Validation of TMMS-24 in Three Spanish-Speaking Countries: Argentina, Ecuador, and Spain

Emotional intelligence (EI) is a fundamental skill related to different aspects of human life, such as psychological well-being or mood states. The present study has a triple objective: first, to explore the psychometric properties of the TMMS-24 in three Spanish-speaking countries (Argentina, Ecuador, and Spain); second, to examine the relation of EI with mood and avoidance of responsibility; and finally, to analyse the influence of sex, age and national differences on EI. The relevance of this study is given by the need for tools to assess EI in different cultures. A sample of 1048 adults (Mage = 21.11 years, SD = 5.84; 52.3% male) was selected by convenience sampling. The psychometric properties of the TMMS-24 were adequate, and the Spanish sample showed lower levels of EI than the Argentinian and Ecuadorian ones. EI was associated with mood and the avoidance of responsibility, with higher levels in women in all cases. Regarding the national and sex-specific differences, the Spanish sample showed significant differences in attention and repair, with men exhibiting higher scores in attention and women having higher scores in repair. In the Argentinean sample, no significant differences were found, and in the Ecuadorian one, women presented higher scores in attention than men. The TMMS-24 can be considered a useful, practical tool to assess EI in adults in different cultures and with different languages.

Antimicrobial resistance in Galapagos tortoises as an indicator of the growing human footprint

Antimicrobial resistance has become one of the main public health threats worldwide with anthropogenic activities driving the spread of resistance. Understanding and combatting the spread of resistant bacteria is a top priority for global health institutions, and it is included as one of the main goals of the One Health initiative. Giant tortoises (Chelonoidis spp.), some of the most iconic species on Earth, are widely distributed across the Galapagos archipelago and are thus perfect candidates to test the hypothesis that wildlife species in the Galapagos carry antimicrobial resistant genes (ARGs) associated with human activities. We sampled a total of 200 free-living Galapagos tortoises from western Santa Cruz Island (C. porteri), the most human-populated island of the archipelago, and 70 tortoises (C. vandenburghi) from the isolated Alcedo Volcano on Isabela Island, a natural area with minimal human presence. Fecal samples were analyzed by quantitative PCR for a panel of 21 ARGs conferring resistance for eight antimicrobial classes. We found ARGs in both Santa Cruz and Alcedo Volcano giant tortoises; however, both qualitative and quantitative results showed higher loads of ARGs in tortoises inhabiting the human modified environments of Santa Cruz. Moreover, Santa Cruz tortoises sampled in higher human-modified landscapes (i.e., farmlands and urban areas) presented a higher number of ARGs, antimicrobial classes, and multi-resistant microbiomes than those from less anthropized areas within the same island. Our findings suggest that human activities in Galapagos have a negative impact on ecosystem health through ARG dispersal. This research highlights a new threat for the health and conservation of the unique wildlife of the Galapagos, their ecosystems, and the humans inhabiting this World Heritage Site. Our recommendation to local policy makers is to control and reduce the use of antibiotics in both human and animal health, thus helping enforce antimicrobial regulations.

Cadmium retention and microbial response in volcanic soils along gradients of soil age and climate on the Galápagos Islands

The behavior of trace metals may vary strongly in the course of volcanic soil development. Cadmium retention in soils is specifically important for some Galápagos islands where agriculture is leading to anthropogenic Cd contamination. To assess the influence of soil development factors on soil Cd retention and toxicity, we performed Cd sorption-desorption experiments with volcanic topsoils from the Galápagos Islands sampled along gradients of (a) substrate age (chronosequence, 1.5-1,070 ka) and (b) climate (elevation sequence, 47-866 m asl) ranging from arid lowland areas to humid highland areas. Additionally, the effects of Cd toxicity on the soil microbial community composition were evaluated for two soils of the chronosequence. In young volcanic soils, the sorption capacity was very high but decreased rapidly with soil age and increasing elevation. These trends were coupled with decreases in soil weathering indicators (e.g., electrical conductivity, pH, and effective cation exchange capacity) as well as changes in soil mineralogy. Cadmium addition did not influence total phospholipid fatty acids and basal respiration in most soils. However, with increasing Cd concentration, a pronounced reduction in the Gram-negative/Gram-positive bacteria ratio (from 0.32 to 0.12) occurred in an old, highly weathered soil with low Cd retention capacity. Our results show that up to 60% of added Cd was only weakly sorbed in old volcanic soils. As a consequence, the old volcanic soils of Galápagos bear the potential risk that the mobile Cd fraction is taken up by soil microorganisms, transferring this element into the food chain.

Water saving practices conditioned by socioeconomic factors: A case study of Ecuadorian households

One of the essential environmental goods is water, thus, some governments have implemented policies that allow regulating and protecting this valuable resource. Additionally, it is necessary to understand the behaviour of people to its consumption. The objective of this paper is to determine which socioeconomic factors have a greater influence on water-saving practices in households in Ecuador and thus be able to recommend policy formulations that help to conserve it. The database for the Monitoring Survey for the National Development Plan applied by the National Institute of Statistics and Censuses [INEC] (December 2019) was used. The sections of the survey that were used to obtain the variables were: education, environmental information, housing, and household data. Furthermore, the econometric logit model was used to identify the factors that influence water-saving practices in the home and five main dependent variables were taken into account: closing the taps while soaping the dishes or doing other activities, showering for less than 10 min, using a bucket and not a hose for certain activities, checking pipes regularly and water reuse while the independent variables were grouped into two groups: socio-economic and environmental awareness and responsibility. The results show that the most significant determinant variables of water-saving practices for households in Ecuador are gender, marital status, homeownership, and the main finding is the variable of perception of environmental problems, which is significant in most of the proposed models. Finally, as a policy implication, in addition to the tax burden on water consumption, governments can implement campaigns that promote awareness, saving, and the proper use of this resource; laws can also be established that sanction the misuse of water.

Sustainability of wild plant use in the Andean Community of South America

Overexploitation is the second biggest driver of global plant extinction. Meanwhile, useful plant species are vital to livelihoods across the world, with global conservation efforts increasingly applying the concept of 'conservation-through-use.' However, successfully balancing conservation and biodiversity use remains challenging. We reviewed literature on the sustainability of wild-collected plant use across the countries of Colombia, Ecuador, Peru, and Bolivia-a region of global importance for its biological and cultural richness. After applying defined search terms and a two-stage screening process, 68 articles were reviewed. The numbers which reported sustainable, unsustainable, or context-dependent outcomes were relatively even, but national differences emerged. Through narrative synthesis, we identified five key, reoccurring themes: plant biology; land tenure; knowledge, resource, and capacity; economics and market pressures; and institutional structures, policy, and legislation. Our results show the need for flexible, context-specific approaches and the importance of collaboration, with bottom-up management and conservation methods involving local communities and traditional ecological knowledge often proving most effective.

Molecular Characterization of Wheat Stripe Rust Pathogen (Puccinia striiformis f. sp. tritici) Collections from Nine Countries

Stripe rust, caused by Puccinia striiformis f. sp. tritici (Pst), is one of the most important diseases of wheat worldwide. To understand the worldwide distribution of its molecular groups, as well as the diversity, differentiation, and migration of the Pst populations, 567 isolates collected from nine countries (China, Pakistan, Italy, Egypt, Ethiopia, Canada, Mexico, Ecuador, and the U.S.) in 2010–2018 were genotyped using 14 codominant simple sequence repeat markers. A total of 433, including 333 new multi-locus genotypes (MLGs), were identified, which were clustered into ten molecular groups (MGs). The MGs and country-wise populations differed in genetic diversity, heterozygosity, and correlation coefficient between the marker and virulence data. Many isolates from different countries, especially the isolates from Mexico, Ecuador, and the U.S., were found to be identical or closely related MLGs, and some of the MGs were present in all countries, indicating Pst migrations among different countries. The analysis of molecular variance revealed 78% variation among isolates, 12% variation among countries, and 10% variation within countries. Only low levels of differentiation were found by the pairwise comparisons of country populations. Of the 10 MGs, 5 were found to be involved in sexual and/or somatic recombination. Identical and closely related MLGs identified from different countries indicated international migrations. The study provides information on the distributions of various Pst genetic groups in different countries and evidence for the global migrations, which should be useful in understanding the pathogen evolution and in stressing the need for continual monitoring of the disease and pathogen populations at the global scale.

