Exploring Health Science Students' Notions on Organ Donation and Transplantation: A Multicenter Study.

The knowledge acquired during university education about organ donation and transplantation (ODT) decisively influences the information future health professionals transmit. This is important in ODT where the participation of the general public is essential to obtain organs. OBJECTIVE: To determine notions of Spanish medicine and nursing students on ODT and its relationship with attitude toward ODT. METHODS AND DESIGN: and design. We conducted a sociologic, multicenter, and observational study. The population for our study consisted of medical and nursing students in Spanish universities. Our database was the Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. Our sample consisted of 9598 medical and 10,566 nursing students (99% confidence interval; precision of ±1%), stratified by geographic area and year of study. RESULTS: The completion rate for our study was 90%. Only 20% (n=3640) of students thought their notions on ODT were good; 41% (n=7531) thought their notions were normal; 36% (n=6550) thought their notions were scarce. Comparing groups, there were differences between those who believed that their notions on ODT were good (44% nursing vs 56% medical students; P < .000), and those who believed it scarce (54% nursing vs 46% medical students; P < .000). Notions on ODT were related with attitude toward the donation of one's own organs: those who considered their notions were good were more in favor then those who considered it scarce (88% vs 72%; P < .000). CONCLUSION: Only 20% of Spanish medical and nursing students thought their notions on ODT were good. Having good knowledge is related to a favorable attitude towards ODT. Receiving specific information on the subject could improve their knowledge about ODT during their training.

Organ Donation Related With Attitude Toward the Law of Presumed Consent: Spanish University Medical and Nursing Students Study.

INTRODUCTION: Information provided by health care professionals is crucial to create a climate of social opinion. This is important in organ donation and transplantation (ODT), where the participation of the general public is essential to obtain organs. OBJECTIVE: To determine the attitude toward the Law of Presumed Consent (LPC) among Spanish university students and to analyze their relation with attitude toward ODT. METHODS: and design. The type of study was a sociologic, multicenter, observational study. The population included medical and nursing students in Spanish universities. Database of Collaborative International Donor Project was used stratified by geographic area and academic course. A validated questionnaire (Collaborative International Donor Project, organ donation and transplantation questionnaire in Spanish [PCID-DTO-RIOS]) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students was analyzed (99% confidence and precision of ±1%) and stratified by geographic area and year of study. RESULTS: Completion rate was 90%. Regarding attitude toward LPC, 66% of the students were against the law, whereas 34% accepted it. Of the students surveyed, 9% considered the law as a gesture of solidarity, 25% as an effective way of not wasting organs, 48% as an abuse of power, and 18% as offenses against the family. Those students who were in favor of LPC also had a more favorable attitude toward ODT (86% vs 76%; P < .001). Comparing groups, nursing students were less in favor of LPC than medical students (32% vs 36%; P < .000). CONCLUSION: Sixty-six percent of Spanish university medical and nursing students were against the LPC. The favorable attitude toward ODT is associated with considering the law as a gesture of solidarity or as an effective way of not wasting organs.

Acceptance of living liver donation among medical students: A multicenter stratified study from Spain.

AIM: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude. STUDY TYPE: A sociological, interdisciplinary, multicenter and observational study. STUDY POPULATION: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011. SAMPLE SIZE: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. STATISTICAL ANALYSIS: Student´s t test, χ(2) test and logistic regression analysis. RESULTS: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001). CONCLUSION: Spanish medical students have a favorable attitude toward LLD.

Perinatal and childhood factors and risk of breast cancer subtypes in adulthood.

