Factors Associated With the Willingness of Clinical Health Care Professionals for Living Organ Donation.

Understanding the attitudes and willingness in regard to living organ donation of health care professionals is important for clinical practice and needs to be addressed. Thus, the objective of this study was to examine willingness and its influencing factors in regard to living organ donation in clinical health care professionals. METHODS: This study used a cross-sectional design. A total of 375 health care professionals from a regional teaching hospital in northern Taiwan were included in this study. RESULTS: Nearly 65% of the participants indicated a willingness to donate their living organ. Of these participants, 97.1% were willing to donate to family members, 80.8% were willing to donate to friends, and 78.9% were willing to donate to strangers. The predictors of willingness to engage in living organ donation were the desire to help others (odds ratio [OR] = 2.96; P < .01), positive attitude toward living organ donation (OR = 1.12; P < .01), financial support from the government (OR = 4.99; P < .01), and fewer physical concerns (OR = 0.97; P = .04). The willingness to donate a living organ was not associated with age, sex, religious belief, education level, participation in voluntary work, years of clinical work, type of profession, or knowledge about living organ donation. CONCLUSION: In general, health care professionals had a positive attitude toward and willingness to engage in living organ donation. It is hoped that the results of this study will serve as a referent framework for policymaking in regard to living organ donation and transplantation.

Comparison of Liver Function, Emotional Status, and Quality of Life of Living Liver Donors in Taiwan.

BACKGROUND: Living donor liver transplantation may put the donor at risk of physical and psychological impacts. Recovery of physical and psychological function as well as quality of life (QOL) in living liver donors warrants investigation. OBJECTIVES: This study aims to examine the recovery of liver function, emotional status, and QOL in living liver donors through a comparison with the general population and reference values. METHODS: This descriptive, comparative study included 97 living liver donors who underwent surgery from 2008 to 2012 and were divided into 4 groups according to their postoperative period (1 year [n = 31], 2 years [n = 31], 3 years [n = 21], and 4 years above [n = 14]). Data were collected retrospectively in a medical center in northern Taiwan. RESULTS: The mean aspartate aminotransferase level was 20.2-32.1 U/L, the mean alanine aminotransferase level was 14.7-33.5 U/L, and the mean total bilirubin level was 10.8-15.5 µmol/L among the 4 groups. Among donors of the 4 groups, 23.8%-51.6% and 0%-29% were defined as having a mild level of anxiety and depression, respectively. Donors in the 1- and 2-year groups had poorer QOL in the physical function, role physical, vitality, and mental health domains than did the general population of Taiwan (P < .05). CONCLUSIONS: Liver function was at normal levels in all 4 groups. The emotional and psychological function of living liver donors should be monitored and health-related QOL should be promoted during the first and second year after liver donation.

Factors Determining Physical and Mental Quality of Life of Living Kidney Donors in Taiwan.

BACKGROUND: Living-donor kidney transplantation has a positive influence on recipients' life expectancy and improves quality of life for patients with end-stage renal disease compared with dialysis patients. Evaluation of the physical and mental quality of life for donors can promote positive perceptions about donation and help potential donors in their decision-making process. The aim of this study was to explore the predictive factors of quality of life for living kidney donors. METHODS: A cross-sectional and descriptive design was used, and the study was conducted from January to July 2013. The donors were a convenience sample of 34 participants who had undergone kidney transplant surgery >1 year earlier. RESULTS: The results showed that kidney donors had a low to moderate physical and mental quality of life. Multiple regression analysis revealed that financial concerns and anxiety explained 27.8% of the total variance of quality of life in the physical component. Anxiety and paid work explained 61.4% of the total variance of quality of life in the mental component. CONCLUSIONS: After renal transplantation, living kidney donors experienced low to moderate quality of life. Because donors are family members (siblings, sons or daughters, spouses, or parents), monthly family income is a significant issue that influences both the decision to donate and quality of life after transplantation. Our findings suggest that pre-transplantation assessment must include social workers as part of the health care team to evaluate the impact of a donor's financial status on post-transplantation quality of life.

Replication of a genetic risk score for venous thromboembolism in whites but not in African Americans.

