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Drowning is a common cause of death and disability worldwide. We report the experience of Ecuador, a middle-income country, where a lifeguard training program was implemented to reduce incidents of drowning. We describe how “Project Ecuador” was able to expand from one to 20 beaches in a five-year period. We detail how these interventions triggered the creation of a self-sustained national program and a law proposal that guarantee a safe environment across the Ecuadorian coastal region. (Am J Public Health. 2022;112(11):1546–1550. https://doi.org/10.2105/AJPH.2022.307013 )

Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value 3 sec (13.7% vs. 30.1%, p-value

We aimed to describe the impact of a structured interventional program to improve learning and study skills in undergraduate medical students from a Latin American medical school. The interventional program’s design was based on diagnostic/prescriptive assessment test scores measuring ten scales. The program consisted of five tailored workshops. The cohort studied consisted of 81 third-year medical students. The outcome variable was the difference between “pre” and “post” test scores. The unadjusted score percentiles were used to compare improvement in learning and study skills. In addition, a sensitivity analysis was conducted to assess variation in the mean difference of the test scores by the number of workshops attended. The response rate was 100% (81/81) for the pre test and ~77% (62/81) for the post test. After the interventional program, nine out of ten scales showed statistical improvement, except for the scale of motivation. The scales with the highest and lowest percent change improvement were time management (66%, p-value

Older adults historically have been excluded from biomedical research, especially in low-and middle-income countries (LMICs). This study aims to assess the scientific production of older adults-related publications (OARPs) in Ecuador and uncover research gaps to inform health and aging policy. A Scopus search was performed to retrieve OARPs published from 2008 to 2018. Bibliometric indicators studied included the number of publications per year, study design, research focus, and research lines. A total of 121 OARPs were retrieved. Sixty-four articles (~ 53%) were excluded. Overall, the most common study designs were cross-sectional and case–control studies, 84.2% (n = 48) and 8.8% (n = 5), respectively. The primary research focus was in the clinical-surgical area (~ 51%), and the most prevalent research lines were in the epidemiology of older-related diseases (35%) and causes of older-related diseases (26.3%). Across the analyzed period, we were not able to find studies related with aging policy, and we found only one OARP dedicated to diagnosis/treatment and provision of geriatric services, respectively. Ecuadorian OARPs were scarce during the last decade, providing limited evidence to address health priorities of the local older population and to inform health policy making. Improving research on the older population would provide valuable inputs to key stakeholders to perform evidence-based policy development that ultimately will improve quality of life and long-term health outcomes in Ecuador and other LMICs.

Purpose Assess the impact of learner-specific interventions on third-year medical students to cope with quarantine distance learning due to the COVID-19 pandemic. Methods We conducted a nested cross-sectional and mixed-methods study in a sample of 81 third-year medical students. Two face-to-face interventions were designed and conducted to offer tools to improve study habits, time management, and prioritizing skills. A nine-item structured questionnaire was administered. Descriptive statistics was performed for the quantitative section and thematic analysis for the qualitative section. Results Of the study population, 74.1% (60/81) completed the online questionnaire, 65.4% were female, and the mean age of the sample was 21.4±1.2 years old. Overall, ~50% of participants affirmed that the workshops were useful to improve time management, organize tasks and adapt to the new study modality imposed by the COVID-19 pandemic. More than 60% of the students found the application of the provided tools during the interventions (SMART and COMPASS) useful to determine personal values and set a proper mindset for coping with distance learning. Further, 93.3% of the respondents applied the SMART strategy learned to set goals at least once during the confinement time. These findings were also seen in the thematic analysis. Conclusions Overall, most of the students found the workshops useful and were able to practice what they had learned during this pandemic lockdown. Medical schools and higher education institutions should evaluate the possibility of formally including study habit preparation for undergraduates’ students in order to provide resilience and successful academic adaptation during an ever-changing world.

Objective To identify the main sources of sodium in the Ecuadorian diet and determine knowledge, attitudes and practices related to the use of salt/sodium.Materials and Methods A cross-sectional study was conducted by taking a convenience sample of 177 adults. Socio-demographic, anthropometric and clinical data were collected. Frequency of consumption of food items high in sodium and knowledge, attitudes and practices regarding salt intake were evaluated.Results Meat products, sugary drinks, sausages, canned fish and seasonings are the food items with the highest consumption and sodium content. Nearly 97% of participants had a misperception about their sodium intake. While 99% know that a diet high in salt causes health problems, only 38.4% take a systematic action to regulate their salt intake.Conclusions There were a common misperception about sodium consumption. Only a small number of people take an action to reduce their consumption, although these actions was ineffective.

