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At least 19 recordsLinked to original sources
PubMed1994

Epidemic neuropathy in Cuba not associated with mitochondrial DNA mutations found in Leber's hereditary optic neuropathy patients. Cuba Neuropathy Field Investigation Team.

An epidemic neuropathy in Cuba has caused bilateral optic neuropathies in more than 26,000 people during the past three years. Various pathogenetic factors have been proposed, including toxins, nutritional deficiencies, and an underlying genetic predisposition involving mitochondrial DNA. As part of a case-control collaborative investigation, 135 Cuban blood samples were analyzed for the most common mitochondrial DNA mutations associated with Leber's hereditary optic neuropathy. None of the participants tested were found to have the mitochondrial DNA mutations at nucleotide positions 11778, 3460, 14484, 7444, or 9804. Of 57 definite case subjects and 69 normal control subjects, three case and three control subjects had the mutation at nucleotide position 9438, three different case and three different control subjects had the mutation at position 13708, and one case and one control subject had the mutation at position 15257 in association with the mutation at position 13708. The most common mitochondrial DNA mutations associated with Leber's hereditary optic neuropathy do not appear to be contributing factors in the epidemic neuropathy in Cuba. We also identified a large Cuban family with maternally related members who experienced visual loss consistent with the diagnosis of Leber's hereditary optic neuropathy. Maternal family members harbored the highly pathogenetic mutation at nucleotide position 11778.

Adolescent↗
PubMed1995

African, Native American, and European mitochondrial DNAs in Cubans from Pinar del Rio Province and implications for the recent epidemic neuropathy in Cuba. Cuba Neuropathy Field Investigation Team.

Genetic predisposition, particularly specific mitochondrial DNA (mtDNA) backgrounds, has been proposed as a contributing factor in the expression of an epidemic of bilateral optic neuropathy that has affected residents of Cuba since 1991. To substantiate or refute the possibility that specific subsets of mtDNAs could participate in disease expression, we took advantage of the heterogeneous ethnic origin of the Cuban population and the recent identification of a number of mtDNA polymorphisms that appear to be specific for Africans, Native Americans, and Europeans. The screening of both carefully selected people with epidemic neuropathy and control subjects from the Pinar del Rio Province for these polymorphisms revealed that African, Native American, and European mtDNA haplotypes were equally represented among case and control subjects, and suggested that approximately 50% of Cuban mtDNAs originated from Europeans, 46% from Africans, and 4% from Native Americans. These findings demonstrate that mutations arising in specific mtDNAs are unlikely to play a role in the epidemic neuropathy and indicate that analysis of mtDNA haplotypes can be a valuable tool for assessing the relative maternal contribution of Africans, Native Americans, and Europeans in a mixed population.

Africa↗
PubMed2006

Towards active community participation in dengue vector control: results from action research in Santiago de Cuba, Cuba.

Community participation is advocated as essential for attaining effective dengue prevention, but knowledge of how to foster this is limited. In Santiago de Cuba, multiple small task forces were created at the neighbourhood level that included all stakeholders in the control of Aedes aegypti. The task forces assessed the perceived needs and elaborated action plans to promote specific behavioural change and to reduce environmental risks through social communication strategies and intersectoral local government activities. We monitored five dimensions of the participation process and assessed behavioural and environmental results and entomological outcomes. Participation was weak to good. At the household level, uncovered water storage containers decreased from 49.3% to 2.6% between 2000 and 2002, and removing larvicide from them dropped from 45.5% to 1%. There was a reduction of 75% in the absolute number of positive containers and a significant decrease from 1.23% to 0.35% in the house index. Local task forces, in which the interests of householders as well as vector control workers are directly represented, can lead to effective government-community partnerships that resolve problems of mutual concern.

Animals↗
PubMedDate not supplied

Reemergence of dengue in Cuba: a 1997 epidemic in Santiago de Cuba.

After 15 years of absence, dengue reemerged in the municipality of Santiago de Cuba because of increasing migration to the area by people from disease-endemic regions, a high level of vector infestation, and the breakdown of eradication measures. The 1997 epidemic was detected early through an active surveillance system. Of 2,946 laboratory-confirmed cases, 205 were dengue hemorrhagic fever, and 12 were fatal. No deaths were reported in persons under 16 years of age. Now the epidemic is fully controlled.

Aedes↗
PubMedDate not supplied

Cancer mortality in Cuba and among the Cuban-born in the United States: 1979-81.

