Thyroid abnormalities in patients with Hodgkin lymphoma: The importance of close surveillance.

INTRODUCTION: Survival in paediatric patients with Hodgkin lymphoma (HL) has increased over the last decades. However, these patients are at increased risk of developing late thyroid sequelae due to the treatment with irradiation and alkylating agents. METHODS: We conducted an observational and retrospective study in patients with a diagnosis of HL between 2007 and 2022, in a hospital that is a paediatric oncology reference centre, through the review of electronic health records. We collected data on demographic (age, sex), clinical, radiological and histopathological variables, the dosage of alkylating agents and radiotherapy (RT) and on thyroid disorders using Microsoft Excel. The data analysis was conducted with SPSS version 17, using the Fisher exact test for qualitative data, a nonparametric test for quantitative data and Kaplan-Meier curves. RESULTS: Sixty patients received a diagnosis of HL from 2007 to 2022. The median duration of follow-up was 78.5 months. There were 4 detected cases of hypothyroidism, 5 of thyroid nodules and 1 of subclinical hyperthyroidism. Treatment with RT was significantly associated with the development of hypothyroidism (P= .026), thyroid nodules (P= .01) and thyroid disease overall (P= .003). We estimated that the risk of thyroid disease increased 8-fold with each additional Grey received (hazard ratio, 1.081; 95% CI, 1.014-1.152; P= .017). CONCLUSION: Hodgkin lymphoma patients treated with RT are at increased risk of late thyroid disorders, mainly hypothyroidism and malignancy. This risk is greater the higher the RT dosage and the longer the follow-up. We did not find evidence of an association between the use of alkylating agents and an increase in the risk of thyroid disease.

Unveiling the intersection: exploring obstetric violence in the Era of COVID-19 in Ecuador.

INTRODUCTION: Changes to healthcare delivery organization that have occurred to protect people from the virus COVID-19 may have led to harmful consequences to pregnant women intensifying obstetric violence. Prevalence of obstetric violence in Ecuador is high with a range between 30 and 70% approximately. METHODS: This cross-sectional study was performed with the participation of 1298 women who answered EPREVO questionnaire from June 2021 to January 2022. Obstetrics characteristics' relationship before and during COVID-19 were examined using Fisher exact test. RESULTS: From 1598 respondents, 1284 (80.4%) gave birth before March 2020 Most of the participants (73.6%; CI:73.59-73.61) experienced obstetric violence during childbirth. Vaginal examination, enemas and genital shaving, episiotomy and cesarean section decreased significantly as well as rooming with the baby during the pandemic. Half of the women did not breastfeed the baby in the first hour but there were not statistically significant differences between giving birth before or during the infection from COVID-19. CONCLUSIONS: Levels of obstetric violence in Ecuador remains high but without major differences due to the COVID-19 pandemic, however some harmful medical practices considered as obstetric violence decreased but maybe to the fear to be infected by the virus.

Uso de la Teleterapia para el Tratamiento de los Trastornos de Ansiedad, TOC y TEPT, Durante la Pandemia por COVID-19 en España / Use of Teletherapy for the Treatment of Anxiety Disorders, OCD and PTSD, During the COVID-19 Pandemic in Spain

La proporción de teletratamiento llevada a cabo por psicólogos durante la pandemia por COVID-19 para el TAG, fobia específica, agorafobia, ansiedad social, pánico, TOC y TEPT, así como si la experiencia en teleterapia tiene un efecto significativo en la demanda no han sido estudiadas. Los resultados indican que el TAG con un 69.2%, es el trastorno que más teletratamiento ha recibido y la fobia con un 60.5%, el que menos. El pánico, la ansiedad social, TEPT, TOC y agorafobia tuvieron una demanda media del 67.2%, 66.8%, 64.0%, 63.5% y 62.2%, respectivamente. La experiencia en teleterapia resultó significativa. El teletratamiento para psicólogos con experiencia aumentó una media del 93.9% respecto al 35.7% de aquellos sin experiencia. Un 22.8% de psicólogos no realizó teletramiento de la ansiedad. Estos resultados puede ser útiles para desarrollar programas específicos de prevención e intervención telemática para los trastornos de ansiedad ante futuras pandemias por coronavirus.

The distribution of teletreatment carried out by psychologists during the COVID-19 pandemic for GAD, specific phobia, agoraphobia, social anxiety, panic, OCD and PTSD, and whether experience in teletherapy has an significant effect on demand have not been studied. The results indicate that GAD with 69.2% has been the disorder that has received the most teletherapy and phobia with 60.5%, the least. Panic, social anxiety, PTSD, OCD, and agoraphobia had a demand of 67.2%, 66.8%, 64.0%, 63.5%, and 62.2%, respectively. The experience in teletherapy was significant. Tele-treatment for experienced psychologists increased an average of 93.9% compared to 35.7% for those without experience. 22.8% of psychologists did not carry out anxiety teletherapy. These results may be useful to develop specific prevention and telematic intervention programs for anxiety disorders in the face of future coronavirus pandemics

Effect of different soil amendments on soil buffering capacity.

