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The significant increase in international cross-border migrations remains a global public health concern; therefore, the need for migrant-specific evidence-based interventions is critical. We assessed the methodological and reporting quality of systematic reviews (SRs) focused on migrant healthcare interventions. We systematically searched in five electronic databases from 2007 to April 2020 to identify SRs on migrant health. Two independent reviewers assessed risk of bias, methodological and reporting quality in included systematic reviews (SRs) using ROBIS, AMSTAR-2 and PRISMA checklist, respectively. We included 57 systematic reviews. The quality in 30 SRs (52.6%) was either low or critically low due to limitations in AMSTAR-2 items 4, 7, 8 and 10–16. The overall risk of bias was high in 23 SRs (40.4%), particularly in domains—data collection and study quality—20 SRs (35.1%), synthesis and findings—19 SRs (33.3%), and study identification and selection 13 SRs (22.8%). The quality of reporting in 36 SRs (63.2%) was moderate, with 19.74 ± 4.67 items fulfilled. While 19 SRs (33.3%) had 10–18 PRISMA items satisfied. Sixteen SRs (28.1%) reported a research protocol and registration. The overall quality of migrant SRs is suboptimal, with critical gaps linked to low protocol registrations, assessment of risk of bias and publication bias, additional analysis of synthesized evidence and available funding. These findings reflect current deficiencies in the development of SR on migrant healthcare.

Background Although cannabis and cannabinoids are widely used with therapeutic purposes, their claimed efficacy is highly controversial. For this reason, medical cannabis use is a broad field of research that is rapidly expanding. Our objectives are to identify, characterize, appraise, and organize the current available evidence surrounding therapeutic use of cannabis and cannabinoids, using evidence maps. Methods We searched PubMed, EMBASE, The Cochrane Library and CINAHL, to identify systematic reviews (SRs) published from their inception up to December 2017. Two authors assessed eligibility and extracted data independently. We assessed methodological quality of the included SRs using the AMSTAR tool. To illustrate the extent of use of medical cannabis, we organized the results according to identified PICO questions using bubble plots corresponding to different clinical scenarios. Results A total of 44 SRs published between 2001 and 2017 were included in this evidence mapping with data from 158 individual studies. We extracted 96 PICO questions in the following medical conditions: multiple sclerosis, movement disorders (e.g. Tourette Syndrome, Parkinson Disease), psychiatry conditions, Alzheimer disease, epilepsy, acute and chronic pain, cancer, neuropathic pain, symptoms related to cancer (e.g. emesis and anorexia related with chemotherapy), rheumatic disorders, HIV-related symptoms, glaucoma, and COPD. The evidence about these conditions is heterogeneous regarding the conclusions and the quality of the individual primary studies. The quality of the SRs was moderate to high according to AMSTAR scores. Conclusions Evidence on medical uses of cannabis is broad. However, due to methodological limitations, conclusions were weak in most of the assessed comparisons. Evidence mapping methodology is useful to perform an overview of available research, since it is possible to systematically describe the extent and distribution of evidence, and to organize scattered data.

This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the accuracy of laboratory tests for the diagnosis of congenital Zika virus infection. SECONDARY OBJECTIVES: To explore potential sources of heterogeneity, and specific factors that may influence the accuracy of diagnostic tests for congenital Zika virus infection, such as geographic area, endemicity of Zika, and the reference standard used (See Investigations of heterogeneity).

Background Neglected tropical diseases (NTDs) continue to be an important cause of disability and mortality in the poorest tropical and subtropical areas. Methods This is an ecological study. We included all death certificates with dengue, cysticercosis and Chagas disease in Ecuador from 2011 to 2016. The spatial autocorrelation was evaluated by GeoDa software through the Global Moran's I index and the formation of clusters by the local index of spatial association. Results The Global Moran's I index for the study period shows a positive spatial autocorrelation for dengue, cysticercosis and Chagas disease (0.25, p=0.001; 0.07, p=0.04; 0.45, p=0.001, respectively). Conclusions The clusters identified as higher risk in the country could be targeted by policymakers to adequately develop strategies to strengthen health promotion policies that break the cycle of these diseases.

