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2.
Respir Physiol Neurobiol ; 277: 103443, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32333993

RESUMEN

In the present study we analyze the epidemiological data of COVID-19 of Tibet and high-altitude regions of Bolivia and Ecuador, and compare to lowland data, to test the hypothesis that high-altitude inhabitants (+2,500 m above sea-level) are less susceptible to develop severe adverse effects in acute SARS-CoV-2 virus infection. Analysis of available epidemiological data suggest that physiological acclimatization/adaptation that counterbalance the hypoxic environment in high-altitude may protect from severe impact of acute SARS-CoV-2 virus infection. Potential underlying mechanisms such as: (i) a compromised half-live of the virus caused by the high-altitude environment, and (ii) a hypoxia mediated down regulation of angiotensin-converting enzyme 2 (ACE2), which is the main binding target of SARS-CoV-2 virus in the pulmonary epithelium are discussed.


Asunto(s)
Betacoronavirus/fisiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Neumonía Viral/epidemiología , Neumonía Viral/virología , Altitud , Betacoronavirus/patogenicidad , Bolivia/epidemiología , Susceptibilidad a Enfermedades , Ecuador/epidemiología , Humanos , Oxígeno , Pandemias , Tibet/epidemiología , Virulencia
3.
J. health med. sci. (Print) ; 6(1): 29-36, ene.-mar. 2020. ilus
Artículo en Español | LILACS | ID: biblio-1096530

RESUMEN

En la actualidad, los análisis de distribución espacial mediante el uso de técnicas de clusters para enfermedades crónicas como el cáncer de mama, son relevantes para la identificación de patrones espaciales de la mortalidad por cáncer según áreas geográficas. Identificar clústeres espaciales de la mortalidad por cáncer de mama en mujeres a nivel de las provincias del Ecuador, entre 2004 al 2018. Estudio observacional, de tipo descriptivo, ecológico multigrupal que compara a nivel espacio ­ temporal las tasas de mortalidad por cáncer de mama en mujeres según las provincias del Ecuador, utilizando el índice de Móran para el análisis de autocorrelación y el algoritmo de k-medias para el análisis de agrupamiento en períodos quinquenales mediante el programa informático ArcGIS versión 10.5. Resultados. En el Ecuador, el 86,5% de las muertes por cáncer de mama en mujeres se registraron en el área urbana, dichas muertes tienen un patrón no aleatorio según el índice de Morán, distinto al área rural que tiene un patrón aleatorio; se identificó diferencia en el agrupamiento de la mortalidad por cáncer de mama en las provincias urbanas y rurales, donde se obtuvo para el área urbana, clústeres con altas, media-altas, media-baja y bajas tasas de mortalidad, mientras que en lo rural se obtuvieron solo clústeres con altas, medias y bajas tasas de mortalidad. La distribución espacial y el análisis de agrupamiento identificó clústeres de la mortalidad por cáncer de mama en el Ecuador, evidenciando entre lo urbano y rural diferencias en los clústeres obtenidos, siendo esta información de utilidad para la implementación de estrategias de control del cáncer en el país.


Currently spatial distribution analyzes through the use of cluster techniques for chronic diseases such as breast cancer are revealing for the identification of spatial patterns of cancer mortality according to geographic areas. Objective. Identify spatial clusters of breast cancer mortality in women at the level of the provinces of Ecuador, between 2004 to 2018. We used an observational, descriptive, ecological multigroup study that compares at a Spatio-temporal level the rates of breast cancer mortality in women according to the provinces of Ecuador, using the Moran index for the autocorrelation analysis and the k-, means algorithm for cluster analysis in five-year periods using the ArcGIS version 10.5 software. Results. In Ecuador, 86.5% of breast cancer deaths in women were recorded in the urban area, these deaths have a non-random pattern according to the Morán Index different from the rural area that has a random pattern; difference was identified in the grouping of breast cancer mortality in urban and rural provinces, where it was obtained for urban areas, clusters with high, medium. high, medium-low and low mortality rates. While in rural areas only clusters with high, medium and low mortality rates were obtained. Conclusions. The spatial distribution and cluster analysis identified clusters of breast cancer mortality in Ecuador; evidencing between urban and rural differences in the clusters obtained, this information is useful for the development of cancer control strategies in the country.


