"Barriers and Advantages of Self-Sampling Tests, for HPV Diagnosis: A Qualitative Field Experience Before Implementation in a Rural Community in Ecuador".

Introduction: Cervical cancer screening has demonstrated high efficacy in reducing cervical cancer mortality worldwide. However, clinician sampling is often perceived as an uncomfortable procedure that could reduce screening uptake. Self-sampling methods for HPV diagnosis have shown high sensitivity, which could increase acceptance and screening rates among women. Purpose: This study aims to identify the perceived barriers and advantages of self-sampling methods versus clinician sampling for cervical cancer screening in a rural setting in Ecuador. Patients and Methods: A qualitative study was conducted. Seven focus group discussions took place in the rural Parish of El Valle in Azuay Province, Cuenca, Ecuador. Women native to this rural area were included in the study. FGDs were recorded and transcribed, and content analysis was performed to categorize and analyze the data. Results: A total of 45 women participated in the study. Clinician sampling was perceived as a painful and intrusive method. However, participants believed that it is more reliable compared to self-sampling methods, attributing this to the direct visualization of the cervix, which facilitates the detection of cervical pathologies. The perceived advantages of self-sampling included increased comfort, pain reduction, time savings, the ability to perform the test at home, and the potential for widespread availability through pharmacies or local traditional healers. Nevertheless, doubts about the test's reliability as well as the user's proficiency in self-testing posed barriers to the adoption of this technique. Conclusion: Self-sampling methods offer several advantages over clinician sampling, such as enhanced privacy, comfort, and accessibility to cancer screening. Barriers primarily revolved around users' proficiency in performing the test and the reliability of the results. Providing training for using self-sampling tests could address these barriers.

Control microbiológico de alimentos en la vía pública en Cuenca, Ecuador

El comercio ambulante de alimentos listos para el consumo ha crecido exponencialmente a nivel mundial. Sin embargo, la falta de condiciones óptimas de preparación y expendio de estos alimentos pueden afectar su inocuidad. El objetivo de este estudio fue evaluar la calidad microbiológica de 19 tipos de alimentos (n= 417), con y sin tratamiento térmico, expendidos en espacios públicos en Cuenca, Ecuador. Según el grupo de alimentos, se analizaron aerobios mesófilos, coliformes/Escherichia coli, mohos y levaduras, Staphylococcus aureus, Salmonella, Listeria spp., Clostridium perfringes y Vibrio parahaemolyticus. Para la identificación y recuento de los microorganismos se aplicaron normativas nacionales y, en casos de ausencia, se adoptaron normas de otros países. Como resultado, el 55,4% de las muestras se consideraron no aptas para el consumo. S. aureus fue el microorganismo patógeno presuntivo de mayor prevalencia (81,7%). El incumplimiento de las normativas fue significativamente mayor entre los alimentos sin tratamiento térmico (54,1%) en comparación con aquellos térmicamente tratados (24%) y los que combinan ingredientes con y sin tratamiento (21,9%) (p<0,001). Se destaca el alto porcentaje de incumplimiento de alimentos sin tratamiento térmico que son manipulados en su preparación, como los jugos. Además, se observó que el tratamiento térmico no garantizó la inocuidad, sugiriendo una posible recontaminación del alimento luego de su preparación hasta su expendio y consumo, por medios ambientales y/o adición de otros ingredientes contaminados. Este estudio recalca la necesidad de acciones concretas con este sector, basados principalmente en capacitación, infraestructura e inclusión, para garantizar la salud de los consumidores.

