Drug-Induced Anaphylaxis Survey in Portuguese Allergy Departments

Background and Objective: Drug-induced anaphylaxis is an unpredictable and potentially fatal adverse drug reaction. The aim of this study was to identify the causes of drug-induced anaphylaxis in Portugal. Methods: During a 4-year period a nationwide notification system for anaphylaxis was implemented, with voluntary reporting by allergists. Data on 313 patients with drug anaphylaxis were received and reviewed. Statistical analysis included distribution tests and multiple logistic regression analysis to investigate significance, regression coefficients, and marginal effects. Results: The mean (SD) age of the patients was 43.8 (17.4) years, and 8.3% were younger than 18 years. The female to male ratio was 2:1. The main culprits were nonsteroidal anti-inflammatory drugs (NSAIDs) (47.9% of cases), antibiotics (35.5%), and anesthetic agents (6.1%). There was a predominance of mucocutaneous symptoms (92.2%), followed by respiratory symptoms (80.4%) and cardiovascular symptoms (49.0%). Patients with NSAID-induced anaphylaxis showed a tendency towards respiratory and mucocutaneous manifestations. We found no significant associations between age, sex, or atopy and type of drug. Anaphylaxis recurrence was observed in 25.6% of cases, and the risk was higher when NSAIDs were involved. Conclusions: NSAIDs were the most common cause of anaphylaxis in this study and were also associated with a higher rate of recurrence. We stress the need for better therapeutic management and prevention of recurring episodes of drug-induced anaphylaxis.

A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminolevulinic Acid Compared With White-Light Surgery

BACKGROUND: High-grade gliomas are aggressive, incurable tumors characterized by extensive diffuse invasion of the normal brain parenchyma. Novel therapies at best prolong survival; their costs are formidable and benefit is marginal. Economic restrictions thus require knowledge of the cost-effectiveness of treatments. Here, we show the cost-effectiveness of enhanced resections in malignant glioma surgery using a well-characterized tool for intraoperative tumor visualization, 5-aminolevulinic acid (5-ALA). OBJECTIVE: To evaluate the cost-effectiveness of 5-ALA fluorescence-guided neurosurgery compared with white-light surgery in adult patients with newly diagnosed high-grade glioma, adopting the perspective of the Portuguese National Health Service. METHODS: We used a Markov model (cohort simulation). Transition probabilities were estimated with the use of data from 1 randomized clinical trial and 1 noninterventional prospective study. Utility values and resource use were obtained from published literature and expert opinion. Unit costs were taken from official Portuguese reimbursement lists (2012 values). The health outcomes considered were quality-adjusted life-years, lifeyears, and progression-free life-years. Extensive 1-way and probabilistic sensitivity analyses were performed. RESULTS: The incremental cost-effectiveness ratios are below €10 000 in all evaluated outcomes, being around €9100 per quality-adjusted life-year gained, €6700 per life-year gained, and €8800 per progression-free life-year gained. The probability of 5-ALA fluorescence-guided surgery cost-effectiveness at a threshold of €20000 is 96.0% for quality-adjusted life-year, 99.6% for life-year, and 98.8% for progression-free life-year. CONCLUSION: 5-ALA fluorescence-guided surgery appears to be cost-effective in newly diagnosed high-grade gliomas compared with white-light surgery. This example demonstrates cost-effectiveness analyses for malignant glioma surgery to be feasible on the basis of existing data.

Effects of lethal and non-lethal malaria on the mononuclear phagocyte system

The effects ofone non-lethal species ofmalarialparasite, Plasmodium yoelii, and one lethal species, P. berghei, on the mononuclear phagocyte system (MPS) of BALB/c mice were studied. P. yoelii caused a greater and more sustained expansion and activation of the MPS, and the two major populations of spleen phagocytic cells-red pulp and marginal zone macrophages - exhibited a greater increase in numbers in this infection. During the course of P. berghei mataria, the spleen was progressively occupied by haematopoietic tissue and, at the terminal stage of infection, an extensive depletion of lymphocytes and macrophages was apparent. The possibility was suggested that the outcome of mataria may be inftuenced by the particular way the parasite interacts with the MPS.

Impact of health conditions on absenteeism from work

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

The role of spleen macrophages in malaria: an ultrastructural study

An electronmicroscopy study of the spleen from mice infected with Plasmodium berghei was carried out to investigate the types ofcells in volved in the removal of parasites from the blood, and the mechanisms by which this occurs. Macrophages, particularly from the red pulp and the marginal zone of the spleen, constituted the most important population of phagocytic cells in the spleen. At the height ofparasitaemia, macrophages in the periphery of the white pulp, especially in the mantle zone of secondary follicles, were also found to participate in phagocytosis, although to a limited extent. Our fingings suggest that phagocytosis of free parasites or parasitized erythrocytes in the spleen is an important mechanism of clearance of parasites from the circulation. Parasites removed from the erythrocytes when these cells cross the interendothelial slits are further phagocytosed by neighbouring macrophages. Evidence is presented suggesting that spleen macrophages may act against the parasite through a process of cytotoxicity.

