The geographic extent of bird populations affected by renewable-energy development.

Bird populations are declining globally. Wind and solar energy can reduce emissions of fossil fuels that drive anthropogenic climate change, yet renewable-energy production represents a potential threat to bird species. Surveys to assess potential effects at renewable-energy facilities are exclusively local, and the geographic extent encompassed by birds killed at these facilities is largely unknown, which creates challenges for minimizing and mitigating the population-level and cumulative effects of these fatalities. We performed geospatial analyses of stable hydrogen isotope data obtained from feathers of 871 individuals of 24 bird species found dead at solar- and wind-energy facilities in California (USA). Most species had individuals with a mix of origins, ranging from 23% to 98% nonlocal. Mean minimum distances to areas of likely origin for nonlocal individuals were as close as 97 to >1250 km, and these minimum distances were larger for species found at solar-energy facilities in deserts than at wind-energy facilities in grasslands (Cohen's d = 6.5). Fatalities were drawn from an estimated 30-100% of species' desingated ranges, and this percentage was significantly smaller for species with large ranges found at wind facilities (Pearson's r = -0.67). Temporal patterns in the geographic origin of fatalities suggested that migratory movements and nonmigratory movements, such as dispersal and nomadism, influence exposure to fatality risk for these birds. Our results illustrate the power of using stable isotope data to assess the geographic extent of renewable-energy fatalities on birds. As the buildout of renewable-energy facilities continues, accurate assessment of the geographic footprint of wildlife fatalities can be used to inform compensatory mitigation for their population-level and cumulative effects.

Extensión geográfica de las poblaciones de aves afectadas por desarrollos de energía renovable Resumen Las poblaciones mundiales de aves están en declive. Las energías solar y eólica pueden reducir las emisiones de combustibles fósiles que causan el cambio climático, aunque la producción de energías renovables representa una amenaza potencial para las aves. Los censos para evaluar los efectos potenciales en los centros de energía renovable son exclusivamente locales y se sabe poco sobre la extensión geográfica representada por las aves que mueren en estas instalaciones, lo que plantea obstáculos para mitigar los efectos acumulativos y de nivel poblacional de estas muertes. Realizamos análisis geoespaciales con datos del isótopo de hidrógeno estable obtenido de las plumas de 871 ejemplares de 24 especies de aves que fueron hallados muertos en los centros de energía solar y eólica en California, EE.UU. La mayoría de las especies contó con ejemplares de orígenes mixtos, con un rango del 23% al 98% no local. La media de la distancia mínima a las áreas de probable origen de los ejemplares no locales varía entre los 97 hasta > 1,250 km. Estas distancias mínimas fueron mayores para las especies encontradas en los centros de energía solar situadas en desiertos que para las especies encontradas en los centros de energía eólica localizadas en pastizales (d de Cohen = 6.5). Las muertes representan un 30­100% de la extensión de las especies. Este porcentaje fue significativamente menor para las especies con extensiones amplias encontradas en instalaciones eólicas (r de Pearson = ­0.67). Los patrones temporales en el origen geográfico de las muertes sugieren que los movimientos migratorios y no migratorios, como la dispersión y el nomadismo, influyen en la exposición de estas aves al riesgo de muerte. Nuestros resultados demuestran la utilidad de los isótopos estables para evaluar el alcance geográfico de las muertes de aves asociadas a energías renovables. Con el progresivo aumento de instalaciones de energía renovable, una evaluación precisa de la huella geográfica de la mortandad de fauna salvaje podrá guiar la mitigación compensatoria de sus efectos acumulativos y de nivel poblacional.

