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.

Pathogen disgust sensitivity protects against infection in a high pathogen environment.

Disgust is hypothesized to be an evolved emotion that functions to regulate the avoidance of pathogen-related stimuli and behaviors. Individuals with higher pathogen disgust sensitivity (PDS) are predicted to be exposed to and thus infected by fewer pathogens, though no studies have tested this directly. Furthermore, PDS is hypothesized to be locally calibrated to the types of pathogens normally encountered and the fitness-related costs and benefits of infection and avoidance. Market integration (the degree of production for and consumption from market-based economies) influences the relative costs/benefits of pathogen exposure and avoidance through sanitation, hygiene, and lifestyle changes, and is thus predicted to affect PDS. Here, we examine the function of PDS in disease avoidance, its environmental calibration, and its socioecological variation by examining associations among PDS, market-related lifestyle factors, and measures of bacterial, viral, and macroparasitic infection at the individual, household, and community levels. Data were collected among 75 participants (ages 5 to 59 y) from 28 households in three Ecuadorian Shuar communities characterized by subsistence-based lifestyles and high pathogen burden, but experiencing rapid market integration. As predicted, we found strong negative associations between PDS and biomarkers of immune response to viral/bacterial infection, and weaker associations between PDS and measures of macroparasite infection, apparently mediated by market integration-related differences. We provide support for the previously untested hypothesis that PDS is negatively associated with infection, and document variation in PDS indicative of calibration to local socioeconomic conditions. More broadly, findings highlight the importance of evolved psychological mechanisms in human health outcomes.

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

INTRODUCTION: 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.

INTRODUCCIÓN: 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.

Inmunosupresión como desencadenante de un síndrome de hiperinfestación por Strongyloides stercolaris en la nefropatía membranosa / Immunosuppression as a trigger for hyperinflammatory syndrome due to Strongyloides stercolaris in membranous nephropathy

La relación entre parásitos y glomerulonefritis (GN) está bien documentada en determinadas parasitosis, no así en casos de Strongyloides stercolaris (S. stercolaris), donde hay pocos casos descritos, siendo la mayoría GN de cambios mínimos. Reportamos un caso de hiperinfestación por S. stercolaris en un paciente afectado de una GN membranosa tratado con corticoides por vía oral con resultado fatal para el paciente. Este caso nos aporta una doble enseñanza: en primer lugar, acerca de una asociación rara de estrongiloidiasis y GN membranosa, y en segundo lugar, sobre la importancia de establecer un diagnóstico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad clínica antes de iniciar cualquier tratamiento inmunosupresor

The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment

Immunosuppression as a trigger for hyperinflammatory syndrome due to Strongyloides stercolaris in membranous nephropathy. / Inmunosupresión como desencadenante de un síndrome de hiperinfestación por Strongyloides stercolaris en la nefropatía membranosa.

The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.

Longer Residence of Ecuadorian and Colombian Migrant Workers in Spain Associated with New Episodes of Common Mental Disorders.

The healthy migrant effect and its impact on mental health has been reported in the general population of many countries. Information is limited about its impact on working populations. The aim of this study is to estimate the incidence of common mental disorders over a one-year follow-up period among a cohort of Colombian and Ecuadorian employees in Spain, taking into account the duration of residence and comparing with Spanish-born workers. Data was from the Longitudinal Studies on Immigrant Families Project (PELFI), a follow-up survey of immigrants and Spanish-born workers interviewed in 2015 and 2016. Mental health was assessed using the 12-item general health questionnaire (GHQ-12). Crude and adjusted odds ratios (ORas) for common mental disorders by sociodemographic and employment characteristics were created. There were differences for immigrants with time of residence less than or equal to 15 years (time of residence 11-15 years: ORa = 0.06, 95% CI = (0.26-0.01); time of residence 1-10 years: ORa = 0.06, 95% CI = (0.36-0.01)). There was evidence of a healthy immigrant worker effect, as newer arrivals from Ecuador and Columbia to Spain had a lower incidence of common mental disorders than either the Spanish-born or immigrant workers who had lived in Spain for more than 15 years.

Oral Health-Related Quality of Life in Native and Immigrant Populations in the PELFI Study in Spain.

