Knowledge and behavior among health professionals in relation to cadaveric organ donation and transplantation: a questionnaire-based analysis in Portuguese hospitals

Objective

To assess knowledge and behavior relative to cadaveric organ donation and transplantation among physicians and nurses working at nine Portuguese hospitals.

Methods

This prospective study between May and October 2009 included 495 questionnaires that were returned among 840 that were delivered, a 59% response rate. The transplant questionnaire comprised three main sections: section 1, sociodemographic-professional variables of the participants with nine questions; section 2, generic questions on organ donation and transplantation with 12 questions; and section 3 evaluated knowledge with 20 specific questions on organ donation and transplantation.

Results

Sixty-one percent of the participants were females, with 40% of the overall cohort between 31 and 40 years old; 62% married; 63% working in the emergency department; and 78% nurses. Although 78% of the participants stated that they had undergone specific training on organ donation and transplantation, 62% felt that they needed more training. The reasons evoked for the low rate of donation included difficulties in initiating the process of organ donation, in diagnosing cerebral death and in obtaining necessary human resources. There were no significant differences in knowledge between physicians and nurses concerning specific organ donation and transplantation issues. Having had specific training on organ donation and transplantation was significantly associated with correct answers to several questions, including those pertaining to knowledge of the national legislation on organ donation and transplantation.

Conclusions

The present study showed a lack of specific knowledge and training on organ donation and transplantation issue. It also suggested that for hospital staff to successfully act as initiators of the organ procurement process, more information and education are necessary. This effort could significantly increase the rate of organ donation and transplantation in Portugal.     

Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly

Summary

The prevalence and risk factors of radiographic vertebral fracture were determined among Brazilian community-dwelling elderly. Vertebral fractures were a common condition in this elderly population, and lower hip bone mineral density was a significant risk factor for vertebral fractures in both genders.

Introduction

The aim of the study was to estimate the prevalence of radiographic vertebral fracture and investigate factors associated with this condition in Brazilian community-dwelling elderly.

Methods

This cross-sectional study included 943 elderly subjects (561 women and 382 men) living in São Paulo, Brazil. Thoracic and lumbar spine radiographs were obtained, and vertebral fractures were evaluated using Genant's semiquantitative method. Bone mineral density (BMD) was measured by dual X-ray absorptiometry, and bone biochemical markers were also evaluated. Female and male subjects were analyzed independently, and each gender was divided into two groups based on whether vertebral fractures were present.

Results

The prevalence of vertebral fracture was 27.5% (95% CI 23.8–31.1) in women and 31.8% in men (95% CI 27.1–36.5) (P?=?0.116). Cox regression analyses using variables that were significant in the univariate analysis showed that age (prevalence ratio?=?1.03, 95% CI 1.01–1.06; p?=?0.019) and total femur BMD (PR?=?0.27, 95% CI 0.08–0.98; p?=?0.048) were independent factors in predicting vertebral fracture for the female group. In the male group, Cox regression analyses demonstrated that femoral neck BMD (PR?=?0.26, 95% CI 0.07–0.98; p?=?0.046) was an independent parameter in predicting vertebral fractures.

Conclusions

Our results suggest that radiographic vertebral fractures are common in Brazilian community-dwelling elderly and that a low hip BMD was an important risk factor for this condition in both genders. Age was also significantly correlated with the presence of vertebral fractures in women.     

Quality of life of pediatric patients with lower urinary tract dysfunction and their caregivers

The interest in quality of life (QoL) studies has increased as they are useful instruments to evaluate and compare medical care delivery and the impact of health interventions. The perception of QoL differs among individuals. Its characterization is especially difficult in the pediatric age group as each developmental stage presents specific demands. The prevalence of congenital lower urinary dysfunction is high and their management changes the daily routine of the patients and their families. In a cross-sectional study, we evaluated the QoL of 28 children and adolescents with urinary malformations and their caregivers using the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQUEI) and Short-Form 36 (SF-36), respectively, and compared the results with 38 healthy control age-paired children/caregivers. Four questions were added to patients' questionnaire to evaluate issues related to their urological management. Our results show lower AUQUEI total scoring in the patients’ group (p < 0.0213, Fisher’s exact test), who also present problems in dealing with social aspects, such as being at classroom, manifest negative feelings in relation to diurnal urinary losses but seem to be well adapted to intermittent urethral catheterization. A tendency for worse QoL scores in the patients’ group caregivers was detected in the SF-36 pain and physical limitation domains.     

