Review and analysis of the results of kidney transplantation programs in Mexico.

OBJECTIVE: To know, analyze and compare kidney transplant programs; considering the survival of recipients at 1 and 5 years, from hospitals in Mexico. METHOD: A systematic review was carried out whose search focused on the survival of kidney transplant recipients. All publications found in PubMed and Google from 1963 to 2021 were included. The expectation-maximization algorithm was applied, proposing a mixture of normals, and hierarchical grouping to establish if there is any type of pattern and determine if there is a difference between the percentages. of survival at 1 and 5 years between the groups formed. RESULTS: Eight hospitals that published the survival of kidney transplant recipients were found. Survival rates ranged, at 1 year, from 94.7% to 100%, and at 5 years, from 85% to 96.2%. The methods used for their comparison indicated that there is a difference between survival at 1 and 5 years. CONCLUSIONS: In Mexico there is little information on the results of kidney transplant programs, and the information found shows great heterogeneity in said programs. Some strategies and actions are proposed to improve survival underreporting.

OBJETIVO: Conocer, analizar y comparar los programas de trasplante renal, considerando la supervivencia de los receptores a 1 y 5 años, en los hospitales en México. MÉTODO: Se realizó una revisión sistemática cuya búsqueda se centró en la supervivencia de los receptores de trasplante renal. Se incluyeron todas las publicaciones encontradas en PubMed y Google de 1963 a 2021. Se aplicó el algoritmo de expectation-maximization, proponiendo una mezcla de normales, y agrupamiento jerárquico para establecer si hay algún tipo de patrón y determinar si hay diferencia entre los porcentajes de supervivencia a 1 y 5 años entre los grupos formados. RESULTADOS: Se encontraron ocho hospitales que publicaron la supervivencia de los receptores de trasplante renal. Los rangos de las tasas de supervivencia fueron, a 1 año, del 94.7% al 100%, y a los 5 años, del 85% al 96.2%. Los métodos empleados para su comparación indican que hay diferencia entre la supervivencia a 1 y 5 años. CONCLUSIONES: En México se tiene poca información sobre los resultados de los programas de trasplante renal, y la información encontrada muestra gran heterogeneidad en dichos programas. Se proponen algunas estrategias y acciones para mejorar el subregistro de supervivencia.

Attitude Toward Organ Donation Among Cuban Residents in Florida.

BACKGROUND: The Cuban population residing in the state of Florida in the United States forms the largest population group of immigrants in that state. It has been described as a population with little awareness of organ donation. The objective is to analyze the factors that Cubans residing in the Florida refer to when expressing an unfavorable attitude toward organ donation and to determine the psychosocial factors associated with the attitude toward organ donation of this population group. METHODS: We performed a cross-sectional observational study. From the Proyecto Colaborativo Internacional Donante (International Donor Collaborative Project), a sample stratified by age and sex of Cubans residing in Florida (N = 1224) is obtained. The sample is analyzed using the validated questionnaire (PCID-DTO-RIOS). The reasons against organ donation were analyzed using a specific multiresponse item, with an open response option. For the analysis of the psychosocial variables, a logistic regression analysis is carried out. RESULTS: A total of 38.2% (n = 468) of the individuals under study declared themselves against organ donation. Of those who were against, the reasons stated were (1) leave the dead in peace (n = 440; 57.6%); (2) religious reasons (n = 192; 25.1%); (3) fear of mutilation (n = 160; 20.9%); (4) assertive refusal (n = 128; 16.8%); (5) apparent death (n = 16; 2.1%); and (6) other reasons (n = 764; 62.4%). CONCLUSIONS: The Cuban population residing in Florida who is against organ donation expresses various reasons. In addition, there are factors associated with the psychosocial profile toward organ donation of this important population group.

International Population Study in Spain, Cuba, and the United States of Attitudes Toward Organ Donation Among the Cuban Population.