The buffering capacity of the soil is a very important property of the soil, which determines the ability of the soil to resist external influences, especially changes in pH and thus create good living conditions for plants and microorganisms in the soil. The buffering capacity thus significantly contributes to maintaining the health and quality of the soil. Buffering capacity is an important indicator of soil quality, because it is related to the overall condition of the soil ecosystem and other soil properties. The goal of this paper is to determine the effect of applying different soil amendments on the soils, 10 years after application. We compared the effect of 6 different treatments in closed plots: Natural conditions (N = control); Bare soil (B); Straw mulching (S); Pine mulch (P); TerraCottem hydroabsorbent polymers (H); Prescribed burn (F); and Sewage sludge (M). Our results have shown that the application of different amedments leads to an effect on the plowing capacity of the soil. While in the case of the control variant (Natural conditions, N) the buffering capacity of the soil was measured at 144.93 ± 0.25, the addition of different amendments decreased the buffering capacity in the following order: Bare soil (B) 142.73±0.21 > TerraCotem hydroaborbent polymer (H) 142.23±.15 > Pine mulch (P) 140.40±0.30, Prescribed burn (F) 138.20±0.30, Sludge (S) 127.47±0.15. In the case of all variants, these are statistically significant differences (p ≤ 0.05). Thus, soil amendments have been shown to have a statistically significant effect on soil buffering capacity.

Felicidad y Salud: evidencias científicas. Revisión bibliográfica / Happiness and Health: scientific evidence. Bibliographic review

OBJETIVO: Comprobar la relación entre felicidad y salud. Material y MÉTODOS: Se encontraron un total de 863 artículos que fueron seleccionados inicialmente. Se procedió a la revisión de los resúmenes de esta selección y se verificó el tema de búsqueda y la duplicación de artículos. Se seleccionaron inicialmente 37 artículos y de estos se excluyeron 18 por no cumplir los criterios de inclusión o porque no se pudo obtener acceso al texto completo. Finalmente se incluyeron en la investigación 19 artículos para ser revisados a profundidad. RESULTADOS:19 artículos seleccionados. CONCLUSIONES: podemos señalar que mayores niveles de bienestar y felicidad influyen de forma positiva en la salud de las personas, disminuyendo el riesgo cardiovascular, los estados inflamatorios, incluso retrasando el envejecimiento celular. Investigaciones posteriores deberán profundizar en su análisis a fin de solventar algunas limitaciones presentes en los artículos revisados

OBJECTIVE: To check the relationship between happiness and health. MATERIAL AND METHODS: A total of 863 articles were found that were initially selected. The abstracts of this selection were reviewed and the search topic and duplication of articles were verified. 37 articles were initially selected and 18 of these were excluded because they did not meet the inclusion criteria or because the full text could not be accessed. Finally, 19 articles were included in the investigation to be reviewed in depth. RESULTS:19 selected articles. CONCLUSIONS: We can point out that higher levels of well-being and happiness positively influence people's health, decreasing cardiovascular risk, inflammatory states, even delaying cellular aging. Subsequent investigations should deepen their analysis in order to overcome some limitations present in the articles reviewed

Internal Consistency of Yesavage Geriatric Depression Scale (GDS 15-Item Version) in Ecuadorian Older Adults.

The present study aimed to assess the validity of a Spanish version of the Geriatric Depression-15 Scale (GDS-15) in Ecuadorian adults. Cross-sectional study to validate GDS-15 in its short version (GDS-15). Internal consistency and factor structure were assessed through Kuder Richardson 20 and Confirmatory Factor Analysis. A total of 211 subjects 65 years of age and older participated in the validation process. Internal consistency was adequate, the Kuder Richardson 20 coefficient for the total scale was 0.73. Three factor structure was found for the scale. This study highlights the importance of having a validated scale for screening depression in the elderly. This study provides an evidence for the use of GDS-15 in Ecuadorian elderly population to screen for depression.

Validity of the Fitzpatrick Skin Phototype Classification in Ecuador.

BACKGROUND: The Fitzpatrick Skin Phototype Classification (FSPC) is the most common tool used to assess skin phototype in White populations according to the amount of pigment the skin has and its reaction to sun exposure. Scientific evidence about the use of this scale for persons with darker skin is limited. OBJECTIVE: To assess the internal consistency, reliability, and construct validity of the FSPC for Ecuadorians. METHODS: This observational cross-sectional study recruited participants of both sexes between 40 and 90 years of age living in a rural area of Quito, Ecuador. Cronbach α values were used to assess the internal consistency of the scale. Construct validity was assessed with confirmatory factor analysis. RESULTS: The internal consistency coefficients indicated that the reliability of the responses to the scale was fair. Total α value was .515, whereas the α values of the two factors were .42 and .67. Most item-to-factor correlations had a low to moderate magnitude, ranging from r = 0.30 to 0.37. Confirmatory factor analysis supported a two-factor solution and achieved good overall fit as indicated by root mean square error of approximation = 0.08, and nonnormed fit index = 0.88 was mediocre. Goodness-of-fit χ = 177.10, P < .001. The factor loads were greater than 0.30, ranging from 0.30 to 0.99. CONCLUSIONS: The FSPC showed an acceptable construct validity and a fair internal consistency. The five-item scale could potentially be used as an effective instrument for assessing skin phototype in non-White people.

