Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC Epidemiologic Study.

OBJECTIVES: To evaluate the rate of hospitalization for acute respiratory tract infection in children less than 24 months with haemodynamically significant congenital cardiac disease, and to describe associated risk factors, preventive measures, aetiology, and clinical course. MATERIALS AND METHODS: We followed 760 subjects from October 2004 through April 2005 in an epidemiological, multicentric, observational, follow-up, prospective study involving 53 Spanish hospitals. RESULTS: Of our cohort, 79 patients (10.4%, 95% CI: 8.2%-12.6%) required a total of 105 admissions to hospital related to respiratory infections. The incidence rate was 21.4 new admissions per 1000 patients-months. Significant associated risk factors for hospitalization included, with odds ratios and 95% confidence intervals shown in parentheses: 22q11 deletion (8.2, 2.5-26.3), weight below the 10th centile (5.2, 1.6-17.4), previous respiratory disease (4.5, 2.3-8.6), incomplete immunoprophylaxis against respiratory syncytial virus (2.2, 1.2-3.9), trisomy 21 (2.1, 1.1-4.2), cardiopulmonary bypass (2.0, 1.1-3.4), and siblings aged less than 11 years old (1.7, 1.1-2.9). Bronchiolitis (51.4%), upper respiratory tract infections (25.7%), and pneumonia (20%) were the main diagnoses. An infectious agent was found in 37 cases (35.2%): respiratory syncytial virus in 25, Streptococcus pneumoniae in 5, and Haemophilus influenzae in 4. The odds ratio for hospitalization due to infection by the respiratory syncytial virus increases by 3.05 (95% CI: 2.14 to 4.35) in patients with incomplete prophylaxis. The median length of hospitalization was 7 days. In 18 patients (17.1%), the clinical course of respiratory infection was complicated and 2 died. CONCLUSIONS: Hospital admissions for respiratory infection in young children with haemodynamically significant congenital cardiac disease are mainly associated with non-cardiac conditions, which may be genetic, malnutrition, or respiratory, and to cardiopulmonary bypass. Respiratory syncytial virus was the most commonly identified infectious agent. Incomplete immunoprophylaxis against the virus increased the risk of hospitalization.

Attitude of ancillary personnel faced with living kidney donation in a hospital with a living donor kidney transplant program.

Hospital ancillary workers' opinion has credibility among the general public because they work on behalf of a hospital. The objective of this study is to analyze the attitude of ancillary employees toward living kidney donation and the variables that influence such attitude. A random sample of ancillary personnel (n=401) was taken and stratified according to type of service in a transplant hospital. Attitude was evaluated using a survey, which was completed anonymously and self-administered. The completion rate was 94% (n=377). Most (85%) are in favor of related living kidney donation, 7% against, and the 8% undecided. The multivariate analysis found that the variables with more weight affecting attitude are: 1) female sex (odds ratio [OR]=3.75); 2) a respondent's lack of concern about the possible "mutilation" of the body after donation (OR=3.65); 3) a respondent's belief in the possibility of needing a future transplant (OR=2.66); and 4) a respondent's willingness to receive a donated living kidney (OR=10.51).

HIV-hepatitis C virus co-infection is associated with decreased plasmatic IL-7 levels.

We analysed the potential influence of hepatitis C virus (HCV) co-infection over IL-7 levels and thymic function in naive HIV-infected patients and after effective HAART. HIV-HCV-co-infected patients had lower plasmatic IL-7 levels compared with HIV-monoinfected patients. This effect may not be associated either with HCV monoinfection or with the rate of liver injury. These lower levels may explain, at least partly, the lower CD4 cell repopulation of HIV-HCV-co-infected patients after HAART.

Socio-personal factors influencing public attitude towards living donation in south-eastern Spain.

OBJECTIVES: Our aim was to determine public attitudes towards living donation compared with cadaveric donation, and to analyse psycho-social factors that may influence this attitude. MATERIALS AND METHODS: An opinion poll was used to study a random sample in two geographical areas (urban and rural). Assessment was made of attitudes towards donation of one's own organs as a living donor to an unknown person, as a living donor to a relative and/or close acquaintance and, as a cadaveric donor, and of the different psycho-social variables that may influence this attitude. RESULTS: In the urban setting, 60% had a favourable response towards cadaveric donation; 29% were in favour of living kidney donation to an unknown person, a percentage which increased to 89% for donation to a relative or a friend. These rates were lower for liver (21 and 74%, respectively). When asked if they would accept an organ donated by a relative or a friend, 67% would accept a kidney and 60% a liver. Attitude towards living donation to an unknown person is more positive among those in favour of cadaveric donation and those who have had previous experience of donation. With respect to level of education, university students are more undecided about living donation to an unknown person than the other groups. In terms of attitude towards donation to relatives and/or friends, there is also the influence of social factors (sex, marital status). However, if the living donation is intended for oneself, there is no variable with which to associate this attitude. In the rural setting, 56% of the respondents refused to complete the survey due to fear of living donation. No statistical study was conducted due to the bias of the rural sample. CONCLUSIONS: There is great fear and ignorance of living donation among the rural population, and uncertainties in the urban population, although attitudes are more positive towards living donation to relatives and/or friends than towards cadaveric donation. These positive attitudes towards living donation are very strongly related to attitudes towards cadaveric donation, previous experience of donation and level of education.

Socio-personal profile of teenagers opposed to organ donation.

BACKGROUND: The teenage population has a more favourable attitude towards organ donation than other population groups. Teenagers represent the future of the community and their opinion directly affects other family members and friends. Therefore, teenagers who are in favour of donation become promoters of organ donation in their area of influence. Our aim was to determine the opinion and fears of the teenage population regarding organ donation in order to define the profile of the subgroup, which is opposed to donation. METHODS: We used a random stratified sample according to gender and geographical location of 15-19-year-old adolescents. The attitude towards organ donation was assessed using the questionnaire on psychosocial aspects of donation. The variables were grouped into socio-personal, donation awareness, social interaction, pro-social activities and attitude towards the body. Data were analysed by descriptive statistics, the chi(2) test, Student's t-test and a logistic regression analysis. RESULTS: Seventy-three per cent of teenagers have a favourable attitude towards organ donation. Twenty-seven per cent are undecided or have negative attitudes; the main reason given is fear of apparent death (48%). Variables with statistical significance, which are against donation, are a low level of education (P = 0.0456), no previous experience with organ donation (P = 0.0254), no knowledge of the brain death concept (P = 0.0054) and refusal to accept cadaver manipulation (P = 0.0037). CONCLUSION: The profile of the teenager who is opposed to organ donation is one who has only primary schooling or who left school early, is not engaged in pro-social activities, rejects cadaver manipulation and has no knowledge of the brain death concept.