RESUMO
OBJECTIVE: The present study seeks to analyse sociodemographic determinants related to severe acute respiratory infections (SARI) and calculate the priorization index in the cantons of Ecuador to identify areas probably most vulnerable to COVID-19 transmission. DESIGN: This descriptive ecological observational study. SETTING: 224 cantons (geographical area) of Ecuador with secondary data sources of hospital information. PARTICIPANTS: The unit of measurement was 224 cantons of Ecuador, in which analysed morbidity and lethality rates for SARI using hospital release data (2016-2018). MAIN MEASUREMENTS: Eight sociodemographic indicators were structuralized, and correlation tests applied for a multiple regression model. The priorization index was created with criteria of efficiency, efficacy, effect size (IRR) and equity. Using the sum of the index for each indicator, the priorization score was calculated and localized in a territorial map. RESULTS: Morbidity associated factors where: school attendance years, urbanization and population density; for mortality resulted: school attendance and ethnics (indigenous) IRR: 1.09 (IC95%:1.06-1.15) and IRR: 1.024 (IC95%:102-1.03) respectively. With lethality where related cantons, with population older than 60 years, IRR: 1.049 (IC95%: 1.03-1.07); 87 cantons had high priority mostly localized in the mountain region and the Morona Santiago Province. CONCLUSIONS: Morbidity and mortality of SARI in Ecuador are associated to social and demographic factors. Priorization exercises considering these factors permit the identification of vulnerable territories facing respiratory disease propagation. The social determinants characteristic for each territory should be added to known individual factors to analyse the risk and vulnerability for COVID in the population.
Assuntos
COVID-19/etiologia , COVID-19/prevenção & controle , Determinantes Sociais da Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/transmissão , Criança , Pré-Escolar , Equador/epidemiologia , Meio Ambiente , Feminino , Mapeamento Geográfico , Humanos , Lactente , Recém-Nascido , Influenza Humana/epidemiologia , Influenza Humana/etiologia , Influenza Humana/prevenção & controle , Influenza Humana/transmissão , Masculino , Pessoa de Meia-Idade , Pandemias , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Socioeconômicos , Populações Vulneráveis , Adulto JovemRESUMO
El consumo de drogas es una importante causa de morbimortalidad a nivel mundial y su impacto genera gastos sanitarios, económicos y sociales importantes. Las mayores tasas de consumo de drogas se observan en la población entre 18 y 25 años en donde una proporción importante son estudiantes universitarios. El objetivo de este estudio fue calcular la prevalencia del consumo de riesgo de sustancias entre estudiantes, profesores y trabajadores de una universidad pública del Ecuador. Además, se realizó el cálculo de la consistencia interna (confabilidad) del cuestionario ASSIST modifcado. Pacientes y Métodos: Se realizó un estudio analítico transversal, se aplicó la prueba de Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) en dos grupos poblacionales (estudiantes y trabajadores docentes). La consistencia interna de cada subescala del cuestionario fue evaluada con alfa (α) de Cronbach. Para estimar la prevalencia del consumo de riesgo se utilizó porcentajes con intervalos de confanza (IC) del 95%. Resultados: 4958 estudiantes y 425 profesores, trabajadores y empleados respondieron el cuestionario ASSIST. El cálculo de la consistencia interna (confabilidad) del instrumento, demostró un α de Cronbach satisfactorio (>0.7) para consumo de: tabaco, alcohol y marihuana. La prevalencia del consumo de riesgo alto para alcohol (5,3% para estudiantes y 4,9% para trabajadores y docentes), tabaco y cannabis fue elevada en los grupos estudiados. Además, el porcentaje de la población con consumo de riesgo moderado también fue signifcativo. Conclusión: En virtud de las elevadas tasas de consumo de riesgo alto y moderado para el consumo de drogas, es necesario la implementación de un programa Integral de promoción, prevención, tratamiento y rehabilitación dirigido a estudiantes universitarios. La prueba ASSIST modifcada mostró una consistencia interna satisfactoria en la evaluación del consumo de riesgo de substancias.
