BACKGROUND: The term sepsis refers to a complex and heterogeneous syndrome. Although great progress has been made in improving the diagnosis and treatment of this condition, it continues to have a huge impact on morbidity and mortality worldwide. Mesenchymal stem cells are a population of multipotent cells that have immunomodulatory properties, anti-apoptotic effects, and antimicrobial activity. We studied these capacities in a porcine model of peritoneal sepsis. METHODS: We infused human adipose-derived mesenchymal stem cells (ADSCs) into a porcine model of peritoneal sepsis. Twenty piglets were treated with antibiotics alone (control group) or antibiotics plus peritoneal infusion of ADSCs at a concentration of 2 × 106 cells/kg or 4 × 106 cells/kg (low- and high-dose experimental groups, respectively). The animals were evaluated at different time points to determine their clinical status, biochemical and hematologic parameters, presence of inflammatory cytokines and chemokines in blood and peritoneal fluid, and finally by histologic analysis of the organs of the peritoneal cavity. RESULTS: One day after sepsis induction, all animals presented peritonitis with bacterial infection as well as elevated C-reactive protein, haptoglobin, IL-1Ra, IL-6, and IL-1b. Xenogeneic ADSC infusion did not elicit an immune response, and peritoneal administration of the treatment was safe and feasible. One day after infusion, the two experimental groups showed a superior physical condition (e.g., mobility, feeding) and a significant increase of IL-10 and TGF-ß in blood and a decrease of IL-1Ra, IL-1b, and IL-6. After 7 days, all animals treated with ADSCs had better results concerning blood biomarkers, and histopathological analysis revealed a lower degree of inflammatory cell infiltration of the organs of the peritoneal cavity. CONCLUSIONS: Intraperitoneal administration of ADSCs as an adjuvant therapy for sepsis improves the outcome and diminishes the effects of peritonitis and associated organ damage by regulating the immune system and reducing intra-abdominal adhesions in a clinically relevant porcine model of abdominal sepsis.
Mesenchymal Stem Cells , Peritonitis , Sepsis , Humans , Animals , Swine , Interleukin 1 Receptor Antagonist Protein/metabolism , Interleukin-6/metabolism , Mesenchymal Stem Cells/metabolism , Peritonitis/therapy , Peritonitis/metabolism , Sepsis/therapy , Sepsis/metabolism , Anti-Bacterial Agents/metabolism
Aluminum thin films were deposited on a 3D prototype employing the direct current magnetron sputtering technique to fabricate a lightweight 3D first surface mirror. Before the aluminizing, the surface of the prototypes was evaluated with interferometry and atomic force microscope (AFM). The thin films were characterized using profilometry, UV-Vis spectroscopy, x-ray diffraction, AFM, x-ray photoelectron spectroscopy (XPS), and scanning electron microscopy. High adherence and homogeneous deposition of the aluminum's thin films were achieved. In addition, the purity of the material was confirmed by XPS analysis.
The building of population pharmacokinetic models can be described as an iterative process in which given a model and a dataset, the pharmacometrician introduces some changes to the model specification, then perform an evaluation and based on the predictions obtained performs further optimization. This process (perform an action, witness a result, optimize your knowledge) is a perfect scenario for the implementation of Reinforcement Learning algorithms. In this paper we present the conceptual background and a implementation of one of those algorithms aiming to show pharmacometricians how to automate (to a certain point) the iterative model building process.We present the selected discretization for the action and the state space. SARSA (State-Action-Reward-State-Action) was selected as the RL algorithm to use, configured with a window of 1000 episodes with and a limit of 30 actions per episode. SARSA was configured to control an interface to the Non-Parametric Optimal Design algorithm, that was actually performing the parameter optimization.The Reinforcement Learning (RL) based agent managed to obtain the same likelihood and number of support points, with a distribution similar to the reported in the original paper. The total amount of time used by the train the agent was 5.5 h although we think this time can be further improved. It is possible to automatically find the structural model that maximizes the final likelihood for an specific pharmacokinetic dataset by using RL algorithm. The framework provided could allow the integration of even more actions i.e: add/remove covariates, non-linear compartments or the execution of secondary analysis. Many limitations were found while performing this study but we hope to address them all in future studies.
