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.

INTRAGASTRIC BALLOON AND IMPACT ON WEIGHT LOSS: EXPERIENCE IN QUITO, EQUADOR.

BACKGROUND: Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem. AIMS: This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition. METHODS: This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed. RESULTS: A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m2 with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study. CONCLUSIONS: The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment.

La enfermería en Latinoamérica: un análisis bibliométrico de la producción científica sobre su historia / Nursing in Latin America: a bibliometric analysis of scientific production on its history

Objetivo principal: Analizar la producción científica sobre historia de la enfermería en Latinoamérica. Metodología: Revisión bibliográfica narrativa y estudio bibliométrico. Estrategia de búsqueda con lenguaje controlado en dos bibliotecas electrónicas y una base de datos bibliográfica. Criterios de inclusión: artículos en español, portugués o inglés, publicados entre enero de 2000 y enero de 2021. El análisis se hizo de forma cuantitativa. Resultados principales: Se analizaron 100 publicaciones encontradas en Scientific Electronic Library Online (58,7%), Biblioteca Virtual de Salud (28,8%) y Web of Science (12,5%), con publicaciones principalmente de Brasil (79%). El promedio de autores y coautores fue 2,7 y de citaciones en Google Scholar fue 10,9. Se formaron clústeres con densidad de tres o cuatro autores y clústeres de palabras-clave. Conclusión principal: Se identificó una alta concentración geográfica de las publicaciones y índices de cooperación y coautoría entre los autores y de citaciones que se mantienen en niveles bajos (AU)

Objective: To analyze the scientific production on the history of nursing in Latin America. Methods: A descriptive and bibliometric study. Search strategy with controlled language in two electronic libraries and one bibliographic database. Inclusion criteria: articles in Spanish, Portuguese, or English, published between January 2000 and January 2021. The analysis was made quantitatively. Results: 100 publications were analyzed. They were retrieved from Scientific Electronic Library Online (58.7%), Virtual Health Library (28.8%), and Web of Science (12,5%), mainly published in Brazil (79%). The average of authors and co-authors was 2.7, and the citations in Google Scholar were 10.9. There were formed clusters with a density of three or four authors and clusters of keywords. Conclusions: There was a high geographic concentration of publications, with high rates of cooperation and co-authorship between authors and low citations (AU)

Intragastric balloon and impact on weight loss: experience in quito, equador / Balão intragástrico e impacto na perda de peso: experiência em quito, equador

ABSTRACT BACKGROUND: Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem. AIMS: This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition. METHODS: This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed. RESULTS: A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m2 with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study. CONCLUSIONS: The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment.

RESUMO RACIONAL: A obesidade está associada a diferentes condições médicas, tais como cardiológicas, respiratórias, gastrointestinais, geniturinárias entre outras e constituem um grave problema de saúde. OBJETIVOS: Avaliar o emprêgo do balão intragástrico na redução de peso e em outras medidas relacionadas à composição corporal. MÉTODOS: Estudo retrospectivo, monocêntrico, incluindo todos os pacientes que optaram pela colocação de balão intragástrico Spatz® entre janeiro de 2018 e julho de 2019, com cumprimento dos critérios de inclusão e exclusão. RESULTADOS: Cento e vinte e um indivíduos foram recrutados neste estudo. A média de idade foi de 36 anos e estatura de 1,64±0,09, sendo 83 (68,6%) do sexo feminino e 38 (31,4%) do sexo masculino. A média do peso e o desvio padrão foram de 89,85±14,65 kg e o índice de massa corporal foi de 33,05±4,03. Após 12 meses, o índice de massa corporal diminuiu para 29,4 kg/m2 com um peso médio de 79,83 kg. Foram registradas diferenças estatísticas no índice de massa corporal, no percentual de gordura, massa livre de gordura (kg), área de gordura visceral e taxa metabólica basal. Houve variação significativa de acordo com o sexo, sendo o masculino com maior redução. O porcentual de perda de excesso de peso foi de 46,19% e de perda de peso total de 9,24 %ao final do estudo. CONCLUSÕES: O estudo demonstrou benefícios do balão intragástrico na perda de peso após 12 meses de colocação do balão. Ao final do tratamento, o índice de massa corporal e as medidas de composição corporal foram significativamente menores. Os homens se beneficiaram mais do que as mulheres do tratamento.

Reliability and Dimensionality of EPREVO ("Experiencias de Parto Relacionadas a Violencia Obstétrica"): Development of a New Instrument, Ecuador.

BACKGROUND: A new instrument called EPREVO has been developed to measure obstetric violence in Ecuador and the objective of this work is to validate its reliability and structural dimensionality. METHODS: Using confirmatory factor analysis (CFA) with a tetrachoric correlation approach. We examined the factor structure of EPREVO, a Spanish instrument to measure obstetric violence. Kuder Richardson values were used to assess the internal consistency of the scale and dimensionality was confirmed with confirmatory factor analysis. RESULTS: Confirmatory factor analysis supported a 3-factor solution. Most item-to-factor-correlations presented moderate to strong magnitude. Total Kuder Richardson was 0.87, while for the three factors were 0.23, 0.47 and 0.94, respectively. The model's goodness-of-fit indexes were satisfactory (χ2 = 1458.83; χ2/g.l = 2.60, p < 0.001; NNFI = 0.90; RMSEA = 0.09); most of the factor loads were greater than 0.30. A confirmatory factor analysis suggested a 3-dimensional structure of EPREVO. CONCLUSION: The scale's factor structure presented satisfactory validity and reliability results, except for one factor. The 30 items scale could potentially be used as an instrument for assessing obstetric violence in different healthcare settings.

