Abstract in English:ABSTRACT INTRODUCTION Suicide is a health problem influenced by biological, genetic, psychological, social and economic factors. It is responsible for 50% of violent deaths in the male population, worldwide, and 71% in the female. In the Americas, 65,000 deaths by suicide occur every year. It is the ninth most frequent cause of death in Cuba, and third among people aged 10–19. OBJECTIVE Characterize the epidemiology of suicide in Cuba from 1987 to 2014. METHODS A retrospective descriptive study was conducted. The information comprised all records of death by suicide from January 1, 1987 to December 31, 2014, in the Cuban Ministry of Public Health’s National Statistics Division database. The variables were sex, age, skin color, employment status/occupation, marital status, and method of suicide. Crude and age-standardized mortality rates and age–sex specific mortality rates were calculated, all per 100,000 population, as well as the sex ratio. Relative change over the series was calculated as a percentage. Distribution of suicides by variable was calculated and proportions expressed as percentages. RESULTS A total of 51,113 deaths by suicide were reported (annual average 1825), of which 34,671 (67.8%) were among men. The sex ratio was 2.1:1 for the entire study period, and 3.9:1 for 2011–2014. Over the course of the period studied, age-standardized suicide rates decreased from 23.9 to 10.8 per 100,000 population (54.8% reduction). The group aged ≥60 years had the highest average age-standardized rate, 44.6 per 100,000 population. The highest suicide burden by age was in the group aged 20–59 years (60.5%). By skin color, the highest burden was in those recorded as white, 68.9%. By marital status, the highest burden was in persons with a stable partner (46.7%), and by employment status/occupation, in retired (25.9%). The most commonly used method was hanging (59.4%). CONCLUSIONS Over the course of about three decades, suicide mortality rates have declined by almost half and they are still slightly higher than overall rates in the Americas. The most commonly used method is hanging. The sex ratio is greater than two and has increased over time. The highest rates occur in the group aged ≥60 years, but finer stratification is needed to identify an age-related risk trend. In view of Cuba’s aging population, these results are of interest for epidemiology and public health.
Abstract in English:ABSTRACT Persons with disabilities constitute one of the most vulnerable groups in every society; their identification, assessment and care present a major challenge. In 2001–2003, Cuba conducted the first comprehensive national study of persons with disabilities in the Americas. In 2007–2010, the study was replicated in Bolivia, Ecuador, Nicaragua, Saint Vincent and the Grenadines, and Venezuela, at their governments’ request. Study results have enabled implementation of strategies with substancial impact on human health in these countries. In response to it, more than a million medical consultations were provided by professionals whose specialties are lacking in the participating countries, including 139,772 clinical genetic consultations. Once each country’s needs were identified, Cuba provided technical assistance with equipment supplied by Venezuela. The study led to development of public policies and programs for disability prevention and care of disabled persons in Bolivia, Ecuador, Nicaragua and Venezuela, and the opening of the National Medical Genetics Center and orthotic and prosthetic laboratories in Venezuela, and rehabilitation centers in Bolivia.
Abstract in English:ABSTRACT To encourage development of negative attitudes toward alcohol use and thus prevent early onset of alcohol use, an intersectoral intervention was conducted from 2014 to 2015 among Cuban adolescents in 14 schools in Havana. The intervention included 312 students (189 girls and 123 boys) aged 14 to 15 years in 10th grade of high school or vocational school. Workshops were conducted using participatory techniques and group dynamics. Qualitative methods were applied, including narrative, desiderative and projective techniques. Indicators included attitudes, motivation, interests and perception of risk. Following the intervention, 82.7% (258/312) of participants reported healthy cultural and recreational interests and 61.9% (193/312) reinforced negative attitudes toward drinking. Such interventions can help prevent early onset of alcohol use in school settings. Given the positive results, the intervention is slated to be reproduced in other Cuban provinces.
Abstract in English:ABSTRACT Harmful use of alcohol—the prime gateway drug to other addictions—is also a problem in Cuba, even though the National Program for Prevention of Harmful Use of Alcohol includes the most effective measures used in analogous programs around the world. As a participant in the program’s committee and empirical observer of its accomplishments and unaccomplished goals, I draw attention to the community’s attitude of tolerance toward intoxication manifested by the lack of proportional consequences, and I insist on the need to broaden the community’s understanding of the risks of non-social drinking, which in Latin America is practically limited to alcoholism and its complications. This undervalues the damage wreaked by unpredictable and dangerous behavior under the influence, as well as the suffering of codependents and other “passive drinkers,” and the adverse effects of even social drinking.
Abstract in English:ABSTRACT WHO considers the effects of air pollution one of the most pressing global health priorities. Several years ago, scientists began noting a link between Saharan dust (a meteorological phenomenon that diminishes air quality as it spreads over the globe) and some diseases, but the few studies to date have been inconsistent. Cuba has the human and material resources to study the association between Saharan dust and health. It is important to encourage creation of multidisciplinary research teams to do so.
Abstract in English:ABSTRACT Gestational diabetes is the most common endocrine disorder affecting pregnant women and its prevalence is on the rise. Prevalence in Cuba is about 5.8%, and global prevalence ranges from 2% to 18% depending on the criteria applied. Gestational diabetes can lead to adverse gestational outcomes, such as fetal death, preterm delivery, dystocia, perinatal asphyxia and neonatal complications. Prompt, accurate diagnosis allowing early treatment can benefit both mother and child. The disease is asymptomatic, so clinical laboratory testing plays a key role in its screening and diagnosis. Cuba’s approach to diabetes screening and diagnosis differs from some international practices. All pregnant women in Cuba are screened with a fasting plasma glucose test and diagnosed using modified WHO criteria. Some international recommendations are to skip the screening step and instead follow the diagnostic criteria of the Hyperglycemia and Adverse Pregnancy Outcomes study. In Cuba, gestational outcomes for women with diabetes (including gestational diabetes) are satisfactory (preeclampsia 5%; preterm delivery 12%; neonatal macrosomia 7.5%; congenital abnormalities 4.3% and perinatal deaths 4.8%). These data do not indicate a need to change established screening and diagnostic criteria.
Abstract in English:ABSTRACT The current definition of universal health coverage lacks several elements essential to advance public health. This article aims to discuss the concept and interpretation of universal health coverage and suggests an inclusive definition that is applicable to states, governments, and the societal and economic sectors ultimately responsible for public health. We will discuss the complexity and social determinants of universal health coverage, and the need for health to be built through social action, together with the states, governments and all societal actors, within a supportive legal framework. One suggestion is to consider health coverage as the ability of society, states and governments to respond to population health and well-being, which includes legislation, infrastructure availability, social capital and technology, as well as comprehensive planning, organizational, action and financing strategies to protect the health of the whole population, equally and inclusively.