Dietary Inflammatory Index and Cardiometabolic Risk in Ecuadorian Women

Low-grade systemic inflammation is implicated in metabolic syndrome (MetS) and cardiometabolic diseases. Diet is hypothesized to be an important low-grade inflammation modifier. However, few studies have examined the association of dietary inflammation with MetS and cardiometabolic risk in Latin American populations and their findings are inconsistent. Our cross-sectional study examined the association of dietary inflammatory potential with MetS and cardiometabolic risk components in 276 urban Ecuadorian women. Dietary inflammation was evaluated using an energy-adjusted Dietary Inflammatory Index (E-DII), divided into quartiles (Q). E-DII scores ranged from −4.89 (most anti-inflammatory) to 4.45 (most pro-inflammatory). Participants in the most pro-inflammatory (Q4) compared to the least inflammatory E-DII quartile (Q1) had a 4.4 increased adjusted odds for MetS (95% C.I. = 2.0, 9.63; p < 0.001). Every one-unit increase in E-DII was associated with a 1.4 increase in MetS (95% CI = 1.22, 1.52; p < 0.001). In other adjusted models, the most pro-inflammatory E-DII quartile (Q4) was positively associated with total blood cholesterol and triglycerides (p < 0.001), LDL-c (p = 0.007), diastolic blood pressure (p< 0.002), mean arterial pressure (p < 0.006), waist circumference (p < 0.008), and Framingham risk score (p < 0.001). However, the previously identified associations with pulse wave velocity and BMI were no longer evident in the models. These findings suggest that more pro-inflammatory diets may contribute to poorer cardiometabolic health. Promoting healthier diets with a lower inflammatory potential may help to prevent or slow development of cardiometabolic disorders.

Variability of the Chemical Composition and Bioactivity between the Essential Oils Isolated from Male and Female Specimens of Hedyosmum racemosum (Ruiz & Pav.) G. Don

Hedyosmum racemosum (Ruiz & Pav.) G. is a native species of Ecuador used in traditional medicine for treatment of rheumatism, bronchitis, cold, cough, asthma, bone pain, and stomach pain. In this study, fresh H. racemosum leaves of male and female specimens were collected and subjected to hydrodistillation for the extraction of the essential oil. The chemical composition of male and female essential oil was determined by gas chromatography–gas chromatography equipped with a flame ionization detector and coupled to a mass spectrometer using a non-polar and a polar chromatographic column. The antibacterial activity was assayed against five Gram-positive and two Gram-negative bacteria, and two dermatophytes fungi. The scavenging radical properties of the essential oil were evaluated by DPPH and ABTS assays. The chemical analysis allowed us to identify forty-three compounds that represent more than 98% of the total composition. In the non-polar and polar column, α-phellandrene was the principal constituent in male (28.24 and 25.90%) and female (26.47 and 23.90%) essential oil. Other main compounds were methyl chavicol, germacrene D, methyl eugenol, and α-pinene. Female essential oil presented a strong activity against Klebsiella pneumoniae (ATCC 9997) with an minimum inhibitory concentration (MIC) of 500 μg/mL and a scavenging capacity SC₅₀ of 800 µg/mL.

Prevalence of metabolic syndrome and diabetes mellitus type-2 and their association with intake of dairy and legume in Andean communities of Ecuador

Metabolic syndrome (MetS) and type 2 diabetes (T2D) are metabolic alterations associated with high morbidity and mortality, particularly in low and middle-income countries. Diet has a significant impact on the risk to develop MetS and T2D; in this regard, consumption of fruits, vegetables, and protein rich foods (from plant and animals) are important to prevent and manage these pathologies. There are limited studies regarding the potential association between Andean foods rich in proteins and the presence of cardio-metabolic conditions in Ecuador. It is necessary to develop new low-cost, local-culturally acceptable strategies to reduce the burden of cardio-metabolic diseases. We describe the prevalence (baseline data) of MetS and T2D in the Ecuadorian cohort of the Prospective Urban and Rural Epidemiology (PURE) study and their potential association with the consumption of protein rich foods, including beef, white meat, dairy and legumes. In this cross-sectional study, we assessed 1,997 individuals aged 35-70 years (mean age 51 years, 72% women), included in the Ecuadorian cohort of the PURE study, from February to December 2018. The prevalence of MetS was 42% for male and 44% for female participants; the prevalence of T2D was 9% for male and 10% for female. Metabolic syndrome and T2D were more common in women older than 50 years of age with primary education or less, low economic income, and with obesity; MetS was more frequent in the rural area while T2D was more frequent in the urban area. Using logistic regression analysis, we observed a significant protective effect of higher consumption of dairy and legumes in the prevalence of MetS and T2D compared with low consumption. It will be important to develop policies for ample production and consumption of protein rich foods such as legumes and dairy, part of traditional diets, to reduce the burden of cardio-metabolic diseases.

Assessing the impact of the 2008 health reform in Ecuador on the performance of primary health care services: an interrupted time series analysis

BACKGROUND

In 2008, Ecuador started a national health reform based on the principles of Alma Ata to achieve Universal Health Coverage. While coverage indicators have increased, a systematic assessment of the impact of the reform on the delivery of health services at primary level is lacking. The aim of this study was to assess the impact of the 2008 health reform on the performance of primary health care services in Ecuador.

METHODS

Ambulatory Care Sensitive Conditions (ACSC) are a subset of diseases where hospital admission is potentially avoidable by high quality well-functioning primary care. Thus, observing the behaviour of ACSC hospitalizations can serve as an indicator of how the primary health care level is performing. Crude and adjusted rates, stratified by sex, were calculated from ten selected ACSC hospitalization discharges during 22 years of data representing 11 years before and after the health reform. An interrupted time series analysis was then conducted by applying a negative binomial regression and adjusting for overdispersion and autocorrelation.

RESULTS

Overall higher crude and adjusted rates for ACSC hospitalizations were observed in women compared to men; both increased gradually since the start of the observation, reaching a peak around 2010, and then started a downwards trend. In men, the incidence rate ratio increased significantly by 3 % per year during the period before the intervention. During the first year after intervention, an increase (13 %) was detected, and then a statistically significant 1 % decrease (IRR = 0.99; 95 % CI: 0.98, 0.99) was observed in the ACSC rate ratio per year in the period after the intervention. Similar trends and effect sizes were found for women.

CONCLUSIONS

The study revealed significant decreasing trends of the ACSC hospitalization rates in both sexes, indicating an improvement of the performance of the primary health care services following the 2008 national health reform. A continuous strengthening of the primary care model as well as a regular monitoring of ACSC hospitalization rates in the country is recommended. A health economic evaluation considering hospitalizations avoided and associated costs is also advisable.

Potential negative impact of reputed regulators' decisions on the approval status of new cancer drugs in Latin American countries: A descriptive analysis

BACKGROUND

Many new cancer drugs are being approved by reputed regulatory authorities without evidence of overall survival benefit, quality of life improvement, and often based on clinical trials at high risk of bias. In recent years, most Latin American (LA) countries have reformed their marketing authorization (MA) rules to directly accept or abbreviate the approval process in case of earlier authorization by the European Medicines Agency (EMA) and the US Food and Drug Administration, mainly. This study assessed the potential impact of decisions taken by EMA regarding the approval of new cancer drugs based on no evidence of overall survival or in potentially biased clinical trials in LA countries.

DESIGN

Descriptive analysis.

