ABSTRACT Aging and Alzheimer is a prospective, longitudinal cohort study involving 2944 adults aged ≥65 years from selected areas in Cuba’s Havana and Matanzas Provinces. This door-to-door study, which began in 2003, includes periodic assessments of the cohort based on an interview; physical exam; anthropometric measurements; and diagnosis of dementia and its subtypes, other mental disorders, and other chronic non-communicable diseases and their risk factors. Information was gathered on sociodemographic characteristics; disability, dependency and frailty; use of health services; and characteristics of care and caregiver burden. The first assessment also included blood tests: complete blood count, blood glucose, and liver function, lipid profile and ApoE4 genotype (a susceptibility marker). In 2007–2011, the second assessment was done of 2010 study subjects aged ≥65 years who were still alive. The study provides data on prevalence and incidence of dementia and its risk factors, and of related conditions that affect the health of older adults. It also contributes valuable experiences from field work and interactions with older adults and their families. Building on lessons learned, a third assessment to be done in 2016–2018 will incorporate a community intervention strategy to respond to diseases and conditions that predispose to dementia, frailty and dependency in older adults.

ABSTRACT Dementia is a great challenge to public health in Cuba due to its impact on society and families. Cuba’s National Intervention Strategy for Alzheimer Disease and Dementia Syndromes is designed to address this challenge. The Strategy includes working guidelines for primary and secondary care, education about rights of people with cognitive impairment, professional development, research, and health promotion and dementia prevention. An associated action plan, focused on primary care, includes proposals for creation of memory clinics, day centers and comprehensive rehabilitation services for cognitive stimulation. Short-term measures proposed include increasing early detection; creating a dementia morbidity and mortality registry; promoting professional training; providing support for families; and promoting basic and clinical research on dementia. Medium-term proposals aim to reduce dementia incidence and mortality by controlling risk factors and promoting healthy lifestyles, offering new treatment options and optimizing early detection. A set of indicators has been developed to evaluate strategy implementation. With this strategy, Cuba joins the small number of developing countries that have responded to WHO’s call to improve care for patients with dementia and alleviate its impact on society and families.

The existance of an ascending line of development of the abilities to interview and of the quality of the medical history taken by students on advancing in the medical career is expected. In order to compare the quality of the medical history recently taken by third- and six-year medical students, 19 patients were sequentially interviewed by the same number of students of each year. The newly taken medical histories were compared taking into consideration qualitative and quantitative criteria. Generally, the medical history taken by the interns were of better quality, mainly because they got more primary information and established the chronopathogram of the clinical data in a better way, excepting 4 cases in which those of the third year were slightly higher. In the rest of the 15 reviewed medical histories, the quality of the interns was significantly higher in 7 and, fundamentally, in one. In the other 7 there was a mild superiority. Emphasis is made on the need to continue teaching and evaluating the abilities to interview at every level of the clinical area and on seeking the most efficient methods to attain it.

Es de esperar que exista una línea de desarrollo ascendente de las habilidades para interrogar y la calidad de la anamnesis recogida por los alumnos al avanzar en la carrera de Medicina. Con el objetivo de comparar la calidad de la anamnesis reciente, recogida por alumnos de tercer y sexo años, 19 pacientes fueron interrogados por igual número de alumnos de cada año de forma secuencial. Las anamnesis recientes recogidas fueron comparadas tomando en cuenta criterios cualitativos y cuantitativos. En sentido general las anamnesis recogidas por los internos fueron de mejor calidad, fundamentalmente porque recogieron más información primaria y establecieron mejor el cronopatograma de los datos clínicos, excepto en 4 casos en que las de los alumnos de tercer año fueron ligeramente superiores. En el resto de las 15 anamnesis revisadas, la calidad de las pertenecientes a los internos fue marcadamente superior en 7 y en la fundamental en una, en las 7 restantes la superioridad fue ligera. Se insiste en la necesidad de dar continuidad a la enseñanza y evaluación de las habilidades para entrevistar en cada estancia del área clínica y en buscar los métodos más eficaces para lograrlo.

Medical questioning allows establishing an adequate physician-patient relationship and achieving a high rate of correct diagnostic hypotheses. However, mistakes are frequent in the interviews. With the aim of detecting the most frequent mistakes made by Internal Medicine residents, determining the diagnostic value of medical history-taking and stating some considerations on the function of teaching in this respect, 60 medical interviews made by Internal Medicine residents were directly observed and the diagnostic impressions of these residents after finishing medical history-taking were compared with final diagnoses. An average of 10.5 mistakes per interview was detected, being the most frequent those related with the completion of information to be collected and other technical ones affecting the physician-patient relationship. Nevertheless, anamnesis provided a correct diagnostic hypothesis in 78.3% of cases. Recommendations were made as to the training of educators in teaching and evaluation of the medical interview and also the use of the direct observation method. Additionally, a mistake classification for medical interviews, which comprises 3 classification groups according to the most related psychological field, was suggested.

El interrogatorio médico permite establecer una adecuada relación médico-paciente y lograr un alto índice de hipótesis diagnósticas correctas. Son frecuentes, sin embargo, los errores al interrogar. Con la intención de detectar los errores más frecuentes cometidos por residentes de Medicina Interna, determinar el valor diagnóstico de la anamnesis y exponer algunas consideraciones sobre la función de la docencia al respecto, se llevó a cabo la observación directa de 60 entrevistas médicas realizadas por residentes de Medicina Interna y se comparó la impresión diagnóstica de estos al terminar la anamnesis con el diagnóstico final. Se detectaron un promedio de 10,5 errores por entrevista; los más frecuentes relacionados con el completamiento de la información a recoger y otros de carácter técnico con influencia en la relación médico-paciente. No obstante, la anamnesis permitió ofrecer una hipótesis diagnóstica correcta en el 78,3 % de los casos. Se hacen recomendaciones como la capacitación del personal docente en la enseñanza y evaluación de la entrevista médica y en la utilización del procedimiento de observación directa. Además se propone una clasificación de los errores al interrogar, en 3 grupos, según la esfera psicológica con que mayor relación tengan.