Asunto(s)
Humanos , Femenino , Neoplasias de la Mama/mortalidad , Análisis por Conglomerados , Medio Rural , Demografía , Área Urbana , Ecuador/epidemiología , Análisis Espacial
4.
J. health med. sci. (Print) ; 6(1): 45-50, ene.-mar. 2020. tab, ilus
Artículo en Español | LILACS | ID: biblio-1096716

RESUMEN

Los métodos de clasificación permiten explorar y analizar grandes conjuntos de datos visualmente, lo cual es de gran utilidad para tomar decisiones rápidas. El objetivo fue comparar dos métodos de análisis de clúster para big data en variables demográficas de las provincias del Ecuador. Se hizo uso de un estudio observacional de tipo comparativo mediante la representación simultanea del HJ-Biplot y el método Two Step (clúster bietápico), a través del software MultBiplot y SPSS. Los datos corresponden a variables demográficas de interés sociosanitarias tasa de mortalidad general, tasa de mortalidad infantil, tasa de natalidad, densidad poblacional, porcentaje urbano y esperanza de vida, medidas en las provincias del Ecuador. Se utilizaron datos provenientes del Instituto de Estadísticas y Censos INEC. Se analizó la asociación entre variables y se identificaron clústeres de las provincias del Ecuador según estas variables demográficas. Según la representación simultánea del HJ-Biplot se identificaron 3 clústeres, el clúster 1 son provincias con mayor densidad poblacional y tasas de mortalidad general, pero valores bajos de tasas de natalidad, el clúster 2 agrupa provincias con mayor esperanza de vida y tasas de mortalidad infantil pero bajos valores de tasa de natalidad y el clúster 3 están las provincias con valores altos de tasas de natalidad y valores bajos de densidad poblacional, esperanza de vida, tasas de mortalidad general y mortalidad infantil, distintos resultados se obtuvieron con el método Two Step. Se pudo concluir que estos métodos son de utilidad para explorar las similitudes entre las provincias según variables demográficas.


The classification methods allow to explore and analyze big data sets visually, which is very useful for making quick decisions. This work aimed to compare of two methods of cluster analysis for big data in demographic variables of the provinces of Ecuador. An observational study of comparative type was carried out through the simultaneous representation of the HJ/Biplot and the Two Step method (two-stage cluster), through the MultBiplot and SPSS software. The data correspond to demographic variables of socio-health interest, general mortality rate, infant mortality rate, birth rate, population density, urban percentage and life expectancy, measured in the provinces of Ecuador. Data from Statistics and Census Institute were used. The association between variables was analyzed and clusters of the provinces of Ecuador were identified according to these demographic variables. According to the simultaneous representation of the HJBiplot, 3 clusters were identified, cluster 1 are provinces with higher population density and general mortality rates, but low birth rates values, cluster 2 are provinces with higher life expectancy and mortality rates infantile but low birth rate values and cluster 3 are the provinces with high birth rates values and low population density, life expectancy, general mortality and infant mortality rates, different results were obtained with the Two Step method. It was concluded that these methods are useful for exploring the similarities between provinces according to demographic variables.


Asunto(s)
Humanos , Análisis por Conglomerados , Demografía , Modelos Estadísticos , Estadísticas Vitales , Ecuador/epidemiología
5.
Am J Trop Med Hyg ; 102(4): 731-739, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32067631

RESUMEN

Pneumonia remains a leading cause of morbidity and mortality in young children. The total cost of pneumonia-related hospitalization, including household-level cost, is poorly understood. To better understand this burden in an urban setting in South America, we incorporated a cost study into a trial assessing zinc supplements in treatment of severe pneumonia among children aged 2-59 months at a public hospital in Quito, Ecuador, which provides such treatment at no charge. Data were collected from children's caregivers at hospitalization and discharge on out-of-pocket payments for medical and nonmedical items, and on employment and lost work time. Analyses encompassed three categories: direct medical costs, direct nonmedical costs, and indirect costs, which covered foregone wages (from caregivers' self-reported lost earnings) and opportunity cost of caregivers' lost time (based on the unskilled labor wage in Ecuador). Caregivers of 153 children completed all questionnaires. Overall, 57% of children were aged less than 12 months, and 46% were female. Just over 50% of mothers and fathers had completed middle school. Most reported direct costs, which averaged $33. Most also reported indirect costs, the mean of which was $74. Fifty-seven reported lost earnings (mean = $79); 29 reported lost time (estimated mean cost = $37). Stratified analyses revealed similar costs for children < 12 months and ≥ 12 months, with variations for specific items. Costs for hospital-based treatment of severe pneumonia in young children represent a major burden for households in low- to middle-income settings, even when such treatment is intended to be provided at no cost.


