Helena J. Chapman MD MPH PhD, Luisa A. Armas-Pérez MD MS, Michael Lauzardo MDMS,
Edilberto R. González-Ochoa MD PhD

Global efforts to eliminate tuberculosis by 2050 continue to challenge health systems. In countries with low reported tuberculosis incidence, such as the USA (3.1/100,000 population) and Cuba (6.9/100,000), differences in classification by income level and health systems’ overall organizational structure are evident. However, the two countries’ low tuberculosis incidence, geographic proximity, robust research capacity and shared health priority for tuberculosis elimination provide fertile territory to strengthen collaboration for tuberculosis control in clinical, laboratory and community settings. Two tuberculosis symposia in Cuba—one at the Cuba Salud Convention in 2015 and the other at the International Forum on Hygiene and Epidemiology in 2016—were instrumental in stimulating dialogue on continued efforts towards eliminating tuberculosis by 2050. In this article, we describe tuberculosis burden in the USA and Cuba, critically analyze strengths and challenges experienced in areas of low tuberculosis incidence and provide recommendations for future institutional collaboration to support tuberculosis elimination and improved population health.

KEYWORDS Tuberculosis/epidemiology, Mycobacterium tuberculosis, prevention, communicable disease control, disease eradication, disease elimination, international cooperation, Cuba, USA

Erratum
Page 60, Table 1, rows 9 and 10: row labels “New cases (%)” and “Previously treated cases (%)” should be indented, to make clear that they are subsets of MDR-TB cases.

Protein–energy malnutrition affects one in nine people worldwide and is most prevalent among children aged less than five years in low-income countries. Early childhood malnutrition can have damaging neurodevelopmental effects, with significant increases in cognitive, neurological and mental health problems over the lifespan, outcomes which can also extend to the next generation. This article describes a research collaboration involving scientists from five centers in Barbados, China, Cuba and the USA. It builds on longer-term joint work between the Barbados Nutrition Study (which, over a 45-year span, has extensively documented nutritional, health, behavioral, social and economic outcomes of individuals who experienced protein–energy malnutrition in the first year of life and healthy controls from the same classrooms and neighborhoods) and the Cuban Neuroscience Center (which has developed low-cost brain imaging methods that can be readily used in low income settings to identify biomarkers for early detection and treatment of adverse consequences of childhood malnutrition).

This collaboration, which involved Barbadian, Cuban and US scientists began in the 1970s, when quantitative EEG techniques were applied to EEG data collected in 1977–78, at which time study participants were aged 5–11 years. These EEG records were never fully analyzed but were stored in New York and made available to this project in 2016. These data have now been processed and analyzed, comparing EEG findings in previously malnourished and control children, and have led to the identification of early biomarkers of long-term effects of early childhood protein–energy malnutrition. The next stage of the project will involve extending earlier work by collecting EEG recordings in the same individuals at ages 45–51 years, 40 years later, and comparing findings to earlier data and to these individuals’ behavioral and cognitive outcomes. Quantitative EEG biomarkers of the effects of protein–energy malnutrition may help identify children at greatest risk for early malnutrition’s adverse neurodevelopmental effects and inform development of targeted interventions to mitigate the long-term adverse effects of protein–energy malnutrition in developing countries.

KEYWORDS Protein–energy malnutrition, electroencephalography, EEG, biomarkers, neurosciences, Barbados, Cuba, USA

ABSTRACT
Cuba eliminated polio in 1962 and was among the first countries to do so. Since then, only 20 cases of vaccine-derived paralytic poliomyelitis have been reported. Because Cuba used oral poliovirus vaccine exclusively in two mass campaigns usually in February and April each year, Sabin viruses were detected only within approximately 6–8 weeks after each annual campaign. This made Cuba a very attractive site to study the epidemiology of poliomyelitis in a tropical country without risk of secondary transmission of Sabin viruses for a large part of each year, an advantage over countries that used oral poliovirus vaccine continuously throughout the year in routine immunization programs. This report summarizes the unique scientific collaboration between Cuba’s Ministry of Public Health and WHO, with participation by US scientists, in the global effort to eradicate polio.

