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The fissure of lip, alveolus, and palate is a frequent congenic malformation, characterized by the lack of fusion of the musculocutaneous components of the face, with a prevalence of 1/650. The first intervention is palatoplasty; it can lead to complications such as fistulas, with a prevalence from 0 to 76% on the national level and 6% in Ecuador. It could cause consequences like nasal regurgitation, speech disorders, dysphagia, etc. Its intervention must be interdisciplinary. General objective: To determine the prevalence of post-surgery fistulas in users with fissure of lip, alveolus, and palate, assisted at the Hospital Vicente Corral Moscoso (HVCM), in the period from January 2016 to December 2019. Methodology: Descriptive study, of retrospective court; done through the revision of forty medical reports of users with fissure of lip, alveolus, and palate, who show fistula, assisted from January 2016 to December 2019 at the HVCM. The information was recollecting in a form and analyzed in the programs SPSS and Excel. Results: forty medical reports obtained by fissure of lip, alveolus, and palate’s users with fistula, the most prevalent type of fistula was the IV (hard palate) with 20%. According to the CIE-10’ s classification, the most frequent fissure is Q35.0 (hard bilateral palate), with 45%; the average of surgical interventions is 2.4; the media of age is 9.7 years, and the trend is 6 years. Finally, the gender with a higher frequency corresponds to the men with 70%. Conclusion: The 94% users assisted at the HVCM did not exhibit fistula or meet the criteria of inclusion for the study, the case being that 6% of registered users obtain fistulas, the most frequent type was IV (hard palate) with a 20%.

Cleft lip palate (CLP) is one of the most common craniofacial malformations globally, the prevalence is 65%, affecting 1 per 600 to 1000 live births (1). The Latin American Institute of Congenital Malformations ECLMC establishes a rate of 10.49% per 10,000 live births. In Ecuador, an incidence of 14.96 per 10,000 births is registered(2). In Vicente Corral Moscoso Hospital, (period 2010- 2015) a prevalence of 37.4% was registered(3). There is a high rate of this malformation. General objective: To determine the prevalence of cleft lip and palate in newborns, Hospital José Carrasco Arteaga, period 2012-2020, Cuenca-Ecuador. Methodology: Retrospective descriptive study in newborns with FLAP attended at the José Carrasco Arteaga Hospital, period 2012-2020. A total of 88 users who met the inclusion criteria were obtained. The research was carried out subject to ICD10, since this public health entity handles this diagnostic coding. The data obtained were extracted from clinical records and recorded in the collection form. The information was entered into SPSS STATISTICS version 25 software. Results: During the 9 years of the study (2012-2020), 88 cases of newborns with FLAP attended at this institution were recorded. Male sex predominated (58%), the most frequent cleft was hard palate and soft palate cleft (17%), the most frequent origin was Azuay (61.36%), the period with more cases registered was 2015-2017 (43.18%). Most cases were not associated with syndromes (94.31%).

Dysphonia is considered an alteration in the qualities of the voice. The user diagnosed with dysphonia has difficulties for the oral communicative exchange at a social, work and emotional level, adding comorbid factors such as age, sex, vocal habits, type of vocal user and the self-perception of her voice; In the last 5 years, studies have been carried out worldwide, where it has been recorded that users diagnosed with dysphonia have had stress and anxiety factors that are part of a more complex clinical picture; The subjective affectation at the organic-functional level, which causes dysphonia, can be determined using the Voice Handicap Index (VHI) Test, which has three sections, vocal functioning, physical, vocal and emotional state in relation to dysphonia, contributing significantly to the approach Therapeutic speech therapy and to determine the impact of the condition perceived by the user and their mood, visualizing it holistically through the results obtained from the test. Treatment aimed at any type of dysphonia; be it organic, functional or organic-functional with hypofunctional and hyperfunctional characterization, it requires an important multidisciplinary team to address different approaches such as the intervention of the ENT and the Speech Therapist. Type of study: Prospective descriptive cross-sectional study. General Objective: To determine the vocal self-perception of users diagnosed with dysphonia who attended the outpatient area of adult speech therapy at the José Carrasco Arteaga Hospital in the period March 2019 - March 2020. Methodology: The sample was comprised of 70 users diagnosed with dysphonia that attended the outpatient adult speech therapy area of the José Carrasco Arteaga Hospital between the period March 2019 - March 2020. The personal information and medical diagnosis of each patient was collected by reviewing the medical records and in which the contact telephone numbers, through which the data collection sheet and the VH