The Cuban-born population of the United States, enumerated at 608,000 in the 1980 census, has been little studied with regard to cancer mortality. Being older and rarely migrating back to Cuba, Cuban Americans present a good subject for comparative cancer mortality. Age-adjusted death rates for selected causes of cancer are compared in this paper for Cubans in Cuba, the Cuban-born in the United States, and all whites in the United States. Two forms of cancer have been of particular concern in Cuba, cancer of the lung and cancer of the prostate, because of their relatively high death rates. The age-adjusted death rates for both of these cancers are lower among the Cuban-born in the United States than they are among Cubans in Cuba and whites in the United States. Death rates for cancer of the cervix and cancer of the rectum among the Cuban-born in this country are also low relative to Cubans in Cuba and whites in the United States. Stomach cancer mortality among Cuban-born men in the United States is lower than for men in Cuba or for white men in the United States, but Cuban-born women in this country have rates that are slightly higher than those of U.S white women. Mortality rates from colon cancer in both sexes and breast cancer among women are intermediate between the lower rates in Cuba and the higher rates among U.S. whites. Finally, the Cuban-born in the United States have higher death rates from cancer of the liver than do Cubans in Cuba or whites in the United States. In general, the profile found for the Cuban-born in the United States reflects the high socioeconomic status of the pre-1980 migrants as well as their exposure to the U.S. environment.

Cuba↗
PubMed1995

Cuba's national AIDS program. The first decade.

There is a high incidence of infection with the human immunodeficiency virus (HIV) in many Caribbean nations. But by 1993 Cuba, with a population of greater than 10 million people, had fewer than 1,000 seropositive persons and less than 200 cases of the acquired immunodeficiency syndrome (AIDS). To investigate Cuba's approach to the AIDS epidemic, we visited Cuba, reviewed published statistics, spoke with health care officials, interviewed HIV-positive patients, and toured medical facilities. Cuba established an extensive HIV surveillance program in 1983, and more than 15 million HIV antibody tests have been done. The sexual contacts of all infected persons are closely observed. A national education program is evolving. Since 1986, all known HIV-positive patients have been placed in sanitariums, which is the most controversial aspect of Cuba's program. We review available information on AIDS in Cuba and describe that nation's attempt to prevent the spread of disease. We discuss how the political system and Cuba's relative isolation have influenced this approach. Strategies have been developed that may be of limited efficacy and would not be acceptable in most Western nations.

AIDS Serodiagnosis↗
PubMedDate not supplied

Primary care in Cuba: a public health approach.

Cuba's primary health care model is presented. Unlike ambulatory care services, which are but one component of primary care, Cuba's model is a comprehensive public health approach that meets the World Health Organization's definition of primary care. The history of the development of Cuba's model is presented, including an update on the innovative neighborhood/home clinics. Achievements in health outcomes as a result of Cuba's model and the consequences for women's health care are discussed. Examples are presented of the effects on health care delivery of the economic hardship that Cuba has experienced since 1991 as a result of the loss of 85% of its trade with the former Soviet Union and the intensified U.S. embargo. A critique of Cuba's model concludes the article.

Cuba↗
PubMed2002

High HIV-1 genetic diversity in Cuba.

BACKGROUND: HIV-1 subtype B is largely predominant in the Caribbean, although other subtypes have been recently identified in Cuba. OBJECTIVES: To examine HIV-1 genetic diversity in Cuba. METHODS: The study enrolled 105 HIV-1-infected individuals, 93 of whom had acquired the infection in Cuba. DNA from peripheral blood mononuclear cells was used for polymerase chain reaction amplification and sequencing of pol (protease-reverse transcriptase) and env (V3 region) segments. Phylogenetic trees were constructed using the neighbour-joining method. Intersubtype recombination was analysed by bootscanning. RESULTS: Of the samples, 50 (48%) were of subtype B and 55 (52%) of diverse non-B subtypes and recombinant forms. Among non-B viruses, 12 were non-recombinant, belonging to six subtypes (C, D, F1, G, H and J), the most frequent of which was subtype G (n = 5). The remaining 43 (78%) non-B viruses were recombinant, with 14 different forms, the two most common of which were Dpol/Aenv (n = 21) and U(unknown)pol/Henv (n = 7), which grouped in respective monophyletic clusters. Twelve recombinant viruses were mosaics of different genetic forms circulating in Cuba. Overall, 21 genetic forms were identified, with all known HIV-1 group M subtypes present in Cuba, either as non-recombinant viruses or as segments of recombinant forms. Non-B subtype viruses were predominant among heterosexuals (72%) and B subtype viruses among homo- or bisexuals (63%). CONCLUSION: An extraordinarily high diversity of HIV-1 genetic forms, unparalleled in the Americas and comparable to that found in Central Africa, is present in Cuba.