Recovery of T cell subsets after autologous bone marrow transplantation is mainly due to proliferation of mature T cells in the graft

In 22 patients with malignancies, treated with high-dose chemoradiotherapy and autologous bone marrow transplantation (BMT), peripheral blood T cell subsets and functions were studied. In ten cytomegalovirus (CMV)-negative patients, CD4+ and CD8+ T cells (representing T cells of the helper/inducer phenotype and T cells of the suppressor/cytotoxic phenotype, respectively), recovered slowly and simultaneously. In 12 CMV-positive patients, however, CD8+ T cells recovered more rapidly than CD4+ T cells and rose to increased counts. No T cells with an immature phenotype (CD1+, OKT6+) were observed. Lymphocyte stimulation by herpes simplex virus infected fibroblasts (and by CMV-infected fibroblasts in CMV-positive patients) in contrast remained high and even increased after BMT in both groups. These data indicate that T cell recovery after autologous BMT is mainly due to proliferation of mature T cells present in the BM graft and not to generation of new T cells from T cell precursors.     

Bilateral Buccal Bifurcation Cyst: Case Report and Literature Review

Buccal bifurcation cyst (BBC) is a rare inflammatory odontogenic cyst that typically occurs at the buccal region of the first or second mandibular molars of children. In the current case, a 9-year-old boy complained of an extraoral soft tissue painful swelling. Intraoral examination revealed a partial eruption of the right permanent mandibular first molar with drainage of purulent material and clinical absence of the left mandibular first molar. Panoramic radiographic and computed tomography showed two well-defined areas surrounding the mandibular first molars consistent with cystic lesions. Surgical enucleations were performed and histopathologic analysis revealed inflammatory cysts. Based on the clinical, microscopic, radiographic, and CT images, the diagnosis of bilateral BBC was established. Patient has been under follow-up for about 1 year showing normal bone repair and eruption of the involved teeth. Although BBC is uncommon, it is important to recognize this entity.     

Prevention of hypertension attenuates albuminuria and renal expression of fibronectin in diabetic spontaneously hypertensive rats

BACKGROUND/AIM: The aim of this study was to evaluate the effect of preventing hypertension on renal disease in a model of genetic hypertension and diabetes. METHODS:Four-week-old spontaneously hypertensive rats (SHR) with streptozotocin-induced diabetes were randomized for no treatment, or for treatment with captopril, losartan or triple therapy (hydrochlorothiazide, reserpine and hydralazine) for 16 weeks. RESULTS: Increase in systolic blood pressure was equally prevented by captopril (128 +/- 3 mm Hg), losartan (128 +/- 2) and triple therapy (129 +/- 2, p < 0.0001). Albuminuria was similarly reduced by captopril (499 (404-659)), losartan (622 (470-976)) and triple therapy (479 (362-600) microg/24 h (p < 0.0001)). Renal fibronectin expression increased in diabetic SHR (125 +/- 13 densitometric unit) as compared to the controls (51 +/- 9, p < 0.0001), and decreased (p < 0.0001 vs. diabetic SHR) with captopril (32 +/- 8), losartan (27 +/- 4) and triple therapy (35 +/- 6). CONCLUSION: The prevention of hypertension in diabetic SHR by captopril, losartan or triple therapy was equally efficacious in impeding increase of albuminuria and the expression of renal fibronectin. Under these conditions, tight blood pressure control was the main determinant in attenuating nephropathy.     