Current status of Bayesian clinical trials for oncology, 2020.

Bayesian methods had established a foothold in developing therapies in oncology trials. METHODS: We identified clinical trials posted on the ClinicalTrials.gov database focused on Oncology trials with a Bayesian approach in their design. Differences in study characteristics such as design, study phase, randomization, masking, purpose of study, main outcomes, gender, age and funding involvement according to Bayesian approach were assessed using Chi-squared or Fisher's exact tests. RESULTS: We identified 225 studies with Bayesian components in their design addressing oncological diseases. The most common designs were Bayesian Toxicity Monitoring (26.4%), Model-based designs (36%) Model-assisted designs (8%). Statistical methods such as Bayesian logistic regression model (59.4%), Bayesian piecewise exponential survival regression (10.9%) and the Continual reassessment method (9.4%) were the most used. CONCLUSIONS: Bayesian trials are more common in the early phases of drug development specifically in phase II trials (43.6%). Cancer institutes or Hospitals funded most of the studies retrieved. This type of design has increased over time and represent an innovative means of increasing trial efficiency.

Actinic keratoses in subjects from la Mitad del Mundo, Ecuador.

BACKGROUND: Quito, the capital of Ecuador due to its geographical location, has a high skin cancer incidence. Actinic keratoses, as premalignant lesions, are precursors of nonmelanoma skin cancer, and the prevalence of this medical condition in the country is unknown. METHODS: An observational, cross-sectional study was performed to assess the prevalence of actinic keratoses (AKs) in a rural area of Quito. Visual skin exams, dermoscopy and biopsy of suspicious lesions were performed. RESULTS: A total of 254 subjects older than 40 years old (71.3% female) were enrolled. The general AK prevalence was 22.4%; in women, the prevalence was 23.6%, while in men, it was 19.4%. The prevalence rates of basocellular and squamous cell carcinomas and Bowen disease were 1.6, 0.8 and 0.4%, respectively. No statistical associations were found between AKs and the studied variables. CONCLUSIONS: This study was the first reporting the prevalence of premalignant lesions in Ecuador. We could not demonstrate a relationship between the presence of AKs and any of the known risk factors for their development.

El método madre canguro y el niño prematuro / Kangaroo mother care and the pre-term child

OBJETIVO: analizar los beneficios del método madre canguro (MMC) y el estado actual en que se encuentra implantado en España. MÉTODO: revisión narrativa. Se realizaron búsquedas bibliográficas en Pubmed, Dialnet y Scielo; usando los términos "método madre-canguro" y "prematuro" y sus sinónimos. La búsqueda se limitó a los últimos 10 años, idiomas inglés y español. Se complementó con búsqueda secundaria a partir de la bibliografía de interés de artículos seleccionados previamente y se complementó con algunos libros y documentos especializados en la materia de organismos relevantes como la Organización Mundial de la Salud (OMS), el Ministerio de Sanidad y Política Social, la Asociación Española de Pediatría (AEP) y la web internacional de European Fundation for the Care of Newborn Infants (EFCNI). RESULTADOS: se seleccionaron en total 18 documentos: tres metanálisis, cuatro revisiones sistemáticas, dos estudios cuasiexperimentales, dos estudios de cohortes, un estudio transversal, cinco revisiones narrativas y un artículo especial. Se complementaron con tres libros y dos monografías. En la revisión se destacan los beneficios de la aplicación del método madre canguro sobre el desarrollo de los prematuros y el vínculo con sus padres. No se mencionan eventos adversos. El conocimiento sobre los beneficios a largo plazo en el ámbito del desarrollo cognitivo y emocional es escaso. La implementación del MMC en las unidades neonatales españolas es heterogéno, siendo inexistente en algunos centros. CONCLUSIONES: la utilización del MMC en las unidades neonatales ha demostrado ser eficaz en muchos aspectos relacionados con el correcto desarrollo de los prematuros. Es necesaria más investigación para determinar sus beneficios a largo plazo en relación al desarrollo cognitivo y emocional. Es fundamental desarrollar protocolos para implementar el MMC en España

