Physical activity during recess in elementary schoolchildren in Belgium and Ecuador: The role of the physical environment at school.

To increase physical activity levels in children, knowledge on how school playgrounds can be optimally designed is important. Until now, the contribution of playground variety and greening to children's physical activity level during recess remains unclear. This study examined the associations of school playground variety and greening with energy expenditure (EE) in elementary school children in Ecuador and Belgium. Additionally, moderating effects of study site and gender were studied. Observational data were collected using SOPLAY in ten schools in East Flanders (Belgium) and Cuenca (Ecuador). Data were analysed with linear mixed-effects model analyses. Results showed that independent of study site, EE was higher in playground areas with less green elements, and a higher level of total variety. Primary surface was only associated with EE in boys, they were more active when an artificial surface was present. Implementation of loose equipment was somewhat more strongly positively associated with EE in Ecuadorian than in Belgian children. Because of the well-known restorative effects of green elements, we do not wish to suggest that less greening should be implemented at schools. However, ideally green spaces should be designed in a way that active play is stimulated by combining green elements with other improvements.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial.

BACKGROUND: In Ecuador, adolescents' food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent's inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents. METHODS: A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage. RESULTS: Data from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66 g; 95% CI: -9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one. CONCLUSIONS: The trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale. TRIAL REGISTRATION: ClinicalTrial.gov-NCT01004367 .

Two years of school-based intervention program could improve the physical fitness among Ecuadorian adolescents at health risk: subgroups analysis from a cluster-randomized trial.

BACKGROUND: Adolescents with overweight and poor physical fitness have an increased likelihood of developing cardiovascular diseases during adulthood. In Ecuador, a health promotion program improved the muscular strength and speed-agility, and reduced the decline of the moderate-to-vigorous physical activity of adolescents after 28 months. We performed a sub-group analysis to assess the differential effect of this intervention in overweight and low-fit adolescents. METHODS: We performed a cluster-randomized pair matched trial in schools located in Cuenca-Ecuador. In total 20 schools (clusters) were pair matched, and 1440 adolescents of grade 8 and 9 (mean age of 12.3 and 13.3 years respectively) participated in the trial. For the purposes of the subgroup analysis, the adolescents were classified into groups according to their weight status (body mass index) and aerobic capacity (scores in the 20 m shuttle run and FITNESSGRAM standards) at baseline. Primary outcomes included physical fitness (vertical jump, speed shuttle run) and physical activity (proportion of students achieving over 60 min of moderate-to-vigorous physical activity/day). For these primary outcomes, we stratified analysis by weight (underweight, normal BMI and overweight/obese) and fitness (fit and low fitness) groups. Mixed linear regression models were used to assess the intervention effect. RESULTS: The prevalence of overweight/obesity, underweight and poor physical fitness was 20.3 %, 5.8 % and 84.8 % respectively. A higher intervention effect was observed for speed shuttle run in overweight (ß = -1.85 s, P = 0.04) adolescents compared to underweight (ß = -1.66 s, P = 0.5) or normal weight (ß = -0.35 s, P = 0.6) peers. The intervention effect on vertical jump was higher in adolescents with poor physical fitness (ß = 3.71 cm, P = 0.005) compared to their fit peers (ß = 1.28 cm, P = 0.4). The proportion of students achieving over 60 min of moderate-to-vigorous physical activity/day was not significantly different according to weight or fitness status. CONCLUSION: Comprehensive school-based interventions that aim to improve diet and physical activity could improve speed and strength aspects of physical fitness in low-fit and overweight/obese adolescents. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01004367 . Registered October 28, 2009.

School-based intervention on healthy behaviour among Ecuadorian adolescents: effect of a cluster-randomized controlled trial on screen-time.