Análise do impacto na despesa pública com medicamentos decorrente da alteração do sistema de preços de referência

RESUMO - Com o presente trabalho pretende-se analisar o impacto na despesa pública com medicamentos decorrente da implementação do Decreto-Lei 48-A/2010, de 13 de Maio, e do Decreto-Lei 106-A/2010, de 1 de Outubro, nos anos de 2011 e 2012. Os referidos diplomas alteraram as regras de formação do preço de referência e terão contribuído para a redução da despesa do SNS com medicamentos verificada em 2011 e 2012. Crê-se que antes da implementação dos referidos diplomas, o mercado concorrencial de medicamentos genéricos não apresentava a competição necessária, não se verificando a aproximação dos preços praticados ao seu custo marginal, de acordo com o previsto na teoria económica clássica. Pretende-se identificar o mercado total dos grupos homogéneos e analisar 50% do seu valor, através da identificação do preço de referência efectivo do 1º trimestre de 2011 ao 4º trimestre de 2012 e do cálculo do preço de referência expectável, na ausência da implementação dos referidos diplomas, com base nas regras existentes antes da implementação dos referidos diplomas. A identificação o peso relativo da alteração das regras do sistema de preços de referência, na despesa do SNS com medicamentos ocorrida em 2011 e 2012, poderemos delinear com maior rigor futuras estratégicas de controlo da despesa pública com medicamentos. Um factor de especial relevância dado o contexto actual de austeridade.

Relação entre despesas em saúde e a saúde das populações : análise da base de dados da OCDE 2012

RESUMO - Introdução: A despesa em saúde aumentou consideravelmente nas últimas décadas na maioria dos países industrializados. Por outro lado, os indicadores de saúde melhoraram. A evidência empírica sobre a relação entre as despesas em saúde e a saúde das populações tem sido inconclusiva. Este estudo aborda a relação entre as despesas em saúde e a saúde das populações através de dados agregados para 34 países para o período 1980-2010. Metodologia: Utilizou-se o coeficiente de correlação de Pearson para avaliar a correlação entre as variáveis explicativas e os indicadores de saúde. Procedeuse ainda à realização de uma regressão multivariada com dados em painel para cada indicador de saúde utilizado como variável dependente: esperança de vida à nascença e aos 65 anos para mulheres e homens, anos de vida potencialmente perdidos para mulheres e homens e mortalidade infantil. A principal variável explicativa utilizada foi a despesa em saúde, mas consideraram-se também vários fatores de confundimento, nomeadamente a riqueza, fatores estilo de vida, e oferta de cuidados. Resultados: A despesa per capita tem impacto nos indicadores de saúde mas ao adicionarmos a variável PIB per capita deixa de ser estatisticamente significativa. Outros fatores têm um impacto significativo para quase todos os indicadores de saúde utilizados: consumo de álcool e tabaco, gordura, o número de médicos e a imunização, confirmando vários resultados da literatura. Conclusão: Os resultados vão ao encontro de alguns estudos que afirmam o impacto marginal das despesas em saúde e do progresso da medicina nos resultados em saúde desde os anos 80 nos países industrializados.

Introducing Mobile Money in Rural Mozambique: Evidence from a Field Experiment*

The limitations of access to finance in Africa, together with the recent boom in cell phone use in that continent, created high expectations regarding the introduction of mobile money in many African countries. The success story of M-PESA in Kenya raised the bar further. We designed and conducted a field experiment to assess the impact of randomized mobile money dissemination in rural Mozambique. For this purpose we benefit from the fact that mobile money was only recently launched in the country, allowing for the identification of a pure control group. This paper reports on the first results of this ongoing project after the first wave of dissemination efforts in rural locations, which included the recruitment and training of mobile money agents, community meetings and theaters, as well as individual rural campaigning. Administrative and behavioral data both show clear adherence to the services in the treatment group. Financial literacy and trust outcomes are also positively affected by the treatment. We present behavioral evidence that the marginal willingness to remit was increased by the availability of mobile money. Finally, we observe a tendency for mobile money to substitute traditional alternatives for both savings and remittances.

