ABSTRACT The final report of the Focus Group on Strategic Planning in the management of academic processes and in health institutions, held on November 19, 2020, at the National Council of Scientific Societies, is presented. It counted with the participation of the Master's Degree in Medical Education students, cadres, officials of the Ministry of Public Health and professors of the National School of Public Health. Its objective was to exchange criteria on strategic planning in academic and institutional health processes.

RESUMEN Se presenta la relatoría final del Grupo Focal sobre Planificación Estratégica en la gestión de los procesos académicos y en instituciones de salud, celebrado el día 19 de noviembre de 2020, en el Consejo Nacional de Sociedades Científicas. Contó con la participación de los maestrantes de la Maestría de Educación Médica, cuadros, funcionarios del Ministerio de Salud Pública y profesores de la Escuela Nacional de Salud Pública. Su objetivo fue intercambiar criterios sobre la planeación estratégica en los procesos académicos e institucionales de salud.

ABSTRACT Introduction: During the life cycle of individuals, interventions are essential to detect and reduce the risk and complications of chronic diseases. Objective: To determine the prevalence of vascular risk values of the main indicators of carbohydrate and lipid metabolism in adolescents and elderlies in Havana. Methods: A cross-sectional study was carried out with a sample made up of apparently healthy adolescents (469; aged 12-16 years) and elderlies (395 aged 65-100 years) without a diagnosis of diseases associated with marked alteration of nutritional and metabolic status. Both populations were evaluated regarding serum glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol using conventional enzymatic methods. Reference risk ranges were used. The results were analyzed using descriptive statistics. Results: In the evaluated adolescents, triglycerides (35.6%) and total cholesterol (23.9%) showed the highest frequencies of risk values. In females, both markers remained the highest in that aspect; while in males, glucose (25.5%) accounted second after triglycerides as the most altered indicators. In the elderlies, low-density lipoprotein cholesterol (58.2%) and total cholesterol (48.6%) corresponded to the highest frequencies of risk values, a pattern that was repeated in each sex. The average values of the indicators were markedly higher in the elderlies than in adolescents, except for glucose and high-density lipoprotein cholesterol. Conclusions: The results obtained show high prevalence of vascular risk values of several metabolic indicators evaluated in adolescents and elderlies, which suggests the need to monitor the analyzed indicators and implement interventions to modify such values, in view of reducing the associated risk, from stages early, such as the pre-adolescence stage.

RESUMEN Introducción: Durante el ciclo de vida de los individuos son imprescindibles intervenciones para detectar y reducir el riesgo y las complicaciones de las enfermedades crónicas. Objetivo: Determinar la prevalencia de valores de riesgo vascular de los principales indicadores del metabolismo glucídico y lipídico en adolescentes y ancianos de La Habana. Métodos: Se realizó un estudio transversal en una muestra conformada por adolescentes (469 de 12-16 años) aparentemente sanos y ancianos (395 de 65-100 años) sin diagnóstico de enfermedades asociadas a la alteración marcada del estado nutricional y metabólico. Ambas poblaciones fueron evaluadas para glucosa, triglicéridos, colesterol total, colesterol de lipoproteinas de alta densidad y colesterol de lipoproteínas de baja densidad, séricos, mediante métodos enzimáticos convencionales. Se usaron rangos de riesgo referentes. Los resultados se analizaron mediante estadística descriptiva. Resultados: En los adolescentes evaluados, los triglicéridos (35,6 %) y el colesterol total (23,9 %) mostraron las mayores frecuencias de valores de riesgo. En las hembras ambos marcadores se mantuvieron como los más elevados en ese orden, mientras que, en los varones, la glucosa (25,5 %) secundó a los triglicéridos como indicadores más alterados. En ancianos, al colesterol de lipoproteínas de baja densidad (58,2 %) y al colesterol total (48,6 %) correspondieron las mayores frecuencias de cifras de riesgo, patrón que se repitió en cada sexo. Los valores promedio de los indicadores fueron marcadamente superiores en ancianos que, en adolescentes, excepto para glucosa y colesterol de lipoproteínas de alta densidad. Conclusiones: Los resultados obtenidos muestran una elevada prevalencia de valores de riesgo vascular de varios indicadores metabólicos evaluados en adolescentes y ancianos, lo que sugiere la necesidad de monitorear los indicadores analizados e implementar intervenciones modificadoras de sus valores hacia la reducción del riesgo asociado, desde etapas tempranas, como las previas a la adolescencia.

