An Integrated Psychosocial Model of Relatives' Decision About Deceased Organ Donation (IMROD): Joining Pieces of the Puzzle.

Organ transplantation remains currently limited because the demand for organs far exceeds the supply. Though organ procurement is a complex process involving social, organizational, and clinical factors, one of the most relevant limitations of organ availability is family refusal to donate organs of a deceased relative. In the past decades, a remarkable corpus of evidence about the factors conditioning relatives' consent has been generated. However, research in the field has been carried out mainly by means of merely empirical approaches, and only partial attempts have been made to integrate the existing empirical evidence within conceptual and theoretically based frameworks. Accordingly, this work articulates the proposal of an Integrated Psychosocial Model of Relatives' Organ Donation (IMROD) which offers a systematic view of the factors and psychosocial processes involved in family decision and their interrelations. Relatives' experience is conceptualized as a decision process about the possibility of vicariously performing an altruistic behavior that takes place under one of the most stressful experiences of one's lifetime and in the context of interaction with different healthcare professionals. Drawing on this, in the proposed model, the influence of the implied factors and their interrelations/interactions are structured and interpreted according to their theoretically based relation with processes like rational/heuristic decision-making, uncertainty, stress, bereavement, emotional reactions, sense of reciprocity, sense of freedom to decide, and attitudes/intentions toward one's own and the deceased's organ donation. Our model also develops a processual perspective and suggests different decisional scenarios that may be reached as a result of the combinations of the considered factors. Each of these scenarios may imply different balances between factors that enhance or hinder donation, such as different levels of uncertainty and potential decisional conflict. Throughout our work, current controversial or inconsistent results are discussed and interpreted on the basis of the relationships that are posited in the proposed model. Finally, we suggest that the structure of the relationships and interactions contained in our model can be used by future research to guide the formulation of hypotheses and the interpretation of results. In this sense, specific guidelines and research questions are also proposed.

Comparison of isoflurane and alfaxalone (Alfaxan) for the induction of anesthesia in flamingos (Phoenicopterus roseus) undergoing orthopedic surgery.

Used since the 1970s as an avian anesthetic, the neurosteroid alfaxalone has been reformulated to avoid side effects from its castor oil excipient. This case report describes the clinical use of a new alfaxalone formulation (Alfaxan) as an intravenous anesthetic induction agent in wild isoflurane-anesthetized rose flamingos (Phoenicopterus roseus). Twenty-five male and female rose flamingos underwent orthopedic surgery using isoflurane anesthesia. The animals were induced following one of two protocols: inhaled isoflurane by facemask (ISO; n = 9) or intravenous alfaxalone (2 mg/kg; ALF; n = 16). The time and quality of anesthetic induction (until first signs of muscle relaxation) and the time and quality of recovery (sternal recumbency) were recorded using a scoring system. Mild sedation was first observed at 18.4 +/- 3.8 min and 1.7 +/- 0.3 min, following isoflurane and alfaxalone administration, respectively (P < 0.001). Alfaxalone induction time was significantly shorter and induction quality was considered smoother than in the ISO group. Flamingos given alfaxalone induction required lower isoflurane concentrations for maintenance anesthesia than did flamingos induced with mask isoflurane (1.5-2 % vol vs. 4-5 % vol for ALF vs. ISO, respectively). Alfaxalone produced moderate cardiorespiratory effects not seen in the isoflurane induction group. Recovery times were similar with both protocols without significant differences in quality and length. The new alfaxalone formulation produces a safe and effective anesthetic induction in rose flamingos and has significant isoflurane-sparing effects during anesthesia.