Alimentación complementaria en lactantes y su relación con el estado nutricional / Complementary feeding of Mexican infants and its relation to the nutritional status

Background: Apropiate introduction to complementary feeding (CF) decreases the risk of nutritional diseases in infants; however there is a paucity of information about the characteristics of CF in mexican children. Objective: To characterize the complementary feeding of Mexican infants and its relation to the nutritional status. Methodology: Transversal, analytical and retrospective study in dyads that required medical care. We performed a nutritional evaluation of the infants and characterized the type of lactation, type and texture of initial solid foods and the subsequent feeding. Results: Final sample consisted of 141 children in which, 59.6% reported that feeding was provided exclusively with formula and only 40% received breast milk. 14.1% of the infants showed low weight-for-height, 17.7% low weight-for-age, and 24.1% low height-for-age. We observed that 55.3% of the infants did not receive complementary feeding with appropriate texture; 58.9% did not receive the appropriate amount; and 44.7, 62.4% and 11.3% received inappropriate amounts of carbohydrates, proteins and fats respectively. Conclusion: A high proportion of infants do not receive appropriate complementary feeding.

Introducción: La introducción apropiada a la alimentación complementaria (AC) disminuye las enfermedades nutricionales en los niños; sin embargo, actualmente, no contamos con una caracterización apropiada de la AC que reciben los lactantes mexicanos. Objetivo: Caracterizar la alimentación complementaria de los lactantes mexicanos y su relación con el estado nutricional. Métodos: Estudio transversal, analítico, retrospectivo en diadas (madre y lactantes de cinco a 12 meses de edad) que acudieron a la consulta externa en la IMF No 82 y la guardería infantil IMSS 001. Se realizó una valoración nutricional de los niños y se analizó la lactancia, el tipo y textura de los alimentos sólidos de inicio y subsecuentes. Resultados: la muestra consistió en 141 niños. Unicamente el 40% de los lactantes recibían leche materna. 14.1% de los lactantes presentaron bajo peso para la talla, 17.7% bajo peso para la edad y 24.1% baja talla para la edad. Observamos que 55.3% de los niños no recibían alimentación complementaria con textura apropiada; 58.9% no recibían cantidad apropiada; y 44.7%, 62.4% y 11.3% recibían cantidades inapropiadas de carbohidratos, proteínas y grasas respectivamente. Conclusión: nuestros datos indican que una alta proporción de los lactantes no reciben alimentación complementaria apropiada.

INPP5K controls the dynamic structure and signaling of wild-type and mutated, leukemia-associated IL-7 receptors.

The downstream signaling of the interleukin-7 (IL-7) receptor (IL-7R) plays important physiological and pathological roles, including the differentiation of lymphoid cells and proliferation of acute lymphoblastic leukemia cells. Gain-of-function mutations in the IL-7Rα chain, the specific component of the receptor for IL-7, result in constitutive, IL-7-independent signaling and trigger acute lymphoblastic leukemia. Here, we show that the loss of the phosphoinositide 5-phosphatase INPP5K is associated with increased levels of the INPP5K substrate phosphatidylinositol 4,5-bisphosphate (PtdIns[4,5]P2) and causes an altered dynamic structure of the IL-7 receptor. We discovered that the IL-7Rα chain contains a very conserved positively charged polybasic amino acid sequence in its cytoplasmic juxtamembrane region; this region establish stronger ionic interactions with negatively charged PtdIns(4,5)P2 in the absence of INPP5K, freezing the IL-7Rα chain structure. This dynamic structural alteration causes defects in IL-7R signaling, culminating in decreased expressions of EBF1 and PAX5 transcription factors, in microdomain formation, cytoskeletal reorganization, and bone marrow B-cell differentiation. Similar alterations after the reduced INPP5K expression also affected mutated, constitutively activated IL-7Rα chains that trigger leukemia development, leading to reduced cell proliferation. Altogether, our results indicate that the lipid 5-phosphatase INPP5K hydrolyzes PtdIns(4,5)P2, allowing the requisite conformational changes of the IL-7Rα chain for optimal signaling.

More difficult still: Treating severe rapidly progressive glomerulonephritis in the context of COVID-19 pneumonia.

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.

Gaps in Hypertension Management in a Middle-Income Community of Quito-Ecuador: A Population-Based Study.

