Cardiovascular risk factors among Ecuadorian adolescents : a school-based health promotion intervention

Non-communicable diseases (NCDs) are the leading cause of death worldwide. More than 80% of deaths from cardiovascular diseases (CVD) and diabetes occur in low- and middle-income countries (LMICs). Identifying and understanding the distribution of risk factors is key to developing effective population intervention programs to prevent NCDs. These preventive strategies should start in youth. In Ecuador diabetes mellitus, hypertension, stroke, ischemic heart disease and heart failure rank high on a list of the ten leading causes of death in the general population. Furthermore, overweight and obesity are prevalent risk factors among adolescents. This thesis aims to: (i) explore the distribution of CVD risk factors with a major focus on diet among adolescents living in urban and rural settings from different socio-economic backgrounds, (ii) analyze the effect on dietary intake, body mass index (BMI), waist circumference and blood pressure of a school-based health promotion intervention, (iii) describe the process evaluation (PE) of the school-based health promotion intervention and, (iv) link the PE data with the intervention effect. To accomplish these objectives, two main activities were performed. A cross-sectional survey among 779 adolescents 10-16 years old from an urban and rural area in Ecuador was performed. The research aimed to identify the prevalence of metabolic CVD risk factors and the dietary intake of the target group. Dyslipidemia, abdominal obesity, high blood cholesterol and overweight were the most prevalent risk factors. The diet of this group of adolescents was carbohydrate based, rich in refined cereals, added sugar and processed foods consumed mainly in snacks. Consumption of fruit, vegetables, fish and oilseeds were very low. An estimated 18% of the adolescents reported skipping breakfast. Differences in dietary intake between urban and rural adolescents were small. Diets high in refined carbohydrates were associated with higher plasma glucose levels, while diets with high fat and low fiber content were correlated with increased levels of low density lipoprotein (LDL) and total blood cholesterol concentrations. The cross-sectional data was combined with theoretical approaches to design a culturally appropriate evidence and theory-based health promotion intervention. A pair matched cluster randomized controlled trial was implemented among 1430 adolescents attending 20 schools in Cuenca-Ecuador during 28 months from 2009-2012, 10 schools were allocated to the intervention group and the remaining ten to the control group. The program aimed to improve dietary intake, physical activity, sedentary behavior and physical fitness (primary outcomes) and reduce BMI, waist circumference and blood pressure (secondary outcomes). The intervention strategies combined the implementation of an individual classroom-based component with an environment-based component along the ten intervention schools. The individual-based component involved the implementation of an educational tool-kit, whilst, the environment-based component consisted in the delivery of educational workshops for parents and food-tuck shop staff. The normal standard curriculum was followed in the control schools. A detailed PE was also conducted. At the end of the intervention, data from 1079 adolescents from the 20 schools originally contacted was available for analysis. The program effectively increased fruit and vegetable intake and decreased added sugar and processed food intake during snacks. The intervention was also effective in decreasing waist circumference and blood pressure in favor of the intervention group. The effect on dietary intake was not moderated by the socioeconomic status or the weight or the age of the participants. However, the effect on waist circumference was higher among younger and overweight-obese adolescents. The program was correctly implemented and well received by the target audiences i.e. adolescents, teachers, parents and food-tuck shop staff. Dose, reach and fidelity were high with the exception of parental reach (only 15%). Barriers for program implementation were the difficulty to attach the program to the school curriculum, the low parental reach and, the resistance to a decrease in portion size served in the food-tuck shops. Although still below the nutritional recommendations, the combined effect of the intervention on several individual risk factors is encouraging and promising. It suggests that school-based interventions can address various risk factors simultaneously in adolescents from LMICs. This thesis provides new evidence for the prevention of NCDs among adolescents from LMICs

Evaluación de hemerotecas electrónicas: Resultados de un estudio de usuarios realizado en la Hemeroteca Electrónica de la Facultad de Ciencias de la Información de la Universidad Complutense.

Se presentan los resultados del estudio de usuarios realizado la Hemeroteca Electrónica de prensa de la Biblioteca de la Facultad de Ciencias de la Información, tras describir su formación y evolución como servicio. Se establecen cuáles son los sujetos investigados y los objetivos del estudio, así como las características del instrumento utilizado para la realización del mismo. Se plantea la realización de un estudio que determine el nivel de uso de los fondos de dicha Hemeroteca Electrónica, así como el grado de satisfacción de los usuarios con el funcionamiento de la misma. Se intenta así mismo conocer, los fines de utilización de la información obtenida en el servicio mencionado, en la actividad diaria de los usuarios del servicio. El fin último de la evaluación realizada es determinar qué pautas pueden servir para guiar la planificación y el funcionamiento de este servicio a corto, medio y largo plazo.The sudy was performed on the electronic newspapers library of the faculty of information science. This study describes the formation and developement of the electronic library. Particular attention was paid to describe in detail who the various users were and their degree of satisfaction in using the electronic library. Finally, the results of this survey are used in the planning of short, medium and long periods of time

Exchange rate USD/MXN forecast through econometric models, time series and HOWMA operators