Algorithms , Reinforcement, Psychology , Workflow , Probability
Presentamos la adaptación española de las Guías Europeas de Prevención Cardiovascular 2021. En esta actualización además del abordaje individual, se pone mucho más énfasis en las políticas sanitarias como estrategia de prevención poblacional. Se recomienda el cálculo del riesgo vascular de manera sistemática a todas las personas adultas con algún factor de riesgo vascular. Los objetivos terapéuticos para el colesterol low density lipoprotein (LDL), la presión arterial y la glucemia no han cambiado respecto a las anteriores guías, pero se recomienda alcanzar estos objetivos de forma escalonada (etapas 1 y 2). Se recomienda llegar siempre hasta la etapa 2, y la intensificación del tratamiento dependerá del riesgo a los 10 años y de por vida, del beneficio del tratamiento, de las comorbilidades, de la fragilidad y de las preferencias de los pacientes. Las guías presentan por primera vez un nuevo modelo para calcular el riesgo Systematic Coronary Risk Evaluation-2 (SCORE2) y Systematic Coronary Risk Evaluation-2 Old person (SCORE2-OP) de morbimortalidad vascular en los próximos 10 años (infarto de miocardio, ictus y mortalidad vascular) en hombres y mujeres entre 40 y 89 años. Otra de las novedades sustanciales es el establecimiento de diferentes umbrales de riesgo dependiendo de la edad (< 50, 50-69 ≥ 70 años).Se presentan diferentes algoritmos de cálculo del riesgo vascular y tratamiento de los factores de riesgo vascular para personas aparentemente sanas, pacientes con diabetes y pacientes con enfermedad vascular aterosclerótica. Los pacientes con enfermedad renal crónica se considerarán de riesgo alto o muy alto según la tasa del filtrado glomerular y el cociente albúmina/creatinina. Se incluyen innovaciones en las recomendaciones sobre los estilos de vida, adaptadas a las recomendaciones del Ministerio de Sanidad, así como aspectos novedosos relacionados con el control de los lípidos, la presión arterial, la diabetes y la insuficiencia renal crónica.
Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithmSCORE2, SCORE-OP is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. [...]
Humans , Male , Female , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Diabetes Mellitus , Arterial Pressure , Life Style , Risk Factors , Practice Guidelines as Topic , Diet, Healthy , Hypertension
Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.
Cardiovascular Diseases , Diabetes Mellitus , Blood Pressure , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Female , Humans , Life Style , Male , Risk Factors
Objetivo Evaluar la exactitud diagnóstica de la ecografía diafragmática para predecir el éxito en la extubación. Diseño Estudio de exactitud diagnóstica. Ámbito Unidad de Cuidado Intensivo Médico de un hospital académico de la ciudad de Bogotá (Colombia). Pacientes o participantes Muestra consecutiva de pacientes mayores de 18 años con ventilación mecánica invasiva durante más de 48h. Intervenciones Evaluación ecográfica diafragmática al finalizar la prueba de ventilación espontánea. Variables de interés principales Se evaluó la excursión diafragmática (ED, cm), el tiempo de inspiración (TPIAdia, s), la velocidad de contracción del diafragma (ED/TPIAdia, cm/s), el tiempo total (Ttot, s) y la fracción de engrosamiento (TFdi, %). Resultados Se incluyeron 84 pacientes, el 79,8% (n=67) con extubación exitosa y el 20,2% (n=17) con extubación fallida. La variable con mejor capacidad discriminatoria para predecir éxito en la extubación fue la velocidad de contracción, con un AUC-ROC de 0,70 (p=0,008). Conclusiones La velocidad de contracción diafragmática mostró una capacidad discriminatoria aceptable. La ultrasonografía podría formar parte de un abordaje multifactorial en el proceso de extubación. (AU)
Objective To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success. Design A diagnostic accuracy study was carried out. Scope Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia). Patients or participants A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h. Interventions Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing. Main variables of interest Diaphragmatic excursion (DE, cm), inspiration time (TPIAdia, s), diaphragm contraction speed (DE/TPIAdia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TFdi, %). Results A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008). Conclusions Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process. (AU)
Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Critical Illness , Airway Extubation , Diaphragm , Diagnostic Imaging , Intensive Care Units , Respiration , Ultrasonography , Ventilator Weaning , Colombia
OBJECTIVE: To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success. DESIGN: A diagnostic accuracy study was carried out. SCOPE: Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia). PATIENTS OR PARTICIPANTS: A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h. INTERVENTIONS: Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing. MAIN VARIABLES OF INTEREST: Diaphragmatic excursion (DE, cm), inspiration time (TPIAdia, s), diaphragm contraction speed (DE/TPIAdia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TFdi, %). RESULTS: A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008). CONCLUSIONS: Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process.
