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1.
Medicina (B Aires) ; 80(1): 31-38, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044739

RESUMO

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.


Assuntos
Comunicação em Saúde , Sistemas de Informação em Saúde/estatística & dados numéricos , Tecnologia da Informação/estatística & dados numéricos , Probabilidade , Processos Estocásticos , Fatores Etários , Índice de Massa Corporal , Pré-Escolar , Equador/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Método de Monte Carlo , Obesidade/epidemiologia , Reprodutibilidade dos Testes , Fatores Sexuais
2.
J Stroke Cerebrovasc Dis ; 29(2): 104497, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31810723

RESUMO

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.


Assuntos
Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Vida Independente , Extremidade Inferior/inervação , Imagem por Ressonância Magnética , Movimento , Neuroimagem/métodos , Síndrome da Mioclonia Noturna/fisiopatologia , Sono , Idoso , Idoso de 80 Anos ou mais , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome da Mioclonia Noturna/diagnóstico , Síndrome da Mioclonia Noturna/epidemiologia , Polissonografia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Saúde da População Rural
3.
J Stroke Cerebrovasc Dis ; 29(2): 104576, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839546

RESUMO

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.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Cognição , Envelhecimento Cognitivo/psicologia , Disfunção Cognitiva/psicologia , Saúde da População Rural , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
4.
Rev Saude Publica ; 53: 97, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800910

RESUMO

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.


Assuntos
Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Equador/epidemiologia , Feminino , Geografia Médica , Humanos , Masculino , Mortalidade , Áreas de Pobreza , Saúde Pública , Fatores Socioeconômicos
5.
J Environ Public Health ; 2019: 6741202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31871470

RESUMO

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.


Assuntos
Habitação/estatística & dados numéricos , Influenza Humana/epidemiologia , Equador/epidemiologia , Humanos , Umidade , Influenza Humana/transmissão , Morbidade , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Estações do Ano , Análise Espaço-Temporal , Temperatura Ambiente
6.
BMC Oral Health ; 19(1): 184, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412847

RESUMO

BACKGROUND: There is a paucity of population-based surveys on oral health conditions in Ecuador. Thus, the aim of this study was to conduct an epidemiological survey with a representative sample of children aged 12 years from public schools of Quito, Ecuador. The aim of this initial report was to describe the methodology used in the survey, as well to present results regarding calibration procedures and prevalence of oral-health related outcomes. METHODS: We invited 33 public schools' coordinators from the urban area of Quito, and 1100 children (12 years old) to take part in this study. Six trained and calibrated examiners conducted clinical examinations using oral mirrors and ball-ended probes to assess: dental caries, traumatic dental injuries, malocclusion, gingival bleeding, presence of calculus and fluorosis. Children also responded a questionnaire on Oral Health-Related Quality of Life (OHRQoL). Individual sociodemographic data was collected through a questionnaire sent to parents. Moreover, some contextual data on school environment (infrastructure conditions, promotion of health practices and negative episodes) were also evaluated. Prevalence values, crude and weighted by sampling weights, and 95% confidence intervals (95%CI) were calculated. RESULTS: Nine hundred and ninety-eight children from 31 schools were examined from March to May 2017. The adjusted prevalence values (95%CI) for the six outcomes evaluated were: dental caries = 60.3% (55.3 to 65.0%); traumatic dental injuries = 20.7% (17.2 to 24.8%); dental fluorosis = 63.7% (58.5 to 68.5%); gingival bleeding = 92.0% (87.1 to 95.2%); presence of calculus = 69.9 (60.5 to 77.9%); and malocclusion = 25.8% (21.8 to 30.3%). Adjusted mean of number of decayed, missed or filled permanent teeth (DMF-T) was 1.61 (1.37 to 1.84). Results on OHRQoL and other contextual variables will be reported in other articles. CONCLUSION: The prevalence of the majority of oral health problems in 12-year-old children from public schools in Quito-Ecuador was compatible with those observed in other similar cities. However, periodontal health and fluorosis seem to be highly prevalent in children from Quito.


Assuntos
Cárie Dentária , Saúde Bucal , Criança , Estudos Transversais , Índice CPO , Cárie Dentária/epidemiologia , Equador/epidemiologia , Humanos , População , Prevalência , Qualidade de Vida , Inquéritos e Questionários
7.
BMC Public Health ; 19(1): 1132, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420035

RESUMO

BACKGROUND: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. METHODS: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. RESULTS: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. CONCLUSIONS: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.