BACKGROUND: Effective interventions on screen-time behaviours (television, video games and computer time) are needed to prevent non-communicable diseases in low- and middle-income countries. The present manuscript investigates the effect of a school-based health promotion intervention on screen-time behaviour among 12- to 15-year-old adolescents. We report the effect of the trial on screen-time after two stages of implementation. METHODS: We performed a cluster-randomised pair matched trial in urban schools in Cuenca-Ecuador. Participants were adolescents of grade eight and nine (mean age 12.8 ± 0.8 years, n = 1370, control group n = 684) from 20 schools (control group n = 10). The intervention included an individual and environmental component tailored to the local context and resources. The first intervention stage focused on diet, physical activity and screen-time behaviour, while the second stage focused only on diet and physical activity. Screen-time behaviours, primary outcome, were assessed at baseline, after the first (18 months) and second stage (28 months). Mixed linear models were used to analyse the data. RESULTS: After the first stage (data from n = 1224 adolescents; control group n = 608), the intervention group had a lower increase in TV-time on a week day (ß = -15.7 min; P = 0.003) and weekend day (ß = -18.9 min; P = 0.005), in total screen-time on a weekday (ß = -25.9 min; P = 0.03) and in the proportion of adolescents that did not meet the screen-time recommendation (ß = -4 percentage point; P = 0.01), compared to the control group. After the second stage (data from n = 1078 adolescents; control group n = 531), the TV-time on a weekday (ß = 13.1 min; P = 0.02), and total screen-time on a weekday (ß = 21.4 min; P = 0.03) increased more in adolescents from the intervention group. No adverse effects were reported. DISCUSSION AND CONCLUSION: A multicomponent school-based intervention was only able to mitigate the increase in adolescents' television time and total screen-time after the first stage of the intervention or in other words, when the intervention included specific components or activities that focused on reducing screen-time. After the second stage of the intervention, which only included components and activities related to improve healthy diet and physical activity and not to decrease the screen-time, the adolescents increased their screen-time again. Our findings might imply that reducing screen-time is only possible when the intervention focuses specifically on reducing screen-time. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01004367.

A school-based intervention improves physical fitness in Ecuadorian adolescents: a cluster-randomized controlled trial.

BACKGROUND: Effective lifestyle interventions are needed to prevent noncommunicable diseases in low- and middle-income countries. We analyzed the effects of a school-based health promotion intervention on physical fitness after 28 months and explored if the effect varied with important school characteristics. We also assessed effects on screen time, physical activity and BMI. METHODS AND RESULTS: We performed a cluster-randomized pair matched trial in schools in urban Ecuador. The intervention included an individual and environmental component tailored to the local context and resources. Primary outcomes were physical fitness (EUROFIT battery), screen time (questionnaires) and physical activity (accelerometers). Change in BMI was a secondary outcome. A total of 1440 grade 8 and 9 adolescents (intervention: n = 700, 48.6%) and 20 schools (intervention: n = 10, 50%) participated. Data of 1083 adolescents (intervention: n = 550, 50.8%) from 20 schools were analyzed. CONCLUSIONS: A school-based intervention with an individual and environment component can improve physical fitness and can minimize the decline in physical activity levels from childhood into adolescence in urban Ecuador. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01004367.

Dietary intake practices associated with cardiovascular risk in urban and rural Ecuadorian adolescents: a cross-sectional study.

BACKGROUND: Cardiovascular diseases (CVD) are amongst the leading causes of death worldwide. Risk factors of CVD develop during childhood and adolescence, and dietary quality has been linked to the development of CVD itself. This study examines the association between dietary patterns and cardiovascular risk in a group of urban and rural Ecuadorian adolescents from different socioeconomic backgrounds. METHODS: A cross-sectional study was conducted from January 2008 to April 2009 among 606 adolescents from the 8th, 9th and 10th grade in an urban area (Cuenca), and 173 adolescents from a rural area (Nabón) in Ecuador. Data collection involved measuring anthropometric data (weight, height and waist circumference), blood pressure, dietary intake (2-day 24 h recall) and socio-demographic characteristics. Fasting blood lipids and glucose were measured in a subsample of 334 adolescents. Factor analysis was used to identify dietary patterns and linear regression models were used to (i) identify differences in food intake practices according to socioeconomic status and place of residence and (ii) establish relationships between dietary patterns and cardiovascular risk factors. RESULTS: Median energy intake was 1851 kcal/day. Overall, fiber, fish and fruit and vegetables were scarcely consumed, while added sugar, refined cereals and processed food were important constituents of the diet. Two dietary patterns emerged, one labelled as "rice-rich non-animal fat pattern" and the other one as "wheat-dense animal-fat pattern". The first pattern was correlated with a moderate increase in glucose in urban participants, while the second pattern was associated with higher LDL and cholesterol blood levels in rural participants. CONCLUSIONS: This group of adolescents presented various dietary practices conducive to CVD development. Effective strategies are needed to prevent CVD in the Ecuadorian population by encouraging a balanced diet, which contains less refined cereals, added sugar, and processed food, but has more fruits, vegetables and whole grain cereals.

