Public-Private Co-operation for Gas Provision in Poor Neighbourhoods of Buenos Aires: Impact on Housing Improvements and Health

This study examines the programme Redes Solidarias, a public-private initiative that connected to natural pipelined gas 4,000 households in the Great Buenos Aires Area during 2005. The main features of the institutional framework are described and the main results of an impact estimation analysis are reported. The mechanism of selection of neighbourhoods for the connection represents a ‘natural experiment’, which allows the estimation of the causal effects of the programme on several indicators, including housing improvements, health and happiness related variables. We perform this analysis using data from two surveys we collected on the neighbourhoods in 2006 and 2007. The programme was found to generate improvements on dwelling walls, and the …infrastructure provision, gas, impact evaluation

A Note on Quadratic Funding under Constrained Matching Funds

In this note I show that quadratic funding achieves decentralized social efficiency in the extent there are enough (donor) matching funds to cover the quadratic funding objective. If individual backers internalize that matching funds will not be sufficient to reach the quadratic level, allocation will be biased towards the capitalist allocation, the more so, the less matching funds are available. This result emerges even when individual contributors are not required to finance the deficit (i.e., the difference between total contributions and available matching funds). I also show properties of the level of required matching fund, in order to better understand under which conditions social efficiency will most likely be compromised

Are the review criteria for automated complete blood counts of the International Society of Laboratory Hematology suitable for all hematology laboratories?

AbstractObjectiveto verify whether the review criteria for automated blood counts suggested by the International Consensus Group for Hematology Review of the International Society for Laboratory Hematology are suitable for the Hematology Laboratory of Hospital de Clinicas, Universidade Federal do Paraná.Methodsinitially, the review criteria of the International Society for Laboratory Hematology were adapted due to limitations in the Institution's electronic hospital records and interfacing systems. The adapted review criteria were tested using 1977 samples. After this first assessment, an additional 180 inpatient samples were analyzed to evaluate the screening criteria of the review criteria in conjunction with positive smear findings established by the institution. The performance of the review criteria was verified by determining false positive, false negative, true positive and true negative rates, sensitivity, specificity, positive predictive value, negative predictive value, microscopic review rate and efficiency.Resultsinitial analysis showed false negatives=6.73%, false positives=23.27%, microscopic review rate=46.03% and efficiency=70.0%. An evaluation of the screening criteria adapted from the review criteria together with the positive smear findings of the institution showed false negatives=15.5%, false positives=10.5%, microscopic review rate=37.3% and efficiency=73.8%. In both situations the safety limit (false negative <5%) recommended by the review criteria was exceeded.Conclusionsthe review criteria adapted from the International Society for Laboratory Hematology are neither suitable nor safe for use in the hematology laboratory of the Hospital de Clinicas. This implies a need to develop and validate institution-specific review criteria in order to decrease false negative results to an acceptable and safe rate for patients

