The Roma population's fear of donating their own organs for transplantation

BACKGROUND

The refusal rate for donating organs among the Roma people is much higher than that of any other social group.

OBJECTIVE

To analyze the attitude towards the donation of one's own organs among the Roma population living in Spain.

METHOD

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TYPE OF STUDY

Spanish national observational sociological study stratified by gender and age.

STUDY POPULATION

Roma population aged ≥15 years living in Spain.

SAMPLE SIZE

1,253 respondents. Assessment instrument: Validated questionnaire on attitude towards organ donation for transplantation "PCID - DTO Ríos". Field work: Random selection based on stratification. Anonymous and self-administered completion. The collaboration of people of Roma ethnicity was required.

STATISTICS

Student's t test, χ², Fisher's exact test and a logistic regression analysis.

RESULTS

The degree of completion was 18.2% (n = 228). Of those who completed the questionnaire, 42.1% (n = 96) were in favor of donation, 30.3% (n = 69) were undecided and the remaining 27.6% (n = 63) were against it. Of the 1,025 (81.8%) who declined to complete the questionnaire, 1,004 (98%) indicated that it was for fear of speaking about and filling in a questionnaire that raises the issue of death and organ donation after death. If those who did not complete the questionnaire due to fear of death and donating organs after death are considered not in favor, the results would be as follows: 7.8% (n = 96) in favor of donating their organs compared to 92.2% (n = 1166) not in favor (against or undecided).

CONCLUSIONS

A majority of the Roma population prefer not speak of death nor organ donation after death. These findings show that current campaigns to promote organ donation are not effective in this population group.

Maximal tear secretion evoked by controlled stimulation of corneal sensory nerves in healthy individuals and dry eye subjects

PURPOSE

To measure, the tear flow changes evoked in healthy subjects and dry eye disease (DED) patients by controlled sensory stimulation of the eye surface with i-Onion™, a new stimulation device.

METHODS

Sensory corneal nerves were stimulated with an instrument (i-Onion™) that ejects puffs of CO₂ gas (99.9%) at 200 ml·min^-1 for 3s, delivered 5 mm from the cornea. Using Schirmer test strips, tear volumes were measured over 3 min in the cornea of one eye before (basal tear volume -BTV) and in the other eye after stimulation of the sensory nerves with CO₂ (stimulated tear volume -STV). These measurements were obtained from a control group of adults of either sex (17 students aged 20-30 and 29 subjects without signs of dry eye aged 25-61), a cohort of DED patients (aged 34-75) that included 12 asymptomatic, suspected DED subjects (Schirmer <7 mm and/or TBUT <10s), and 30 Sjögren's syndrome (SS) patients.

RESULTS

CO₂ stimulation significantly increased the tear volume (BTV = 14.6 ± 1.0 mm, STV = 19.0 ± 1.1 mm: n = 46) in 78% of control subjects, reflecting a mean tear reserve volume (TRV = STV-BTV) of 4.4 ± 0.8 mm. Individual differences were wide, and while no increase in reflex tearing was evoked in 30% of subjects with a BTV >10 mm, the remaining 70% responded vigorously to stimulation, even those with a BTV >18 mm. Asymptomatic DED subjects displayed weaker responses to CO₂ stimulation, with lower STVs. Both the BTV and STV of SS patients were low, significantly below those of the healthy controls.

CONCLUSIONS

Measuring the rise in reflex tearing volume evoked by controlled corneal stimulation provides objective information about the tear glands' secretory capacity in health and disease.

