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Juliana Machado-Rugolo,1,2 Tabatha Gutierrez Prieto,1 Alexandre Todorovic Fabro,3 Edwin Roger Parra Cuentas,4 Vanessa Karen Sá,5 Camila Machado Baldavira,1 Claudia Aparecida Rainho,6 Erick C Castelli,7,8 Cecilia Farhat,1 Teresa Yae Takagaki,9 Maria Aparecida Nagai,10,11 Vera Luiza Capelozzi1 1Laboratory of Genomics and Histomorphometry, Department of Pathology, University of São Paulo Medical School (USP), São Paulo, Brazil; 2Health Technology Assessment Center, Clinical Hospital (HCFMB), Medical School of São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; 3Department of Pathology and Legal Medicine, Ribeirão Preto School of Medicine, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil; 4Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; 5Laboratory of Genomics and Molecular Biology, Centro Internacional De Pesquisa (CIPE), AC Camargo Cancer Center, São Paulo, SP, Brazil; 6Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; 7Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (UNIPEX), Medical School of São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; 8Department of Pathology, Medical School of São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; 9Division of Pneumology, Heart Institute (Incor), Clinical Hospital, University of São Paulo Medical School (USP), São Paulo, São Paulo, Brazil; 10Department of Radiology and Oncology, University of São Paulo Medical School (USP), São Paulo, Brazil; 11Laboratory of Molecular Genetics, Center for Translational Research in Oncology, Cancer Institute of São Paulo (ICESP), São Paulo, BrazilCorrespondence: Vera Luiza CapelozziDepartment of Pathology, University of São Paulo Medical School (USP), Av Dr Arnaldo 455, Room 1143, São Paulo, São Paulo State, 01246-903, BrazilTel +55 11 3061 7427Fax +55 11 3064-2744Email vera.capelozzi@fm.usp.brPurpose: Although non-small cell lung cancer (NSCLC) remains a deadly disease, new predictive biomarkers have emerged to assist in managing the disease, of which one of the most promising is the programmed death‐ligand 1 (PD-L1). Each, PD-L1 variant seem to modulate the function of immune checkpoints differently and affect response to adjuvant treatment and outcome in NSCLC patients. We thus investigated the influence of these PD-L1 genetic variations in genetically admixed NSCLC tissue samples, and correlated these values with clinicopathological characteristics, including prognosis.Materials and Methods: We evaluated PD-L1 non-coding genetic variants and protein expression in lung adenocarcinomas (ADC), squamous cell carcinomas (SqCC), and large cell carcinomas (LCC) in silico. Microarray paraffin blocks from 70 samples of ADC (N=33), SqCC (N=24), and LCC (N=13) were used to create PD-L1 multiplex immunofluorescence assays with a Cell Signaling E1L3N clone. Fifteen polymorphisms of the PD-L1 gene were investigated by targeted sequencing and evaluated in silico using dedicated tools.Results: Although PD-L1 polymorphisms seemed not to interfere with protein expression, PD-L1 expression varied among different histological subtypes, as did clinical outcomes, with the rs4742098A>G, rs4143815G>C, and rs7041009G>A variants being associated with relapse (P=0.01; P=0.05; P=0.02, respectively). The rs7041009 GG genotype showed a significant correlation with younger and alive patients compared to carriers of the A allele (P=0.02 and P< 0.01, respectively). The Cox regression model showed that the rs7041009 GG genotype may influence OS (P< 0.01) as a co-dependent factor associated with radiotherapy and recurrence in NSCLC patients. Furthermore, the Kaplan–Meier survival curves showed that rs7041009 and rs4742098 might impact PPS in relapsed patients. In silico approaches identified the variants as benign.Conclusion: PD-L1 non-coding variants play an important role in modulating immune checkpoint function and may be explored as immunotherapy biomarkers. We highlight the rs7041009 variant, which impacts OS and PPS in NSCLC patients.Keywords: PD-L1, non-small cell lung cancer, single nucleotide polymorphisms, next-generation sequencing