Phonological awareness is a metaphorological ability that refers to the ability to identify the sounds that make up speech, allows to know and use the phonemes that constitute a word. Deficit in phonological awareness skills causes difficulties in literacy learning in the school stage. General objective: To determine the development of Phonological Awareness in schoolchildren from 5 to 7 years at the Zoila Aurora Palacios Cuenca 2020 School of Basic Education. Methodology: The PECFO Phonological Awareness Assessment Test was applied, the scores were recorded in the general test registration protocol, the results were interpreted using the test standards, obtained the information was recorded on the Form, tabulating with the program SPSS Statistics V. 22 and Microsoft Excel. Results: 54.0% were women and 46.0% were men. Depending on the age, they had 7 to 7 years 11 months with 51.6%, depending on the year of basic education, most belonged to 3rd basic with 38.7%. In silabic consciousness a normal result of 73.4% was obtained, while 8.9% had deficits. In fonémic awareness, 66.2% achieved a normal result and 16.1% deficit. Conclusion: It was determined that 69.4% of children mostly have a development of normal phonological awareness, however there is a representative percentage of 16.9% that is at risk and a minimum percentage of 13.7% have deficit.

The application of a special examination to the processes is fundamental to determine the level of fulfillment of the objectives and based on the results of the examination to make the pertinent decisions. The application of the special examination to the Cooperativa de Ahorro y Crédito Jardín Azuayo will provide a more complete approach to analyze its management and financial analysis, to date, March 2018 the cooperative presents "783 million United States dollars of America in assets, of which $ 110,657,250.43 represent investments, $ 556,279,860.46 loan portfolio, accounts receivable $ 7,020,778.32, thanks to the philosophy and joint work of its members have made it possible for the Cooperative count on 436,340 partners "distributed in 7 provinces of Ecuador. This integrating project is aimed at the process of managing risk assets in the Cooperativa de Ahorro y Crédito Jardín Azuayo Office Cuenca, 2016-2017 period, it is essential to analyze in a concise way the most relevant risk assets for the cooperative in terms of its management and financially for good decision-making and cooperative growth. The methodology used in the present project was quantitative and qualitative for the delimitation of the components to be analyzed, through the collection of information work papers were elaborated, application of financial indicators, audit tests to issue a final report containing findings, conclusions and recommendations.

Dysphonia is a vocal disorder of multifactorial origin, including biological, anatomical, emotional and lifestyle aspects. All these, combined or in isolation with intense vocal demand contribute to the appearance of vocal pathologies and affects the qualities of it. The voice is related to the physical and emotional aspects of each individual, it is an essential work tool that allows communication and mediation with other individuals. People with vocal alterations can present difficulties at a social, professional and emotional level that interfere in their performance and impact on communication. (1)Type of study: This research is descriptive-retrospective.General Objective: To determine the prevalence of dysphonia and its etiology in the patients of Area # 3 of Rehabilitation of adults of the Hospital José Carrasco Arteaga, in the period 2017-2018.Methodology: To determine the prevalence of dysphonia and its etiology in Hospital "José Carrasco Arteaga", a review of the clinical history was made in the database of those patients who presented a diagnosis of Dysphonia during the last 2 years. The data that was obtained was tabulated through the SPSS version 22 and Microsoft Excel programs, using frequency tables and percentages to better understand the results.Results:In this study, 145 patients were registered, of which 67.59% were women and 32.42% men. 42.76% among men and women were engaged in education, followed by "Others" (retirees, housewives, students and health personnel) with 40.00%. The most frequent age was recorded in “older than 61 years” with 33.79%, and among the “51 to 60 years” with 30.35%. As for the most representative etiologies, they are of an “Acquired” character (Laryngeal cancer, thyroidectomies and GERD), in women with 27.59% and in men with 15.55%, due to vocal overexertion, 13 were found. 10% in women and 8.28% in men. In attending Phonoaudiological Intervention in Area # 3 of Adult Rehabilitation it was shown that 57.93% did not go to t

GENERAL OBJETIVE: To determine the performance of the production of the narrative discourse in children from 4 years to 6 years in schools of the Cuenca city during the academic year 2018 – 2019. METHODOLOGY: The present research project is a prospective descriptive observational quantitative study, with a population of 173 boys and girls between the ages of 4 to 6 years of the levels of initial 2 and first year of basic education of the morning section of the millenium educational unit Manuel J. Calle wich belongs to urban zone and the millenium educational unit UEM Sayausí, found in the rural zone of the Cuenca city during the academic year 2018 – 2019. This research Project was done trough the aplication of the third section of the evaluating the production of the narrative discourse (EDNA) which evaluates the production of the Narrative Discourse. USE OF RESULTS: The results obtained after evaluating the production of the narrative discourse, they allowed us to known that. The location of the school of participating children directly influences because the Narrative Discourse Development was with a percentage of 35,84% in rural schools and the 20,81% of children enrolled in urban schools present a normal development of narrative discourse what is at variance with studies conduced in other countries. Thus, in the present research project we have summarized with precisión the results obtained. The results also show that, 11.56% of children of 6 years have a decreased development in narrative discourse, in children of 5 years 5.78% and in children of 4 years only 2.31%.