The uneasy case for lower parking standards

Minimum parking requirements are the norm for urban and suburban development in the United States (Davidson and Dolnick (2002)). The justification for parking space requirements is that overflow parking will occupy nearby street or off-street parking. Shoup (1999) and Willson (1995) provides cases where there is reason to believe that parking space requirements have forced parcel developers to place more parking than they would in the absence of parking requirements. If the effect of parking minimums is to significantly increase the land area devoted to parking, then the increase in impervious surfaces would likely cause water quality degradation, increased flooding, and decreased groundwater recharge. However, to our knowledge the existing literature does not test the effect of parking minimums on the amount of lot space devoted to parking beyond a few case studies. This paper tests the hypothesis that parking space requirements cause an oversupply of parking by examining the implicit marginal value of land allocated to parking spaces. This is an indirect test of the effects of parking requirements that is similar to Glaeser and Gyourko (2003). A simple theoretical model shows that the marginal value of additional parking to the sale price should be equal to the cost of land plus the cost of parking construction. We estimate the marginal values of parking and lot area with spatial methods using a large data set from the Los Angeles area non-residential property sales and find that for most of the property types the marginal value of parking is significantly below that of the parcel area. This evidence supports the contention that minimum parking requirements significantly increase the amount of parcel area devoted to parking.

The ambivalence of two-part tariffs for bottleneck access

Two-part tariffs, when used at the retail level, increase efficiency by lowering the price of marginal units. The same potential for higher efficiency exists for two-part tariffs at wholesale level for a given market structure, but the fixed part of the wholesale tariff can negatively affect the latter. In a simulated competition model of next-generation telecommunications access networks that has been calibrated with engineering cost data, we show that the latter effects strongly outweigh the former. That is, substituting a cost-based linear wholesale access tariff with revenue-equivalent two-part tariffs reduces the number of access seekers and therefore leads to higher prices and lower welfare and consumer surplus.

Public funding of higher education: who gains, who loses?

This paper analyses the effects of public funding of higher education on the welfare of the different agents. It takes into account the hierarchical nature of the educational system and also the fact that parents always have the possibility to complement basic public education with private expenditures in individual tutoring. It is obtained that although public funding implies a larger access to higher education it is always the case that some of the agents that gain access lose in welfare terms. Moreover, it is shown that the marginal agent to access university would always prefer a pure private funding system. Thus, when studying the effects of public funding of higher education, we can not identify gaining access to University with an increase in welfare. Finally, I consider a funding system where only those that send their o¤spring to university support the funding of higher education.

Money for nothing?: The net costs of medical training

A Masters Thesis, presented as part of the requirements for the award of a Research Masters Degree in Economics from NOVA – School of Business and Economics

Alcácer-Quibir. Uma obra têxtil de Paula Rego na década de 1960

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em História de Arte Contemporânea

Going beyond duopoly: Connectivity breakdowns under receiving party pays

We show that the prediction of strategic connectivity breakdowns under a receiving-party-pays system and discrimination between on and off-net prices does not hold up once more than two mobile networks are considered. Indeed, if there are at least three competing networks and enough utility is obtained from receiving calls, only equilibria with finite call prices and receiving prices exist. Private negotiations over access charges then achieve the efficient outcome. Bill & keep (zero access charges) and free outgoing and incoming calls are efficient if and only marginal costs of calls are zero.

As atitudes face à doença no Portugal dos séculos XIV e XV: a lepra, os leprosos e as leprosarias

A doença como tópico de reflexão historiográfica encontra-se relativamente ausente do actual rol de interesses da medievística portuguesa. Apesar de lhe ser feita referência em vários artigos de pequena e média dimensão – publicados, sobretudo, nas décadas de 80 e 90 do século passado -, a enfermidade aparece, por norma, como subtema de problemáticas maiores como a assistência ou a pobreza, não tendo merecido ainda estudos de grande profundidade. Num sentido inverso, a historiografia internacional, com particular destaque para a francesa e inglesa, tem vindo a desenvolver interessantes e renovadas perspectivas de análise que incidem não só sobre as percepções medievais da doença mas também sobre as atitudes dos indivíduos face aos seus congéneres enfermos. O presente artigo segue algumas destas linhas de investigação recentemente propostas, procurando aplicá-las ao caso português nas centúrias de Quatrocentos e Quinhentos. Em concreto, interessa-nos avaliar a validade e/ou utilidade das equações “lepra = medo do contágio”, “leproso = pobre e marginal”, “leprosaria = segregação social”. Para tal, começaremos por discutir o conceito de doença, avançando, depois, para a análise das fontes recolhidas, privilegiando o caso de Lisboa mas sem esquecer outros núcleos urbanos como o Porto, Coimbra, Évora e Santarém. Aqui serão explorados problemas na linha dos que se seguem: Era comum, em contexto urbano, a noção de contágio da lepra? Em sendo, as atitudes face aos leprosos respondiam apenas a essa ideia ou devem ser tidos em conta outros factores? Qual a pertinência de uma abordagem genera-lista em relação à suposta posição marginalizada dos leprosos? Que diferenças existiam entre os “lázaros andantes ao mundo”, os residentes nas leprosarias e os lázaros domésticos? Devem entender-se as gafarias meramente como mecanismos profilácticos e como espaços de exclusão social ou há que ter em consideração ainda o papel que desempenhavam na integração dos enfermos?