Introduction: In multicenter studies, the protocolization of data is a critical phase that can generate biases.The objective is to analyze the concordance and reliability of the data obtained in a clinical multicenter study between the protocolization in the center of origin and the centralized protocolization of the data by a data -manager., Methods: National multicenter clinical study about an infrequent carcinoma. A double protocolization of the data is carried out: (a) center of origin; and (b) centralized by a data manager: The concordance between the data is analyzed for the global data and for the two groups of the project: (a) study group (Familiar carcinoma, 30 researchers protocolize); (b) control group (Sporadic carcinoma, 4 people protocolize). Interobserver variability is evaluated using Cohen's kappa coefficient., Results: The study includes a total of 689 patients with carcinoma, 252 in the study group and 437 in the control group. Regarding the concordance analysis of the tumor stage, 2.5% of disagreements were observed and the concordance between people who protocolize was near perfect (Kappa = 0.931). Regarding the evaluation of the recurrence risk, disagreements occurred in 7% of the cases and the concordance was near perfect (Kappa = 0.819). Regarding the sonography evaluation (TIRADS), the disagreements were 6.9% and the concordance was near perfect (Kappa = 0.922). Also, 4.6% of transcription errors were detected., Conclusions: In multicenter clinical studies, the centralized data protocolization o by a data-manager seems to present similar results to the direct protocolization in the database in the center of origin., (Copyright © 2023 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

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: ., 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, χ 2 , 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., (Copyright © 2022 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Background: The Cuban population residing in the state of Florida in the United States forms the largest population group of immigrants in that state. It has been described as a population with little awareness of organ donation. The objective is to analyze the factors that Cubans residing in the Florida refer to when expressing an unfavorable attitude toward organ donation and to determine the psychosocial factors associated with the attitude toward organ donation of this population group., Methods: We performed a cross-sectional observational study. From the Proyecto Colaborativo Internacional Donante (International Donor Collaborative Project), a sample stratified by age and sex of Cubans residing in Florida (N = 1224) is obtained. The sample is analyzed using the validated questionnaire (PCID-DTO-RIOS). The reasons against organ donation were analyzed using a specific multiresponse item, with an open response option. For the analysis of the psychosocial variables, a logistic regression analysis is carried out., Results: A total of 38.2% (n = 468) of the individuals under study declared themselves against organ donation. Of those who were against, the reasons stated were (1) leave the dead in peace (n = 440; 57.6%); (2) religious reasons (n = 192; 25.1%); (3) fear of mutilation (n = 160; 20.9%); (4) assertive refusal (n = 128; 16.8%); (5) apparent death (n = 16; 2.1%); and (6) other reasons (n = 764; 62.4%)., Conclusions: The Cuban population residing in Florida who is against organ donation expresses various reasons. In addition, there are factors associated with the psychosocial profile toward organ donation of this important population group., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Attitude toward organ donation mobilizes donation behavior and makes transplant surgery possible. As future health professionals, medical students will be a relevant generating opinion group and will have an important role in the organ requesting process. The goals of this meta-analysis were to obtain polled rates of medical students who are in favor, against, or indecisive toward cadaveric organ donation in the studies conducted around the world, and to explore sociocultural variables influencing the willingness to donate. Electronic search and revision of references from previous literature allowed us to locate 57 studies fulfilling the inclusion criteria. Data extraction and risk of bias assessment were performed by two independent investigators. Pooled estimations were computed assuming a random-effects model. Despite the fact that willingness to donate was elevated in medical students, estimated rates in studies from different geographical areas and sociocultural backgrounds exhibited significant differences. The age and the grade of the students also influenced the rate of students in favor. Donation campaigns should take into account cultural factors, especially in countries where certain beliefs and values could hamper organ donation. Also, knowledge and skills related to organ donation and transplant should be acquired early in the medical curriculum when a negative attitude is less resistant to change., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Iniesta-Sepúlveda, López-Navas, Gutiérrez, Ramírez and Ríos.)

