COVID-19: Pandemic in Ecuador: a health disparities perspective.

BACKGROUND: The global COVID-19 pandemic initiated in Ecuador with the patient zero in February 2020 and since more than 40,000 persons have been tested positive to the virus, leaving some 3,500 deceased, while approximately about 10,500 persons above annual average numbers died within March to May. A strict lockdown was applied by mid-March, which resulted to a severe economic crisis in the country. Although during the lockdown. OBJECTIVE: Our study postulates, that persons who are most likely to be infected during such secondary wave will be people who have already health issues to which we count besides the known ones, especially those who are already suffer by the distribution of volcanic ashes, as such pyroclastic material is known to affect lunges and thyroids. occurred a notable decrease in the number of new cases, the spread of the infection was already massive, untechnical, political and economic decisions will certainly lead to continuous wave of infections for months. METHODS: A descriptive ecological study of information related to COVID-19 infection at a national level using official data from the Minister of Public Health and volcanic ash fall by geographical area in Ecuador. RESULTS: The mortality rate per canton indicated that those with lower attack rates are the ones with highest mortality rate. For instance, Portovelo (21.3/100,000), Playas (18.4/100,000), Santa Rosa (15.8/100,000), Suscal (15.3/100,000) and Penipe (14.3/100,000) reported the highest mortality rate per 100,000 people. The main distribution of such volcanic material is within the central to northern area of the Highlands and Inter-Andean Valley of Ecuador, due to the analysis of some 7394 satellite images of the last 21 years. CONCLUSIONS: We conclude that areas with high vulnerabilities are also most susceptible to develop COVID-19. Such areas with their respective populations will be affected above average and shall be protected in particular within the presently starting during possible second wave of infection.

Increased Cardiovascular Mortality in Ecuador during COVID-19 Pandemic.

Before the COVID-19 pandemic, chronic noncommunicable diseases (NCDs), represented a high burden for low and middle-income countries. Patients with NCDs are at higher risk of COVID-19 and suffer worse clinical outcomes. We present mortality trends for myocardial infarction (AMI), stroke, hypertension (HT), and type-2 diabetes mellitus (T2DM) from 2005 to 2021 in Ecuador. The greatest increase in mortality observed in the pandemic was in AMI, T2DM, and HT. Factors related to COVID-19, health services, and patients with NCDs could contribute to these important increases in mortality.

In the name of COVID-19: legitimizing the exclusion of community participation in Ecuador's health policy.

Global shifts toward a disease-oriented, vertical approach to health has involved limiting the right for communities to participate in decision-making. Ecuador's authoritarian legacy has forced civil society and social organizations to adopt 'coping strategies', while large protests recently derived into violent struggles. The country has been severely hit by the COVID-19 pandemic amid corruption scandals involving hospital and food purchases by government during the response. This study critically examines how Ecuador's government took into consideration 'community participation' as a value and tenet of health promotion. Our systematic textual analysis focuses on 53 consecutive resolutions by the National Emergency Operations Committee (EOC) leading the decision-making processes, which, explicitly requires community participation. Results show that the 'lifecycle' of the central government's evolving policy framing centered on law enforcement and the private sector, followed by the social sector. Further, there is no evidence of stakeholders from civil society or organizations taking part in decision-making. Having legitimized the exclusion of community participation in Ecuador's response to the COVID-19 pandemic, it is possible that the government will fail to consider the wider social implications of its impact. In particular, the limits to local governments becoming informed and making decisions without mediation by the National EOC will further impede community participation in health decision-making in the future. This implies that local knowledge and experiences will also not inform health policy.

A comprehensive study of Ecuadorian adult patients with a mild and moderate presentation of COViD-19.