Background: Three main explanations of the relationship between income and population health have been identified: the absolute, the contextual and the relative income hypotheses. The evidence about their relevance particularly in egalitarian societies is, however, inconsistent. This study aimed to test the three hypotheses in relation to psychological distress in northern Sweden. Methods: Data come from the 2014 cross-sectional survey from the four northern-most counties in Sweden, and included people aged 25-84 years (n = 21 004). Psychological distress was measured by the General Health Questionnaire-12 and income information came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzhaki index. Prevalence ratios (PR) were calculated from log-binomial regression analyses. Results: A gradient in poor mental health was observed across quintiles of individual income, with the poorest substantially more likely to report poor health compared with the highest quintile (PR = 1.56; 95% CI = 1.19, 2.04). Second, municipalities in the quintiles 2-3 of the Gini coefficient had a better mental health compared with those in the most equal municipalities. Third, a gradient in poor mental health across quintiles of relative deprivation was also found, with the most deprived quintile the most likely to report poor health (PR = 1.37; 95% CI = 1.06, 1.76). Conclusion: This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap may be necessary in order to reduce psychosocial distress differences in northern Sweden.

This paper explores whether the principles of horizontal and vertical equity in healthcare are met by the Spanish national health system in the case of the Roma and general populations. The 2011/2012 Spanish National Health Survey (n = 21,650) and the 2014 National Health Survey of the Spanish Roma Population (n = 1167) were analyzed. Use of healthcare services was measured in terms of visits to a general practitioner (GP), visits to an emergency department, and hospitalizations. Healthcare need was measured using (a) self-rated health and (b) the reported number of chronic diseases. The Roma reported worse self-rated health and a higher prevalence of chronic diseases. A redistributive effect (increased healthcare service use among Roma and those in lower socio-economic classes) was found for hospitalizations and emergency visits. This effect was also observed in GP visits for women, but not for men. Vertical inequity was observed in the general population but not in the Roma population for GP visits. The results suggest the existence of horizontal inequity in the use of GP services (Roma women), emergency department visits (Roma and general population), and hospitalizations (Roma population) and of vertical inequity in the use of GP services among the general population.

This paper explores whether the principles of horizontal and vertical equity in healthcare are met by the Spanish national health system in the case of the Roma and general populations. The 2011/2012 Spanish National Health Survey (n = 21,650) and the 2014 National Health Survey of the Spanish Roma Population (n = 1167) were analyzed. Use of healthcare services was measured in terms of visits to a general practitioner (GP), visits to an emergency department, and hospitalizations. Healthcare need was measured using (a) self-rated health and (b) the reported number of chronic diseases. The Roma reported worse self-rated health and a higher prevalence of chronic diseases. A redistributive effect (increased healthcare service use among Roma and those in lower socio-economic classes) was found for hospitalizations and emergency visits. This effect was also observed in GP visits for women, but not for men. Vertical inequity was observed in the general population but not in the Roma population for GP visits. The results suggest the existence of horizontal inequity in the use of GP services (Roma women), emergency department visits (Roma and general population), and hospitalizations (Roma population) and of vertical inequity in the use of GP services among the general population.

Background: The lips, tongue and veil of palate mobility participes in the speech as regularity factor so the phonemes adquire their own characteristics, it alteration is one of the main causes of the articulation disorders. These disorders have favorable prognosis if they are attended properly.However many are identified very late ages or when these are consolidated, for this reason the early evaluation and intervention are very necessary to avoid future problems in the development of the child. General Objetive: To determine the incidence of Articulation Disorders related to labiolinguovelar mobility in children from 36 to 59 months of age of the "Luis Cordero Crespo" preschool, Cuenca 2017-2018. Methodology: Method: The investigation was descriptive, prospective and transversal. The Universe was finite, heterogeneous and initially it was constituted by 230 children from 36 to 59 months of age, they were of male and female sex, and they go the Luis Cordero Crespo preschool in the Cuenca City, Province of Azuay. Only the 150 children were evaluated because the 49 persons didn´t satisfy with the inclusion standard and the others 31 leave the preschool. The information was collected directly, the children were evaluated with the MBGR Protocol, Section 3,4, 5 and also the PLS4 Articulation Screening. The data were analyzed and tabulate through the versión 15.0 of the SPSS program. Results: The150 individuals were evaluated in the investigation, the 30.7% of children didn't present any mobility alteration while that the 69.3% presented them, of which the 45.3% present evolutionary dyslalia, the 12% functional dyslalia and the other 12% didn´t have any articulation disorders