OBJECTIVE: to analyze the benefits of Kangaroo Mother Care (KMC) and its current status of implementation in Spain. METHOD: a narrative review. A bibliographic search was conducted in Pubmed, Dialnet and Scielo, using the terms Kangaroo Mother Care ("método madre-canguro") and pre-term ("prematuro") and their synonyms. The search was limited to the last 10 years, in English and Spanish. This was complemented with a secondary search based on the bibliography of interest of previously selected articles, as well as with some books and documents specialized in the matter, by relevant agencies such as the World Health Organization (WHO), the Ministry of Health and Social Policy, the Spanish Association of Pediatrics (AEP), and the international website for the European Foundation for the Care of Newborn Infants (EFCNI). RESULTS: in total, 18 (eighteen) documents were selected: three meta-analyses, four systematic reviews, two quasi-experimental studies, two cohort studies, one cross-sectional study, five narrative reviews and two monographs. The review highlights the benefits of the application of Kangaroo Mother Care on the development of pre-term babies and their bond with parents. No adverse events were mentioned. There is limited knowledge about the long-term benefits at the level of cognitive and emotional development. The implementation of KMC in Spanish newborn units is heterogeneous and non-existent in some centers. CONCLUSIONS: the use of KMC in newborn units has demonstrated efficacy in many aspects associated with the adequate development of newborn babies. More research is required in order to determine its long-term benefits in terms of cognitive and emotional development. It is essential to create protocols for the implementation of KMC in Spain

The relationship between conformity to male and female gender norms and depression during pregnancy.

To analyze whether there is an association between conformity to male and female gender norms and the Edinburgh Postnatal Depression Scale (EPDS) score as an indicator of depression during pregnancy, a cross-sectional study was made to a sample of 200 pregnant women being seen at any of the public primary care centers in Segovia (Spain) for the prenatal care. A score of 13 points or higher on the Spanish version of the EPDS is considered to be an indicator of antenatal depression. The Conformity to Feminine Norms Inventory (CFNI-84) and the Conformity to Masculine Norms Inventory (CMNI-94) were used to determine the degree of conformity to gender norms. Descriptive and inferential statistics, as well as multivariate analysis, were carried out. Logistic regression analysis showed the Nice in Relationships Subscale score to be associated with a decreased risk of depression (OR = 0.88; 95%CI 0.79-0.98; p = 0.029). In addition, the CMNI total score, as well as the Self-Reliance subscale, were associated with an increased risk of depression (OR = 1.04; 95%CI 1.01-1.07; p = 0.022; OR = 1.30; 95%CI 1.08-1.55; p = 0.004, respectively). An association between conformity to male gender norms and nonconformity to some female gender norms in pregnant women and a score on the EPDS indicating depression during pregnancy was found. Particularly, an increase in the CMNI total score was associated to increased risk of suffering depression in the pregnant women studied.

Factores asociados al nivel de ansiedad y de conocimientos sobre puericultura y lactancia de embarazadas primerizas / Factors associated with the anxiety level and knowledge about childcare and lactation in first-time pregnant women

Objetivo: Conocer el nivel de ansiedad y conocimientos de puericultura y lactancia de las embarazadas primerizas actuales, y las variables clínico-demográficas con las que se relacionan. Diseño: Estudio transversal. Emplazamiento: Siete centros de salud del Área V (Asturias). Participantes: Embarazadas primerizas que completaron cursos preparto del 01.06.2015 al 31.10.2015, excluyendo gestación múltiple, embarazo de riesgo, lactancia materna (LM) contraindicada y problemas lingüísticos. Intervenciones: Cuestionario de variables sociodemográficas, cuestionario ansiedad STAI y 23 preguntas sobre puericultura y lactancia. Mediciones principales: Realizamos análisis descriptivo y coeficientes de regresión lineal múltiple (programa R). Resultados; Captamos 104 embarazadas, con una edad media de 34,2(DE: 4,5) años; el 94,2% eran españolas, el 61,5% universitarias, el 17,3% fumadoras en el embarazo, y el 23,1% tenía antecedentes psicopatológicos. El 88,4% planeaba dar LM. El STAI estado (STAI-E) medio fue de 18,1(DE: 7,4) y puntuaron 4,5(DE: 2,3) errores de media. Las preguntas más falladas versaban sobre causas de fiebre (56,7%), medición de fiebre (54,8%) y deposiciones fisiológicas (55,7%). El análisis multivariante entre conocimientos y perfil mostró asociaciones estadísticamente significativas con ser extranjera, universitaria, con planificación del embarazo y con la matrona. En relación con el STAI-E, este fue significativo para ser fumadora, haber recibido LM, antecedentes psicopatológicos y matrona. Conclusiones: Las embarazadas actuales que completan cursos preparto son principalmente maduras, universitarias y españolas. Poseen buenos conceptos sobre lactancia pero muchas desconocen conceptos básicos de fiebre y deposiciones del lactante. Las madres extranjeras, con embarazo no deseado y estudios primarios parecen tener conceptos más confusos. Las madres fumadoras, con antecedentes psicopatológicos y que no han recibido LM presentan más ansiedad. La matrona influye significativamente sobre la ansiedad y los conceptos adquiridos