KEYWORDS Poliomyelitis, disease eradication, disease elimination, oral poliovirus vaccine, Sabin vaccine, inactivated poliovirus vaccine, Salk vaccine, Cuba, WHO

In 1961, the USA severed diplomatic relations with Cuba, and in 1962 an embargo was imposed on trade and financial relations with that country. It was not until five decades later that the USA and Cuba would reestablish relations. This opened the way for the New York State Trade Mission to Cuba in April 2015, during which Cuba’s Molecular Immunology Center and Buffalo, New York’s Roswell Park Cancer Institute signed a formal agreement that would set in motion biotechnology research collaboration to address one of the most important causes of death in both countries. Significant research from Cuba led to this groundbreaking collaboration. The purpose of this paper is to discuss the development of this cooperation, from the Molecular Immunology Center’s initial investigations, through the opening of a phase I clinical trial at Roswell Park Cancer Institute with therapies developed at the Center. This cooperation was responsible for the first clinical trial for CIMAvax-EGF involving advanced-stage non-small cell lung cancer patients in the USA. A license was also approved by the US Department of the Treasury’s Office of Foreign Assets Control authorizing a commercial partnership for development of biotechnology products, combining the cancer research efforts of both institutions. This unusual collaboration between Cuba and the USA—the US economic embargo and travel restrictions not withstanding—opens good prospects for expanded medical research between the two countries. While political and logistical challenges remain, the shared mission and dedication of these Cuban and US scientists points the way towards relationships that can lead to development, testing, approval and use of promising new therapies for cancer patients.

KEYWORDS Biotechnology, clinical trials, cancer vaccines, cancer immunotherapy, non-small cell lung cancer, NSCLC, Cuba, USA

Gastroenterology, hepatology and liver transplant exchanges between the USA and Cuba have mainly consisted of scientific events and short visits. This has facilitated Cuba’s inclusion in recognized scientific organizations, familiarity with Cuba’s biotech products for treatment of liver disease, and access by Cuban professionals to the highest level of scientific information for clinical practice. It has also given health professionals in the US a more accurate picture of Cuba’s health sector. The results of the Global Alcoholic Liver Disease Survey, which included Cuba and was designed and coordinated in the USA, opened doors to joint research and scientific publications. Until now, there have been no protocols for ongoing cooperation to enable bilateral clinical trials or continuing professional development in diagnostic, therapeutic and surgical techniques for hepatology and liver transplantation. There are many mutually beneficial research prospects in these areas. What has been accomplished to date, described in this article, is encouraging and sets the stage for future collaboration.

KEYWORDS Hepatology, liver transplant, health, medicine, science, Cuba, USA

Joan O’Connell MHSc PhD, Ana María Gálvez-González PhD, Jean Scandlyn PhD, María Rosa Sala-Adam MS DDS, Xiomara Martín-Linares MS

In 2011, the US Department of the Treasury changed its regulations to allow US students to participate in short-term education programs in Cuba. Beginning in 2012, and each year thereafter, Cuba’s National School of Public Health and the Colorado School of Public Health have jointly taught a class on the Cuban public health system. The program goals are to provide US students with an opportunity to learn about the Cuban national health system’s focus on 1) prevention and primary health care services; 2) financial and geographic access to services and health equity; 3) continuum of care across the home, family doctor-and-nurse offices, polyclinics and hospitals; 4) data collection at all levels to understand health risks, including outbreaks, and to guide resource allocation; 5) assessing patients’ health and risks using a comprehensive definition of health; 6) multisectoral collaborations between the Ministry of Public Health and other Cuban agencies and organizations to address population health risks; 7) disaster preparedness, response and recovery; and 8) provision of international health assistance. The class incorporates information about health systems in Latin American and other Caribbean countries to provide context for understanding the Cuban health system.