BACKGROUND: Accumulated exposure to hormones and growth factors during early life may influence the future risk of breast cancer (BC). This study examines the influence of childhood-related, socio-demographic and anthropometric variables on BC risk, overall and by specific pathologic subtypes. METHODS: This is a case-control study where 1539 histologically-confirmed BC cases (23-85 years) and 1621 population controls, frequency matched by age, were recruited in 10 Spanish provinces. Perinatal and childhood-related characteristics were directly surveyed by trained staff. The association with BC risk, globally and according to menopausal status and pathologic subtypes, was evaluated using logistic and multinomial regression models, adjusting for tumor specific risk factors. RESULTS: Birth characteristics were not related with BC risk. However, women with high socioeconomic level at birth presented a decreased BC risk (OR=0.45; 95% CI=0.29-0.70), while those whose mothers were aged over 39 years at their birth showed an almost significant excess risk of hormone receptor positive tumors (HR+) (OR=1.35; 95% CI=0.99-1.84). Women who were taller than their girl mates before puberty showed increased postmenopausal BC risk (OR=1.26; 95% CI=1.03-1.54) and increased HR+ BC risk (OR=1.26; 95% CI=1.04-1.52). Regarding prepubertal weight, while those women who were thinner than average showed higher postmenopausal BC risk (OR=1.46; 95% CI=1.20-1.78), associated with HR+ tumors (OR=1.34; 95% CI=1.12-1.61) and with triple negative tumors (OR=1.56; 95% CI=1.03-2.35), those who were heavier than average presented lower premenopausal BC risk (OR=0.64; 95% CI=0.46-0.90) and lower risk of epidermal growth factor receptor positive tumors (OR=0.61; 95% CI=0.40-0.93). CONCLUSION: These data reflect the importance of hormones and growth factors in the early stages of life, when the mammary gland is in development and therefore more vulnerable to proliferative stimuli.

The level of acceptance of spanish medical students of the transplantation of solid organs from animals: a stratified and multicentre study.

INTRODUCTION: Research into the transplantation of solid organs from animals (xenotransplantation) is generating interest and curiosity given that this could be a way of resolving the shortage in transplant organs. However, the fact is that currently xenotransplantation is far from becoming a clinical practice. OBJECTIVE: To analyse the attitude of medical students from Spanish universities towards the donation of organs from animals and to determine the factors affecting their attitudes. TYPE OF STUDY: A sociological, interdisciplinary, observational and multicentre study in Spain. STUDY POPULATION: Students enrolled on the medical degree in Spain (n = 34 000). SAMPLE SIZE: A sample of 9598 students (a confidence level of 99% and precision of ± 1%) stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ xenotransplantation (PCID-XenoTx RIOS) which was self-administered and completed anonymously. RESULTS: A completion rate of 95.7% (n = 9275) was obtained. If the results of xenotransplantation were as good as in human donation, 81% (n = 7491) would be in favour, 3% (n = 308) against and 16% (n = 1476) undecided. The following variables affected this attitude: sex (P < 0.001); academic year (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); the opinion of one's partner (P < 0.001); the respondent's attitude towards organ donation (P < 0.001); religion (P < 0.001); and participation in altruistic activities (P < 0.001). The following variables persisted in the multivariate analysis: (1) being a female (OR = 1.794; P < 0.001); (2) academic year (OR = 2.487; P < 0.001); (3) having spoken about the issue with one's family (OR = 1.200; P = 0.019); (4) the favourable opinion of one's partner (OR = 1.526; P = 0.028); (5) an attitude in favour of donation (OR = 2.087; P < 0.001); (6) being an atheist/agnostic, (OR = 2.5; P < 0.001); and (7) a belief that one's religion is in favour of transplantation (OR = 1.317; P = 0.005). CONCLUSIONS: Spanish medical students have a favourable attitude towards xenotransplantation. This willingness and interest could be a decisive platform for the development and strengthening of research, both for centres with a pre-clinical xenotransplantation programme and new healthcare centres.

