Ecuador
Calidad del sueño y contaminación visual nocturna. Sleep quality and nighttime visual pollution.
Palabras clave: Calidad del sueño,
Contaminación visual nocturna,
Ecuador,
Escala de Pittsburgh,
Zonas rurales,
Propiedades psicométricas de un Instrumento de Tamizaje para Autismo (ITEA) en niños y adolescentes del Ecuador. Psychometric properties of an Autism Screening Instrument (ITEA) in children and adolescents from Ecuador
This study explores factorial validity of the Autism Spectrum Screening Test (ITEA) for the identification of autism in schooled children and adolescents in Ecuador. The psychometric study analyzes the validity and reliability, as well as internal consistency of the elements of the scale. The sample consisted of 848 autistic people, and 350 non-autistic, of ages between 4 and 17 years old, who attended regular schools. The Confirmatory Factor Analysis shows that the ITEA adjustment model behaves adequately for the Ecuadorian population, corroborated by means of a model of four first-order factors and a second-order general agglutinating factor with 32 items, in fact, the absolute, relative, and non-centrality-based fit indicators confirm this. In addition, the scale is highly reliable in terms of internal consistency with ω= .92 [.91 – .93], since it allows obtaining greater precision in the evaluation of the studied construct. It can be concluded that evidence of factorial validity and reliability show that the ITEA, in its structural model, is adequately adjusted for the screening of autism in schooled children with ages between 4 to 17 years old
in Ecuador. According to Support Vector Machines (SVM), which allows information regarding the accuracy of each evaluated item, the set of 42 items reached 89.04% Analysis using the Request for Evidence test (RFE) showed that, in order to increase the accuracy level of ITEA, 31 items exceeded the global value. Regarding the 7 categories evaluated (language, communication, social skills, affectivity, information processing, inflexibility, and sensory perception), a value of 89.387% was obtained, according to the SVM algorithm with “rbf” kernel. The data shows the ability of ITEA to show specific characteristics to identify autism
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Number of Neurologists and Neurology Training Programs available in the Public Health System of Ecuador: Analysis and Recommendations. Número de Neurólogos y Programas de Entrenamiento en Neurología disponibles en el Sistema de Salud Público del Ecuador: Análisis y Recomendaciones.
Introduction: In 2008, Ecuador’s neurologic healthcare profile displayed significant needs, a lack of neurologists, and neurology training accessibility. In that year, a new constitution introduced universal health care. No publication analyzes Ecuador’s neurological Public Healthcare capacity. Hence, an up-to-date analysis of the number of neurologists and neurology training programs is required.
Objective: Determine if Ecuador’s public healthcare meets the minimum ideal ratio recommended by the World Health Organization of 1 neurologist per 100,000 population and the numb er of neurology training programs in Ecuador.
Methods: Cross-sectional analysis of public data until November 2022 from Ecuador’s Public Health System (PHS) and the Council of Higher Education. Ratios were calculated using the N ational Institute of Statistics and Censuses’ information.
Results: The public health network had ninety-four neurologists. Most found in Pichincha (37/39.4%) and Guayas (24/25.5%). There was one per province in five provinces. No neurologists were available in eight provinces. Two provinces met the ideal ratio. Ecuador’s ratio was 0.54:100,000 neurologists per population. One neuro logy training program was found in Quito.
Conclusion: Ecuador’s PHS has a shortage of neurologists, unfulfilling the minimum ideal ratio, and a severe lack of neurology training. Decentralizing neurological services, primary care support, and governmental funding for neurology training are an urgent need.
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Psychiatrists available in the Ecuadorian public health system and psychiatry residency programs in Ecuador – A cross-sectional analysis. Psiquiatras disponibles en el sistema de salud público y programas de residencia en psiquiatría del Ecuador – Un análisis transversal
Introduction: In 2008, Ecuador’s mental health profile displayed deficiencies due to the lack of psychiatrists and psychiatry residency programs. The same year, access to universal health care, was instituted as a right in the Constitution. There are no studies on the Public Health System’s capacity to provide mental health services, hence an updated analysis of the number of psychiatrists and psychiatry training programs available is required.
Objective: To determine the number of psychiatrists available through the Public Health System and to calculate the ratio of psychiatrist per 10,000 population; to establish the number of residency programs available.
Methods: Cross-sectional analysis of the data available from the Ecuadorian Public Health System and the Higher Education Council of Ecuador. Ratios were calculated using data from the National Institute of Statistics and Censuses.
Results: Ecuador’s psychiatrists ratio is 0.08:10,000 and the adjusted ratio (psychiatrists and psychologists) is 0.65:10,000. The Public Health System has 138 psychiatrists, concentrated in Pichincha (n=51) and Guayas (n=27). Three provinces had no psychiatrists available. There are two psychiatry training programs in Quito.
