The Hallmarks of Cervical Cancer: Molecular Mechanisms Induced by Human Papillomavirus.

Human papillomaviruses (HPVs) and, specifically, high-risk HPVs (HR-HPVs) are identified as necessary factors in the development of cancer of the lower genital tract, with CaCU standing out as the most prevalent tumor. This review summarizes ten mechanisms activated by HR-HPVs during cervical carcinogenesis, which are broadly associated with at least seven of the fourteen distinctive physiological capacities of cancer in the newly established model by Hanahan in 2022. These mechanisms involve infection by human papillomavirus, cellular tropism, genetic predisposition to uterine cervical cancer (CaCU), viral load, viral physical state, regulation of epigenetic mechanisms, loss of function of the E2 protein, deregulated expression of E6/E7 oncogenes, regulation of host cell protein function, and acquisition of the mesenchymal phenotype.

INTRARETINAL HUMAN AMNIOTIC MEMBRANE AFTER MACULAR HOLE REPAIR.

PURPOSE: To describe a unique complication of macular hole repair surgery using a subretinal human amniotic membrane plug. METHODS: Retrospective, interventional case report. RESULTS: A 71-year-old man presented with a chronic full-thickness macular hole in his left eye. Conventional 23-gauge pars plana vitrectomy with internal limiting membrane peeling and implantation of a subretinal human amniotic membrane plug was performed. In the postoperative period, centripetal growth of external retinal layers was observed under the plug. Six months after the surgery, the human amniotic membrane plug was completely integrated into the retina. CONCLUSION: This is the first reported case of intraretinal integration of a human amniotic membrane plug after macular hole repair surgery.

Impact of an Educational Intervention for Healthy Eating in Older Adults: A Quasi-Experimental Study.

The elderly population in Ecuador is increasing rapidly, with an increasing incidence of diet-related diseases. The elderly living in the community seek alternative and complementary methods to improve their diet and quality of life. This study aimed to investigate the impact of an educational intervention on knowledge related to healthy eating among older adults. This intervention is rooted in the principles of meaningful learning and incorporates culturally adapted materials. A quasi-experimental study design was employed using a pre-test-post-test control group. Study participants were a total of 109 elderly (intervention: n = 51, control: n = 58) people in Cuenca, Ecuador. The educational intervention based on Ausubel's theory of significant learning and Vygotsky's sociocultural theory was programmed to be carried out for one session per week, over 24 weeks, with a duration of 120 min per session. The measures were the general characteristics of the study participants and knowledge about necessary amounts, food sources and the consequences of deficits or excesses in the consumption of macro- and micronutrients. Data were collected from August 2018 to February 2019. Statistically significant differences were observed between the intervention group (IG) and the control group (CG) in terms of knowledge about healthy eating for older adults following the educational intervention. The outcomes of this study strongly suggest the efficacy of the program in improving knowledge related to healthy eating among older adults. Healthcare providers should prioritize food education based on meaningful learning, utilizing culturally adapted materials for the elderly individuals residing within the community.

Vacunación antigripal en niños / Anti-flu Vaccination in Children

El Comité Asesor de Vacunas de la Asociación Española de Pediatría considera que la vacunación antigripal de los niños/as mayores de 6 meses no incluidos en grupos de riesgo es una medida recomendable, pues proporciona protección individual y favorece la protección familiar y comunitaria. Es decir, se recomienda la vacunación antigripal infantil universal en niños/as entre 6 y 59 meses, tal y como propone, asimismo, la Organización Mundial de la Salud (OMS).Los niños/as sanos son la principal fuente de difusión de la gripe en la familia, pues excretan una mayor carga viral y durante más tiempo que los adultos. Los niños/as que parecen tener el mayor riesgo de complicaciones por la gripe son aquellos con una afección médica crónica subyacente y, por tanto, es necesario que se vacunen.Para la temporada 2022-2023, en España, se disponen de dos tipos de vacunas antigripales autorizadas para menores de 18 años, parenterales inactivadas e inhalada atenuada. Las vacunas parenterales están autorizadas a partir de los 6 meses (una de ellas a partir de los 24 meses) y la inhalada a partir de los 24 meses. El Consejo Interterritorial del Sistema Nacional de Salud ha incluido recientemente esta vacunación para todos los niños/as para la temporada 2023-2024.(AU)