SETTING

Publicly accessible marketing authorization databases from LA regulators, European Public Assessment Report by EMA, and previous studies accessing EMA approvals of new cancer drugs 2009-2016.

MAIN OUTCOME AND MEASURES

Number of new cancer drugs approved by LA countries without evidence of overall survival (2009-2013), and without at least one clinical trial scored at low risk of bias, or with no trial supporting the marketing authorization at all (2014-2016).

RESULTS

Argentina, Brazil, Chile, Colombia, Ecuador, Panama and Peru have publicly accessible and trustful MA databases and were included. Of the 17 cancer drugs approved by EMA (2009-2013) without evidence of OS benefit after a postmarketing median time of 5.4 years, 6 LA regulators approved more than 70% of them. Of the 13 drugs approved by EMA (2014-2016), either without supporting trial or with no trial at low risk of bias, Brazil approved 11, Chile 10, Peru 10, Argentina 10, Colombia 9, Ecuador 9, and Panama 8.

CONCLUSIONS

LA countries keep approving new cancer drugs often based on poorly performed clinical trials measuring surrogate endpoints. EMA and other reputed regulators must be aware that their regulatory decisions might directly influence decisions regarding MA, health budgets and patient's care elsewhere.

Evidence of Oropouche Orthobunyavirus Infection, Colombia, 2017

We describe an Oropouche orthobunyavirus infection in a women 28 years of age in Colombia. We confirmed the diagnosis by viral isolation, quantitative reverse transcription PCR, and phylogenetic analysis of the small, medium, and large genomic segments. The virus is related to a strain isolated in Ecuador in 2016.

The Ecuadorian Version of the Burnout Assessment Tool (BAT): Adaptation and Validation

This study aimed to adapt and show evidence of validity for the Ecuadorian version of the Burnout Assessment Tool (BAT) considering only its "core" dimensions. The adaptation process included its translation and back translation. For content validation, expert reviews and focus groups were carried out. A confirmatory factor analysis was used to identify the psychometric properties and dimensionality of the scale. The reliability of the scale was assessed through the alpha, omega and composite reliability indices. To carry out the study, the questionnaire was applied to a sample of workers with a high level of education in Ecuador. In total, 2237 respondents were considered in the analysis. The results showed that the hierarchical model for BAT-23 and its short version, the BAT-12 scale, is the most adequate structure for analysis of the construct in the Ecuadorian context. The reliability of the general factor of burnout and its dimensions, evaluated by composite reliability, omega and Cronbach's alpha, showed satisfactory indices. The findings obtained provide support for the reliability and validity of the Burnout Assessment Tool for the Ecuadorian context.

Spatial distribution and level of contamination of potentially toxic elements in sediments and soils of a biological reserve wetland, northern Amazon region of Ecuador

This study quantifies the degree of pollution and assess the ecological risk of As, Ba, Cd, Co, Cr, Cu, Mo, Ni, Pb, V and Zn in sediments and soils of the Limoncocha Biological Reserve (Ecuador), identified as a Ramsar site with high ecological and socioeconomic value. The hydrologic system of the Reserve is mainly formed by two rivers that drain into the Limoncocha lagoon, which occupies only five percent of the protected area but support a high anthropic influence. Local statistical baseline of studied potentially toxic elements is established using cumulative frequency method, and Al is selected as reference element due to the good correlation with the studied elements. The grade of pollution and the potential ecological risk are evaluated applying three individual (Contamination Factor, Geo-accumulation Index and Enrichment Factor) and six integrated (Degree and modified degree of contamination, Pollution Load Index, Nemerow and modified Nemerow pollution indexes and potential ecological risk index) indices. Results analysis are based on the combined application of traditional statistics, multivariate data analysis and self organizing maps. Outcomes suggest to classify sediments and soils as "moderate contamination and enrichment" due mainly to the concentrations of Cu (66.4-110 mg/kg) and Cd (0.0262-0.808 mg/kg), derived from domestic wastewaters and agricultural activities, and in a lesser extent due to Mo (0.822-4.37 mg/kg), Ni (10.3-25.8 mg/kg), Co (7.27-24.8 mg/kg) and V (60.3-178 mg/kg), derived from oil field drilling activities. The distributions of As (0.328-8.83 mg/kg), Ba (143-1100 mg/kg), Pb (7.20-26.5 mg/kg), Zn (60.1-276 mg/kg) and Cr (10.1-48.6 mg/kg) are heterogeneous in the studied sampling sites. Sediments located next to the pier and at the central area of the Limoncocha lagoon, show moderate potential risk and according to sediment quality guidelines, the calculated mean Effect Range Median quotient (mERMq) classify the sites as medium-low priority risk level. A three-level classification of a mean quotient based on soil quality and soil potential uses is proposed. Soil sites with high anthropogenic activities show low to moderate potential ecological risk being classified as poor soil quality sites but with all potential soil uses allowed according to the legal limits for land uses in Ecuador.

Preliminary Assessment of Plastic Litter and Microplastic Contamination in Freshwater Depositional Areas: The Case Study of Puerto Misahualli, Ecuadorian Amazonia

We quantify plastic litter (PL, > 2 cm) and microplastics (MP, < 5 mm) from the sediments of a beach formed at a riverine depositional area, at the upper Amazon River basin, Ecuador. In the collection area (4400 m²), the PL density was 0.045 items m^-2, where low-density polyethylene bags were the prevalent PL. The beach was classified as "very clean" (Clean Coast Index (CCI) of 1.3 items m^-2). Regarding MP, in 55 sampling stations, average MP concentrations ranged from 0 to 2200 items kg^-1 of dry sediment (0.5-2 mm), and 0-4200 items kg^-1 of dry sediment (2-5 mm). Blue fibers were the prevalent MP. Our results represent the first report to show the ubiquitous presence of PL and MP for the area. The monitoring and management of plastic disposal in freshwater beaches are necessary, as here we report a small part of an undocumented issue.

Emerging Contaminants in the Northeast Andean Foothills of Amazonia: The Case of Study of the City of Tena, Napo, Ecuador

This work is a study on the occurrence of emerging pollutants in the northeast Ecuadorian Amazon. Emerging contaminants (ECs)-caffeine, triclosan, estradiol, acetaminophen, nicotine, and ibuprofen-were quantified by gas chromatography-mass spectrometry in rivers and streams of the Amazon basin near the city of Tena, Ecuador. For that, a total of 16 natural water samples were taken in 8 locations. Sampling sites included areas impacted by discharges from inefficient sewage networks in urban areas, wastes from fish farming and non-functional landfill, a stream with few threats, tap water, and treated sewage. Caffeine was found in the 38% of the samples studied while trimethoprim and acetaminophen had an occurrence of 13%. Caffeine was detected at two sites receiving untreated sewage and one site receiving treated sewage with mean concentrations that ranged between 19 and 31.5 μg L^-1. Acetaminophen (50.4 μg L^-1) and trimethoprim (2 μg L^-1) were only detected in the river receiving treated sewage effluent. This is the first assessment of emerging contaminants in the upper Ecuadorian Amazon basin, and our observations highlight the need for better sewage treatment and water quality monitoring in Amazonian cities.

Assessment of Microplastic and Organophosphate Pesticides Contamination in Fiddler Crabs from a Ramsar Site in the Estuary of Guayas River, Ecuador

We assessed the concentration of organophosphate pesticides (OPs) and microplastics (MPs) in water and sediments from the burrows, and tissues of the fiddler crabs Leptuca festae and Minuca ecuadoriensis, from Isla Santay, a Ramsar site in the estuary of the Guayas River, Ecuador. MPs concentrations in the burrows were 660 ± 174.36 items kg^-1 (w.w.) and 26 ± 1 items L^-1 in collected sediments and water, respectively. Regarding OPs, water and sediment concentrations were up to 26 times above the USEPA thresholds for chronic exposure, indicating environmental risk. MPs were found in tissues collected from both species. The highest abundance was in the gills followed by the digestive tract and hepatopancreas. OPs concentrations in tissues were below the detection limits. Because fiddler crabs are chronically exposed to environmental contamination, they are suitable bioindicators to monitor Isla Santay and to comprehend human impacts in coastal environments of Ecuador.