A study on correlations between precipitation ETCCDI and airborne pollen/fungal spore parameters in the NE Iberian Peninsula

Precipitation is one of the meteorological variables usually involved in the aerobiological studies, which presents a complex relationship with atmospheric levels of pollen and fungal spores and the temporal characteristics of their seasons. This complexity is due in a large part to rainfall's twofold impact of having, prior to pollination, a positive influence on subsequent pollen production and of contributing, during pollination, to pollen removal from the air through a wash-out effect. To better explore this impact, we place particular emphasis on extreme rainfall by calculating the correlation between airborne pollen and fungal spore parameters and the precipitation indices that the Expert Team on Climate Change Detection and Indices (ETCCDI) proposed for characterising climate extremes. Parameters for twenty-seven pollen and fungal spore taxa measured in six aerobiological stations in the NE Iberian Peninsula have been considered. We have distinguished between annual and winter ETCCDI in order to compare the correlations between extreme rainfall and airborne pollen concentrations and to avoid the wash-out effect as far as possible. Results show a positive influence from an increase in moderately extreme winter rainfall, specifically on subsequent pollen/fungal spore production: the percentage of all possible significant correlations is higher for winter than for annual rainfall. Furthermore, while annual rainfall in this region has nearly the same number of positive as negative correlations, the positive correlations for winter rainfall are more than twice that of the negative ones. The seasonal consideration on rainfall ETCCDI made with the aim to avoid the confounding overlapping of different rainfall impacts has led to more sharpened observations of its positive and negative effects on airborne pollen and fungal spore concentrations.

Gypsy Population Presents a Favorable Attitude Toward Related Living Donation

INTRODUCTION

Negative organ donation rates among the Gypsies is much higher than that of any other social group in Spain. However, living donation rates have not been raised much in this social group, despite the existence of several Gypsy patients on the waiting list for transplantation.

OBJECTIVE

To analyze the attitude toward related living donation among the Gypsy population who reside in Spain.

METHODS

This type of study is an observational sociological study. The study consisted of the adult Gypsy population residing in Spain, and a random sampling of 230 adult gypsies was conducted. Attitude questionnaires for live donation, both hepatic PCID-DVH-Ríos and renal PCID-DVR-Ríos, were used, and random selection was based on stratification. Questionnaires were self-administered and completed anonymously. Student t test, χ2, Fisher, and a logistic regression analysis were used.

RESULTS

A sample of 206 Gypsies (52% women) with a mean age of 34 years is obtained. Seventy-two percent (n = 150) would donate an organ to a relative in life, 8% (n = 16) would not donate it, and 20% (n = 41) have doubts. Respondents with a favorable attitude toward living donation presented a more favorable attitude toward cadaveric organ donation (55% vs 0%, P < .001). The attitude toward living kidney donation was more favorable (81% in favor) than toward living liver donation (P < .001).

CONCLUSIONS

The Gypsy ethnic group is sensitized to live donor transplantation. The family and cultural roots of Gypsy people could condition this favorable attitude, a fact to be taken into account to sensitize this social group and promote donation campaigns with the aim of increasing donation rates.

Spatial and temporal variations in airborne Ambrosia pollen in Europe

The European Commission Cooperation in Science and Technology (COST) Action FA1203 "SMARTER" aims to make recommendations for the sustainable management of Ambrosia across Europe and for monitoring its efficiency and cost-effectiveness. The goal of the present study is to provide a baseline for spatial and temporal variations in airborne Ambrosia pollen in Europe that can be used for the management and evaluation of this noxious plant. The study covers the full range of Ambrosia artemisiifolia L. distribution over Europe (39°N-60°N; 2°W-45°E). Airborne Ambrosia pollen data for the principal flowering period of Ambrosia (August-September) recorded during a 10-year period (2004-2013) were obtained from 242 monitoring sites. The mean sum of daily average airborne Ambrosia pollen and the number of days that Ambrosia pollen was recorded in the air were analysed. The mean and standard deviation (SD) were calculated regardless of the number of years included in the study period, while trends are based on those time series with 8 or more years of data. Trends were considered significant at p < 0.05. There were few significant trends in the magnitude and frequency of atmospheric Ambrosia pollen (only 8% for the mean sum of daily average Ambrosia pollen concentrations and 14% for the mean number of days Ambrosia pollen were recorded in the air). The direction of any trends varied locally and reflected changes in sources of the pollen, either in size or in distance from the monitoring station. Pollen monitoring is important for providing an early warning of the expansion of this invasive and noxious plant.

