One hundred years of Ecuadorian biomedical scientific output and its association with the main causes of mortality: a bibliometric study.

Introduction: Historically, low-and middle-income countries have been scarce producers of biomedical research; only 2% of the global scientific output is produced by these countries despite accounting for 92% of the global burden of disease. In addition, few low-and middle-income countries have exhaustively mapped and analyzed their scientific production in health and its association with main local burden of disease. Objective: To evaluate the evolution of biomedical research in Ecuador over the last 100 years and its relationship with the main causes of mortality. Methods: A bibliometric study embedded in a systematic review design was carried out using biomedical publications indexed in Scopus and Web of Science (WoS) during the period 1920-2021. Information from the National Institute of Statistics and Census was used to identify the main causes of mortality. Results: Our search strategy identified 16,697 publications related to biomedicine in Ecuador. Of these 3,225 articles met the criteria for this study. Since 2010, there has been an exponential increase in scientific production in biomedicine. This increase was predominantly based on cross-sectional observational studies (49.67%). During the period analyzed (1920-2021), biomedical production was distributed with 52.43% in clinical research, 37.79% in public health, and 9.77% in basic sciences. The research focus with the highest number of publications was epidemiology and surveillance system of diseases (23.44%). Additionally, private universities are the largest producers of biomedical research compared to public universities, 40.12% vs. 19.60%, respectively. Of the total biomedical research produced, 18.54% is associated with the main causes of mortality, and the Ecuadorian private university is the largest contributor to these studies compared to public universities, 39.97% vs. 16.72%. Conclusion: In one century, Ecuador produced 3,225 articles in biomedicine, according to our criteria. 18.54% of the total produced is aimed at solving the main causes of mortality in the country. Private universities are the leaders in scientific production related to health in Ecuador.

Prevalence of chronic pelvic pain and associated factors among indigenous women of reproductive age in Ecuador.

BACKGROUND: Chronic pelvic pain is a common disease that affects approximately 4% of women of reproductive age in developed countries. This number is estimated to be higher in developing countries, with a significant negative personal and socioeconomic impact on women. The lack of data on this condition in several countries, particularly those in development and in socially and biologically vulnerable populations such as the indigenous, makes it difficult to guide public policies. OBJECTIVES: To evaluate the prevalence of chronic pelvic pain (dysmenorrhea, dyspareunia, non-cyclical pain) and identify which variables are independently associated with the presence of the condition in indigenous women from Otavalo-Ecuador. DESIGN: A cross-sectional study was carried out including a sample of 2429 women of reproductive age between 14 and 49 years old, obtained from April 2022 to March 2023. A directed questionnaire was used, collected by bilingual interviewers (Kichwa and Spanish) belonging to the community itself; the number of patients was selected by random sampling proportional to the number of women estimated by sample calculation. Data are presented as case prevalence, odds ratio, and 95% confidence interval, with p < 0.05. RESULTS: The prevalence of primary dysmenorrhea, non-cyclic pelvic pain, and dyspareunia was, respectively, 26.6%, 8.9%, and 3.9%.all forms of chronic pain were independently associated with each other. Additionally, dysmenorrhoea was independently associated with hypertension, intestinal symptoms, miscegenation, long cycles, previous pregnancy, use of contraceptives and pear body shape. Pain in other sites, late menarche, exercise, and pear body shape were associated with non-cyclic pelvic pain. And, urinary symptoms, previous pregnancy loss, miscegenation, and pear body shape were associated with dyspareunia. CONCLUSION: The prevalence of primary dysmenorrhea and non-cyclical chronic pelvic pain was notably high, in contrast with the frequency of reported dyspareunia. Briefly, our results suggest an association between dysmenorrhoea and conditions related to inflammatory and/or systemic metabolic disorders, including a potential causal relationship with other manifestations of pelvic pain, and between non-cyclical pelvic pain and signs/symptoms suggesting central sensitization. The report of dyspareunia may be influenced by local cultural values and beliefs.