Assessing the Quality of Amazon Aquatic Ecosystems with Multiple Lines of Evidence: The Case of the Northeast Andean Foothills of Ecuador

We assessed the quality of Andes-Amazonia streams in Ecuador impacted by gold mining (GM), discharges from inefficient sewage network in urban areas (UA), wastes from fish farming (FF) and from non-functional landfill (LF) and other few threats (FT). We selected three lines of evidence (LOE) that were used separately and integrated into a index: water quality (WQI) and macroinvertebrate community (AAMBI) indices and phytotoxicity tests. Streams affected by UA and LF had the lowest scores to WQI and phytotoxicity, and by GM had the lowest scores to AAMBI. Macroinvertebrate absence in GM should be considered as a warning signal of long-term mining impacts in the area. The integrated LOE index showed that sites with identified threats had 30%-53% stream quality decline compared to FT sites. The use of the selected LOE seems to be a useful tools for long-term monitoring and evaluation of this sensitive aquatic ecosystem.

Assessing Adolescent Dating Violence in the YourLife Project: Proposal of an Instrument for Spanish-Speaking Countries

Background: Several instruments have been developed to assess adolescent dating violence but only few have been validated in Spanish-speaking settings. Some instruments are too long and may not be feasible to include them in a multipurpose questionnaire. We developed an instrument to be used in the YourLife project, an international project about young people lifestyles. Objective: We aimed to analyze the psychometric properties of this instrument in three Spanish-speaking countries (Chile, Ecuador, and Spain). Method: We included 1049 participants, aged 13–18 years. Exploratory and confirmatory factor analyses were conducted. Associations between dating violence and variables expected to covariate with it (substance use, school peer aggression, justification of dating violence, and relationship power imbalance), were tested. Results: Two different constructs (psychological and physical/sexual) for suffered and perpetrated violence were identified and confirmed in the three countries. The dating violence subscales had Cronbach’s alpha scores higher than 0.85. The strongest associations between dating violence and variables related to it were found within the relationship power imbalance items, suggesting that these items may be useful to detect adolescent dating violence when a specific questionnaire cannot be implemented. Conclusion: This instrument seems to be adequate to assess suffered and perpetrated adolescent dating violence within a multipurpose questionnaire among schooled adolescents.

Beliefs About Morphine in Palliative Care: Results From an Ecuadorian Sample

BACKGROUND

Previous research unambiguously establishes the importance of knowledge and education about opioids and pain management in medical care. This article aimed at describing the perception of the general public on the uses and the risks of morphine in palliative care in an Ecuadorian sample, where training and access to those services is limited.

METHODS

We used an online recruited sample of 257 participants for this cross-sectional descriptive study. Participants responded to an online self-report survey regarding morphine's effects and its relationship with addiction and death in a palliative care context.

RESULTS

Analyses indicate that there is a lack of understanding about the effectiveness of morphine and that, overall, participants did not associate morphine with death and dying. Results also show that people in health-related occupations did not differ from the general public in beliefs about the addiction and the effectiveness of morphine. However, occupation and education effects were noted for several other items, as well as whether the participants had direct experiences with palliative care as either a patient or a caregiver.

CONCLUSIONS

There is still misinformation about opioids such as morphine in the general public and health professionals in Ecuador. Although personal experiences with pain control and palliative care are linked to better knowledge about opioids, education is still necessary to overcome the myths around them. Future research could address the found misconceptions to increase health literacy through education policies and interventions.

Disjoint and Functional Principal Component Analysis for Infected Cases and Deaths Due to COVID-19 in South American Countries with Sensor-Related Data

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.

Automatic ladybird beetle detection using deep-learning models

Fast and accurate taxonomic identification of invasive trans-located ladybird beetle species is essential to prevent significant impacts on biological communities, ecosystem functions, and agricultural business economics. Therefore, in this work we propose a two-step automatic detector for ladybird beetles in random environment images as the first stage towards an automated classification system. First, an image processing module composed of a saliency map representation, simple linear iterative clustering superpixels segmentation, and active contour methods allowed us to generate bounding boxes with possible ladybird beetles locations within an image. Subsequently, a deep convolutional neural network-based classifier selects only the bounding boxes with ladybird beetles as the final output. This method was validated on a 2, 300 ladybird beetle image data set from Ecuador and Colombia obtained from the iNaturalist project. The proposed approach achieved an accuracy score of 92% and an area under the receiver operating characteristic curve of 0.977 for the bounding box generation and classification tasks. These successful results enable the proposed detector as a valuable tool for helping specialists in the ladybird beetle detection problem.

Health Transparency and Communication on the Government Websites of Ibero-American Countries: The Cases of Chile, Colombia, Ecuador, and Spain

Through the strategic use of health communication from their websites, government institutions can achieve greater promotion and prevent health issues for citizens, at whom such websites are aimed. Thus, the transparency of these sites is essential to favor issues such as participation, accountability, and good governance. In the present study, through content analysis, we examined how active transparency and communication in health is built through analyzing the information provided by the different administrative levels with competencies in this field (government, regions, and municipalities) from the following countries: Chile, Colombia, Ecuador, and Spain. The results were projected according to a double axis of analysis. On the one hand, we offer a description of the levels of management of this phenomenon (structural characteristics and available resources). On the other hand, we developed indices based on each of the countries to compare the typologies grouped in these Ibero-American countries. As a general conclusion, the results evinced insufficient transparency in common; however, the deficit was less in countries that had a public health system.

Heavy metal contents, mobility and origin in agricultural topsoils of the Galápagos Islands

While the Galápagos Islands have been renowned for their unique flora and fauna since the time of Charles Darwin, the soils of the isolated island chain have been mostly overlooked and little information on their heavy metal contents is available. The aim of this study was therefore to examine the total heavy metal (Cd, Co, Cr, Cu, Ni, Pb, U, Zn) contents of soils from the agricultural areas on islands Isabela, Santa Cruz and San Cristóbal, and identify trends with duration of exposure to weathering processes. Additionally, the mobility of these elements was assessed using ammonium nitrate extraction. In general, levels of Cd, Co, Cr, Cu, Ni and Zn were high compared to other world locations, while Pb levels were low and U levels were similar. Ni, Co, Cr, and to a lesser extent Pb and U tended to accumulate with increasing weathering duration. Soil concentrations of Cd, Zn, Cu, and possibly Pb and U, may have been influenced by use of agrochemicals, particularly on Santa Cruz Island. Mobility of Cd displayed an increasing trend with soil age, while Ni mobility decreased. Many soils had total contents of Cd, Co, Cr, Cu, Ni and Zn above threshold values indicating possible ecological or health risks. Systematic examination of trace element contents in soils from pristine national park areas would further assist in the delineation of background levels and the development of soil quality standards to ensure crop quality, animal and human health on this unique island chain.

Re-infection of SARS-CoV-2: A case in a young dental healthcare worker

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.