UNLABELLED: ESSENTIALS: There is little prospective information on genetic risk scores to predict venous thromboembolism (VT). Community based cohort followed a median of 22.6 years for VT occurrence. A 5-SNP risk score identified whites at risk of VT, but not African Americans. The utility of genetic risk scores for VT is yet to be established. BACKGROUND: Case-control studies have created genetic risk scores of single nucleotide polymorphisms (SNPs) associated with venous thromboembolism (VTE) and documented their ability to predict VTE, but prospective data are lacking. OBJECTIVE: To test the ability of a genetic risk score to predict VTE incidence in a prospective study, particularly in African Americans. METHODS: We computed a previously proposed genetic risk score, based on five established VTE SNPs in the F5, F2, ABO, FGG, and F11 genes, in 9520 whites and 3049 African Americans initially free of VTE. We followed them a median of 22.6 years for VTE occurrence (n = 380 events in whites and n = 187 in African Americans). RESULTS: In whites, the five-SNP weighted genetic risk score ranged from 0 to 5.8, and VTE risk increased 1.41-fold (95% confidence interval [CI] 1.27-fold to 1.56-fold) per allele increment. In African Americans, the weighted genetic risk score ranged from 0 to 4.6 and the hazard ratio per risk allele was 1.14 (95% CI 0.94-1.38), with adjustment for 10 principal components of ancestry. The area under the receiver operating characteristic curve for 20-year prediction of VTE from the weighted genetic risk score was 0.59 (95% CI 0.56-0.63) in whites and 0.56 (95% CI 0.51-0.61) in African Americans. Adding non-genetic factors increased the area under the curve to 0.67 in whites and to 0.66 in African Americans. CONCLUSIONS: Higher values for a five-SNP genetic risk score helped identify white adults at risk of VTE. The genetic risk score did not identify future VTE occurrence in African Americans.

Factors determining social function of patients after renal transplantation in Taiwan.

BACKGROUND: Patients who are no longer in need of dialysis as a consequence save time and reduce stress every day. Social function was an important issue in patients with successful renal transplantation. According Bandura's social cognitive theory, ones' behavior is affected by social context and affective factors continuously. The quality of social function needs further investigation. PURPOSE: The aims of this study were to describe the degree of social function after renal transplantation and to explore its predictive factors. METHOD: A cross-sectional and descriptive study design was conducted in the outpatient department of a medical center in northern Taiwan from July to October 2010. The recipients were a convenience sample of 101 participants who had undergone renal transplantation. Hierarchical multivariate regression analysis was used to explore the predictive factors related to social function. RESULTS: The results showed that renal transplant recipients have moderate to high social function. Regression analyses showed that psychological factors (perceived stress, stress after renal transplantation, and depressive symptoms) and social participation (paid-work and leisure activity) explained 37.1% of the total variance for social function. Depressive symptoms explained most of the total variance. CONCLUSION: After renal transplantation, patients experienced higher levels of social function. Perceived stress, stress after renal transplantation, depressive symptoms, paid-work, and leisure activity were the predictive factors of social function. Managing levels of depressive symptoms is highly recommended to elevate the patient's social function.

Association between use of FK506 and prevalence of post-transplantation diabetes mellitus in kidney transplant patients.

BACKGROUND: Tacrolimus (FK506) use has been suggested as a risk factor for post-transplantation diabetes mellitus (PTDM) because it can impair insulin secretion. This association warrants further investigation. This study aimed to examine the prevalence of PTDM and its association with FK506 use in kidney transplant recipients. The study also aimed to examine the relationship of FK506 use and diabetes-related biologic markers. METHODS: A retrospective chart review was used to collect data at a medical center in northern Taiwan from September 2003 to February 2012. PTDM was defined with the use of the criteria of the American Diabetes Association. RESULTS: Among 166 patients included in the analysis, PTDM was reported in 49 patients (29.5%). A total of 93 patients used the FK506 regimen, of whom 34 (36.6%) were PTDM cases. Logistic regression showed that FK506 use (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.20-6.11; P = .016) and older age (OR,1.08; 95% CI, 1.03-1.13; P = .001) were significant risk factors for PTDM. In addition, FK506 use in PTDM cases was associated with a significantly higher hemoglobin A1c level (7.55 vs 5.81; P = .01) and a borderline significantly higher insulin resistance index (3.24 vs 1.92; P = .053) than was FK506 use without the presence of PTDM. CONCLUSIONS: Older age and an FK506 regimen were important predictors of the prevalence of PTDM. Greater early detection and prevention efforts for PTDM are needed for older transplant recipients. PTDM patients with an FK506 regimen had higher hemoglobin A1c levels and insulin resistance index than did patients who did not use FK506. The association of serum indicators with FK506 use in the prevalence of PTDM warrants further investigation.