Conclusion: Ecuadorian Public Healthcare holds a shortage of psychiatrists which inhibit the minimum ideal ratio fulfillment, along with a noticeable lack of psychiatric training programs availability.
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Práctica de la neuropsicología en Ecuador. Practice of neuropsychology in Ecuador
Objectives: To explore the current state of neuropsychology practice in Ecuador through the administration of an online survey.
Methods: A total of 48 professionals working in the field of neuropsychology completed an online survey between August 2018 and December 2019.
Results: The majority of the participants were female (62.5%), with a mean age of 37.23. 87.5% report having received postgraduate neuropsychology training. Most are employed in private practice, universities and/or clinics, and report being satisfied with their work. The most commonly treated diagnoses are Attention Deficit with Hyperactivity Disorder (ADHD), learning disabilities and language disorders. The three main barriers identified for the development of neuropsychology are the lack of academic training programs, the lack of clinical training programs and the lack of willingness to collaborate among professionals.
Conclusions: The practice of neuropsychology in Ecuador is on par with that of Latin America. However, certain changes are needed, such as increasing academic and clinical training programs in the area, formalizing regulations that guarantee quality and standards in practice, and continuing to standardize and validate neuropsychological tests in the country.
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Prevalence Of Major Depressive Disorder In Portoviejo, Ecuador. Prevalencia del Trastorno Depresivo Mayor en Portoviejo, Ecuador.
Major depressive disorder (MDD) is a debilitating neuropsychiatric disorder that affects more than 300 million people, causing enormous socioeconomic burden. Little data has been known about prevalence of MDD in Ecuador. Thus, the aim of this study was to describe the prevalence of MDD in the population in a highly populated city in Ecuadorian Coast. This population-based study was accomplished in Portoviejo, Manabí. Here, we analyzed 114.239 records about MDD using Structured Clinical Interview for the Diagnosis of DSM-IV Disorders in younger, adults, and older peoples. We observed that the MDD score of 8.6% of the studied population. There was a suitable agreement between mild MDD and residence location scores (urban or rural zone). Both models had a good standard of fit (R2 = 0.91 and 0.95) and a mean p-value of 0.04 for both locations. A significant positive correlation between marital status and MDD scores, particularly for single (p = 0.001361, r = 0.94), and education levels (p = 0.00102, r = 0.95) was also demonstrated. Moreover, both age (p = 0.001067, r = -0.94) and widowed (p = 0.009662, r = -0.87) were negatively correlated with MDD scores. Collectively, our results revealed a high prevalence of MDD in the Portoviejo population, an effect more prominent in man, living alone, young and resident of the urban zone.
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Diseño y validación de un paradigma para evaluar la atención selectiva, utilizando el software de código abierto “PsychoPy”, aplicable a la Resonancia Magnética Funcional. Design and validation of a paradigm to evaluate selective attention, using the open source software “PsychoPy”, applicable to Functional Magnetic Resonance.
Introduction: Selective attention is a neuropsychological function involved in carrying out activities, from the simplest to the most complex, guiding us towards the search for relevant elements for the achievement of proposed tasks and inhibiting other responses.
Objective: Design and validation of the paradigm to evaluate selective attention.
Methodology: Quantitative study, exploratory-descriptive, experimental. The instrument was designed in three stages: 1) elaboration of the paradigm, 2) validation of the construct and content, 3) Field test and data analysis applied to 18 healthy adults, selected in a non-probabilistic way, between 18 and 30 years old. The paradigm was developed virtually in “PsychoPy”, based on the d2 test and adapted for the Magnetic Resonator.
Results: High scores were found in the evaluation of selective attention and the average time of correct answers is adequate in relation to the amount of work. When analyzing the influence of age and sex with the frequency of correct answers, no statistically significant differences were found.
Conclusions: The selective attention paradigm is a complementary prognostic tool, useful to assess this function, because it has construct and content validity; being a safe, free and easy-to-apply instrument.
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Enfermedades Neuro-Psiquiátricas en Atención Primaria en una Zona Rural de la Sierra Ecuatoriana en el 2018. Neuro-Psychiatric Diseases In Primary Care In A Rural Area Of The Ecuadorian Highlands 2018
Aim: To provide epidemiological data of neuro-psychiatric diseases. Methods: The sample corresponds to a native population of the northern Ecuadorian highlands, the data was retrospectively collected obtained from daily records of the health center in 2018. Neurological and mental health pathologies codified in ICD-10 were considered. Results: Of the total registered medical consultations, 521 corresponded to neuro-psychiatric diagnoses (4.07%). The majority of patients were women 66.79%. The average age was 39.22 years old 95% CI 37.17-41.26. Ethnic self-identification was native in 90.79%. The most frequent neurological pathology observed was the spectrum of headaches including migraine, tension headache and headache with 240 cases; and the psychiatric mental and behavioral disorder with 18 cases. It was also found that older women are more predisposed to suffer from these diseases. Conclusions: The integration of neurological and psychiatric services in primary health care should be an important political objective in our country for the early diagnosis and treatment of these pathologies with great impact on health.