Cuban immigrants constitute an important group in both the United States and Spain, with different behaviors toward organ donation having been described among the different Latin American nationalities. We analyzed the attitude toward organ donation among the Cuban populations in Cuba, Spain, and Florida. The study population was Cuban immigrants over 15 years of age residing in Cuba, Spain, and Florida, with samples randomly stratified by age and sex. A validated questionnaire on psychosocial aspects of organ donation (PCID-DTO Rios) was used. Census was used as the sampling base in all 3 countries; however, additionally, in Spain and the United States (Florida), we sought the support of immigration support associations to determine the Cuban population without legal documentation. The questionnaire was completed anonymously and self-administered. The completion rate of the study was 74% (4123/5574) among 424 surveyed in Spain, 1224 in Florida, and 2475 in Cuba. The attitude in favor of donating their own organs upon death was 60.6% of those surveyed in Spain, 37.6% in Florida, and 68.9% in Cuba, or 58% of the global sample. Multivariate analysis showed that country of residence was an independent factor associated with attitude toward organ donation (odds ratio, 1.929). Other factors associated with attitude were sex, educational level, performance of prosocial activities, knowledge of the brain death concept, religion, the couple's opinion toward donation, fear of mutilation after donation, and attitude toward manipulation of the body after death. The attitude toward organ donation among Cubans in their country of origin and immigrants in Spain was similar, being significantly different from those who emigrate to Florida, where the attitude is much less favorable.

Establishing consensus on the perioperative management of cholecystectomy in public hospitals: a Delphi study with an expert panel in Mexico.

BACKGROUND: Several guidelines have put forward recommendations about the perioperative process of cholecystectomy. Despite the recommendations, controversy remains concerning several topics, especially in low- and middle-income countries. The aim of this study was to develop uniform recommendations for perioperative practices in cholecystectomy in Mexico to standardize this process and save public health system resources. METHODS: A modified Delphi method was used. An expert panel of 23 surgeons anonymously completed two rounds of responses to a 29-item questionnaire with 110 possible answers. The consensus was assessed using the percentage of responders agreeing on each question. RESULTS: From the 29 questions, the study generated 27 recommendations based on 20 (69.0%) questions reaching consensus, one that was considered uncertain (3.4%), and six (20.7%) items that remained open questions. In two (6.9%) cases, no consensus was reached, and no recommendation could be made. CONCLUSIONS: This study provides recommendations for the perioperative management of cholecystectomy in public hospitals in Mexico. As a guide for public institutions in low- and middle-income countries, the study identifies recommendations for perioperative tests and evaluations, perioperative decision making, postoperative interventions and institutional investment, that might ensure the safe practice of cholecystectomy and contribute to conserving resources.

Differences in Attitude Toward Organ Donation in the Three Main Cities of Cuba.

BACKGROUND: Cuba is one of the Latin American countries with the highest rates of organ donation. Social and cultural differences among the population throughout the country may also affect attitudes toward donation. Knowledge of these characteristics would facilitate awareness of the population most reluctant to donate and transplant. OBJECTIVE: We sought to analyze the differences in attitudes toward organ donation among Cubans living in the main capitals of Cuba. MATERIALS AND METHODS: Study population. The study group was the Cuban population living in the cities of Cienfuegos (n=636), Havana (n=920), and Santiago de Cuba (n=455), extracted from the database of the International Collaborative Donor Project. Sample of the population. Participants were older than 15 years, and data were stratified by geographic area, age, and sex. Assessment instrument. We used a validated questionnaire of attitude toward organ donation for transplant (PCID-DTO-Ríos), anonymously filled in and self-administered. STATISTICS: Student t test was applied together with the χ2 test, complemented by an analysis of the remainders. RESULTS: The favorable attitude among inhabitants in Cienfuegos was 71.2% (n=453), 68.3% (n=628) among those in Havana, and 69.5% (n=316) among those in Santiago de Cuba (P < .05). The psycho-social profile of respondents favoring organ donation was similar in the 3 cities. CONCLUSIONS: The attitude toward organ donation among the population of the main cities of Cuba was favorable and similar in all of them. The psycho-social profile toward organ donation was similar in the 3 cities.