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.

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.

Components of obstetric violence in health facilities in Quito, Ecuador: A descriptive study on information, accompaniment, and position during childbirth.

OBJECTIVE: To describe three factors of obstetric violence in health centers that attend births in Quito, Ecuador: information; accompaniment; and free position. METHOD: A cross-sectional descriptive study of 388 women was conducted, focusing on the analysis of three factors of obstetric violence. This study forms part of a larger study that explores the experiences of women in childbirth in Quito between July 1, 2016 and July 1, 2017. RESULTS: Of all procedures, the performance of episiotomies and the application of fundal pressure during the second stage of labor (Kristeller) stand out, as more than 35% of the women were not informed about them. In total, 121 (46.9%) women who gave birth vaginally were not given the opportunity to be accompanied by someone of their choice, neither in labor nor during delivery. While in the cases of cesarean deliveries, this increased to 116 (92.1%) women. A total of 119 (37.2%) women did not have the opportunity to choose their birthing position (or they did not know they could choose). During delivery, 138 (53.5%) women indicated the same. CONCLUSION: Obstetric violence is seen in all three components: information; accompaniment; and free position.

Assessment of Predictors of Sun Sensitivity as Defined by Fitzpatrick Skin Phototype in an Ecuadorian Population and Its Correlation with Skin Damage.

BACKGROUND: The Fitzpatrick skin phototype scale (FSPTS) is a widely used instrument to assess skin type. METHODS: A cross-sectional survey collected responses from 254 subjects from Quito regarding self-reported FSPTS, gender, age, education, and tobacco and alcohol consumption. Univariate and multivariate logistic regression analyses were performed to determine if ethnicity, hair color, and eye color significantly predict FSPTS. In addition, we studied the correlation between FSPTS and the SCINEXA scale with Pearson's correlation coefficient. RESULTS: Ethnicity, eye color, and hair color are significant independent predictors of FSPTS (p < 0.0001). CONCLUSIONS: Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by Fitzpatrick skin phototype. Our study does not fully represent the population of the country. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk.

Exploratory study of the reproducibility of the SCore for INtrinsic and EXtrinsic skin aging (SCINEXA) scale in "Ruta Escondida de la Mitad del Mundo", Ecuador, 2017.

BACKGROUND: Few studies have been published related to the analysis of different skin aging parameters for whole-body skin using the SCINEXA scale for skin damage. The aim of this study was to evaluate the reproducibility of the SCINEXA scale (SCore for INtrinsic and EXtrinsic skin Aging) in South-Americans non-Caucasian population of a region of Ecuador. METHODS: Exploratory observational study. Thirty subjects of both genders, over 40 years old and living in a rural area with particular characteristics regarding sun exposure were included. The SCINEXA scale was applied at three different time points to assess its reproducibility. Repeated measures analysis of variance was used for comparison of mean SCINEXA scores. Intraclass correlation coefficient, 95% CI and "Cronbach's alpha" coefficient were performed to measure reproducibility. RESULTS: Among participants, 86.7% were female; mean age was over 67 years old, with mainly low educational level, and almost half had more than six hours of sun exposure per day. Test-retest reproducibility of this scale demonstrated almost perfect agreement. The SCINEXA score was greater than 2 points in half of the subjects, reflecting aging due to sun exposure. LIMITATIONS: Most participants were women from one town in a particular geographical area, and the sample size was small. Genetic determinants of skin phenotypes were not assessed. CONCLUSIONS: The SCINEXA score is reproducible in South American non-Caucasian subjects of a particular region of the country. Damage from sun exposure was evident in participants.

Childbirth experiences related to obstetric violence in public health units in Quito, Ecuador.

OBJECTIVE: To explore women's experiences of obstetric violence related to childbirth in Ecuador. METHODS: The present cross-sectional descriptive study combined qualitative and quantitative elements of women's childbirth experience in Quito, Ecuador, between July 1, 2016, and July 1, 2017. Women who delivered in public health units providing different levels of care completed a survey of 32 questions, divided into six dimensions of obstetric violence. RESULTS: Overall, 388 women completed the survey, of whom 259 (66.8%) delivered vaginally and 129 (33.2%) delivered by cesarean. Among 120 women who delivered for the first time, 62 (51.7%) had an episiotomy. At the second stage of labor, uterine fundus pressure (Kristeller maneuver) was performed for 49 (19.4%) of 252 women. Overall, 196 (50.5%) women reported that they were not allowed to engage in early attachment, and 135 (34.8%) reported that they did not receive support for the initiation of breastfeeding. CONCLUSION: Various forms of obstetric violence are occurring in the public health services of Quito, despite World Health Organization recognition of the need for perinatal care at the highest level. Programs designed to prevent and diminish obstetric violence are urgently required.