INTRODUCTION: The prognosis of MEN 1 patients is not only determined by pancreatic disease; it is also related to other uncommon tumors. The objective of this study is to analyze the tumors associated with MEN 1 outside the classic triad and to investigate their relationship with mortality. MATERIALS AND METHODS: One hundred and five MEN 1 patients were studied in a tertiary referral hospital (1980-2019). RESULTS: With a follow-up of 11 ± 4 years, seven patients died (8%), four as a consequence MEN syndrome. Thirty-three percent had adrenal gland tumors. One patient died of adrenal cancer. Eight percent presented with a neuroendocrine thoracic neoplasm, and one patient died. Another patient died due to cutaneous T-cell lymphoma. A further patient died because of a gastrinoma with liver metastasis. CONCLUSIONS: To conclude, 75% of MEN-related deaths were the result of an uncommon pathology, and we, therefore, recommend that these tumors should be taken into account in the screening and follow-up of these patients.
Adrenal Gland Neoplasms , Gastrinoma , Lymphoma, T-Cell, Cutaneous , Multiple Endocrine Neoplasia Type 1 , Neuroendocrine Tumors , Thoracic Neoplasms , Adrenal Gland Neoplasms/mortality , Adrenal Gland Neoplasms/pathology , Cause of Death , Cohort Studies , Early Detection of Cancer/methods , Early Detection of Cancer/standards , Female , Follow-Up Studies , Gastrinoma/mortality , Gastrinoma/pathology , Humans , Lymphoma, T-Cell, Cutaneous/mortality , Lymphoma, T-Cell, Cutaneous/pathology , Male , Middle Aged , Multiple Endocrine Neoplasia Type 1/diagnosis , Multiple Endocrine Neoplasia Type 1/mortality , Multiple Endocrine Neoplasia Type 1/pathology , Neoplasm Staging , Neuroendocrine Tumors/mortality , Neuroendocrine Tumors/pathology , Prognosis , Spain/epidemiology , Thoracic Neoplasms/mortality , Thoracic Neoplasms/pathology
In this work, we present a method to fabricate a hyaluronic acid (HA) hydrogel with spatially controlled cell-adhesion properties based on photo-polymerisation cross-linking and functionalization. The approach utilises the same reaction pathway for both steps meaning that it is user-friendly and allows for adaptation at any stage during the fabrication process. Moreover, the process does not require any additional cross-linkers. The hydrogel is formed by UV-initiated radical addition reaction between acrylamide (Am) groups on the HA backbone. Cell adhesion is modulated by functionalising the adhesion peptide sequence arginine-glycine-aspartate onto the hydrogel surface via radical mediated thiol-ene reaction using the non-reacted Am groups. We show that 10 × 10 µm2 squares could be patterned with sharp features and a good resolution. The smallest area that could be patterned resulting in good cell adhesion was 25 × 25 µm2 squares, showing single-cell adhesion. Mouse brain endothelial cells adhered and remained in culture for up to 7 days on 100 × 100 µm2 square patterns. We see potential for this material combination for future use in novel organ-on-chip models and tissue engineering where the location of the cells is of importance and to further study endothelial cell biology.