Multicentric Study to Evaluate Mexican Medical Students' Knowledge of Transplants and Organ Donation.

INTRODUCTION: Transplants and organ donation are greatly aided by future medical professionals having adequate knowledge of this topic. This study aimed to elucidate the level of Mexican medical students' knowledge in the field of transplants and organ donation. MATERIALS AND METHODS: The evaluation instrument was designed and validated. The design used simple sampling with replacement, selecting a random sample of 5 universities from among the institutional members of the Mexican Association of Departments and Schools of Medicine (Asociación Mexicana de Facultades y Escuelas de Medicina [AMFEM]). The sample was composed of 3214 medical students. Measures of central tendency were determined, and the mean scores obtained across the different universities were compared using a Kruskal-Wallis test. The odds ratio was calculated for the students whose school or department included instruction on transplants and donation within their curriculum. Kendall correlation was used for the students' academic grade level and score. All analyses considered a threshold of P < .05. RESULTS: A questionnaire was administered to a sample of 2563 students to evaluate their knowledge of transplants and organ donation. The average score was 4.02 on a scale of 0 to 10 (standard deviation 0.03), with a 95% confidence interval (3.96-4.08). Students whose school or department taught the subject of transplants and donations within their curriculum obtained an odds ratio of 1.44 (P = .0000822). CONCLUSIONS: The findings of this study suggest that medical students in Mexico do not have sufficient knowledge of transplants and organ donation.

Is the Population of Santiago de Cuba Sensitized to Xenotransplantation? A Multivariate Analysis.

INTRODUCTION: New transplant-related therapies such as xenotransplantation of solid cells, tissues, and organs are still poorly understood, especially in countries without preclinical xenotransplantation programs. OBJECTIVE: Analyze the attitude toward xenotransplantation among the population of Santiago de Cuba. METHOD: Type of study. Cross-sectional observational study. SAMPLE: Random sampling of 455 individuals residing in Santiago de Cuba. Assessment instrument. Validated questionnaire of attitude toward the xenotransplant, "PCID-XenoTx-Ríos." Field work. Random selection based on stratification. Anonymous and self-administered completion. RESULTS: A total of 49.9% would accept a solid organ xenotransplant if they needed it and the results were similar to those currently obtained with human organs, 27.5% have doubts, and the remaining 22.6% would not accept it. They are presented as statistically significant variables (P < .05): level of studies; comment with the family about the donation; opinion of a partner; religion; opinion of religion; performing prosocial activities; attitude toward donation; previous relationship with the organ donation and transplant; favorable attitude toward live kidney donation. In the multivariate analysis, the following persist: 1. level of university studies: odds ratio (OR) = 5.076; 2. not having a partner: OR = 5.154; 3. belonging to another religion: OR = 2.061; 4. favorable attitude toward organ donation: OR = 5; and 5. favorable attitude toward living donation: OR = 3.759. CONCLUSIONS: The population of Santiago de Cuba is less sensitized toward xenotransplantation, possibly due to ignorance of the issue due to lack of preclinical trials in their countries.

Nicaraguan Population Residing in Florida Attitude Toward Different Types of Organ Donation.

