir el modelo, sus singularidades, sus elementos distintivos, y sus principales logros, retos y desafíos. Se realizó una revisión documental en artículos de revistas, libros y documentos oficiales del Ministerio de Salud Pública de Cuba sobre la creación y desarrollo del modelo, seleccionados y analizados por expertos para la elaboración del presente informe. Se presentan elementos conceptuales del modelo, así como indicadores que sustentan la información. En este trabajo se identificaron las principales características de la medicina familiar en Cuba, sus logros fundamentales, retos y desafíos. Con base en sus resultados, se concluye que el modelo de medicina familiar de Cuba es un referente para la Región de las Américas. Es aún un modelo en desarrollo, perfectible y susceptible de transformaciones para enfrentar nuevos retos, el mayor de los cuales será renovar el modelo manteniendo y fortaleciendo las ideas fundacionales del programa.

Genetics and genomic medicine in Cuba.

Genetics and genomic medicine in Cuba.

Safety assessment of a traditionally used extract from leaves of Boldoa purpurascens

Ethnopharmacological relevanceBoldoa purpurascens Cav. (Nyctaginaceae) is a plant species used in traditional medicine in Cuba as a diuretic. Aim of the studyThe aim of the present investigation was to evaluate the safety profile of a hydroalcoholic extract from leaves of Boldoa purpurascens. Materials and methodsFirst, an experimental study to assess the oral acute toxicity at a dose of 2000mg/kg body weight of the extract was carried out. Potential genotoxicity of the extract was evaluated using the Ames test and the micronucleus induction assay in mouse bone marrow. In the Ames test a concentration range of 50, 100, 150, 300 and 500µg/plate was tested. In the micronucleus induction assay, doses of 500, 1000 and 2000mg/kg of body weight were tested. For completeness, since the extract contains saponins, the evaluation of the hemolytic activity, ocular and skin irritation were included. ResultsNo signs or symptoms of toxicity were observed in the oral acute toxicity test (body weight at baseline, seven days and end of the experiment of 236.41±20.07, 256.81±30.44 and 240.02±26.16 respectively for the treated group). The hydroalcoholic extract from the leaves was not mutagenic in the Ames test, and no genotoxicity was observed in the micronucleus assay. A hemolysis test at concentration of 1mg/mL confirmed hemolytic activity, which is not a safety concern since saponins are not absorbed after oral administration. In order to evaluate the percentage of protein denaturation, the ocular irritability index was calculated. The extract was found to be irritating. Finally, skin irritability was evaluated and the irritation index was equal to zero. ConclusionsBased on the toxicological evaluation of a traditionally used hydroalcoholic extract from the leaves of Boldoa purpurascens we can confirm the safety of its oral use.

El proceso de organización de la sanidad en Cuba (1902-1906). Las ordenanzas sanitarias de 1906

Between 1898 and 1909, medicine in Cuba underwent a period of profound transformations. The culminating point of that period were the Health Ordinances of 1906, the first Cuban sanitary code. It constituted, until that moment, the biggest attempt to organize the health in the country. It disposed of a technical rigor to the height of the most advanced in the world then. However, the lack of investigative-analytical attention to their content is contradictory. The aim of this paper was to analyze the main legal provisions regarding Health in the period 1898-1906 as well as the content of the Sanitary Ordinances. Guided by the scientific method, heuristic, historical- logical, inductive-deductive, synthetic analytical methods were used, among others. A total of 12 materials wereconsulted. Of primary importance were primary sources such as the Sanitary Ordinances, the Acts of the Constituent Assembly of 1901 and the Military Order 159. In a conclusive way, beyond their demonstrated values, the fundamental limitation of the Law on SanitaryOrdinances was based on the decentralized character of the health that it raised, when the Local Health Boards were dependent on the municipal councils.

O Sistema Nacional de Saúde Cubano: Caracterização dos serviços de Atenção Primária à Saúde.

This article presents a report on the experience of healthcare professionals in Florianopolis, who took the course La Atencion Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS) and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS) Cuba’s SNS Family Healthcare (SF) service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

Africa’s Last Colony

Africa’s Last Colony

Comparación Entre La Composición Química Y Las Propiedades Antiinflamatorias Del Sebo De Carnero De Origen Cubano Y Del Sahara

Según CLAUS y TYLER, 1998, el sebo de carnero, corresponde a la grasa interna del abdomen de la oveja Ovisaries L (Fam. Bóvidae, purificada por fusión y filtrado que contiene entre 70-80 % de la mezcla de ácido esteárico y ácido palmítico y 20-30 % de ácido oleico con propiedades emolientes y uso como base para ungüentos que necesitan más consistencia que la obtenida con otros ingredientes utilizados con estos fines. En Cuba, se utiliza en fricciones para aliviar procesos inflamatorios según la medicina tradicional, por lo que se decidió realizar una comparación entre el sebo procedente de Cuba con el sebo obtenido de la región del Sahara donde tiene el mismo uso popular y evaluar en ambos su composición química así como el efecto antiinflamatorio popularmente descrito para los mismos. En el presente trabajo se realiza un análisis por CG-EM de las muestras transmetiladas. El sebo procedente de Cuba tiene un 49,8 % de ácidos grasos saturados frente a 59,3 % el del Sahara y 36,1 % y 27,7 % de ácidos grasos insaturados respectivamente. Comparando con la indometacina, utilizada como control positivo, en el ensayo de la inducción de la inflamación por carragenina, se encontró que el sebo procedente de Cuba tiene aproximadamente 40 % menos de actividad antiinflamatoria que el procedente del Sahara e igual resultado que la indometacina utilizada como control positivo.

