Multivariate Analysis of Factors Affecting Attitude Toward Living Kidney Donation Among the Puerto Rican Population Resident in Florida.

Puerto Rican and Cuban populations are 2 of the most important migration groups in Florida. Awareness about organ donation among them is fundamental. It is important to determine the factors that influence attitudes toward organ donation. OBJECTIVE: To analyze the attitude toward living kidney donation (LKD) among Florida's Puerto Rican residents. METHODS: Study population: Population born in Puerto Rico resident in Florida (United States). INCLUSION CRITERIA: A sample of population older than 15 years was obtained randomly and stratified by age and sex. Instrument valuation: LKD attitude questionnaire Proyecto Colaborativo Internacional Donantesobre Donación de Vivo Renal, Rios. SETTING: for the study: Random selection based on stratification. Immigration support associations in Florida were needed to locate potential respondents. Anonymized and self-administered with verbal consent completion. RESULTS: Of the 259 respondents, 55% (n = 143) are in favor of related LKD (family or friends). The following factors were associated with this attitude: marital status (P = .008); educational level (P < .001); personal experience with organ donation and transplantation (P < .001); attitude toward deceased organ donation (P < .001); realization of prosocial activities (P = .02); family comments about organ donation (P < .001) and comments within couples (P < .001); not being concerned about possible mutilation of the body after donation (P < .001); believing that one's own religion was in favor of donation and transplantation (P < .001); economic incentives of donation (P < .001), and evaluation of the risk from living kidney donation (P < .001). In the multivariate analysis, only marital status is featured as an independent variable (odds ratio, 32.258; P < .001). CONCLUSIONS: The attitude toward related LKD among the Puerto Rican population who resides in Florida is not very favorable; only 55% would do it.

Are Dominicans in Favor of Xenotransplantation? A Study of the Attitude of Dominican Immigrants Residing in Spain and the United States.

Xenotransplantation carries many social and cultural implications. The immigrant population in countries with xenotransplantation programs, such as Spain and the United States, will play an important role in accepting such therapy. The objective of the study is to analyze the attitude toward xenotransplantation among the Dominican population residing in the United States and Spain. METHODS: The study population was born in the Dominican Republic and resides in the southeastern United States and Spain. A sample population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTx-Ríos). A random selection of people to be surveyed was carried out. Assistance from immigration support associations was needed to advise on the location of potential respondents. RESULTS: A total of 123 respondents were included in the study: A sample was taken of residents of the population from the Dominican Republic residing in Florida, United States (n = 66), and in Spain (n = 57). If it was assumed that xenotransplanted organs functioned as well as human ones, 30% would be in favor. If the results were worse, only 7% would be in favor. This favorable attitude was related to the following variables (P < .05): level of education, an attitude in favor of deceased and living organ donation, and having spoken about donation and transplantation within the family. CONCLUSIONS: The attitude toward xenotransplantation among the population from the Dominican Republic who are residing in the southeastern United States and Spain is unfavorable.

Emigration From Puerto Rico to Florida: Multivariate Analysis of Factors That Condition Attitudes of the Puerto Rican Population Toward Organ Donation for Transplant.

BACKGROUND: The Puerto Rican population represents one of the largest immigration groups in Florida, and this has an impact on the organ transplant donation process. Our aim was to analyze attitudes toward organ donation among Puerto Ricans who currently reside in the state of Florida (USA). METHODS: The population screened consisted of individuals >15 years old, who were born in Puerto Rico, living in Florida, and awaiting organs for transplant. All participants completed the "PCID-DTO Rios" questionnaire. Random selection was done according to stratification. Support from immigration associations in Spain was needed for advice on the locations of potential respondents. Study participation was anonymized and self-administered. RESULTS: There were 259 respondents, 37% (n = 95) were in favor of donation, 36% (n = 93) were against donation, and 27% (n = 71) were undecided. The variables associated with these attitudes were: age (P = .017); civil status (P = .021); level of education (P < .001); previous experience with donation and transplant (P < .001); attitude toward organ donation of a relative (P < .001); carrying out pro-social activities (P < .001); discussing the issue of transplant with the family (P < .001) or couple (P < .001); attitude toward incineration (P < .001), burial (P < .001), and autopsy (P < .001); fear of mutilation after donation (P < .001); and religious beliefs (P < .001). In the multivariate study, it remained an independent variable to have discussed the issue at the family level (odds ratio = 11.627; P = .009). CONCLUSION: The Puerto Rican study population residing in Florida has an unfavorable attitude toward organ donation.

Differences in Attitudes Toward Living Kidney Donation Among Dominican Immigrants Living in Spain and the United States.