Adherence to highly active antiretroviral therapy in Spain. A meta-analysis

Objectives: To estimate the percentage of adherence to highly-active antiretroviral therapy (HAART) inSpanish observational studies and to identify the variables associated with adherence.Methods: Seven electronic databases were used to locate the studies. Six inclusion criteria were established.Two coders codified the variables independently. Intercoder reliability was calculated. Publicationbias was analyzed through the Begg, Egger and Trim and Fill tests. Homogeneity was evaluated using theQ test and the l2 index. A random effects model was assumed to estimate both the overall percentage ofadherence and to explain heterogeneity.Results: This meta-analysis included 23 observational studies, yielding a total of 34 adherence estimates.The sample was composed of 9,931 HIV-positive individuals (72% men) older than 18 years under treatmentwithHAART. The percentage of patients adhering to an intake of>90%of the prescribed antiretroviraldrugs was 55%. Wide heterogeneity was detected (I2 = 91.20; 95%CI: 88.75-93.13). Adherence was mainlymeasured using a single strategy (47.8%), the most widely used being self-report (48.7%). In the univariateanalysis, the following factors were significant: infection stages A (= 0.68, p <0.001) and B (= –0.56,p <0.01), viral loads >200 copies/ml (= –0.41, p <0.05) and <200 (= 0.39, p <0.05), and universityeducation (= –0.66, p<0.05).Conclusions: The overall percentage of adherence was 55%, although this value may be an overestimate.Adherence was associated with infection stage A and with a viral load of <200 copies/ml (AU)

Objetivo: Calcular el porcentaje de adherencia al TARGA en estudios observacionales espa˜ noles, así comoidentificar las variables asociadas a ella.Métodos: Para localizar los estudios se emplearon siete bases bibliográficas. Se establecieron seis criteriosde inclusión. Dos codificadores realizaron la codificación de forma independiente. Se calculó la fiabilidadintercodificadores. El sesgo de publicación se evaluó mediante los tests de Begg y de Egger, y Trim & Fill.La homogeneidad se estimó mediante la pruebaQy el índice I2. Se asumió un modelo de efectos aleatoriostanto para la estimación del porcentaje global de adherencia como para explicar la heterogeneidad.Resultados: El metaanálisis incluyó 23 estudios observacionales que proporcionaron 34 estimaciones dela adherencia. La muestra está constituida por 9931 individuos VIH+ (72,2% hombres), mayores de 18 a˜nosy en tratamiento con TARGA. El porcentaje de pacientes con una adherencia al tratamiento de >90% deingestión de los antirretrovirales prescritos fue del 55%. Se detectó una gran heterogeneidad (I2 = 91.20;IC95%: 88.75-93.13). La adherencia fue evaluada principalmente con una única estrategia (47,8%); elautoinforme fue la más empleada (48,7%). En el análisis univariado resultaron significativo los estadiosA (= 0,68, p <0,001) y B (= -0,56, p <0,01), la carga viral >200 copias/ml (= -0,41, p <0,05) y <200copias/ml (= 0,39, p <0,05), y el nivel de educación de estudios superiores (= -0,66, p <0,05).Conclusiones: El porcentaje global de adherencia fue del 55%, pero este valor puede estar sobrestimado.La adherencia se asoció al estadio A de la infección y a una carga viral <200 copias/ml (AU)

Adherence to highly active antiretroviral therapy in Spain. A meta-analysis.

OBJECTIVES: To estimate the percentage of adherence to highly-active antiretroviral therapy (HAART) in Spanish observational studies and to identify the variables associated with adherence. METHODS: Seven electronic databases were used to locate the studies. Six inclusion criteria were established. Two coders codified the variables independently. Intercoder reliability was calculated. Publication bias was analyzed through the Begg, Egger and Trim and Fill tests. Homogeneity was evaluated using the Q test and the l² index. A random effects model was assumed to estimate both the overall percentage of adherence and to explain heterogeneity. RESULTS: This meta-analysis included 23 observational studies, yielding a total of 34 adherence estimates. The sample was composed of 9,931 HIV-positive individuals (72% men) older than 18 years under treatment with HAART. The percentage of patients adhering to an intake of >90% of the prescribed antiretroviral drugs was 55%. Wide heterogeneity was detected (I² =91.20; 95%CI: 88.75-93.13). Adherence was mainly measured using a single strategy (47.8%), the most widely used being self-report (48.7%). In the univariate analysis, the following factors were significant: infection stages A (ß=0.68, p <0.001) and B (ß=-0.56, p <0.01), viral loads >200 copies/ml (ß=-0.41, p <0.05) and <200 (ß=0.39, p <0.05), and university education (ß=-0.66, p<0.05). CONCLUSIONS: The overall percentage of adherence was 55%, although this value may be an overestimate. Adherence was associated with infection stage A and with a viral load of <200 copies/ml.

Complete reversal of coenzyme specificity of isocitrate dehydrogenase from Haloferax volcanii.

