Unintentional poisonings remain a substantial global health challenge, resulting in an estimated 106,683 deaths and 6.3 million disability-adjusted life years in 2016.[1] Of these poisonings, methanol toxicity results from the metabolic breakdown of ingested methanol found in cleaning products, antifreeze, paints, and harmful and potentially lethal acidic compounds, among others. Consumption of tainted alcoholic beverages […]

  Dr Barry is incoming Board Chair of the Consortium of Universities for Global Health (CUGH) and past President of the American Society of Tropical Medicine and Hygiene. She is a member of the National Academies of Sciences, Engineering, and Medicine, and serves on the National Academy of Medicine’s Board of Global Health. She has […]

Full disclosure: chief weather forecaster is not his official title, but rather one affectionally conferred on Dr Rubiera by the Cuban people, who look to him not only in times of peril, but also to learn about the science of meteorology. Anyone who has taken a taxi in Cuba during hurricane season (June 1 to November 30), and bothered to ask the driver, will receive a clear explanation about how hurricanes are formed, what the Saffir-Simpson scale is all about, and how the season is shaping up—all courtesy of Dr Rubiera’s talent for communication during nightly weather forecasts and special broadcasts. It’s no exaggeration to say that he is something of an icon in Cuba, a man people trust.

Now, he is retired as chief of forecasting at Cuba’s Meteorology Institute, but he stays on as an advisor, and since 1989 represents Cuba’s Meteorological Service as the Vice Chairperson of the World Meteorological Organization’s Hurricane Committee for Region IV (North America, Central America and the Caribbean). He also keeps a spot on nightly news and hosts two TV shows of his own: Global Weather and Weather in the Caribbean. And his PhD in meteorology serves him well as full professor at the University of Havana in—what else?—meteorology communications.

Finally, he has been a driving force in Cuba for collaboration with Miami’s National Hurricane Center (NHC) and other US meteorologists (in fact, the Chairperson of the Region IV Committee is the head of the NHC).

But, as he says over a cup of rich Cuban coffee, it all started with a two-year-old in a yellow sweater.

INTRODUCTION In 2012, North Carolina ranked in the top ten states in refugee resettlement, with central Guilford County one of the most diverse in the southeast.

OBJECTIVE Examine the local resettlement environmental, nutrition and health barriers and needs of refugees in Guilford County, as perceived by individuals providing services to them.

METHODS Participants (n = 40) included: medical and social service providers, educators, faith-based volunteers, resettlement agency caseworkers and liaisons to a variety of refugee communities. Guided semistructured interviews were audio-recorded and transcribed verbatim. Themes were identified using deductive content analysis and categorized by frequency of reporting by participants.

RESULTS Perceptions were consistent across participants regarding a diverse local refugee population. Resettlement housing was observed to be in poor condition, located in areas of poverty with transportation barriers. However, refugees rarely relocated, due to strong community relationships and support. Perceived dietary risks included: difficulties budgeting and maintaining food assistance, hoarding food, high consumption of sodas and sweets, misperceptions regarding US products (e.g., perceived need for infant formula), and limited health knowledge. Respondents observed that most refugees preferred “fresh” foods, and had strong agricultural skills but lacked green space. Major barriers to health care reported were: poverty, short duration of initial Medicaid coverage, and language (both lack of interpretation services and translated materials). Providers consistently observed type 2 diabetes, weight gain and dental problems across refugee groups.

CONCLUSIONS Direct service providers’ experiences and observations working with a diverse resettlement population provide unique insight into consistent barriers to achieving good health that confront refugees. While refugees face many barriers, groups often have impressive strengths, such as agricultural skills, on which to focus.

KEYWORDS Refugees, emigration, immigration, minority health, health care disparities, diet, environment, USA

Among environmental problems, climate change presents the greatest challenges to developing countries, especially island nations. Changes in climate and the resulting effects on human health call for examination of the interactions between environmental and social factors. Important in Cuba’s case are soil conditions, food availability, disease burden, ecological changes, extreme weather events, water quality and rising sea levels, all in conjunction with a range of social, cultural, economic and demographic conditions.

KEYWORDS Climate change, health, environment, social factors, Cuba

This paper contextualizes the chronic kidney disease epidemic and related burden of disease affecting Central American farming communities. It summarizes the two main causal hypotheses (heat stress and agrochemicals), draws attention to the consequences of dichotomous reasoning concerning causality, and warns of potential conflicts of interest and their role in “manufacturing doubt.” It describes some methodological errors that compromise past study findings and cautions against delaying public health actions until a conclusive understanding is reached about the epidemic’s causes and underlying mechanisms. It makes the case for a comprehensive approach to the historical, social and epidemiological facts of the epidemic, for critically assessing existing studies and for enhanced rigor in new research.

KEYWORDS Epidemiology, public health, chronic kidney disease, causality, epidemic, agriculture, environment, agrochemicals, pesticides, heat stress, social determinants of health, Central America

INTRODUCTION Pre-eclampsia is a major cause of morbidity and mortality during pregnancy worldwide and is among the leading causes of maternal mortality in Cuba. It is a complex, multifactoral disease, in which interaction of genetic and environmental factors should not be overlooked if the goal is proper risk assessment to support personalized preventive genetic counseling and more effective prenatal care to prevent pregnancy complications.

OBJECTIVE Determine the contribution to pre-eclampsia of interaction between a predisposing genome and adverse environmental factors in pregnant women in a Havana maternity hospital.

METHODS This was the exploratory phase of a hospital-based case-control study, using January 2007–December 2009 patient records from the Eusebio Hernández University Hospital, a provincial maternity hospital in Havana. Eighty pregnant women diagnosed with pre-eclampsia and 160 controls were studied. The main variables were age, parity, nutritional status (measured by BMI), alcohol use, tobacco use, and history of pre-eclampsia in relatives of the pregnant woman (proband) or of her partner. Pearson chi square and Fisher exact test were used to assess statistical significance of associations between variables and odds ratio as a measure of association strength. Familial aggregation was studied and a case-control design used to assess gene–environment interaction, using multiplicative and additive models.

RESULTS Among the environmental risk factors studied, alcohol showed the strongest effect on pre-eclampsia risk (OR 3.87, 95% CI 1.64–9.13). Familial pre-eclampsia clustering was observed; risk was increased for both first-degree (OR 2.43, 95% CI 1.62–3.73) and second-degree (OR 1.89, 95% CI 1.34–2.68) relatives as well as for husband’s relatives (OR 2.32, 95% CI 1.40–3.86). There was evidence of interaction between alcohol consumption and family history.

CONCLUSIONS Familial aggregation of the disorder was demonstrated, the first Cuban epidemiological evidence of genetic and enviromental contributions to pre-eclampsia risk. Familial clustering among the husband’s relatives demonstrates the fetal genome’s importance in genesis of pre-eclampsia. The interaction of environmental risk factors with genetic ones produces increased pre-eclampsia risk, compared to expectations based on independent action of these variables.

KEYWORDS Pre-eclampsia, toxemia of pregnancy, pregnancy outcome, environment, genetics, genome–environment interaction, genetic epidemiology, Cuba