A census, uniform screening questionnaire, and simple screening neurologic examination were administered in a door-to-door survey to residents of Quiroga, Ecuador, a rural community in the Andes Mountains. The screening procedures had been pretested to assure a high level of sensitivity for detecting children and adults with major neurologic disease. A total of 1,113 participated in the study. Of these, 399 had responses or findings suggesting the presence of neurologic disease. These individuals were then examined by a neurologist, who used fixed diagnostic criteria. The prevalence ratios (per 1,000) for the most common neurologic conditions identified in this survey are: recurrent/persistent severe headache = 68.3, and epilepsy = 17.1.

Rev Fac Cien Med (Quito), 2018; 43 (1): 46 La atención del cáncer en el Ecuador: pasado, presente y futuro Rev. Fac Cien Med (Quito), 2018; 43(1): Recibido: 09/08/17; Aceptado: 04/12/17 Autor correspondiente: José Ruales jose.ruales@quito.gob.ec Resumen:Contexto: el Ecuador tiene un sistema nacional de salud caracterizado por una amplia fragmentación institucional, por segmentación poblacional y del financiamiento. Esto determina una distribución inequitativa de recursos y servicios para el control del cáncer. SOLCA es una organización privada que desde 1951, ofrece al país atención especializada en cáncer. Por otra parte, la incorporación de los servicios de oncología en los hospitales públicos del MSP es relativamente reciente.Discusión: la nueva Estrategia Nacional para la Atención Integral del Cáncer en Ecuador incluye líneas de acción dirigidas a la prevención, detección temprana, diagnóstico, tratamiento, rehabilitación y cuidados paliativos, promoviendo la acción social e intersectorial e incidiendo en la educación de la población. Además, se espera que esta estrategia disminuya la carga socioeconómica, promueva la calidad de vida y reduzca la inequidad en el acceso a los servicios de salud; sin embargo, su adecuada implementación requerirá de la participación y los esfuerzos de todos los sectores involucrados, incluyendo las organizaciones civiles.Conclusión: el control y atención integral del cáncer en Ecuador debe ser una prioridad nacional por lo cual, las decisiones y acciones futuras, deberán basarse en una responsabilidad compartida entre los diferentes actores, en el marco de una verdadera conciencia social y en la aplicación del derecho constitucional a la salud.Descriptores DeCs: sistemas de atención en salud, estrategia nacional del cáncer, salud pública, cáncer, América Latina, Ecuador, SOLCA Abstract:Context: Ecuador has a national health system characterized by a wide institutional fragmentation, by population segmentation and financing. This determines an inequitable distribution of re-sources and healthcare services for cancer control. The Society for the Fight against Cancer (SOLCA) is a private organization that, since 1951, offers specialized cancer care in the country. On the other hand, the incorporation of oncology services in public hospitals of the MSP is relatively recent.Discussion: dthe new National Strategy for Comprehensive Cancer Care in Ecuador includes lines of action aimed at prevention, early detection, diagnosis, treatment, rehabilitation and palliative care, promoting social and intersectoral action, and influencing the education of the population. In addition, this strategy is expected to reduce the socioeconomic burden, promote quality of life and reduce inequity in access to health services. However, its proper implementation will re-quire the participation and efforts of all the sectors involved, 46-59 46-59

