A pilot cost-of-illness study on long-term complications/sequelae of AOM

OBJECTIVES

Acute otitis media (AOM) commonly affects young children and occasionally results in serious complications/sequelae. This pilot cost-of-illness study aimed to assess the economic burden of long-term AOM complications/sequelae in Belgium, and to establish a thorough methodology for a larger study.

METHODOLOGY

We retrospectively reviewed charts of patients aged 10-20 years with long-term complications/sequelae considered to be AOM-related, and > or = 8 years of follow-up. From a list of 215 eligible patients, we selected 25 patients representing each of seven categories of complications/sequelae.

RESULTS

Included patients had a mean age of 12.9 years; nine had chronic suppurative otitis media with cholesteatoma; six sensorineural hearing loss; six chronic perforation of the tympanic membrane; and one each with conductive hearing loss, facial paralysis, neurological impairment after intracranial complications, and complications of surgery. During 8-15 years of follow-up, the most common complications were hearing loss, chronic otitis media (OM), and cholesteatoma. These generally occurred > 5 years after the first AOM event, although chronic OM occurred after a mean time of 3.3 years. Yearly public health care payer (PHCP) costs ranged from Euro 119 to Euro 7957 per patient, and were highest for patients with sensorineural hearing loss. Yearly costs to the patients ranged from Euro 7 to Euro 289 per patient, and were also highest for patients with sensorineural hearing loss.

CONCLUSIONS

Although complications/sequelae of AOM are rare, they can result in substantial costs. The applied methodology should be feasible for a larger study, with some minor adjustments.

Halictine social evolution: the Australian enigma

Australian halictines belong to the primitive genus Lasioglossum or related subgenera. The underground nests have lined cells in series or clusters and sometimes at the end of laterals. Two full generations per year are produced in the communal nests. Overwintered and newly emerged females form unique "pseudosocieties" rather than matrifilial societies along Holarctic patterns. Several Chilalictus species produce a "male caste" of big-headed, flightless males, in addition to normal individuals. Oviposition of unfertilized eggs on large pollen balls causes such allometric bees.

The Nottingham study of neurotic disorder: predictors of 12 year costs

OBJECTIVE

To examine the relationship between clinical, demographic and socio-economic characteristics and the long-term costs of a cohort of neurotic patients.

METHOD

Analysis of the costs of a cohort of 210 people entered in the Nottingham study of neurotic disorders, a randomized controlled evaluation of five treatments for neurotic disorders. Service use data were collected at 5 and 12 years after study entry. Multiple regression analyses were conducted.

RESULTS

The total cost per patient over the 12-year follow-up period was calculated to be $11,940 (SD $15,520) ( pound7450, SD pound9690). Higher costs were significantly associated with the presence of general neurotic syndrome, an initial diagnosis of dysthymia and a recurrent episode of illness.

CONCLUSION

The total costs of care for a range of neurotic disorders are broadly comparable with other estimates of costs reported in the literature for similar populations. Those responsible for higher costs in the longer-term have comorbid anxiety, depressive and personality disorders.

Opportunist mycobacteria in England and Wales: 1982 to 1994

Three thousand and fifty-two infections with opportunist mycobacteria were reported to the PHLS Communicable Disease Surveillance Centre from 1982 to 1994. The commonest reported species was Mycobacterium avium-intracellulare (MAI), followed by M. kansasii and M. malmoense. The annual totals of opportunist mycobacteria increased steadily over this period, mostly, but not exclusively, due to an increase in reports of MAI associated with HIV infection. There were also increases in reports of MAI not associated with HIV infection, and in reports of M. malmoense. The increase in reports of opportunist mycobacteria was seen throughout England and Wales, but underreporting of MAI infection in the National Health Service Thames regions appears to have increased in recent years. Continued referral of isolates of opportunist mycobacteria to one of the PHLS regional centres for mycobacteriology or the Mycobacterium Reference Unit, and reporting to CDSC, is essential for the surveillance of these infections.

Diapause induction in the sawfly Neodiprion rugifrons Middleton (Hymenoptera: Diprionidae)

Neodiprion rugifrons Midd. occurs on jack pine in eastern North America, where it has a single generation per year in Ontario, but two generations in Wisconsin when spring is exceptionally mild and early. Only in this situation will the sensitive last larval instar in June receive the photoperiod of around 17 h that prevents diapause induction and allows the production of another generation, whose sensitive stage is then subjected to a short, diapause-inducing photoregime in September or October.

Synergistic evolution of halictine nest architecture and social behavior

Halictinae are a large and taxonomically diverse group of ground-nesting bees. Solitary and social members coexist in all faunal zones, and several distinct evolutionary pathways to higher social levels can be discerned among extant species. The genus Evylaeus embraces the most advanced halictine societies known. These are made up of a queen and numerous small, unmated and nonreproductive workers. A strong correlation exists between architectural complexity and the level of socialization attained in those forms, since only a structural preadaptation permits a development of large colonies possessing a division of labor and intensive brood care.

Brood care in halictine bees

Four species of the halictine bee genus Evylaeus keep their brood cells open during most or part of the development of the larvae. In the colonial summer phase, house bees care for the young and keep brood cells clean from feces and exuviae. Progressive feeding of nector is present at least in Evylaeus malachurus, whose fully fed larvae are, on an average, 60 percent heavier than the egg-and-pollen stage. Interactions between the two generations of social Halictinae are of general occurrence, and their intensity corresponds to the level of social behavior attained.

Polymorphism in Some Nearctic Halictine Bees

Average difference in size between queens and workers of four social Halictinae common to southern Ontario ranges from 6 percent in Augochlorella striata (Prov.) to 15 percent in Evylaeus cinctipes (Prov.). Spring larvae receive. provisions averaging 33.9 milligrams and become small workers; summer larvae consume on average 61.7 milligrams and develop into large queens and males.