Physical fitness among urban and rural Ecuadorian adolescents and its association with blood lipids: a cross sectional study.

BACKGROUND: Physical fitness has been proposed as a marker for health during adolescence. Currently, little is known about physical fitness and its association with blood lipid profile in adolescents from low and middle-income countries. The aim of this study is therefore to assess physical fitness among urban and rural adolescents and its associations with blood lipid profile in a middle-income country. METHODS: A cross-sectional study was conducted between January 2008 and April 2009 in 648 Ecuadorian adolescents (52.3% boys), aged 11 to 15 years, attending secondary schools in Cuenca (urban n = 490) and Nabón (rural n = 158). Data collection included anthropometric measures, application of the EUROFIT battery, dietary intake (2-day 24 h recall), socio-demographic characteristics, and blood samples from a subsample (n = 301). The FITNESGRAM standards were used to evaluate fitness. The associations of fitness and residential location with blood lipid profile were assessed by linear and logistic regression after adjusting for confounding factors. RESULTS: The majority (59%) of the adolescents exhibited low levels of aerobic capacity as defined by the FITNESSGRAM standards. Urban adolescents had significantly higher mean scores in five EUROFIT tests (20 m shuttle, speed shuttle run, plate tapping, sit-up and vertical jump) and significantly most favorable improved plasma lipid profile (triglycerides and HDL) as compared to rural adolescents. There was a weak association between blood lipid profile and physical fitness in both urban and rural adolescents, even after adjustment for confounding factors. CONCLUSIONS: Physical fitness, in our sample of Ecuadorian adolescents, was generally poor. Urban adolescents had better physical fitness and blood lipid profiles than rural adolescents. The differences in fitness did not explain those in blood lipid profile between urban and rural adolescents.

Mother's smoking habits affects IL10 methylation but not asthma in Ecuadorian children.

There is no evidence evaluating the IL10 epigenetic upregulation among mestizo children in a high-altitude Andean city in Latin America. OBJECTIVE: To identify polymorphisms and methylation profiles in the IL10 gene associated with asthma in children aged 5 to 11. METHODS: A case-control study was conducted with asthmatic and non-asthmatic children aged 5 to 11 years in Cuenca-Ecuador. Data on allergic diseases and risk factors were collected through a questionnaire for parents. Atopy was measured by skin prick test (SPT) to relevant aeroallergens. Three IL10 single nucleotide polymorphisms were evaluated in all participants, and methylation analysis was performed in 54 participants. Association between risk factors, allergic diseases and genetic factors were estimated using multivariate logistic regression. RESULTS: The results of polymorphisms showed no differences between cases and controls when comparing the SNPs rs3024495, rs3024496, rs1800896 allelic and genotypic frequencies. In the methylation analysis, no differences in the IL10 methylation profile were found between cases and controls; however, the multivariate analysis showed an association between the mother's smoking habits and the IL10 methylation profile. CONCLUSION: Smoking habit could be essential as an environmental exposure factor in regulating gene expression in children with asthma.

Physical Activity Policies at National and Subnational Levels: A Study in Colombia, Costa Rica, Ecuador, and Mexico.