Biocompatible Materials/chemistry , Cell Culture Techniques/methods , Hydrogels/chemistry , Oligopeptides/chemistry , Sulfhydryl Compounds/chemistry , Animals , Arginine/chemistry , Aspartic Acid/chemistry , Brain/metabolism , Cell Adhesion , Cross-Linking Reagents/chemistry , Endothelial Cells/metabolism , Glycine/chemistry , Hyaluronic Acid/chemistry , In Vitro Techniques , Kinetics , Mice , Peptides/chemistry , Polymers/chemistry , Stress, Mechanical , Tissue Engineering/methods , Ultraviolet Rays
PURPOSE: Neurotrophic corneal ulcers are difficult to treat, and the conventional treatment often results in failure. A new matrix regenerating agent ("ReGeneraTing Agents"), Cacicol® (Laboratoires Théa), has demonstrated good results over the last few years. Therefore, the aim of this study was to evaluate the response to Cacicol® in a series of cases with neurotrophic corneal ulcers. METHODS: Retrospective case series looking at 11 patients with corneal ulcers unresponsive to conventional therapy that underwent treatment with Cacicol®. One cycle included 1 drop every two days for 5 days. RESULTS: The range of conventional therapy prior to Cacicol® was 0-91 days. On introducing Cacicol® 82% (9/11) of the cases were cured, and 18% (2/11) failed, requiring an amniotic membrane transplant or penetrating keratoplasty. The healing only required one cycle of Cacicol® in 67% (6/9) of the patients. More than one cycle of Cacicol® was needed in 45% (5/11) patients. One corneal bacterial ulcer responded favourably and one case related to Acanthamoeba did not respond. Most of the patients improved or maintained their visual acuity. CONCLUSION: Cacicol® was a useful therapy in a high number of difficult neurotrophic corneal ulcers, including corneal infections. Some cases may require more than one cycle of Cacicol® or used as first-line treatment in order to achieve the desired result.
Virtual clinical trials (VCT) are in-silico reproductions of medical examinations, which adopt digital models of patients and simulated devices. They are intended to produce clinically equivalent outcome data avoiding long execution times, ethical issues related to radiation induced risks and huge costs related to real clinical trials with a patient population. In this work, we present a platform for VCT in 2D and 3D X-ray breast imaging. The VCT platform uses Monte Carlo simulations based on the Geant4 toolkit and patient breast models derived from a cohort of high resolution dedicated breast CT (BCT) volume data sets. Projection images of the breast and three-dimensional glandular dose maps are generated for a given breast model, by simulating both 2D full-field digital mammography (DM) and 3D BCT examinations. Uncompressed voxelized breast models were derived from segmented patient images. Compressed versions of the digital breast phantoms for DM were generated using a previously published digital compression algorithm. The Monte Carlo simulation framework has the capability of generating and tracking ~105 photons/s using a server equipped with 16-cores and 3.0 GHz clock speed. The VCT platform will provide a framework for scanner design optimization, comparison between different scanner designs and between different modalities or protocols on computational breast models, without the need for scanning actual patients as in conventional clinical trials.
Breast/diagnostic imaging , Clinical Trials as Topic , Mammography , Monte Carlo Method , Humans , Imaging, Three-Dimensional
PURPOSE: A modular phantom for dosimetry and imaging performance evaluation in cone-beam computed tomography (CBCT) is reported, providing a tool for quantitative technical assessment that can be adapted to a broad variety of CBCT imaging configurations and clinical applications. METHODS: The phantom presents a set of modules that can be ordered in various configurations suitable to a particular CBCT system. Modules include slabs containing a uniform medium, low-contrast inserts, line-spread features, and disk features suitable to measurement of image uniformity, noise, noise-power spectrum (NPS), contrast, contrast-to-noise ratio (CNR), Hounsfield (HU) accuracy, linearity, spatial resolution modulation transfer function (MTF), and magnitude of cone-beam artifact. Automated software recognizes the phantom configuration in DICOM images and provides structured reporting of such test measures. In any modular configuration, the phantom permits measurement of air kerma in central and peripheral locations with an air ionization chamber (e.g., Farmer chamber). The utility and adaptability of the phantom were demonstrated across a spectrum of CBCT systems, including scanners for orthopaedic imaging (Carestream OnSight 3D, Rochester NY), breast imaging (Doheny prototype, UC Davis), image-guided surgery (IGS, Medtronic O-arm, Littleton MA), angiography (Siemens Artis Zeego, Forcheim Germany), and image-guided radiation therapy (IGRT, Elekta Synergy XVI, Stockholm Sweden). RESULTS: The phantom provided a consistent platform for quantitative assessment of dose and imaging performance compatible with a broad spectrum of CBCT systems. The purpose of the survey was not to obtain head-to-head performance comparison of systems designed for such distinct clinical applications. Rather, the survey demonstrated the suitability of the phantom to a broad spectrum of systems in a manner that provides characterization pertinent to disparate applications and imaging tasks. For example: the orthopaedic CBCT system (pertinent clinical tasks relating to high-resolution bone imaging) was shown to achieve MTF consistent with imaging of high-contrast trabecular bone structures (i.e., the MTF reduced to 10% at spatial frequency, f 10 = 1.2 mm-1 ); the breast system (even higher-resolution imaging of microcalcifications) exhibited f 10 = 2.2 mm-1 ; the IGS system (tasks including both bone and soft-tissue contrast resolution) provided f 10 = 0.9 mm-1 and soft-tissue CNR = 1.64; the angiography system (soft-tissue body interventions) demonstrated CNR = 1.2 in soft tissues approximating liver lesions; and the IGRT system (pertinent tasks emphasizing HU linearity and image uniformity) showed linear response with HU values ( R 2 = 1), with a cupping artifact ( t cup = 5.8%) due to x-ray scatter. CONCLUSIONS: The phantom provides an adaptable, quantitative basis for CBCT dosimetry and imaging performance evaluation suitable to a broad variety of CBCT systems. The dosimetry and image quality metrics are consistent with up-to-date methods for rigorous, quantitative, physics testing and should be suitable to emerging standards for CBCT quality assurance.
