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BACKGROUND: Limited evidence exists regarding transient neurobehavioral alterations associated with episodic pesticide exposures or agricultural pesticide spray periods. We previously observed that children examined soon after a pesticide spray period (the Mother's Day flower harvest [MDH]) had lower neurobehavioral performance than children examined later. The present study builds on our previous work by incorporating longitudinal analyses from childhood through adolescence. METHODS: We examined participants in agricultural communities in Ecuador (ESPINA study) during three periods: July-August 2008 (N = 313, 4-9-year-olds); April 2016 (N = 330, 11-17-year-olds); July-October 2016 (N = 535, 11-17-year-olds). Participants were examined primarily during a period of low floricultural production. Neurobehavior was assessed using the NEPSY-II (domains: Attention/Inhibitory Control, Language, Memory/Learning, Visuospatial Processing, and Social Perception). Linear regression and generalized linear mixed models were used to examine cross-sectional and longitudinal associations between examination date (days) after the MDH and neurobehavioral outcomes, adjusting for demographic, anthropometric, and socio-economic variables. RESULTS: Participants were examined between 63 and 171 days after the MDH. Mean neurobehavioral domain scores ranged from 1.0 to 17.0 (SDrange = 2.1-3.1) in 2008 and 1.0 to 15.5 (SDrange = 2.0-2.3) in 2016. In cross-sectional analyses (2016 only; N = 523), we found significant or borderline positive associations between time after the MDH and Attention/Inhibitory Control (difference/10 days [ß] = 0.22 points [95% CI = 0.03, 0.41]) and Language (ß = 0.16 points [95% CI = -0.03, 0.34]). We also observed positive, longitudinal associations (2008-2016) with Attention/Inhibitory Control (ß = 0.19 points [95% CI = 0.04, 0.34]) through 112 days after the harvest and Visuospatial Processing (ß = 3.56, ß-quadratic = -0.19 [95% CI: -0.29, -0.09]) through 92 days. CONCLUSIONS: Children examined sooner after the harvest had lower neurobehavioral performance compared to children examined later, suggesting that peak pesticide spray seasons may transiently affect neurobehavior followed by recovery during low pesticide-use periods. Reduction of pesticide exposure potential for children during peak pesticide-use periods is advised.
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Plaguicidas , Adolescente , Niño , Estudios Transversales , Ecuador/epidemiología , Exposición a Riesgos Ambientales , Humanos , Pruebas NeuropsicológicasRESUMEN
INTRODUCTION: Ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. OBJECTIVE: To analyze the attitude toward living kidney donation (LKD) among ancillary personnel in Spanish and Latin-American hospitals and to analyze the variables that might influence such attitude. PATIENTS AND METHOD: from «International Collaborative Donor Project¼ a random sample was taken among ancillary personnel in Spain, Mexico and Cuba hospitals. Attitude towards LKD was evaluated using a validated, anonymously filled and self-administered survey. RESULTS: 951 professionals were surveyed (Spain: 277, Mexico: 632, Cuba: 42). 89% (n=850) are in favor of related kidney donation, lowering to 31% (n=289) in non-related donation. Of the rest, 8% (n=78) are not in favor and the 3% (n=23) are unsure. By country, Cubans (98%) and Mexicans (91%) are more in favour than Spanish (84%) (P=.001). The following variables are related to favourable attitude towards LKD: female sex (P=.017), university degree (P=.010), work in health services (P=.035), labour stability (P=.016), personal experience in donation and transplantation (P=.001), positive attitude toward cadaveric donation (P<.001), belief that he or she might need a transplant in the future (P<.001), positive attitude towards living liver donation (P<.001), a willingness to receive a donated living liver if needed (P<.001), having discussed the subject of organ donation and transplantation within the family (P<.001), partner's positive attitude towards the subject (P<.001), participation in voluntary type pro-social activities (P=.002) and not being concerned about possible mutilation after donation (P<.001) CONCLUSIONS: The attitude toward living related kidney donation is favourable among ancillary personnel in Spanish and Latin-Americans hospitals. Because living donation is a better source of organs than cadaveric ones, this favourable predisposition can be used as promoting agent of living donation in order to develop it in Spanish-speaking countries.
