Increasing myocardial infarction mortality trends in a middle-income country.

BACKGROUND: Developed countries continue to show a decrease in cardiovascular disease (CVD) mortality. Little is known about CVD mortality trends in low and middle-income countries. The aim of our study is to describe myocardial infarction (MI) mortality trends and evaluate if differences between ethnic groups and geographic regions are present among the Ecuadorians with acute MI. METHODS: We conducted a cross sectional analysis mortality national registry and included deaths related to MI between 2012 and 2016 that had complete demographic data. To describe the general population, we used the 2010 census and applied estimates as population projections. We calculated age and sex standardized MI mortality rates per 100,000. We compared trends in MI mortality rate for every ethnic group and geographic region and used linear regression to estimate predictors of the changing mortality rates. RESULTS: We included 18,277 MI deaths between the years 2012 and 2016. The mean age of death was 73.6±19.5, 59% were male and 33% were illiterate. From 2012 to 2016, the standardized MI mortality rate increased from 51 to 157 deaths per 100,000. The most significant predictors of the increasing mortality rate were living in the coast (ß=0.10), belonging to a mixed race (ß=-0.033) and the year of death (ß=0.013). CONCLUSIONS: Our study found a worrisome increase in MI mortality between 2012-2016 in Ecuador, a middle-income country in South America. This rapid increase seems to be driven by geographic and racial differences. A thorough evaluation of the causes of this increase has to be undertaken by the Ecuadorian health authorities.

Informed consent comprehension among vulnerable populations in Ecuador: video-delivered vs. in-person standard method.

The informed consent comprehension process is key to engaging potential research subject participation. The aim of this study is to compare informed consent comprehension between two methods: standard and video-delivered. We compared the in-person and video-delivered informed consent process in the Familias Unidas intervention. We evaluated comprehension using a 7-item true/false questionnaire. There were a total of 152 participants in the control group and 87 in the experimental. General characteristics were similar between both groups (p > 0.05). First-attempt informed consent comprehension was higher in the intervention group but was not statistically significant (80% and 78% respectively p = 0.44). A video-delivered informed consent process did not differ from the standard method of informed consent in a low educational and socioeconomic environment.

Impact of the 2016 Ecuador Earthquake on Zika Virus Cases.

OBJECTIVES: To evaluate the impact of the April 2016 7.8-magnitude earthquake in Ecuador on the incidence of Zika virus (ZIKV) cases. METHODS: We used the national public health surveillance system for reportable transmissible conditions and included suspected and laboratory-confirmed ZIKV cases. We compared the number of cases before and after the earthquake in areas closer to and farther from the epicenter. RESULTS: From January to July 2016, 2234 patients suspected of having ZIKV infection were reported in both affected and control areas. A total of 1110 patients had a reverse transcription-polymerase chain reaction assay, and 159 were positive for ZIKV. The cumulative incidence of ZIKV in the affected area was 11.1 per 100 000 after the earthquake. The odds ratio of having ZIKV infection in those living in the affected area was 8.0 (95% CI = 4.4, 14.6; P < .01) compared with the control area and adjusted for age, gender, province population, and number of government health care facilities. CONCLUSIONS: A spike in ZIKV cases occurred after the earthquake. Patients in the area closest to the epicenter had a delay in seeking care.