INTRODUCTION: The population of Nicaraguan immigrants is growing in North America; however, they have been little analyzed concerning their attitude toward donation and organ transplantation. OBJECTIVE: To analyze the attitude toward the different types of organ donation among the Nicaraguan population residing in Florida. METHODS: Study population. Nicaraguan population residing in Florida (USA). INCLUSION CRITERIA: Population sample over 15 years stratified by age and sex. Instrument valuation. Attitude questionnaires toward organ donation for transplantation "PCID-DTO-Ríos," "PCID-DVR-Ríos," and "PCID-XenoTx-Ríos." Setting for the study. Random selection of people to be surveyed according to stratification. The assistance of immigrant support associations in Florida was required to locate respondents. RESULTS: Sample composed of 89 participants. In the attitude toward donation of one's own organs after death, 22% (n = 20) were in favor, 41% (n = 36) were against, and 37% (n = 33) were undecided. Regarding the donation of living related organs, 76% were in favor (n = 68), 10% were against (n = 9), and 14% were undecided (n = 12). Finally, regarding attitudes toward the acceptance of organ xenotransplantation, if the results were similar to those obtained with human organs, they were not in favor, with 72% (n = 64) against and 28% (n = 25) doubtful. CONCLUSIONS: The attitude of the Nicaraguan population residing in Florida toward different types of organ donation is unfavorable.

Puerto Rican Population Residing in Florida: Attitude Towards Organ Xenotransplantation.

INTRODUCTION: Puerto Ricans are one of the majority immigration groups in Florida. However, little is known about their attitudes toward xenotransplantation (XenoTx), a still experimental technique, which is making significant progress. OBJECTIVE: To analyze the attitude toward XenoTx of organs among the population of Puerto Rican residents in Florida. METHODS: Population under study. Sample taken from the International Collaborative Donor Project and formed by the population born in Puerto Rico and resident in Florida. INCLUSION CRITERIA: Over 15 years stratified by age and sex. Instrument valuation. Validated questionnaire of attitude toward xenotransplantation "PCID-XenoTx-Ríos." Setting for the study. Random selection of people to survey based on stratification. Immigrant assistance associations in Florida were consulted to locate potential respondents. RESULTS: Of the 259 respondents, 16% are in favor of XenoTx if the results are similar to those obtained with human organs, 74% are against, and 10% are doubtful. If the results are worse than with human organs, only 2% are in favor, 74% against, and 24% undecided. The variables that are associated with this attitude are the following: sex (P = .001); marital status (P < .001); have offspring (P = .004); level of education (P < .001), opinion of a partner toward donation (P = .008), religious beliefs (P < .001), knowing the opinion toward donation of religion (P < .001), prosocial activity (P < .001), attitude toward donation (P ≤ .001), previous relationship with donation (P < .001), possibility of receiving a transplant in the future (P = .001), and attitude toward donation to a relative (P < .001). CONCLUSIONS: The Puerto Rican population residing in Florida does not hold a favorable attitude toward xenotransplantation.

Population of Cienfuegos (Cuba) and Their Knowledge About the Concept of Brain Death: Multivariate Analysis of the Associated Psychosocial Factors.

INTRODUCTION: The favorable knowledge of the concept of brain death (BD) is a determinant for organ donation. OBJECTIVE: To analyze the level of knowledge of the concept of BD in the population of Cienfuegos (Cuba) and determine the factors that condition it. METHODS: Sample of Cubans residing in Cienfuegos (n = 636) stratified by age and sex. The assessment instrument is the validated questionnaire of attitude toward donation and transplant, "PCID-DTO-Ríos," self-administered and anonymously filled out. STATISTICS: χ2, Student t test, and a logistic regression analysis. RESULTS: A total of 636 individuals completed the questionnaire. Fifty percent of participants understood the concept of BD and accept it as a person's death (n = 318). Of the rest, 13.4% (n = 85) did not understand it, and 36.6% (n = 233) had a misconception. The marital status (be married and / or with a partner) of the respondent is associated with the knowledge BD (P < .001) as are the following variables: level of education; offspring; having discussed the issue of donation and transplantation with the family; opinion of the couple toward donation and transplantation; religion; and favorable attitude toward the organ donation and transplant. In the multivariate analysis, the following are independent variables: 1. studies (odds ratio [OR] = 4.664; P = .002); 2. has no offspring (OR = 3.129; P < .001); 3. has commented on it in the family nucleus (OR = 2.759; P < .001); 4. despite having an opinion against (OR = 16.999; P < .001); 5. religion (OR = 1.878; P = .042); and 6. favorable attitude toward the donation of cadaver organs (OR = 2.026; P = .011). CONCLUSIONS: Half of the population of Cienfuegos knows and accepts the concept of BD as the death of an individual, associating said acceptance with a favorable attitude toward organ donation.