The Vaccine Advisory Committee of the Spanish Paediatrics Association considers that anti-flu vaccination for children >6 months of age not included in risk groups is a recommended measure, because it provides individual protection and improves family and community protection. That is to say, universal anti-flu paediatric vaccination is recommended for children between 6 and 59 months of age; this is also suggested by the World Health Organization (WHO).Healthy children are the main source for spreading flu in the family, because they excrete a higher viral load, and for a longer time than adults. Children who seem to have the highest risk of flu-related complications are those with an underlying medical condition and, therefore, it is necessary to get them vaccinated.For the 2022-2023 season, there are two types of anti-flu vaccines authorized in Spain for <18-year-olds, which are the parenteral inactivated and the inhaled attenuated vaccines. Parenteral vaccines are authorized for >6-month-old children (one of them, for >24-month-old children), and the inhaled vaccine from the age of 24 months. The Interterritorial Council of the National Health System has recently included this vaccination for all children in the 2023-2024 season.(AU)

Human Papillomavirus Prevalence and Associated Factors in Indigenous Women in Ecuador: A Cross-Sectional Analytical Study.

Cervical cancer (CC) is the second leading cause of death from malignancy in women in Ecuador. Human papillomavirus (HPV) is the main causative agent of CC. Although several studies have been conducted on HPV detection in Ecuador, there are limited data on indigenous women. This cross-sectional study aimed to analyze the prevalence of HPV and associated factors in women from the indigenous communities of Quilloac, Saraguro and Sevilla Don Bosco. The study included 396 sexually active women belonging to the aforementioned ethnicities. A validated questionnaire was used to collect socio-demographic data, and real-time Polymerase Chain Reaction (PCR) tests were used to detect HPV and other sexually transmitted infections (STIs). These communities are located in the southern region of Ecuador and face geographical and cultural barriers to accessing health services. The results showed that 28.35% of women tested positive for both types of HPV, 23.48% for high-risk (HR) HPV, and 10.35% for low-risk (LR) HPV. Statistically significant associations were found between HR HPV and having more than three sexual partners (OR 1.99, CI 1.03-3.85) and Chlamydia trachomatis infection (OR 2.54, CI 1.08-5.99). This study suggests that HPV infection and other sexually transmitted pathogens are common among indigenous women, highlighting the need for control measures and timely diagnosis in this population.

Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals.

BACKGROUND: Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer. METHODOLOGY: A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data. RESULTS: Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient-physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women's empowerment. CONCLUSIONS: The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.

Role of Self-Sampling for Cervical Cancer Screening: Diagnostic Test Properties of Three Tests for the Diagnosis of HPV in Rural Communities of Cuenca, Ecuador.

BACKGROUND: HPV primary screening has shown effectiveness for cancer prevention; however, gynaecological examination is considered uncomfortable. Self-sampling methods increase the acceptance of screening. The aim of this study is to compare the sensitivity and specificity of clinician sampling versus vaginal and urine self-sampling for HPV diagnosis. METHODS: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer's instructions. RESULTS: Characteristics of the participants were: median age 35 years; 40.8% married; 46.7% had a primary level of education; and median age of sexual onset, 17.6 years. The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2-99.9), and specificity 92.1% (IC 85.2-95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2-96.9). The negative predictive value was 98.9% (IC 94.2-99.8) for vaginal self-sampling and 97.6% (IC 92.6-99.4) for urine sampling. CONCLUSIONS: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory.

Bilateral Macular Hole Related to Tamoxifen Low-Dose Toxicity.

Bilateral macular hole is a rare secondary effect of tamoxifen, a condition which is probably underdiagnosed. We describe the case of a 63-year-old woman who had received low-dose treatment with tamoxifen for 10 years. She presented with a best-corrected visual acuity of 20/40 in both eyes and bilateral macular hole with posterior hyaloid attachment. No reflective deposits were observed. A 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade was performed in the right eye with no anatomical or functional improvement. The most accepted mechanism of macular hole related to tamoxifen is Müller cell toxicity with retinal tissue loss. Therefore, it seems that the standard procedure used in idiopathic macular hole is not the optimal choice, due to a different pathogenic mechanism.