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Índice Ventricular De Levene y Mensuración del Tercer Ventrículo en Neonatos Ecuatorianos Mediante Ecografía Cerebral. Levene Ventricular Index And Measurement Of The Third Ventricle In Ecuadorian Neonates By Means Of Cerebral Ultrasound.
Introduction: The application of ultrasound in the brain evaluation of the neonate allows the measurement of brain structures. Objective: To obtain the sizes of the third ventricle and the ventricular index of Levene in a group of Ecuadorian neonates without neurological alterations. To establish normal ranges that can be used in the daily work of the neonatology service. Methods: A group of neonates without neurological alterations was studied. Through the anterior fontanelle, the Levene index was determined. The third ventricle’s diameter was seized through the temporal cranial window. Results: Sixty-six patients of 37 weeks’ gestational age at birth (range 27-42 weeks), predominantly male and an average weight at birth of 2554 grams, were included. The third ventricle’s mean diameter was 1.5 mm (range: 0.5 mm – 3.8 mm). The average Lindergaard index was 12.7 mm (8.2-27 mm). Both, the diameter of the third ventricle and the ventricular index were affected by the birth weight of newborns. Regarding the moment of delivery, there was no significant difference in ventricular size. Conclusions: Compared with the results of other series, our study offers different parameters.
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El Perfil Epidemiológico y Clínico de la Esclerosis Múltiple en el Ecuador. The Clinical And Epidemiological Profile Of Multiple Sclerosis In Ecuador.
In recent years, the number of publications on Multiple Sclerosis (MS) from Ecuador has seen a significant increase. As a result, the research on the clinical and epidemiological behaviour of the disease has allowed us to make comparisons with other cohorts of patients with MS that come from regions where the prevalence of the disease is high. Nevertheless, Ecuador is still a country in which the prevalence of MS is low with a prevalence that fluctuates between 3 to 5 cases per 100,000 inhabitants. The epidemiological behaviour of MS is very similar to that of european cohorts, for example female patients are the most affected. However, the clinical behaviour of multiple sclerosis differs in terms of cognitive impairment and fatigue being less frequent. The impact of vitamin D on patients with MS is still unknown as only one study has been carried out. This study show that there is a high prevalence of vitamin D deficiency and insufficiency in ecuadorian patients, but this does not translate into an increase in prevalence or disability as it does in european populations. Although we have a better understanding of the disease in the country, more studies are necessary, and it is imperative that all ecuadorian patients with MS be included in future studies in order to improve our knowledge about the behaviour of this disease in our region.
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Infección por el Virus Linfotrópico de Células T Humano HTLV-1 y Paraparesia Espástica Tropical en Ecuador: Paradigma de Enfermedad Tropical Desatendida. Human T-Lymphotrophic Virus Infection (HTLV-1) And Tropical Spastic Paraparesis: Paradigms Of An Overlooked Tropical Disease.
The human T cell lymphotropic virus (HTLV-1) infection is considered endemic in South America. For more than two decades clinical cases of HTLV-1 associated mielopaties have been reported in Ecuador, pathology known as tropical spastic paraparesis. There is only two studies about HTLV-1 seroprevalence in Ecuador, both of them with small sample size but showing a high prevalence of HTLV-1 infection, at least for afrodescendants and indigenous communities. However, there is not a currently screening for blood and organ banks carried out by ecuadorian public health authorities. This scenario makes HTLV-1 infection and associated pathologies (like tropical spastic paraparesis) neglected diseases in Ecuador. More epidemiological studies need to be implemented in order to develop control and prevention strategies in the country.
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Fibrinólisis Farmacológica en el Ictus Isquémico Agudo. Experiencia en un Hospital Terciario del Ecuador. Pharmacological Thrombolysis In Ischemic Stroke. Experience In A Tertiary Hospital From Ecuador.
Introduction. Pharmacological thrombolysis in ischemic stroke is associated with a better recovery.
Objective. Describe the thrombolysis results after using r-Tpa applying an intrahospital stroke code, during one year.
Methods. A prospective, longitudinal study was performed in patients with cerebral infarction admitted to the stroke unit, with clinical follow-up up to 3 months after hospital discharge. The variables evaluated were compared in two groups of patients (only one group received the treatment).
Results. 107 patients were studied: 16 (14.9%) were thrombolyzed, 29 (27.1%) arrived in the therapeutic window period and 76 (71%) arrived after 4.5 hours. The average age was 68, 8 years and women predominated. The greatest impact of thrombolysis was on the difference in score between the initial assessment and the discharge on the NIHSS scale. At three months of evolution, the percentage of patients with mild disability (Rankin 0-2) was almost equal in the two groups. Mortality increased in patients with more severe disability (Rankin 3-5).
