Abstract in English:Over 2200 new cases of breast cancer are diagnosed annually in Cuba, and a decade ago I became one of them. Late in 2000, I underwent breast cancer surgery at the National Oncology and Radiology Institute in the Cuban capital. My experience-both with the disease and as a sociologist at the University of Havana studying gender relations-serves as the basis for the following essay. The article characterizes today's Cuban women, particularly those of us with or at risk of breast cancer, and describes my own and others' responses to our disease. My aim is to provide insights useful to the physicians, nurses, engineers, physicists, technicians, and service and administrative workers in Cuba's health services who interact with us, whose increased awareness will make us feel more deeply understood and respected. In this context, I also refl ect on the Cuban media's portrayal of cancer, with recommendations for dismantling the biases of fatalism and even pity often conveyed.
Abstract in English:INTRODUCTION: There is a tendency among women today to delay the age at which they have their first child or subsequent children. This creates a dilemma for couples, since health professionals tend to counsel against pregnancy in women aged >40 years without considering their reproductive potential and their ability to and likelihood of conceiving and carrying to term a healthy newborn at little or no risk. OBJECTIVE: Assess hypothalamic-pituitary-gonadal axis function in menopausal women in Havana, to evaluate relevance to reproductive potential. METHODS: A retrospective study was conducted from March 2006 through March 2008 of 230 healthy women aged 40-59 years seen in the Menopause and Osteoporosis Clinic in Havana, Cuba. Chart review yielded data on current age, stage of climacteric and hormone levels expressed in means and standard deviations: serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol and testosterone. Analysis of variance was used for assesment by age group and stage of menopause (eumenorrheic, perimenopausal and postmenopausal), with a p value of <0.05 set as significance level. RESULTS: Mean serum hormone levels in eumenorrheic women were: FSH 6.97 IU/L, LH 4.23 IU/L and estradiol 314 pmol/L; in perimenopausal women: FSH 34.69 IU/L, LH 20.78 IU/L and estradiol 201 pmol/L; and in postmenopausal women: FSH 75.43 IU/L, LH 37.59 IU/L and estradiol 117 pmol/L (p <0.05 for difference between eumenorrheic and postmenopausal women). There was a progressive increase in FSH and LH and a decline in estradiol with older age. There was no significant difference in testosterone levels by age or stage of menopause. CONCLUSIONS: Menstrual cycle and hormonal levels of the hypothalamic-pituitary-gonadal axis should be considered in addition to chronological age when determining reproductive potential in women aged 40-59 years.
Abstract in English:INTRODUCTION: Athletes' kinanthropometric profiles are widely addressed in the scientific literature. Such profiles are particularly important in volleyball because absolute size contributes a significant percentage of total variance associated with athletic success. As in other team sports, volleyball players' kinanthropometric attributes correlate with the game's tactical demands. From 1992 through 2000, the Cuban women's volleyball team achieved top global performance, winning first place in three successive Summer Olympic Games. OBJECTIVE: Describe the kinanthropometric profiles of Cuban women Olympic volleyball champions during 1992-2000 and compare these by position played. METHODS: Measurements were taken of body composition, somatotype, proportionality and several anthropometric indicators in 41 Cuban women volleyball players, grouped by playing position. All were members of the national team that participated in the Summer Olympic Games in Barcelona (1992), Atlanta (1996) and Sydney (2000). Mean and standard deviations were calculated for all study variables. Analysis of variance was used to compare means for different positions for the variables weight; height; percent adipose, muscle and bone mass; body mass index; and muscle-to-bone ratio. Discriminant analysis was performed to identify anthropometric dimensions differentiating playing positions (center, spiker and setter), using p<0.05 as significance threshold. Results were presented in tables and figures. RESULTS: Centers presented greater absolute size and higher average adipose (22.8±1.7 kg) and bone (7.1±0.6 kg) mass. The mean somatotype of all volleyball players was balanced mesomorphic (2.7-3.6-2.9). Classified by position, centers (2.9-3.4-3.4) and spikers (2.8-3.6-2.9) presented an average mesomorphic-ectomorphic somatotype, and setters (2.6-3.7-2.6) were balanced mesomorphic. On assessing Somatotype Attitudinal Mean (SAM), centers and spikers showed more intrapositional homogeneity than that of setters. Centers were significantly taller (187.1±2.5 cm) than players in other positions. Centers' percent adipose tissue mass (28.9±2.7%) was significantly higher than that of setters (24.3±2.7%), who were leanest of all positions. CONCLUSIONS: The kinanthropometric profile of Cuban women Olympic volleyball champions was defined by considerable muscular-skeletal development, with a predominantly mesomorphic somatotype and low endomorphy. Height and body composition varied significantly by playing position.