Airborne pollen trends in the Iberian Peninsula

Airborne pollen monitoring is an effective tool for studying the reproductive phenology of anemophilous plants, an important bioindicator of plant behavior. Recent decades have revealed a trend towards rising airborne pollen concentrations in Europe, attributing these trends to an increase in anthropogenic CO2 emissions and temperature. However, the lack of water availability in southern Europe may prompt a trend towards lower flowering intensity, especially in herbaceous plants. Here we show variations in flowering intensity by analyzing the Annual Pollen Index (API) of 12 anemophilous taxa across 12 locations in the Iberian Peninsula, over the last two decades, and detecting the influence of the North Atlantic Oscillation (NAO). Results revealed differences in the distribution and flowering intensity of anemophilous species. A negative correlation was observed between airborne pollen concentrations and winter averages of the NAO index. This study confirms that changes in rainfall in the Mediterranean region, attributed to climate change, have an important impact on the phenology of plants.

A new method for determining the sources of airborne particles

Air quality is a major issue for humans owing to the fact that the content of particles in the atmosphere has multiple implications for life quality, ecosystem dynamics and environment. Scientists are therefore particularly interested in discovering the origin of airborne particles. A new method has been developed to model the relationship between the emission surface and the total amount of airborne particles at a given distance, employing olive pollen and olive groves as examples. A third-degree polynomial relationship between the air particles at a particular point and the distance from the source was observed, signifying that the nearest area to a point is not that which is most correlated with its air features. This work allows the origin of airborne particles to be discovered and could be implemented in different disciplines related to atmospheric aerosol, thus providing a new approach with which to discover the dynamics of airborne particles.

Impact of influenza season and environmental factors on the clinical presentation and outcome of invasive pneumococcal disease

Influenza and meteorological factors have been associated with increases in the incidence of invasive pneumococcal disease (IPD). However, scant data regarding the impact of influenza and the environment on the clinical presentation of IPD are available. An observational study of all adults hospitalized with IPD was performed between 1996 and 2012 in our hospital. The incidence of IPD correlated with the incidence rates of influenza and with environmental data. A negative binominal regression was used to assess the relationship between these factors. Clinical presentation of IPD during the influenza and non-influenza periods was compared. During the study, 1,150 episodes of IPD were diagnosed. After adjusting for confounding variables, factors correlating with the rates of IPD were the incidence of influenza infection (IRR 1.229, 95% CI 1.025-1.472) and the average ambient temperature (IRR 0.921, 95% CI 0.88-0.964). Patients with IPD during the influenza period had a worse respiratory status. A greater proportion of patients had respiratory failure (45.6% vs 52%, p = 0.032) and higher requirements for ICU admission (19.3% vs 24.7%, p = 0.018) and mechanical ventilation (11% vs 15.1%, p = 0.038). When we stratified by invasiveness of pneumococcal serotypes and the presence of comorbid conditions, the increase in the severity of clinical presentation was focused on healthy adults with IPD caused by nonhighly invasive serotypes. Beyond the increase in the burden of IPD associated with influenza, a more severe clinical pattern of pneumococcal disease was observed in the influenza period. This effect varied according to pneumococcal serotype, host comorbidities, and age.

Long-range transport of beech (Fagus sylvatica L.) pollen to Catalonia (north-eastern Spain)

Local and long-range transport of beech (Fagus sylvatica) pollen was analysed by using 23-year data (1983-2007) at six stations in Catalonia, Spain, and numerical simulations. Back trajectories and synoptic meteorology indicated a consistent north European provenance during beech pollen peak days. Specifically, the area from northern Italy to central Germany was the most probable source, as indicated by a source-receptor model based on back trajectories. For the event with the highest pollen levels (17 May 2004), back trajectories indicated a source in the Vosges (NE France) and the Schwarzwald (SW Germany) regions. By applying a mesoscale model (MM5) to this event, pollen transport could be further refined, allowing its entrance to Catalonia through the lower easternmost pass of the Pyrenees (the Alberes pass, 500 m a.s.l.) to be described. Hourly counts of Fagus pollen allowed the timing of pollen arrival during this episode to be matched with the model results regarding the above-mentioned passage. This study may help to interpret some results of modern beech genetic diversity and contribute to the understanding of paleopalynological records by taking long-range transport into consideration.