Bone marrow transplantation for aplastic anemia

As aplasias medulares compreendem entidades clínicas adquiridas e congênitas que, através de mecanismos distintos, determinam redução acentuada da celularidade da medula óssea em uma ou mais linhagens, sem infiltração neoplásica ou fibrose. A intensidade das citopenias, no sangue periférico, confere a gravidade da doença, particularmente quando relacionada à trombocitopenia e à neutropenia. A Anemia Aplástica Severa (AAS) adquirida é a entidade mais freqüente deste grupo e seu tratamento consiste em medidas de suporte, terapia imunossupressora (TI) e transplante de medula óssea (TMO). O tratamento de suporte é fundamental para evitar complicações fatais, especialmente hemorragias e infecções. A escolha do tratamento definitivo, TI ou TMO, fundamenta-se na intensidade da neutropenia, na idade do paciente e, obviamente, na existência de doador aparentado HLA idêntico. O TMO está indicado nos casos de AAS com idade inferior a 20 anos e naqueles entre 20 e 40 anos, que sejam considerados de alto risco e, nesta mesma faixa etária ou acima de 40 anos, que não tenham respondido ao TI. Transfusões sangüíneas prévias ao TMO interferem no seu sucesso, pois os pacientes com menos de 15 transfusões apresentam uma sobrevida superior a 90% e naqueles mais transfundidos, cai para 65%. O TMO entre singênicos (gêmeos idênticos) exibe características próprias e a utilização de doadores não aparentados é viável, porém, permanece em fase experimental. A Anemia de Fanconi (AF) é a mais comum aplasia de origem hereditária e pode ser totalmente corrigida pelo TMO. Devido à extrema sensibilidade dos pacientes a agentes alquilantes e à irradiação, foi necessário desenvolver um regime de condicionamento específico para reduzir sua toxicidade e melhorar os resultados. A regeneração hematológica completa, após TMO alogênico aparentado, ocorre em mais de 80% dos pacientes. Ao contrário, os resultados com doadores não aparentados são pobres. Disceratose Congênita, Anemia de Blackfan-Diamond e Trombocitopenias Hereditárias são outras formas de aplasias hereditárias passíveis de correção completa pelo TMO.Aplastic anemias are congenital or acquired clinical disorders characterized by cytopenia of peripheral blood associated with a hypocellular bone marrow not infiltrated by other abnormal tissues or fibrosis. The degree of pancitopenia, particularly thrombocytopenia and granulocytopenia, establishes the prognosis. Severe Aplastic Anemia (SAA) is the most frequent entity of this group of diseases and its treatment involves supportive measures, immunosuppressive therapy (IT) and bone marrow transplantation (BMT). Supportive treatment is of major importance to prevent serious and fatal complications, particularly bleeding and infections. The choice of the definitive therapy is based in the age of the patient, disease severity and obviously the availability of an HLA identical sibling marrow donor. BMT is indicated for patients with SAA younger than 20 years, for high risk patients between the ages 20-40 and for other patients who did not respond to IT. Blood transfusions previous to BMT are an adverse factor, since in patients less transfused (&lt;15 units), the long term disease free survival is more than 90%, and for those heavily transfused it drops to 65%. Syngeneic (identical twin) transplants are successful, however have specific characteristics. The utilization of an unrelated marrow donor for BMT in SAA is possible but it is still considered experimental. Fanconi Anemia (FA) is the most common hereditary aplastic anemia in which BMT is able to restore a normal hematopoiesis. FA patients are extremely sensitive to alkylating agents and irradiation and a specific preparative regimen for BMT was developed to avoid unacceptable toxicity. Currently, complete hematologic recovery occurs in more than 80% of FA patients after an HLA-identical sibling allogeneic BMT. The results of unrelated bone marrow donor transplantation in FA are still poor. Dyskeratosis Congenita, Blackfan-Diamond Anemia and Hereditary Thrombocytopenias are other forms of hereditary aplasias in which BMT is able to fully correct the hematological abnormalities

Transplante de medula óssea: uma confluência biopsicossocial

The purpose of this article is to verify certain components of the contextualization of bone marrow transplanting and its interference in the care and interpretation of the psyche-body of the person who is suffering the illnes. The identification of the psychological aspects of cancer, boné marrow transplant, patients and psychosocial morbidity is an important step towards therapeutic intervention plans. Psychologists and doctors can work together with the aim of reducing stress and contributing positively towards patients' recovery, since the experience of a bone marrow transplant includes undergoing physical and physiological alterations, emotional, functional, social, family and spiritual changes. Keywords: Bone Marrow Transplant vs. Biological and Psychosocial Convergence.O objetivo deste artigo é verificar alguns componentes da contextualização do transplante de medula óssea e a sua interferência nos cuidados e na interpretação da psique-corpo daquele que perpassa pelo adoecimento. A identificação dos aspectos psicológicos do câncer, do transplante de medula óssea, dos pacientes e da morbidade psicossocial é um passo importante em direção aos planos de intervenções terapêuticas. Psicólogos e médicos podem trabalhar juntos com o intuito de reduzir o estresse e contribuir positivamente na recuperação dos pacientes, pois a vivência do transplante de medula óssea inclui a experimentação de alterações físicas, fisiológicas, mobilizações emocionais, funcionais, sociais, familiares e espirituais. Palavras-chave: Transplante de Medula Óssea x Confluência biopsicossocial

Chronic Myeloid Leukemia National Consensus Meeting

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Patients' Perceptions About Diagnosis And Treatment Of Chronic Myeloid Leukemia: A Cross-sectional Study Among Brazilian Patients.