Assuntos
Saúde da Criança/economia , Mortalidade da Criança/tendências , Pobreza/economia , Assistência Pública/economia , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Diarreia/economia , Diarreia/mortalidade , Equador/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Análise de Regressão , Infecções Respiratórias/economia , Infecções Respiratórias/mortalidade
8.
Rev Inst Med Trop Sao Paulo ; 61: e41, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31432990

RESUMO

Even though there are data published on HPV epidemiology in Ecuador, the distribution of genotypes in Guayaquil, the largest city in the country, has not been previously determined in a study including including both, men and women. The present study aimed to determine the distribution of 37 HPV genotypes in genital samples from Ecuadorian men and women living in the city of Guayaquil. Genital samples included in daily diagnostic routine were analyzed by the 37 HPV GenoArray Diagnostic Kit (Hybribio® Ltd., Sheung Wan, Hong Kong). The relative frequency of detectable genotypes was determined. HPV relative frequency according to sample characteristics, including sex and age groups, was compared using c2 test. From the 800 samples (400 men and 400 women), 411 (51.38%) were positive for HPV DNA. The obtained frequency was higher among samples from men (253/400 or 63.25%) in comparison to samples from women (158/400 or 39.50%), with a p value <0.05. Samples from men showed a higher frequency of HPV genotypes 6, 16, 18 and 11, while among samples from women genotypes 39, 16, 6 and 58 were the most frequent. Considering male and female samples together, genotypes 6, 16, 39 and 11 presented the highest frequencies. HPV DNA was detected in half of the studied samples, with a higher frequency among samples from men. Genotype 39 was the most frequent among women, and ranked third when samples from men and women are analyzed together.


Assuntos
DNA Viral/genética , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Equador/epidemiologia , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
9.
Dermatology ; 235(5): 400-406, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31288228

RESUMO

BACKGROUND: The Fitzpatrick skin phototype scale (FSPTS) is a widely used instrument to assess skin type. METHODS: A cross-sectional survey collected responses from 254 subjects from Quito regarding self-reported FSPTS, gender, age, education, and tobacco and alcohol consumption. Univariate and multivariate logistic regression analyses were performed to determine if ethnicity, hair color, and eye color significantly predict FSPTS. In addition, we studied the correlation between FSPTS and the SCINEXA scale with Pearson's correlation coefficient. RESULTS: Ethnicity, eye color, and hair color are significant independent predictors of FSPTS (p < 0.0001). CONCLUSIONS: Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by Fitzpatrick skin phototype. Our study does not fully represent the population of the country. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk.


Assuntos
Transtornos de Fotossensibilidade/classificação , Transtornos de Fotossensibilidade/epidemiologia , Pigmentação da Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/diagnóstico , Transtornos de Fotossensibilidade/fisiopatologia , Fatores de Risco , Autorrelato , Pigmentação da Pele/fisiologia , Queimadura Solar/diagnóstico , Queimadura Solar/epidemiologia , Queimadura Solar/etnologia , Queimadura Solar/fisiopatologia , Bronzeado/fisiologia
10.
Diabetes Metab Syndr ; 13(2): 1015-1020, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336437

RESUMO

AIMS: To determine optimal waist circumference cutoff values for predicting metabolic syndrome (MetS) among adults aged 60 years and older in Ecuador. MATERIAL AND METHODS: The National Survey of Health, Wellbeing, and Aging survey was used to describe the prevalence of MetS according to standard definitions. Receiver operating characteristics (ROC) curve analyses and the Younden index J (YI) were performed to examine optimal waist circumference cutoff values for predicting MetS. Moreover, the prevalence of MetS according to country-specific waist circumference cutoff values was compared with those using standard definitions. RESULTS: Among 2306 participants with a mean age of 70.6 years, the optimal waist circumference cutoff value for predicting MetS was 90.7 cm in women with a sensitivity of 66.1%, specificity of 65.6% and YI of 0.31. In men, a waist circumference of 91.2 cm with a sensitivity of 73.2%, specificity of 62.8%, and YI of 0.36 was the optimal cutoff point for predicting MetS. In general, applying country-specific cutoff values decreased the prevalence of MetS among older Ecuadorian women. In men, except with the ATP III definition, similar MetS prevalence rates were seen whether the country-specific or standard waist circumference cutoff values were applied. CONCLUSIONS: The optimal waist circumference cutoff values for predicting metabolic syndrome among older Ecuadorians adults were 90.7 cm for women and 91.2 cm for men. Moreover, current standard definitions of abdominal obesity may overestimate the prevalence of MetS, particularly in Latin American women.


