Social support for overcoming fear of contagion at the start of the COVID-19 pandemic. Cross-sectional study in Latin America.

Background: The psychological impact of the COVID-19 pandemic on healthcare professionals has been widely studied, along with different strategies to minimize it. However, professionals' assessment of the social support received and the factors that mitigated their fear of contagion have not been described. This study aimed to assess healthcare professionals' satisfaction with the social support and information received and their efforts to self-isolate to avoid infecting loved ones in Chile, Colombia, and Ecuador. Methods: A cross-sectional online survey, conducted from July to September 2020 in three Latin American countries, elicited healthcare professionals' satisfaction with social support from colleagues, their community, the media, and scientific societies; as well as the information received about the evolution of the pandemic and measures to avoid contagion. The EASE scale was used to measure acute stress. Results: Survey responses were received from 700 professionals. The response rate per country exceeded the estimated sample size except in the case of Colombia, which was 81.4%. In general, peer support was highly valued, though satisfaction was lower in high-risk units (p < 0.001). Those who directly assisted COVID-19 patients perceived the least community support (p = 0.023). Professionals from high-risk units (p = 0.013) and those who experienced greater acute stress (p = 0.05) assigned the lowest rating to the information offered by the centre on the pandemic. Men perceived more support from colleagues and better information from the centre than women (p < 0.05). Just 10.7% of professionals changed their residence during the pandemic, but those who worked in high-risk areas self-isolated more frequently (p = 0.026). Conclusion: In the early stages of the COVID-19 pandemic, healthcare professionals in Chile, Colombia, and Ecuador greatly valued the support received from their peers. Being infected with COVID-19, working in high-risk areas, experiencing higher self-reported acute stress, and having an infected co-worker were predictors for self-isolation to protect their relatives. These results point to the appropriateness of putting in place institutional resources based on peer support and specific communication strategies and action protocols to build resilience and responsiveness to future health crises.

Social and health determinants related to adverse short-term outcomes after a first-ever stroke in adults younger than 65 years.

BACKGROUND: Stroke-related mortality and disability-adjusted life years in adults younger than 65 have increased over the last decade. However, geographical differences in distributing these outcomes could reflect dissimilarity in determinants. Therefore, this cross-sectional study of secondary data from Chilean hospitals aims to analyze the association of sociodemographic and clinical factors with in-hospital case-fatality risk or acquired neurologic deficits (adverse outcomes) in inpatients aged 18 to 64 who experienced their first-ever stroke. METHODOLOGY: Adjusted multivariable logistic regression models and interaction analysis using multiple imputation for missing data (4.99%) for 1,043 hospital discharge records from the UC-CHRISTUS Health Network International Refined Diagnosis Related Groups (IR-DRG) system database (2010-2021) were conducted. RESULTS: Mean age: 51.47 years (SD, 10.79); female: 39.60%. Stroke types: subarachnoid hemorrhage (SAH): 5.66%, intracerebral hemorrhage (ICH): 11.98%, and ischemic: 82.45%. Adverse outcomes: 25.22% (neurological deficit: 23.59%; in-hospital case-fatality risk: 1.63%). After adjusting for confounders, adverse outcomes were associated with stroke type (patients with ICH and ischemic stroke had higher odds than those with SAH), sociodemographic characteristics (age ≥ 40 years, residence in an area of the capital city other than the center-east, and coverage by public health insurance), and discharge diagnoses (obesity, coronary artery and chronic kidney diseases, and mood and anxiety disorders). For hypertension, women had higher odds of adverse outcomes. CONCLUSIONS: In this predominantly Hispanic sample, modifiable social and health determinants are related to adverse short-term outcomes after a first-ever stroke. Longitudinal studies are needed to investigate the causal role of these factors.

Technical and economical assessment of the treatment of vinasse from Pisco production using the advanced oxidation process.