The course includes: 1) seminars, online readings and discussions before travel to Cuba; 2) seminars at Cuba’s National School of Public Health, visits to Cuban national health institutions at all levels, from community-based family doctor-and-nurse offices and multispecialty clinics (polyclinics) to internationally recognized national health institutions, and guided visits and activities about Cuban culture and history during their 12 days in Cuba; and 3) followup course work upon return to the USA in which students integrate what they learned into their final class reports and presentations. During time spent planning, implementing and revising the program, both institutions have learned from each other about global health teaching methodologies and have laid a foundation for future teaching and research collaborations. To date, 49 individuals have participated in the program.

KEYWORDS Medical education, public health system, collaboration, Cuba, USA

After December 17, 2014, when the US and Cuban governments announced their intent to restore relations, the two countries participated in various exchange activities in an effort to encourage cooperation in public health, health research and biomedical sciences. The conference entitled Exploring Opportunities for Arbovirus Research Collaboration, hosted at Havana’s Hotel Nacional, was part of these efforts and was the first major US–Cuban scientific conference in over 50 years. Its purpose was to share information about current arbovirus research and recent findings, and to explore opportunities for future joint research. The nearly 100 participants included leading arbovirus and vector transmission experts from ten US academic institutions, NIH, CDC, FDA and the US Department of Defense. Cuban participants included researchers, clinicians and students from Cuba’s Ministry of Public Health, Pedro Kourí Tropical Medicine Institute, Center for Genetic Engineering and Biotechnology, Center for State Control of Medicines and Medical Devices and other health research and regulatory organizations. Topics highlighted at the three-day meeting included surveillance, research and epidemiology; pathogenesis, immunology and virology; treatment and diagnosis; vector biology and control; vaccine development and clinical trials; and regulatory matters. Concurrent breakout discussions focused on novel vector control, nonvector transmission, community engagement, Zika in pregnancy, and workforce development. Following the conference, the Pedro Kourí Tropical Medicine Institute and the US National Institute of Allergic and Infectious Diseases have continued to explore ways to encourage and support scientists in Cuba and the USA who wish to pursue arbovirus research cooperation to advance scientific discovery to improve disease prevention and control.

KEYWORDS Arboviruses, flavivirus, Zika virus, chikungunya virus, dengue virus, research, disease vectors, Cuba, USA

From 1991 to 1993, an epidemic of optic and peripheral neuropathy—the largest of the century—broke out in Cuba, affecting more than 50,000 people. Initially the main clinical features were decreased visual acuity, central and cecocentral scotomas, impaired color vision and absence of the papillomacular bundle. Later, peripheral and mixed optic–peripheral forms began to appear. Due to the magnitude of the epidemic, the Cuban government requested help from the international community at the 46th World Health Assembly in 1993. PAHO and WHO immediately responded by sending a mission of international experts. Several hypotheses regarding the pathogenesis of Cuban epidemic neuropathy were put forward including: toxic, nutritional, genetic and infectious. The authors refer to extensive studies by researchers sponsored by the Cuban government and PAHO/WHO, joined by scientists from several other countries, including the USA. This paper describes their multidisciplinary work, particularly devoted to investigating the hypothesis of a primary toxic–nutritional cause of the epidemic. Clinical aspects, such as case definition and clinical description, were vital issues from the start. Cuban physicians who first examined patients received a clear impression of its toxic–nutritional origin, later confirmed by international experts. Research then focused on the mechanisms contributing to damage under the toxic–nutritional hypothesis. These included injuries to the mitochondrial oxidative phosphorylation pathway, nutritional deficiencies, excitotoxicity, formate toxicity and dysfunction of the blood–brain barrier. It was expected that the results of such international collaboration into this major health problem would also shed more light on mechanisms underlying other nutritional or tropical myeloneuropathies.

