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1.
Sensors (Basel) ; 21(12)2021 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-34198627

RESUMEN

In this paper, we group South American countries based on the number of infected cases and deaths due to COVID-19. The countries considered are: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Peru, Paraguay, Uruguay, and Venezuela. The data used are collected from a database of Johns Hopkins University, an institution that is dedicated to sensing and monitoring the evolution of the COVID-19 pandemic. A statistical analysis, based on principal components with modern and recent techniques, is conducted. Initially, utilizing the correlation matrix, standard components and varimax rotations are calculated. Then, by using disjoint components and functional components, the countries are grouped. An algorithm that allows us to keep the principal component analysis updated with a sensor in the data warehouse is designed. As reported in the conclusions, this grouping changes depending on the number of components considered, the type of principal component (standard, disjoint or functional) and the variable to be considered (infected cases or deaths). The results obtained are compared to the k-means technique. The COVID-19 cases and their deaths vary in the different countries due to diverse reasons, as reported in the conclusions.


Asunto(s)
COVID-19 , Pandemias , Argentina , Brasil , Chile , Colombia , Ecuador , Humanos , Perú , Análisis de Componente Principal , SARS-CoV-2 , Uruguay , Venezuela
3.
Hist. ciênc. saúde-Manguinhos ; 28(2): 587-591, abr.-jun. 2021.
Artículo en Español | LILACS | ID: biblio-1279128

RESUMEN

Resumen El caso de la covid-19 en Guayaquil demuestra que las esferas médica y científica no están divorciadas de los factores coyunturales políticos, sociales y económicos, sino que se condicionan mutuamente. En particular, las crisis políticas y desigualdades socioeconómicas que afectaban al Ecuador antes de la llegada de la pandemia prepararon el camino para los estragos causados por el nuevo coronavirus en el país.


Abstract The case of covid-19 in Guayaquil shows that the medical and scientific spheres are not divorced from contemporary political, social and economic factors, but that they act upon one another. In particular, the political crises and socioeconomic inequalities that affected Ecuador before the arrival of the pandemic paved the way for the havoc caused by the new coronavirus in the country.


Asunto(s)
Humanos , COVID-19/epidemiología , Política , Factores Socioeconómicos , Salud Pública , Ecuador/epidemiología
5.
Int J Infect Dis ; 108: 531-536, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34119677

RESUMEN

BACKGROUND: One of the constraints in containing the impact of the COVID-19 pandemic in Ecuador is limited testing capacity, especially in high-risk populations such as people living in humanitarian shelters. OBJECTIVES: The "United Nations High Commissioner for Refugees" office in Ecuador in collaboration with "Universidad de Las Américas" performed surveillance screening at shelters for women victims of gender-based violence. They had been granted access to RT-qPCR tests for SARS-CoV-2 diagnosis since July 2020, a few weeks after the general population lockdown was lifted. RESULTS: From 411 people tested, 52 tests were SARS-CoV-2 positive, yielding an overall high attack rate of 12.65%. Moreover, COVID-19 outbreaks were found in nine of 11 shelters that were included in the study. While attacks rates varied among shelters, no association was found with occupancy. CONCLUSION: This study is key to clarifying the epidemiological situation in this highly vulnerable population in Latin America. It highlights the importance of mass testing beyond the symptomatic population to prevent the spread of COVID-19.

6.
Hist Cienc Saude Manguinhos ; 28(2): 587-591, 2021.
Artículo en Español | MEDLINE | ID: mdl-34190796

RESUMEN

The case of covid-19 in Guayaquil shows that the medical and scientific spheres are not divorced from contemporary political, social and economic factors, but that they act upon one another. In particular, the political crises and socioeconomic inequalities that affected Ecuador before the arrival of the pandemic paved the way for the havoc caused by the new coronavirus in the country.


Asunto(s)
COVID-19/epidemiología , Ecuador/epidemiología , Humanos , Política , Salud Pública , Factores Socioeconómicos
7.
Soc Sci Med ; 281: 114040, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34144481