The removal of organic matter from Pisco production wastewater was evaluated using coagulation/flocculation, filtration as a pre-treatment, and solar photo-Fenton, with the use of two types of photoreactors: compound parabolic collectors (CPC) and flat plate (FP), with and without utilizing the ozonation process. The overall removal efficiency for chemical oxygen demand (COD) was 63% and 15% using FP and CPC, respectively. Also, for the overall removal efficiency of polyphenols, a percentage of 73% and 43% were obtained using FP and CPC, respectively. When ozone was used in the solar photoreactors, the resulting trends were similar. COD and polyphenol removal, using an FP photoreactor in the solar photo-Fenton/O3 process, resulted in values of 98.8% and 86.2% after the process. COD and polyphenol removal, using solar photo-Fenton/O3 process in a CPC, resulted in values of 49.5% and 72.4%, respectively. The economic indicators of annual worth and economic treatment capacity established that FP reactors represent lower costs than CPCs. These results were corroborated by the economic analyses of the evolution of costs versus COD removed as well as by the cash flow diagrams projected for 5, 10, and 15 years.

Use of copper sheet in a solar photo-Fenton-like process applied in the treatment of landfill leachate.

It is known that copper can be used as catalyst in photo-Fenton-like process; however, there is a lack of information related with its use in the treatment of landfill leachate (LL) in solar photo-Fenton-like processes. Here, we studied the effect of the mass of a copper sheet, the pH of the solution, and the concentration of LL in the removal of the organic matter present in this water. Before the reaction with landfill leachate, the copper sheet used in the reaction was constituted by Cu+ and Cu2O, respectively. The results showed that in a volume of 0.5 L of a pretreated LL, the higher removal of organic matter resulted using a mass of 2.7 g of the copper sheet, a pH of solution of 5, and a concentration of LL of a 10%, obtaining a final value of C/C0 of chemical oxygen demand (COD) of 0.34, 0.54, 0.66, and 0.84 for concentrations of 25%, 50%, 75%, and 100%, respectively, and 0.0041, 0.0042, 0.0043, and 0.016 for concentration of 25%, 50%, 75%, and 100%, respectively, of C/C0 of humic acids. The photolysis on LL at its natural pH using solar UV removes very little humic acid and COD, going from 9.4 to 8.5 and 7.7 Abs254 for photolysis and UV + H2O2, obtaining 8.6 and 17.6% of removal, respectively, and 2.01 and 13.04% removal of COD, respectively. Copper sheet applied under Fenton-like conditions results in 65.9% removal and an increase of 0.2% for humic acid and COD, respectively. Removal using only H2O2 for Abs254 and COD was 11.95 and 4.3%, respectively. Raw LL produced a 29.1% inhibition of the biological activated sludge rate after the adjustment to pH 7 and the final process of inhibition was 0.23%.

Use of vinasse and coffee waste as chelating agent of photo-Fenton landfill leachate treatment.

This research studies the use of vinasse (VS) coming from Pisco and caffeic acid (Caa) from solid coffee waste as chelating agents of this process, to carry out a photo-Fenton process using UVc lamps of 254-nm wavelength for 60 min, at the natural pH of the landfill leachate (8.9). Without the chelating agent, there was a removal of UV 254 and COD of 54.2% and 54.7%, respectively, when the photo-Fenton reaction was carried out at pH 3; at pH 6, the removal of UV 254 and COD was 13.1% and 39.2%, respectively, and at pH 8.9, the elimination of UV 254 and COD was 10.8% and 16.1%, respectively. When Caa was used in the landfill leachate (LL) for the photo-catalytic processes carried out at pH 8.9, a removal of 24.1%, 43.0%, and 47.4% of UV 254 was obtained using 5 mg/L, 50 mg/L, and 100 mg/L of Caa. The removal of UV 254 was 27.3%, 30.7%, and 36.3% using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively, and the removal of COD was 32.2%, 35.4%, and 39.2% using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively. When Caa was used in the LL at pH 8.9, the concentration of total Fe went from 37.5 to 33.2, from 40.2 to 36.8, and from 45.2 to 42.1, using 5 mg/L, 50 mg/L, and 100 mg/L of caffeic acid, respectively. Using VS in the LL at pH 8.9, the concentration of total Fe along the run went from 35.1 to 32.2, from 39.4 to 34.8, and from 42.1 to 40.2, using 5 mg/L, 50 mg/L, and 100 mg/L of VS, respectively. As a result of these processes, it was noted that the use of Caa and VS increases the solubility of Fe at a higher pH.

