scholarly journals Differences in the Distribution of Non-Hodgkin Lymphoma in Public Versus Private Institution in a Latin American Country: A Cohort of 5,807 Cases

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4511-4511
Author(s):  
Jule F Vasquez ◽  
Alonso Diaz ◽  
Any S Mendoza ◽  
Claudio Flores ◽  
Carlos Barrionuevo ◽  
...  

Abstract Differences in the Distribution of non-Hodgkin Lymphoma in public versus private institution in a Latin American country: A cohort of 5,807 cases. Background: Non-Hodgkin lymphoma (NHL) is the most frequent hematological malignancy. B-cell (BCL) and T-cell (TCL) NHL subtypes differs in high income and low-and middle-income countries. In Peru, the healthcare system (HCS) is divided mainly into public and private institutions. We previously demonstrated that there is a difference in the distribution of NHL between the HCS. We aimed to describe the subtypes of NHL seen according to healthcare facilities in a large cohort. Methods: We reviewed medical records at National Cancer Institute and Oncosalud, both the leading public and private cancer centers in Peru, respectively. All patients diagnosed with NHL from 2010-2019 according to the 2016 WHO classification were included. Baseline characteristics were compared between public and private institutions using Student's t test and Chi-square as appropriate. Results: A total of 5,807 NHL were included from both institutions. The median age was 60 years (range 15-103), 50.6% were male. Most patients NHL cases were encountered at the public institution (92.4%, n = 5,368); 82.9% (n = 4,815) were BCL and 17.1% (n = 992) TCL. Differences of BCL and TCL frequencies were seen among institutions. More BCL cases were seen at the private institution (86.1%, n = 378 versus 82.7%, n = 4,437, respectively) whereas TCL were common in the public institution (17.3%, n = 931 versus 13.9%, n = 61, respectively) (p < 0.065). The most frequent BCL was DLBCL with 68.6% (n = 3045) and 54.2% (n = 205) seen in public and private institutions, respectively (p < 0.001). The second most frequent BCL was follicular lymphoma (FL) with 11.2% (n = 495) and 20.9% (n = 79) seen in the public and private institutions, respectively (p < 0.001). Chronic lymphocytic lymphoma (CLL) and Burkitt lymphoma (BL) were most frequent in private institution (CLL 6.3%, n = 24 vs. 3.5%, n = 154, p = 0.004; BL 3.4%, n = 13 vs. 1.4%, n = 60, p = 0.001). The most frequent TCL was peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) (24.5%, n = 228) for the public institution and mycosis fungoides (MF) (42.6%, n = 26) for the private institution. The second most frequent TCL was natural killer/TCL (NKTCL) (23.5%, n = 219) for the public institution, and PTCL, NOS (21.3%, n = 13) for the private institution. There was significant difference in the number of NKTCL and MF cases seen during the study period among institutions (NKTCL public 23.5%, n = 219 vs. private 4.9%, n = 3, p = 0.001; MF public 9.1%, n = 90 vs. private 42.6%, n = 26, p <0.001). Conclusions: The distribution of NHL subtypes differs according to the type of healthcare system in Peru. Our large cohort confirms that DLBCL and NKTCL are more frequent in patients treated at the public cancer center than in private center. On the contrary FL, CLL, BL and MF are more frequent in private cancer center. The difference in the distribution of BCL and TCL was not statistically significant. Disclosures No relevant conflicts of interest to declare.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19569-e19569
Author(s):  
Jule Franve Vasquez Chavez ◽  
Alonso Diaz ◽  
Daniel Enriquez ◽  
Luis Malpica ◽  
Michaell Cabrejos ◽  
...  