Asunto(s)
Composición Familiar , Costos de la Atención en Salud , Neumonía Bacteriana/economía , Neumonía Bacteriana/epidemiología , Preescolar , Costo de Enfermedad , Recolección de Datos , Ecuador/epidemiología , Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Humanos , Factores Socioeconómicos
6.
BMC Evol Biol ; 20(1): 31, 2020 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-32075576

RESUMEN

BACKGROUND: In recent years, Ecuador and other South American countries have experienced an increase in arboviral diseases. A rise in dengue infections was followed by introductions of chikungunya and Zika, two viruses never before seen in many of these areas. Furthermore, the latest socioeconomic and political instability in Venezuela and the mass migration of its population into the neighboring countries has given rise to concerns of infectious disease spillover and escalation of arboviral spread in the region. RESULTS: We performed phylogeographic analyses of dengue (DENV) and chikungunya (CHIKV) virus genomes sampled from a surveillance site in Ecuador in 2014-2015, along with genomes from the surrounding countries. Our results revealed at least two introductions of DENV, in 2011 and late 2013, that initially originated from Venezuela and/or Colombia. The introductions were subsequent to increases in the influx of Venezuelan and Colombian citizens into Ecuador, which in 2013 were 343% and 214% higher than in 2009, respectively. However, we show that Venezuela has historically been an important source of DENV dispersal in this region, even before the massive exodus of its population, suggesting already established paths of viral distribution. Like DENV, CHIKV was introduced into Ecuador at multiple time points in 2013-2014, but unlike DENV, these introductions were associated with the Caribbean. Our findings indicated no direct CHIKV connection between Ecuador, Colombia, and Venezuela as of 2015, suggesting that CHIKV was, at this point, not following the paths of DENV spread. CONCLUSION: Our results reveal that Ecuador is vulnerable to arbovirus import from many geographic locations, emphasizing the need of continued surveillance and more diversified prevention strategies. Importantly, increase in human movement along established paths of viral dissemination, combined with regional outbreaks and epidemics, may facilitate viral spread and lead to novel virus introductions. Thus, strengthening infectious disease surveillance and control along migration routes and improving access to healthcare for the vulnerable populations is of utmost importance.


Asunto(s)
Fiebre Chikungunya/epidemiología , Virus Chikungunya/clasificación , Virus Chikungunya/genética , Virus del Dengue/clasificación , Virus del Dengue/genética , Dengue/epidemiología , Emigración e Inmigración/estadística & datos numéricos , Fiebre Chikungunya/transmisión , Fiebre Chikungunya/virología , Virus Chikungunya/aislamiento & purificación , Colombia/epidemiología , Dengue/transmisión , Dengue/virología , Virus del Dengue/aislamiento & purificación , Brotes de Enfermedades , Ecuador/epidemiología , Emigración e Inmigración/tendencias , Genoma Viral , Genotipo , Humanos , Mutación Missense/fisiología , Fenotipo , Filogeografía , Análisis de Secuencia de ADN , América del Sur/epidemiología , Venezuela/epidemiología , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/transmisión , Infección por el Virus Zika/virología
7.
PLoS Negl Trop Dis ; 14(2): e0007969, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32059026

RESUMEN

BACKGROUND: Dengue, chikungunya, and Zika are arboviruses of major global health concern. Decisions regarding the clinical management of suspected arboviral infection are challenging in resource-limited settings, particularly when deciding on patient hospitalization. The objective of this study was to determine if hospitalization of individuals with suspected arboviral infections could be predicted using subject intake data. METHODOLOGY/PRINCIPAL FINDINGS: Two prediction models were developed using data from a surveillance study in Machala, a city in southern coastal Ecuador with a high burden of arboviral infections. Data were obtained from subjects who presented at sentinel medical centers with suspected arboviral infection (November 2013 to September 2017). The first prediction model-called the Severity Index for Suspected Arbovirus (SISA)-used only demographic and symptom data. The second prediction model-called the Severity Index for Suspected Arbovirus with Laboratory (SISAL)-incorporated laboratory data. These models were selected by comparing the prediction ability of seven machine learning algorithms; the area under the receiver operating characteristic curve from the prediction of a test dataset was used to select the final algorithm for each model. After eliminating those with missing data, the SISA dataset had 534 subjects, and the SISAL dataset had 98 subjects. For SISA, the best prediction algorithm was the generalized boosting model, with an AUC of 0.91. For SISAL, the best prediction algorithm was the elastic net with an AUC of 0.94. A sensitivity analysis revealed that SISA and SISAL are not directly comparable to one another. CONCLUSIONS/SIGNIFICANCE: Both SISA and SISAL were able to predict arbovirus hospitalization with a high degree of accuracy in our dataset. These algorithms will need to be tested and validated on new data from future patients. Machine learning is a powerful prediction tool and provides an excellent option for new management tools and clinical assessment of arboviral infection.