Quality of life and its relationship to oral health is an important consideration in the determinants of health of vulnerable groups. The aim of this study is to assess oral health-related quality of life (OHRQoL) and its related factors in native and immigrant population families from the Platform of Longitudinal Studies on Immigrant Families (PELFI) study in Spain. A cross-sectional study was conducted in a sample of 401 adults aged 18 years and older from Spain, Ecuador, Colombia, and Morocco. The OHIP-14 instrument was applied, and three summary variables were used (prevalence, extent, and severity). Sociodemographic and self-perceived health variables were included. Bivariate analyzes were carried out to summarize the variables of the OHIP-14 according to sociodemographic and health variables, and bivariate analyzes of the OHIP-14 dimensions was conducted by country of origin. Multivariate linear models were used to investigate predictors for the dimensions of the OHIP-14. Multivariate logistic models were used to estimate the association of OHRQoL with immigration status using crude and adjusted odds ratios with 95% confidence intervals (OR-95% CI). It was found that 14.8% of men and 23.8% of women reported negative impacts in terms of OHRQoL (statistically significant differences: p < 0.05). There were statistically significant differences according to the country of origin in the prevalence and severity outcomes of the OHIP-14 in women (p < 0.05), and severe outcomes were observed in Moroccan women. In women, statistically significant differences (p < 0.05) in OHRQoL were observed according to age and marital status. There were some differences between OHIP-14 summary outcomes according to the health variables. Some sociodemographic and health variables were predictors for the OHIP-14 and their dimensions with differences by sex. Multivariate analysis showed a statistically significant association between OHRQoL and immigration status for Moroccan women. Differences in OHRQoL were found according to sociodemographic and health variables. Further research could clarify the predictors of OHRQoL through epidemiological surveillance and longitudinal studies.

Amyotrophic lateral sclerosis mortality rates among ethnic groups in a predominant admixed population in Latin America: a population-based study in Ecuador.

Current evidence suggests heterogeneity of amyotrophic lateral sclerosis (ALS) among geographic areas and populations. Lower mortality rates have been reported in admixed populations compared to European origin populations. We aimed to describe and compare ALS mortality rates among ethnic groups using a population-based approach in a multiethnic country. Annual mortality cause registers were searched to determine ALS deaths from the National Institute of Statistics and Censuses in Ecuador (INEC) from 1990 to 2016. Mid-year population was considered for each year. The time trend was assessed using a negative binomial regression. Rate ratio statistics were performed to compare the age and sex standardized rates based on the 2010 US population among ethnic groups. Overall, 570 ALS deaths were identified. ALS mortality showed an age-related profile with a peak between 55 and 70 years. After age-sex standardization on the 2010 US population, mortality rate was 0.33 (CI 0.30-0.36) per 100,000. The time trend showed an increase of ALS mortality (p < 0.001). There was no statistical difference in age-sex standardized mortality rates per 100,000 when admixed was compared to white (p = 0.231) and black (p = 0.125). Differences reached statistical significance between admixed and other ethnics (p = 0.015). Our population-based study supports the hypothesis that ALS occurrence is lower in predominant admixed populations from Latin America compared to European and Northern American populations. Further studies are needed to clarify the role of ancestral origin in ALS susceptibility.

Relación entre estilos parentales y conductas autolesivas sin intención suicida en población ecuatoriana / Relationship between parenting styles and self-harm without suicide intention in Ecuadorian population

