Abstract Background Changes in the body composition of the elderly can be quickly identified by health professionals in primary care, reducing the impact on health, nutritional status, and functional capacity. Objective To look for links between muscle mass and strength, nutritional status, and functional capacity in community-dwelling elderly. Method A cross-sectional study involving 323 elderly people was carried out. Body composition assessment was performed by absorptiometry (DEXA) and anthropometry. Functional capacity was assessed by Instrumental Activities of Daily Living and by gait speed (VM) and Time Up and Go (TUG). Results In this sample, the lean mass index (LMI) was associated with indicators of nutritional status (BMI, NC, and WC), in addition to having shown an important correlation with handgrip strength (HGS). HGS was associated with VM and TUG. Regression analysis identified an association between BMI and LMI (p < 0.001) and between GS and HGS (p = 0.003). Conclusion HGS was an important indicator of functional capacity and correlated with LMI. Consequently, the LMI is associated with indicators of nutritional status. Therefore, when it is impossible to assess the LMI, we recommend the assessment of HGS, NC and BMI as predictors of compromised nutritional status and functional disability in the elderly.

Resumo Introdução Alterações na composição corporal do idoso podem ser rapidamente identificadas por profissionais de saúde na Atenção Básica, reduzindo o impacto sobre a saúde, o estado nutricional e a capacidade funcional. Objetivo Identificar relações entre massa e força muscular com o estado nutricional e a capacidade funcional em idosos da comunidade. Método Estudo transversal, envolvendo 323 idosos. A avaliação da composição corporal foi realizada por absorciometria (DEXA) e antropometria. A capacidade funcional foi avaliada pelas Atividades Instrumentais de Vida Diária, pela velocidade da marcha (VM) e Time Up and Go (TUG). Resultados Nesta amostra, o índice de massa magra (IMM) se mostrou associado aos indicadores do estado nutricional (IMC, CP e CC), além de ter apresentado importante correlação com a força de preensão palmar (FPP). A FPP esteve relacionada à VM e ao TUG. A análise de regressão identificou associação entre o IMC e o IMM (p<0,001), bem como entre a VM e a FPP (p=0,003). Conclusão A FPP se apresentou como importante indicador da capacidade funcional e se mostrou correlacionada com o IMM. Consequentemente, o IMM está associado aos indicadores do estado nutricional. Logo, na impossibilidade de avaliação do IMM, recomendamos a avaliação da FPP, CP e IMC como preditores de comprometimento do estado nutricional e da incapacidade funcional do idoso.

ABSTRACT Introduction: New SARS-CoV-2 strains recently detected cause an increase in morbidity and mortality not only in the elderly. Identifying the vulnerable population is a challenge. Objective: To estimate the prevalence of adults vulnerable to severe COVID-19 and its associated sociodemographic factors. Methods: An observational cross-sectional analytic study using data from the 2018-2020 National Health Survey. It included 13 684 individuals aged 19 years and over. The structured questionnaire included information on the sociodemographic variables, personal and family pathological antecedents, and records of blood pressure and biochemistry tests, among others. Vulnerability to severe COVID-19 was developed based on the proposal from the CDC Atlanta, USA and it was the dependable variable. Results: The prevalence of adults vulnerable to severe COVID-19 in the country was 68.3%. At higher risk are the elderly (86.5%), non-white individuals, and those who perceived themselves as having poor living conditions. For the elderly, being male was a protective factor, while living in the western region of the country was a risk factor. High blood pressure (39.4%), smoking (22.2%), obesity (16.6%) and chronic respiratory diseases (10.6%) were the most frequent health problems. Conclusions: Vulnerability to severe COVID-19 in the Cuban adult population is high; consequently, it is considered a serious health problem. Non-modifiable factors are positively associated with vulnerability: being an older adult, female, non-white skin color, and suffering from hypertension; while “poor” living conditions is the only modifiable factor.