Conclusions. Treatment with r-Tpa shows benefits at hospital discharge. Further analysis is required with a greater number of cases.
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Palabras clave: Accidente Cerebrovascular,
Ecuador,
Fibrinólisis,
infarto cerebral,
Terapia Trombolítica,
Salud Cardiovascular en Población Migrante Ecuatoriana en Madrid (España). ¿Debemos Preocuparnos?* Cardiovascular Health in an Ecuadorian Migrant Population to Madrid (Spain). Should we worry?
Background: The Ecuadorian community is the third largest foreign community in Spain. However, little is known about their cardiovascular (CV) health status and whether the effects of migration have caused a detriment in that state. Methods: With the aim of knowing the CV health in an Ecuadorian population of migrants in Madrid, a non-randomized, cross-sectional study was carried out, which included people of Ecuadorian nationality, older than 25 years, living in Madrid for a year or more. Surveys were conducted through the use of previously validated questionnaires, to determine the health status of the population, as well as the degree of neuro-physiological distress. Results: We included 165 participants (68.5% women), with an average age of 49 years. Of these, 86.1% presented poor cardiovascular health and 13.9% intermediate, without significant differences according to sex. There were no individuals that met the 7 variables consistent with and ideal CV status. Women had higher scores on the DASS-21 questionnaire compared to men (p <0.05). Conclusion: In the Ecuadorian migrant population living in Madrid, more than 85% had poor CV health, and none had an ideal CV health. Most prevalent risk factors in this population were poor physical activity, overweight/obesity and poor dietary habits. More studies are required to identify the real situation of CV risk in the Ecuadorian migrant population. Probably, in the medium-long term, it will be necessary to implement health policies especially addressed to migrants.
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Evaluación Neuropsicológica de la Atención: Test de Símbolos y Dígitos. Neuropsychological Assessment of Attention: Symbols And Digits Test.
Introduction: The symbol digit modality test is a reactive which provides great support in neuropsychological evaluation. Its execution permits to evaluate brain functions such as visual perception, stimuli recognition, attention (focal, selective and sustained), task supervision, interference control among others. Object: The purpose of the current research study was to analyze the normative percentiles of the execution of the test, to identify the performance activity of the reactive according to age group and gender; applying the test in a sample of college students. Method: The sample included 250 university students,142 (56.8%) males and 108 (43.2%) females. The age range of the participants was between 18 and 34 years old (M=21.53, DE=2.25). A transversal, non-experimental, quantitative research model with a correlational scope was used. Results: The correct answer average for the test was 52.83 (DE=13,60) and for percentile P5 31,55 right answers were found; for percentile P75 60,00 right answers, P25 had 46,00 right answers, and for P95 74,45 right answers were found. No significant differences were found for the mean of errors in the test in terms of age group f(3, 246)=0,67, p=0,57 and gender t(248)=0,68, p=0,49 of the participants as comparison factor. Conclusions: Results were discussed based on prior research pointing out the importance of counting with a first statistical parameter of the test as ground for neuropsychological clinical practice in Ecuador.
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Atahualpa, Una Población Rural Ideal Para la Práctica de Estudios Epidemiológicos. Atahualpa, An Optimal Rural Setting For The Practice Of Epidemiological Studies
Atahualpa is a rural village located in coastal Ecuador that achieve a number of requisites to be considered as an optimal setting for the practice of epidemiological studies. Atahualpa is an isolated village with a very low index of migration rate. Inhabitants are fairly homogeneous regarding race, lifestyles and diet, which is rich in oily fish. From the racial point of view, inhabitants are Ecuadorian natives with little evidence of cross-breading. Most men are artisan carpenters and most women are homemakers. These coincidences reduce the risk of the presence of unexpected confounders at the time of data analyses. However, this may also cause that data obtained might not be extrapolated to other regions. The practice of studies in neighboring villages, using similar protocols, is needed to validate generality of data obtained in Atahualpa.
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El Proyecto Atahualpa, Protocolo, Definiciones Operacionales y Diseño Inicial. The Atahualpa Project: Protocol, Operational Definitions, And Initial Study Design
Non-communicable diseases are the new health epidemics in developing countries due to increased life expectancy, and changes in lifestyle and dietary habits of the population. The Atahualpa Project was designed as a multi-step population-based cohort study designed to reduce the increasing burden of these conditions in rural Ecuador. The first step of the study followed a 3-Phase design, aimed to get information on demographics and cardiovascular risk factors of Atahualpa residents aged ≥40 years, as well as to assess the prevalence of stroke and ischemic heart disease. During Phase I, participants were screened with standardized questionnaires to evaluate their cardiovascular health and to identify those with suspected stroke or ischemic heart disease. In Phase II, neurologists and cardiologists examined suspected cases of stroke or ischemic heart disease, as well as a random sample of matched negative individuals, to assess prevalence of these conditions. In Phase III, patients with diagnosis of stroke and ischemic heart disease underwent complementary tests for achieving more specific diagnosis. Implementation of public health strategies directed to improve the cardiovascular health status of a given population must be based on studies evaluating specific risk factors at regional levels. Epidemiologic surveys such as the Atahualpa Project may prove cost-effective for improving the cardiovascular health status of people living in Latin American rural villages by increasing the knowledge on the particular needs of these populations.
