Ethnodemographic characterization of stroke incidence and burden of disease in hospital discharge records in Ecuador

Introduction: Stroke is the second most common cause of death and disability-adjusted life years (DALYs) globally. However, the incidence and impact of stroke by ethnicity and gender is frequently distinct. This is particularly the case in Ecuador where geographic and economic marginalization are often correlated with ethnic marginalization and the extent to which females lack the same opportunities as their male counterparts. The aim of this paper is to investigate the differential impacts in terms of stroke diagnosis and burden of disease by ethnicity and gender, using hospital discharge records over the years 2015–2020. Methods: This paper calculates stroke incidence, and fatality rates using hospital discharge and death records over the years 2015–2020. The DALY package in R was employed to calculate the Disability Adjusted Life Years lost due to stroke in Ecuador. Results: The results show that while the incidence rate of stroke in males (64.96 per 100,000 persons-year) is higher than that for females on average (57.84 per 100,000 persons-year), males accounted for 52.41% of all stroke cases and 53% of all surviving cases. Thus, hospital data suggests that females had a higher death rate when compared to males. Case fatality rates also differed significantly by ethnicity. The highest fatality rate corresponded to the Montubio ethnic group (87.65%), followed by Afrodescendants (67.21%). The estimated burden of disease of stroke calculated using Ecuadorian hospital records (2015–2020) varied from 1,468 to 2,991 DALY per 1,000 population on average. Discussion: Differences in the burden of disease by ethnic group are likely to reflect differential access to care by region and socio-economic group, both of which are frequently correlated with ethnic composition in Ecuador. Equitable access to health services remains an important challenge in the country. The gender discrepancy in fatality rates suggests that there is a need for targeted educational campaigns to identify stroke signs early, especially in the female population

A critical appraisal of relational approaches to psychoanalysis

textIn the last twenty years, relational psychoanalysis has emerged as an important voice in psychoanalytic theory and practice. Relational approaches operate within the tension between intrapsychic and interpersonal levels of explanation. On the one hand, intrapsychic explanations assume the existence of a private inner life focusing on internal processes such as fantasy, desires, repression, and unconscious motivations. On the other hand, interpersonal explanations focus on transactions with others, the daily give and take of our relationships, and our inextricable participation in the social realm. Schools in the relational movement often struggle to integrate these two poles, but the risk seems to be collapsing one explanatory pole into the other. This work argues that framing this discussion within a wider philosophical horizon can suggest a compelling new way of thinking about these matters. The theoretical psychology of Jack Martin and Jeff Sugarman (1999, 2000), the philosophy of Hans-Georg Gadamer (1977, 1994), and Martin Heidegger (1993, 1996), offer a view of selfhood that transcends the problematic internal-external dichotomy pervasive in relational approaches.Educational Psycholog

"Infeliz " or "Triste ": A Paradigm for Mixed Methods Exploration of Outcome Measures Adaptation Across Language Variants

The literature on measure translation tends to hold, overtly or covertly, a questionable assumption about the possibility of exact translation and almost completely ignores issues of within language variation. Equally, psychometric methods used to assess cross-cultural validity after translation focus on large sample tests of cross-sectional measurement invariance. Such invariance is often not found and is of dubious pertinence to change/outcome measures usually used in psychotherapy research. We present a sequential process of three substudies using quantitative and qualitative procedures to explore whether an outcome measure needs to be changed when used across language variation. Qualitative data confirmed that an item was not ideal in the new context. However, quantitative exploration showed that, although statistically significant and affected by gender and item order, the impact of changing the item in the overall score was small, allowing retention of the existing Spanish translation. We argue that the myth of perfect translation and over-reliance on large-sample psychometric testing pursuing measurement invariance limit exploration of language effects. We recommend that these be used in the companion of user-based, sequential, mixed-method exploration to support the development of a richer field of understanding of outcomes and change self-report measures across languages and cultures and both across and within languages

Exploration of the psychometric properties of the Clinical Outcomes in Routine Evaluation-Outcome Measure in Ecuador