Cuban immigrants constitute an important group in both the United States and Spain, with different behaviors toward organ donation having been described among the different Latin American nationalities. We analyzed the attitude toward organ donation among the Cuban populations in Cuba, Spain, and Florida. The study population was Cuban immigrants over 15 years of age residing in Cuba, Spain, and Florida, with samples randomly stratified by age and sex. A validated questionnaire on psychosocial aspects of organ donation (PCID-DTO Rios) was used. Census was used as the sampling base in all 3 countries; however, additionally, in Spain and the United States (Florida), we sought the support of immigration support associations to determine the Cuban population without legal documentation. The questionnaire was completed anonymously and self-administered. The completion rate of the study was 74% (4123/5574) among 424 surveyed in Spain, 1224 in Florida, and 2475 in Cuba. The attitude in favor of donating their own organs upon death was 60.6% of those surveyed in Spain, 37.6% in Florida, and 68.9% in Cuba, or 58% of the global sample. Multivariate analysis showed that country of residence was an independent factor associated with attitude toward organ donation (odds ratio, 1.929). Other factors associated with attitude were sex, educational level, performance of prosocial activities, knowledge of the brain death concept, religion, the couple's opinion toward donation, fear of mutilation after donation, and attitude toward manipulation of the body after death. The attitude toward organ donation among Cubans in their country of origin and immigrants in Spain was similar, being significantly different from those who emigrate to Florida, where the attitude is much less favorable., (© 2021 The Authors. Liver Transplantation published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.)

The knowledge acquired during university education about organ donation and transplantation (ODT) decisively influences the information future health professionals transmit. This is important in ODT where the participation of the general public is essential to obtain organs., Objective: To determine notions of Spanish medicine and nursing students on ODT and its relationship with attitude toward ODT., Methods and Design: and design. We conducted a sociologic, multicenter, and observational study. The population for our study consisted of medical and nursing students in Spanish universities. Our database was the Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. Our sample consisted of 9598 medical and 10,566 nursing students (99% confidence interval; precision of ±1%), stratified by geographic area and year of study., Results: The completion rate for our study was 90%. Only 20% (n=3640) of students thought their notions on ODT were good; 41% (n=7531) thought their notions were normal; 36% (n=6550) thought their notions were scarce. Comparing groups, there were differences between those who believed that their notions on ODT were good (44% nursing vs 56% medical students; P < .000), and those who believed it scarce (54% nursing vs 46% medical students; P < .000). Notions on ODT were related with attitude toward the donation of one's own organs: those who considered their notions were good were more in favor then those who considered it scarce (88% vs 72%; P < .000)., Conclusion: Only 20% of Spanish medical and nursing students thought their notions on ODT were good. Having good knowledge is related to a favorable attitude towards ODT. Receiving specific information on the subject could improve their knowledge about ODT during their training., (Copyright © 2020 Elsevier Inc. All rights reserved.)

A primary care physician (PCP) not only accompanies the patient in the process of an illness, but throughout his or her life. The confidence we have in these health professionals is fundamental, and their favorable attitude toward organ donation and transplantation (ODT) has a significant influence on the population., Objective: To analyze trust in PCPs among Spanish medical and nursing students, the relationship with their attitude toward ODT, and the factors that condition it., Methods and Design: A sociologic, multicenter, and observational study., Population: medical and nursing students in Spanish universities., Database: Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students (99% confidence and precision of ±1%), stratified by geographic area and year of study., Results: Completion rate: 90%. With respect to students' trust in their physician, 18% (n = 3267) of them totally trust (completely), 45% (n = 8101) trust enough, 30% (n = 5478) of them have not enough trust, and 7% not at all. Comparing groups, medical students totally trust more in PCPs than nursing students (55% vs 45%; P < .000), however, nursing students have less than enough trust in their PCP than medical students (53% vs 47%; P < .000). Students that totally trust in their PCP were more in favor toward ODT than students with not enough trust (83% vs 77%; P < .000)., Conclusion: Only 18% of Spanish medical and nursing students totally trust in their PCP. Attitude toward ODT is related to a higher level of trust in PCPs