Contributing factors for acute stress in healthcare workers caring for COVID-19 patients in Argentina, Chile, Colombia, and Ecuador.

This study analyzed the frequency and intensity of acute stress among health professionals caring for COVID-19 patients in four Latin American Spanish-speaking countries during the outbreak. A cross-sectional study involved a non-probability sample of healthcare professionals in four Latin American countries. Participants from each country were invited using a platform and mobile application designed for this study. Hospital and primary care workers from different services caring for COVID-19 patients were included. The EASE Scale (SARS-CoV-2 Emotional Overload Scale, in Spanish named Escala Auto-aplicada de Sobrecarga Emocional) was a previously validated measure of acute stress. EASE scores were described overall by age, sex, work area, and experience of being ill with COVID-19. Using the Mann-Whitney U test, the EASE scores were compared according to the most critical moments of the pandemic. Univariate and multivariate analysis was performed to investigate associations between these factors and the outcome 'acute stress'. Finally, the Kruskal-Wallis was used to compare EASE scores and the experience of being ill. A total of 1372 professionals responded to all the items in the EASE scale: 375 (27.3%) Argentines, 365 (26.6%) Colombians, 345 (25.1%) Chileans, 209 (15.2%) Ecuadorians, and 78 (5.7%) from other countries. 27% of providers suffered middle-higher acute stress due to the outbreak. Worse results were observed in moments of peak incidence of cases (14.3 ± 5.3 vs. 6.9 ± 1.7, p < 0.05). Higher scores were found in professionals in COVID-19 critical care (13 ± 1.2) than those in non-COVID-19 areas (10.7 ± 1.9) (p = 0.03). Distress was higher among professionals who were COVID-19 patients (11.7 ± 1) or had doubts about their potential infection (12 ± 1.2) compared to those not infected (9.5 ± 0.7) (p = 0.001). Around one-third of the professionals experienced acute stress, increasing in intensity as the incidence of COVID-19 increased and as they became infected or in doubt whether they were infected. EASE scale could be a valuable asset for monitoring acute stress levels among health professionals in Latin America.ClinicalTrials: NCT04486404.

Carbon dioxide emission control of a vermicompost process using fly ash.

Composting and vermicomposting generate a valuable product rich in plant nutrients and at the same time, reduce environmental pollution. However, along with these processes and in relation to the metabolism of the microorganism and the worms present in the vermicomposting, CO2 is emitted to the atmosphere, contributing to the greenhouse effect. Taking these issues into account, different masses of fly ash were used to study the control of the CO2 of the gas coming from a vermicomposting process and to evaluate the possibility of using the adsorbent as fertilizer in the culture of lettuce Lactuca sativa. Along the vermicomposting process, an increase in the concentration of CO2 emissions was observed, with a maximum level of emission at the day 20 of the process and an average of 770 mg/L in air. After the adsorption process, the CO2 concentration was lower due to the effect of the fly ash that was able to trap the emitted gas. The percentage of CO2 adsorption shows maximum values of 55.5, 58.1 and 63.8% with 0.5, 1 and 1.5 kg of fly ash, respectively. The CO2 uptake capacities of the different loads of fly ash used were 3.39, 7.03 and 6.84 mmol CO2/g sorbent with 0.5, 1 and 1.5 kg of fly ash, respectively. After five weeks of sowing L. sativa, it was observed that when no fly ash was used in the soil, the length of the stem was 10.2 cm. Then, the length of the stem was 22 cm, and 16 cm when 10% of fly ash was applied and not applied in the adsorption process, getting a significant correlation between the load of fly ash and the length of the stem. The r when fly ash was used in the adsorption process was 0.9817 and 0.9811 when no ash fly was used in the process.

Incorporation of solar-heated aeration and greenhouse in grass composting.

