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Economy, politics, and health status in Cuba.

An economic contraction occurred in Cuba at the beginning of the 1990s, of a magnitude greater than in any developed country in the last half century. This resulted primarily from the disappearance of the European socialist bloc and simultaneous tightening of the U.S. government's blockade at a time when Cuba was engaged in correcting its main economic problems. The economic crisis affected a number of areas of Cuban society. The state adopted a series of measures to cope with the socioeconomic situation, which have yielded positive results in the social and economic fields, as well as some undesirable results. In the health sector, the economic crisis has mainly reduced the availability of resources and has adversely affected some health determinants and some aspects of the population's health status. Despite the prevailing economic difficulties, the government is determined to preserve the country's achievements in health, and to develop them still further. The solution is not privatization or the introduction of health insurance systems or similar measures. Rather, Cuba will seek greater rationality and economic efficiency in the health sector. It has ratified the principles that the state should continue to finance the health system and maintain universal coverage and accessibility through free services.

Cost-Benefit Analysis↗

Mortality of childhood-onset IDDM patients. A cohort study in Havana City Province, Cuba.

OBJECTIVE: To determine the survival pattern and the underlying cause of death in a cohort of childhood-onset IDDm subjects from Havana City Province, Cuba. RESEARCH DESIGN AND METHODS: This was a descriptive study carried out on a historical cohort of IDDM subjects with disease onset before 15 years of age in Havana City Province, Cuba. The cohort was assembled from several sources. Subjects were diagnosed from 1965 to 1980, and their vital status was assessed at 31 December 1991. Cumulative survival rate was calculated by the Kaplan-Meier method, and a univariate analysis was performed. To test survival differences between groups, the Cox-Mantel test was used. To compare the cohort mortality with the general population, standardized mortality ratios by sex and age were calculated. Specific causes of death were determined by a committee examining death certificates, clinical records, and necropsy reports. RESULTS: A total of 504 subjects were identified, and the mean follow-up time was 17.5 years. Of the subjects, 70 (13.9%) had died at 31 December 1991. Overall, the cohort had a 71% cumulative survival rate at 25 years of IDDM duration. There were no survival differences according to sex or calendar period of IDDM diagnosis. Statistically significant differences were found among age-at-diagnosis groups. The group with a peripubertal age at diagnosis showed the worst prognosis. The cohort experienced 8.5 times the all-causes death rate, compared with the general population. Renal disease accounted for almost half the deaths. CONCLUSIONS: IDDM subjects from Havana City Province, Cuba, showed a better survival pattern than IDDM subjects from other developing countries. However, when compared with IDDM populations from developed countries, there is a survival reserve to be achieved by reducing mortality due to renal disease and infections.

Adolescent↗

Family medicine in Cuba: community-oriented primary care and complementary and alternative medicine.

Family physicians in Cuba and the United States operate within very different health systems. Cuba's health system is notable for achieving developed country health outcomes despite a developing country economy. The authors of this study traveled to Cuba and reviewed the literature to investigate which practices of Cuban family physicians might be applicable for US family physicians wishing to learn from the Cuban experience. We found that community-oriented primary care (COPC) and complementary and alternative medicine (CAM) are well developed within the Cuban medical system. Because COPC and CAM are already recommended by US family medicine professional bodies, US family physicians may want to learn from the Cuban experience and perhaps incorporate elements into their individual practices.

Community Health Services↗

Effect of the U.S. embargo and economic decline on health in Cuba.

This article describes the ways in which economic crisis and the U.S. embargo have affected Cuba's health care system during the past 15 years. With the demise of subsidized trade, the absence of aid from the former Soviet Union, and the progressive tightening of U.S. sanctions, Cuba's model health care system has become threatened by serious shortages of medical supplies. Several public health catastrophes have occurred, including an epidemic of blindness that was partially attributed to a dramatic decrease in access to nutrients; an outbreak of the Guillain-Barré syndrome caused by lack of chlorination chemicals; and an epidemic of lye ingestion in toddlers due to severe shortages of soap. The policy of mandatory quarantine for HIV-infected Cubans has evolved into a less rigid system. Although the prevalence of HIV infection in Cuba is low compared with that in the United States and other Caribbean nations, it is threatened by prostitution, which has increased along with tourism. In general, economic sanctions may have an unintended but profound effect on the health and nutrition of vulnerable populations.