Minireview: Situación actual del cáncer de cuello uterino en Ecuador, 2019 / Minireview: Current situation of cervical cancer in Ecuador, 2019

El cáncer de cuello uterino (CCU) es una neoplasia producida principalmente por el virus del papiloma humano (VPH), mismo que se adquiere a través del contacto sexual. El CCU tiene mayor prevalencia en países de ingresos medios y bajos, el 88% de muertes por esta causa a nivel mundial, se producen en países en vías de desarrollo, tales como el Ecuador. El proyecto ELEVATE (Early detection of cervical cancer in hard-to-reach populations of women through portable and point- of-care HPV testing), financiado por la Unión Europea, busca caracterizar el contexto nacional de esta enfermedad; con esta finalidad, se realizó una búsqueda sistemática de artículos científicos y de literatura gris, producida en el Ecuador, utilizando motores de búsqueda especializados, y repositorios virtuales institucionales, de universidades e instancias gubernamentales.(au)

Cervical cancer is a neoplasm mainly caused by the human papillomavirus (HPV), which is acquired through sexual contact. Cervical cancer is more prevalent in low and middle income countries; 88% of worldwide deaths from this cause, occur in developing countries, such as Ecuador. The ELEVATE project (Early detection of cervical cancer in hard-to-reach populations of women through portable and point-of-care HPV testing), funded by the European Union, seeks to characterize the national context of this disease; with this purpose, we carried out a systematic search for scientific articles and gray literature, produced in Ecuador, using specialized search engines, and virtual repositories from universities and government institutions.(au)

Parámetros dietéticos y alimentación habitual de adultos mayores. Cuenca 2018 ­ 2019 / Dietary parameters and habitual diet of older adults. Cuenca 2018 - 2019

Objetivo: conocer los parámetros dietéticos y hábitos alimenticios de adultos mayores atendidos en centros de salud de primer nivel, en la ciudad de Cuenca-Ecuador.Población y métodos: en el estudio descriptivo participaron 102 adultos mayores (AM) pertenecientes a los clubes de la tercera edad de los centros de salud de primer nivel. Los estudiantes del ciclo comunitario de la carrera de Medicina aplicaron un formulario validado previamente con preguntas de condiciones sociodemográficas, parámetros dietéticos y hábitos alimenticios, previa capacitación y firma del consentimiento informado.Resultados: la edad promedio fue de 76 ± 7.20 años, de entre 65 a 95 años, la mayoría eran mujeres, casadas, jubiladas, con educación prima-ria, desocupadas y de estrato socioeconómico bajo. Casi todos ingieren desayuno, almuerzo y merienda, con una consistencia normal. Uno de cada cuatro AM ingiere suplementos vitamínicos, minerales y hierbas. Eligen los alimentos por sabor y menor costo. Ocho de cada diez no pueden preparar sus alimentos. Seis de cada diez se alimentan en forma deficiente, sin necesidad que les agrade o les desagrade lo que comen. Conclusiones: los parámetros y hábitos alimenticios de los AM están relacionados con el envejecimiento y varios factores determinantes. Su cono-cimiento servirá para plantear propuestas sobre alimentación saludable y prevenir enfermedades relacionadas.

Objective: to describe the dietary parameters and eating habits of the elderly who were treated in health centers of the first level, in the city of Cuenca-Ecuador.Population and methods: the descriptive study involved 102 elderly adults belonging to the senior clubs of the first level health centers. The students of the Community Cycle of the medical career applied a validated form, with questions of sociodemographic conditions, dietary parameters and eating habits, with prior training and signing of the informed consent. Results: the average age was 76 ± 7.20 years, between 65 and 95 years, the majority was, married and retired women with primary education, they were unemployed and with low socioeconomic status. Almost everyone eats breakfast, lunch and dinner, with a normal consistency. One in four AM ingests vitamin, mineral and herbal supplements. They choose foods by taste and lower cost. Eight in ten people cannot prepare their food. Six in ten people feed poorly, it does not matter if they like or dislike what they eat. Conclusions: the parameters and eating habits of the AM are related to aging and several determining factors. The knowledge will serve to propose healthy eating and prevent related diseases.

Biofluid quantification of TWEAK/Fn14 axis in combination with a selected biomarker panel improves assessment of prostate cancer aggressiveness.