Purpose The purpose of this study is to evaluate the impact in the development of intracerebral hemorrhage in elderly critically ill patients who received prophylactic subcutaneous unfractionated heparin (SCUFH) less than 24 hours after undergoing emergency neurosurgery. Methods A retrospective analysis was performed on patients who underwent emergency neurosurgery and were admitted to the surgical intensive care unit (SICU) at a tertiary care center over a 10-year period. Administration of prophylactic SCUFH within 24 hours of neurosurgery was required for inclusion. Demographic and clinical characteristics were recorded. The primary outcome was a rate of postoperative hemorrhagic complications with respect to age. Results We identified 223 emergency neurosurgical patients: 100 (45%) patients did not receive prophylactic SCUFH and were excluded. The remaining 123 (55%) patients met all inclusion criteria, of whom 73 (59%) patients were under 65 years old, and 50 (41%) patients were over 65 years old. Patients under 65 years old had significantly lower body mass index (BMI), lower Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, and Simplified Acute Physiology Score (SAPS) scores, and shorter median SICU length of stay compared to patients over 65 years old. No statistically significant difference in the rate of postoperative hemorrhagic or non-hemorrhagic neurological complications was observed between patients in either age group. Conclusion Age over 65 years was not associated with a higher risk of postoperative hemorrhage in patients who received SCUFH after emergency neurosurgery. SCUFH can be safely used as a chemoprophylactic agent against venous thromboembolism for elderly patients when used within 24 hours after emergency neurosurgery.

Background: Over the past decade, the political movement called ‘Revolución Ciudadana’ implemented a variety of policies and interventions (P&I) in Ecuador to improve higher education and strengthen local research capacity. We refer specifically to the ‘Mandato 14’ and the Higher Education Law (LOES, Spanish acronym) launched in 2008 and 2010, respectively. Objective: To assess the impact of these P&I (Mandato 14/LOES) on the production of health sciences-related articles (HSRA), and the relationship of these HSRA with the country’s health priorities. Methods: A Scopus search was performed to retrieve HSRA published from 1999 to 2017. Bivariate analysis was used to assess variation between the period I (1999–2008) and period II (2009–2017). Further, we examined the association between the top 10 causes of mortality and the total HSRA output. Results: The final study sample consisted of 2784 articles. After 2008, Ecuadorian production of HSRA increased steadily from 671 to 2133 publications (p.05). Conclusions: Ecuadorian HSRA output increased significantly after 2008. This larger volume of scientific output could be the result to the Mandato 14/LOES implemented in the last decade. However, a low percentage of HSRA are dedicated to addressing the country’s health priorities. Proper planning, execution and monitoring of national health research agendas would reduce the mismatch between health burden and the HSRA output in Ecuador and other low-and middle-income countries.

Objective High sodium consumption is associated with cardiovascular disease (CVD). CVD is the leading cause of mortality in Ecuador, which may be caused in part by unhealthy eating habits. Currently, there are no data on the consumption of sodium using 24-hr urine samples. The aims of the study were to provide preliminary data of sodium intake in an urban population sample consisting of adults between 25 and 64 years old, and to explore the feasibility to conduct a population-level sodium intake determination by using 24-hr urine samples.Methods A cross-sectional study was conducted in a sample of 129 adults living in an urban setting. 24-hr urinary samples were collected and the WHO STEPS instrument was used to collect the socio-demographic and clinical characteristics of participants. A reference value of 2.0 g/day was used to differentiate between normal and high sodium intake groups.Results Participants’ median age was 39 years, 91% of them identified themselves as belonging to the mestizo race, and 60% were female. The average sodium intake was 2 655(±1 185) mg/d (range: 1 725 to 3 404), which is equivalent to a salt intake of 6.8 g/d (range: 4.4 to 8.7). Sodium intake was significantly higher in males than in females: 3 175(±1 202) mg/d vs. 2 304(±1 042) mg/d, respectively, (p

