Lifeguard Training Program and Drowning Death Rates in Ecuador, 2000-2019.

Drowning is a common cause of death and disability worldwide. We report the experience of Ecuador, a middle-income country, where a lifeguard training program was implemented to reduce incidents of drowning. We describe how "Project Ecuador" was able to expand from one to 20 beaches in a five-year period. We detail how these interventions triggered the creation of a self-sustained national program and a law proposal that guarantee a safe environment across the Ecuadorian coastal region. (Am J Public Health. 2022;112(11):1546-1550. https://doi.org/10.2105/AJPH.2022.307013).

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study.

Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.

Impact of diet on CVD and diabetes mortality in Latin America and the Caribbean: a comparative risk assessment analysis.

OBJECTIVE: To quantify diet-related burdens of cardiometabolic diseases (CMD) by country, age and sex in Latin America and the Caribbean (LAC). DESIGN: Intakes of eleven key dietary factors were obtained from the Global Dietary Database Consortium. Aetiologic effects of dietary factors on CMD outcomes were obtained from meta-analyses. We combined these inputs with cause-specific mortality data to compute country-, age- and sex-specific absolute and proportional CMD mortality of eleven dietary factors in 1990 and 2010. SETTING: Thirty-two countries in LAC. PARTICIPANTS: Adults aged 25 years and older. RESULTS: In 2010, an estimated 513 371 (95 % uncertainty interval (UI) 423 286-547 841; 53·8 %) cardiometabolic deaths were related to suboptimal diet. Largest diet-related CMD burdens were related to low intake of nuts/seeds (109 831 deaths (95 % UI 71 920-121 079); 11·5 %), low fruit intake (106 285 deaths (95 % UI 94 904-112 320); 11·1 %) and high processed meat consumption (89 381 deaths (95 % UI 82 984-97 196); 9·4 %). Among countries, highest CMD burdens (deaths per million adults) attributable to diet were in Trinidad and Tobago (1779) and Guyana (1700) and the lowest were in Peru (492) and The Bahamas (504). Between 1990 and 2010, greatest decline (35 %) in diet-attributable CMD mortality was related to greater consumption of fruit, while greatest increase (7·2 %) was related to increased intakes of sugar-sweetened beverages. CONCLUSIONS: Suboptimal intakes of commonly consumed foods were associated with substantial CMD mortality in LAC with significant heterogeneity across countries. Improved access to healthful foods, such as nuts and fruits, and limits in availability of unhealthful factors, such as processed foods, would reduce diet-related burdens of CMD in LAC.

One hundred years of Ecuadorian biomedical scientific output and its association with the main causes of mortality: a bibliometric study.

Introduction: Historically, low-and middle-income countries have been scarce producers of biomedical research; only 2% of the global scientific output is produced by these countries despite accounting for 92% of the global burden of disease. In addition, few low-and middle-income countries have exhaustively mapped and analyzed their scientific production in health and its association with main local burden of disease. Objective: To evaluate the evolution of biomedical research in Ecuador over the last 100 years and its relationship with the main causes of mortality. Methods: A bibliometric study embedded in a systematic review design was carried out using biomedical publications indexed in Scopus and Web of Science (WoS) during the period 1920-2021. Information from the National Institute of Statistics and Census was used to identify the main causes of mortality. Results: Our search strategy identified 16,697 publications related to biomedicine in Ecuador. Of these 3,225 articles met the criteria for this study. Since 2010, there has been an exponential increase in scientific production in biomedicine. This increase was predominantly based on cross-sectional observational studies (49.67%). During the period analyzed (1920-2021), biomedical production was distributed with 52.43% in clinical research, 37.79% in public health, and 9.77% in basic sciences. The research focus with the highest number of publications was epidemiology and surveillance system of diseases (23.44%). Additionally, private universities are the largest producers of biomedical research compared to public universities, 40.12% vs. 19.60%, respectively. Of the total biomedical research produced, 18.54% is associated with the main causes of mortality, and the Ecuadorian private university is the largest contributor to these studies compared to public universities, 39.97% vs. 16.72%. Conclusion: In one century, Ecuador produced 3,225 articles in biomedicine, according to our criteria. 18.54% of the total produced is aimed at solving the main causes of mortality in the country. Private universities are the leaders in scientific production related to health in Ecuador.

