Comportamento alimentar durante o confinamento por COVID-19 (CoV-Eat Project): protocolo de um estudo transversal em países de língua espanhola

In December 2019, cases of pneumonia of unknown etiology emerged, which were later classified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On March 11st, the pandemic by COVID-19 disease was declared, and since then it has been used transmission containment measures such as social distancing and confinement, measures with known effects as stressors that can influence eating behavior. Therefore, the aim of this research protocol is to identify eating behavior through dietary restriction, emotional feeding, and uncontrolled intake and to explore the factors associated with these adult behaviors during the COVID-19 pandemic in Spanish-speaking countries.En diciembre de 2019 surgieron casos de neumonía de etiología desconocida, que más tarde fueron clasificados como coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2). El 11 de marzo se declaró la pandemia por la enfermedad respiratoria coronavirus disease 2019 (COVID-19), por lo que se recurrió a medidas de contención de la transmisión, como el distanciamiento social y confinamiento, medidas con conocidos efectos estresores que pueden influir en la conducta alimentaria. Por ello, el objetivo de esta investigación es identificar la conducta alimentaria a través de la restricción dietética, alimentación emocional e ingesta incontrolada, y explorar los factores asociados con estas conductas en adultos durante el confinamiento por COVID-19 en países hispanohablantes.Em dezembro de 2019 surgiram casos de pneumonia de etiologia desconhecida, posteriormente classificados como coronavírus de síndrome respiratória aguda grave do tipo 2 (SARS-CoV-2). No dia 11 de março, foi declarada a pandemia pela doença respiratória coronavirus disease 2019 (COVID-19), por isto foram utilizadas medidas de contenção da transmissão, como o distanciamento social e o confinamento, medidas com conhecidos efeitos estressantes que podem influenciar o comportamento alimentar. Portanto, o objetivo desta pesquisa é identificar o comportamento alimentar por meio da restrição dietética, a alimentação emocional e a ingestão descontrolada, e explorar os fatores associados a esses comportamentos em adultos durante o confinamento por COVID-19 em países de língua espanhola

Muestreo aleatorio de base espacial y su utilidad en la investigación epidemiológica

The correct application of the sampling process techniques has become indispensable for research in the field of epidemiology, the challenge of every researcher, is that the results of a few can be extrapolated to a population. This article is a non-systematic review, which provides information on the application of a random sampling method associated with a geographical location, for the study of “Reference Values of Grip Force in adults of the department of Cochabamba-Bolivia”. First, the introduction reviews the importance of estimating reference population parameters, based on descriptive questions. Next, the characteristics of the epidemiological research associated with spatiality are mentioned, in third place, the methodology and the experiences that the application of sampling in the project entails. Finally, an emphasis is placed on the need and relevance of the use of this methodology.La correcta aplicación de las técnicas del proceso de muestreo se ha hecho indispensable para la investigación en el campo de la epidemiologia, el desafío de todo investigador, es que los resultados de unos cuantos, puedan ser extrapolables para una población. El presente artículo, es una revisión no sistemática, que proporciona información sobre la aplicación de un método de muestreo aleatorio asociado con una ubicación geográfica, para el estudio de “Valores de Referencia de la Fuerza de Agarre en adultos del departamento de Cochabamba-Bolivia”. Primeramente, en la introducción se revisa la importancia de estimación de parámetros poblaciones de referencia, a partir de preguntas descriptivas. Seguidamente se menciona las características de la investigación epidemiológica asociada a la espacialidad; en tercer lugar, se detalla la metodología y las experiencias que conllevo la aplicación del muestreo en el proyecto. Finalmente se hace un hincapié en la necesidad y relevancia del uso de esta metodología

Caracterización del perfil epidemiológico del síndrome metabólico y factores de riesgo asociados. Cochabamba, Bolivia

Objective: to characterize the epidemiological profile of Metabolic Syndrome and risk factors associated in the general population over 18 years of age in Cercado-Cochabamba city, from Bolivia, during the second semester of 2016. Methods: an observational, analytical, cross-sectional study was conducted in the general population of 18 years of age or older, with a sample of n = 186 subjects adjusted by age group and sex based on the population pyramid of Cochabamba-Bolivia. WHO-STEPS approach was applied for the collection of information focused on sociodemographic data, life habits, physical and laboratory evaluation. Proportions and 95% confidence intervals were calculated as established in the STEP´ implementation manual, and multivariate logistic regression was calculated to obtain adjusted OR for the level of risk associated with Metabolic Syndrome. Results: the overall prevalence of metabolic syndrome was 44.1%; the prevalence of risk factors associated were: STEP-1, Smoking 11.29%; current alcohol consumption 63.44%; low consumption of fruits and vegetables 76.88%; sedentary lifestyle or low level of physical activity 75.81%. STEP-2: overweight 44.62%; obesity 24.73%; abdominal obesity 38.7% and high blood pressure 35.14%. STEP3: Hyperglycemia in 36.02%; basal insulin elevated 36.56%; total cholesterol 36.02%; Triglycerides elevated 46.77% and HDL-cholesterol reduced in 66.67%. Conclusion: metabolic syndrome is highly prevalent in the general population in Cochabamba City and is associated with high levels of BMI, high blood pressure high values of the laboratorial profile.Objetivo: caracterizar el perfil epidemiológico del Síndrome Metabólico y sus factores de riesgo asociados en población general mayor ,18 años en la ciudad de Cochabamba, Bolivia, durante la gestión II-2016. Métodos: se realizó un estudio observacional, analítico de corte transversal, en población general de 18 o más años, con una muestra de n=186 sujetos ajustados por grupo etario y sexo en base a la pirámide poblacional de Cochabamba-Bolivia. Se aplicó la metodología STEPS (pasos) de la OPS/OMS para la recolección de la información centrada en datos sociodemográficos, hábitos de vida, evaluación física y laboratorial. Se calcularon proporciones e intervalos de confianza al 95% conforme lo establecido en el manual de implementación de la metodología STEP; y regresión logística multivariada para la obtención del OR ajustado para el nivel de riesgo asociados al Síndrome Metabólico. Resultados: la prevalencia global de Síndrome metabólico fue de 44,1%; la prevalencia de sus factores de riesgo asociados fue: STEP-1, Tabaquismo 11,29%; consumo actual de alcohol 63,44%; bajo consumo de frutas y vegetales 76,88%; sedentarismo o bajo nivel de actividad física 75,81%. STEP-2: sobrepeso 44,62%; obesidad 24,73%; obesidad abdominal 38,7% y presión arterial elevada en 35,14%. STEP3: Glicemia alterada en ayunas 36,02%; Insulina basal alterada 36,56%; colesterol total elevado 36,02%; Triglicéridos elevados 46,77% y HDL-colesterol reducido en el 66,67%. Los niveles de OR ajustado fueron >1 y estadísticamente significativas para las medidas físicas y laboratoriales. Conclusión: el síndrome metabólico en altamente prevalente en la población general de la ciudad de Cochabamba y se asocia a niveles elevados de IMC, presión arterial elevada y perfil laboratorial alterado

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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<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<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. Funding: National Institute for Health and Care Research