Cuba↗

[Epidemiology of hemorrhagic cerebrovascular disease in the central region of Cuba].

INTRODUCTION: Cerebrovascular diseases are the third most important cause of death in Cuba. Among the programmes given priority by the Cuban Ministry of Public Health and the World Health Organization (WHO), hemorrhagic disorders are the most lethal . OBJECTIVE: To determine the behaviour of hemorrhagic cerebrovascular disease in the central region of Cuba. PATIENTS AND METHODS: . An exploratory, descriptive, retrospective study in which 1,401 clinical histories were reviewed. The variables being investigated were then processed using the computer data processor EPINFO 6.0 to determine the mean, standard deviation and chi squared. RESULTS: An annual incidence rate of 84.03 per 100,000 persons was seen for hemorrhagic cerebrovascular disease; 54.16 and 29.86 per 100,000 persons respectively for intracerebral hemorrhage and subarachnoid hemorrhage; and total mortality of 68.95%. The disorder was associated with possible meteorological factors and the highest percentage was due to intracerebral hemorrhage with 64.45%. Arterial hypertension was the most intensely studied risk marker (p< 0.01). Most cases were elderly (p< 0.001). Surgical treatment was given to 81 patients with subarachnoid hemorrhage, with a predominance of malformations of the middle and anterior cerebral arteries. Treatment was based on depletion using Manitol and calcium antagonists. A considerable number of patients required mechanical ventilation and vaso active drug support. Most were attended in Intermediate Polyvalent Treatment Units and the main complication was sepsis. CONCLUSIONS: There is a high mortality from hemorrhagic cerebrovascular disease in the central region of Cuba, and once the diagnosis has been made the prognosis is usually poor. The patients included in the programme of attention for subarachnoid haemorrhage showed promising results.

Adolescent↗

[New species of bees of Cuba and La Espanola (Hymenoptera: Colletidae, MEgachilidae, Apidae)].

Five new species of Antillean bees are described and illustrated: Colletes granpiedrensis n. sp. (Cuba) (Colletidae) is characterized as follows: Head and mesosoma black, legs and metasoma brown. Dense brown hairs on head and mesosoma; white on frons and metasomal terga. Clypeus, frons and mesosoma with large punctures, lesser on vertex and metasoma. Malar space more wide than long. Male and female slightly similar, except in the apical margin of clypeus, supraclipeal area, and color of the pubescence on legs and sterna; Osmia (Diceratosmia) stangei n. sp. (Dominican Republic) (Megachilidae) is characterized as follows: Dark metallic green, metasoma black with metallic green reflections. Pubescence light; body with large, closed punctures. Female with violet reflections in tergum III and mandible tridentate; Coelioxys (Cyrtocoelioxys) alayoi n. sp. (Cuba) (Megachilidae) is characterized as follows: Female black, except basal area of mandibles, tegula, legs, lateral area of tergum I and sterna, reddish brown. Posterior margin of scutellum rounded. Apex of tergum VI with spine curved up. Sternum VI fringed with short, closed setae, and the apex with short spine; Coelioxys (Boreocoelioxys) sannicolarensis n. sp. (Cuba) (Megachilidae) is characterized as follows: Black, except antenna and tegula brown; legs and sterna reddish brown. Clypeal margin straight in profile. Gradular grooves on metasomal terga II and III distinct medially. Fovea on metasomal tergum II of male deep and short, and Triepeolus nisibonensis n. sp. (Dominican Republic) (Apidae) is characterized as follows: Dorsal pubescence (short and dense) on mesosoma and metasoma from white to yellow, according to specimen; ventral pubescence white. Tergal bands of hairs interrupted medially; two spots of light pubescence on tergum II. Male metasomal sternum VII with anterior margin V-shaped and basal constriction narrow.

