Profile of patients who consult with internists for an osteoporosis assessment: The OSTEOMED registry.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; p<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; p<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; p<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED / Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry

Antecedentes y objetivo La osteoporosis se considera un trastorno generalizado del esqueleto en el que existe una alteración de la resistencia ósea que predispone a la persona a un mayor riesgo de fractura. Este estudio transversal pretende recoger y presentar las principales características clínicas de los pacientes que acuden a la consulta de los médicos internistas en España. Conocer estas características podría facilitar la puesta en marcha de planes de actuación para mejorar la atención de estos pacientes de manera más eficaz y eficiente. Material y métodos A través del análisis del registro OSTEOMED (Osteoporosis en Medicina Interna), este trabajo presenta las principales características clínicas de los pacientes con osteoporosis que acudieron a las consultas de Medicina Interna en 23 centros hospitalarios españoles entre 2012 y 2017. Se han analizado los motivos de consulta, los valores densitométricos, la presencia de comorbilidades, el tratamiento prescrito y otros factores relacionados con el estilo de vida. Resultados En total se evaluó a 2.024 pacientes con osteoporosis (89,87% mujeres, 10,13% hombres). La edad media de los pacientes fue de 64,1 ±12,1 años (mujeres, 64,7 ±11,5 años; hombres, 61,2 ±14,2 años). No hubo diferencia entre sexos en la historia de caídas recientes (9,1-6,7%), mientras que sí se apreció en la ingesta diaria de calcio de lácteos (553,8 ±332,6mg en mujeres vs. 450,2 ±303,3mg en hombres; p <0,001) y en causas secundarias de osteoporosis (13% de hombres vs. 6,5% de mujeres; p <0,001). En la muestra se observaron un total de 404 fracturas (20%) (AU)

Background and objectives Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients’ care more effectively and efficiently. Material and methods Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. Results In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients’ mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001) (AU)

Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry. / Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care.

The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. PURPOSE: To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. METHODS: A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. RESULTS: Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. CONCLUSIONS: The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.

Are the intertidal fish highly resistant to UV-B radiation? A study based on oxidative stress in Girella laevifrons (Kyphosidae).

Sea chub, Girella laevifrons, is a coastal fish that inhabits high intertidal rockpools along the coast of Chile. The intertidal pools where the juveniles live, are an extreme environment with high levels of ultraviolet (UV) radiation, becoming harmful to the organisms, due to oxidative stress generated by reactive oxygen species. For this reason organisms develop adaptations that allow them to survive in this complex environment. The search of biomonitor species, sensitive to UV radiation is very important in aquatic ecosystems, mainly in the southern hemisphere where depletion of the ozone layer and the consequent increase of UV radiation, have become an environmental problem. The aim of this study was to evaluate the effect of ultraviolet radiation in G. laevifrons and its possible use as UV-B radiation biomonitor specie in intertidal systems, which are very important for the Chilean fisheries. The effect of UV radiation exposure on juvenile G. laevifrons was measured through oxidative stress parameters. Catalase's activity increased with the time of exposure, unlike superoxide dismutase's activity which peaked at 2h, decreasing towards the 5th hour of irradiation. The superoxide dismutase activity in muscle tissue did not show significant differences. The lipid peroxidation and DNA damage increased in relation to exposition times. Tissue muscle's DNA damage was shown only at 5h of exposure. Significant differences between the two organs in the antioxidant capacity were observed, the liver of G. laevifrons exhibited the higher antioxidant capacity. It can be concluded that this specie exhibits effective protection mechanisms against UV radiation exposure and it is not appropriate specie as a biomonitor in intertidal systems.

Modifying RANKL/OPG mRNA expression in differentiating and growing human primary osteoblasts.

The OPG/RANKL system in primary cultures of human osteoblasts has been studied by different authors. However, very few studies have been performed on gene expression of RANKL and OPG at different stages of maturation on human osteoblast cultures. The effect of 17- beta-estradiol and 1,25dihydroxyvitamin D3 on the OPG/RANKL system is not known during the different states of cellular maturation. In this work we quantified OPG and RANKL protein levels (ELISA) and the mRNA of OPG, RANKL, collagen type I, alkaline phosphatase, and osteocalcin (semi-quantitative RT-PCR) in human osteoblasts. We analyzed these in basal conditions and after incubation with 17- beta-estradiol and 1,25dihydroxyvitamin D3 in the first and second phases. We found that OPG secretion and expression levels increased throughout cellular growth. RANKL proteins were detected only in the first stage, and the expression increased throughout the first phase. Thus, the RANKL/OPG ratio was higher in immature osteoblasts than in mature osteoblasts. The evolution of RANKL gene expression was related to collagen I and alkaline phosphatase, while OPG was related to osteocalcin. We observed no modifications after estradiol and 1,25dihydroxyvitamin D3 treatment. Our results suggest that the OB is a positive stimulator at precocious stages of differentiation on osteoclastogenic modulates.

