Americans' willingness to give to global immunization programs: Political heterogeneity in preferences for program management and response to priming communications.

To develop effective private donation campaigns that support vaccine distribution in low- and middle-income countries (LMICs), one must understand donors' willingness to give, response to stimuli, and preferences for program management. We use a contingent valuation method to estimate United States citizens' willingness to give to nongovernmental COVID-19 immunization programs in LMICs during the emergency phase of the pandemic. Using split-sample treatments, we evaluate the impact of the immunization program administrator (generic NGO or COVAX) and the role of priming communications on inequality in income and vaccination rates between the US and recipient countries. Results show that the median American would donate $42 towards global immunization programs. Preferences for program management and responses to priming communications are heterogeneous across political affiliations, after controlling for altruistic motives, experiences with COVID, giving behaviors, and sociodemographic characteristics. Specifically, Democrats and Independents are more likely to donate to the COVAX-administered fund, and more responsive to priming statements regarding vaccine-gaps. Policy implications are discussed.

Treatment of Lethal Caffeine Overdose with Haemodialysis: A Case Report and Review.

Caffeine, chemically 1,3,7-trimethylxanthine, is the most widely consumed central nervous system stimulant in the world with pleiotropic effects on the cardiovascular, pulmonary, and renal systems. The advent of over the counter (OTC) caffeine formulations has opened the window for potential toxicity, either by inadvertent or intentional overdosing. We present the case of a patient who attempted suicide by caffeine overdose treated with emergent haemodialysis and a review of the literature.

Valuing improved water services and negative environmental externalities from seawater desalination technology: A choice experiment from the Galápagos.

While seawater desalination technologies can improve drinking water supply, they can also generate significant environmental externalities. A choice experiment was implemented to investigate household preferences for potential trade-offs between improved water services and environmental impacts from seawater desalination in the Galápagos Islands. Our results indicate that households are willing to pay for water quality improvements, and for protection of coastal ecosystems and marine organisms. In contrast, households seem indifferent regarding water availability and potential impacts on air quality. Our findings also suggest that respondents who consistently reject the proposed desalination project tend to be less affluent and have stronger environmental preferences than those who support it. It is concluded that stated-preference studies on improved water services should also elicit preferences for potential environmental effects of the proposed water technology.

Willingness to give amid pandemics: a contingent valuation of anticipated nongovernmental immunization programs.

Given that altruism is crucial in assisting impoverished households to cope with health and economic crises, it is important to improve our understanding of how preferences and motives for giving differ during a pandemic. We implemented a web-based, contingent valuation survey to estimate Americans' willingness to give for nongovernmental immunization programs in the context of the COVID-19 pandemic. Our results indicate that the median person is willing to give a one-time donation of $26, or at least $13 when willingness-to-give estimates are corrected for uncertainty regarding future donations. We find that willingness to give is related to income, concern levels, vaccine usage, and sociodemographic characteristics. Our findings also shed light on purely and impurely altruistic motives underlying the willingness to fund immunization programs.

Will Americans Get Vaccinated? Predicting COVID-19 Vaccine Uptake Rates Under Contingent Scenarios.

OBJECTIVES: Amid a pandemic, vaccines represent a promising solution for mitigating public health and economic crises, and an improved understanding of individuals' vaccination intentions is crucial to design optimal immunization campaigns. This study predicts uptake rates for different COVID-19 vaccine specifications and identifies personal characteristics that moderate an individual's responsiveness to vaccine attributes. METHODS: We developed an online survey with contingent specifications of a COVID-19 vaccine, varying in effectiveness, risks of side effects, duration of immunity, and out-of-pocket cost. Using population-averaged logit models, we estimated vaccine uptake rates that account for uncertainty, heterogeneity across respondents, and interactions between vaccine and personal characteristics. RESULTS: We obtained 3047 completed surveys. The highest uptake rate for an annual vaccine, 62%, is predicted when vaccine effectiveness is 80% to 90%, side effects are minimal, and the vaccine is provided at zero cost, with decreases seen in the uptake rate for less effective vaccines, for example, 50% for 50% to 60% effectiveness. Moreover, we found that Americans' response to vaccine effectiveness depends on their self-reported concern, that is, concerned respondents report a higher willingness to get vaccinated. Our findings also indicate that COVID-19 vaccine uptake rates decrease with vaccine cost and that responsiveness to vaccine cost is moderated by income. CONCLUSIONS: Although providing the COVID-19 vaccine at zero cost will motivate many individuals to get vaccinated, a policy focused exclusively on vaccine cost may not be enough to reach herd immunity thresholds. Although those concerned with COVID-19 will participate, further evidence is needed on how to incentivize participation among the unconcerned (43%) to prevent further pandemic spread.

