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RESUMEN Los objetivos de este artículo son describir las características del abordaje de vinculación de bases de datos administrativos y sus usos en investigación en salud pública, y discutir las potencialidades y retos para su implementación en Ecuador. La vinculación de bases de datos permite integrar datos de una misma persona dispersos en distintos subsectores como salud, educación, justicia, inmigración y programas sociales, y posibilita investigaciones que informen una gestión más eficiente de programas y políticas sociales y de salud. Las principales ventajas del uso de bases de datos relacionadas son la diversidad de datos, la cobertura poblacional, la estabilidad temporal y el costo menor en comparación con la recolección de datos primarios. A pesar de la disponibilidad de herramientas para procesar, vincular y analizar grandes conjuntos de datos, el uso de este abordaje es mínimo en los países de América Latina. Ecuador tiene un alto potencial para explotar este abordaje, debido a la obligatoriedad del uso de un identificador único en la prestación de servicios de salud, que permite la vinculación con otros sistemas de información nacionales. Sin embargo, enfrenta una serie de retos técnicos, ético-legales, culturales y políticos. Para aprovechar su potencial, Ecuador necesita desarrollar una estrategia de gobernanza de datos que incluya normativas de acceso y uso de los datos, de manera simultánea con mecanismos de control y calidad de los datos, una mayor inversión en formación profesional en el uso de los datos dentro y fuera del sector salud, y colaboraciones entre entidades gubernamentales, universidades y organizaciones de la sociedad civil.

Background In Argentina, there is evidence suggesting the obesity prevalence follows a social gradient. We analyze geographical differentials and trends in obesity burden according to socio-demographic conditions in Argentina (2005-2013). Methods The geographical distribution (n = 24 provinces) of the obesity burden in adult population of Argentina in 2005, 2009, and 2013 was analyzed by using mapping techniques. The National Survey of Chronic Diseases Risk Factors datasets were used to estimate and map the age-standardized prevalence of obesity (ASPO) and group-specific prevalence (% obesity) by province and year. Population groups were defined according to socio-demographic factors: age, sex, income level, education, and poverty level (by unsatisfied basic needs –UBN). Results Most of the provinces had an increasing ASPO between 2005 and 2013. In 2013, 75% of the provinces showed an ASPO above 20% in men, while 50% of the provinces exceed this ASPO value in women. In both sexes, the middle-aged group presented the most unfavorable situation. Overall, all the socio-demographic groups considered showed growing trends in obesity prevalence, although there were geographical disparities. Among the middle-income level population, a marked rising change was observed from 2009 to 2013. The population with incomplete primary education presented higher prevalence for all the years studied compared to the population with university education. Conclusions Since 2005, there was an overall increase in obesity prevalence in Argentina, with persistence of geographical disparities according to socio-demographical conditions. Key messages An overall rising trend in obesity prevalence was observed in Argentina. Geographical disparities by social groups were observed.

We aimed to develop models to explain performance and pacing during a 10-km running trial. Well-trained runners (n = 27, VO2max = 62.3 ± 4.5 mL·kg−1·min−1) divided into High (HPG, T10km = 33.9 ± 1....

Some rural areas of Ecuador, including the Imbabura Province of the Andes Highlands, are experiencing a double burden of malnutrition where micronutrient deficiencies persist at the same time obesity is increasing as many traditional home-grown foods are being replaced with more commercially prepared convenience foods. Thus, the relationships among agricultural food production diversity (FPD), dietary diversity (DD), and household food insecurity (HFI) of the rural small holder farmers need further study. Therefore, we examined these associations in small holder farmers residing in this Province in the Andes Highlands (elevation &gt, 2500 m). Non-pregnant maternal home managers (n = 558, x age = 44.1, SD = 16.5 y) were interviewed regarding the number of different agricultural food crops cultivated and domestic animals raised in their family farm plots. DD was determined using the Minimum Dietary Diversity for Women Score (MDD-W) based on the number of 10 different food groups consumed, and household food insecurity (HFI) was determined using the 8-item Household Food Insecurity Experience Scale. The women reported consuming an average of 53% of their total food from what they cultivated or raised. Women with higher DD [MMD-W score &ge, 5 food groups (79% of total sample)] were on farms that cultivated a greater variety of crops (x = 8.7 vs. 6.7), raised more animals (x = 17.9 vs. 12.7, p &lt, 0.05), and reported lower HFI and significantly higher intakes of energy, protein, iron, zinc, and vitamin A (all p &lt, 0.05). Multiple regression analyses demonstrated that FPD was only modestly related to DD, which together with years of education, per capita family income, and HFI accounted for 26% of DD variance. In rural areas of the Imbabura Province, small holder farmers still rely heavily on consumption of self-cultivated foods, but greater diversity of crops grown in family farm plots is only weakly associated with greater DD and lower HFI among the female caretakers.