Association of Carbohydrate and Fat Intake with Prevalence of Metabolic Syndrome Can Be Modified by Physical Activity and Physical Environment in Ecuadorian Adults: The ENSANUT-ECU Study

The associations of lifestyle and environment with metabolic syndrome (MetS) and cardiovascular disease have recently resulted in increased attention in research. This study aimed to examine interactive associations among carbohydrate and fat intake, physical environment (i.e., elevation and humidity), lifestyle, and MetS among Ecuadorian adults. We used data from the Ecuador National Health and Nutrition Survey 2012 (ENSANUT-ECU), with a total of 6023 participants aged 20 to 60 years included in this study. Logistic regression was used to determine the association of status of carbohydrate and fat intake, low-carbohydrate high-fat diet (LCHF) and medium-carbohydrate and fat (MCF) diet with MetS, where the high-carbohydrate low-fat (HCLF) diet was used as a reference. Women with LCHF and MCF diets showed lower prevalence of increased blood pressure (OR = 0.34, 95% CI: 0.19–0.59; OR = 0.50, 95% CI: 0.32–0.79, respectively). Women with MCF diet also showed lower prevalence of elevated fasting glucose (OR = 0.58, 95% CI: 0.37–0.91). Moreover, there were negative associations between MetS and reduced HDL cholesterol in women with MCF diet residing in low relative humidity (OR = 0.66, 95% CI: 0.45–0.98) and in women with LCHF diet residing at a high elevation (OR = 0.37, 95% CI: 0.16–0.86). Additionally, higher prevalence of increased waist circumference was observed in men with both MFC and LCHF diets who were physically inactive (OR = 1.89, 95% CI: 1.12–3.20; OR = 2.34, 95% CI: 1.19–4.60, respectively) and residing in high relative humidity (OR = 1.90, 95% CI: 1.08–2.89; OR = 2.63, 95% CI: 1.32–5.28, respectively). Our findings suggest that LCHF intake is associated with lower blood pressure, while MCF intake is associated with lower blood pressure and fasting glucose in Ecuadorian women. Furthermore, the associations of carbohydrate and fat intake with prevalence of MetS can be modified by physical activity, relative humidity, and elevation. The obtained outcomes may provide useful information for health programs focusing on dietary intake and lifestyle according to physical environment of the population to promote health and prevent metabolic diseases.

Maternal precarity and HPA axis functioning shape infant gut microbiota and HPA axis development in humans

BACKGROUND

Early life exposure to adverse environments, and maternal stress in particular, has been shown to increase risk for metabolic diseases and neurobehavioral disorders. While many studies have examined the hypothalamic-pituitary-adrenal axis (HPA axis) as the primary mechanism behind these relationships, emerging research on the brain-gut axis suggests that the microbiome may play a role. In this study, we tested the relationships among maternal precarity and HPA axis dysregulation during the peripartum period, infant gut microbiome composition, and infant HPA axis functioning.

METHODS

Data come from 25 mother-infant dyads in the Galápagos, Ecuador. Women completed surveys on precarity measures (food insecurity, low social support, depression, and stress) and gave salivary cortisol samples during and after pregnancy. Infant salivary cortisol and stool were collected in the postpartum. Statistical significance of differences in microbial diversity and relative abundance were assessed with respect to adjusted linear regression models.

RESULTS

Maternal precarity was associated with lower diversity and higher relative abundance of Enterobacteriaceae and Streptococcaceae and a lower relative abundance of Bifidobacterium and Lachnospiraceae. These patterns of colonization for Enterobacteriaceae and Bifidobacterium mirrored those found in infants with HPA axis dysregulation. Maternal HPA axis dysregulation during pregnancy was also associated with a greater relative abundance of Veillonella.

CONCLUSIONS

Overall, exposures to precarity and HPA axis dysregulation were associated with an increase in groups that include potentially pathogenic bacteria, including Enterobacteriaceae, Streptococcaceae, and Veillonella, and a decrease in potentially protective bacteria, including Bifidobacterium and Lachnospiraceae, as well as a decrease in overall diversity.

New Records of Anopheles benarrochi B (Diptera: Culicidae) in Malaria Hotspots in the Amazon Regions of Ecuador and Peru

The increase in malaria transmission in the Amazon region motivated vector control units of the Ministry of Health of Ecuador and Peru to investigate Anopheles (Diptera: Culicidae) species present in transmission hotspots. Mosquitoes were collected using prokopack aspirators and CDC light traps (Ecuador) and human landing catch in Peru. In Ecuador, 84 Anopheles were captured from Pastaza, Morona Santiago, and Orellana provinces and identified morphologically [An. (An.) apicimacula Dyar and Knab, An. (Nys.) near benarrochi, An. (Nys.) near oswaldoi, An. (Nys.) near strodei, An. (An.) nimbus (Theobald, 1902), and An. (Nyssorhynchus) sp.]. In Peru, 1,150 Anopheles were collected in Andoas District. A subsample of 166 specimens was stored under silica and identified as An. near oswaldoi, An. darlingi, and An. (An.) mattogrossensis Lutz and Neiva. COI barcode region sequences were obtained for 137 adults (107 from Peru, 30 from Ecuador) identified by ITS2 PCR-RFLP as An. benarrochi Gabaldon, Cova Garcia, and Lopez and retained in the final analysis. Haplotypes from the present study plus An. benarrochi B GenBank sequences grouped separately from Brazilian An. benarrochi GenBank sequences by 44 mutation steps, indicating that the present study specimens were An. benarrochi B. Our findings confirm the presence of An. benarrochi B in Ecuador and reported here for the first time from the Amazonian provinces of Orellana and Morona Santiago. Furthermore, we confirm that the species collected in Andoas District in the Datem del Maranon Province, Peru, is An. benarrochi B, and we observed that it is highly anthropophilic. Overall, the known distribution of An. benarrochi B has been extended and includes southern Colombia, much of Peru and eastern Ecuador.

Metals in commercial fish in the Galapagos Marine Reserve: Contribution to food security and toxic risk assessment

Metal pollution in the marine environment can damage places with exceptional biodiversity such as the Galapagos Islands. For this reason, it is important to evaluate the toxic risk from metals derived from fish consumption and to perform a nutritional assessment. We sampled 20 individuals of demersal (Caulolatilus princeps and Mycteroperca olfax) and pelagic (Thunnus albacares and Seriolella violacea) species. The levels of the toxic elements (Al, B, Ba, Cd, Ni, Pb and Sr), and the macroelements, microelements and trace elements (Ca, Cr, Fe, K, Li, Mn, Mo, Mg, Na, V and Zn) of species muscle tissue were analyzed by Inductively Coupled Plasma Optical Spectrometry (ICP-OES). Demersal species have higher concentrations of Cr, K, Mg and Mo; while pelagic species have higher levels of Zn. M. olfax could potentially cause Cd toxicity so it is recommended not to ingest more than 86 and 73 g of this species (i.e. roughly, one serving) per week for men and women, respectively. None of the species could be marketed in Europe and the USA due to Cd level exceed the allowed limits by EFSA and FAO. Furthermore, the dietary intake of C. princeps is recommended due to its high concentration of Ca, Na, K, Mg and Cr, while T. albacares is recommended for people with Zn deficiency. However, due to the Cd level in C. princeps it is not recommended to ingest more than five servings per week. We attribute the source of metals in the studied fish from the volcanic origin of the islands rather than from human pollution. This is the first study that thoroughly estimate concentration of metals in commercial fish species and its contribution to food security in the Galapagos.

Leaf trait variation in species-rich tropical Andean forests

Screening species-rich communities for the variation in functional traits along environmental gradients may help understanding the abiotic drivers of plant performance in a mechanistic way. We investigated tree leaf trait variation along an elevation gradient (1000-3000 m) in highly diverse neotropical montane forests to test the hypothesis that elevational trait change reflects a trend toward more conservative resource use strategies at higher elevations, with interspecific trait variation decreasing and trait integration increasing due to environmental filtering. Analysis of trait variance partitioning across the 52 tree species revealed for most traits a dominant influence of phylogeny, except for SLA, leaf thickness and foliar Ca, where elevation was most influential. The community-level means of SLA, foliar N and Ca, and foliar N/P ratio decreased with elevation, while leaf thickness and toughness increased. The contribution of intraspecific variation was substantial at the community level in most traits, yet smaller than the interspecific component. Both within-species and between-species trait variation did not change systematically with elevation. High phylogenetic diversity, together with small-scale edaphic heterogeneity, cause large interspecific leaf trait variation in these hyper-diverse Andean forests. Trait network analysis revealed increasing leaf trait integration with elevation, suggesting stronger environmental filtering at colder and nutrient-poorer sites.