Introducción: La familia es un contexto de protección que salvaguarda el desarrollo del individuo. En este ámbito, para el niño, se comienza no solo el aprendizaje de modelos útiles para relacionarse con la sociedad sino que, en su lado deficitario, es el foco de necesidades que han de resolverse por otros medios. Los estilos parentales determinan e influyen en gran medida, las conductas pro sociales o desadaptativas, positivas o negativas, integrativas o disruptivas de los hijos. En este sentido, la necesidad de llamar la atención ha sido relacionada en la literatura con conductas tales como la realización de tatuajes. Objetivo: Desvelar la relación entre conductas autolesivas, llamada de atención y ciertos estilos parentales. Métodos: Se llevaron a cabo distintos análisis correlacionales (utilizando una r de Pearson) con una muestra de 881 estudiantes universitarios, entre los diferentes estilos parentales, las conductas autolesivas y la intención de realizarse un tatuaje. Resultados: Conductas parentales (como el control materno) correlacionan tanto con la realización de tatuajes como con ciertas conductas autolesivas. El amor parental de ambos progenitores, por el contrario, es un factor protector que correlaciona negativamente con este tipo de conductas de autolesión. El dato más claro reside en la correlación positiva entre la negligencia parental (la falta de atención) con las conductas autolesivas. Conclusiones: Se concluye que la llamada de atención es un factor inherente a las conductas autolesivas, aunque tan solo es uno de tantos factores(AU)

Introduction: Family is a context of protection that safeguards the development of the individual. In this area, for the child, learning of useful models begins which they will relate to society later on. It is also the focus of needs to solve by other means. The parental styles, therefore, largely determine and influence the prosocial or maladaptive behaviors, positive or negative, integrative or disruptive of children. In this sense, literature has related the need to draw attention been with behaviors such receiving tattoos. Objective: To show the relationship between self-injurious behavior, attention call and certain parental styles. Methods: We conducted various correlational analysis (using Pearson r) with a sample of 881 college students between the different parenting styles, self-injurious behavior and intent of receiving tattoo. Results: Parental behaviors (such as maternal control) correlate both with receiving tattoo and with certain self-injurious behaviors. Parental love (of both parents), on the other hand, is a protective factor since it correlates negatively with this type of self-harm behavior. The clearest information lies in the positive correlation between parental negligence (and therefore, lack of attention) with self-injurious behaviors. Conclusions: Our study concludes that drawing attention is an inherent factor in self-injurious behavior, although it is only one of many factors(AU)

North of Home: Obligations to Families of Undocumented Patients.

Undocumented and undomiciled, Gustavo Jiménez had been in the United States for several years. He knew his leg wasn't right when it began to swell and redden. After the cellulitis spread to his bloodstream, he was found unconscious on the street and admitted to the intensive care unit. He improved quickly and was soon able to tell a social worker his name and that he had family in Quito. Then his health took a turn for the worse, and he developed multisystem organ failure. His doctors believed his prognosis grave and further care futile. They wanted to invoke a provision under their state's law that allows, at the discretion of at least two physicians, for the withdrawal of life-sustaining therapy for isolated and decisionally incapacitated patients, but the social worker had ethical concerns about the doctors' desire to make such a momentous decision without family input. She asked for a "time-out to locate his family," but one of the doctors asserted, "His family isn't here, and you'll never find them. Besides we need the bed. The ER is full of patients we can help." What is owed a patient and family in such a situation?

Intercultural health in Ecuador: an asymmetrical and incomplete project.

Intimate connections between culture and health are complicated by various understandings of the human body, divergent beliefs about reality and place-bound theories about healing. Health care systems in various countries are modified with a goal of creating 'hybrid' structures that make room for traditional practices within a dominant Western model. But genuine intercultural health care is elusive. In Ecuador, a country with great cultural and geographic diversity, the culture-health spectrum is broad and bumpy. This is especially evident in health care politics, education and administration. A constitution adopted in 2008 aims for inclusivity and equality by incorporating indigenous concepts of the 'good life' and ideals of an intercultural society. These new values and perspectives should be reflected in economics, law, education and health care. But these concepts confront a racial, political and economic history that has delegitimized indigenous systems of knowledge and belief. This paper contrasts 'ideal' and 'real' intercultural health care using case studies of the Tsáchila, an indigenous group in coastal Ecuador. The conclusion is that 'ideal' intercultural health care, as reflected in medical school education and clinical practice, is a superficial attempt at dialogue and understanding between indigenous and western medicine. 'Real' intercultural health care involves a more profound level of mutual respect and cross-cultural understanding that aims for symmetry in patient-doctor relationships. Insights from medical anthropology guide the authors through a critical analysis that addresses interculturality as a political issue and a political struggle that the Tsáchilas - like other indigenous groups - are losing.