In Ecuador, according to the CONADIS, in 2017, hearing impairment is considered the third cause of disability in the population with 12.86%, in Guacaleo in 2016 the percentage of hearing disability in the male sex corresponds to 55.57%, while that in the female sex it represents 44.43%; so it is important to detect hearing loss in this locality, being the study population schoolchildren from 5 to 9 years. GENERAL PURPOSE To determine the prevalence of hearing loss in schoolchildren from 5 to 9 years old in Guacaleo, 2017. METHODOLOGY The present research project corresponds to a descriptive and cross-sectional study, the Moreno Vazquez Hospital of the Gualaceo parish being the study area. The teachers of the selected schools filled out a school screening card (Annex 2), and the child, not meeting 5 criteria, is a candidate to present a hearing loss. A sample unit was obtained corresponding to 154 schoolchildren (5-9 years) who were selected by simple random sampling, and sent to the Moreno Vázquez Hospital. RESULTS There was a higher frequency of hearing loss in the male sex with 6.5%; the predominant age group is from 6 to 7 years with 4.5%, the highest percentage of patients with hearing loss live in the rural area with 6.5%; The predominant diagnosis is mild conductive hearing loss with 5.8% for OD and 6.5% for LE; finally, hearing loss is 11.7% in all students evaluated.

Ankyloglossia is an alteration that occurs with a short or thick lingual frenulum and is sometimes shown with the tongue completely attached to the floor of the mouth, limiting the functionality of the tongue presenting a lack of mobility, causing newborn problems in the newborn lactation, which is evidenced in the presence of inadequate nutritive suction, therefore this study included the evaluation of the lingual frenulum through the test of the tongue to children from 0 to 6 months in the center of integral rehabilitation CRIE N ° 5 of the city of Cuenca. GENERAL OBJECTIVE: To determine the incidence of ankyloglossia in children from 0 to 6 months of age in the Center for Specialized Integral Rehabilitation CRIE N ° 5. Cuenca 2017-2018. METHODOLOGY: The research was of a descriptive - transversal nature, where the incidence of ankyloglossia was determined in the infants who attended the Center for Specialized Integral Rehabilitation CRIE N ° 5, with the evaluation instrument "Test de la Lengüita". The universe consisted of 134 children aged between 0 and 6 months. The data obtained were tabulated through the SPSS free version program, which allowed the use of frequency and association tables for the analysis of the results. RESULTS: A total of 134 children were evaluated in ages ranging from 0 to 6 months; 25.4% (34) presented Ankyloglossia, with a higher incidence in females, 14.9% (19). Inadequate nutrient suction corresponded to 25.4% (34).

The language is the capacity of the human being that is acquired in the first years of life and that will allow him to communicate ideas, needs and understand a conversation, maintain and store information recept, The main alteration of child development, is the disorder of language development, therefore this study covered the evaluation of children's Centers (CNH) of 3 sectors (Baños, El Valle, Bellavista) of the city of Cuenca. General Objective: Determine the incidence of disorders in the development of language in boys and girls of 18 to 48 months that attend the program to grow with our children "CNH". Methodology: To determine the index of TDL used the instrument of evaluation PLS4, which allowed to obtain the age of development of language that presented the children evaluated in the investigation. This investigation went of transverse descriptive character, with a universe of 120 children, in ages understood between 18 to 48 months, who are distributed in the CHN authorized by the MIES. The obtained information was tabulated by means of the program SPSS 15 free version, which allowed the use of stage of frequency and association for the best comprehension of the results. Results: We evaluated a total of 120 children aged 18 to 48 months, presenting 36 cases (30%) disorder in the development of language, with a greater incidence in males and the CNH El Valle obtained a higher percentage of children with alteration of language

Background: The voice is a work tool that teachers use for much of their days, this over time and bad habits lead to vocal problems. In our environment, voice evaluation is left in the background within occupational health and there is no training for the proper use of it in the teaching staff of all educational levels. General Objective: Determine the incidence of voice problems in teachers of initial education, zone 6 of education district 01d01. Cuenca, October 2017 - March 2018. Methodology and Materials: A descriptive, cross-sectional study was carried out in 51 teachers of initial education, in which a questionnaire of personal and work data, vocal habits, VHI (voice handicap index) and subjective GRABS assessment was applied. Subsequently, the data was processed in the SPSS 15. 0 program, which is presented in the relevant tables. Conclusions: When we relate the rate of vocal disability with the degree of dysphonia, we can see that a large number of teachers with moderate disability have a moderate degree of dysphonia; a p-value of less than 0.005 was also obtained, which indicates that there is a statistical relationship between the rate of vocal disability and the degree of dysphonia.