KEYWORDS Optic neuritis, optic neuropathy, peripheral neuropathy, neurotoxicity syndromes, disease outbreaks, international cooperation, Cuba

Erratum:
Page 30, first complete paragraph, line 7, “Two models were developed independently by Cuban researchers” should read “Two models were developed independently by AAS and AGQ.”

Scientific research cooperation between Cuba and the USA has a long history that dates back to the 19th century. For the past 200 years, the two countries’ relationship has been subject to complex economic, political and social forces. In the second half of the 20th century, the Cuban revolution and the subsequent escalation of the US government embargo impacted every aspect of Cuban life. While science was no exception, scientific interactions never ceased. Over the past decade, scientific cooperation—led and facilitated by scientific organizations such as the Cuban Academy of Sciences, the American Association for the Advancement of Science and others—has steadily increased to address ever more critical issues facing both countries. Science and global health diplomacy were key to reestablishing a trusting and productive relationship of mutual and global benefit after the USA and Cuba restored diplomatic relations in 2015. However, recent changes in Cuba policy by the new US administration are jeopardizing these opportunities for increased scientific cooperation, which are in the best interests of people in both countries.

KEYWORDS International cooperation, academies and institutes, Cuba, USA

INTRODUCCIÓN La disponibilidad de los anticuerpos monoclonales en Cuba facilitó el desarrollo y la aplicación de técnicas innovadoras (inmunogammagrafía y radioinmunoterapia) para el diagnóstico y el tratamiento del cáncer.

OBJETIVO Revisar la literatura sobre las técnicas de inmunogammagrafía y radioinmunoterapia, y analizar su uso en Cuba. Se describe la experiencia del Centro de Investigaciones Clínicas de La Habana con anticuerpos monoclonales marcados para el diagnóstico y el tratamiento del cáncer durante el período 1993–2013.

RECOPILACIÓN DE LAS EVIDENCIAS Se revisaron los conceptos básicos sobre cáncer y anticuerpos monoclonales, así como los resultados relevantes internacionales y cubanos. Se estudiaron 49 documentos: 2 libros de texto, 34 artículos de autores cubanos y 13 de autores internacionales. Se incluyeron todos los trabajos publicados por el Centro de Investigaciones Clínicas desde 1993 hasta 2013. La bibliografía se obtuvo de la biblioteca del Centro de Investigaciones Clínicas y de Infomed, la red telemática nacional de salud de Cuba, y se utilizaron las siguientes palabras clave: anticuerpos monoclonales, inmunogammagrafía y radioinmunoterapia (en inglés y en español).

RESULTADOS El marcaje de los anticuerpos (ior t3, ior t1, ior cea1, ior egf/r3, ior c5, h-R3, 14 F7 y rituximab) con los isótopos radiactivos constituyó una línea básica de investigación en Cuba y permitió su uso para el diagnóstico y la terapéutica. Los estudios realizados demuestran la buena sensibilidad y la precisión diagnóstica de la inmunogammagrafía para la detección de varios tipos de tumores (cabeza y cuello, ovario, colon, mama, cerebro, y linfoma).

La obtención de conjugados radioinmunes con isótopos radiactivos como el 99mTc y el 188Re permitió el radioinmunodiagnóstico y la administración de la radioinmunoterapia a los pacientes con varios tipos de cánceres (cerebro, mama, linfomas). El 60% de los ensayos clínicos se propuso determinar la farmacocinética, la dosimetría interna y los efectos adversos de los anticuerpos monoclonales, así como la respuesta tumoral; hubo pocos efectos adversos, no se observó daño en los órganos vitales, y hubo una respuesta antitumoral en una proporción sustancial de los pacientes.