AIM: To characterize non-hospitalized patients with mild and moderate clinical presentation. METHODS: We performed an epidemiological, observational, descriptive, and cross-sectional study carried out in Ecuador, with 1,447 participants between 18 and 66 years, non-hospitalized, with a molecular RT-PCR test for SARS-CoV2. We analyzed demographic characteristics according to sex, age group, clinical findings, behavior after diagnosis, family and social behavior, sequelae, clinical evolution, type of exposure, and personal history. RESULTS: The sample analyzed had a mean age of 37 years (95% CI 18-66), women 713 individuals (49.27%), men 733 individuals (50.66%). Age group distribution was 18-30 years, 524 individuals (36.29%), 31-45, 538 individuals (37.26), and more of 45 years, 382 individuals (26.46%). 1416 individuals were mestizos (97.99%). According to the province of residence from Pichincha were 1019 patients (70.52%), followed by Imbabura, 93 patients (6.44%), and the others 335 (23.15%) patients come from all over the country. In women, the most common findings were fever >38°C (54.40%), sputum (27.43%) and hypoxia (16.32%); HTN (5.75%) and hypercholesterolemia (3.69%). Men were more prevalent in all other findings. Comorbidities were more prevalent in all those over 45 years of age. COVID-19 antibodies test was positive in 416 patients (28.85%). Neuropsychiatric symptoms such as sleep disorders, generalized anxiety disorder, depressed mood, and chronic fatigue were more prevalent in men than women. Still, generalized anxiety disorder and chronic fatigue were more common in individuals of 31 to 45 years. 868 patients (60.07%) were in contact with a known infected person, 318 patients (22.02%) were health workers, and 782 patients (57.63%) were informed about work exposure. 545 patients (37.72%) were overweight, primarily women 310 (42.29%). 609 patients (42.65%) showed symptoms after the acute period, and 331 individuals (23.49%) reported some sequelae. CONCLUSION: The epidemiological and clinical behavior of hospitalized and critical patients differs greatly from ambulatory or mild or moderate symptoms. It is essential to highlight those non-hospitalized patients constitute the predominant population of patients, hence the importance of adequate management that would directly affect the development of complicated forms and, consequently, the collapse of healthcare centers. It is vitally important to open more investigations that compare hospitalized and outpatient patients to have a clearer picture of the epidemic.

Comparison of Pediatric Patients With and Without Multisystem Inflammatory Syndrome Associated With COVID-19: Retrospective Cohort From Ecuador.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C). METHODS: One hundred and sixty-seven children (0-15 years) admitted to the pediatric intensive care unit COVID-19 ward of a national reference children's hospital in Quito, Ecuador, from June 2020 to June 2021 who developed PARDS with or without MIS-C. To diagnose PARDS, the criteria of the Pediatric Acute Lung Injury Consensus Conference Group were used, and to diagnose MIS-C, the criteria of the Centers for Disease Control and Prevention were used. Additionally, the PRISM score was used to calculate the mortality risk of study patients on admission. RESULTS: Of the 167 patients with PARDS, ~59% also developed MIS-C. Patients with PARDS + MIS-C had higher risks than patients without MIS-C in the following: frequency of associated bacterial infections (81.6% vs. 55.1%), mortality risk (36.7% vs. 11.6%), use of respiratory support (invasive mechanical ventilation: 92% vs. 86%), use of vasopressors/inotropes (90.8% vs. 30.4%), renal complications (36.7% vs. 8.7%), septic shock (84.7% vs. 20.3%), multiorgan failure (39.8% vs. 1.4%) and mortality at discharge (39.8% vs. 4.3%). Logistic regression failed to find an association between MIS-C and age, race, sex, ≥3 signs/symptoms and ≥2 comorbidities. CONCLUSIONS: Patients with PARDS + MIS-C had a more severe clinical picture than patients without MIS-C. The findings provide useful information to improve the management of PARDS patients with and without MIS-C in Ecuador.

Determinants of self-reported health status during COVID-19 lockdown among surveyed Ecuadorian population: A cross sectional study.