Assuntos
Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Obesidade/fisiopatologia , Circunferência da Cintura , Adulto , Idoso , Equador/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Curva ROC , Fatores de Risco
11.
Malar J ; 18(1): 251, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349843

RESUMO

BACKGROUND: Ecuador plans to eliminate malaria by 2020, and the country has already seen a decrease in the number of cases from more than 100,000 in 2000 to only 618 in 2015. Around 30% of malaria infections in Ecuador are caused by Plasmodium falciparum. Most malaria population genetics studies performed in Latin America, especially in the Pacific Coast, indicate a high clonality and a clear structure of P. falciparum populations. It was shown that an outbreak of P. falciparum in northwest Ecuador was the result of a clonal expansion of parasites circulating at low levels in the country or re-invading Ecuador from neighbouring territories. However, general characteristics of P. falciparum circulating in the northwest coast of Ecuador have not been determined. The main goal of this study was to genetically characterize the population structure of P. falciparum in coastal Ecuadorian localities bordering with Colombia. METHODS: Molecular investigation of 41 samples collected from 2013 to 2016 in San Lorenzo County, northwest Ecuador was performed using seven neutral microsatellite markers. RESULTS: The genetic population structure of P. falciparum in northwest Ecuador is clearly defined as three different genetic groups previously reported in Ecuador, Peru and Colombia. CONCLUSIONS: The limited number of P. falciparum clonal types that are circulating in northwest Ecuador, are related to ancestral parasite clonal lineages reported in the Pacific Coast. These parasites could be a product of migration from neighbouring regions or residual clonal types circulating in the country in low proportions. Studies of the genetic characterization of P. falciparum in eliminating areas help determine the possible origin of parasites in order to create strategies to prevent the entrance of new lineages and achieve local elimination of malaria.


Assuntos
Variação Genética , Repetições de Microssatélites , Plasmodium falciparum/genética , Equador/epidemiologia , Malária Falciparum/epidemiologia
12.
BMC Public Health ; 19(1): 809, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234866

RESUMO

BACKGROUND: Physical activity is a cornerstone in the prevention and treatment of obesity. There are relatively few studies that explore the effect of accelerometer-determined moderate-to-vigorous physical activity (MVPA) on neck circumference (NC), most of them confined to single high-income countries. The present study investigated the association of accelerometer-determined MVPA with NC in adolescents and adults from eight Latin American countries, which are mostly upper-middle income countries. METHODS: The sample consisted of 2370 participants (47.8% male) from the Latin American Study of Nutrition and Health, a multicenter cross-sectional nutrition and health surveillance study of a nationally representative sample from eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Times (min/day) in MVPA (defined as time accumulated at ≥1952 activity counts/min) was assessed by ActiGraph GT3X+ accelerometer over 7 days. NC for adolescent was categorized as abnormal if circumference was > 34.5 cm for boys and > 31.25 for girls, whereas for adults the cut-off points for abnormal were > 39 cm for men and > 35 cm women. Multilevel logistic models, including country and region as random effects and adjusted for sex, age, socioeconomic level, and educational level, were used to study the association between MVPA and NC. RESULTS: The average time of MVPA was 34.88 min/day, ranging from 31.16 in Venezuela to 40.27 in Chile. Concerning NC, 37.0% of the sample was classified as having elevated NC. Chile was the country with the highest percentage of people with elevated NC (56.9%), and Colombia had the lowest percentage (24.8%). Overall, the MVPA (min/day) was associated with elevated NC (OR = 0.994, CI95% = 0.990-0.998). In Costa Rica and Peru, there were significant associations between MVPA and NC when analyzed by country. CONCLUSIONS: The present study provided evidence of significant associations between MVPA and NC in adolescents and adults from Latin America, independent of sex, age, socioeconomic level, and educational level. This analysis of accelerometry data and NC represents the first examination of these associations in eight Latin America countries. Further research is required to understand the differences between countries in the observed associations. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627 . Retrospectively registered on August 27, 2014.


