Tipologías nutricionales en población infantil menor de 5 años de la provincia de Chimborazo, Ecuador

Introduction: the aim of this study was to establish nutritional typologies of children under 5 years of age. Material and methods: Observational study. 6,040 children under 5 years of age (2,955 men and 3,085 women) were studied attending to the operational units of the Dirección Provincial de Salud de Chimborazo during 2013. The variables studied were: geographical area, age, sex, weight, length / size, breastfeeding and supplementation with Iron and Vitamin A. For the diagnosis of nutritional status, anthropometric indicators were used: height for age (H // A) and body mass index for age (BMI // A), the cut-off points that were used for diagnosis of nutritional status were from the WHO-2006. The data was analyzed using the Anthro v1.0.4 and JMP v11 programs. A univariate analysis and then a multivariate analysis per cluster with the method K means were carried out to establish nutritional typologies. Results: The prevalence of delay in height was 36.8% and the prevalence of excess weight was 6.3%. The cluster 3 has the following characteristics; lower H // A, higher BMI // A, lower age, shorter exclusive breastfeeding time, lower weaning age, median prescription of iron and Vitamin A. This cluster represents 54.95% of children. Conclusion: Cluster 3 is the most important for nutritional support and surveillance.Introducción: El objetivo de este estudio fue establecer tipologías nutricionales de niños y niñas menores de 5 años de edad. Material y métodos: Estudio observacional. Se estudiaron 6.040 niños y niñas menores de 5 años (2.955 hombres y 3.085 mujeres) atendidos en las unidades operativas de la Dirección Provincial de Salud de Chimborazo durante el año 2013. Las variables estudiadas fueron: zona geográfica, edad, sexo, peso, longitud/talla, lactancia materna y suplementación con Hierro y Vitamina A. Para el diagnóstico del estado nutricional se utilizó los indicadores antropométricos: talla para edad (T//E) é índice de masa corporal para edad (IMC//E), los puntos de corte que se utilizaron para el diagnóstico del estado nutricional fueron de la OMS-2006. Los datos se analizaron utilizando los programas Anthro v1.0.4 y JMP v11. Se realizó un análisis univariable y luego un análisis multivariable por cluster con el método K means para establecer tipologías nutricionales. Resultados: La prevalencia de retardo en talla fue de 36,8 % y la prevalencia exceso de peso fue de 6.3 %. El cluster (conglomerado) 3 presenta las siguientes características; menor T//E, mayor IMC//E, menor edad, menor tiempo de lactancia exclusiva, menor edad de destete, mediana prescripción de hierro y Vitamina A. Este cluster representa el 54,95 % de los niños y niñas. Conclusión: El cluster 3 es el de mayor importancia para el apoyo y vigilancia nutricional

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

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

Acceso a datos de investigación e información científica en Chile

The following article presents the principal results and analysis from the first study carried out in Chile designed to measure the capacity to manage the research data and scientific information created through public funding. The results are presented according to ten principles and guidelines prepared by the OECD, to guide countries towards taking actions that help bring about standardized management policies and procedures agreed among the different actors involved in their creation.<br><br>En el siguiente artículo se presentan los principales análisis y resultados del primer estudio desarrollado en Chile para medir las capacidades en gestión de datos de investigación e información científica generada con fondos públicos. Los resultados se presentan de acuerdo a diez principios y directrices elaborados por la OCDE, para orientar a los países a tomar medidas que permitan materializar políticas y procedimientos de gestión estandarizados y consensuados entre los distintos actores involucrados en su generación

Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Valor diagnóstico de indicadores antropométricos para sobrepeso y obesidad

La obesidad se define por un exceso de masa grasa, sin embargo, hay otros indicadores antropométricos que pueden ser útiles para el diagnóstico de sobrepeso u obesidad; Objetivo. Determinar la exactitud diagnóstica del índice de masa corporal (IMC), circunferencia de la cintura (CC) e índice de forma corporal (ABSI) para el diagnóstico de sobrepeso u obesidad en una población adulta del Ecuador. Materiales y métodos. Se desarrolló un estudio observacional de corte transversal en el que participaron 253 sujetos con edades entre 20 y 60 años. Se midió peso, estatura, circunferencia de la cintura y porcentaje de grasa corporal (PGC). Se correlacionó el PGC con IMC, CC y ABSI y se estableció la sensibilidad y especificidad de estos indicadores para el diagnóstico de sobrepeso u obesidad con curvas ROC. Resultados. El PGC fue menor en hombres que en mujeres (30,9 vs 41,87), ABSI y CC fue mayor en hombres que en mujeres (0,079 vs 0,075) y (99,76 vs 91,25) respectivamente. Se encontró una correlación positiva fuerte (≥0,75) entre el PGC e IMC y CC. En la curva ROC, el área bajo la curva más alta se observa para el IMC (0,949), mientras que el área más baja se observa para ABSI (0,395). Conclusión. El IMC es el indicador con mayor precisión diagnóstica de sobrepeso u obesidad. ABSI no sería un indicador útil en el diagnóstico de sobrepeso u obesidad.Obesity is defined by an excess of fat mass, however, there are other anthropometric indicators that can be useful for the diagnosis of overweight or obesity; Objetive. To determine the diagnostic accuracy of the body mass index (BMI), waist circumference (WC) and body shape index (ABSI) for the diagnosis of overweight or obesity in an adult population of Ecuador. Materials and methods. An observational cross-sectional study was carried out in which 253 subjects aged between 20 and 60 years participated. Weight, height, waist circumference and percentage body fat (PBF) were measured. The PBF was correlated with BMI, WC and ABSI and the sensitivity and specificity of these indicators were established for the diagnosis of overweight or obesity with ROC curves. Results. The PBF was lower in men than in women (30.09 vs 41.87), ABSI and CC were higher in men than in women (0.079 vs 0.075) and (99.76 vs 91.25) respectively. A strong positive correlation (≥0.75) was found between % body fat and BMI and WC. On the ROC curve, the area under the highest curve is observed for BMI (0.949), while the lowest area is observed for ABSI (0.395). Conclusion. The BMI is the indicator with the highest diagnostic precision of overweight or obesity. ABSI would not be a useful indicator in the diagnosis of overweight or obesity

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 +1 to +2 overweight and >+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+1 a +2 con sobrepeso y >+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<0,0001). Igualmente, el exceso de peso es estadísticamente mayor en los escolares hombres, 31,0% que en escolares mujeres, 24,4% (p<0,0001). Y es estadísticamente mayor en adolescentes mujeres, 23,3% que en adolescentes hombres, 19,8% (p<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<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