OBJECTIVE: To examine the associations of sociodemographic, socioeconomic, and behavioral factors with depression, anxiety, and self-reported health status during the COVID-19 lockdown in Ecuador. We also assessed the differences in these associations between women and men. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional survey between July to October 2020 to adults who were living in Ecuador between March to October 2020. All data were collected through an online survey. We ran descriptive and bivariate analyses and fitted sex-stratified multivariate logistic regression models to assess the association between explanatory variables and self-reported health status. RESULTS: 1801 women and 1123 men completed the survey. Their median (IQR) age was 34 (27-44) years, most participants had a university education (84%) and a full-time public or private job (63%); 16% of participants had poor health self-perception. Poor self-perceived health was associated with being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status. For women, self-employment, having solely public healthcare system access, perceiving housing conditions as inadequate, having cohabitants requiring care, having very high difficulties to cope with household chores, having COVID-19, and having a chronic disease increased the likelihood of having poor self-reported health status. For men, poor or inadequate housing, presence of any chronic disease, and depression increased the likelihood of having poor self-reported health status. CONCLUSION: Being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status in Ecuadorian population.

The Role of Remote Sensing and Geospatial Analysis for Understanding COVID-19 Population Severity: A Systematic Review.

Remote sensing (RS), satellite imaging (SI), and geospatial analysis have established themselves as extremely useful and very diverse domains for research associated with space, spatio-temporal components, and geography. We evaluated in this review the existing evidence on the application of those geospatial techniques, tools, and methods in the coronavirus pandemic. We reviewed and retrieved nine research studies that directly used geospatial techniques, remote sensing, or satellite imaging as part of their research analysis. Articles included studies from Europe, Somalia, the USA, Indonesia, Iran, Ecuador, China, and India. Two papers used only satellite imaging data, three papers used remote sensing, three papers used a combination of both satellite imaging and remote sensing. One paper mentioned the use of spatiotemporal data. Many studies used reports from healthcare facilities and geospatial agencies to collect the type of data. The aim of this review was to show the use of remote sensing, satellite imaging, and geospatial data in defining features and relationships that are related to the spread and mortality rate of COVID-19 around the world. This review should ensure that these innovations and technologies are instantly available to assist decision-making and robust scientific research that will improve the population health diseases outcomes around the globe.

Occurrence of SARS-CoV-2 reinfections at regular intervals in Ecuador.

SARS-CoV-2 reinfection is defined as a new infection with a different virus variant in an individual who has already recovered from a previous episode of COVID-19. The first case of reinfection in the world was described in August 2020, since then, reinfections have increased over time and their incidence has fluctuated with specific SARS-CoV-2 variant waves. Initially, reinfections were estimated to represent less than 1% of total COVID-19 infections. With the advent of the Omicron variant, reinfections became more frequent, representing up to 10% of cases (based on data from developed countries). The frequency of reinfections in Latin America has been scarcely reported. The current study shows that in Ecuador, the frequency of reinfections has increased 10-fold following the introduction of Omicron, after 22 months of surveillance in a single center of COVID-19 diagnostics. Suspected reinfections were identified retrospectively from a database of RT-qPCR-positive patients. Cases were confirmed by sequencing viral genomes from the first and second infections using the ONT MinION platform. Monthly surveillance showed that the main incidence peaks of reinfections were reached within four to five months, coinciding with the increase of COVID-19 cases in the country, suggesting that the emergence of reinfections is related to higher exposure to the virus during outbreaks. This study performed the longest monitoring of SARS-CoV-2 reinfections, showing an occurrence at regular intervals of 4-5 months and confirming a greater propensity of Omicron to cause reinfections.

Psychological Distress in the Galapagos Islands During the COVID-19 Pandemic.

Objectives: to explore the emotional impact of the COVID-19 pandemic in the Galapagos Islands. Methods: an online survey of 369 participants, conducted on October of 2020, was used to assess levels of depression, anxiety, and stress, as well as specific behavioral and emotional reactions to the pandemic. Results: the prevalence of anxiety was 4% and depression 3.65%. Perceived stress level was higher, with 52% of the sample reporting moderate amounts. Women had higher levels of depression and perceived stress. Financial distress, interpersonal conflicts, feelings of isolation and fear of contagion of COVID-19 were all associated with higher levels of anxiety, depression, and stress. Conclusion: prevalence of anxiety and depression is lower in the Galápagos Islands during the pandemic compared to other regions, while stress levels are more significant and may warrant intervention. Despite being low, anxiety and depression were associated with potentially problematic behaviors and emotional reactions.