Immediate and informative feedback during a pandemic: Using stated preference analysis to predict vaccine uptake rates.

In response to an emerging pandemic, there is urgent need for information regarding individual evaluation of risk and preferences toward mitigation strategies such as vaccinations. However, with social distancing policies and financial stress during an outbreak, traditional robust survey methodologies of face-to-face, probabilistic sampling, may not be feasible to deploy quickly, especially in developing countries. We recommend a protocol that calls for a sensitive survey design, acceptance of a web-based approach and adjustments for uncertainty of respondents, to deliver urgently needed information to policymakers as the public health crisis unfolds, rather than in its aftermath. This information is critical to tailor comprehensive vaccination campaigns that reach critical immunity thresholds. We apply our recommendations in a regional study of 16 Latin American countries in the month following index cases of COVID-19. We use a split-sample, contingent valuation approach to evaluate the effects of cost, duration of immunity and effectiveness of the vaccine. Our results show that cost and duration of immunity are significant factors in the decision to vaccinate, while the degree of effectiveness is insignificant, unless the vaccine is 100% effective. Income as well as perceived risk and severity of the virus are important determinants also.

The value of COVID-19 tests in Latin America.

Testing is a crucial strategy to control the spread of a pandemic. Voluntary participation in this strategy will depend on individual preferences towards and willingness-to-pay (WTP) for test results. We distributed a web-based, contingent valuation survey to social-media users in 16 Latin American countries to evaluate regional attitudes towards the emerging COVID-19 outbreak and WTP for COVID-19 testing. We observe that the cost of the test and household income are important determinants of testing intentions. We find higher WTP among those reporting greater concern relative to the average respondent. Accounting for uncertainty, our results indicate a WTP of approximately $45 dollars or 4.2 % of monthly income among respondents. These results, paired with our predicted participation rate of between 84-94 % for a $1 test, suggest that local officials will be able to effectively recruit participation in this mitigation strategy given the appropriate subsidization structure.

Bactericidal effect on skin mucosa of dietary guava (Psidium guajava L.) leaves in hybrid tilapia (Oreochromis niloticus × O. mossambicus).

ETHNOPHARMACOLOGICAL RELEVANCE: Due to the intensification practices in global aquaculture, fish are often confined in small volumes, which can results in outbreak diseases. In this context, the use of antibiotics is very usual. Thus, looking for natural substance able to reduce the use of the antibiotics is imperative. Among them, there is a great interest at present in the study of medicinal plants such as guava (Psidium guajava L.). These plants could help to develop a more sustainable aquaculture all over the world. The application of guava in traditional medicine dates for centuries and it is widely used in tropical countries for the treatment of diseases in human and animals. AIM OF THE STUDY: The purpose of this work was to study the effects of the dietary administration of dried leaves of Psidium guajava on the skin mucosal immunity of hybrid tilapia (Oreochromis niloticus × O. mossambicus). Furthermore, the ability of this plant to inhibit the bacterial load in different tissues after an experimental infection with Vibrio harveyi was studied. MATERIALS AND METHODS: P. guajava leaves collection and the experimentation was carried out in Dominican Republic. Fish were fed with a commercial diet supplemented with guava leaf at different concentrations (0%, 1.5% and 3%) for 21 days before being intraperitoneally injected with V. harveyi (1 × 104 cells mL-1). Thereafter, several immune activities were measured in fish skin mucus and after 48 h of injection, the skin, spleen and liver were collected to analyse the bactericidal activity of guava leaf and the gene expression of some immune related genes. RESULTS: The administration of P. guajava leaves significantly modulated some immune-related enzymes (protease, antiprotease and peroxidase) in the skin mucus of hybrid tilapia. In addition, the bacterial load after V. harveyi infection in skin, spleen and liver significantly reduced in fish supplemented with guava leaves. Finally, the expression profile of hepcidin gene in skin and liver was modulated in fish feed with control diet after V. harveyi infection. CONCLUSION: These results demonstrate that the dietary intake of guava leaves increases the skin mucosal barrier defences of hybrid tilapia and confers protection against V. harveyi colonization.