Composting is an environment-friendly method for recycling organic waste, and incorporation of heat and aeration can enhance favorable conditions for microbial growth in the process. This research aimed to evaluate the influence of the introduction of solar heat and aeration to the waste grass exposed to the composting process. The compost piles studied were subjected to different processes: application of solar-heated aeration, only-aeration, solar heating with a greenhouse, and control. Solar-heated air was introduced to a compost pile of grass clippings and compared with a greenhouse compost system. The composting process of 70 days was monitored for temperature, oxygen, moisture, organic matter loss, and humification rate. Germination index has been used to evaluate the maturation of the composts produced. The highest temperature was obtained at the compost pile with the greenhouse. This system reached the highest temperature (68.2 °C) on day 15; the ambient temperature on that day was 20.6 °C. The decreases in the C/N ratios after day 70 of composting were 20% and 15% for the greenhouse and the system where solar-heated air was introduced, respectively. Although the temperature of the solar-heated air was higher than that of the greenhouse, thermophilic temperature levels could not be reached in the aerated compost pile, which indicated a cooling effect of excessive aeration even with the heated air. Composting of grass clippings resulted in a decrease in organic matter content and enhancement in seed germination and root growth, obtaining high GI levels, inferring no phytotoxicity. This study showed that composting of grass clippings with low C/N ratios and high humidity can still be possible by using solar energy.

What Ibero-American hospitals do when things go wrong? A cross-sectional international study.

OBJECTIVE: To know what hospital managers and safety leaders in Ibero-American countries are doing to respond effectively to the occurrence of adverse events (AEs) with serious consequences for patients. DESIGN: Cross-sectional international study. SETTING: Public and private hospitals in Ibero-American countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru, Portugal and Spain). PARTICIPANTS: A convenience sample of hospital managers and safety leaders from eight Ibero-American countries. A minimum of 25 managers/leaders from each country were surveyed. INTERVENTIONS: A selection of 37 actions for the effective management of AEs was explored. These were related to the safety culture, existence of a crisis plan, communication and transparency processes with the patients and their families, attention to second victims and institutional communication. MAIN OUTCOME MEASURE: Degree of implementation of the actions studied. RESULTS: A total of 190 managers/leaders from 126 (66.3%) public hospitals and 64 (33.7%) private hospitals participated. Reporting systems, in-depth analysis of incidents and non-punitive approaches were the most implemented interventions, while patient information and care for second victims after an AE were the least frequent interventions. CONCLUSIONS: The majority of these hospitals have not protocolized how to act after an AE. For this reason, it is urgent to develop and apply a strategic action plan to respond to this imperative safety challenge. This is the first study to identify areas of work and future research questions in Ibero-American countries.

Use of sawdust as pretreatment of photo-Fenton process in the depuration of landfill leachate.

A research of the depuration of landfill leachate using sawdust as activated carbon material to be applied in adsorption process as pretreatment of solar photo-Fenton and solar photo-Fenton + O3, was carried out. The activated sawdust shows very irregular shapes and pores, and a high capacity to remove ammonium (87.0%), iron (70.2%) and copper (61.1%). As well, it has the capacity to remove humic acid (18.3%), COD (33.7%) and colour (19.5%). Also, a removal of organic matter was obtained in terms of COD (76.4%), colour (74.9%), nitrate (50.0%), ammonium (12.8%) and humic acid (73.3%) due to the joint action of ozone and solar photo-Fenton process. The overall treatment (filtration, adsorption, photo-Fenton and photo-Fenton + ozone) carried out showed a very high removal of pollutants, with a reduction of COD, colour, ammonium and humic acid of 95.1%, 95.0%, 94.5% and 97.9%, respectively. With this enhancement in the landfill leachate (LL) quality, there is a reduction of toxicity, obtaining with the LL 50% diluted, a germination index for Lactuca sativa of 20% GI. This shows that the incorporation of sawdust is a useful pretreatment of photo-Fenton in the treatment of landfill leachate.

Improvement of the solar drying process of sludge using thermal storage.

Improvement of the drying process of sludge issuing from the coagulation/flocculation of landfill leachate was investigated using thermal storage systems, which consisted of a rock bed with air preheated by a solar air heater passing through the system. Sludge runs were dried inside the solar dryer with and without thermal storage, as well as outside the dryer. The values for the solar energy accumulated per mass of sludge required to obtain a stable sludge mass were 107.5 kJ/kg (with thermal storage), 240 kJ/kg (without thermal storage) and 580.5 kJ/kg, outside the dryer. The values for the energetic efficiency of the drying process were 38.13% and 16.45% for the processes with and without thermal storage, respectively. The net heat input to the storage system during the charging stage was 420 W and 120 W for the discharging stage, resulting in a global energy efficiency in the storage system of 0.28. The thermal efficiency of the solar drying with and without thermal storage system was 37.8% and 22.2%, respectively.