Attitude of personnel in hospital cadaveric organ transplant-related units faced with living kidney donation in a hospital with a living kidney donor transplantation program.

INTRODUCTION: The attitude of health care personnel is fundamental for the procurement of organs, especially when they are based in transplant-related services. The objective of this study is to assess the attitude of hospital personnel in transplant-related services toward living kidney donation in a hospital with a cadaveric and living solid organ transplant program. MATERIALS AND METHODS: A random sample was taken and stratified by type of service and job category (n = 330) in transplant-related services (procurement units, transplant units and follow-up units). The attitude toward cadaveric organ donation was evaluated using a validated psychosocial questionnaire. Student's t test, chi(2) test, and logistic regression analysis were applied for statistical analysis. RESULTS: The questionnaire completion rate was 94% (n = 309). Most respondents (87%, n = 268) are in favor of related living kidney donation. However, only 17% (n = 53) of respondents are in favor if this donation is unrelated. Of the rest, 4% (n = 12) of respondents would not accept a donated living kidney organ and the remaining 9% (n = 29) are undecided. Only two variables are significantly related to attitude towards living kidney donation: age (p = 0.013) and a willingness to receive a donated living organ on the part of the respondent, if a transplant organ were needed (p < 0.001). Both variables persist as significant independent variables in the logistic regression analysis. There is also a close relationship between attitude toward living kidney donation and attitude toward living liver donation (p < 0.001). CONCLUSIONS: The personnel in donation and transplantation units tend to have a favorable attitude towards living kidney donation making them a key element in the current promotion of living kidney donation. Moreover, the youngest workers in these units are those who tend to be more in favor, thus offering a promising future for this type of kidney donation which is becoming more of a necessity given the cadaveric organ deficit.

Hospital personnel in surgical services in a transplant hospital faced with living liver donation: an attitudinal survey.

UNLABELLED: Living liver donation is becoming a more widely accepted practice given the decrease in donor morbidity and mortality and the beneficial results in the recipient. Use of this technique is unusual in Spain. There are a number of workers against its use within the health care system. The objective of this study was to analyze attitudes toward and the variables that affect them concerning living liver donation among surgical services in a transplant hospital. MATERIALS AND METHODS: A random survey was stratified by surgical area and job category in a Spanish third-level hospital with an ongoing solid organ transplant program. Attitudes toward living liver donation were assessed using a questionnaire about organ donation and transplantation that evaluated various psychosocial variables. Student's t test and the chi square test were used. RESULTS: A total of 263 workers were surveyed (mean age as 40 +/- 9 years). Regarding attitudes toward living liver donation, the level of acceptance was 80% (n = 211) of respondents, whereas 10% were undecided (n = 26), and another 10% were against (n = 26), assuming that the donations were related. When we asked about unrelated living donation, the percentage in favor decreased to 10% (n = 27). No differences were found with respect to job category or type of service. The variables that are related to such an attitude are the following: (1) possibility of respondent needing an organ (P = .001); (2) favorable attitude toward living kidney donation (P < .000); and (3) a belief that medical errors exist (P = .004). An important finding was that attitudes toward living liver donation were not more favorable according to whether the respondent was in favor or against cadaveric organ donation (P = .175). CONCLUSION: There was a highly favorable attitude toward living liver donation among hospital personnel in surgical services, which is an important factor to take into account if this type of donation is to be encouraged in Spain.

Benefit of a hospital course about organ donation and transplantation: an evaluation by Spanish hospital transplant personnel.