Asunto(s)
Infecciones por Arbovirus/terapia , Arbovirus/fisiología , Adolescente , Infecciones por Arbovirus/epidemiología , Infecciones por Arbovirus/patología , Infecciones por Arbovirus/virología , Arbovirus/genética , Niño , Preescolar , Ecuador/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Aprendizaje Automático , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
8.
PLoS Negl Trop Dis ; 14(2): e0007858, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32084134

RESUMEN

We review epidemiological and clinical data on human myiasis from Ecuador, based on data from the Ministry of Public Health (MPH) and a review of the available literature for clinical cases. The larvae of four flies, Dermatobia hominis, Cochliomyia hominivorax, Sarcophaga haemorrhoidalis, and Lucilia eximia, were identified as the causative agents in 39 reported clinical cases. The obligate D. hominis, causing furuncular lesions, caused 17 (43.5%) cases distributed along the tropical Pacific coast and the Amazon regions. The facultative C. hominivorax was identified in 15 (38%) clinical cases, infesting wound and cavitary lesions including orbital, nasal, aural and vaginal, and occurred in both subtropical and Andean regions. C. hominivorax was also identified in a nosocomial hospital-acquired wound. Single infestations were reported for S. haemorrhoidalis and L. eximia. Of the 39 clinical cases, 8 (21%) occurred in tourists. Ivermectin, when it became available, was used to treat furuncular, wound, and cavitary lesions successfully. MPH data for 2013-2015 registered 2,187 cases of which 54% were reported in men; 46% occurred in the tropical Pacific coast, 30% in the temperate Andes, 24% in the tropical Amazon, and 0.2% in the Galapagos Islands. The highest annual incidence was reported in the Amazon (23 cases/100,000 population), followed by Coast (5.1/100,000) and Andes (4.7/100,000). Human myiasis is a neglected and understudied ectoparasitic infestation, being endemic in both temperate and tropical regions of Ecuador. Improved education and awareness among populations living in, visitors to, and health personnel working in high-risk regions, is required for improved epidemiological surveillance, prevention, and correct diagnosis and treatment.


Asunto(s)
Miasis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Dípteros/clasificación , Dípteros/genética , Dípteros/fisiología , Ecuador/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Miasis/diagnóstico , Miasis/parasitología , Viaje/estadística & datos numéricos , Adulto Joven
9.
Medicina (B Aires) ; 80(1): 31-38, 2020.
Artículo en Español | MEDLINE | ID: mdl-32044739

RESUMEN

A stochastic simulation model allows to study and represents in a simplified manner the behavior of complex variables in terms of probability. In this context, the objective of this work is to present, through the use of information and communication technology tools, the applicability of simulation models and methods, in studies of indicators within the health sector. Through the development of a case study, this work demonstrates the potential of the @Risk and Excel technological tools in the construction of stochastic models that allow health professionals to predict, monitor and support decision making in the treatment and monitoring of indicators and indices of a population.


Asunto(s)
Comunicación en Salud , Sistemas de Información en Salud/estadística & datos numéricos , Tecnología de la Información/estadística & datos numéricos , Probabilidad , Procesos Estocásticos , Factores de Edad , Índice de Masa Corporal , Preescolar , Ecuador/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Método de Montecarlo , Obesidad/epidemiología , Reproducibilidad de los Resultados , Factores Sexuales
10.
PLoS Negl Trop Dis ; 14(1): e0007987, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31999721

