What is happening with the clinical nutritionist? Realities and challenges.

BACKGROUND: At hospital level, clinical nutritionists play a fundamental role in health recovery, contributing to shorter hospital stays and addressing hospital malnutrition. However, in Latin America no studies have been conducted on the activities of the nutritionist and the factors influencing their performance. AIMS: to describe the activities of the clinical nutritionist in public and private hospital settings in Latin America and to determine the factors associated with disciplinary practice. METHODS: A cross-sectional analytical, quantitative study was conducted. Participants consisted of hospital nutritionists from 13 Latin American countries who had participated in a previously validated online survey on the activities performed during their daily work, obtaining a Professional Activities Score (PAS). RESULTS: 1222 nutritionists participated. Of the activities associated with the professional role, the only ones who reached over 75 % of execution were: performing nutritional intervention; performing nutritional assessment and diagnosis; providing counseling and dietary prescription; developing nutritional care plans for patients with nutritional problems; and performing the monitoring and evaluation of results of priority patients. The least frequent activities were: university teaching and collaborating in research. Regarding the reasons for not performing activities: 34.0 % reported not being included in the activities, 24.5 % mentioned lack of time, and 13.6 % indicated that the activities were conducted by another professional. Variables positively associated with an increase in the PAS were: having spent more years exercising the profession (Beta: 0.028, 95 % CI: 0.004; 0.051), and having a greater number of specialties (4 or more, Beta: 2.294, 95 % CI: 1.031; 3.557). Working in lower-complexity facilities (Low: Beta: -1.037, 95 % CI: -1.443; -0.630), and having more reasons for not performing the activities (3 or more: Beta: -3.105, 95 % CI: -4.111; -2.099) were inversely associated. From the sample, 1.8 % held a doctorate in clinical nutrition, 43.9 % had a specialty, and 64.4 % had a diploma or postgraduate degree in clinical nutrition. CONCLUSION: None of the activities related to the nutritionist work was performed on a 100 % basis. In Latin America, Ministries of Health should standardize and regulate the functions of the clinical nutritionist, as well as quantifying understaffing and proposing solutions to alleviate the shortage of these professionals, acknowledging the positive impact that they have on the recovery of hospital patients.

[Effect of gender equality on mortality from non-communicable diseases]. / Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles.

OBJECTIVE: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. METHOD: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. RESULTS: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14-3.99; p=0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40-5.06; p=0.003) than in men (OR: 2.12; 95% CI: 1.44-3.98; p=0.017). CONCLUSIONS: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.

Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles / Effect of gender equality on mortality from non-communicable diseases

Objetivo: Relacionar las desigualdades de género con la probabilidad de mortalidad por enfermedades no transmisibles (ENT) en los países del mundo desde 2000 hasta 2019, para detectar el progreso de la Meta 3.4 del Objetivo de Desarrollo Sostenible 3, de reducir en un tercio las ENT entre los 30 y los 70 años para 2030. Método: Estudio ecológico exploratorio sobre la asociación entre la probabilidad de fallecimiento por ENT y el índice de desigualdad de género (IDG) en el mundo en 2000, 2015 y 2019. Estimación mediante regresión logística del riesgo de no estar en proceso de cumplir la Meta 3.4 en 2019 según desigualdad de género. Resultados: La probabilidad media de fallecimiento por ENT descendió progresivamente en todos los países. Medianas 2000/2015/2019: mujeres 20,20/16,58/16; hombres 26,59/22,45/21,88; total 23,14/20,10/19,23. El riesgo de no estar logrando la meta en 2019 es mayor en los países con menor IDG que en los países con mayor IDG (OR: 2,13; IC95%: 1,14-3,99; p = 0,018), siendo el riesgo mayor en las mujeres (OR: 2,64; IC95%: 1,40-5,06; p = 0,003) que en los hombres (OR: 2,12; IC95%: 1,44-3,98; p = 0,017). Conclusiones: El riesgo de fallecimiento por ENT descendió en ambos sexos en todos los países del mundo desde el año 2000, pero el progreso es lento y, a mayor desigualdad de género en los países, mayor riesgo de no estar logrando el descenso necesitado para cumplir con el acuerdo de reducir un tercio la mortalidad por ENT en 2030, siendo este riesgo mayor en las mujeres que en los hombres.(AU)