Background: The elderly population over the years has multiple health problems due to the weakening of different structures and their functionality, as is the case of dysphagia that presents itself in comorbidity to various pathologies, which is why this study assesses the motor skills of the fonoarticulatory organs and swallowing in the elderly. Objective: To determine the incidence of dysphagia in the elderly of the Urban Geriatric Centers of Cuenca 2017-2018 Methodology: A cross-sectional descriptive study was carried out, with an initial population of 185 older adults, 65 years of age and older, both male and female of the urban geriatric centers of Cuenca proposed by the Ministry of Economic and Social Inclusion (MESI). However, 162 older adults were finally evaluated, leaving aside those who did not meet the inclusion criteria. The information was collected directly through the Clinical History and Myofunctional Examination - MBGR (item 5 and other swallowing problems) and the Deglution Screening "GUSS". The data were tabulated and analyzed using the SPSS version 15 program and Microsoft Excel, the results were expressed by frequency and association tables. Results: Of a total of 162 older adults evaluated aged 65 and older, 28.4% do not have dysphagia; 59.9% presented mild dysphagia with a higher incidence of 13.6% in the age range of 86-90 years, this level of dysphagia being the most recorded in the population of older adults evaluated; and 11.1% presented moderate dysphagia and with a lower percentage of 0.6% presented severe dysphagia

BACKGROUND: Early life is thought of as a foundation for health inequalities in adulthood. However, research directly examining the contribution of childhood circumstances to the integrated phenomenon of adult social inequalities in health is absent. The present study aimed to examine whether, and to what degree, social conditions during childhood explain income inequalities in metabolic syndrome in mid-adulthood. METHODS: The sample (N = 12 481) comprised all 40- and 50-year-old participants in the Västerbotten Intervention Program in Northern Sweden 2008, 2009 and 2010. Measures from health examinations were used to operationalize metabolic syndrome, which was linked to register data including socioeconomic conditions at age 40-50 years, as well as childhood conditions at participant age 10-12 years. Income inequality in metabolic syndrome in middle age was estimated by the concentration index and decomposed by childhood and current socioeconomic conditions using decomposition analysis. RESULTS: Childhood conditions jointed explained 7% (men) to 10% (women) of health inequalities in middle age. Adding mid-adulthood sociodemographic factors showed a dominant contribution of chiefly current income and educational level in both gender. In women, the addition of current factors slightly attenuated the contribution of childhood conditions, but with paternal income and education still contributing. In contrast, the corresponding addition in men removed all explanation attributable to childhood conditions. CONCLUSIONS: Despite that the influence of early life conditions to adult health inequalities was considerably smaller than that of concurrent conditions, the study suggests that early interventions against social inequalities potentially could reduce health inequalities in the adult population for decades to come.

Background: The Swedish health care system has successively moved toward increased market-orientation, which has raised concerns as to whether Sweden still offers health on equal terms. To explore this issue, this study aimed (i) to assess if the principles of horizontal equity (equal access for equal need regardless of socio-economic factors) are met in Northern Sweden 2006-14; and (ii) to explore the contribution of different factors to the inequalities in access along the same period. Data came from cross sectional surveys known in 2006, 2010 and 2014 targeting 16-84-year-old residents in the four northern-most counties in Sweden. The horizontal inequity index was calculated based on variables representing (i) the individual socioeconomic status, (ii) the health care needs, (iii) non-need factors as well as (iv) health care utilization: general practitioner (GP), specialist doctors, hospitalization. Decomposition analysis of the concentration index for need-standardized health care utilization was applied. Adjusting for needs, there was a higher use of GP services by rich people during the two last surveys, a roughly equal use of specialists, and hospitalization concentrated among the poor but with a clear time trend toward equality. The pro-rich inequalities in GP use were to a large part explained by the income gap. While health care utilization can be considered equitable regarding specialist and hospital use, the increasing pro-rich trend in the use of GP is a concern. Further studies are required to investigate the reasons and a constant monitoring of socioeconomic differences in health care access is recommended.