Animals↗

[The influence of geographical background on the clinical and neurophysiological characteristics of patients with multiple sclerosis in Cuba].

INTRODUCTION: Multiple sclerosis (MS) was first described by Charcot in 1868 and the first case in Cuba was reported in 1965. Prevalence rate is now considered to be about 10 cases/100,000 inhabitants. Cuba is an island that can be divided into three different geographical regions and a comparison of these areas is interesting because it is known that geographical features exert an influence on MS. Demographic differences are also present. AIMS: The purpose of this study was to evaluate a sample of cases from the Western part of the country as regards their results on two important scales and the results of evoked potentials (EP), and to compare them with two samples of patients from the other two regions. PATIENTS AND METHODS: The first sample was made up of 50 patients living in the western region; their diagnosis was confirmed, the scales were applied and the EP test was performed because of its high degree of sensitivity, objectivity and reproducibility. Results were then compared with the other two studies that had already been reported. RESULTS: Most cases had a score of between 0.5 and 5.5 points on the EDSS and only 6% scored above 7.0 points. Patients with PP type MS obtained higher scores. More than half the cases had more than 80 points on the Scripps scale and the second largest group had between 61 and 80 points; the two progressive forms behaved in a similar manner. The most sensitive EP are visual, followed by somatosensory and, lastly, by brain stem auditory EP (BAEP). The vast majority of the results compared with the series from the central region and from Santiago de Cuba were similar, yet some significant differences were found: progression time is longer in the West, EDSS scores were higher in the primary progressive form in the East and the BAEP were less sensitive in the West. CONCLUSIONS: Our findings correspond to those available from other countries around the world and it can be seen that some of the parameters differ between the three regions.

Cuba↗

[Clinical features of multiple sclerosis in Western Cuba. A comparison with two other regions in the country].

INTRODUCTION: Multiple sclerosis (MS) is an inflammatory disease in its early stages whose primary or secondary immunological mechanisms produce reversible or irreversible lesions in the myelin and axons in the central nervous system. The first case of MS in Cuba was reported in 1965. Current prevalence of MS is considered to be 10 cases/100,000 inhabitants. AIMS: The aim of this study was to characterise MS in Western Cuba from a clinical point of view and in comparison with other similar studies carried out in two other regions in the country. PATIENTS AND METHODS: 50 patients living in the western region were clinically assessed. Statistical tests were carried out to compare this survey with two similar studies conducted in the central and eastern regions. RESULTS: 80% of our patients were females, predominantly white skinned, the main events in their family histories were neurological diseases and psychiatric diseases, essentially schizophrenia, the chief triggering event being psychic tension, the most frequent form of progression was the remittent recurring form, followed by secondary progressive form, and then the primary progressive; the main symptoms at onset were visual, followed by pyramidal and sensory; the most strongly affected functional system was the pyramidal and then the sensory system; the functional systems are more affected in the primary progressive form, except the visual and the brainstem; the largest group of patients corresponded to those that had a history of over 10 years with the disorder. By far the majority of results compared with the series from the central region and from Santiago de Cuba were similar, but some significant differences did appear on comparing these two series. CONCLUSIONS: The study shows the characteristics of the disease in the Western region valuated using distinct parameters and several differences between the three series can be observed fundamentally with regard to skin colour, triggering events, symptoms at onset and functional involvement in the forms of progression.

Cuba↗

Serologic evidence for West Nile virus transmission in Puerto Rico and Cuba.