BACKGROUND: National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries. METHODS: The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were assessed using descriptive statistics. RESULTS: Twenty-three (response rate = 85.2%) informants provided data, mainly from the health sector (52.2%), followed by the sport (26.1%), transport (13.0%), and education (8.7%) sectors. Most informants reported that their countries had a current PA policy embedded within noncommunicable diseases prevention plans (46.2%), other plans (46.2%), or obesity prevention/management/control plans (7.7%). Respondents at the subnational level rated PA promotion as central (64.3%), while the national-level role was important but not central (75.0%). National and subnational policymakers indicated low-to-little involvement in the other level's PA policy processes across the 5 policy stages. CONCLUSIONS: This study demonstrated that collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network was feasible. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels.

Predictors of validity and reliability of a physical activity record in adolescents.

BACKGROUND: Poor to moderate validity of self-reported physical activity instruments is commonly observed in young people in low- and middle-income countries. However, the reasons for such low validity have not been examined in detail. We tested the validity of a self-administered daily physical activity record in adolescents and assessed if personal characteristics or the convenience level of reporting physical activity modified the validity estimates. METHODS: The study comprised a total of 302 adolescents from an urban and rural area in Ecuador. Validity was evaluated by comparing the record with accelerometer recordings for seven consecutive days. Test-retest reliability was examined by comparing registrations from two records administered three weeks apart. Time spent on sedentary (SED), low (LPA), moderate (MPA) and vigorous (VPA) intensity physical activity was estimated. Bland Altman plots were used to evaluate measurement agreement. We assessed if age, sex, urban or rural setting, anthropometry and convenience of completing the record explained differences in validity estimates using a linear mixed model. RESULTS: Although the record provided higher estimates for SED and VPA and lower estimates for LPA and MPA compared to the accelerometer, it showed an overall fair measurement agreement for validity. There was modest reliability for assessing physical activity in each intensity level. Validity was associated with adolescents' personal characteristics: sex (SED: P=0.007; LPA: P=0.001; VPA: P=0.009) and setting (LPA: P=0.000; MPA: P=0.047). Reliability was associated with the convenience of completing the physical activity record for LPA (low convenience: P=0.014; high convenience: P=0.045). CONCLUSIONS: The physical activity record provided acceptable estimates for reliability and validity on a group level. Sex and setting were associated with validity estimates, whereas convenience to fill out the record was associated with better reliability estimates for LPA. This tendency of improved reliability estimates for adolescents reporting higher convenience merits further consideration.

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys.

BACKGROUND: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. METHODS: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. RESULTS: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. CONCLUSION: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

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 (ß-4.07 mg/dL; 95% CI: -7.00; -1.15; P = 0.007) but higher levels of LDL cholesterol (ß 8.52 mg/dL; 95% CI: 1.38; 15.66; P = 0.019). Hepatic enzymes were also higher among urban children (SGOT: ß% 22.13; 95% CI: 17.33; 26.93; P < 0.001; SGPT: ß 0.84 U/L; 95% CI: 0.09; 1.59; P = 0.028). Leptin blood levels were higher (ß% 29.27; 95% CI: 3.57; 54.97; P = 0.026), meanwhile adiponectin plasma concentrations were lower among urban children (ß%-103.24; 95% CI: -58.9; -147.58; P = < 0.001). Fiber intake was inversely associated with total cholesterol (ß-9.27 mg/dL; 95% CI -18.09; -0.45; P = 0.040) and LDL cholesterol blood levels (ß-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.

Nature relatedness as a potential factor to promote physical activity and reduce sedentary behavior in Ecuadorian children.