RESUMEN Introducción: Nuevas cepas de SARS-CoV-2 detectadas recientemente provocan aumento de la morbilidad y mortalidad no solo en adultos mayores. Conocer la población vulnerable es un reto. Objetivo: Estimar la prevalencia de adultos vulnerables a la COVID-19 severa y sus factores sociodemográficos asociados. Métodos: Estudio observacional transversal analítico con datos provenientes de la encuesta nacional de salud 2018-2020, que incluye 13 684 personas de 19 y más años de edad. El cuestionario estructurado provee la información de variables sociodemográficas, antecedentes patológicos personales e historia familiar, mediciones de la presión arterial y bioquímicas, entre otras. Vulnerabilidad a COVID-19 severa se construyó según propuesta del CDC de Atlanta, EE. UU y fue la variable dependiente. Resultados: La prevalencia de adultos vulnerables a COVID-19 severa en el país fue de 68,3 %, riesgo superior en el adulto mayor (86,5 %), en los no blancos y en la percepción de condiciones de vida “malas”. En adultos mayores ser hombre protege, en tanto, fue riesgo, vivir en la región oriental del país. La hipertensión arterial (39,4 %), seguida del tabaquismo (22,2 %), la obesidad (16,6 %) y las enfermedades respiratorias crónicas (10,6 %) fueron las afecciones médicas más frecuentes. Conclusiones: La vulnerabilidad a la COVID-19 severa en la población adulta cubana es elevada, consecuentemente, constituye un serio problema de salud. Factores no modificables se asocian positivamente a la vulnerabilidad: ser adulto mayor, mujer, color de piel no blanca y padecer hipertensión arterial, en tanto, las “malas” condiciones de vida es el único que puede ser modificado.

ABSTRACT Introduction: Epidemiological risk stratification is an integrated process of diagnosis, intervention and evaluation, used for decision-making. The risk of dying by suicide in those who make attempts is a hundred times higher than in the general population. Objective: To stratify suicide attempt epidemiologically, according to province of residence. Methods: A mixed ecological study was carried out. The universe was made up of the records of suicide attempts, accessed through the files of reportable diseases from the Medical Registries and Statistics of the Ministry of Public Health from 1990 to 2014. The variables were sex, age and provinces of residence. Cumulative gross, adjusted and specific morbidity rates per 100 000 inhabitants were calculated. The stratification was carried out taking the percentiles as cut-off point, leaving very high risk above the 75th percentile, high risk between the 50th and the 74th percentiles, moderate risk between the 25th and the 49th percentiles, and low risk below the 25th percentile. The relative change percentage of the series and the percentages were calculated, according to variables. Results: From 1990 to 2014, there were 291 524 suicide attempts (20 823 attempts per year), of which 71.5% corresponded to women. The provinces with very high risk in the period 1990-2014 were Cienfuegos, Holguín, Santiago de Cuba and Granma, accounting, respectively, for rates of 151.9, 135.2, 126.9 and 125.2 per 100 000 inhabitants; and during 2011-2014, Matanzas, Las Tunas, Cienfuegos and Holguín, accounting, respectively, for rates of 154.4, 154.3, 148.3 and 147.3 per 100 000 inhabitants. Conclusions: Risk stratification at the provincial level varied in the periods studied. The female sex and adolescents were the most at risk of suicide attempt.

RESUMEN Introducción: La estratificación epidemiológica de riesgo es un proceso integrado de diagnóstico-intervención-evaluación, que sirve para la toma de decisiones. El riesgo de morir por suicidio, en quienes hacen intentos es 100 veces superior a la población general. Objetivo: Estratificar epidemiológicamente el intento suicida según provincias de residencia. Métodos: Se realizó un estudio ecológico mixto. El universo fueron los registros de intento suicida, a través de las tarjetas de enfermedad de declaración obligatoria de los Registros Médicos y Estadísticas del Ministerio de Salud Pública desde 1990 hasta 2014. Las variables fueron: sexo, edad y provincias de residencia. Se calcularon las tasas de morbilidad acumuladas, brutas, ajustadas y específicas por 100 000 habitantes. La estratificación se realizó tomando como punto de corte los percentiles, quedando Muy alto riesgo por encima del 75 percentil, Alto riesgo entre 50-74; Moderado riesgo entre 25-49 y Bajo riesgo por debajo del 25 percentil. Se calculó el porcentaje de cambio relativo de la serie y los porcentajes, según variables. Resultados: Desde 1990-2014 se produjeron 291 524 intentos suicidas (20 823 intentos por año), de los cuales el 71,5 % fueron mujeres, Las provincias de Muy Alto Riesgo en el periodo 1990-2014 fueron: Cienfuegos (tasa 151,9), Holguín (135,2), Santiago de Cuba (126,9) y Granma (125,2) tasas por 100 000 habitantes; y durante 2011-2014: Matanzas (tasas de 154,4), Las Tunas (154,3), Cienfuegos (148,3) y Holguín (147,3) por 100 000 hab. Conclusiones: La estratificación de riesgo a nivel provincial varió en los periodos estudiados. El sexo femenino y los adolescentes fueron los de mayor riesgo en el intento suicida.