BACKGROUND: Despite the goal of the Swedish health system to offer health care according to the principle of horizontal equity, little is known about the equality in access to health care use among young people. To explore this issue, the present study aimed i) to assess horizontal inequity in health care utilization among young people in Northern Sweden; and ii) to explore the contribution of different factors to explain the observed inequalities. METHODS: Participants (N = 3016 youths aged 16-25 years) came from the "Health on Equal terms" survey conducted in 2014 in the four northernmost counties in Sweden. Concentration indices (C) and horizontal inequity indices (HI) were calculated to measure inequalities in the utilization of two health care services (general practitioners (GP) and youth clinics). The HI was calculated based on health care utilization and variables representing socioeconomic status (household income), health care needs factors and non-need factors affecting health care use. A decomposition analysis was carried out to explain the income-related inequalities. RESULTS: Results showed a significant positive income-related inequality for youth clinic utilization in women (C = 0.166) and total sample (C = 0.097), indicating that services were concentrated among the better-off. In contrast, general practitioner visits showed inequality pointing toward a higher utilization among less affluent individuals; significant in women (C = -0.079), men (C = -0.101) and pooled sample (C = -0.097). After taking health care needs into consideration, the utilization of youth clinics remained significantly pro-rich in women (HI = 0.121) and total sample (HI = 0.099); and consistently pro-poor for the GP visits in the pooled sample (HI = -0.058). The decomposition analyses suggest that socioeconomic inequalities explain a considerable portion of the pro-rich utilization of youth clinics services among young women. The corresponding analyses for GP visits showed tha

BACKGROUND: Studies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. Few studies have examined the underpinnings of such sexual orientation inequalities in health. To expand this literature, the present study aimed to employ decomposition analysis to explain health inequalities between people with heterosexual and non-heterosexual orientation in Sweden, a country with an international reputation for heeding the human rights of non-heterosexual people. METHODS: Participants (N = 23,446) came from a population-based cross-sectional survey in the four northernmost counties in Sweden in 2014. Participants completed self-administered questionnaires, covering sexual orientation, mental and general physical health, social conditions and unmet health care needs, and sociodemographic data was retrieved from total population registers. Sexual orientation inequalities in health were decomposed by Blinder-Oaxaca decomposition analysis. RESULTS: Results showed noticeable mental and general health inequalities between heterosexual and non-heterosexual orientation groups. Health inequalities were partly explained (total explained fraction 64-74%) by inequalities in degrading treatment (24-26% of the explained fraction), but to a considerable degree also by material conditions (38-45%) and unmet care needs (25-43%). CONCLUSIONS: Psychosocial experiences may be insufficient to explain and understand health inequalities by sexual orientation in a reputedly 'gay-friendly' setting. Less overt forms of structural discrimination may need to be considered to capture the pervasive material discrimination that seems to underpin the embodiment of sexual minority inequalities. This ought to be taken into consideration in research, policy-making and monitoring aiming to work towards equity in health across sexual orientations.

Background: There has been a substantial increase of income inequalities in Sweden over the last 20 years, which also could be reflected in health inequalities, including mental health inequalities. Despite the growing body of literature focusing on health inequalities in Sweden, income-related inequalities in mental health have received little attention. Particularly scarce are research from Northern Sweden and examinations of the social determinants of health inequalities. Objectives: The present study seeks to provide evidence regarding inequalities in mental health in Northern Sweden. The specific aims were to (1) quantify the income-related inequality in mental health in Northern Sweden, and (2) determine the contribution of social determinants to the inequality. Methods: The study population comprised 25,646 participants of the 2014 Health on Equal Terms survey in the four northernmost counties of Sweden, aged 16 to 84 years old. Income-related inequalities in mental health were quantified by the concentration index and further decomposed by applying Wagstaff-type decomposition analysis. Results: The overall concentration index of mental health in Northern Sweden was −0.15 (95% CI: −0.17 to −0.13), indicating income inequalities in mental health disfavoring the less affluent population. The decomposition analysis results revealed that socio-economic conditions, including employment status (31%), income (22.6%), and cash margin (14%), made the largest contribution to the pro-rich inequalities in mental health. The second-largest contribution came from demographic factors, mainly age (11.3%) and gender (6%). Psychosocial factors were of smaller importance, with perceived discrimination (8%) and emotional support (3.4%) making moderate contributions to the health inequalities. Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings. These findings suggest

Background: The relationship between income and population health has received considerable attention in the last decades. Three main explanations of the relationship have been identified: the absolute, the contextual, and the relative income effects hypotheses. The evidence about their relevance, particularly in egalitarian societies like the Scandinavian one, is however inconsistent. The present study aimed to test the three hypotheses in relation to psychological distress in northern Sweden. Methods: Data come from the 2014 cross sectional survey “Health on equal terms”, from the four northern-most counties in Sweden, and included people 25-84 years (n = 21,004). Psychological distress was measured by the General Health Questionnaire-12 and information on disposable income came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzaki index. The research questions were tested by log-binomial regression analysis. Results: First, a strong individual income gradient in mental ill health was observed, with the very poor more likely to report poor health (PR = 1.56; 95% CI = 1.19, 2.04) compared to the highest income quintile. Second, municipalities in the quintiles 2-4 of the Gini coefficient had a better mental health than those municipalities in the extremes of the distribution. Third, a clear statistically significant gradient in the association of relative deprivation and ill mental health was also found (PR = 1.37 95% CI = 1.06, 1.76). Conclusions: This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap are probably necessary in order to reduce psychosocial distress differences in this population of northern Sweden. Key messages: A strong, moderate and lack of support for the absolute

