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There is no evidence evaluating the IL10 epigenetic upregulation among mestizo children in a high-altitude Andean city in Latin America. OBJECTIVE: To identify polymorphisms and methylation profiles in the IL10 gene associated with asthma in children aged 5 to 11. METHODS: A case-control study was conducted with asthmatic and non-asthmatic children aged 5 to 11 years in Cuenca-Ecuador. Data on allergic diseases and risk factors were collected through a questionnaire for parents. Atopy was measured by skin prick test (SPT) to relevant aeroallergens. Three IL10 single nucleotide polymorphisms were evaluated in all participants, and methylation analysis was performed in 54 participants. Association between risk factors, allergic diseases and genetic factors were estimated using multivariate logistic regression. RESULTS: The results of polymorphisms showed no differences between cases and controls when comparing the SNPs rs3024495, rs3024496, rs1800896 allelic and genotypic frequencies. In the methylation analysis, no differences in the IL10 methylation profile were found between cases and controls; however, the multivariate analysis showed an association between the mother's smoking habits and the IL10 methylation profile. CONCLUSION: Smoking habit could be essential as an environmental exposure factor in regulating gene expression in children with asthma.

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BACKGROUND: National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries. METHODS: The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were assessed using descriptive statistics. RESULTS: Twenty-three (response rate = 85.2%) informants provided data, mainly from the health sector (52.2%), followed by the sport (26.1%), transport (13.0%), and education (8.7%) sectors. Most informants reported that their countries had a current PA policy embedded within noncommunicable diseases prevention plans (46.2%), other plans (46.2%), or obesity prevention/management/control plans (7.7%). Respondents at the subnational level rated PA promotion as central (64.3%), while the national-level role was important but not central (75.0%). National and subnational policymakers indicated low-to-little involvement in the other level's PA policy processes across the 5 policy stages. CONCLUSIONS: This study demonstrated that collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network was feasible. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels.

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Introduction. The intake of energy-dense unhealthy food at school could influence the overall energy intake of children. Objective: To characterize the patterns of buying a snack at school and to analyze the association of these patterns with the source of the school snack (brought from home or bought at school) and screen time. Materials and methods: A cross-sectional study was conducted from October 2018 until May 2019 among school children (9 to 12-year-olds) from Cuenca-Ecuador. Intake of energy-dense unhealthy food groups, the source of the school snack, and screen time were assessed using questionnaires. Multiple correspondence analysis was used to identify intake patterns of unhealthy food groups, and logistic regression to assess the association between intake of energy-dense unhealthy food groups (FG) with the school snack source. Results: Among 1,028 children recruited 63%, 42%, 30% and 22% of the children reported consuming sweets/confiture, savory snacks, fast food, and pastry products, respectively, at least two days per week. Around 39% of the children were classified as "Frequent consumers of energy-dense unhealthy FG". Buying the snack at school was associated with a more frequent intake of sweets/confiture (OR=1.56, CI 95% =1.05-2.32) and fast food (OR=2.01, CI 95% =1.15-3.50) during the week, as well as with being classified in the "frequent consumer of energy-dense unhealthy FG" (OR=1.99, 95% CI=1.40-2.82). Conclusions: Ecuadorian children still consume prohibited unhealthy foods at school. These results reinforce the importance of evaluating, monitoring, and adapting strategies to promote a balanced diet(AU)

Introducción. La ingesta de alimentos poco saludables con alto contenido energético en la escuela podría influir en la ingesta energética total de los niños. Objetivo: Caracterizar los patrones de compra de snacks en el colegio y analizar la asociación de estos patrones con la procedencia del snack escolar (de la casa o comprada en el colegio) y el tiempo de pantalla. Materiales y métodos: Se realizó un estudio transversal (octubre 2018-mayo 2019) en escolares (9-12 años) Cuenca- Ecuador. La ingesta de grupos de alimentos (FG) no saludables altos en energía, la fuente del snack escolar y el tiempo de pantalla se evaluaron mediante cuestionarios. Se utilizó análisis de correspondencias múltiples para identificar patrones de ingesta de FG poco saludables y la regresión logística para evaluar asociación entre la ingesta FG no saludables con la fuente del snack escolar. Resultados: En 1.028 niños 63%, 42%, 30% y 22% declararon consumir dulces/golosinas, aperitivos salados, comida rápida y productos de pastelería, respectivamente, al menos dos/días/ semana. Un 39% fueron clasificados como "Consumidores frecuentes de FG poco saludables de alta densidad energética". La compra de los snacks en el colegio se asoció con una ingesta más frecuente de dulces/golosinas (OR=1,56; IC95%=1,05-2,32) y comida rápida (OR=2,01; IC95%=1,15-3,50) durante la semana y con la clasificación en el grupo" consumidores frecuentes de FG poco saludables de alta densidad energética" (OR=1,99; IC95%=1,40- 2,82). Conclusiones: Los niños ecuatorianos aún consumen alimentos no saludables prohibidos en la escuela. Estos resultados refuerzan la importancia de evaluar, monitorear y adaptar estrategias para promover una dieta balanceada(AU)