e19569 Background: Non-Hodgkin lymphoma (NHL) is the most frequent hematological malignancy. B-cell (BCL) and T-cell (TCL) NHL subtypes differs in high income and low-and middle-income countries. In Peru, the healthcare system is divided mainly into public and private institutions. We aimed to describe the subtypes of NHL seen according to healthcare facilities. Methods: We reviewed medical records at National Cancer Institute and Oncosalud, both the leading public and private cancer centers in Peru, respectively. All patients diagnosed with NHL from 2015-2018 according to the 2016 WHO classification were included. Baseline characteristics were compared between public and private institutions using Student’s t test and Chi-square as appropriate. Results: A total of 2,317 NHL were included from both institutions. The median age was 61 years (range 15-99), 49.7% were male. Most patients NHL cases were encountered at the public institution (88.9%, n = 2,059); 84.4% (n = 1,957) were BCL and 15.5% (n = 360) TCL. Differences of BCL and TCL frequencies were seen among institutions. More BCL cases were seen at the private institution (96.6%, n = 230 versus 83.9%, n = 1,727, respectively) whereas TCL were common in the public institution (16.1%, n = 332 versus 11.8%, n = 28, respectively) (p < 0.035). The most frequent BCL was DLBCL with 70.0% (n = 1209) and 49.6% (n = 114) seen in public and private institutions, respectively (p < 0.001). The second most frequent BCL was follicular lymphoma (FL) with 10.8% (n = 187) and 20.4% (n = 47) seen in the public and private institutions, respectively (p < 0.001). Chronic lymphocytic lymphoma (CLL) and Burkitt lymphoma (BL) were most frequent in private institution (CLL 7%, n = 16 vs. 3.5%, n = 60, p = 0.017; BL 3.9%, n = 9 vs. 1.2%, n = 21, p = 0.004). The most frequent TCL was peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) (27.7%, n = 92) for the public institution and mycosis fungoides (MF) (39.3%, n = 11) for the private institution. The second most frequent TCL was natural killer/TCL (NKTCL) (22.6%, n = 75) for the public institution, and PTCL, NOS (17.9%, n = 5) for the private institution. There was significant difference in the number of NKTCL and MF cases seen during the study period among institutions (NKTCL public 22.6%, n = 75 vs. private 3.6%, n = 1, p = 0.033; MF public 15.1%, n = 50 vs. private 39.3%, n = 11, p = 0.003). The presence of extranodal involvement was more frequent in the public institution (52.3%, n = 1,049 vs. 35.3%, n = 84, p < 0.001). Conclusions: The distribution of NHL differs according to the type of healthcare system in Peru. Extranodal involvement, TCL, DLBCL and NKTCL are more frequent in patients treated at the public cancer center than in private center. On the contrary BCL, FL, CLL, BL and MF are more frequent in private cancer center. Our institutions are currently building the largest registry of NHL patients diagnosed and treated in Peru.


2021 ◽  
Vol 12 (1) ◽  
pp. 117-136
Author(s):  
Bernadette Califano ◽  
Martín Becerra

This article analyses the digital policies introduced in different Latin American countries during the first three months after the outbreak of COVID-19 reached the region (March–June 2020). This analysis has a three-fold objective: (a) to give an overview of the status of connectivity in five big Latin American countries – Argentina, Brazil, Chile, Colombia and Mexico; (b) to study comparatively the actions and regulations implemented on connectivity matters by the governments of each country to face the pandemic; and (c) to provide insights in relation with telecommunications policies in the context of pandemic emergence at a regional level. To that end, this study will consider legal regulations and specific public policies in this field, official documents from the public and private sectors, and statistics on ICT access and usage in the region.


Author(s):  
Cass R. Sunstein

It is important to distinguish between two kinds of transparency. The government can be transparent about its “inputs”: about who, within government, said what to whom, and when, and why. The government can also be transparent about its “outputs”: its regulations and its policies, its findings about air and water quality, or its analysis of the costs and benefits of drone strikes. The argument for output transparency is often very strong, because members of the public can receive information that can help them in their daily lives and because output transparency can improve the performance of both public and private institutions. The argument for input transparency is different and often weaker, because the benefits of disclosure can be low and the costs can be high. It is challenging to make general pronouncements about input transparency and the appropriate evaluation of leaks and leakers without making a contestable judgment about whether a particular government is well-functioning and capable of self-correction.