Resumen Introduccion y objetivo La mortalidad por enfermedad cardiovascular (ECV) se incrementara en America Latina debido al rapido envejecimiento de su poblacion. Sin embargo, existe poca informacion sobre la evaluacion del riesgo de ECV como medida de prevencion primaria en este grupo de alto riesgo. Material y metodos Se predijo el riesgo nacional de desarrollar ECV en la poblacion adulta mayor ecuatoriana utilizando los modelos Systematic COronary Risk Evaluation in Older Persons (SCORE OP) High y Low, por categorias de riesgo y region en el ano 2009. Se obtuvieron datos nacionales sobre factores de riesgo cardiovascular de la Encuesta sobre Salud, Bienestar y Envejecimiento. Se calculo el riesgo a 5 anos de desarrollar ECV y comparamos el grado de concordancia/reclasificacion entre modelos SCORE OP High y Low para estratificar a los individuos con alto riesgo. Se realizaron analisis por categoria de riesgo, region y sexo. Resultados En 2009, segun SCORE OP Low, aproximadamente el 42% de los adultos mayores en Ecuador tuvieron un alto riesgo de presentar ECV en un periodo de 5 anos. El grado de concordancia entre los modelos de prediccion SCORE OP High y Low fue moderado (prueba de kappa: 0,5), alrededor del 34% de los individuos fueron reclasificados en diferente categoria de riesgo y un tercio de la poblacion se hubiera beneficiado de una intervencion farmacologica para reducir el riesgo de ECV. Conclusiones El 42% de la poblacion adulta mayor ecuatoriana tuvo un alto riesgo de presentar ECV en un periodo de 5 anos, mostrando una urgente necesidad de intervencion de prevencion primaria en esta poblacion vulnerable de alto riesgo.

Introduction and objective Cardiovascular disease (CVD) mortality is predicted to increase in Latin America countries due to their rapidly aging population. However, there is very little information about CVD risk assessment as a primary preventive measure in this high-risk population. Material and methods We predicted the national risk of developing CVD in Ecuadorian elderly population using the Systematic COronary Risk Evaluation in Older Persons (SCORE OP) High and Low models by risk categories/CVD risk region in 2009. Data on national cardiovascular risk factors were obtained from the Encuesta sobre Salud, Bienestar y Envejecimiento. We computed the predicted 5-year risk of CVD risk and compared the extent of agreement and reclassification in stratifying high-risk individuals between SCORE OP High and Low models. Analyses were done by risk categories, CVD risk region, and sex. Results In 2009, based on SCORE OP Low model almost 42% of elderly adults living in Ecuador were at high risk of suffering CVD over a 5-year period. The extent of agreement between SCORE OP High and Low risk prediction models was moderate (Cohen's kappa test of 0.5), 34% of individuals approximately were reclassified into different risk categories and a third of the population would benefit from a pharmacologic intervention to reduce the CVD risk. Conclusions Forty-two percent of elderly Ecuadorians were at high risk of suffering CVD over a 5-year period, indicating an urgent need to tailor primary preventive measures for this vulnerable and high-risk population.

Objective:To quantify diet-related burdens of cardiometabolic diseases (CMD) by country, age and sex in Latin America and the Caribbean (LAC).Design:Intakes of eleven key dietary factors were obtained from the Global Dietary Database Consortium. Aetiologic effects of dietary factors on CMD outcomes were obtained from meta-analyses. We combined these inputs with cause-specific mortality data to compute country-, age- and sex-specific absolute and proportional CMD mortality of eleven dietary factors in 1990 and 2010.Setting:Thirty-two countries in LAC.Participants:Adults aged 25 years and older.Results:In 2010, an estimated 513 371 (95 % uncertainty interval (UI) 423 286–547 841; 53·8 %) cardiometabolic deaths were related to suboptimal diet. Largest diet-related CMD burdens were related to low intake of nuts/seeds (109 831 deaths (95 % UI 71 920–121 079); 11·5 %), low fruit intake (106 285 deaths (95 % UI 94 904–112 320); 11·1 %) and high processed meat consumption (89 381 deaths (95 % UI 82 984–97 196); 9·4 %). Among countries, highest CMD burdens (deaths per million adults) attributable to diet were in Trinidad and Tobago (1779) and Guyana (1700) and the lowest were in Peru (492) and The Bahamas (504). Between 1990 and 2010, greatest decline (35 %) in diet-attributable CMD mortality was related to greater consumption of fruit, while greatest increase (7·2 %) was related to increased intakes of sugar-sweetened beverages.Conclusions:Suboptimal intakes of commonly consumed foods were associated with substantial CMD mortality in LAC with significant heterogeneity across countries. Improved access to healthful foods, such as nuts and fruits, and limits in availability of unhealthful factors, such as processed foods, would reduce diet-related burdens of CMD in LAC.

