La población gitana tiene miedos sobre la donación de órganos propios para trasplante / The Roma population's fear of donating their own organs for transplantation

Introducción: La tasa de negativas a la donación entre el pueblo gitano es muy superior a la de cualquier otro grupo social. Objetivo: Analizar la actitud hacia la donación de los órganos propios entre la población gitana residente en España. Métodos: Tipo de estudio: estudio sociológico observacional nacional español estratificado por género y edad. Población a estudio: población gitana con edad≥15 años residente en España. Tamaño muestral: 1.253 encuestados. Instrumento de valoración: cuestionario validado de actitud hacia la donación de órganos para trasplante PCID-DTO Ríos. Trabajo de campo: selección aleatoria en función de la estratificación. Cumplimentación anónima y autoadministrada. Fue precisa la colaboración de personas de etnia gitana. Estadística: test de t de Student, χ2, Fisher y un análisis de regresión logística. Resultados: El grado de cumplimentación fue del 18,2% (n=228). De los que han cumplimentado el cuestionario, están a favor de la donación el 42,1% (n=96), indeciso el 30,3% (n=69) y en contra el 27,6% restante (n=63). De los 1.025 (81,8%) que rechazaron cumplimentar el cuestionario, 1.004 (98%) indicaron que era por miedo a hablar y rellenar un cuestionario que plantee el tema de la muerte y la donación de órganos tras fallecer. Si se considera que los que no han cumplimentado el cuestionario por miedo a la muerte y la donación de órganos tras fallecer no están a favor, los resultados serían los siguientes: el 7,8% (n=96) a favor de donar sus órganos frente al 92,2% (n=1.136) no a favor (en contra o indecisos). Conclusiones: La población gitana presenta un rechazo mayoritario a plantear el tema de la muerte y la donación de órganos tras fallecer. Estos hallazgos muestran que las campañas actuales para promover la donación de órganos no son efectivas en este grupo de población. (AU)

Introduction: The refusal rate for donating organs among the Roma people is much higher than that of any other social group. Objective: To analyze the attitude towards the donation of one's own organs among the Roma population living in Spain. Methods: Type of study: Spanish national observational sociological study stratified by gender and age. Study population: Roma population aged≥15 years living in Spain. Sample size: 1253 respondents. Assessment instrument: validated questionnaire on attitude towards organ donation for transplantation PCID-DTO Ríos. Field work: random selection based on stratification. Anonymous and self-administered completion. The collaboration of people of Roma ethnicity was required. Statistics: Student's t test, χ2, Fisher's exact test and a logistic regression analysis. Results: The degree of completion was 18.2% (n=228). Of those who completed the questionnaire, 42.1% (n=96) were in favor of donation, 30.3% (n=69) were undecided and the remaining 27.6% (n=63) were against it. Of the 1025 (81.8%) who declined to complete the questionnaire, 1004 (98%) indicated that it was for fear of speaking about and filling in a questionnaire that raises the issue of death and organ donation after death. If those who did not complete the questionnaire due to fear of death and donating organs after death are considered not in favor, the results would be as follows: 7.8% (n=96) in favor of donating their organs compared to 92.2% (n=1136) not in favor (against or undecided). Conclusions: A majority of the Roma population prefer not speak of death nor organ donation after death. These findings show that current campaigns to promote organ donation are not effective in this population group. (AU)

The Roma population's fear of donating their own organs for transplantation.

BACKGROUND: The refusal rate for donating organs among the Roma people is much higher than that of any other social group. OBJECTIVE: To analyze the attitude towards the donation of one's own organs among the Roma population living in Spain. METHOD: . TYPE OF STUDY: Spanish national observational sociological study stratified by gender and age. STUDY POPULATION: Roma population aged ≥15 years living in Spain. SAMPLE SIZE: 1,253 respondents. Assessment instrument: Validated questionnaire on attitude towards organ donation for transplantation "PCID - DTO Ríos". Field work: Random selection based on stratification. Anonymous and self-administered completion. The collaboration of people of Roma ethnicity was required. STATISTICS: Student's t test, χ2, Fisher's exact test and a logistic regression analysis. RESULTS: The degree of completion was 18.2% (n = 228). Of those who completed the questionnaire, 42.1% (n = 96) were in favor of donation, 30.3% (n = 69) were undecided and the remaining 27.6% (n = 63) were against it. Of the 1,025 (81.8%) who declined to complete the questionnaire, 1,004 (98%) indicated that it was for fear of speaking about and filling in a questionnaire that raises the issue of death and organ donation after death. If those who did not complete the questionnaire due to fear of death and donating organs after death are considered not in favor, the results would be as follows: 7.8% (n = 96) in favor of donating their organs compared to 92.2% (n = 1166) not in favor (against or undecided). CONCLUSIONS: A majority of the Roma population prefer not speak of death nor organ donation after death. These findings show that current campaigns to promote organ donation are not effective in this population group.