RESUMEN

RATIONALE: Stress process theory considers that actual and perceived isolation, caused by mobility restrictions from attempted containment of the COVID-19 pandemic, deteriorates mental health. OBJECTIVE: We examine the relationship between the COVID-19 lockdowns and mental health-related Google searches in 11 Latin American countries. We include the following countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Uruguay. We also explore how changes in search patterns relate to income support policies and to COVID-19 death rates. METHOD: Using Google Trends data and an event-study design, as well as a difference-in-differences analysis, we investigate the association between country specific stay-at-home orders and internet searches including the following words: insomnia, stress, anxiety, sadness, depression, and suicide. RESULTS: We find three main patterns. First, searches for insomnia peak but then decline. Second, searches for stress, anxiety, and sadness increase and remain high throughout the lockdown. Third, there is no substantial change in depression-related or suicide-related searches after the lockdown. In terms of potential mechanisms, our results suggest that searches declined for suicide and insomnia following the passage of each country's income support, while in countries with higher COVID-19-related death rates, searches for insomnia, stress, and anxiety increased by more. CONCLUSIONS: Our results suggest that, in Latin America, Google searches for words associated with mild mental health disorders increased during the COVID-19 stay-at-home orders. Nonetheless, these conclusions should not be construed as a general population mental health deterioration, as we cannot verify that search indicators are accurately related to the users' current feelings and behaviors, and as internet users may not be representative of the population in this region.


Asunto(s)
COVID-19 , Salud Mental , Motor de Búsqueda , Argentina , Bolivia , Chile , Colombia , Control de Enfermedades Transmisibles , Ecuador , Guatemala , Honduras , Humanos , América Latina/epidemiología , México , Pandemias , Perú , SARS-CoV-2 , Uruguay
9.
BMC Infect Dis ; 21(1): 558, 2021 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-34118895

RESUMEN

BACKGROUND: The quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR) effectively detects the SARS-COV-2 virus. SARS-CoV-2 Nevertheless, some critical gaps remain in the identification and monitoring of asymptomatic people. METHODS: This retrospective study included 733 asymptomatic and symptomatic COVID-19 subjects, who were submitted to the RT-qPCR test. The objective was to assess the efficacy of an expanded triage of subjects undergoing the RT-qPCR test for SARS-COV-2 to identify the largest possible number of COVID-19 cases in a hospital setting in Ecuador. SARS-CoV-2 Firstly, the sensitivity and specificity as well as the predictive values of an expanded triage method were calculated. In addition, the Kappa coefficient was also determined to assess the concordance between laboratory test results and the expanded triage. RESULTS: Of a total of 733 sputum samples; 229 were RT-qPCR-positive (31.2%) and mortality rate reached 1.2%. Overall sensitivity and specificity were 86.0% (95% confidence interval: 81.0-90.0%) and 37.0% (95% confidence interval: 32.0-41.0%) respectively, with a diagnostic accuracy of 52.0% and a Kappa coefficient of 0.73. An association between the positivity of the test and its performance before 10 days was found. CONCLUSIONS: The clinical sensitivity for COVID-19 detection was within acceptable standards, but the specificity still fell below the values of reference. The lack of symptoms did not always mean to have a negative SARS-COV-2 RT-qPCR test. The expanded triage identified a still unnoticed percentage of asymptomatic subjects showing positive results for the SARS-COV-2 RT-qPCR test. The study also revealed a significant relationship between the number of RT-qPCR-positive cases and the performance of the molecular diagnosis within the first 10 days of COVID-19 in the symptomatic group.


Asunto(s)
Prueba de COVID-19 , COVID-19/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , SARS-CoV-2 , Esputo/virología , Ecuador , Humanos , Estudios Retrospectivos , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Sensibilidad y Especificidad , Triaje
10.
Artículo en Inglés | MEDLINE | ID: mdl-34064780

RESUMEN

Due to the COVID-19 global pandemic, guidelines for people's confinement have been implemented to prevent the disease's spread. As a result of this, companies have implemented teleworking as an emerging way to work from home using information technology. This cross-sectional study was conducted in Ecuador, with a sample of 204 teleworkers in the city of Quito. The results show that the teleworkers rearranged their bedrooms to carry out their activities. The respondents in each age group stated they did not perceive more significant ailments than those experienced before beginning teleworking. The relationships between the variables were analyzed utilizing the Chi-Square test and Fisher's exact test, finding a relationship between neck ailments and age of p = 0.031 * and between arm/forearm ailments of p = 0.032 *. This study contributes to a greater understanding of the ergonomic situation of the teleworkers and provides us with information to mitigate the ergonomic risks to which they are exposed.