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Cardiovascular diseases have their origins in childhood. At least 20% of children and adolescents in Latin America are overweight or obese. However, little is known regarding the cardiovascular risk of young children living in the region. This paper aims to identify associations between socio-demographics, adiposity, and dietary intake with cardiometabolic risk among children between 6- and 8-years old living in urban and rural Andean regions of Ecuador. A cross-sectional study was conducted among 267 children attending elementary schools between February and August 2018. Sociodemographic data were collected using a structured interview. Bodyweight, height, and waist circumference were measured in duplicate; blood samples were taken after overnight fasting to determine blood lipids, hepatic enzymes, and adipokines; food intake data was assessed by two 24-h recalls administered to the guardians. Associations between cardiometabolic risk (i.e., blood lipids, hepatic enzymes, and adipokines) with sociodemographic characteristics, dietary intake, and waist circumference were tested using multiple hierarchical regression models. Twenty-nine percent of the children were overweight or obese, 12% had low HDL levels, and over 18% had high levels of LDL and triglycerides. Children living in the urban region had lower levels of HDL (ß-4.07 mg/dL; 95% CI: -7.00; -1.15; P = 0.007) but higher levels of LDL cholesterol (ß 8.52 mg/dL; 95% CI: 1.38; 15.66; P = 0.019). Hepatic enzymes were also higher among urban children (SGOT: ß% 22.13; 95% CI: 17.33; 26.93; P < 0.001; SGPT: ß 0.84 U/L; 95% CI: 0.09; 1.59; P = 0.028). Leptin blood levels were higher (ß% 29.27; 95% CI: 3.57; 54.97; P = 0.026), meanwhile adiponectin plasma concentrations were lower among urban children (ß%-103.24; 95% CI: -58.9; -147.58; P = < 0.001). Fiber intake was inversely associated with total cholesterol (ß-9.27 mg/dL; 95% CI -18.09; -0.45; P = 0.040) and LDL cholesterol blood levels (ß-9.99 mg/dL; 95% CI: -18.22; -1.75; P = 0.018). Our findings demonstrate that young children are at high cardiovascular risk; if no actions are taken, the burden of non-communicable diseases will be substantial. The differences in risk between rural and urban areas are evident; urbanization might predispose children to a different reality and, in most cases, result in poor habits.

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To increase physical activity levels in children, knowledge on how school playgrounds can be optimally designed is important. Until now, the contribution of playground variety and greening to children's physical activity level during recess remains unclear. This study examined the associations of school playground variety and greening with energy expenditure (EE) in elementary school children in Ecuador and Belgium. Additionally, moderating effects of study site and gender were studied. Observational data were collected using SOPLAY in ten schools in East Flanders (Belgium) and Cuenca (Ecuador). Data were analysed with linear mixed-effects model analyses. Results showed that independent of study site, EE was higher in playground areas with less green elements, and a higher level of total variety. Primary surface was only associated with EE in boys, they were more active when an artificial surface was present. Implementation of loose equipment was somewhat more strongly positively associated with EE in Ecuadorian than in Belgian children. Because of the well-known restorative effects of green elements, we do not wish to suggest that less greening should be implemented at schools. However, ideally green spaces should be designed in a way that active play is stimulated by combining green elements with other improvements.

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BACKGROUND: Asthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. METHODS: We used data from a prospective cohort of 213 children aged 5-17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). RESULTS: During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72-1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14-0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04-0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90-1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10-1.58, P = 0.003). CONCLUSIONS: In a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.

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BACKGROUND: Nature relatedness can be associated with health-related outcomes. This study aims to evaluate the associations of nature relatedness with physical activity and sedentary behavior. METHODS: A cross-sectional study involving 9-12 year old children living in Cuenca, Ecuador, was conducted between October 2018 and March 2019. Questionnaires were used to evaluate physical activity (PAQ-C), out-of-school sedentary behavior, nature relatedness and wellbeing. Associations of nature relatedness with physical activity, and sedentary behavior were evaluated using linear regression models or tobit regressions adjusted by age, sex, school type, wellbeing, and body mass index z-score. RESULTS: A total of 1028 children were surveyed (average age:10.4±1.22 years, 52% female.). Nature relatedness was positively associated with physical activity (ß = 0.07; CI 95%: 0.05-0.09; p < 0.001) and non-screen-related sedentary leisure (ß = 3.77 minutes; CI 95%: 0.76-6.68; p < 0.05); it was negatively associated with screen time (ß = -5.59 minutes; CI 95%: -10.53-0.65; p < 0.05). CONCLUSIONS: Findings suggest that nature relatedness is associated with physical activity and some sedentary behaviors among Ecuadorian school-age children. The promotion of nature relatedness has the potential to improve health.