This study was aimed to describe the gastric cancer mortality trend, and to analyze the spatial distribution of gastric cancer mortality in Ecuador, between 2004 and 2015.Data were collected from the National Institute of Statistics and Census (INEC) database. Crude gastric cancer mortality rates, standardized mortality ratios (SMRs) and indirect standardized mortality rates (ISMRs) were calculated per 100,000 persons. For time trend analysis, joinpoint regression was used. The annual percentage rate change (APC) and the average annual percent change (AAPC) was computed for each province. Spatial age-adjusted analysis was used to detect high risk clusters of gastric cancer mortality, from 2010 to 2015, using Kulldorff spatial scan statistics.In Ecuador, between 2004 and 2015, gastric cancer caused a total of 19,115 deaths: 10,679 in men and 8436 in women. When crude rates were analyzed, a significant decline was detected (AAPC: -1.8%; p0.001). ISMR also decreased, but this change was not statistically significant (APC: -0.53%; p=0.36). From 2004 to 2007 and from 2008 to 2011 the province with the highest ISMR was Carchi; and, from 2012 to 2015, was Cotopaxi. The most likely high occurrence cluster included Bolívar, Los Ríos, Chimborazo, Tungurahua, and Cotopaxi provinces, with a relative risk of 1.34 (p0.001).There is a substantial geographic variation in gastric cancer mortality rates among Ecuadorian provinces. The spatial analysis indicates the presence of high occurrence clusters throughout the Andes Mountains.

Good mental health is related to mental and psychological well-being, and there is growing interest in the potential role of the built environment on mental health, yet the evidence base underpinning the direct or indirect effects of the built environment is not fully clear. The aim of this overview is to assess the effect of the built environment on mental health-related outcomes. Methods. This study provides an overview of published systematic reviews (SRs) that assess the effect of the built environment on mental health. We reported the overview according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched until November 2019 included the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE (OVID 1946 to present), LILACS, and PsycINFO. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using the Assessing Methodological Quality of Systematic Reviews-2 (AMSTAR-2). Results. In total, 357 records were identified from a structured search of five databases combined with the references of the included studies, and eleven SRs were included in the narrative synthesis. Outcomes included mental health and well-being, depression and stress, and psychological distress. According to AMSTAR-2 scores, the quality assessment of the included SRs was categorized as “high” in two SRs and as “critically low” in nine SRs. According to the conclusions of the SRs reported by the authors, only one SR reported a “beneficial” effect on mental health and well-being outcomes. Conclusion. There was insufficient evidence to make firm conclusions on the effects of built environment interventions on mental health outcomes (well-being, depression and stress, and psychological distress). The evidence collected reported high heterogeneity (outcomes and measures) and a moderate- to low-quality assessment among the included SRs.

Objetivos. Analizar la tendencia temporal de la mortalidad por diabetes mellitus (DM) e identificar la presencia de conglomerados espacio-temporales de alta y baja mortalidad en el Ecuador en el período 2001 a 2016.Materiales y métodos. Se llevó a cabo un estudio ecológico mixto. Se calcularon las tasas de mortalidad específica y ajustada por edad para el periodo 2001 a 2016 en el Ecuador. Se utilizó un análisis de regresión joinpoint para el análisis de las tendencias y la metodología desarrollada por Kulldorf para el análisis de conglomerados espacio-temporales. Resultados. Durante el período 2001-2016, se registraron 57.788 defunciones por DM en el Ecuador. En el análisis joinpoint las tasas ajustadas por edad en hombres reportaron un ascenso significativo del porcentaje de cambio anual (PCA) del 2,4% (2001-2016; p

La edición genómica en células germinales es una técnica de ingeniería genética en la que el ADN es insertado, eliminado o reemplazado en el genoma de los gametos o células precursoras. En noviembre de 2018, el investigador chino He Jiankui, anunciaba junto con sus colegas la "creación" de los primeros bebés genéticamente modificados del mundo a través del sistema CRISPR-Cas9, las gemelas Lulu y Nana. Estas declaraciones generaron diferentes reacciones en la comunidad científica, así como preguntas sobre los dilemas bioéticos que envuelven este tipo de procedimientos. El objetivo del presente artículo es analizar los consensos nacionales e internacionales relacionados con los aspectos bioéticos en la investigación de edición genómica en humanos.