BACKGROUND: Conventional clinical biomarkers cannot accurately differentiate indolent from aggressive prostate cancer (PCa). We investigated the usefulness of a biomarker panel measured exclusively in biofluids for assessment of PCa aggressiveness. METHODS: We collected biofluid samples (plasma/serum/semen/post-prostatic massage urine) from 98 patients that had undergone radical prostatectomy. Clinical biochemistry was performed and several cytokines/chemokines including soluble(s) TWEAK, sFn14, sCD163, sCXCL5 and sCCL7 were quantified by ELISA in selected biofluids. Also, the expression of KLK2, KLK3, Fn14, CD163, CXCR2 and CCR3 was quantified by real-time PCR in semen cell sediment. Univariate, logistic regression, and receiver operating characteristic (ROC) analyses were used to assess the predictive ability of the selected biomarker panel in conjunction with clinical and metabolic variables for the evaluation of PCa aggressiveness. RESULTS: Total serum levels of prostate-specific antigen (PSA), semen levels of sTWEAK, fasting glycemia and mRNA levels of Fn14, KLK2, CXCR2 and CCR3 in semen cell sediment constituted a panel of markers that was significantly different between patients with less aggressive tumors [International Society of Urological Pathology (ISUP) grade I and II] and those with more aggressive tumors (ISUP grade III, IV and V). ROC curve analysis showed that this panel could be used to correctly classify tumor aggressiveness in 90.9% of patients. Area under the curve (AUC) analysis revealed that this combination was more accurate [AUC = 0.913 95% confidence interval (CI) 0.782-1] than a classical non-invasive selected clinical panel comprising age, tumor clinical stage (T-classification) and total serum PSA (AUC = 0.721 95% CI 0.613-0.830). CONCLUSIONS: TWEAK/Fn14 axis in combination with a selected non-invasive biomarker panel, including conventional clinical biochemistry, can improve the predictive power of serum PSA levels and could be used to classify PCa aggressiveness.

Ética y estética de las vacunaciones / No disponible

No disponible

Estudio Transversal: Perfil Epidemiológico de Sífilis Notificada en el Instituto Nacional de Investigación en Salud Pública. Zonas 6 y 7 Ecuador / Cross-sectional Research: Epidemiological Profile of Syphilis Notified in the National Institute of Public Health Research. Zones 6 and 7 Ecuador

INTRODUCCIÓN: La sífilis constituye un desafío para la salud pública nacional y global por las repercusiones en la vida humana. El objetivo del estudio fue caracterizar el perfil epidemiológico de los casos de sífilis atendidos en el sistema de salud de las zonas 6 y 7. MÉTODOS: Estudio de corte transversal, de datos recogidos en los formularios de investigación/notificación de sífilis de todas las personas atendidas y diagnosticadas mediante pruebas de absorción de anticuerpos treponémicos fluorescentes. Los criterios de inclusión fueron los datos clínicos y epidemiológicos de sospecha para sífilis. Las variables analizadas fueron edad, sexo, procedencia, residencia y pruebas diagnósticas. Para el análisis de inferencia estadística se utilizó Odds Ratio y Chi2 mediante el programa Epi info 7.2 RESULTADOS: El 72 % de las personas diagnosticadas de sífilis tienen entre 20 a 49 años, 53 % del sexo femenino. Las pruebas confirmatorias resultaron reactivas en el 75 % de los casos, de los cuales el 27 % presentaron pruebas serológicas no reactivas y 77 % sin pruebas previas. Las provincias con mayor incidencia de casos fueron Cañar (93 %) y Morona Santiago (87 %) . Se detectaron como factores protectores el sexo femenino (OR 0.41; IC95 % 0.25 ­ 0.68) y la residencia en la provincia de Loja (OR 0.21; IC 95 % 0.10 ­ 0.46). CONCLUSIONES: La prevalencia de casos de sífilis se encuentra en el grupo etario de 20 a 49 años y de sexo masculino. Los factores protectores identificados de manera estadísticamente significativos fueron el sexo femenino y la residencia en la provincia de Loja. Se sugieren desarrollar estrategias para ampliar la cobertura en las personas con sospecha de sífilis, para emprender programas prevención y promoción de la salud.

