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1.
Artigo em Inglês | MEDLINE | ID: mdl-33668717

RESUMO

The aim of the present cross-sectional study was to analyze the differential impact of the first COVID-19 lockdown (3 April 2020) on stress, health practices, and self-care activities across different Hispanic countries, age range, and gender groups. One thousand and eighty-two participants from Spain, Chile, Colombia, and Ecuador took part in this study. Irrespective of the country, and controlling for income level, young people, especially females, suffered a greater level of stress, perceived the situation as more severe, showed less adherence to health guidelines, and reported lower levels of health consciousness, in comparison to their male peers and older groups. However, in the case of self-care, it seems that older and female groups are generally more involved in self-care activities and adopt more healthy daily routines. These results are mostly similar between Colombia, Ecuador, and Spain. However, Chile showed some different tendencies, as males reported higher levels of healthy daily routines and better adherence to health guidelines compared to females and people over the age of 60. Differences between countries, genders, and age ranges should be considered in order to improve health recommendations and adherence to guidelines. Moreover, developing community action and intersectoral strategies with a gender-based approach could help to reduce health inequalities and increase the success of people's adherence to health guidelines and self-care-promoting interventions. Future studies should be addressed to explore the possible causations of such differences in more cultural-distant samples and at later stages of the current outbreak.


Assuntos
/psicologia , Comportamentos Relacionados com a Saúde , Autocuidado , Estresse Psicológico/epidemiologia , Chile/epidemiologia , Colômbia/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Espanha/epidemiologia
2.
Washington; Organización Panamericana de la Salud; feb. 24, 2021. 32 p.
Não convencional em Espanhol | LILACS | ID: biblio-1151147

RESUMO

El 11 de marzo de 2020, el Director General de la Organización Mundial de la Salud (OMS) declaró al COVID-19 como pandemia. En este contexto, la o¬cina de la OPS en Ecuador coordinó sus actividades con el Ministerio de Salud Pública (MSP) a ¬n de desarrollar el plan estratégico de preparación y respuesta al COVID-19 a nivel nacional, basado en los 9 pilares propuestos por la OMS. El plan tuvo un gran énfasis en la intervención en aquellas zonas de difícil acceso geográ¬co, como lo es la Amazonía ecuatoriana y que además se conforman de población indígena y montubia, ya que estos grupos/pueblos son considerados vulnerables y han sido priorizados por el gobierno nacional, respaldando con ello la promesa de "no dejar a nadie atrás". Es importante tomar en cuenta que el Ecuador es un país con una amplia diversidad cultural, conformada por 14 nacionalidades y 18 pueblos, los cuales se encuentran distribuidos en diferentes áreas geográ¬cas del país. En la región amazónica, estas comunidades se ubican en las provincias de Sucumbíos, Orellana, Pastaza, Napo, Morona Santiago, Zamora Chinchipe; y en el norte y en la región andina central del altiplano, en las provincias de Imbabura, Cotopaxi, Tungurahua, Bolívar, Chimborazo y Cañar. En muchos casos el ingreso a estas comunidades debe realizarse por vía uvial o aérea, lo que, entre otras realidades socioeconómicas, di¬culta la posibilidad de recibir atención primaria de salud, hecho que representó un mayor desafío para la ejecución de actividades de respuesta a emergencias. Adicionalmente, muchas de las comunidades indígenas decidieron realizar un aislamiento comunitario, prohibiendo la salida de sus ciudadanos y la entrada de personas ajenas a la comunidad, para evitar la propagación del COVID-19 en sus territorios. Una estrategia de respuesta con la mirada en los más vulnerables A la par de esta situación, como acción ante la emergencia, el gobierno ecuatoriano declaró un estado de excepción que restringió la movilidad humana y -si bien dentro del plan de respuesta al COVID-19 se encuentran acciones clave en los 9 pilares- las primeras actividades se enfocaron en el objetivo de salvar vidas, especialmente en las áreas urbanas donde hubo los picos más altos de contagio. Esto llevó a la concentración de recursos humanos, ¬nancieros y físicos a nivel hospitalario en las grandes ciudades, al inicio de la pandemia. Además, las medidas implementadas por el gobierno, contribuyeron de manera colateral a la interrupción de los servicios de salud esenciales en la mayor parte del territorio nacional. A pesar de ser este problema de índole nacional, los desafíos en las provincias con mayor concentración de población indígena fueron más importantes. Estas realidades requirieron la promoción de un trabajo coordinado con la participación activa de los líderes de estas comunidades a ¬n de de-nir acciones que pudieran ser efectivas para prevenir la enfermedad y el cuidado de las personas infectadas al mismo tiempo, respetando el contexto cultural y la cosmovisión indígena. Este boletín resume las actividades más importantes ejecutadas de agosto a diciembre del 2020 en cada una de las provincias priorizadas y enmarcadas en las recomendaciones del "Plan estratégico de preparación y respuesta para la enfermedad por coronavirus 2019 (COVID-19)", de acuerdo con los pilares 1, 2, 3, 5, 6, 7, y 9. Y comprende, principalmente, el apoyo en el análisis de la data en el contexto de la pandemia, la gestión de apoyo técnico para la revisión de estrategias de respuesta, la identi¬cación de necesidades para dotación de insumos y dispositivos médicos, el acompañamiento en el uso de herramientas OPS/OMS y la capacitación a equipos técnicos y operativos, entre otras