ABSTRACT Introduction: During the life cycle of individuals, interventions are essential to detect and reduce the risk and complications of chronic diseases. Objective: To determine the prevalence of vascular risk values of the main indicators of carbohydrate and lipid metabolism in adolescents and elderlies in Havana. Methods: A cross-sectional study was carried out with a sample made up of apparently healthy adolescents (469; aged 12-16 years) and elderlies (395 aged 65-100 years) without a diagnosis of diseases associated with marked alteration of nutritional and metabolic status. Both populations were evaluated regarding serum glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol using conventional enzymatic methods. Reference risk ranges were used. The results were analyzed using descriptive statistics. Results: In the evaluated adolescents, triglycerides (35.6%) and total cholesterol (23.9%) showed the highest frequencies of risk values. In females, both markers remained the highest in that aspect; while in males, glucose (25.5%) accounted second after triglycerides as the most altered indicators. In the elderlies, low-density lipoprotein cholesterol (58.2%) and total cholesterol (48.6%) corresponded to the highest frequencies of risk values, a pattern that was repeated in each sex. The average values of the indicators were markedly higher in the elderlies than in adolescents, except for glucose and high-density lipoprotein cholesterol. Conclusions: The results obtained show high prevalence of vascular risk values of several metabolic indicators evaluated in adolescents and elderlies, which suggests the need to monitor the analyzed indicators and implement interventions to modify such values, in view of reducing the associated risk, from stages early, such as the pre-adolescence stage.

RESUMEN Introducción: Durante el ciclo de vida de los individuos son imprescindibles intervenciones para detectar y reducir el riesgo y las complicaciones de las enfermedades crónicas. Objetivo: Determinar la prevalencia de valores de riesgo vascular de los principales indicadores del metabolismo glucídico y lipídico en adolescentes y ancianos de La Habana. Métodos: Se realizó un estudio transversal en una muestra conformada por adolescentes (469 de 12-16 años) aparentemente sanos y ancianos (395 de 65-100 años) sin diagnóstico de enfermedades asociadas a la alteración marcada del estado nutricional y metabólico. Ambas poblaciones fueron evaluadas para glucosa, triglicéridos, colesterol total, colesterol de lipoproteinas de alta densidad y colesterol de lipoproteínas de baja densidad, séricos, mediante métodos enzimáticos convencionales. Se usaron rangos de riesgo referentes. Los resultados se analizaron mediante estadística descriptiva. Resultados: En los adolescentes evaluados, los triglicéridos (35,6 %) y el colesterol total (23,9 %) mostraron las mayores frecuencias de valores de riesgo. En las hembras ambos marcadores se mantuvieron como los más elevados en ese orden, mientras que, en los varones, la glucosa (25,5 %) secundó a los triglicéridos como indicadores más alterados. En ancianos, al colesterol de lipoproteínas de baja densidad (58,2 %) y al colesterol total (48,6 %) correspondieron las mayores frecuencias de cifras de riesgo, patrón que se repitió en cada sexo. Los valores promedio de los indicadores fueron marcadamente superiores en ancianos que, en adolescentes, excepto para glucosa y colesterol de lipoproteínas de alta densidad. Conclusiones: Los resultados obtenidos muestran una elevada prevalencia de valores de riesgo vascular de varios indicadores metabólicos evaluados en adolescentes y ancianos, lo que sugiere la necesidad de monitorear los indicadores analizados e implementar intervenciones modificadoras de sus valores hacia la reducción del riesgo asociado, desde etapas tempranas, como las previas a la adolescencia.