This paper aims to provide models that can predict the exchange rate and generate future scenarios of this variable, this because exchange risk management has become a strategic activity of the corporate governance. Also the study aims to expand the uses of operators like Heavy Ordering Weight Moving Average (HOWMA) in different fields of economy and management

Government transparency measurement through prioritized distance operators

© 2018 - IOS Press and the authors. All rights reserved. The prioritized induced probabilistic ordered weighted average distance (PIPOWAD) has been developed. This new operator is an extension of the ordered weighted average (OWA) operator that can be used in cases where we have two sets of data that want to be compared. Some of the main characteristics of this new operator are: 1) Not all the decision makers are equally important, so the information needs to be prioritized, 2) The information has a probability to occur and 3) The decision makers can change the importance of the information based in an induced variable. Additionally, characteristics and families of the PIPOWAD operator are presented. Finally, an application of the PIPOWAD operator in order to measure government transparency in Mexico is presented

Prevalence and risk factors for asthma, rhinitis, eczema, and atopy among preschool children in an Andean city.

BACKGROUND: Limited data are available on prevalence and associated risk factors for atopy and allergic diseases from high-altitude urban settings in Latin America. OBJECTIVE: To estimate the prevalence of atopy, asthma, rhinitis, and eczema, and associations with relevant risk factors in preschool children in the Andean city of Cuenca. METHODS: A cross-sectional study was undertaken using a representative sample of 535 children aged 3-5 years attending 30 nursery schools in the city of Cuenca, Ecuador. Data on allergic diseases and risk factors were collected by parental questionnaire. Atopy was measured by skin prick test (SPT) reactivity to a panel of relevant aeroallergens. Associations between risk factors and the prevalence of atopy and allergic diseases were estimated using multivariable logistic regression. RESULTS: Asthma symptoms were reported for 18% of children, rhinitis for 48%, and eczema for 28%, while SPT reactivity was present in 33%. Population fractions of asthma, rhinitis, and eczema attributable to SPT were 3.4%, 7.9%, and 2.9%, respectively. In multivariable models, an increased risk of asthma was observed among children with a maternal history of rhinitis (OR 1.85); rhinitis was significantly increased in children of high compared to low socioeconomic level (OR 2.09), among children with a maternal history of rhinitis (OR 2.29) or paternal history of eczema (OR 2.07), but reduced among children attending daycare (OR 0.64); eczema was associated with a paternal history of eczema (OR 3.73), and SPT was associated with having a dog inside the house (OR 1.67). CONCLUSIONS: A high prevalence of asthma, rhinitis, and eczema symptoms were observed among preschool children in a high-altitude Andean setting. Despite a high prevalence of atopy, only a small fraction of symptoms was associated with atopy. Parental history of allergic diseases was the most consistent risk factor for symptoms in preschool children

Cardiovascular risk among 6-8-year-old children living in urban and rural communities in Ecuador: A cross-sectional analysis

Cardiovascular diseases have their origins in childhood. At least 20% of children and adolescents in Latin America are overweight or obese. However, little is known regarding the cardiovascular risk of young children living in the region. This paper aims to identify associations between socio-demographics, adiposity, and dietary intake with cardiometabolic risk among children between 6- and 8-years old living in urban and rural Andean regions of Ecuador. A cross-sectional study was conducted among 267 children attending elementary schools between February and August 2018. Sociodemographic data were collected using a structured interview. Bodyweight, height, and waist circumference were measured in duplicate; blood samples were taken after overnight fasting to determine blood lipids, hepatic enzymes, and adipokines; food intake data was assessed by two 24-h recalls administered to the guardians. Associations between cardiometabolic risk (i.e., blood lipids, hepatic enzymes, and adipokines) with sociodemographic characteristics, dietary intake, and waist circumference were tested using multiple hierarchical regression models. Twenty-nine percent of the children were overweight or obese, 12% had low HDL levels, and over 18% had high levels of LDL and triglycerides. Children living in the urban region had lower levels of HDL (β−4.07 mg/dL; 95% CI: −7.00; −1.15; P = 0.007) but higher levels of LDL cholesterol (β 8.52 mg/dL; 95% CI: 1.38; 15.66; P = 0.019). Hepatic enzymes were also higher among urban children (SGOT: β% 22.13; 95% CI: 17.33; 26.93; P < 0.001; SGPT: β 0.84 U/L; 95% CI: 0.09; 1.59; P = 0.028). Leptin blood levels were higher (β% 29.27; 95% CI: 3.57; 54.97; P = 0.026), meanwhile adiponectin plasma concentrations were lower among urban children (β%−103.24; 95% CI: −58.9; −147.58; P = < 0.001). Fiber intake was inversely associated with total cholesterol (β−9.27 mg/dL; 95% CI –18.09; −0.45; P = 0.040) and LDL cholesterol blood levels (β−9.99 mg/dL; 95% CI: −18.22; −1.75; P = 0.018). Our findings demonstrate that young children are at high cardiovascular risk; if no actions are taken, the burden of non-communicable diseases will be substantial. The differences in risk between rural and urban areas are evident; urbanization might predispose children to a different reality and, in most cases, result in poor habits