BACKGROUND: Syphilis constitutes a challenge for national and global public health due to the repercussions on human life. The objective of the study was to characterize the epidemiological profile of the cases of syphilis treated in the health system of zones 6 and 7. METHODS: Cross-sectional study of secondary data collected in the form of investigation / notification of syphilis of all people attended and diagnosed by fluorescent treponemal antibody absorption tests. The inclusion criteria were the clinical and epidemiological data of suspicion for syphilis. The variables analyzed were age, sex, origin, residence and diagnostic tests. Odds Ratio and Chi2 were used for the statistical inference analysis using the Epi info 7.2 programs RESULTS: 72 % of people diagnosed with syphilis are between 20 and 49 years old, 53 % of women. The confirmatory tests were reactive in 75 % of the cases, of which 27 % presented non-reactive serological tests and 77 % without previous tests. The provinces with the highest incidence of cases were Cañar (93 %) and Morona Santiago (87 %). Protective factors were female sex (OR 0.41, 95 % CI 0.25 - 0.68) and residence in the province of Loja (OR 0.21, 95 % CI 0.10 - 0.46) CONCLUSIONS: The prevalence of cases of syphilis is found in the age group of 20 to 49 years andmale. The protective factors identified in a statistically significant manner were female sex and residence in the province of Loja. It is suggested to develop strategies to expand coverage in people with suspected syphilis, to undertake prevention and health promotion programs.

Effect of lemon leaves on energy and C-N balances, methane emission, and milk performance in Murciano-Granadina dairy goats.

The objective of this experiment was to find out the effect of lemon leaves on energy and C-N balances, methane emission, and milk performance in dairy goats. Lemon leaves were used to replace alfalfa as forage in a diet for Murciano-Granadina goats. Ten Murciano-Granadina dairy goats (44.1 ± 4.47 kg of BW) in late lactation (185 ± 7.2 d) were selected in a crossover design experiment, where each goat received 2 treatments in 2 periods. One group was fed a mixed ration with 450 g of pelleted alfalfa per kilogram of DM (ALF diet) and, the other group replaced alfalfa with 450 g of pelleted lemon leaves per kilogram DM (LEM diet). The concentrate was pelleted, being the same for the two groups (forage to concentrate ratio was 45/55). The goats were allocated to individual metabolism cages. After 14 d of adaptation, feed intake, total fecal and urine output, and milk yield were recorded daily over a 5-d period. Then, gas exchange measurements were recorded individually by an open-circuit indirect calorimetry system using a head box. Higher dietary lipids in LEM diet reduced DMI (200 g/d) and energy intake (251 kJ/kg of BW0.75), although no differences between treatments were observed for ME intake (998 kJ/kg of BW0.75, on average) and oxidation of nutrients (64% and 25% for carbohydrates and fat oxidation, respectively, on heat production from oxidation basis). Greater (P < 0.05) milk fat values for C18:2n6t and CLA 9c11t + 9t11c were found in LEM compared with ALF diet. Goats fed LEM diet produced significantly fewer CH4 emissions than ALF diet (18%). Likewise, the use of lemon leaves as forage reduced the amount of CH4 in 2.7 g/kg of milk. Results suggest that lemon leaves are effective in reducing CH4 emission without detrimental effect on milk yield.

Correction: The Tetraspanin-Associated Uroplakins Family (UPK2/3) Is Evolutionarily Related to PTPRQ, a Phosphotyrosine Phosphatase Receptor.

[This corrects the article DOI: 10.1371/journal.pone.0170196.].

The Tetraspanin-Associated Uroplakins Family (UPK2/3) Is Evolutionarily Related to PTPRQ, a Phosphotyrosine Phosphatase Receptor.

Uroplakins are a widespread group of vertebrate integral membrane proteins that belong to two different families: UPK1a and UPK1b belong to the large tetraspanin (TSPAN) gene family, and UPK3a, UPK3b, UPK3c, UPK3d, UPK2a and UPK2b form a family of their own, the UPK2/3 tetraspanin-associated family. In a previous study, we reported that uroplakins first appeared in vertebrates, and that uroplakin tetraspanins (UPK1a and UPK1b) should have originated by duplication of an ancestor tetraspanin gene. However, the evolutionary origin of the UPK2/3 family remains unclear. In this study, we provide evidence that the UPK2/3 family originated by gene duplication and domain loss from a protoPTPRQ-like basal deuterostome gene. PTPRQs are members of the subtype R3 tyrosine phosphatase receptor (R3 PTPR) family, which are characterized by having a unique modular composition of extracellular fibronectin (FN3) repeats, a transmembrane helix, and a single intra-cytoplasmic phosphotyrosine phophatase (PTP) domain. Our assumption of a deuterostome protoPTPRQ-like gene as an ancestor of the UPK2/3 family by gene duplication and loss of its PTP and fibronectin (FN3) domains, excluding the one closest to the transmembrane helix, is based on the following: (i) phylogenetic analyses, (ii) the existence of an identical intron/exon gene pattern between UPK2/3 and the corresponding genetic region in R3 PTPRs, (iii) the conservation of cysteine patterns and protein motifs between UPK2/3 and PTPRQ proteins and, (iv) the existence in tunicates, the closest organisms to vertebrates, of two sequences related to PTPRQ; one with the full subtype R3 modular characteristic and another without the PTP domain but with a short cytoplasmic tail with some sequence similarity to that of UPK3a. This finding will facilitate further studies on the structure and function of these important proteins with implications in human diseases.