CONCLUSIONES Cuba tiene experiencia en la producción y el radiomarcaje de los anticuerpos monoclonales, lo que facilita el uso de estos agentes. Los estudios realizados por el Centro de Investigaciones Clínicas durante los pasados 20 años muestran resultados satisfactorios. La evidencia obtenida sugiere un prometedor potencial de los anticuerpos monoclonales y de la medicina nuclear, ya que las técnicas de radioinmunodiagnóstico y radioinmunoterapia proporcionan alternativas para el diagnóstico y el tratamiento del cáncer en Cuba.

PALABRAS CLAVE Inmunogammagrafía, radioinmunoterapia, conjugado radioinmune, marcaje, anticuerpo monoclonal, inmunocromatografía, radioinmunodetección, radiomarcaje, Cuba

INTRODUCCIÓN Durante los últimos 40 años, se ha reportado una alta prevalencia de tabaquismo en Cuba, que incluye la ciudad de Cienfuegos en la parte central de la isla.

OBJETIVO Determinar la prevalencia de tabaquismo y los potenciales factores de riesgo asociados en la ciudad de Cienfuegos durante 2010-2011.

MÉTODOS Se realizó un estudio descriptivo de corte transversal en la ciudad de Cienfuegos, en el contexto de CARMEN (Conjunto de Acciones para Reducir Multifactorialmente las Enfermedades no Transmisibles), una iniciativa de varios países de la OPS para un enfoque multidimensional de las enfermedades crónicas no transmisibles. Los participantes, 2 193 (con edades entre 15-74 años), se seleccionaron al azar a través de un complejo muestreo probabilístico en tres etapas. Las variables examinadas en relación con el tabaquismo incluyeron la edad, el sexo, el color de la piel, el estado civil y el nivel de educación.

RESULTADOS Aproximadamente el 25% de los encuestados eran fumadores (el 30.3% de los hombres y el 21.0% de las mujeres). Para los hombres, la mayor prevalencia estuvo en los grupos de 25-34 y 55-64 años; para las mujeres, en el grupo de 45-54 años. Con respecto al color de la piel, las tasas de tabaquismo fueron mayores entre los negros y los mestizos (29.5%); y en relación con el estado civil, entre los que estaban separados, viudos o divorciados (30.0%). La prevalencia de tabaquismo disminuía al aumentar el nivel educacional; de acuerdo con esa tendencia, el grupo con educación universitaria tuvo la menor prevalencia (16.2%).

CONCLUSIONES Aunque uno de cada cuatro residentes en Cienfuegos con edades ≥15 años fumaba en 2010-2011, la prevalencia allí fue menor que en encuestas anteriores. Las diferencias observadas por: edad, sexo, color de la piel, estado civil y nivel educacional pueden ser útiles para la planificación de las acciones futuras de prevención y control del tabaquismo.

PALABRAS CLAVE Tabaco, tabaquismo, prevalencia, encuestas de salud, vigilancia de factores de riesgo, Cuba

INTRODUCTION Primary hypertension has its origins in childhood and is a risk factor for atherosclerosis; it is considered an important health problem because of its high prevalence worldwide.

OBJECTIVE Describe the development of hypertension during adolescence, including some factors that influence its persistence and progression in Cuban adolescents.

METHODS A cohort study was conducted in an intentional sample of 252 apparently healthy adolescents from the catchment area of the Héroes del Moncada Polyclinic in Plaza de la Revolución Municipality, Havana. They were assessed in two cross-sectional studies in 2004 and 2008. Mean age at first assessment was 13.2 years, 17.1 years at the second. Variables were weight, height, body mass index, waist circumference, blood pressure, smoking, family history of hypertension and birth weight. Correlation coefficients and growth curve analyses were applied to assess blood pressure persistence. Risk of developing prehypertension and hypertension was estimated in the second assessment, based on predictors identified in the 2004 cut. Forecasting models with these factors were developed using classification trees as analytical tools.

