Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis
Objective: To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument. Sources of data: A systematic review was performed with meta-analysis for the mean difference in each of...
- Autores:
-
Ruidiaz Gómez, Keydis Sulay
Higuita Gutiérrez, Luis Felipe
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2020
- Institución:
- Universidad Cooperativa de Colombia
- Repositorio:
- Repositorio UCC
- Idioma:
- OAI Identifier:
- oai:repository.ucc.edu.co:20.500.12494/32754
- Acceso en línea:
- https://doi.org/10.1016/j.jped.2020.10.013
https://hdl.handle.net/20.500.12494/32754
- Palabra clave:
- Chronic kidney disease
Pediatric
Quality of life
Chronic kidney disease
Pediatric
Quality of life
- Rights
- openAccess
- License
- Atribución
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Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis |
| title |
Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis |
| spellingShingle |
Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis Chronic kidney disease Pediatric Quality of life Chronic kidney disease Pediatric Quality of life |
| title_short |
Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis |
| title_full |
Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis |
| title_fullStr |
Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis |
| title_full_unstemmed |
Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis |
| title_sort |
Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis |
| dc.creator.fl_str_mv |
Ruidiaz Gómez, Keydis Sulay Higuita Gutiérrez, Luis Felipe |
| dc.contributor.author.none.fl_str_mv |
Ruidiaz Gómez, Keydis Sulay Higuita Gutiérrez, Luis Felipe |
| dc.subject.spa.fl_str_mv |
Chronic kidney disease Pediatric Quality of life |
| topic |
Chronic kidney disease Pediatric Quality of life Chronic kidney disease Pediatric Quality of life |
| dc.subject.other.spa.fl_str_mv |
Chronic kidney disease Pediatric Quality of life |
| description |
Objective: To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument. Sources of data: A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out. Summary of the findings: 17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3-5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the physical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points. Conclusion: The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the "school" dimension being the most affected and the "emotional" one the least. In this sense, we suggest monitoring the health-related quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease. |
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2020 |
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2020-12-17 |
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2021-01-21T21:36:28Z |
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2021-01-21T21:36:28Z |
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Artículo |
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http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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16784782 |
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https://doi.org/10.1016/j.jped.2020.10.013 |
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https://hdl.handle.net/20.500.12494/32754 |
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Ruidiaz-Gómez, K. S., & Higuita-Gutiérrez, L. F. (2020). Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis. Jornal de pediatria, S0021-7557(20)30243-6.Mu |
| identifier_str_mv |
16784782 Ruidiaz-Gómez, K. S., & Higuita-Gutiérrez, L. F. (2020). Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis. Jornal de pediatria, S0021-7557(20)30243-6.Mu |
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https://doi.org/10.1016/j.jped.2020.10.013 https://hdl.handle.net/20.500.12494/32754 |
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https://pubmed.ncbi.nlm.nih.gov/33340460/ |
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Jornal de Pediatria |