UNLABELLED: A considerable percentage of hospital personnel are against organ donation, which at a crucial time could act as an obstacle to donation. Moreover, there is often a lack of training of personnel necessary for them to provide accurate information about organ donation and transplantation. Our objective was to determine the acceptability of a training course about organ donation among hospital workers in a center with an ongoing solid organ transplant program. MATERIALS AND METHODS: A random sample (n = 1168) was stratified by type of service and job category among workers in hospital services within an organ transplant program. An evaluation was made of attitudes toward donation and acceptance of a training course using a validated psychosocial questionnaire. Distribution of the survey was made by the head of each service and job category. The survey was completed anonymously and self-administered. RESULTS: Sixty-nine percent (n = 808) of respondents were in favor of donating their own organs. With respect to the benefit of a training course about organ donation and transplantation, 50% (n = 584) of respondents considered it to be a useful idea, whereas 15% (n = 176) did not, and 35% (n = 408) were not sure. An important finding was that 56% (n = 452) of those who are in favor of donation would take part in the course compared to only 37% (n = 132) of those who were against or undecided. There was a significant relationship between those workers who believed that the training course will be of use and the following factors: younger age (P = .000); women (P = .000); single (P = .000); nursing job category (P = .000); a temporary contract (P = .012); a worker in nonsurgical services (P = .000); prior understanding of the concept of brain death (P = .003); favoring cadaveric organ donation (P = .000); performing pro-social voluntary type activities (P = .000); discussions of organ donation and transplantation within the family (P = .022); Catholic religion (P = .001); a partner in favor of organ donation and transplantation (P = .001); and a belief that he may need a transplant (P = .000). CONCLUSIONS: A training course about organ donation and transplantation might be useful given that only half of the workers would be prepared to take part and with respect to the target population, only 37% of them stating that they would participate. Its main use would be to reinforce the positive attitude of those who are already in favor and increase their knowledge about the subject. What is more, if these workers received adequate training they would serve to promote donation both directly and indirectly to the general public and other hospital personnel.

Personnel in cadaveric organ transplant-related hospital units faced with living liver donation: an attitudinal study in a Spanish hospital with a cadaveric and living liver transplant programme.

INTRODUCTION: The attitude of health-care personnel is fundamental for the procurement of transplant organs, especially in those services that are related to transplantation. The objective of this study is to find out the attitude towards living liver donation among personnel who work in transplant-related services in a hospital with a cadaveric and living organ transplant programme. MATERIALS AND METHODS: A random sample was taken and stratified by type of service and job category (N=330), in services related to transplantation (procurement units, transplant units and follow-up units). Attitude was evaluated using a validated psychosocial questionnaire. CONTROL GROUP: a random sample of personnel in clinical services that do not have any direct contact with solid organ transplantation. Student's t-test and the chi(2) test complemented by a logistical regression analysis were applied in the statistical analysis. RESULTS: The questionnaire completion rate was 94% (N=309). Only 10% (N=31) of respondents are in favour of living liver donation if it is unrelated, but another 67% (N=207) are in favour if donation were for a relative. Of the rest, 11% (N=33) do not agree with living liver donation and the remaining 12% (N=38) are undecided. In the control group, attitude towards living liver donation is favourable in 82% (N=344) (P=0.0908). An analysis of the variables that influence attitude shows that the following factors are significantly related: (1) age (P=0.037); (2) a respondent's belief that he or she may need a transplant in the future (P=0.013); and (3) if it were necessary, a willingness to receive a donated living liver organ (P=0.000). Of the variables that have the most influence on attitude towards living liver donation in the bivariate analysis, there are two variables that are statistically significant in the multivariate analysis: (1) age and (2) willingness to accept a donated living liver organ from a relative if it were needed (OR=14.19). There is also a close relationship between attitude towards living liver donation and attitude towards living kidney donation (P=0.000) CONCLUSIONS: There is a favourable attitude towards living liver donation among personnel in units related to the transplantation and donation process, although it is less favourable than expected. Therefore, it will be necessary to increase this level of acceptance and to improve information about the matter if we want to encourage living liver donation. The youngest workers in these units are those who are most in favour, which leads us to believe that there is a hopeful future for this type of liver donation that is so necessary given the cadaveric organ deficit.

British citizens in a regional community of southeastern Spain with a pre-clinical organ xenotransplantation program. A study of attitude toward xenotransplantation.