ABSTRACT Introduction: Epidemiological risk stratification is a process that categorizes geo-ecological areas and population groups according to risks factors in a particular health problem. Suicide in Cuba is the tenth cause of death and the third one in the age group of 10 - 19 years. Objective: To present the epidemiological stratification of mortality by suicide in Cuba during the period between 2011 and 2016. Material and Methods: A descriptive retrospective study was carried out. The universe consisted of the records of death by suicide from the Dirección de Registros Médicos y Estadísticas de Cuba from 2011 to 2016. The variables studied were: sex, age, place of death, skin color, and provinces of residence. Cumulative, gross, adjusted and specific rates per 100,000 inhabitants were calculated. The percentage was calculated according to variables and the relative change of the series. Mortality was stratified by provinces of residence, in adolescents and for all age groups, using percentiles as a cut-off point. Results: It was identified that 79.9 % of the deceased were men. The ( 60 year- old-group had the highest average rate (26.8 per 100,000 inhabitants). Regarding place of death, residence predominated (57.1%). Provincial stratification in adolescents showed Very High Risk in Mayabeque (rate: 4.9), Cienfuegos (4.0), Granma (3.8) and Las Tunas (3.0) per 100,000 inhabitants; whereas in all ages, Very High Risk was present in: Villa Clara (rate: 17.9), Las Tunas (17.6), Holguín (17.1) and Mayabeque (16.7) per 100,000 inhabitants. Conclusions: Suicide rates are lower among women. There are differences in the provincial risk stratification. The results contribute to the epidemiological update of suicide in Cuba.

RESUMEN Introducción: La estratificación epidemiológica de riesgo es un proceso que categoriza áreas geoecológicas y grupos poblacionales, de acuerdo con factores de riesgo de un determinado problema de salud. El suicidio en Cuba es la décima causa de muerte y la tercera en el grupo de 10 a 19 años. Objetivo: Estratificar epidemiológicamente la mortalidad por suicidio en Cuba, en el periodo comprendido entre 2011- 2016. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo. El universo fueron los registros de fallecimiento por suicidio de la Dirección de Registros Médicos y Estadísticas de Cuba, desde 2011- 2016. Las variables estudiadas: sexo, edad, lugar de fallecimiento, color de la piel, y provincias de residencia. Se calcularon las tasas acumuladas, brutas, ajustadas y específicas por 100,000 habitantes. Se calculó el porcentaje según variables y el cambio relativo de la serie. Se estratificó la mortalidad por provincias de residencia, en adolescentes y para todos los grupos de edades, utilizando como punto de cortes los percentiles. Resultados: El 79,9% de los fallecidos fueron hombres. El grupo de ( 60 años tuvo la más alta tasa promedio (26,8 por 100,000 habitantes). Predominó según lugar de fallecimiento, el domicilio (57,1%). La estratificación provincial en adolescentes mostró; Muy Alto Riesgo: Mayabeque (tasa 4,9); Cienfuegos (4,0); Granma (3,8); Las Tunas (3,0) por 100,000 habitantes. En todas las edades; Muy Alto riesgo: Villa Clara (tasa 17,9); Las Tunas (17,6); Holguín (17,1); Mayabeque (16,7) por 100,000 habitantes. Conclusiones: Las tasas de suicidio son más bajas entre las mujeres. Existen diferencias en la estratificación de riesgo provincial. Los resultados contribuyen a la actualización epidemiológica del suicidio en Cuba.

SUMMARY 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. 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.

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.

Introduction: the term extremely serious or severe maternal morbidity is considered very useful as this is an indicator highly associated to maternal death and an intermediate stage in virtually all of the deceased cases. Objective: To characterize the processes of hospital care to extremely severe maternal morbidity in Havana during 2009. Methods: a descriptive study was conducted in six gynecological and maternal services in Havana from January to December 2009, in order to characterize the hospital processes of care to extremely serious maternal cases. Medical records and forms were completed for this purpose. The arising results were taken in a database in Access. Results are expressed through averages and percentages and are shown in tables and graphs. Results: classification by color coding and identification of risk obstetrics showed values of 80.6% and 73.1% respectively. Tracking early signs of hypovolemic shock only reached 81% and 77% of these patients underwent a cesarean, out of which 75.5% had a complication during or after this procedure. Hypovolemic shock was the extremely severe maternal morbidity for specific disease. Conclusions: non-compliance of care processes could adversely affect the care of extremely severe maternal morbidity and even increased mortality.