Change in the type of work of postoperative liver transplant patients.

BACKGROUND: Returning to work has been recognized as an indicator of functional recovery. Few studies have aimed to explore whether one's type of work changes after transplantation. PURPOSE: This study aims to describe the change in types of work in liver transplant patients. METHODS: A retrospective and descriptive study was conducted at a medical center in northern Taiwan. The data were collected by a self-report questionnaire between July and September 2010. Descriptive statistics an correlational analysis were used to analyze the data. RESULTS: A convenience sample of 111 adult liver transplant patients was included in this study. Of the sample, 20 patients remained unemployed, 44 had a change in status by becoming unemployed (n=42) or employed (n=2), and 47 patients remained employed after transplantation. At the time of data collection, 49 (44.1%) liver transplant patients were gainfully employed, a rate that was lower than that of the pretransplantation stage (n=89, 80.2%). The number of workers engaged in manual labor decreased from 40 to 18 between pre- and posttransplantation. Of the 47 still-employed patients, 6 (12.8%) changed their occupation after transplantation. CONCLUSION: The rate of gainful employment after liver transplantation was low, and those patients who had done manual labor pretransplantation were no longer able to do this type of work and were unemployed. The still-employed patients who worked in management or were professionals did not change their type of work after transplantation; however, service and labor workers did change their type of work.

Nosocomial and community-acquired Enterobacter cloacae bloodstream infection: risk factors for and prevalence of SHV-12 in multiresistant isolates in a medical centre.

In a medical centre in northern Taiwan, 60 patients had bloodstream infection caused by Enterobacter cloacae from 1 January 2002 to 30 April 2003. Forty (66.7%) were nosocomial and 26 were caused by multiresistant isolates. Twenty patients died due to the infection. Central venous catheterization and mechanical ventilation were relative risks for nosocomial E. cloacae infection. Age and mechanical ventilation were risk factors for multiresistant E. cloacae infection. Mortality was associated with multiresistant isolates and polymicrobial infection. Pulsed-field gel electrophoresis (PFGE) analysis showed, the 26 multiresistant isolates comprised 12 different types, with type A predominating (12 isolates). Excluding the patients infected with PFGE type A, central venous catheterization was a relative risk for infection, and polymicrobial infection was a risk factor for mortality. All but one of the 26 multiresistant isolates had the extended-spectrum beta-lactamase SHV-12. TEM-1 and ampC beta-lactamase genes were also detected in 25 of the 26 multiresistant isolates. Southern blotting indicated that the SHV-12 gene was located on plasmids. Eleven of the 26 multiresistant isolates had minimum inhibitory concentrations (MIC) > or =16 mg/L for cefepime, which was reduced by the addition of sulbactam for most isolates, resulting in susceptibility. The combination of cefepime and sulbactam may be effective in the treatment of multiresistant E. cloacae bloodstream infection.

Characterization of group D1 non-typhoid Salmonella isolates by serotyping and pulsed field gel electrophoresis.

Non-typhoid salmonella infection is not uncommon in immunocompetent patients in Taiwan. Bacterial factors may play an important role in the pathogenesis of such infections. In a previous study, Salmonella group D1 was found to have the tendency to cause bacteremia with a higher frequency than other serotypes. In the present study, we prospectively collected 94 Salmonella group D1 isolates for serotyping and molecular typing. Salmonella panama and Salmonella dublin seemed more invasive than other serotypes. Pulsed field gel electrophoresis was also done to characterize of Salmonella enteritidis and Salmonella dublin. PFGE type "a" of Salmonella dublin appeared to be more invasive than the other two PFGE types. All six Salmonella dublin isolates were Vi antigen negative. Further study using a larger number of isolates is needed to identify the tendency to invade blood stream of Salmonella dublin and Salmonella panama.

