Objetivo: analizar determinantes sociodemográficos relacionados con IRAg y calcular un índice de priorización en los cantones del Ecuador para identificar áreas vulnerables para transmisión COVID-19. Diseño: Estudio observacional ecológico descriptivo. Emplazamiento: 224 cantones del Ecuador con fuentes de datos secundarios de información hospitalaria. Participantes: La unidad de medida fueron 224 cantones del Ecuador, en las cuales se analizó tasas de morbilidad y letalidad por IRAg con datos de egresos hospitalarios (2016-2018). Mediciones principales: Se estructuraron 8 variables sociodemográficos y se aplicaron pruebas correlacionales (modelo de regresión múltiple). El índice de priorización considera criterios de eficiencia, eficacia, tamaño de efecto y equidad; usando la suma para cada indicador, se calculó el puntaje de priorización. Resultados: Factores asociados con morbilidad por IRAg fueron: escolaridad, urbanización y densidad poblacional; para mortalidad fueron: escolaridad y etnia (indígena) IRR:1.09 (IC95%:1.06-1.15), IRR:1.024 (IC95%:1.02-1.03) respectivamente. Con letalidad se asociaron los cantones con población mayor de 60 años (IRR:1.049 IC95%:1.03-1.07). Se obtuvo 86 cantones de alta prioridad, mayoritariamente localizados en la región sierra centro y la provincia de Morona Santiago. Conclusiones: Morbilidad y mortalidad por IRA grave en Ecuador se asociaron a factores sociales y demográficos. Los ejercicios de priorización que consideran estos factores permiten identificar territorios vulnerables durante la propagación de enfermedades respiratorias. Determinantes sociales propias de cada territorio deben sumarse a factores individuales conocidos, para analizar riesgo y vulnerabilidad por COVID.

Purpose: To explore the effects of mobility restriction on the mental health of Ecuadorian young adults. Methods: The current is a cross-sectional study that included 8426 young adults. Socio-demographic and mental health data were collected through an online survey during May and June 2020 in Ecuador. Data on mobility was extracted from Google Mobility Reports. Four aspects of the participants’ mental health were evaluated: eating behavior (emotional eating), depression, sleep quality and sense of coherence using previously validated instruments. Data were analyzed using linear regression using R. Results: Mean age of the participants was 22.85 (SD = 4.43), most of whom were women (n = 5943, 70.53%). During mandatory confinement, mobility due to retail and recreation, to groceries and pharmacies, to parks, to transit stations, to workplaces were reduced by nearly 50%. In contrast, mobility to places of residence increased by nearly 20%. A reduction in mobility to workplaces was associated to less healthy eating behavior, depression and worse sleep quality. Less healthy eating behavior was also associated to decreased mobility due to recreation and retail and increased mobility to transit stations. Sense of coherence was not associated to changes on mobility. Women and youngsters more often showed depression, less healthy eating behavior, worse quality of sleep and lower sense of coherence. Conclusion: Mobility restrictions during COVID-19 pandemic has negative effects on people's mental health. Prevention and health promotion measures directed to ameliorate the effects of confinement on mental health should target risk populations including women and youngsters.

La bioética es una disciplina trascendental en la formación médica para la toma de decisiones. Profesores y estudiantes se encuentran alejados de los conocimientos adecuados. Se planteó un estudio descriptivo de corte transversal. Se encuestaron 15 profesores y 231 estudiantes para evaluar el grado de conocimientos bioéticos con una encuesta estandarizada. Se encontraron bajos niveles de conocimiento en profesores y estudiantes por debajo del 70%. Se comparó en conocimientos a médicos de Argentina, México y Ecuador sin encontrarse diferencias significativas. El nivel de conocimientos sobre bioética en profesores y estudiantes es limitado. Es indispensable establecer programas de formación y capacitación.

Drug use is a major cause of global morbidity and its impact generates significant 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 significant 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 modified 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 significant. 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 modified ASSIST test showed satisfactory internal consistency in the assessment of substance risk consumption.

IntroductionHealth professional’s exposure to the new coronavirus (SARS-CoV-2) as well as their risk of acquiring COVID-19 “its associated disease”, has been higher compared to other population groups. Nevertheless, the correct implementation of biosecurity measures could reduce their infection risk. The objective of this study was to evaluate the availability of personal protective equipment “PPE”, occupational risks and its relationship with COVID-19 in health professionals.Patients and methods603 subjects among students, teachers, and health professionals were included in a cross-sectional descriptive observational study. Occupational exposure and incidence of COVID-19 were the main measurements. ResultsMost of the subjects were women (73.5%) and young adults (92.6%) and 23.55% (95% CI 20.3-27.1) referred a diagnosis of COVID-19 (15% confirmed, 8% suspected). People who worked in Pichincha’s province and those who did not have soap presented a higher risk of COVID-19 infection (adjusted OR= 2.85 and 2.68 respectively). Contact with confirmed and suspicious cases were the variables that were associated with the highest risk of infection (adjusted OR= 9.28 and 3.07 respectively).Conclusions The high incidence of COVID-19 in the subjects was associated with PPE deficiencies. Health professional’s protection must be a priority for health and labor authorities, who must also provide the PPE and necessary supplies. A periodic screening in this occupational group to assess the impact of protective measures and analyze the implementation of necessary corrections.is recommended.