Trends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022.

BACKGROUND: Traffic accidents (TA) remain a significant global public health concern, impacting low-and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011-2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities. METHODS: An ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities. RESULTS: There were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV - 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25-40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV - 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV - 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII. CONCLUSION: While overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning.

Analysis of the legal situation regarding euthanasia in Ecuador, Colombia, and Peru: Towards a Latin American model of medical assistance in dying?

Colombia was one of the first countries to decriminalise euthanasia. However, what is known in the international academic literature about the country's regulations is scarce and outdated. Such lack of information on the situation in Latin America is even more evident in the case of Peru, where the Lima Superior Court of Justice set a precedent by allowing a person to have access to euthanasia in 2021. Ecuador, which has just decriminalised euthanasia for all its citizens in February 2024, risks being similarly absent from the international dialogue. This article summarises for the first time all the regulations in force regarding euthanasia in Latin America, through a study of primary sources in Spanish, and analyses some of the convergences between these three neighbouring countries.

A Descriptive Study of Spanish and Ecuadorian Commercial Infant Cereals: Are They in Line with Current Recommendations?

Cereals are an important source of nutrients, especially used in complementary feeding. The objective of this study is to review the nutritional composition of cereal-based foods for infants from 4 months and toddlers that are offered in Spain and Ecuador, countries selected because of the opportunity to work in them, and due to their socio-economic differences (industrialized and developing countries, respectively). The number of these products was 105 cereals in Spain and 22 in Ecuador. The products were classified as gluten-free cereals, five cereals, eight cereals, multigrain cereals, and cookies. A 25 g serving was used to determine the percentage in which the samples analyzed can cover the Reference Nutrient Intake (RNI) for micronutrients in infants from 7 months and toddlers according to the European Food Safety Authority (EFSA). Nutritional information per 100 g of dry product was collected according to medium, minimum, and maximum units, and nutrient density was calculated. The age range in which these products are recommended is different in both countries. The nutritional composition presents some differences; Spanish cereals show a lower content of sodium, added sugars, hydrolyzed cereals, and maltodextrin than Ecuadorian cereals. Commercialized cereals could contribute to satisfying the nutritional needs of infants and toddlers; however, they can also be a source of non-recommended components.

Space-time distribution of intestinal infectious diseases and their association with socioeconomic variables in Ecuador.

Background: Intestinal infectious diseases are a global concern in terms of morbidity, and they are closely linked to socioeconomic variables such as quality of life, weather and access to healthcare services. Despite progress in spatial analysis tools and geographic information systems in epidemiology, studies in Ecuador that evaluate temporal trends, specific geographic groups, and their correlation with socioeconomic variables are lacking. The absence of such information makes it challenging to formulate public health policies. This study sought to identify the spatial and temporal patterns of these diseases in Ecuador, along with their correlation with socioeconomic variables. Methods: In Ecuador, the study was carried out in a continental territory, focusing on data related to intestinal infectious diseases collected from the National Institute of Statistics and Census (Instituto Nacional de Estadística y Censos) during the period from 2014 to 2019. This study involved spatial and temporal analyses using tools such as the global Moran's index and Local Indicators of Spatial Association to identify spatial clustering patterns and autocorrelation. Additionally, correlations between morbidity rates and socioeconomic variables were examined. Results: During the investigated period, Ecuador registered 209,668 cases of these diseases. Notable variations in case numbers were identified, with a 9.2% increase in 2019 compared to the previous year. The most impacted group was children under 5 years old, and the highest rates were centered in the southern and southwestern regions of the country, with Limón Indanza and Chunchi being the cantons with the highest rates, notably showing a significant increase in Limón Indanza. Additionally, there were significant correlations between morbidity rates and socioeconomic variables, school dropout rates, low birth weight, and access to water services. Conclusion: This study emphasizes the importance of considering socioeconomic variables when addressing these diseases in Ecuador. Understanding these correlations and geospatial trends can guide the development of health policies and specific intervention programs to reduce the incidence in identified high-risk areas. More specific research is needed to understand the underlying causes of variability in morbidity and develop effective prevention strategies.