Objective: To know the level of anxiety and knowledge of childcare and lactation of the current pregnant women, and the clinical-demographic variables with which they are related. Design: Cross-sectional study. Setting:Seven health centers of Area V (Asturias). Participants: First-time pregnant women who completed preparatory courses from 01.06.2015 to 31.10.2015, excluding multiple gestation, risk pregnancy, contraindicated breastfeeding and language problems. Interventions: Sociodemographic variables questionnaire, STAI state anxiety questionnaire and 23 questions about childcare and lactation. Main measurements: We performed descriptive and multivariate analysis (program R) of the variables of the questionnaire. Results: We captured 104 pregnant women; average age 34.2(SD: 4.5), 94.2% Spanish, 61.5% university, 17.3% smokers in pregnancy, 23.1% with psychopathological antecedents; 88.4% planned to give breastfeeding. The mean STAI-S was 18.1(SD: 7.4) and scored 4.5(SD: 2.3) mean errors. The most faulty ones were on causes of fever (56.7%), fever measurement (54.8%) and physiological stools (55.7%). The multivariate analysis between knowledge and profile showed statistically significant associations with: being foreign, university, pregnancy planning and matron. In relation to the STAI-S was significant for being a smoker, receiving breastfeeding, psychopathological antecedents and matron. Conclusions: The current pregnant women who complete preparatory courses are mainly mature, university and Spanish. They have good concepts about breastfeeding but many are unaware of basic concepts of fever and stool of the infant. Foreign mothers with unwanted pregnancy and primary education seem to have more confusing concepts. Smoking mothers with psychopathological antecedents and who have not received breastfeeding present more anxiety. The matron significantly influences anxiety and acquired concepts

[Factors associated with the anxiety level and knowledge about childcare and lactation in first-time pregnant women]. / Factores asociados al nivel de ansiedad y de conocimientos sobre puericultura y lactancia de embarazadas primerizas.

OBJECTIVE: To know the level of anxiety and knowledge of childcare and lactation of the current pregnant women, and the clinical-demographic variables with which they are related. DESIGN: Cross-sectional study. SETTING: Seven health centers of Area V (Asturias). PARTICIPANTS: First-time pregnant women who completed preparatory courses from 01.06.2015 to 31.10.2015, excluding multiple gestation, risk pregnancy, contraindicated breastfeeding and language problems. INTERVENTIONS: Sociodemographic variables questionnaire, STAI state anxiety questionnaire and 23 questions about childcare and lactation. MAIN MEASUREMENTS: We performed descriptive and multivariate analysis (program R) of the variables of the questionnaire. RESULTS: We captured 104 pregnant women; average age 34.2(SD: 4.5), 94.2% Spanish, 61.5% university, 17.3% smokers in pregnancy, 23.1% with psychopathological antecedents; 88.4% planned to give breastfeeding. The mean STAI-S was 18.1(SD: 7.4) and scored 4.5(SD: 2.3) mean errors. The most faulty ones were on causes of fever (56.7%), fever measurement (54.8%) and physiological stools (55.7%). The multivariate analysis between knowledge and profile showed statistically significant associations with: being foreign, university, pregnancy planning and matron. In relation to the STAI-S was significant for being a smoker, receiving breastfeeding, psychopathological antecedents and matron. CONCLUSIONS: The current pregnant women who complete preparatory courses are mainly mature, university and Spanish. They have good concepts about breastfeeding but many are unaware of basic concepts of fever and stool of the infant. Foreign mothers with unwanted pregnancy and primary education seem to have more confusing concepts. Smoking mothers with psychopathological antecedents and who have not received breastfeeding present more anxiety. The matron significantly influences anxiety and acquired concepts.

Prescribed fire impacts on soil properties, overland flow and sediment transport in a Mediterranean forest: A 5 year study.

Prescribed fire is a common management practice in Mediterranean region to reduce the amount of fuel and to decrease the wildfire risk. The objective of this study is to assess the effect of a prescribed fire on some soil properties, hydrological response and vegetation recovery in experimental plots 5 years after. The results showed that: i) with the exception of electrical conductivity, the prescribed fire did not affect the analyzed soil properties, and ii) overland flow and sediment transport were increased during the first two years, returning to levels pre-fire, 5 years post-fire. The rainfall threshold for overland flow generation was lower during the following months after the prescribed fire owing to the depletion of the vegetation cover. Immediately after the fire, the vegetation cover was of 1.9%, being the three main soil surface components that dominated the hydrological response: charcoal and decayed wood; blackish and greyish ash, and bare soil. However, these areas decreased very rapidly during the second year following the fire, principally, owing to the regrowth of herbaceous plants and shrubs. In addition, the vegetation cover in burned plots was 16.1% higher than that measured in the unburned ones. Overall, the prescribed fire only had an impact on runoff and sediment transport in the two years post-fire, as consequence of vegetation removal.