Conhecimento e percepções relacionadas ao HIV/AIDS nas comunidades Shuar do Equador / Conocimientos y percepciones vinculadas con el VIH/SIDA en comunidades Shuar del Ecuador / Knowledge and perceptions linked to HIV/AIDS in Shuar communities of Ecuador

RESUMEN Objetivo: Analizar los conocimientos y las percepciones vinculadas con el VIH/SIDA en comunidades Shuar de la parroquia Sevilla Don Bosco - Provincia Morona Santiago, Ecuador. Material y Método: Estudio cualitativo fenomenológico, cuyas técnicas de investigación fueron entrevistas en profundidad y grupos focales. La muestra fue seleccionada por conveniencia; participaron 40 personas entre hombres y mujeres de 14 a 50 años. Los criterios de inclusión fueron: personas Shuar con vida sexual activa y no diagnosticadas con VIH/SIDA. Las categorías de análisis fueron la información, conocimientos y percepciones respecto al VIH/SIDA. Resultados: Los datos reflejan que en las comunidades de Sevilla Don Bosco existe un acceso a la información condicionado por la interacción de la comunidad con las instituciones de salud pública, instituciones educativas y tecnologías de la información y comunicación; los conocimientos y las percepciones sobre el VIH/SIDA varían por género, edad, nivel de educación y el lugar de vivienda de los participantes. Conclusiones: En la comunidad Shuar se expresan limitaciones e imprecisiones de los conceptos y procesos propios del virus y la enfermedad; el tema circula como rumor; los adolescentes mayormente obtienen información en los colegios y por medio de la internet; conocen mejor el VIH/SIDA los hombres y los adolescentes en general; las mujeres tienen limitaciones para expresar conocimientos y opiniones; la enfermedad ha sido estigmatizada; la vulnerabilidad de la población frente a la inmunodeficiencia y el peligro de las enfermedades oportunistas es clara en la comunidad; manifiestan interés y disposición a conocer mejor el VIH/SIDA.

ABSTRACT Objective: To analyze the knowledge and perceptions related to HIV/AIDS in Shuar communities from the parish of Sevilla Don Bosco, Morona-Santiago Province, Ecuador. Materials and Methods: Qualitative phenomenological study using following research techniques: in-depth interviews and focus groups. A convenience sample was used: 40 men and women aged 14 to 50 years participated. The inclusion criteria corresponded to Shuar people with active sexual life and without HIV/AIDS diagnosis. The categories of analysis were information, knowledge, and perceptions regarding HIV/AIDS. Results: The data show that in the communities of Sevilla Don Bosco there is access to information conditioned by the interaction of the community with public health institutions, educational institutions, and information and communication technologies. Knowledge and perceptions regarding HIV/AIDS vary according to gender, age, level of education, and place of residence of the participants. Conclusions: In the Shuar community, limitations and inaccuracies about the concepts and processes of the virus and the disease are expressed. The subject circulates as a rumor. Adolescents obtain information mostly in schools and through the Internet. In general, men and young people have more knowledge about HIV/AIDS. Women have limitations to express knowledge and opinions. The disease has been stigmatized. The population's vulnerability against immunodeficiency and the danger of opportunistic diseases is clear in the community. They show interest and willingness to learn more about HIV/AIDS.

RESUMO Objetivo: Analisar os conhecimentos e as percepções relacionadas ao HIV/AIDS nas comunidades Shuar da paróquia Sevilla Don Bosco - Morona Santiago, Equador. Material e Método: Estudo qualitativo fenomenológico, as técnicas de investigação foram entrevistas em profundidade e grupos focais. A amostra foi selecionada por conveniência; participaram 40 pessoas entre homens e mulheres de 14 a 50 anos. Os critérios de inclusão foram: pessoas Shuar com vida sexual ativa e sem diagnóstico de HIV/AIDS. As categorias de análise foram a informação, os conhecimentos e as percepções em relação ao HIV/AIDS. Resultados: Os dados concluíram que nas comunidades de Sevilla Don Bosco existe acesso à informação condicionado pela interação da comunidade com as instituições de saúde, instituições de educação e tecnologias da informação e comunicação; os conhecimentos e as percepções sobre o HIV/AIDS são diferentes segundo o gênero, a idade, o nível de educação e o local de residência dos participantes. Conclusões: Na comunidade Shuar ficam expressas limitações e imprecisões dos conceitos e dos processos próprios do vírus e da enfermidade; o assunto circula como rumor; os adolescentes com frequência obtêm informação das escolas e através da internet; em geral, homens e adolescentes conhecem mais o HIV/AIDS; as mulheres possuem limitações para expressar conhecimentos e opiniões; a enfermidade tem sido estigmatizada; a vulnerabilidade da população frente à imunodeficiência e o perigo das doenças oportunistas são claros na comunidade; manifesta-se interesse e disposição para conhecer melhor o HIV/AIDS.