IntroductionCurrent evidence still does not support the role of vitamin B12 or vitamin D in age-associated cognitive impairment.ObjectiveEvaluate the association between vitamin B12 and D and cognitive function in elders.MethodologySample included 1733 individuals 60 years old and older, who participated in the SABE study that was carried out in Ecuador. Cognitive function was measured using abbreviated version of minimental state examination (MMSE). Vitamin B12 and D were measured in blood. Data were analyzed through linear regression models with restricted cubic splines (RCSs). Models were adjusted by sex, years of education, region (urban highland, urban coast, rural highlands, rural coast), socioeconomic status, and ethnicity.ResultsIndependently from sex, age, years of education, ethnicity, socioeconomic status and geographical zone of residence, we found that vitamin B12 but not vitamin D levels were associated with cognitive function in a representative group of Ecuadorian elders. Elders with lower levels of vitamin B12 showed lower MMSE scores in comparison to elders with higher levels of vitamin B12. Moreover, a statically significant non linear interaction was found between vitamin B12 and age with respect to cognitive function. In this way, we observed that in elders 75 years old and older whose levels of vitamin B12 were 271 pg/ml or less, the drop of cognitive function was particularly steep in comparison to elders whose levels of vitamin B12 were 647 pg/ml or more.ConclusionsLow levels of vitamin B12 but not of vitamin D are associated with low cognitive functioning.

Purpose: To explore the effects of mobility restriction on the mental health of Ecuadorian young adults. Methods: The current is a cross-sectional study that included 8426 young adults. Socio-demographic and mental health data were collected through an online survey during May-June 2020 in Ecuador. Data on mobility was extracted from Google Mobility Reports. Four aspects of the participants’ mental health were evaluated: eating behavior (emotional eating), depression, sleep quality and sense of coherence using previously validated instruments. Data were analyzed using linear regression using R. Results: Mean age of the participants was 22.85 (SD = 4.43), most of whom were women (n = 5943, 70.53%). During mandatory confinement, mobility due to retail and recreation, to groceries and pharmacies, to parks, to transit stations, to workplaces were reduced by nearly 50%. In contrast, mobility to places of residence increased by nearly 20%. Less healthy eating behavior was associated with lower mobility to retail/recreation, residential or workplaces. Depression was associated with lower mobility to residential and workplaces. Worse quality of sleep was associated with lower mobility to retail/recreation, residential and workplaces. Higher sense of coherence was associated with higher mobility to residential and to workplaces. Women and youngsters more often showed depression, less healthy eating behavior, worse quality of sleep and lower sense of coherence. Conclusion: Mobility restrictions during COVID-19 pandemic has negative effects on people's mental health. Prevention and health promotion measures directed to ameliorate the effects of confinement on mental health should target risk populations including women and youngsters.

Antecedentes: La infección por el virus Zika se ha asociado con abortos y en los recién nacidos con un patrón de anomalías del desarrollo denominado síndrome del Zika congénito. El inicio del brote de Zika en el Ecuador coincidió con el terremoto en Pedernales aumentando su riesgo y vulnerabilidad. El objetivo de este estudio fue evaluar los Conocimientos, Actitudes y Prácticas de los jefes de familia con relación al Zika en el embarazo. Metodología: Se realizó un estudio observacional, exploratorio, descriptivo y transversal, mediante la aplicación de una encuesta sobre conocimientos, actitudes y prácticas en la enfermedad viral de Zika, a los habitantes (jefe de hogar) del área urbana de la ciudad de Pedernales. Fue realizada en septiembre 28 y 29 del 2016. Resultados: Se encuestaron 60 jefes de familia. El 78,3 % de las personas encuestadas fueron mujeres. El 65% de jefes de familia encuestados no tenía empleo. El 83.3% de la población conoce que la enfermedad se puede dar por la picadura del mosquito. El 16.7% de encuestados conoce que la transmisión puede darse por vía sexual. En cinco mujeres embarazadas encontradas (8.3%), dos tuvieron síntomas sugestivos de Zika en el embarazo y ninguna se realizó pruebas diagnósticas para la enfermedad por Zika. El 38,3% de los encuestados opina que las mujeres que contraigan el virus de Zika durante el embarazo deberían tener acceso a servicios de aborto seguro y legal. Discusión: El riesgo elevado frente al Zika resulta evidente debido a la condición post terremoto. Los conocimientos, actitudes y prácticas de Zika relacionados con el embarazo en Pedernales fueron inadecuados por lo que se debe fortalecer los conocimientos sobre mecanismos de transmisión del Zika principalmente de la vía sexual.