Situación de Salud de los Médicos Especialistas Graduados en la Universidad de Cuenca, Años 2004 - 2013 / Health situation of medical specialists graduated from the University of Cuenca, years 2004 - 2013

OBJETIVO: Describir la situación de salud de los egresa-dos y especialistas médicos graduados en la Facultad de Ciencias Médicas de la Universidad de Cuenca durante los años 2004 a 2013 y su relación con las condiciones laborales.METODOLOGÍA: Se realizó un estudio de corte transversal mediante un formulario validado autoadministrado por 102 médicos especialistas, luego del consentimien-to informado; también se realizaron entrevistas a informantes claves y revisión de fuentes documentales. El análisis estadístico descriptivo se efectuó mediante frecuencias y porcentajes, y para el cálculo de la probabilidad de asociación entre la autopercepción de la sa-lud con las condiciones laborales, se utilizó la Regresión Logística multivariable, a través del programa SPSS v-20.RESULTADOS: La situación de salud de los especialistas médicos se caracterizó por una autopercepción de la salud entre más que regular y mal en el 22%, riesgo de sufrir algún problema de salud mental (13%), muy poca actividad física (33%), práctica de deporte menos de una vez por semana o no lo hacen (64%), alimentación inadecuada (47%), presencia de dolor (72%), enferme-dades provocadas o agravadas por el trabajo (25%), accidentes laborales (7%), consumo de analgésicos (40%). La autopercepción buena y muy buena de la salud están asociados de manera estadísticamente significativa con el apoyo económico familiar (OR 3.20; IC 95% 1.18 ­ 8.70), vivir con familiares (OR 4.58; IC 95% 1.49 ­ 13.99), y decisión sobre cuándo descansar (OR 5.37; IC 95% 2.19 ­ 13.17). El riesgo de salud mental se asocia de manera significativa con la preocupación sobre los cambios en el salario (OR 5.12; IC 95% 1.46 ­ 17.93).CONCLUSIONES: La autopercepción de buena salud depende del apoyo familiar y del descanso, y el riesgo de la salud mental está asociado con los cambios en los salarios.

METHODS: A cross-sectional study was carried out using a validated self-administered form by 102 medical spe-cialists after informed consent; also conducted inter-views with key informants and review of documentary sources were done. The descriptive statistical analysis was performed using frequencies and percentages, and for the calculation of the probability of association between self-perception of health and working con-ditions, the Multivariable Logistic Regression was used through the SPSS v-20 program. RESULTS: The health status of medical specialists was cha-racterized by a self-perception of the health between regular and bad in 22% with risk to suffer any health mental problem (13%), very little physical activity (33%) people who practice any sport less than one time per week or nothing (64%), inadequate food (47%), presen-ce of pain (72%), diseases provoked or aggravated by work (25%), occupational accidents (7%), consumption of analgesics (40%). A good and very good self-percep-tion of health are associated in a statistically significant way with family economic support (OR 3.20, 95% CI 1.18 - 8.70), live with relatives (OR 4.58, 95% CI 1.49 - 13.99), and decision on when to rest (OR 5.37; 95% CI 2.19 to 13.17). The health mental risk is significantly associated with changes in wages (OR 5.12, 95% CI 1.46 - 17.93). CONCLUSIONS: The self-perception of good health de-pends on family support and rest, and the health mental risk is associated with changes in wages.Keywords: Occupational Health, Mental Health, Socioe-conomic Factors, Risk Factors. Medical Staff, Hospital. Universidad de Cuenca.