2018 ◽  
Vol 25 (1) ◽  
pp. 107327481879795 ◽  
Author(s):  
Nancy Rihana ◽  
Sowmya Nanjappa ◽  
Cara Sullivan ◽  
Ana Paula Velez ◽  
Narach Tienchai ◽  
...  

The introduction of antiretroviral therapy (ART) in 1995 had a dramatic impact on the morbidity and mortality of the HIV population, and subsequently, the natural history of cancer has changed. The purpose of our study was to review the prevalence of AIDS-defining malignancies and non-AIDS defining cancers (NADC), taking into consideration racial and gender variations. After the institutional review board approval, the study was conducted as a retrospective chart review of 279 HIV-infected patients who were treated at the Moffitt Cancer Center between January 1, 2000 and December 31, 2010. The demographic characteristics included gender, ethnicity, race, presence or absence of ART, and the type of malignancy reviewed. Of 233 men, 78 (33.5%) had AIDS-defining malignancies. AIDS-related non-Hodgkin lymphoma (NHL) was detected in 49 (21%) patients and Kaposi sarcoma (KS) in 29 (12%) patients. Two-thirds of male patients had NADC, with anal cancer being the most prevalent (8.5%), followed by Hodgkin lymphoma (6%). AIDS-related NHL was also the predominant malignancy for women with a prevalence of 19.5% followed by invasive cervical cancer (ICC) and breast cancer, both with a similar prevalence of 11%. Kaposi sarcoma and anal cancer were equally detected in 2% of women. The prevalence rates of AIDS-defining malignancies among those of white race were 34%, ranging from 21% for NHL to 13% for KS and 1.5% for ICC. Twenty-one (7.7%) patients had anal cancer. AIDS-defining malignancies were found in 36% of patients of black race and 60% had NHL. Non-AIDS-related NHL was the second most common malignancy, followed by breast cancer and anal cancer with a similar prevalence of 6.5%. Of 279 patients, 53% were taking ART; 39.4% were not taking ART; and in 7.5% of the patients, it was unknown if they were taking ART. In the ART era, our study found NADC to be more prevalent than AIDS-defining malignancies with 60% versus 40%, respectively. Non-Hodgkin lymphoma remained the most common AIDS-related malignancy in both genders. Among the patients with NADC, anal cancer was the predominant malignancy. The increasing incidence of some of the NADC is expected as this population is living longer with chronic exposure of viral replication of virus with oncogenic potential such as Human papillomavirus (HPV), Hepatitis B virus (HBV), Epstein-Barr virus (EBV), and Human herpesvirus 8 (HHV-8). Early ART initiation, aggressive vaccination, and judicious cancer screening are the cornerstone of cancer prevention of this growing population.


2019 ◽  
Vol 99 (7) ◽  
pp. 849-861 ◽  
Author(s):  
Tara Dickson ◽  
Barrett J Taylor

AbstractBackgroundBetween 1995 and 2015, the number of accredited physical therapist education programs in the United States rose from 127 to 224. Colleges and universities have been known to develop new programs in an effort to generate revenues through student tuition.ObjectiveIn the present study, sources of institutional revenue and expenditures were used as predictors for the adoption of physical therapist education programs.DesignYearly data from the Integrated Postsecondary Education Data System for 1731 higher education institutions were combined with dates from the Commission on Accreditation in Physical Therapy Education for physical therapist education program accreditation from 1995 to 2015.MethodsA retrospective event history analysis of yearly institutional data was used to calculate the hazard of an institution adopting a physical therapist education program on the basis of institutional revenues and expenditures.ResultsPrivate institutions were 62% less likely to adopt a physical therapist education program when they experienced a 1% increase in total revenue per full-time–equivalent student. Conversely, a given private institution was 2.71 times more likely to adopt a physical therapist education program for every 1% increase in total expenditures per full-time–equivalent student. Both public and private institutions experienced an increased chance of adopting an entry-level (professional) physical therapist education program when instructional expenditures rose. They were also more than twice as likely to adopt physical therapist education programs when they experienced a 1% increase in the number of students.LimitationsCausation between professional physical therapist education program adoption and the variables studied cannot be determined through observational analysis alone.ConclusionsThe more revenue a private institution generated, the less likely it was to add a program in the search for further revenues. As expenses rose, the chance of adoption trended upward beyond increases in institutional revenues for both public and private not-for-profit institutions.