Drug use is a major cause of global morbidity and its impact generates signifcant health, economic and social expenditures. The highest rates of drug use are seen in the population between the ages of 18 and 25, where a signifcant proportion are university students. The objective of this study was to calculate the prevalence of substance risk consumption among students, professors and workers at a public university in Ecuador. In addition, the calculation of the internal consistency (reliability) of the modifed ASSIST questionnaire was performed. Patients and Methods: A cross-analytical study was conducted, the Alcohol, Tobacco and Substances Consumption Detection (ASSIST) test was applied in two population groups (students and workers teachers). The internal consistency of each subscale of the questionnaire was evaluated with Cronbach's alpha. Percentages with 95% CI were used to estimate the prevalence of risk consumption. Results: 4958 students and 425 teachers, workers and employees responded to the ASSIST questionnaire. The calculation of the internal consistency (reliability) of the instrument, proved Cronbach satisfactory (>0.7) for consumption of tobacco, alcohol and marijuana. The prevalence of high-risk alcohol use (5.3% for students and 4.9% for workers and teachers), tobacco and cannabis were high in the groups studied. In addition, the percentage of the population with moderate risk consumption was also signifcant. Conclusions: Under the high rates of high and moderate risk use for drug use, it is necessary to implement a comprehensive program of promotion, prevention, treatment and rehabilitation aimed at university students. The modifed ASSIST test showed satisfactory internal consistency in the assessment of substance risk consumption.
Assuntos
Humanos , Masculino , Feminino , Estudantes , Diagnóstico , Abuso Oral de Substâncias , Universidades , Pessoal AdministrativoRESUMO
Chagas disease is a parasitic disease caused by the protozoan parasite Trypanosoma cruzi and about 230,000 persons are estimated to be infected in Ecuador. However, limited studies have been performed in the Amazon region, on the eastern side of the country. We evaluated here the seroprevalence of Trypanosoma cruzi infection in 12 rural villages of the Loreto canton, Orellana Province in schoolchildren aged 5-15 years and in pregnant women. A total of 1,649 blood samples were tested for Trypanosoma cruzi antibodies by enzyme-linked immunosorbent assay and indirect hemaglutination, and discordant samples were tested by indirect immunofluorescence assay. We detected a seroprevalence of anti-Trypanosoma cruzi antibodies of 1.3% in schoolchildren aged 5-15 years, indicating the persistence of a constant and active vectorial transmission in the Loreto County and confirming the need of the implementation of nonconventional vector control. We also observed a seroprevalence of 3.8% in pregnant women, indicating a clear risk of congenital transmission. Further studies should help define this risk more precisely and implement current international guidelines for the diagnosis, treatment, and care of these cases.
Assuntos
Doença de Chagas/epidemiologia , Trypanosoma cruzi , Adolescente , Anticorpos Antiprotozoários/sangue , Anticorpos Antiprotozoários/imunologia , Criança , Pré-Escolar , Equador/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Testes de Hemaglutinação , Humanos , Masculino , Gravidez , Estudos Soroepidemiológicos , Trypanosoma cruzi/imunologiaRESUMO
En pacientes con síndrome coronario agudo los puntajes de riesgo GRACE y TIMI son herramientas para estimar el pronóstico de desenlaces cardiovasculares. Las comparaciones entre ambos puntajes en poblaciones latinoamericanas son escasas. Objetivo Comparar la capacidad discriminatoria de los puntajes GRACE y TIMI para eventos cardiovasculares durante la hospitalización en pacientes con infarto de miocardio sin elevación ST (IMSEST) y angina inestable (AI). Diseño Cohorte retrospectiva. Lugar y sujetos 378 pacientes con diagnóstico de IMSEST o AI atendidos durante el período 2011 2014 en el Hospital Carlos Andrade Marín de la ciudad de Quito. Mediciones principales Puntaje de riesgo GRACE, puntaje de riesgo TIMI, aparición de eventos cardiovasculares (muerte, reinfarto, angina refractaria e intervención coronaria de urgencia) durante la hospitalización. Capacidad discriminatoria de los puntajes evaluada mediante curvas ROC. Resultados En los pacientes predominó el sexo masculino (78%). En orden de frecuencia los eventos cardiovasculares fueron: intervención coronaria de urgencia (51%), angina refractaria (12%), muerte (9%) y reinfarto (5%). El score GRACE presentó resultados de área bajo la curva (AUC) mayores y estadísticamente signifcativos para muerte (AUC: 0.72; ρ<0.0001), mientras que para angina refractaria e intervención coronaria de urgencia, el score TIMI tuvo resultados estadísticamente signifcativos; sin embargo su AUC no presentó valores representativos. Para el reinfarto el score GRACE presentó valores estadísticos limítrofes con una AUC baja. Conclusión El score GRACE tiene una mejor capacidad pronóstica para muerte y reinfarto frente al score TIMI en pacientes con IMSEST y AI
