ABSTRACT Introduction: In Cuba, chronic obstructive pulmonary disease is the sixth leading cause of death. There is insufficient knowledge concerning its scope. Objective: To determine the prevalence and characteristics of the disease in Havana (2017-2018). Methods: A multicenter, cross-sectional study coordinated by Iniciative Burden of Lung Disease. It included 349 non-hospitalized people aged 40 and over from four family doctor´s offices (random selection). A questionnaire with sociodemographic variables on previous medical diagnosis and smoking was applied. A spirometric study was conducted before and after salbutamol administration to determine airflow limitations, and the disease was classified as mild, moderate, severe, and very severe. Results: Overall prevalence was 20.9% (95 % CI: 16.6-25.2); with males accounting for 25.3%; and females for 17.7%. It increased with age. Mild forms of the disease affected 60% of the population; they were more common in females (67%) than in males (severe forms, 22%). Previous spirometry was performed in 15% of respondents. Fourteen people (19.1%) had previously been diagnosed with pulmonary emphysema, chronic bronchitis, or chronic obstructive pulmonary disease. Smoking prevalence was 36%, with a higher percentage in the severe forms of the disease. One-third (31.7%) were exposed to second-hand tobacco smoke at home or at work, with a daily average exposure of 5 hours. Conclusions: Chronic obstructive pulmonary disease is a major health problem in Havana due to its high prevalence and underdiagnosis. An increase in prevalence is predicted given the demographic dynamics in the country and the high level of tobacco consumption among the population. Therefore, more comprehensive management of this preventable disease is required.

RESUMEN Introducción: En Cuba la enfermedad pulmonar obstructiva crónica es sexta causa de mortalidad general. Existe insuficiente conocimiento sobre su magnitud. Objetivo: Determinar la prevalencia y características de la enfermedad en La Habana (2017-2018). Métodos: Estudio multicéntrico transversal, coordinado por Iniciative Burden of Lung Disease, incluyó 349 personas no institucionalizadas de 40 años y más de cuatro consultorios médicos (selección aleatoria). Se aplicó cuestionario con variables sociodemográficas relacionadas con diagnóstico médico previo y tabaquismo. Se realizó estudio de espirometría, pre-pos aplicación de salbutamol para determinar limitación del flujo aéreo y clasificó severidad de la enfermedad en leve, moderada, severa y muy severa. Resultados: Prevalencia global 20,9 % (IC 95 %:16,6-25,2); en hombres 25,3 %, en mujeres 17,7 %. Se incrementó con la edad. Formas leves 60 %, más frecuentes en mujeres 67 % vs. severas en hombres, 22 %. Espirometría previa 15 % de encuestados. Catorce encuestados (19,1 %) tenían el diagnóstico médico previo de enfisema pulmonar, bronquitis crónica o enfermedad pulmonar obstructiva crónica. Prevalencia de tabaquismo 36,0 %, mayor porcentaje en formas severas. La tercera parte (31,7 %), expuestos al humo de tabaco ajeno, en hogar o trabajo; media de exposición diaria 5 h. Conclusiones: La alta prevalencia y subdiagnóstico de enfermedad pulmonar obstructiva crónica la convierten en un importante problema de salud en La Habana. Se pronostica incremento de la prevalencia relacionado con la dinámica poblacional en el país y el alto consumo de tabaco en la población. Se requiere un manejo más integral de esta enfermedad prevenible.

ABSTRACT Introduction: In the early detection of development problems, it is important to use screening instruments. Objective: To describe the design of an instrument for the screening of psychomotor development's problems in children under six years old. Methods: Development research conducted in Havana, in healthy children under six years old (n= 1 333). The design of instrument was based on the estimation of the ages of compliance related to a set of development guidelines. The 25th, 50th, 75th and 90th percentiles (± 95% CI) of the compliance age of 80 psychomotor development patterns were estimated by means of a logistic regression with inverse transformation. The 50th percentile was compared with that of other similar tests. The instrument was designed with a graphical method with Microsoft Excel 2010 program. Results: All percentiles were estimated in 93.8% of the selected guidelines; in three of them it was not possible to obtain the 25th percentile, the 50th or both, and in two cases they were fulfilled by all the children, so their behavior was not according to a "maturational" model. In the comparisons with respect to foreign tests, the patterns fulfilled at similar and advanced ages prevailed. Conclusions: The instrument designed is a useful tool for the investigation of psychomotor development problems in early childhood, both in care practice and epidemiological studies, and their application in these scenarios contributes to raising the quality of pediatric care.