Cone-Beam Computed Tomography/instrumentation , Phantoms, Imaging , Radiation Dosage , Artifacts , Quality Control , Signal-To-Noise Ratio
BACKGROUND AND OBJECTIVE: Outpatient vital signs monitoring has a key role in medical diagnosis and treatment. However, ambulatory vital signs monitoring has great challenges to overcome, being the most important, the reduction of noise and Motion Artifacts, which hide essential information, particularly in Electrocardiographic signals. Despite efforts being made to reduce these artifacts, a comparative performance assessment of proposed techniques does not exist to the best of our knowledge and there are no enhancement level measurements obtained by the signals in the artifacts reduction. This article presents a new method based on Ensemble Average for the performance comparison of reported techniques for the processing and reduction of noise and artifacts in Electrocardiographic signals. METHODS: The comparison was done using a dataset composed by six synthetic noised Electrocardiographic signals and six real one acquired from healthy volunteers that intentionally introduced Motion Artifacts. Several techniques that have reported positive results in the enhancement of Electrocardiographic signals were applied to this dataset to compare their performance in the reduction of Motion Artifacts. The Signal-to-Noise Ratio and the Ensemble Average as a distortion measurement were used to compare the performance of algorithms to produce an enhanced signal. RESULTS: In agreement to previous reports, all studied methods show a significant improvement of the Signal-to-Noise Ratio. Concerning the distortion of the waveform, although all methods caused high distortion on the enhanced signal waveform, the Wavelet-ICA method showed the best performance. The percentage of signal distortion introduced by denoising techniques was evaluated through the proposed Ensemble Average Electrocardiographic method. CONCLUSIONS: It was found that the proposed method based on Ensemble Average offers a complementary way to measure the performance of denoising techniques when considering the introduced distortion in the waveform segments once the artifact reduction process was applied and not only the change in the Signal-to-Noise Ratio.
Artifacts , Electrocardiography/methods , Signal-To-Noise Ratio , Signal Processing, Computer-Assisted
INTRODUCTION: Religious factors have conditioned the attitude toward organ donation and transplantation (ODT) since the beginning of transplantation, despite the fact that most religions are in favor of transplantation. OBJECTIVE: To assess the impact of religious beliefs of medical students on their attitude toward ODT. METHOD: Population under study: Medical students in Spanish universities. STUDY SAMPLE: Stratified by geographical area and academic course. Assessment instrument: Attitude ODT questionnaire PCID-DTO-Ríos, anonymous and self-administered. RESULTS: Of all students, 42% (n = 3907) declare themselves atheists or agnostics. The remaining 58% (n = 5368) declare themselves to be religious, the majority being Catholic (55%, n = 5102). Of the rest, 0.2% are Muslims (n = 8), 0.1% Protestants (n = 1), and the remaining 2.7% (n = 257) indicate other religious doctrines but do not want to specify it. Regarding their attitude toward ODT, those who consider themselves atheists or agnostics have a more favorable attitude than those who consider themselves religious (84% versus 76%; P < .001). Among those who follow some kind of religion, Catholics are more in favor of ODT than non-Catholics (77% vs 64%, P < .001). Note that among the religious, only 57% (n = 3050) know which religion is in favor of transplantation, while 22% (n = 1,152) consider that it has not been pronounced on the matter, 13% (n = 723) think the religion is against donation, and the remaining 8% (n = 443) do not know. CONCLUSION: The religion professed by medical students conditions their attitude toward donation, with the atheists and agnostics being more in favor of donation.