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Salud Cardiovascular en Habitantes de Atahualpa: Características y Correlatos. Cardiovascular Health Status In Atahualpa Residents: Characteristics And Correlates
Stroke and cardiovascular diseases will be the next epidemics in Latin America due to changes in lifestyle and increased life expectancy. Knowledge of cardiovascular health (CVH) status of the population is mandatory to implement cost-effective strategies directed to reduce the burden of vascular diseases in the region. In the Atahualpa Project, we assessed the CVH status of participants using the metrics proposed by the American Heart Association. The basal study included 616 subjects free of stroke and ischemic heart disease aged ≥40 years. Of these, 2.1% had ideal, 28.1% had intermediate and 69.8% had poor CVH status. Poorest metrics were blood pressure, fasting glucose, and BMI. The odds for having a poor CVH status were increased in persons aged ≥ 60 years and in those with only primary school education. Then, we compared our results with the Hispanic population of the Northern Manhattan Stroke Study (NOMAS), and found that Atahualpa residents had significantly better metrics than those enrolled in the NOMAS, with the exception of fasting glucose levels. Likewise, the odds for having 5 to 7 ideal metrics were also better in Atahualpa residents, irrespective of age. We also conducted a case-control study to assess the CVH status of Atahualpa residents according to their living arrangements, and found that social isolation was associated with a worse CVH status in this population. A couple of studies showed correlation between some sleep related disorders and poor CVH status. We have also started an ongoing program called “known your numbers”, which, together with community talks, is directed to improve the CVH status and to reduce the burden of vascular diseases in the region.
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Palabras clave: apoyo comunitario,
Atahualpa,
Ecuador,
epidemiología,
estudio poblacional,
salud cardiovascular,
síndrome metabólico,
trastornos de sueño,
Sub-estudio de Neuroimagen del Proyecto Atahualpa. Neuroimaging Substudy Of The Atahualpa Project
The Atahualpa Project includes a Neuroimaging sub-study, which consists in the practice of MRIs and MRAs to all participants aged ≥60 years, as well as those presenting with specific neurological complains. Likewise, all participants aged ≥20 years have been invited for the practice of a head CT. MRIs and MRAs have been performed with the use of a Philips Intera 1.5T MRI machine, and TCs with the use of a Philips Brilliance 64 CT scanner, following established protocols. All exams have been independently reviewed by a neurologist and a neuroradiologist, with adequate kappa coefficients for inter-rater agreement. MRIs studies have been focused on the evaluation of global cortical atrophy, posterior parietal atrophy, bicaudate index, Evans index, hippocampal atrophy, signatures of cerebral small vessel disease, and lesions consistent with ischemic or hemorrhagic strokes. By the use of MRI, we have assessed the prevalence of intracranial artery stenosis, intracranial dolichoectasia and variations in the configuration of the circle of Willis. Using CT, we have focused on the diagnosis of neurocysticercosis, pineal gland calcifications, as well as in variations and characteristics of skull bones, cerebellar atrophy, and severity of carotid siphon calcifications. In the present study, we focused on the description of basic protocols used for assessment of previously mentioned lesions of interest.
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Búsqueda de Substitutos Para Estudios de Neuroimagen con Propósitos de Investigación: Experiencia del Proyecto Atahualpa. The Search Of Surrogates For Neuroimaging Studies For Research Purposes: The Atahualpa Project Experience
Diagnosis of many non-communicable neurological diseases require the use of MRI, which is not readily available in remote rural populations. Efforts should be directed to find portable screening diagnostic tools that may help identify candidates for MRI screening. In the Atahualpa Project, all participants aged ≥60 years have been invited for the practice of MRI, and about 80% of them have underwent the procedure. Therefore, we have the unique opportunity to test the accuracy of non-invasive exams to be used as surrogates to MRI for identifying candidates for the practice of this exam. To date, we have assessed the value of the ankle-brachial index (ABI), the reliability of the neutrophil-to-lymphocyte ratio (NLR), the accuracy of hypertensive retinopathy, and the value of transcranial Doppler (TCD) to detect individuals with cerebral small vessel disease. Individuals with an abnormal ABI have 4 times de odds of having a silent lacunar infarct than those with a normal ABI. A high NLR has a poor sensitivity but is highly specific for detecting persons with at least one imaging signature of small vessel disease. Individuals with hypertensive retinopathy Grades 2-3 are almost four times more likely to have moderate-to-severe white matter hyperintensities than those with no- or only Grade 1 retinopathy. Finally, the correlation between the pulsatility indexes of major cerebral arteries with imaging markers of small vessel disease, as assessed by TCD, was poor. We are still in the search of some non-expensive and readily available biomarker that allow the identification of apparently healthy persons at risk of suffering a catastrophic cerebrovascular event.