BACKGROUND: Nature relatedness can be associated with health-related outcomes. This study aims to evaluate the associations of nature relatedness with physical activity and sedentary behavior. METHODS: A cross-sectional study involving 9-12 year old children living in Cuenca, Ecuador, was conducted between October 2018 and March 2019. Questionnaires were used to evaluate physical activity (PAQ-C), out-of-school sedentary behavior, nature relatedness and wellbeing. Associations of nature relatedness with physical activity, and sedentary behavior were evaluated using linear regression models or tobit regressions adjusted by age, sex, school type, wellbeing, and body mass index z-score. RESULTS: A total of 1028 children were surveyed (average age:10.4±1.22 years, 52% female.). Nature relatedness was positively associated with physical activity (ß = 0.07; CI 95%: 0.05-0.09; p < 0.001) and non-screen-related sedentary leisure (ß = 3.77 minutes; CI 95%: 0.76-6.68; p < 0.05); it was negatively associated with screen time (ß = -5.59 minutes; CI 95%: -10.53-0.65; p < 0.05). CONCLUSIONS: Findings suggest that nature relatedness is associated with physical activity and some sedentary behaviors among Ecuadorian school-age children. The promotion of nature relatedness has the potential to improve health.

Impact of COVID-19 pandemic on asthma symptoms and management: A prospective analysis of asthmatic children in Ecuador.

BACKGROUND: Asthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. METHODS: We used data from a prospective cohort of 213 children aged 5-17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). RESULTS: During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72-1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14-0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04-0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90-1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10-1.58, P = 0.003). CONCLUSIONS: In a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.

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

[This corrects the article DOI: 10.1371/journal.pone.0234633.].

Viperidae snakebites in Ecuador: A review of epidemiological and ecological aspects.

Snakebite envenoming is a neglected disease of public health concern. Most snakebite accidents occur in developing countries. In Ecuador, 17 viper species are responsible for 99% of official accidents, and ten species are in critical conservation states. This report analyzes the snakebite incident cases and mortality rates in Ecuador between 2014 and 2019. The data obtained from the national surveillance system suggests that the incidence and mortality rates remained constant. The geographic region with the highest incidence rates is the Amazonian region. National policies are urgently needed to prevent snakebite accidents and to protect snakes in danger of extinction.

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.

Food allergy, airborne allergies, and allergic sensitisation among adolescents living in two disparate socioeconomic regions in Ecuador: A cross-sectional study.

BACKGROUND: Allergic diseases are under-investigated and overlooked health conditions in developing countries. We measured the prevalence of food allergy (FA), airborne allergic disease, and allergic sensitisation among adolescents living in 2 socio-demographically disparate regions in Ecuador. We investigated which risk factors are associated with these conditions. METHODS: A cross-sectional study involved 1338 students (mean age: 13 ± 0.9 years old) living in Cuenca (n = 876) and Santa Isabel (n = 462). History of allergic symptoms (noted by parents or doctor) to food, house dust mites (HDM), pollen, and pets were recorded. Sociodemographic characteristics, environmental exposures, and parental history of allergic disorders data were collected. Sensitisation to 19 food and 20 aeroallergens was measured by skin-prick testing (SPT). FA and airborne allergic diseases (to HDM, pollen, cat, or dog) were defined as a report of allergic symptoms noted by doctor, together with a positive SPT (wheal size ≥3 mm). Logistic regression models were used to identify environmental and parental factors associated with allergic conditions. RESULTS: FA was prevalent among 0.4% (95% CI 0.2%-0.9%), and food sensitisation among 19.1% of the adolescents. Shrimp was the most frequent food linked with FA and food sensitisation. Risk factors associated with FA could not be evaluated due to the low prevalence. Food sensitisation was higher among adolescents exposed to family smoking (OR 1.63, 95% CI 1.14-2.34, p = 0.008) and those with parental history of allergic disorders (OR 1.68, 95% CI 1.13-2.49, p = 0.01), but less common among adolescents owning dogs (OR 0.59, 95% CI 0.41-0.84, p = 0.003).Airborne allergic diseases were prevalent amongst 12.0% of the adolescents (95% CI: 10.4-13.9, n = 1321), with HDM as the primary allergen (11.2%). Airborne allergic diseases were less common among adolescents with more siblings (OR 0.79, 95% CI 0.65-0.96, p = 0.02) and those who lived with farm animals in the first year of life (OR 0.47, 95% CI 0.23-0.95, p = 0.04), but, most common among adolescents with a smoking family (OR 1.67, 95% CI 1.04-2.70, p = 0.03) and with a parental history of allergic disorders (OR self-perceived: 2.62, 95% CI 1.46-4.71, p = 0.001; OR diagnosed by a doctor: 4.07, 95% CI 2.44-6.80, p < 0.001). CONCLUSIONS: FA and airborne allergies are less prevalent in Ecuador than in developed regions; there is a great dissociation between the prevalence of allergic disease and allergic sensitisation. Shrimp and HDM were the most prevalent allergens. Risk factors identified in this study to be related to allergic diseases should be considered by physicians, health practitioners, and epidemiologists in Ecuador.