Optimal hypertension care and control at population level significantly reduces cardiovascular morbidity and mortality. The study objective was to measure the gaps in the diagnosis, care, and control of hypertension in residents of an urban community in Quito, Ecuador. A cross-sectional population-based study with a sample of 2160 persons was performed using a survey and direct blood pressure measurement. Logistical regression models were used for analyzing factors associated with the gaps, expressed as percentages. The prevalence of hypertension was 17.6% [CI 95% 17.3-17.9%]. The diagnosis gap was 6.1% [CI 95% 5.9-6.2%] among the entire population and 34.5% [CI 95% 33.7-35.3%] among persons with hypertension. No access gaps were detected; whereas the follow-up gap was 22.7% [CI 95% 21.8-23.6%] and control gap reached 43.5% [CI 95% 42.6-44.2%]. Results indicated that being male, older than 64 years, an employee, without health insurance, and not perceiving a need for healthcare, increased the risk of experiencing these gaps. Data showed appropriate access to health services and high coverage in the diagnosis was due to the application of a community and family healthcare model. Notwithstanding, we found significant gaps in the follow-up and control of hypertensive patients, especially among older males, which should warrant the attention of the Ministry of Health.

Ecuadorian adaptation and validation of the Scale ofRisk Factors Associated with Eating Disorders (EFRATA)

El objetivo de este estudio fue adaptar y conocer la estructura factorial y la confiabilidad en la población ecuatoriana de la Escala EFRATA de Factores de Riesgo Asociados a los Trastornos de la Conducta Alimentaria. Se utilizó una muestra no probabilística de 1172 participantes (edad: M = 21.99; DT = 2.49; 58.6% mujeres y 41.4% hombres). El primer estudio de análisis paralelo identificó siete factores interpretables que explican el 50% de la varianza. El segundo estudio de análisis factorial confirmatorio indica un ajuste aceptable (GFI = 0.96; AGFI = 0.95; NFI = 0,94; RMR = 0.08). Los coeficientes de confiabilidad para el alfa de Cronbach y el omega de McDonald's fueron 0.89 y 0.90 respectivamente. La versión ecuatoriana de la EFRATA muestra buenas propiedades psicométricas y se adapta al contexto cultural de este país.(AU)

The objective of this study was to adapt and know the factorial structure and reliability in the Ecuadorian population of the EFRATA Scale of Risk Factors Associated with Eating Disorders. A non-probabilistic sample of 1172 participants were used (age: M= 21.99; SD= 2.49; 58.6% women and 41.4% men). The first parallel analysis study iden-tified seven interpretable factors that explain 50% of the variance. The second confirmatory factor analysis study indicates an acceptable fit (GFI = 0.96; AGFI = 0.95; NFI = 0.94; RMR = 0.08). The reliability coeffi-cients for Cronbach's alpha and McDonald's omega were 0.89 and 0.90 re-spectively. The Ecuadorian version of the EFRATA shows good psycho-metric properties and adapts to the cultural context of this country

Development and characterization of rabbit monoclonal antibodies that recognize human spermine oxidase and application to immunohistochemistry of human cancer tissues.

The enzyme spermine oxidase (SMOX) is involved in polyamine catabolism and converts spermine to spermidine. The enzymatic reaction generates reactive hydrogen peroxide and aldehydes as by-products that can damage DNA and other biomolecules. Increased expression of SMOX is frequently found in lung, prostate, colon, stomach and liver cancer models, and the enzyme also appears to play a role in neuronal dysfunction and vascular retinopathy. Because of growing evidence that links SMOX activity with DNA damage, inflammation, and carcinogenesis, the enzyme has come into view as a potential drug target. A major challenge in cancer research is the lack of characterization of antibodies used for identification of target proteins. To overcome this limitation, we generated a panel of high-affinity rabbit monoclonal antibodies against various SMOX epitopes and selected antibodies for use in immunoblotting, SMOX quantification assays, immunofluorescence microscopy and immunohistochemistry. Immunohistochemistry analysis with the antibody SMAB10 in normal and transformed tissues confirms that SMOX is upregulated in several different cancers. Together, the panel of antibodies generated herein adds to the toolbox of high-quality reagents to study SMOX biology and to facilitate SMOX drug development.

Demographic implications of lead poisoning for eagles across North America.

