A Multicentre and stratified study of the attitude of medical students towards organ donation in Spain.

INTRODUCTION: Medical students represent a new generation of medical thought, and if they have a favourable attitude towards organ donation this will greatly encourage its promotion. OBJECTIVE: To analyse the attitude of medical students in Spanish universities towards the donation of their own organs and to determine the factors affecting this attitude. MATERIAL AND METHODS: Type of study: A sociological, interdisciplinary, multicentre, and observational study in Spain. STUDY POPULATION: Students studying a degree in medicine enrolled in Spain (n = 34,000). SAMPLE SIZE: A sample of 9598 students (confidence of 99% and precision of ±1%), stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ donation and transplantation (PCID-DTO RIOS) was self-administered and completed anonymously. RESULTS: The questionnaire completion rate was 95.7% (n = 9.275). 80% were in favour of donation, 2% against and 18% were undecided. The following main variables were related to a favourable attitude: being of the female sex (Odds Ratio = 1.739); being in the sixth year of the degree (OR = 2.506); knowing a donor (OR = 1.346); having spoken about the subject with one's family (OR = 2.132) and friends (OR = 1.333); having a family circle that is in favour, more specifically, having a father (OR = 1.841), mother (OR = 2.538) or partner in favour (OR = 2.192); being a blood donor (OR = 2.824); acceptance of the mutilation of the body if it were necessary (OR = 2.958); and being an atheist or an agnostic (OR = 1.766). CONCLUSIONS: Spanish medical students generally have a favourable attitude towards organ donation, although 20% are not in favour.

Do Spanish Medical Students Understand the Concept of Brain Death?

OBJECTIVE: To analyze the level of understanding of the brain death concept among medical students in universities in Spain. METHODS: This cross-sectional sociological, interdisciplinary, and multicenter study was performed on 9598 medical students in Spain. The sample was stratified by geographical area and academic year. A previously validated self-reported measure of brain death knowledge (questionnaire Proyecto Colaborativo Internacional Donante sobre la Donación y Transplante de Organos) was completed anonymously by students. RESULTS: Respondents completed 9275 surveys for a completion rate of 95.7%. Of those, 67% (n = 6190) of the respondents understood the brain death concept. Of the rest, 28% (n = 2652) did not know what it meant, and the remaining 5% (n = 433) believed that it did not mean that the patient was dead. The variables related to a correct understanding of the concept were: (1) being older ( P < .001), (2) studying at a public university ( P < .001), (3) year of medical school ( P < .001), (4) studying at one of the universities in the south of Spain ( P = .003), (5) having discussed donation and transplantation with the family ( P < .001), (6) having spoken to friends about the matter ( P < .001), (7) a partner's favorable attitude toward donation and transplantation ( P < .001), and (8) religious beliefs ( P < .001). CONCLUSIONS: Sixty-seven percent of medical students know the concept of brain death, and knowledge improved as they advanced in their degree.

Serology and longevity of immunity against Echinococcus granulosus in sheep and llama induced by an oil-based EG95 vaccine.

An oil-based formulation of the EG95 vaccine to protect grazing animals against infection with Echinococcus granulosus was formulated in Argentina. The efficacy of the vaccine was monitored by serology in sheep and llama (Lama glama) and was compared to the serology in sheep previously published using a QuilA-adjuvanted vaccine. Long-term efficacy was also tested in sheep by challenging with E. granulosus eggs of the G1 strain 4 years after the beginning of the trial. The serological results for both sheep and llama were similar to those described previously, except that there was a more rapid response after the first vaccination. A third vaccination given after 1 year resulted in a transient boost in serology that lasted for about 12 months, which was similar to results previously described. Sheep challenged after 4 years with three vaccinations presented 84·2% reduction of live cysts counts compared with control group, and after a fourth vaccination prior to challenge, this reduction was 94·7%. The oil-based vaccine appeared to be bio-equivalent to the QuilA vaccine.

Medical students faced with related and unrelated living kidney donation: a stratified and multicentre study in Spain.

