The social value of health programs: Is age a relevant factor?

In cost-effectiveness analysis (CEA) it is usually assumed that a QALY is of equal value to everybody, irrespective of the patient's age. However, it is possible that society assigns different social values to a QALY according to who gets it. In this paper we discuss the possibility of weighting health benefits for age in CEA. We also examinethe possibility that age-related preferences depend on the size of the health gain. An experiment was performedto test these hypotheses. The results assessing suggest that the patient's age is a relevant factor when assessing health gains.

Esotropie précoce: résultats à long terme d'une série de 82 cas opérés par myopexie rétro-équatoriale et recul simultané des deux muscles droits médiaux avant l'âge de 24 mois [Early-onset esotropia operated before the age of 24 months: long-term results of Cüpper's retropexy combined with simultaneous recession of both medial recti]

BACKGROUND: When and how to operate an early-onset esotropia (onset before 6 months of age) is still controversial. We conducted a retrospective study of such patients operated before the age of 24 months. PATIENTS AND METHODS: 82 patients were operated by one surgeon (GK) and followed by the same team. At 5 years post-operation, evaluation criteria included the residual angle of deviation, visual acuity (Birkhäuser Nr 505, 5 m) and binocularity (Lang stereotest I, Bagolini glasses). RESULTS: At 5 years, the residual angle was excellent (0 degrees to + 5 degrees ) in 67 % good, (>+5 degrees to +10 degrees or 0 to -5 degrees ) in 23 %, and poor (>+10 degrees or <-5 degrees ) in 10 %. During the 5 years of follow-up the rate of reoperation was 9.7 %. Isoacuity was obtained in 62 %, slight amblyopia (2 lines of interocular difference) was present in 32 %, and average amblyopia (> 3 lines of interocular difference) was noted in 6 %. Simultaneous perception was present in 53 %, whereas one eye was suppressed or results were undetermined in 47 %. No patient demonstrated stereoscopy using the Lang's stereotest I. CONCLUSION: The results from our study demonstrate that early surgery of early-onset esotropia has a favourable outcome on both visual acuity and the residual angle of strabismus. Simultaneous perception was achieved in 53 %. These figures are comparable to the results of the ELISSS multicentric study.

Prevention of age-associated dementia.

The advancement of medical sciences during the last century has resulted in a considerable increase in life expectancy. As more people live to old age, one of the most fundamental questions of the 21st century is whether the number of individuals suffering from dementia will also continue to increase. Alzheimer's disease (AD) accounts for the majority of cases of dementia in the elderly, but there is currently no curative treatment available. Several strategies have been introduced for treatment, the most recent strategy of which was the immunization of patients using antibodies against Abeta, which is a naturally occurring, even though misfolded peptide in the AD brain. Both active and passive immunization routes have been shown to reduce the pathology associated with Abeta accumulation in brains of genetically designed animal models. However, despite tremendous efforts, no unequivocal proof of therapeutic efficacy could be shown in AD patients. Particularly, the persistence of the neurofibrillary tangles in immunized brains and the issue of inducing cerebral amyloid angiopathy are major limiting factors of antibody therapy. Furthermore, physical activity, a healthy immune system and nutritional habits are suggested to protect against the onset of age-associated dementia. Thus, accumulative evidence suggests that an early integrated strategy, combining pharmacological, immunological, nutritional and life-style factors, is the most pragmatic approach to delay the onset and progression of age-associated dementia.