among these students., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Despite sensitization of medical students toward the donation of organs, a non-negligible percentage of students are not in favor of donation., Objective: To analyze the reasons of Spanish medical students who do not have a favorable attitude toward the donation of their own organs after death., Method: The population under study is medical students in Spanish universities, using the database of the International Donor Collaborative Project, stratified by geographic area and academic year. The questionnaire completion was anonymous and self-administered. The study group is medical students with an unfavorable attitude toward organ donation. The assessment instrument used is a validated questionnaire of attitude toward the donation of organs for transplant, "PCID-DTO-Ríos." The reasons against the donation are valued in the questionnaire through a question., Results: Of the participants included in the PCID, students who are not in favor of organ donation were selected (n = 1899). Of them, 8.1% (n = 154) are against and 91.1% (n = 1745) are doubtful. The main reasons indicated are the fear of apparent death in 11.4% of respondents, fear of possible mutilation after donation in 11.1%, and religious reasons in 2.6%. Of those, 6.9% indicate other reasons but do not clearly specify the reasons, using words such as "fear" (2.5%) or "doubts about the process" (4.1%); 66.2% (n = 1257) indicated an "assertive refusal" ("I don't want to express my reasons")., Conclusion: Twenty percent of Spanish medical students are not in favor of donating their organs and are not in favor of showing their reasons., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Awareness of organ donation among Spanish doctors and medical students is very positive. However, the emerging group of professionals of non-Spanish nationality studying in Spain has not been analyzed., Objective: To analyze the differences in the attitudes toward the different types of donation among medical students, according to their nationality., Methods: The population under study is medical students in Spanish universities using the database of the International Collaborative Donor Project, stratified by geographic area and academic year. Groups under study include students of non-Spanish nationality as group 1 (n = 1570) and students of Spanish nationality as Group 2 (n = 7705). Instruments are validated questionnaires of attitude toward donation "PCID-DTO-Ríos," "PCID-DVR-Ríos," "PCID-DVH-Ríos," and "PCID-XenoTx-Ríos.", Results: The attitude toward the donation of own organs after death is similar in both groups (P = .703). Non-Spaniards are 79.2% in favor compared to 79.6% of Spaniards. Living kidney donation, both unrelated (33.3% vs 29.3% in favor; P = .001) and related (91.2% vs 89, 6% in favor; P = .047), is more favorable among non-Spanish students. There are no differences regarding non-related living liver donation (29.7% vs 29.3% in favor; P = .063), but there are differences in the results for related living liver donation (94.1% vs 88%; P < .001). The attitude toward xenotransplantation of organs is similar (80.8% vs 80.8%; P = .999)., Conclusions: Awareness of the donation of organs among Spanish medical students is similar to non-Spanish students studying in Spain, except the attitude toward living donation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Information provided by health care professionals is crucial to create a climate of social opinion. This is important in organ donation and transplantation (ODT), where the participation of the general public is essential to obtain organs., Objective: To determine the attitude toward the Law of Presumed Consent (LPC) among Spanish university students and to analyze their relation with attitude toward ODT., Methods: and design. The type of study was a sociologic, multicenter, observational study. The population included medical and nursing students in Spanish universities. Database of Collaborative International Donor Project was used stratified by geographic area and academic course. A validated questionnaire (Collaborative International Donor Project, organ donation and transplantation questionnaire in Spanish [PCID-DTO-RIOS]) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students was analyzed (99% confidence and precision of ±1%) and stratified by geographic area and year of study., Results: Completion rate was 90%. Regarding attitude toward LPC, 66% of the students were against the law, whereas 34% accepted it. Of the students surveyed, 9% considered the law as a gesture of solidarity, 25% as an effective way of not wasting organs, 48% as an abuse of power, and 18% as offenses against the family. Those students who were in favor of LPC also had a more favorable attitude toward ODT (86% vs 76%; P < .001). Comparing groups, nursing students were less in favor of LPC than medical students (32% vs 36%; P < .000)., Conclusion: Sixty-six percent of Spanish university medical and nursing students were against the LPC. The favorable attitude toward ODT is associated with considering the law as a gesture of solidarity or as an effective way of not wasting