BACKGROUND: It is important to find out about the social acceptance of xenotransplantation, especially in populations where there are pre-clinical xenotransplantation projects, and therefore the possibility of xenotransplantation to humans. In the native population of southeastern Spain this situation is well-known, but in recent years there has been an important social change because of a considerable migrational flow into Spain, especially from the British Isles. OBJECTIVE: To analyze the attitude toward xenotransplantation among the population living in southeastern Spain born in the British Isles and to determine the variables that affect this attitude. METHOD: A random sample was taken of British and Irish citizens resident in southeast Spain and stratified according to a respondent's nationality (n = 1700). The data were obtained between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire that was completed anonymously and self-administered. The control group comprised a random sample (n = 250) of the native population. Student's t-test, the chi-squared test, Fischer's exact test and a logistic regression analysis were used in the statistical analysis. RESULTS: The questionnaire completion rate was 91% (n = 1546), with 69% of respondents in favor of xenotransplantation, 8% against and 23% unsure, an attitude that is similar to that of the control group (P = 0.1616). These attitudes were based on the assumption that transplanted animal organs had the same outcomes and involved the same risks as human ones. This attitude is related to the following factors: (i) being of male sex (P = 0.0477); (ii) level of education (P = 0.012); (iii) being natives from England or Wales (P = 0.016); (iv) participation in voluntary pro-social activities (P = 0.035); (v) the respondent's religion (P < 0.001); (vi) knowing that one's religion has a favorable attitude toward transplantation (P < 0.001); (vii) having discussed the subject of organ donation and transplantation within the family (P < 0.001); (viii) a partner's favorable attitude toward transplantation (P < 0.001); (ix) previous experience of donation or transplantation (P = 0.024); (x) the belief that in the future one might need a transplant (P = 0.007) and (xi) a favorable attitude toward human donation, both deceased and living (P < 0.001). In the multivariate analysis, the following are significant independent variables: sex [odds ratio (OR) = 2.206], a favorable attitude toward deceased donation (OR = 1.977), and attitude toward living donation (OR = 2.097). CONCLUSIONS: Attitude toward xenotransplantation among British residents who usually live in the southeast of Spain is similar to that of the native Spanish population, and is determined by many psychosocial factors, mainly related to previous attitude toward the different types of human organ donation and the respondent's sex.

El personal no sanitario de un hospital español con programa de trasplantes ante la donación de vivo hepática / Ancillary personnel faced with living liver donation in a Spanish hospital with a transplant program

Introducción: los profesionales no sanitarios de centros hospitalarios representan un grupo de opinión importante,pues por el hecho de trabajar en un centro hospitalario su opinión tiene credibilidad entre la población, y sin embargo no tienen la preparación ni formación sanitaria en la mayoría de casos, lo cual hace que su actitud pueda estar basada en el desconocimiento o miedos no fundados. El objetivo es analizar la actitud hacia la donación hepática de vivo de los profesionalesno sanitarios de un hospital con programa de trasplante de órganos de cadáver y de donante vivo hepático, y analizar las variables que influyen en dicha actitud.Pacientes y método: muestra aleatoria y estratificada porservicio (n = 401) entre el personal no sanitario del hospital. La actitud se valoró mediante una encuesta validada en nuestro medio. Para su distribución se contactó en cada servicio con el representante del mismo al cual se le explicó el estudio y fue el responsable del reparto del cuestionario en los turnos seleccionados.La encuesta fue cumplimentada de forma anónima yautoadministrada. Estadística: test de Chi cuadrado, t de Student y análisis de regresión logística.Resultados: el grado de cumplimentación del cuestionariofue del 94% (n = 377). De los encuestados, el 20% (n = 74) está a favor de la donación de vivo de un hemi-hígado tanto relacionada como no relacionada, porcentaje que asciende hasta el 82% (n = 307) si la donación fuera relacionada. Del resto, el 8% (n = 30) no acepta dicha donación y el 11% (n = 40) restante está indeciso. Al analizar las variables que se relacionan con la actitud hacia la donación de vivo hepática se obtienen: laactitud hacia la donación de cadáver (p = 0,002), el creer el encuestado en la posibilidad de necesitar un trasplante en el futuro (p < 0,001) y en dicho caso la aceptación de un hígado de donante vivo (p < 0,001). Al realizar el análisis multivariante persisten ambas: a) el creer el encuestado en la posibilidad de necesitar un trasplante en un futuro (OR = 1,5); y b) en dicho caso la aceptación de un riñón de donante vivo (OR = 16,2).Conclusiones: la actitud hacia la donación de vivo hepática entre el personal no sanitario de un hospital trasplantador es bastante favorable, y no está condicionada por los factores psico-sociales descritos previamente asociados a la actitud hacia la donación. Sin embargo, si se quiere potenciar este tipo de trasplante con donante vivo es necesario continuar con la realización de campañas de información y concienciación hospitalaria

