Desnutrición intrahospitalaria: ELAN - ECUADOR. Hospital Miguel H. Alcívar. Cantón Sucre, Manabí 2011

El objetivo de la presente investigación fue establecer la prevalencia de desnutrición hospitalaria y sus determinantes socio demográficos, de condición clínico-quirúrgica, hospitalización y calidad de atención en el Hospital Miguel H. Alcívar- Manabí. Se implementó un estudio de diseño no experimental tipo transversal, en la que participaron 150 pacientes mayores de 18 años con estancia hospitalaria mayor a 24 horas y menor a 6 meses, con su Historia Clínica abierta y su consentimiento informado para participar en la investigación. A cada paciente se le aplicó dos encuestas: una de Valoración Global Subjetiva y otra de Nutrición Hospitalaria. Para el análisis se utilizó el programa estadístico JMP versión 5.1. Realizándose un análisis univariable para establecer la prevalencia de los determinantes y su asociación con la variable resultado. Las pruebas estadísticas aplicadas fueron de probabilidad, medidas de tendencia central, medidas de dispersión y prueba de X2. Encontrando una prevalencia de desnutrición del 28,7% (entre desnutrición moderada y grave). El 46% de los pacientes recibieron calidad de atención regular. Hubo una relación estadísticamente significativa entre la enfermedad de base y el Estado Nutricional. Se detectó más probabilidad de encontrar pacientes desnutridos del Estrato Popular Bajo, en género femenino, y en pacientes de mayor edad aunque estas diferencias no fueron estadísticamente significativas. Se concluye que existe una alta prevalencia de desnutrición en los pacientes, confirmada mediante la Valoración Global Subjetiva, que demuestra ser un instrumento sencillo y de bajo costo. Se detecto una deficiente práctica de valoración, asesoría y control nutricional. Se recomienda implementar un equipo de atención nutricional de calidad en el hospital con la finalidad de disminuir la desnutrición hospitalaria y con ella sus consecuencias.Objective of this research was to establish the prevalence of hospital malnutrition and the social and demographic determinants such as clinicalsurgical condition, hospitalization and quality of care at the Hospital Miguel H. Alcívar-Manabí. It was implemented a non-experimental study design transversal type which involved 150 patients over 18 years with hospital stays longer than 24 hours and less than 6 months. Patients showed their medical history and participate in the research with their consent. Each patient was administered two surveys: the Subjective Global Assessment and the Hospital Nutrition survey. For data analysis the JMP statistical software version 5.1 was used. Single variable analysis was performed to establish the prevalence of determinants and its association with the outcome variable. The statistical tests applied were probability, measures of central tendency, measures of dispersion and the X 2 test. Prevalence of malnutrition on 28.7% (between moderate and severe) was found. 46% of patients received regular care quality. There was a statistically significant relationship between the underlying disease and nutritional status.It was detected more likely to find malnourished to those coming from a Stratum Popular Low, female gender, and older patients although these differences were not statistically significant. It is concluded that there is a high prevalence of malnutrition in patients, confirmed by the Subjective Global Assessment, which proves to be a simple and low cost tool. It was also detected poor assessment practice, counseling and nutritional control. It is recommended to implement a nutritional quality care team in the hospital in order to reduce patient´s hospital malnutrition and its consequences

Análisis estratégico de las políticas públicas de investigación en salud en Ecuador/Strategic analysis of public health research policies in Ecuador