organs., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: A favorable attitude toward organ donation and transplantation (ODT) is fundamental among health professionals at the time of transplant promotion. In this sense, the training and awareness of professionals are fundamental., Objective: To analyze the differences in the attitude toward ODT and the factors that condition it among Andalusian medical and nursing students., Methods and Design: The study is a sociologic, multicenter, observational study. The population includes medical and nursing students in Andalusian universities. Database of the Collaborative International Donor Project is used and data are stratified by geographic area and academic course. The instrument of measurement was a validated questionnaire (PCID-DTO-RIOS) that was handed out to every student in a compulsory session. Completion of the questionnaire was anonymous and self-administered. The sample included Andalusian medical and nursing students (99% confidence and precision of ±1%) stratified by geographic area and year of study., Results: There was a completion rate of 91%; 79% (n = 2879) of Andalusian students were in favor of donation and 21% were not in favor. The attitude toward ODT is more favorable in medical compared with nursing students (80% vs 77%; P = .021). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): knowing a transplant patient, having received information about the subject, attitude toward family donation, and having discussed transplantation with family and friends., Conclusion: Andalusian medical students favored organ donation more than Andalusian nursing students, and the favorable attitude is associated with having an awareness of the subject., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Health professionals are asked to promote health, especially organ transplantation; however, they do not always have specific training., Objective: To analyze information about donation and organ transplantation among Spanish medical students., Method: The population under study is medical students in Spanish universities using the database of the International Donor Collaborative Project, stratified by geographic area and academic year (n = 9275). The instrument used is the attitude questionnaire for organ donation for "PCID-DTO-Ríos" transplantation, validated with an explained variance of 63.203% and α = 0.834. The Student t test was applied together with the χ 2 test, complemented by an analysis of the remainders, and Fisher's exact test was applied., Results: Of the students, 74% indicate that they have received information from university professors about organ transplant. Concerning specific issues with the donation, it is notable that only 66.7% (n = 6190) know and accept the concept of brain death as the death of a person. However, only 22% consider themselves as having good information, and 35.3% indicate that their information is scarce or void. Students indicate having received information about transplant from other extra-university sources, such as television and Internet (80.9%), books and magazines (73.2%), and the press (66.9%). From the information obtained in the sociofamilial field, 60.7% have obtained information from the family and 58.1% from friends. Of this information, 9% has been negative from friends, 7.5% from family, 6% from the Internet and television, and 4% from university professors., Conclusion: Spanish medical students believe they have little information about organ transplantation and have received negative information., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Medical students represent a new generation of medical thought, and if they have a favourable attitude towards organ donation this will greatly encourage its promotion., Objective: To analyse the attitude of medical students in Spanish universities towards the donation of their own organs and to determine the factors affecting this attitude., Material and Methods: Type of study: A sociological, interdisciplinary, multicentre, and observational study in Spain., Study Population: Students studying a degree in medicine enrolled in Spain (n = 34,000)., Sample Size: A sample of 9598 students (confidence of 99% and precision of ±1%), stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ donation and transplantation (PCID-DTO RIOS) was self-administered and completed anonymously., Results: The questionnaire completion rate was 95.7% (n = 9.275). 80% were in favour of donation, 2% against and 18% were undecided. The following main variables were related to a favourable attitude: being of the female sex (Odds Ratio = 1.739); being in the sixth year of the degree (OR = 2.506); knowing a donor (OR = 1.346); having spoken about the subject with one's family (OR = 2.132) and friends (OR = 1.333); having a family circle that is in favour, more specifically, having a father (OR = 1.841), mother (OR = 2.538) or partner in favour (OR = 2.192); being a blood donor (OR = 2.824); acceptance of the mutilation of the body if it were necessary (OR = 2.958); and being an atheist or an agnostic (OR = 1.766)., Conclusions: Spanish medical students generally have a favourable attitude towards organ donation, although 20% are not in favour.