Introduction: ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. The objective of this study is to analyze the attitude toward living liver donation among ancillary personnel in a hospital with a cadaveric and living liver organ transplant program and to analyze the variables that might influence such attitude. Patients and method: a random sample was taken which was stratified by service (n = 401) among ancillary personnel in the hospital. Attitude was evaluated using a survey that was validated in our geographical area. A representative from each service was contacted. This person was given an explanation of the study and was made responsible for the distribution of the questionnaire in selected work shifts. The survey was completed anonymously and was self-administered. The X2 test, Student’s ttest and logistical regression analysis were used in the statistical analysis. Results: the questionnaire completion rate was 94% (n = 377). Of all the respondents, 20% (n = 74) are in favor of donating a living hemi-liver, but an additional 62% (n = 233) are in favor if donation is for a relative. Of the rest, 8% (n = 30) do not accept this type of donation and the remaining 11% (n = 40) are unsure. The following variables are related to attitude toward living liver donation: attitude toward cadaveric donation (p = 0.002); a respondent’s belief that he or she might need a transplant in the future (p < 0.001) and a willingness to receive a donated living liver if one were needed (p < 0.001). In the multivariate analysis the following have been found to be significantly related variables: a) a respondent’s belief that he or she might need a transplant in the future (OR = 1.5); and b) a willingness to receive a living donated kidney if one were needed (OR = 16.2). Conclusions: attitude toward living liver donation is fairly favorable among ancillary personnel in a transplant hospital and is not affected by the psychosocial factors found to be related to attitude toward donation in previous studies. However, if we want to encourage this type of transplantation with living donors it will be necessary to carry out informative campaigns to raise awareness within the hospital

Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program.

INTRODUCTION: A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program. MATERIALS AND METHODS: The study was carried out in a third-level Spanish hospital with a solid organ transplant program. A random sample was taken (n = 1262) and stratified by job category and type of service. Attitude was evaluated using a validated questionnaire. Contact was made in each service with the person responsible for each of the job categories in order to distribute the survey. The survey was completed anonymously and was self-administered. Student's t-test, the chi-squared test, and logistic regression analysis were applied in the statistical analysis. RESULTS: The survey completion rate was 93% (n = 1168). Most respondents were in favor of donation [69% (n = 808)]. Of those who are not in favor, 29% (n = 105) provide fear of apparent death as the reason whilst most do not give a reason (negative assertion; 57%; n = 206). There are many factors related to this attitude toward donation, which are evident in the multivariate analysis: (i) job category, in which physicians are twice as likely to be in favor of donation than ancillary personnel (OR = 2.02); (ii) a respondent's knowledge of brain death (OR = 1.64); (iii) having discussed the matter of organ donation and transplantation within the family (OR = 1.89); (iv) a preference for other options apart from burial (OR = 3.66); (v) being in favor of the performance of autopsy if it were necessary (OR = 2.76); (vi) not being concerned about mutilation of the cadaver (OR = 2); and (vii) having a partner with a favorable attitude toward donation (OR = 2.2). CONCLUSIONS: Attitude toward cadaveric organ donation among personnel in a transplant hospital is similar to that described in the general public and is determined by many factors. The following factors are most noteworthy: (i) job category; (ii) knowledge of the concept of brain death; (iii) consideration of the matter of donation in the family; and (iv) fear of manipulation of the cadaver. In view of this attitude, which is similar to that of the general public, it is necessary to carry out promotion activities if we want to increase cadaveric donation rates.

Hospital personnel faced with organ xenotransplantation: an attitudinal survey in a hospital with a pre-clinical liver xenotransplantation program.