Hypertension is a growing concern worldwide, causing over 10 million deaths each year. The prevalence of high blood pressure (BP) in Argentina is 36.3% and 38% of these are unaware of their disease. Half of the hypertensive patients are on pharmacological treatment and only a quarter of them are controlled. The International Society of Hypertension initiated the May Measurement Month (MMM) as a global campaign to raise awareness on high BP that may also serve as a temporary solution to the lack of global screening programs worldwide. A volunteer cross-sectional survey was carried out in May 2017 across 56 health centres. Blood pressure measurement, definition of hypertension and statistical analysis followed the MMM protocol. For this awareness campaign, the Argentine Society of Hypertension coined the slogan: ‘Know and control your blood pressure’. A total of 32 346 individuals aged at least 18 years were screened during MMM17. After imputation, 16 263 (50.4%) were hypertensive. Of the 12 156 receiving antihypertensive medication 5400 (44.4%) still had uncontrolled BP. MMM17, called in our country ‘Know and control your blood pressure’, was the largest BP screening campaign done in Argentina. Almost 6 out of 10 hypertensive patients were either not on treatment or were not controlled to the BP goal. These results suggest that appropriate screening can help to identify a significant number of people with high BP.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Previous hypertension surveys in Ecuador, showed that there was a prevalence of 28% of adults with hypertension in 1999, 53% in adults between 60 and 75 years in 2010, and. 9.3% in people between 18 and 59 years in 2012 [Freire WB, Ramírez-Luzuriaga MJ, Belmont P, Mendieta MJ, Silva-Jaramillo MK, Romero N, Sáenz K, Piñeiros P, Gómez LF, Monge R. Tomo I: Encuesta Nacional de Salud y Nutrición de la población ecuatoriana de cero a 59 años. ENSANUT-ECU 2012. Ministerio de Salud Pública/Instituto Nacional de Estadísticas y Censos. Quito-Ecuador 2014]. The May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP that can temporarily address the lack of screening programmes worldwide. Verbal informed consent was obtained from respondents. We enrolled 16 sites for the measurement of arterial BP and completion of the MMM17 questionnaire, the most important sites being: Guayaquil, Quito, Cuenca, Milagro, Esmeraldas, Duran, Naranjito, and Machala. We administered the MMM17 survey on 6984 people, of which 50.5% of them were men and 48.4% were women. Mean age was 46.62 ± 17.71 SD. The crude mean BP was 115/74 mmHg. Of the 6984 people who completed the survey, we had 1522 that were already taking anti-hypertensive treatment. The number of people with hypertension (≥140 or ≥90 or on treatment for hypertension) was 1968/6982 (28.2%) persons. The number of people with hypertension of those not receiving treatment was 446/5460 (8.2%) and the number of people receiving treatment but with controlled and uncontrolled BP was 1136/1522 (74.6%) and 386/1522 (25.4%), respectively. MMM17 was the largest BP screening campaign undertaken in Ecuador. We identified 446 people with hypertension that were not receiving any treatment and 386 people with uncontrolled hypertension. These results suggest that opportunistic screening can identify significant numbers with raised BP.

Arterial hypertension is a growing burden worldwide, leading to over 10.8 million deaths each year. In Ecuador, it is the main risk factor for the major cause of death, coronary, and cerebrovascular disease [GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1923–1994]. The May Measurement Month Campaign in 2019 (MMM19) is a global initiative of the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programs worldwide. A volunteer cross-sectional survey was carried out in May 2019 across 42 health centres in Ecuador. The average age was 51 (SD ±17.6) years. Blood pressure measurement, the definition of hypertension (mean of the second and third BP measurement ≥140/90 mmHg or who were medicated for high BP), and statistical analysis followed the standard MMM protocol. In total, 15 885 volunteers participated in MMM19. After multiple imputation, 6654 (41.9%) had hypertension. Of individuals not receiving antihypertensive medication, 2383 (20.5%) were hypertensive. Of individuals receiving antihypertensive medication, 1004 (23.5%) had uncontrolled BP. May Measurement Month 2019 was the largest BP screening campaign done in Ecuador. In the survey, including 6654 participants with hypertension, only 49.1% had their BP values controlled (<140/90 mmHg). May Measurement Month 2019 demonstrated a high prevalence of hypertension among volunteer screenees in our country. The high percentage of persons untreated or with uncontrolled hypertension while on pharmacologic treatment suggest that appropriate screening can help to identify a significant number of people with high BP. These data should attract the attention of health care providers and the healthcare system in Ecuador.