Influence of age and diet on the performance of Cephalonomia stephanoderis (Hymenoptera, Bethylidae) a parasitoid of the coffee berry borer, Hypothenemus hampei (Coleoptera, Curculionidae)

The importance of age and feeding on the performance of Cephalonomia stephanoderis (Hymenoptera, Bethylidae), a parasitoid of the coffee berry borer, Hypothenemus hampei (Coleoptera, Curculionidae) was investigated in the laboratory. Groups of female parasitoids were subject to the following treatments: a group fed during one, five and ten days after emergence of adults with coffee borer larvae; another group fed only with honey solution during five days after emergence; and as a control, a third group was kept without food for five days. At the end of each treatment, survivorship, parasitoid activity (walking and flying capacity in an arena), search capacity for finding coffee borer-infested berries, host feeding and oviposition (on immature hosts), were assessed. Unfed females showed a significant decrease in survivorship compared to individuals that were fed. The type of meal (insects or honey) did not significantly influence parasitoid activity, search and oviposition capacities. Females fed with honey solution significantly consumed less immature coffee borers. Younger females (one day old) walked and flew out of the arena significantly faster than older ones (5 and 10 days old). Implications of these results are discussed on the performance of C. stephanoderis as a biological control agent of the coffee berry borer.

Effects of female diet and age on offspring sex ratio of the solitary parasitoid Pachycrepoideus vindemmiae (Rondani) (Hymenoptera, Pteromalidae)

Effects of female diet and age on offspring sex ratio of the solitary parasitoid Pachycrepoideus vindemmiae (Rondani) (Hymenoptera, Pteromalidae). Theories predict that females of parasitoid wasps would adjust the offspring sex ratio to environmental conditions in the oviposition patch, but the diet and age of females would also affect the sex ratio adjustment. Our focus was to test the effects of female diet and age on offspring sex ratio of the solitary parasitoid wasp, Pachycrepoideus vindemmiae (Rondani, 1875). Our results showed that females fed with honey had significantly less female biased offspring sex ratio than those fed only with water. Offspring sex ratio (male percentage) decreased with female age or female longevity at the beginning of oviposition but increased at the end. There should be a sperm limitation in P. vindemmiae females at the end of oviposition, and a higher frequency of unfertilized eggs were laid then. Females also laid more unfertilized eggs at the beginning of oviposition, which would be necessary to insure the mating among offspring. Male offspring developed faster and emerged earlier, which would also reduce the risk of virginity in offspring with female-biased sex ratio.

Age and multiple mating effects on reproductive success of Grapholita molesta (Busck) (Lepidoptera, Tortricidae)

The reproductive success of the oriental peach moth was evaluated in four experiments: 1) assessment of the mating duration, fecundity, fertility and longevity of females paired with virgin and immediately mated males; 2) mating duration, spermatophore size, fecundity, fertility and longevity in females paired with virgin and up to four times mated males; 3) receptivity of females to additional copulations after mating with virgin or mated males, and the effects of this behavior in female fecundity, fertility and longevity; 4) influence of insects age in the reproductive output. Males (33%) could copulate immediately after a previous copula. They were fertile until the fourth mating, but only in the first copula they transferred the longest (1.43 ± 0.10 mm) and widest (0.83 ± 0.11 mm) spermatophore, presenting the fastest mating duration (34.8 ± 2.62 min). A high proportion of females copulated by non-virgin males (84%) was receptive to other copulas, in comparison to those copulated by virgin males (32.4%). However, the fecundity, fertility, and longevity were similar among females that copulate once or more. The age was the most important factor affecting reproductive variables, where one and three day old insects had a significant higher fecundity, fertility and presented a shorter mating duration in comparison with older individuals. Results pointed out that the reproductive capacity of Grapholita molesta changes a little with respect to the analyzed factors, highlighting the elevated biotic potential of the species.

Local-scale spatial variation in diversity of social wasps in an Amazonian rain forest in Caxiuanã, Pará, Brazil (Hymenoptera, Vespidae, Polistinae)