[Suitability of newborn donor corneal graft in penetrating keratoplasty]

OBJECTIVE

The lower recommended age of the donor cornea is a controversial matter. Although newborn corneas have a high endothelial cell density, there are anatomical, refractive (myopic shift) and postoperative problems. Two cases are analyzed; one had an atypical refractive result and the other an unexpectedly severe immune response. We also review the use of pediatric donor corneas in penetrating keratoplasty.

METHODS

Two young patients with keratoconus, in whom a penetrating keratoplasty was done using a 4-month-old newborn corneal donor with high endothelial cell density (4.500 cell/mm2) are reported.

RESULTS

In the early postoperative period, both had high hypermetropy with weak astigmatism that improved over the next few months. In one patient a marked increase in the astigmatism after removal of the continuous suture was observed. One and a half years after the penetrating keratoplasty there was V=1 corrected vision and the endothelial population was almost unchanged (4,300 cell/mm2). The other patient suffered an allograft reaction with corneal oedema in the seventh postoperative month, and subsequent rupture of the continuous suture made its early removal necessary. The oedema partially diminished with high doses of steroids, but still persisted eighteen months later.

CONCLUSION

The newborn corneal graft might have led to an early strong hypermetropy as opposed to the supposed myopic shift referred to in the literature. The extremely rapid healing seen in young recipients may lead to early loosening of the continuous suture. High endothelial cell density increases the risk of irreversible graft failure probably due to a high antigenic response. The use of a newborn donor cornea is questionable due to unpredictable refractive and immunological responses.

Comparison of the OptiMAL rapid test and microscopy for detection of malaria in pregnant women in Nigeria

Malaria during pregnancy causes anaemia in pregnant women and low birthweight in infants. The purpose of this study was to evaluate the OptiMAL rapid malaria test in comparison with standard microscopy for malaria diagnosis in 268 pregnant women attending antenatal clinics at the Jos University Teaching Hospital and the Federal Medical Centre-Gombe in Nigeria. Positive results by either method were confirmed using a polymerase chain reaction assay for malaria. Although the OptiMAL assay did not detect malaria in the blood of pregnant women with low levels of parasitaemia, it may be useful for the detection of placental malaria which predisposes to low birthweight infants.

Surgical treatment of dry eye syndrome: conjunctival graft of the minor salivary gland

Despite the availability of efficient tear substitutes, many patients with dry eye syndrome experience severe corneal injuries and a subsequent loss of vision. Surgical techniques using mayor salivary glands to provide a substitute for tears have been reported; with this technique the drainage of saliva goes into the conjunctival fornix, permitting corneal and conjunctival humidification. The authors describe a new surgical approach in which minor salivary glands are autotransplanted into the conjunctival fornix by means of a graft of the intraoral mucosa-transporting salivary glands. This approach was used in a 56-year-old woman with a 2-year history of refractory and pharmacologically untreatable dry eye syndrome caused by Sjögren's syndrome. The right eye had more severe corneal and conjunctival lesions than did the contralateral one, so the treatment was planned in the right eye only. A weekly follow-up during the first 6 months confirmed the significant improvement of dry eye symptoms in the surgically treated eye. Three months after surgery, a biopsy was performed in the minor salivary gland graft, and the histologic findings revealed the presence of glandular acinus, duct with mucin content, and lymphocyte infiltration. The significant improvement obtained in this patient suggests that the secretion from the grafted salivary minor glands was better in promoting homeostasis of the ocular surface than are artificial tears. This may be explained by: (1) The lacrimal and salivary secretions contain biologically active constituents that may protect from infection and promote normal growth epithelium; (2) The secreted mucin is thought to coat the epithelial surface, reducing the high surface tension of the eye wetted by aqueous tears; (3) The thick secretions of the minor gland might act in reducing the evaporation of the underlying tear layer and form a hydrophobic barrier along the lid margin that can retain the lid margin tear string and prevent its flow onto the skin. Minor gland salivary autotransplant is a new surgical technique with effectiveness demonstrated in one patient, but the scientific explanation is not clear; additional experience with more cases could confirm the initial success.

