Unburden American science.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Événement(s) lié(s) : - Réunion annuelle de la Société canadienne de phytopathologie; Québec (FRA) - (2006)

Cost of Care of Rare Hematologic Disorders in the United States: Call to Action for Policy Supporting Pharmacologic Innovation

The International Continence Society (ICS) identifies several urinary incontinence (UI) subtypes: urgency urinary incontinence (UUI), stress UI (SUI), and mixed UI (MUI). UUI is a common symptom of overactive bladder (OAB) syndrome. Based on the current ICS definition of OAB, all patients with UUI have OAB, whereas not all patients with OAB have UUI. Because UUI is a chronic condition that is expected to increase in prevalence as the population of elderly individuals grows, it is important to understand its economic burden on society and patients and its cost components. To summarize the published English language medical literature on estimates of the economic burden of UUI in the United States from a societal and patient perspective, including direct costs (diagnosis, treatment, routine care [including incontinence pads], and UUI-associated comorbidities/complications); indirect costs (lost wages by patients and caregivers and lost work productivity due to absenteeism and presenteeism); and intangible costs (pain, suffering, and decreased health-related quality of life). A PubMed search of the literature for articles on the economic burden of UUI in the United States was conducted using the search terms (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR cost OR economic) AND (United States), with limits for English language, publication from 1991 to 2011, humans, and adults (19+ years). Only primary articles of non-neurogenic UUI in the United States were retained. Seven studies were identified that included data on the economic burden of UUI in the United States from a societal and patient perspective. Although estimates of the total economic burden of UUI include direct, indirect, and intangible costs, none of the 7 U.S. studies included all of these cost components. Furthermore, the costs of UUI often could not be fully extracted from the costs of OAB, which include patients with and without UUI, or the costs of other types of UI. The most recent cost analysis incorporated OAB with UUI prevalence rates and data on use of each cost component to calculate the total annual direct costs in 2007 for adults aged ≥ 25 years. The estimated total national cost of OAB with UUI in 2007 was $65.9 billion, with projected costs of $76.2 billion in 2015 and $82.6 billion in 2020. This 2007 estimate was markedly higher than those reported in older studies. Direct costs are the main driver of the overall cost of UUI in the United States. Studies that assessed patient costs indicated that the personal costs of routine care items for UUI and MUI represent a meaningful contribution to the overall economic burden of these conditions. These substantial personal expenditures may explain why patients reported that they were willing to pay considerable amounts for a treatment that would reduce the frequency of their UUI episodes. UUI in the United States is associated with a substantial economic burden from both a societal and patient perspective. Studies evaluating the impact of interventions that reduce the frequency of UUI episodes on the overall economic burden of UUI are warranted.

The Fourth Canadian Workshop on Fusarium Head Blight / Quatrième colloque canadien sur la fusariose

Biological control of seedling damping-off with fish emulsion derived from menhaden fish. P.A. Abbasi, K.L. Conn, R. Earl, and G. Lazarovits. Southern Crop Protection and Food Research Centre, Agriculture and Agri-Food Canada, 1391 Sandford Street, London, ON N5V 4T3, Canada. Fungitoxicity of smoke from some Ghanaian medicinal plants. R. Addai. Department of Crop Science, Faculty of Agriculture, Kwame Nkrumah University of Science and Technology, P.O. Box KS 13128, Adum, Kumasi, Ghana. Efficacy of OxiDateTM for control of potato storage pathogens. K.I. Al-Mughrabi. Potato Development Centre, New Brunswick Department of Agriculture, Fisheries and Aquaculture, 39 Barker Lane, Wicklow, NB