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study.

Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ±â€…13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

Comparison of Pediatric Patients With and Without Multisystem Inflammatory Syndrome Associated With COVID-19: Retrospective Cohort From Ecuador.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C). METHODS: One hundred and sixty-seven children (0-15 years) admitted to the pediatric intensive care unit COVID-19 ward of a national reference children's hospital in Quito, Ecuador, from June 2020 to June 2021 who developed PARDS with or without MIS-C. To diagnose PARDS, the criteria of the Pediatric Acute Lung Injury Consensus Conference Group were used, and to diagnose MIS-C, the criteria of the Centers for Disease Control and Prevention were used. Additionally, the PRISM score was used to calculate the mortality risk of study patients on admission. RESULTS: Of the 167 patients with PARDS, ~59% also developed MIS-C. Patients with PARDS + MIS-C had higher risks than patients without MIS-C in the following: frequency of associated bacterial infections (81.6% vs. 55.1%), mortality risk (36.7% vs. 11.6%), use of respiratory support (invasive mechanical ventilation: 92% vs. 86%), use of vasopressors/inotropes (90.8% vs. 30.4%), renal complications (36.7% vs. 8.7%), septic shock (84.7% vs. 20.3%), multiorgan failure (39.8% vs. 1.4%) and mortality at discharge (39.8% vs. 4.3%). Logistic regression failed to find an association between MIS-C and age, race, sex, ≥3 signs/symptoms and ≥2 comorbidities. CONCLUSIONS: Patients with PARDS + MIS-C had a more severe clinical picture than patients without MIS-C. The findings provide useful information to improve the management of PARDS patients with and without MIS-C in Ecuador.

Increased Cardiovascular Mortality in Ecuador during COVID-19 Pandemic.

Before the COVID-19 pandemic, chronic noncommunicable diseases (NCDs), represented a high burden for low and middle-income countries. Patients with NCDs are at higher risk of COVID-19 and suffer worse clinical outcomes. We present mortality trends for myocardial infarction (AMI), stroke, hypertension (HT), and type-2 diabetes mellitus (T2DM) from 2005 to 2021 in Ecuador. The greatest increase in mortality observed in the pandemic was in AMI, T2DM, and HT. Factors related to COVID-19, health services, and patients with NCDs could contribute to these important increases in mortality.

Improving Learning and Study Strategies in Undergraduate Medical Students: A Pre-Post Study.

We aimed to describe the impact of a structured interventional program to improve learning and study skills in undergraduate medical students from a Latin American medical school. The interventional program's design was based on diagnostic/prescriptive assessment test scores measuring ten scales. The program consisted of five tailored workshops. The cohort studied consisted of 81 third-year medical students. The outcome variable was the difference between "pre" and "post" test scores. The unadjusted score percentiles were used to compare improvement in learning and study skills. In addition, a sensitivity analysis was conducted to assess variation in the mean difference of the test scores by the number of workshops attended. The response rate was 100% (81/81) for the pre test and ~77% (62/81) for the post test. After the interventional program, nine out of ten scales showed statistical improvement, except for the scale of motivation. The scales with the highest and lowest percent change improvement were time management (66%, p-value: <0.001) and motivation (14.9%, p-value: 0.06). The students who attended more workshops obtained a higher percent change improvement in the post test. These findings suggest that through a well-designed interventional program, it is possible to improve learning and study skills among medical students.

Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view.