Digital health literacy and subjective wellbeing in the context of COVID-19: A cross-sectional study among university students in Ecuador.

Background: The COVID-19 pandemic has generated an avalanche of information, which, if not properly addressed, generates uncertainty and limits healthy decision-making. On the other hand, the pandemic has exacerbated mental health problems among young people and adolescents, causing a worsening of their wellbeing. Previous studies have found that digital health literacy has a positive impact on people's attitudes toward the disease. This study aimed to analyze the association between digital health literacy on COVID-19 with subjective wellbeing in university students. Methods: A cross-sectional study was developed in 917 students from Ecuador. Subjective wellbeing was measured with the World Health Organization WellBeing Scale. Digital health literacy was assessed using the Spanish-translated version of the Digital Health Literacy Instrument adapted to the context of the COVID-19 pandemic. Bivariate and multivariate linear regressions were performed. Results: Digital health literacy and subjective wellbeing proofed to be significantly higher among males and among students with higher social status. The association between digital health literacy and subjective wellbeing was significant; for each increase of one point in the digital health literacy scale, an average increase of 9.64 points could be observed on the subjective wellbeing scale (IC 95% 5.61 - 13.67, p-value <0.001). This correlation persisted after adjust by demographic and socioeconomic variables. Conclusion: Improving digital health literacy in health would improve the subjective wellbeing of university students. It is suggested strengthen the digital health literacy through public and university policies that promote access, search skills and discernment of digital information. Socioeconomic and gender inequalities related to digital health literacy need to be further investigated.

Decreasing incidence rates of osteoporotic hip fractures in Ecuador during the COVID-19 pandemic.

We aimed at comparing the incidence of hip fractures in older adults from Ecuador before and during the COVID-19 pandemic. There was a significant reduction in the number of hip fractures, with no change in the length of hospital stay, mortality, and case-fatality rate, during the period of social isolation. INTRODUCTION: The impact that the COVID-19 pandemic has had on fragility fractures is being recently evaluated in the literature. Despite this, data from Latin America in this regard is scarce. PURPOSE: This study aims to compare the incidence rate of hip fractures before and during the COVID-19 pandemic in older adults who received care in the public and private health system of Ecuador. METHODS: This was a descriptive and retrospective study that analyzed data of individuals aged 60 years and older who had hip fractures before and during the COVID-19 pandemic. The information was obtained from the National Hospital Discharge Yearbook. We calculated the incidence, average length of hospital stay, mortality, and case-fatality rate associated with hip fractures. RESULTS: There was a significant reduction in the incidence of hip fractures in adults 60 or older during the period of social isolation due to COVID-19. Between March and December 2019, there was an incidence of 152 hip fractures per 100,000 inhabitants, whereas during the same period but in 2020 in the incidence was 110 per 100,000 inhabitants (p < 0.0001). The main decrease was observed in women aged 80 or more. The average length of hospital stay did not show significant changes. Mortality displayed a non-significant decrease (p = 0.14), although this decrease was significant among women (p = 0.02). Case-fatality rate showed a non-significant increase for the whole group (p = 0.68) and for men (p = 0.09). CONCLUSION: Hip fracture rates decreased significantly in adults aged 60 and older in 2020 compared to 2019. This decrease of hip fracture incidence rates was mainly due to the reductions observed in older people and women. The average length of hospital stay, mortality, and case-fatality rate associated with hip fractures did not show significant changes during the pandemic.

A competing risk survival analysis of the sociodemographic factors of COVID-19 in-hospital mortality in Ecuador.

