Comportamiento epidemiológico del Dengue en Ecuador desde su reemergencia. Periodo 1980-2020 / Epidemiological behavior of Dengue in Ecuador since its reemergence. Period 1980-2020

INTRODUCCIÓN. El dengue es una enfermedad infecciosa de origen viral, transmitida principalmente por el mosquito Aedes aegypti. Es un grave problema de salud pública a nivel mundial, en las Américas y en el Ecuador. OBJETIVOS. Analizar el comportamiento epidemiológico del dengue desde 1980 hasta el 2020, los factores de riesgo que mantienen la transmisión y las acciones que el país ha implementado para su prevención y control. METODOLOGÍA. Revisión bibliográfica narrativa, teniendo como fuente las páginas web de la Organización Mundial de la Salud, de la Organización Panamericana de la Salud, Ministerio de Salud Pública del Ecuador, artículos de revistas de bibliotecas virtuales e informes técnicos publicados en Google académico, Scielo, Biblioteca Virtual en Salud y PubMed. RESULTADOS. Los registros encontrados sobre presencia de casos de dengue datan de 1988 cuando se presentó la gran epidemia de dengue en Guayaquil. Posteriormente, mantiene un comportamiento endemo-epidémico. A partir del año 2000 se presentan casos de dengue grave. Su pico más alto de letalidad fue de 2,44% en el 2010. El serotipo DEN 1 es el más frecuente, pero a partir del 2000 circulan los 4 serotipos. Las acciones de prevención y control no han sido sostenidas. CONCLUSIONES. El dengue en Ecuador en los últimos cuarenta años mantiene una importante trasmisión, caracterizada por años epidémicos. No ha podido ser controlado el vector, el cual ha ido infestando más localidades. Las condicionantes climáticas y ecológicas, explican en parte la persistencia, pero la determinación más importante está dada por las inequidades sociales, falta de servicios básicos, y la poca continuidad e impacto de las medidas de prevención y control.

INTRODUCTION. Dengue is an infectious disease of viral origin, transmitted mainly by the Aedes aegypti mosquito. It is a serious public health problem worldwide, in the Americas and in Ecuador. OBJECTIVES: To analyze the epidemiological behavior of dengue fever from 1980 to 2020, the risk factors that maintain transmission and the actions that the country has implemented for its prevention and control. METHODOLOGY. Narrative bibliographic review, taking as sources the web pages of the World Health Organization, Pan American Health Organization, Ministry of Public Health of Ecuador, journal articles from virtual libraries and technical reports published in Google Scholar, Scielo, Virtual Health Library and PubMed. RESULTS. The records found on the presence of dengue cases date back to 1988 when the great dengue epidemic occurred in Guayaquil. Subsequently, it maintained an endemic-epidemic behavior. Beginning in 2000, severe cases of dengue fever occurred. Its highest lethality peak was 2.44% in 2010. DEN 1 serotype is the most frequent, but since 2000 all 4 serotypes have been circulating. Prevention and control actions have not been sustained. CONCLUSIONS. Dengue in Ecuador over the last forty years has maintained an important transmission, characterized by epidemic years. It has not been possible to control the vector, which has been infesting more localities. Climatic and ecological conditions partly explain its persistence, but the most important determinant is given by social inequalities, lack of basic services, and the lack of continuity and impact of prevention and control measures.

Coping Strategies Used by Health Care Workers in Ecuador During the COVID-19 Pandemic: Observational Study to Enhance Resilience and Develop Training Tools.

BACKGROUND: The COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience. OBJECTIVE: This study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations. METHODS: The study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises. RESULTS: The findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used. CONCLUSIONS: Ensuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams.

Percepción de funcionarios sobre la gestión del Sistema de Salud de Chone, ante el terremoto de Pedernales / Perception of officials on the management of the Chone Health System, in the face of the Pedernales earthquake