The involvement of health professionals from their training period is important for the promotion of living liver donation. There are data that indicate that the awareness of living donation is lower in areas with high rates of deceased donation., Objective: To analyze the attitude toward living liver donation among Spanish medical students, according to donation rates of their regions., Method: Population under study: Medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: group 1 (n = 1136): students in universities of regions with >50 donors per million population (pmp); group 2 (n = 2018): students in region universities with <40 donors pmp. Assessment instrument: the attitude questionnaire for living liver donation Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Hepático-Ríos (PCID-DVH Ríos)., Results: The attitude toward related liver donation is more favorable among the students of regions with <40 donors pmp than among those of >50 donors pmp. Thus, in group 1, a total of 88% (n = 1002) of students are in favor compared with 91% (n = 1831) of group 2 (P=.02). The psychosocial profile of each study group about their attitude toward living related liver donation is analyzed. There is a similar profile between the 2 groups, although there are differences in some variables such as age, a belief that one might need a transplant, family discussion about donation and transplantation, discussion with friends about donation and transplantation, and knowing about a donor., Conclusions: The awareness of living related donation among Spanish medical students is greater among the regions with lower organ donation rates., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Religious factors have conditioned the attitude toward organ donation and transplantation (ODT) since the beginning of transplantation, despite the fact that most religions are in favor of transplantation., Objective: To assess the impact of religious beliefs of medical students on their attitude toward ODT., Method: Population under study: Medical students in Spanish universities., Study Sample: Stratified by geographical area and academic course. Assessment instrument: Attitude ODT questionnaire PCID-DTO-Ríos, anonymous and self-administered., Results: Of all students, 42% (n = 3907) declare themselves atheists or agnostics. The remaining 58% (n = 5368) declare themselves to be religious, the majority being Catholic (55%, n = 5102). Of the rest, 0.2% are Muslims (n = 8), 0.1% Protestants (n = 1), and the remaining 2.7% (n = 257) indicate other religious doctrines but do not want to specify it. Regarding their attitude toward ODT, those who consider themselves atheists or agnostics have a more favorable attitude than those who consider themselves religious (84% versus 76%; P < .001). Among those who follow some kind of religion, Catholics are more in favor of ODT than non-Catholics (77% vs 64%, P < .001). Note that among the religious, only 57% (n = 3050) know which religion is in favor of transplantation, while 22% (n = 1,152) consider that it has not been pronounced on the matter, 13% (n = 723) think the religion is against donation, and the remaining 8% (n = 443) do not know., Conclusion: The religion professed by medical students conditions their attitude toward donation, with the atheists and agnostics being more in favor of donation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The awareness of organ donation among health professionals is important at the time of transplant promotion. In this sense, the training and awareness of the professionals in training is fundamental., Objective: To analyze the differences in the attitude toward organ donation and the factors that condition it among medical students of regions with donation rates >50 donors per million population (pmp) with respect to those with rates <40 donor pmp., Method: Population under study: medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: Group 1 (n = 1136): students in universities of regions with >50 donors pmp. Group 2 (n = 2018): university students in regions with <40 donors pmp. Assessment instrument: attitude questionnaire for organ donation for transplant PCID-DTO-Ríos., Results: The attitude toward organ donation for transplantation is similar among students from the autonomous communities with >50 donors pmp and with <40 donors pmp. In group 1, 79% (n = 897) of students are in favor compared with 81% (n = 1625) of group 2 (P=.29). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): sex, having discussed transplantation with family and as a couple, considering the possibility of needing a transplant, involvement in prosocial activities, attitude toward the manipulation of corpses, knowledge of the brain death concept, and religion., Conclusions: The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To analyze the level of understanding of the brain death concept among medical students in universities in Spain., Methods: This cross-sectional sociological, interdisciplinary, and multicenter study was performed on 9598 medical students in Spain. The sample was stratified by geographical area and academic year. A previously validated self-reported measure of brain death knowledge (questionnaire Proyecto Colaborativo Internacional Donante sobre la Donación y Transplante de Organos) was completed anonymously by students., Results: Respondents completed 9275 surveys for a completion rate of 95.7%. Of those, 67% (n = 6190) of the respondents understood the brain death concept. Of the rest, 28% (n = 2652) did not know what it meant, and the remaining 5% (n = 433) believed that it did not mean that the patient was dead. The variables related to a correct understanding of the concept were: (1) being older ( P < .001), (2) studying at a public university ( P < .001), (3) year of medical school ( P < .001), (4) studying at one of the universities in the south of Spain ( P = .003), (5) having discussed donation and transplantation with the family ( P < .001), (6) having spoken to friends about the matter ( P < .001), (7) a partner's favorable attitude toward donation and transplantation ( P < .001), and (8) religious beliefs ( P < .001)., Conclusions: Sixty-seven percent of medical students know the concept of brain death, and knowledge improved as they advanced in their degree.