Health Knowledge, Attitudes, Practice , Religion , Students, Medical/psychology , Tissue and Organ Procurement , Adult , Female , Humans , Male , Spain , Surveys and Questionnaires
The involvement of health professionals from their training period is important for the promotion of living liver donation. There are data that indicate that the awareness of living donation is lower in areas with high rates of deceased donation. OBJECTIVE: To analyze the attitude toward living liver donation among Spanish medical students, according to donation rates of their regions. METHOD: Population under study: Medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: group 1 (n = 1136): students in universities of regions with >50 donors per million population (pmp); group 2 (n = 2018): students in region universities with <40 donors pmp. Assessment instrument: the attitude questionnaire for living liver donation Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Hepático-Ríos (PCID-DVH Ríos). RESULTS: The attitude toward related liver donation is more favorable among the students of regions with <40 donors pmp than among those of >50 donors pmp. Thus, in group 1, a total of 88% (n = 1002) of students are in favor compared with 91% (n = 1831) of group 2 (P=.02). The psychosocial profile of each study group about their attitude toward living related liver donation is analyzed. There is a similar profile between the 2 groups, although there are differences in some variables such as age, a belief that one might need a transplant, family discussion about donation and transplantation, discussion with friends about donation and transplantation, and knowing about a donor. CONCLUSIONS: The awareness of living related donation among Spanish medical students is greater among the regions with lower organ donation rates.
Health Knowledge, Attitudes, Practice , Liver Transplantation/psychology , Living Donors , Social Behavior , Students, Medical/psychology , Adult , Awareness , Female , Humans , Living Donors/supply & distribution , Male , Middle Aged , Surveys and Questionnaires , Tissue and Organ Procurement
The Latin American population has a double way of immigration, one toward the United States by proximity and another toward Spain by sociocultural affinity. This population increase is affecting organ donation and transplantation in receiving countries. OBJECTIVE: To analyze the brain death (BD) concept knowledge in the Dominican Republic immigrant population in Florida (United States) and Spain. METHOD: Population under study: Population born in the Dominican Republic, resident in Florida (United States) and in Spain. INCLUSION CRITERIA: Population older than 15 years stratified by age and sex. Assessment instrument: Donation attitude questionnaire PCID-DTO-Ríos. Fieldwork: Random selection based on stratification. Immigration support association collaboration in Florida and Spain was needed to locate potential respondents. Completion was anonymous and self-administered, with verbal consent. RESULTS: A total of 123 respondents, 57 residents in Spain and 66 in Florida, have been included in the study. The 27% (n = 33) of the respondents knowledgeable of the BD concept consider it the death of an individual. Of the remainder, 52% (n = 64) do not know about it, and the remaining 21% (n = 26) believe it does not mean the death of a patient. No differences were observed regarding migration countries (P > .05). There was no association of the BD concept with other psychosocial factors analyzed or with the attitude toward organ donation. CONCLUSIONS: Knowledge of the BD concept among the Dominican immigrant population is similar in Spain and Florida, and, unlike most studies, there is no objective association with the attitude toward organ donation.