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Monitoramento Epidemiológico , Povos Indígenas , Equador/epidemiologia
3.
BMC Med Educ ; 21(1): 128, 2021 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627116

RESUMO

BACKGROUND: As the disease caused by the novel coronavirus has spread globally, there has been significant economic instability in the healthcare systems. This reality was especially accentuated in Ecuador where, the shortage of healthcare workers combined with cultural and macroeconomic factors has led Ecuador to face the most aggressive outbreak in Latin America. In this context, the participation of final-year medical students on the front line is indispensable. Appropriate training on COVID-19 is an urgent requirement that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes, and practices of Ecuadorian final-year medical students that could potentially guide the design of better medical education curricula regarding COVID-19. METHODS: This was a cross-sectional 33-item online survey conducted between April 6 to April 2020 assessing the knowledge, attitudes, and practices toward the diagnosis, treatment, prevention, and prognosis toward COVID-19 in Ecuadorian final-year medical students. It was sent by email, Facebook, and WhatsApp. RESULTS: A total of 309 students responded to the survey. Out of which 88% of students scored high (≥ 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID-19 and volunteering during the outbreak in Ecuador (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment. The latter finding was significantly associated with negative attitudes. CONCLUSIONS: Although a large number of students displayed negative attitudes, the non-depreciable percentage of students who were willing to volunteer and the coexisting high level of knowledge displayed by students, suggests that Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Not having personal protective equipment was significantly associated to negative attitudes. Providing the necessary tools and creating a national curriculum may be one of the most effective ways to ensure all students are trained, whilst simultaneously focusing on the students' most pressing concerns. With this additional training, negative attitudes will improve and students will be better qualified.


Assuntos
/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Estudantes de Medicina/psicologia , Adulto , Atitude do Pessoal de Saúde , /terapia , Estudos Transversais , Equador/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Equipamento de Proteção Individual/estatística & dados numéricos , Prognóstico , Estudantes de Medicina/estatística & dados numéricos , Voluntários/estatística & dados numéricos , Adulto Jovem
4.
Nat Commun ; 12(1): 1233, 2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33623008

RESUMO

Climate drives population dynamics through multiple mechanisms, which can lead to seemingly context-dependent effects of climate on natural populations. For climate-sensitive diseases, such as dengue, chikungunya, and Zika, climate appears to have opposing effects in different contexts. Here we show that a model, parameterized with laboratory measured climate-driven mosquito physiology, captures three key epidemic characteristics across ecologically and culturally distinct settings in Ecuador and Kenya: the number, timing, and duration of outbreaks. The model generates a range of disease dynamics consistent with observed Aedes aegypti abundances and laboratory-confirmed arboviral incidence with variable accuracy (28-85% for vectors, 44-88% for incidence). The model predicted vector dynamics better in sites with a smaller proportion of young children in the population, lower mean temperature, and homes with piped water and made of cement. Models with limited calibration that robustly capture climate-virus relationships can help guide intervention efforts and climate change disease projections.


Assuntos
Mudança Climática , Geografia , Doenças Transmitidas por Vetores/epidemiologia , Doenças Transmitidas por Vetores/transmissão , Animais , Número Básico de Reprodução , Culicidae/fisiologia , Surtos de Doenças , Equador/epidemiologia , Humanos , Quênia/epidemiologia , Modelos Biológicos , Dinâmica não Linear , Fatores Socioeconômicos , Análise Espaço-Temporal , Fatores de Tempo
5.
Artigo em Inglês | MEDLINE | ID: mdl-33578745