This study aimed to analyze the effect of sociodemographic characteristics on COVID-19 in-hospital mortality in Ecuador from March 1 to December 31, 2020. This retrospective longitudinal study was performed with data from publicly accessible registries of the Ecuadorian National Institute of Statistics and Censuses (INEC). Data underwent a competing risk analysis with estimates of the cumulative incidence function (CIF). The effect of covariates on CIFs was estimated using the Fine-Gray model and results were expressed as adjusted subdistribution hazard ratios (SHR). The analysis included 30,991 confirmed COVID-19 patients with a mean age of 56.57±18.53 years; 60.7% (n = 18,816) were men and 39.3% (n = 12,175) were women. Being of advanced age, especially older than or equal to 75 years (SHR = 17.97; 95%CI: 13.08-24.69), being a man (SHR = 1.29; 95%CI: 1.22-1.36), living in rural areas (SHR = 1.18; 95%CI: 1.10-1.26), and receiving care in a public health center (SHR = 1.64; 95%CI: 1.51-1.78) were factors that increased the incidence of death from COVID-19, while living at an elevation higher than 2,500 meters above sea level (SHR = 0.69; 95%CI: 0.66-0.73) decreased this incidence. Since the incidence of death for individuals living in rural areas and who received medical care from the public sector was higher, income and poverty are important factors in the final outcome of this disease.

Analysis of Socio-demographic, Economic and Individual Reasons for COVID-19 Vaccination Hesitancy in Ecuador: A Nationwide Longitudinal Study.

The current outbreak of SARS-Cov-2, a virus responsible for COVID-19, has infected millions and caused a soaring death toll worldwide. Vaccination represents a powerful tool in our fight against the transmission of SARS-CoV-2. Ecuador is one of the Latin American countries most impacted by COVID-19. Despite free COVID-19 vaccines, Ecuadorians still hesitate to get vaccinated. A multivariate binary logistic regression was used to analyze data from the Ecuadorian National Institute of Statistics and Censuses. This study investigated socio-demographics, economic, and individual reasons associated with a person having "no intention" to receive COVID-19 vaccine across the study period of October 2021 to March 2022. The survey revealed an increase of unvaccinated people having no intention of COVID-19 vaccination from 57.4% (October-December 2021) to 72.9% (January-March 2022). COVID-19 vaccine hesitancy was dependent on factors like sex, age and ethnicity. Socio-economic characteristics and education level were not found to be statistically significant in lack of vaccine intention, but most vaccination hesitancy was due to distrust in the COVID-19 vaccine. People who believed that the vaccine could be unsafe because of possible side effects represented half of the surveyed participants, a proportion that barely diminished during the progress of the vaccination campaign across October-December 2021 (57.04%) and January-March 2022 (49.59%) periods. People who did not believe that the vaccine was effective enough increased from 11.47 to 18.46%. Misbeliefs about effectiveness and safety of vaccines should be considered in the implementation of public health initiatives of communication, education and intervention to improve vaccination campaigns.

Covid-19 en la población LGBTIQ+ en Ecuador: Perspectivas de una junta asesora comunitaria.

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Sense of Coherence in Healthcare Workers During the COVID-19 Pandemic in Ecuador: Association With Work Engagement, Work Environment and Psychological Distress Factors.

Objectives: The aim of this study was to test the association between the sense of coherence, work engagement, and psychological distress in healthcare workers in Ecuador during the first phase of the COVID-19 pandemic. Methods: A cross-sectional observational study in a sample of 803 healthcare professionals from all regions of Ecuador between 2 April and 17 May 2020. A self-administered questionnaire was used, which contained sociodemographic and work environment variables, the Utrecht Work Engagement Scale (UWES-9), the General Health Questionnaire (GHQ-12), and Sense of Coherence Scale (SOC-13). Results: The mean value of sense of coherence was M = 65.04; SD = 12.74; for work engagement, it was M = 39.36; SD = 10.53; and for psychological distress, M = 4.58; SD = 3.44. There is a positive correlation (p < 0.01) between the sense of coherence and work engagement, and a negative correlation with psychological distress. Conclusion: During the pandemic in Ecuador, healthcare professionals have suffered a major deterioration of their mental health. Sense of coherence has been associated with work engagement and psychological distress. They have perceived a worsening of the quality of care and working conditions compared to those existing before COVID-19.