Percepciones Sobre la Salud Sexual y Reproductiva de las Mujeres Indígenas Kichwas y Shuaras. Ecuador, 2016 / Perceptions on the Sexual and Reproductive Health of Kichwa and Shuara Indigenous Women. Ecuador, 2016

El cáncer de cuello uterino (CCU), es un problema de salud aún no resuelto en los países en vías de desarrollo; esta patología es la principal causa de muerte por cáncer ginecológico en el Ecuador. La cobertura del tamizaje preventivo está influenciada por concepciones culturales de la población, que tienen asidero en las percepciones de cada etnia sobre el proceso etiológico del complejo salud-enfermedad. OBJETIVO: Interpretar las percepciones que tienen las mujeres de los pueblos y nacionalidades indígenas Shuar de Sevilla Don Bosco y Kichwas de Quilloac y Saraguro, acerca de la salud sexual y reproductiva, las infecciones de transmisión sexual, CCU y condiciones asociadas. METODOLOGÍA: Se realizó un estudio cualitativo fenomenológico, mediante 17 grupos focales, 13 historias de vida, con un total de 102 personas entrevistadas. RESULTADOS: Los relatos de las mujeres, entendidos como construcciones colectivas de sus respectivos grupos étnicos, en el contexto de una cultura hegemónica occidental, patriarcal y machista, hacen referencia principalmente a procesos destructivos de su salud sexual y reproductiva, manifestados como infidelidad y promiscuidad masculina, así como la falta de protección con preservativos, lo cual incide en la prevalencia de infecciones de transmisión sexual y CCU. CONCLUSIONES: Las mujeres tienen conciencia sobre un concepto amplio de la salud, que incluye nociones de salud sexual y reproductiva; sin embargo, refieren obstáculos en su ejercicio pleno relacionados con inequidades de clase, género, etnia y generacional, expresados como procesos destructivos de su salud.

Cervical cancer is a health problem unresolved in de-veloping countries; this disease is the leading cause of death from gynecologic cancer in Ecuador. Coverage of preventive screening is influenced by cultural con-ceptions of the population, which are based on the per-ceptions of each ethnic group on the etiologic process health-disease complex. OBJECTIVE: To interpret the perceptions of women of in-digenous peoples and nationalities Shuar of Sevilla Don Bosco and Kichwas of Quilloac and Saraguro, about sexual and reproductive health, sexually transmitted in-fections, cervical cancer and associated conditions. METHODOLOGY: A qualitative, phenomenological study was conducted through 17 focus groups and 13 stories of life study. A total of 102 people interviewed. RESULTS: The stories of women understood as collective constructions of their respective ethnic groups in the context of a Western, patriarchal and maleness hege-monic culture, mainly refer to destructive processes of sexual and reproductive health, manifested as infideli-ty and male promiscuity and as the lack of protection with condoms, which affects the prevalence of sexually transmitted infections and Cervical Cancer. CONCLUSIONS: Women have awareness of a broad concept of health, including notions of sexual and re-productive health; however, relate obstacles in their full exercise, related to inequalities of class, gender, and generational etnia1 expressed as destructive processes of their health.

Use of an Inverse Method for Time Series to Estimate the Dynamics of and Management Strategies for the Box Jellyfish Carybdea marsupialis.

Frequently, population ecology of marine organisms uses a descriptive approach in which their sizes and densities are plotted over time. This approach has limited usefulness for design strategies in management or modelling different scenarios. Population projection matrix models are among the most widely used tools in ecology. Unfortunately, for the majority of pelagic marine organisms, it is difficult to mark individuals and follow them over time to determine their vital rates and built a population projection matrix model. Nevertheless, it is possible to get time-series data to calculate size structure and densities of each size, in order to determine the matrix parameters. This approach is known as a "demographic inverse problem" and it is based on quadratic programming methods, but it has rarely been used on aquatic organisms. We used unpublished field data of a population of cubomedusae Carybdea marsupialis to construct a population projection matrix model and compare two different management strategies to lower population to values before year 2008 when there was no significant interaction with bathers. Those strategies were by direct removal of medusae and by reducing prey. Our results showed that removal of jellyfish from all size classes was more effective than removing only juveniles or adults. When reducing prey, the highest efficiency to lower the C. marsupialis population occurred when prey depletion affected prey of all medusae sizes. Our model fit well with the field data and may serve to design an efficient management strategy or build hypothetical scenarios such as removal of individuals or reducing prey. TThis This sdfsdshis method is applicable to other marine or terrestrial species, for which density and population structure over time are available.