In counteracting highly infectious and disruptive respiratory diseases such as COVID-19, vaccination remains the primary and safest way to prevent disease, reduce the severity of illness, and save lives. Unfortunately, vaccination is often not the first intervention deployed for a new pandemic, as it takes time to develop and test vaccines, and confirmation of safety requires a period of observation after vaccination to detect potential late-onset vaccine-associated adverse events. In the meantime, nonpharmacologic public health interventions such as mask-wearing and social distancing can provide some degree of protection. As climate change, with its environmental impacts on pathogen evolution and international mobility continue to rise, highly infectious respiratory diseases will likely emerge more frequently and their impact is expected to be substantial. How quickly a safe and efficacious vaccine can be deployed against rising infectious respiratory diseases may be the most important challenge that humanity will face in the near future. While some organizations are engaged in addressing the World Health Organization's "blueprint for priority diseases", the lack of worldwide preparedness, and the uncertainty around universal vaccine availability, remain major concerns. We therefore propose the establishment of an international candidate vaccine pool repository for potential respiratory diseases, supported by multiple stakeholders and countries that contribute facilities, technologies, and other medical and financial resources. The types and categories of candidate vaccines can be determined based on information from previous pandemics and epidemics. Each participant country or region can focus on developing one or a few vaccine types or categories, together covering most if not all possible potential infectious diseases. The safety of these vaccines can be tested using animal models. Information for effective candidates that can be potentially applied to humans will then be shared across all participants. When a new pandemic arises, these pre-selected and tested vaccines can be quickly tested in RCTs for human populations.

Misleading Advertising of Health-Related Products in Ecuador during the COVID-19 Pandemic.

Background Media coverage of the COVID-19 pandemic increased tuning ratings during this time. The aim of this study was to identify misleading advertising of health-related products on Ecuadorian television during the COVID-19 pandemic. Methods Television channels were monitored for 111 h in the months of June and October 2020. Verbal, nonverbal and context content were analyzed from each advertising spot according to ethical standards for the promotion of products for human health Results A total of 667 spots were analyzed. Most, 90%, involved misleading advertising of health-related products. Products for gastrointestinal conditions were the most publicized (17.8%) during the period analyzed. Newscasts most often advertised products intended to improve sexual potency (22.9%) and to a lesser degree those intended to prevent and treat respiratory problems (1.8%); this relationship was reversed when compared to general programming (p < 0.05). Conclusions Most of the health-related products advertised on Ecuadorian television are advertised misleadingly, with news programs having the highest number of such advertisements per hour of programming.

Prophylactic Unfractionated Subcutaneous Heparin Does Not Increase Postoperative Hemorrhage in Elderly Patients Undergoing Emergency Neurosurgical Procedures.

Purpose The purpose of this study is to evaluate the impact in the development of intracerebral hemorrhage in elderly critically ill patients who received prophylactic subcutaneous unfractionated heparin (SCUFH) less than 24 hours after undergoing emergency neurosurgery.  Methods A retrospective analysis was performed on patients who underwent emergency neurosurgery and were admitted to the surgical intensive care unit (SICU) at a tertiary care center over a 10-year period. Administration of prophylactic SCUFH within 24 hours of neurosurgery was required for inclusion. Demographic and clinical characteristics were recorded. The primary outcome was a rate of postoperative hemorrhagic complications with respect to age. Results We identified 223 emergency neurosurgical patients: 100 (45%) patients did not receive prophylactic SCUFH and were excluded. The remaining 123 (55%) patients met all inclusion criteria, of whom 73 (59%) patients were under 65 years old, and 50 (41%) patients were over 65 years old. Patients under 65 years old had significantly lower body mass index (BMI), lower Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, and Simplified Acute Physiology Score (SAPS) scores, and shorter median SICU length of stay compared to patients over 65 years old. No statistically significant difference in the rate of postoperative hemorrhagic or non-hemorrhagic neurological complications was observed between patients in either age group.  Conclusion Age over 65 years was not associated with a higher risk of postoperative hemorrhage in patients who received SCUFH after emergency neurosurgery. SCUFH can be safely used as a chemoprophylactic agent against venous thromboembolism for elderly patients when used within 24 hours after emergency neurosurgery.

[Scientific output in the health sciences in Ecuador]. / La producción científica en ciencias de la salud en Ecuador.

