Combining health and social protection measures to reach the ultra ...

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Research resources 1,6 100 1,4 1,2 1 90 80 70 60 0,8 50 0,6 0,4 0,2 40 30 20 10 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Morbidity Coverture 0 Figure 4: Incidence and vaccination coverage by Haemophilus influenzae type b, in the period 1994–2006 Scientific research in this field has enabled the country to become currently self-sufficient, with the production of 527 drugs including the antiretroviral, anticancer and immunosupressive drugs supporting the national programmes of HIV/AIDS, control of cancer and organ transplantation. Monoclonal antibodies, of wide application in nephrology and oncology, human transference factor and growth factor used in the treatment of cancer, proctitis and ulcers, and Surfacen for the treatment of respiratory distress of newborn are also included in the range of Cuban products. UltramicroELISA, a Cuban diagnostic technology for neonatal and infectious disease screening, is widely used in the country, supporting the epidemiological surveillance of several infectious diseases such as dengue, HIV, HBV and HCV and the screening in all pregnant women of neonatal disorders such as congenital hypothyroidism, phenylketonuria, galactosemia and other malformations. In the period 1982 to 2006, more than 3 million pregnant women were screened and 6748 congenital malformations were detected .24 . Also, more than 2.7 million (100%) of newborns were studied, detecting 731 with congenital hypothyroidism. These children were treated early, avoiding cretinism. UltramicroELISA has also been fundamental for the blood certification programme. A relatively recent national investigation allowed screening of all individuals with some disability. The physical and psychological characteristics of these persons and the contributing factors for intellectual or mental disability were determined. In the Medical Genetic services, extended to all provinces of the country as part of the National Programme of Attention to Persons with Some Disability and the programme of Medical Genetics, 29 genetic pathologies and more than 50 metabolic disorders are diagnosed. Several investigations relative to schizophrenia and Alzheimer disease, among others, are under way. The development of advanced technology medical BCG HB DTwP - HB + Hib AM-BC MMR DTwP Hib DT AT(Vi) TT OPV (campaign) Table 1: Cuban immunization programme RESEARCH (22) Cholera Tuberculosis Adjuvant N. meningitides B Malaria Leishmania Shiguella-Salmonella Leptospira Pertussis acellular Pseudomonas Animal models Monoclonal antibodies HIV/AIDS Dengue 8 Cancer vaccines DEVELOPMENT (13) Cholera attenuated DT, dT y t (reduced doses) Poli ACYW135 Poli AC dT - Poli Vi BCG intra vesical VA-MENGOC- BC ® reduced aluminum VME as product Cholera inactivated Adjuvant Cocleato Neumococo HC therapeutic HB therapeutic Newborn Newborn 2, 4 & 6 months 3 & 5 month 1 & 6 years 18 months 18 months 6 years 10, 13 & 16 years 14 years
Research resources poliomyelitis and given the particular success of the Cuban vaccination strategy, several investigations supporting global polio eradication have been conducted in our country at the request of the World Health Organization (WHO) and the Pan American Health Organization (PAHO), allowing demonstration of the circulation-time of the vaccine viruses in the environment after the oral vaccination and the immunity of the inactivated vaccine. This new knowledge and the investigations in course will allow improved definition of the strategy for global polio vaccination after eradication 25 . New findings of global impact related to dengue hemorrhagic fever (DHF), have been reported by Cuban scientists. The confirmation of secondary infection as a risk factor for DHF, the influence of the interval between infections and the role of ethnicity and chronic diseases are only some examples 20 . Flexibility also characterizes Cuban science, allowing incorporation of new topics in the research agenda depending on the epidemiological national and international situation. The preparation of the country in terms of surveillance, diagnosis and research to face new global epidemics such as West Nile Fever, SARS and Avian Flu are recent examples. Current research needs and agenda At present, the Cuban population shows a very high health level with the Millennium Development Goals already accomplished 26,27,28 . However, the country is working to reach new goals, with an infant mortality ratio of less than five deaths per 1000 live births, life expectancy at birth of 80 years and quality of life improvement being the most important new targets. At this new stage, research occupies a leading place due to its direct impact on health development. To achieve these new goals, different investigations are under development, notable ones being active screening of risk groups and of the open population for diseases that are the major causes of mortality. These investigations will allow early detection of the illness in order to apply the appropriate treatment and management of patients, avoiding disability and death. Supporting this new strategy, the accessibility of the health system has increased by the introduction of advanced technology at the primary heath care level. A totally different health picture is observed in many other poor countries. According to WHO, and as an example, Africa shows an infant mortality per 1000 live births of 100, a life expectancy at birth of 47 years for males and 49 for females, and HIV/AIDS and TB constitute major causes of mortality 29,30,31 . Due to this serious situation, a new agenda for research and the implementation of research findings is needed at the global level. In this sense, Cuba is developing a new model of regional and international cooperation in health, education and science. Currently, the