Background Leptospirosis is a zoonotic disease that is considered an important public health problem in tropical regions and the world's poorest countries. Methods In this ecological study, we included cases of leptospirosis reported in Ecuador from 2013 to 2018. Spatial autocorrelation was evaluated through the global Moran I index and spatial-temporal scan statistics were used to identify high-risk clusters. Results In Ecuador, the leptospirosis incidence rates decreased from 3.3 cases per 100 000 population in 2013 to 0.8 cases per 100 000 population in 2018. The global Moran I index for the study period showed a positive spatial autocorrelation (0.68; p=0.001). We identified three significant spatial-temporal clusters for a high occurrence of leptospirosis incidence located in cantons of the Coast and Amazon regions. Conclusions The clusters identified could be targeted by policymakers and stakeholders in order to direct surveillance and understand the dynamics of the distribution of leptospirosis in Ecuador.

Objective: The aim of this study is two fold. First, it describes the temporal trends of malignant melanoma mortality from 2000 to 2016 in Ecuador. Second, it analyzes the spatial clusters of high mortality rates due to malignant melanoma in the country, from 2011 to 2016. Methods: This is an ecological study; we included all death certificates of malignant melanoma from the National Institute of Statistics and Census database in Ecuador from 2000 to 2016. We calculated crude mortality rates and age-standardized mortality rates, all rates are expressed as deaths per 100,000 population. In order to assess the trend of malignant melanoma rates, we obtained average annual percent changes through Joinpoint regression analysis. Spatial scan statistics were used to identify high-risk clusters and the spatial autocorrelation was evaluated through a global Moran index. Results: In Ecuador, between 2000 and 2016, malignant melanoma caused a total of 958 deaths. Crude mortality rates increased significantly (annual percent change = 4.8%; 95% confidence interval: 2.6–7.0), the age-standardized mortality rate also increased (annual percent change: 2.9%; 95% confidence interval: 0.5–5.4). The most likely cluster included 19 cantons and the second most likely cluster included 10 cantons, located in the Highlands region. The Global Moran I index for the study period shows a positive spatial autocorrelation (0.32; p = 0.001). Conclusion: Mortality due to malignant melanoma in Ecuador significantly increased over the 17-year study period; the spatial analysis and spatial autocorrelation indicates the presence of high-risk occurrence clusters in the Highlands region of the country.

Background. Leukocytes contained in the allogeneic packed red blood cell (PRBC) are the cause of certain adverse reactions associated with blood transfusion. Leukoreduction consists of eliminating leukocytes in all blood products below the established safety levels for any patient type. In this systematic review, we appraise the clinical effectiveness of allogeneic leukodepleted (LD) PRBC transfusion for preventing infections and death in patients undergoing major cardiovascular surgical procedures.Methods. We searched randomized controlled trials (RCT), enrolling patients undergoing a major cardiovascular surgical procedure and transfused with LD-PRBC. Data were extracted, and risk of bias was assessed according to Cochrane guidelines. In addition, trial sequential analysis (TSA) was used to assess the need of conducting additional trials. Quality of the evidence was assessed using the GRADE approach.Results. Seven studies met the eligibility criteria. Quality of the evidence was rated as moderate for both outcomes. The risk ratio for death from any cause comparing the LD-PRBC versus non-LD-PRBC group was 0.69 (CI 95% = 0.53 to 0.90;I2 = 0%). The risk ratio for infection in the same comparison groups was 0.77 (CI 95% = 0.66 to 0.91;I2 = 0%). TSA showed a conclusive result in this outcome.Conclusions. We found evidence that supports the routine use of leukodepletion in patients undergoing a major cardiovascular surgical procedure requiring PRBC transfusion to prevent death and infection. In the case of infection, the evidence should be considered sufficient and conclusive and hence indicated that further trials would not be required.