May Measurement Month 2021: an analysis of blood pressure screening results from Ecuador.

Arterial hypertension is a growing burden worldwide, leading to over 10.8 million deaths each year. Before the outbreak of the COVID-19 pandemic, cardiovascular diseases were the main cause of death in Ecuador. Hypertension is the main risk factor for the major cause of death, coronary and cerebrovascular disease. The 2021 May Measurement Month Campaign (MMM21) is a global initiative by the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to provide a temporary solution for opportunistic screening until more systematic approaches can be established. A cross-sectional survey was carried out in May 2021 across 22 health centres in Ecuador. The average age of participants was 44.7 ± 15.8 years. Blood pressure measurement, the definition of hypertension (mean of the 2nd and 3rd BP measurements ≥ 140/90 mmHg or on medication for high BP), and statistical analysis followed the standard MMM protocol. In total, 1326 volunteers participated in MMM21. After multiple imputation of missing BP readings, 423 (31.9%) had hypertension. Of those, 70.5% were receiving antihypertensive medication. Of individuals receiving antihypertensive medication, 50.0% had uncontrolled BP. Overall, of 423 participants with hypertension, only 35.2% had their BP controlled (<140/90 mmHg). MMM21 demonstrated a high prevalence of hypertension in Ecuador during the COVID-19 pandemic. It was the largest BP screening campaign done in Ecuador thus far. The high percentage of persons untreated or with uncontrolled hypertension while on pharmacologic treatment suggests that appropriate screening can help to identify a significant number of people with elevated BP and those inadequately treated. These data should attract the attention of doctors and health care providers in Ecuador.

Assessment of the COVID-19 pandemic progression in Ecuador through seroprevalence analysis of anti-SARS-CoV-2 IgG/IgM antibodies in blood donors.

Introduction: Coronavirus Disease 2019 (COVID-19) is a severe respiratory illness caused by the RNA virus SARS-CoV-2. Globally, there have been over 759.4 million cases and 6.74 million deaths, while Ecuador has reported more than 1.06 million cases and 35.9 thousand deaths. To describe the COVID-19 pandemic impact and the vaccinations effectiveness in a low-income country like Ecuador, we aim to assess the seroprevalence of IgG and IgM antibodies against SARS-CoV-2 in a sample from healthy blood donors at the Cruz Roja Ecuatoriana. Methods: The present seroprevalence study used a lateral flow immunoassay (LFIA) to detect anti-SARS-CoV-2 IgG and IgM antibodies in months with the highest confirmed case rates (May 2020; January, April 2021; January, February, June, July 2022) and months with the highest vaccination rates (May, June, July, August, December 2021) in Quito, Ecuador. The IgG and IgM seroprevalence were also assessed based on sex, age range, blood type and RhD antigen type. The sample size was 8,159, and sampling was performed based on the availability of each blood type. Results: The results showed an overall IgG and IgM seroprevalence of 47.76% and 3.44%, respectively. There were no differences in IgG and IgM seroprevalences between blood groups and sex, whereas statistical differences were found based on months, age range groups, and RhD antigen type. For instance, the highest IgG seroprevalence was observed in February 2022 and within the 17-26 years age range group, while the highest IgM seroprevalence was in April 2021 and within the 47-56 years age range group. Lastly, only IgG seroprevalence was higher in RhD+ individuals while IgM seroprevalence was similar across RhD types. Discussion: This project contributes to limited data on IgG and IgM antibodies against SARS-CoV-2 in Ecuador. It suggests that herd immunity may have been achieved in the last evaluated months, and highlights a potential link between the RhD antigen type and COVID-19 susceptibility. These findings have implications for public health strategies and vaccine distribution not only in Ecuador but also in regions with similar characteristics.