RESULTS Of the six adolescents categorized as hypertensive in the first assessment, five still showed blood pressure alterations after four years. The main factors related to hypertension in those aged 16–19 were blood pressure itself and a body mass index >90th percentile, followed by low birth weight and abdominal obesity. Prognostic models for predicting this condition at the end of adolescence demonstrated the importance of blood pressure alterations at age 12–15 years.

CONCLUSIONS High rates of persistence and progression of hypertension during adolescence highlights the need for systematic blood pressure screening at the primary health care level and adoption of primary prevention strategies beginning in childhood.

KEYWORDS Atherosclerosis, atherogenesis, high blood pressure, adolescence, hypertension, risk factors, Cuba

INTRODUCTION Hyperphenylalaninemias are inborn errors of phenylalanine metabolism caused by deficiency of L-phenylalanine hydroxylase (the enzyme that converts phenylalanine to tyrosine), resulting in increased serum phenylalanine (>4 mg/dL or 240 µmol/L). Phenylketonuria, or PKU, is the most common form. Untreated PKU is associated with progressive neurodevelopmental delay, evolving towards intellectual impairment.

Cuba introduced a national newborn screening program for PKU in 1986. It has enabled early diagnosis and initiation of dietary treatment, reducing appearance of intellectual impairment in these patients. Originally, confirmatory diagnosis was done only by quantifying serum phenylalanine. In 2010, however, an HPLC method for quantifying serum phenylalanine and tyrosine simultaneously was validated at the National Medical Genetics Center, to perform confirmatory and differential diagnosis of hyperphenylalaninemias, as well as biochemical monitoring of patients diagnosed.

OBJECTIVES Describe experience using HPLC confirmatory diagnosis for positive cases from the National Neonatal Screening Program for Phenylketonuria and in biochemical monitoring of diagnosed patients after initiation of dietary treatment.

METHODS A descriptive retrospective case-series study was conducted from June 2010 through June 2012. The study population comprised 531 infants who tested positive in the National Neonatal Screening Program for Phenylketonuria. Variables used were serum phenylalanine concentration (first criterion of positivity) and tyrosine, phenylalanine/tyrosine ratio (second criterion, both detected by reverse-phase HPLC with direct fluorescence), hyperphenylalaninemia classification, year of diagnosis, sex, and province of origin.

RESULTS Of the samples, 97.7% (519/531) were confirmed as false positives, and 10.4% (55/531) had transient neonatal tyrosinemia. Hyperphenylalaninemia was diagnosed in 12 infants (2.2%): 1.3% (7/531) presented classical PKU, with 34.7 ± 14.7 mg/dL phenylalanine in serum and phenylalanine/tyrosine ratio of 18.9 ± 12.7; and 0.9% (5/531) had persistent hyperphenylalaninemia, with 8.9 ± 3.4 mg/dL of phenylalanine and phenylalanine/tyrosine ratio of 4.5 ± 1.6. Matanzas Province contributed more cases than any of Cuba’s 14 other provinces (3/12, 25%) and there was a slight predominance of male sex (7/12, 58.3%). During biochemical monitoring, 83.3% of patients (10/12) reduced their levels of phenylalanine (≤5 mg/dL or 300 µmol/L): 5 with classical PKU and all 5 with persistent hyperphenylalaninemia. The incidence of neonatal hyperphenylalaninemias was 1/22,503 live births and 1/38,577 for classical PKU.

CONCLUSIONS HPLC for simultaneous quantification of phenylalanine and tyrosine in serum meets the needs of a confirmatory test for patients testing positive in Cuba’s National Neonatal Screening Program for Phenylketonuria (which has high false positive rates). It has enabled introduction in Cuba of a second PKU diagnostic criterion of positivity for both the classification of hyperphenylalaninemias and the biochemical monitoring of diagnosed patients.