Cardiovascular risk factors in a Mexican middle-class urban population: The Lindavista Study. Baseline data / Factores de riesgo cardiovascular en mexicanos de clase media: el estudio Lindavista. Datos basales

Introduction and objective: The aim of this communication is to describe the cardiovascular risk factors affecting a Mexican urban middle-class population. Methods: A convenience sample of 2602 middle class urban subjects composed the cohort of the Lindavista Study, a prospective study aimed to determine if conventional cardiovascular risks factors have the same prognosis impact as in other populations. For the baseline data, several measurements were done: obesity indexes, smoking, blood pressure, fasting serum glucose, total cholesterol, HDL-c, LDL-c and triglycerides. This paper presents the basal values of this population, which represents a sample of the Mexican growing urban middle-class. Results: The mean age in the sample was 50 years; 59% were females. Around 50% of the entire group were overweighed, while around 24% were obese. 32% smoked; 32% were hypertensive with a 20% rate of controlled pressure. 6% had diabetes, and 14% had impaired fasting glucose; 66% had total cholesterol ≥ 200mg/dL; 62% showed HDL-c levels <40mg/dL; 52% triglycerides > 150 mg/dL, and 34% levels of LDL-c ≥ 160 mg/dL. Half of the population studied had the metabolic syndrome. Conclusion: These data show a population with a high-risk profile, secondary to the agglomeration of several cardiovascular risk factors.

Introducción y objetivo: el objetivo de este comunicado es describir los factores de riesgo cardiovascular en la población urbana mexicana de clase media. Métodos: La cohorte del estudio Lindavista se compone de una muestra por conveniencia de 2,602 sujetos de clase media. El estudio es prospectivo y tiene como finalidad determinar si los factores de riesgo cardiovascular tienen el mismo factor pronóstico que en otras poblaciones. Para los datos basales, se hicieron varias determinaciones: índices de obesidad, consumo de tabaco, presión arterial, glucosa, colesterol total, c-HDL, c-LDL y triglicéridos en ayuno. Resultados: La media de edad fue de 50 años; el 59% fueron mujeres. Aproximadamente el 50% de la muestra presentó sobrepeso, mientras que el 24% eran obesos. El 32% fumaban, el 32% eran hipertensos con una tasa de control del 20%. El 6% tenían diabetes y el 14% resistencia a la insulina. El 66% tuvieron colesterol total ≥ 200 mg/dl; el 62% mostraron bajos niveles de c-HDL, el 52% triglicéridos > 150 mg/dl, y el 34% niveles de c-LDL ≥ 160 mg/dl. La mitad de la muestra tenía síndrome metabólico. Conclusión: Los datos revelan una población de alto riesgo cardiovascular debido a la aglomeración de diversos factores de riesgo.

Cardiovascular risk factors in a Mexican middle-class urban population. The Lindavista Study. Baseline data.

INTRODUCTION AND OBJECTIVE: The aim of this communication is to describe the cardiovascular risk factors affecting a Mexican urban middle-class population. METHODS: A convenience sample of 2602 middle class urban subjects composed the cohort of the Lindavista Study, a prospective study aimed to determine if conventional cardiovascular risks factors have the same prognosis impact as in other populations. For the baseline data, several measurements were done: obesity indexes, smoking, blood pressure, fasting serum glucose, total cholesterol, HDL-c, LDL-c and triglycerides. This paper presents the basal values of this population, which represents a sample of the Mexican growing urban middle-class. RESULTS: The mean age in the sample was 50 years; 59% were females. Around 50% of the entire group were overweighed, while around 24% were obese. 32% smoked; 32% were hypertensive with a 20% rate of controlled pressure. 6% had diabetes, and 14% had impaired fasting glucose; 66% had total cholesterol ≥ 200 mg/dL; 62% showed HDL-c levels<40 mg/dL; 52% triglycerides>150 mg/dL, and 34% levels of LDL-c ≥ 160 mg/dL. Half of the population studied had the metabolic syndrome. CONCLUSION: These data show a population with a high-risk profile, secondary to the agglomeration of several cardiovascular risk factors.

Anthropometric traits, blood pressure, and dietary and physical exercise habits in health sciences students; the obesity observatory project.