Ultrasound and heterogeneous photocatalysis for the treatment of vinasse from pisco production.

Production of the distilled alcohol pisco results in vinasse, dark brown wastewater with high polyphenols contents and chemical oxygen demand (COD). No prior research exists on the efficiency of advanced oxidations processes (AOPs) in treating pisco vinasse. Therefore, the purpose of this study was to assess the efficiency of ultraviolet (UV), ultrasound (US), US + UV, heterogeneous photocatalysis (HP), and HP + US treatments. Polyphenols, COD, and color removal, as well as oxidation-reduction potential, were monitored over a 60-minute treatment period. Energy consumption levels and synergies were also calculated. The HP + US treatment achieved the best removal ratios for polyphenols (68%), COD (70%), and color (48%). While the HP treatment was the second most efficient in terms of polyphenols (62%), COD (58%), and color (40%) removal, this AOP comparatively required the least amount of energy. Considering the energy efficiency and relatively high pollutant-removal rates of the HP treatment, this AOP is recommended as a practical alternative for treating pisco vinasse.

Improved landfill leachate quality using ozone, UV solar radiation, hydrogen peroxide, persulfate and adsorption processes.

Advanced oxidation processes based on ozonation, UV solar radiation, hydrogen peroxide, and persulfate were tested for the complete treatment of a specific landfill leachate. As a post-treatment of the advanced oxidation process, an additional adsorption process was carried out using a natural zeolite. Application of the UVsolar/O3/H2O2 process required 140 min of irradiation and the consumption of 0.67 g/L H2O2 to eliminate 56% and 17% of colour and chemical oxygen demand (COD), respectively. When adding persulfate to the system (UVsolar/O3/H2O2/S2O8-2), colour and COD were reduced by 29% and 77%, respectively, with a 0.2 g/L concentration of S2O8-2 requiring 250 min of irradiation time. In an experimental run with landfill leachate, adsorption post-treatment with a natural zeolite resulted in 36%, 99%, and 18% total reductions in COD, ammonium, and chloride, respectively. In another experimental run, adsorption with a zeolite was used as a pre-treatment for the advanced oxidation process (UVsolar/O3/H2O2 and UVsolar/O3/H2O2/S2O8-2). The results were similar to those for adsorption post-treatment, with 30%, 90%, and 20% total reductions in COD, ammonium, and chloride, respectively. Despite improvements, some measured parameters of treated landfill leachate still exceeded Chilean regulations for water quality. Furthermore, Lactuca sativa seeds did not germinate after irrigation with 100% treated landfill leachate or dilutions above 3%. Finally, EC50 values were enhanced during treatment, going from 0.002% for raw landfill leachate to 1.179% after the adsorption process.

A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge.

OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimated for each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge / Un cuestionario en espanol sobre seguridad del paciente para medir las actitudes y los conocimientos de los estudiantes de medicina y enfermería

OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimatedfor each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