Polistine wasps are important in Neotropical ecosystems due to their ubiquity and diversity. Inventories have not adequately considered spatial attributes of collected specimens. Spatial data on biodiversity are important for study and mitigation of anthropogenic impacts over natural ecosystems and for protecting species. We described and analyzed local-scale spatial patterns of collecting records of wasp species, as well as spatial variation of diversity descriptors in a 2500-hectare area of an Amazon forest in Brazil. Rare species comprised the largest fraction of the fauna. Close range spatial effects were detected for most of the more common species, with clustering of presence-data at short distances. Larger spatial lag effects could also be identified in some species, constituting probably cases of exogenous autocorrelation and candidates for explanations based on environmental factors. In a few cases, significant or near significant correlations were found between five species (of Agelaia, Angiopolybia, and Mischocyttarus) and three studied environmental variables: distance to nearest stream, terrain altitude, and the type of forest canopy. However, association between these factors and biodiversity variables were generally low. When used as predictors of polistine richness in a linear multiple regression, only the coefficient for the forest canopy variable resulted significant. Some level of prediction of wasp diversity variables can be attained based on environmental variables, especially vegetation structure. Large-scale landscape and regional studies should be scheduled to address this issue.

Lending to the borrower from hell: Debt and default in the age of Philip II, 1556-1598

What sustained borrowing without third-party enforcement, in the early days of sovereignlending? Philip II of Spain accumulated towering debts while stopping all payments tohis lenders four times. How could the sovereign borrow much and default often? Weargue that bankers ability to cut off Philip II s access to smoothing services was key. Aform of syndicated lending created cohesion among his Genoese bankers. As a result,lending moratoria were sustained through a cheat the cheater mechanism (Kletzer andWright, 2000). Our paper thus lends empirical support to a recent literature emphasizingthe role of bankers incentives for continued sovereign borrowing.

Diversity of Braconidae (Insecta, Hymenoptera) of the Parque Natural Municipal de Porto Velho, Rondonia, Brazil

Braconidae is a highly diversified family of Hymenoptera and usually known by their role in biological control both in agricultural and natural ecosystems. Despite of that, little is known about its diversity in the Amazon region. The present work inventoried the braconid fauna of an Open Ombrophylous Forest with Palm Trees of the Parque Natural Municipal de Porto Velho, RO. Insects were collect from June/2008 to May/2009 using six Malaise traps in different parts of the reserve. A total of 377 wasps were captured, 17 subfamilies and 56 genera identified. Braconinae, Microgastrinae, Doryctinae and Rogadinae subfamilies were very abundant, and also the genera Aleiodes, Bracon, Capitonius, Compsobracon, Heterospilus, Hymenochaonia, Opius, Pedinotus, Rogas and Stantonia. The calculated Shannon diversity index was 2.15 and 3.3 for subfamily and genera, respectively, which were, generally, higher than the values found for other regions in Brazil. Generally, parasitoids were more abundant during the rainy season. The present work contributes with new genera records and faunistic data of Braconidae in Rondonia State, western Amazon.

Diversity of Ephemeroptera (Insecta) of the Serra da Mantiqueira and Serra do Mar, southeastern Brazil

The aim of this study was to inventory the mayfly fauna, based on nymphal and alate stages, in Serra da Mantiqueira and in Serra do Mar, São Paulo State, as well as to present information about habitats used by the genera. Nymphs were collected in several streams and mesohabitats with a Surber sampler and the winged stages with light attraction methods, entomological nets, and Malaise traps. In all, eight families and 33 genera were recorded, representing a very significant portion of the Brazilian fauna (80% of families and 49% of genera). Furthermore, it was possible to identify 11 species, of which two are new records for the state: Tricorythodes santarita Traver and Caenis reissi Malzacher. Despite the high diversity recorded, the accumulation curves presented an ascending form, indicating an increase in the number of genera with additional sampling effort. The high richness found in these areas are in agreement with the high biodiversity of the Atlantic Forest biome and the sampling effort employed, which included the use of different methods, the collection of both nymphs and winged stages, and the sampling of a large area with diverse streams and habitats.

Regional diversity in the fruit sector in the European Union

This article aims to identify the key groups of regions with respectto farms oriented to fruit and citrus production.Twenty variables of fruit and citrus oriented farms corresponding toforty-one regions of the European Union were analyzed. Seven groupsemerged from cluster analysis. Only two of them showed good perspectives. Regions in the South of the Community need an important modernisation and restructuring process, which entails serious social consequences.

