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Contemporary considerations and future scenes of the epidemiologic profile of myocardial infartion in Guantanamo(1991-2002), Cuba.

Elias Sierra,Reinaldo; Duverger Goyanes,Jacinto; Betancourt Pulsan,Anselma; Bordelois Abdo, Max Santiago; Gamboa Pellicer,Yoeldis.

General Teaching Hospital " Dr. Agostinho Neto".
Guantanamo, Cuba.


Introduction: Ischemic cardiopathy is the main cause of death in Cuba, where it is planned to reduce the mortality due to this cause in a 20%. It turns necessary to identify its current and future behaviour in order to set the bases for the promotion of health.
Objectives: To estimate the future scene (until 2002) for the behaviour of acute myocardial infarction in Guantánamo.
Method: The outlook of the problem in the province is established (indicators of morbility, mortality and lethality which are afterwards fundamented on the criterion of experts and through participative techniques clue variables and social actors involved in the problem are reflected on. Strategic aims are established, as well as the position of social actors in the view of these and the correlation of strengths. Possible hypotheses are estimated and on their bases it is possible to generate future scenes and the possibility of occurrence, and to achieve this, structural analysis (MICMAC) and positioning matrix (MACTOR method) are used.
Results: medical personnel motivation for the prevention and control of ischemic cardiopathy, sanitary education of population and the control of cardiovascular risk factors are the determinant variables of the problem. It is determined that Public Health Ministry, Popular Power, and population are the most important social actors to promote health, as well as the 4 more probable future scenes and the actions to empower its occurrence.


Introduction:  Ischemic cardiopathy is the main cause of death in Cuba,that is why its attention isan objetive wich has a great priority in our Ministry of Public Health. This objetive is focused on reducing lethality below 50 percent.

In Guantanamo the mortality rate due tomyocardial infartion (MI) ranges around 128,6 per 100 000 inhabitans which, by the way , is undergoing a continued increase. To modify its epidemiologic rofile it necesaryto determine the scene that will be presented tothe organizers and sponsors of Public Health with the aimof potentializing the infrastructure of the servicesand resouces with alevel of organitation and performance that could guarantee the results demanded.


Objectives:  To characterize the future scene of the epidemiologic profile of MI in Guantanamo up to the year 2000 (key variables, social actors, strategic objetives, positioning of the actors per objetive and their correlation of strength and probable scenes.


Methods:  A descriptive-applicative study was carried out in Guantanamo, Cuba in 1998.For such purpose, a group of experts in ischemic cardiopahty were chosen.

The information was obtained through participation techniques which contributed to complete the research.

Primarily, the current situation of MI in the region was analized. On the basis of the results the missionof the study was established.then, trough "brain" storming", 37 variables were generated, all of them related to the scientific problem selected. On analizing them it was possible to identify those that had a grater impact. They were classified as internal (They characterized the essence of the problem). They were processed by means of a structural analysis to determine the influence and dependency (interrelation), this permitted the identification of the key variables wich determined the problem. The strategic objectives were formulated and the social actors involved in this problem were identified, so as the position of the actors with regard to such objetives and their correlations of strength. The connections and conflicts among the actors were studied. By means of a tablework hypotheses on the future behavior of MI in Guantanamo were generated and on the basis of these hypothesis hte possible future scenes in such respect.

The 4 with more probability of occurance were identified.


Results: The control of cardiovascular risk factors, the sanitary education of the population, amd the motivation of health personnel towards the program of control (variables determiners of the problem) were identified as the variables of more influence and lower dependency. Other influential variables but very dependent (relief variables) were MI lethality ;its complcations and mortality due to this reason, the doctor`s level of information on the affection, the social envoronment, the functionability of the integrated medical emergency system and the hospital services.

Some variables turned out to be of very low influence and very depent (place of origin of the patient); therefor, they were considered "resulting variables"; others were influentially limited and of very low dependency (null variables), among them, the caracteristics of the patient, the availability of medications or diagnosis technology, the transportation of the patient to the health center and the existance of specialized bibliography on Mi themes.

The social actors determiners of the future behavior of Mi were defined as The Ministry of Public Health (MPH), The National Institute of Sports Physical Education and Recreation (NISPER), The Church, The Popular Power (PP), The Ministry of Higher Education (MHE), The Ministry of Education (ME), Ministry of Fishing Industry (MFI), The Ministry of Agriculture (MA),and the population. He strategic objetives enunciated by the expertswere the following: to identifiy and guarantee the specific protection of MI high risk groups (objetive No. 1); to reduce the rates of prevalence and incidence of the risk factos and of the ischemic cardiophaty ( objetive No.2); to guarantee the availabity and correct use of the diagnostic and therapetic means for MI (objetive No.3); to increase the quality of the health care to ischemic patiens (objetive No.4); and to obtain and integrate the collaboration among the influential organizations in the health program chosen (objetive No.5).

Other results are reflected on the charts, it is interesting to poin out that there were not conflicts among the factors to potentialize the fulfillment of these objetives.


Discussion: In spite of the fact that lethality was the variable of greater influence and dependency in the problem, strategies were primarily oriented towards the epidemiologic control. This emphasizes the need of prevention activities and the roles of primary health care and of the integral general physician in this problem. The actors that is more likely to provide ajoint worksis the population, this reflects its leadership. The basis of the srtucture and the priorities of haelth to favorably the behavior of MI in the year 2002 are established.


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