ABSTRACT INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders. OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults. METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen’s criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups. RESULTS Persons with Alzheimer disease presented significantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were significantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not significantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were significantly higher for hyperhomocysteinemia (PR = 3.26; 1.84–5.80) and deficiency of all B vitamins: thiamine (PR = 1.89; 1.04–3.43), B-2 (PR = 2.85; 1.54–5.26), folate (PR = 3.02; 1.53–5.95), B-12 (PR = 2.21; 1.17–4.19), vitamin C (PR = 3.88; 2.12–7.10) and A (PR = 5.47; 3.26–9.17). In mild cognitive impairment, prevalence rates were significantly higher for hyperhomocysteinemia (PR = 1.42; 1.08–1.87), vitamin B-2 deficiency (PR = 1.70; 1.24–2.32) and vitamin A deficiency (PR =1.88; 1.05–3.38). CONCLUSIONS Hyperhomocysteinemia and various vitamin deficiencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies.

ABSTRACT Arbuscular mycorrhizal fungi (AMF) are represented in almost all terrestrial ecosystems and colonize more than 90 % of plants. Its association depends on many edaphoclimatic factors including pH one of the most important chemical parameters of the soil which directly regulates the availability of nutrients and can affect germination, diversity, spore density and colonization of roots by AMF The objective of this study was to evaluate the effect of the pH of the Strullu and Romand Modified culture medium (SRM) on the presymbiotic growth of Rhizoglomus irregulare (INCAM 11) on in vitro conditions. For the development of the experiment, surface sterilized AMF spores were exposed to different pH conditions (4.5, 5.5, 6.5 and 7.5). The growth of the germinative tube was evaluated during 4 weeks, presenting the higher values on pH 7.5. This result is within the range of optimum pH recommended for this strain in field experiments, in which it shows its highest efficiency.

RESUMEN Los hongos micorrízicos arbusculares (HMA) están representados en casi todos los ecosistemas terrestres y colonizan a más del 90 % de las plantas. Su asociación depende de muchos factores edafoclimáticos entre ellos el pH, uno de los parámetros químicos más importantes del suelo, que regula directamente la disponibilidad de los nutrientes y puede afectar la germinación, diversidad, densidad de esporas y colonización de raíces por HMA El presente estudio tuvo como objetivo evaluar el efecto del pH del medio de cultivo Strullu y Romand Modificado (SRM) en el crecimiento presimbiótico de Rhizoglomus irregulare (INCAM 11) en condiciones “in vitro”. Para el desarrollo del experimento las esporas de HMA se expusieron a diferentes pH (4,5; 5,5; 6,5 y 7,5) y se evaluó el crecimiento del tubo germinativo durante 4 semanas presentando los mayores valores de crecimiento en el pH 7,5. Este resultado está dentro del rango de pH óptimo recomendado para esta cepa en experimentos de campo, en los cuales muestra su mayor eficiencia.

ABSTRACT INTRODUCTION Iron deficiency is the main cause of anemia, but infections, inflammation and other factors also play a role. Anemia in women of childbearing age is a risk for pregnancy, childbirth and childhood development during the first two years of life. In Cuba, per WHO definition, anemia is a moderate public health problem in the third trimester of pregnancy and in preschoolers, with a prevalence of 21.6%, in both cases. OBJECTIVE Estimate prevalence of anemia and iron deficiency in women of childbearing age and assess its relation to inflammation, overweight, central adiposity, H. pylori infection and ingestion of iron-rich foods and enhancers of iron absorption. METHODS A cross-sectional, analytical study was performed in 391 women aged 18–40 years in four municipalities of Havana, Cuba, from February through June 2014. Variables (indicators in parentheses) were anemia (hemoglobin), iron deficiency (ferritin), nutritional status (body mass index and waist circumference), inflammation (C-reactive protein, acid alpha 1-glycoprotein and interleukin 6), H. pylori infection and ingestion of iron-rich foods. SPSS 20.0 and Epi Info 7.1.2.0 were used for statistical analysis. RESULTS Anemia prevalence was 24.6% (96/391); iron deficiency, 68% (266/391); H. pylori infection, 47.1% (184/391); inflammation detected by C-reactive protein, 8.4 % (33/391) and by alpha-1-gly-coprotein, 19.9% (78/391). Limited results are included for interleukin 6, which was determined in fewer cases (96). Excess body weight was found in 38.7% (150/388) and increased central adiposity in 26.7% (101/378). Iron deficiency was the main cause of anemia (OR 2.68). Central adiposity, excess body weight, and iron deficiency were positively associated with inflammation (OR of 1.77, 1.23 and 1.72, respectively), whereas H. pylori infection was negatively associated with iron deficiency and anemia (OR 0.75 and 0.94, respectively). Low consumption of meat (OR 1.17) and vegetables (OR 1.36) showed discrete limited positive associations with iron deficiency, as well as low consumption of eggs (OR 1.69) and vegetables (OR 1.56) with anemia. CONCLUSIONS Anemia is a moderate public health problem in the studied group, but with iron deficiency present in two thirds of the population and associated with anemia. Risk factors for anemia and iron deficiency, such as menorrhagia and bacterial or viral infections, should be assessed in women of childbearing age, to support interventions needed to reduce risks in pregnancy and childbirth.