Author(s):  
Daniel Levy

Hugo Chavez's clash with Venezuelan higher education is a vivid present-day example of a history of confrontation between leftist, populist regimes and higher education in Latin America. Chavez has transformed the public sector through creation and expansion of new universities. Chavez's policies have alienated the country's private institutions of higher education. Both public and private universities are reduced in importance.


1996 ◽  
Vol 13 (1) ◽  
pp. 6-8 ◽  
Author(s):  
John M Cooney ◽  
Conor K Farren ◽  
Anthony W Clare

AbstractObjective: The identification of personality disorder among psychiatric in-patients is important because of the effect on the course and outcome of illness. The introduction of a multiaxial approach to diagnosis, has resulted in a higher than previously reported rate of occurrence of personality disorder in a variety of psychiatric settings. A prevalence of personality disorder of 4.9% is reported in the official statistics for Irish psychiatric hospitals. The aim of this study is to determine the true prevalence of personality disorders in two Irish psychiatric hospitals, one public and one private, using a multiaxial approach to diagnosis.Methods: The Standardised Assessment of Personality (SAP) is a validated, semistructured, informant based instrument that reliably generates diagnoses of personality disorder irrespective of current mental state. Over a four month period, 78 consecutive, first ever admissions to two hospitals were examined using the SAP.Results: The prevalence of personality disorder in this population was 26%. There was no significant difference in the rate of personality disorder between the public and private institutions.Conclusions: The prevalence of personality disorder amongst in-patients in both public and private psychiatric hospitals in Ireland is far higher than previously reported. This highlights the importance of a multiaxial approach to diagnosis in order to establish the true extent of psychiatric morbidity.


1939 ◽  
Vol 6 (2) ◽  
pp. 147-175 ◽  
Author(s):  
F. L. Ganshof

A Number of important studies have been published in recent years on the subject of benefice and vassalage during the early Middle Ages, and it may consequently be worth while to re-examine some of the problems raised by the origin and early development of these two institutions. I have dealt elsewhere with, the circumstances which tended towards their union early in the eighth, century, under the early Carolingians, In this article I hope to indicate at least the principal features of the history of benefice and vassalage during the reign of Charlemagne. The Influence which Charles exercised on the public and private institutions of the Frankish state was so definite and far-reaching as fully to justify the limitation of the subject-matter of my inquiry to the space of a single reign. Unfortunately the lack of adequate sources, though less serious than for the preceding period, renders the task of tracing their history a somewhat difficult one. Although the capitularies contain a relatively large number of provisions that deal specifically with these institutions, we have very little information as to how they worked in practice. The narrative sources, with the exception of two or three texts, tell us little or nothing. We have to fall back on the evidence of charters, though even these only rarely, when dealing with a dispute or legal proceeding, throw some light on the subject. This is what we might in any case expect, for the essential feature of the entry of a person into vassalage or of the gift of a benefice was the oral act, and not any embodiment of it in writing.