Objective: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. Method: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. Results: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14–3.99; p = 0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40–5.06; p = 0.003) than in men (OR: 2.12; 95% CI: 1.44–3.98; p = 0.017). Conclusions: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.(AU)

Factors associated with the consumption of fruits and vegetables in latin american university students

Objective: Explore the association between compliance with recommended consumption (5-a-day) of fruits and vegetables (F&V) with sociodemographic factors of university students of Latin America. Subjects: We conducted an analytical cross-sectional study in which 4,880 university students from 10 Latin American countries completed a self-administered online survey. Methods: F&V consumption and other sociodemographic variables were measured according to a validated survey. Body mass index was self-reported. Ordinal logistic regression models were applied. Results: Regarding the consumption of F&V, 4.7% of men complied with the recommendation, while in women this value reached 7.7%. In the adjusted model, having a normal weight (OR= 0.59; 95% CI 0.44-0.7; p=<0.001), being female (OR= 0.67; 95% CI 0.49-0.89; p=<0.01), being enrolled in a health-related degree program (OR= 0,60; IC95% 0,45-0,78; p<0.001), having professional parents (OR= 0.75; 95% CI 0.60-0.95; p=<0.05) and practicing physical activity (OR= 0.34; 95% CI 0.27-0.42; p=<0.001) were associated with compliance to F&V consumption recommendations. In the analysis by country, physical activity was the variable most associated with F&V consumption. Conclusion: We observed a low consumption of F&V in university students. The variables associated with compliance to the F&V recommendation were being normal weight, female, being enrolled in a health-related degree program, having professional parents, and practicing physical activity, the latter being the most important variable.

Objetivo: Explorar la asociación de la frecuencia de cumplimiento de las recomendaciones de consumo (5 al día) de frutas y verduras (F&V) con factores sociodemográficos de estudiantes universitarios de América Latina. Metodología: Se realizó un estudio transversal analítico con 4.880 estudiantes universitarios de 10 países de América Latina, quienes completaron una encuesta en línea autoadministrada. Se midió el consumo de F&V y otras variables sociodemográficas según una encuesta previamente validada. El índice de masa corporal fue autoinformado. Se aplicaron modelos de regresión logística ordinal. Resultados: En cuanto al consumo de F&V, en los hombres el 4,7% cumple con la recomendación, mientras que en las mujeres este valor alcanza el 7,7%. En el modelo más ajustado, presentar normopeso (OR= 0,59; IC 95% 0,44-0,7; p=<0,001), ser mujer (OR= 0,67; IC 95% 0,49-0,89; p=<0,01), estar matriculado en carrera relacionada con la salud (OR= 0,60; IC95% 0,45-0,78; p<0,001), tener padres profesionales (OR= 0,75; IC 95% 0,60-0,95; p=<0,05) y realizar actividad física (OR= 0,34; IC 95% 0,27-0,42; p=<0,001) fueron las variables asociadas al cumplimiento del consumo de F&V. En el análisis por país, la actividad física fue la variable más asociada al consumo de F&V. Conclusión: Se observa un bajo consumo de F&V en estudiantes universitarios, y entre las variables asociadas al cumplimiento de la recomendación de F&V se encuentran estar normopeso, sexo femenino, estar cursando una carrera relacionada con la salud, tener los padres y la práctica de actividad física, siendo esta última la variable más importante.

Barriers and Opportunities for Clinical Nutritionists in 13 Latin American Countries: A Qualitative Study.

A clinical nutritionist (CN) is a university-educated professional trained to perform preventive and recovery functions in the health of patients. The actions of these professionals, both worldwide and in Latin America, may face barriers and opportunities that require careful identification and examination. The main objective of this study is to identify the most important barriers and opportunities for the clinical nutritionist in 13 Latin American countries. A qualitative study was carried out; the initial phase involved conducting in-depth individual interviews with 89 informants, experienced CNs from 13 Latin American countries. After calculating the mean and standard deviation, we ranked the top 10 most frequently reported barriers by assigning a score ranging from 1 to 10. Additionally, 3 opportunities were identified with a lower score from 1 to 3. Means and standard deviation were calculated to sort the responses. Results: the most important barrier was the absence of public policies that regulate and/or monitor compliance with the staffing of CNs according to the number of hospital beds, while the most important opportunity was the advances in technology such as software, body analysis equipment and other tools used in Nutritional Care. The identified barriers can interfere with the professional performance of CNs and, moreover, make it difficult to monitor the good nutritional status of patients. It is recommended to consider the barriers identified in this study, as well as the opportunities, with a view to improving the quality of hospital services with an adequate supply of nutritionists.