country hosts 22 000 students from developing countries in its medical schools and more than 32 000 Cuban collaborators labour in more than 80 countries. From the 1960s, more than 132 000 health workers collaborated in 102 countries of the developing world. This model of collaboration is having a direct impact on strengthening human capacities, the development of scientific research and public health. ❏ Gustavo Kourí is a researcher, professor and Vice-President of the Cuban Academy of Science. He is also Director General of the Instituto Medicina Tropical Pedro Kourí in Havana, Cuba. María G Guzmán is a researcher, professor and Director of the WHO/PAHO Collaborative Centre for Dengue study and its vector. She is Chief of the Virology Department at the Instituto Medicina Tropical Pedro Kourí in Havana, Cuba, and is a Member of the Cuban Academy of Science. José Luis Pelegrino is a researcher, professor and a Master in Virology. He is also a research coordinator and a member of staff of the WHO/PAHO Collaborator Centre for Dengue and its vector. He is also on the staff of the Instituto Medicina Tropical Pedro Kourí in Havana, Cuba. Alicia Reyes is an economist and Vice-Director of the Instituto Medicina Tropical Pedro Kourí in Havana, Cuba. Luis Estruch is a researcher, professor and epidemiologist, Cuban Ministry of Health. Niviola Cabrera is a professor and National Director for Science and Technology, Cuban Ministry of Health. 114 ✜ Global Forum Update on Research for Health Volume 4
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Global Forum Update on Research for
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Editorial Advisory Board: Luis Gabr
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Contents 096 Child immunization: ac
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Introduction Research contributions
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Introduction Type I Type II Type II
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Introduction making), takes account
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Access to health Strengthening heal
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Access to health raising public awa
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Access to health Recent trends in r
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Access to health districts with a p
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Access to health Understanding heal
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Access to health This study investi
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Access to health References continu
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Access to health combining particip
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Access to health 2002 2005 Diff. SU
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Access to health References continu
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Access to health Americans think th
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Access to health threatening and se
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Access to health References 1. Worl
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Access to health Open access to res
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Access to health References 1. Rose
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Access to health national and globa
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Access to health Senior Research Fe
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Access to health ✜ Rights alone a
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Page 59 and 60: Access to health The diverse pathwa
Page 61 and 62: Access to health 2001, WTO ruled th
Page 63 and 64: Access to health knowledge and educ
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Page 67 and 68: Innovation 076 Towards the developm
Page 69 and 70: Innovation ✜ Creating a viable va
Page 71 and 72: Innovation Natural sciences and env
Page 73 and 74: Innovation References 1. Morel C et
Page 75 and 76: Innovation The changes in internati
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Page 81 and 82: Innovation future global health fin
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Page 85 and 86: Innovation Health system strengthen
Page 87 and 88: Innovation Being healthy: the role
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Page 91 and 92: Innovation The role of Knowledge Tr
Page 93 and 94: Innovation knowledge - the “know
Page 95 and 96: Research resources 110 Research imp
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Page 103 and 104: Research resources Nursing research
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Page 107 and 108: Research resources The need to deve
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Page 131 and 132: Decision-making Delivering evidence
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Page 135 and 136: Decision-making years’ experience
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Page 139 and 140: Decision-making interview studies),
Page 141 and 142: Decision-making References 1. Haine
Page 143 and 144: Decision-making reviews in this fie
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Decision-making Low- and middle-inc
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Decision-making Europe and Central
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Decision-making Europe and Central
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Decision-making References 1. Banni
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Decision-making irresponsible-to be
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Decision-making Several strategies
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To achieve better health, particula
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