BACKGROUND: Obesity and the metabolic syndrome affect a considerable segment of the population worldwide, including health professionals. In fact, several studies have reported that physicians tend to have more cardiovascular risk factors than their patients. The present cross-sectional study assessed whether the Health Sciences students had a healthier lifestyle, thus could have a more preventive attitude towards chronic diseases than the general population. MATERIALS AND METHODS: Students of the medical-biological areas were surveyed by answering a questionnaire about familiar cardiovascular risk factors, personal smoking, alcohol drinking, dietary and exercise habits. Blood pressure was also measured, along with weight, height, and abdominal circumference. RESULTS: 23.4% of the participants were overweight and 10% obese. Parental obesity was the most frequent risk factor, followed by social drinking and smoking. We found high consumption of animal derived foods, breakfast- like cereals, pastries, white bread and sweetened beverages; while low intake of fruit and vegetables were reported. More than half the sample reported to practice very little or no exercise at all. DISCUSSION AND CONCLUSIONS: We found similar or even higher rates of risk factors than the average population, that may eventually lead to the development of chronic cardiometabolic diseases. Thus we can infer that biomedical education is inefficient in inducing healthy lifestyles among biomedical students, which could have impact in their future practice as they will most probable become obese health-professionals, thus fail to effectively treat their own patients.

Introducción: La obesidad y el síndrome metabólico afectan a un segmento considerable de la población mundial, incluyendo a los profesionales de la salud. De hecho, diversos estudios han reportado que los médicos tienden a presentar más factores de riesgo cardiovascular que sus propios pacientes. El presente estudio transversal evaluó si los estudiantes del área de la salud tenían un estilo de vida más saludable y, por tanto, una mejor actitud en cuanto a la prevención de las enfermedades crónico-degenerativas, que el resto de la población. Materiales y métodos: Se encuestaron estudiantes del área medico-biológica a través de un cuestionario sobre antecedentes heredo-familiares de riesgo cardiovascular, consumo actual de tabaco y alcohol, así como hábitos alimentarios y de ejercicio físico. Se midió la presión arterial, el peos, la talla y la circunferencia abdominal. Resultados: 23.4% de los participantes presentaban sobrepeso y 10% obesidad. La obesidad paterna fue el factor de riesgo más frecuente, seguido de consumo social de alcohol y tabaquismo. Se encontró un alto consume de alimentos de origen animal, cereales industrializados y refrescos; por otra parte, se reportó un bajo consumo de verduras y frutas. Más de la mitad de la muestra refirió ser sedentario. Discusión y conclusiones: Se encontraron datos muy similares a aquéllos reportados sobre la población general, que eventualmente conducirán al desarrollo de enfermedades cardiometabólicas. Por tanto, es posible inferir que la educación biomédica no es eficiente en la inducción de un estilo de vida saludable entre los estudiantes de ciencias de la salud. Tal fenómeno podría impactar su práctica futura ya que probablemente se convertirán en profesionistas obesos, con la consecuente falla en la prevención primaria y secundaria de sus propios pacientes.

Identification of repressor element 1 in cytochrome P450 genes and their negative regulation by RE1 silencing transcription factor/neuron-restrictive silencer factor.

RE1 silencing transcription factor/neuron-restrictive silencing factor (REST/NRSF) mediates transcriptional repression in many neuron-specific genes by interaction with the repressor element 1/neuron-restrictive silencing element (RE1/NRSE). This element has been identified at least in 20 neuron specific genes. REST/NRSF is highly expressed in non-neuronal tissues, where it is thought to repress gene transcription. We performed a BLAST search to look for the presence of RE1/NRSE elements in the rat cytochrome P450 genes. We identified the presence of RE1/NRSE element in the cytochrome P450 genes CYP1A1, 2A2, 2E1 and 3A2. Electrophoretic mobility shift assay and supershift assays were carried out to prove functionality of these sites and detect the interaction of REST/NRSF with this sequence. Cotransfection studies in PC12 cells with a plasmid containing the RE1 element of the CYP genes, cloned upstream of the minimal type II sodium channel promoter, in the presence of REST/NRSF, showed a marked expression inhibition of the CAT reporter gene. These data suggest that the RE1 elements that exist in these four CYP genes might be a target for the REST/NRSF transcription factor and such an interaction might play a role in the negative regulation of these genes.