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Trastornos de Sueño en Residentes de Atahualpa. Sleep Disorders In Atahualpa Residents.
Health problems related to sleep disorders are likely on the rise in rural areas of Latin America, partly related to changes in life style, shift work, and other factors. However, little is known on the burden of these conditions in remote rural settings. In the Atahualpa Project, we have investigated sleep disorders using standardized field instruments associated with sophisticated technology such as polysomnography. A poor sleep quality has been associated with frailty and with the presence of neuroimaging markers of cerebral small vessel disease and global cortical atrophy. On the contrary, dietary intake of oily fish was associated with a better sleep quality. We have also investigated the prevalence and some correlates of the restless legs syndrome (Willis-Ekbom disease), and found a prevalence relatively higher than that described in most other tropical regions, as well as the association of this condition with psychological stress. Finally, a preliminary report shows a high prevalence of moderate-to-severe obstructive sleep apnea in Atahualpa residents aged ≥60 years (27%) and its correlation with diffuse subcortical damage of vascular origin. Further studies are needed to better understand consequences of sleep-related symptoms in underserved populations.
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Alcohol: Consumo, Consecuencias y Complicaciones Neurológicas. Resultados del Proyecto Atahualpa. Alcohol: Intake, Consequences and Neurological Complications. Results From The Atahualpa Project.
Information about the burden and consequences of alcohol intake in rural communities of Latin America is scarce. This study aims to assess the magnitude of alcohol intake in Atahualpa as well as its consequences and prevalence of neurological complications. Male residents aged ≥40 years (n=277) were interviewed with a structured questionnaire designed to evaluate prevalence, drinking patterns and consequences of chronic alcohol intake. Most of them were current drinkers and 40% started drinking below the legal age (18 years). Weekly binge drinking were admitted by 81% individuals, 58% referred physical consequences related to alcohol intake, 59% had social consequences, and 51% recognized alcohol intake as a major economic burden. Individuals who started drinking below the legal age were more often involved in binge drinking and consumed more alcohol than those aged ≥18 years at first regular drink. The relationship between alcohol intake and alcoholic cerebellar degeneration was evaluated by the use of the BARS scale, with 14.6% of individuals having clinically relevant alcoholic cerebellar degeneration. Predictive models showed significant relationships between BARS score margins and years of drinking and the amount of alcohol intake. Our study also provided robust evidence favoring an independent and synergistic effect of age and years of drinking in the relationship between ACD and cognitive decline. This study shows a high prevalence of chronic alcohol intake in community-dwelling men living in Atahualpa.
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Palabras clave: alcohol,
Atahualpa,
degeneración cerebelosa alcohólica,
Ecuador,
epidemiología,
estudio poblacional,
Enfermedad Cerebrovascular en Atahualpa: Prevalencia e Incidencia. Cerebrovascular Disease In Atahualpa: Prevalence And Incidence
Stroke burden is on the rise in rural regions of South America. We evaluated prevalence, pattern of subtypes and pathogenetic mechanisms underlying stroke in Atahualpa. In a three-phase epidemiologic study, suspected cases were detected by a door-to-door survey. Then, neurologists evaluated suspected cases and randomly selected negative persons, and confirmed patients underwent complementary exams. We found 20 stroke patients among 642 persons aged ≥ 40 years. Stroke prevalence was 31.15‰ that increased with age. Hypertensive arteriolopathy was the most likely mechanism underlying strokes (55% patients). Extracranial atherosclerotic lesions or cardiac sources of emboli were not found in any case. Comparison of our findings with a previous survey performed in the same village showed an alarming increase in stroke prevalence (from 14.08‰ in 2003 to 31.15‰ in 2012, p=0.03). Thereafter, we conducted an incidence study. For this, first-ever strokes occurring over four years were identified from yearly door-to-door surveys and other overlapping sources. Of 807 stroke-free individuals prospectively enrolled in the Atahualpa Project, follow-up was achieved in 718 (89%), contributing 2,499 years of follow-up (average 3.48±0.95 years). Stroke incidence rate was 2.97 per 100 person-years of follow-up (95% C.I.: 1.73–4.2), which increased to 4.77 (95% C.I.: 1.61–14.1) when only persons aged ≥57 years were considered. Poisson regression models, adjusted for relevant confounders, showed that high blood pressure (IRR: 5.24; 95% C.I.: 2.55–7.93) and severe edentulism (IRR: 5.06; 95% C.I.: 2.28–7.85) were the factors independently increasing stroke incidence. Stroke incidence in Atahualpa is comparable to that reported from the developed world. Besides age and high blood pressure, severe edentulism is a major factor independently predicting incident strokes.
