RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Positive Action in EU Gender Equality Law: promoting more women in corporate decision making?

Equality is a broad and complex concept with various meanings (equal treatment, equal opportunities, formal equality, and substantive or de facto equality). Although there are strong similarities in the definition of key concepts related to equality, the EU and other international organisation have interpreted them differently. The way the concept of positive action, as an expression of the principle of de facto equality, has been understood by these institutions has led to a certain degree of uncertainty and methodological confusion. Similarly, despite the undeniable degree of harmonization that the EU legal framework on this field provides, still key notions of equality law, among them, the term positive action, are defined and applied differently in the various legal systems of the EU Member States. In the first place, this paper provides a comparative legal analysis of the concept of equality. In the second place, attention is paid to the notion of positive action in EU law and, in particular, in the case law of the Court of Justice of the EU. This paper includes an analysis of the interpretative value of that case law to provide guidance for the adoption of positive action measures and the possible clashes with the international and national contexts. Finally, attention is paid to the recent actions adopted by the European Commission to promote gender balance in decision-making positions. In EU law, positive action is still understood as an exception rather than a concrete substantiation of equality. This approach seems to ignore the positive duty to promote equality between men and women and combat social discrimination included in the EU Treaties. An alternative line of reasoning is to consider positive action as a useful instrument to prevent social exclusion of minorities, - informed by dignity, restitution and redistribution as values linked to equality - rather than an exceptional equal opportunities policy. From this point of view, positive action is regarded as a corollary of the Member States’ obligation to promote real equality among their citizens, from an individual as well as from a collective perspective, by the way of removing the obstacles that hinder their full participation in political, economic and social life

Positive action in EU gender equality law: promoting women in corporate decision-making positions

Equality is a complex concept having a variety of meanings (equal treatment, equal opportunities, formal equality, and substantive or de facto equality). Although there are strong similarities in the definitions of key concepts related to equality, the EU and other international organisations have interpreted and applied them differently. Interpretation by these institutions of the concept of positive action, as an expression of the principle of de facto equality, has led to uncertainty and methodological confusion. Similarly, despite the undeniable degree of harmonization provided by EU legislation regarding this field, key notions of equality law, among them, the term positive action, are still defined and applied differently in the various legal systems of the EU Member States. First, this paper provides a comparative legal analysis of the concept of equality. Second, it addresses the notion of positive action in EU law and, specifically, in the case law of the Court of Justice of the EU. An analysis of the interpretative value of that case law is included in order to provide guidance for the adoption of positive action measures and potential clashes with the international and national contexts. Finally, recent actions adopted by the European Commission to promote gender balance in decision-making positions are presented. Keywords: equality, positive action measures, EU law and case law