Assuntos
Acelerometria/estatística & dados numéricos , Tamanho Corporal , Exercício , Pescoço/fisiopatologia , Vigilância da População , Adolescente , Adulto , Argentina/epidemiologia , Brasil/epidemiologia , Chile/epidemiologia , Colômbia/epidemiologia , Costa Rica/epidemiologia , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Obesidade/epidemiologia , Peru/epidemiologia , Venezuela/epidemiologia , Adulto Jovem
13.
BMC Vet Res ; 15(1): 194, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185969

RESUMO

BACKGROUND: Determining the infectious cause of abortion in cattle is difficult. This case-control study was set up to investigate the infectious causes of abortion by determining the seroprevalence of three reproductive pathogens in dairy cattle in Ecuador and their association with abortion: Brucella abortus, Neospora caninum and Coxiella burnetii. RESULTS: Ninety-five blood samples were obtained from cows that had experienced a mid- or late gestation abortion of their first calf and seventy-seven samples from a control group of cows with the same age that did not experience abortion problems. No antibodies were detected for B. abortus in any of the serum samples, but a high seroprevalence for both C. burnetii (52.9%) and N. caninum infection (21.5%) was found in group of cows. The seroprevalence of N. caninum infection in cattle that had experienced abortions was significantly higher (p < 0.05) than the seroprevalence in the control cows on one of the cattle farms, but no association between abortion and seropositivity for C. burnetii was found. CONCLUSION: We conclude that Neosporosis plays an important role in the epidemiology of abortion on one cattle farm, but that Q fever is apparently not an important cause for abortion in this setting.


Assuntos
Aborto Animal/epidemiologia , Doenças dos Bovinos/epidemiologia , Coccidiose/veterinária , Febre Q/veterinária , Aborto Animal/microbiologia , Aborto Animal/parasitologia , Animais , Anticorpos Antibacterianos/sangue , Anticorpos Antiprotozoários/sangue , Brucella abortus/imunologia , Brucelose Bovina/epidemiologia , Estudos de Casos e Controles , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/parasitologia , Coccidiose/epidemiologia , Coxiella burnetii/imunologia , Indústria de Laticínios , Equador/epidemiologia , Feminino , Neospora/imunologia , Gravidez , Febre Q/epidemiologia , Estudos Soroepidemiológicos
14.
PLoS Negl Trop Dis ; 13(6): e0007472, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31194754

RESUMO

BACKGROUND: Human transmission of Chagas disease (CD) most commonly occurs in domiciliary spaces where triatomines remain hidden to feed on blood sources during inhabitants' sleep. Similar to other neglected tropical diseases (NTDs), sustainable control of CD requires attention to the structural conditions of life of populations at risk, in this case, the conditions of their living environments. Considering socio-cultural and political dynamics involved in dwellings' construction, this study aimed to explore social factors that contribute or limit sustainability of CD's prevention models focused on home improvement. METHODS AND MAIN FINDINGS: Using Healthy Homes for Healthy Living (HHHL)-a health promotion strategy focused on improvement of living environments and system-based health promotion-as a reference, a qualitative study was conducted. Research participants were selected from three rural communities of a CD endemic region in southern Ecuador involved in HHHL's refurbishment and reconstruction interventions between 2013 and 2016. Folowing an ethnographic approach, data were collected through interviews, participant observation, informal conversations and document analysis. Our results indicate that the HHHL model addressed risk factors for CD at the household level, while simultaneously promoting wellbeing at emotional, economic and social levels in local communities. We argue that sustainability of the CD prevention model proposed by HHHL is enhanced by the confluence of three factors: systemic improvement of families' quality of life, perceived usefulness of control measures, and flexibility to adapt to emerging dynamics of the context. CONCLUSION: HHHL's proposed home improvement, facilitated through system-based rather than disease specific health promotion processes, enhances agency in populations at risk and facilitates community partnerships forged around CD prevention. Although an independent analysis of cost-effectiveness is recommended, structural poverty experienced by local families is still the most important factor to consider when evaluating the sustainability and scalability of this model.