Effect of nitrogen dioxide and ozone on the risk of dying in patients with severe asthma

BACKGROUND

A study was performed to assess the acute association between air pollution, pollen and spores, and mortality in a population based cohort of subjects with asthma recruited from emergency room admissions for an asthma exacerbation using a case crossover design.

METHODS

Patients in Barcelona aged over 14 years who died during the period 1985-95 who had visited the emergency department of one of the four largest hospitals in the city for asthma during 1985-9 were included in the study (a total of 467 men and 611 women). Deaths were identified by record linkage of the cohort individuals with the Catalonia mortality registry. Causes of death were based on the underlying cause on the death certificate. Air pollution, pollen and spore levels were measured at the city monitoring stations which provide an average for the entire city.

RESULTS

Nitrogen dioxide was associated with mortality for all causes of death (adjusted odds ratio (OR) for an increase of the interquartile range = 1.50, 95% confidence interval (CI) 1.09 to 2.64) in asthmatic patients with more than one emergency room admission for asthma. The association was particularly strong for respiratory causes (OR 1.63, 95% CI 0.93 to 2.86). Ozone also increased the risk of death in asthmatic patients (OR 1.90, 95% CI 1.09 to 3.30) during spring and summer. The association with particles, pollen, and spores was not significant, and no interactions between air pollutants and pollen and spores were found.

CONCLUSION

Nitrogen dioxide and ozone may exacerbate severe asthma and even cause death among asthmatic subjects.

Triatoma infestans in Greater Buenos Aires, Argentina

The Health Administration Agencies of many municipalities in Greater Buenos Aires (GBA) receive frequent reports on triatomines in houses. The aim of this work was to identify and describe the dispersal foci of Triatoma infestans in an urban neighborhood of GBA, and contribute to the knowledge of the epidemiological situation in the region. In June 1998, potentially infested places were entomologically evaluated. T. infestans was only detected in a hen building for egg production, which housed approximately 6,000 birds. A total of 2,930 insects were collected. Density was about 9 triatomines/m(2). The proportions of fifth instar nymphs and adults were significantly higher than those of the other stages (p<0.001). The number of triatomines collected largely exceeded the highest domestic infestation found in one house from rural endemic areas of Argentina. Though triatomines were negative for Trypanosoma cruzi, they could acquire the parasite by coming in contact with infected people living in GBA. Besides, the numerous and widely distributed places housing hens and chickens, would favor the settlement of the vector. Together, both facts may constitute a risk of parasitic vectorial transmission. It is recommended to intensify systematic activities of vector search and case detection in GBA.

Parietaria allergy in children

Parietaria, a grassy plant belonging to the Urticaceae family which is commonly found in urban environments, tends to grow on fences, walls and soils with a high content in nitrogen. Since 1983 the Xarxa Aerobiologica de Catalunya (Catalonian Aerobiological Network) has been using Hirst and Court sensors to monitor the daily concentrations of its pollen with respect to the weather conditions (wind, rain, temperature) in various sites in Catalonia and the Balearic Islands. This pollen is present practically all year round in our area, mainly during cold, rainy and seaside areas. Studies at a pediatric level are scarce and this is why we reviewed our data in this field. The study included a total of 12,650 case histories of first time attendances to our Pediatric Allergology Unit; 449 children showed sensitivity to Parietal pollen. Exclusive sensitivity to Parietaria in this age group of 1 and 15 years olds tended to be very low. However, we observed that after initial preferential sensitization to domestic allergens, Parietal pollen became the most frequent cause of sensitivity as the patients grew older. Although rhinoconjunctival manifestations predominate, at least at a pediatric level, the implication of Parietal pollen as a cause of bronchial asthma cannot be ignored.

