Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia

Total Sanitation and Sanitation Marketing (TSSM) is the Indonesian component of World Bank Water and Sanitation Program's Scaling Up Rural Sanitation initiative. The approach consists of raising awareness of the problems of open defecation; marketing sanitation products; and supporting policies, financing, training, and regulations that are conducive to these efforts. Therefore, desired outcomes of the program include changes in perception of the consequences of poor sanitation, toilet construction and access to improved sanitation, reduction in open defecation, and child health outcomes. This impact evaluation assesses these results using a randomized controlled trial (RCT), and unlike many RCTs that are carried out on pilot programs, it looks at an intervention that has been implemented at scale and led by the government under real-world conditions, providing more reliable estimates. TSSM is associated with sanitation improvements overall, particularly among wealthier households that had no sanitation prior to the intervention

Do workfare programmes reduce educational attainment? Evidence from India

Workfare programmes have become an increasingly common form of social transfer. From 2007-2009, the World Bank alone funded workfare programmes in 24 different countries. While they offer a valuable safety net to households in lean times, workfare programmes can also produce unintended effects. Looking at the case of NREGA in India, today’s blog argues that a better understanding of ‘price effects’ is needed to improve targeting and reduce trade-offs to educatio

Face Value: Information and Signaling in an Illegal Market

Economists argue that rich information environments and formal enforcement of contracts are necessary to prevent market failures when information asymmetries exist. We test for the necessity of formal enforcement to overcome the problems of asymmetric information by estimating the value of information in an illegal market with a particularly rich information structure: the online market for male sex work. We assemble a rich dataset from the largest and most comprehensive online male sex worker website to estimate the effect of information on pricing. We show how clients of male sex workers informally police the market in a way that makes signaling credible. Using our institutional knowledge, we also identify the specific signal male sex workers use to communicate quality to clients: face pictures. We find that there is a substantial return to information, and that it is due entirely to face pictures. Interestingly, the return is in the range of returns to information estimated for legal markets. We also provide suggestive evidence that our premium to face pictures is not being driven by a beauty premium. The findings provide novel evidence on the ability of rich information environments to overcome the problems of asymmetric information without formal enforcement mechanisms.

Early Child Development and Maternal Labor Force Participation: Using Handedness as an Instrument

We estimate the effect of early child development on maternal labor force participation using data from teacher assessments. Mothers might react to having a poorly developing child by dropping out of the formal labor force in order to spend more time with their child, or they could potentially increase their labor supply to be able to provide the funds for better education and health resources. Which action dominates is therefore the empirical question we seek to answer in this paper. Importantly, we control for the potential endogeneity of child development by using an instrumental variables approach, uniquely exploiting exogenous variation in child development associated with child handedness. We find that having a poorly developing young child reduces the probability that a mother will participate in the labor market by about 25 percentage points.handedness, child development, maternal labor force participation

Handedness, Health and Cognitive Development: Evidence from Children in the NLSY

Using data from the US National Longitudinal Survey of Youth, and fitting family fixed-effects models of child health and cognitive development, we test if left-handed children do significantly worse than their right-handed counterparts. The health measures cover both physical and mental health, and the cognitive development test scores span (1) Memory, (2) Vocabulary, (3) Mathematics, (4) Reading and (5) Comprehension. We find that while left-handed children have a significantly higher probability of suffering an injury needing medical attention, there is no difference in their experience of illness or poor mental health. We also find that left-handed children have significantly lower cognitive development test scores than right-handed children for all areas of development with the exception of reading. Moreover, the left-handedness disadvantage is larger for boys than girls, and remains roughly constant as children grow older for most outcomes. We also find that the probability of a child being left-handed is not related to the socioeconomic characteristics of the family, such as income or maternal education. All these results tend to support a difference in brain functioning or neurological explanation for handedness differentials rather than one based on left-handed children living in a right-handed world.handedness, children, health, cognitive development, family fixed-effects

Association of ABO Blood Groups with Cardiovascular Diseases in Adult Indian Population

This study was designed to investigate whether there was an association between ABO blood groups and major cardiovascular diseases (ischemic heart diseases) in adult Indian population. The present retrospective study analyzed ABO blood groups among 1527 patients with documented IHD, who were treated at CIMS Hospital in Ahmedabad city from January to December, 2011 comparing with a control group of 860 subjects. Data were analyzed with GraphPad Prism 6.0 and by using chi square test. A p-value less than 0.05 were considered as +statistically significant. No significant difference in distribution of ABO blood groups was seen in patients with IHD (A, 21.95%; B, 35.41%; AB, 8.61%; O, 34.01%) and also after adjustment for common cardiovascular risk factors such as age, gender, addiction history, obesity, hypertension, diabetes in these patients (A, 25.47%; B, 37.53%; AB, 9.04%; O, 27.94%) as compared to the controls (A, 22.32%; B, 35.58%; AB, 8.83%; O, 33.25%), p-value = 0.9916 and 0.2778 respectively. The findings of the study suggest that there seems to be no correlation between various ABO blood groups and development of cardiovascular diseases. Moreover, the prevalence of major risk factors was equal in patients with different blood groups and blood groups had no impact on development of cardiovascular pathogenesis in individual subjects

The complicated management of a patient following transarterial chemoembolization for metastatic carcinoid