During the spring of 2004, approximately 1,950 blood specimens were collected from resident and Nearctic-Neotropical migratory birds on the Caribbean islands of Puerto Rico and Cuba prior to northerly spring migrations. Eleven birds and seven birds, collected in Puerto Rico and Cuba, respectively, showed evidence of antibody in a flavivirus enzyme-linked immunosorbent assay. Confirmatory plaque-reduction neutralization test results indicated neutralizing antibodies to West Nile virus in non-migratory resident birds from Puerto Rico and Cuba, which indicated local transmission.

Animal Migration↗

Learning together: a Canada-Cuba research collaboration to improve the sustainable management of environmental health risks.

OBJECTIVE: To build a national Cuban capacity for training environmental health professionals directly linked to the needs of policy-makers and communities. PARTICIPANTS: The University of Manitoba and University of British Columbia collaborated with an established training centre in Cuba (the Instituto Nacional de Higiene y Epidemiologia--INHEM) and new centres in the Central (Santa Clara) and Eastern (Santiago) regions of the country. SETTING: Cuba. INTERVENTION: In the mid-1990s, a comprehensive curriculum (masters and diploma programs) was collaboratively developed, applying interactive teaching methods, and was delivered through a series of workshops and other interactions in Cuba, and short-term visits to Canada by Cuban PhD students. OUTCOMES: The collaboration was successful in fulfilling capacity-building targets (over 50 Masters graduates, 467 Diploma graduates, over 30 trained core faculty in all regional centres as well as new curriculum and new accredited regional programs). Alongside this, a number of collaborative community-based research projects were undertaken in all three regions (drinking water in Santiago; housing and urban renewal, and dengue control in Havana; and tourism-related effects, and effective intersectoral management of population health determinants in Santa Clara). CONCLUSION: The collaboration led to adopting new strategies for challenges such as a dengue epidemic in 2002, and new research on the effectiveness of intersectoral management of risks of particular interest to both Cuban and Canadian policy-makers. It triggered an ambitious collaboration between the Canadian-Cuban team and colleagues in Ecuador in order to build a similar national network there, built on South-South and North-South links.

Canada↗

EBV-specific humoral antibodies in nasopharyngeal carcinoma patients in Cuba.

Sera of 24 patients with nasopharyngeal carcinoma (NPC) and of 60 healthy donors were studied for presence of IgG and IgA antibodies against different antigens induced by Epstein--Barr virus (EBV). The results obtained demonstrate that NPC in Cuba, as in other countries, is accompanied by elevated antibody titers against EBV-specific IgG antibodies, whose levels strongly differ from those of healthy persons. Patients with NPC in Cuba had higher titers of antibody against VCA of EBV in comparison with patients of Caucasian origin in those countries where NPC, the same as in cuba, is rarely found. Cuban NPC patients had high levels of antibody against EA, often higher than in NPC patients in endemic zones of this disease.

Adolescent↗

[IgG- and IgA-antibodies to the Epstein-Barr virus in the sera of patients with nasopharyngeal carcinoma in Cuba].

Sera from 24 patients with nasopharyngeal carcinoma (NPC) and from 60 normal subjects were examined for the presence of IgG and IgA antibody to various antigens associated with Epstein-Barr virus (EBV). The results indicate that NPC in Cuba, like in other countries, was accompanied by high titers of EBV-specific IgG antibody the levels of which differed markedly from those in normal subjects. Serological activity of the patients differed depending on the stage of the illness and its duration. Geometric mean antibody titers to the capsid antigen (VCA), D and R components of early antigen (EA) of EBV complex were higher in patients with extensive tumour process (III--IV stages) and in patients with the duration of the disease since the onset less than 3 years. Sera of the most patients contained EBV-specific IgA antibody which were practically completely absent in sera of the control subjects. Alongside with characteristic manifestations of responsiveness to EBV observed by other workers, patients with NPC in Cuba had specific features: higher antibody titers to VCA than in Caucasian subjects in the countries where this disease occurred sporadically, like in Cuba; high levels of antibody to EA, frequently exceeding those in patients with NPC from endemic zones (for instance in Chinese patients); prevalence of EBV-specific antibody to the R component of EA complex.