Brain Death , Emigrants and Immigrants/psychology , Health Knowledge, Attitudes, Practice/ethnology , Tissue and Organ Procurement , Adult , Dominican Republic , Female , Florida , Hispanic or Latino/psychology , Humans , Male , Organ Transplantation/psychology , Spain , Surveys and Questionnaires
INTRODUCTION: The population from Mali is migrating toward Europe in a significant way. OBJECTIVE: To analyze the attitude toward organ donation (ODT) among the population born in Mali who are currently residents in Spain. METHOD: Study population: people born in Mali who are ≥15 years of age and residents of Spain, stratified by age and sex. The assessment instrument is the validated attitude questionnaire toward organ donation (PCID-DTO-Ríos). Fulfillment was anonymous and self-administred. The statistics used were descriptive, χ2 test, Student t test, and a logistic regression analysis. RESULTS: This study surveyed 402 Malians. Thirty-four percent (n = 136) are in favor of donating their own organs after dying, 39% (n = 156) are against organ donation, and 27% (n = 110) are undecided. Multiple factors are associated with this attitude, such as level of studies (P = .042, OR = 6.535), having a positive attitude toward ODT (P = .001, OR = 47.619), performing prosocial activities (P = .001, OR = 141.679), being familiar with the scope of the transplant (P < .001, OR = 16.949), the attitude toward the incineration of the body (P = .002, OR = 8.928) and toward autopsy (P = .003, OR = 8.620), having had a prior donation or transplantation relationship (P = .001, OR = 17.910) and not having concerns about the possible mutilation of the body after donating (P < .001; OR = 90.909). CONCLUSIONS: The Malians have an unfavorable attitude toward the donation of their own organs, which is conditioned by multiple psychosocial factors.
Emigrants and Immigrants/psychology , Health Knowledge, Attitudes, Practice/ethnology , Tissue and Organ Procurement , Adolescent , Adult , Female , Humans , Male , Mali , Middle Aged , Multivariate Analysis , Organ Transplantation/psychology , Spain , Surveys and Questionnaires
The awareness of organ donation among health professionals is important at the time of transplant promotion. In this sense, the training and awareness of the professionals in training is fundamental. OBJECTIVE: To analyze the differences in the attitude toward organ donation and the factors that condition it among medical students of regions with donation rates >50 donors per million population (pmp) with respect to those with rates <40 donor pmp. METHOD: Population under study: medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: Group 1 (n = 1136): students in universities of regions with >50 donors pmp. Group 2 (n = 2018): university students in regions with <40 donors pmp. Assessment instrument: attitude questionnaire for organ donation for transplant PCID-DTO-Ríos. RESULTS: The attitude toward organ donation for transplantation is similar among students from the autonomous communities with >50 donors pmp and with <40 donors pmp. In group 1, 79% (n = 897) of students are in favor compared with 81% (n = 1625) of group 2 (P=.29). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): sex, having discussed transplantation with family and as a couple, considering the possibility of needing a transplant, involvement in prosocial activities, attitude toward the manipulation of corpses, knowledge of the brain death concept, and religion. CONCLUSIONS: The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region.
Health Knowledge, Attitudes, Practice , Social Behavior , Students, Medical/psychology , Tissue and Organ Procurement , Adult , Awareness , Female , Humans , Male , Organ Transplantation/psychology , Surveys and Questionnaires
INTRODUCTION: The Ghanaian population is migrating toward the European economic community, especially toward the southern countries. OBJECTIVE: To analyze the attitude toward organ donation among the population born in Ghana but currently residing in Spain. METHOD: The study included the population born in Ghana who are ≥ 15 years of age and residents of Spain, stratified by age and sex. The assessment instrument used is the donation and transplant attitude questionnaire of Proyecto Colaborativo Internacional Donante (PCID-DTO Ríos), which was self-administered and anonymously completed with verbal consent. The statistics used were descriptive, χ2, Student t test, and a logistic regression analysis. RESULTS: The questionnaire was completed by 237 Ghanaians. Forty-three percent (n = 102) are in favor of cadaveric organ donation, 35% (n = 83) are against donating their own organs, and 20% (n = 48) are undecided. In the multivariate analysis, the association was maintained at the level of the primary studies (P < .001, OR = 25), not being afraid of possible mutilation after donating (P < .001, OR = 76.923), religion (P < .001; OR = 27.777), performing prosocial activities (P = .016, OR = 12.048), and having previously commented on the issue of organ donation and transplantation in the family setting (P = .012, OR = 4.878). CONCLUSIONS: The Ghanaian immigrant population in Spain has an unfavorable attitude toward the donation of their own organs at death, which is conditioned by multiple psychosocial factors.
Emigrants and Immigrants/psychology , Health Knowledge, Attitudes, Practice/ethnology , Tissue and Organ Procurement , Adolescent , Adult , Cadaver , Female , Ghana , Humans , Male , Middle Aged , Multivariate Analysis , Organ Transplantation/psychology , Religion , Spain , Surveys and Questionnaires