RESUMEN

INTRODUCTION: Control of triatomine infestation is a key strategy for the prevention of Chagas disease (CD). To promote this strategy, it is important to know which antecedents to behavioral change are the best to emphasize when promoting prevention. OBJECTIVE: The aim of this study was to determine predictors for intention to prevent home infestation based on the Health Belief Model (HBM), a commonly used health intervention planning theory. MATERIALS & METHODS: A cross-sectional study was conducted with 112 heads of household in six communities with endemic and high rates of triatomine infestation in Loja province, Ecuador. The data was collected by a questionnaire including perceived severity, susceptibility, benefits to action, barriers to action, and self-efficacy. These data were also used to predict actual infestation of homes. RESULTS: Community members reported strong intentions to prevent home infestation. HBM constructs predicted about 14% of the observed variance in intentions. Perceived susceptibility and severity did not predict behavioral intention well; perceived barriers to small-scale action that reduce likelihood of infestation and self-efficacy in participating in surveillance systems did. Self-efficacy and perception of barriers were equally powerful predictors. The HBM constructs, however, did not predict well actual infestation. CONCLUSION: The findings supported the HBM as a way to predict intentions to prevent infestation of the home by triatomine bugs. The findings highlight that messages emphasizing self-efficacy in participating in surveillance systems and overcoming barriers to small-scale action that reduce likelihood of infestation, rather than a focus on risk, should be central messages when designing and implementing educational interventions for CD. The gap between behavioral intention and actual infestation reveals the need to assess home practices and their actual efficacy to fully enact and apply the HBM.


Asunto(s)
Enfermedad de Chagas/prevención & control , Control de Insectos , Población Rural , Triatominae , Animales , Enfermedad de Chagas/epidemiología , Estudios Transversales , Ecuador/epidemiología , Composición Familiar , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Factores de Riesgo
11.
J Stroke Cerebrovasc Dis ; 29(2): 104576, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31839546

RESUMEN

BACKGROUND: Little is known on factors influencing cognitive function in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the carotid intima-media thickness (cIMT) - used as a surrogate of extracranial carotid atherosclerosis - is associated with cognitive performance and further decline in community-dwelling adults living in a rural setting. METHODS: The study included Atahualpa residents aged greater than or equal to 40 years who had ultrasound examination of the extracranial carotid arteries and a baseline Montreal Cognitive Assessment (MoCA), as well as the subset of individuals who also had a follow-up MoCA at least 1 year after baseline. Relationship between cIMT and cognitive function was assessed by means of generalized linear and longitudinal models, adjusted for relevant covariates. Mediation analysis was utilized to establish the proportion of the effect between increased cIMT and cognitive performance, which is mediated by age. RESULTS: A total of 561 individuals were included for the cross-sectional study, and 510 of them were assessed for the prospective cohort. Univariate analysis showed a significant association between increased cIMT and worse cognitive performance (P < .001), which vanishes after considering the effect of age and low scholarity. Causal mediation analysis confirms that age captures 82.6% (95% C.I.: 63.9% to 100%) of the effect of this association. There was no relationship between increased cIMT and cognitive decline in the follow-up. CONCLUSIONS: In this rural population, the association between increased cIMT and cognitive dysfunction is mostly mediated by increasing age.


Asunto(s)
Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Cognición , Envejecimiento Cognitivo/psicología , Disfunción Cognitiva/psicología , Salud Rural , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/epidemiología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Estudios Transversales , Ecuador/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
12.
Lett Appl Microbiol ; 70(3): 203-209, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31837237

RESUMEN

Ready-to-eat food contamination with ESBL-producing Escherichia coli is a growing health concern. Some of these strains also are epidemic clones and can cause community-associated infections that are difficult to treat. In this study, the occurrence of ESBL-producing E. coli contaminated ready-to-eat street food in Quito, Ecuador was evaluated. In total, 150 samples were collected randomly in the most crowded sites of the city. In all, 34 samples (34/150; 22·6%) were positive for total thermotolerant (44·5°C) coliforms resistant to cefotaxime. MALDI-TOF analysis identified that the E. coli was found in 20 food samples (20/34; 59%). ESBL gene blaCTX-M-55 was identified in nine isolates, blaCTX-M-15 in six isolates, blaCTX-M-14 in two isolates, and one isolate each harboured blaCTX-M-24 , blaCTX-M-65 , blaCTX-M-55 and blaCTX-M-8 . Phylogenetic groups like A and B1 were the most common, followed by groups D and B2. MLST analysis identified 12 different sequence types (STs), the most common was ST162. Recognized epidemic clonal groups ST410, ST131 and ST744 were encountered. Ready-to-eat street food is a potential way of spreading ESBL-producing E. coli epidemic clones in Quito, Ecuador. SIGNIFICANCE AND IMPACT OF THE STUDY: This study identified ESBL-producing Escherichia coli epidemic clones: ST131, ST410 and ST744 in ready-to-eat street food samples. Street food is a possible way to spread harm multidrug-resistant (MDR) E. coli strains in the community. Studies to identify the contamination sources of this kind of food are needed to tackle MDR E. coli dissemination.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Escherichia coli/transmisión , Escherichia coli/efectos de los fármacos , Escherichia coli/genética , Comida Rápida/microbiología , beta-Lactamasas/genética , Antibacterianos/farmacología , Ecuador/epidemiología , Infecciones por Escherichia coli/epidemiología , Contaminación de Alimentos/análisis , Humanos , Tipificación de Secuencias Multilocus , Filogenia
13.
J Stroke Cerebrovasc Dis ; 29(2): 104497, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31810723