Asunto(s)
COVID-19 , Teletrabajo , Estudios Transversales , Ecuador/epidemiología , Ergonomía , Humanos , Pandemias , Factores de Riesgo , SARS-CoV-2
11.
One Health ; : 100267, 2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34056057

RESUMEN

COVID-19 pandemic has challenged public health systems worldwide, particularly affecting developing countries in Latin America like Ecuador. In this report, we exposed the fundamental role of the Ecuadorian universities to improve COVID-19 surveillance in the country, with an overall contribution over 15% of the total SARS-CoV-2 RT-PCR tests done. We highlight the role of our university during the first semester of the COVID-19 pandemic, contributing to a massive free SARS-CoV-2 testing up to almost 10% of the total diagnosis completed in the country, mainly focus on underserved urban, rural and indigenous communities. Finally, we described our contribution to a high quality and low-cost SARS-CoV-2 RT-PCR diagnostic in Ecuador.

12.
Disaster Med Public Health Prep ; : 1-13, 2021 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-34006342

RESUMEN

The global coronavirus disease 2019 (COVID-19) pandemic has altered entire nations and their health systems. The greatest impact of the pandemic has been seen among vulnerable populations, such as those with comorbidities like heart diseases, kidney failure, obesity, or those with worse health determinants such as unemployment and poverty. In the current study, we are proposing previous exposure to fine-grained volcanic ashes as a risk factor for developing COVID-19. Based on several previous studies it has been known since the mid 1980s of the past century that volcanic ash is most likely an accelerating factor to suffer from different types of cancer, including lung or thyroid cancer. Our study postulates, that people who are most likely to be infected during a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) widespread wave will be those with comorbidities that are related to previous exposure to volcanic ashes. We have explored 8703 satellite images from the past 21 y of available data from the National Oceanic and Atmospheric Administration (NOAA) database and correlated them with the data from the national institute of health statistics in Ecuador. Additionally, we provide more realistic numbers of fatalities due to the virus based on excess mortality data of 2020-2021, when compared with previous years. This study would be a very first of its kind combining social and spatial distribution of COVID-19 infections and volcanic ash distribution. The results and implications of our study will also help countries to identify such aforementioned vulnerable parts of the society, if the given geodynamic and volcanic settings are similar.

13.
PLoS One ; 16(5): e0251295, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33999930

RESUMEN

The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.


Asunto(s)
COVID-19/diagnóstico por imagen , COVID-19/epidemiología , Hospitales Especializados/organización & administración , Hospitales Especializados/tendencias , Pandemias/prevención & control , SARS-CoV-2/genética , Triaje/métodos , Adulto , Anciano , Inteligencia Artificial , COVID-19/prevención & control , COVID-19/virología , Prueba de Ácido Nucleico para COVID-19 , Ecuador/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Radiografías Pulmonares Masivas/métodos , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos
14.
J Infect Public Health ; 14(6): 685-688, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33971576

RESUMEN

Reinfection with SARS-CoV-2 is a rare phenomenon. To date, there has been some cases reported from countries such as United States, Ecuador, Hong Kong, the Netherlands and Belgium. This case report presents the first case of reinfection from Saudi Arabia, and probably the first dental student to have been re-infected with COVID-19. A 24-year-old male dental student presents with reinfection after a period of three months since he was first infected with COVID-19. The signs and symptoms reported by the patient were similar in both instances, except that he developed fever only at the time of reinfection. The infection and reinfection were confirmed with a RT-PCR test reports. This report highlights how it is necessary to continue to observe all the prescriptions recently indicated in the literature in order to avoid new contagion for all health workers after healed from covid-19 or asymptomatic positive, since as seen sometimes the infection does not ensures complete immunity in 100% of cases.


Asunto(s)
COVID-19 , SARS-CoV-2 , Adulto , Bélgica , Ecuador , Personal de Salud , Humanos , Masculino , Países Bajos , Reinfección , Arabia Saudita , Adulto Joven
15.
Artículo en Español | MEDLINE | ID: mdl-33950104

RESUMEN

The case of covid-19 in Guayaquil shows that the medical and scientific spheres are not divorced from contemporary political, social and economic factors, but that they act upon one another. In particular, the political crises and socioeconomic inequalities that affected Ecuador before the arrival of the pandemic paved the way for the havoc caused by the new coronavirus in the country.