Genetic knowledge and attitudes towards genetic testing among final-year medical students at a public university in Ecuador.

Background: Genetics plays a crucial role in the field of medicine, offering numerous applications. However, health professionals often have insufficient knowledge in this area. Therefore, it is essential to provide appropriate genetics education during university studies. Aim: This study aimed to assess the knowledge and attitudes towards genetic testing among final-year medical students at a public university in Ecuador. Methods: A cross-sectional study was conducted involving final-year medical students from a public university in Ecuador. The third version of the Genetic Literacy and Attitudes Survey was administered between April and May 2022. The study examined sociodemographic characteristics, genetic knowledge, and attitudes towards genetic testing. Results: The study included 153 medical students, of which 58.2% identified as female. Most participants fell within the age range of 22 to 25 years old (85.0%). Regarding genetic knowledge, three-quarters of the participants (75.2%) demonstrated intermediate proficiency, while only 9.80% possessed a high level of knowledge. Attitudes towards the clinical and therapeutic applications of genetics, scientific advancements, access to conventional medicine, and other related topics were found to be appropriate. Conclusion: The findings suggest that most final-year medical students at a public university in Ecuador have intermediate genetic knowledge and hold appropriate attitudes towards genetic testing. However, higher education institutions should conduct a comprehensive analysis and restructure their curricula to better prepare students for the medical and technological challenges of the 21st century.

Proposal of a domain model for 3D representation of buildings in Ecuador.

The accelerated urban sprawl of cities around the world presents major challenges for urban planning and land resource management. In this context, it is crucial to have a detailed 3D representation of buildings enriched with accurate alphanumeric information. A distinctive aspect of this proposal is its specific focus on the spatial unit corresponding to buildings. In order to propose a domain model for the 3D representation of buildings, the national standard of Ecuador and the international standard (ISO 19152:2012 LADM) were considered. The proposal includes a detailed specification of attributes, both for the general subclass of buildings and for their infrastructure. The application of the domain model proposal was crucial in a study area located in the Riobamba canton, due to the characteristics of the buildings in that area. For this purpose, a geodatabase was created in pgAdmin4 with official information, taking into account the structure of the proposed model and linking it with geospatial data for an adequate management and 3D representation of the buildings in an open-source Geographic Information System. This application improves cadastral management in the study region and has wider implications. This model is intended to serve as a benchmark for other countries facing similar challenges in cadastral management and 3D representation of buildings, promote efficient urban development and contribute to global sustainable development.

Exploring the ethnobiological practices of fire in three natural regions of Ecuador, through the integration of traditional knowledge and scientific approaches.

This study examines the convergence between traditional and scientific knowledge regarding the use of fire and its potential to trigger wildfires, with possible impacts on ecosystems and human well-being. The research encompasses three distinct natural regions of Ecuador: the coast, the highlands, and the Amazon. Data on traditional fire use were collected through semi-structured interviews with 791 members from five local communities. These data were compared with climatic variables (rainfall (mm), relative humidity (%), wind speed (km/h), and wind direction) to understand the climatic conditions conducive to wildfires and their relationship with human perceptions. Furthermore, the severity of fires over the past 4 years (2019-2022) was assessed using remote sensing methods, employing the Normalized Burn Ratio (NBR) and the difference between pre-fire and post-fire conditions (NBR Pre-fire-NBR Post-fire). The results revealed a significant alignment between traditional knowledge, climatic data, and many fires, which were of low severity, suggesting potential benefits for ecosystems. These findings not only enable the identification of optimal techniques and timing for traditional burns but also contribute to human well-being by maintaining a harmonious balance between communities and their environment. Additionally, they provide valuable insights for the development of more inclusive and effective integrated fire management strategies in these natural areas of Ecuador.

Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years.

