ABSTRACT
The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador's response to the outbreak.
Subject(s)
COVID-19/mortality , Disease Outbreaks , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Cost of Illness , Cross-Sectional Studies , Ecuador/epidemiology , Female , Geography , Humans , Infant , Infant, Newborn , Logistic Models , Male , Middle Aged , Occupations , Risk Factors , Sex Distribution , Social Class , Symptom Assessment , Unemployment , Young AdultABSTRACT
Objetivo. Analizar la frecuencia del uso del test de evaluación cognitiva de Montreal (MoCA) como instrumento de cribado cognitivo, su adaptación transcultural, la existencia de baremos y estudios de validación clínica en países de habla hispana en América Latina. Sujetos y métodos. Se ha realizado una revisión sistemática de todos los estudios desarrollados en América Latina, con referencia al MoCA, que incluyan datos normativos, datos psicométricos y estudios de baremación o de validación clínica. Fueron consultadas sistemáticamente, entre abril y junio de 2017, las bases de datos Medline, PsycINFO, Web of Science, Scopus y Scielo, conforme a la metodología PRISMA. Resultados. De los 80 estudios encontrados, 19 cumplieron los criterios de inclusión. La mayoría de los estudios menciona el uso de la versión española y comunica un efecto significativo del sexo, la edad y la escolaridad. El punto de corte adoptado por la mayoría de los autores para el diagnóstico de deterioro cognitivo es el mismo del estudio original. Conclusiones. El reducido número de artículos identificados refleja posiblemente un inicio tardío de la utilización del MoCA en América Latina. Esto pone de manifiesto una tendencia en la región a utilizar la prueba sin hacer una adaptación transcultural de la versión original y sin recurrir a normas internacionales para el diagnóstico. La presente revisión sistemática demuestra la necesidad de trabajos futuros de investigación que puedan ofrecer una versión lingüísticamente adaptada del MoCA para América Latina y un estudio de sus propiedades psicométricas, con miras a una evaluación cognitiva de mayor calidad
Aim. To analyze the frequency of use of the Montreal Cognitive Assessment (MoCA) as a cognitive screening instrument, cross-cultural adaptation, the existence of normative data and clinical validation studies in Latin America Hispanic countries. Subjects and methods. The Medline, PsycINFO, Web of Science, Scopus and Scielo databases were consulted between April and June 2017 according to the PRISMA methodology. We included all studies referencing the MoCA as an instrument to evaluate cognitive deterioration conducted in Latin America and that included normative and psychometric data, as well as its clinical validation. Results. Of the 80 studies identified, 19 met the inclusion criteria. Most of the studies mentioned the use of the Spanish version of the MoCA and reported a statistically significant effect of gender, age and, most of all, education on the performance of this test. Only five studies presented with a detailed analysis of the psychometric characteristics of the test, and in most articles cut-off scores for the diagnosis of cognitive impairment were the same as the original study. Conclusions. The small number of articles identified may reflect a late start of the use of MoCA in Latin America. A tendency towards the use of this test without making a cross-cultural adaptation and the use of international norms was observed in this region. The present systematic review demonstrates the need for future research tackling the development of a linguistically adapted version of the MoCA to Latin America and the study of its psychometric properties, with the aim of improving cognitive assessment