Lead poisoning occurs worldwide in populations of predatory birds, but exposure rates and population impacts are known only from regional studies. We evaluated the lead exposure of 1210 bald and golden eagles from 38 US states across North America, including 620 live eagles. We detected unexpectedly high frequencies of lead poisoning of eagles, both chronic (46 to 47% of bald and golden eagles, as measured in bone) and acute (27 to 33% of bald eagles and 7 to 35% of golden eagles, as measured in liver, blood, and feathers). Frequency of lead poisoning was influenced by age and, for bald eagles, by region and season. Continent-wide demographic modeling suggests that poisoning at this level suppresses population growth rates for bald eagles by 3.8% (95% confidence interval: 2.5%, 5.4%) and for golden eagles by 0.8% (0.7%, 0.9%). Lead poisoning is an underappreciated but important constraint on continent-wide populations of these iconic protected species.

Human papillomavirus infection and seroprevalence among female university students in Mexico.

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases, and the main etiology of cervical cancer. This study was aimed to assess type-specific cervical HPV prevalence and their association with HPV-specific antibodies in a cohort of female university students. HPV genotyping was performed by amplifying and sequencing a fragment of the L1 protein. A BLAST search was performed to identify HPV types. HPV-specific IgG antibodies were measured by ELISA in serum samples. A total of 129 women participated, with an average age of 21.75 years. The prevalence of vaginal HPV infection was 74.42%. The most predominant high-risk HPV types were 18 (13.95%), 31 (10.85%), and 16 (9.3%). We found that early age at coitarche and a higher number of sexual partners were significantly associated with a high prevalence of HPV infection. In addition to sexual behavior, we observed that the presence of serum-specific IgG antibodies against HPV can impact the prevalence of the virus. Seropositivity to HPV-16 and HPV-18 was associated with a lower prevalence of HPV-16, but not for other HPV types. Of note, there was a lower proportion of HPV-specific seropositivity in women who had the presence of the same HPV type in a cervical specimen, suggesting an immunoregulatory mechanism associated with the viral infection. In conclusion, the prevalence of HPV in university women was higher than expected and it was associated with early age of sexual debut, an increasing number of sexual partners, and a low proportion of HPV seropositivity.

Purshia plicata Triggers and Regulates Proteins Related to Apoptosis in HeLa Cancer Cells.

Cervical cancer represents a public health problem, develops resistance to traditional therapies and cost-of-treatment is high. These disadvantages have led to the search for alternative bioactive-compound-based therapies. Said bioactive compounds include phenolic compounds, flavonoids, and tannins. The present study aimed to evaluate the therapeutic effect of a P. plicata extract on the HeLa cell line. Viability and apoptosis assays were run on the two cell lines treated with the extract. The peptides, up- and down-expressed in both cell lines, were identified by PDQuest analysis software and high-performance liquid chromatography/mass spectrometry/mass spectrometry (HPLC/MS/MS). Our results show that a 500 mg/L treatment deregulated cell viability, with different apoptotic morphologies observed which are associated with the presence of bio-compounds, which up- and down-regulated the peptides. In conclusion, P. plicata regulates proteins associated with apoptosis in HeLa cancer cells.

Etiquetado nutricional de alimentos procesados (semáforo nutri-cional) y su relación con factores socioeconómicos, culturales, demográficos y publicitarios, según padres de niños entre 5-11 años de dos colegios de Quito / Nutritional labeling of processed foods (nutritional stoplight) and its relationship with socioeconomic, cultural, demographic and advertising factors, according to parents of children between 5-11 years of age from two schools in Quito

