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The 1980s were a watershed for Cuban research in medicine and health: significant financing and material resources buttressed a strategy to improve population health through enhanced biopharmaceutical innovation and clinical best practices applied to Cuba’s universal public health system. Redirecting research priorities and providing substantial public funding to tackle the top population health problems was a radical idea at the time, especially for a developing country like Cuba. Doing so has become a hallmark of Cuba’s scientific achievements and approach ever since. Among the institutions exemplifying this strategy is the Pedro Kourí Tropical Medicine Institute (IPK). Founded in 1937 with a research mission dedicated to parasitology and transmission of known tropical diseases, it wasn’t until the late Dr Gustavo Kourí Flores was appointed director in 1979 that IPK’s core objectives and facilities were expanded to include a comprehensive teaching component, a state-of-the-art clinical hospital to treat tropical and other communicable diseases, and an international collaboration strategy to facilitate knowledge and technology transfer. Today, IPK is Cuba’s national reference center for diagnosis, treatment, control and prevention of communicable diseases and is a regional leader in applied research into so-called neglected diseases—usually diseases of the poor. With departments of parasitology, bacteriology, virology, pharmacology and more, it’s a magnet for some of the country’s most accomplished scientists—most of them women—and a major contributor to Cuba’s portfolio of scientific products, research and publishing. This interview with virologist Dr María Guadalupe Guzmán, director of IPK’s Reference Center for Research and Diagnosis, is the third in MEDICC Review’s series on outstanding Cuban women in science and medicine. Recognized as a leading expert in dengue research, Dr Guzmán is also director of the WHO/PAHO Collaborating Center for Dengue and its Control and was president of the Arbovirus Diagnosis Laboratory Network of the Americas (RELDA) from 2010 through 2018. Currently, she is president of the Cuban Society of Microbiology and Parasitology, directs IPK’s Scientific Council that sets the Institute’s research priorities, and is a distinguished professor and author. In 2016, she published Dengue (Editorial Ciencias Médicas, Havana), the most comprehensive collection of original Cuban research available on the topic.

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A 2014 PAHO resolution that Cristian Morales helped formulate serves as a framework for the Americas’ governments to actively work towards health for all their people, incorporating this aim into national programs for sustainable development. This September, the UN General Assembly will sponsor a High-Level Meeting on Universal Health . . . a first in its history. In part two of MEDICC Review’s interview with Dr Morales, he outlines strategies he believes vital for transforming health systems to reach universal health—defined as coverage and access for all—and for turning words into action.

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Art, education, health and nutrition: encouraging healthy eating at an early age is central to the World Food Programme’s (WFP) goals. To this end, using art as a learning and communications tool, the program sponsors WFP in Action, a drawing contest open to youngsters 5–18 years old. Cuba has participated in the contest nationally since the 1990s, and since 2002 has sent a selection of drawings annually to the international competition at WFP headquarters in Rome. In the 2018 edition of the contest, international judges received 5 drawings from each of 20 participating countries. Applying criteria of esthetic appeal, originality and artistic quality, they awarded 20 prizes. Four of the five drawings from Cuba were among the international prize winners. The WFP reproduces prize-winning images in calendars, t-shirts, and other materials to promote their programs and raise funds towards ending world hunger and child malnutrition. WFP began its collaboration with Cuba in 1963, providing emergency relief after Hurricane Flora devastated the island’s eastern provinces. Today, WFP programs in Cuba aim to boost food and nutritional security among the country’s most vulnerable populations, strengthen the food supply chain with an emphasis on high-protein beans (a Cuban dietary staple) and consolidate community resiliency and responsiveness in disaster risk management. MEDICC Review is pleased to reproduce this year’s four winning drawings by Cuban children—each of whom hails from a different province.