Chronic myeloid leukemia (CML) requires strict daily compliance with oral medication and regular blood and bone marrow control tests. The objective was to evaluate CML patients' perceptions about the disease, their access to information regarding the diagnosis, monitoring and treatment, adverse effects and associations of these variables with patients' demographics, region and healthcare access. Prospective cross-sectional study among CML patients registered with the Brazilian Lymphoma and Leukemia Association (ABRALE). CML patients receiving treatment through the public healthcare system were interviewed by telephone. Among 1,102 patients interviewed, the symptoms most frequently leading them to seek medical care were weakness or fatigue. One third were diagnosed by means of routine tests. The time that elapsed between first symptoms and seeking medical care was 42.28 ± 154.21 days. Most patients had been tested at least once for Philadelphia chromosome, but 43.2% did not know the results. 64.8% had had polymerase chain reaction testing for the BCR/ABL gene every three months. 47% believed that CML could be controlled, but 33.1% believed that there was no treatment. About 24% reported occasionally stopping their medication. Imatinib was associated with nausea, cramps and muscle pain. Self-reported treatment adherence was significantly associated with normalized blood count, and positively associated with imatinib. There is a lack of information or understanding about disease monitoring tools among Brazilian CML patients; they are diagnosed quickly and have good access to treatment. Correct comprehension of CML control tools is impaired in Brazilian patients.0

Accelerated phase chronic myeloid leukemia: evaluation of clinical criteria as predictors of survival, major cytogenetic response and progression to blast phase

AbstractBackgroundPublished criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome.MethodsThis is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10–29%, basophils≥20%, platelets>1×106/μL or <1×105/μL and white blood cells>1×105/μL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin<10g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity.ResultsRisk factors for poor survival in multivariate analysis were Grades 3–4 hematologic toxicity (p-value=0.001), blasts 10–29% (p-value=0.023), and hemoglobin<10g/dL (p-value=0.04). Risk factors for not achieving major cytogenetic response were blasts 10–29% (p-value=0.007), hemoglobin<10g/dL (p-value=0.001), and previous use of interferon (p-value=0.032). Risk factors for progression to the blast phase were hemoglobin<10g/dL (p-value=0.005), basophils≥20% (p-value=0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment>12 months (p-value=0.030).ConclusionThese data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used

UTILIZAÇÃO DO RAMO E PROCESSO CORONÓIDE DA MANDÍBULA PARA A RECONSTRUÇÃO TOTAL DE MAXILA ATRÓFICA

A reabilitação implanto-suportada dos maxilares atróficos requer reconstrução prévia do volume ósseo a fim de permitir a instalação de implantes dentários em ótima posição tridimensional e assim proporcionar uma reabilitação protética ideal funcionalmente e esteticamente.  A escolha do sítio doador do enxerto ósseo a ser utilizado deve considerar características e intensidade da atrofia óssea. Diversas fontes doadoras de enxerto ósseo estão disponíveis para reconstruções maxilares, diferenciando-se quanto as características embriológicas (ossificação endocondral x intramembranosa), tipo de osso (cortical x medular), características físicas e morfológicas, volume de osso disponível, morbidade associada à remoção e taxa de reabsorção do enxerto. O presente trabalho visa demonstrar um caso clínico de reconstrução total de maxila atrófica com enxerto ósseo removido dos ramos e processos coronóides da mandíbula. Tal enxerto, além de evitar a remoção de enxertos ósseos de fontes extra-orais e consequentemente a morbidade associada a tal remoção, cumpriu os requisitos ideais dos enxertos ósseos, tais como baixa morbidade do sítio doador, mínima reabsorção, facilidade de remoção, alto componente cortical e principalmente promoção de volume ósseo suficiente para a instalação de implantes dentários após incorporação do osso transplantado