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Palabras clave: Atahualpa,
Ecuador,
epidemiología,
estudio poblacional,
infarto cerebral hemorragia intracraneal,
Deterioro Cognitivo: Prevalencia y Correlatos en una Comunidad Rural Ecuatoriana. Lecciones del Proyecto Atahualpa. Cognitive Decline: Prevalence And Correlates In A Rural Ecuadorian Community. Lessons From The Atahualpa Project.
Assessment of cognitive impairment in rural areas of developing countries is complicated by illiteracy and cross-cultural factors. The Montreal Cognitive Assessment (MoCA) was used to estimate cognitive performance in individuals enrolled in the Atahualpa Project. Some problems were noticed with the use of this test, including issues related to naming animals, as well as the need to adjust a different cutoff for diagnosing mild cognitive decline than that used in highly educated individuals living in developed countries. After correlating MoCA scores with neuroimaging signatures of cortical and subcortical atrophy, a cutoff of 19-20 points would better define cognitive impaired individuals in rural areas. We also noticed that severe edentulism as well as psychological distress were associated with poor cognitive performance in older adults living in Atahualpa. In contrast, our study showed a linear, and dose-dependent, direct relationship between dietary oily fish intake and cognitive performance. We also aimed to assess the independent contribution and the interaction of age, the stroke itself and diffuse subcortical damage in the poor cognitive performance observed in patients with stroke, and noticed that interaction of age and diffuse subcortical damage are major determinants for poor cognitive performance among stroke patients. The total cerebral small vessel disease score can be used as a reliable predictor of poor cognitive performance, although its predictive power is not better than that of isolated neuroimaging signatures of cerebral small vessel disease. Finally, we noticed an inverse relationship between calcium content in the carotid siphon – used as a surrogate of intracranial atherosclerosis – and cognitive performance in our population.
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Prevalencia de la Enfermedad de Parkinson: Estudio Puerta-Puerta en la Provincia de Manabí-Ecuador. Prevalence of Parkinson’s Disease: Door-to-door Study in Manabi-Ecuador.
Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders after dementias, with a worldwide prevalence of more than 1% in patients older than 65 years. In Ecuador, there are not direct statistical data on this disease. The aim of our research lies in establishing for the first time, the prevalence of Parkinson’s disease in the province of Manabi. For that, a door-to-door study was designed in two phases. They were selected 116,983 people, over forty years old. During the first phase, they were evaluated by survey, according to the London Brain Bank criteria for diagnosis. In the second phase, patients who met the criteria were referred to a neurologist for a definitive diagnosis. A total of 285 people (0.24%) were positive for Parkinson’s disease, predominating those aged over 61 years (33.33%), and with a slightly higher prevalence among males (56.14%) than in women (43.86%).
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Palabras clave: Ecuador,
enfermedad de Parkinson,
epidemiología,
estudio puerta a puerta,
Prevalencia,
Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones
Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.
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Sistemas de Atención Focalizada, Sostenida y Selectiva en Universitarios de Quito-Ecuador
Introduction. Attention is a neuropsychological function that has threads of targeting, selectivity, sustainability, division and alternation, which enable human beings identify a particular stimulus for cognitive and brain processing. Objective. To analyze the performance of college students in a focused, sustained and selective attention test, considering age group, gender and academic level comparing factors. Method. A quantitative, non experimental, transectional and based on the comparison group research design was used. The sample size was 246 college students (50.8% men and 49.2% women), within17 and 29 years (M = 21.01, SD = 2.35) Results. It was found that targeting attentional processes, sustainability and selectivity are similar between the different age groups, educational level and gender. Conclusions. The basic attentional processes are fully developed in college students. Data are discussed around previous research and theoretical postulates of cognitive neuroscience.
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Palabras clave: atención selectiva,
atención sostenida,
Ecuador,
estudiantes universitarios,
focalización,
neuropsicología,
Manifestaciones Neurológicas Asociadas a Infección por Virus Zika
Zika virus is a flavivirus and it is part of the flaviviridae family. This virus is transmitted by Aedes mosquito bites and sexual intercourse. The virus was discovered in 1947 but it was almost unknown until it spread along America in 2015 and was associated with multiple neurological disorders. Due to this incidence, the World Health Organization declared an emergency status in 2016. In Ecuador, the first case of Guillain-Barre Syndrome associated with Zika virus infection was reported during
the same year.
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Concepto de la Demencia como Enfermedad en un Grupo Poblacional de la Ciudad de Guayaquil
Background: Dementia is a clinical condition that causes progressive cognitive impairment, and early diagnosis may have a significant impact on the quality of life. So far, no studies have been conducted to evaluate the conception of the general population about this disease.