INTRODUCTION: The attitude of medical students towards living kidney donation (LKD) is of great interest given that they will become promoters of this technique in the near future. OBJECTIVE: To analyse the attitude of Spanish medical students towards related and unrelated LKD and to determine the factors affecting this attitude. MATERIALS AND METHODS: Type of study: A sociological, interdisciplinary, multicentre, and observational study. STUDY POPULATION: Medical students enrolled in Spain (n = 34.000). SAMPLE SIZE: A sample of 9598 students (99 % confidence and precision of ±1 %), stratified by geographical area and academic year. Measurement instrument: A validated questionnaire (PCID-DVR RIOS) was administered and completed anonymously. RESULTS: There was a completion rate of 95.7 % (n = 9275); 93 % (n = 8630) were in favour of related LKD, and 30 % (n = 2784) were in favour of unrelated LKD. The following factors were associated with this attitude: (1) age (p = 0.008); (2) sex (p < 0.001); (3) year of university degree (p < 0.001); (4) a belief that a transplant might be necessary in the future (p < 0.001); (5) attitude towards deceased organ donation (p < 0.001); (6) a willingness to accept a kidney from a living donor (p < 0.001); (7) attitude towards living liver donation (p < 0.001); (8) a partner's attitude towards donation (p < 0.001); (9) having spoken about the subject with one's family (p < 0.001), or friends (p < 0.001); (10) pro-social behaviour (p < 0.001); (11) the respondent's religious attitude (p < 0.001); and (12) fear of possible mutilation of the body after donation (p < 0.001). CONCLUSIONS: The attitude of medical students towards LKD is very favourable when it is the related kind of donation, and it is associated with factors of general knowledge about organ donation and transplantation and social interaction and religion.

[Brain death: is it an appropriate term?]. / Muerte cerebral: ¿es un término adecuado?

INTRODUCTION: Brain death is generally accepted as a concept to indicate death. It was introduced about 40 years ago, and it was considered the ideal situation for donation of organs. METHODS: During this time, however, there have been problems in the understanding of this concept both in the medical profession and in the general population. University students from medical and non-medical schools were tested for their understanding of this concept. RESULTS: Our results show that less than one third of the non-medical students identified brain death as death. The data from the medical students changed as they progressed through their studies, but only 2/3 of the graduating medical class believed that brain death is death. CONCLUSION: Similar results have been seen in other universities around the world, and a renewed effort on the re-education of the concept of brain death may be worthwhile. Although we cannot extrapolate these results to the general population, the confusion is probably similar; hence an effort should be made to solve this problem.

Information About Donation and Organ Transplantation Among Spanish Medical Students.

INTRODUCTION: Health professionals are asked to promote health, especially organ transplantation; however, they do not always have specific training. OBJECTIVE: To analyze information about donation and organ transplantation among Spanish medical students. METHOD: The population under study is medical students in Spanish universities using the database of the International Donor Collaborative Project, stratified by geographic area and academic year (n = 9275). The instrument used is the attitude questionnaire for organ donation for "PCID-DTO-Ríos" transplantation, validated with an explained variance of 63.203% and α = 0.834. The Student t test was applied together with the χ2 test, complemented by an analysis of the remainders, and Fisher's exact test was applied. RESULTS: Of the students, 74% indicate that they have received information from university professors about organ transplant. Concerning specific issues with the donation, it is notable that only 66.7% (n = 6190) know and accept the concept of brain death as the death of a person. However, only 22% consider themselves as having good information, and 35.3% indicate that their information is scarce or void. Students indicate having received information about transplant from other extra-university sources, such as television and Internet (80.9%), books and magazines (73.2%), and the press (66.9%). From the information obtained in the sociofamilial field, 60.7% have obtained information from the family and 58.1% from friends. Of this information, 9% has been negative from friends, 7.5% from family, 6% from the Internet and television, and 4% from university professors. CONCLUSION: Spanish medical students believe they have little information about organ transplantation and have received negative information.

Are Medical Students of Non-Spanish Nationality Studying in Spain as Sensitized to Transplantation as Those of Spanish Nationality?

