Francisella tularensis subspecies holarctica occurs in Swedish mosquitoes, persists through the developmental stages of laboratory-infected mosquitoes and is transmissible during blood feeding.

In Sweden, mosquitoes are considered the major vectors of the bacterium Francisella tularensis subsp. holarctica, which causes tularaemia. The aim of this study was to investigate whether mosquitoes acquire the bacterium as aquatic larvae and transmit the disease as adults. Mosquitoes sampled in a Swedish area where tularaemia is endemic (Örebro) were positive for the presence of F. tularensis deoxyribonucleic acid throughout the summer. Presence of the clinically relevant F. tularensis subsp. holarctica was confirmed in 11 out of the 14 mosquito species sampled. Experiments performed using laboratory-reared Aedes aegypti confirmed that F. tularensis subsp. holarctica was transstadially maintained from orally infected larvae to adult mosquitoes and that 25% of the adults exposed as larvae were positive for the presence of F. tularensis-specific sequences for at least 2 weeks. In addition, we found that F. tularensis subsp. holarctica was transmitted to 58% of the adult mosquitoes feeding on diseased mice. In a small-scale in vivo transmission experiment with F. tularensis subsp. holarctica-positive adult mosquitoes and susceptible mice, none of the animals developed tularaemia. However, we confirmed that there was transmission of the bacterium to blood vials by mosquitoes that had been exposed to the bacterium in the larval stage. Taken together, these results provide evidence that mosquitoes play a role in disease transmission in part of Sweden where tularaemia recurs.

Molecular Detection of Persistent Francisella tularensis Subspecies holarctica in Natural Waters.

Tularemia, caused by the bacterium Francisella tularensis, where F. tularensis subspecies holarctica has long been the cause of endemic disease in parts of northern Sweden. Despite this, our understanding of the natural life-cycle of the organism is still limited. During three years, we collected surface water samples (n = 341) and sediment samples (n = 245) in two areas in Sweden with endemic tularemia. Real-time PCR screening demonstrated the presence of F. tularenis lpnA sequences in 108 (32%) and 48 (20%) of the samples, respectively. The 16S rRNA sequences from those samples all grouped to the species F. tularensis. Analysis of the FtM19InDel region of lpnA-positive samples from selected sampling points confirmed the presence of F. tularensis subspecies holarctica-specific sequences. These sequences were detected in water sampled during both outbreak and nonoutbreak years. Our results indicate that diverse F. tularensis-like organisms, including F. tularensis subsp. holarctica, persist in natural waters and sediments in the investigated areas with endemic tularemia.

Bioaccumulation of 14C-PCB 101 and 14C-PBDE 99 in the marine planktonic copepod Calanus finmarchicus under different food regimes.

Bioaccumulation factors (BAFs) were determined for (14)C-PCB 101 and (14)C-PBDE 99 in the pelagic copepod Calanus finmarchicus after exposure to either contaminated water or after being fed contaminated phytoplankton (the dinoflagellate Prorocentrum minimum or the diatom Thalassiosira weissflogii). BAFs in algae range from 7.6 to 8.0 for PCB 101 and from 8.5 to 8.6 for PBDE 99. BAFs in copepods were significantly lower, 6.3-6.8 for PCB 101 and 7.6 for PBDE 99. For each compound, the BAFs in copepods were independent of what algal species they had consumed, even though the bioaccumulation of both compounds were higher in P. minimum than in T. weissflogii. The ratios between BAF and the K(ow) for PCB 101 and PBDE 99 were similar within each of the three species, but varied between species. For copepods the ratios were 2-4, for T. weissfloggii 15-22 and for P. minimum 32-40. The data strongly suggest that the two compounds bioaccumulate in a similar manner and that there is no biomagnification in the transfer between phytoplankton and herbivorous copepods.

Economic evaluation of infertility treatment for tubal disease.

PURPOSE: The number of published studies comparing cost-effectiveness of tubal surgery and IVF treatment is limited, in part because of the difficulties of conducting randomized trials, given that IVF is now a clinically accepted treatment and the decision to offer surgery or IVF is often dictated by the severity of the tubal disease and by the availability of the methods. The aim of this study was to compare the costs of our policy of offering tubal surgery to patients with mild or moderate tubal disease with the cost of offering IVF to these and severe tubal disease. METHODS: In this retrospective cohort study patients with tubal pathology as the sole reason for their infertility were included: 61 patients in the tubal surgery group and 464 patients in the IVF group. The delivery rates and costs per delivery were compared. RESULTS: Delivery rates were 28% in the tubal surgery group within 2 years of follow-up and 52% in the IVF group that involved up to three cycles of treatment. This economic evaluation demonstrated only small differences in the average cost when considering the cost per delivery. CONCLUSIONS: With a policy involving strict selection of patients, tubal surgery will continue to have a role in the treatment of infertility.

Effects of the cannabimimetic fatty acid derivatives 2-arachidonoylglycerol, anandamide, palmitoylethanolamide and methanandamide upon IgE-dependent antigen-induced beta-hexosaminidase, serotonin and TNF alpha release from rat RBL-2H3 basophilic leukaemic cells.