Assessment of the Health Status of Spanish Schoolchildren Based on Nutrimetry, Lifestyle and Intestinal Parasites.

Malnutrition in Spanish schoolchildren, and its relationship with lifestyles, has been studied, but Nutrimetry (a nutritional status indicator), and data on intestinal parasitism and its risk factors, have never before been taken into account. A total of 206 children aged 3-11 years, from two schools in the Valencian Community, participated. Demographic characteristics, diet, lifestyles, behavioural habits and anthropometric (weight, height) and coproparasitological data were collected. Nutrimetry was used to analyse nutritional status. Statistical analyses were performed to ascertain associations between lifestyle, selected parasite species and nutritional status. Multivariate logistic regression analysis was used to assess the strength of the association of the suspected risk factors with the presence of intestinal parasitism. The prevalence of overweight was 32.6%. A total of 43.9% had a high adherence to the Mediterranean Diet, for which mean daily intake was 2428.7 kcal. Intestinal parasitism was identified in 49.5% of the children (Giardia duodenalis: 28.6%). The source of drinking water was found to be a risk factor for intestinal parasitism. No positive association between the variables analysed and nutritional status could be confirmed. Nutrimetry is a good indicator for a complete analysis of nutritional status. It highlights the prevalence of overweight. Intestinal parasitism was identified in almost half of the participants and is a variable that should not be underestimated.

The double burden of malnutrition and gross motor development in infants: A cross-sectional study.

OBJECTIVE: The objective of the present work was to study the relationship between the double burden of malnutrition and gross motor development in infants. METHOD: ology: Sample included 5900 infants under 24 months of age, participants of the ENSANUT-ECU study. To evaluate nutritional status, we calculated z-scores for body mass index/age (BAZ) and height/age (HAZ). Six gross motor milestones were considered: sitting without-support, crawling, standing and walking with-support, standing and walking without-support. Data was analysed using logistic regression models in R. RESULTS: Independently form age, sex and other socio-economic factors, the probability of achieving three gross motor milestones was significantly lower among chronically undernourished infants compared to their peers: sitting without-support, crawling, and walking without-support. Compared to no malnourished infants the probability of sitting without-support at six months was 10% lower for chronically undernourished infants (0.70, 95%CI [0.64-0.75]; 0.60, 95%CI [0.52-0.67]; respectively). The probability of crawling at eight months and walking without-support at 12 months were also significantly lower among chronically undernourished infants (0.62, 95%CI [0.58-0.67]); 0.25, 95%CI [0.20-0.30]; respectively) in comparison to no malnourished infants (0.67, 95%CI [0.63-0.72]); 0.29, 95%CI [0.25-0.34]; respectively). Obesity/overweight was not associated with the achievement of gross motor milestones, except for sitting without-support. Chronically undernourished infants with low or high BMI/age were generally delayed in the achievement of gross motor milestones than their peers. CONCLUSIONS: Chronic undernutrition is related to delayed gross motor development. Public health measures are needed to be implemented to prevent the double burden of malnutrition and its detrimental effects on infant development.

Mobility restrictions and mental health among young adults during the COVID-19 pandemic in Ecuador / Restricción de movilidad y salud mental entre adultos jóvenes durante la pandemia de COVID-19 en Ecuador