INTRODUCTION: Awareness of organ donation among Spanish doctors and medical students is very positive. However, the emerging group of professionals of non-Spanish nationality studying in Spain has not been analyzed. OBJECTIVE: To analyze the differences in the attitudes toward the different types of donation among medical students, according to their nationality. METHODS: The population under study is medical students in Spanish universities using the database of the International Collaborative Donor Project, stratified by geographic area and academic year. Groups under study include students of non-Spanish nationality as group 1 (n = 1570) and students of Spanish nationality as Group 2 (n = 7705). Instruments are validated questionnaires of attitude toward donation "PCID-DTO-Ríos," "PCID-DVR-Ríos," "PCID-DVH-Ríos," and "PCID-XenoTx-Ríos." RESULTS: The attitude toward the donation of own organs after death is similar in both groups (P = .703). Non-Spaniards are 79.2% in favor compared to 79.6% of Spaniards. Living kidney donation, both unrelated (33.3% vs 29.3% in favor; P = .001) and related (91.2% vs 89, 6% in favor; P = .047), is more favorable among non-Spanish students. There are no differences regarding non-related living liver donation (29.7% vs 29.3% in favor; P = .063), but there are differences in the results for related living liver donation (94.1% vs 88%; P < .001). The attitude toward xenotransplantation of organs is similar (80.8% vs 80.8%; P = .999). CONCLUSIONS: Awareness of the donation of organs among Spanish medical students is similar to non-Spanish students studying in Spain, except the attitude toward living donation.

What Reasons Lead Spanish Medical Students Not to Be in Favor of Organ Donation?

INTRODUCTION: Despite sensitization of medical students toward the donation of organs, a non-negligible percentage of students are not in favor of donation. OBJECTIVE: To analyze the reasons of Spanish medical students who do not have a favorable attitude toward the donation of their own organs after death. METHOD: The population under study is medical students in Spanish universities, using the database of the International Donor Collaborative Project, stratified by geographic area and academic year. The questionnaire completion was anonymous and self-administered. The study group is medical students with an unfavorable attitude toward organ donation. The assessment instrument used is a validated questionnaire of attitude toward the donation of organs for transplant, "PCID-DTO-Ríos." The reasons against the donation are valued in the questionnaire through a question. RESULTS: Of the participants included in the PCID, students who are not in favor of organ donation were selected (n = 1899). Of them, 8.1% (n = 154) are against and 91.1% (n = 1745) are doubtful. The main reasons indicated are the fear of apparent death in 11.4% of respondents, fear of possible mutilation after donation in 11.1%, and religious reasons in 2.6%. Of those, 6.9% indicate other reasons but do not clearly specify the reasons, using words such as "fear" (2.5%) or "doubts about the process" (4.1%); 66.2% (n = 1257) indicated an "assertive refusal" ("I don't want to express my reasons"). CONCLUSION: Twenty percent of Spanish medical students are not in favor of donating their organs and are not in favor of showing their reasons.

Do Religious Factors Influence the Attitude Toward Organ Donation Among Medical Students? A Spanish Multicenter Study.

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.

Are High Rates of Deceased Donation Conditioning the Attitude Toward Liver Donation Among Medical Students?

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.

Sensitization Toward Organ Donation Among Medical Students in Spanish Regions With More Than 50 Donors Per Million Population.

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.

Oscillatory changes related to the forced termination of a movement.

OBJECTIVE: Stimulus-induced movements are accompanied by a definite pattern of oscillatory changes, that include a frontal 15 Hz synchronization, a central peri-movement desynchronization, and a contralateral beta rebound after the movement. Our aim was to study the oscillatory changes related to the forced termination of a single complex motor program (signature) and compare them with those observed after the normal termination of the movement. METHODS: Fifty-eight reference-free EEG channels were analyzed in 10 healthy subjects. A 2000 Hz tone (S1, go signal) indicated the subject to begin to write his/her complete signature. A second 2000 Hz tone 0.8 s afterwards (50% probability: S2, stop signal) indicated the subject to stop immediately. Movement-related energy changes were evaluated by means of time-frequency (Gabor) transforms. RESULTS: A frontal 15 Hz synchronization was observed after S1, but not after S2. The amplitude of the post-movement beta increase was significantly lower when the movement was abnormally terminated (p=0.005), while the peri-movement decrease was similar. CONCLUSIONS: The forced termination of a motor program reduces significantly the amplitude of the post-movement beta increment, conserving its temporal pattern. Also, the presence of the 15 Hz frontal synchronization only after S1, together with the results of previous studies, suggests that the frontal mechanisms involved in go/no go and stop signals are very different. SIGNIFICANCE: Our results indicate that the beta rebound is an active process, independent of the peri-movement beta decrease, which is influenced by how the movement is terminated.