RESUMO

Several public health measures have been implemented to contain the SARS-CoV-2 outbreak. The adherence to control measures is known to be influenced by people's knowledge, attitudes and practices with regard to the disease. This study aimed at assessing COVID-19 knowledge in individuals who were tested for the virus. An online cross-sectional survey of 32 items, adapted to the national context, was conducted among 1656 Ecuadorians. The mean knowledge score was 22.5 ± 3 out of 28, with significant differences being observed with regard to educational attainment. People with postgraduate training scored higher than those with college, secondary and elementary instruction. Indeed, multiple linear regression revealed that lower scores were associated significantly with the latter three levels of education. Interviewees were knowledgeable about the symptoms, detection, transmission and prevention of the disease. However, they were less assertive regarding the characteristics of the virus as well as the usefulness of traditional and unproven treatments. These outcomes indicated a lack of knowledge in fundamental aspects of virus biology, which may limit the effectiveness of further prevention campaigns. Conclusively, educational and communicational programs must place emphasis on explaining the basic molecular characteristics of SARS-CoV-2; such information will certainly contribute to improve the public's adherence to control measures.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Estudos Transversais , Equador/epidemiologia , Humanos , Inquéritos e Questionários
6.
Sci Total Environ ; 770: 145225, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-33513511

RESUMO

AIM: COVID-19 pandemic has posed an unprecedented pressure on health systems and economies worldwide. Delivery services have grown as an alternative source of revenue for many people. Consumers generally perceive that delivery services are safer than going into a restaurant, because they reduce exposure to other people and their risk of SARS-CoV-2 contagion. There are no studies analyzing viral load or the burden of COID-19 within this population. This study aims to describe the presence of SARS-CoV-2 among food delivery riders in the city of Quito, Ecuador. STUDY DESIGN: From July and August 2020, bike and motorbike riders self-employed in two of the main online delivery services in Quito, Ecuador, were invited for RT-PCR testing for SARS-CoV-2 detection during the compulsory lockdown due to the COVID-19 pandemic. The Center for Disease Control (CDC) 2019-Novel Coronavirus (2019-nCoV) RT-qPCR Diagnostic Panel was used to identify the presence of SARS-CoV-2 in nasopharyngeal swabs. All samples were processed in the BSL2 certified molecular biology laboratory at Universidad de Las Americas. RESULTS: A total of 22 out of 145 delivery workers (15.2%) tested positive for SARS-CoV-2. The majority of workers were men (n = 138), the average age of male workers was 32 years-old (±7.3) and 38 years-old (± 10.6) for females. The presence of mild symptoms was reported in only 9 subjects (6%). The calculated viral load was higher among males with 1.31E+08 copies/mL vs 2.30E+06 in females, although this difference was not statistically significant (p value: 0.68, [CI: -53 to -79]). CONCLUSIONS: The self-employed food delivery riders have a high incidence rate of SARS-CoV-2 infection in relation to the national average. It is important to point out that this is the first study of its kind in Latin-American and probably one of the very few in the world. The results emphasize the need for policy makers to look at the pandemic from as many population's sub-groups as possible. Delivery riders are a highly moving population that offer their services to a wide range of clients, including vulnerable populations such as the elderly or those less likely to leave their house for basic needs stoking.


Assuntos
Adulto , Idoso , Controle de Doenças Transmissíveis , Equador/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Prevalência
7.
PLoS Negl Trop Dis ; 15(1): e0008958, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395425

RESUMO

The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador's response to the outbreak.


Assuntos
/mortalidade , Surtos de Doenças , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Estudos Transversais , Equador/epidemiologia , Feminino , Geografia , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ocupações , Fatores de Risco , Distribuição por Sexo , Classe Social , Avaliação de Sintomas , Desemprego , Adulto Jovem
8.
PLoS One ; 15(10): e0240011, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33022023

RESUMO

BACKGROUND: Understanding public perceptions of government responses to COVID-19 may foster improved public cooperation. Trust in government and population risk of exposure may influence public perception of the response. Other population-level characteristics, such as country socio-economic development, COVID-19 morbidity and mortality, and degree of democratic government, may influence perception. METHODS AND FINDINGS: We developed a novel ten-item instrument that asks respondents to rate key aspects of their government's response to the pandemic (COVID-SCORE). We examined whether the results varied by gender, age group, education level, and monthly income. We also examined the internal and external validity of the index using appropriate predefined variables. To test for dimensionality of the results, we used a principal component analysis (PCA) for the ten survey items. We found that Cronbach's alpha was 0.92 and that the first component of the PCA explained 60% of variance with the remaining factors having eigenvalues below 1, strongly indicating that the tool is both reliable and unidimensional. Based on responses from 13,426 people randomly selected from the general population in 19 countries, the mean national scores ranged from 35.76 (Ecuador) to 80.48 (China) out of a maximum of 100 points. Heterogeneity in responses was observed across age, gender, education and income with the greatest amount of heterogeneity observed between countries. National scores correlated with respondents' reported levels of trust in government and with country-level COVID-19 mortality rates. CONCLUSIONS: The COVID-SCORE survey instrument demonstrated satisfactory validity. It may help governments more effectively engage constituents in current and future efforts to control COVID-19. Additional country-specific assessment should be undertaken to measure trends over time and the public perceptions of key aspects of government responses in other countries.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Governo , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Opinião Pública , Projetos de Pesquisa , Inquéritos e Questionários , Adolescente , Adulto , Idoso , China/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Análise de Componente Principal , Saúde Pública/métodos , Quarentena/métodos , Confiança , Adulto Jovem
9.
BMC Dermatol ; 20(1): 11, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109125