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K.R. Ribeiro Cuidados de enfermagem aos pacientes com insuficiência renal crônica no ambientes hospitalar Rev Cient Enferm., 6 (2016), pp. 26-35 N.M. Jesus, G.F. Souza, C. Mendes-Rodrigues, O.P. Almeida Neto, D.D. Rodrigues, C.M. Cunha Quality of life of individuals with chronic kidney disease on dialysis J Bras Nefrol., 41 (2019), pp. 364-374 J.C. Flores Chronic Kidney Disease: epidemiology and risk factors Rev Med Clinc Condes., 21 (2010), pp. 502-507 Ministerio de Sanidad Servicios Sociales e Igualdad Dirección General de Salud Pública. Documento Marco sobre Enfermedad Renal Crónica (ERC) dentro de la Estrategia de Abordaje a la Cronicidad en el SNS [Internet]. 2015 [accessed 26 Sept. 2018]. Available from: http://www.senefro.org/modules/noticias/images/enfermedad_renal_cronica_2015.pdf. S. García de Vinuesa Progression factors for chronic kidney disease. Secondary prevention Nefrologia., 28 (2008), pp. 17-21 M. Carrasco Hidalgo-Barquero, J.M. de Cea Crespo Hematuria Protoc Diagn Ter Pediatr., 1 (2014), pp. 53-68 A.K. Jain, P. Blake, P. Cordy, A.X. Garg Global trends in rates of peritoneal dialysis J Am Soc Nephrol., 23 (2012), pp. 533-544 O.A. Montell Hernández, A. Vidal Tallet, C. Sánchez Hernández, A. Méndez Dayout, Delgado Fernández del RM, F.M. Bolaños Drake Enfermedad renal crónica no terminal en los pacientes en edad pediátrica ingresados y seguidos en consulta de Nefrología Rev Med Electrón., 35 (2013), pp. 1-5 R. Areses Trapote, M.J. Sanahuja Ibáñez Navarro M; Investigadores Centros Participantes en el REPIR II. Epidemiology of chronic kidney disease in Spanish pediatric population. REPIR II Project Nefrologia., 30 (2010), pp. 508-517 C.D. Kaspar, R. Bholah, T.E. Bunchman A Review of Pediatric Chronic Kidney Disease Blood Purif., 41 (2016), pp. 211-217 C.J. Wong, M. Moxey-Mims, J. Jerry-Fluker, B.A. Warady, S.L. Furth CKiD (CKD in children) prospective cohort study: a review of current findings Am J Kidney Dis., 60 (2012), pp. 1002-1011 J. Harambat, K.J. van Stralen, J.J. Kim, E.J. Tizard Epidemiology of chronic kidney disease in children Pediatr Nephrol., 27 (2012), pp. 363-373 Erratum in: Pediatr Nephrol. 2012;27:507. N. Chesnaye, M. Bonthuis, F. Schaefer, J.W. Groothoff, E. Verrina, J.G. Heaf, et al. Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA-EDTA registry Pediatr Nephrol., 29 (2014), pp. 2403-2410 A.J. Carrillo Algarra Análisis de la capacidad de autocuidados en pacientes en diálisis peritoneal Enferm Nefrol., 18 (2015), pp. 31-40 S.S. Abrahão, J. Ricas, D.F. Andrade, F.C. Pompeu, L. Chamahum, T.M. Araújo, et al. Difficulties experienced by children/adolescents with chronic kidney disease and by their families J Bras Nefrol., 32 (2010), pp. 16-20 J. O’Sullivan-Oliveira, S.M. Fernandes, L.F. Borges, L.N. Fishman Transition of pediatric patients to adult care: an analysis of provider perceptions across discipline and role Pediatr Nurs., 40 (2014) 113-20, 142 World Health Organization (WHO) Quality of life assessment. An annotated bibliography WHO, Genova (1994) (MNH/PSF/94.1) The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization Soc Sci Med., 41 (1995), pp. 1403-1409 P. Rebollo, M.P. González, J. Bobes, P. Saiz, F. Ortega Interpretation of health-related quality of life of patients on replacement therapy in end-stage renal disease Nefrologia., 20 (2000), pp. 431-439 D. Varela, M. Gaurían Parra, N. Hincapié, S. Hincapié, K. Rodríguez Factores no tradicionales influyentes en la calidad de vida de los pacientes de hemodiálisis Rev Colombiana Nefrología., 3 (2014), pp. 17-24 L. Schwartzmann Calidad de vida relacionada con la salud: aspectos conceptuales Cienc Enferm., 9 (2003), pp. 09-21 C.J. Bulpitt Quality of life as an outcome measure Postgrad Med J., 73 (1997), pp. 613-616 P. Rebollo, F. Ortega, T. Ortega, C. Valdés, M. García-Mendoza, E. Gómez Spanish validation of the "kidney transplant questionnaire": a useful instrument for assessing health related quality of life in kidney