Objective: To study the association between mobility restriction and mental health outcomes among Ecuadorian young adults. Method: The present is a cross-sectional study that included a non-probabilistic sample of mostly highly educated young adults. Socio-demographic and mental health data were collected through an online survey, between May and June 2020, when confinement was mandatory in Ecuador. Data on mobility was extracted from Google Community Mobility Reports. Four aspects of the participants’ mental health were evaluated: eating behavior (emotional eating), depression, sleep quality and sense of coherence as a proxy of resilience, using previously validated instruments. Data were analyzed using multiple linear regression models in R. Results: Sample included 8426 young adults, with a mean age of 22.85 (standard deviation: 4.43), most of whom were women (n = 5943, 70.53%). During mandatory confinement, in Ecuador mobility in general was reduced by nearly 50% in comparison to January/February, 2020. Less healthy eating behavior, depression, worse sleep quality and lower sense of coherence were associated with higher mobility restriction to workplaces and groceries/pharmacies. Women and youngsters more often showed depression, less healthy eating behavior, worse quality of sleep and lower sense of coherence in comparison with men and older respondents. Conclusions: Mobility restrictions during COVID-19 pandemic were associated with worse self-reported mental health in a sample of young highly-educated Ecuadorian adults. Women and youngsters were the most affected. Our findings highlight the need of implementing health promotion measures directed to ameliorate the effects of confinement on mental health, focusing on women and youngsters. (AU)

Objetivo: Estudiar la asociación entre la restricción de movilidad y la salud mental en personas adultas jóvenes de Ecuador. Método: Estudio transversal que incluyó una muestra no probabilística de personas adultas jóvenes con alto nivel de educación. Los datos sociodemográficos y de salud mental se recolectaron entre mayo y junio de 2020, cuando el confinamiento fue obligatorio, usando una encuesta en línea. Los datos sobre movilidad se extrajeron de Google Community Mobility Reports. Se evaluaron cuatro aspectos de la salud mental: alimentación emocional, depresión, calidad de sueño y sentido de coherencia como proxy de resiliencia, usando instrumentos previamente validados. Los datos se analizaron con modelos de regresión lineal múltiple usando R. Resultados: La muestra incluyó 8426 jóvenes, con una edad media de 22,85 años (desviación estándar: 4.43), mujeres en su mayoría (n = 5943, 70.53%). Durante el confinamiento obligatorio, la movilidad se redujo aproximadamente un 50%. Comportamientos alimentarios menos saludables, depresión, peor calidad del sueño y menor sentido de coherencia se asociaron con mayor restricción de movilidad a lugares de trabajo y pequeños comercios o farmacias. Mujeres y jóvenes mostraron con mayor frecuencia depresión, conductas alimentarias menos saludables, peor calidad del sueño y menor sentido de coherencia. Conclusiones: Las restricciones de movilidad durante la pandemia de COVID-19 se asociaron con una peor salud mental en personas adultas jóvenes con alto nivel de educación. Mujeres y jóvenes fueron los más afectados. Es necesario implementar medidas de promoción de la salud dirigidas a paliar los efectos del confinamiento en la salud mental, especialmente en mujeres y jóvenes. (AU)

Evaluation of School Children Nutritional Status in Ecuador Using Nutrimetry: A Proposal of an Education Protocol to Address the Determinants of Malnutrition.

The education sector is a cornerstone in the battle against malnutrition in children. However, there are still no consolidated protocols that outline strategies for how nutrition programs in low- and middle-income countries can be delivered through the education sector. Establishing the correct community diagnosis is essential prior to the elaboration of an intervention plan for a school population that takes into account more than just traditional variables related to the nutritional status. A total of 574 boys and girls aged 3-11 years from three educational institutions in different municipalities in Ecuador participated in the study. Sociodemographic, anthropometric (weight and height) and coproparasitological data were obtained. Nutrimetry, which is a combination of two classical anthropometrics indicators, was used for the analysis of the nutritional status, and the indicators' frequencies varied among the schools. In order to improve the nutritional status of children, we proposed a framework mainly focusing on establishing alliances with the education sector and taking into account gender equality; respect for the environment; and the customs, beliefs and traditions of each population. The results obtained from the analyses of other variables demonstrated the importance of an adequate diagnosis prior to any type of intervention at the nutritional level, since characteristics could vary by local area and have an impact on the successfulness of the intervention.

Cognitive function and vitamin B12 and D among community-dwelling elders: A cross-sectional study.