Modern food systems generate social inequalities in the access to healthy food, but some families maintain behaviors that provide an alternative to these systems. Agroecological consumers (ACs) and non-agroecological direct market consumers (DMCs) are key actors in alternative food systems. We assessed the characteristics of ACs and DMCs using data from a representative sample of households in Ibarra, Quito and Riobamba (n = 2914). We also deepened the exploration of motivations for adopting these practices through mini-ethnographies with families who were identified as ACs or DMCs (n = 15). We found motivations related to personal health problems, food quality (e.g., taste, freshness), and safety (e.g., avoiding pesticides) to be key. Other motivations were price and community solidarity with farmers. Barriers included inconvenience, lack of awareness, and insecurity of market location. Using Chi-square tests, we found differences between ACs and DMCs on place of residence, education, employment, health, and diet. Controlling for socioeconomic and health variables using logistic regressions, we found DMC dietary habits to be similar to the remainder of the study population, except that they were less likely to eat processed foods less frequently (adjusted odds ratio (AOR) 0.6, 95% confidence interval 0.4&ndash, 0.9). In contrast, ACs were more likely than the remainder of the study population to control their salt intake (3.2, 1.9&ndash, 5.2) and have greater knowledge of nutrition labels (2.8, 1.7&ndash, 4.6). They were more likely to eat traditional foods frequently (1.9, 1.1&ndash, 3.3), fruit and vegetables daily (1.6, 1.0&ndash, 2.8), and processed foods less frequently (2.7, 1.5&ndash, 4.8). Hence, these two types of alternative food provisioning practices (AC and DMC) were adopted by different types of consumers, with heterogenous motivations and food consumption practices. These findings have implications for public health initiatives aiming to scale up the nutrition and ecological potential of alternative food systems.

Antecedentes: La enfermedad renal crónica (ERC) conlleva una alta morbimortalidad; los programas de prevención son eficaces para lograr mejores desenlaces clínicos.Objetivo: Determinar la frecuencia de inicio de diálisis y mortalidad en un grupo de adultos con ERC avanzada y evaluar qué variables clínicas y demográficas se asocian con estos desenlaces.Materiales y métodos: Estudio de cohorte retrospectiva en el que se evaluaron 511 pacientes con ERC en estadios 3 a 5, admitidos en un programa de prevención entre abril 2010 y mayo 2013. Se calcularon tasas de densidad de incidencia. La asociación entre los factores clínicos y demográficos con los desenlaces se evaluó usando regresión de Cox.Resultados: Los 551 pacientes evaluados contribuyeron con 1.199 años-riesgo; del total de pacientes 301 (54,6%) fueron mujeres; la media de edad fue de 75,8 años; las principales causas de ERC fueron hipertensión 431 (78,2%) y diabetes 101 (18,3%). Al ingreso al estudio, la mediana de tasa de filtración glomerular (TFG) fue 40,9 ml/min/1,73m² y la de índice de masa corporal IMC fue de 22,9 kg/m².La tasa de inicio de diálisis fue 2,1 por 100 pacientes-año; se observó que otras causas de ERC (diferentes a hipertensión) y la diabetes, predicen mayor riesgo de inicio de diálisis, por el contrario, la mayor TFG y la mayor edad, menor riesgo.La tasa de mortalidad fue 2.9 por 100 pacientes-año, los mejores predictores encontrados para este desenlace fueron TFG, IMC y sexo masculino; la elevación de la TFG y del IMC, están asociadas con menor riesgo. Conclusión: La mayor TFG disminuye el riesgo para ambos desenlaces; a diferencia de otros estudios, la edad avanzada parece ser predictor de bajo riesgo de mortalidad y no fue un buen predictor de inicio de diálisis.

OBJECTIVEDiagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection.METHODSA cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule.RESULTSAmong 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94).CONCLUSIONSThe prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted.

ResumenLa ehrlichiosis es una infección no reconocida ni sospechada en nuestro medio, sin embargo, ciertas características epidemiológicas hacen que deba pensarse en esta entidad a la hora de abordar a un paciente con un cuadro clínico compatible. Presentamos el caso de un soldado joven con factores de riesgo claros para zoonosis, con fiebre, erupción petequial, trombocitopenia, hepatitis y disfunción orgánica múltiple a quien se le confirmó infección por Ehrlichia chaffeensis por medio de serología luego de descartar infecciones comunes y otras infecciones por vectores.Existen limitaciones en los registros de este tipo de enfermedades pues no son de notificación obligatoria y un alto número cursan de manera subclínica, lo que hace probable un elevado subregistro. La importancia de tener en mente esta condición radica en que el retraso del tratamiento se asocia a mayor incidencia de complicaciones, incluyendo desenlaces fatales.AbstractHuman ehrlichiosis is an infection that is neither suspected or recognized in our country. Certain epidemiologic clues should arouse suspicion for this entity when the symptoms are suggestive. We present a case of a young soldier with clear risk factors for zoonotic infection, with fever, a petechial rash, thrombocytopenia, hepatitis and multiple organ failure, for whom a diagnosis of Ehrlichia chaffeensis was confirmed by serology after ruling out common infections and other infections caused by vectors.There are important limitations in documenting these cases, because there is no mandatory public reporting and a significant proportion of these cases are asymptomatic, leading to underdocumentation. It is however, of critical importance to raise awareness about this entity since delays in treatment portend a higher incidence of complications, including death.

OBJECTIVES The nutrition and physical activity transitions, characterized by increased consumption of high energy density foods and more sedentary lifestyles, are associated with increased obesity and hypertension in Ecuador. These transitions have been characterized primarily in urban areas, which may neglect variation in specific rural areas of Ecuador. Therefore we examined the extent of the differences in dietary and activity patterns, obesity prevalence, and blood pressure (BP) in urban and rural-dwelling women in the Ecuadorian central highlands. METHODS Urban-dwelling women (UW, n = 198, mean age = 44 years) from three areas of a city of 250,000 residents and rural women (RW; n = 202, mean age = 47 years) from three remote communities in the same province (Chimborazo) were randomly selected and surveyed for dietary and activity practices, BP, and anthropometrics. RESULTS Ninety percent of UW reported obtaining their food primarily from markets while 65% of RW women obtained their food primarily from their own cultivation. Cookies, cakes, candies, ice cream, and French fries were consumed more frequently by UW. RW reported lower consumption of beef, poultry, and chicken, as well as fruits, milk, and white rice. UW compared to RW women spent less time walking and in strenuous work activities. Obesity (BMI > 30 kg/m2 ) (UW = 18.7% vs RW = 9.2%) and hypertension (UW = 15.7%, RW= 3.0%) were more common in UW. Average systolic and diastolic BP was significantly higher in UW. CONCLUSIONS The nutrition and physical activity transitions appear more evident in urban- compared to rural-dwelling women, and are associated with more obesity and higher BP.

The contribution of community-based interventions, including farmer field schools (FFSs) in integrated pest management (IPM), to reducing pesticide exposures and associated neurotoxic burden among small-farm families in Ecuador was assessed in three Andean farming communities in a co-design of targeted action-research. Baseline questionnaire surveys elicited pesticide-related knowledge, practices, and exposure and neurobehavioral assessments were done using an adapted WHO battery. Pesticide applications on plots farmed by FFS versus non-FFS participants were compared. A year later, repeated surveys of participating households (n = 29) and neurobehavioral testing of individuals (n = 63) permitted comparisons of pre- and post-intervention values. The FFS graduates applied pesticides on their plots less frequently (p = 0.171). FFS households had increased pesticide-related knowledge of labels and exposure risk factors (both p < 0.004), better pesticide-handling practices (p < 0.01), and less skin exposure (p < 0.01). Neurobehavioural status had improved, particularly digit span and visuo-spatial function, resulting in overall z-score increases. Thus, community interventions reduced pesticide use, reported skin exposure, and neurotoxic burden among smallholder farm families.