El presente estudio analiza los cambios en la tendencia temporal y describir la carga de la mortalidad por cáncer de mama en el Ecuador en el período 2001 a 2016. Así, se llevó a cabo un estudio ecológico de series de tiempo. Se utilizó un análisis de regresión joinpoint (puntos de cambio) para el análisis de las tendencias y el indicador para los años potenciales de vida perdidos (APVP) para describir la carga de la mortalidad por cáncer de mama. Desde 2001 hasta 2016 se registraron 6 788 defunciones por cáncer de mama en el Ecuador. En el análisis de regresión joinpoint de las tasas de mortalidad ajustadas por edad, el Porcentaje de Cambio Anual (PCA) presentó un ascenso estadísticamente significativo de 1,49 % anual en el periodo 2001-2016 (p = 0,002); en el análisis de las tasas crudas de mortalidad, el PCA presentó un ascenso estadísticamente significativo de 2,44 % anual (2001-2016; p < 0,001). Los APVP reportados en 2001 se incrementaron para el año 2016 (6 688 a 12 275 APVP). En sí, se ha detectado un incremento estadísticamente significativo de la mortalidad por cáncer de mama de 2001-2016; lo que duplica los años potenciales de vida perdidos.

Background: Ischemic Heart Disease (IHD) is the leading cause of mortality worldwide. Aim: To analyze the evolution of mortality by IHD in Ecuador, from 2001 to 2016. Material and Methods: Analysis of Ecuador death registries elaborated by the National Statistics and Census Institute. Specific and age-adjusted mortality rates were calculated for the 2001-2016 period in Ecuador. The annual percent change (APC) and the average annual percent change (AAPC) were estimated. Changes in trends were located through joinpoint regression analysis. Results: From 2001 to 2016 there were 46,133 deaths due to IHD in Ecuador, of which 60% (n = 27,489) corresponded to men. In the joinpoint regression analysis, the crude mortality rates for IHD reported an increase in the AAPC of 4.0% (2001-2016, 95% CI: 1.5 – 6.6). Rates adjusted for age increased with an AAPC of 3.2% (2001-2016, 95% CI: 0.7 – 5.8). Conclusions: Mortality due to ischemic heart disease increased in Ecuador in the period 2001-2016. Two marked periods were observed, one with a decrease followed by a significant increase, in both sexes and all age groups.

Altres ajuts: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: I.A-R. is co-funded by European Social Fund 2014-2020, 'Investing in your future'). Few Orthopaedics and Traumatology journals from Latin America and Spain are indexed in major databases; controlled clinical trials published in these journals cannot be exhaustively retrieved using electronic literature searches. We aimed to identify, describe and assess the quality of controlled clinical trials published in Orthopaedics and Traumatology journals from Latin America and Spain through handsearching and evidence mapping methods. We identified controlled clinical trials published in eligible Orthopaedics/Traumatology journals in Spanish until July 2017 by handsearching. Data were extracted for controlled clinical trials main characteristics and the Cochrane risk of bias tool was used to assess the controlled clinical trials methodological quality. In addition, we mapped the main findings of these trials. As a result, we assessed 5631 references in 29 eligible journals of which 57 were controlled clinical trials (1.0%). Controlled clinical trials were published between 1995 and 2017 at a rate of 2.5 per year. Journals from Spain and Mexico published around 63% of the controlled clinical trials identified. The median sample size of patients enrolled was 60 (range = 30-300 participants). About conditions assessed, 38.5% of controlled clinical trials assessed issues related to knee conditions, 15.7% about hip and 10.5% about trauma or spine. The risk of bias domains most affected was selective reporting bias and random sequence generation. In addition, only two and seven trials had low risk of bias in all items related to participant/personnel and outcome assessment blindings, respectively. More than 40% of studies did not report differences on benefits/harms between the interventions assessed. As a conclusion, the number of controlled clinical trials published in Orthopaedics/Traumatology journals from Latin America and Spain is low. These controlled clinical trials had important methodological shortcomings and were judged as unclear or high risk of bias. These trials are now available in CENTRAL for their potential inclusion in systematic reviews and other documents of synthesis.