Adolescent↗

[Serotypes of meningococci isolated in the USSR and the Republic of Cuba].

The results of serotyping of 101 meningococcal strains isolated in the Soviet Union and 23 strains isolated in the Republic of Cuba are presented. Typing within groups was carried out by Frasch's method in the double diffusion test in gel. For this purpose serotype antigens were prepared from each strain. These antigens were used in the test only after their purification by ultracentrifugation. In all cases the prevalence of serotype 2 was revealed. A great number of Cuban strains contained a wide spectrum of type antigens of both protein and lipopolysaccharide nature. Serotype antigen 15 occurred in meningococci isolated both in the USSR and in Cuba. In most cases type 15 occurred in combination with types 2 and 8. The comparison of the results obtained in the serotyping of meningococci isolated in situations, nonepidemic (USSR) and epidemic (Cuba) for serogroup B, gives no grounds for considering type 2 as the "marker of virulence". Probably, this problem will be solved by the differentiation of subtypes within type 2. Attention should be paid to the serotype antigens of the lipopolysaccharide nature with a view to their epidemiological evaluation.

Antigens, Bacterial↗

[Comparative study of various heath indicators in Japan and Cuba].

The medical systems in Cuba and Japan are described by using specific indicators and considering geographical, demographic and economical situations of the two countries. Objective data were tabulated to compare the present situation. An attempt was made to predict the future prospects of the medical system in both countries. The following difference between the two countries was noted. Japan is a highly industrialized country with a high standard of living and a mature economy that can tolerate unfavourable international economy. In recent years, the growth of the economy in Cuba has been made stable due to government planning at a rate of 5 percent in 1983. However, Cuba is still in the midst of industrialization and highly susceptible to the bad condition of the international economy.

Adolescent↗

Lessons from Cuba: mass campaign administration of trivalent oral poliovirus vaccine and seroprevalence of poliovirus neutralizing antibodies.

The immunogenicity of trivalent oral poliovirus vaccine (TOPV), which is less effective in tropical than in temperate areas, may potentially be improved in several ways, including increasing the number of doses. Little information is available on TOPV when more than 6 doses are given. The situation in Cuba provides a unique opportunity to relate the seroprevalence of neutralizing antibodies to the dose of TOPV because Cuba has not reported culture-confirmed poliomyelitis since 1973 and TOPV is only administered in twice yearly 1-week mass immunization campaigns. Sera from 2000 children nationwide were studied for neutralizing antibody among children who received 0, 2, 4, 6 and 8 doses of TOPV. These doses were administered in the period 1989-91, when TOPV (from the USSR) was being used with 500,000, 200,000, and 300,000 median tissue-culture-infecting doses (TCID50) for types 1, 2 and 3, respectively--the 5:2:3 formulation. Seroprevalence of neutralizing antibody after two TOPV doses was 91.5% for type 1, 90.8% for type 2, and 45.9% for type 3. Seroprevalence of type-3 neutralizing antibody after 6 doses remained low (73.4%), but increased to 83.5% after 8 doses (P < 0.05). Although 16.5% of the children remained unprotected for type-3 infection even after 8 doses, mass campaign immunization strategies were sufficient to eradicate the transmission of wild poliovirus in Cuba. Because the seroprevalence of type-1 neutralizing antibody was high (91.5%) after two campaign doses, additional studies using different formulations are needed to determine whether simultaneous improvement in the type-3 response to two campaign doses can be achieved.

Antibodies, Viral↗

[The trends by province of tuberculosis in Cuba: 1979-1993].