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INTRODUCTION The steadily increasing prevalence of diabetes globally has captured researchers’ attention. Cuban production of scientific articles on diabetes has not been studied from a bibliometric perspective. OBJECTIVE Characterize the production and impact of research and review articles on diabetes by Cuban authors in journals listed in the Scopus bibliographic database, as well as related collaboration among Cuban institutions and between Cuban and non-Cuban institutions. METHODS A bibliometric analysis was conducted using 2000–2017 data from the Scopus database. The following search strategy was used: descriptor (diabetes), country (Cuba), publication source (journal), article type (original research, review article). Bibliographic indicators of production, visibility, impact and collaboration were examined. RESULTS Cuba contributed 3.2% of Latin American production and 0.1% of global production related to diabetes. Within Cuba’s scientific production (610 articles, 538 original research and 72 review), 85.9% had a Cuban corresponding author (Cuban leadership). In articles with international collaboration (22.9%), however, most (67.9%) had non-Cuban corresponding authors. A total of 47% (287) were articles involving a single institution. Only 11.1% were published in top-ranked journals, and 14.4% were cited >10 times. Cubans were lead authors on 0.3% of the most frequently cited (top 10%) articles on diabetes in Scopus. A total of 38.4% of this production appeared in low-impact journals and 57.9% in Cuban journals. Articles published in English accounted for 30% of total and obtained higher impact in terms of citations than articles in Spanish. The strongest networks for scientific collaboration were those that connected Cuban and US researchers. CONCLUSIONS Cuban scientists conduct research on diabetes, but their work is not highly visible in the peer-reviewed literature, particularly in top-ranked journals. The problem is not simply one of publishing more, but of knowing how and where to publish. It is urgent that Cuban universities training health professionals at all levels include instruction on scientific writing.

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Pleural effusion is a common condition in critically ill patients (both clinical and surgical). Its diagnosis and classification are important for followup of patients with cardiorespiratory difficulty. Lung ultrasound is used for this purpose, but no reports have been published on its use in Cuba with critically ill patients in intensive care units. We performed lung ultrasound on 144 such patients with cardiorespiratory illnesses, average age 54 years, predominantly men (66%; 95/144), with average APACHE II score 13.6, and 22.1% mortality risk. Patients were divided into two groups: clinical (bronchopneumonia and cardiac insufficiency) and surgical (postoperative liver and kidney transplant or vascular and cardiovascular surgery) to diagnose and classify pleural effusion according to locus (right, left and bilateral) and structural pattern (I, II A, II B, III and IV). Pleural effusions were diagnosed in 81.2% (117/144) of patients (clinical 44.4%, 52/117; surgical 55.6%, 65/117). Bilateral location was the most common (68.4%, 80/117), followed by right (23.9%, 28/117) and then left (7.7%, 9/117). Structural pattern I (anechoic appearance) was observed in 61.5% of cases (72/117); 21.4% (25/117) were II A, 12.8% (15/117) II B, 3.4% (4/117) III, and 0.9% (1/117) were IV. We found no association between pleural effusion localization and ultrasound structural pattern in clinical patients (Fisher exact test 4.2 p = 0.9). In surgical patients, however, complex ultrasound patterns (II A, II B and III) were significantly more common in bilateral forms (Fisher exact test 14.1; p = 0.009). Further studies of this type in Cuba will help provide useful data for prompt treatment and followup of these patients.

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The first 1000 days of life constitute a short and exceptionally important period when the foundation is established for children’s growth, development and lifelong health. Cuba has a comprehensive care system for this population that aims to promote the best start in life so that children can reach their highest development potential. This is carried out through the national public health and education systems and also includes elements of health protection, prevention of harm and disease and social welfare for children. Cuba’s infant mortality rate has remained <5 deaths per 1000 live births for 10 consecutive years, and in 2017 reached 4 per 1000, the lowest rate to date. The mortality rate for children aged <5 years in 2017 was 5.5 per 1000 live births, with a survival rate of 99.5%; low birth weight was 5.1% and vaccination coverage >95%. Among children aged 1 year in Cuba’s Educate Your Child program in 2014, >90% met age-specific indicators in all four developmental domains (intellectual, motor, socioaffective and language). Cuba has universal coverage for antenatal care and, in 2017, 99.9% of births occurred in health institutions. All working mothers receive paid antenatal leave from 34 weeks of gestation, continued through the child’s first year, to facilitate breastfeeding and child care. In 2018, the Cuban government allocated 27% of its national budget to health and social welfare and 21% to education.

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The process of research and evaluation of new products and technologies requires a combination of transdisciplinary theoretical and methodological approaches for managing and achieving objectives. The research, development and evaluation strategy of the new Cuban pneumococcal vaccine combines the approaches of team science and accelerated vaccine introduction. These frameworks are proposed for discussions regarding biotech product evaluation, using their application to the Pneumococcus Project as an example. Emphasis is on the use of team science to eliminate obstacles to obtaining a product of great scientific and technological complexity while establishing robust scientific evidence to support its use and marketing. All of this is in support of opportune and efficient decisions for accelerated introduction of new vaccines in Cuba. Translated from Spanish and reprinted with permission from Revista Cubana de Salud Pública Vol 44 No 2, Apr–Jun 2018. Original available from: http://www.revsaludpublica.sld.cu/index.php/spu/article/view/1065