transplant patients Health Qual Life Outcomes., 1 (2003), p. 56 E. Tomás Bernabeu, A. Junqué Jiménez, G. Iza Pinedo, I. Luceño Solé, O. Paz López, M. Lavado Santpere Beneficios de un programa de entrenamiento físico en la sintomatología depresiva y calidad de vida en los pacientes en hemodiálisis Enferm Nefrol., 16 (2013), pp. 170-171 J.M. Moreira, C.M. Bouissou Morais Soares, A.L. Teixeira, A.C. Simões E Silva, A.M. Kummer Anxiety, depression, resilience and quality of life in children and adolescents with pre-dialysis chronic kidney disease Pediatr Nephrol., 30 (2015), pp. 2153-2162 A.M. El Shafei, I. Soliman Hegazy, F.I. Fadel, E.M. Nagy Assessment of Quality of Life among Children with End-Stage Renal Disease: A Cross-Sectional Study J Environ Public Health., 2018 (2018), Article 8565498 R.C. Marciano, C.M. Soares, J.S. Diniz, E.M. Lima, J.M. Silva, M.R. Canhestro, et al. Behavioral disorders and low quality of life in children and adolescents with chronic kidney disease Pediatr Nephrol., 26 (2011), pp. 281-290 J.M. Quiceno, S. Vinaccia Health-related quality of life infantile: an approach from chronic illness Psychol Av Discip., 7 (2013), pp. 69-86 L. Rajmil, M. Roizen, A.U. Psy, C. Hidalgo-Rasmussen, G. Fernández, J.J. Dapueto, et al. Health-related quality of life measurement in children and adolescents in Ibero-American countries, 2000 to 2010 Value Health, 15 (2012), pp. 312-322 La Vinney, Jd Grade, Np. Connor Feasibility of using a handheld electronic device for the collection of patient reported outcomes data from children J Commun Disord., 45 (2012), pp. 12-19 L. Haverman, V. Engelen, M.A. van Rossum, H.S. Heymans, M.A. Grootenhuis Monitoring health-related quality of life in paediatric practice: development of an innovative web-based application BMC Pediatr., 11 (2011), p. 3 J.W. Varni, E.R. Katz, M. Seid, D.J. Quiggins, A. Friedman-Bender, C.M. Castro The Pediatric Cancer Quality of Life Inventory (PCQL). I. Instrument development, descriptive statistics, and cross-informant variance J Behav Med., 21 (1998), pp. 179-204 J.W. Varni, C.A. Limbers, T.M. Burwinkle Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales Health Qual Life Outcomes, 5 (2007), p. 43 Jw Varni, M. Seid, Ps. Kurtin PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations Med Care., 39 (2001), pp. 800-812 C.M. Vélez, A.C. Villada Ramírez, A.C. Arias, J.H. Eslava-Schmalbach [Rasch Model in the Validation of the Paediatric Quality of Life Inventory™ 4.0 (PedsQL 4.0™) in Colombian Children and Adolescents] Rev Colomb Psiquiatr, 45 (2016), pp. 186-193 D. Moher, A. Liberati, J. Tetzlaff, D.G. Altman, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement PLoS Med., 6 (2009), Article e1000097 E. von Elm, D.G. Altman, M. Egger, S.J. Pocock, P.C. Gøtzsche, J.P. Vandenbroucke, et al. The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies Gac Sanit., 22 (2008) 144-50. Erratum in: Gac Sanit. 2008;22:391. J. Mehring, M.V. Brennan, M.E. Izzo, M. Pico, C. Vezzani, S. Blasi Calidad de vida relacionada con la salud en niños y adolescentes con enfermedad renal crónica Diaeta (B. Aires)., 34 (2016), pp. 7-13 A.M. Abd-Elmonem, A.M. Al-Tohamy, R.E. Galal, F.A. Abd-Elhalim Effects of progressive resistance exercises on quality of life and functional capacity in pediatric patients with chronic kidney disease: a randomized trial J Musculoskelet Neuronal Interact., 19 (2019), pp. 187-195 L.S. Tay, D. Wan, M. Aw, Y.H. Kim Examining HealthRelated Quality of Life (HRQoL), disease specific quality of life, and coping behaviors in adolescents with renal disease Asia Pac Psychiatry., 3 (2011), pp. 204-211 S.K. Neul, C.G. Minard, H. Currier, S.L. Goldstein Health-related quality of life functioning over a 2-year period in children with end-stage renal disease Pediatr Nephrol., 28 (2013), pp. 285-293 S.L. Goldstein, N. Graham, T. Burwinkle, B. Warady, R. Farrah, J.W. Varni Health-related quality of life in pediatric patients with ESRD Pediatr Nephrol., 21 (2006), pp. 846-850 A.C. Gerson, A. Wentz, A.G. Abraham, S.R. Mendley, S.R. Hooper, R.W. Butler, et