A comparison of Kato-Katz technique to three other methods for diagnosis of Amphimerus spp. liver fluke infection and the prevalence of infection in Chachi Amerindians of Ecuador.

BACKGROUND: Recently, a high prevalence of infection by the liver fluke Amphimerus spp. has been documented in the Chachi Amerindians of Ecuador. For diagnosis, no studies exist that compare the sensitivity of different coproparasitological detection techniques. The present study compares the Kato-Katz technique with three other coproparasitological methods for detecting eggs of Amphimerus in stools, as well as determines the prevalence of infection in Chachi residents in a Tropical rain forest area in the northwest coast of Ecuador. METHODOLOGY/RESULTS: A total of 105 samples, utilizing the Kato-Katz technique (KK), the spontaneous sedimentation technique in tube (SSTT), the formalin-ether concentration technique (FEC), and direct smear microscopy (DM), were examined. Combining the four methods (fixed "gold" standard), 38 samples were positive with a prevalence of infection of 36.2%. The sensitivities of individual methods were 71%, 58%, 50% and 3% for KK, SSTT, FEC, and DM respectively. Our results indicated that KK alone had the best performance, detecting 27 (71%) of the 38 positive samples. The combination of KK and SSTT detected amphimeriasis in 36 (95%) samples, and KK and FEC in 31 (82%) samples. CONCLUSIONS: DM showed the lowest sensitivity, which raises concern for its value, because it is the standard technique for stool examination for detection of parasites in both public and private laboratories in Ecuador. SSTT alone detected eggs in 22 samples (58%) and would be recommended for field studies because of its simplicity. Performing two techniques on a single sample enhances the detection of Amphimerus infection. Its sensitivity is relative to a fixed "gold" standard, determined as the combined results of the four techniques performed. This study confirms the high prevalence of human infection by Amphimerus in the indigenous Chachi group where the first human cases were described.

Assessing the influence of working hours on general health by migrant status and family structure: the case of Ecuadorian-, Colombian-, and Spanish-born workers in Spain.

OBJECTIVES: The purpose of this study was to analyze the relationship between working hours (WHs) and the likelihood of poor self-reported general health (SRGH) in the first data wave from a cohort of immigrant and native workers in Spain. STUDY DESIGN: Cross-sectional analyses from a prospective cohort study. METHODS: Data were drawn from the first wave of the Platform of Longitudinal Studies on Immigrant Families. The selected sample was composed of 217 immigrant workers and 89 native-born workers. We explored differences by immigrant status and family structure, assessing prevalences and Poisson regression models; an additional analysis explored statistically optimized work hour cut points. RESULTS: Highest prevalence of poor SRGH (72.7%) was reported by immigrant, single-parent workers working >40 WH/week. Immigrant single-parent families were more likely to report poor SRGH for three WH categories: ≤20 WH/week (prevalence ratio [PR] = 3.3, 95% confidence interval [CI] 1.6-7.2), >30-≤40 WH/week (PR = 2.8, 95% CI 1.3-6.4), and >40 WH/week (PR = 4.2, 95% CI 1.8-10.1). In two-parent families, immigrants working standard hours (i.e. >30-≤40) and native-born workers in the highest and lowest categories of WHs (i.e. ≤20 and >40) had similar PRs for poor SRGH compared with native-born workers working standard hours. Findings suggested that native-born workers residing in two-parent families were able to work more than 10 h longer per week than immigrant workers before reporting equivalent prevalences of poor SRGH. CONCLUSIONS: Differences in the association of WHs and poor SRGH among immigrants in Spain seem to be explained by family structure, which suggests that the influence of WHs on health differentially affects vulnerable groups, such as immigrant workers residing in single-parent families.