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

TTN novel splice variant in familial dilated cardiomyopathy and splice variants review: a case report.

This case report details the identification of a novel likely pathogenic splicing variant in the TTN gene, associated with dilated cardiomyopathy (DCM), in a 42-year-old male patient presenting with early-onset heart failure and reduced ejection fraction. DCM is a nonischemic heart condition characterized by left biventricular dilation and systolic dysfunction, with approximately one-third of cases being familial and often linked to genetic mutations. The TTN gene, encoding the largest human protein essential for muscle contraction and sarcomere structure, is implicated in about 25% of DCM cases through mutations, especially truncating variants. Our investigation revealed a previously unreported G > C mutation at the splice acceptor site in intron 356 of TTN, confirmed by Sanger sequencing and not found in population databases, suggesting a novel contribution to the understanding of DCM etiology. The case emphasizes the critical role of the TTN gene in cardiac function and the genetic complexity underlying DCM. A comprehensive literature review highlighted the prevalence and significance of splice variants in the TTN gene, particularly those affecting the titin A-band, which is known for its role in muscle contraction and stability. This variant's identification underscores the importance of genetic screening in patients with DCM, offering insights into the disease's familial transmission and potential therapeutic targets. Our findings contribute to the expanding knowledge of genetic factors in DCM, demonstrating the necessity of integrating genetic diagnostics in cardiovascular medicine. This case supports the growing evidence linking splicing mutations in specific regions of the TTN gene to DCM development and underscores the importance of genetic counseling and testing in managing heart disease.

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.

Undetection of vector-borne viruses in equids of Galapagos Islands.

Domestic species, including equids, were introduced in the Galapagos Islands in the XIX century. Equine vector-borne diseases are circulating in South America but their occurrence in the Galapagos Island was unknown. The objective of this study was to detect the occurrence of West Nile virus (WNV), Usutu virus (USUV) and equine infectious anemia virus (EIAV) in the four Galapagos Islands raising equids if they were present at a prevalence >1%. Serum samples were collected from 411 equids belonging to 124 owners from April to July 2019. All the results were negative to the ELISA tests used suggesting that WNV, USUV and EIAV are not circulating in the equine population of the Galapagos Islands.

High levels of anxiety and depression in women farmers from Ecuador: A cross-section study in Coastal and Highlands regions.

BACKGROUND: Previous studies have shown that women farmers are particularly vulnerable to mental health disorders such as depression and anxiety. AIMS: This study aimed to investigate the prevalence of anxiety and depression in women farmers from Ecuador Coastal and Highlands regions. METHOD: General Anxiety Disorder­7 (GAD­7) and Patient Health Questionnaire­9 (PHQ­9) were applied. In addition, self-reported number of children, days off, hours of work, pesticide use, sleep habits and years of work in agriculture, were also collected. This cross-sectional study occurred during 2023 with 443 women, for Coastal (197) and Highlands (246), respectively. Multivariable binary logistic regression models were performed to obtained adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI). RESULTS: 34.5% of Coastal women had depression, while 27.2% of Highlands women had depression. 20.3% of coastal women farmers had anxiety, while in the Highlands 24.8% had anxiety. Coastal mestizo and montubio women exhibited lower probability of depression, but this was not significant in the Highlands. Coastal women farmers that did not have children showed lower odds of depression (aOR 0.05, 95% CI [0.01, 0.34]). A lower likelihood of depression was observed in coastal women that worked more than 8 hours (aOR 0.22, 95% CI [0.07, 0.72]). Women from the Highlands that had shortened sleep duration exhibited lower odds of depression and anxiety. CONCLUSIONS: A higher proportion of depressed women farmers was observed in the Coast region and slightly higher numbers of anxiety cases in the Highlands. The number of children may cause workload and is correlated with depression in Coastal women.

The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador.

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

First report of Bartonella henselae and Bartonella clarridgeiae carriage in stray cats from Ecuador and its link to a cat scratch disease outbreak in 2022.