Cuba↗
PubMed1995

On politics and health: an epidemic of neurologic disease in Cuba.

Political decisions may cause disease. During 1992 and 1993, an epidemic of neuropathy in Cuba--largely overlooked by U.S. physicians--affected more than 50,000 persons and caused optic neuropathy, deafness, myelopathy, and sensory neuropathy. Patients with the neurologic disease responded to B group vitamins, and oral vitamin supplementation of the population curbed the epidemic. Dietary restrictions and excessive carbohydrate intake were the immediated cause of the epidemic; however, the primary cause might have been political. Political changes in eastern Europe had major repercussions on Cuba's economy and food supply. In turn, these changes compounded the effects of internal political decisions in the island, leading toward isolationism and economic dependence on the former Soviet Union. Also, for more than 30 years, the United States has maintained an economic embargo against Cuba. In 1992, the U.S. embargo was tightened by the Torricelli amendment (or the Cuba Democracy Act), which prohibited third-country subsidiaries of U.S. companies from trading with Cuba and prevented food and medicines from reaching the island; this amendment produced a virtual economic blockade. Penuries resulting from all these political events resulted in the largest epidemic of neurologic disease in this century. Physicians may need to use their influence to modify political decisions when these decisions result in adverse health consequences. The American Academy of Neurology has issued a plea to encourage physicians and other health personnel to support efforts leading to lifting of the U.S. embargo against Cuba for humanitarian reasons.

Cuba↗
PubMed2006

HIV Type 1 molecular epidemiology in cuba: high genetic diversity, frequent mosaicism, and recent expansion of BG intersubtype recombinant forms.

Highly diverse HIV-1 genetic forms are circulating in Cuba, including subtypes B and G and two recombinant forms of African origin (CRF18_cpx and CRF19_cpx). Here we phylogenetically analyze pol sequences from a large collection of recent samples from Cuba, corresponding to 425 individuals from all Cuban provinces, which represents approximately 12% of prevalent infections in the country. RNA from plasma was used to amplify a pol segment by reverse transcription-polymerase chain reaction; phylogenetic analyses were performed with neighbour-joining trees and bootscanning. The distribution of genetic forms was subtype B, 41.2%; CRF19_cpx, 18.4%; BG recombinants, 11.6%; CRF18_cpx, 7.1%; subtype C, 6.1%; subtype G, 3.8%; B/CRF18 recombinants, 2.6%; subtype H, 2.1%; B/CRF19 recombinants, 1.7%; and others, 5.4%. Seventy-five (17.6%) viruses were recombinant between genetic forms circulating in Cuba. In logistic regression analyses, adjusting by gender and region, subtype B was more prevalent (OR 5.0, 95% CI 2.0-12.3) and subtype G less prevalent (OR 0.1, 95% CI 0.0-0.5) among men who have sex with men (MSM) than among heterosexuals. Within the main genetic forms of Cuba there were phylogenetic subclusters, several of which correlated with risk exposure or region. BG recombinants formed three phylogenetically related subclusters, corresponding to three different mosaic structures; most of these recombinants were from MSM from Havana City, among whom they have expanded recently, reaching 31% HIV-1 infections diagnosed in 2003. This study confirms the high HIV-1 diversity and frequent recombination in Cuba and reveals the recent expansion of diverse related BG recombinant forms in this country.

Cuba↗
PubMed2003

[Tuberculin reactivity among ninth-grade schoolchildren in the city of Havana, Cuba].