Las políticas públicas son los proyectos que gestiona el gobierno con el fin de satisfacer una necesidad en la sociedad. Objetivo: Analizar la situación de las políticas públicas de investigación en salud en Ecuador. Métodos: Se realizó un estudio FODA (fortalezas, oportunidades, debilidades y amenazas) más un estudio Delphi a 20 informantes clave (sector público y privado) sobre su percepción de los aspectos positivos y negativos de las políticas públicas de investigación en salud del Ecuador en los últimos 8 años (2007-2014). Realización del estudio: Marzo, 2014 a febrero, 2015. Fuente de información: encuesta online. Posteriormente, los participantes ordenaron las tres estrategias más nombradas en cada componente del FODA según su importancia. Tras calcular la mediana, rangos inter cuartil y valores mínimo y máximo, los expertos llegaron al consenso final. Resultados: Los 4 componentes FODA más frecuentes fueron: Fortaleza: Apoyo gubernamental mediante Becas del Gobierno; Oportunidades: Coordinación Interinstitucional y redes de investigación. Debilidades: Trámites burocráticos, especialmente para obtención de fondos económicos para investigación, y evaluaciones de proyectos por profesionales con poca experiencia. Amenazas: Cambios de políticas inesperados, legislación confusa, disminución en los presupuestos. Conclusiones: La investigación y producción científica en el Ecuador presenta cambios importantes, se recomienda aprovechar el apoyo gubernamental, la coordinación y financiamiento institucional, fortaleciendo los recursos destinados para la investigación y evitando los trámites burocráticos y reglamentos confusos. Public policies are the projects that the government manages in order to satisfy a need in society. Objective: To analyze the situation of public health research policies in Ecuador. Methods: A SWOT study (strengths, opportunities, weaknesses and threats) plus a Delphi study was conducted on 20 key informants (public and private sector) on their perception of the positive and negative aspects of Ecuador’s public health research policies in the last 8 years (2007-2014). Conduct of the study: March 2014 to February 2015. Source of information: online survey. Subsequently, the participants ordered the three most-named strategies in each SWOT component according to their importance. After calculating the mean, median and minimum and maximum values, the experts reached the final consensus. Results: The 4 most frequent SWOT components were: Strength: Government support through Government Scholarships; Opportunities: Inter-institutional coordination and research networks. Weaknesses: Bureaucratic procedures, especially to obtain economic funds for research, and project evaluations by professionals with little experience. Threats: Unexpected policy changes, confusing legislation, decrease in budgets. Conclusions: Research and scientific production in Ecuador presents important changes, it is recommended to take advantage of government support, institutional coordination and financing, strengthening the resources allocated for research and avoiding bureaucratic procedures and confusing regulations. Palabras claves: Políticas públicas, Investigación en salud, Ecuador, Delfos. Key words: Public policies, Health research, Ecuador, Delphi

Seasonality and ADHD: Summer time is associated with less symptoms of inattention among children and adolescents with ADHD

Background: Although alertness and activity status are related to light intensity, the effects of seasonal light variability on patients with Attention Deficit Hyperactivity Disorder (ADHD) have been scarcely studied. Our objective was to investigate the effect of seasonality (summer time vs. winter time) on ADHD symptomatology and on the circadian pattern of motor activity in children and adolescents with ADHD and healthy controls. Methods: A total of 117 participants (56.4 % males; age [mean ± SD] 9.2 ± 2.8 years; 51 % patients with ADHD) were included in this cross-sectional study. For all participants we assessed ADHD symptomatology using the Conners Parents Rating Scale-Revised and the circadian pattern of motor activity using actigraphy. Data were collected when schools were in session. General linear models were used to test for differences in outcome variables based on seasonality and ADHD subtype. Results: The results revealed that seasonality had a significant effect among ADHD-I patients. Particularly, we observed that inattention symptoms were ~8.1 points lower (p = 0.002) in summer time, relative to winter time. In addition, we observed that among patients with ADHD-I, the intradaily variability was also significantly lower in summer (p = 0.024). Conclusion: The results from this preliminary study suggest that seasonal light variability could be a factor that modifies the behavior of children and adolescents with ADHD-I.</p

Relación entre estrés percibido y peso corporal en un grupo de adultos ecuatorianos