Epidemiological characteristics of a Zika outbreak in Portoviejo, Ecuador, 2016

[ABSTRACT]. Objective. To estimate the number and percentage of cases with Zika diagnosis at a hospital in Portoviejo, Manabí, Ecuador. Methods. This was a hospital-based, retrospective, observational, descriptive, cross-sectional study conducted at the Dr. Verdi Cevallos Balda Hospital from January – August 2016. A secondary analysis of a database was performed to estimate the number and percentage of patients positive for Zika virus, by sex, age group, ethnicity, and type of medical care. Prevalence and odds ratios with 95% Confidence Intervals were calculated using the Mantel and Haenszel method. Laboratory diagnostics included assays for the detection of Zika, chikungunya, dengue, and others. Results. In all, 467 suspected cases of Zika were identified based on clinical criteria. Of these, 148 cases (31.7%) were confirmed by detection of ZIKV RNA. The peak of the outbreak was documented in May – July 2016 during the rainy season, following the earthquake of April 2016. The adjusted odds ratios indicated that Zika virus was less likely in men and in subjects < 20 years of age. Most of the infected pregnant women (61%) were in the second trimester of pregnancy. No cases of microcephaly were reported. Conclusions. Because Zika was more likely to occur among women and those ≥ 20 years of age, surveillance of these groups is imperative to avoid transmission to newborns. Future studies that address the research gap and inform the country’s Zika control efforts are recommended.

[RESUMEN]. Objetivo. Estimar el número y porcentaje de casos con diagnóstico de infección por el virus del Zika en un hospital de Puertoviejo (Manabí, Ecuador). Métodos. Este fue un estudio retrospectivo basado en un hospital, transversal, descriptivo, de observación, realizado en el Hospital Dr. Verdi Cevallos Balda entre enero y agosto del 2016. Se llevó a cabo un análisis secundario de una base de datos para estimar el número y porcentaje de pacientes positivos para el virus del Zika por sexo, grupo etario, etnicidad y tipo de atención médica. Se calcularon la prevalencia y la razón de posibilidades, con intervalos de confianza de 95%, por el método de Mantel y Haenszel. Los métodos diagnósticos de laboratorio incluyeron análisis para la detección de los virus del Zika, el chikunguña y el dengue, entre otros. Resultados. En total, se detectaron 467 casos presuntos de infección por el virus del Zika con base en criterios clínicos. De ellos, 148 casos (31,7%) se confirmaron por detección de ARN del virus. El punto máximo del brote se documentó entre mayo y julio del 2016, durante la temporada de lluvias, después del terremoto de abril del 2016. La razón de posibilidades no ajustada indicó que fue menos probable la infección por el virus del Zika en los hombres y en las personas menores de 20 años. La mayoría de las embarazadas infectadas (61%) estaban en el segundo trimestre del embarazo. No se notificaron casos de microcefalia. Conclusiones. Dado que fue más probable la infección por el virus del Zika en las mujeres y las personas de 20 años en adelante, es indispensable la vigilancia de estos grupos para prevenir la transmisión a los recién nacidos. Se recomiendan estudios ulteriores que subsanen las deficiencias en la investigación y den sustento a las medidas de control del virus del Zika en el país.

[RESUMO]. Objetivo. Estimar o número e o percentual de casos diagnosticados com vírus zika em um hospital em Portoviejo, Manabí, Equador. Métodos. Estudo observacional transversal descritivo e retrospectivo sediado em um hospital (Hospital Dr. Verdi Cevallo Balda) conduzido de janeiro a agosto de 2016 na cidade de Portoviejo (Manabí), no Equador. Foi realizada uma análise secundária de uma base de dados para estimar o número e o percentual de casos de pacientes infectados pelo vírus zika, desagregada por sexo, faixa etária, grupo étnico e tipo de atenção médica prestada. A prevalência e as razões de chances, com os respectivos intervalos de confiança de 95%, foram calculados com o uso do método de Mantel e Haenszel. Os exames de diagnóstico laboratorial incluíram ensaios para a detecção dos vírus zika, chikungunya e dengue, entre outros. Resultados. Ao todo, 467 casos suspeitos de zika foram identificados segundo criterios clínicos. Destes, 148 casos (31,7%) foram confirmados com a detecção do RNA do vírus. Documentou-se a ocorrência do pico do surto entre maio e julho de 2016 durante a estação de chuvas, após o terremoto ocorrido em abril daquele ano. As razões de chances ajustadas indicaram menor probabilidade de infeção no sexo masculino e em indivíduos com idade inferior a 20 anos. A maioria das gestantes infectadas (61%) estava no segundo trimestre de gestação. Nenhum caso de microcefalia foi notificado. Conclusões. Visto que se verificou uma maior probabilidade de ocorrência de zika no sexo feminino e em indivíduos com idade acima de 20 anos, é imprescindível a vigilância desses grupos a fim de prevenir a transmissão aos recém-nascidos. Recomenda-se realizar outros estudos para contemplar a lacuna de pesquisa e subsidiar os esforços de controle da zika no país.