RESUMEN

BACKGROUND: Evidence of the relationship between periodic limb movements during sleep (PLMS) and cerebral small vessel disease (cSVD) is limited and inconsistent. Here, we aimed to assess the independent association between PLMS and the different neuroimaging signatures of cSVD. METHODS: Atahualpa residents aged more than or equal to 60 years enrolled in the Atahualpa Project undergoing polysomnography and MRI with time intervals less than or equal to 6 months were included. MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and more than 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Data from single-night polysomnograms were interpreted according to recommendations of the American Academy of Sleep Medicine. Associations between the PLMS index and neuroimaging signatures of cSVD (as dependent variables) were assessed by means of logistic regression models, adjusted for relevant confounders. RESULTS: A total of 146 individuals (mean age: 71.4 ± 7.5 years; 64% women) were included. A PLMS index more than or equal to 15 per hour were noted in 48 (33%) participants. Moderate-to-severe WMH were present in 33 individuals (23%), deep CMB in 9 (6%), silent LI in 16 (11%), and more than 10 BG-PVS in 44 (30%). In univariate analyses, silent LI (P = .035) and the presence of more than 10 enlarged BG-PVS (P = .034) were significantly higher among participants with a PLMS index more than or equal to 15 per hour. However, fully-adjusted multivariate models showed no significant association between PLMS index more than or equal to 15 per hour and any of the neuroimaging signatures of cSVD. CONCLUSIONS: This study shows no independent association between the PLMS index and neuroimaging signatures of cSVD in stroke-free community-dwelling older adults.


Asunto(s)
Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Vida Independiente , Extremidad Inferior/inervación , Imagen por Resonancia Magnética , Movimiento , Neuroimagen/métodos , Síndrome de Mioclonía Nocturna/fisiopatología , Sueño , Anciano , Anciano de 80 o más Años , Enfermedades de los Pequeños Vasos Cerebrales/epidemiología , Enfermedades de los Pequeños Vasos Cerebrales/fisiopatología , Ecuador/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Mioclonía Nocturna/diagnóstico , Síndrome de Mioclonía Nocturna/epidemiología , Polisomnografía , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Salud Rural
14.
Am J Trop Med Hyg ; 102(2): 346-349, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31833465

RESUMEN

Data on the prevalence of strongyloidiasis in Ecuador are patchy. The aim of this study was to document the presence of Strongyloides stercoralis infection in rural communities of different provinces of Ecuador. We tested 1,418 serum samples stored at the biobank of the Central University of Ecuador, Quito, with an ELISA test for Strongyloides. The samples had been collected in eight different provinces of Ecuador. Two hundred ninety-four samples (20.7%) were positive, and Jipijapa, Manabí Province, was the site with the largest proportion of positive samples (66.7%). Further surveys aimed at estimating the prevalence of the infection should be carried out in areas where the infection seems highly prevalent, and ad hoc control measures should be adopted.


Asunto(s)
Estudios Seroepidemiológicos , Strongyloides stercoralis , Estrongiloidiasis/epidemiología , Estrongiloidiasis/parasitología , Adulto , Animales , Niño , Estudios Transversales , Ecuador/epidemiología , Femenino , Humanos , Masculino
15.
J Appl Microbiol ; 128(5): 1347-1354, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31867847