[Classification of sleep disorders]. / Clasificación de los trastornos del sueño.

Sleep disorders are frequent processes, both as a symptom associated with other diseases and as independent disorders. However, only in the last 4 decades has Sleep medicine gained its position among the medical specialties. In fact, it was only in these years that significant advances were obtained in the study of the etiology and treatment of these disorders. Similarly, the different classifications have been evolving over the years. First, they were based upon the clinical symptom; later on, more emphasis was given to the diseases. Finally, in 2005, the new classification was once again based on the symptoms. More than 90 disorders are listed in this latest classification, and an attempt is made to include the symptoms and the diseases of sleep, as well as those in which sleep disorders are fundamental. It is essential to have a clear idea of this complete classification of sleep disorders in order to deal with these patients appropriately.

High frequency oscillations in the somatosensory evoked potentials (SSEP's) are mainly due to phase-resetting phenomena.

A small series of high frequency oscillations (HFOs) overlapping the earliest part of the N20 wave can be observed in the somatosensory evoked potentials (SSEPs) of normal subjects. We tried to elucidate whether these high frequency components are mainly due to phase-resetting phenomena, to the emergence of new oscillations related to the stimuli, or to a combination of both. Averaged median-nerve SSEPs from seven healthy subjects were studied by means of time-frequency analysis. The presence of new oscillatory activities was evaluated by averaging the energy of the single-trial time-frequency transforms in the HFOs range (400-1000 Hz). To study phase-resetting phenomena, we measured inter-trial coherence (ITC) in the same frequency range. A marked inter-trial coherence related to the HFOs was found, whereas energy changes (related to the emergence of new oscillations) were minimal. The combination of these three different approaches suggests that the HFOs are mainly due to resettings of the ongoing EEG activity originated in response to the stimuli. The emergence of new activities does not seem to be a relevant mechanism in the formation of these components.

Alpha and beta changes in cortical oscillatory activity in a go/no go randomly-delayed-response choice reaction time paradigm.

OBJECTIVE: Predictable movements induce oscillatory changes over the contralateral motor cortex that begin before the movement, but their significance has not been fully established. We studied non-phase-locked changes in cortical oscillatory activity in a S1-centred double-stimulus go/no go paradigm with random interstimulus interval. METHODS: About 58 reference-free EEG channels were analyzed by means of Gabor transforms in a group of 10 healthy subjects. A 2000 Hz tone (S1go, 84% probability) indicated the subject to make a brisk wrist extension after a second 2000 Hz tone (S2go). The S1-S2 interval was either 1.5, 3 or 4.5 s. A 1000 Hz tone (S1 no go, 16% probability) indicated the subject not to move (and wait for another S1 tone). RESULTS: A frontal 15 Hz synchronization was observed after S1 in all conditions. No further significant changes were observed in the no go condition. A small pre-S2 alpha and beta desynchronization could be observed only in the 3 and 4.5s-interval go conditions, being larger in the latter. CONCLUSIONS: These results suggest that the predictability of the timing of a movement influences the appearance of the pre-movement oscillatory changes; not only motor planning (the 'go' decision) is necessary, but also an estimation of when to move. SIGNIFICANCE: Our findings provide new insight on the relationship between the decision-making process, movement, and cortical oscillatory activity.

Imitating versus non-imitating movements: differences in frontal electroencephalographic oscillatory activity.

Non phase-locked oscillatory changes were studied in seven healthy volunteers during two different reaction time movement paradigms, in which the stimulus was a wrist movement (either extension or flexion) performed by another person seated in front of the subject (examiner). In the first paradigm (imitation), the subject was instructed to perform the same movement observed. In the second paradigm (non-imitation), the subject was instructed to perform the opposite movement (flexion when an extension was observed, and vice-versa). Changes in the 7-37 Hz range band were determined by means of Gabor transforms. A frontal energy increase (event-related synchronization, ERS) around 15 Hz could be observed in the frontal region after the examiner's movement; this frontal ERS was significantly larger in the non-imitation paradigm. A typical alpha and beta movement-related event-related desynchronization/synchronization (ERD/ERS) pattern was also observed in both paradigms in the central region. The beta-ERD was significantly larger in the imitation paradigm. Our results show that the motor preparation mechanisms involved in an imitated and a non-imitated movement are different.