Street-vending trade in ready-to-eat foods has grown exponentially, worldwide. However, the lack of optimal conditions for the preparation and sale of these foods can affect their safety. The objective of this study was to evaluate the microbiological quality of 19 types of foods (n= 417), with and without heat treatment, sold in public spaces in Cuenca, Ecuador. According to the food group, mesophilic aerobes, coliforms/Escherichia coli, molds and yeasts, Staphylococcus aureus, Salmonella, Listeria spp., Clostridium perfringens, and Vibrio parahaemolyticus were examined. For microorganisms identification and counting, national regulations were applied and, in cases of absence, regulations from other countries were adopted. As a result, 55,4% of the samples were considered inadequate for consumption. S. aureus was the most prevalent presumptive pathogenic microorganism (81.7%). Non-compliance with regulations was significantly higher among foods without heat treatment (54.1%) compared to those heat treated (24%) and those that combine ingredients with and without treatment (21.9%) (p<0.001). The high percentage of non-compliance with foods without heat treatment that is handled for preparation, such as juices, stands out. In addition, it was observed that the heat treatment did not guarantee safety, suggesting possible food recontamination after preparation until sale and consumption, due to environmental means and/or the addition of other contaminated ingredients. This study emphasizes the need for concrete actions in this sector, mainly based on training, infrastructure, and inclusion, to guarantee consumers' health.

Minireview: Situación actual del cáncer de cuello uterino en Ecuador, 2019 / Minireview: Current situation of cervical cancer in Ecuador, 2019

El cáncer de cuello uterino (CCU) es una neoplasia producida principalmente por el virus del papiloma humano (VPH), mismo que se adquiere a través del contacto sexual. El CCU tiene mayor prevalencia en países de ingresos medios y bajos, el 88% de muertes por esta causa a nivel mundial, se producen en países en vías de desarrollo, tales como el Ecuador. El proyecto ELEVATE (Early detection of cervical cancer in hard-to-reach populations of women through portable and point- of-care HPV testing), financiado por la Unión Europea, busca caracterizar el contexto nacional de esta enfermedad; con esta finalidad, se realizó una búsqueda sistemática de artículos científicos y de literatura gris, producida en el Ecuador, utilizando motores de búsqueda especializados, y repositorios virtuales institucionales, de universidades e instancias gubernamentales.(au)

Cervical cancer is a neoplasm mainly caused by the human papillomavirus (HPV), which is acquired through sexual contact. Cervical cancer is more prevalent in low and middle income countries; 88% of worldwide deaths from this cause, occur in developing countries, such as Ecuador. The ELEVATE project (Early detection of cervical cancer in hard-to-reach populations of women through portable and point-of-care HPV testing), funded by the European Union, seeks to characterize the national context of this disease; with this purpose, we carried out a systematic search for scientific articles and gray literature, produced in Ecuador, using specialized search engines, and virtual repositories from universities and government institutions.(au)

Multiple mycotoxin exposure of infants and young children via breastfeeding and complementary/weaning foods consumption in Ecuadorian highlands.

The dietary exposure to mycotoxins in Ecuadorian children aged 0-23 months (320 rural and 603 urban) was evaluated based on the intake of breast milk and staple cereals used as complementary/weaning foods. A probabilistic distribution approach by first order Monte Carlo simulation was adopted to assess the locally occurring mycotoxins (aflatoxins M1 and B1 in breast milk, ochratoxin A and deoxynivalenol in wheat noodles and oat flakes, and HT-2 toxin in polished rice). Overall, exposure was modest but higher for rural children due to their monotonous diet. Aflatoxin exposure by breast milk intake were of health concern in both areas (Margin of Exposure and Combined Margin of Exposure Index<10,000). Mycotoxin exposure by staple cereals intake was considered tolerable across feeding stages for individual mycotoxin-cereal combination (Hazard Quotient<1) and combined exposure (Hazard Index<1). The major exposure was to HT-2 toxin by rice intake at complementary feeding (15% rural and 4% urban above TDI) and at weaning stage (26% rural and 6% urban above TDI). Since the usual Ecuadorian diet is based on the same staple cereals, risk management actions could lead to a better protection of young children and also ensure higher safety of the recommended breastfeeding practices by protecting nursing mothers.