Acceptance of Solid Organ Xenotransplantation by the Ecuadorian Population Residing in Spain.

INTRODUCTION: Ecuadorians are the largest immigrant group in Spain. In countries with preclinical programs of xenotransplantation (XenoTx), it is important to know the population attitude toward them; however, in the Ecuadorian population it is not known. OBJECTIVE: To analyze the attitude toward XenoTx of organs among the Ecuadorian population residing in Spain. METHODS: Population under study. Ecuadorians residing in Spain. INCLUSION CRITERIA: Sample of population over 15 years stratified by age and sex. Instrument valuation. Validated questionnaire of attitude towards xenotransplantation PCID-XenoTx-Ríos. Setting for the study. Random selection of people to survey based on stratification. RESULTS: Of the 461 respondents, 36% are in favor of XenoTx if the results were similar to those obtained with humans, 15% against, and 49% undecided. If the results were worse than with human organs, 11% would be in favor, 26% against, and 63% undecided. The variables associated with this attitude are age (P = .018), marital status (P = .026), studies (P < .001), comment with family (P = .001), couple attitude (P = .039), attitude toward cadaveric donation (P < .001), previous experience with donation (P = .001), consider the possibility of needing a transplant in the future (P < .001), and attitude toward related living donation (P < .001). In the multivariate analysis, these data persist: university studies (odds ratio [OR] = 3.875; P = .007); in favor of cadaveric organ donation (OR = 2.840; P < .001); previous relationship with donation and organ transplantation (OR = 1.901; P = .026); and consider the possibility of needing a transplant in the future (OR = 4.329; P = .002). CONCLUSIONS: The attitude toward XenoTx among Ecuadorian residents in Spain is unfavorable and is conditioned by different psychosocial variables.

Knowledge of the Brain Death Concept Among the Puerto Rican Population Residing in Florida.

INTRODUCTION: Puerto Rican and Cuban populations constitute the largest immigrant groups in Florida. This leads to an increase in their involvement in the organ donation and transplantation process (ODT); however, there is very little understanding about their attitude toward and knowledge of related key aspects such as brain death (BD). OBJECTIVE: Analyze knowledge of the BD concept among the Puerto Rican population residing in Florida. MATERIAL AND METHODS: The population under study is born in Puerto Rico and residing in Florida. Inclusion criteria was the population over 15 years stratified by age and sex. The assessment instrument was a validated questionnaire of attitude toward donation and organ transplantation "PCID-DTO-Ríos." A random selection of people was surveyed according to stratification. Support from immigration assistance associations in Florida was needed to locate potential respondents. Survey completion was anonymous and self-administered. RESULTS: Of the 259 respondents, 35% (n = 90) know the BD concept and consider it the death of an individual, 44% (n = 113) do not know it, and 21% (n = 56) do not consider them death. Variables significantly related to the correct knowledge of BD are as follows: sex (P = .012); marital status (P = .043); and couple's opinion (P = .001) and religion (P < .001). In the multivariate analysis, the variables that persist as significant are being married (odds ratio [OR] = 5.231; P = .002); to know the organ donation and transplantation couple attitude as favorable (OR = 4.819; P = .001) and not being Catholic (OR = 4.090; P < .001). CONCLUSIONS: Only one third of the Puerto Rican population residing in Florida knows the concept of BD and accepts it as the death of a person.

Renal transplantation recipient patients survival.