KEYWORDS Hyperphenylalaninemias, phenylketonuria, phenylalanine hydroxylase deficiency disease, HPLC, phenylalanine, tyrosine, PKU, PAH deficiency, BH4 deficiency, genetic disease, hereditary disease, screening, Folling disease, Cuba

INTRODUCTION Improved survival rates of neonates with very low birth weight (<1500 g) have led to a higher incidence of neurodevelopmental sequelae.

OBJECTIVE Examine neurodevelopment outcomes over the first two years of life of infants who weighed <1500 g at birth, in relation to birth weight, gestational age and 1-minute and 5-minute Apgar scores, in a Havana tertiary care hospital.

METHODS A case-series study was conducted to assess neurodevelopment outcomes of very low birth weight infants over their first two years of life. The study population comprised 116 surviving neonates with very low birth weight (<1500 g), born in the Dr Ramón González Coro University Maternity Hospital in Havana, Cuba, 2006–2010. A longitudinal, multidisciplinary and interdisciplinary follow up of all infants’ neurodevelopment was performed, from hospital discharge to age two years, corrected for gestational age at birth. Data on each infant’s perinatal variables were collected: birth weight in grams, gestational age at birth, and 1-minute and 5-minute Apgar scores. Patients were classified as having normal neurodevelopment, mild abnormalities and moderate-to-severe abnormalities. Pearson’s chi-square test was used to determine possible relationships between perinatal variables studied and neurodevelopment, with exact sampling distribution and 95% confidence level.

RESULTS Normal neurodevelopment was observed in 69% of very low birth weight infants, 25.9% had mild abnormalities, and 5.2% displayed moderate-to-severe abnormalities. The results demonstrate a statistically significant relationship between gestational age and neurodevelopmental outcomes; more neurodevelopmental abnormalities were found in infants born at earlier gestational age (<30 weeks).

CONCLUSIONS Surviving very low birth weight neonates with lower gestational age at birth face a higher risk of neurodevelopmental abnormalities.

KEYWORDS Very low birth weight newborn, neurodevelopment, sequelae, Apgar score, Cuba

Mientras recorría las nieves del Himalaya para atender pacientes después del te-rremoto de Pakistán en 2005, el internista Félix Báez nunca podría haber imaginado que nueve años más tarde estaría en la primera línea del enfrentamiento al ébola en Sierra Leona… y mucho menos, que  contraería el mortal virus, sobreviviría para contarlo y además, que regresaría con sus colegas a África para continuar la batalla. A su lado, en el Hospital Universitario de Ginebra a donde fue transportado por vía aérea, estuvo el Dr. Jorge Pérez, hoy director del Instituto de Medicina Tropical Pedro Kouri (IPK) de Cuba, pero más conocido como “el doctor cubano del sida”. Para ambos médicos los tiempos han cambiado, y ahora, cuando el ébola hace estragos, es lo primero en sus mentes,

Al momento de esta entrevista, aunque existe un optimismo cauteloso en Liberia, la epidemia no está aún bajo control. El ébola ha infectado cerca de 22 000 personas, llevándose consigo más de 8 600 vidas; Sierra Leona es uno de los países más golpeados. Entre los contagiados y las víctimas mortales ha habido muchos trabajadores locales de la salud: 103 de los 138 infectados según la última cuenta.

El primero en lanzar la alarma global fue Médicos sin Fronteras, quienes, como Cuba, ya tenían personal médico en tierras africanas. A estos se unieron muchos otros, y Cuba fue el país que ofreció la mayor ayuda una vez que la OMS hizo el llamado a las naciones para hacer frente a la epidemia con financiamiento y, más importante aún, con recursos humanos.

Cuba envió 256 voluntarios, todos con una sólida experiencia en emergencias internacionales: 38 a Guinea, 53 a Liberia y 165 a Sierra Leona. Y otros esperan a tomar el relevo, todos trabajadores de la salud entrenados en desastres y que han recibido ya un primer curso sobre ébola en el IPK.