This research aimed to establish the association between body mass index and perceived stress in a group of Ecuadorian adults and determine the predictive capacity of some sociodemographic variables concerning body mass index. The study had an observational design, associative scope, and cross-sectional, in which 307 adults between 18 and 65 years of age were included through a snowball procedure. Data were collected using the Perceived Stress Scale and two additional sections for general data and anthropometric measurements. It was found that 36.8% of the study population was overweight or obese. In comparison, 77.5% had a medium risk of stress, with women being the most affected, without sex being statistically associated with body mass index or risk of stress. In the investigated population, the age group between 18 and 30 years old, the female sex, and those who declared they were students when filling out the instrument predominated. The adjusted R square value indicated that the sociodemographic variables studied grouped predicted BMI in the investigated environment.El objetivo de la investigación fue establecer la asociación entre índice de masa corporal y estrés percibido en un grupo de adultos ecuatorianos; así como, determinar la capacidad predictiva de algunas variables sociodemográficas con respecto al índice de masa corporal. El estudio tuvo un diseño observacional, alcance asociativo y de corte transversal, en el que participaron 307 personas adultas con edades entre 18 a 65 años incluidos mediante un procedimiento de bola de nieve. Los datos se recolectaron mediante el uso de la Escala de Estrés Percibido y dos secciones adicionales para datos generales y medidas antropométricas. Se halló que el 36,8% de la población de estudio tenía sobrepeso u obesidad, mientras que el 77,5% de la población tiene un mediano riesgo de estrés, siendo las mujeres las más afectadas; sin que se asociara estadísticamente al sexo con el índice de masa corporal ni con el riesgo de estrés. En la población investigada predominó el grupo etario entre 18 y 30 años, el sexo femenino y los que declararon ser estudiantes en el momento de llenar el instrumento. El valor de R cuadrado ajustado indicó que el conjunto de variables sociodemográficas estudiadas agrupadas era predictor del IMC en el entorno investigado

Population attitudes and practices regarding the ‘traffic light’-style labeling in Ecuador

Introducción: La elección de alimentos es fundamental para la salud de las poblaciones. Las estrategias como las normas del etiquetado en los productos alimenticios podrían ayudar a que el consumidor tenga información clara de los alimentos que consume. Objetivos: Explorar la asociación del sexo y la edad con las actitudes y prácticas frente al etiquetado nutricional tipo “Semáforo Nutricional” en Ecuador. Material y métodos: Estudio transversal en una muestra por conveniencia de 622 sujetos de ambos sexos en 6 supermercados del área urbana de Riobamba durante los meses de septiembre de 2014 a febrero de 2015. Se realizaron contrastes de hipótesis de diferencias de proporciones y regresión logística para determinar la asociación de las actitudes y prácticas con el sexo y edad. Resultados: Respecto a las mujeres, los hombres (OR=1,58; IC95%: 1,13–2,21; p40 años (OR= 1,72; IC95%: 1,22–2,44; p=0,002) tienen más probabilidad de creer que actualmente hay demasiada presión para comer de forma saludable. Igualmente los hombres tienen menos probabilidad de creer que consumen demasiada grasa (OR=0,61; IC95%: 0,43–0,85; p=0,01) respecto a las mujeres. Los participantes de entre 18-40 años frente a >40 años tienen más probabilidad de tratar de reducir al mínimo la cantidad de azúcar (OR=2,41; IC95%: 1,55–3,76; p40 years (OR=1.72; 95%CI:1.22–2.44; p=0.002) are more likely to believe that there is currently too much pressure to eat healthily. Likewise, men are less likely to believe that they consume too much fat (OR=0.61; 95%CI:0.43–0.85; p=0.01) compared to women. Participants aged between 18-40 years are more likely to try to minimize the amount of sugar (OR=2.41; 95%CI:1.55–3.76; p<0.001), sal (OR=2.24; 95%CI:1.50–3.60; p<0.001) and fat consuming (OR=2.17; 95%CI:1.44-3.27; p<0.001) vs. 40 years. Conclusions: The attitudes and practices of the population regarding the ‘traffic light’-style nutritional labeling can vary with respect to age and sex

ADHD subtypes are associated differently with circadian rhythms of motor activity, sleep disturbances, and body mass index in children and adolescents: a case-control study

To date, few studies have examined the circadian pattern of motor activity in children and adolescents newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). The objective was to study the circadian pattern of motor activity in subjects with ADHD (medication naïve) and to investigate the relationships between alterations in circadian patterns, the ADHD subtype (combined or inattentive), sleep disturbances and body mass index (BMI). One-hundred twenty children and adolescents (60 medication naïve ADHD and 60 controls) were included in a gender- and age-matched case-control study. ADHD was diagnosed according to the DSM-IV-TR, the Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, and the Conner's Parents Rating Scale-Revised. Circadian rhythms of motor activity and sleep parameters were measured using actigraphy and the Sleep Disturbance Scale for Children. BMI and dietary intake were also evaluated. ADHD patients showed a trend towards eveningness and greater sleep disturbances than controls. Additionally, patients with ADHD-combined had significantly higher mean values of motor activity and showed a significant delay in bedtime. Furthermore, among ADHD-C patients hyperactivity symptoms were significantly associated with the least 5 h of activity. Regarding patients with ADHD-inattentive, increased fragmentation of the circadian pattern was associated with inattention symptoms, and they also showed a significant increase in BMI of 2.52 kg/m2 [95% CI 0.31, 4.73] in comparison with controls. Our findings highlight the potential use of actigraphy as a clinical tool to aid in the diagnosis of ADHD. It should be noted that evaluating motor activity variables could also allow the differentiation between ADHD subtype</p