al. Health-related quality of life of children with mild to moderate chronic kidney disease Pediatrics., 125 (2010), pp. e349-57 T. Damri, O. Louthrenoo, W. Chartapisak, S. Opastirakul Psychosocial problems and quality of life in children with chronic kidney disease Chiang Mai Med J. [Internet]., 53 (2020), pp. 127-134 A. Al-Uzri, M. Matheson, D.S. Gipson, S.R. Mendley, S.R. Hooper, O. Yadin, et al. The impact of short stature on health-related quality of life in children with chronic kidney disease J Pediatr., 163 (2013) 736-41.e1 J. Heath, P. Norman, M. Christian, A. Watson Measurement of quality of life and attitudes towards illness in children and young people with chronic kidney disease Qual Life Res., 26 (2017), pp. 2409-2419 S. Clavé, M. Tsimaratos, M. Boucekine, B. Ranchin, R. Salomon, O. Dunand, et al. Quality of life in adolescents with chronic kidney disease who initiate haemodialysis treatment BMC Nephrol., 20 (2019), p. 163 H. Öborn, L. Wettergren, M. Herthelius, U. Forinder Associations between lower urinary tract dysfunction and health-related quality of life in children with chronic kidney disease Acta Paediatr., 105 (2016), pp. 959-966 J. Dotis, A. Pavlaki, N. Printza, S. Stabouli, S. Antoniou, C. Gkogka, et al. Quality of life in children with chronic kidney disease Pediatr Nephrol., 31 (2016), pp. 2309-2316 A. Tong, G. Wong, S. McTaggart, P. Henning, F. Mackie, R.P. Carroll, et al. Quality of life of young adults and adolescents with chronic kidney disease J Pediatr., 163 (2013) 1179-85.e5. D. Mekahli, S. Ledermann, A. Gullett, L. Rees Evaluation of quality of life by young adult survivors of severe chronic kidney disease in infancy Pediatr Nephrol., 29 (2014), pp. 1387-1393 C. Aparicio López, A. Fernández Escribano, G. Garrido Cantanero, A. Luque, E. Izquierdo García Calidad de vida percibida por niños con enfermedad renal crónica y por sus padres Perceived quality of life in children with chronic renal disease and in their parents Nefrologia., 30 (2010), pp. 103-109 A.C. Gerson, A. Riley, B.A. Fivush, N. Pham, J. Fiorenza, J. Robertson, et al. Assessing health status and health care utilization in adolescents with chronic kidney disease J Am Soc Nephrol., 16 (2005) 1427-32. doi: 10.1681/ASN.2004040258. Epub 2005 Mar 16. PMID: 15772253. Am McKenna, Le Keating, A. Vigneux, S. Stevens, A. Williams, Df. Geary Quality of life in children with chronic kidney disease-patient and caregiver assessments Nephrol Dial Transplant., 21 (2006), pp. 1899-1905 A. Francis, M.S. Didsbury, A. van Zwieten, K. Chen, L.J. James, S. Kim, et al. Quality of life of children and adolescents with chronic kidney disease: a cross-sectional study Arch Dis Child., 104 (2019), pp. 134-140 A.A. El-Monem Impact of chronic kidney disease on anthropometric profile, health-related quality of life and cognitive function in children Bull Fac Phys Ther., 24 (2019), pp. 26-31 K. Pirojsakul, N. Mathews, G. Mouin Chronic kidney disease in children: recent update Open Urol Nephrol J., 8 (2015), pp. 117-123 E.G. Ingulli, R.H. Mak Growth in children with chronic kidney disease: role of nutrition, growth hormone, dialysis, and steroids Curr Opin Pediatr., 26 (2014), pp. 187-192 Correas Espeche E. LD, C. Lirio, D.M. Adragna, M. Monteverde, L. Briones, et al. Programa de actividad física en niños con insuficiencia renal crónica Medicina Infantil., 23 (2016), pp. 159-162 P. Morales, R. Loza, J. Vasquez, P. Baique, M. Reyes Quality of Life of Children with Chronic Kidney Disease Undergoing Renal Replacement Therapy J Kidney., 4 (2018), p. 173 L. Tjaden, A. Tong, P. Henning, J. Groothoff, J.C. Craig Children’s experiences of dialysis: a systematic review of qualitative studies Arch Dis Child., 97 (2012), pp. 395-402 A.R. Watson Psychosocial support for children and families requiring renal replacement therapy Pediatr Nephrol., 29 (2014), pp. 1169-1174 H.R. Alvarado, A. Casallas Vega, D. Andrade Fonseca, A.M. Bertolotto Calidad de vida en los niños que viven con enfermedad