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Servicios Técnicos en Hospital , Actitud Frente a la Salud , Trasplante de Riñón , Donadores Vivos , Nefrectomía , Recolección de Tejidos y Órganos , Adulto , Cuba , Femenino , Humanos , Masculino , México , España , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
INTRODUCTION: Current liver donation rates are insufficient to cover transplant needs. Therefore, it is essential to promote living liver donation (LLD) given the ever decreasing morbidity and mortality in the donor and the improving results in the recipient. LLD is becoming increasingly accepted. However, in the health care system, a percentage of the personnel are not in favor. OBJECTIVE: To analyze the attitude of personnel in surgical services in Spain and Latin-America hospitals toward LLD. MATERIALS AND METHODS: As part of the "International Collaborative Donor Project," a random sample was taken and stratified according to surgical service and job category in 10 hospitals; three in Spain, five in Mexico, and two in Cuba (n = 496). Attitude was evaluated using a validated survey that was completed anonymously and self-administered. RESULTS: Eighty-six percent (n = 425) of respondents were in favor of related living liver donation, and 30% (n = 147) were in favor if it were not related. According to country, 88% of the Mexican respondents were in favor of living liver donation, 85% of the Cubans, and 82% of the Spanish (P > .05). In the multivariate analysis of the variables with most weight affecting attitude toward LLD, the following significant associations were found: (1) a favourable attitude toward living kidney donation (odds ratio [OR] = 91; P < .001); (2) acceptance of a donated living liver if one were needed (OR = 11; P < .001); and (3) family discussion about donation and transplantation (OR = 2.581; P = .037). CONCLUSIONS: Attitude toward related living liver donation was very favorable among hospital personnel in Spanish and Latin American surgical services.
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Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Trasplante de Hígado/psicología , Donadores Vivos/psicología , Servicio de Cirugía en Hospital , Obtención de Tejidos y Órganos , Adulto , Altruismo , Distribución de Chi-Cuadrado , Comprensión , Cuba , Características Culturales , Femenino , Donaciones , Humanos , Trasplante de Riñón/psicología , Masculino , México , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , España , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
BACKGROUND: Transplantation hospitals have played a key role in developing deceased organ donation and transplantation (ODT). To reduce the number of deaths on the transplant waiting list, it is essential to encourage living liver donation (LLD). Involvement of personnel in these hospitals is crucial. PURPOSE: We analyzed the attitudes toward LLD among hospital personnel in Spain, Mexico, and Cuba. MATERIALS AND METHODS: Data were obtained from 5 transplant hospitals in Spain, Mexico, and Cuba. The sample was stratified according to job category and type of service (n=2273). A validated questionnaire about living donation was used as the instrument. RESULTS: Most respondents (82%) were in favor of related LLD. If the LLD was not related, acceptance fell to 21%. A total of 85% of physicians, 79% of nursing personnel, 74% of nursing assistants, and 83% of auxiliary staff were in favor (p<.001). A favorable attitude toward LLD was associated (P<.05) with age (37±10 y vs 39±10 y), a favorable attitude toward deceased donation, a belief that a possible transplant is needed, acceptance of LLD if necessary, a favorable attitude toward living kidney donation, family discussion about ODT, a partner's favorable attitude toward ODT, an intention to participate in prosocial activities, being a Catholic, and a belief that one's religion is in favor of ODT. CONCLUSIONS: Personnel from Spanish, Mexican, and Cuban transplantation hospitals have favorable attitudes toward LLD. This suggests that there may be an increase in LLD in the future, provided that there is the necessary sociopolitical and economic support.
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Actitud Frente a la Salud , Hospitales Especializados/organización & administración , Donadores Vivos , Cuba , Humanos , México , Análisis Multivariante , EspañaRESUMEN
OBJECTIVE: To analyze the attitude of nursing personnel about organ donation and transplantation in hospitals in Spain and Latin America, and factors that affect this attitude. METHODS: Data were selected from 12 hospitals and 32 primary care centers participating in an international study (Proyecto Donante, Murcia) in 4 countries including Spain (n = 650), Mexico (n = 428), Cuba (n = 89), and Costa Rica (n = 27). The sample was random and stratified by type of service among nursing personnel (n = 1194). Attitude was evaluated using a psychosocial questionnaire. RESULTS: Of nursing personnel surveyed, 77% (n = 922) were in favor of organ donation. No differences were found according to whether they were directly involved in transplantation-related services (P < .05). Attitude in favor of organ donation varied between countries: 92% in Cuba, 85% in Costa Rica, 80% in Mexico, and 73% in Spain (P < .001) This attitude was also related to donation of a family member's organs (P < .001), having discussed organ donation and transplantation within the family (P < .001), the concept of brain death (P < .001), fear of body mutilation (P < .001), and manipulation of the body after death (P = .001). CONCLUSION: Attitude toward deceased organ donation among nurses varies between countries. There is a discrepancy between those in favor vs actual donation rates in countries and work centers. These fears may become worse when donation is seen as common in daily clinical practice.