16.
Am J Trop Med Hyg ; 2021 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-34014837

RESUMEN

Shortages of essential supplies used to prevent, diagnose, and treat COVID-19 have been a global concern, and price speculation and hikes may have negatively influenced access. This study identifies variability in prices of products acquired through government-driven contracts in Ecuador during the early pandemic response, when the highest mortality rates were registered in a single day. Data were obtained from the National Public Procurement Service (SERCOP) database between March 1 and July 31, 2020. A statistical descriptive analysis was conducted to extract relevant measures for commonly purchased products, medical devices, pharmaceutical drugs, and other goods. Among the most frequently purchased products, the greatest amounts were spent on face masks (US$4.5 million), acetaminophen (US$2.2 million), and reverse transcriptase quantitative polymerase chain reaction assay kits (US$1.8 million). Prices varied greatly, depending on each individual contract and on the number of units purchased; some were exceptionally higher than their market value. Compared with 2019, the mean price of medical examination gloves increased up to 1,307%, acetaminophen 500 mg pills, up to 796%, and oxygen flasks, 30.8%. In a context of budgetary constraints that actually required an effective use of available funds, speculative price hikes may have limited patient access to health care and the protection of the general population and health care workers. COVID-19 vaccine allocations to privileged individuals have also been widely reported. Price caps and other forms of regulation, as well as greater scrutiny and transparency of government-driven purchases, and investment in local production, are warranted in Ecuador for improved infectious disease prevention.

17.
Medisur ; 19(2): 323-328, graf
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1279451

RESUMEN

RESUMEN Fundamento Los cierres temporales de instituciones de educación superior a causa de la COVID-19, han significado un proceso de rápida asimilación de nuevos contenidos, que antes apoyaban la modalidad presencial, pero que ahora son el único medio de enseñanza. Objetivo describir la experiencia de adquisición de habilidades por docentes universitarios en los contextos educativos impuestos por la COVID-19. Métodos estudio descriptivo, realizado en el periodo febrero-julio de 2020, con la participación de 16 docentes de la Universidad Metropolitana de Ecuador, específicamente de dos carreras de ciencias de la Salud. La técnica fundamental fue la encuesta. Se analizaron variables relacionadas con las habilidades adquiridas, directa e indirectamente. Resultados en cuanto al dominio de los entornos virtuales de aprendizaje predominó el manejo "adecuado", y en ningún caso se consideró "inadecuado". Sobre la percepción del proceso de adquisición de habilidades, el tiempo de estudio fue calificado de "poco adecuado" por el 69 % de los docentes; y el 61 % manifestó como "adecuado", el interés por el contenido recibido. El 93 % de los participantes manifestó que, en alguna medida, las habilidades adquiridas habían servido como motivación para su acción docente, tanto presente como futura. Conclusión Aunque los resultados denotan que el conocimiento sobre los entornos virtuales de aprendizaje no es óptimo entre los docentes del claustro, estos ya cuentan con habilidades cognitivas y tecnológicas, las cuales podrán incrementarse con el tiempo.


ABSTRACT Background The temporary closures of higher education institutions due to COVID-19 have meant a process of rapid assimilation of new content, which previously supported the face-to-face modality, but which are now the only way of teaching. Objective to describe the acquisition of skills experience by university teachers in the educational contexts imposed by COVID-19. Methods descriptive study, carried out from February to July 2020, with the participation of 16 teachers from the Ecuador Metropolitan University, specifically from two health sciences careers. The fundamental technique was the survey. Variables related to acquired skills were analyzed, directly and indirectly. Results regarding the domain of virtual learning environments in general, "adequate" management prevailed, and in no case was it considered "inappropriate". Regarding the perception of the skills acquisition process, the study time was described as "not very adequate" by the 69% of the teachers; and the 61% declared their interest in the content received as "adequate". The 93% of the participants stated that, to some extent, the skills acquired had served as motivation for their teaching action, both present and future. Conclusion Although the results show that knowledge about virtual learning environments is not optimal among faculty teachers, they already have cognitive and technological skills, which may increase over time.

18.
Rev. ecuat. pediatr ; 22(1): 1-6, Abril 30, 2021.
Artículo en Inglés | LILACS | ID: biblio-1222378

RESUMEN

Introducción: Los virus de RNA son conocidos por tener altas tasas de variabilidad genética. El SARS-CoV-2 ha producido diversas variantes en la actualidad que pueden cambiar la presentación clínica. Se presenta el primer caso clínico de la variante B.1.1.7 con estado clínico crítico en un paciente pediátrico y nos alerta sobre la vigilancia de nuevas variantes y la relación de casos críticos en pacientes pediátricos. Caso clínico: Paciente pediátrica con antecedente de parálisis cerebral infantil, atrofia subcortical severa completa, síndrome de Lennox-Gastaut y neumonía recurrente. Presentó una evolución tórpida con necesidad de terapia intensiva por SDRA en relación con la variante B 1.1.7 del SARS-CoV-2. Evolución: Inicialmente fue atendido en un hospital privado, en el cual debido al SDRA necesitó de cuidados intensivos, fue trasladado a un hospital público en el cual posterior a 38 días fue dada de alta por evolución favorable de su cuadro infeccioso. Conclusión: Las nuevas variantes de SARS-CoV-2 pueden mostrar nuevos comportamientos clínicos. A pesar de los antecedentes del paciente estudiado, no se había observado previamente una evolución clínica hacia síntomas graves en pacientes pediátricos con COVID-19. Eso podría estar relacionado con la infección por SARS-CoV-2 variante B.1.1.7 que presentó este paciente.