BACKGROUND & AIMS: Little is know on the association between mild or sub-clinical vitamin B12 or D deficiencies and cognitive decline. The objective of the present work was to evaluate the association between vitamin B12 and D levels, and cognitive function in community-dwelling elders. METHODS: Cross-sectional study that included data from elders who participated in the SABE study, a population-based study that was carried out in Ecuador. Participants of SABE were selected by probabilistic sampling from the whole country. Vitamin B12 and D were measured in blood and cognitive status was assessed using an abbreviated version of the minimental state examination (MMSE). RESULTS: The sample included 1733 elders from whom 936 (54.01%) were female. Independently from sex, age, years of education, ethnicity, socioeconomic status and geographical zone of residence, we found that vitamin B12 levels were associated to MMSE scores and that this relationship changed depending on age. In this way, we observed that from 75 years of age, drop of cognitive function was particularly steep in individuals with low levels of vitamin B12. We did not find evidence to support an association between vitamin D levels and cognitive function. CONCLUSIONS: Low levels of vitamin B12 but not of vitamin D are associated with low cognitive functioning in a sample of community-dwelling elders.

Stress and Diet Quality Among Ecuadorian Adults During the COVID-19 Pandemic. A Cross-Sectional Study.

Background: Stress has been associated with food habits. Stress changes eating patterns and the salience and consumption of hyperpalatable foods. During the lock-down due to the COVID-19 pandemic, stress was very common. Objective: We investigated the association between stress and diet quality in Ecuadorian adults during the COVID-19 pandemic. Design: A cross-sectional study. Setting: Data was collected using a self-administered online survey. Stress was measured using the Perceived Stress Scale (PSS-14), and diet quality was evaluated using the Global Diet Index (GDI). A linear regression model with restrictive cubic splines was used to investigate the association between stress and diet quality. Participants: Participants were recruited by convenience sampling, including a total of 2602 individuals. Most participants were female (68.57%) and had university education (78.52%), with a median age of 25 (IQR: 25, 37). Results: Stress was reported by 26.06% of participants. The majority of individuals (75.79%) reported having a diet that needed changes or an unhealthy diet. Independently from biological sex, age, level of education, people/room ratio, economic allowance, and expenses for food, stress was statistically significantly associated with diet quality (p = 0.035). The association between stress and diet quality was inverse and non-linear; higher stress levels were associated with poorer diet quality. The consumption of palatable foods was not statistically significant associated with stress. Conclusions: Stress is associated with poorer diet quality. Public health measures to improve the mental health and lifestyle of the population are needed during the lock-down of the pandemic.

Relationship between perceived stress and emotional eating. A cross sectional study.

BACKGROUND AND AIMS: Stress-related to self-isolation during the COVID-19 pandemic has shown a strong correlation with issues in the diet and health of the population. In this study, we aimed to relate the perceived stress of a group of Ecuadorian adults with emotional eating. METHODS: Cross-sectional design study. We applied validated questionnaires of perceived stress and emotional eating to adults of both sexes who virtually completed a form between the months of January and March 2021. The analyzes were carried out using Chi2 statistical tests, Student's t-tests and a multiple linear regression model., the analyzes were performed using the statistical software R. RESULTS: The sample was composed of 2333 participants, the median age was 25 years (interquartile range 21-37 years). Females reported more perceived stress than males (77.91% vs. 22.09%). Nearly 64% of participants who displayed perceived stress were emotional eaters. A statistically significant association was found between the emotional eating score and perceived stress (p < 0.001), the effect was an elevation of 0.44 points in the emotional eating score for each stress point perceived. For each unit increase in BMI the emotional eating score increased 0.26 units (p < 0.001) and for each unit increase in age the emotional eating score decreased by 0.27 units (p = 0.03). CONCLUSIONS: It is concluded that stress is associated to emotional eating. Dietary intake that responds to emotions and not to physiological hunger may have long-term problems related to unhealthy diet. It is recommended to consider stress and emotional eating in the nutritional care process of people.

Mobility restrictions and mental health among young adults during the COVID-19 pandemic in Ecuador.