OBJETIVO: Diseñar y validar un cuestionario de evaluación de las actitudes y los conocimientos en materia de seguridad del paciente con una muestra de estudiantes de medicina y enfermería que reciben formación médica en Espana y en cuatro países de América Latina. MÉTODOS: En este estudio transversal se llevó a cabo una revisión bibliográfica y se encuestó a un total de 786 estudiantes de medicina y enfermería de ocho universidades de cinco países (Chile, Colombia, El Salvador, Espana y Guatemala) con objeto de elaborar y corregir un cuestionario en espanol sobre conocimientos y actitudes en materia de seguridad del paciente. El ámbito del cuestionario se basó en cinco dimensiones (factores) presentadas en estudios relacionados con la cultura de la seguridad del paciente encontrados en PubMed y Scopus. Con base en los cinco factores, se elaboraron 25 ítems reactivos. Se calcularon los índices de fiabilidad compuesta y alfa de Cronbach para cada factor, y se realizó un análisis factorial confirmatorio para evaluar la validez. Tras una prueba piloto se corrigió el cuestionario mediante modelos confirmatorios, el cálculo de la máxima probabilidad y la matriz de variancia-covariancia (como insumo). Se utilizaron modelos de regresión lineal múltiple para confirmar la validez externa, considerando las variables relacionadas con la cultura de seguridad del paciente como variables dependientes y los cinco factores como variables independientes. RESULTADOS: El instrumento final fue una encuesta autoadministrada mediante escala de Likert estructurada en cinco puntos ("Cuestionario de Seguridad del Paciente para Estudiantes Latinos"), que consta de 21 ítems agrupados en cinco factores. Los índices de fiabilidad compuesta (prueba estadística de alfa de Cronbach) calculados para los cinco factores fueron aproximadamente de 0,7 o superiores. Los resultados de los análisis de regresión lineal múltiple indicaron un buen ajuste del modelo (índice de bondad de ajuste: 0,9). Las correlaciones ítem-total fueron superiores a 0,3 en todos los casos. La validez convergente y discriminatoria fue adecuada. CONCLUSIONES: El cuestionario disenado y validado en este estudio evalúa las actitudes y los conocimientos de los estudiantes de enfermería y medicina en materia de seguridad del paciente. Este instrumento podría utilizarse para evaluar indirectamente si los estudiantes de disciplinas de la salud están adquiriendo, y por lo tanto, es probable que pongan en práctica, las habilidades profesionales consideradas actualmente como más apropiadas para la seguridad del paciente.

A Spanish-language patient safety questionnaire to measure medical and nursing students’ attitudes and knowledge / Un cuestionario en español sobre seguridad del paciente para medir las actitudes y los conocimientos de los estudiantes de medicina y enfermería

Objetivo. Diseñar y validar un cuestionario de evaluación de las actitudes y los conocimientos en materia de seguridad del paciente con una muestra de estudiantes de medicina y enfermería que reciben formación médica en España y en cuatro países de América Latina. Métodos. En este estudio transversal se llevó a cabo una revisión bibliográfica y se encuestó a un total de 786 estudiantes de medicina y enfermería de ocho universidades de cinco países (Chile, Colombia, El Salvador, España y Guatemala) con objeto de elaborar y corregir un cuestionario en español sobre conocimientos y actitudes en materia de seguridad del paciente. El ámbito del cuestionario se basó en cinco dimensiones (factores) presentadas en estudios relacionados con la cultura de la seguridad del paciente encontrados en PubMed y Scopus. Con base en los cinco factores, se elaboraron 25 ítems reactivos. Se calcularon los índices de fiabilidad compuesta y alfa de Cronbach para cada factor, y se realizó un análisis factorial confirmatorio para evaluar la validez. Tras una prueba piloto se corrigió el cuestionario mediante modelos confirmatorios, el cálculo de la máxima probabilidad y la matriz de variancia-covariancia (como insumo). Se utilizaron modelos de regresión lineal múltiple para confirmar la validez externa, considerando las variables relacionadas con la cultura de seguridad del paciente como variables dependientes y los cinco factores como variables independientes. Resultados. El instrumento final fue una encuesta autoadministrada mediante escala de Likert estructurada en cinco puntos (“Cuestionario de Seguridad del Paciente para Estudiantes Latinos”), que consta de 21 ítems agrupados en cinco factores. Los índices de fiabilidad compuesta (prueba estadística de alfa de Cronbach) calculados para los cinco factores fueron aproximadamente de 0,7 o superiores. Los resultados de los análisis de regresión lineal múltiple indicaron un buen ajuste del modelo (índice de bondad de ajuste: 0,9). Las correlaciones ítem-total fueron superiores a 0,3 en todos los casos. La validez convergente y discriminatoria fue adecuada. Conclusiones. El cuestionario diseñado y validado en este estudio evalúa las actitudes y los conocimientos de los estudiantes de enfermería y medicina en materia de seguridad del paciente. Este instrumento podría utilizarse para evaluar indirectamente si los estudiantes de disciplinas de la salud están adquiriendo, y por lo tanto, es probable que pongan en práctica, las habilidades profesionales consideradas actualmente como más apropiadas para la seguridad del paciente.