Fatigue responses in exercise under control of VO2

To examine the fatigue response during an exhaustive heavy exercise performed under control of oxygen uptake (SS@V.O (2)Delta50) or power output (SS@pDelta50), eleven trained male subjects performed an incremental test to determine the peak of the oxygen uptake value (V.O (2peak)) and lactate threshold and two exhaustive steady-state cycling exercises at the intermediate value between the lactate threshold and V.O (2peak) (SS@V.O (2)Delta50 and SS@pDelta50). The control of V.O (2) induced an oscillation of the power output, which lowered the average power output (276 +/- 47 vs. 315 +/- 40 W, p = 0.004) and cancelled the slow component of oxygen kinetics. However, all subjects reached maximal cardiac output (CO) and heart rate (HR) values which were sustained almost two times longer in SS@V.O (2)Delta50 compared to SS@pDelta50 (979 +/- 854 vs. 475 +/- 236 s, p = 0.046 for CO and 1050 +/- 890 vs. 513 +/- 288 s, p = 0.037 for HR). Furthermore, SS@pDelta50 elicited V.O (2peak) but not SS@V.O (2)Delta50 (4963 +/- 434 vs. 4723 +/- 460 mL . min (-1), p = 0.026). Finally, the time spent at the maximal CO and HR values is correlated with time to exhaustion at V.O (2)Delta50. In conclusion, the cause of fatigue does not seem to have the same origin during exhaustive supra-lactate threshold exercise under control of V.O (2) (V.O (2)Delta50) compared to constant power output (pDelta50), while both elicit the maximal HR and CO values.     

Analysis of estrogen receptor polymorphism in codon 325 by PCR-SSCP in breast cancer: association with lymph node metastasis

Breast cancer is the most frequent neoplasm in women. Expression of the estrogen receptor (ER) has a key role in breast cancer; the ER gene is located at chromosome 6q24-q27 and is made up of 8 exons with a total of 140 kb. The polymorphism in codon 325 of exon 4 (ER325) is a transition CCC→CCG. The objective of this study is to analyze the frequency of this polymorphism in breast cancer using the polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) technology. DNA was extracted from tumor cells of 70 breast cancer patients and from the peripheral blood of 69 individuals without any known pathology (control group). Amplification products of the ER gene were analyzed by SSCP. In breast cancer patients the ER325 polymorphism was detected in 42.8% of the cases. In contrast, in the control group, the frequency of the same polymorphism was 24.6. Statistical comparison of the frequency distributions revealed that they are significantly different ( p = 0.023). There was also an association between ER325 polymorphism and the absence of lymph node metastases ( p = 0.038). Our data suggest that there is a relationship between the ER325 polymorphism and susceptibility to breast cancer (OR = 2.3; 1.10 < OR < 5.1) and that it can also be related with the metastasization process.     

Visceral fat measured by DXA is associated with increased risk of non-spine fractures in nonobese elderly women: a population-based prospective cohort analysis from the São Paulo Ageing &amp; Health (SPAH) Study

Summary

The present study investigates the relationship between visceral fat measured by dual-energy X-ray absorptiometry (DXA) and the incidence of non-spine fractures in community-dwelling elderly women. We demonstrated a potential negative effect of visceral fat on bone health in nonobese women.

Introduction

The protective effect of obesity on bone health has been questioned because visceral fat has been demonstrated to have a deleterious effect on bone. The aim of this study was to investigate the association of visceral fat measured by DXA with the incidence of non-spine fractures in community-dwelling elderly women.

Methods

This longitudinal prospective population-based cohort study evaluated 433 community-dwelling women aged 65 years or older. A specific clinical questionnaire, including personal history of a fragility fracture in non-spine osteoporotic sites, was administered at baseline and after an average of 4.3 years. All incidences of fragility fractures during the study period were confirmed by affected-site radiography. Visceral adipose tissue (VAT) was measured in the android region of a whole-body DXA scan.

Results

The mean age was 72.8?±?4.7 years, and 28 incident non-spine osteoporotic fractures were identified after a mean follow-up time of 4.3?±?0.8 years. According to the Lipschitz classification for nutritional status in the elderly, 38.6 % of women were nonobese (BMI?≤?27 kg/m²) and 61.4 % were obese/overweight. Logistic regression models were used to estimate the relationship between VAT and non-spine fractures in elderly women. After adjusting for age, race, previous fractures, and BMD, VAT (mass, area, volume) had a significant association with the incidence of non-spine fractures only in nonobese elderly women (VAT mass: OR, 1.42 [95 % CI, 1.09–1.85; p?=?0.010]; VAT area: OR, 1.19 [95 % CI, 1.05–1.36; p?=?0.008]; VAT volume: OR, 1.40 [95 % CI, 1.09–1.80; p?=?0.009]).

Conclusion

This study suggests a potential negative effect of visceral adiposity on bone health in nonobese women.