OBJECTIVE: To determine the proportion of 14-year-old schoolchildren in the city of Havana, Cuba, with a positive tuberculin skin test, as an indicator of the prevalence of tuberculosis infection among them. METHODS: Using single-stage cluster sampling, 1 936 Mantoux (tuberculin) tests were carried out with ninth-grade students (cohort born in 1985) during the 1999- 2000 school year in 20 basic high schools randomly selected in Havana. The tests were performed according to the standard technique recommended by the World Health Organization, and they were read after 72 hours. The percentage of skin tests that were positive and the average diameter of the indurations were calculated for the cohort overall and for the two genders. The means and the percentages were compared using the chi-square test, with 95% confidence intervals. The computer software used was Epi Info version 6.0. RESULTS: Of the tests read, 96% of them were negative (0-4 mm), 2.5% were doubtful (5-9 mm), and 1.5% were positive (>/=10 mm). The percentage of reactivity was 0.1% when a cutoff value of 15 mm was used. The mean diameter of the indurations was 0.41 mm. No statistically significant difference was found between the genders. CONCLUSIONS: In this study the proportion of schoolchildren with tuberculin reactivity, using an induration-diameter cutoff point of 10 mm, was very low (1.5%), and it was much lower (0.1%) when a cutoff point of 15 mm was used. The skin reactions with an induration diameter of >/=10 mm could be the expression of a natural infection if one takes into account the low frequency of bacillary tuberculosis in Cuba and that there is an inverse relationship between the time elapsed from the BCG vaccination and the intensity of the response to tuberculin. Therefore, that would mean that in this case (l)the point (.)prevalence of tuberculosis infection in this group of schoolchildren wou d be 1.5% ResumenObjetivos. Determinar la proporción de personas que reaccionan a la tuberculina como indicador de la prevalencia de infección tuberculosa en escolares de 14 años de Ciudad de La Habana, Cuba. Métodos. Mediante un muestreo monoetápico por conglomerados se aplicaron 1 936 pruebas de Mantoux (tuberculina) a estudiantes de noveno grado del curso escolar 1999-2000 (cohorte de los nacidos en 1985) de 20 escuelas secundarias básicas seleccionadas aleatoriamente en Ciudad de La Habana, Cuba. Las pruebas se realizaron según la técnica estándar recomendada por la Organización Mundial de la Salud y se evaluaron a las 72 horas. Se calcularon los porcentajes de reactividad y el diámetro medio de las induraciones cutáneas en la cohorte y según el sexo. Las comparaciones de medias y porcentajes se realizaron mediante la prueba de ji al cuadrado con 95% de confiabilidad. Se usó el programa Epi Info v. 6.0. Resultados. Noventa y seis por ciento de las pruebas leídas fueron negativas (0-4 mm), 2,5% fueron dudosas (5-9 mm) y 1,5% resultaron positivas ( >/= 10 mm). El porcentaje de reactividad disminuyó a 0,1% cuando se utilizó un valor de corte de 15 mm. El diámetro medio de las induraciones fue de 0,41 mm y no se detectó ninguna diferencia estadísticamente significativa en función del sexo. Conclusiones. La proporción de personas que reaccionaron a la tuberculina, usando como punto de corte un diámetro de induración cutánea de 10 mm, fue muy baja (1,5%) en este estudio y mucho más baja (0,1%) cuando se utilizó 15 mm como punto de corte. Si se toma en cuenta la baja frecuencia de tuberculosis bacilífera en Cuba y que hay una relación inversa entre el tiempo transcurrido desde la aplicación de la vacuna a base del bacilo de Calmette-Guérin (BCG) y la intensidad de la respuesta a la tuberculina, las reacciones cutáneas con un diámetro de induración >/= 10 mm podrían ser la expresión de una infección natural, por lo que, en ese caso, la prevalencia puntual de infección tuberculosa en este grupo de escolares sería de 1,5%.

Adolescent↗
PubMed1984

Pesticide use, alternatives and workers' health in Cuba.

Cuba provides a unique example of a country that is actively implementing a program to reduce its dependence on pesticides. This paper addresses Cuba's current efforts to develop and implement alternatives to pesticides and legislation to limit exposure and protect workers in the interim. In 1980 Cuba embarked on a national program to utilize alternatives to chemical pest control. This three-part program includes expansion of knowledge of Cuban agro-ecology in order to implement cultural control practices; research and implementation on biological control of pests; and research on plant resistance and development of resistant crop varieties. To date, the program has enabled Cuba to reduce pesticide usage in sugar cane, citrus, tobacco, corn, and vegetable crops, among others. While alternatives to chemical pest control are being developed, the Cubans are paying special attention to regulating pesticide use and the safety of workers and members of the public exposed to toxic chemicals. In addition to the Resolution on Health and Safety (1967) and the Safety and Health Law (1978) which cover all workers, including Cuba's 250,000 agricultural workers, the Ministry of Public Health promulgated Resolution 335 in 1967. This resolution addresses requirements and administration of structural pest control, production, importation, transport and storage of pesticides, as well as requirements for worker contact with pesticides, pesticides for domestic use, aerial application of pesticides, and violations of the regulations. The paper concludes with a description of how the system works on the provincial level, as exemplified by Villa Clara, and the steps that have been taken to eliminate worker exposure to pesticides, to utilize pesticides which pose less of a hazard to workers, and to assure early detection of ill effects.