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Cadáver , Enfermeras y Enfermeros/psicología , Personal de Enfermería en Hospital/psicología , Obtención de Tejidos y Órganos/estadística & datos numéricos , Adulto , Factores de Edad , Actitud Frente a la Salud , Costa Rica , Cuba , Femenino , Hispánicos o Latinos/psicología , Humanos , Masculino , Estado Civil , México , España , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Xenotransplantation is far from becoming a clinical reality. However, in vital organs it could be used as a bridge until a human organ becomes available, in an emergency situation. We analyzed the attitude toward xenotransplantation among personnel in transplant-related services in several hospitals in Spain and Latin America. METHODS: A random sample stratified by type of service and job category (n = 738), in transplant-related services (procurement units, transplant units, and transplant patient follow-up units) was examined in eight hospital centers from three different countries: Spain (n = 349), Mexico (n = 269), and Cuba (n = 120). A self-administered validated questionnaire was completed anonymously. RESULTS: Based on the assumption that all the results of xenotransplantation were similar to those achieved with human donors, most respondents [66% (n = 484)] would be in favor. The employees from Cuban centers had the most favorable attitudes (72% in favor), followed by the Spanish (64%) and the Mexicans (61%; P = .013). However, the differences were mainly determined by job category: Physicians showed the most favorable attitudes and auxiliary staff the least (67% vs 40%; P = .010). Attitudes were significantly related to beliefs about different types of human donation [deceased (P < .001) and living (P < .001)], the possibility of needing a transplant for oneself (P < .001), and a favorable attitude toward donating the organs of a deceased family member (P = .004). CONCLUSIONS: Currently, a third of health care employees working in transplant-related services are not in favor of xenotransplantation. More information should be provided about the subject, especially in centers with preclinical xenotransplantation programs.
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Personal de Hospital/psicología , Trasplante Heterólogo/psicología , Factores de Edad , Animales , Actitud Frente a la Salud , Cadáver , Cuba , Cultura , Femenino , Humanos , Donadores Vivos , Masculino , Cuerpo Médico de Hospitales/psicología , México , Personal de Enfermería en Hospital/psicología , Caracteres Sexuales , España , Encuestas y Cuestionarios , Donantes de Tejidos , Trasplante/psicologíaRESUMEN
INTRODUCTION: Living donor kidney (LKD) transplantation provides better results than deceased donor donation, involving minimum risk for the donor. However, LKD donation rates are low in most countries. We analyzed attitudes toward LKD in transplant hospitals in Spain, Mexico, and Cuba. MATERIALS AND METHODS: Data were obtained from five transplant hospitals through the International Collaborative Program "Proyecto Donante Vivo, Murcia" in three countries: Spain (n = 1168), Mexico (n = 903), and Cuba (n = 202). The random sample (2273 employees) was stratified according to job category. The instrument used to evaluate attitude was a validated questionnaire. Statistical analysis included Student t test, the chi(2) test, and multivariate analysis. RESULTS: Eighty eight percent (n = 2002) of Spanish, Mexican, and Cuban transplant hospital personnel were in favor of related LKD and 24% nonrelated LKD (n = 555). Attitudes were more favorable among centers in Cuba 97% (n = 195), followed by Mexico 88% (n = 793) and by Spain 87% (n = 1014; P < .001). According to job category, 91% (n = 617) of physicians were in favor, 88% (n = 543) of nurses, 85% (n = 198) of health care assistants, and 85% (n = 198) of auxiliary personnel. Attitudes were related to variables of: attitude toward deceased donation (P < .001), discussion about organ donation and transplantation (P < .001), concern about body mutilation after donation (P = .001), a possible need for a transplant in the future (P < .001), and attitude toward living liver donation (P < .001). CONCLUSIONS: Attitudes toward LKD in Hispanic/Latin Transplant Hospitals were favorable and could encourage an increase in LKD in the coming years assuming suitable sociopolitical and economic condition, as well as support from nephrologists.