Extreme attitudes toward organ transplantation: how do supporters and opponents of this method of treatment differ in Poland?

BACKGROUND: Many medical professionals share the opinion that the negative social attitudes toward transplantation are the basic cause of the deficit of organ from deceased donors. Although public opinion polls in Poland invariably reveal overall acceptance of transplantation, it is extremely difficult to procure organs. The purpose of this study was to compare the attitudes of supporters and opponents of organ transplantation. MATERIALS AND METHODS: In social psychology, attitude is defined as a relatively stable inclination toward a positive or negative relation to a person or an object. It was assumed that positive attitudes are favorable as regards transplantation, whereas negative attitudes constitute a social obstacle to this method of treatment. The survey conducted between May and August 2002 included a representative sample of 1000 Poles over 15 years of age. The first part of the survey measured the general attitude toward transplantation on a rating scale ranging from "definitely agree" to "definitely disagree." RESULTS: We distinguished two extreme attitudes, ie, supporters and opponents. CONCLUSIONS: The attitudes of supporters were mainly cognitive, whereas the attitudes of opponents were dominated by negative emotions associated with fear of death, psychological trauma, and physical injury which led to avoidance behavior, passive resistance, and selective and biased information processing. Opponents often concealed or belittled their standpoints and were reluctant to discuss transplantation issues. Their behavior was more passive, and their familiarity with the medical and legal aspects of transplantation was relatively poor compared with supporters.

Patients' understanding of disease status and treatment plan at initial hematopoietic stem cell transplantation consultation.

Patients referred for hematopoietic stem cell transplantation (HSCT) often have knowledge deficits about their disease and overestimate their prognosis making it difficult initially to discuss potentially life-threatening transplant options. To determine patients' understanding of their disease and the adequacy of a 3-h consultation at our center, we developed a survey that measured perceived knowledge deficits of disease, prognosis, and emotional status before and after their initial consultation. Ninety nine consecutive eligible patients completed the survey. Although 76.7% claimed adequate information about their disease pre-HCST visit, 51.5 and 41.4% respectively lacked knowledge about their 1-year prognosis with and without any therapy. After the visit, 66.7% of the patients had obtained enough information to make an informed decision regarding HSCT versus 23.2% pre-visit, and a significant reduction in the need for further information was reported by 53.5% of patients (P<0.001). Patients were not overwhelmed or confused by the visit and there was a small but significant decrease in negative affect. Measures to increase patients understanding of their disease and its prognosis pre-HSCT consultation visit are warranted; however, a 3-h consultation visit provides the majority of patients with sufficient information to make an informed decision about the risk/benefit ratio of HSCT.

[A sense of coherence and mental disorders]. / Poczucie koherencji a zaburzenia psychiczne.

Sense of coherence, a health-promoting life orientation, i.e. perceiving the world as comprehensible, manageable and meaningful, was compared in three groups: of healthy controls (37 males and 45 females), neurotic patients (31 males and 54 females), and hospitalized patients with depressive syndrome defined according to DSM-IV criteria (13 females). Two self-report questionnaires were used in the study: Antonovsky's SOC-29 scale measuring the sense of coherence, and SCL-90-R by Derogatis, measuring psychopathological symptoms intensity. As hypothesized, psychopathology level in the groups under study was significantly differentiated, being most marked in patients with depression. Sense of coherence and all its constituents turned out to be significantly lower in both clinical groups as compared to controls; the lowest SOC level was noted in depressive patients. Moreover, in the latter group, in contradistinction to the other two, significant correlations between sense of coherence (SOC) and general self-rated health (positive correlations), and between SOC and symptoms intensity (negative correlations) have disappeared. Due to the small size of the depressive group it was possible only to suggest a hypothesis explaining the findings, namely, that the SOC protective function disappears in persons situated far away from the "health" pole of the health-disease continuum.

Multiple sclerosis and prions.

The etiology of Multiple Sclerosis (MS) is unknown. Existing epidemiologic data suggests that MS can be an infectious disease. MS used to be classified as one of the 'slow infections'--many of these are caused by prions. Prions are small, proteinaceous, infectious particles--distinguished from viruses by the absence of intrinsic nucleic acids. In a contrast to the 'classic' prional diseases (Kuru, Scrapie or Creutzfeldt-Jacob Disease) that in CNS affect primarily neurons, the 'target' cell in MS is an oligodendrocyte. This may explain differences in disease presentation. This paper presents a pathophysiological model of MS based on the assumption that MS is a prional disease. Processes leading to the demyelination in Multiple Sclerosis seem also to involve lymphocytes, astrocytes and macrophages as well as the interferon system.

Reoperation for coronary artery bypass grafting: anesthetic challenge.

The problem of caring for patients undergoing reoperative coronary revascularization is one that cardiac anesthesiologists will face with increasing frequency. Many thousands of CABG procedures continue to be performed annually with ever-increasing survival rates. Consequently, the population at risk for reoperative CABG is growing, while surgical intervention necessarily follows apace. As one recent long-term, retrospective study showed, patients surviving 12 years after CABG have a reoperative rate of 17.3%. Physicians caring for these patients must recognize that they are not seeing patients with routine CAD, but with a different entity: coronary graft disease (CGD). These patients with CGD are different in many ways from those with native CAD, and these differences must be taken into account when planning for their perioperative care. Cardiologists have strived to check the growth of CGD by aggressive emphasis on modification of coronary risk factors such as tobacco use, hypertension, and hyperlipidemia. In addition, recent interest has been focused on a pharmacologic approach via the platelet-prostaglandin system. Surgeons have also attempted to reduce the incidence of CGD by recognition that significantly improved long-term patency rates can be achieved by the use of the internal thoracic artery as a bypass conduit. Consequently, an expanded role for this vessel in the form of free, sequential, and bilateral ITA grafting is currently being advocated as a surgical solution to the problem of CGD. In contrast, the anesthesiologist probably has little to add to the prevention of CGD, but may be able to contribute to a favorable outcome at reoperation. The medical variables and preoperative characteristics that make reoperative CABG patients different from those presenting for primary CABG should be recognized. A firm appreciation of the nature of graft disease, as well as the surgical intricacies required for correction, can only serve to improve the care offered during these often complex operations. Aggressive, invasive hemodynamic monitoring, constant vigilance for signs of early ischemia, and preparedness for prebypass hemorrhage and postbypass ventricular dysfunction should be made. Furthermore, if anesthesiologists are to contribute to an improved outcome in these patients, strategies must be developed to attenuate cerebral and myocardial damage resulting from hemorrhage and atheroembolic catastrophies that appear to be frequent complications in these challenging surgical patients.