Introduction: The attitude of medical students towards living kidney donation (LKD) is of great interest given that they will become promoters of this technique in the near future., Objective: To analyse the attitude of Spanish medical students towards related and unrelated LKD and to determine the factors affecting this attitude., Materials and Methods: Type of study: A sociological, interdisciplinary, multicentre, and observational study., Study Population: Medical students enrolled in Spain (n = 34.000)., Sample Size: A sample of 9598 students (99 % confidence and precision of ±1 %), stratified by geographical area and academic year. Measurement instrument: A validated questionnaire (PCID-DVR RIOS) was administered and completed anonymously., Results: There was a completion rate of 95.7 % (n = 9275); 93 % (n = 8630) were in favour of related LKD, and 30 % (n = 2784) were in favour of unrelated LKD. The following factors were associated with this attitude: (1) age (p = 0.008); (2) sex (p < 0.001); (3) year of university degree (p < 0.001); (4) a belief that a transplant might be necessary in the future (p < 0.001); (5) attitude towards deceased organ donation (p < 0.001); (6) a willingness to accept a kidney from a living donor (p < 0.001); (7) attitude towards living liver donation (p < 0.001); (8) a partner's attitude towards donation (p < 0.001); (9) having spoken about the subject with one's family (p < 0.001), or friends (p < 0.001); (10) pro-social behaviour (p < 0.001); (11) the respondent's religious attitude (p < 0.001); and (12) fear of possible mutilation of the body after donation (p < 0.001)., Conclusions: The attitude of medical students towards LKD is very favourable when it is the related kind of donation, and it is associated with factors of general knowledge about organ donation and transplantation and social interaction and religion.

Aim: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude., Study Type: A sociological, interdisciplinary, multicenter and observational study., Study Population: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011., Sample Size: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions., Statistical Analysis: Student´s t test, χ(2) test and logistic regression analysis., Results: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001)., Conclusion: Spanish medical students have a favorable attitude toward LLD.

Introduction: Research into the transplantation of solid organs from animals (xenotransplantation) is generating interest and curiosity given that this could be a way of resolving the shortage in transplant organs. However, the fact is that currently xenotransplantation is far from becoming a clinical practice., Objective: To analyse the attitude of medical students from Spanish universities towards the donation of organs from animals and to determine the factors affecting their attitudes., Type of Study: A sociological, interdisciplinary, observational and multicentre study in Spain., Study Population: Students enrolled on the medical degree in Spain (n = 34 000)., Sample Size: A sample of 9598 students (a confidence level of 99% and precision of ± 1%) stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ xenotransplantation (PCID-XenoTx RIOS) which was self-administered and completed anonymously., Results: A completion rate of 95.7% (n = 9275) was obtained. If the results of xenotransplantation were as good as in human donation, 81% (n = 7491) would be in favour, 3% (n = 308) against and 16% (n = 1476) undecided. The following variables affected this attitude: sex (P < 0.001); academic year (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); the opinion of one's partner (P < 0.001); the respondent's attitude towards organ donation (P < 0.001); religion (P < 0.001); and participation in altruistic activities (P < 0.001). The following variables persisted in the multivariate analysis: (1) being a female (OR = 1.794; P < 0.001); (2) academic year (OR = 2.487; P < 0.001); (3) having spoken about the issue with one's family (OR = 1.200; P = 0.019); (4) the favourable opinion of one's partner (OR = 1.526; P = 0.028); (5) an attitude in favour of donation (OR = 2.087; P < 0.001); (6) being an atheist/agnostic, (OR = 2.5; P < 0.001); and (7) a belief that one's religion is in favour of transplantation (OR = 1.317; P = 0.005)., Conclusions: Spanish medical students have a favourable attitude towards xenotransplantation. This