Cytology Versus Molecular Diagnosis of HPV for Cervical Cancer Screening. Comparison of the Diagnostic Properties of Four Tests in a Rural Community of Cuenca Ecuador

Cervical cancer (CC) is considered a threat to women’s lives, which is why the WHO launched the 90-70-90 strategy, seeking to eradicate CC by 2030. Part of the strategy involves screening with highly sensitive molecular biology tests for HPV diagnosis to replace cervical cytology. The objective of this research was to compare the sensitivity and specificity of molecular biology tests, including self-testing for HPV diagnosis with traditional cytology. Methodology: A study of diagnostic tests was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected a vaginal and a urine sample and then a health professional performed a standard cervical smear for HPV molecular diagnosis and cytology. The latter test was considered the gold standard. All three samples were processed with the same amplification and genomic hybridization protocol for HPV detection (Hybribio) following the manufacturer’s instructions. Cytology was processed following the standard technique. Results: The sensitivity of vaginal self-sampling for the diagnosis of HR HPV reached 100% (CI 75.7, 100.0), and specificity 94.4% (CI 88.4, 97.43). Urine self-sampling had a sensitivity of 91.6% (CI 64.61, 98.51), and a specificity of 96.435 (CI 91.18, 98.6). Cervical cytology achieved a sensitivity of 41.67% (CI 19.33, 68.5) and a specificity of 85.19% (CI 77.28, 90.67) Conclusions: This study demonstrates that vaginal self-sampling and urine self-sampling methods have similar sensitivity and specificity compared to the sample taken by the health professional for molecular diagnosis of HPV. The sensitivity of cytology (Papanicolaou) was lower in relation to molecular biology tests for primary screening of CC. Keywords: HPV; vaginal self-sampling; urine self-sampling; health professional sampling; cytology, sensitivity and specificity. Resumen El cáncer de cuello uterino (CC) es considerado una amenaza para la vida de las mujeres, por esta razón la OMS lanzó la estrategia 90-70-90, que busca erradicar el CC hasta el 2030. Parte de la estrategia implica el tamizaje con pruebas de biología molecular de alta sensibilidad para el diagnóstico de VPH, que sustituyan a la citología cervical. El objetivo de esta investigación, fue comparar la sensibilidad y especificidad de las pruebas de biología molecular, incluyendo la auto toma para el diagnóstico del VPH con la citología tradicional. Metodología: Se realizó un estudio de pruebas diagnósticas, en una parroquia rural de Cuenca, Ecuador. Un total de 120 mujeres participaron. Cada participante recolectó por sí misma una muestra vaginal y otra de orina y luego un profesional de salud realizó una toma cervical estándar para el diagnóstico molecular de VPH y citología. Esta última prueba fue considerada como el estándar de oro. Las tres muestras fueron procesadas con el mismo protocolo de amplificación e hibridación genómica para de detección del VPH (Hybribio) siguiendo las instrucciones del fabricante. La citología fue procesada siguiendo la técnica estándar. Resultados: La sensibilidad de la auto toma vaginal para el diagnóstico del VPH AR alcanzó el 100 % (IC 75.7, 100.0), y la especificidad 94.4% (IC 88.4, 97,43). El auto muestreo de orina tuvo una sensibilidad de 91,6 % (IC 64.61, 98.51), y una especificidad de 96,435 (IC 91.18, 98.6). La citología cervical alcanzó una sensibilidad 41,67% (IC 19.33, 68.5) y una especificidad de 85,19% (IC 77.28, 90.67) Conclusiones: Este estudio demuestra que los métodos de auto muestreo vaginal y auto muestreo en orina tienen una sensibilidad y especificidad similar a la comparada con la muestra tomada por el profesional de salud para el diagnóstico molecular del VPH. La sensibilidad de la citología (Papanicolaou) es inferior en relación a las pruebas de biología molecular para el tamizaje primario del CC. Palabras Clave: VPH; auto muestreo vaginal; auto muestreo en orina; muestreo por profesional de salud; citología, sensibilidad y especificidad

Identification of rare earth minerals associated to K-feldspar: Capacsaya project in Peru

A recently discovered the rare-earth-rich site in Capacsaya, located at 123 km northwest of Cusco, at the south of Peru, contains signifcant quantities of light and heavy rare-earth elements such as neodymium, lanthanum, cerium, europium, and yttrium. This work reports the identifcation of rare-earth elements and their associated minerals using scanning electron microscopy, energy-dispersive X-ray spectroscopy and X-ray difraction analyses. Five (5) samples extracted from diferent locations at the Capacsaya site were characterized and identifed K-feldspar as the mineral associated with the rare-earth elements in a representative sample with a high concentration of lanthanum and cerium. The results showed rare-earth elements contained within the mineral phase monazite, being cerium the dominant element in the phase (La, Ce, Nd)PO4. Finally, through the electrostatic separation process we demonstrate that it was possible to achieve an efcient separation of the K-feldspar phase in the particle size range 75–150 μm