Agricultural Workers' Diseases↗
PubMed1994

The politics of suffering: the impact of the U.S. embargo on the health of the Cuban people. Report of a fact-finding trip to Cuba, June 6-11, 1993.

The past several years have been difficult for the Cuban people. The economies of Cuba's major trading partners have collapsed. The 33-year U.S. embargo was tightened with passage of "The Cuban Democracy Act of 1992" to include trade--mostly in food and medicines--by subsidiaries of U.S. companies in other countries. The March 1993 "Storm of the Century," which devastated communities from the Caribbean to Canada, caused an estimated $1 billion in damage to Cuba. A mysterious disease known as neuropathy, which can affect vision, appeared in late 1991 and has spread throughout the island. All this has created a situation of scarcity and uncertainty that has affected all aspects of Cuban society, including its health care system. In June 1993 a delegation that included members of the American Public Health Association traveled to Cuba to investigate the current health situation in the country, with an emphasis on the impact of the U.S. embargo. The delegation found that compared to two and three years ago, the general standard of living in Cuba and the quality of health services have declined dramatically. It concluded that while the overall health of the Cuban population has not yet seriously eroded as a result of the economic decline, severe problems threaten to emerge in the future. The delegation called for lifting of the embargo as part of a new approach in U.S. policy toward Cuba.

Adult↗
PubMed1987

Cuba and the Philippines: contrasting cases in world-system analysis.

Cuba and the Philippines are countries with broad similarities in historical background yet sharp divergences in political economic developments and relations to the capitalist world-system in recent times. U.S. economic and political interests dominated both countries during the first half of the 20th century. The changes generated by the Cuban revolution resulted in the end of U.S. power in Cuba in 1959. The Philippines, however, remain profoundly dependent on the United States. The approach taken in this article contrasts these countries, asking what the results of their divergent paths are in terms of health and health services. The ability of Cuba and the Philippines to support the primary health care (PHC) approach by fostering socioeconomic justice, authentic citizen participation, and a regionalized health system is examined. It is clear that the last 25 years of socialist-oriented development in Cuba reversed the negative effects of the previous market economy by providing improved social and health services. The success of the political economy and the fully regionalized health system, supportive of the PHC approach in Cuba, is reflected in the high-level health status of the people. In contrast, poverty, gross social and economic inequities, high prevalence of infectious disease, and inaccessible, inadequate, and uncoordinated health services persist in the Philippines after some 85 years of international and national capitalist development. The poor health status of the Philippine people is a direct reflection of this underdeveloped system.

Community Participation↗
PubMedDate not supplied

[Actual status of multiple sclerosis in Cuba. National cooperative group for the clinical trial "Recombinant interferon alpha-2b in multiple sclerosis"].

INTRODUCTION: Multiple sclerosis (MS) has been considered to be an uncommon disorder in Cuba. In recent years many Cuban investigators have worked hard studying MS in Cuba. DEVELOPMENT: We review the history, epidemiology, clinical characteristics, complementary investigations and clinical trials of recent studies published in national and international journals on the most important investigations done on MS in Cuba. There is an outstanding placebo-controlled, double blind, multicentric randomised clinical trial using recombinant alpha 2b-IFN in the relapsing-remitting clinical form in which the results obtained in the first 30 patients who completed 2 years treatment show a statistically significant reduction in the frequency of relapses and the number of patients free of relapses in patients who received alpha-IFN as compared with those given placebo treatment. CONCLUSIONS: There has been an increase in the number of studies made on MS in Cuba in the past two years. Numerous clinical, neuroepidemiological, neurophysiological, biochemical, immunological, imaging and neuropsychological investigations and clinical trials indicate a marked increase in understanding of MS. The results of all these studies indicated the need for the creation of a National Reference Centre for Patients with Multiple Sclerosis, due to the complexity of this type of patients and the need to offer improved medical attention from a specialist team and to integrate the investigations in Cuba and internationally so as to reach the level of more developed countries.

Adjuvants, Immunologic↗