RESUMO

BACKGROUND: Quito, the capital of Ecuador due to its geographical location, has a high skin cancer incidence. Actinic keratoses, as premalignant lesions, are precursors of nonmelanoma skin cancer, and the prevalence of this medical condition in the country is unknown. METHODS: An observational, cross-sectional study was performed to assess the prevalence of actinic keratoses (AKs) in a rural area of Quito. Visual skin exams, dermoscopy and biopsy of suspicious lesions were performed. RESULTS: A total of 254 subjects older than 40 years old (71.3% female) were enrolled. The general AK prevalence was 22.4%; in women, the prevalence was 23.6%, while in men, it was 19.4%. The prevalence rates of basocellular and squamous cell carcinomas and Bowen disease were 1.6, 0.8 and 0.4%, respectively. No statistical associations were found between AKs and the studied variables. CONCLUSIONS: This study was the first reporting the prevalence of premalignant lesions in Ecuador. We could not demonstrate a relationship between the presence of AKs and any of the known risk factors for their development.


Assuntos
Ceratose Actínica/epidemiologia , Adulto , Idoso , Doença de Bowen/epidemiologia , Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Neoplasias Cutâneas/epidemiologia , Protetores Solares
10.
Nutr. hosp ; 37(5): 926-932, sept.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198007

RESUMO

ANTECEDENTES: los adultos mayores presentan enfermedades que pueden repercutir en sus parámetros funcionales, psicológicos y sociales. La Valoración Geriátrica integral (VGI) se utiliza como herramienta de evaluación de estos parámetros a través del uso de instrumentos validados, sencillos y de fácil aplicación. OBJETIVO: determinar el estado de salud de los adultos mayores en un área urbano-marginal de Guayaquil (Ecuador) mediante la VGI, como primer paso para poder establecer un plan de cuidados coordinado en las áreas estudiadas. MATERIAL Y MÉTODOS: estudio transversal de 196 sujetos mayores de 65 años que acuden a un centro de salud comunitario de atención primaria en Guayaquil y a los que se les ha realizado una VGI. RESULTADOS: los participantes tenían una edad media de 70,9 ± 7,1 años. Variables demográficas: el 73 % eran afroecuatorianos, el 69 % tenían instrucción básica y el 57 % no realizaban ninguna actividad física. Evaluación clínica: el 47,4 % presentaban dificultad de visión, el 52 % riesgo nutricional y el 6 % desnutrición. Valoración social: el 13 % tenían deterioro social severo; el 40 % presentaban algún deterioro cognitivo y el 8,2 % tenían depresión; el 46,9 % eran funcionalmente dependientes y el 16,8 % presentaban dinapenia. CONCLUSIONES: la VGI permite identificar los principales problemas de salud de esta población, por lo que se considera una herramienta práctica y fácil de aplicar en los centros de atención primaria de las poblaciones urbano-marginales, como primer paso para mejorar el estado de salud de esta población mayor que en los últimos años está creciendo de forma importante en los países en vías de desarrollo tales como Ecuador


BACKGROUND: older adults suffer from diseases that can affect their functional, psychological and social parameters. The Comprehensive Geriatric Assessment (CGA) is used as an evaluation tool for these parameters through the use of validated, simple and easy-to-apply instruments. OBJECTIVE: to report the health status of older adults who attend a primary care center in an urban-marginal area of Guayaquil (Ecuador) through CGA, as a first step in order to establish a coordinated care plan in the areas studied. MATERIAL AND METHODS: a cross-sectional assessment of 196 aged subjects with a median age of 70.9 years (83 % females) who attended a Primary Care Community Health Center in Guayaquil. Nutritional, social, demographic, functional, and cognitive variables were assessed. RESULTS: participants had a mean age of 70.9 ± 7.1 years. Demographic variables: 73 % were Afro-Ecuadorian, 69 % had basic education, and 57 % performed no physical activity. Clinical assessment: 47.4 % presented with vision impairment, and 37.8 % with hearing problems; 52 % had nutritional risk and 6 % malnutrition. Social valuation: 13 % had severe social deterioration; 40 % had some cognitive impairment, and 8.2 % had depression; 46.9 % were functionally dependent, and 16.8 % had dynapenia. CONCLUSIONS: CGA allows to identify major health problems in this population, which is why it is considered a practical and easy tool to apply in primary care centers in marginal urban populations as a first step to improve health status for this older population, which in recent years is growing significantly in developing countries such as Ecuador