Assuntos
Doença de Chagas/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Características da Família , Controle de Insetos/economia , Controle de Insetos/métodos , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Doença de Chagas/epidemiologia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural
15.
Public Health ; 172: 52-60, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202092

RESUMO

OBJECTIVE: In Ecuador, the reported maternal death rate was 45.71 per 100,000 live births in 2013. This may be partly due to a lack of maternal knowledge of obstetric warning signs during pregnancy, delivery and the post-partum period. This study sought to evaluate awareness of obstetric warning signs among pregnant women in relation to individual demographic and area-level socio-economic indicators. STUDY DESIGN: We conducted a cross-sectional analysis of data collected by Ecuador's Ministry of Health at the conclusion of a national maternal health campaign (2014-2015). A nationally representative sample of 3435 pregnant women from the nine administrative zones completed surveys regarding basic demographics and their awareness of obstetric warning signs. METHODS: We defined eight obstetrical warning signs according to the literature and Ecuadorian practice that could occur during pregnancy, delivery and the post-partum period (severe headache, strong abdominal ache, bleeding or presence of malodorous secretion, rupture of the amniotic sac, high fever, abnormal presentation of the baby, decrease in baby's movements and delayed labour). A woman was considered 'aware' if she recognised at least four of the eight warning signs and stated she would seek immediate healthcare at their presentation. For each administrative zone, four socio-economic indicators (poverty, illiteracy, unemployment and subemployment) were obtained from the National Institute of Statistics and Census. Correlates of awareness of the obstetric warning signs were evaluated using hierarchical logistic models clustered by the administrative zone. RESULTS: Nationally, 86.9% of women were 'aware' of obstetric warning signs. After adjustment for age, socio-economic indicators and clustering, indigenous participants were 59% less likely to be aware of obstetric warning signs than mestizos (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.28-0.59). For every 1% increase in area poverty, participants had a 5% decreased likelihood of being aware of obstetric warning signs (OR = 0.95, 95% CI = 0.93-0.96), adjusting for age, ethnicity and other socio-economic indicators. The most effective source of campaign information about obstetric warning signs was personal communication with a healthcare professional, as opposed to mass media advertisements (OR = 1.90, 95% CI = 1.34-2.71). CONCLUSIONS: A majority of Ecuadorian pregnant and post-partum women are aware of obstetric warning signs. Indigenous ethnicity and area-level poverty are associated with a lack of awareness. Personal communication with a healthcare professional was the most effective source of information. These findings have implications for improvement of maternal awareness of warning signs.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Complicações do Trabalho de Parto/psicologia , Adulto , Estudos Transversais , Equador/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Mortalidade Materna , Grupos Populacionais/psicologia , Grupos Populacionais/estatística & dados numéricos , Áreas de Pobreza , Gravidez , Inquéritos e Questionários , Adulto Jovem
16.
Am J Trop Med Hyg ; 101(1): 45-50, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31162016

RESUMO

Waterborne pathogens, associated with poverty and poor sanitary conditions, are a major cause of morbidity and mortality worldwide. There are limited data on the epidemiology of waterborne pathogens in indigenous populations living in the Amazon region. We did a cross-sectional survey in two indigenous Shuar communities in the Amazon region of Ecuador in which we documented the presence of pathogens representing different sources of environmental contamination of water. We detected protozoa and soil-transmitted helminths by microscopy of fecal samples and the presence of IgG antibodies to hepatitis A and Leptospira spp. in blood samples from individuals older than 2 years and collected data by questionnaire on sociodemographic factors and knowledge of infectious diseases. Seroprevalence for hepatitis A and Leptospira spp. were 98.1% (95% CI: 97.0-99.8) and 50.0% (95% CI: 43.3-56.6), respectively, whereas 62.6% (95% CI: 55.8-69.4) had enteric parasites in stool samples. In participants older than 6 years, eight of 10 had evidence of infection with or exposure to at least one of the pathogens studied. Although prevalence of pathogens varied by age, it did not vary significantly by gender, temporal migration, illiteracy, perceived morbidity, receipt of conditional cash transfers, water boiling practices, poor housing conditions, and anthropometric status. These findings indicate a high level of contamination of drinking water by human pathogens in these indigenous communities and the need for interventions to improve access to and use of clean drinking water in these marginalized communities.