This cross-sectional study describes the characteristics and trends of health sciences-related studies published in Ecuador from 1999-2009. Its objective is to contribute to the design and implementation of a research and development policy whose work is centered on the country's health priorities. Bibliometric indicators of production applied to publications in health sciences in Ecuador were used for the analysis. The publications were from the LILACS and MEDLINE databases. It was found that 625 articles were published from 1999-2009, primarily in the clinical-surgical areas (60%), followed by epidemiology (17.4%), basic sciences (14.1%), and health systems (8.5%). Only 4.3% and 7.2% of the production in this period was related to the primary causes of morbidity and mortality, respectively. It was found that private institutions generated more health research than public institutions, and hospitals (public, private, and mixed) produced a higher percentage than universities. The analysis showed that there was limited scientific production in health sciences in Ecuador during the study period, with a slight increase in the last two years that may be due in part to greater investment in research and development by the National Secretariat of Science and Technology (SENACYT). Investment increased from 0.20% to 0.44% of gross domestic product between 2006 and 2009.

The Impact of Strengthening Study Habits for Medical Students During COVID-19 Academic Transition: a Mixed-Methods Study.

PURPOSE: Assess the impact of learner-specific interventions on third-year medical students to cope with quarantine distance learning due to the COVID-19 pandemic. METHODS: We conducted a nested cross-sectional and mixed-methods study in a sample of 81 third-year medical students. Two face-to-face interventions were designed and conducted to offer tools to improve study habits, time management, and prioritizing skills. A nine-item structured questionnaire was administered. Descriptive statistics was performed for the quantitative section and thematic analysis for the qualitative section. RESULTS: Of the study population, 74.1% (60/81) completed the online questionnaire, 65.4% were female, and the mean age of the sample was 21.4±1.2 years old. Overall, ~50% of participants affirmed that the workshops were useful to improve time management, organize tasks and adapt to the new study modality imposed by the COVID-19 pandemic. More than 60% of the students found the application of the provided tools during the interventions (SMART and COMPASS) useful to determine personal values and set a proper mindset for coping with distance learning. Further, 93.3% of the respondents applied the SMART strategy learned to set goals at least once during the confinement time. These findings were also seen in the thematic analysis. CONCLUSIONS: Overall, most of the students found the workshops useful and were able to practice what they had learned during this pandemic lockdown. Medical schools and higher education institutions should evaluate the possibility of formally including study habit preparation for undergraduates' students in order to provide resilience and successful academic adaptation during an ever-changing world.

A decade of Ecuador´s efforts to raise its health research output: a bibliometric analysis.

Background: Over the past decade, the political movement called 'Revolución Ciudadana' implemented a variety of policies and interventions (P&I) in Ecuador to improve higher education and strengthen local research capacity. We refer specifically to the 'Mandato 14' and the Higher Education Law (LOES, Spanish acronym) launched in 2008 and 2010, respectively. Objective: To assess the impact of these P&I (Mandato 14/LOES) on the production of health sciences-related articles (HSRA), and the relationship of these HSRA with the country's health priorities. Methods: A Scopus search was performed to retrieve HSRA published from 1999 to 2017. Bivariate analysis was used to assess variation between the period I (1999-2008) and period II (2009-2017). Further, we examined the association between the top 10 causes of mortality and the total HSRA output. Results: The final study sample consisted of 2784 articles. After 2008, Ecuadorian production of HSRA increased steadily from 671 to 2133 publications (p<.001). Overall (1999-2017), the most common study design was cross-sectional (32.3%), the primary research focus was in the clinical-surgical area (49.3%), and the academic institutions were the primary drivers of scientific production during period II (56.9% vs. 29.5%, p<.001). Further, we found a decrease in the production of randomized controlled trials (6.7% vs. 1.8%, p<.001). Only 9% of research production involved the primary causes of mortality, and the proportion has remained unchanged over time (8.2% vs. 9.3%, p>.05). Conclusions: Ecuadorian HSRA output increased significantly after 2008. This larger volume of scientific output could be the result to the Mandato 14/LOES implemented in the last decade. However, a low percentage of HSRA are dedicated to addressing the country's health priorities. Proper planning, execution and monitoring of national health research agendas would reduce the mismatch between health burden and the HSRA output in Ecuador and other low-and middle-income countries.