Rapid detection of herpes simplex virus by polymerase chain reaction.

This study reports the successful use of three sets of primers, each from different genes on the herpes simplex virus (HSV) genome, 1) the DNA polymerase gene, 2) the glycoprotein B gene, and 3) the glycoprotein D gene, for detection of HSV DNA by polymerase chain reaction (PCR). All three sets of primers detected the same HSV DNA in the throat and genital specimens. Using the conventional viral culture as a standard, PCR provided a sensitivity of 100% and a specificity of 100% in this study. In addition, a nested-PCR protocol using two sets of primers in the glycoprotein D gene, one set internal to the other, was evaluated for the amplification of HSV DNA in cerebrospinal fluid (CSF) from patients suspected of having herpes simplex encephalitis (HSE). Five of the 10 CSF specimens tested were found positive. In conclusion, PCR detection is a valuable tool for rapid diagnosis of HSV infection, especially for CSF specimens.

Investigation of an outbreak of Pseudomonas putida using antimicrobial susceptibility patterns, pulsed-field gel electrophoresis of genomic DNA and restriction fragment length polymorphism of PCR-amplified rRNA operons.

Seventeen Pseudomonas putida isolates were investigated which were collected from the urine specimens of 14 patients and one reflectrometer by comparing antimicrobial susceptibility patterns, pulsed-field gel electrophoresis (PFGE) of genomic DNA, and restriction fragment length polymorphism (RFLP) of PCR-amplified rRNA operons. Three susceptibility patterns were defined by testing 22 antimicrobial agents, with 14 isolates resistant to all agents. PFGE of XbaI-genomic DNA fragments divided the 17 isolates into 9 distinct types. One type, seen in 6 isolates showing identical patterns of approximately 35 fragments of 10 to 350 kb, was defined as the outbreak strain. Another 4 types, in a total of 6 isolates, were considered closely related to the outbreak strain; 2 types in 1 isolate each were possibly related to the outbreak strain; and 2 types in a total of 3 isolates were different from the outbreak strain. All 12 outbreak or closely related isolates were from patients in the surgical intensive care unit and a surgical ward, and were different from isolates in other wards, clearly indicating an outbreak of P. putida. Only two types were defined by the RFLP of 4.5 kb PCR-amplified rRNA operons; one type was seen in 15 isolates, while the other was seen in only 2 isolates. In conclusion, PFGE of genomic DNA is a highly discriminatory and reproducible method for epidemiological typing of P. putida.

Reaction of hydrogen peroxide with the rapid form of resting cytochrome oxidase.

The hydrogen peroxide binding reaction has been examined with alkaline-purified resting enzyme in order to avoid mixtures of low pH induced fast and slow conformers. At pH 8.8-9.0 (20 degrees C), the reactivity of resting enzyme was similar to the peroxide-free, pulsed conformer that has been characterized by other investigators. The reaction showed single-phase reactivity at 435 and 655 nm and required a minimum 8:1 molar excess of peroxide (over cytochrome a3) for quantitative reaction. At 16:1, the Soret band was stable for 1.0-1.5 h, but above 80:1, the band began showing generalized attenuation within 1-2 min. The peroxide binding reaction was also associated with an increase in absorbance at 606 nm which correlated with the rate of change at 435 and 655 nm. The observed rate constants at each of these wavelengths showed similar linear dependence on peroxide concentration, giving an average bimolecular rate constant of 391 M-1.s-1 and a Kd of 5.1 microM. The rise phase at 606 nm was observed to saturate at an 8:1 molar excess of peroxide but showed a slow, concentration-dependent first-order decay that gave a bimolecular rate constant and Kd of 38 M-1.s-1 and 20 microM, respectively. The decay was not associated with a change in the Soret absorption or charge-transfer regions, suggesting a type of spectral decoupling. An isosbestic point at 588 nm was consistent with the 606- to 580-nm conversion proposed by other investigators, although direct observation of a new band at 580 nm was difficult.(ABSTRACT TRUNCATED AT 250 WORDS)