Assuntos
Anticorpos Antibacterianos/sangue , Anticorpos Antivirais/sangue , Hepatite A/epidemiologia , Leptospirose/epidemiologia , Microbiologia da Água , Água/parasitologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Equador/epidemiologia , Hepatite A/sangue , Vírus da Hepatite A/imunologia , Humanos , Imunoglobulina G/sangue , Leptospira/imunologia , Leptospirose/sangue , Pessoa de Meia-Idade , Pobreza , Saneamento , Estudos Soroepidemiológicos , Abastecimento de Água , Adulto Jovem
17.
BMC Health Serv Res ; 19(1): 363, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174529

RESUMO

BACKGROUND: Health systems worldwide rely on health professionals to deliver services and provide framework structures. Considering their opinions about their work environment, the public policies that regulate their work and the deficiencies of the health care system are key aspects of the governance within the system. The aim of this study was to assess the perceptions of Ecuadorian physicians about several aspects of the performance of the health delivery and monitoring systems locally. METHODS: A cross-sectional survey was performed in a group of physicians in Ecuador during 2017 using a self-selection sampling strategy. The participants were contacted by telephone, direct email or in person and asked to complete the online survey which contained 47 questions. RESULTS: A total of 607 full responses were received from physicians, where 68.6% of those had graduated within the last 17 years. 46.4% of respondents were medical specialists, 23.1% general practitioners, 10.0% rural health practitioners, 9.5% sub-specialists, 5.9% were formally enrolled in a specialty program and 5.1% were researchers or administrative physicians. Data analysis of the answers showed that approximately 62% of physician respondents in the study found their current workload at the time of the survey was unmanageable, the most common complaints about the Public Health system in the study being the amount of daily paperwork (78.4%), followed by a perceived lack of vision of the health authorities (60.1%) and the resource limitations within the public hospitals (53.5%). Additionally, 71.8% of respondents referred to limitations of the National Essential Medicines chart- especially on the availability of some drugs- and 57.5% of the respondents reported concerns about the quality of medicines available for treatment. CONCLUSIONS: The data provide basic inputs for health authorities regarding the functioning of the health system in Ecuador. Health professionals' concerns can be a valuable resource for monitoring and improving health system performance: however, there is a perceived sense of disconnection between the governance or management and the service delivery arms of the healthcare system in Ecuador. Whilst not representative of the entirety of the population of doctors, the study does give insight into where improvements to the health system might be made.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde/normas , Médicos/psicologia , Médicos/estatística & dados numéricos , Adulto , Estudos Transversais , Assistência à Saúde/organização & administração , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Especialização
18.
Public Health ; 176: 36-42, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31104808

RESUMO

OBJECTIVES: This community-based study explores the syndemic nature of HIV/AIDS risk and resilience among Indigenous Kichwa communities in the province of Imbabura, Ecuador. This study elucidates individual and community-level factors that serve to exacerbate HIV/AIDS risk, as they relate to underlying macrolevel, structural forces. Critically, this study also elicited opportunities for community-based opportunities for resiliency from HIV/AIDS. STUDY DESIGN: Exploratory qualitative study. METHODS: Guided by syndemic theory, a qualitative study was conducted to explore HIV risk and resilience among Indigenous Kichwa communities in the Northern Andean highlands of Ecuador. Eight focus groups (n = 59) with men and women from two communities were conducted. The data were analyzed using applied thematic analysis techniques. RESULTS: Identified risk factors for HIV/AIDS centered around the following themes: (1) parents leaving the community for work, (2) alcohol and drug consumption, (3) unprotected sex, and (4) barriers to health care. Identified HIV/AIDS resiliency factors included the preservation of Indigenous culture and family-focused interventions. CONCLUSIONS: The identified risk factors for HIV/AIDS are interrelated within a complex syndemic relationship. The mutually reinforcing individual-level risk factors of substance abuse and risky sexual behavior coalesce with violence to exacerbate the risk for HIV/AIDS acquisition among Ecuadorian Highland Indigenous communities. Moreover, HIV/AIDS risk prevails in the macrolevel context of disproportionate unemployment among Indigenous peoples and a systematically fragmented healthcare system. It is critical that public health professionals work to revolutionize the systematic discrimination that underpins indigenous health disparities at-large.