Background:Suicide is a global public health problem, ranking among the top 20 leading causes of mortality.Objective:The aim of the present study is two-fold. Firstly, it describes the temporal trends of suicide in adolescents from 1997 to 2016 in Ecuador, allowing us to identify critical periods. Secondly, it analyzes the spatiotemporal clusters of high mortality rates and the spatial distribution due to suicide in the country, from 2011 to 2016.Methods:This is an ecological study; we included all death certificates of suicide among adolescents in the 10 - 19 age groups both sex, from the National Institute of Statistics and Census (INEC) database in Ecuador from 1997 to 2016. In order to assess the trend of suicide rates, we obtained Annual Percentage Changes (APCs) and average Annual Percent Changes (AAPCs) through Joinpoint regression analysis. Space-time scan statistics were used to identify high-risk clusters, and the spatial autocorrelation was evaluated through global Moran index.Results:Suicides at a national level increased from 165 deaths in 1997 to 286 deaths in 2016; rates increased from 12.7 to 23.3 per 100,000 population along with a significant increase of the trend at the national level (AAPC=3.7%; 95% CI: 2.1 to 5.2). We identified two significant spatial clusters for a high occurrence of suicide: the primary most likely cluster included 83 cantons (Risk Relative=2.28) while the second most likely cluster included 20 cantons (Risk Relative=1.74). The Global Moran I index for the study period showed a positive spatial autocorrelation (0.27; p = 0.001).Conclusion:Suicide rates in adolescents significantly increased over the 20-year study period; the spatial analysis indicates the presence of high occurrence clusters in the Amazon and Southern Highlands regions of the country. This growing phenomenon may be a reflection of the lack of policies and strategies focused on the adolescent’s mental health at a national level, added to factors such as family dysfunction, school failure, vulnerable ethnic groups, and immigration patterns.

Ischemic Heart Disease (IHD) is the leading cause of mortality worldwide.To analyze the evolution of mortality by IHD in Ecuador, from 2001 to 2016.Analysis of Ecuador death registries elaborated by the National Statistics and Census Institute. Specific and age-adjusted mortality rates were calculated for the 2001-2016 period in Ecuador. The annual percent change (APC) and the average annual percent change (AAPC) were estimated. Changes in trends were located through joinpoint regression analysis.From 2001 to 2016 there were 46,133 deaths due to IHD in Ecuador, of which 60% (n = 27,489) corresponded to men. In the joinpoint regression analysis, the crude mortality rates for IHD reported an increase in the AAPC of 4.0% (2001-2016, 95% CI: 1.5 - 6.6). Rates adjusted for age increased with an AAPC of 3.2% (2001-2016, 95% CI: 0.7 - 5.8).Mortality due to ischemic heart disease increased in Ecuador in the period 2001-2016. Two marked periods were observed, one with a decrease followed by a significant increase, in both sexes and all age groups.

The aims of this study were to describe the temporal trend of OC from 2001 to 2016 and to analyze the space and space-time clusters of high mortality due to OC in Ecuador from 2011 to 2016. Methods. The present study is a mixed ecological study; the time trends were obtained using a Joinpoint regression model, space-time scan statistics was used to identify high-risk clusters, and Global Moran I index was calculated. Results. In Ecuador, between 2001 and 2016, OC caused a total of 1,025 deaths. Crude mortality rates significantly increased, with an APC (annual percentage change) of 2.7% (p=0.009). The age-standardized mortality rate did not significantly increase (APC: 1.73%; p=0.08). The most likely cluster was detected in 2015, included 20 cantons. The second cluster included 38 cantons, in the years 2014 to 2016. The Global Moran I index for the study period showed a negative spatial autocorrelation (−0.067; p=0.37). Conclusion. Mortality due to OC in Ecuador significantly increased over the 16-year study period, the young groups being the most affected. Ecuadorian provinces present high variability in types of OC and cancer rates.