Do the urban poor want household taps? Community preferences and willingness to pay for household taps in Accra, Ghana.

In Sub-Saharan Africa, only 35% of the urban population has piped water on premises despite the economic (time savings) and public health benefits that household taps offer. In the urban informal settlements, even fewer people own household taps. However, while there is extensive literature on everyday urban water insecurity in the region, far less attention has focused on whether the urban poor are interested in private taps, and if so, what service attributes are important to them. We implemented a choice experiment in Nima, an urban settlement in Accra, Ghana, to investigate community preferences and willingness to pay (WTP) for household taps. We used a comprehensive set of system attributes including days of service, service hours, water pressure, water quality, connection fees, monthly payment, and management, an attribute very few WTP studies have explored. Results from the choice experiment show that residents are more sensitive to time (not day) of service delivery, quality of water, connection fees, and monthly water bills. Households had no preference between a 24-h supply and 12-h supply during the day. Households preferred Accra Metropolitan Assembly (AMA) to Ghana Water Company Limited (GWCL) as the service provider and were willing to pay more for a system managed by AMA, an indication of declining trust in GWCL. The findings provide valuable information that policymakers and water utilities can use to assess the feasibility and cost effectiveness of extending household taps to poor urban settlements.

Climbing the water ladder in poor urban areas: Preferences for 'limited' and 'basic' water services in Accra, Ghana.

While providing drinking water on premises to all citizens in urban areas may be desirable, economic and institutional challenges coupled with poverty, insecure tenure, and other barriers prevent many water utilities from providing private taps to all households. To meet growing water demand and fill gaps in service delivery, alternative forms of public water service provision are critical. We implemented a choice experiment in Nima-Maamobi, a poor, underserved urban settlement in Accra, Ghana, to investigate household preferences for public standpipes based on the basic and limited water service categories under the WHO/UNICEF Joint Monitoring Programme's new water ladder. We also elicited local preferences for potential service administrators of the standpipes. Choice responses provided by 344 respondents were analyzed using a generalized multinomial logit model. Households were willing to pay up to US$1.25 for a 20-liter bucket of safe drinkable water, which is consistent with the average household water expenditure in the study site. Households spend at least 22% of their monthly income on water. Households' willingness to pay varied according to alternative levels of accessibility, availability, and quality of water services. Households showed strong preferences for community-based committees and nongovernmental organizations over the current water utility and the municipal assembly. The policy implications of the findings are discussed.

Unbundling household preferences for improved sanitation: A choice experiment from an urban settlement in Nicaragua.

Many urban settlements in developing countries still lack access to sanitation services, which puts the environment and population health at risk. The lack of knowledge on household preferences for improved sanitation has been an impediment to extending conventional and onsite sanitation infrastructure. This study implemented a choice experiment to elicit households' willingness to pay for the disposal of different types of waste (i.e. wastewater, excreta, and rainwater) in an urban settlement in Nicaragua. Generalized multinomial logit models were estimated to account for heterogeneity among respondents in both choice behavior and preferences for specific attributes. Findings indicate that households are willing to pay a considerable amount of money for improved disposal of wastewater, excreta, and rainwater. However, households have stronger preferences for wastewater and excreta removal than for disposal of rainwater.

Management and time preferences for lakes restoration in Brazil.

As in many developing countries, the eutrophication of lakes has become one of the most severe environmental problems in Brazil. We implemented a choice experiment to investigate local preferences for the restoration of five lakes in the city of Campos dos Goytacazes, Brazil. This study focuses on two attributes of the proposed environmental project: 1) the delay in reaching the targeted level of water quality and 2) the institution that would manage the lakes restoration project. Choice responses are analyzed using a mixed logit model to control for potential heterogeneity among respondents. Results show that the willingness to pay for lakes restoration decays with restoration time in a non-linear fashion. Findings also indicate that respondents would prefer an interinstitutional, non-governmental committee over the municipal government to manage the lakes restoration project.

Water system unreliability and diarrhea incidence among children in Guatemala.