INTRODUCTION Anemia is the main nutritional problem in Cuban preschool children, prompting several interventions to prevent and control it. An enhanced national strategy was established in 2008, and particular attention paid to the eastern provinces, the region with greatest challenges in social determinants of health. OBJECTIVE Determine anemia prevalence in children aged 6-59 months in Cuba's five eastern provinces in three separate years within a decade, as well as association of anemia with epidemiological and nutritional factors, to assess impact of Cuba's Comprehensive Plan for Prevention and Control of Iron-Deficiency Anemia in Cuba. METHODS Cross-sectional studies of children aged 6-59 months (completed) were conducted in 2005, 2008 and 2011. Hemoglobin levels were measured to diagnose anemia (hemoglobin <110 g/L) and data were collected on independent variables such as age, sex, area of residence (urban or rural), daycare center enrollment, birth weight, breastfeeding history, and maternal anemia during pregnancy. Frequency distributions were created and comparisons tested with the chi square, and odds ratios calculated with 95% confidence intervals. RESULTS Anemia prevalence in the region fell from 31.8% in 2005 to 26% in 2011; most of cases were mild (hemoglobin: 100-109 g/L). Prevalence was higher in children aged 6-23 months than in those aged 24-59 months throughout. No significant differences were found in anemia prevalence between boys and girls. Prevalence was higher in rural than in urban areas in 2005 (p = 0.026) and 2011 (p = 0.012). Daycare enrollment emerged as a protective factor in all three years. Low birth weight was associated with anemia only in 2011 (OR 1.74, CI 1.04-2.92). Prevalence of exclusive breastfeeding for six months increased over the study period; lack of breastfeeding was found to be associated with anemia in 2005 (OR 1.57, CI 1.05-2.34). Maternal anemia at onset of and during pregnancy was a significant risk factor in 2005 (OR 1.98, CI 1.27-3.10) and 2011 (OR 1.43, CI 1.05-1.94). CONCLUSIONS Although anemia prevalence steadily decreased over the study period, it continues to be a public health problem in Cuba and anemia prevention and control measures should be maintained and strengthened: interventions for women of childbearing age, fostering exclusive breastfeeding of infants through their sixth month, and encouraging compliance with recommendations on complementary feeding per Cuba's nutritional guidelines for children aged <2 years. Further evaluation is needed to identify the causes of anemia in the population of preschool children.

Antecedentes: la enfermedad cardiovascular se asocia con alteraciones lipídicas, hiperglucemia y exceso de peso. Objetivo: asociar las alteraciones en los lípidos séricos y la glucemia con exceso de peso y adiposidad corporal, en adolescentes aparentemente sanos. Material y métodos: estudio descriptivo transversal en 372 adolescentes de12 a 15 años, de la escuela secundaria básica Protesta de Baraguá-Cuba, en quienes se relacionó el índice de masa corporal (IMC) y circunferencia de la cintura con los lípidos séricos y la glucemia. Resultados: se encontraron las siguientes prevalencias: CT>170 mg/dL, 24,7%; c-LDL>110 mg/dL, 12,6%; TG>90 mg/dL, 34,1%; c-HDL<45 mg/dL, 16,1% y glucemia >125mg/dL 10,5%. La prevalencia de exceso de peso según IMC >p85 fue 14,7% y la de valores de riesgo y atípicos de circunferencia de cintura (CC) fue 23,6%. Según Chi2 en las mujeres se encontraron diferencias entre glucemia >125mg/dL según IMC y CC (p<0,001) y en los hombre entre c-HDL<45mg/dL según CC (p=0,037) y entre TG >90 mg/dL según IMC (p=0,040) y CC (p=0,036). Las demás comparaciones entre lípidos séricos y glucemia según IMC y CC no fueron significativas (p>0,05). Conclusión: en los adolescentes estudiados las prevalencias de exceso de peso y de adiposidad central fueron altas, las relaciones entre valores alterados de TG, c-HDL e hiperglucemia con exceso de peso y adiposidad central dependen del sexo.