[Mathematical analyses in the study of electroencephalographic signals]. / Análisis matemáticos en el estudio de señales electroencefalográficas.

AIM: The principal mathematical techniques applied to the EEG are reviewed. DEVELOPMENT: After the introduction of digital EEG, new mathematical tools have been developed for the EEG analysis. Nowadays there are several techniques that analyse the EEG signal in different ways, getting a better understanding of the EEG: development of new montages; artifact removal; analysis in time domain, phase coherence and synchrony; source analysis; epileptic seizures detection and prediction; superposition of electrical activity and other neuroimaging techniques. Although they have demonstrated their efficacy, the comparison between them is not always easy. CONCLUSIONS: The development of mathematical tools for EEG analysis has improved the knowledge of the electric cerebral activity in normal and pathological conditions. They study many different aspects of the EEG signal. Their continuous development will produce an increase the knowledge of the normal and pathological cerebral functions.

Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome.

OBJECTIVE: To investigate the patterns of occurrence of psychogenic pseudoseizures (PPS) of 45 consecutive patients during a 6-month period after diagnosis, and to determine whether psychiatric and neurologic variables identified previously in PPS patient series can predict their recurrence after diagnosis, and whether any of these variables are associated with a particular outcome pattern. METHOD: Postdiagnosis PPS recurrence was assessed twice: during the first month and during a period ranging from the second to the sixth month. Outcome was categorized as follows: class I, complete cessation of PPS; class II, PPS only during one of the two observation periods; and class III, persistent PPS during the two observation periods. The authors used a logistic regression model to identify predictors of PPS recurrence (versus no PPS) among four neurologic and nine psychiatric variables, and compared their frequency among the three outcome classes. RESULTS: Class I, n = 13 (29%); class II, n = 12 (27%); and class III, n = 20 (44%). The presence of an abnormal MR image predicted PPS recurrence during the second observation period with a 75% accuracy. The presence of all nine psychiatric variables predicted PPS recurrence during both the first and second observation periods with a 93% and an 89% accuracy respectively. Patients with a class III outcome had a markedly higher frequency of recurrent major depression, dissociative and personality disorders, and a history of chronic abuse. Patients with a class II outcome displayed a notably higher frequency of denial of stressors and psychosocial problems, refusal of treatment recommendations, and new somatic symptoms after disclosure of diagnosis. Conversely, one episode of major depression was the one common diagnosis in patients with a class I outcome. CONCLUSIONS: PPS outcome after disclosure of diagnosis can be predicted by the presence of certain psychiatric characteristics. More than one psychopathogenic mechanism appears to operate in PPS.

Synthesis of heteroaromatic potential beta-adrenergic antagonists by the glycidol route.

The synthesis of several 3-alkylamino-2-hydroxypropyl heteroaryl ethers (13-15, 17, and 18) is described. These compounds were prepared by the alkylamination of the corresponding glycidyl ethers (6-8, 10, and 11), which in turn were obtained from the requisite heteroaryl halides and the sodium salt of glycidol. The above basic ethers exhibited beta-blocking activity, but the potency of the tested compounds was considerably less than that of propanolol. Only 3-tert-butylamino-2-hydroxyl-1-(1,2,4-thiadiazol-5-yl) propyl ether (13) showed some selective myocardial beta-blocking activity.

Vaccination trials in Australia and Argentina confirm the effectiveness of the EG95 hydatid vaccine in sheep.

Experimental vaccine trials against hydatid disease have been undertaken in sheep using the EG95 recombinant vaccine. Challenge infection was with viable Echinococcus granulosus eggs obtained from a New Zealand isolate (dog/sheep cycle), an Australian isolate (dingo/wallaby cycle) and an Argentine isolate (dog/sheep cycle). Vaccination with EG95 conferred a high degree of protection against challenge with all three parasite isolates (protection range 96-100%). Taken together, the trials demonstrated that 86% of vaccinated sheep were completely free of viable hydatid cysts when examined approximately 1 year after challenge infection. Vaccination reduced the number of viable cysts by 99.3% compared with unvaccinated controls. These results suggest that the EG95 vaccine could have wide applicability as a new tool for use in hydatid control campaigns.