Introducción: El etiquetado nutricional es una herramienta gráfica para notificar al consumidor sobre las propiedades nutricionales de un alimento lo que facilita su selección. El objetivo del presente estudio fue determinar la influencia del etiquetado nutricional y los factores socioeconómicos, culturales, demográficos, publicitarios en la selección de alimentos en un grupo de padres de niños entre 5-11 años en dos unidades educativas públicas y privadas de Quito. Métodos: Con diseño mixto, cuantitativo- transversal y cualitativa interpretativa se analizó una muestra de opiniones de 240 padres en las Unidades Educativas (UE) Nueva Aurora (Privada) y 235 padres en la UE Julio María Matovelle (Pública) de Quito. Se realizaron tres grupos focales, grabados y transcriptos de forma textual y se aplicó un cuestionario. El paquete esta-dístico usado fue SPSS v24.0. Resultados: Hubo mayor consumo de alimentos procesados en la UE Privada n=79/240 (32.9%). Selección por fácil preparación (39.2% UE Privada y 46.4% UE Pública). El 54.2 % y 57 % de los padres ven publicidad en la televisión. El conocimiento del etiquetado fue superior en la UE privada (94.9%; n=223). Asociación entre edad [OR: 2.3; IC 95%: 1.08-5.04] instrucción [OR: 3.95; IC 95%: 2.12-7.37], exposición a la publicidad [OR: 0.62; IC 95%: 0.36-1.05] y conocimientos (P<0.05). La actitud se asoció con el nivel de instrucción [OR: 2.57; IC 95%: 1.62-4.09] e ingresos (P<0.05). Análisis cualitativo: grado de conocimiento y publicidad elevados, con un impacto importante en la selección de los alimentos. Conclusiones: El conocimiento sobre el etiquetado nutricional fue elevado; pero no fue el principal factor para seleccionar alimentos. El tiempo de preparación y el sabor fueron más importantes que las especificaciones nutricionales

Introduction: Nutrition labeling is a graphic tool to notify consumers about the nutritional properties of a food, which facilitates their selection. The objective of this study was to determine the influence of nutri-tional labeling and socioeconomic, cultural, demographic, and advertising factors on food selection in a group of parents of children between 5-11 years old in two public and private educational units in Quito. Methods: With a mixed, quantitative-transversal and qualitative interpretative design, a sample of opin-ions of 240 parents in the Educational Units (EU) Nueva Aurora (Fiscal) and 235 parents in the EU Julio María Matovelle (Private) of Quito was analyzed. Three focus groups were carried out, recorded and transcribed textually, and a questionnaire was administered. The statistical package used was SPSS v24.0. Results: There was a higher consumption of processed foods in the private EU n = 79/240 (32.9%). Selection for easy preparation (39.2% Private EU and 46.4% Public EU). 54.2% and 57% of parents see advertising on television. Knowledge of labeling was higher in the private EU (94.9%; n = 223). Association between age [OR: 2.3; 95% CI: 1.08-5.04] instruction [OR: 3.95; 95% CI: 2.12-7.37], exposure to advertising [OR: 0.62; 95% CI: 0.36-1.05] and knowledge (P <0.05). Attitude was associated with educational level [OR: 2.57; 95% CI: 1.62-4.09] and admissions (P <0.05). Qualitative analysis: high degree of knowledge and publicity, with a significant impact on food selection. Conclusions: Knowledge about nutritional labeling was high, but it was not the main factor in selecting food. Prep time and flavor were more important than nutritional specifications.

Acute kidney injury in 3182 patients admitted with COVID-19: a single-center, retrospective, case-control study.

BACKGROUND: Acute kidney injury (AKI) may develop in coronavirus disease 2019 (COVID-19) patients and may be associated with a worse outcome. The aim of this study is to describe AKI incidence during the first 45 days of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Spain, its reversibility and the association with mortality. METHODS: This was an observational retrospective case-control study based on patients hospitalized between 1 March and 15 April 2020 with SARS-CoV-2 infection and AKI. Confirmed AKI cases were compared with stable kidney function patients for baseline characteristics, analytical data, treatment and renal outcome. Patients with end-stage kidney disease were excluded. RESULTS: AKI incidence was 17.22% among 3182 admitted COVID-19 patients and acute kidney disease (AKD) incidence was 6.82%. The most frequent causes of AKI were prerenal (68.8%) and sepsis (21.9%). Odds ratio (OR) for AKI was increased in patients with pre-existent hypertension [OR 2.58, 95% confidence interval (CI) 1.71-3.89] and chronic kidney disease (CKD) (OR 2.14, 95% CI 1.33-3.42) and in those with respiratory distress (OR 2.37, 95% CI 1.52-3.70). Low arterial pressure at admission increased the risk for Stage 3 AKI (OR 1.65, 95% CI 1.09-2.50). Baseline kidney function was not recovered in 45.73% of overall AKI cases and in 52.75% of AKI patients with prior CKD. Mortality was 38.5% compared with 13.4% of the overall sample population. AKI increased mortality risk at any time of hospitalization (hazard ratio 1.45, 95% CI 1.09-1.93). CONCLUSIONS: AKI is frequent in COVID-19 patients and is associated with mortality, independently of acute respiratory distress syndrome. AKD was also frequent and merits adequate follow-up.