Background The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a pan-theoretical and pan-diagnostic measure of mental health designed to cover issues that people wish to change in psychotherapy. The objective of this study was to explore the psychometric properties of the Spanish translation of the CORE-OM, in a country, Ecuador for which there is not a single measure suitable for this purpose with empirically demonstrated local acceptability and psychometric properties. Methods In total, 886 adults not currently receiving psychotherapy treatment or taking psychotropic medication were included in the analysis. The analyses broadly followed and compared with results from previous studies. These analyses consisted of assessment of acceptability, internal consistency, test-retest reliability, influences of demographic variables, correlations between domain scores, and convergent validity with Spanish versions of the Outcome Questionnaire 45.2 and Schwartz Outcome Scale-10. Results The questionnaire showed good acceptability (overall omission rate of 0.56%), good reliability (α = .93 [.92, .94], test-retest correlations ranged from .59 to .85), and good convergent validity with the Outcome Questionnaire 45.2 (r = .84) and the Schwartz Outcome Scale-10 (r = −.73). Statistically significant gender differences were found in two domains: females scored higher on Well-being (M = 1.23) than males (M = 1.01), though effect size was small (g = 0.31); and males (M = 0.31) scored higher than females on Risk (M = 0.25), with even smaller effect size (g = 0.06). Age was negatively correlated with psychological distress in all domains and coefficients ranged from −.14 for Risk to −.29 for Functioning. Conclusions The results support the use of the CORE-OM as a valid and reliable instrument in a non-clinical Ecuadorean population. Exploration of the psychometric properties in a clinical population is recommended to assure its use in clinical settings

Knowledge of Palliative Care in Ecuador

Palliative care is a holistic approach to care for people with chronic, advanced, and life-threatening illnesses. It improves the quality of life of patients and their caregivers. However, there is still limited access to palliative care in many countries. Knowledge about palliative care is key to increase its availability. Thus, this article aimed to explore the knowledge of the general population about palliative care in Ecuador. The study had a descriptive cross-sectional design. Through snowball sampling, between September 2019 and January 2020, 257 people completed an anonymous online questionnaire about general and specific aspects of palliative care. Descriptive and ANOVA analyses indicate that people have many misconceptions about palliative care and how it should be provided. Gender, education, training, occupation, and experience as caregivers were related to the total level of knowledge about palliative care. Regression analyses show other variables as predictors of knowledge. This study highlights the lack of knowledge about specific issues within palliative care in the general population in Ecuador. It also shows the need to develop and implement education measures to fill these gaps and enhance access to palliative care in health systems

Empathy and COVID-19: Study in Professionals and Students of the Social Health Field in Ecuador

Empathy plays a fundamental role in health related occupations. In this study, we analysed empathy levels in professionals (117) and students (170) from various healthcare fields in Ecuador during the COVID-19 pandemic. The Interpersonal Reactivity Index was used in an online survey. The results show high levels of empathy in both groups, influenced by age and gender. The students presented higher levels of personal distress, and their age was negatively correlated to empathy. Additionally, professionals working in physical health scored higher levels of personal distress compared to those in the field of emotional health. COVID-19 has placed social health systems in great stress. Despite this, the personal capacities for empathy of both students and health professionals have not been diminished

Normative data for tests of attention and executive functions in a sample of European Portuguese adult population

Objective: The main goal of this study was to produce normative data for the Portuguese population on five neuropsychological tests frequently used to assess executive functions and attention: the Modified Wisconsin Card Sorting Test (M-WCST), the Stroop Color and Word Test, the Trail Making Test (TMT), the Brief Test of Attention (BTA), and the Symbol Digit Modalities Test (SDMT). Method: The study included 300 individuals aged between 18 and 93 years, who had educational backgrounds ranging from 3 to 25 years. Results: The influence of age, education, and sex was explored for each measure, as well as their contribution to explain the performance variance. Conclusions: The normative data are presented as regression-based algorithms to adjust direct and derived test scores for sex, age, and education. This study provides a calculator of normative data, derived from the results of the regression models.info:eu-repo/semantics/publishedVersio