Assuntos
Humanos , Assistência Integral à Saúde/organização & administração , Nível de Saúde , Atenção Primária à Saúde , Exercício Físico , Avaliação da Deficiência , Serviços de Saúde para Idosos , Equador/epidemiologia , Estudos Transversais , Serviços de Saúde Comunitária , Inquéritos e Questionários , Atividade Motora
11.
PLoS One ; 15(9): e0240008, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997705

RESUMO

Ecuador has been one of the most affected countries by the Corona Virus Disease 19 (COVID-19) pandemic, by April 2020 this country presented the highest rates of mortality in Latin America. The purpose of the present study was to identify behaviors during confinement and sociodemographic variables associated with the mental health status of confirmed or suspected COVID-19 patients who were part of the epidemiological surveillance program in Ecuador that included mandatory confinement and self-isolation. A cross-sectional study was performed from March 22th to April 18th, 2020 using an online survey. The survey collected socio-demographic information and severity of depressive symptoms using the Patient Health Questionnaire-9 and anxiety symptoms through the Generalized Anxiety Disorder-7. A total of 759 patients completed the questionnaire, 20.3% presented moderate to severe symptoms of depression and 22.5% moderate to severe symptoms of anxiety. Being a woman and from the Coastal region were risk factors. Exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to an hour was associated with better mental health. Regression analysis indicated that the mentioned behaviors explained approximately 17% of the variance for depression sum scores and 11.8% of the variance for anxiety sum scores while controlling for gender and region. Understanding the association between sociodemographic variables and psychological states in patients with COVID-19 is relevant to tackle future public mental health problems and to implement health policies that are intended to palliate further psychiatric complications. Promotion of modifiable behaviors such as exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to less than an hour is recommended.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/epidemiologia , Pneumonia Viral/psicologia , Atividades Cotidianas , Adolescente , Adulto , Betacoronavirus , Busca de Comunicante , Estudos Transversais , Equador/epidemiologia , Monitoramento Epidemiológico , Exercício Físico , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Questionário de Saúde do Paciente , Quarentena , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
12.
PLoS One ; 15(9): e0239585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970743

RESUMO

BACKGROUND: Anemia is a condition characterized by a decline in the number of functional red blood cells or hemoglobin. Women of reproductive age from low- and middle-income countries are at higher risk of anemia, which could lead to prenatal, obstetric and perinatal complications. The aim of our study was to explore associations between anemia status and a set of demographic, socio-economic and reproductive factors, among Ecuadorian women of reproductive age (WRA). METHODS: We used data from non-pregnant, WRA (≥12 and ≤49 years) women enrolled in the nationally representative cross-sectional Ecuadorian National Health and Nutrition Survey 2012 (ENSANUT-ECU 2012). Anemia and moderate-severe anemia were assessed using hemoglobin concentrations cutoffs of <12 g/dL and <11 g/dL, respectively. Logistic regression was used to obtain unadjusted and adjusted prevalence odds ratios (aOR). All analyzes were adjusted for multi-stage sampling, stratification and clustering. RESULTS: The study population included a subset of 7415 non-pregnant WRA. Mean hemoglobin concentration was 12.84 g/dL (95% CI = 12.8-12.9). The overall prevalence of anemia and moderate-severe anemia was 16.8% and 5.0%, respectively. Some factors were associated with an increase in anemia prevalence odds: living in Guayaquil (aOR 1.82, 95% CI 1.16-2.84) and Quito (aOR 1.84, 95% CI 1.17-2.90) compared to living in the rural Amazon, having given birth to more than four alive children compared with being nulliparous (aOR 1.85, 95% CI 1.00-3.43), currently taking contraceptives compared with former use (aOR 1.46, 95% CI 1.09-1.97). In addition, moderate-severe anemia was associated with age and region of residence. CONCLUSION: In 2012, the prevalence of anemia among Ecuadorian WRA was considered a mild public health concern. However, we identified groups with higher anemia prevalence. Thus, emphasizing the importance of analyzing the prevalence in sub-populations of WRA and identifying populations where more frequent surveillance may be helpful.