There are conflicting reports in the literature as to whether palmitoylethanolamide affects the function of mast cell-related cell lines in vitro, in contrast to the well-documented effects of this compound upon mast cell function in vivo. In the present study, we have reinvestigated the effects of palmitoylethanolamide upon antigen-induced release of [3H]serotonin and beta-hexosaminidase from rat basophilic leukemia RBL-2H3 cells and compared these effects with those of 2-arachidonoylglycerol, anandamide and R1-methanandamide. RBL-2H3 cells were sensitized with a monoclonal anti-DNP IgE, after which they were stimulated with antigen (DNP-HSA). Palmitoylethanolamide produced a small, but significant reduction in antigen-stimulated [3H]serotonin release at high concentrations, whereas anandamide was without effect. In contrast, 2-arachidonoylglycerol and methanandamide increased the antigen-stimulated release of both [3H]serotonin and beta-hexosaminidase. It is concluded that in RBL-2H3 cells, these cannabimimetic fatty acid derivatives do not have potent stabilizing effects upon antigen-induced degranulation.

A cost comparison of infertility treatment for clomiphene resistant polycystic ovary syndrome.

BACKGROUND: The study compares treatment outcome and costs of ovulation induction cycles and in vitro fertilization cycles in infertile women with clomiphene resistant polycystic ovary syndrome. METHODS: Twenty-eight infertile women with clomiphene resistant polycystic ovary syndrome referred to a university clinic were prospectively randomized to ovulation induction or in vitro fertilization. Forty-one ovulation induction cycles and thirty in vitro fertilization cycles were performed. Mann-Whitney U-test was used for between group comparisons and frequencies were compared with Fisher's exact test. RESULTS: More pregnancies per completed cycle were noted in the in vitro fertilization group than in the ovulation induction group. Drug costs were not much higher in the in vitro fertilization group but treatment costs were higher due to the additional costs of ovum pick up and embryo transfer. The cost per pregnancy was about twice as high in the ovulation induction group as in the in vitro fertilization group. The cost per term pregnancy including delivery was 1.6 times higher in the ovulation induction group. CONCLUSION: For a group of obese women with clomiphene resistant polycystic ovary syndrome, in vitro fertilization seems a cost-effective treatment.

Financing of IVF/ET in the Nordic countries.

BACKGROUND: The need for calculations of costs of health care has increased during the last few years. When priorities within the national health services in the five Nordic countries are discussed, treatment of infertility is often one of the issues. AIM AND METHODS: The aim of this study was to evaluate cost effectiveness and calculate the proportion of publicly financed in-vitro fertilization/embryo transfers in the Nordic countries. The mean direct and indirect costs of the treatments were calculated in both public and private clinics. The total cost of in-vitro fertilization was calculated and compared with the proportion financed through the national health services in the five countries. RESULTS: The cost analysis showed a direct and indirect cost of 3,300 Pounds per started treatment and 12,700 Pounds per term pregnancy for the whole Nordic material. The publicly financed costs were calculated at 27,342,300 Pounds, which is 66% of the total cost for in-vitro fertilization treatments. When these costs were compared with the total cost of health care in the countries, the proportion used for in-vitro fertilization treatments was between 0.08 and 0.16%. CONCLUSION: It will be difficult for the national health services in the five countries to make large savings by limiting the number of treatments financed within the system.

Cost-effectiveness of intracytoplasmic sperm injection in comparison with donor insemination.

BACKGROUND: Due to the need for cost containment in the national health services in many countries, there is a demand for analysis of both medical and cost benefits of new technologies. Intracytoplasmic sperm injection has in recent years been proved to be the method of choice for treating severe infertility. It also needs to be shown that intracytoplasmic sperm injection is a cost-effective treatment. AIM AND METHODS: The aim of this study was to evaluate the cost-effectiveness of intracytoplasmic sperm injection over a two-year period and to compare it with the cost-effectiveness of donor insemination. The mean direct and indirect costs of the two modes of treatment were compared with the outcome of the subsequent pregnancies and the cost per delivery in the two groups were calculated. RESULTS AND CONCLUSIONS: The cost analysis showed a direct and indirect cost per delivery after intracytoplasmic sperm injection of 264.300 SEK in 1993, decreasing to 174.900 SEK in 1994. The corresponding cost of donor insemination was 88.900 SEK during the two-year period. The cost analysis showed a 34% increase in cost-effectiveness of intracytoplasmic sperm injection from the first to the second year, an increase that will most probably continue. In the near future intracytoplasmic sperm injection will be a cost-effective treatment and, in addition, intracytoplasmic sperm injection will have the advantage of resulting in genetic children in a majority of the treated couples suffering from severe male subfertility.

Couples' willingness to pay for IVF/ET.

BACKGROUND: Many politicians and decision-makers in health care consider assisted reproduction an expensive and exclusive treatment despite the results of in vitro fertilization/embryo transfer (IVF/ET) treatments having improved considerably during the last few years. With the improved results the costs in relation to successful outcome are decreasing. AIM AND METHODS: The aim of this study was to evaluate the cost-benefit of IVF/ET treatments in a group of infertile couples. The benefit was measured as willingness to pay (WTP) for IVF/ET treatment and was related to the cost of IVF/ET: For the calculation of costs, data from one private and one public IVF clinic in Sweden during the period from January 1992 to March 1993 were used. RESULTS AND CONCLUSIONS: The cost analysis showed a direct cost for IVF/ET of 3,170 pounds per started treatment and 9,410 pounds per delivery. Including the indirect cost, the total cost was 3,880 pounds per started IVF/ET treatment and 11,490 pounds per delivery. The survey of the WTP showed that the infertile couples gave high economic priority to infertility treatment. A majority of the couples were willing to pay more for a child than the calculated direct cost.