Occurrence of emerging contaminants in surface water bodies of a coastal province in Ecuador and possible influence of tourism decline caused by COVID-19 lockdown.

Emerging contaminants in water bodies is an issue of concern due to their impact on the ecosystem and human health. The COVID-19 pandemic has forced the implementation of protective measures such as social distancing, lockdowns, and remote work, which have affected the tourism influx. This study aimed to evaluate the occurrence of emerging pollutants in bodies of water in Esmeraldas, a coastal province of Ecuador, before and during the COVID-19 pandemic in a highly touristic region. For this purpose, surface waters from 14 beaches and ten river mouths were sampled at two-time points in November 2019 and November 2020. Compounds widely consumed in Ecuador: acetaminophen, caffeine, sodium diclofenac, trimethoprim, and sulfamethoxazole were extracted from water samples by solid phase extraction SPE and detected with a UPLC-QTOF-MS system. We found a decrease in the occurrence of caffeine from 100 % to 4.2 % of caffeine and 25 % to 0 % of diclofenac, likely related to the decline in tourist afflux due to the lockdown measures. Most of the compounds diminished in terms of frequency and/or concentration; however, as COVID-19 treatments make use of different pharmaceutical compounds such as antivirals, antibiotics, antiparasitics, or glucocorticoids, future studies should include these to assess their environmental impact.

A 71-Year-Old Man From Ecuador With a History of Type 2 Diabetes Mellitus and Severe COVID-19 Pneumonia and Lung Cavitation Associated With Triple Infection With Trichosporon Asahii, Klebsiella Pneumoniae, and Pseudomonas Aeruginosa.

Unvaccinated patients with comorbidities that impair the immune function, such as type 2 diabetes mellitus, are more likely to develop severe COVID-19. The COVID-19-associated acute respiratory distress syndrome has raised new concerns in intensive care units globally owing to the presence of secondary fungal infections. We report the case of a 71-year-old man from Ecuador with a history of type 2 diabetes mellitus, severe COVID-19 pneumonia, and lung cavitation associated with triple infections with Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient with a history of high blood pressure and type 2 diabetes was admitted to our hospital from a private care center with a diagnosis of COVID-19-associated acute respiratory distress syndrome. On arrival, the patient presented with signs of hypoxemic respiratory failure. During his stay at another hospital, he had received tocilizumab and corticosteroid therapy. Therefore, intubation was performed and mechanical ventilation was initiated. The patient developed a septic shock and renal failure with a glomerular filtration rate of 27.5 mL/min/1.73 m2; therefore, two hemodiafiltration sessions were started. The bronchoalveolar lavage revealed erythematous lesions in the bronchial tree and abundant purulent secretions and erosions in the bronchial mucosa, with a cavitary lesion in the right bronchial tree. The bronchoalveolar lavage samples were used to isolate Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa carbapenemase class A. Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) Biotyper mass spectrometry and polymerase chain reaction (PCR) molecular identification were performed. This case report suggested that patients with severe COVID-19 pneumonia, with or without comorbidities, are more susceptible to opportunistic infections.

A Cross-Sectional Analysis of Self-Medication Patterns during the COVID-19 Pandemic in Ecuador.