Background: Cardiovascular disease is associated with lipid abnormalities, hyperglycaemia and overweight. Objectives: To study the relationship between serum lipids and fasting glycaemia with body mass index and waist circumference. Materials and methods: 372 adolescents, 12 to 15 years, participated in a cross sectional study. Associations between Body Mass Index and waist circumference with serum lipids and glycaemia were evaluated. Results: The following prevalence was found: CT>170 mg/dL, 24.7%; LDL- c >110 mg/dL, 12.6%; TG>90 mg/dL, 34.1%; HDL-c<45 mg/dL, 6.1% and glycaemia >125mg/dL 10.5%. Overweight prevalence, BMI> p85 was 14.7% and risk of high waist circumference and atypical values was 23.6%. According Chi2, in girls differences were found between glycaemia > 125mg/dl according BMI and WC (p <0.001) and in boys between HDL-c <45mg/dL according WC (p = 0.037) and between TG > 90 mg / dL according BMI (p = 0.040) and WC (p = 0.036). Conclusions: In adolescents studied the prevalence of overweight and central adiposity were high, the relationship between altered TG, HDL-c and hyperglycemia overweight and central adiposity values depend on sex.

Cerebrovascular diseases are one of the main health problems in all the developed countries and in our country. Our purpose is to deepen in the factors striking in the morbilethality of these patients in our area, fulfilling the general objective of deepening in the study of the cerebrovascular diseases to interact and achieve a decrease of their morbidity, sequelae and the lethality characterizing them. We carried out a descriptive prospective study, including the patients entering the hospital “Dr. Mario Muñoz Monroy” of Matanzas with cardiovascular diseases from June 2000 to June 2003 obtaining that the most frequent genre is the male one, and the age group, the one between 70-79 years-old, being arterial hypertension the risk fact with higher incidence, most of the patients showing some level of disability. We arrived to the conclusion that morbidity and lethality increase with age, associated to the most frequent presentation, cerebral stroke, affecting mainly the cerebral media. Septic complications are predominant, with difficulties in the clinic-pathologic correlation.

Las enfermedades cerebrovasculares (ECV) constituyen uno de los problemas de salud más importantes en todos los países desarrollados y en nuestro país. Nos proponemos profundizar en los factores que inciden en la morbiletalidad de estos pacientes en nuestra área, cumpliendo con el objetivo general de profundizar en el estudio de las enfermedades cerebrovasculares para interactuar y lograr disminuir su morbilidad, sus secuelas y la letalidad que las caracterizan. Se realiza un estudio prospectivo descriptivo, se incluyen los pacientes que ingresaron en el hospital “Dr. Mario Muñoz Monroy” de Matanzas con enfermedades cerebrovasculares de Junio del 2000 a Junio del 2003, tenemos que el sexo más frecuente es el masculino y el grupo de edad, el comprendido entre 70-79 años, resultando la Hipertensión Arterial , el factor de riesgo que más incide, presentándose en la mayoría de los pacientes, algún grado de discapacidad. Llegamos a la conclusión que el incremento de la morbilidad y letalidad, a medida que aumenta la edad, asociado a la forma mas frecuente de presentación que lo constituye el infarto cerebral, con afectación de la cerebral media, fundamentalmente, predominando las complicaciones sépticas, existiendo dificultad en cuanto a la correlación clínico patológica.