OBJECTIVES: This article examines the effect of water system unreliability on diarrhea incidence among children aged 0-5 in Guatemala. METHODS: We use secondary data from a nationally representative sample of 7579 children to estimate the effects of uninterrupted and interrupted water services on diarrhea incidence. The national scope of this study imposes some methodological challenges due to unobserved geographical heterogeneity. To address this issue, we estimate mixed-effects logit models that control for unobserved heterogeneity by estimating random effects of selected covariates that can vary across geographical areas (i.e. water system reliability). RESULTS: Compared to children without access to piped water, children with uninterrupted water services have a lower probability of diarrhea incidence by approximately 33 percentage points. Conversely, there is no differential effect between children without access and those with at least one day of service interruptions in the previous month. Results also confirm negative effects of age, female gender, spanish language, and garbage disposal on diarrhea incidence. CONCLUSIONS: Public health benefits of piped water are realized through uninterrupted provision of service, not merely access. Policy implications are discussed.

Choice modeling of system-wide or large scale environmental change in a developing country context: Lessons from the Paraíba do Sul River.

The Rio Paraiba do Sul is a highly polluted river in south central Brazil, that is contaminated by industrial, agricultural and municipal wastes, as well as being impacted by dams, water withdrawals and deforestation in the watershed. Since only very intensive and farreaching environmental policies could result in water quality improvements, valuing the restoration of the river presents many unique challenges. We develop a choice-modeling approach to valuation of the restoration of this river, with general tightening of environmental policy as the policy, and an increase in prices as the payment vehicle. The estimation is performed in willingness to pay space, adjusting for heterogeneity of tastes. We find that respondents, who are primarily low income, exhibit higher willingness to pay for complete restoration than moderate restoration, higher for moderate restoration in comparison to minimal restoration, and that they prefer restoration sooner, rather than later.

Household shocks, child labor, and child schooling: evidence from Guatemala.

Using data from the National Survey of Standards of Living conducted in Guatemala in 2000, this article tests the hypothesis that Guatemalan households use child labor and reduce child schooling to cope with household shocks. First, the authors use factor analysis to estimate the latent household propensity to natural disasters and socioeconomic shocks. Then, they estimate bivariate probit models to identify the determinants of child labor and schooling, including household propensity to natural disasters and socioeconomic shocks. Results suggest that households use child labor to cope with natural disasters and socioeconomic shocks. In contrast, the authors found no evidence that suggests that households reduce child schooling to cope with shocks. Findings also indicate that poor households are more likely to use child labor and schooling reduction as strategies to cope with socioeconomic shocks.

Willingness to pay for safe drinking water: Evidence from Parral, Mexico.

A referendum-format contingent valuation (CV) survey is used to elicit household willingness to pay responses for safe and reliable drinking water in Parral, Mexico. Households currently adopt a variety of averting and private investment choices (e.g., bottled water consumption, home-based water treatment, and installation of water storage facilities) to adapt to the existing water supply system. These revealed behaviors indicate the latent demand for safer and more reliable water services, which is corroborated by the CV survey evidence. Validity findings include significant scope sensitivity in WTP for water services. Further, results indicate that households are willing to pay from 1.8% to 7.55% of reported household income above their current water bill for safe and reliable drinking water services, depending upon the assumptions about response uncertainty.

Genotipificación del virus de papiloma humano en pacientes con condilomas acuminados / Genotyping of human papillomavirus in patients with condylomata acuminata

El condiloma acuminado es una de las enfermedades más comunes de transmisión sexual alrededor del mundo. Estas lesiones están asociadas con la infección por los tipos de Virus de Papiloma Humano (VPH) 6 y 11 de bajo riesgo oncogénico. En nuestro país, la prevalencia de la infección por estos virus es alta (65 %), razón por la cual, el objetivo del presente trabajo fue la detección y tipificación del VPH mediante la reacción en cadena de la polimerasa en un grupo de pacientes que presentaban condilomas acuminados en el área genital. De las 90 biopsias evaluadas, de pacientes con infección sugestiva por el VPH, 72 (80 %) correspondieron a condilomas acuminados según el diagnóstico histopatológico, y el 20% presentaron otras patologías. La infección por el VPH se detectó en los 72 condilomas acuminados, observándose con mayor frecuencia el tipo 6 (54,2 %), seguido del tipo 11 (36,1 %); tres casos (4,2 %) presentaron coinfección con los tipos 6 y 11 y en cuatro casos (5,6 %) no se logró tipificar. Los resultados muestran una clara vinculación entre los tipos de VPH 6 y 11 de bajo riesgo oncogénico y el desarrollo de las verrugas genitales, a diferencia de las neoplasias intraepiteliales.