Methods: Cross-sectional, descriptive and analytical study, which surveyed individuals between 55 and 65 years old without neurocognitive pathology about the concept of the term “dementia”. The educational level of each respondent was also collected. The responses were assigned to one of 6 possible response groups for analysis, depending on which group better matched each individual response. The percentage of each type of response was calculated, and chi-square was used to observe the relationship between level of education and the type of answers given.
Results: a total of 274 individuals were surveyed, 35.8% were male and 64.2% female. Most patients (36.5%) had only elementary education. 11.7% did not know what dementia means. 45.5% defined it as memory loss and 23% incorrectly identified it as a psychiatric illness. A very small percentage of individuals correctly defined it as a type of cognitive impairment. We found a statistically significant relationship between the level of education and the type of answers obtained (p <0.001).
Discussion: more than half of respondents gave an acceptably correct answer about the concept of dementia, but there is still a significant percentage of people who do not know its meaning, or confuse it with psychiatric illness. It is imperative to carry out health campaigns to alert people about this disease and how to delay it’s onset by lowering risk factors, and to train as well primary care physicians to provide better information to their patients in order to improve the prevention of dementia and lessen its impact on quality of life.
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Neurofobia entre los estudiantes de la Carrera de Medicina de sexto a décimo semestre en la Universidad Católica Santiago de Guayaquil.
Background: Neurophobia is defined as fear to neuroscience and clinical neurology. By the impact of neurological diseases worldwide, management of these disorders could be affected. No data exist of this phenomenon in Ecuador. Objectives: To evaluate the difficulty, knowledge, confidence and interest in neurology, neuroscience specialties, affinity factors for difficulty in neurology and neurological training among medical students.
Methods and Materials: A descriptive study was conducted at the Catholic University of Santiago de Guayaquil, surveying: difficulty, knowledge, confidence and interest among specialties; affinity to neuroscience as a specialty, factors contributing neurology´s perception as difficult, and neurological undergraduate training.
Results: The response rate was 78.32% (401/512). Neurology was the most difficult (3.01±0.048), the second with less clinical confidence (2.01±0.056), and third with less knowledge (1.96±0.058). The differences were significant (p <0.001). 70.82% did not plan to pursue a specialty related to neuroscience, 59.85% for absent personal affinity; 10.97% for poor teaching; Contrary, 29.18% want a related specialty in neuroscience, 19.95% by personal affinity and 9.23% for good teaching. Need to know basic neuroscience was the most important for the perception of difficulty (2.76±0.055) followed by poor teaching factor in neurological involvement (2.68±0.57). Training in Neurological Semiology the lowest (1.70±0.061) followed by Neuroanatomy (1.98±0.58) and Neurology (2.52±0.81). Neurologic semiology had the highest percentage of inadequate training (20.45%) compared to Neuroanatomy (9.47%) and Neurology (6.16%).
Conclusions: There is neurophobia among our students. Research and modifications in teaching must be developed to prevent neurophobia and contribute to “neurophilia.”
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Perfil de la Epilepsia en el Ecuador
The point prevalence of active epilepsy in Ecuador is between 7/1000 and 12/1000, which is similar to that reported in developed countries; however, this finding does not necessarily indicate that the risk to develop epilepsy is the same in these two populations. The incidence of epilepsy in Ecuador is between 120/100,000 and 172/100,000, which is two to threefold higher than that reported in developed countries. These results should be confirmed by further studies. In Ecuador, the frequency of epilepsy is highest during adolescence and adulthood, probably due to the high prevalence of infectious and parasitic diseases in these age groups. Regarding the prognosis, seizures recur in 43% of patients with epilepsy. The risk of recurrence by the Kaplan-Meier actuarial analysis is 30% at 12 months, 51% at 24 months, and 79% at 45 months of follow-up. Statistically significant risk factors for recurrence are the etiology (52% recurrence risk in patients with symptomatic epilepsy) and the presence of an abnormal CT scan (51% recurrence risk in patients with abnormal CT scans). Mortality in patients with epilepsy is six-fold higher than in the general population of Ecuador (standardized mortality ratio SMR of 6.3). The SMR for sudden death in patients with epilepsy (3.9) is also higher than that reported in developed countries. These greater mortality ratios probably explain the relatively low prevalence rates in our country. In 1995, Ecuador spent 4.6% of the gross national product on the health system. The Ministry of Health, which funds the public health system, contributed only 1.5% of this amount. This government contribution is one of the lowest in South America. There are no government programs in Ecuador working to manage and prevent chronic diseases, such as epilepsy. There are also no laws to protect patients with epilepsy. This complex background obligates the health authorities, scientific community, and the society in general, to join together in the fight against epilepsy, as a bio-psycho- social problem.