Assuntos
Anemia/epidemiologia , Adolescente , Adulto , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Prevalência , Reprodução , Fatores de Risco , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
13.
PLoS Negl Trop Dis ; 14(9): e0008640, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32986701

RESUMO

Several hundred thousand Zika cases have been reported across the Americas since 2015. Incidence of infection was likely much higher, however, due to a high frequency of asymptomatic infection and other challenges that surveillance systems faced. Using a hierarchical Bayesian model with empirically-informed priors, we leveraged multiple types of Zika case data from 15 countries to estimate subnational reporting probabilities and infection attack rates (IARs). Zika IAR estimates ranged from 0.084 (95% CrI: 0.067-0.096) in Peru to 0.361 (95% CrI: 0.214-0.514) in Ecuador, with significant subnational variability in every country. Totaling infection estimates across these and 33 other countries and territories, our results suggest that 132.3 million (95% CrI: 111.3-170.2 million) people in the Americas had been infected by the end of 2018. These estimates represent the most extensive attempt to determine the size of the Zika epidemic in the Americas, offering a baseline for assessing the risk of future Zika epidemics in this region.


Assuntos
Infecção por Zika virus/epidemiologia , América/epidemiologia , Infecções Assintomáticas/epidemiologia , Teorema de Bayes , Equador/epidemiologia , Epidemias , Humanos , Incidência , Peru/epidemiologia , Zika virus , Infecção por Zika virus/transmissão , Infecção por Zika virus/virologia
14.
J Stroke Cerebrovasc Dis ; 29(10): 105135, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912521

RESUMO

BACKGROUND: Knowledge on the prevalence and correlates of intracranial atherosclerotic disease (ICAD) is limited. We aimed to assess prevalence, clinical and neuroimaging correlates of ICAD in a cohort of older adults of Amerindian ancestry. METHODS: The study included 581 community-dwellers aged ≥60 years (mean age 71 ± 8.4 years; 57% women) living in rural Ecuadorian villages. ICAD was identified by means of CT determinations of carotid siphon calcifications (CSC) or MRA findings of significant stenosis of intracranial arteries. Fully-adjusted logistic regression models were fitted with biomarkers of ICAD as the dependent variables. RESULTS: A total of 205 (35%) of 581 participants had ICAD, including 185 with high calcium content in the carotid siphons and 40 with significant stenosis of at least one intracranial artery (20 subjects had both biomarkers). Increasing age, high fasting blood glucose, >10 enlarged basal ganglia-perivascular spaces and non-lacunar strokes were associated with high calcium content in the carotid siphons. In contrast, male gender, moderate-to-severe white matter hyperintensities, lacunar and non-lacunar strokes were associated with significant stenosis of intracranial arteries. Stroke was more common among subjects with any biomarker of ICAD than in those with no biomarkers (29% versus 9%, p < 0.001). Significant stenosis of intracranial arteries was more often associated with stroke than high calcium content in the carotid siphons, suggesting that CSC are more likely an ICAD biomarker than causally related to stroke. CONCLUSIONS: ICAD prevalence in Amerindians is high, and is significantly associated with stroke. CSC and significant stenosis of intracranial arteries may represent different phenotypes of ICAD.


Assuntos
Vida Independente , Índios Sul-Americanos , Arteriosclerose Intracraniana/etnologia , Saúde da População Rural/etnologia , Acidente Vascular Cerebral/etnologia , Calcificação Vascular/etnologia , Fatores Etários , Idoso , Envelhecimento/etnologia , Comorbidade , Equador/epidemiologia , Feminino , Nível de Saúde , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem
15.
J Community Health ; 45(6): 1158-1167, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32915380

RESUMO

Preventing the transmission of SARS-CoV-2 (causative agent for COVID-19) requires implementing contact and respiratory precautions. Modifying human behavior is challenging and requires understanding knowledge, attitudes, and practices (KAPs) regarding health threats. This study explored KAPs among people in Ecuador. A cross-sectional, internet-based questionnaire was used to assess knowledge about COVID-19, attitudes toward ability to control COVID-19, self-reported practices related to COVID-19, and demographics. A total of 2399 individuals participated. Participants had moderate to high levels of knowledge. Participants expressed mixed attitudes about the eventual control of COVID-19 in Ecuador. Participants reported high levels of adoption of preventive practices. Binomial regression analysis suggests unemployed individuals, househusbands/housewives, or manual laborers, as well as those with an elementary school education, have lower levels of knowledge. Women, people over 50 years of age, and those with higher levels of schooling were the most optimistic. Men, individuals 18-29, single, and unemployed people took the riskiest behaviors. Generally, knowledge was not associated with optimism or with practices. Our findings indicate knowledge about COVID-19 is insufficient to prompt behavioral change among Ecuadorians. Since current COVID-19 control campaigns seek to educate the public, these efforts' impacts are likely to be limited. Given attitudes determine people's actions, further investigation into the factors underlying the lack of confidence in the ability of the world, and of Ecuador, to overcome COVID-19, is warranted. Edu-communicational campaigns should be accompanied by efforts to provide economically disadvantaged populations resources to facilitate adherence to recommendations to prevent the spread of the virus.


