Worldwide Network for Blood and Marrow Transplantation Recommendations for Establishing a Hematopoietic Stem Cell Transplantation Program in Countries with Limited Resources, Part II: Clinical, Technical, and Socioeconomic Considerations.

The development of hematopoietic stem cell transplantation (HSCT) programs can face significant challenges in most developing countries because such endeavors must compete with other government health care priorities, including the delivery of basic services. Although this is may be a limiting factor, these countries should prioritize development of the needed expertise to offer state-of-the-art treatments, including transplantation, by providing financial, technological, legal, ethical, and other needed support. This would prove beneficial in providing successful programs customized to the needs of their population and potentially provide long-term cost savings by circumventing the need for their citizens to seek care abroad. The costs of establishing an HSCT program and the costs of the HSCT procedure itself can be substantial barriers in developing countries. In addition, socioeconomic factors intrinsic to specific countries can influence access to HSCT, patient eligibility for HSCT, and timely utilization of HSCT center capabilities. This report describes recommendations from the Worldwide Network for Blood and Marrow Transplantation for establishing HSCT programs, with a specific focus on developing countries, and identifies challenges and opportunities for providing this specialized procedure in resource-constrained settings.

Status of hematopoietic stem cell transplantation in the WHO Eastern Mediterranean Region (EMRO).

Several centers are now performing allogeneic hematopoietic stem cell transplantation (HSCT) in the World Health Organization Eastern Mediterranean Region (EMRO) but the availability is still limited due to high cost and the need for multi-disciplinary team and an advanced laboratory support. Special issues including compatible donor availability, potential for alternate donor programs, differences in pattern of disease, pre-HSCT general status particularly for patients with BM failure, high sero-positivity for CMV, Hepatitis B and C infection and specific observations about GVHD with its relation to genetically homogeneous community are discussed. A total of 17 HSCT programs (performing five or more HSCTs annually) exist in nine countries of the EM region. Only six programs are currently reporting to EBMT or IBMTR. A total of 7617 HSCTs including 5701 allogeneic HSCTs have been performed. Due to low HSCT team density (1.5583 teams/10 million inhabitants versus 14.4333 in Europe) and very low HSCT team distribution (0.2729 teams/10,000 sq km area versus <1 to 6 teams in Europe) only 70.8% of total population has access to such a program in EM region. GNI/capita had no clear association with low HSCT activity; however improvement in infrastructure and establishment of EM regional HSCT registry need prioritization.

The economic impact of electric saw injuries to the hand.

PURPOSE: Injuries from electric saws cause considerable hand trauma. This study is designed to provide information detailing the costs of these injuries. METHODS: The study was performed in a tertiary referral academic medical center. The records of patients injured by electric table saws were reviewed. Information regarding demographics, injury severity, medical expense, and time lost from work was analyzed. The patients were stratified by injury severity for further analysis. The mean wage for the region was used to estimate costs of time away from work. The Consumer Protection Agency's review was used to estimate the nationwide burden of these injuries. RESULTS: The study group included 134 patients. Of these patients, 126 were male and 8 were female. The dominant hand was injured in 20; the nondominant, in 114. The mean age was 47.0 years. The mean time lost from work was 64 days. The mean cost of medical expenses for all patients was $22,086, with $8,668 in lost wages, for a total of $30,754 mean cost per injury. The total economic burden for the injuries in this study is $4,121,097. These injuries represent a spectrum of severity, with minor injuries incurring lower hospital fees and requiring less time off work as compared to more involved injuries. CONCLUSIONS: Electric saws cause a wide spectrum of injuries that result in not only tremendous physical and emotional pain but also substantial economic impact as well. Technologies that would prevent such injuries would be a socioeconomic advancement. Federal mandates to implement such technologies should be encouraged.

Exercise level and energy expenditure in the TAKE 10! in-class physical activity program.

This study evaluated the effectiveness of an innovative, classroom-based physical activity prevention program designed to integrate academic curriculum elements along with a physical activity program in providing moderate-to-vigorous intensity physical activity. A convenience sample of three public school classrooms (one first, third, and fifth grade class) was observed implementing the TAKE 10! program while monitored by either CSA accelerometers or digital pedometers. Pedometer step counts and CSA data were recorded for each student and activity. As calculated from CSA data, average MET levels during the activities were 5.72-7.05 (first grade), 5.51-6.77 (third grade), and 4.98-7.19 (fifth grade), and levels were not different between grades (p > 0.05). Average caloric expenditure (Kcal) per 10-minute session was 25.6-27.8 (first grade), 27.6-33.9 (third grade), and 29.7-42.9 (fifth grade). Measured pedometer step counts per session ranged from 644-931 in first grade, 659-1, 376 in third grade, and 1002-1041 in fifth grade. TAKE 10! sessions for all three grades produced exercise levels in the moderate intensity range throughout full duration of the session. Classroom-based physical activity promotion provides a useful strategy to promote meaningful physical activity among school children.