Uptake and accumulation of Cr in edible parts of Eruca sativa from irrigation water. Effects on polyphenol profile and antioxidant capacity.

Metals in the environment have been an increasing research topic over the past decade, since they can be found in both natural and drinking water, including irrigation of crops and edible plants with contaminated water. The aim of this study was to investigate the uptake of Cr by arugula (Eruca sativa) in a greenhouse experiment, simulating the open field irrigation conditions. We also evaluate the toxic effects of Cr on oxidative stress by measuring the antioxidant capacity and polyphenol profile in the plant. The study examines the irrigation of arugula, during 15 and 21 days, with four Cr (VI) concentrations, ranging from 0 (control) to 250 µg. L-1. Arugula plants were able to accumulate Cr when irrigated during 15 and 21 days in all the Cr concentrations evaluated. The estimated daily intake (EDI) shows that the amount of Cr accumulated by arugula plants does not represent a threat to human health. Application of Cr levels induced some changes in content, profile and capacity of antioxidants depending on Cr concentration and time of exposure. Taking into account that E. sativa is consumed due to its polyphenol-related health benefits, the allowable Cr limits in irrigation water should be reviewed, in order to maximize health benefits associated with its consumption, and also to improve vegetable quality. Arugula is a valuable and nutritious food, that should not be excluded from a balanced diet. Chromium concentration in irrigation water as well as the speciation forms present in vegetables should be controlled.

More difficult still: Treating severe rapidly progressive glomerulonephritis in the context of COVID-19 pneumonia. / Más difícil todavía: tratar una glomerulonefritis rápidamente progresiva grave en el seno de una neumonía por COVID-19.

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.

A Brief Version of the Difficulties in Emotion Regulation Scale (DERS): Validity Evidence in Ecuadorian Population.

Due to the scarcity of evaluation instruments on the construct of difficulties in emotional regulation in the Ecuadorian university context, the objective of the present study was to adapt linguistically and to study the psychometric properties of the Difficulty Scale in Emotional Regulation (DERS) in a sample of Ecuadorian university students. A non-probability sample of 1172 participants between 17 and 32 years of age (M = 21.99; DT = 2.49), which consisted of 58.6% women and 41.4% men, was used. The research was carried out in three stages. The first study evaluated the Ecuadorian linguistic adaptation of the scale. The second study referred to the factorization by main axes identifying five factors (Lack of emotional understanding; Limited access to regulation strategies; Difficulties in impulse control; Interferences in goal-directed behaviors; Lack of emotional clarity) theoretically interpretable, which explain 49.22% of the variance. The third study developed a confirmatory factor analysis that specified an acceptable fit of the model (GFI = .95; AGFI = .95; NFI = .94; RMR = .11). The reliability coefficients are acceptable as .90 Cronbach's alpha and .91 McDonald's omega. In conclusion, it is mentioned that the Ecuadorian version of the DERS in a university sample exhibits good psychometric characteristics of internal structure and responses.

