Altitudinal Assessment of Amblyomma aureolatum and Amblyomma ovale (Acari: Ixodidae), Vectors of Spotted Fever Group Rickettsiosis in the State of São Paulo, Brazil.

Amblyomma aureolatum (Pallas) and Amblyomma ovale Koch are common ectoparasites of domestic dogs in São Paulo state, southeastern Brazil, where they are vectors of distinct spotted fever group rickettsioses, one caused by Rickettsia rickettsii (transmitted by A. aureolatum), and the other caused by Rickettsia sp. strain Atlantic rainforest (transmitted by A. ovale). For the present study, we performed an altitudinal assessment of all 1992-2012 records of A. aureolatum and A. ovale retrieved from a tick collection. The municipalities with A. ovale records presented significantly (P < 0.05) lower altitude than the ones with A. aureolatum records; the higher the altitude, the lower the chances for the occurrence of A. ovale and the greater the likelihood for the occurrence of A. aureolatum. Regarding A. aureolatum, the chances of finding it in municipalities between 101 and 700 m are nine times higher than in municipalities at ≤ 100 m, or 31.5 times higher in municipalities above 700 m, when compared with municipalities at ≤ 100 m. The reverse was observed for A. ovale, which had its odds ratio diminishing at higher altitudes. These findings have a major role to public health, as A. aureolatum is associated with the transmission of a highly lethal spotted fever (caused by R. rickettsii), whereas A. ovale is associated with the transmission of a milder spotted fever (caused by Rickettsia sp. strain Atlantic rainforest, a R. parkeri-like agent), both in the state of São Paulo.

Cost-effectiveness of prostate cancer screening: a simulation study based on ERSPC data.

BACKGROUND: The results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial showed a statistically significant 29% prostate cancer mortality reduction for the men screened in the intervention arm and a 23% negative impact on the life-years gained because of quality of life. However, alternative prostate-specific antigen (PSA) screening strategies for the population may exist, optimizing the effects on mortality reduction, quality of life, overdiagnosis, and costs. METHODS: Based on data of the ERSPC trial, we predicted the numbers of prostate cancers diagnosed, prostate cancer deaths averted, life-years and quality-adjusted life-years (QALY) gained, and cost-effectiveness of 68 screening strategies starting at age 55 years, with a PSA threshold of 3, using microsimulation modeling. The screening strategies varied by age to stop screening and screening interval (one to 14 years or once in a lifetime screens), and therefore number of tests. RESULTS: Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost-effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were overdiagnosed. When better quality of life for the post-treatment period could be achieved, an older age of 65 to 72 years for ending screening was obtained. CONCLUSION: Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.

Predicting the economic impact of an invasive species on an ecosystem service.

Quantifying the impact of alien invasive species on ecosystem services is an essential step in developing effective practices and policy for invasive species management. Here we develop a stochastic bioeconomic model that enables the economic impact of an invasive pest to be estimated before its arrival, based on relatively poorly specified ecological and economic parameters. We developed the model by using a hypothetical invasion of the varroa bee mite (Varroa destructor) into Australia and the negative flow-on effects that it would have on pollination by reducing honey bee populations, giving rise to a loss of pollination services, reduced crop yields, and additional production costs. If the mite were to continue to be prevented from entering the country over the next 30 years, we estimate that the economic costs avoided would be U.S. $16.4-38.8 million (Aus $21.3-50.5 million) per year. We suggest that current invasion response funding arrangements in Australia, which do not acknowledge these avoided damages, require amendment.

Prospective evaluation plan for randomised trials of prostate cancer screening. The International Prostate Cancer Screening Trial Evaluation Group.

To enable pooled analyses of continuing and planned randomised trials of prostate cancer screening, guidelines for minimal data required for such analyses were developed in the recent meeting of the International Prostate Screening Trial Evaluation Group (IPSTEG). The aim of the pooled analysis with data on individual level will be: (a) Estimation of the effect of screening on prostate cancer mortality with greater precision than individual studies (b) Assessment of optimal screening procedures and interval (c) Identification of subgroups within the populations that might receive most benefit from screening (d) Evaluation of the quality of life effects and cost effectiveness of screening. All studies included in the combined analysis share a common core protocol with minimum data requirements. The protocol allows, however, adaptation of the procedures to local circumstances within defined options. It should be noted that the process is continuing and the protocol is subject to evaluation and revision in the meetings of the IPSTEG on a regular basis.

Healthcare resources should be targeted to chemoprevention in prostate cancer: the argument for.

The search for localised disease increases the incidence of histologically determined prostate cancer, termed 'minimal' disease. Moreover, the number of locally advanced cases found at surgery increases the push towards surgery at earlier stages of disease. We already have knowledge of risk factors and epidemiological autopsy incidences, and have developed hypotheses to prevent clinical prostate cancer, therefore we should now be performing chemoprevention studies in time to save the next generation from unneeded treatment and healthcare deficits.