Reduced Violence-Related Burden and Mortality at Higher Altitudes: Examining the Association between High Altitude Living and Homicide Rates in Ecuador.

Esteban Ortiz-Prado, Juan Sebastian Izquierdo-Condoy, María G. Dávila-Rosero, Jorge Vásconez-González, Ana M. Diaz, Carla E. Moyano, Vanessa Arcos-Valle, Ginés Viscor, and Joshua H. West. Reduced Violence-Related Burden and Mortality at Higher Altitudes: Examining the Association between High Altitude Living and Homicide Rates in Ecuador. High Alt Med Biol. 00:000-000, 0000. Background: Homicides are a major public health concern and a leading cause of preventable deaths worldwide. The relationship between altitude and homicides remains unclear, and evidence of the possible effects of living at high altitudes on homicide rates is limited. This research aimed to investigate the mortality rates resulting from various types of aggression that culminated in homicides in Ecuador and to explore potential differences associated with altitude. Methods: An ecological analysis of homicide rates in Ecuador was conducted from 2001 to 2022. Homicide cases and the population at risk were categorized based on their place of residence according to two altitude classifications: a binary classification of low (<2,500 m) and high altitude (>2,500 m), and a detailed classification according to criteria by the International Society for Mountain Medicine, which includes low (<1,500 m), moderate (1,500-2,500 m), high (2,500-3,500 m), and very high altitude (3,500-5,500 m) categories. Both crude and directly age-sex standardized mortality rates were calculated for each altitude category. Results: We analyzed a total of 40,708 deaths attributed to aggressions (ICD-10 codes X85-Y09). The total homicide rate for men was 21.29 per 100,000 (95% confidence interval [CI]: 9.55-32.37), whereas for women, it was 2.46 per 100,000 (95% CI: 1.44-3.27). Average rates across the 22 analyzed years were higher at low altitudes (men: 13.2/100,000 and women: 1.33/100,000) as compared with high altitudes (men: 5.79/100,000 and women: 1.05/100,000). Notably, the male-to-female rate difference was more pronounced at low altitudes (898%) than at high altitudes (451%). Conclusions: Our study revealed a higher prevalence of homicides in certain provinces and significant disparities in mortality rates between men and women. Although we cannot establish a direct relationship between altitude and homicide rates, further research is needed to explore potential confounding factors and a better understanding of the underlying causes for these variations.

Female homicides and femicides in Ecuador: a nationwide ecological analysis from 2001 to 2017.

BACKGROUND: Gender-based violence is a major public health concern arising from the structural discrimination of women and girls. In 2014, Ecuador criminalized acts of femicide in response to a growing crisis across the region. As no epidemiological studies on the state of female homicides and femicides have been published, we estimated patterns of female homicides and femicides nationally and the burden through economic cost per years of life lost, between 2001 and 2017. METHODS: Using aggregated data from the National Institute of Census and Statistics and police records we estimated the annual mortality rates, cumulative incidence and prevalence odds ratios for female homicides and femicides, from 2001 to 2017. The impact of aggressions, assaults and violence on years of life lost due to premature mortality was estimated using the Human Capital method. RESULTS: Over the period, at least 3236 cases of female homicides and femicides were reported. The highest murder rate occurred in the province of Sucumbíos (6.5 per 100,000) and in the Putumayo canton (12.5 per 100,000). The most common way to murder their victims was using firearms (38%). The highest odds ratio was estimated for women aged between 25 and 29, at 4.5 (3.9-5.1), of primary school attainment at 17.2 (14.6-20.3) and of Afro-Ecuadoran descent 18.1 (10.5-30.9). Female homicide-related costs reached, on average, $35 million per year and more than $500 million lost from 2001 to 2017. CONCLUSIONS: The high rates, distribution and cost indicate that investments are urgently needed to address the structural causes and reduce the impact of female homicides and femicides in Ecuador; thereby protecting the livelihood and well-being of their women and girls.

Epidemiological, socio-demographic and clinical features of the early phase of the COVID-19 epidemic in Ecuador.

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.

Digital Medication Adherence Support: Could Healthcare Providers Recommend Mobile Health Apps?

Adherence to prescribed medication is suboptimal in 50% of the chronic population, resulting in negative medical and economic outcomes. With the widespread use of mobile phones worldwide, medication adherence apps for mobile phones become promising medication adherence aids thanks to simplicity, user-friendliness, and accessibility for the public. Yet, until today, there is insufficient evidence in favor of using mobile health (mHealth) apps to increase medication adherence. This study aims to develop a methodology for scientific and end-user (patient) mHealth evaluation (a) to identify medication adherence apps search terms, (b) to evaluate identified apps based on scientific criteria, and (c) to report best smartphone apps evaluated by patients. Search terms were identified via literature review and expertise. Firstly, an online questionnaire was developed to identify frequently used search terms by recruited patients. Related medication adherence apps were identified and selected using predefined inclusion criteria. Secondly, identified apps were evaluated thanks to a scientific evaluation method and a created online questionnaire for patient feedback. Recruited patients were invited to test and evaluate the selected apps. Out of 1,833 free-of-charge and 307 paid apps identified, only four free-of-charge and three paid apps remained included in the study after eligibility criteria. None of the selected app reached a high score. Looking at the overall scores, Medisafe (59%), MyTherapy (56%), and Meds on time (44%) received the highest scores in the scientific app evaluation. In the patient evaluation, Dosecast (3.83 out of five points), Medisafe (3.62), and SwissMeds (3.50) received the highest scores. None of the apps in this research has undergone a process for certification, for example, CE marking, through a notified body. Security and data protection aspects of existing apps highly contribute to these low evaluation scores through little information on patient's data processing and storage. This might be corrected through the introduction of General Data Protection Regulation (GDPR) in the European Economic Area (EEA) and more scrutiny through regulatory bodies in the EU/EEA and the USA. None of the applications should be recommended by healthcare providers. In addition, clinical studies with chronic patients are necessary to measure long-term app impacts.

Expanding the application of stir bar sorptive-dispersive microextraction approach to solid matrices: Determination of ultraviolet filters in coastal sand samples.

This work describes a new method for the determination of organic compounds in solid samples based on the equilibrium desorption of the analytes in an aqueous phase followed by stir bar sorptive-dispersive microextraction (SBSDME). Sand samples, contaminated with UV filters due to bathing and recreational activities, were dispersed in an aqueous medium by using a coated stir bar with CoFe2O4@oleic acid magnetic nanoparticles. The UV filters were physically desorbed from the surface of the sand particles and rapidly adsorbed on the hydrophobic coating of the nanoparticles, which were retrieved by means of their magnetism after stopping the stirring. In this manner, both preconcentration of the analytes and clean-up were simultaneously accomplished without the requirement of any additional sample preparation steps. After extraction, the analytes were desorbed in ethanol and then analyzed by gas chromatography-mass spectrometry (GC-MS). The main variables involved in the extraction process (i.e., sorbent amount, extraction time, pH and ionic strength) were studied to provide the best extraction efficiencies and maximum enrichment factors. Under the selected conditions, the figures of merit of the proposed method were evaluated providing limits of detection in the low ng g-1 range, enrichment factors between 23 and 80, and relative standard deviations (RSD%) below 14% for all the target analytes. Matrix effects were observed in real costal sand samples and thus standard addition calibration was employed for quantification. The method was successfully applied to the analysis of UV filters in several coastal sand samples of different origin. This work expands the analytical potential of the novel SBSDME approach to the determination of organic compounds in solid matrices.