OBJECTIVE: To study the association between mobility restriction and mental health outcomes among Ecuadorian young adults. METHOD: The present is a cross-sectional study that included a non-probabilistic sample of mostly highly educated young adults. Socio-demographic and mental health data were collected through an online survey, between May and June 2020, when confinement was mandatory in Ecuador. Data on mobility was extracted from Google Community Mobility Reports. Four aspects of the participants' mental health were evaluated: eating behavior (emotional eating), depression, sleep quality and sense of coherence as a proxy of resilience, using previously validated instruments. Data were analyzed using multiple linear regression models in R. RESULTS: Sample included 8426 young adults, with a mean age of 22.85 (standard deviation: 4.43), most of whom were women (n=5943, 70.53%). During mandatory confinement, in Ecuador mobility in general was reduced by nearly 50% in comparison to January/February, 2020. Less healthy eating behavior, depression, worse sleep quality and lower sense of coherence were associated with higher mobility restriction to workplaces and groceries/pharmacies. Women and youngsters more often showed depression, less healthy eating behavior, worse quality of sleep and lower sense of coherence in comparison with men and older respondents. CONCLUSIONS: Mobility restrictions during COVID-19 pandemic were associated with worse self-reported mental health in a sample of young highly-educated Ecuadorian adults. Women and youngsters were the most affected. Our findings highlight the need of implementing health promotion measures directed to ameliorate the effects of confinement on mental health, focusing on women and youngsters.

Healthcare professionals' experiences and perceptions regarding health care of indigenous pregnant women in Ecuador.

BACKGROUND: Pregnancy is an important life experience that requires uniquely tailored approach to health care. The socio-cultural care practices of indigenous pregnant women (IPW) are passed along the maternal line with respect to identity, worldview and nature. The cultural differences between non-indigenous healthcare professionals (HPs) and IPW could present a great challenge in women's health care. This article presents an analysis from a human rights and gender perspective of this potential cultural divide that could affect the health of the IPW in an Andean region of Ecuador with the objective of describing the health challenges of IPWs as rights holders through the experiences and perceptions of HP as guarantors of rights. METHODS: We conducted 15 in-depth interviews with HPs who care for IPW in Chimborazo, Pichincha provinces of Ecuador. We utilized a semi-structured interview guide including questions about the experiences and perceptions of HPs in delivering health care to IPW. The interviews were recorded, transcribed and subjected to thematic analysis in Spanish and translated for reporting. RESULTS: We found disagreements and discrepancies in the Ecuadorian health service that led to the ignorance of indigenous cultural values. Common characteristics among the indigenous population such as illiteracy, low income and the age of pregnancy are important challenges for the health system. The gender approach highlights the enormous challenges: machismo, gender stereotypes and communication problems that IPWs face in accessing quality healthcare. CONCLUSIONS: Understanding the diverse perspectives of IPW, acknowledging their human rights particularly those related to gender, has the potential to lead to more comprehensive and respectful health care delivery in Ecuador. Further, recognizing there is a gender and power differential between the provider and the IPW can lead to improvements in the quality of health care delivery and reproductive, maternal and child health outcomes.

Eating Habits and Sleep Quality during the COVID-19 Pandemic in Adult Population of Ecuador.

Confinement due to COVID-19 has brought important changes in people's lives as well as in their eating and resting habits. In this study we aimed at exploring the eating habits and sleep quality of the adult population of Ecuador during the mandatory confinement due to the COVID-19 pandemic. This is a cross-sectional study, which used an online survey that included questions about eating habits and sleeping habits in adults (n = 9522) between 18-69 years old. The Pittsburg sleep quality questionnaire validated for the Hispanic population was used, and questions about dietary habits. The statistical test Chi-square statistical test was used to analyze the data. The results show that sleep quality differs according to sex, being worse in women, both in all components of sleep quality and in the total score (p < 0.001). Women had greater changes in the habitual consumption of food compared to men (24.24% vs. 22.53%), and people between 18 and 40 years of age decreased their food consumption in relation to people >40 years (24.06% vs. 17.73%). Our results indicate that mandatory confinement due to the COVID-19 pandemic in Ecuador has generated changes in the eating habits and sleep quality in the adult population sampled, and these changes are more noticeable in women and young adults. These changes offer an important alert for the health system and further, advice for the implementation of future public health policies.

