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Key contributors to these results have been universal screening of pregnant women in primary care, installation of diagnostic laboratories in every province, genetic counseling for couples, testing of fetal DNA (allowing couples to decide whether to continue the pregnancy if the fetus tests positive for the disease) and guaranteed multidisciplinary clinical care for patients. The Cuban experience shows that a middle-income country can mitigate the impact of a genetic disease through a universal preventive program based in primary care, which also pays particular attention to afflicted patients. KEYWORDS Sickle cell anemia, sickle cell disease, sickle cell disorders, hemolytic anemia, sickle cell trait, sickle cell hemoglobin C disease, HbS disease, prevention, antenatal screening, preventive health services, Cuba.Cuba's maternity homes were founded in 1962 as part of the gen-eral movement to extend health services to the whole population in the context of the post-1959 social transformations. The over-arching goal of the homes was to improve the health of pregnant women, mothers and newborns. Hence, in the beginning when there were few hospitals in Cuba's rural areas, their initial pur-pose was to increase institutional births by providing pregnant women a homelike environment closer to hospitals. There, they lived during the final weeks before delivery, where they received medical care, room and board free of charge. Over time, and with expanded access to community and hospital health facilities across Cuba, the numbers, activities, modalities and criteria for admission also changed. In particular, in addition to geographi-cal considerations, expectant mothers with defined risk factors were prioritized. For example, during the 1990s economic crisis, the maternity homes' role in healthy nutrition became paramount. The purpose of this essay is to provide a historical perspective of this process, describe the changes and results during the 55 years examined, and take a critical look at the challenges to suc-cessful implementation of this model, a mainstay at the primary healthcare level of the public health system's Maternal-Child Health Program. KEYWORDS Maternal health, maternal-child health, obstetrics, pregnancy, Cuba.Every year, meningococcal infection by Neisseria meningitidis causes over 500,000 cases and 85,000 deaths in the world, with 20% of survivors suffering sequelae. NIBR-LTSi In Cuba its incidence in 1980 reached 5.9 cases per 100,000 population; about 80% of cases were serogroup B, prompting health authorities to declare meningococcal disease the country's main public health problem. Several provinces reported over 120 cases per 100,000 children aged 4 years). The vaccine and its proteoliposome technology have had an impact and continue to have potential, not only for meningococcal disease, but also for development of other vaccines and adjuvants.KEYWORDS Neisseria meningitidis, meningococcal disease, meningo-coccal vaccine, biotechnology, pharmaceutical industry, bacterial menin-gitis, meningococcal meningitis, immunization, vaccination, Cuba.She was a country girl from the northeast-ern Cuban province of Holguín, her father a farmer, her mother a teacher. Fast forward a few decades Dr Lilliam Álvarez mastered mathematics, physics and nuclear science, finally specializing in numeric solutions to differential equations. She spent 20 years at the Cybernetics and Physics Institute in Havana, half that time as deputy director. For another eight years, she served as di-rector of science in the Ministry of Science, Technology and the Environment. Full professor and senior researcher at the Uni-versity of Havana, she is a member of the national academic authority that awards doctoral degrees in math and is Cuba ́s ambassador to the International Math-ematical Union. In 2000, she was inducted into the Caribbean Academy of Sciences, and in 2008, was elected a full member of the Third World Academy of Science (now The World Academy of Sciences). But over time, her rich bibliography, with titles the likes of Anumerical technique to solve linear and non-linear singularly perturbed problems began to be peppered with other provoca-tive gender-informed work Women doing hard sciences in the Caribbean, Are Women Good for Math? and her 2011 book Ser mujer científi ca o morir en el intento (Be a Woman Scien-tist or Die Trying). Her focus on women in science-and their rights to belong in its leadership as well as its ranks-is also reflected in her activist approach internationally and in Cuba. She is a member of the Organization for Women in Science for the Developing World and heads its Cuban chapter. After her designation as a Distinguished Member of the Cuban Acad-emy of Sciences, she was elected Secretary in 2010 and also chairs its Commission on Women in Science.The Cuban Academy of Sciences was the right place to hear her story and to explore the way she sees women scientists in today's Cuba-and the country she would like to see in the future.Cuba's public health outcomes are rooted in political and social phenomena that have favored achievement of health indicators well above expectations for an economy of its size. A less studied causal component of Cuba's development in health is the creation, from early in the 1960s, of scientific research capacity throughout the health system, including use of science to launch a domestic industry for manufacturing high-tech products. This component should play an even greater role in meeting Cuba's 21st century health challenges, especially the demographic and epidemiologi-cal transitions, increasing prevalence of chronic diseases, rapid emergence of a complex-product biotechnology pharmacopoeia, greater molecular stratification of diseases, rising health costs, and the need to maintain communicable diseases under control in a global context of climate change and more population mobility.Tackling these challenges will demand greater scientific influence in the health system, application of a scientific approach in all ac-tivities and at all levels, and integration with scientific endeavors of other sectors such as agriculture, industry and education. KEYWORDS Public health, science, health care costs, health workforce, chronic disease, biotechnology, immunology, aging, Cuba.
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