INTRODUCCIÓN. En abril de 2016 ocurrió en la provincia de Manabí-Ecuador un terremoto de 7,6 grados, escala de Richter. Afectó la gestión de entidades de salud de dicha provincia. El país viene implementando políticas para alcanzar acceso universal de atención de salud, pero, el sistema mantiene debilidades en el modelo de atención primaria. OBJETIVO. Describir los efectos del terremoto en la gestión del sistema de salud en el Distrito de Chone, en base a las percepciones de los funcionarios de salud. MATERIALES Y MÉTODOS. Estudio cualitativo. Se describió el evento desde la perspectiva de 11 funcionarios seleccionados de diferentes niveles de gestión técnica en el sistema de salud, que laboraron durante el terremoto. Datos obtenidos por una encuesta semiestructurada sobre las tres funciones del sistema de salud: Rectoría, Provisión de Servicios y Financiamiento. RESULTADOS. El terremoto profundizó las debilidades que ya existían, afectó la ejecución de los programas de salud. La gestión del nivel central del Ministerio de Salud Pública sobrecargó el trabajo del personal local y la asignación de recursos fue insuficiente. DISCUSIÓN. A pesar que la evidencia demostró que una adecuada atención primaria con suficiente personal de salud, mejora la respuesta ante desastres, sin embargo, esto no se dio y los efectos negativos del desastre se mantienen años después. CONCLUSIÓN. Las deficiencias en la atención primaria de salud, así como insuficiente preparación para la gestión adecuada ante un desastre natural, influyeron en la calidad de la respuesta del sistema de salud.

INTRODUCTION. In april 2016, an earthquake of 7.6 degrees, on the Richter scale, occurred in the province of Manabí-Ecuador. It affected the management of health entities in said province. The country has been implementing policies to achieve universal access to health care, but the system maintains weaknesses in the primary care model. OBJECTIVE. Describe the effects of the earthquake on the management of the health system in the Chone District, based on the perceptions of health officials. MATERIALS AND METHODS. Qualitative study. The event was described from the perspective of 11 officials selected from different levels of technical management in the health system, who worked during the earthquake. Data obtained by a semi-structured survey on the three functions of the health system: Stewardship, Provision of Services and Financing. RESULTS. The earthquake deepened the weaknesses that already existed, affected the execution of health programs. Management at the central level of the Ministry of Public Health overloaded the work of local staff and the allocation of resources was insufficient. DISCUSSION. Although the evidence showed that adequate primary care with sufficient health personnel improves the response to disasters, however, this did not occur and the negative effects of the disaster continue years later. CONCLUSION. Deficiencies in primary health care, as well as insufficient preparation to properly manage a natural disaster, influenced the quality of the health system response.

El sistema nacional de salud del Perú: entrevista al Dr. David Tejada de Rivero / The national health system of Peru: interview with David Tejada de Rivero MD PhD

A propósito de mi tesis doctoral: "Evolución del sistema de salud de Perú, 2005-2014. Buenas prácticas de gestión", de la Facultad de Medicina, Universidad Nacional Mayor de San Marcos, del año 2017, realicé una entrevista a profundidad al Dr. David Tejada de Rivero en junio de 2015. En ocasión anterior ya le había realizado una entrevista sobre la Atención Primaria de la Salud y su rol en la declaración de Alma Ata, disponible en YouTube. La tesis buscaba entender y explicar los avances y desafíos del sistema nacional de salud del Perú, las buenas prácticas y los factores que influyeron en su implementación. Para alcanzar ese propósito, en base a la metodología de investigación cualitativa se consultaron las opiniones, discurso y reflexiones de altos directivos del Ministerio de Salud, expertos de salud pública, académicos y representantes de la sociedad civil peruana, entre los que estaba incluido el Dr. David Tejada. La entrevista fue realizada en su departamento en Miraflores, Lima, grabada y transcrita para realizar su posterior análisis. La entrevista fue previamente consultada y concertada con el entrevistado, así como todas las entrevistas que se hicieron a propósito del estudio. Por considerar de interés académico e histórico se consideró la importancia de publicar la entrevista completa del Dr. David Tejada de Rivero como homenaje y reconocimiento a sus importantes contribuciones a la salud publica peruana y mundial.

About my doctoral thesis: "Evolution of the health system of Peru, 2005-2014. Good management practices ", from the Facultad de Medicina, Universidad Nacional Mayor de San Marcos, in 2017, i conducted an in-depth interview with Dr. David Tejada de Rivero in june 2015. On the previous occasion I had already interviewed him Primary Health Care and its role in the Alma Ata declaration, available on YouTube. The thesis sought to understand and explain the advances and challenges of the national health system of Peru, good practices and the factors that influenced its implementation. To achieve this purpose, based on the qualitative research methodology, the opinions, discourse and reflections of senior executives of the Ministry of Health, public health experts, academics and representatives of Peruvian civil society were consulted, including Dr. David Tejada The interview was conducted in his apartment in Miraflores, Lima, recorded and transcribed for further analysis. The interview was previously consulted and agreed upon with the interviewee, as well as all the interviews that were made about the study. Considering the academic and historical interest, the importance of publishing the complete interview of Dr. David Tejada de Rivero as a tribute and recognition of his important contributions to Peruvian and world public health was considered.