<p>Abstract</p> <p>Background</p> <p>Transarterial Chemoembolization (TACE) has been recognized as a successful way of managing symptomatic and/or progressive hepatic carcinoid metastases not amenable to surgical resection. Although it is a fairly safe procedure, it is not without its complications.</p> <p>Case presentation</p> <p>This is a case of a 53 year-old woman with a patent foramen ovale (PFO) and mild pulmonary hypertension who underwent TACE for progressive carcinoid liver metastases. She developed acute heart failure, due to a severe inflammatory response; this resulted in pneumatosis intestinalis due to non-occlusive mesenteric ischemia. We describe the successful non-operative management of her pneumatosis intestinalis and the role of a PFO in this patient's heart failure.</p> <p>Conclusion</p> <p>TACE remains an effective and safe treatment for metastatic carcinoid not amenable to resection, this case illustrates the complexity of complications that can arise. A multi-disciplinary approach including ready access to advanced critical care facilities is recommended in managing such complex patients.</p

Ukierunkowane molekularnie leczenie chorych na raka tarczycy — przegląd badań klinicznych

Purpose of review. Several new targeted therapies with multikinase inhibitors targeting vascular endothelial growth factor (VEGF), rearranged during transfection and v-raf murine sarcoma viral oncogene homolog B1 pathways have been tested in clinical trials for radioiodine-refractory differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC) in the past 10 years. Recent findings. Results of the fi rst phase III trial of VEGF-targeted therapy (sorafenib) in DTC were presented in June 2013, and two phase III trials with VEGF and rearranged during transfection-targeted therapies (vandetanib and cabozantinib) in MTC have led to approval by US Food and Drug Administration in the past 2 years. Whereas such therapies increase median progression-free survival compared to placebo, there is no therapy proven to improve overall survival yet. Signifi cant potential adverse event risks associated with such therapies need to be recognized. Dissemination of knowledge about targeted therapies is critical for various medical specialists as patient care for thyroid cancers is best delivered in a multidisciplinary setting. Summary. Successful development of targeted systemic therapies in DTC and MTC in the past 5 years is incredibly exciting in the fi eld and patients with advanced DTC/MTC now have new standard-of-care therapy options.Cel przeglądu. W ciągu ostatnich 10 lat w kilku badaniach klinicznych oceniano rolę wielokinazowych inhibitorów czynnika wzrostu śródbłonka naczyń (VEGF), protoonogenu RET (REarranged during Transfection) i protoonkogennej kinazy serynowo-treoninowej BRAF (v-raf murine sarcoma viral oncogene homolog B1) w leczeniu chorych na zróżnicowanego raka tarczycy (DTC) opornego na jod radioaktywny oraz raka rdzeniastego tarczycy (MTC). Najnowsze odkrycia. W czerwcu 2013 roku przedstawiono wyniki pierwszego badania III fazy dotyczącego leczenia ukierunkowanego przeciwko VEGF (sorafenib) w DTC, a w ciągu ostatnich 2 lat wyniki dwóch innych badań III fazy analizujących leki skierowane przeciwko VEGF i RET (wandetanib i kabozantynib) w MTC, które doprowadziły do rejestracji tych leków przez amerykańską Agencję ds. Żywności i Leków. W porównaniu z placebo, leczenie ukierunkowane wydłużało medianę czasu przeżycia wolnego od progresji, jednak żaden z ocenianych schematów terapeutycznych nie wpływał na przeżycie całkowite. Planując leczenie należy brać pod uwagę ryzyko istotnych działań niepożądanych. Postępowanie terapeutyczne u chorych na raka tarczycy ma charakter wielodyscyplinarny, dlatego istotne znaczenie ma popularyzacja wiedzy na temat leczenia ukierunkowanego molekularnie wśród lekarzy różnych specjalności. Podsumowanie. Znaczący rozwój metod leczenia ukierunkowanego molekularnie sprawił, że w ciągu ostatnich 5 lat pojawiły się nowe opcje terapeutyczne dla chorych na zaawansowane DTC/MTC

Luteoma in pregnancy: a rare cause of threatened preterm labour!

Pregnancy luteoma is a rare non-neoplastic tumor-like mass of the ovary. They are usually asymptomatic and found incidentally during ultrasound imaging or surgery. Rarely do they present with pain abdomen mimicking threatened preterm labor. They regress spontaneously after delivery. We presented a case of a 29-year-old G4A3 with twin pregnancies and chronic hypertension who presented with acute flank pain, constipation, and occasional hardening of the uterus. A provisional diagnosis threatened preterm labor with suspected ureteric colic and cystitis was made. The patient was initially managed on the same line but on a detailed in-patient evaluation her ultrasound revealed bilateral multicystic ovaries with few hypoechoic areas inside it mostly suggestive of ‘luteoma of pregnancy’. The patient had acne, hirsutism, and chronic hypertension well controlled on antihypertensives. The patient delivered twins successfully by cesarean section and luteoma and symptoms were resolved postpartum after 4 months. Recognition of this entity is important so that malignancy can be ruled out and unnecessary surgery, with concomitant risk to both the mother and the fetus, is avoided

How Does Health Promotion Work? Evidence from the Dirty Business of Eliminating Dirty Defecation

We investigate the mechanisms underlying health promotion campaigns designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. Health promotion works through a number of mechanisms, including: providing information on the return to better behavior, nudging better behavior that one already knows is in her self-interest, and encouraging households to invest in health products that lower the marginal cost of good behavior. We find that health promotion generally worked through both convincing households to invest in in-home sanitation facilities and nudging increased use of those facilities. We also estimate the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation for identification. Surprisingly we find a fairly linear relationship between village open defecation rates and the height of children less than 5 years old. Fully eliminating open defecation from a village where everyone defecates in the open would increase child height by 0.44 standard deviations. Hence modest to small reductions in open defecation are unlikely to have a detectable effect on child height and explain why many health promotion interventions designed to reduce open defecation fail to improve child height. Our results suggest that stronger interventions that combine intensive health promotional nudges with subsidies for sanitation construction may be needed to reduce open defecation enough to generate meaningful improvements in child health