BACKGROUND: The Dominican population has a double-emigration pathway: one is to the USA, by proximity, and the other is to Spain, by sociocultural identification. Our aim was to determine attitudes toward living organ donation among Dominicans residing in Florida (USA) and Spain. METHODS: All study participants were at least 15 years old and living in either Florida (USA) or Spain, and stratified by gender and age. A questionnaire on attitudes toward living kidney donation ("PCID-LKD Ríos") was used. The support of immigrant associations in Florida and Spain was required to advise on survey locations. Data obtained were anonymized and self-administered. RESULTS: The study questionnaire was completed by 123 Dominicans, 68% of whom were in favor of living related kidney donation. There were differences (P = .004) according to the country of residence. Eighty-one percent of Spain's Dominican residents were in favor, compared with 56% of Florida's residents. Factors associated with attitude toward donation were level of education (P < .001), previous experience with organ donation (P = .006), attitude toward cadaveric organ donation (P < .001), belief in the possibility of needing a transplant in the future (P = .016), discussing the issue with one's family (P = .007), discussing the issue with husband/wife/partner (P = .002), carrying out pro-social activities (P = .029), religious beliefs (P = .001), and understanding the risk of living kidney donation (P = .046). CONCLUSION: Attitudes toward living kidney donation among immigrant Dominicans varies between Spain and the USA, with the former showing a more positive view.

Does the Attitude Toward Organ Donation Change as a Function of the Country Where People Emigrate? Study Between Uruguayan Emigrants to the United States and Spain.

INTRODUCTION: The Uruguayan population is sensitized toward transplantation. However, it has not been studied how this awareness can change when emigrating to different countries. OBJECTIVE: To analyze the attitude toward cadaveric organ donation and living organ donation between the Uruguayan population residing in Florida (United States) and the Uruguayan population residing in Spain. METHOD: Adults born in Uruguay and residing in Florida and Spain were screened. The questionnaire "PCID-DTO Ríos" (donation of cadaveric organs) and "PCID-DVR Ríos" (living renal donation) were used. Subjects were randomly selected according to age and gender stratification. Support from Latin-American immigration associations in Spain and Florida was needed. The survey was anonymized and self-administered. Verbal consent was obtained to collaborate in the study. RESULTS: Because the emigrant population to Spain is far larger than the emigrant population to the United States, a 2:1 proportional sampling was performed (n = 132). Sixty-seven percent of residents in Spain were in favor of organ donation at the time of death compared with 50% among residents in Florida (P = .082), and 100% of residents in Spain were in favor of living renal donation compared with 50% of those living in Florida (P < .001). CONCLUSIONS: The attitude toward donation is more favorable among Uruguayan emigrants to Spain than emigrants to the United States, especially in related kidney donation.

[Evaluation of the potential organ and tissue donor within the pandemic of influenza H1N1]. / Valoración del potencial donante de órganos y tejidos en el seno de la pandemia por gripe A H1N1.

The pandemic strain of H1N1 supposes a challenge to the health care system in general and for Intensive Care Units (ICU) in particular. Therefore, it will undoubtedly have repercussions on the organ and tissue donation process. In a possible scenario of bed shortage in the ICU and difficulties in maintaining the surgical activity at a normal pace, a significant effort must be made to assure the maintenance of normal transplant activity, which should not be considered as an elective surgical procedure. Another problem related with the impact of the pandemic on the organ donation process is the possibility that a donor with influenza virus could transmit the disease to recipients. This work aims to clarify this issue, reviewing existing data on the potential transmission of influenza viruses with transplanted organs or tissue, the recommendations published in other countries and those developed in Spain by an ad hoc work group that is made up by representatives from the National Transplant Organization, the Ministry of Health and Social Policy, Regional Offices of Transplant Coordination, and various scientific societies, including SEMICYUC.

Disparities in access to liver transplantation in Spain.

BACKGROUND: The maintenance of an equitable system for access to transplantation is a matter of concern to all professionals involved in this field. Any national system must ensure equity. METHODS: The rates of indication for liver transplantation have been reviewed for all Spanish regions. The time to transplantation was evaluated with respect to different recipient characteristics and donor rates. The indication rates for liver transplantation are similar in the different countries with liver transplant programs but are far from similar among different regions in Spain. This suggests that there is not equity in the access to liver transplantation. RESULTS: A review of the factors affecting the waiting times to transplantation after being registered for the waiting list shows that some groups of patients are currently waiting less time than others. Shorter waiting times occur in patients of the AB group, children, patients with hepatocarcinoma, and patients living in the zone of Valencia, despite similar organ donation rates in all transplant zones. CONCLUSION: Neither the rate nor the probability of liver transplantation is affected exclusively by the organ donation rate in Spain but also depends on the number of patients admitted to the waiting list. Despite the existence of an organ allocation system that is center-oriented, liver patients are receiving grafts mainly based on the severity of the illness, because clearance rates from the waiting list of both dead patients and grafted patients are the same.