INTRODUCTION: The Bajío High Specialty Regional Hospital started operating in 2007 to tackle the health demands of 5.8 million inhabitants. It has 184 beds and a transplant unit with 26 beds. In 2008, the renal transplant program launched activities. OBJECTIVE: To describe the survival of kidney transplant receptor patients and of the grafted kidney at the Bajío High Specialty Regional Hospital. METHODS: Retrospective cohort study, where consecutive transplants carried out between 2008 and 2016 were included. Statistical analysis was performed using the Kaplan-Meier method. RESULTS: A total of 837 transplants were analyzed. Graft survival censored for death, with a functional graft at 1 and 5 years, was 94.6% and 78.9%. Patient survival at 1 and 5 years was 95.4% and 88.1%. CONCLUSIONS: The renal transplant program is one of the the best programs established in Mexico, both for the number of deceased-donor kidney transplants performed and for the patient and graft survival achieved. These data indicate that the renal transplant program has had a sustained development.

INTRODUCCIÓN: El Hospital Regional de Alta Especialidad del Bajío inició sus funciones en 2007 para atender la demanda de salud de 5.8 millones de habitantes, cuenta con 184 camas y una unidad de trasplantes con 26 camas. En 2008 inició actividades el programa de trasplante renal. OBJETIVO: Presentar la supervivencia de los pacientes receptores de trasplante renal y del riñón injertado en el Hospital Regional de Alta Especialidad del Bajío, Guanajuato, México. MÉTODO: Estudio de cohorte retrospectivo en el que se incluyeron los trasplantes consecutivos realizados entre 2008 y 2016. El análisis estadístico se efectuó con el método de Kaplan-Meier. RESULTADOS: Se analizaron 837 trasplantes. La supervivencia del injerto censurada para muerte con injerto funcional a uno y cinco años fue de 94.6 y 78.9 %. La supervivencia del paciente a uno y cinco años fue de 95.4 y 88.1 %. CONCLUSIONES: El programa de trasplante renal constituye uno de los mejor establecidos en México, tanto por el número de trasplantes renales de donante fallecido realizados como por la supervivencia obtenida de paciente e injerto. Los datos indican que el programa de trasplante renal ha tenido un desarrollo sostenido.

Ecuadorian Population Residing in Spain and Their Knowledge of Brain Death Concept.

BACKGROUND: The Ecuadorian population forms the largest Latin American immigrant group in Spain. However, their knowledge about the brain death (BD) concept and the relationship with the attitude toward organ donation has been little analyzed. The objective of the study is to analyze the knowledge of the BD concept among the Ecuadorian population resident in Spain. METHODS: The population under study was the population born in Ecuador and resident in Spain. Inclusion criterion was age older than 15 years stratified by age and sex. The assessment instrument was PCID-DTO-Ríos, a validated questionnaire of attitude toward donation and organ transplantation. Field work involved random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered. RESULTS: Of the 461 respondents, 22% (n =102) know the BD concept and accept it as the death of the person; 61% (n = 283) do not know it; and for 17% (n = 76) it does not mean the death of the person. The variables related to the correct knowledge of BD are age (P = .007) and marital status (P = .028), with age persisting in the multivariate study (odds ratio, 1.036; P = .008). There is no objective relationship with the attitude toward organ donation. Thus, 60% of those who know the concept are in favor of donating (n = 61), and 59% of those who do not know it are in favor (n = 210; P = .813). CONCLUSIONS: The BD concept is little known among Ecuadorians residing in Spain, and it is not associated with the attitude toward donation.