INTRODUCTION: The genus Bartonella includes species and subspecies of fastidious, facultative intracellular Gram-negative bacilli that infect a wide variety of mammalian reservoirs including cats and humans. In 2022, the Ecuadorian Ministry of Health reported an outbreak of cat scratch disease caused by B. henselae in the city of Guayaquil. Therefore, we aimed to characterize the presence of Bartonella spp. in domestic and stray cats from the area of Guayaquil where the outbreak happened in 2022. METHODS: Whole blood samples of 100 domestic and stray cats were collected. Riboflavin synthase (ribC) and 16S rRNA genes detection was performed by PCR using Bartonella spp. specific primers, followed by Sanger sequencing and phylogenetic analysis. RESULTS: 14 cats were positive for Bartonella spp. carriage. Phylogenetic analysis confirmed the presence of 12 cats infected with B. henselae and 2 cats with B. clarridgeiae. CONCLUSIONS: There is a high prevalence of Bartonella spp. carriage in cats in the city of Guayaquil within the area where a recent cat scratch disease outbreak happened. Considering the high presence of cats and other domestic and stray animals in the city of Guayaquil, a One Health approach for surveillance and prevention of zoonotic diseases like cat scratch disease is needed.

Psychometric validation of the internet related experiences questionnaire and mobile related experiences questionnaire among Ecuadorian teenagers.

Introduction: Excessive internet and mobile cell phone use has been increasing in recent years especially in teenagers who are a vulnerable population. However, there is a lack of psychometric evaluation of instruments that allow to identify behavior regarding problematic use of the internet and cell phones in the Latin America, particularly in Ecuador. The main aim of this study is to examine the psychometric properties of two instruments: the Internet-related experiences questionnaire (IREQ) and Mobile-related experiences questionnaire (MREQ) in high school students (n = 4, 174, M age = 15.63; 51.19% male and 48.37% female). Methods: The validation process was performed using one and two factors for both questionnaires according to previous literature. After checking the models proposed to date, the best fit model was the one-factor model for (IREQ) and one-factor model for (MREQ). Results and discussion: The invariance was performed using two samples according to gender (male, female) and has been confirmed with an acceptable internal consistency for both questionnaires. For IREQ (All, ω = 0.80; Male, ω = 0.77; Female, ω = 0.82) and for MREQ (All, ω = 0.83; Male, ω = 0.82; Female, ω = 0.84). In addition, we performed the correlation analysis between IREQ, MREQ, and socio-demographic variables and finally, both instruments demonstrated strong psychometric qualities within the local population.

Amalophyllonmiraculum (Gesneriaceae), an exceptionally small lithophilous new species from the western Andean slopes of Ecuador.

Recent exploratory field expeditions to the western slopes of the Ecuadorian Andes resulted in the discovery of a new species of Amalophyllon (Gesneriaceae). Amalophyllonmiraculum J.L.Clark, sp. nov. is described from two localities in the Centinela region in the Santo Domingo de los Tsáchilas province. The new species is differentiated from congeners by the pendent habit, basal rosette of leaves, leaf blades with deeply serrate margins, and miniature size. Based on IUCN guidelines, a preliminary conservation status is assigned as Critically Endangered (CR).

ResumenRecientes expediciones exploratorias de campo a las laderas occidentales de los Andes ecuatorianos dieron como resultado el descubrimiento de una nueva especie de Amalophyllon (Gesneriaceae). Amalophyllonmiraculum J.L.Clark, sp. nov. se describe de dos localidades de la región de Centinela en la provincia de Santo Domingo de los Tsáchilas. La nueva especie se diferencia de otros congéneres por el hábito colgante, la roseta basal de las hojas, las láminas foliares con márgenes profundamente aserrados y su tamaño en miniatura. Según las directrices de la UICN, se le asigna el estado de conservación preliminar de En Peligro Crítico (CR).