Introduction: RNA viruses are known to have a high genetic variability. To date, SARS-CoV-2 has produced several variants that can change the clinical presentation of COVID-19. The first clinical case of variant B.1.1.7 with a critical clinical status in a pediatric patient is presented. It indicates that surveillance of new variants and their relationship to critical cases in pediatric patients are required. Clinical case: A pediatric patient with a history of infantile cerebral palsy, complete severe subcortical atrophy, Lennox−Gastaut syndrome, and recurrent pneumonia. She had a slow evolution requiring intensive therapy for acute respiratory distress syndrome (ARDS) that was related to SARS-CoV-2 variant B 1.1.7. Evolution: Initially, she was treated at a private hospital because she required intensive care due to ARDS, and she was then transferred to a public hospital. She was discharged after 35 days due to a favorable evolution of her infectious etiology. Conclusions: New SARS-CoV-2 variants may show new clinical behaviors. Despite this patient's history, a clinical course towards severe symptoms had not been previously observed in pediatric patients with COVID-19. The severe symptoms could be related to the SARS-CoV-2 variant B.1.1.7 infection in this patient.


Asunto(s)
Edema Pulmonar , Niño , Infecciones por Coronavirus , Cuidados Críticos , Medición de Resultados Informados por el Paciente
19.
Int J Infect Dis ; 108: 53-56, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33930542

RESUMEN

OBJECTIVES: To date, reported SARS-CoV-2 reinfection cases are mainly from strains belonging to different clades. As the pandemic advances, a few lineages have become dominant in certain areas leading to reinfections by similar strains. Here, we report a reinfection case within the same clade of the initial infection in a symptomatic 28-year-old-male in Quito-Ecuador. METHODS: Infection was detected by reverse transcription-polymerase chain reaction, and immune response evaluated by antibody testing. Whole-genome sequencing was performed and phylogenetic analysis conducted to determine relatedness. RESULTS: Both the infection and the reinfection strains were assigned as Nextstrain 20B, Pangolin lineage B.1.1 and GISAID clade O. Our analysis indicated 4-6 fold more nucleotide changes than are expected for reactivation or persistence compared with the natural rate of SARS-CoV-2 mutation (∼2-3 nucleotide changes per month), thus supporting reinfection. Furthermore, approximately 3 months after the second infection, COVID-19 antibodies were not detectable in the patient, suggesting potential vulnerability to a third infection. CONCLUSIONS: Our results showed evidence of SARS-CoV-2 reinfection within the same clade in Ecuador, indicating that previous exposure to SARS-CoV-2 does not guarantee immunity in all cases.

20.
Health Care Manag Sci ; 24(2): 286-304, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33839993

RESUMEN

The Covid-19 pandemic challenges healthcare systems worldwide while severely impacting mental health. As a result, the rising demand for psychological assistance during crisis times requires early and effective intervention. This contributes to the well-being of the public and front-line workers and prevents mental health disorders. Many countries are offering diverse and accessible services of tele-psychological intervention; Ecuador is not the exception. The present study combines statistical analyses and discrete optimization techniques to solve the problem of assigning patients to therapists for crisis intervention with a single tele-psychotherapy session. The statistical analyses showed that professionals and healthcare workers in contact with Covid-19 patients or with a confirmed diagnosis had a significant relationship with suicide risk, sadness, experiential avoidance, and perception of severity. Moreover, some Covid-19-related variables were found to be predictors of sadness and suicide risk as unveiled via path analysis. This allowed categorizing patients according to their screening and grouping therapists according to their qualifications. With this stratification, a multi-periodic optimization model and a heuristic are proposed to find an adequate assignment of patients to therapists over time. The integer programming model was validated with real-world data, and its results were applied in a volunteer program in Ecuador.


Asunto(s)
COVID-19/psicología , Salud Mental , Psicoterapia , Telemedicina , Triaje/métodos , Adulto , Ecuador , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Adulto Joven
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