Factores de riesgo para las enfermedades no transmisibles: metodología y resultados globales de la encuesta de base del programa CARMEN: conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles / Risk factors for chronic non communicable diseases: methods and results of CARMEN program basal survey

Background: In the last decades, chronic non communicable diseases are becoming the main cause of disability and mortality among adults. The risk factor surveillance and management is the most efficient mean of reducing the impact of these diseases. Aim: To report the results of a non communicable disease risk factor surveillance program in Valparaiso, Chile. Material and methods: a random samples of people aged 25 to 64 years old living in Valparaiso, Chile was studied. Subjects were questioned about smoking and physical activity habits. Blood pressure, height and weight were measured using standardized techniques at their homes and blood samples were obtained to measure serum lipid levels and oral glucose tolerance test at the nearest outpatient clinic. Results: Of the initial 3852 homes selected, 752 individuals did no agree to answer the inquiry, therefore 3120 subjects were finally interviewed. Of these, 40.6 percent were smokers, 15 percent drank alcohol in two or more occasions per month, 84.6 percent were physically inactive, 19.7 percent had a body mass index over 30 kg/m2, 11.1 percent had high blood pressure, 3.9 percent were diabetic and 46.9 percent had high serum cholesterol levels. Conclusions: The basal survey for the CARMEN program shows a high prevalence of cardiovascular risk factors among chileans

Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis.

OBJECTIVE: To analyze the prognosis and costs of mechanical ventilation in patients with exacerbations of chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy. DESIGN: A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis. SETTING: A medical-surgical intensive care unit (ICU) in a university hospital. PATIENTS: 20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure. MEASUREMENTS AND MAIN RESULTS: Mortality in the ICU, in-hospital mortality (ICU plus ward), and mortality at 1 and 5 years, and factors associated with prognosis and cost-utility were assessed. The mean Acute Physiology and Chronic Health Evaluation II score was 20 (median 20 range 12-36). Cumulative mortality was 35% in the ICU, 50% in hospital, 75% at 1 year, and 85% at 5 years. Factors significantly associated with mortality in the ICU were low levels of albumin (p = 0.05) and sodium (p = 0.01) at admission. Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEV1) than survivors (p = 0.03 and p = 0.05, respectively). The cost per Quality Adjusted Life Year (QALY) was U.S. $26283 and U.S. $44602 in a "best" (cost/QALY calculated for the life expectancy in Spain) and a "worst case scenario" (cost/QALY calculated for a 68-year life expectancy), respectively. CONCLUSIONS: Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost. Factors significantly associated with mortality in the ICU were albumin and sodium concentrations and FEV1 in hospital and in the first year after discharge.

[Anthropometric evaluation of the nutritional status of a elderly group from Madrid (Spain)]. / Valoración antropométrica del estado nutricional de un colectivo de ancianos de Madrid (España).

Body composition was assessed by means of anthropometry in a group of 75 elderly people (21 men and 54 women), aged 65 to 95 years (mean age 82.1 +/- 0.7) (x +/- SE), mean weight 58.5 +/- 1.7 kg and mean height 150.4 +/- 1.1 cm, which live in al Old People's Home in the Autonomic Community of Madrid. The average Quetelet Index 25.7 +/- 0.7 kg/m2 indicates a basically normal situation although there are 21% obese elderly with Quetelet over 30 kg/m2 and 12% of the cases with the index under 20 kg/m2. Even though the skinfold thickness in our population is inferior to the results obtained in other studies, the triceps skinfold is nearer the values given by other authors, and the suprailiac skinfold is completely different. This means that the elderly studied have less abdominal fat accumulation and more accumulation in arms and legs. This fat distribution can be beneficial in relationship to the risk of suffering several pathologies. Of the males, 15% and 22% of the females have their weight 25% and 30%, respectively, higher than their ideal weight. But there are also some of them with ponderal deficiency; by this means, 23% have 95% lesser than their ideal weight, indicating moderate malnutrition. A total of 16% have less than 85%, indicating medium malnutrition and 2 have less than 75% of the ideal weight, which is indicating of severe deficiency. With age, the measured height, weight, skinfolds, circumferences and diameters, the fat and lean body mass values decrease, the abdominal skinfold and the fat body mass decreasing significantly. Our results can contribute to increase knowledge as to the nutritional status and body composition of the Spanish elderly, and emphasize the coexistence of fat and ponderal excess with deficiencies of higher or lower importance.