BACKGROUND: In situations of extreme urgency when there is a need for vital organs, xenotransplantation could provide a bridge until the arrival of a human organ. However, it is important to find out the level of acceptance of this potential therapy among the health care workers who would be involved in its implementation. The objective of this study is to analyze attitude among personnel in a hospital with a pre-clinical xenotransplantation program toward xenotransplantation and to determine the variables that influence this attitude. MATERIALS AND METHODS: A random sample (n=1168) was taken and stratified according to job category and service. Attitude toward xenotransplantation was evaluated using a validated questionnaire. Contact was made with the head of each service who was given an explanation of the project. This person was made responsible for the distribution and collection of the survey in each service in randomly selected work shifts. Such a survey was completed anonymously and was self-administered. A random sample of 250 individuals from our regional community was used as a control group. RESULTS: The survey completion rate was 98% (n=1148). Most respondents are in favor (67%), 7% are against and 26% undecided. Such an attitude is more favorable in the control group (74% vs. 67%; P=0.0378). The following factors are positively related to such an attitude: (1) male sex (P<0.0005); (2) a younger age (P=0.013); (3) participation in prosocial voluntary activities (P=0.002); (4) knowing that the church has a positive attitude toward donation and transplantation (P<0.0005); (5) a partner's favorable attitude toward transplantation (P<0.0005); (6) a physician's job category (P<0.0005); (7) a resident physician's job contract situation (P=0.017); (8) a respondent's belief that he or she may need a transplant in the future (P<0.0005); and (9) a favorable attitude toward human donation, whether this be cadaveric or living (P<0.0005). In the multivariate analysis, the following persist as independent variables: (1) sex (odds ratio=1.6); (2) participation in prosocial voluntary activities (odds ratio=2.2); (3) a partner's unfavorable attitude toward transplantation (odds ratio=0.3); (4) a favorable attitude toward cadaveric donation (odds ratio=2); and (5) attitude toward living liver donation (odds ratio=3.8). CONCLUSIONS: Attitude toward xenotransplantation is not as favorable among hospital personnel as it is in the general public and this is determined by many factors. It will be necessary for research groups to periodically carry out awareness-raising activities about our findings in our own centers, to avoid the rejection that could be generated by a lack of awareness.

Acute lower gastrointestinal hemorrhage originating in the small intestine.

INTRODUCTION: Lower gastrointestinal hemorrhage (LGIH) is generally self-limiting, and the most frequent etiologies are located at colonic level. The objective here is to analyze the diagnostic and therapeutic handling of acute LGIH when its etiology was located in the small intestine. PATIENTS AND METHODS: Between 1975 and March 2002, 12 acute cases of LGIH originating in the small intestine were admitted to our service. All consulted the hospital with acute rectorrhage, requiring a transfusion of at least 3 units of concentrated red blood cells. The mean age was 54 +/- 21 years, 58% were women, and 83% had experienced previous episodes of LGIH. RESULTS: in eleven cases (92%) an urgent lower and upper endoscopy was performed without locating the source of bleeding. An arteriography was indicated in 7 patients (58%), which located the bleeding origin in 5 of them. In two cases a scintigraphy was performed, showing a Meckel's diverticulum in one patient and a normal image in another. All were operated on; in 8 cases (67%), surgery was urgent; in 9 cases, a tumor was found, and in three additional patients, a case of Meckel's diverticulum was found, with a resection being carried out for all lesions. Histology showed a leiomyoma in 7 cases, a Meckel's diverticulum in 3 cases, a leiomyoblastoma in 1, and an angioma in the remaining case. After a mean follow-up of 132 +/- 75 months, the leiomyoblastoma resulted in death, and there was a relapse in the case of angioma, which was successfully embolized with interventional radiology. CONCLUSIONS: Acute LGIH originating in the small intestine should be considered a possible etiology when digestive endoscopy does not locate the source of bleeding, with arteriography being a useful diagnostic technique for bleeding localization. Surgery is the definitive treatment--it confirms the etiology and rules out the presence of malignancy.

Leiomioblastoma maligno de intestino delgado como causa de hemorragia digestiva baja grave / Malignant leiomyoblastoma of the small bowel due to acute lower gastrointestinal bleeding

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Attitudes of primary care professionals in Spain toward xenotransplantation.