RESUMEN Introducción: En la detección temprana de los problemas del desarrollo resulta importante emplear instrumentos de pesquisa. Objetivo: Describir el diseño de un instrumento para la pesquisa de los problemas del desarrollo psicomotor en niños menores de seis años. Métodos: Investigación de desarrollo realizada en La Habana, en niños sanos menores de seis años (n=1 333). El instrumento se diseñó a partir de la estimación de las edades de cumplimiento de un conjunto de pautas de desarrollo. Se estimaron los percentiles 25, 50, 75 y 90 (± IC95 %) de la edad de cumplimiento de 80 pautas del desarrollo psicomotor mediante una regresión logística con transformación inversa. Se comparó el percentil 50 con el de las pautas de otras pruebas similares. El instrumento se diseñó con un método gráfico con el programa Microsoft Excel 2010. Resultados: Se estimaron todos los percentiles en 93,8 % de las pautas seleccionadas; en tres de ellas no fue posible obtener el percentil 25, el 50 o ambos y en dos casos fueron cumplidas por todos los niños, por lo que su comportamiento no fue acorde a un modelo “madurativo”. En las comparaciones respecto a pruebas foráneas predominaron las pautas cumplidas a edades similares y adelantadas. Conclusiones: El instrumento diseñado constituye una herramienta útil para la pesquisa de los problemas del desarrollo psicomotor en la primera infancia, tanto en la práctica asistencial como en estudios epidemiológicos. Su aplicación en estos escenarios contribuye a elevar la calidad de la atención pediátrica.

ABSTRACT Growth and development is considered the best positive indicator of children’s quality of life and well-being. Studies have been carried out in Cuba since the early 20th century and large scale, periodic anthropometric surveys have been regularly conducted by its National Health System to chart modifications in growth patterns of children and adolescents. These surveys have produced national references for the anthropometric indicators most commonly applied in individual assessment of the health and nutritional status of children and adolescents in health care settings. These have also provided data for estimating the magnitude and characteristics of secular growth trends, and for comparing growth of Cuban children with that of children in other countries and with WHO’s proposed growth standards. The data have also served as evidence of persisting social gradients. The most important results include, as positive data, the positive secular trend in school-aged children’s growth of 9.7 cm between 1919 and 2005, with an average increase of 1.1 cm per decade, and, in preschool children, 1.9 and 1.8 cm in boys and girls, respectively, between 1972 and 2015. More recent studies have detected unfavorable changes associated with a marked increase in adiposity and, therefore, in the prevalence of excess weight and obesity. Another interesting result is the gradual movement toward WHO height-for-age standards in preschool children in Havana, verified in surveys conducted in 2005 and 2015.

ABSTRACT Introduction: The adolescence is a period of development and growth during which the persons establish its sense of individual identity, adaptation to more mature intellectual capacities, to the requirements of the society as for the conduct, internalization of a system of personal values and the preparation for adults' rolls. In this period there happen biological, psychological and social transformations that need of specializing attention. The results of the scientific investigation that are translated in scientific production can contribute to the improving of the integral attention to and the adolescents. Objective: To characterize the behavior of the scientific production related to the adolescence, bibliométricos realized a descriptive study, defining the scientific productions and investigations that tackle the main problems of health of and the Cuban adolescents. Methods: For the study there took the universe of the scientific production of the Cuban Magazine of Public health, Cuban Magazine of Paediatrics and Cuban Magazine of Familiar Medicine in the period 2011-2015. Results: The present investigation allowed to identify of harmonic form the mail between the main problems of health of and the adolescents and the subject-matters tackled in the chosen magazines. Conclusions: The generalization of the scientific communication favors the solution of the main problems of health identified in and the Cuban adolescents.