E7L 3S4, Canada. Biological control of Carthamus lanatus in Australia. G.J. Ash, N.S. Crump, A. Breen, E. Anschaw, R.O. Kennedy, J.D.I. Harper, A. Nikandrow, and D. Hailstones. Farrer Centre, Charles Sturt University, Wagga Wagga, NSW 2678, Australia; (A.N.) Orange Agricultural Institute, New South Wales (NSW) Agriculture, Forest Road, Orange, NSW 2800, Australia; and (D.H.) Elizabeth Macarthur Agricultural Institute, NSW Agriculture, Woodbridge Road, Menangle, NSW 2568, Australia. Assessment of resistance to late blight within primitive cultivated Andigena potato lines. P. Audy, T. Somerville, and T. Mossman. Potato Research Centre, Agriculture and Agri-Food Canada, 850 Lincoln Road, P.O. Box 20280, Fredericton, NB E3B 4Z7, Canada. Validation of impaction-type spore sampler as a tool to estimate inoculum of Uncinula necator. R. Bacon, B. Talbot, and O. Carisse. (R.B., O.C.) Horticultural Research and Development Centre, Agriculture and Agri-Food Canada, 430 Gouin Boulevard, Saint-Jean-sur-Richelieu, QC J3B 3E6, Canada; and (R.B., B.T.) Département de biologie, Université de Sherbrooke, 2500 Université Street, Sherbrooke, QC J1K 2R1, Canada. Identification and detection of fungi associated with root rot of soybean seedling in Eastern Canada. T. Barasubiye, C.A. Lévesque, A. Tenuta, S. Rioux, K. Seifert, T.R. Anderson, and E. Cober. Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, 960 Carling Avenue, Ottawa, ON K1A 0C6, Canada; (A.T.) Ontario Ministry of Agriculture and Food, P.O. Box 400, Main Street, Ridgetown, ON N0P 2C0, Canada; (S.R.) Centre de recherche sur les grains, 2700 Einstein Street, Sainte-Foy, QC G1P 3W8, Canada; and (T.R.A.) Greenhouse and Processing Crops Research Centre, Agriculture and Agri-Food Canada, 2585 County Road 20, Harrow, ON N0R 1G0, Canada. Genetic diversity between Melampsora spp., causal agents of foliar rusts. M.J. Bergeron, M. Bourassa, D.L. Joly, and R.C. Hamelin. Canadian Forest Service, Natural Resources Canada, Sainte-Foy, QC G1V 4C7, Canada. Molecular diagnosis of Phytophthora ramorum by realtime polymerase chain reaction, using Taqman®, SybrGreen, and Molecular beacons. G. Bilodeau, C.A. Lévesque, A.W.A.M. De Cock, G. Kristjansson, J. McDonald, and R.C. Hamelin. Natural Resources Canada, QC G1V 4C7, Canada; (C.A.L.) Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, 960 Carling Avenue, Ottawa, ON K1A 0C6, Canada; (A.W.A.M.D.C.) Centraalbureau voor Schimmelcultures, NL-3508 AD Utrecht, Netherlands; and (G.K., J.M.) Canadian Food Inspection Agency, Ottawa, ON K2H 8P9, Canada. Première observation du Melampsora larici-populina au Canada. M. Bourassa, L. Innes, L. Marchand, P. Frey et R.C. Hamelin. Service canadien des forêts, Ressources naturelles du Canada, Sainte-Foy, QC G1V 4C7, Canada; (L.I., L.M.) Direction de la conservation des forêts, ministère des Ressources naturelles du Québec, Sainte-Foy, QC G1P 3W8, Canada; et (P.F.) Institut national de la recherche agronomique – Nancy, Unité de pathologie forestière, 54280 Champenoux, France. Spatial distribution of ascospores of Venturia inaequalis within the tree canopy.O. Carisse and D. Rolland. Horticultural Research and Development Centre, Agriculture and Agri-Food Canada, 430 Gouin Boulevard, Saint-Jean-sur- Richelieu, QC J3B 3E6, Canada. Incidence of iprodione-insensitive isolates of Botrytis squamosa. O. Carisse and M. Tremblay. Horticultural Research and Development Centre, Agriculture and Agri-Food Canada, 430 Gouin Boulevard, Saint-Jean-sur-Richelieu, QC J3B 3E6, Canada. The significance of ethylene in the interaction between Nicotiana tabacum and Colletotrichum destructivum. N. Chen, P.H. Goodwin, and T. Hsiang. Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada. Interactions between weakly and highly virulent strains of Leptosphaeria maculans, leading to induced resistance to black leg in canola. Y. Chen and W.G.D. Fernando. Department of Plant Science, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. Optimization of geldanamycin production by Streptomyces melanosporofaciens strain EF-76, a biocontrol agent of plant diseases. N. Clermont and C. Beaulieu. Centre d’étude et de valorisation de la diversité microbienne, Département de biologie, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada. Reduction of potato scab with volatile fatty acids and acidified liquid swine manure in soil amendments. K.L. Conn, P.A. Abbasi, Y. Lin, and G. Lazarovits. Southern Crop Protection and Food Research Centre, Agriculture and Agri-Food Canada, 1391 Sandford Street, London, ON N5V 4T3, Canada. Genetic and chemical control of Rhizoctonia solani on chickpea. E.B. Connor and R. Hall. Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada. M13 DNA fragment as an external control to normalize quantification of fungal DNA from soil by real-time polymerase chain reaction. A.L. Dauch, A.K. Watson, and S.H. Jabaji-Hare. Department of Plant Science, McGill University, 21 111 Lakeshore Road, QC H9X 3V9, Canada. A satellite double-stranded RNA in hypovirulent isolates of Sclerotinia homoeocarpa. F. Deng and G.J. Boland. Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada. Effect of 1-methylcyclopropene on postharvest blue and gray molds of apples and pears. D. Errampalli. Southern Crop Protection and Food Research Centre, Vineland Station, Agriculture and Agri-Food Canada, Vineland, ON L0R 2E0, Canada. Fusarium spp. in residues of cereal and noncereal crops grown in rotation in eastern Saskatchewan. M.R. Fernandez, P.G. Pearse, and G. Holzgang. Semiarid Prairie Agricultural Research Centre, Agriculture and Agri-Food Canada, P.O. Box 1030, Swift Current, SK S9H 3X2, Canada; and (P.G.P., G.H.) Saskatchewan Agriculture, Food and Rural Revitalization, 3085 Albert Street, Regina, SK S4S 0B1, Canada. Impact of rotation sequence on common root rot of wheat in the Brown soil zone of western Canada. M.R. Fernandez and R.P. Zentner. Semiarid Prairie Agricultural Research Centre, Agriculture and Agri-Food Canada, P.O. Box 1030, Swift Current, SK S9H 3X2, Canada. Temperature sensitivity of resistance genes to oat stem rust. T. Fetch. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada. Potential role of lipid-transfer proteins in resistance to snow mould in winter wheat. D.A. Gaudet, M. Frick, S. Huang, N. Foroud, B. Puchalski, T. Despins, F. Eudes, and A. Laroche. Lethbridge Research Centre, Agriculture and Agri-Food Canada, P.O. Box 3000, Lethbridge, AB T1J 4B1, Canada. Pathotypes of Cochliobolus sativus in Manitoba. H. Ghazvini and A. Tekauz. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada. Persistence of Ascochyta rabiei in chickpea residue in Saskatchewan. B.D. Gossen. Saskatoon Research Centre, Agriculture and Agri-Food Canada, Saskatoon, SK S7N 0X2 Canada. Effect of tillage management on diseases of canola in Saskatchewan. B.D. Gossen and H.R. Kutcher. Saskatoon Research Centre, Agriculture and Agri-Food Canada, Saskatoon, SK S7N 0X2, Canada. Soluble invertase, and not invertase bound to cell wall, supplies hexose from wheat to powdery mildew. D.L. Greenshields, F. Wang, G. Selvaraj, and Y. Wei. Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, SK S7N 5E2, Canada; and (G.S.) Plant Biotechnology Institute, National Research Council of Canada, 110 Gymnasium Place, Saskatoon, SK S7N 0W9, Canada. Characterization of Rhizoctonia solani infecting lettuce in Germany. R. Grosch, J.H.M. Schneider, and A. Kofoet. Institute of Vegetable and Ornamental Crops, Echtermeyer Weg 1, D-14979 Großbeeren, Germany; and (J.H.M.S.) Institute of Sugar Beet Research, P.O. Box 32, 4600 AA Bergen op Zoom, Netherlands. Fungi associated with the European pine shoot beetle, Tomicus piniperda, in southern Ontario. G. Hausner, C.N. Davis, E.A. Gibb, J. Reid, and A.A. Hopkin. Department of Microbiology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; (C.N.D., A.A.H.) Great Lakes Forestry Centre, Canadian Forest Service, 1219 Queen Street, Sault Sainte Marie, ON P6A 2E5, Canada; and (J.R.) Senior Scholar, Department of Botany, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. Godronia canker of lowbush blueberry. P.D. Hilderbrand, W.E. Renderos, R.J. Davies, and K.B. McRae. Atlantic Food and Horticulture Research Centre, Agriculture and Agri-Food Canada, 32 Main Street, Kentville, NS B4N 1J5, Canada. Use of polymerase chain reaction – single–strand conformational polymorphism analysis to monitor impacts of biocontrol agents on selected