Epidemiological characteristics of a Zika outbreak in Portoviejo, Ecuador, 2016.

OBJECTIVE: To estimate the number and percentage of cases with Zika diagnosis at a hospital in Portoviejo, Manabí, Ecuador. METHODS: This was a hospital-based, retrospective, observational, descriptive, cross-sectional study conducted at the Dr. Verdi Cevallos Balda Hospital from January - August 2016. A secondary analysis of a database was performed to estimate the number and percentage of patients positive for Zika virus, by sex, age group, ethnicity, and type of medical care. Prevalence and odds ratios with 95% Confidence Intervals were calculated using the Mantel and Haenszel method. Laboratory diagnostics included assays for the detection of Zika, chikungunya, dengue, and others. RESULTS: In all, 467 suspected cases of Zika were identified based on clinical criteria. Of these, 148 cases (31.7%) were confirmed by detection of ZIKV RNA. The peak of the outbreak was documented in May - July 2016 during the rainy season, following the earthquake of April 2016. The adjusted odds ratios indicated that Zika virus was less likely in men and in subjects < 20 years of age. Most of the infected pregnant women (61%) were in the second trimester of pregnancy. No cases of microcephaly were reported. CONCLUSIONS: Because Zika was more likely to occur among women and those ≥ 20 years of age, surveillance of these groups is imperative to avoid transmission to newborns. Future studies that address the research gap and inform the country's Zika control efforts are recommended.

Epidemiological characteristics of a Zika outbreak in Portoviejo, Ecuador, 2016 / Características epidemiológicas de un brote de infección por el virus del Zika en Portoviejo, Ecuador, en el 2016 / Características epidemiológicas de um surto de zika em Portoviejo, Equador, 2016

ABSTRACT Objective To estimate the number and percentage of cases with Zika diagnosis at a hospital in Portoviejo, Manabí, Ecuador. Methods This was a hospital-based, retrospective, observational, descriptive, cross-sectional study conducted at the Dr. Verdi Cevallos Balda Hospital from January - August 2016. A secondary analysis of a database was performed to estimate the number and percentage of patients positive for Zika virus, by sex, age group, ethnicity, and type of medical care. Prevalence and odds ratios with 95% Confidence Intervals were calculated using the Mantel and Haenszel method. Laboratory diagnostics included assays for the detection of Zika, chikungunya, dengue, and others. Results In all, 467 suspected cases of Zika were identified based on clinical criteria. Of these, 148 cases (31.7%) were confirmed by detection of ZIKV RNA. The peak of the outbreak was documented in May - July 2016 during the rainy season, following the earthquake of April 2016. The adjusted odds ratios indicated that Zika virus was less likely in men and in subjects < 20 years of age. Most of the infected pregnant women (61%) were in the second trimester of pregnancy. No cases of microcephaly were reported. Conclusions Because Zika was more likely to occur among women and those ≥ 20 years of age, surveillance of these groups is imperative to avoid transmission to newborns. Future studies that address the research gap and inform the country's Zika control efforts are recommended.

RESUMEN Objetivo Estimar el número y porcentaje de casos con diagnóstico de infección por el virus del Zika en un hospital de Puertoviejo (Manabí, Ecuador). Métodos Este fue un estudio retrospectivo basado en un hospital, transversal, descriptivo, de observación, realizado en el Hospital Dr. Verdi Cevallos Balda entre enero y agosto del 2016. Se llevó a cabo un análisis secundario de una base de datos para estimar el número y porcentaje de pacientes positivos para el virus del Zika por sexo, grupo etario, etnicidad y tipo de atención médica. Se calcularon la prevalencia y la razón de posibilidades, con intervalos de confianza de 95%, por el método de Mantel y Haenszel. Los métodos diagnósticos de laboratorio incluyeron análisis para la detección de los virus del Zika, el chikunguña y el dengue, entre otros. Resultados En total, se detectaron 467 casos presuntos de infección por el virus del Zika con base en criterios clínicos. De ellos, 148 casos (31,7%) se confirmaron por detección de ARN del virus. El punto máximo del brote se documentó entre mayo y julio del 2016, durante la temporada de lluvias, después del terremoto de abril del 2016. La razón de posibilidades no ajustada indicó que fue menos probable la infección por el virus del Zika en los hombres y en las personas menores de 20 años. La mayoría de las embarazadas infectadas (61%) estaban en el segundo trimestre del embarazo. No se notificaron casos de microcefalia. Conclusiones Dado que fue más probable la infección por el virus del Zika en las mujeres y las personas de 20 años en adelante, es indispensable la vigilancia de estos grupos para prevenir la transmisión a los recién nacidos. Se recomiendan estudios ulteriores que subsanen las deficiencias en la investigación y den sustento a las medidas de control del virus del Zika en el país.