Estimación del peso conforme a la edad en niños y niñas ecuatorianos: validación de la ecuación APLS / Estimation of weight based on age in Ecuadorian boys and girls: a validation of the APLS formula

INTRODUCCIÓN: en niños y niñas, la aplicación de intervenciones terapéuticas, lo que incluye la administración de medicamentos, se basa en el peso corporal. OBJETIVO: validar las ecuaciones propuestas por "Advanced Pediatric Life Support - APLS" en 2011 (APLS 1) y 2001 (APLS 2) para estimar el peso de las niñas y niños ecuatorianos, considerando la diversidad étnica y los grupos de edad. MÉTODOS: estudio transversal que incluyó 21.735 niñas y niños pertenecientes a tres grupos étnicos -mestizo, indígena y otro (blancos, negros y mulatos)- con edades comprendidas entre 0 y 12 años y que habían participado en el estudio ENSANUT-ECU. Se calcularon las diferencias, la correlación de Spearman, los gráficos de Bland-Altman y el porcentaje error (PE). Los datos se procesaron y analizaron usando R. RESULTADOS: la APLS 1 tiende a sobrestimar el peso mientras que la APLS 2 lo subestima. El sesgo del peso estimado fue mayor para la ecuación clásica. Los grupos étnicos indígena y otro presentaron las diferencias más altas con respecto al peso medido. Las diferencias de peso estimado con respecto al medido aumentaron progresivamente con la edad. Con la APLS 1, el porcentaje de individuos con un PE > 10 % fue mayor que con la APLS 2. CONCLUSIONES: la APLS no estima con exactitud el peso en la población pediátrica ecuatoriana. La diferencia entre el peso estimado y el peso medido es sensible a las diferencias étnicas y de edad

INTRODUCTION: in children the use of therapeutic interventions, which includes the administration of medications, is based on body weight. OBJECTIVE: to validate the equations proposed by "Advanced Pediatric Life Support - APLS" in 2011 (APLS 1) and 2001 (APLS 2) to estimate weight in Ecuadorian girls and boys, considering their ethnic diversity and age groups. METHODS: a cross-sectional study which included 21,735 girls and boys belonging to three ethnic groups: mestizo, indigenous, and other (white, black, and mulatto), with ages between 0 and 12 years, who participated in the ENSANUT-ECU study. Differences, Spearman's correlation, Bland-Altman graphs, and percentage error (PE) were calculated. Data were processed and analyzed using R. RESULTS: APLS 1 tends to overestimate weight whereas APLS 2 underestimates it. The estimated weight bias was greater for the classical equation. The indigenous and "other" ethnic groups presented the highest differences with respect to measured weight. The differences between estimated weight and measured weight increased progressively with age. With APLS 1, the percentage of individuals with a PE > 10 % was greater than with APLS 2. CONCLUSIONS: APLS does not accurately estimate weight in the Ecuadorian pediatric population. The difference between estimated weight and measured weight is sensitive to ethnic and age differences

Anthropometry, dietetic habits and sleepiness in Ecuadorian adults

The reduction of hours of sleep affects the physical and mental health of people. Having unhealthy sleep habits are associated with a greater occurrence of daytime sleepiness, which in turn has been related to poorer nutritional status. The objective of this study was to relate food intake, anthropometric measurements, and daytime sleepiness in Ecuadorian adults. Non-experimental, cross-sectional study, the sample included 400 men and women between 18 and 65 years of age, who attended an outpatient consultation of general medicine, family medicine, and traumatology services of a public hospital in Quito-Ecuador. Anthropometric and body composition measurements were measured using tetrapolar bio-impedance, following the recommendations of the International Society for the Advancement of Anthropometry (ISAK). Caloric intake was measured using a 24-hour recall and for daytime sleepiness (DS) the Epworth questionnaire was used. Statistical analyzes were performed using R. From the sample 56.5% presented DS, which affected women more frequently compared to men (p < 0.05). Differences were found between body measurements and dietary intake between groups of people with and without DS. Caloric intake, waist circumference, percentage of fat mass were higher in people with DS (p < 0.05), while muscle mass was higher in subjects without DS (p <0.05). No differences were found concerning visceral fat. We conclude that SD is related to less healthy values in terms of dietary intake and anthropometric measures(AU)