microbial populations in soybean crops.R. Hogue, E. Plante, I. Larouche, R. Jeannotte, and N. Daigle. Institut de recherche et de développement en agroenvironnement, 2700, rue Einstein, Sainte-Foy, QC G1P 3W8, Canada; and (R.J.) Department of Natural Resources Sciences, Université McGill, Sainte- Anne-de-Bellevue, QC H9X 3V9, Canada. Confirmation of the role of ascospores in field epidemics of speckled leaf blotch of wheat in Manitoba. C. Hoorne, L. Lamari, and G.M. Ballance. Department of Plant Science, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. Effects of seeding rate, seeding depth, and seed infection on mycosphaerella blight and seed yield of field pea. S.F. Hwang, R.L. Conner, K.F. Chang, G.D. Turnbull, R.J. Howard, and S.F. Blade. Alberta Research Council, Vegreville, AB T9C 1T4, Canada; (R.L.C.) Cereal Research Centre, Agriculture and Agri-Food Canada, Morden Research Station, Unit 100–101, Route 100, Morden, MB R6M 1Y5, Canada; (K.F.C.) Food and Rural Development, Field Crop Development Centre, Alberta Agriculture, Lacombe, AB T4L 1W1, Canada; (R.J.H.) Food and Rural Development, Crop Diversification Centre South, Alberta Agriculture, Brooks AB T1R 1E6, Canada; and (S.F.B.) Food and Rural Development, Crop Diversification Centre North, Alberta Agriculture, Edmonton, AB T5J 4K3, Canada. Effect of antagonistic fungi on the production of perithecia of Gibberella zeae on wheat residue. S. Inch and J. Gilbert. Cereal Research Centre, Agriculture and Agri-Food Canada, 195 Dafoe Road, Winnipeg, MB R3T 2M9, Canada. Characterization of Phoma lingam isolates recovered from Canadian accessions of Thlaspi arvense. M.R. Islam, B. Koopmann, R.K. Gugel, and G. Séguin-Swartz. Institute for Plant Pathology and Plant Protection, Georg- August-Universität Göttingen Grisebachstr. 6, 37077 Göttingen, Germany; and (R.K.G., G.S.-S.) Saskatoon Research Centre, Agriculture and Agri-Food Canada, 107 Science Place, Saskatoon, SK S7N 0X2, Canada Influence of inoculum sources on cultivar susceptibility to apple scab. T. Jobin, P. Neumann, and O. Carisse. Département des sciences biologiques, Université de Montréal, C.P. 6128, Montréal, QC H3C 3J7, Canada; and (O.C.) Horticultural Research and Development Centre, Agriculture and Agri-Food Canada, 430 Gouin Boulevard, Saint-Jean-sur-Richelieu, QC J3B 3E6, Canada. Photosynthesis, net carbon gain, and growth of hydroponic bell peppers (Capsicum annuum ‘Cubico’) following root infection by Pythium aphanidermatum. M. Johnstone, S. Chatterton, J. Sutton, and B. Grodzinski. Department of Plant Agriculture University of Guelph, Guelph, ON N1G 2W1, Canada; and (S.C., J.S.) Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada. Local and systemic induced resistance to the root-knot nematodes (Meloidogyne incognita) in tomato by different doses of chemicals and its comparison with a biological control agent (Paenibacillus polymyxa). H.U. Khan and Y.H. Kim. Pakistan Science Foundation, Islamabad, Pakistan; and (Y.H.K.) School of Agricultural Biotechnology, Seoul National University, Suwon 441-744, Korea. Cultural control of sclerotinia rot of carrot by lateral clipping of carrot canopy. C. Kora, M.R. McDonald, and G.J. Boland. Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; and (M.R.M) Department of Plant Agriculture, University of Guelph, Guelph, ON N1G 2W1, Canada. Metabolic fingerprinting, using mass ions to discriminate diseases of potato.A.C. Kushalappa, L.H. Lui, A. Vikram, and B. Prithiviraj. Plant Science Department, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada. Intensive crop rotations of canola and field pea in western Canada. H.R. Kutcher, D. Ulrich, and S. Brandt. Melfort Research Farm, Saskatoon Research Centre, Agriculture and Agri-Food Canada, P.O. Box 1240, Melfort, SK S0E 1A0, Canada; and (D.U., S.B.), Scott Research Farm, Saskatoon Research Centre, Agriculture and Agri-Food Canada, Scott, SK S0K 4A0, Canada. Development and design of a marker based on polymerase chain reaction for the detection of Fusarium proliferatum isolates from field-grown asparagus.K. Labour, M. St-Arnaud, and S.H. Jabaji-Hare. Department of Plant Science, McGill University, 21 111 Lakeshore Road, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada; and (M.S.