Mobility restrictions and mental health among young adults during the COVID-19 pandemic in Ecuador

Objective: To study the association between mobility restriction and mental health outcomes among Ecuadorian young adults. Method: The present is a cross-sectional study that included a non-probabilistic sample of mostly highly educated young adults. Socio-demographic and mental health data were collected through an online survey, between May and June 2020, when confinement was mandatory in Ecuador. Data on mobility was extracted from Google Community Mobility Reports. Four aspects of the participants’ mental health were evaluated: eating behavior (emotional eating), depression, sleep quality and sense of coherence as a proxy of resilience, using previously validated instruments. Data were analyzed using multiple linear regression models in R. Results: Sample included 8426 young adults, with a mean age of 22.85 (standard deviation: 4.43), most of whom were women (n = 5943, 70.53%). During mandatory confinement, in Ecuador mobility in general was reduced by nearly 50% in comparison to January/February, 2020. Less healthy eating behavior, depression, worse sleep quality and lower sense of coherence were associated with higher mobility restriction to workplaces and groceries/pharmacies. Women and youngsters more often showed depression, less healthy eating behavior, worse quality of sleep and lower sense of coherence in comparison with men and older respondents. Conclusions: Mobility restrictions during COVID-19 pandemic were associated with worse self-reported mental health in a sample of young highly-educated Ecuadorian adults. Women and youngsters were the most affected. Our findings highlight the need of implementing health promotion measures directed to ameliorate the effects of confinement on mental health, focusing on women and youngsters

Sobrepeso y obesidad en escolares y adolescentes del área urbana de la ciudad de Riobamba, Ecuador

Introduction: To determine the prevalence of overweight and obesity among school students and adolescents of a urban area of the city of Riobamba.Material and Methods: 3680 students between 5 and 19 years, 1581 school students and 2099 adolescents enrolled in 65 units of basic education and high school were studied. The variables studied were: type of educational establishment, sex, age, weight and height. For the diagnosis of nutritional status, the WHO-2007 reference standards of body mass index for were used. School children and adolescents whose standard deviation was found &lt;–2 were considered thin, between –2 and +1 normal weight, &gt;+1 to +2 overweight and &gt;+2 as obesity. Data were analyzed by the computer programs: Anthro Plus v1.0.4 and SPSS v20.Results: Being overweight affects 24.1% of school/adolescents; overweight, 17.8% and 6.3% obese. Excess weight is statistically higher (p&lt;0.0001) in school (27.7%) than in adolescents (21.5%). Similarly, excess weight is statistically higher (p&lt;0.0001) in children men (31.0%) than in women (24,4%) at school age. And it is statistically higher (p&lt;0.0001) in adolescent females (23.3%) than in adolescent males (19.8%). Being overweight in school/adolescents affects: private schools (27.7%), treasury missionary establishments (25.3%) and fiscal establishments (22.9%). Similarly, excess weight is greater among schoolchildren in private schools (28.1%) than in fiscal establishments, 27.7% (non statistically p = 0.9984). And it is statistically greater (p &lt;0.0001) in adolescents of private establishments (27.6%) than in fiscal establishments (18.4%).Conclusions: The prevalence of weight excess (overweight / obesity) in school students and young urban area of the city of Riobamba is high (24.1%), and is higher in school age (27.7%) than in adolescents (21,5%). An intervention is needed to prevent and treat this serious public health trend. Comments in: http://dx.doi.org/10.14306/renhyd.20.4.210Introducción: Determinar la prevalencia de sobrepeso y obesidad en estudiantes escolares y adolescentes del área Urbana de la ciudad de Riobamba.Material y Métodos: Se estudiaron 3.680 estudiantes entre 5 y 19 años, 1.581 escolares y 2.099 adolescentes matriculados en 65 unidades de educación básica y bachillerato. Las variables estudiadas fueron: tipo de establecimiento educativo, sexo, edad, peso, talla. Para el diagnóstico del estado nutricional se utilizó el Índice de Masa Corporal para edad y se empleó los patrones de referencia de la OMS-2007. Los escolares y adolescentes cuya desviación estándar se encontraron &lt;–2 se consideraron con delgadez, entre –2 y +1 con peso normal, &gt;+1 a +2 con sobrepeso y &gt;+2 con obesidad. Los datos se analizaron en los programas de computación: Anthro Plus v1.0.4 y SPSS v20.Resultados: El exceso de peso afecta al 24,1% de los escolares/adolescentes; sobrepeso, 17,8% y obesidad 6,3%. El exceso de peso es estadísticamente mayor en escolares, 27,7% que en adolescentes, 21,5% (p&lt;0,0001). Igualmente, el exceso de peso es estadísticamente mayor en los escolares hombres, 31,0% que en escolares mujeres, 24,4% (p&lt;0,0001). Y es estadísticamente mayor en adolescentes mujeres, 23,3% que en adolescentes hombres, 19,8% (p&lt;0,0001). El exceso de peso en escolares/adolescentes afecta a: establecimientos particulares, 27,7%, establecimientos fiscomisionales, 25,3% y establecimientos fiscales, 22,9%. Igualmente, el exceso de peso es mayor en escolares de establecimientos particulares, 28,1% que en establecimientos fiscales, 27,7% (p=0,9984). Y es estadísticamente mayor en los adolescentes de establecimientos particulares, 27,6% que en establecimientos fiscales, 18,4% (p&lt;0,0001).Conclusiones: La prevalencia de exceso de peso (sobrepeso/obesidad) en estudiantes escolares y adolescentes del área urbana de la ciudad de Riobamba es alta (24,1%) y es mayor en escolares (27,7%) que en adolescentes (21,5%). Son necesarias medidas de intervención inmediatas para prevenir y tratar este grave problema de Salud Pública. Comentarios en: http://dx.doi.org/10.14306/renhyd.20.4.21