The condylomata acuminata is one of the common sexually transmitted disease around the world. These lesions are associated with the Human Papillomavirus (HPV) types 6 and 11 of oncogenic low-risk. In our country, the prevalence for this virus infection is high (65 %). The aim of this study was the detection and typing of HPV by polimerase chain reaction (PCR) in a group of patients that presented warts in the genital area. Ninety biopsies were evaluated coming from patients with suggestive infection for the HPV: 72 (80 %) were histological confirmed as condylomata acuminata and 20% have other pathologies. The HPV was detected in all specimens of condylomata acuminate. HPV type 6 was observed with more frequency (54.17 %), followed by type 11 (36.11 %); three cases (4.17%) showed co-infection with types 6 and 11 and four cases (5.56 %) were non tipificable. These results show a clear association of low oncogenic risk HPV types 6 and 11 and the development of the genital warts unlike to the cervical intraepithelial neoplasia where exists a great HPV genotypes spectrum.

Experiencia de la cirugía laparoscópica infantil en el Instituto Especializado de Salud del Niño / Experience of laparoscopic surgery in childrens in Instituto Especializado de Salud del Niño

Se estudió a los pacientes pediátricos que habían sido sometidos a cirugía laparoscópica en el Instituto Especializado de Salud del Niño, desde el inicio de las operaciones en noviembre de 1999 hasta mayo del 2004. El objetivo fue conocer las características derivadas del uso de esta nueva técnica quirúrgica, progresos en su seguridad y sus beneficios. Involucra a 304 pacientes que corresponden al total de casos, a través del uso de una ficha de recolección de datos aplicada a las historias clínicas. Las edades oscilaron entre el mes de vida y 18 años. Las operaciones más frecuentes fueron la laparoscopia exploratoria con biopsia hepática 78 casos (25,7 por ciento), ligadura de varicocele 73 casos (24,1 por ciento), apendicectomía 47 casos (15,5 por ciento), laparoscopia exploratoria 33 casos (10,9 por ciento), colecistectomía 22 casos (7,3 por ciento), gonadectomía 11 (3,6 por ciento), esplenectomía 7 (2,3 por ciento) además: liberación de bridas y adherencias, nefrectomía, histerectomía, fundoplicatura de Nissen. El presente estudio demuestra que la cirugía laparoscópica es una alternativa tan segura y efectiva como la cirugía abierta en pacientes pediátricos, incluyendo situaciones de emergencia.

Dermatosis ampollar por IgA lineal de la infancia: reporte de un caso y revisión de la literatura / Ampuller dermatose by IgA lineal of the cildhood: report of a case and literature review

La dermatosis ampollar por IgA lineal es una enfermedad vesiculoampollar subepidérmica de etiología autoinmune que puede ser idiopática o también inducida por drogas. Clínicamente suele ser muy heterogénea pudiendo presentar características fenotípicas de epidermólisis ampollar adquirida, dermatitis herpetiforme, penfigoide ampollar y cicatricial. Se discute el caso de un preescolar de 6 años de edad en el cual se establece diagnóstico de dermatosis ampollar por IgA lineal por clínica, histopatológia e inmunofluorescencia, evolucionando satisfactoriamente con la administración combinada de metilprednisolona y dapsona

Síndrome basocelular nevoide: reporte de dos casos y revisión de la literatura / Nevoid baso-cellular syndrome: report of a case and literature review

El Síndrome Basocelular Nevoide es un raro síndrome que se caracteriza por una serie de hallazgos clínicos y paraclínicos entre los cuales destacan como manifestaciones mayores: múltiples carcinomas basocelulares (escasos hasta cientos), quistes odontogénicos de mandibula, agujeros en palma de las manos y plantas de los pies, calcificaciones de la hoz cerebral y anormalidades esqueléticas de desarrollo. Presentamos en esta publicación, dos hermanos con este raro síndrome. El primer caso reunía varios criterios para ser considerado como portador de este síndrome, no demostrándose en el enfermedad metastásica. El segundo caso, hermano del anterior, presentó múltiples carcinomas basocelulares de comportamiento agresivo, muriendo de metástasis en varios órganos internos