Facteurs de risque fracturaire, nouveaux traitements: comment evolue la prise en charge de l'ostéoporose de la personne agée [Fracture risk, new treatments: how does the management of the osteoporosis of elderly change?]

Osteoporosis of elderly is a growing medical, economic and health-care problem. It is due to the increase of the life expectancy and the number of osteoporotic fractures. With the new Swiss-specific tool FRAX and the development of inpatients fracture trajectory, we can better identify patients with high risk of fracture. An appropriate treatment can be proposed more quickly. The follow-up of bone markers increases the treatment efficiency. With a better identification, treatment and follow-up of osteoporosis of elderly patients, we can ameliorate the patient's quality of life and decrease the number of osteoporotic fractures with a good cost-effectiveness ratio.

Comparative abundance and diversity of Dryininae (Hymenoptera, Dryinidae) in three savannah phytophysiognomies in southeastern Brazil, under three sampling methods

Comparative abundance and diversity of Dryininae (Hymenoptera, Dryinidae) in three savannah phytophysiognomies in southeastern Brazil, under three sampling methods. This study aimed to assess the abundance and diversity of Dryininae in riparian vegetation, Brazilian savannah, and savannah woodland vegetation at the Estação Ecológica de Jataí, in Luiz Antônio, State of São Paulo, Brazil, by using Moericke, Malaise, and light traps. The sampling was carried out from December 2006 to November 2009, and 371 specimens of Dryininae were caught, with the highest frequencies in spring and summer. Fourteen species of Dryinus Latreille, 1804 and one of Thaumatodryinus Perkins, 1905 were identified. The highest frequencies of Dryinus in the riparian vegetation differed significantly from those obtained in the Brazilian savannah and savannah woodland vegetation. In the riparian vegetation, the highest number of Dryinus was collected using light traps and the interactions between abundance and the collection method used were significant. The number of specimens of Dryinus collected in the Brazilian savannah and savannah woodland vegetation using Malaise traps did not differ significantly from those obtained using Moericke traps. Males significantly outnumbered females in the sex ratio of Dryinus. The species diversity of Dryinus based on females collected using Malaise traps was high in the Brazilian savannah. Furthermore, high species richness of female Dryinus was observed in riparian vegetation (six species) and Brazilian savannah (five). The light trap was the most successful method for sampling diversity of Dryininae.

Diversity and aspects of the ecology of social wasps (Vespidae, Polistinae) in Central Amazonian "terra firme" forest

Diversity and aspects of the ecology of social wasps (Vespidae, Polistinae) in Central Amazonian "terra firme" forest. The knowledge of social wasp richness and biology in the Amazonian region is considered insufficient. Although the Amazonas state is the largest in the region, until now only two brief surveys were conducted there. Considering that the systematic inventory of an area is the first step towards its conservation and wise use, this study presents faunal data on social wasp diversity in a 25 km² area of "terra firme" (upland forest) at the Ducke Reserve, Manaus, Amazonas, Brazil. Wasps were collected in the understory, following a protocol of three collectors walking along 60 trails 1,000 m in extension for 16 days between August and October 2010. Methods used were active search of individuals with entomological nets and nest collecting. Fifty-eight species of social wasps, allocated in 13 genera, were recorded; 67% of the collected species belong to Polybia, Agelaia and Mischocyttarus; other genera were represented by only four species or less. The most frequent species in active searches were Agelaia fulvofasciata (DeGeer, 1773), Agelaia testacea (Fabricius, 1804) and Angiopolybia pallens (Lepeletier, 1836). Twelve species were collected in nests. Prior to this study, 65 Polistinae species were deposited at the INPA Collection. Collecting in the study grid, an area not previously sampled for wasps, resulted in an increase of 25% species, and species richness was 86. According to the results, there is evidence that the diversity of social wasps at the Ducke Reserve is even higher, making it one of the richest areas in the Brazilian Amazonia.