This study was carried out in order to describe tuberculosis trends in Cuba and its provinces between 1979 and 1993. For this purpose, reports of new cases of all forms of tuberculosis were obtained from the National Statistics Bureau of the Ministry of Public Health. In addition, tuberculosis incidence rates and their trends between 1979 and 1992 were determined. The data were analyzed by means of simple linear and exponential regression models. Finally, the percentage reductions in incidence between 1979 and 1992 were calculated and the observed changes were described in reference to the expected values derived from the regression models. The number of new tuberculosis cases reported in Cuba decreased from 1133 (11.6 per 100,000 population) in 1979 to 633 (5.8 per 100,000) in 1992 (a 44% reduction). In 1993, 788 cases were reported (7.2 per 100,000). In almost all the provinces the incidence tended to decrease between 1979 and 1992, and the average annual number of new case notifications fell between 4.0 and 5.4%, although in some, less than 3%. In 1992, the number of new case notifications in the country was 25% higher than in 1991, and the incidence rates in all the provinces were higher than expected. The incidence in La Habana, the City of Havana, Villa Clara, Cienfuegos, Ciego de Avila, Santiago de Cuba, and Guantánamo exceeded the overall national incidence. In 1993, incidence in the country was 55.6% higher than it had been in 1991 and 24.5% higher than in 1992. Incidence rose in all provinces, and especially in the City of Havana, Matanzas, and Guantánamo. Although incidence remained below 8 cases per 100,000 population between 1992 and 1993, it rose during those years, as it did in other countries. The increase appears to be attributable to the economic crisis that affects the country and to have very little connection to human immunodeficiency virus infection.

AIDS-Related Opportunistic Infections↗

Primary care in Cuba: low- and high-technology developments pertinent to family medicine.

Cuba's accomplishments in primary care, while controversial, include several developments pertinent to family medicine. These accomplishments involve low-technology and organizational innovations such as neighborhood-based family medicine as the focus of primary care; regionalized systems of hospital services and professional training; innovative public health initiatives and epidemiologic surveillance; universal access to services without substantial barriers related to race, social class, gender, and age; and active programs in treatments such as "green medicine" and "thermalism." High-technology achievements include innovations in pharmacology and biotechnology, surgical procedures, and care of patients infected by the human immunodeficiency virus (HIV). Limited access to Cuban publications, impediments to presentations by Cuban health care professionals at professional meetings, and the prohibition on importing products of Cuban biotechnology to the United States inhibit a detached, scientific appraisal of Cuba's accomplishments. Cuba's isolation from the US clinical and research communities has prevented interchanges that would improve primary care services in both countries.

Acquired Immunodeficiency Syndrome↗

Asthma mortality in Cuba during 1972-1993.

UNLABELLED: Morbi-mortality due to asthma has increased in recent years both throughout the world in Cuba. A study of mortality caused by this disease has conducted in order to describe its current trend in the country. METHOD: A time series study was conducted which included all deaths attributed to asthma in Cuba recorded in the vital statistics records of the Ministry of Public Health from 1972 to 1993. Rates, secular trends of general mortality and according to gender were estimated. The proportional mortality for the 1972-1993 period was calculated and the potential years of life lost during the 90-92 trienium were quantified. RESULTS AND DISCUSSION: A drop in these global rates occurred between 1972 and 1975, with values of 3.6; 4.1; 3.0; 2.2; respectively; possibly due to the introduction of disodic chromoglycate among other drugs and the beginning of the Asthmatic Patient Program. An later increase in mortality was observed until 1993 (5.9 x 100,000 inhabitants) which may attributed to a drop of the intensity and regularity of said program and to other internationally knowledge factors which are present in our country. The trend of general mortality rose during this period and was greater in females than in males; which means that the risk to die of this cause has increased. Proportional Mortality since 1980 (0.50%) also increased until 1993 (0.80%). Potential years of life lost due to premature death ranged from 5,646 in 1990 to 7,386 in 1992. The increase in proportional mortality and the potential years of life lost suggest that this disease should been given priority by the National Health Program as a preventable cause of death, especially in women. CONCLUSIONS: There is a rising trend of mortality among asthmatic patients during the period under consideration. Asthma is a cause of premature death in Cuba.

Asthma↗