Este artículo analiza el tema de la Bioética con una perspectiva de docentes/investigadores activos. La investigación da lugar a un círculo virtuoso en el que la generación de conocimiento de la práctica clínica permite traducir la información en bienes y servicios para el cuidado de la salud. En el Ecuador, SENESCYT, la instancia más alta en la administración de ciencia y tecnología no tiene injerencia en la regulación de la bioética en investigación en seres humanos; y por otro lado, el MSP cuya función es proveer únicamente servicios de salud ha tomado un papel protagónico en este sentido, pudiendo dar lugar a un conflicto de intereses. Al momento se ha impuesto una híper-regulación para la realización de estudios clínicos. Así por ejemplo, mientras en países desarrollados, las investigaciones observacionales con muestras biológicas se catalogan como de riesgo mínimo y pasan por una revisión expedita de los comités; en el Ecuador, la toma de muestras biológicas debe pasar por una aprobación del comité institucional en pleno; y además necesitan la aprobación del MSP. Esta situación se agrava aún más si se desea realizar un estudio de intervención, estos, adicionalmente requieren de la aprobación de la ARCSA, que tiene 36 requerimientos. A esta problemática hay que añadir el tiempo que las instancias regulatorias se toman para la aprobación de los proyectos, que fácilmente superan un año. Las barreras indicadas crean un escenario fértil para el incumplimiento de las regulaciones y la práctica de la corrupción. Un estudio encontró que los ensayos clínicos en el Ecuador se redujeron de forma significativa, de 6.7% a 1.8% en los últimos años. Surge entonces la interrogante sobre qué tan ético es que las instancias de control dificulten a que la universidad pueda cumplir con su papel de formar recursos humanos al más alto nivel y brindar el máximo beneficio para la población. ¿Por qué no considerar que todos los datos clínicos que se generan por la prestación de los servicios de salud pueda ser utilizados con fines de investigación? Para contrastar, la ley establece que los habitantes del Ecuador somos donantes de órganos a menos que cada persona indique lo contrario. Es necesario cambiar la híper-regulación actual en la práctica de investigación clínica que no es ética y que perjudica gravemente la generación de conocimiento y la formación de recursos humanos.

The present study aimed to predict the risk of developing cardiovascular disease (CVD) over a 5-year period and how it might vary by sex in an ethnically diverse population of older adults. We used a novel CVD risk model built and validated in older adults named the Systematic Coronary Risk Evaluation in Older Persons (SCORE OP). A population-based study analyzed a total of 1307 older adults. Analyses were done by various risk categories and sex. Of the study population, 54% were female with a mean age of 75±7.1 years. According to the SCORE OP model, individuals were classified as having low (9.8%), moderate (48.1%), and high or very high risk (42.1%) of CVD-related mortality. Individuals at higher risk of CVD were more likely to be male compared with females, 53.9% vs 31.8%, respectively (p

Cardiovascular disease (CVD) mortality is predicted to increase in Latin America countries due to their rapidly aging population. However, there is very little information about CVD risk assessment as a primary preventive measure in this high-risk population.We predicted the national risk of developing CVD in Ecuadorian elderly population using the Systematic COronary Risk Evaluation in Older Persons (SCORE OP) High and Low models by risk categories/CVD risk region in 2009. Data on national cardiovascular risk factors were obtained from the Encuesta sobre Salud, Bienestar y Envejecimiento. We computed the predicted 5-year risk of CVD risk and compared the extent of agreement and reclassification in stratifying high-risk individuals between SCORE OP High and Low models. Analyses were done by risk categories, CVD risk region, and sex.In 2009, based on SCORE OP Low model almost 42% of elderly adults living in Ecuador were at high risk of suffering CVD over a 5-year period. The extent of agreement between SCORE OP High and Low risk prediction models was moderate (Cohen's kappa test of 0.5), 34% of individuals approximately were reclassified into different risk categories and a third of the population would benefit from a pharmacologic intervention to reduce the CVD risk.Forty-two percent of elderly Ecuadorians were at high risk of suffering CVD over a 5-year period, indicating an urgent need to tailor primary preventive measures for this vulnerable and high-risk population.