La reducción de las horas de sueño afecta la salud física y mental de las personas. Tener hábitos de sueño poco saludables se asocia a una mayor ocurrencia de somnolencia diurna, lo que a su vez se ha relacionado con un peor Estado Nutricional. El objetivo de este estudio fue relacionar la ingesta de alimentos, las medidas antropométricas y la somnolencia diurna en adultos ecuatorianos. Estudio no experimental, transversal n=400 hombres y mujeres entre 18 y 65 años, que acudieron a consulta externa de los servicios de medicina general, medicina familiar y traumatología de un hospital público de Quito, Ecuador tomado como referencia. Se tomaron medidas antropométricas siguiendo las recomendaciones de la Sociedad Internacional para el Avance de la Antropometría (ISAK) y de composición corporal a través de la bioimpedancia tetrapolar. La ingesta calórica se midió mediante un recordatorio de 24 horas y para somnolencia diurna (SD)se utilizó el cuestionario de Epworth. Los análisis estadísticos se realizaron utilizando el software R. 56,5% de la muestra presenta SD, que afectó con mayor frecuencia a las mujeres en comparación con los hombres (p <0,05). Se encontraron diferencias entre las medidas corporales y la ingesta dietética entre grupos de personas con SD y sin ella. La ingesta calórica, la circunferencia de la cintura, el porcentaje de masa grasa fue mayor en personas con SD (p <0.05), mientras que la masa muscular fue mayor en sujetos sin SD (p <0.05). No se encontraron diferencias en relación con la grasa visceral. Concluimos que SD está relacionada con valores menos saludables en cuanto a ingesta dietética y medidas antropométricas(AU)

Sleep quality does not mediate the negative effects of chronodisruption on body composition and metabolic syndrome in healthcare workers in Ecuador.

BACKGROUND AND AIMS: The objective of the present work was to determine to what extent sleep quality may mediate the association between chronodisruption (CD) and metabolic syndrome (MS), and between CD and body composition (BC). METHODOLOGY: Cross-sectional study which included 300 adult health workers, 150 of whom were night shift workers and thereby exposed to CD. Diagnosis of MS was made based on Adult Treatment Panel III criteria. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Body mass index (BMI), fat mass percentage, and visceral fat percentage were measured as indicators of body composition (BC). Data were analyzed using logistic, linear regression and structural equation models. RESULTS: The odds of health workers exposed to CD to suffer MS was 22.13 (IC95 8.68-66.07) when the model was adjusted for age, gender, physical activity and energy consumption. CD was also significantly associated with an increase in fat mass and visceral fat percentages, but not to BMI. Surprisingly, there was not enough evidence supporting the hypothesis that sleep quality contributes to the association between CD and MS or between CD and BC. CONCLUSIONS: Sleep quality does not mediate the negative effects of CD on MS nor on BC.

ADHD subtypes are associated differently with circadian rhythms of motor activity, sleep disturbances, and body mass index in children and adolescents: a case-control study.

To date, few studies have examined the circadian pattern of motor activity in children and adolescents newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). The objective was to study the circadian pattern of motor activity in subjects with ADHD (medication naïve) and to investigate the relationships between alterations in circadian patterns, the ADHD subtype (combined or inattentive), sleep disturbances and body mass index (BMI). One-hundred twenty children and adolescents (60 medication naïve ADHD and 60 controls) were included in a gender- and age-matched case-control study. ADHD was diagnosed according to the DSM-IV-TR, the Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, and the Conner's Parents Rating Scale-Revised. Circadian rhythms of motor activity and sleep parameters were measured using actigraphy and the Sleep Disturbance Scale for Children. BMI and dietary intake were also evaluated. ADHD patients showed a trend towards eveningness and greater sleep disturbances than controls. Additionally, patients with ADHD-combined had significantly higher mean values of motor activity and showed a significant delay in bedtime. Furthermore, among ADHD-C patients hyperactivity symptoms were significantly associated with the least 5 h of activity. Regarding patients with ADHD-inattentive, increased fragmentation of the circadian pattern was associated with inattention symptoms, and they also showed a significant increase in BMI of 2.52 kg/m2 [95% CI 0.31, 4.73] in comparison with controls. Our findings highlight the potential use of actigraphy as a clinical tool to aid in the diagnosis of ADHD. It should be noted that evaluating motor activity variables could also allow the differentiation between ADHD subtypes.