Estos cubanos y otros voluntarios internacionales están logrando salvar a pacientes de una muerte segura, apoyando a los trabajadores de la salud y los educadores comunitarios locales. Y personas como Jorge Pérez están trabajando a fondo en la investigación del ébola para ayudar a evitar su diseminación por toda África y otras zonas del mundo.

Pero evitar que otra epidemia así tenga lugar nuevamente, requiere más, mucho más. No solo la comunidad internacional pudo haber hecho más esta vez. Sino que, como advirtió Jim Kim,  Presidente del Banco Mundial, el ébola no empezó con la enfermedad, sino más bien con las desigualdades históricas, enconándose el virus en sistemas de salud que apenas logran funcionar. Una lección para todos nosotros.

Horas antes de que el doctor Báez regresara a Sierra Leona —donde se encuentra actualmente— MEDICC Review lo entrevistó a él y al Dr. Pérez en el IPK, en la Habana.

INTRODUCTION Recent decades have seen an uptick in suicide attempts and completed suicides among adolescents and young adults worldwide. In the Americas, including Cuba, suicide is the third leading cause of death in adolescents (ages 10–19 years).

OBJECTIVE Characterize the epidemiology of attempted and completed suicide in Cuban adolescents from 2011 through 2014.

METHODS A descriptive epidemiological study was carried out. The information was gathered from morbidity records for suicide attempts and mortality records for suicide deaths in adolescents, taken from the Cuban Ministry of Public Health’s Medical Records and Health Statistics Division database for January 1, 2011 through December 31, 2014. Variables were sex, age, occupation or employment status, and suicide method. Suicide attempt incidence rates and suicide mortality rates by age group per 100,000 population (crude, adjusted and age/sex specific), mortality sex ratio and attempt/suicide ratio were calculated. Relative change was calculated as a percentage, as were frequencies by variable for attempted suicide and suicide, and by age and sex for method used.

RESULTS A total of 19,541 suicide attempts and 149 suicides were reported. Average annual numbers were 4,885.2 suicide attempts and 37.2 suicides (131:1 ratio). There were 3,966 suicide attempts among boys, for a sex ratio of 0.25:1. Age-adjusted suicide attempt rates decreased from 391.8 per 100,000 population to 304.5 (22.3% reduction over the study period). Boys accounted for 107 of 149 suicide deaths, for a sex ratio of 2.5:1. Age-adjusted suicide mortality rates decreased from 2.8 to 2.3 per 100,000 population (17.9% reduction). The group aged 15–19 years had the highest age-adjusted suicide rate (3.9 per 100,000 population) and contributed the most deaths (114/149, 76.5%), although it did experience a 31.8% reduction over the study period. The group aged 10–14 years recorded a relative increase of 60% over the study period. Hanging was the most common suicide method (116/149, 77.9%). The suicide rate in Cuban adolescents (2.6 per 100,000 population, 3.7 in boys and 1.5 in girls) is less than that reported by the Region of the Americas between 2005 and 2009, 3.7 per 100,000 population (5/100,000 in boys and 2.3/100,000 in girls).

CONCLUSIONS Suicide rates in Cuban adolescents are lower than reported elsewhere in the Americas. Suicide attempts and suicide rates decreased modestly between 2011 and 2014. Hanging is the most commonly used method. The highest rates occur in the group aged 15–19 years, but those aged 10–14 years showed a relative increase over the study period. These results update the epidemiology of suicide in Cuban adolescents and demonstrate the extent of the problem. Suicides and suicide attempts show opposite patterns in boys and girls; suicides are more frequent among boys while suicide attempts are more frequent among girls.

KEYWORDS Suicide, suicide, attempted, mortality rate, adolescents, Cuba

CONTRIBUTION OF THIS RESEARCH These results update the epidemiology of suicide in Cuban adolescents and reveal the extent of the problem for one of the main preventable causes of death in this age group.