Objective: This study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV). Methods: A qualitative study was conducted using semi-structured interviews with 160 health professionals working in 16 PHC centres in Spain. Data were analysed using a qualitative content analysis. Results: Four categories emerged from the interview analysis: those committed to the PHC approach, but with difficulties implementing it; community work relying on voluntarism; multidisciplinary team work or professionals who work together?; and continuity of care hindered by heavy work load. Participants felt that person-centred care as well as other attributes of the PHC approach facilitated detecting IPV and a better response to the problem. However, they also pointed out that the current management of the health system (workload, weak supervision and little feedback, misdistribution of human and material resources, etc.) does not facilitate the sustainability of such an approach. Conclusion: There is a gap between the theoretical attributes of PHC and the “reality” of how these attributes are managed in everyday work, and how this influences IPV care., Objetivo: Este estudio presenta las percepciones de profesionales de atención primaria sobre cómo los atributos de la atención primaria en España pueden influenciar las respuestas sanitarias a la violencia del compañero íntimo (VCI). Métodos: Estudio cualitativo con entrevistas semiestructuradas con 160 profesionales sanitarios de 16 centros de atención primaria en España. Los datos se analizaron con el enfoque de análisis de contenido. Resultados: Del análisis de las entrevistas emergieron cuatro categorías: Implicados/as con el enfoque de primaria, pero enfrentando dificultades para implementarlo; El trabajo comunitario depende del voluntarismo; ¿Trabajo multidisciplinario o profesionales que trabajan juntos?; y Continuidad amenazada por la sobrecarga de trabajo. Los participantes consideraron que la atención centrada en la persona y otros atributos del enfoque de atención primaria facilitaban la detección de VCI y una mejor respuesta a este problema. Sin embargo, también reconocieron que la forma en que se gestionan los servicios sanitarios (sobrecarga de trabajo, débil supervisión y escaso feed-back, distribución de los recursos humanos y materiales, etc.) no facilita la sostenibilidad de este enfoque. Conclusión: Existe una brecha entre los atributos teóricos de la atención primaria y la «realidad» de cómo estos atributos se gestionan en la actividad profesional del día a día y de qué manera esta influye en la atención a la VCI.

Background: The voice as the main communication method of human beings should be studied through an objective assessment of its acoustic properties for a precise diagnostic that approaches in an optimal treatment, so that the patient will be rehabilitated. In Cuenca, the population voice acoustic parameters are unknown for that reason raises the need to develop a study to learn their values. Objective: Execute the voice acoustic assessment of students of University of Cuenca, Faculty of Medical Science, School of Medical Technology in 2016. Methodology: This research has a descriptive style with transversal view. Anagraf computer application is used to develop the statistical analysis of the objective voice parameter in real time. Data was compiled in forms and processed in SPSS v.15 form IBM with range, mean and standard deviation and represented it by charts. Results: 136 young healthy students between 18 to 27 years old, 23 men and 113 women were processed. The vowels /a/ and /u/ were recorded and analyzed with Anagraf giving the values of fundamental frequency, formants (F1, F2), Energy, Harmonic to Noise Ratio, Jitter, Shimmer. Range, mean and standard deviation were obtained with the following acoustic parameters values: for the /a/ vowel for men are F0: 137Hz; F1: 126Hz.; F2: 1279Hz.; Energy: 36dB; HNR: 5,02dB; Jitter: 1,07%; Shimmer: 0,38%. And women values are F0: 239Hz.; F1: 319Hz.; F2:1509 Hz.; Energy: 29dB; HNR: 6,69dB; Jitter: 1,18%; Shimmer: 0,51%. For the /u/ vowel for men are F0: 142Hz.; F1: 316Hz.; F2: 1906Hz.; Energy: 37dB; HNR: 6,26dB; Jitter: 1,17%; Shimmer: 0,45%. And women values are F0: 248Hz.; F1: 309Hz.; F2: 1091Hz.; Energy: 31dB; HNR: 6,68dB; Jitter: 1,19%; Shimmer: 0,45%