Maximal tear secretion evoked by controlled stimulation of corneal sensory nerves in healthy individuals and dry eye subjects.

PURPOSE: To measure, the tear flow changes evoked in healthy subjects and dry eye disease (DED) patients by controlled sensory stimulation of the eye surface with i-Onion™, a new stimulation device. METHODS: Sensory corneal nerves were stimulated with an instrument (i-Onion™) that ejects puffs of CO2 gas (99.9%) at 200 ml·min-1 for 3s, delivered 5 mm from the cornea. Using Schirmer test strips, tear volumes were measured over 3 min in the cornea of one eye before (basal tear volume -BTV) and in the other eye after stimulation of the sensory nerves with CO2 (stimulated tear volume -STV). These measurements were obtained from a control group of adults of either sex (17 students aged 20-30 and 29 subjects without signs of dry eye aged 25-61), a cohort of DED patients (aged 34-75) that included 12 asymptomatic, suspected DED subjects (Schirmer <7 mm and/or TBUT <10s), and 30 Sjögren's syndrome (SS) patients. RESULTS: CO2 stimulation significantly increased the tear volume (BTV = 14.6 ± 1.0 mm, STV = 19.0 ± 1.1 mm: n = 46) in 78% of control subjects, reflecting a mean tear reserve volume (TRV = STV-BTV) of 4.4 ± 0.8 mm. Individual differences were wide, and while no increase in reflex tearing was evoked in 30% of subjects with a BTV >10 mm, the remaining 70% responded vigorously to stimulation, even those with a BTV >18 mm. Asymptomatic DED subjects displayed weaker responses to CO2 stimulation, with lower STVs. Both the BTV and STV of SS patients were low, significantly below those of the healthy controls. CONCLUSIONS: Measuring the rise in reflex tearing volume evoked by controlled corneal stimulation provides objective information about the tear glands' secretory capacity in health and disease.

Surgical treatment of dry eye syndrome: conjunctival graft of the minor salivary gland.

Despite the availability of efficient tear substitutes, many patients with dry eye syndrome experience severe corneal injuries and a subsequent loss of vision. Surgical techniques using mayor salivary glands to provide a substitute for tears have been reported; with this technique the drainage of saliva goes into the conjunctival fornix, permitting corneal and conjunctival humidification. The authors describe a new surgical approach in which minor salivary glands are autotransplanted into the conjunctival fornix by means of a graft of the intraoral mucosa-transporting salivary glands. This approach was used in a 56-year-old woman with a 2-year history of refractory and pharmacologically untreatable dry eye syndrome caused by Sjögren's syndrome. The right eye had more severe corneal and conjunctival lesions than did the contralateral one, so the treatment was planned in the right eye only. A weekly follow-up during the first 6 months confirmed the significant improvement of dry eye symptoms in the surgically treated eye. Three months after surgery, a biopsy was performed in the minor salivary gland graft, and the histologic findings revealed the presence of glandular acinus, duct with mucin content, and lymphocyte infiltration. The significant improvement obtained in this patient suggests that the secretion from the grafted salivary minor glands was better in promoting homeostasis of the ocular surface than are artificial tears. This may be explained by: (1) The lacrimal and salivary secretions contain biologically active constituents that may protect from infection and promote normal growth epithelium; (2) The secreted mucin is thought to coat the epithelial surface, reducing the high surface tension of the eye wetted by aqueous tears; (3) The thick secretions of the minor gland might act in reducing the evaporation of the underlying tear layer and form a hydrophobic barrier along the lid margin that can retain the lid margin tear string and prevent its flow onto the skin. Minor gland salivary autotransplant is a new surgical technique with effectiveness demonstrated in one patient, but the scientific explanation is not clear; additional experience with more cases could confirm the initial success.

Manifestaciones reumáticas de las enfermedades endocrinas / Rheumatic manifestations of endocrinological diseases

El compromiso musculoesquelético se da en grado variable en las diferentes afecciones del sistema endocrino, siendo destacable el compromiso articular en la acromegalia, el compromiso óseo en el hiperparatiroidismo y la deficiencia estrogénica y la afección muscular en las disfunciones tiroideas y de suprarrenales. En el presente artículo se detallan los cambios osteomioarticulares que se presentan en algunas enfermedades endocrinas así como su etiopatogenia y su relación con la patología de fondo, sus manifestaciones y su tratamiento.