Red List assessment of amphibian species of Ecuador: A multidimensional approach for their conservation

Ecuador is one of the most biodiverse countries in the world, but faces severe pressures and threats to its natural ecosystems. Numerous species have declined and require to be objectively evaluated and quantified, as a step towards the development of conservation strategies. Herein, we present an updated National Red List Assessment for amphibian species of Ecuador, with one of the most detailed and complete coverages for any Ecuadorian taxonomic group to date. Based on standardized methodologies that integrate taxonomic work, spatial analyses, and ecological niche modeling, we assessed the extinction risk and identified the main threats for all Ecuadorian native amphibians (635 species), using the IUCN Red List Categories and Criteria. Our evaluation reveals that 57% (363 species) are categorized as Threatened, 12% (78 species) as Near Threatened, 4% (26 species) as Data Deficient, and 27% (168 species) as Least Concern. Our assessment almost doubles the number of threatened species in comparison with previous evaluations. In addition to habitat loss, the expansion of the agricultural/cattle raising frontier and other anthropogenic threats (roads, human settlements, and mining/oil activities) amplify the incidence of other pressures as relevant predictors of ecological integrity. Potential synergic effects with climate change and emergent diseases (apparently responsible for the sudden declines), had particular importance amongst the threats sustained by Ecuadorian amphibians. Most threatened species are distributed in montane forests and paramo habitats of the Andes, with nearly 10% of them occurring outside the National System of Protected Areas of the Ecuadorian government. Based on our results, we recommend the following actions: (i) An increase of the National System of Protected Areas to include threatened species. (ii) Supporting the ex/in-situ conservation programs to protect species considered like Critically Endangered and Endangered. (iii) Focalizing research efforts towards the description of new species, as well as species currently categorized as Data Deficient (DD) that may turn out to be threatened. The implementation of the described actions is challenging, but urgent, given the current conservation crisis faced by amphibians.

Sexually transmitted infections and factors associated with risky sexual practices among female sex workers: A cross sectional study in a large Andean city

Background

There are limited published data on factors related to risky sexual practices (RSP) affecting sexually transmitted infections (STIs) among female sex workers (FSWs) in Ecuador.

Methods

Cross-sectional study of FSWs presenting for a consultation in a primary health care centre during 2017. A questionnaire was administered to collect information on RSP and potential risk factors including age, membership of an FSW association, self-report of previous STI diagnosis, previous treatment for suspected STI and temporary migration for sex work. Associations between RSP and potential risk factors were estimated by logistic regression. The proportion of STI was estimated from vaginal swabs by real-time PCR for four sexually transmitted pathogens (Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and Mycoplasma genitalium).

Results

Of 249 FSWs recruited, 22.5% had reported RSPs at least once during sex work. Among FSWs reporting unprotected vaginal sex in the previous three months, 25.5% had at least one other RSP type. 17.6% (95%CI 13.3–22.8) had at least one active STI. Prevalence of co-infections was 2.4% (95%CI 1.1–5.2). In multivariable analysis, RSP was associated with age (adjusted OR 1.06; 95%CI 1.02–1.10), membership of an FSWs association (aOR 3.51; 95%CI 1.60–7.72) and self-reported previous STI (aOR 3.43; 95%CI 1.28–9.17).

Conclusions

Among a population of female sex workers with high proportion of STIs, increasing age and belonging to an FSWs association was associated with a higher likelihood of engaging in RSP with clients. Engaging with FSWs organisations may reduce the burden of STI among sex workers.

Is it possible to find a bifactor structure in the Fear of COVID-19 Scale (FCV-19S)? Psychometric evidence in an Ecuadorian sample

The aim of the study was to evaluate the construct validity based on the internal structure, the relationship with other variables, and the internal consistency among items of the Fear of COVID-19 Scale (FCV-19S) in a sample of 743 Ecuadorians. The findings confirm the presence of a bifactor structure, which includes a general factor and two specific factors: one emotional and the other physiological. The general factor, and the specific factors presented adequate levels of internal consistency. Finally, the FCV-19S showed a highly significant relationship with GAD-7 at the latent level. The scale has adequate psychometric properties for its application.

Karyotype Description of Two Andean Species of the guarani Group of Drosophila (Díptera: Drosophilidae) and Cytological Notes

The guarani group of Drosophila genus (Diptera: Drosophilidae) is formed by 24 species however the relationship of these species is not clear. In the present study are described the karyotypes of Drosophila sachapuyu Peñafiel and Rafael, 2018 and Drosophila zamorana Peñafiel and Rafael, 2018, two Andean species members of the guarani group. Mitotic chromosomes from cerebral ganglia of third stand larval were obtained by thermal shock and cell suspension techniques. The karyotype of D. sachapuyu, presents 2n = 10 (4R, 1V; X = R, Y = R) while D. zamorana exhibits karyotype 2n = 12 (5R, 1V; X = V, Y = R).

Behavioural response to songs between genetically diverged allopatric populations of Darwin's small tree finch in the Galápagos

Empirical data that identify contemporary mechanisms of divergence shed light on how species could multiply. In this study, we measured population genetic structure, song syllable diversity and response to simulated intruder song in Darwin's small tree finch (Camarhynchus parvulus) on Santa Cruz and Floreana Islands, Galápagos archipelago. Our aim was to test whether the magnitude of contemporary behavioural response in resident birds was consistent with patterns of genetic or cultural differences between populations. We analysed genetic structure and the occurrence of song syllable types, and experimentally measured the response of resident birds to intruder bird song from different geographical origin (i.e., island) or syllable type. We discovered a weak signal of population genetic structure between Santa Cruz and Floreana Islands. Although some song syllables occurred on both islands, others were unique to each island; Santa Cruz Island males used more unique syllables than Floreana Island males. Both Santa Cruz and Floreana resident males discriminated their response towards a simulated intruder song based on the geographical origin of the intruder song, but not on the syllable type sung by the intruder. We conclude that the populations are diverging in genetic and cultural traits and identified a signal of contemporary behavioural response that could maintain divergence upon secondary contact.

Knowledge of Palliative Care in Ecuador

Palliative care is a holistic approach to care for people with chronic, advanced, and life-threatening illnesses. It improves the quality of life of patients and their caregivers. However, there is still limited access to palliative care in many countries. Knowledge about palliative care is key to increase its availability. Thus, this article aimed to explore the knowledge of the general population about palliative care in Ecuador. The study had a descriptive cross-sectional design. Through snowball sampling, between September 2019 and January 2020, 257 people completed an anonymous online questionnaire about general and specific aspects of palliative care. Descriptive and ANOVA analyses indicate that people have many misconceptions about palliative care and how it should be provided. Gender, education, training, occupation, and experience as caregivers were related to the total level of knowledge about palliative care. Regression analyses show other variables as predictors of knowledge. This study highlights the lack of knowledge about specific issues within palliative care in the general population in Ecuador. It also shows the need to develop and implement education measures to fill these gaps and enhance access to palliative care in health systems.

[I promotori di salute come attori-protagonisti delle cure primarie nel controllo delle malattie comunicabili e non comunicabili e nell' empowerment delle comunità. Esperienza e risultati di lungo periodo in aree marginali in Ecuador dal 1980 al 2018.]

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INTRODUCTION

Against the increasing recognition of the critical importance of a direct participation of community members to assure effective health care in peripheral areas of Middle and Low Income Countries (MLIC), representative field experiences of their essential role are only occasionally available.

AIMS AND METHODS

We report a narrative, factual documentation of a spectrum of projects covering the basic and specific health needs of the disperse communities in Ecuador, a model MLIC, and discuss the broader implications of the role and performance of HPs over a long period, 1980-2018, in the project activation, implementation and monitoring.