Assuntos
Infecções por Coronavirus , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Estudos Transversais , Surtos de Doenças , Equador/epidemiologia , Feminino , Humanos , Masculino , Inquéritos e Questionários
16.
PLoS One ; 15(7): e0236924, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735608

RESUMO

BACKGROUND: Soil-transmitted helminth (STH) infections have many negative health outcomes (e.g., diarrhea, nutritional deficiencies) that can also exacerbate poverty. These infections are generally highest among low-income populations, many of which are also undergoing market integration (MI; increased participation in a market-based economy). Yet the direct impact of MI-related social and environmental changes on STH infection patterns is poorly understood, making it unclear which lifestyle factors should be targeted to better control disease spread. This cross-sectional study examines if household infrastructure associated with greater MI is associated with lower STH burdens among Indigenous Ecuadorian Shuar. METHODS: Kato-Katz fecal smears were used to determine STH infection status and intensity (n = 620 participants; 308 females, 312 males, aged 6 months-86 years); Ascaris lumbricoides (ascarid) and Trichuris trichiura (whipworm) were the primary infection types detected. Structured interviews assessing lifestyle patterns (e.g., measures of household infrastructure) measured participant MI. Multilevel regression analyses and zero-inflated negative binomial regression models tested associations between MI measures and STH infection status or intensity, controlling for individual and community characteristics. RESULTS: Participants residing in more market-integrated households exhibited lower infection rates and intensities than those in less market integrated households. Parasite infection status and T. trichiura infection intensity were lower among participants living in houses with wood floors than those with dirt floors, while individuals using well or piped water from a spring exhibited lower A. lumbricoides infection intensities compared to those using river or stream water. Unexpectedly, latrine type was not significantly related to STH infection status or intensity. These results suggest that sources of exposure differ between the two helminth species. CONCLUSIONS: This study documents associations between household measures and STH infection among an Indigenous population undergoing rapid MI. These findings can help healthcare programs better target interventions and reduce STH exposure among at-risk populations.


Assuntos
Fezes/parasitologia , Helmintíase , Pobreza/estatística & dados numéricos , Solo/parasitologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Ascaríase/epidemiologia , Ascaríase/transmissão , Ascaris lumbricoides/isolamento & purificação , Criança , Pré-Escolar , Estudos Transversais , Equador/epidemiologia , Características da Família , Feminino , Helmintíase/epidemiologia , Helmintíase/transmissão , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Grupos Populacionais/estatística & dados numéricos , Prevalência , Fatores de Risco , Saneamento/estatística & dados numéricos , Inquéritos e Questionários , Toaletes/estatística & dados numéricos , Tricuríase/epidemiologia , Tricuríase/transmissão , Trichuris/isolamento & purificação , Adulto Jovem
17.
Pediatr Infect Dis J ; 39(10): e291-e296, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32773657

RESUMO

BACKGROUND: Human coronaviruses (HCoVs) cause respiratory tract infections during childhood manifesting as common colds, bronchiolitis, croup and pneumonia. In temperate geographies, HCoV activity peaks between December and March. The epidemiology and manifestations of HCoV infections have not been previously reported from Ecuador. METHODS: Children <5 years who presented with ≥2 symptoms consistent with an acute respiratory tract infection were eligible for enrollment. After obtaining informed consent, demographic data and details regarding the acute illness were recorded. Secretions collected with a nasopharyngeal swab underwent diagnostic testing using multiplex polymerase chain reaction. RESULTS: A total of 850 subjects were enrolled. A total of 677 (80%) tested positive for at least 1 pathogen, including 49 (7.2%) who tested positive for ≥1 HCoV type. HCoV-NL63 was the most frequent type detected (39%), followed by HCoV-OC43 (27%), 229E (22%) and HKU1 (12%). Nearly all subjects who tested positive for HCoV had nasal congestion or secretions (47/49; 96%). The most frequent syndromic diagnosis was common cold (41%), followed by bronchiolitis (27%). We found no association between the infecting HCoV type and subject's syndromic diagnosis (P > 0.05) or anatomic location of infection (upper vs. lower respiratory tract; P > 0.05). The 2018-2019 peak HCoV activity occurred from October to November; the 2019-2020 peak occurred from January to February. CONCLUSIONS: HCoVs were detected in ~7% of outpatient Ecuadorean children <5 years of age with symptoms of acute respiratory tract infection. The most frequently detected HCoV types, and the period of peak HCoV activity differed for the 2018-2019 and 2019-2020 seasons.