Objective. To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. Methods. In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach’s alpha statistics were estimated for each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance–covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. Results. The final instrument was a structured five-point Likert self-administered survey (the “Latino Student Patient Safety Questionnaire”) consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach’s alpha statistic) calculated for the ive factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item–total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. Conclusions. The questionnaire designed and validated in this study assesses nursing and medical students’ attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

Solar photocatalytic treatment of landfill leachate using a solid mineral by-product as a catalyst.

The treatment of municipal solid waste landfill leachate in a pilot plant made up of solar compound parabolic collectors, using a solid industrial titanium by-product (WTiO(2)) containing TiO(2) and Fe(III) as a photocatalyst, was investigated. In the study evidence was found showing that the degradation performed with WTiO(2) was mainly due to the Fe provided by this by-product, instead of TiO(2). However, although TiO(2) had very little effect by itself, a synergistic effect was observed between Fe and TiO(2). The application of WTiO(2), which produced coupled photo-Fenton and heterogeneous catalysis reactions, achieved a surprisingly high depuration level (86% of COD removal), higher than that reached by photo-Fenton using commercial FeSO(4) (43%) in the same conditions. After the oxidation process the biodegradability and toxicity of the landfill leachate were studied. The results showed that the leachate biodegradability was substantially increased, at least in the first stages of the process, and again that WTiO(2) was more efficient than FeSO(4) in terms of increasing biodegradability.

Melanocortin 1 receptor is expressed by uveal malignant melanoma and can be considered a new target for diagnosis and immunotherapy.

PURPOSE: Uveal melanoma is the most common primary malignant ocular cancer in adults. This tumor has a distinct expression pattern of markers compared with cutaneous melanoma. MC1R is under study as a potential target for antitumor immunity. Because of the potential immunogenicity of MC1R, it is important to evaluate its expression on uveal melanomas. METHODS: Two novel monoclonal antibodies (MP1.1C11 and MP1.1B7) were used to examine the expression of MC1R in uveal melanomas. Tissue samples obtained from 17 patients were analyzed for expression of MC1R by immunohistochemistry. Additionally, uveal melanoma cell lines were treated with proinflammatory cytokines, after which MC1R cell surface expression was analyzed by flow cytometry. RESULTS: Results demonstrated that MC1R is expressed by uveal melanoma to a significantly greater extent than other melanoma markers. With the use of MP1.1C11 or MP1.1B7, MC1R was detected in 95% of the tested melanoma tissues, including one liver metastasis. In contrast, MART-1, S100-specific protein, and gp-100 were only expressed by 66%, 33%, and 67% of the analyzed samples, respectively. Results also demonstrated that even though MC1R is mainly located intracellularly, its cell surface expression can be promoted by cytokines such as IFN-gamma, TNF-alpha, IL-4, and IL-10. CONCLUSIONS: These observations support the inclusion of MC1R in the panel of markers for the diagnosis of uveal melanoma. Therapeutic use of MC1R-specific antibodies targeting cytokine-induced MC1R potentially requires expression of the target molecule on the surfaces of tumor cells. Data presented here support MC1R as a new marker and a putative therapeutic target for uveal melanoma.

[Vibrio vulnificus: an infrequent cause of septic shock]. / Vibrio vulnificus: una causa infrecuente de shock séptico.

Vibrio vulnificus is a lactose positive Gram negative rod that lives in warm seas and can infect wounds and produce sepsis. Its infection is acquired after eating oysters or other filtering marine organisms. We report a 53 years old diabetic male who started with fever after a voyage to Central America. He was admitted febrile, hypotense, dehydrated and polypneic. Painful erythematous lesions and lumps were observed in his upper and lower limbs. After 72 hours of evolution, the lesions became violaceous, with crepitating vesicles full of hemorrhagic exudate. He developed a renal failure and a disseminated intravascular coagulation. Blood cultures demonstrated the presence of Vibrio vulnificus and the patient died 68 hours after admission.