Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years

BACKGROUND/AIMS: Alveolar echinococcosis (AE) is a serious liver disease. The aim of this study was to explore the long-term prognosis of AE patients, the burden of this disease in Switzerland and the cost-effectiveness of treatment. METHODS: Relative survival analysis was undertaken using a national database with 329 patient records. 155 representative cases had sufficient details regarding treatment costs and patient outcome to estimate the financial implications and treatment costs of AE. RESULTS: For an average 54-year-old patient diagnosed with AE in 1970 the life expectancy was estimated to be reduced by 18.2 and 21.3 years for men and women, respectively. By 2005 this was reduced to approximately 3.5 and 2.6 years, respectively. Patients undergoing radical surgery had a better outcome, whereas the older patients had a poorer prognosis than the younger patients. Costs amount to approximately Euro108,762 per patient. Assuming the improved life expectancy of AE patients is due to modern treatment the cost per disability-adjusted life years (DALY) saved is approximately Euro6,032. CONCLUSIONS: Current treatments have substantially improved the prognosis of AE patients compared to the 1970s. The cost per DALY saved is low compared to the average national annual income. Hence, AE treatment is highly cost-effective in Switzerland.

Tracing glacier wastage in the Northern Tien Shan (Kyrgyzstan/Central Asia) over the last 40 years

The status and dynamics of glaciers are crucial for agriculture in semiarid parts of Central Asia, since river flow is characterized by major runoff in spring and summer, supplied by glacier- and snowmelt. Ideally, this coincides with the critical period of water demand for irrigation. The present study shows a clear trend in glacier retreat between 1963 and 2000 in the Sokoluk watershed, a catchment of the Northern Tien Shan mountain range in Kyrgyzstan. The overall area loss of 28% observed for the period 1963–2000, and a clear acceleration of wastage since the 1980s, correlate with the results of previous studies in other regions of the Tien Shan as well as the Alps. In particular, glaciers smaller than 0.5 km2 have exhibited this phenomenon most starkly. While they registered a medium decrease of only 9.1% for 1963–1986, they lost 41.5% of their surface area between 1986 and 2000. Furthermore, a general increase in the minimum glacier elevation of 78 m has been observed over the last three decades. This corresponds to about one-third of the entire retreat of the minimum glacier elevation in the Northern Tien Shan since the Little Ice Age maximum.

Winter precipitation trends for two selected European regions over the last 500 years and their possible dynamical background

We analyse winter (DJF) precipitation over the last 500 years on trends using a spatially and temporally highly resolved gridded multi-proxy reconstruction over European land areas. The trends are detected applying trend matrices, and the significance is assessed with the Mann–Kendall-trend test. Results are presented for southwestern Norway and southern Spain/northern Morocco, two regions that show high reconstruction skill over the entire period. The absolute trend values found in the second part of the 20th century are unprecedented over the last 500 years in both regions. During the period 1715–1765, the precipitation trends were most pronounced in southwestern Norway as well as southern Spain/northern Morocco, with first a distinct negative trend followed by a positive countertrend of similar strength. Relating the precipitation time series to variations of the North Atlantic Oscillation Index (NAOI) and the solar irradiance using running correlations revealed a couple of instationarities. Nevertheless, it appears that the NAO is responsible in both regions for most of the significant winter precipitation trends during the earlier centuries as well as during recent decades. Some of the significant winter precipitation trends over southwestern Norway and southern Spain/northern Morocco might be related to changes in the solar irradiance.

Palaeohydrology, fires and vegetation succession in the southern Baltic during the last 7500 years reconstructed from a raised bog based on multi-proxy data

We present the first 7500 yr long multi-proxy record from a raised bog located at the southern Baltic coast, Poland. Testate amoebae, plant macrofossils, pollen and microscopic charcoal were used to reconstruct environmental changes in Pomerania (northern Poland, Kaszuby Lakeland) from a 7-m thick peat archive of Stążki bog dated 5500 BC–AD 1250. We obtained a record of proxies representing different spatial scales: regional vegetation changed simultaneously with local vegetation, and testate amoebae showed a pattern of change similar to that of pollen and plant macrofossils. On the basis of the combined proxies, we distinguished three hydroclimatic stages: moist conditions 5500–3450 BC, drier conditions with regionally increased fires up to 600 BC, and again moist conditions from 600 BC onward. During the drier interval, a first climatic shift to wetter conditions at 1700 BC is indicated by regional pollen as the replacement of Corylus by Carpinus, and locally by, e.g., the increase of Hyalosphenia elegans and mire plants such as Sphagnum sec. Cuspidata. Furthermore, we observed a correlation since 600 BC among the re-expansion of Carpinus (after a sudden decline ca. 950 BC), increased peat accumulation, increase of Hyalosphenia species, and fewer fires, suggesting lower evapotranspiration and a stable high water table in the bog. Fagus started to expand after AD 810 gradually replacing Carpinus, which was possibly due to a gradually more oceanic climate, though we cannot exclude human impact on the forests. Peat accumulation, determined by radiocarbon dating, varied with bog surface wetness. The hydroclimatic phases found in Stążki peatland are similar to moisture changes recorded in other sites from Poland and Europe. This is the first detailed record of hydroclimatic change during the Holocene in the southern Baltic region, so it forms a reference site for further studies on other southern Baltic bogs that are in progress.

Multi-proxy summer and winter precipitation reconstruction for southern Africa over the last 200 years

This study presents the first consolidation of palaeoclimate proxy records from multiple archives to develop statistical rainfall reconstructions for southern Africa covering the last two centuries. State-of-the-art ensemble reconstructions reveal multi-decadal rainfall variability in the summer and winter rainfall zones. A decrease in precipitation amount over time is identified in the summer rainfall zone. No significant change in precipitation amount occurred in the winter rainfall zone, but rainfall variability has increased over time. Generally synchronous rainfall fluctuations between the two zones are identified on decadal scales, with common wet (dry) periods reconstructed around 1890 (1930). A strong relationship between seasonal rainfall and sea surface temperatures (SSTs) in the surrounding oceans is confirmed. Coherence among decadal-scale fluctuations of southern African rainfall, regional SST, SSTs in the Pacific Ocean and rainfall in south-eastern Australia suggest SST-rainfall teleconnections across the southern hemisphere. Temporal breakdowns of the SST-rainfall relationship in the southern African regions and the connection between the two rainfall zones are observed, for example during the 1950s. Our results confirm the complex interplay between large-scale teleconnections, regional SSTs and local effects in modulating multi-decadal southern African rainfall variability over long timescales.