Supervivencia de los pacientes receptores de trasplante renal / Renal transplantation recipient patients survival

Resumen Introducción: El Hospital Regional de Alta Especialidad del Bajío inició sus funciones en 2007 para atender la demanda de salud de 5.8 millones de habitantes, cuenta con 184 camas y una unidad de trasplantes con 26 camas. En 2008 inició actividades el programa de trasplante renal. Objetivo: Presentar la supervivencia de los pacientes receptores de trasplante renal y del riñón injertado en el Hospital Regional de Alta Especialidad del Bajío, Guanajuato, México. Método: Estudio de cohorte retrospectivo en el que se incluyeron los trasplantes consecutivos realizados entre 2008 y 2016. El análisis estadístico se efectuó con el método de Kaplan-Meier. Resultados: Se analizaron 837 trasplantes. La supervivencia del injerto censurada para muerte con injerto funcional a uno y cinco años fue de 94.6 y 78.9 %. La supervivencia del paciente a uno y cinco años fue de 95.4 y 88.1 %. Conclusiones: El programa de trasplante renal constituye uno de los mejor establecidos en México, tanto por el número de trasplantes renales de donante fallecido realizados como por la supervivencia obtenida de paciente e injerto. Los datos indican que el programa de trasplante renal ha tenido un desarrollo sostenido.

Abstract Introduction: The Bajío High Specialty Regional Hospital started operating in 2007 to tackle the health demands of 5.8 million inhabitants. It has 184 beds and a transplant unit with 26 beds. In 2008, the renal transplant program launched activities. Objective: To describe the survival of kidney transplant receptor patients and of the grafted kidney at the Bajío High Specialty Regional Hospital. Methods: Retrospective cohort study, where consecutive transplants carried out between 2008 and 2016 were included. Statistical analysis was performed using the Kaplan-Meier method. Results: A total of 837 transplants were analyzed. Graft survival censored for death, with a functional graft at 1 and 5 years, was 94.6% and 78.9%. Patient survival at 1 and 5 years was 95.4% and 88.1%. Conclusions: The renal transplant program is one of the the best programs established in Mexico, both for the number of deceased-donor kidney transplants performed and for the patient and graft survival achieved. These data indicate that the renal transplant program has had a sustained development.

Flow mediated vasodilation compared with carotid intima media thickness in the evaluation of early cardiovascular damage in menopausal women and the influence of biological and psychosocial factors.

BACKGROUND: Women after menopause increase risk for cardiovascular disease and several factors may be related. The purpose was to study biological and psychosocial factors associated with early cardiovascular damage in pre- and postmenopausal women, assessed with carotid intima-media thickness vs flow-mediated dilatation. METHODS: Women 45 to 57 years old were grouped in the pre- (n = 60), early (n = 58) and late post-menopause (n = 59). Anthropometric, metabolic and hormonal data were registered, as well as measures of depression, anxiety, submission, perceived stress, and sleep alterations. Heart Rate Variability was recorded to obtain the information regarding sympathovagal balance. Carotid intima-media thickness and flow-mediated dilatation were assessed by ultrasound. Two-way ANOVA and multiple regression model were used. RESULTS: At late postmenopause, the carotid intima-media was thicker (p < 0.001) and flow-mediated dilatation decreased (p < 0.001). Carotid intima-media thickness was associated positively with age (p < 0.001), submission score (p = 0.029), follicle stimulating hormone levels (p < 0.001), and body mass index (p = 0.009). Flow-mediated dilatation was associated only with age (p < 0.001). Regarding heart rate variability, the time domain pNN50 measurement was higher in premenopausal women (p = 0.001), Low Frequency (LF) was higher in the two groups of postmenopausal (p = 0.001) and High Frequency (HF) higher in the early postmenopausal women (p = 0.042). CONCLUSIONS: Under our conditions carotid intima-media thickness had higher predictive value for early cardiovascular damage at menopause. The finding of the association of the submission score, indicates de influence of stress on vascular damage.

[Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]. / Estudio multicéntrico hospitalario en España, México y Cuba de actitud hacia la donación de vivo hepática.

INTRODUCTION: Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion. OBJECTIVE: To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America. MATERIAL AND METHOD: Ten hospitals were selected from the «International Donor Collaborative Project¼: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis. RESULTS: Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001). CONCLUSIONS: Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.