Assuntos
Infecções por Coronavirus/virologia , Coronavirus/isolamento & purificação , Infecções Respiratórias/virologia , Doença Aguda , Assistência Ambulatorial/estatística & dados numéricos , Pré-Escolar , Coronavirus/classificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Equador/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nasofaringe/virologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/patologia , Estações do Ano
18.
Int J Infect Dis ; 99: 226-228, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32781165

RESUMO

A sudden increase in adult mortality associated with respiratory diseases was noticed in Atahualpa (a rural Ecuadorian village), coinciding with the introduction of SARS-CoV-2 in the region. From a total of 1,852 individuals aged ≥18 years, 40 deaths occurred between January and June, 2020. In addition, a seroprevalence survey showed that 45% of the adult population have SARS-CoV-2 antibodies. Verbal autopsies revealed SARS-CoV-2 as the most likely cause of death in 29 cases. The mean age of suspected or confirmed SARS-CoV-2 cases was 76.9±12.1 years, while that of those dying from unrelated causes was 60.3±20.4 years (p=0.003). The overall mortality rate was 21.6 per 1,000 population (95% C.I.: 15.9 - 29.2), almost three-quarters of it due to SARS-CoV-2 (15.7 per 1,000; 95% C.I.: 11 - 22.4). This configures a 266% of excess mortality when compared to 5.9 per 1,000 (95% C.I.: 3.3 - 10.6) deaths from other causes. When SARS-CoV-2 mortality rate was calculated in individuals aged ≥60 years, it raised up to 68.9 per 1,000 (95% C.I.: 47.8 - 98.4). After peaking in April and May, mortality significantly decreased. It is possible that the high proportion of infected individuals and the resulting herd immunity contributed to the observed reduction in mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , População Rural , Estudos Soroepidemiológicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Equador/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade
19.
Am J Trop Med Hyg ; 103(3): 1207-1210, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32755528

RESUMO

The SARS-CoV-2 pandemic is now expanding into the developing world with devastating consequences. Departing from a population-based study in rural Ecuador where all adult individuals (aged 40 years or older) were tested for SARS-CoV-2 IgG and IgM antibodies, we expanded it to include a house-based case-control component assessing in-house clustering and other variables potentially associated with infection. We selected houses where exactly two study participants lived and were both seropositive (case-houses), and matched 1:1 to control-houses where both were seronegative. Younger household members had an antibody test performed. Infected household members were found in 33 (92%) case-houses and in only six (17%) control-houses. In 28/29 discordant house pairs, the case-house had seropositive household members and the control-house did not (odds ratio: 28; 95% CI: 4.6-1,144). Our data demonstrate strong in-house clustering of infection in community settings, stressing the importance of early case ascertainment and isolation for SARS-CoV-2 control.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Estudos de Casos e Controles , Criança , Análise por Conglomerados , Equador/epidemiologia , Características da Família , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
20.
Eur Rev Med Pharmacol Sci ; 24(15): 8226-8231, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767354

RESUMO

OBJECTIVE: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared. MATERIALS AND METHODS: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVID-John Hopkins University website. Lethality of countries located within the 5th parallels North/South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate. RESULTS: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01-0.51). This result does not seem to be totally related to the differences in age distribution of different sites. CONCLUSIONS: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.


Assuntos
Clima , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Estações do Ano , Tempo (Meteorologia) , Betacoronavirus , Brunei/epidemiologia , Burundi/epidemiologia , Congo/epidemiologia , Infecções por Coronavirus/epidemiologia , Equador/epidemiologia , Guiné Equatorial/epidemiologia , Europa (Continente) , França/epidemiologia , Gabão/epidemiologia , Humanos , Ilhas do Oceano Índico/epidemiologia , Indonésia/epidemiologia , Quênia/epidemiologia , Malásia/epidemiologia , Melanesia/epidemiologia , Micronésia/epidemiologia , Países Baixos/epidemiologia , Pandemias , Papua Nova Guiné/epidemiologia , Pneumonia Viral/epidemiologia , Ruanda/epidemiologia , Samoa/epidemiologia , São Tomé e Príncipe/epidemiologia , Seicheles/epidemiologia , Singapura/epidemiologia , Somália/epidemiologia , Timor-Leste/epidemiologia , Clima Tropical , Uganda/epidemiologia , Reino Unido/epidemiologia
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