BACKGROUND: The hearing is an important and fundamental system that allows the acquisition and development of the language in the human beings. The language offers to the human beings the capacity of communication and social participation, favoring the interaction of the same ones inside the cultural group to which they belong. Different factors can alter the hearing of a person, between them the exhibition to the constant noise and of high intensity. The drivers of urban transport are exposed every day to the noise. The level of intensity and the time of exhibition to the noise of the vehicles that they lead they generate alterations in his health, being the hearing one of the most affected and less studied organs of this population. For what is important to know the prevalence of auditory alterations that can generate the exhibition to the noise. GENERAL OBJECTIVE: To determine the auditory capacity in the drivers of the company of urban transport “Ricaurte S.A" of the city of Cuenca 2017. METHODOLOGY: This study is descriptive transverse court. The universe of study includes the drivers of the company of Urban Transport "Ricaurte S.A " of the city of Cuenca that corresponds to 90 patients of masculine sex, in ages between 25 to 60 years. The group of study was realized subjected to and otoscopy and audiometric test, later quantify the results determining the prevalence of auditory alterations of the group of study. The results were interpreted by means of tables and graph. RESULTS: Through the application of hearing tests to the drivers of the public transport company "Ricaurte SA", it was shown that there is a decrease in hearing capacity by 40% from 21 to 40dB in the range of 20 to 40 years, while the 33% presented normal hearing

Background: Voice is the main element of human communication and in certain professions, as in teaching, it is a working tool. Its use and abuse can have serious consequences on the health of the speech apparatus. General Objective: To determine the disturbance index of the Voice in Teachers of the School of Medical Technology and School of Nursing of the University of Cuenca in the year 2017. Methodology and Materials: A descriptive, cross-sectional study was carried out in 50 teachers of the Faculty of Medical Sciences of the University of Cuenca. A survey, a questionnaire for vocal disability index (VHI-30), and an acoustic record through the Anagraf program were applied, data were processed in SPSS 15.0 program, which were later represented in tables. Results: The disturbance measure with the highest percentage of alteration was Jitter, in 50%. When applying the Voice Handicap Index (VHI), it was evidenced that 98% of the teachers had mild vocal disability. According to the incidence of vocal disturbance (PI), 34% of teachers present a risk of vocal disturbance and 22% present vocal disturbance. Conclusion: 56% of the teachers whose voice was analyzed are outside the normal range, there was no statistically significant association between voice disturbance index (PI) with: age, sex, years of teaching and hours at the week that uses the voice to practice teaching.

BACKGROUND This study arises from the high prevalence of cases presented in Bolivia, Ecuador and Paraguay, according to a Latin American collaborative study of congenital malformations (1), which attract anttention the fact that there are no previous studies in the Vicente Corral Moscoso Hospital City of Cuenca, so it is considered important to establish the frequency. GENERAL OBJECTIVE To determine the frequency of cleft lip and cleft palate in patients who attended the Departments of Maxillofacial Surgery and Plastic Surgery of the Vicente Corral Moscoso Hospital in the city of Cuenca, from January 2010 to December 2015. METHODOLOGY It is a descriptive - retrospective study, the universe is made up of all the clinical records of children between 0 and 6 years old, who attended the departments of Maxillofacial Surgery and Plastic Surgery. RESULTS In the present investigation, 305 clinical records of patients with cleft lip and palate were obtained, of which, the greatest frequency was found in males with 63.0%; the age group predominant is 0 months to 1 year with 64.9%; the higher percent of patients is in the province of Azuay with 37.0%, of equal distribution between both genders; the predominant percentage diagnosis is Q37.5 (cleft palate of the hard palate and soft palate with cleft lip, unilateral) presented with 26.6%; It was finally found that 2.2% of the patients had a cleft lip and palate associated with a syndrome.

The main disorder that is evident in children 2 to 4 years of age, is the delay in language, research and early intervention is fundamental for child development. General Objective: To determine the prevalence in the development of language in children aged 18 to 42 months who present a possible delay in their neurodevelopment from the Center of Infants in Good Living in the district of Gualaceo. 2017 Methodology: To obtain results two instruments were used: the pediatric neurodevelopment screening (NPed), through which data was derived in order to obtain a second test known as (PLS IV), which specifically evaluated the age of language development; both comprehensive and expressive language made by the children. This experiment was cross sectional descriptive using 238 children aged between 18 - 42 months, they were from all ten center of Infants from the Gualaceo district. The data was computed using the EPIDAT version 4 program in Spanish and employed graphs, frequency tables and a statistical analysis. Results: To total of 238 preschoolers were evaluated, all aged between 18 - 42 months. According to the data obtained from the pediatric neurodevelopment screening (Nped), 134 children (56.30%) displayed a possible delay in neurodevelopment; these children were also tested using the PLS IV. It was found that there were 55 cases (41.04%) of children with a delay in learning development. In males there were 33 cases (60.00%), in urban areas there were 29 cases (52.73%) and the level of mild involvement with 47 children (19.74%).