Estado nutricional población pediátrica y funcionalidad familiar en una unidad educativa ecuatoriana

El estado de la funcionalidad de la familia influye en la calidad nutricional de sus miembros. El objetivo del presente estudio fue describir el estado nutricional de población pediátrica y la funcionalidad familiar en una unidad educativa pública en la provincia Cotopaxi, Ecuador, durante 2020. Se desarrolló una investigación descriptiva transversal, en la que participaron 179 familias de alumnos con edades entre 5 y 19 años, cuyos padres o tutores legales aportaron los datos de interés. La población pediátrica estuvo conformada por 91 niños/as de 5 a 9 años y 88 adolescentes de 10 a 19 años. El 54,7% correspondió al sexo femenino. En este contexto predominó el estado nutricional normal en los menores de edad y las familias funcionales (57%). La funcionalidad familiar se asoció significativamente con el grupo etario y el estado nutricional atendiendo a la talla/edad. Sin embargo, esa variable resultó independiente con respecto al estado nutricional según IMC/edad.The state of family functionality influences the nutritional quality of its members. This study aimed to describe the nutritional status of the pediatric population and family functionality in a public educational unit in the Cotopaxi province, Ecuador, during 2020. Cross-sectional descriptive research was developed. The population was constituted by 179 families of students aged between 5 and 19 years old, whose parents or legal guardians provided the data of interest. The pediatric population consisted of 91 children from 5 to 9 years old and 88 adolescents from 10 to 19 years old. 54.7% corresponded to the female sex. In this context, normal nutritional status prevailed in minors and functional families (57%). Family functionality was significantly associated with age group and nutritional status according to height/age. However, this variable was independent with respect to nutritional status according to BMI/age

Sleep quality does not mediate the negative effects of chronodisruption on body composition and metabolic syndrome in healthcare workers in Ecuador

Background and aims: The objective of the present work was to determine to what extent sleep quality may mediate the association between chronodisruption (CD) and metabolic syndrome (MS), and between CD and body composition (BC). Methodology: Cross-sectional study which included 300 adult health workers, 150 of whom were night shift workers and thereby exposed to CD. Diagnosis of MS was made based on Adult Treatment Panel III criteria. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Body mass index (BMI), fat mass percentage, and visceral fat percentage were mea