The risk scores GRACE and TIMI are tools to estimate the prognosis of cardiovascular outcomes in patients with acute coronary syndrome. There are few comparisons between the two scores in Latin American populations. Objective To compare the discriminatory ability of GRACE and TIMI scores for cardiovascular events during hospitalization in patients with myocardial infarction without ST elevation (NSTEMI) and unstable angina (UA). Design Retrospective cohort. Subjects and settings 378 patients with a diagnosis of NSTEMI or UA attended during the period 2011-2014 in the Carlos Andrade Marín Hospital, Quito-Ecuador. Main measurements GRACE risk score, TIMI risk score, cardiovascular events (death, reinfarction, refractory angina and emergency coronary angioplasty) during hospitalization. Discriminatory capacity of the scores assessed by ROC curves. Results Male patients were the most frequent (78%). The frequency of cardiovascular events was: emergency coronary angioplasty (51%), refractory angina (12%), death (9%) and re-infarction (5%). The GRACE score showed higher and statistically signifcant results of area under the curve (AUC) for death (AUC: 0.72; ρ<0.0001), whereas for refractory angina and emergency coronary angioplasty the TIMI score had statistically signifcant results; however the AUC did not provide representative values. For re-infarction the GRACE score presented borderline statistical values with low AUC. Conclusion The GRACE score has a better prognostic value for death and reinfarction compared to TIMI score in patients with NSTEMI and AI
Assuntos
Humanos , Síndrome Coronariana Aguda , Infarto do Miocárdio sem Supradesnível do Segmento ST , Angina Instável , Prognóstico , Hospitalização , Infarto do MiocárdioRESUMO
RATIONALE: Bedside use of Bayes' theorem for estimating probabilities of diseases is cumbersome. An alternative approach based on five categories of powers of tests from 'useless' to 'very strong' has been proposed. The performance of clinicians using it was assessed. METHODS: Fifty clinicians attending a course of tropical medicine estimated powers of tests and post-test probabilities using the classical vs. the categorical Bayesian approach. The estimation of post-test probability was assessed for real and dummy diseases in order to avoid the bias of previous knowledge. Accuracy of answers was measured by the difference with reference values obtained from an expert system (Kabisa). RESULTS: Clinicians estimated positive likelihood ratios (LRs) a median of -1.07 log(10) lower than Kabisa [interquartile range (IQR): -1.47; -0.80] when derived classically and -0.17 (IQR: -0.42; +0.04) when estimated categorically (P < 0.001). For negative LRs the median was +0.39 log(10) higher (IQR: +0.71; +0.08) when derived classically and -0.18 log(10) lower (IQR: +0.03; -0.36) when estimated categorically (P < 0.001). Twenty (40%) disclosed not being able to calculate post-test probabilities using sensitivities and specificities. Regardless the approach post-test probabilities were overestimated both for real and dummy diseases [respectively +1.23 log(10) (IQR: +0,67; +2.08) and +2.03 log(10) (IQR: +0.49; +2.42)] (P = 0277), but the range was wider for the latter (P = 0.001). CONCLUSIONS: Participants were more accurate in estimating powers with a categorical approach than with sensitivities and specificities. Post-test probabilities were overestimated with both approaches. Knowledge of the disease did not influence the estimation of post-test probabilities. A categorical approach might be an interesting instructional tool, but the effect of training with this approach needs assessment.
Assuntos
Teorema de Bayes , Competência Clínica/normas , Técnicas e Procedimentos Diagnósticos/normas , Intuição , Funções Verossimilhança , Sensibilidade e Especificidade , Adulto , África/epidemiologia , Análise de Variância , Apendicite/diagnóstico , Apendicite/epidemiologia , Bélgica , Epidemiologia/educação , Sistemas Inteligentes , Feminino , Humanos , Masculino , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/epidemiologia , Probabilidade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Software , Estatísticas não Paramétricas , Inquéritos e Questionários , Medicina Tropical/educação , Medicina Tropical/métodos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologiaRESUMO
Esta revisión estadística tiene por objeto poner a disposición de los niveles provinciales y locales, la información epidemiológica obtenida del formulario EPI 1 (1998); útil para la definición de prioridades y toma de decisiones. Para ello, se escogió las cinco patologías con las tasas de incidencia más altas en cada provincia. Las tasas se calcularon por 100.000 habitantes para las patologías que afectan a la población general y 100.000 nacidos vivos para el tétanos neonatal. Según los resultados, las enfermedades más frecuentes fueron: el paludismo, como la primera causa de morbilidad, especialmente en la Costa y el Oriente, seguido por las intoxicaciones alimentarias. En tercer lugar, las enfermedades eruptivas...
Assuntos
Doenças Endêmicas , Epidemiologia , EquadorRESUMO
El desarrollo teórico, metodológico y práctico de la Epidemiología Comunitaria tiene como antecedente la Declaración de Alma Ata y por lo tanto la formulación de la Estrategia de Atención Primaria para la Salud como política para que los pueblos aclcancen un estado de salud y vida satisfactorio