Social support in rural communities in Manabi province, Ecuador.

INTRODUCTION: Social support has been found in many contexts, and in urban Ecuador, to be protective of health, particularly in the context of disaster. Fewer studies have explored the presence and impact of social support in rural Ecuador. This study engages a rural community in Ecuador to examine the general levels of social support, differences in social support based on different demographic groupings and relationships among social support and health outcomes and protective health behaviors. METHODS: A cross-sectional design was used to survey 416 people in a rural Ecuadorian community that had recently experienced an earthquake. Spanish-language versions of the Multidimensional Scale of Perceived Social Support and the Interpersonal Support Evaluation List-12 were applied, as well as questions about demographics and risk reduction behaviors. Body mass index, blood pressure, and cholesterol and blood sugar levels were assessed. Analysis of variance assessed differences in social support among demographic groupings, risk reduction behaviors, and health outcomes. RESULTS: Levels of social support were moderate. Few statistically significant (ie p<0.05) differences in amount of social support received or in sources of social support were found. Men, people 80 years or older, divorced or widowed people, and people living in peripheral areas received less social support than women, people of all other ages, married/cohabitating people, and people living within the village, respectively. Effect sizes of these differences were small. No relationship between social support and health outcomes were found, and few were found for risk reduction factors. CONCLUSION: These findings indicate that social support may function differently in rural Ecuador than in urban contexts. Those promoting social support in rural communities may wish to focus on community-level, not individual-level, interventions. Limitations of applying an assessment of social support from urban Ecuadorian contexts to rural Ecuadorian contexts are discussed.

Zika virus knowledge and attitudes in Ecuador.

Since its discovery in 1947 in Uganda, ZIKV has spread to 61 countries with a total of 229,238 confirmed human cases worldwide. Specifically, Ecuador has recorded 3,058 confirmed cases and 7 confirmed cases of congenital syndrome associated with ZIKV. Using the Health Belief Model (HBM), this pilot study was conducted to assess Zika virus-related knowledge and attitudes among adults in Ecuador. The survey data were collected in public places in rural and urban areas of Ecuador in May 2016. Seven items measured ZIKV knowledge and 23 items measured attitudes toward ZIKV. A total of 181 Ecuadorians participated in this study. The average age of the sample was 33.4. With respect to ZIKV knowledge, the majority of the participants had heard of ZIKV (n = 162, 89.5%). More males reported first hearing of ZIKV on the internet (p = 0.02), more rural individuals reported knowing someone diagnosed with ZIKV (p = 0.02), more primary school educated individuals reported hearing about ZIKV first from their doctor/nurse (p = 0.03), and more high school graduates correctly identified that ZIKV could be transmitted from mother to child (p = 0.03). As for the HBM constructs, there was a statistically significant difference between gender and cues to action (p = 0.04), with males having a statistically significant lower mean on the cues to action items compared to females. There were also statistically significant differences between those categorized as having "adequate" knowledge compared to "low" knowledge on the benefits construct (p = 0.04) and the perceived severity construct (p = 0.03). There is a clear need for education about the transmission and prevention of ZIKV. High levels of self-efficacy for prevention behaviors for ZIKV combined with low perceived barriers in this community set the stage for effective educational interventions or health promotion campaigns that can ameliorate the knowledge deficits surrounding transmission and prevention.

Self-efficacy of Osteopathic Medical Students in a Rural-Urban Underserved Pathway Program.

CONTEXT: Self-efficacy has been shown to play a role in medical students' choice of practice location. More physicians are needed in rural and urban underserved communities. Ohio University Heritage College of Osteopathic Medicine has a co-curricular training program in rural and urban underserved practice to address this shortage. OBJECTIVE: To assess whether participation in the co-curricular program in rural and urban underserved practice affects self-efficacy related to rural and underserved urban practice. METHODS: This cross-sectional study explored self-efficacy using Bandura's 5 sources of self-efficacy (vicarious learning, verbal persuasion, positive emotional arousal, negative emotional arousal, and performance accomplishments). A validated scale on self-efficacy for rural practice was expanded to include self-efficacy for urban underserved practice and e-mailed to all 707 medical students across 4 years of medical school. Composite rural and urban underserved self-efficacy scores were calculated. Scores from participants in the rural and urban underserved training program were compared with those who were not in the program. RESULTS: Data were obtained from 277 students. In the overall sample, students who indicated that they grew up in a rural community reported significantly higher rural self-efficacy scores than those who did not grow up in a rural community (F1,250=27.56, P<.001). Conversely, students who indicated that they grew up in a nonrural community reported significantly higher urban underserved self-efficacy scores than those who grew up in a rural community (F1,237=7.50, P=.007). The participants who stated primary care as their career interest (n=122) had higher rural self-efficacy scores than the participants who reported a preference for generalist specialties (general surgery, general psychiatry, and general obstetrics and gynecology) or other specialties (n=155) (F2,249=7.16, P=.001). Students who participated in the rural and urban underserved training program (n=49) reported higher rural self-efficacy scores (mean [SD], 21.06 [5.06]) than those who were not in the program (19.22 [4.22]) (t65=2.36; P=.022; equal variances not assumed). The weakest source of self-efficacy for rural practice in participants was vicarious experience. The weakest source of urban underserved self-efficacy was verbal persuasion. CONCLUSION: Opportunities exist for strengthening weaker sources of self-efficacy for rural practice, including vicarious experience and verbal persuasion. The findings suggest a need for longitudinal research into self-efficacy and practice type interest in osteopathic medical students.

Cardiometabolic risk factors, metabolic syndrome and pre-diabetes in adolescents in the Sierra region of Ecuador.

BACKGROUND: Excess weight (overweight and obesity) is the major modifiable risk factor for type 2 diabetes mellitus (T2DM) and other non-communicable diseases. However, excess weight may not be as predictive of diabetes risk as once thought. While excess weight and other obesity-related non-communicable diseases are of growing concern in low-middle income countries in Latin America, there is limited research on risk factors associated with T2DM in adolescents. This study investigated prevalence of overweight, obesity, prediabetes, diabetes and metabolic syndrome in adolescents in Ecuador. METHODS: A cross-sectional study was conducted with 433 adolescents from two schools in a small urban center in southern Ecuador and two schools in a large urban center in Quito. Risk factors were measured, including: height, weight, BMI, waist-to-hip ratio, fasting glucose, lipid panel, and HbA1c. Multivariate analysis of variance (MANOVA) was separately applied to risk factors and demographic factors as a set of dependent variables with sex, location and their interaction included as predictors. An independent t test was run on the data at 95% confidence intervals for the mean difference. The values for the triglycerides, LDL and VLDL were positively skewed. A Mann-Whitney U test was run on these data. RESULTS: Using IOTF standards, 9.8% were overweight and 1.9% were obese. Only 1.6% of the sample met the criteria for prediabetes by fasting glucose but 12.4% of the sample met the criteria for prediabetes by HbA1c. None of the participants met criteria for diabetes. There were 2.3% of the participants that met the IDF criteria for metabolic syndrome. Adolescents from the larger urban center had higher rates of prediabetes, higher mean HbA1c, blood pressure, lipid values, and lower HDL levels. CONCLUSIONS: Use of HbA1c identified more adolescents with prediabetes than FBG. The HbA1c measure is an attractive screening tool for prediabetes in developing countries. Although rates of obesity in Ecuadorian adolescents are low there is significant evidence to suggest that prediabetes is permeating the smaller urban centers. Traditional screening tools may underestimate this risk.