-A.) Jardin botanique de Montréal and Institut de recherche en biologie végétale, 4101, rue Sherbrooke Est, Montréal, QC H1X 2B2, Canada. Use of acidic electrolyzed water for reducing populations of Xanthomonas campestris pv. vesicatoria on tomato seed and foliage. G. Lazarovits, P.A. Abbasi, and R. Earl. Southern Crop Protection and Food Research Centre, Agriculture and Agri-Food Canada, 1391 Sandford Street, London, ON N5V 4T3, Canada. One-carbon metabolism in response to biotic and abiotic stresses. W. Liu, Y. Wei, and J. King. Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, SK S7N 5E2, Canada. Relative importance of storage conditions on development of postharvest carrot diseases. T. MacDonald, R.N. Markarian, C. Vigneault, and V. Toussaint. Horticultural Research and Development Centre, Agriculture and Agri- Food Canada, Saint-Jean-sur-Richelieu, QC J3B 3E6, Canada. Involvement of antibiosis in the biocontrol of potato silver scurf by different bacteria. C. Martinez, J.-N. Simard, J. Labonté, R.R. Bélanger, and R.J. Tweddell. Centre de recherche en horticulture, Université Laval, Quebec, QC G1K 7P4, Canada. Mycelial interactions between vegetatively incompatible Fusarium graminearum (Gibberella zeae)isolates.B.D. McCallum, A. Tekauz, and J. Gilbert. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada. Latent infection and distribution of a hypovirulenceassociated double-stranded RNA (OnuMV3a) in populations of Sclerotinia homoeocarpa. M.S. Melzer, F. Deng, and G.J. Boland. Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada. In vitro effects of salt compounds on radial growth, sporulation, and spore germination of postharvest potato diseases. A.A.S. Mills, H.W. Platt, R.A.R. Hurta, and R.A. MacPhail. Crops and Livestock Research Centre, Agriculture and Agri-Food Canada, 440 University Ave., Charlottetown, PE C1A 4N6, Canada; and (R.A.R.H.) Department of Biology, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE C1A 4P3, Canada. Patterns of gene expression during infection of soybean by Phytophthora sojae. P. Moy, I. Atkinson, D. Qutob, and M. Gijzen. Southern Crop Protection and Food Research Centre, Agriculture and Agri-Food Canada, 1391 Sandford Street, London, ON N5V 4T3, Canada. Some factors involved in soil disturbance that reduces disease of wheat caused by Rhizoctonia solani AG 8. S.M. Neate. Department of Plant Pathology, North Dakota State University, P.O. Box 5012 Fargo, ND 58105-5012, U.S.A. Comparison of epidemics caused by Pythium aphanidermatum and P. dissotocum in pepper plants grown in small-scale hydroponic trough systems. T.N. Owen-Going and J.C. Sutton. Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada. Molecular differentiation between Peridermium harknessiiand Cronartium quercuum f. sp. banksianae. F. Paradis, D.L. Joly, J. Walla, and R.C. Hamelin. Laurentian Forestry Centre, Natural Resources Canada, Sainte- Foy, QC G1V 4C7, Canada; and (J.W.) Plant Pathology Department, North Dakota State University, Fargo, ND 58105-5012, U.S.A. Refining the protocols for screening of resistance of spring wheat to fusarium head blight under controlled conditions. M.P. Pradhan and J. Gilbert. Cereal Research Centre, Agriculture and Agri-Food Canada, 195 Dafoe Road, Winnipeg, MB R3T 2M9, Canada. Effect of soil amendments on common scab of potato and soil bacterial communities. K. Prévost, B. Shipley, and C. Beaulieu. Centre d’étude et de valorisation de la diversité microbienne, Département de biologie, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada. Volatile metabolite profiling of cultivars of onion differing in resistance to Fusarium oxysporum, Botrytis allii, and Erwinia carotovora subsp. carotovora. B. Prithiviraj, A. Vikram, and A.C. Kushalappa. Department of Plant Science, Macdonald Campus, McGill University, Sainte-Annede- Bellevue, QC H9X 3V9, Canada. Effect of biological and nutritional factors on development of cylindrocarpon root rot on American ginseng. M. Rahman and Z.K. Punja. Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada. Flax rust races – an important collection needs preservation. K.Y. Rashid. Cereal Research Centre, Agriculture and Agri-Food Canada, Morden Research Station, Unit 100–101, Route 100, Morden, MB R6M 1Y5, Canada. Epidemiology of sclerotinia head rot in wild sunflower. K.Y. Rashid and G.J. Seiler. Cereal Research Centre, Agriculture and Agri-Food Canada, Morden Research Station, Unit 100–101, Route 100, Morden, MB R6M 1Y5, Canada; and (G.J.S.) Northern Crop Science Laboratory, Agricultural Research Service, United States Department of Agriculture, Fargo, ND 58105, U.S.A. Use of bacteriophages for the management of soft rot of calla lilies caused by Erwinia sp. in closed irrigation systems. M. Ravensdale, T. Blom, J. Gracia-Garza, and A. Svircev. Department of Plant Agriculture, University of Guelph, Guelph, ON N1G 2W1, Canada; and (J.G.G., A.S.) Southern Crop Protection and Food Research Centre, Vineland Station, Agriculture and Agri-Food Canada, Vineland, ON L0R 2E0, Canada. An epidemiological study of verticillium wilt of potatoes: host–pathogen interactions of various Verticillium spp. N. Robinson, H.W. Platt, L. Hale, and V. MacLean. Crops and Livestock Research Centre, Agriculture and Agri–Food Canada, 440 University Avenue, Charlottetown, PE C1A 4N6, Canada; and (L.H.) Department of Biology, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE C1A 4P3, Canada. Assessment of soil or compost suppressiveness to Sclerotinia sclerotiorum under growth chamber condition: correlations with laboratory and field assessments. G. Rousseau, S. Rioux, and D. Dostaler. Département de phytologie, Pavillon des sciences de et de Université Laval, Québec, QC G1K 7P4, Canada; and (S.R.) Centre de recherche sur les grains, 2700, rue Einstein, Sainte-Foy, QC G1P 3W8, Canada. A to monitor soil or compost suppressiveness to Sclerotinia sclerotiorum under laboratory conditions. G. and R. Département de phytologie, Pavillon des sciences de et de Université Laval, Québec, QC G1K 7P4, Canada; and des Institut de recherche 32, France. The Centraalbureau voor the of the R.A. and Centraalbureau voor Schimmelcultures, P.O. Box AD Utrecht, Netherlands. to Rhizoctonia solani AG in in the Netherlands. J.H.M. and Y. Institute of Sugar Beet Research, P.O. Box 32, 4600 AA Bergen op Zoom, Netherlands. to Rhizoctonia solani AG in in the Netherlands. J.H.M. and Y. Institute of Sugar Beet Research, P.O. Box 32, 4600 AA Bergen op Zoom, Netherlands. to Rhizoctonia solani AG in plant and J.H.M. Schneider, and S. Jabaji-Hare. Institute of Sugar Beet Research, P.O. Box 32, 4600 AA Bergen op Zoom, Netherlands; and Department of Plant Science, McGill University, 21 111 Lakeshore Road, Bellevue, QC H9X 3V9, Canada. and L. and University of Edmonton, AB Canada. of seedling resistance to diseases in wheat. and Department of Plant Sciences, University of Saskatchewan, Drive, Saskatoon, SK S7N Canada. Characterization of a metabolite by a causal agent of blight on field H. S.F. Hwang, K.F. Chang, S.F. G.D. Turnbull, and R.J. Alberta Research Council, Vegreville, AB T9C 1T4, Canada; (K.F.C.) Field Crop Diversification Centre, Alberta Agriculture, Food and Rural Development Lacombe, AB T4L 1W1, Canada; (S.F.B.) Crop Diversification Centre North, Edmonton, Edmonton, AB 4K3, Canada; and (R.J.H.) Crop Diversification Centre South, AB T1R 1E6, Canada. Assessment of fungi as biological control agents of in G. S.F. and Z.K. Punja. Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC 1S6, Canada; and Forestry Centre, Canadian Forest Service, BC Canada. and biocontrol by a of in the of and M. of University, Department of Molecular and University of Guelph, Guelph, ON Canada. of fusarium head blight in Canadian A. Tekauz. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada. fungi from oat in western Canada in A. Tekauz, N. B. McCallum, and J. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada. In vitro interaction between the wheat and of K. and Department of Plant Science, McGill University, 21 111 Lakeshore Road, Bellevue, QC H9X 3V9, Canada. of Xanthomonas campestris pv. in to disease and of lettuce leaf on bacterial V. and O. Carisse. Horticultural Research and Development Centre, Agriculture and Agri-Food Canada, 430 Gouin Boulevard, Saint-Jean-sur-Richelieu, QC J3B 3E6, Canada; and de pathologie végétale, Institut national de la recherche France. in causal for and disease control N. L. MacDonald, and Z.K. Punja. Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; and Ministry of Agriculture, Food and Road, BC Canada. volatile from apple with fungal pathogens. A. Vikram, B. Prithiviraj, and A.C. Kushalappa. Plant Science Department, McGill University, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada. of development of late blight in potato using polymerase chain reaction. O. F. L. Lamari, and L. Department of Plant Science, University of Manitoba, Agriculture Winnipeg, MB R3T 2N2, Canada. Molecular detection of in and in during O. F. M. L. B. T. P. and S. Department of Plant Science, University of Manitoba, Agriculture Winnipeg, MB R3T 2N2, Canada; Alberta Research Council, P.O. Box Vegreville, AB T9C 1T4, Canada; and Agriculture and Food, P.O. Box MB Canada. of Streptomyces potato by polymerase chain reaction. A. and G. Lazarovits. Department of Biology, Biological and University of London, ON Canada; and Southern Crop Protection and Food Research Centre, Agriculture and Agri-Food Canada, 1391 Sandford Street, London, ON N5V 4T3, Canada. Molecular and of of a involved in fungal F. Wang, G. Selvaraj, and Y. Wei. Department of Biology, University of Saskatchewan, 112 Science Saskatoon, SK S7N 5E2, Canada; and (G.S.) Plant Biotechnology Institute, National Research Council of Canada, 110 Gymnasium Place, Saskatoon, SK S7N 0W9, Canada. Impact of on Wang, S.F. Hwang, B.D. K.F. Chang, G.D. Turnbull, and R.J. Alberta Research Council, Vegreville, AB T9C 1T4, Canada; Saskatoon Research Centre, Agriculture and Agri-Food Canada, Saskatoon, SK S7N 0X2, Canada; (K.F.C.) Field Crop Development Centre, Lacombe, AB T4L Canada; and (R.J.H.) Crop Diversification Centre South, Alberta Agriculture, Food and Rural Development, AB T1R 1E6, Canada. The role of in germination and development in Colletotrichum J. and Department of Botany, University of ON Canada. gene expression of and A in potato with and of Phytophthora and F. Department of Plant Science, Agriculture University of Manitoba, Winnipeg, MB R3T 2N2, Canada. Epidemiology of in R.R. MacDonald, and Z.K. Punja. Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; Horticultural Crops Research Laboratory, Agricultural Research Service, United States Department of Agriculture, Avenue, and Ministry of Agriculture, Food and Road, BC Canada. of leaf blight in carrot by of S.M. A. and M.R. Department of Plant Agriculture, Crop Science University of Guelph, Guelph, ON N1G 2W1, Canada. Effect of a on by the G.J. and Department of Plant Pathology, University of U.S.A. and wheat response to leaf rust. T. D. M. C. W. T. and B. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada; and Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, Ottawa, ON K1A 0C6, Canada. in biotic and abiotic stresses. T. T. and J. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada; and Department of Biological Sciences, University of South U.S.A. for gene T. and J. Cereal Research Centre, Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada. of isolates of Fusarium spp. head blight in wheat. G. Y. Chen, F. and C. Eastern Cereal and Oilseed Research Centre, Agriculture and Agri- Food Canada, 960 Carling Avenue, Ottawa, ON K1A 0C6, Canada. Effect of seed on of different of soybean E. T.R. Anderson, S. Rioux, R. and M. Eastern Cereal and Oilseed Research Centre, Agriculture and Agri–Food Canada, 960 Carling Avenue, Ottawa, ON K1A 0C6, Canada; (T.R.A.) Greenhouse and Processing Crops Research Centre, Agriculture and Agri–Food Canada, 2585 County Road 20, Harrow, ON N0R 1G0, Canada; (S.R.) Centre de recherche sur les grains, 2700, rue Einstein, Sainte-Foy, QC G1P 3W8, Canada; and University of Guelph, Guelph, ON N1G 2W1, Canada. Effect of on the of and in potato H. R. and R.J. Tweddell. Centre de recherche en horticulture, Université Laval, Québec, QC G1K 7P4, Canada; and Centre de recherche et de développement en horticulture, Agriculture et Canada, Saint-Jean-sur-Richelieu, QC J3B 3E6, Canada. chain reaction – for Fusarium diversity in E. M. V. and M. Institut de recherche en biologie végétale, Université de Montréal, and Jardin botanique de Montréal, Montréal, QC H1X 2B2, Canada.