OBJECTIVE: The deficit in transplantable organs is making it necessary to find alternative sources. One possibility is xenotransplantation. However, the use of animal organs may be rejected by society and among health professionals. Primary Care is fundamental for promoting matters of health; in Spain it has access to nearly 100% of the population. Our objective was to analyze the acceptance of this therapy, although it is experimental, among Primary Care professionals, given that they are the ones most involved in spreading information about this therapy if it was confirmed to be useful. MATERIALS AND METHODS: A random sample was stratified by sex, job category, and geographical location among Primary Care personnel, including 428 professionals in 32 health centers among population of 2851 professionals. Attitudes toward xenotransplantation were evaluated using a questionnaire on psychosocial attitudes validated in our geographical area. Contact was made in each center with the Doctor Coordinator for doctors, the Nursing Coordinator for nurses, and an Administrative Officer for ancillary personnel. The chi-square test and Student t test were applied to evaluate categorical and continuous data, respectively. RESULTS: Attitudes toward xenotransplantation were similar to those obtained in human organs: favorable in 79% (n = 325), whereas 19% (n = 78) had doubts and 2% (n = 10) were against. The attitude was more favorable in men (89% vs 72%; P < .000), those who had cared for transplant patients (84% vs 71%; P = .009), those with previous experience in organ donation and transplantation (84% vs 75%; P = .033), those with an attitude in favor of cadaveric organ donation (83% vs 66%; P < .0001), and those in favor of living donation of the kidney (P < .000) or the liver (P < .000), as well as those who believed that they may need a transplant at some time in the future (84% vs 74%; P = .045). There was a clear difference in attitude according to job category (P = .018): approval rates were 89% for doctors, 76% for nurses, and 70% for ancillary personnel. CONCLUSIONS: Attitudes toward future application of xenotransplantation were quite positive among doctors. However, the attitudes of nursing and ancillary personnel were similar to those of the general population. The main factors related to such an attitude depended mainly on the previous relationship and attitude of the respondent toward human organ donation and transplantation.

Primary care doctors faced with living organ donation.

OBJECTIVE: The attitudes of health care personnel, specifically doctors, have a significant influence on public attitudes toward organ donation and transplantation. The objective herein was to analyze the attitudes of Primary Care (PC) doctors toward living organ donation and to determine the psychosocial factors that condition these attitudes. MATERIALS AND METHODS: A random sample was stratified by geographical location (six health areas in our community) among PC doctors, including 155 respondents from 32 health centers. Attitudes toward donation were evaluated using a psychosocial questionnaire validated in our geographical area. Contact was made with the Doctor Coordinator in each center for distribution of the questionnaires, which were completed anonymously. The chi-square test and Student t test were applied to evaluate the data. RESULTS: When the living donor is not related, only 21% (n = 32) of PC doctors were in favor of living kidney donation, and only 20% (n = 31) for living liver donation (P > .05). In contrast, these percentages were 90% and 89% in favor of kidney and liver related donation, respectively. Upon analysis of the psychosocial variables affecting these attitudes, there was only an association with their partner's opinion (P = .009 for kidney and P = .000 for liver), and the possibility of needing a transplant oneself (P = .000). CONCLUSIONS: PC doctors have favorable attitudes toward related living donation. If living donation is promoted by transplant coordination units, such PC professionals could act as a source of positive information about the matter for the general public.

Ancillary hospital personnel faced with organ donation and transplantation.

OBJECTIVE: To reduce the number of family organ donation refusals, it is necessary not only to act on the general public but also on the health care system. In this respect, there are data suggesting that the percentage of hospital personnel against donation is high, especially among ancillary personnel. The objective herein was to analyze the attitudes of ancillary hospital professionals toward donation of their own organs and determine factors that conditioned such attitudes. MATERIALS AND METHODS: A random sample in a third-level hospital with a solid organ transplant program was stratified by ancillary services: administrative, porters, maintenance, cleaning, and cooking. Attitudes toward donation of one's own organs after death were evaluated using a questionnaire on psychosocial aspects validated in our area. It included various psychosocial variables that could affect such attitudes. The Student t test and chi-square test were used to evaluate the data. RESULTS: We analyzed 277 respondents of mean age 43 +/- 8 years and 96% women. The level of acceptance of organ donation was 64% (n = 178), whereas 46% were either against or undecided (n = 98). The variables which determined the attitudes were understanding of brain death (P = .004); attitude toward cadaveric manipulation, especially toward autopsy (P = .013) and cremation (P = .004); concern about mutilation after donation (P = .014); religion (P = .032); partner's attitude toward donation (P < .0001); and possibility of needing an organ in the future (P = .031). CONCLUSIONS: Ancillary hospital personnel had similar attitudes toward donation as those of the general public as observed in other studies. The attitudes were determined by many psychosocial factors. A campaign to raise awareness among professionals has become a priority, given that working in a hospital, their unfavorable attitude could have a strong negative impact on the general public.