renal crónica Investig Enferm Imagen Desarr, 21 (2) (2020), 10.11144/Javeriana.ie21-2.cvnv M.C. Duque El apoyo social y las personas con enfermedades crónicas; reflexiones para un cuidado de enfermería basado en la participación. Cuidado al paciente con enfermedad crónica. Colombia: Editorial Javeriana (2010), pp. 83-98 N.R. Powe, M.E. Tarver-Carr, M.S. Eberhardt, F.L. Brancati Receipt of renal replacement therapy in the United States: a population-based study of sociodemographic disparities from the Second National Health and Nutrition Examination Survey (NHANES II) Am J Kidney Dis., 42 (2003), pp. 249-255 N. Buyan, M.A. Türkmen, I. Bilge, E. Baskin, M. Haberal, Y. Bilginer, et al. Quality of life in children with chronic kidney disease (with child and parent assessments) Pediatr Nephrol., 25 (2010) 1487-96. doi: 10.1007/s00467-010-1486-1. Epub 2010 Apr 10. PMID: 20383649 L. Haverman, P.F. Limperg, N.L. Young, M.A. Grootenhuis, R.J. Klaassen Paediatric health-related quality of life: what is it and why should we measure it? Arch Dis Child., 102 (2017), pp. 393-400 S.L. Goldstein, N.M. Rosburg, B.A. Warady, M. Seikaly, R. McDonald, C. Limbers, et al. Pediatric end stage renal disease health-related quality of life differs by modality: a PedsQL ESRD analysis Pediatr Nephrol., 24 (2009), pp. 1553-1560 D. Mekahli, S. Ledermann, A. Gullett, L. Rees Evaluation of quality of life by young adult survivors of severe chronic kidney disease in infancy Pediatr Nephrol., 29 (2014), pp. 1387-1393 C. Tufanaru, Z. Munn, M. Stephenson, E. Aromataris Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness Int J Evid Based Healthc., 13 (2015), pp. 196-207 H.E. Jones, A.E. Ades, A.J. Sutton, N.J. Welton Use of a random effects meta-analysis in the design and analysis of a new clinical trial Stat Med., 37 (2018), pp. 4665-4679 |
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Ruidiaz Gómez, Keydis SulayHiguita Gutiérrez, Luis FelipeS0021-7557(20)30243-62021-01-21T21:36:28Z2021-01-21T21:36:28Z2020-12-1716784782https://doi.org/10.1016/j.jped.2020.10.013https://hdl.handle.net/20.500.12494/32754Ruidiaz-Gómez, K. S., & Higuita-Gutiérrez, L. F. (2020). Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis. Jornal de pediatria, S0021-7557(20)30243-6.MuObjective: To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument. Sources of data: A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out. Summary of the findings: 17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3-5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the physical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points. Conclusion: The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the "school" dimension being the most affected and the "emotional" one the least. In this sense, we suggest monitoring the health-related quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001501791https://orcid.org/0000-0003-1361-3124https://scienti.minciencias.gov.co/gruplac/jsp/visualiza/visualizagr.jsp?nro=00000000011355luis.higuita@campusucc.edu.co12Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Medicina, Medellín y EnvigadoSociedade Brasileira de PediatriaMedicinaMedellínhttps://pubmed.ncbi.nlm.nih.gov/33340460/Jornal de PediatriaK.R. Ribeiro Cuidados de enfermagem aos pacientes com insuficiência renal crônica no ambientes hospitalar Rev Cient Enferm., 6 (2016), pp. 26-35N.M. Jesus, G.F. Souza, C. Mendes-Rodrigues, O.P. Almeida Neto, D.D. Rodrigues, C.M. 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Welton Use of a random effects meta-analysis in the design and analysis of a new clinical trial Stat Med., 37 (2018), pp. 4665-4679Chronic kidney diseasePediatricQuality of lifeChronic kidney diseasePediatricQuality of lifeImpact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysisArtículohttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionAtribucióninfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2PublicationLICENSElicense.txtlicense.txttext/plain; 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