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

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

Actitudes y prácticas de la población en relación al etiquetado de tipo “semáforo nutricional” en Ecuador

Introduction: Choosing food is critical to the health of populations. Strategies such as labeling rules in products could help consumers to have clear information on the food they eat. Objectives: To explore the association of sex and age with the attitudes and practices with regard to the ‘traffic light’-style nutritional labeling in Ecuador. Material and Methods: A cross-sectional study was carried out in a convenience sample of 622 subjects of both sexes in 6 supermarkets in the urban area of Riobamba from September 2014 to February 2015. Differences of proportions and logistic regression hypotheses were tested to determine the association of attitudes and practices with sex and age. Results: Men with respect to women (OR=1.58; 95%CI:1.13–2.21; p<0.001) and participants aged 18-40 years with respect to those aged >40 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.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; p<0,001), sal (OR=2,24; IC95%: 1,50–3,60; p<0,001) y grasa (OR=2,17; IC95%: 1,44–3,27; p<0,001) que consumen. Conclusión: Las actitudes y prácticas de la población respecto al semáforo nutricional pueden variar respecto a la edad y el sexo

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

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