EAD em FOCO ◽  
2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Daniela Da Costa Britto Pereira Lima ◽  
Lívia Soares de Lima Sousa

A utilização da EaD como forma de democratizar o ensino superior no Brasil tem sido discutida por pesquisadores afetos aos mais diversos temas educacionais. Trazemos neste estudo uma breve retomada histórica, demonstrando que os primeiros cursos de ensino superior no Brasil não se destinavam às consideradas classes subalternas. Esse processo histórico fez com que o ensino superior se tornasse algo quase restrito às classes dominantes. Apresentamos a EaD e sua legislação a fim de introduzir também a criação e implementação do Sistema Universidade Aberta do Brasil (UAB), política com vistas à democratização do acesso ao ensino superior. Elencamos alguns autores contrários ao uso da EaD como forma de democratizar o ensino no Brasil. Embora em direções diferentes, os autores contrários ao uso da EaD caminham quase sempre num mesmo viés. Um dos principais argumentos trazidos no bojo de suas argumentações contrárias é de que a EaD estaria servindo apenas aos interesses mercantilistas? preconizados pela reestruturação do aparelho do Estado, operacionalizado principalmente na década de 1990. Tais autores desconsideram os avanços obtidos por meio da EaD, a despeito dos percalços e/ou dificuldades enfrentadas em tal modalidade. Sendo assim, trazemos autores favoráveis à implementação da EaD como política de popularização do ensino, a fim de demonstrar como ela tem sido importante no processo histórico de democratizar o ensino superior em nosso país, ampliando suas vagas, avançando na questão do acesso e, ainda, interiorizando as IES públicas e privadas em praticamente todo o território nacional.Palavras-chave: EaD; Ensino a distância no Brasil; Democratização do ensino superior.The EaD in Brazil and the Process of Democratization of Access to Higher Education: Possible DialoguesAbstractThe use of E-learning as a way to democratize higher education in Brazil has been discussed by researchers concerned about the most diverse educational themes. We bring in this study a brief historic overview showing that the first higher education courses in Brazil were not destined to the classes considered subaltern. This historical process has made higher education to become something almost restricted to the dominant classes. We present E-learning and its legislation in order to introduce also the creation and implementation of Open University System of Brazil (UAB), with aiming the access to higher education democratization. We also mention some authors opposed to use of E-learning as a way to democratize the education in Brazil. Although in different directions, authors opposed to use of E-learning follow the same bias almost always. One of the main arguments is that E-learning was only serving the "mercantilist" interests recommended by the State reconstruction process which took place mainly in the 90s. Such authors disregard the advances obtained by education through E-learning, despite the difficulties faced in such modality. Therefore, we bring authors in favor of E-learning as education democratization policy implementation in order to demonstrate how E-learning has been important in the historical process higher education democratization in our country, increasing their number of vacancies, improving the issue of access and interiorizing the public and private Institutions of Higher Education in almost all the national territory.Keywords: E-learning; Distance education in Brazil; Higher education; Democratization.


2020 ◽  
Vol 322 ◽  
pp. 01041
Author(s):  
Francis Pfenniger

The twenty years of research experience of the Chilean Construction Institute (IC) to promote “public and private efforts to improve quality, productivity and sustainability in construction” are presented in this paper. IC is a non-profit organisation formed by some public, private and academic actors: two ministries, two universities (Universidad de Chile and Universidad Católica de Chile) the Chilean Construction Chamber, three guilds (Architects, Builders and Engineers) and private industries (from the materials sector) formed this very atypical organisation back in the nineteen-nineties. The IC is a transverse association in which the actors meet freely to discuss issues that affect the construction sector, trying to find common proposals to contribute regarding the development of the country. Important actions have been developed, such as the Chilean isolation regulation; the social housing pathologies study; the National Construction Norms Council; the Chilean construction norms site; the public buildings case study; the CES - Chilean building certification system; the digitalisation of the building authorization system (on the municipal level); the Regional Seismic Code (for all Latin American and Caribbean countries) and others impossible to include here. This effort has proved to be effective and efficient in order to promote regulation upgrading and conduct studies that would otherwise be difficult to do. An interesting case is the thermal isolation regulation: with the support of the academic world, it was possible to agree a common starting point which, at the beginning, was strongly opposed by some actors. This updated regulation has proven that this public-private and academic joint venture is reliable and effective. Two cases are discussed in detail in this document.


Sign in / Sign up

Export Citation Format

Share Document