RESUMEN Introducción: La adolescencia es un periodo de desarrollo y crecimiento durante el cual las personas establecen su sentido de identidad individual, adaptación a capacidades intelectuales más maduras, a las exigencias de la sociedad en lo que respecta a la conducta, internalización de un sistema de valores personales y la preparación para roles de adultos. En este periodo acontecen transformaciones biológicas, psicológicas y sociales que requieren de atención especializada. Los resultados de la investigación científica que se traducen en producción científica pueden contribuir al perfeccionamiento de la atención integral a los adolescentes. Objetivo: Caracterizar el comportamiento de la producción científica relacionada con la adolescencia. Métodos: Se realizó un estudio descriptivo bibliométrico, se definieron las producciones científicas e investigaciones que abordan los principales problemas de salud de los adolescentes cubanos. Para el estudio se tomó el universo de la producción científica de la Revista Cubana de Salud Pública, Revista Cubana de Pediatría y Revista Cubana de Medicina Familiar en el periodo 2011-2015. Resultados: Se identificaron de forma armónica la correspondencia entre los principales problemas de salud de los adolescentes y las temáticas abordadas en las revistas seleccionadas. Conclusiones: La generalización de la comunicación científica favorece la solución de los principales problemas de salud identificados en los adolescentes cubanos.

ABSTRACT Introduction: The application of screening tests in the health controls of children allows the early detection of psychomotor development’s problems. Objective: To describe the design and methods used to obtain an instrument for the detection of psychomotor developmental problems in children under six years old. Methods: A development research was carried out between 2014 and 2018, in which a stratified, three-phase and equiprobabilistic sample design was applied by age group and sex. It included nine health areas (polyclinics) in the same number of municipalities and 256 Family doctor-and-nurse’s offices. The inclusion criteria were: children classified as healthy, between 15 days and 6.5 years, with permanent residence in the care area of the selected family doctor-and-nurse’s offices and with the consent of parents or guardians; those with acute diseases at the time of evaluation were excluded. Results: 80 developmental guidelines were selected, and those were distributed in 4 areas and 25 age groups. A total of 1 333 children were studied representing the 96.8 % of the estimated sample. On average, 53 children were evaluated by age group; the average of guidelines evaluated per child was 22. The level of maternal education was high. Conclusions: The design and methods used constitute a reliable base with the purpose of obtaining a valid instrument for the research of psychomotor development’s problems in children under six years, which also it allows obtaining useful information from the assistance and epidemiological point of view.

RESUMEN Introducción: La aplicación de pruebas de pesquisa en los controles de salud de los niños permite la detección temprana de problemas del desarrollo psicomotor. Objetivo: Describir el diseño y los métodos empleados para obtener un instrumento para la pesquisa de problemas del desarrollo psicomotor en niños menores de seis años. Métodos: Investigación de desarrollo realizada entre 2014-2018 y en la que se aplicó un diseño muestral estratificado, trietápico y equiprobabilístico por cada grupo de edad y sexo. Incluyó nueve áreas de salud en igual número de municipios y 256 consultorios. Los criterios de inclusión fueron: niños dispensarizados como sanos, edad entre 15 días y 6,5 años, residencia permanente en el área de atención de los consultorios seleccionados y consentimiento informado de los padres o tutores; se excluyeron aquellos con enfermedades agudas en el momento de la evaluación. Resultados: Se seleccionaron 80 pautas de desarrollo distribuidas en 4 áreas y 25 grupos de edad. Se estudiaron 1 333 niños, el 96,8 % de la muestra estimada. Se evaluaron, como promedio, 53 niños por grupo de edad, el promedio de pautas evaluadas por niño fue de 22. El nivel de educación materna fue elevado. Conclusiones: El diseño y los métodos empleados constituyen una base fiable para el propósito de obtener un instrumento válido para la pesquisa de problemas del desarrollo psicomotor en niños menores de seis años, que permite además, obtener información útil desde el punto de vista asistencial y epidemiológico.

The first 1000 days of life constitute a short and exceptionally important period when the foundation is established for children’s growth, development and lifelong health. Cuba has a comprehensive care system for this population that aims to promote the best start in life so that children can reach their highest development potential. This is carried out through the national public health and education systems and also includes elements of health protection, prevention of harm and disease and social welfare for children. Cuba’s infant mortality rate has remained <5 deaths per 1000 live births for 10 consecutive years, and in 2017 reached 4 per 1000, the lowest rate to date. The mortality rate for children aged <5 years in 2017 was 5.5 per 1000 live births, with a survival rate of 99.5%; low birth weight was 5.1% and vaccination coverage >95%. Among children aged 1 year in Cuba’s Educate Your Child program in 2014, >90% met age-specific indicators in all four developmental domains (intellectual, motor, socioaffective and language). Cuba has universal coverage for antenatal care and, in 2017, 99.9% of births occurred in health institutions. All working mothers receive paid antenatal leave from 34 weeks of gestation, continued through the child’s first year, to facilitate breastfeeding and child care. In 2018, the Cuban government allocated 27% of its national budget to health and social welfare and 21% to education.

