Relación entre el nivel de estrés y el desarrollo de las funciones ejecutivas en mujeres entre 15 y 24 años en el asentamiento humano José Carlos Mariátegui en el Distrito de San Juan De Lurigancho (Lima)

El principal objetivo de esta investigación radicó en explorar la relación entre el nivel de estrés y el desarrollo de las funciones ejecutivas en mujeres de bajo nivel socioeconómico en el asentamiento humano José Carlos Mariátegui en el distrito de San Juan de Lurigancho (Lima). La muestra estuvo compuesta por 53 mujeres entre 15 y 24 años. Se aplicó una metodología cuantitativa con la administración de las pruebas neuropsicológicas (i) Test de Memoria Auditiva de las Palabras de Rey (RAVLT), (ii) Test de Colores y Palabras STROOP, (iii) Test de Clasificación de Tarjetas de Wisconsin (WCST) para medir el desarrollo de las funciones ejecutivas y (i) la Escala de Estrés Percibido (PSS) para la medición del nivel de estrés. Los resultados no permitieron establecer una relación entre las variables nivel de estrés percibido y desarrollo de las funciones ejecutivas, con unos valores de RAVLT (p = 0,215), STROOP (p = 0,480) y WCST (p = 0,217) en la prueba Chi cuadrado. En conclusión, se requiere profundizar en las metodologías utilizadas para poder observar con más detalle el nivel de estrés, el desarrollo de las funciones ejecutivas y las relaciones que existen entre ambas variables de la población observada.The main objective of this research was to explore the relationship between the level of stress and the development of executive functions in women of low socioeconomic status in the José Carlos Mariátegui human settlement in the district of San Juan de Lurigancho (Lima). The sample consisted of 53 women between 15 and 24 years of age. A quantitative methodology was applied with the administration of the neuropsychological tests (i) Rey Auditory Verbal Learning Test (RAVLT), (ii) STROOP Colors and Words Test, (iii) Wisconsin Card Sorting Test (WCST) to measure the development of executive functions and (i) the Perceived Stress Scale (PSS) to measure the level of stress. The results did not allow establishing a relationship between the variables perceived stress level and development of executive functions, with values of RAVLT (p = 0.215), STROOP (p = 0.480) and WCST (p = 0.217) in the Chi-square test. In conclusion, it is necessary to deepen the methodologies used in order to be able to observe in more detail the level of stress, the development of executive functions and the relationships that exist between both variables in the observed population

Availability of assisted peritoneal dialysis in Europe : call for increased and equal access

Background Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilized in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries. Methods Members of the group filled in a proforma with the following headings: personal experience, country experience, who are the assistants, funding of asPD, barriers to growth, what is needed to grow and their top three priorities. Results Only 5 of the 13 countries surveyed provided publicly funded reimbursement for asPD. The use of asPD depends on overall attitudes to PD, with all respondents mentioning the need for nephrology team education and/or patient education and involvement in dialysis modality decision making. Conclusions and call to action Many people with advanced kidney disease would prefer to have their dialysis at home, yet if the frail patient chooses PD most healthcare systems cannot provide their choice. AsPD should be available in all countries in Europe and in all renal centres. The top priorities to make this happen are education of renal healthcare teams about the advantages of PD, education of and discussion with patients and their families as they approach the need for dialysis, and engagement with policymakers and healthcare providers to develop and support assistance for PD.Peer reviewe

Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients

<p>Abstract</p> <p>Background</p> <p>Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR) in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy.</p> <p>Methods</p> <p>Hemodialysis patients at any of the six outpatient clinics in Calgary, Alberta, treated with warfarin anticoagulation were included. Two five-month time periods were compared: prior to and post implementation of the nomogram. The primary endpoint was adequacy of anticoagulation (proportion of INR measurements within range ± 0.5 units).</p> <p>Results</p> <p>Overall, 67 patients were included in the pre- and 55 in the post-period (with 40 patients in both periods). Using generalized linear mixed models, the adequacy of INR control was similar in both periods for all range INR levels: in detail, range INR 1.5 to 2.5 (pre 93.6% (95% CI: 88.6% - 96.5%); post 95.6% (95% CI: 89.4% - 98.3%); p = 0.95); INR 2.0 to 3.0 (pre 82.2% (95% CI: 77.9% - 85.8%); post 77.4% (95% CI: 72.0% - 82.0%); p = 0.20); and, INR 2.5 to 3.5 (pre 84.3% (95% CI: 59.4% - 95.1%); post 66.8% (95% CI: 39.9% - 86.0%); p = 0.29). The mean number of INR measurements per patient decreased significantly between the pre- (30.5, 95% CI: 27.0 - 34.0) and post- (22.3, 95% CI: 18.4 - 26.1) (p = 0.003) period. There were 3 bleeding events in each of the periods.</p> <p>Conclusions</p> <p>An electronic warfarin anticoagulation nomogram administered by nurses achieved INR control similar to that of physician directed therapy among hemodialysis patients in an outpatient setting, with a significant reduction in frequency of testing. Future controlled trials are required to confirm the efficacy of this nomogram.</p

The Risk of Severe Infections Following Rituximab Administration in Patients With Autoimmune Kidney Diseases: Austrian ABCDE Registry Analysis.

OBJECTIVE: To characterize the incidence, type, and risk factors of severe infections (SI) in patients with autoimmune kidney diseases treated with rituximab (RTX). METHODS: We conducted a multicenter retrospective cohort study of adult patients with immune-related kidney diseases treated with at least one course of RTX between 2015 and 2019. As a part of the ABCDE Registry, detailed data on RTX application and SI were collected. SI were defined by Common Terminology Criteria for Adverse Events v5.0 as infectious complications grade 3 and above. Patients were dichotomized between "nephrotic" and "nephritic" indications. The primary outcome was the incidence of SI within 12 months after the first RTX application. RESULTS: A total of 144 patients were included. Twenty-five patients (17.4%) presented with SI, mostly within the first 3 months after RTX administration. Most patients in the nephritic group had ANCA-associated vasculitis, while membranous nephropathy was the leading entity in the nephrotic group. Respiratory infections were the leading SI (n= 10, 40%), followed by urinary tract (n=3, 12%) and gastrointestinal infections (n=2, 8%). On multivariable analysis, body mass index (BMI, 24.6 kg/m2versus 26.9 kg/m2, HR: 0.88; 95%CI: 0.79-0.99; p=0.039) and baseline creatinine (HR: 1.25; 95%CI: 1.04-1.49; p=0.017) were significantly associated with SI. All patients in the nephritic group (n=19; 100%) who experienced a SI received oral glucocorticoid (GC) treatment at the time of infection. Hypogammaglobulinemia was frequent (58.5%) but not associated with SI. CONCLUSIONS: After RTX administration, impaired kidney function and lower BMI are independent risk factors for SI. Patients with nephritic glomerular diseases having concomitant GC treatment might be at higher risk of developing SI

Socio-ecological innovations in the context of the German "Energiewende" : an analysis of benefits and necessities in the urban arena

Alternative power initiatives are socio-ecological innovations that substantially contribute to city's sustainable development and, therefore, are of particular societal benefit and value. Cities should, consequently, have an inherent interest in their existence and proliferation. This, however, asks for strategic innovation management. While, acknowledgement of the project's innovativeness constitutes the precondition for management, in the further process of steering activity the tasks to reduce hurdles, create open space and support the project's capacities need to be mastered. Thereby, cities are increasingly asked to become innovative themselves in order to find ways to optimally make use of their available tools and capacities