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INTRODUCCIÓN: El síndrome de intestino irritable (SII) es un trastorno funcional digestivo frecuente en personal de salud, con importantes repercusiones en la calidad de vida, en el trabajo, en el sistema de salud y la sociedad. El objetivo del presente estudio fue determinar la frecuencia de reporte del SII y sus subtipos en los historiales médicos del personal de enfermería de un hospital en Cuenca - Ecuador. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, en una muestra aleatoria de trabajadores del área de enfermería del José Carrasco Arteaga de Cuenca-Ecuador, entre junio 2017-abril 2018. De acuerdo con los criterios de Roma III, se valoraron los historiales médicos de los trabajadores para determinar la frecuencia de SII y sus subtipos. Finalmente, se describieron los factores sociodemográficos, laborales y psicológicos del personal de enfermería. RESULTADOS: Fueron evaluados los historiales médicos de 214 miembros del personal de enfermería (media de edad: 38.7±10.4 años, sexo: 95.3% de mujeres). Se encontró diagnóstico de SII en el 7.0% (15/214) del personal evaluado, siendo los subtipos indeterminado (7/15) y mixto (4/15) los más frecuentes. El 20% del personal del área de enfermería con SII tenía trastornos mentales (ansiedad, depresión y/o distimia) y el mismo porcentaje trabajaban por turnos CONCLUSIÓN: Los resultados obtenidos permiten evidenciar que el SII reportado en historiales médicos de personal de enfermería, en la ciudad de Cuenca-Ecuador, es menor a lo esperado (7%). Los subtipos de SII más frecuentes fueron el subtipo indeterminado, seguido del subtipo mixto.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional-digestive disorder in health personnel, with significant repercussions on life quality, work, healthcare system and society. The aim of this study was to determine the frequency of reported IBS and its subtypes in the nursing staffs' medical records of a public hospital, in Cuenca - Ecuador. METHODOLOGY: A cross-sectional, descriptive study, with a randomized sample of nursing workers of Hospital Jose Carrasco Arteaga, Cuenca- Ecuador; between June 2017 and April 2018. According to Rome III criteria, medical records were assessed looking for IBS diagnosis and the subtype. Finally, sociodemographic, occupational and psychological factors among the nursing staff was also described. RESULTS: Two-hundred and fourteen medical records were evaluated (average age: 38.7 ± 10.4 years, 95.3% women). A diagnosis of IBS was found in 7.0% (15/214) of the personnel evaluated. The most frequent IBS subtypes were undetermined (46.7%, 7/15) and mixed (26.7%, 4/15). Twenty percent of the nursing staff with IBS, had mental disorders diagnosis (anxiety, depression and/or dysthymia), the same percent worked shifts. CONCLUSION: The diagnosis of IBS reported in the nursing staff medical records, in Cuenca- Ecuador was lower than expected (7%). The most frequent IBS subtypes were undetermined subtype, followed by mixed subtype.

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BACKGROUND: Allergic diseases are under-investigated and overlooked health conditions in developing countries. We measured the prevalence of food allergy (FA), airborne allergic disease, and allergic sensitisation among adolescents living in 2 socio-demographically disparate regions in Ecuador. We investigated which risk factors are associated with these conditions. METHODS: A cross-sectional study involved 1338 students (mean age: 13 ± 0.9 years old) living in Cuenca (n = 876) and Santa Isabel (n = 462). History of allergic symptoms (noted by parents or doctor) to food, house dust mites (HDM), pollen, and pets were recorded. Sociodemographic characteristics, environmental exposures, and parental history of allergic disorders data were collected. Sensitisation to 19 food and 20 aeroallergens was measured by skin-prick testing (SPT). FA and airborne allergic diseases (to HDM, pollen, cat, or dog) were defined as a report of allergic symptoms noted by doctor, together with a positive SPT (wheal size ≥3 mm). Logistic regression models were used to identify environmental and parental factors associated with allergic conditions. RESULTS: FA was prevalent among 0.4% (95% CI 0.2%-0.9%), and food sensitisation among 19.1% of the adolescents. Shrimp was the most frequent food linked with FA and food sensitisation. Risk factors associated with FA could not be evaluated due to the low prevalence. Food sensitisation was higher among adolescents exposed to family smoking (OR 1.63, 95% CI 1.14-2.34, p = 0.008) and those with parental history of allergic disorders (OR 1.68, 95% CI 1.13-2.49, p = 0.01), but less common among adolescents owning dogs (OR 0.59, 95% CI 0.41-0.84, p = 0.003).Airborne allergic diseases were prevalent amongst 12.0% of the adolescents (95% CI: 10.4-13.9, n = 1321), with HDM as the primary allergen (11.2%). Airborne allergic diseases were less common among adolescents with more siblings (OR 0.79, 95% CI 0.65-0.96, p = 0.02) and those who lived with farm animals in the first year of life (OR 0.47, 95% CI 0.23-0.95, p = 0.04), but, most common among adolescents with a smoking family (OR 1.67, 95% CI 1.04-2.70, p = 0.03) and with a parental history of allergic disorders (OR self-perceived: 2.62, 95% CI 1.46-4.71, p = 0.001; OR diagnosed by a doctor: 4.07, 95% CI 2.44-6.80, p < 0.001). CONCLUSIONS: FA and airborne allergies are less prevalent in Ecuador than in developed regions; there is a great dissociation between the prevalence of allergic disease and allergic sensitisation. Shrimp and HDM were the most prevalent allergens. Risk factors identified in this study to be related to allergic diseases should be considered by physicians, health practitioners, and epidemiologists in Ecuador.