Introducción: el término morbilidad materna extremadamente grave o severa, se considera de gran utilidad al ser este un indicador muy asociado a la muerte materna y un estadio intermedio en prácticamente la totalidad de las fallecidas. Objetivo: caracterizar los procesos de atención hospitalaria a la morbilidad materna extremadamente grave en La Habana en el año 2009. Métodos: se realizó una investigación descriptiva en 6 servicios ginecobstétricos de hospitales generales y maternos de La Habana, en el período comprendido de enero-diciembre del 2009, con el objetivo de caracterizar los procesos de atención hospitalario a las maternas extremadamente graves. Para ello se consultaron las historias clínicas y se completó un formulario creado al efecto, cuyos resultados se vaciaron en una base de datos en Access. Los resultados se expresan a través de promedios y porcentajes y se muestran en tablas y gráficos. Resultados: la clasificación por código de colores y la identificación del riesgo obstétrico mostraron valores de 80,6 % y 73,1 % respectivamente. El seguimiento de los signos precoces de shock hipovolémico solo alcanzó un 81 % y el 77 % de estas pacientes fueron sometidas a la realización de una cesárea de las que el 75,5 % tuvieron una complicación durante o después de este proceder. La morbilidad materna extremadamente grave por enfermedad específica con mayor frecuencia, fue por el shock hipovolémico. Conclusiones: el no cumplimiento de los procesos de atención pudiese influir negativamente en la atención a la morbilidad materna extremadamente grave e inclusive incrementar la mortalidad materna.

Community health is directly related to factors fitting the relation between health and disease and the basic human need of a safe environment. The environmental health offers a conceptual frame to achieve better conditions from the health, environmental and socioeconomic point of view and thus incorporate multiples sectors and disciplines. The aim of present paper is to expose the more significant and current features in relation to environmental health, as well as the need to apply with a great emphasis the ecosystem approach in human health. Above mentioned approach (Ecohealth) has many challenges, since cross the traditional frontiers of research. In reality, it is a new approach connecting the integrated environmental management with a holistic comprehension of human health, taking into account the social, economic and cultural factors inherent to a given ecosystem.

La salud de una comunidad está directamente relacionada con factores que condicionan la relación entre salud y enfermedad, y la necesidad básica humana de un ambiente seguro. La salud ambiental ofrece el marco conceptual para lograr mejores condiciones desde el punto de vista sanitario, ambiental y socioeconómico, y para esto incorpora múltiples sectores y disciplinas. Este trabajo tiene la finalidad de exponer los aspectos más importantes y actuales en relación con la salud ambiental, así como la necesidad de aplicar con más énfasis el enfoque ecosistémico en la salud humana. El enfoque ecosistémico para la salud humana (Ecosalud) presenta muchos desafíos, ya que atraviesa las fronteras tradicionales de la investigación. De hecho, constituye un nuevo enfoque que conecta la gestión ambiental integrada con una comprensión holística de la salud humana, tomando en cuenta los factores sociales, económicos y culturales inherentes a un ecosistema dado.

In our center there have been implemented courses of early basic surgical abilities to the students of the first and second year of their careers, with satisfactory results. The arrival, at our center, of Latin American students for the pre doctorate preparation was a challenge for all the teaching departments, which created their clubs, and our department created the Club of experimental surgery. The initial inscription of our club was of 126 students, having three theoretical and practical confrontations and was programmed by cycles including six topics. The results were satisfactory and amazing from the point of view of the acquisition of knowledge in surgical procedures as in the development of the required abilities. The Club was important in orienting the students to decide to follow up a surgical residency once graduated and for others, to quit the idea. Besides, it allowed increasing the level of preparation of students for the successful development of any other investigative project which needed a surgical technique and also in their stay in E.R. and patient's care.

El aprendizaje de los procedimientos quirúrgicos en edades tempranas, favorece la adquisición de conocimientos y habilidades en el alumno en los primeros años de la Carrera de Medicina. Nuestro Centro ha impartido cursos de habilidades quirúrgicas básicas tempranas a alumnos 1ro y 2do año de Medicina, con resultados satisfactorios. La llegada a nuestra Institución de los alumnos latinoamericanos para la realización del pre-médico constituyó un reto para infinidad de Departamentos docentes que crearon sus clubes, no quedando exento nuestro Centro que creó el Club de Cirugía experimental. El club contó con una matrícula inicial de 126 alumnos, teniendo tres encuentros teórico-prácticos y se programó por ciclos que incluía 6 temas. Los resultados fueron satisfactorios y sorprendentes tanto desde el punto de vista de la adquisición de conocimientos en los procedimientos quirúrgicos como en el desarrollo de las habilidades requeridas. El Club sirvió para orientar a los alumnos a decidirse por estudiar una especialidad quirúrgica, una vez graduados, y para otros a desistir. Además permitió elevar el nivel de preparación de los estudiantes para el desarrollo exitoso de cualquier proyecto de investigación que necesite de alguna técnica quirúrgica y en sus estancias en los cuerpos de guardia en atención de los pacientes.