Unhealthy food consumption among Ecuadorian children: A cross-sectional study in the context of the school food regulation / Consumo de alimentos poco saludables en niños ecuatorianos: estudio transversal en el contexto del reglamento de alimentación escolar

Introduction. The intake of energy-dense unhealthy food at school could influence the overall energy intake of children. Objective: To characterize the patterns of buying a snack at school and to analyze the association of these patterns with the source of the school snack (brought from home or bought at school) and screen time. Materials and methods: A cross-sectional study was conducted from October 2018 until May 2019 among school children (9 to 12-year-olds) from Cuenca-Ecuador. Intake of energy-dense unhealthy food groups, the source of the school snack, and screen time were assessed using questionnaires. Multiple correspondence analysis was used to identify intake patterns of unhealthy food groups, and logistic regression to assess the association between intake of energy-dense unhealthy food groups (FG) with the school snack source. Results: Among 1,028 children recruited 63%, 42%, 30% and 22% of the children reported consuming sweets/confiture, savory snacks, fast food, and pastry products, respectively, at least two days per week. Around 39% of the children were classified as "Frequent consumers of energy-dense unhealthy FG". Buying the snack at school was associated with a more frequent intake of sweets/confiture (OR=1.56, CI 95% =1.05-2.32) and fast food (OR=2.01, CI 95% =1.15-3.50) during the week, as well as with being classified in the "frequent consumer of energy-dense unhealthy FG" (OR=1.99, 95% CI=1.40-2.82). Conclusions: Ecuadorian children still consume prohibited unhealthy foods at school. These results reinforce the importance of evaluating, monitoring, and adapting strategies to promote a balanced diet(AU)

Introducción. La ingesta de alimentos poco saludables con alto contenido energético en la escuela podría influir en la ingesta energética total de los niños. Objetivo: Caracterizar los patrones de compra de snacks en el colegio y analizar la asociación de estos patrones con la procedencia del snack escolar (de la casa o comprada en el colegio) y el tiempo de pantalla. Materiales y métodos: Se realizó un estudio transversal (octubre 2018-mayo 2019) en escolares (9-12 años) Cuenca- Ecuador. La ingesta de grupos de alimentos (FG) no saludables altos en energía, la fuente del snack escolar y el tiempo de pantalla se evaluaron mediante cuestionarios. Se utilizó análisis de correspondencias múltiples para identificar patrones de ingesta de FG poco saludables y la regresión logística para evaluar asociación entre la ingesta FG no saludables con la fuente del snack escolar. Resultados: En 1.028 niños 63%, 42%, 30% y 22% declararon consumir dulces/golosinas, aperitivos salados, comida rápida y productos de pastelería, respectivamente, al menos dos/días/ semana. Un 39% fueron clasificados como "Consumidores frecuentes de FG poco saludables de alta densidad energética". La compra de los snacks en el colegio se asoció con una ingesta más frecuente de dulces/golosinas (OR=1,56; IC95%=1,05-2,32) y comida rápida (OR=2,01; IC95%=1,15-3,50) durante la semana y con la clasificación en el grupo" consumidores frecuentes de FG poco saludables de alta densidad energética" (OR=1,99; IC95%=1,40- 2,82). Conclusiones: Los niños ecuatorianos aún consumen alimentos no saludables prohibidos en la escuela. Estos resultados refuerzan la importancia de evaluar, monitorear y adaptar estrategias para promover una dieta balanceada(AU)