RESUMEN

AIMS: This study evaluated the antimicrobial resistance of Salmonella enterica strains from layer poultry farms in central Ecuador isolated during 2017. This geographical area is responsible for around 60% of total domestic egg production, yet, as of 2019, no reports had been published on the phenotypic and genotypic antibiotic resistance patterns of Salmonella in the layer poultry farms of this area. METHODS AND RESULTS: Thirty-one isolates from layer poultry farms in central Ecuador obtained during 2017 were evaluated. The resistance profiles exhibited considerable differences in serovar and sample origin, grouping into nine clades by phenotype. S. Infantis strains were of the MDR phenotype in 94·4% of isolates. S. Typhimurium strains were of a reduced antimicrobial resistance phenotype and 50% showed resistance to one antimicrobial compound. One of the S. enterica nontyped strains had an MDR profile to 11 of the 20 antibiotics evaluated (eight groups). And the two remaining S. enterica nontyped strains showed resistance to two and three antibiotics respectively. The ESBL phenotype, which is resistant to clinically notable antibiotics such as ceftriaxone, ampicillin and cefepime, was observed only in S. Infantis (15/18). These strains harbour the emerging blaCTX-M-65 gene, and co-harbour tetA and sul1 resistance genes in four strains. Additional ß-lactamase genes, carbapenemase-producing genes (blaIMP, blaVIM , blaOXA48 , blaKPC , blaNDM ) and colistin-mobile resistance gene mcr-1 were not detected. CONCLUSIONS: The findings highlight the potential role of layer poultry farm environments in central Ecuador as reservoirs of MDR Salmonella strains. SIGNIFICANCE AND IMPACT OF THE STUDY: These results suggest the necessity of reinforcing biosecurity practices to reduce the probability of transmission of MDR Salmonella across the food chain.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Aves de Corral/microbiología , Salmonella/efectos de los fármacos , Salmonella/aislamiento & purificación , Animales , Proteínas Bacterianas/genética , Farmacorresistencia Bacteriana/efectos de los fármacos , Farmacorresistencia Bacteriana/genética , Ecuador/epidemiología , Granjas , Pruebas de Sensibilidad Microbiana , Salmonella/clasificación , Salmonella/genética , Salmonelosis Animal/epidemiología , Salmonelosis Animal/microbiología , Serogrupo , beta-Lactamasas/genética
16.
Rev Saude Publica ; 53: 97, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800910

RESUMEN

OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013-2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.


Asunto(s)
Disparidades en el Estado de Salud , Indicadores de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Ecuador/epidemiología , Femenino , Geografía Médica , Humanos , Masculino , Mortalidad , Áreas de Pobreza , Salud Pública , Factores Socioeconómicos
17.
Int J Mycobacteriol ; 8(4): 366-370, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31793507

RESUMEN

Background: Strains of the Beijing sublineage of Mycobacterium tuberculosis have caused large outbreaks of tuberculosis, often involving multidrug resistance strains and this genetically highly conserved family of strains predominates in some geographic areas. For most of the countries of Latin America, no country-wide studies about the prevalence of the Beijing lineage are available. Methods: In this study, we determine the prevalence of the Beijing sublineage in Ecuador, using a large nation-wide sample of 991 isolates from the years 2014-2016 and with the strains, in case-related-proportional representation, emerging from most of the provinces of the country. The isolates were genotyped with asinglenucleotidespecific polymorphism (SNP) polymerase chain reaction for the Beijing sublineage. SNPpositive strains were confirmed as belonging to this lineage with 24 mycobacterial interspersed repetitive unitvariable number of tandem repeat and DNA sequencing. Results: We identified only four Beijing isolates in this collection of 991 strains and calculated a prevalence rate of 0.43%. Conclusions: Our study shows a limited dissemination of the Beijing strains in the Ecuadorian population. This in contrast with the neighbor countries of Peru and Colombia were locally a prevalence of up to 16% has been reported.


Asunto(s)
Tamizaje Masivo/estadística & datos numéricos , Mycobacterium tuberculosis/genética , Polimorfismo de Nucleótido Simple , Tuberculosis/epidemiología , Tuberculosis/microbiología , ADN Bacteriano/aislamiento & purificación , Farmacorresistencia Bacteriana , Ecuador/epidemiología , Genotipo , Humanos , Repeticiones de Minisatélite , Mycobacterium tuberculosis/clasificación , Mycobacterium tuberculosis/efectos de los fármacos , Reacción en Cadena de la Polimerasa , Prevalencia , Análisis de Secuencia de ADN
18.
J Environ Public Health ; 2019: 6741202, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31871470

RESUMEN

The external environment directly influences human health. However, what happens inside? This work deals with the effect that the interior thermal variables have on the propagation of respiratory diseases and focused on the relation of the temperature and relative humidity inside social housing in the 1040 parishes of Ecuador and the transmission of influenza. On the one hand, historical weather-related variables were used to simulate and estimate the interior conditions, and thresholds on temperature and humidity were determined. On the other hand, the health-related variable was determined by analyzing the statistics corresponding to the influenza and viral pneumonia in 2009 since that year was critical for these diseases; the data were divided by month for each parish. Finally, the correlation of these variables determines the relative importance of the interior conditions on the respiratory health of its inhabitants. The preliminary results indicate that the places with the lowest temperatures and relative humidity could favor the virus transmission. Also, the analysis indicated that respiratory diseases increase in August and October. In this way, it is clear that social housing projects in Ecuador require a study which guarantees not only energy efficiency and sustainability related issues but also the well-being of their inhabitants.