ABSTRACT In Cuba, maternal and child health care is based on the priority granted by the State, the implementation of the National Maternal and Child Health Program and the guarantee of equitable access to health services. This article describes the Cuban experience in this field, as well as its main achievements, challenges, and lessons learned. Among the most relevant results up to 2015 are the reduction of infant mortality rate and under-five mortality rate to 4.3 and 5.7 deaths per 1 000 live births, respectively; 5-year survival of 99.4%; more than 10 prenatal check-ups per delivery; 5.3% of low birth weight; 99.9% of institutional births; and being the first country to validate the elimination of mother-to-child transmission of HIV/AIDS and congenital syphilis. The main challenges are to increase the rate of exclusive breastfeeding; to reduce anemia due to iron deficiency in children and pregnant women; to reduce overweight in children; to prevent accidents; and to reduce maternal mortality, adolescent fertility rate, and voluntary abortion. Among the lessons learned are the priority given by the State to health, the programmatic management of maternal and child care, the guarantee of universal coverage, the systematic collection of information for decision-making, the integration of sectors and social participation in health. Sustaining and improving the results achieved will contribute to the fulfillment of the Sustainable Development Agenda for 2030.

RESUMEN En Cuba, la atención a la salud maternoinfantil se sustenta en la prioridad que le otorga el Estado, la ejecución del Programa Nacional de Atención Materno Infantil y la garantía de acceso equitativo a los servicios de salud. Este artículo describe la experiencia cubana en este campo, así como sus principales logros, desafíos y lecciones aprendidas. Entre los resultados más relevantes hasta el 2015 se encuentran la reducción de la mortalidad infantil y del menor de 5 años a 4,3 y 5,7 fallecidos por 1 000 nacidos vivos, respectivamente; supervivencia a los 5 años de 99,4%; más de 10 controles prenatales por parto; 5,3% de peso bajo al nacer; 99,9% de partos institucionales; y ser el primer país en validar la eliminación de la transmisión vertical del VIH y la sífilis congénita. Los principales desafíos son aumentar la tasa de lactancia materna exclusiva; reducir la anemia por déficit de hierro en niños y gestantes y el sobrepeso infantil; prevenir los accidentes; y reducir la mortalidad materna, la tasa de fecundidad en las adolescentes y el aborto voluntario. Entre las lecciones aprendidas se destacan la prioridad que el Estado otorga a la salud, la conducción programática de la atención maternoinfantil, la garantía de cobertura universal, la recolección sistemática de información para la toma de decisiones, la integración de los sectores y la participación social en la salud. Sostener y mejorar los resultados alcanzados contribuirá al cumplimiento de la Agenda de Desarrollo Sostenible para el 2030.

RESUMO Em Cuba, os cuidados de saúde materno-infantil baseiam-se na prioridade concedida pelo Estado, na implementação do Programa Nacional de Saúde Materno-Infantil e na garantia de acesso equitativo aos serviços de saúde. Este artigo descreve a experiência cubana neste campo, bem como as principais conquistas, desafios e lições aprendidas. Entre os resultados mais relevantes até 2015 estão a redução da mortalidade infantil e mortalidade em menores de 5 anos para 4,3 e 5,7 mortes por 1 000 nascidos vivos, respectivamente; sobrevivência a 5 anos de 99,4%; mais de 10 exames pré-natal por nascimento; 5,3% do baixo peso ao nascer; 99,9% dos partos institucionais; e seja o primeiro país a validar a eliminação da transmissão materno-infantil de HIV/AIDS e sífilis congênita. Os principais desafios são aumentar a taxa de aleitamento materno exclusivo; reduzir a anemia devido a deficiência de ferro em crianças e mulheres grávidas e reduzir o excesso de peso infantil; prevenir acidentes; e reduzir a mortalidade materna, taxa de fertilidade adolescente e aborto voluntário. Entre as lições aprendidas estão a prioridade dada pelo Estado à saúde, a gestão programática dos cuidados materno e infantil, a garantia de cobertura universal, a coleta sistemática de informações para a tomada de decisões, a integração de setores e a participação social em saúde. Sustentar e melhorar os resultados obtidos contribuirá para o cumprimento da Agenda de Desenvolvimento Sustentável para 2030.