Analysis of policy implications and challenges of the Cuban health assistance program related to human resources for health in the Pacific

BackgroundCuba has extended its medical cooperation to Pacific Island Countries (PICs) by supplying doctors to boost service delivery and offering scholarships for Pacific Islanders to study medicine in Cuba. Given the small populations of PICs, the Cuban engagement could prove particularly significant for health systems development in the region. This paper reviews the magnitude and form of Cuban medical cooperation in the Pacific and analyses its implications for health policy, human resource capacity and overall development assistance for health in the region.MethodsWe reviewed both published and grey literature on health workforce in the Pacific including health workforce plans and human resource policy documents. Further information was gathered through discussions with key stakeholders involved in health workforce development in the region.ResultsCuba formalised its relationship with PICs in September 2008 following the first Cuba-Pacific Islands ministerial meeting. Some 33 Cuban health personnel work in Pacific Island Countries and 177 Pacific island students are studying medicine in Cuba in 2010 with the most extensive engagement in Kiribati, the Solomon Islands, Tuvalu and Vanuatu. The cost of the Cuban medical cooperation to PICs comes in the form of countries providing benefits and paying allowances to in-country Cuban health workers and return airfares for their students in Cuba. This has been seen by some PICs as a cheaper alternative to training doctors in other countries.ConclusionsThe Cuban engagement with PICs, while smaller than engagement with other countries, presents several opportunities and challenges for health system strengthening in the region. In particular, it allows PICs to increase their health workforce numbers at relatively low cost and extends delivery of health services to remote areas. A key challenge is that with the potential increase in the number of medical doctors, once the local students return from Cuba, some PICs may face substantial rises in salary expenditure which could significantly strain already stretched government budgets. Finally, the Cuban engagement in the Pacific has implications for the wider geo-political and health sector support environment as the relatively few major bilateral donors, notably Australia (through AusAID) and New Zealand (through NZAID), and multilaterals such as the World Bank will need to accommodate an additional player with whom existing links are limited.

The traceability chain of 131I measurements for nuclear medicine in Cuba

The national traceability chain for 131I activity measurements performed in nuclear medicine in Cuba is described. At the highest (primary) level, liquid scintillation counting employing the CIEMAT/NIST method is used; at the secondary level, a secondary standard radionuclide calibrator is utilized that allows for a quick and simple transference of the measurement unit to the tertiary level of end-users' instruments. The equivalence of Cuban standards and the assessment of measurement uncertainties at the end-user level are determined through the results of measurement comparisons.

Generating Potential for Regenerative Medicine in Cuba: Porfirio Hernández MD DrSc. National Regenerative Medicine Group, Cuban Ministry of Public Health

Generating Potential for Regenerative Medicine in Cuba: Porfirio Hernández MD DrSc. National Regenerative Medicine Group, Cuban Ministry of Public Health

Genomics as public health? Community genetics and the challenge of personalised medicine in Cuba

Making use of a comparative perspective on the emergence of ‘breast cancer genetics’ in the different cultural context of the UK and Cuba, this article examines the tensions between the modern promise of genomics as personalised medicine and a commitment to public health. Focusing primarily on the Cuba context and drawing on ethnographic research as part of a collaborative project working with genetic professionals and publics, the article examines the particular technologies, identities and socialities at stake in an emerging and evolving field of genetic medicine. It highlights how long-standing continuities in the commitment to the equitable provision of public health, particularly as this relates to ‘family medicine’, are central to understanding the scope and expansion of ‘community genetics’ interventions, even when at the level of local practice, public health is also now subject to the unequal dynamics of economic necessity through the working out of ‘lo informal’. Illuminating the different ways agency, risk, responsibility, citizenship and activism get configured by and between publics and health professionals in Cuba, the article reveals the challenges and opportunities posed by predictive genomic medicine in relation to the dynamic and shifting terrain of public health.

Promoting the health of marginalized populations in Ecuador through international collaboration and educational innovations.

This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Escuela Latinoamericana de Medicina in Spanish). We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants. We highlight some ways we can learn from such training programmes with particular regard to lessons, barriers and opportunities for their sustainability at the local, national and international levels and for pursuing similar initiatives in other countries and contexts. We conclude that educational efforts focused on the challenges of marginalization and the determinants of health require explicit attention not only to the knowledge, attitudes and skills of graduates but also on effectively engaging the health settings and systems that will reinforce the establishment and retention of capacity in low- and middle-income settings where this is most needed.

Natural and Traditional Medicine in Cuba: Lessons For U.S. Medical Education

The Institute of Medicine's (IOM's) Academy of Science has recommended that medical schools incorporate information on CAM (complementary and alternative medicine) into required medical school curricula so that graduates will be able to competently advise their patients in the use of CAM. The report states a need to study models of systems that integrate CAM and allopathic medicine. The authors present Cuba's health care system as one such model and describe how CAM (or natural and traditional medicine) is integrated into all levels of clinical care and medical education in Cuba. The authors examine the Cuban medical school curriculum in which students, residents, and practicing physicians are oriented in the two paradigms of CAM and allopathic medicine. Only health professionals are permitted to practice CAM in Cuba; therefore, Cuba's medical education curriculum incorporates not only teaching about CAM, but it also teaches basic CAM approaches and clinical skills. Both the theory and practice of CAM are integrated into courses throughout the six-year curriculum. Similarities and differences between the U.S. and Cuban approaches to CAM are examined, including issues of access and cost, and levels of acceptance by the medical profession and by the public at large in both countries. The authors conclude that there is potentially much to learn from the Cuban experience to inform U.S. medical educators and institutions in their endeavors to comply with the IOM recommendations and to incorporate CAM into medical school curricula.