RESULTS

The role of 60 HPs, with the coordination of a small core group of professionals of the Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET) is documented through their main achievements which include: infectious diseases and in particular Neglected Tropical Diseases (eradication of onchocerciasis and yaws; virtual elimination of malaria and of strongyloidiasis; identification and control of a new focus of Chagas Disease; control of tuberculosis), mother and child health, reproductive health, hypertension (as model of the emergence of non-transmissible, chronic diseases). The most effective and sustainable strategies and methods are discussed also in terms of their more general transferability, already partially tested in programs in Bolivia, Burkina Faso, undeserved areas of Argentina.

CONCLUSIONS

The systematic availability of non-professional, trained HPs should be recommended as a sustainable and reliable component of health care strategies and interventions targeted to marginalized settings, to assure a concrete accessibility to the fundamental human right to life.

An efficient route design for solid waste collection using graph theory and the algorithm of the traveling agent in dynamic programming

In Santo Domingo de los Tsa'chilas province, Ecuador, the population grows proportionally to the territorial extension in urban and rural parishes; therefore, the conception of domestic solid waste has increased exponentially. In this context, in recent years, the distribution of routes for waste collection has not been dealt with or technically explored. The research objective is to apply the theory of graphs to the sector and use the exact method of the Travel Agent Problem (TSP) in dynamic programming to generate optimal routes by sectors. In addition to measuring the variables longitudinally, we test the researcher's hypothesis using parametric techniques for independent samples in the variable's travel time and distance between the usual route and the new route in the Río Verde parish of Santo Domingo Canton.

Emergency Department Characteristics and Capabilities in Quito, Ecuador

Background

Emergency care is an essential part of a health system. Ecuador has recognized emergency medicine as a specialty and has two emergency medicine residency training programs. However, little has been published about emergency department characteristics and capabilities in Ecuador.

Objective

We described the characteristics and capabilities of emergency departments (EDs) in Quito, Ecuador, in 2017, using the National Emergency Department Inventory (NEDI) survey.

Methods

The 23-item survey included questions pertaining to ED characteristics, including: visit volume, physical and administrative structure, clinical capabilities, technological resources, and consult personnel availability. This study included all EDs in Quito operating 24 hours/day, 7 days/week, and serving all patients seeking care. One representative from each ED was asked to complete the survey based on calendar year 2017.

Findings

Thirty EDs met the inclusion criteria, and 26 completed the survey (87% response). The median number of ED beds was 17 (range 2-61). Median annual visit volume was 22,580 (range 1,680 to 129,676). All but two EDs provided care for both children and adults. Cardiac monitors were available in 88% of EDs, CT scanners in 68%, and rooms for respiratory isolation in 31%. Most EDs could manage patients with general medicine (92%), general surgery (92%), and gynecology (88%) emergencies 24/7. Fewer were able to provide hand surgery (45%) and dental (28%) care 24/7. Typical length of stay was 1-6 hours in 65% and >6 hours in 31% of EDs. Half of EDs reported operating at full capacity and 27% reported operating over their capacity. When compared to private EDs, government EDs (public and social security) had a higher mean number of visits per year (50,090 government vs. 13,968 private, p < 0.001), higher mean number of ED beds (36 government vs. 9 private, p = 0.002), and higher length of stay (58% of patient stays > 6 hours in government EDs vs. 86% of patient stays 1-6 hours in private EDs, p = 0.009).

Conclusions

EDs in Quito varied widely with respect to annual visit volume, ability to treat different pathologies 24/7, and resources. Most EDs are functioning at or over capacity, and a substantial number have long lengths of stay. Further research and investment in emergency care could help increase the capacity and efficiency of EDs in Ecuador.

Spatial and temporal variations of greenhouse gas emissions from a waste stabilization pond: Effects of sludge distribution and accumulation

Due to regular influx of organic matter and nutrients, waste stabilization ponds (WSPs) can release considerable quantities of greenhouse gases (GHGs). To investigate the spatiotemporal variations of GHG emissions from WSPs with a focus on the effects of sludge accumulation and distribution, we conducted a bathymetry survey and two sampling campaigns in Ucubamba WSP (Cuenca, Ecuador). The results indicated that spatial variation of GHG emissions was strongly dependent on sludge distribution. Thick sludge layers in aerated ponds and facultative ponds caused substantial CO₂ and CH₄ emissions which accounted for 21.3% and 78.7% of the total emissions from the plant. Conversely, the prevalence of anoxic conditions stimulated the N₂O consumption via complete denitrification leading to a net uptake from the atmosphere, i.e. up to 1.4±0.2 mg-N m^-2 d^-1. Double emission rates of CO₂ were found in the facultative and maturation ponds during the day compared to night-time emissions, indicating the important role of algal respiration, while no diel variation of the CH₄ and N₂O emissions was found. Despite the uptake of N₂O, the total GHG emissions of the WSP was higher than constructed wetlands and conventional centralized wastewater treatment facilities. Hence, it is recommended that sludge management with proper desludging regulation should be included as an important mitigation measure to reduce the carbon footprint of pond treatment facilities.

New Ecuadorian records of the eyeless banjo catfish Micromyzon akamai (Siluriformes: Aspredinidae) expand the species range and reveal intraspecific morphological variation

Two specimens of Micromyzon akamai, an eyeless and miniaturized species previously known only from the deep channels of the eastern Amazon basin in Brazil, are reported from the Curaray River, a tributary of the Napo River in Ecuador. The new specimens are the first records of Micromyzon in the headwaters of the Amazon River and the first records of M. akamai outside Brazil. External morphological characters and a phylogenetic analysis of cytochrome c oxidase I (coI) gene support the identification of the new specimens as M. akamai. Nevertheless, the new specimens also indicate that some features previously hypothesized to be apomorphic for M. akamai are intraspecifically variable.

250-year records of mercury and trace element deposition in two lakes from Cajas National Park, SW Ecuadorian Andes

Historical records of trace elements in lake sediments provide source-to-sink information about potentially toxic pollutants across space and time. We investigated two lakes located at different elevations in the Ecuadorian Andes to understand how trace element fluxes are related to (i) geology, (ii) erosion in the watersheds, and (iii) local point sources and atmospheric loads. In remote Lake Fondococha (4150 m a.s.l.), total Hg fluxes stay constant between ca. 1760 and 1950 and show an approximately 4.4-fold increase between pre-1950 and post-1950 values. The post-1950 increase in fluxes of other trace elements (V, Cr, Co, Ni, Cu, Zn, As, Cd, and Pb) is lower (2.1-3.0-fold) than for Hg. Mostly lithogenic sources and enhanced soil erosion contribute to their post-1950 increase (lithogenic contribution: > 85%, Hg: ~ 58%). Average post-1950 Hg fluxes are approximately 4.3 times higher in peri-urban Lake Llaviucu (3150 m a.s.l.) than in the remote Lake Fondococha. Post-1950 fluxes of the other trace elements showed larger differences between Lakes Fondococha and Llaviucu (5.2 < 25-29.5-fold increase; Ni < Pb-Cd). The comparison of the post-1950 average trace element fluxes that are derived from point and airborne sources revealed 5-687 (Hg-Pb) times higher values in Lake Llaviucu than in Lake Fondococha suggesting that Lake Llaviucu's proximity to the city of Cuenca strongly influences its deposition record (industrial emissions, traffic, caged fishery). Both lakes responded with temporary drops in trace element accumulations to park regulations in the 1970s and 1990s, but show again increasing trends in recent times, most likely caused by increase in vehicular traffic and openings of copper and gold mines around Cajas National Park.