Assuntos
Infecções por HIV/epidemiologia , Grupos Populacionais/estatística & dados numéricos , Adolescente , Adulto , Idoso , Equador/epidemiologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores de Risco , Adulto Jovem
19.
Am J Trop Med Hyg ; 100(6): 1312-1320, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31038099

RESUMO

Brucellosis is an important but neglected zoonosis that causes serious economic losses both in livestock and human populations. The aim of the present study was to estimate the true prevalence of brucellosis together with diagnostic sensitivity and specificity of three serological tests in humans of the northwestern part of Ecuador using a Bayesian approach adjusted for the dependencies among the multiple tests to avoid any misinterpretation. In addition, the causal agent responsible for human brucellosis was also identified. Using a total of 3,733 samples collected from humans in this area between 2006 and 2008, the prevalence of human brucellosis and the diagnostic test characteristics of the Rose Bengal fast agglutination test (RBT), Wright's slow agglutination test with ethylenediaminetetraacetic acid disodium salt dehydrate (EDTA) (SAT-EDTA), and indirect ELISA (iELISA) were estimated using a Bayesian approach. The estimated true prevalence of human brucellosis was 1% (credibility interval: 0.4-1.6). The sensitivities of iELISA and RBT were higher than and similar (95.1% and 95.0%, respectively) to those of SAT-EDTA (60.8%). Even though all tests indicated a high specificity (> 99.0%), the specificity of SAT-EDTA was highest (99.9%). The circulating strain in this study area was identified to be Brucella abortus biotype 4 based on culture and microbiological characterization. The RBT and the iELISA are recommended for estimating the true prevalence of human brucellosis and/or for surveillance programs following their high sensitivities and specificities. The proposed strategy supports evidence-based medicine for clinicians and policy-makers to ensure appropriate preventive and control program of brucellosis worldwide.


Assuntos
Testes de Aglutinação/normas , Anticorpos Antibacterianos/sangue , Brucella abortus/isolamento & purificação , Brucelose/diagnóstico , Brucelose/epidemiologia , Ensaio de Imunoadsorção Enzimática/normas , Adolescente , Adulto , Idoso , Animais , Teorema de Bayes , Brucella abortus/imunologia , Brucelose/microbiologia , Brucelose/transmissão , Bovinos , Estudos Transversais , Equador/epidemiologia , Ácido Edético/química , Monitoramento Epidemiológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Rosa Bengala/química , Sensibilidade e Especificidade
20.
PLoS Negl Trop Dis ; 13(5): e0007360, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31059505

RESUMO

Season is a major determinant of infectious disease rates, including arboviruses spread by mosquitoes, such as dengue, chikungunya, and Zika. Seasonal patterns of disease are driven by a combination of climatic or environmental factors, such as temperature or rainfall, and human behavioral time trends, such as school year schedules, holidays, and weekday-weekend patterns. These factors affect both disease rates and healthcare-seeking behavior. Seasonality of dengue fever has been studied in the context of climatic factors, but short- and long-term time trends are less well-understood. With 2009-2016 medical record data from patients diagnosed with dengue fever at two hospitals in rural Ecuador, we used Poisson generalized linear modeling to determine short- and long-term seasonal patterns of dengue fever, as well as the effect of day of the week and public holidays. In a subset analysis, we determined the impact of school schedules on school-aged children. With a separate model, we examined the effect of climate on diagnosis patterns. In the first model, the most important predictors of dengue fever were annual sinusoidal fluctuations in disease, long-term trends (as represented by a spline for the full study duration), day of the week, and hospital. Seasonal trends showed single peaks in case diagnoses, during mid-March. Compared to the average of all days, cases were more likely to be diagnosed on Tuesdays (risk ratio (RR): 1.26, 95% confidence interval (CI) 1.05-1.51) and Thursdays (RR: 1.25, 95% CI 1.02-1.53), and less likely to be diagnosed on Saturdays (RR: 0.81, 95% CI 0.65-1.01) and Sundays (RR: 0.74, 95% CI 0.58-0.95). Public holidays were not significant predictors of dengue fever diagnoses, except for an increase in diagnoses on the day after Christmas (RR: 2.77, 95% CI 1.46-5.24). School schedules did not impact dengue diagnoses in school-aged children. In the climate model, important climate variables included the monthly total precipitation, an interaction between total precipitation and monthly absolute minimum temperature, an interaction between total precipitation and monthly precipitation days, and a three-way interaction between minimum temperature, total precipitation, and precipitation days. This is the first report of long-term dengue fever seasonality in Ecuador, one of few reports from rural patients, and one of very few studies utilizing daily disease reports. These results can inform local disease prevention efforts, public health planning, as well as global and regional models of dengue fever trends.


Assuntos
Dengue/epidemiologia , Adolescente , Criança , Pré-Escolar , Equador/epidemiologia , Feminino , Humanos , Masculino , Fatores de Risco , População Rural/estatística & dados numéricos , Estações do Ano
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