In diets for Totoaba macdonaldi juveniles (26.3 ± 4.7g y 13.6 ± 1cm) the partial replacement of fishmeal protein (HP) with shrimp head meal (HCC) was evaluated, over their growth, survival, fed conversion (FCA) and chemical composition of tissues and the apparent digestibility coefficient of dry matter (CDA), protein (CDAP) and lipids (CDAL) of these diets. The HCC used were from the whole shrimp head sun dried (F) and smashed shrimp head dehydrated in a hot air drier. Diets were isoproteic (55.5% crude protein), isolipídic (15% lipids) and isocaloric (4.6 kcal g-1) replacing 0% (control diet; DC), 15% (F15 and M15) and 30% (F30 and M30) of the HP protein by the HCC. At 57th day, survival with HCC (99.44 ± 1.92%) was higher than DC (88.89 ± 3.85 %). The gain weight, weight specific growth (TCE) and total intake were not statistically different (P > 0.05) between organisms feed with HCC, however with the M30 diet the TCE had higher average (0.99 ± 0.06) and growth (19.82 ± 1.64 g/fish). With diet M30 the FCA was the best significantly (1.61 ± 0.13) and the higher CDA (66.18 ± 1.28), CDAP (86.51 ± 0.53) and CDAL (72.29 ± 1.10). It concluded that replaced protein of HP by HCC in diet for juvenile totoaba improved the growth and CDAs, yielding better results with the inclusion of macerated HCC with a replacement level of 30%.

En dietas para juveniles de Totoaba macdonaldi (26,3 ± 4,7 g y 13,6 ± 1 cm) se evaluó la sustitución proteica parcial de harina de pescado (HP) por harinas de cabeza de camarón (HCC), sobre su crecimiento, sobrevivencia, factor de conversión alimenticia (FCA) y composición química de tejidos, y el coeficiente de digestibilidad aparente de materia seca (CDA), proteínas (CDAP) y lípidos (CDAL) de estas dietas. Se utilizó HCC de cabezas enteras deshidratadas al sol (F) y HCC de cabezas maceradas y deshidratadas en secador de aire (M). Las dietas fueron isoproteicas (55,5% de proteína cruda), isolipídicas (15% de lípidos) e isoenergéticas (4,6 Kcal g-1) remplazando el 0% (dieta control; DC), 15% (F15 y M15) y 30% (F30 y M3ü) de la proteína de la HP por la de HCC. Después de 57 días la sobrevivencia con HCC (99.44 ± 1.92%) fue mayor que DC (88,89 ± 3,85%). El peso ganado, crecimiento específico en peso (TCE) y el consumo total no presentaron diferencias estadísticas (P > 0,05) entre los organismos alimentados con HCC. No obstante, la dieta M30 presentó un promedio mayor en TCE (0,99 ± 0,06) y crecimiento (19,82 ± 1.64 g/pez). La dieta M30 significativamente tuvo la mejor FCA (1,61 ± 0,13) y las más altas CDA (66,18 ± 1,28), CDAP (86,51 ± 0,53) y CDAL (72,29 ± 1,10). Se concluye que la sustitución proteica de HP por HCC en alimento para juveniles de totoabas mejoró los parámetros productivos y los CDAs, obteniéndose mejores resultados con la inclusión de HCC macerada y niveles de sustitución de 30%.

The notable rise in survival rates of Cuban children has presented new challenges in the search for continued improvement of their welfare and quality of life. These advances can be achieved only to the extent that preventive care and health promotion are also improved. This article describes the design of a strategy for comprehensive care of children and adolescents based on better quality of well child visits, defining visit components, age-specific activities for each visit, and guidelines for followup based on visit findings. Complementary to the strategy, indicators and standards are identified for systematic evaluation of visit quality, enabling collection of objective and specific information about individual visits and assessment of trends over time, which in turn facilitates further improvements in this strategy over the long term.