Background and Objectives: Drug consumption is a widely developed practice around the world. However, sometimes medicines are acquired with or without prescription, a practice termed self-medication, which can have negative impacts on the health of the population. It has been observed that with the arrival of the coronavirus disease 2019 (COVID-19) pandemic, self-medicated drug consumption figures increased in several countries. To describe the patterns of medication, use and the prevalence of self-medication during the COVID-19 pandemic in inhabitants of the capital province of Pichincha, Ecuador. Materials and Methods: A descriptive, cross-sectional study was conducted based on a self-administered online questionnaire from April to June 2022, among residents of the province of Pichincha, Ecuador. Participants were invited through social networks (WhatsApp and Facebook). A total of 401 surveys were included in this study. Consumption patterns (prescription of and treatment with) of medicines during the pandemic were evaluated, as well as the prevalence of self-medication and variables that characterize the way of acquiring medicines. The Chi-square test was used to look for relationships between consumption patterns, self-medication, and the characteristics of the participants. Results: Most participants were female (53.4%), and 59.4% reported having had COVID-19. A total of 244 (60.9%) consumed medications during the pandemic, mostly for the purpose of treating the infection. About half (48.4%) self-medicated. The most used medications were paracetamol (87.3%) and ibuprofen (47.5%). Drugs consumption as a treatment and informal sources of information (TV, social networks, advice) were associated with the practice of self-medication (p < 0.05). Conclusions: A significant percentage of over-the-counter (OTC) and legal drug use was found to persist after the COVID-19 pandemic. Our findings highlight the effects that alternative forms of information sources other than medical personnel can have on drug consumption and self-medication practices.

A Comparison of Working Conditions and Workers' Perceptions among On-Site, Telework, and Hybrid Workers in Ecuador during the COVID-19 Pandemic.

The COVID-19 pandemic has forced many companies to adopt different work modalities to ensure their operation during this period. In this study, we described and compared working conditions and perceptions among face-to-face workers, teleworkers, and hybrid workers in Ecuador. A cross-sectional study was conducted with a sample of 542 participants, using a self-report survey to assess sociodemographic data, working conditions, and workers' perceptions. Variables were described and then compared by the Chi-square test, ANOVA, and the Kruskal-Wallis test. The results indicated a higher proportion of on-site workers without higher education and in the public sector compared to the other modalities. At the same time, there was evidence of increased perceived productivity. People in the hybrid modality tended to have more than one job, earning a higher monthly salary, perceiving a decrease in productivity, an increase in daily working hours, and a lower capacity for time management. In addition, most teleworkers reported fair working conditions, a dedicated workspace, and easy adaptation to this work mode. This study builds a more in-depth understanding of how workers perceived their working conditions among work modalities for organizational decision-making because the evolution of the COVID-19 pandemic is modifying the ways of working permanently.

Suicide rates in Ecuador: A nationwide study from 2011 until 2020.

Suicide, suicide ideations, and psychiatric disorder rates tend to increase after natural disasters such as earthquake. In 2016 Ecuador experienced a 7.8Mw earthquake and, more recently, the Covid-19 confinement. Both events may have negatively affected the mental health of the Ecuadorian population. Therefore, the present study aimed to evaluate the suicide rates and choice of suicide method in the Ecuadorian population between January 2011 and December 2020. The dataset used is publicly available on the Ecuadorian National Institute of Statistics and Censuses. Multivariate logistic regression models were used to calculate adjusted odds ratios (OR) for potential sociodemographic factors associated with each suicide method compared to other reported suicide methods. There were 10,380 registered cases of suicide in Ecuador between 2011 and 2020. Significant suicide rates per provinces were seen in Napo with 12.63 and Azuay with 12.52, followed by Bolívar with 12.30, and Orellana with 11.36 suicides/100,000 habitants. Hanging accounted for 7082 cases (68.2 %). The mestizos (82 %) were the most prevalent ethnicity of all suicide cases. School-age children with 6-12 years (OR 8.83, 95 % CI 5.34-14.59) and adolescents with 13-19 years (OR 1.46, 95 % CI 1.29-1.66) were more likely to use hanging as method of suicide. In conclusion, we observed an increase of suicide rates from 8.15 per 100,000 in 2011 to 8.81 in 2020. The confinement of COVID-19 pandemic in the period evaluated did not significantly affect the suicide rates. An increased suicide rate was observed in the province hardest hit by the 2016 earthquake.