A Hispanic mother's beliefs about stuttering aetiology: A systemic functional linguistic analysis.

The aim of this study was to identify the linguistic resources a Hispanic mother used to convey her beliefs about the aetiology of her adult son's stuttering. A qualitative research paradigm was adopted for data collection and analysis. An Ecuadorian mother and her adult son who stutters recorded a conversation in Spanish about the son's stuttering. Tools derived from systemic functional linguistic (SFL) theory were used to analyse conversation transcripts and to describe the word choices and sentence structures the mother used to talk about her son's stuttering. The mother deflected community-assigned blame for causing her son's stuttering by configuring her 'strong' temperament as a separate, uncontrollable entity. She structured the pervasiveness of stigma, lack of resources and misinformation within the community as causes for her inability to identify and seek help for her son's stuttering, which also served as a means for deflecting blame. SFL-based analyses were appropriate tools for the investigation of how a Hispanic mother construes her views, attitudes and experiences relative to her son's stuttering. Clinical implications of findings regarding parent education and the utility of SFL-based tools in the speech-language therapy setting are discussed.

Cracking the Egg Potential: Traditional Knowledge, Attitudes, and Practices in a Food-Based Nutrition Intervention in Highland Ecuador.

BACKGROUND: Food-based interventions can reduce the prevalence of undernutrition and improve household food security, but nutritious and accessible foods may be underutilized. In Ecuador, eggs are inexpensive and widely available, but while they are a valuable source of essential nutrients for infants and young children, medical advice and community-based information have limited their inclusion in infants' diets. OBJECTIVE: A qualitative component was conducted to understand local perceptions, knowledge, and practices to complement a randomized control trial that studied the effect of introducing eggs on nutritional status and growth in infants from 6 to 9 months in rural communities in the highland province of Cotopaxi, Ecuador. METHODS: The qualitative inquiry consisted of key informant interviews, focus group discussions (FGDs), and structured observations in order to understand perceptions, knowledge, and practices related to household egg consumption and to the introduction of eggs in infants' diets. RESULTS: The two principal findings were that: (i) eggs are an available and culturally acceptable food source although they are not always a part of the diet; and (ii) perceptions and practices related to household consumption and the introduction of eggs into the diet of infants are shaped by local knowledge and practices, which are shaped by biomedical information and advice provided by public health professionals. CONCLUSION: Through an effective food-based intervention that includes qualitative research and a social marketing component, the behaviors of mothers and other caregivers can be modified, enabling children to realize the nutritional advantages of early introduction of eggs into their diet.

Efecto de las actividades físicas en la disminución del estrés laboral / Effect of physical activity in reducing work-related stress

Introducción: el estrés laboral, como fenómeno asociado al proceso de industrialización, es causa frecuente de saturación física y metal, provocando una reducción de la efectividad productiva y la calidad del vida de sujeto; en la intervención de este proceso influye, entre otros aspectos, el índice de actividad física y social que posee el individuo y su entorno. Objetivo: disminuir el estrés laboral del personal administrativo de la Universidad de las Fuerzas Armadas ESPE, Sangolquí, Ecuador. Métodos: se investigó una muestra de 47 trabajadores administrativos de una población de 255 sujetos, los cuales fueron sometidos a un diagnóstico mediante una encuesta de 10 preguntas diseñadas para determinar la presencia de algunos síntomas relacionados con el estrés antes y después de implementar un programa de actividades físicas durante seis meses. Resultados: las pruebas realizadas antes y después de iniciar el proceso de aplicación de la propuesta se sometieron al análisis estadístico a partir de la Prueba de Friedman, la cual demostró la existencia de diferencias significativas favorables en el postest (p= 0,000) por la incidencia efectiva del programa de actividades físicas en el grupo intervenido, corroborado por la Prueba de los Rangos con Signo de Wilcoxon que demostró diferencias significativas en todas las categorías estudiadas en las variables (Siempre: p= 0,011; Casi Siempre: p= 0,005; Raras Veces: p= 0,005 y Nunca: p= 0,015). Conclusiones: se determina una disminución del estrés en el personal administrativo al comparar los rangos promedios de la prueba inicial y final aplicada(AU)