Asunto(s)
Vivienda/estadística & datos numéricos , Gripe Humana/epidemiología , Ecuador/epidemiología , Humanos , Humedad , Gripe Humana/transmisión , Morbilidad , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Estaciones del Año , Análisis Espacio-Temporal , Temperatura
19.
Glob Heart ; 14(4): 373-378, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31727267

RESUMEN

BACKGROUND: In contrast with the abundance of global epidemiological descriptive data on cardiovascular diseases and their risk factors, information on the outcomes of real populations prospectively followed up in their life and care settings is much rarer, especially in low-income countries. OBJECTIVES: This study sought to evaluate the feasibility and the overall results of a hypertension control program, based mainly on a network of community nonprofessional health promoters, in the poor rural region of Borbon (Ecuador). METHODS: This is a prospective cohort study describing the results of a program of hypertension diagnosis, treatment and follow-up from 2004 to 2015 in the area, carried out mainly by the health promoters. RESULTS: The number of hypertensive patients identified and followed over the years increased from 1,024 in 2004 to 1,733 in 2015. The percentage of patients with no visits during a year was reduced to <10%, whereas the proportion of hypertensive subjects attending all 4 scheduled annual checks approached and, in some years, exceeded 50%. From 2004 to 2015, the proportion of patients at high or very high cardiovascular risk progressively decreased from 26.6% in 2004 to 17.5% in 2015 (p for trend <0.01), whereas the proportion of hypertensive patients at low or very low risk increased from 30.4% in 2004 to 45.0% in 2015 (p for trend <0.01). CONCLUSIONS: In a poor, disadvantaged area, a strategy of control mainly based on the involvement and responsibility of community health promoters (with health professionals as supporters more than direct actors) can achieve adequate follow-up of the population of hypertensive patients and improve their global cardiovascular risk level.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Hipertensión/prevención & control , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Ecuador/epidemiología , Estudios de Factibilidad , Femenino , Promoción de la Salud/métodos , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Factores de Riesgo , Salud Rural/estadística & datos numéricos , Resultado del Tratamiento
20.
Am J Trop Med Hyg ; 101(6): 1350-1358, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31595866

RESUMEN

Congenital infection with Trypanosoma cruzi remains a major route for Chagas disease transmission in endemic and non-endemic regions. We evaluated an intervention strategy aimed to detect congenital Chagas disease cases at a major hospital in the Ecuadorian Amazon via cord blood analysis at the time of delivery. All women giving birth at the hospital during the study period (191) were invited to participate. Among them, two (1.0%) did not adjust to the inclusion criteria and four (2.1%) declined to participate in the study, showing the intervention had good acceptability among the mothers. It was possible to obtain cord blood samples during 146 of the deliveries, and only one woman was found to be seropositive, without evidence of transmission to the newborn at delivery or 8 months later. In addition, sociodemographic and economic characterization of the study population revealed that few women had previous knowledge about Chagas disease (16.1%) whereas more than half (62.5%) recognized the vector. Recognizing the vector and having seen it indoors were associated with women from rural families, involved in agriculture, and hunting in the forest. Interestingly, most women (87.3%) reported having easy access to Ecuador's national health system, suggesting serological screening during prenatal visits would be of value in this province. With a proper prenatal screening system in place, cord blood screening would allow for timely detection of T. cruzi infection in newborns from both seropositive women and the minority (2.1%) of women who do not comply with prenatal care visits.


Asunto(s)
Enfermedad de Chagas/congénito , Enfermedad de Chagas/epidemiología , Transmisión Vertical de Enfermedad Infecciosa , Adolescente , Adulto , Animales , Enfermedad de Chagas/prevención & control , Estudios Transversales , Vectores de Enfermedades , Ecuador/epidemiología , Femenino , Sangre Fetal/parasitología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Madres , Embarazo , Diagnóstico Prenatal , Factores de Riesgo , Población Rural , Encuestas y Cuestionarios , Adulto Joven
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