Biomass yield and carbon abatement potential of banana crops (Musa spp.) in Ecuador

Banana is one of the most important agricultural products of Ecuador. It relies on intensive monoculture cropping systems with a large volume of standing biomass and large amounts of residual biomass that can be used for carbon sequestration. This study was performed (1) to quantify the yearly residual biomass generation, (2) to quantify the carbon stock of standing banana biomass, (3) to estimate the carbon sequestration potential by using the residual biomass generated yearly, and (4) to propose a biomass prediction model for banana crops in Ecuador. The study was conducted between March 2018 and January 2019 in the three main banana-producing provinces of Ecuador (Los Ríos, Guayas, and El Oro). Samples of rachis, pseudostem, leaves, and flowers from 36 banana plants of the variety Musa AAA Cavendish were taken for laboratory tests. Physical measurements such as height, circumferences, number of leaves, and weights were determined for the 36 plants. Results showed an average residue-to-product ratio of 3.79 and a country's yearly biomass generation of 2.65 Mt on a dry basis. The carbon stock of the standing biomass was estimated as 4.18 ± 1.02 Mg/ha, 5.44 ± 0.96 Mg/ha, and 5.13 ± 1.11 Mg/ha for Los Ríos, Guayas, and El Oro, respectively. The estimated carbon abatement capacity of the residual biomass is 3.92 MtCO₂/year. Three biomass estimation models were developed in Python®, using the data collected in this study and least squares fitting for exponential models of the form: Y = AXⁿ + C. The models showed good prediction capacity for Ecuadorian banana plants, with R² up to 0.85. It is expected that this study could serve as the basis for studies on developing sustainable conversion processes of banana residual biomass.

Reducing unnecessary antibiotic prescription through implementation of a clinical guideline on self-limiting respiratory tract infections

BACKGROUND

Clinical guidelines (CG) are used to reduce variability in practice when the scientific evidence is sparse or when multiple therapies are available. The development and implementation of evidence-based CG is intended to organize and provide the best available evidence to support clinical decision making in order to improve quality of care. Upper respiratory tract infections (URTI) are the leading cause of misuse of antibiotics and a CG may reduce the unnecessary antibiotic prescription.

METHODS

The aim of this quasi-experimental, before-after study was to analyze the short- and long-term effects of the implementation of a CG to decrease the rate of antibiotic prescription in URTI cases in the emergency department of a third level private hospital in Quito, Ecuador. The study included 444 patients with a main diagnosis of URTI. They were distributed in three groups: a baseline cohort 2011 (n = 114), a first post-implementation cohort 2011 (n = 114), and a later post-implementation cohort 2018 (n = 216). The implementation strategy consisted of five key steps: acceptance of the need for implementation of the CG, dissemination of the CG, an educational campaign, constant feedback, and sustainability of the strategy through continuous training.

RESULTS

The results of this study show a 42.90% of antibiotic prescription rate before the CG implementation. After the implementation of the CG, the prescription rate of antibiotics was significantly reduced by 24.5% (42.9% vs 18.4%, p<0.0001) and the appropriate antibiotic prescription rate was significantly increased by 44.2% (22.4% vs 66.6%, p<0.0001) in the first post-implementation cohort 2011. There was not a significant difference in antibiotic prescription rate and appropriate antibiotic prescription rate between two post-implementation cohorts: 18.4% vs 25.9% (p = 0.125) and 66.6% vs 50% (p = 0.191), respectively.

CONCLUSIONS

The implementation of CGs decreases the rate of antibiotic prescription in URTI cases. The results are remarkable after early implementation, but the effect persists over time. The emphasis must shift from guideline development to strategy implementation.

Personalized prescription of ACEI/ARBs for hypertensive COVID-19 patients

The COVID-19 pandemic has prompted an international effort to develop and repurpose medications and procedures to effectively combat the disease. Several groups have focused on the potential treatment utility of angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) for hypertensive COVID-19 patients, with inconclusive evidence thus far. We couple electronic medical record (EMR) and registry data of 3,643 patients from Spain, Italy, Germany, Ecuador, and the US with a machine learning framework to personalize the prescription of ACEIs and ARBs to hypertensive COVID-19 patients. Our approach leverages clinical and demographic information to identify hospitalized individuals whose probability of mortality or morbidity can decrease by prescribing this class of drugs. In particular, the algorithm proposes increasing ACEI/ARBs prescriptions for patients with cardiovascular disease and decreasing prescriptions for those with low oxygen saturation at admission. We show that personalized recommendations can improve patient outcomes by 1.0% compared to the standard of care when applied to external populations. We develop an interactive interface for our algorithm, providing physicians with an actionable tool to easily assess treatment alternatives and inform clinical decisions. This work offers the first personalized recommendation system to accurately evaluate the efficacy and risks of prescribing ACEIs and ARBs to hypertensive COVID-19 patients.

Natural and anthropogenic-induced stressors affecting the composition of fish communities on the rocky reefs of Ecuador

Natural and human-induced stressors have threatened the sustainability of the fish communities of coral-rocky reefs worldwide in the last decades. The composition of the fish communities on the reefs of Ecuador and the factors affecting spatiotemporal changes are unknown. We studied the influence of the descriptors of structural complexity, the current status of coral and human-induced variables over fish communities. A video transect method was used to assess fish communities in three zones (slope, crest, and bottom) of two reefs during two seasons (rainy and dry). The structure of fish communities was highly influenced by the zones and season; rugosity and live coral affected the fish composition on the crest and slope zones. The fractured coral and derelict fishing gear on coral produced an adverse effect on fish composition over the crest. A multifactorial process causing loss of structural complexity and affecting fish composition was identified, however, periodical assessment is required for a greater understanding of this process.

Ethnic Disparities in Nutritional Status among Older Adults: Evidence from the Survey of Health, Welfare and Aging (SABE) Ecuador

This study aims to identify those populations that should be targeted by specific interventions. A cross-sectional design was utilized. Ordered logistic regression analysis was utilized to assess the association between ethnic identity and risk of malnutrition. Data were drawn from Ecuador's Survey of Health, Welfare and Aging (SABE). The final sample consisted of 4,572 people who were 60 years or older who were able to provide responses to the survey by themselves. Ethnic identity was categorized into four: indigenous, mestizo (Spanish and Indigenous mixed heritage), Afro-Ecuadorian/mulato, and other. Risk of malnutrition was measured using Mini Nutritional Assessment Short-Form (MNA-SF). A range of covariates were selected from three groups of factors: sociodemographic, health-related, and social network. Results revealed that the indigenous ethnicity was the only group who had significantly higher risk of malnutrition compared to mestizo even after controlling for a range of covariates including socio-economic status, health related factors, and social support. Findings suggest the existence of underlaying factors hindering the risk of malnutrition among indigenous older adults. Considering the information revealed by SABE, interventions and other strategies should be targeted and designed specifically accounting for the needs, preferences, and culture of the most vulnerable population.

Factors That Determine the Dietary Diversity Score in Rural Households: The Case of the Paute River Basin of Azuay Province, Ecuador

Inadequate food and nutrition affect human well-being, particularly for many poor subpopulations living in rural areas. The purpose of this research was to analyze the factors that determine the Household Dietary Diversity Score (HDDS) in the rural area of the Paute River Basin, Azuay Province, Ecuador. The sample size of 383 surveys was determined by a stratified random sampling method with proportional affixation. Dietary diversity was measured through the HDDS, with 12 food groups (cereals; roots and tubers; fruits; sugar/honey; meat and eggs; legumes or grains; vegetables; oils/fats; milk and dairy products; meats; miscellaneous; fish and shellfish) over a recall period of 7 days. A Poisson regression model was used to determine the relationship between the HDDS and sociodemographic variables. The results show that the average HDDS of food consumption is 10.89 foods. Of the analyzed food groups, the most consumed are cereals; roots and tubers; fruits; sugar/honey. In addition, the determinants that best explain the HDDS in the predictive model were housing size, household size, per capita food expenditure, area of cultivated land, level of education, and marital status of the head of household. The tools used in this research can be used to analyze food and nutrition security interventions. Furthermore, the results allow policymakers to identify applicable public policies in the fight against hunger.