RESUMO Objetivo Estimar o número e o percentual de casos diagnosticados com vírus zika em um hospital em Portoviejo, Manabí, Equador. Métodos Estudo observacional transversal descritivo e retrospectivo sediado em um hospital (Hospital Dr. Verdi Cevallo Balda) conduzido de janeiro a agosto de 2016 na cidade de Portoviejo (Manabí), no Equador. Foi realizada uma análise secundária de uma base de dados para estimar o número e o percentual de casos de pacientes infectados pelo vírus zika, desagregada por sexo, faixa etária, grupo étnico e tipo de atenção médica prestada. A prevalência e as razões de chances, com os respectivos intervalos de confiança de 95%, foram calculados com o uso do método de Mantel e Haenszel. Os exames de diagnóstico laboratorial incluíram ensaios para a detecção dos vírus zika, chikungunya e dengue, entre outros. Resultados Ao todo, 467 casos suspeitos de zika foram identificados segundo critérios clínicos. Destes, 148 casos (31,7%) foram confirmados com a detecção do RNA do vírus. Documentou-se a ocorrência do pico do surto entre maio e julho de 2016 durante a estação de chuvas, após o terremoto ocorrido em abril daquele ano. As razões de chances ajustadas indicaram menor probabilidade de infeção no sexo masculino e em indivíduos com idade inferior a 20 anos. A maioria das gestantes infectadas (61%) estava no segundo trimestre de gestação. Nenhum caso de microcefalia foi notificado. Conclusões Visto que se verificou uma maior probabilidade de ocorrência de zika no sexo feminino e em indivíduos com idade acima de 20 anos, é imprescindível a vigilância desses grupos a fim de prevenir a transmissão aos recém-nascidos. Recomenda-se realizar outros estudos para contemplar a lacuna de pesquisa e subsidiar os esforços de controle da zika no país.

Sex-specific associations of different anthropometric indices with acute and chronic insomnia.

Background: Sleep disorders, including insomnia, are risk factors for weight gain. However, few epidemiological studies have investigated the association of anthropometric markers with insomnia as an outcome. Methods: In this observational, cross-sectional study, we assessed the association of 3 different anthropometric indices with acute and chronic insomnia. We used data from 13 389 French adults (mean age= 51.9 ± 13.1 years; 70.3% women) enrolled in the NutriNet-Santé-Biobank cohort. Body weight, height, waist and hip circumference were measured once during a clinic visit (2011-14). Body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were the main predictors. Acute (past 8 days) and chronic (≥3 months) insomnia were assessed in 2014 via a self-report questionnaire. We fit multivariable logistic regression models providing odds ratios (OR) and 95% confidence intervals (CI). Results: Overweight (25.0 ≤ BMI < 30.0 kg/m2) and general obesity (BMI ≥ 30.0 kg/m2) appeared to have an inverse association with acute insomnia only among men (overweight: OR= 0.80, 95% CI: 0.70, 0.92; obesity: OR= 0.78, 95% CI: 0.63, 0.98). Obesity assessed by BMI and WHR appeared to be positively associated with chronic insomnia only among women (BMI: OR= 1.23, 95% CI: 1.04, 1.45; WHR: OR= 2.24, 95% CI: 1.07, 4.72). WC did not display any significant associations in either sex. Conclusions: These cross-sectional results revealed sex-specific associations of overweight/obesity with different types of insomnia, and merit confirmation longitudinally with objectively assessed sleep parameters. Nonetheless, the findings reinforce the critical importance of joint health behaviour promotion.

Major Change in Body Weight over 5 Years and Total Sleep Time: Investigation of Effect Modification by Sex and Obesity in a Large e-Cohort.

PURPOSE: We assessed the association of long-term weight change ≥5 kg with total sleep time (TST), investigating effect modification by sex and overweight/obesity. METHOD: In a cross-sectional context, we studied 41,610 adults from the general population-based NutriNet-Santé e-cohort. A sleep questionnaire was self-administered in 2014. It included sleep logs for the estimation of average TST at night, and items for the calculation of major weight change as experienced over the previous 5 years. We fit multivariate polytomous logistic regression models. RESULTS: Overall, women with major weight loss had an increased likelihood of short TST (≤6 h) when compared with women with stable weight (OR = 1.15, 95% CI: 1.05-1.25). Individuals with major weight gain had an increased likelihood of short TST compared with their counterparts with stable weight (men: OR = 1.20, 95% CI: 1.05-1.37; women: OR = 1.24, 95% CI: 1.15-1.33). Men with major weight gain were less likely to report long TST compared with men with stable weight (OR = 0.83, 95% CI: 0.70-0.97). Overweight or obesity did not moderate the associations. CONCLUSIONS: The study advances knowledge in the fields of public health and nutrition by providing some evidence of a sex-specific association of major weight change with both short and long TST. These associations merit future investigation in a longitudinal context with repeated, objective measures of both weight and sleep time, while applying more stringent interaction test criteria and accounting for changes in health behaviors.