Abstract in English:INTRODUCTION: Studies of neuroplasticity have shown that the brain's neural networks change in the absence of sensory input such as hearing or vision. However, little is known about what happens when both sensory modalities are lost (deaf-blindness). Hence, this study of cortical reorganization in visually-impaired child cochlear implant (CI) candidates. OBJECTIVE: Assess cross-modal plasticity, specifically cortical reorganization for tactile representation in visually-impaired child CI candidates, through study of topography of somatosensory evoked potentials (SEP). METHODS: From April through September 2005, SEP from median and tibial nerve electrical stimulation were studied in 12 visually-impaired child CI candidates aged 3-15 years and 23 healthy controls. Following placement of 19 recording electrodes using the International 10-20 System , SEP were recorded and then processed. Topographic maps were obtained for SEP N20 (median nerve) and SEP P40 (tibial nerve), permitting assessment of cortical reorganization by comparing visually-impaired, deaf children's maps with those of healthy children by means of visual inspection and statistical comparison using a permutation test. RESULTS: SEP N20 topography was significantly more extensive in visually-impaired child CI candidates than in healthy children. An asymmetrical pattern occurred from the expansion of hand tactile activation into the temporal and occipital regions in the left hemisphere on right median nerve stimulation. This did not occur for SEP P40 on tibial nerve stimulation (right and left). Magnitude of expanded SEP N20 response was related to severity of visual impairment and longer duration of dual sensory loss. CONCLUSIONS: Changes in SEP N20 topography are evidence of cross-modal plasticity in visually-impaired child CI candidates, appearing to result from a complex interaction between severity of visual impairment and duration of multisensory deprivation.
Abstract in English:INTRODUCTION: An HIV diagnosis, like that of any another chronic illness, alters family dynamics. Although the whole family is affected, usually only one member is the primary caregiver of the sick person. Children and adolescents with HIV/AIDS need care according to their physical, psychological and social needs, requiring responsible caregivers who maintain adequate physical and mental health. OBJECTIVE: To describe general mental health characteristics of primary caregivers of Cuban children and adolescents from across the country diagnosed with HIV/AIDS at the Pedro Kourí Tropical Medicine Institute. METHODS: A descriptive study was carried out from November 2009 through March 2010. Twenty-six caregivers met inclusion criteria and 13 participated. A psychological assessment was made of each caregiver's mental health, including both externally evaluated and self reported factors associated with physical or psychological problems. Clinical interview and observation, psychiatric examination and various psychological tests were used. A simple descriptive analysis of caregiver characteristics, qualitative information and test results was made. RESULTS: Most caregivers were women, infected with HIV/AIDS themselves, unemployed and without a partner. They presented symptoms of anxiety but no clinical psychiatric diagnoses. The study group reported dissatisfaction with family functioning and partner relationships, as well as problems related to HIV and poor employment prospects. CONCLUSIONS: Caregivers studied described complex intra-and interpersonal life dynamics influenced by their HIV infection. Their mental health status, evaluated through a combination of objective and subjective factors reveals a complex reality, indicating the need for a more comprehensive and efficient approach to caregivers' health care, integrating attention to both physical and mental health.
Abstract in English:Gender identity is a sociocultural construct based (in nearly every society) on a binary norm: female and male. Transsexual individuals suffer from intense family and social discrimination because they express a dissident sexuality incongruent with this norm. They assert they feel trapped in a body that does not belong to them, so they seek help from health professionals to modify their bodies, to "adapt their bodies to their minds." This essay discusses health care for transsexual persons in Cuba from a human rights perspective that does not pathologize their gender identification.
Abstract in English:The article describes progress and challenges in incorporating a gender perspective into the Cuban health system. Results obtained thus far indicate progress in raising consciousness and in concentration on the interaction between biological and social factors, in particular recognizing gender as a social determinant of health. Weaknesses are also identified, and recommendations made for introduction of a gender perspective in various areas of the health system such as policy making; services planning, organization and delivery; population health assessments; and human resources training and development.
Abstract in English:In 1981, Cuba reported the first hemorrhagic dengue epidemic in the Americas, with 344,203 cases, including 10,312 severe and very severe cases, resulting in 158 deaths. In the 30 years following the epidemic, surveillance, control and research have kept Cuba dengue free; although isolated, interrupted epidemics and transmissions have been reported. In this article, we summarize issues of interest regarding the 1981 epidemic, as well as laboratory surveillance data and various related research results.