Abstract Background: Among congenital heart diseases, those with univentricular physiology are the most severe with the lowest survival. Fontan surgery (FS) is the procedure of choice, as it bypasses the flow from the caval veins to the pulmonary circulation but requires close monitoring for late complications. The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic caused nations to prioritize the availability of human and material health resources to benefit those infected. This study aimed to evaluate the clinical consequences of hospital reconversion due to the COVID-19 pandemic in a univentricular heart clinic for patients with FS from the bioethical perspective. Methods: We conducted an analytical cross-sectional study in a captive cohort of patients with FS treated in a tertiary hospital with conversion to COVID-19 patient care. The consequences of discontinuation of follow-up were recorded. Qualitative variables were expressed as frequencies and percentages, and quantitative variables as medians and interquartile ranges (p25-p75). Comparison between the two groups was performed with the χ2 test. Results: We included 51 patients with a median age of 13 years and a follow-up of 5 years. The male: female ratio was 0.88:1.12, and 41% (21) presented failures. More than 90% of the patients presented needs for medications and imaging studies. The two patients cared for in palliative care discontinued their care. Conclusions: Continuity of care must be guaranteed for all patients who require it, so health policies are needed to ensure compliance with vulnerable groups.

Resumen Introducción: Entre las cardiopatías congénitas, las de fisiología univentricular son el espectro más grave y con menor supervivencia. La cirugía de Fontan es el procedimiento de elección, ya que deriva el flujo de las venas cava a la circulación pulmonar, pero requiere un seguimiento estrecho de las complicaciones tardías. La pandemia por el SARS-CoV-2 (coronavirus 2 causante del síndrome respiratorio agudo grave) condicionó que las naciones priorizaran la disposición de los recursos humanos y materiales en salud en beneficio de los infectados. El objetivo de este estudio fue evaluar las consecuencias clínicas de la reconversión hospitalaria por la pandemia de COVID-19 en una clínica de corazón univentricular de los pacientes con cirugía de Fontan desde el punto de vista bioético. Métodos: Se llevó a cabo un estudio transversal analítico en una cohorte cautiva de pacientes con cirugía de Fontan atendidos en un hospital de tercer nivel con reconversión para atención de pacientes por COVID-19. Se registraron las consecuencias derivadas de la interrupción del seguimiento. Las variables cualitativas se expresaron en frecuencias y porcentajes, y las cuantitativas en medianas y rangos intercuartílicos (p25-p75). La comparación entre ambos grupos se realizó con la prueba de χ2. Resultados: Se incluyeron 51 pacientes, con una mediana de edad de 13 años y seguimiento de 5 años. La relación de sexo masculino: femenino fue de 0.88:1.12, y el 41% (21) presentaron fallas. Más del 90% de los pacientes presentaron necesidades en el suministro de medicamentos y estudios de imagen. Los dos pacientes atendidos en cuidados paliativos suspendieron su atención. Conclusiones: La continuidad asistencial debe estar garantizada para todos los enfermos que la requieran, por lo que se necesitan políticas de salud para que esta continuidad se cumpla en los grupos vulnerables.

ABSTRACT Intersectoral action in health refers to actions led by the health sector based on coordinated national and local policies, strategically oriented to address priority health issues where actions by other sectors can have a decisive impact on health outcomes. A Cuban example of this approach is the joint efforts by the Ministry of Public Health and the biotechnology industry in development and application of technologies for cervical cancer screening, early detection and treatment. The resulting products have been used by the National Health System since 2010, as part of efforts to reduce cervical cancer mortality. This is an example of intersectoral action intended to identify and contribute to solving problems affecting people’s well-being and quality of life.

A review was conducted of screening strategies for detecting the main cancer sites for which screening has been recommended, assessing WHO and other international organizations' positions, as well as the requirements of Cuba's cancer control strategy. Universally, screening is recommended for cervical, breast and colorectal cancer, all included in the Cuban strategy. Additionally, in Cuba, PSA testing is indicated for men considered at risk (aged >45 years with family history) and those aged >50 years who request it; annual oral exams and teaching of oral self-examination are recommended for the entire population; and for adults aged >35 years, active annual oral cancer case finding. Screening for skin cancer is performed by physical examination of individuals at risk. To maximize benefits of early cancer detection, greater coverage is needed as well as studies of how well screening is performing under current Cuban conditions.