willingness and interest could be a decisive platform for the development and strengthening of research, both for centres with a pre-clinical xenotransplantation programme and new healthcare centres., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction and Objectives: Erectile dysfunction (ED) leads to psychological disturbances, especially anxiety and loss of self-esteem. We try to understand the emotional changes, based on self-esteem and relationships in a group of Spanish men with ED after sildenafil treatment, with the use of the the SEAR questionnaire (Self-Esteem And Relationship)., Materials and Methods: The patients recruited in Spain, where selected from an international, multicenter, randomized, parallel-group, double-blind, placebo-controlled, sildenafil study designed to assess self-esteem and relationships in men with ED. We compared the changes in the different domains of the SEAR questionnaire (Self-steem, sexual activity, self-confidence and general relationships) that was administered before and after treatment; the different domains of the IIEF was evaluated as well. We also calculated the correlation between changes in self-esteem domain of the SEAR questionnaire. The statistical study was based on an analysis of covariance of change in scores and a correlation analysis., Results: The Spanish group of researchers included 119 patients. The erectile function domain score showed significantly greater improvement for the group of sildenafil. The difference in change in total mean score of the SEAR after treatment was 16.9 (95% CI 8.9, 24.8) for sildenafil over placebo (p=0.0001), with a significantly higher score improvement in all the domains of the SEAR for Sildenafil. There was a significant correlation between the changes in the domain of self-esteem of the SEAR and the IIEF erectile function domain for both treatment groups., Conclusions: Emotional improvement was confirmed in patients treated with sildenafil based on improved self-esteem, self-confidence and relationships. Changes in the IIEF erectile function domain correlate with the SEAR self-esteem domain.

Introduction: Erectile dysfunction (ED) has been associated with several comorbidities and can cause significant loss of quality of life and self-esteem., Aim: In men with ED, to use the validated Self-Esteem and Relationship (SEAR) questionnaire to evaluate changes in self-esteem associated with sildenafil treatment of ED and to assess changes dependent on concomitant comorbid conditions., Methods: This was a 14-week, international, randomized, parallel-group, double-blind, flexible-dose (25, 50, or 100 mg), placebo-controlled study of sildenafil in men aged >or=18 years with a clinical diagnosis of ED (score

Background: To determine the clinical and radiographic results of arthroereisis using the Giannini endo-orthotic implant for the treatment of pediatric flatfoot deformity, we retrospectively evaluated 37 patients (65 feet)., Methods: Twenty-two boys and 15 girls were followed for an average of 26.5 months. Their overall average age was 9.4 (range 5 to 14) years. Pain, function, participation in sports activity, and the changes in radiographic measurements taken at 3, 6, and 12 months and then at 1-year intervals were evaluated., Results: Pain or discomfort decreased from 60% (22 patients) preoperatively to 6% (2 patients) postoperatively. The percentage of normal postoperative footprints was 59% (38 feet) with first-degree flatfoot present in 27 feet (41%). Sports activities were taken up by 19 patients (51%) after surgery. An 8-mm endo-orthotic implant was used in 43 (66%) feet and an Achilles tenotomy was done in 38 feet (59%). The radiographic angles with the greatest degree of correction when compared to preoperative angles were the talar-first metatarsal angle (99%) and the calcaneal-pitch (36%). After placement of the endo-orthotic implant, the talar angle influenced the rest of the radiographic measurements. There was no postoperative deterioration in any of the radiographic angles measured during the monitoring period. Complications occurred in 10.7% of the patients, with postoperative pain being the most frequently reported (6% of patients). There was no infection or local reaction to a foreign body. Removal of the endo-orthotic implant was not done on a routine basis., Conclusion: This operative technique respects the anatomical structure of the foot and produces good clinical and radiographic results.