Experimental study of different intraocular lens designs implanted in the bag after capsulorhexis

OBJECTIVE

To analyze experimentally in cadaver eyes several models of commercially available posterior chamber intraocular lenses (IOLs) to determine their stability, fixation, and behavior in the capsular bag in relation to their overall size, optic diameter, shape, material, and haptic configuration.

SETTING

Eye Bank and Department of Ophthalmology, University General Hospital of Alicante, Spain.

METHODS

Thirty-three IOLs of different sizes, shapes, and designs, divided in two series and five groups, were implanted successively in 31 cadaver eyes. All the proceedings were videotaped, and measurements were made on the television screen with the picture static. Main outcome measures were the diameters of the lens, the empty capsular bag, and the capsulorhexis; capsular distension by the IOL haptics; extent of haptic arc of contact with the capsular equator; and IOL mobility in the bag.

RESULTS

The stability of and stretching caused by the IOLs varied greatly depending on their overall size, haptic flexibility, and the extent of the arc of haptic contact with the capsular equator. Lenses between 13.5 and 14.0 mm had good stability but stretched the capsule excessively. The J-loop haptic configuration produced a spindle-shaped bag deformity that might come in contact with the ciliary processes in the physiologic eye. Among IOLs designed for in-the-bag implantation after capsulorhexis, the two smaller than 12.0 mm were unstable, permitting excessive mobility in the capsular bag. Except for IOLs with a 5.0 mm optic, all 12.0 mm IOLs had reasonable stability, little or no mobility within the capsular bag, and good short-term centering. Lenses with a broad angulation at the haptic-optic junction, to about 90 degrees, achieved the largest arc of contact with the equator and behaved as lenses with larger optics. The Pharmacia 808 performed best.

CONCLUSION

After capsulorhexis and extracapsular cataract extraction, 12.0 mm, poly(methyl methacrylate), one-piece IOLs with modified C-shaped loops, 90 degree angulation at the haptic-optic junction, and an optic diameter between 6.0 and 6.5 mm performed best in the capsular bag.

Mercurialis annua pollen: a new source of allergic sensitization and respiratory disease

Sensitization to Mercurialis annua pollen in 13 patients admitted for allergy study of asthma, rhinitis, or rhinoconjunctivitis is described. Twelve of these patients were also sensitized to other common aeroallergens. In five patients, a relationship was found between exposure to M. annua pollen and elicitation of symptoms. All patients were prick test and RAST positive to an extract of M. annua pollen. Nasal provocation test proved positive in 10 of 12 patients, and bronchial provocation test was positive in the only patient in whom it was performed. Two late responses were recorded. Immunoblotting of the 13 sera revealed two different groups of relevant allergens; one of isoelectric point 10.2, reacting with 12 of the 13 sera, and the other allergen of isoelectric point 5.0 to 5.5, reacting with 11 of the 13 sera. M. annua pollen is able to induce both sensitization and clinical disease in atopic patients. Since sensitization to this pollen accounts for 8.5% of total positive skin tested patients in the same period, we believe M. annua pollen should be considered as a relevant allergen and thus included in skin test batteries. Some patients labeled as having "intrinsic" asthma or rhinitis might be sensitized to this and other previously unknown allergens.

Asthma trough to Parietaria in pediatrics

We selected 183 patients with asthma, rhinitis and/or conjunctivitis. They responded positively to Parietaria Judaica skin prick-tests. In the first test 91 were positive. Of those 11 were monosensitive and 80 polysensitive. In the follow-up tests 92 were positive, of which 5 were monosensitive and 87 polysensitive. There were 54 cases of rhinitis, of which 23 developed asthma. Of 129 asthma cases, 90 developed asthma with rhinitis. The main seasons are Spring and Autumn and activity declines during winter. 18.57% are perennial. IgE was greater in the re-examination of the polysensitive cases. The monosensative cases confirmed the clinical symptoms most characteristic of rhinitis syndrome, 16.893% and asthma with rhinitis, 49.18%.