Haloferax volcanii Ds-threo-isocitrate dehydrogenase (ICDH) was highly expressed in bacteria as inclusion bodies. The recombinant enzyme was refolded, purified and characterized, and was found to be NADP-dependent like the wild-type protein. Sequence alignment of several isocitrate dehydrogenases from evolutionarily divergent organisms including H. volcanii revealed that the amino acid residues involved in coenzyme specificity are highly conserved. Our objective was to switch the coenzyme specificity of halophilic ICDH by altering these conserved amino acids. We were able to switch coenzyme specificity from NADP+ to NAD+ by changing five amino acids by site-directed mutagenesis (Arg291, Lys343, Tyr344, Val350 and Tyr390). The five mutants of ICDH were overexpressed in Escherichia coli as inclusion bodies and each recombinant ICDH protein was refolded and purified, and its kinetic parameters were determined. Coenzyme specificity did not switch until all five amino acids were substituted.

Prótesis oculo-palpebral. A propósito de un caso clínico / Orbital prosthesis. A clinical case report

La prótesis maxilofacial comprende aquellos dispositivos artificiales que restauran una parte ausente de la cara, debido a tumores, traumatismos, o como resultado de una anomalía congénita. El objetivo de este artículo es la exposición de un caso clínico que precisaba la confección de una prótesis óculo-palpebral tras sufrir una pérdida de sustancia por causa oncológica. Este tipo de prótesis son de las más difíciles de elaborar con buenos resultados pues intentan reconstruir un órgano móvil con una prótesis estática. La prótesis maxilofacial tiene la finalidad de aumentar la calidad de vida del paciente y ayudar a la seguridad emocional de los mismos, quedando así rehabilitados para poder integrarse nuevamente en la sociedad (AU)

Denaturation studies by fluorescence and quenching of thermophilic protein NAD+-glutamate dehydrogenase from Thermus thermophilus HB8.

Fluorescence techniques have been used to study the structural characteristics of many proteins. The thermophilic enzyme NAD-glutamate dehydrogenase from Thermus thermophilus HB8 is found to be a hexameric enzyme. Fluorescence spectra of native and denatured protein and effect of denaturants as urea and guanidine hydrochloride on enzyme activity of thermophilic glutamate dehydrogenase (t-GDH) have been analyzed. Native t-GDH presents the maximum emission at 338 nm. The denaturation process is accompanied by an exposure to the solvent of the tryptophan residues, as manifested by the red shift of the emission maximum. Fluorescence quenching by external quenchers, KI and acrylamide, has also been carried out.

A radioautographic analysis of the prospective cardiac area in the chick blastoderm by means of labeled grafts.

Grafting regions of the blastodisc of the chick, labeled with H3-thymidine at Stages 5 and 6 ofHAMILTON andHAMBURGER, is a very useful technique for following the morphogenetic movements of the grafted material. Areas (E-M) of the blastodisc of 2.75 by 0.55 mm, grafted in the homologous region of an embryo, participate in its morphogenetic movements. The labeled reversed cardiac area can sometimes be incorporated into the host, and a tubular heart can develop which includes some of the graft tissue, Figs. 3, 4, 5, and 6. The morphogenetic movements shaping the anterior intesinal portal and early foregut can occur despite the reversal of a large rectangle of the endomesoderm, Fig. 6. The coelomic epithelium lining the operated side, a part of the myoepicardium of this side, as well as the endoderm of the ventral portion of the foregut, and, more caudally, half of the anterior intestinal portal are derived from the graft as shown by strong radioactive labeling of the cells, Figs. 3, 4 and 6. The morphogenetic movements of the graft endoderm and mesoderm are independent, the pre-heart mesoderm moving in a cranial direction, while the endoderm extends caudally, Figs. 3 and 4.This study raises an interesting question: Can the original cephalic preconal cardiogenic mesoderm regulate to form sinoatrial tissue (and vice versa) ? The evidence obtained in the present investigation is not extensive enough to warrant conclusions as to the important question of "regulation"; for this a considerable number of operated embryos is required in which a recognizable normal heart has developed (up to Stage 12-13).