Debido a la escasez de instrumentos de evaluación sobre el constructo de dificultades en la regulación emocional en el contexto universitario ecuatoriano, el objetivo del presente estudio fue adaptar lingüísticamente y estudiar las propiedades psicométricas de la Escala de dificultades en la regulación emocional (DERS) en una muestra de estudiantes universitarios ecuatorianos. Se empleó una muestra no probabilística de 1172 participantes de 17 a 32 años de edad (M = 21.99; DT = 2.49), de los cuales 58.6% eran mujeres y 41.4% hombres. La investigación se desplegó en tres etapas: el primer estudio desarrolló la adaptación lingüística ecuatoriana de la escala. El segundo estudio se refirió a la factorización por ejes principales identificando cinco factores (Falta de compresión emocional; Acceso limitado a estrategias de regulación; Dificultades en el control de impulsos; Interferencias en conductas dirigidas a metas; Falta de claridad emocional) interpretables teóricamente, que explican el 49.22% de la varianza. El tercer estudio desarrolló un análisis factorial confirmatorio, el cual indicó un ajuste aceptable del modelo (GFI = .95; AGFI = .95; NFI = .94; RMR = .11). Los coeficientes de fiabilidad se revelaron aceptables de .90 alfa de Cronbach y .91 omega de McDonald. Como conclusión se menciona que la versión ecuatoriana de la DERS en una muestra universitaria exhibe buenas características psicométricas de estructura interna y fiabilidad.

Unidades de Enfermedad Renal Crónica Avanzada en España: una encuesta nacional sobre los estándares de estructura, recursos, resultados y seguridad del paciente / Advanced Chronic Kidney Disease Units in Spain: a national survey on standards of structure, resources, results and patient safety

ANTECEDENTES Y OBJETIVO: Recientemente, se han desarrollado en España las Unidades de Enfermedad Renal Crónica Avanzada (UERCA) con el objetivo de ofrecer una mayor calidad de vida a los pacientes con ERCA, mejorar su supervivencia y disminuir la morbilidad en esta fase de la enfermedad. Al día de hoy, hay poca evidencia en la literatura española e internacional con respecto a la estructura y cómo conseguir estos objetivos en las UERCA. Desde el grupo de trabajo ERCA de la Sociedad Española de Nefrología (SEN) se impulsa este proyecto para mejorar la atención a los pacientes ERCA a través de la definición de estándares de calidad para el funcionamiento de las UERCA. MATERIAL Y MÉTODOS: Se conformó una propuesta inicial de estándares de calidad sobre el funcionamiento de las UERCA a través de la consulta de principales fuentes de referencias y el asesoramiento de un grupo de trabajo de expertos a través de reuniones presenciales y no presenciales. A partir de esta propuesta inicial de estándares, se diseñó y envío una encuesta vía correo electrónico a 121 especialistas de nefrología y profesionales de enfermería con experiencia en UERCA españolas para conocer entre otros, la idoneidad de cada estándar, es decir, su obligatoriedad o recomendación como estándar. Se permitió acceso a la encuesta entre el 16 de julio de 2018, hasta el 26 de septiembre de 2018. RESULTADOS: Participaron un total de 95 (78,5%) profesionales de los 121 que fueron invitados a participar. De éstos, 80 fueron especialistas en nefrología y 15 profesionales de enfermería, obteniéndose una variada representación de profesionales de la geografía española. Tras analizar las opiniones de estos participantes, los estándares quedaron definidos a un total de 68, 37 de ellos (54,4%) obligatorios y 31 de ellos (45,5%) recomendables. Además, se observó que el volumen de pacientes atendidos en las UERCA se sitúa usualmente por encima de los 100 pacientes, y que el criterio de derivación por regla general está por debajo de 25-29 mL/min/1,73 m2 de filtración glomerular. CONCLUSIONES: Este trabajo constituye una primera propuesta de estándares de calidad para el funcionamiento de una UERCA en España. La definición de estos estándares ha permitido establecer las bases para la estandarización de la organización de las UERCA, y trabajar posteriormente en la configuración de un manual de estándares para la acreditación de estas Unidades

BACKGROUND AND OBJECTIVE: Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS: A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units

Advanced Chronic Kidney Disease Units in Spain: a national survey on standards of structure, resources, results and patient safety. / Unidades de Enfermedad Renal Crónica Avanzada en España: una encuesta nacional sobre los estándares de estructura, recursos, resultados y seguridad del paciente.

BACKGROUND AND OBJECTIVE: Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS: A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units.