Community-based monitoring to facilitate water management by local institutions in Costa Rica.

Water scarcity is a global problem that can be compounded by inefficient water management, including underinvestment in infrastructure, underpricing of water use, and underenforcement of user rules. Here, we explore whether these inefficiencies can be reduced in rural Costa Rica via an externally driven community monitoring program (i.e., a program initiated by an outside organization and run by citizens). The monitoring program aimed to reduce groundwater extraction from aquifers, as well as to improve water quality and user satisfaction, by supplying additional information about field conditions and additional scrutiny of user and management authority activities and by fostering citizen engagement in water management. Using a specially designed smartphone application (app) and WhatsApp, monitors could report weekly on the conditions of the water system, including service disruptions, water quality, leaks, and source contamination. The app automatically compiled the individual reports into a summary report, which was then made available to the community water management committees and water users. The program was randomly implemented in 80 of 161 communities that expressed an interest in participating. One year after the program started, we detect modest, albeit imprecisely estimated, effects of the program in the predicted directions: less groundwater extracted, better water quality, and more satisfied users. Although the estimated effects are imprecise, the monitoring program appears to be equally or more cost effective for reducing groundwater extraction than another program in the same region that encouraged households to adopt water-efficient technologies.

Perceptions of the seriousness of major public health problems during the COVID-19 pandemic in seven middle-income countries.

INTRODUCTION: Public perception of the seriousness of the COVID-19 pandemic compared to six other major public health problems (alcoholism and drug use, HIV/AIDS, malaria, tuberculosis, lung cancer and respiratory diseases caused by air pollution and smoking, and water-borne diseases like diarrhea) is unclear. We designed a survey to examine this issue using YouGov's internet panels in seven middle-income countries in Africa, Asia, and Latin America in early 2022. METHODS: Respondents rank ordered the seriousness of the seven health problems using a repeated best-worst question format. Rank-ordered logit models allow comparisons within and across countries and assessment of covariates. RESULTS: In six of the seven countries, respondents perceived other respiratory illnesses to be a more serious problem than COVID-19. Only in Vietnam was COVID-19 ranked above other respiratory illnesses. Alcoholism and drug use was ranked the second most serious problem in the African countries. HIV/AIDS ranked relatively high in all countries. Covariates, particularly a COVID-19 knowledge scale, explained differences within countries; statistics about the pandemic were highly correlated with differences in COVID-19's perceived seriousness. CONCLUSIONS: People in the seven middle-income countries perceived COVID-19 to be serious (on par with HIV/AIDS) but not as serious as other respiratory illnesses. In the African countries, respondents perceived alcoholism and drug use as more serious than COVID-19. Our survey-based approach can be used to quickly understand how the threat of a newly emergent disease, like COVID-19, fits into the larger context of public perceptions of the seriousness of health problems.

We were curious what people in different countries thought about the seriousness of COVID-19 compared to other health problems. We designed a survey, and hired YouGov, a survey research firm, to administer it in seven countries in Africa, Asia, and Latin America in early 2022. Respondents answered the questions on their computer, tablets, or smart phones. Their answers revealed that in most countries respiratory illnesses were perceived to be a more serious problem than COVID-19. In Africa people felt that alcoholism and drug use were also more serious than COVID-19. These findings are important because they show that people still care about the health problems they were facing before the pandemic, which is useful information for healthcare providers.

On the preconditions for large-scale collective action.

The phenomenon of collective action and the origin of collective action problems have been extensively and systematically studied in the social sciences. Yet, while we have substantial knowledge about the factors promoting collective action at the local level, we know far less about how these insights travel to large-scale collective action problems. Such problems, however, are at the heart of humanity's most pressing challenges, including climate change, large-scale natural resource depletion, biodiversity loss, nuclear proliferation, antibiotic resistance due to overconsumption of antibiotics, and pollution. In this paper, we suggest an analytical framework that captures the theoretical understanding of preconditions for large-scale collective action. This analytical framework aims at supporting future empirical analyses of how to cope with and overcome larger-scale collective action problems. More specifically, we (i) define and describe the main characteristics of a large-scale collective action problem and (ii) explain why voluntary and, in particular, spontaneous large-scale collective action among individual actors becomes more improbable as the collective action problem becomes larger, thus demanding interventions by an external authority (a third party) for such action to be generated. Based on this, we (iii) outline an analytical framework that illustrates the connection between third-party interventions and large-scale collective action. We conclude by suggesting avenues for future research.

Experiencia con el tratamiento del sarcoma de Ewing en el Hospital Nacional de Niños / The treatment of Ewing sarcoma at the National Children's Hospital

Entre 1965 y 1987 han sido tratados en el Hospital Nacional de Niños 15 pacientes con diagnóstico histológico de sarcoma de Ewing, 8 hombres y 7 mujeres, con una edad promedio de 9 años. Los signos clínicos que presentaron fueron dolor, tumor y fiebre y confundieron y retardaron el diagnóstico en 6 de ellos. El fémur fue sitio de origen en 27%, pelvis 50%, húmero, peroné y tibia en el 13% respectivamente y escápula y tejido blandos en 6%. Diez casos presentaban el tumor localizado, cuatro ingresaron con metástasis a pulmon y uno extraóseo, diseminado. Siete de los casos ingresaron entre 1965 y 1977 y fueron tratados con radioterapía y en algunos casos quimioterapia con C Act y V, en ninguno se hizo resección del tumor; de este grupo sobreviven dos, uno de ellos curado espontaneamente. Del grupo tratado a partir de 1978 con radioterapia y quimioterapia con 5 drogas (V A C Act y MTX) por 18 meses y resección del tumor en 6 casos, sobreviven 4 con un tiempo promdeio en remisión de 83 meses. Se considera que la quimioterapia múltiple, la resección quirúrgica amplia y radioterapia postoperatoria han mejorado el pronóstico de este tumor en nuestro medio. La presencia de metástasis al ingreso constituye un signo de mal pronóstico, lo mismo que la recidiva local, pero otros esquemas terapeputicos y el uso de quimioterapia intra arterial pueden cambiar las perspectivas en estos casos