Introduction: Work stress, as a phenomenon associated with the industrialization process, is a frequent cause of physical and mental saturation, causing a reduction of the subject's productive effectiveness and quality of life. In the intervention of this process, among other aspects, there is an influence of the index of physical and social activity by the individual and its environments. Objective: To reduce the work stress of the directing staff of ESPE University of the Armed Forces in Sangolquí, Ecuador. Methods: A sample of 47 directing workers was investigated, out of a population of 255 subjects. They underwent a diagnosis through a survey of 10 questions designed to determine the presence of some symptoms related to stress, before and after implementing a program of activities for six months. Results: The tests performed before and after starting the program's application were submitted for statistical analysis through the Friedman test, which showed the existence of significant favorable differences in the post-test (p= 0.000) for the incidence of the physical activity program in the intervention group, corroborated by the Wilcoxon Sign Rank Test, which showed significant differences in all the categories studied in the variables (always: p= 0.011, almost always: p= 0.005, seldom: p= 0.005, and never: p= 0.015). Conclusions: A decrease in stress in the directing staff is determined when comparing the average ranges of the initial and final tests applied(AU)

Efecto de las actividades físicas en la disminución del estrés laboral / Effect of physical activity in reducing work-related stress

Introducción: el estrés laboral, como fenómeno asociado al proceso de industrialización, es causa frecuente de saturación física y metal, provocando una reducción de la efectividad productiva y la calidad del vida de sujeto; en la intervención de este proceso influye, entre otros aspectos, el índice de actividad física y social que posee el individuo y su entorno. Objetivo: disminuir el estrés laboral del personal administrativo de la Universidad de las Fuerzas Armadas ESPE, Sangolquí, Ecuador. Métodos: se investigó una muestra de 47 trabajadores administrativos de una población de 255 sujetos, los cuales fueron sometidos a un diagnóstico mediante una encuesta de 10 preguntas diseñadas para determinar la presencia de algunos síntomas relacionados con el estrés antes y después de implementar un programa de actividades físicas durante seis meses. Resultados: las pruebas realizadas antes y después de iniciar el proceso de aplicación de la propuesta se sometieron al análisis estadístico a partir de la Prueba de Friedman, la cual demostró la existencia de diferencias significativas favorables en el postest (p= 0,000) por la incidencia efectiva del programa de actividades físicas en el grupo intervenido, corroborado por la Prueba de los Rangos con Signo de Wilcoxon que demostró diferencias significativas en todas las categorías estudiadas en las variables (Siempre: p= 0,011; Casi Siempre: p= 0,005; Raras Veces: p= 0,005 y Nunca: p= 0,015). Conclusiones: se determina una disminución del estrés en el personal administrativo al comparar los rangos promedios de la prueba inicial y final aplicada(AU)

Introduction: Work stress, as a phenomenon associated with the industrialization process, is a frequent cause of physical and mental saturation, causing a reduction of the subject's productive effectiveness and quality of life. In the intervention of this process, among other aspects, there is an influence of the index of physical and social activity by the individual and its environments. Objective: To reduce the work stress of the directing staff of ESPE University of the Armed Forces in Sangolquí, Ecuador. Methods: A sample of 47 directing workers was investigated, out of a population of 255 subjects. They underwent a diagnosis through a survey of 10 questions designed to determine the presence of some symptoms related to stress, before and after implementing a program of activities for six months. Results: The tests performed before and after starting the program's application were submitted for statistical analysis through the Friedman test, which showed the existence of significant favorable differences in the post-test (p= 0.000) for the incidence of the physical activity program in the intervention group, corroborated by the Wilcoxon Sign Rank Test, which showed significant differences in all the categories studied in the variables (always: p= 0.011, almost always: p= 0.005, seldom: p= 0.005, and never: p= 0.015). Conclusions: A decrease in stress in the directing staff is determined when comparing the average ranges of the initial and final tests applied(AU)