Web Exclusives2 May 2017Annals for Educators - 2 May 2017FREEDarren B. Taichman, MD, PhDDarren B. Taichman, MD, PhDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AFED201705020 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsAssociation Between a Virtual Glucose Management Service and Glycemic Control in Hospitalized Adult Patients. An Observational StudyDiabetes mellitus or uncontrolled hyperglycemia is common among inpatients and is associated with adverse outcomes. This study assessed the effect of a virtual glucose management service on inpatient glycemic control.Use this study to:Start a teaching session with a multiple-choice question. We've provided one below!Ask your learners what effects hyperglycemia has on outcomes among hospitalized patients.How do your learners choose a glycemic target range for a hospitalized patient? What variables might alter their goals?What medications do you use, and in what manner? Do you use a basal–bolus approach? Why?What variables pose particular challenges to ideal glucose control in the hospital (e.g., changes in the timing of meals, concurrent metabolic derangements, fasting for procedures)? Use the accompanying editorial to help frame your discussion.Present serial glucose measurements together with recent medication administration and nutritional intake information on a few theoretical patients to prompt discussion of what, if any, alteration in therapy might be appropriate for each. You might show the flow sheet in Appendix Figure 2 of the article as an example for discussion. What would your learners have done in response to the blood glucose reading of 310 mg/dL?Review the diabetic flow sheets of patients on your service. Is there adequate glycemic control? Are there regularly occurring problems that your team can identify? How might they be remedied?In the Clinic: Polymyalgia RheumaticaPolymyalgia rheumatica is a common, chronic, systemic rheumatic inflammatory disease that affects adults older than 50 years. Although symptoms of proximal muscle stiffness and elevated inflammatory markers are typical, there are no specific diagnostic features. Are your learners prepared to recognize patients presenting with possible polymyalgia rheumatica?Use this review to:Ask your learners what the possible symptoms of polymyalgia rheumatica are. Use the box on page ITC67.What physical examination findings should be considered? What is seronegative symmetrical synovitis with pitting edema?What is the differential diagnosis of polymyalgia rheumatica? Why is it important to differentiate it from giant cell arteritis, for example? How does the specific diagnosis alter short- and long-term management?In whom should an ultrasound be considered? Should other tests be considered? Which ones?How is therapy approached? When should steroids be started, and when should they be tapered? When should other agents be considered? When is consultation with a rheumatologist appropriate?Use the teaching slides to help prepare for a teaching session. Break up the teaching session with the multiple-choice questions, and be sure to log on to enter your answers to earn CME credit for yourself!Understanding Clinical ResearchAnnals Understanding Clinical Research: Intention-to-Treat AnalysisThis brief tutorial helps clinicians assess the clinical relevance of results from intention-to-treat analyses and decide whether results from additional analyses may be helpful.Use this paper to:Ask your learners to define bias as it relates to the results of a study aiming to assess whether a treatment improves an outcome. How does randomization in a trial help to minimize bias?What does (or should) it mean when one reads “intention to treat” in the report of a randomized clinical trial? Why might crossover from one assigned treatment group to another or some participants' failure to adhere to their assigned treatment protocols bias the results? Does an intention-to-treat analysis ensure that such bias does not affect the reported results and conclusions? The authors explain why it does not.Ask your learners what the authors mean when they write that an “as-treated” analysis would not be “protected by the randomization.” What bias would be introduced with a “per protocol” analysis? Why do these details matter when assessing how the analysis was performed and reported in a paper?Our Health Care System: Hassles and SolutionsAnnals Graphic Medicine: Anatomy of a Donut HolePutting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of PhysiciansA Tale of Two Countries: How I Saw More Patients With More Joy in Internal Medicine PracticeDesigning and Regulating Wisely: Removing Barriers to Joy in PracticeExcessive administrative tasks divert time and focus from more clinically important tasks. This Annals Graphic Medicine piece (a comic!) tells the familiar story of how a patient—and his doctor—became trapped within a bureaucratic system and how it affected the care the patient received. The position paper offers a framework to evaluate administrative tasks and recommendations to reduce excessive administrative duties in health care. The essay contrasts the experience of practicing general internal medicine in Australia with that in the United States and explains why the author experienced more joy in practice in Australia. The editorial discusses the negative consequences of excessive administrative tasks and views the ACP's recommendations as a timely call for greater evidence-based regulation and a shared responsibility to create better value in health care.Use these pieces to:Show the Annals Graphic Medicine piece to your learners. Ask them if they can relate to how the author feels. Does it make them laugh? Feel angry? Feel sad? All three?Do your learners understand the “donut hole”? To whom should they turn for help in figuring out such issues? Is there adequate support for patients and clinicians at your center with “administrative tasks”?What are the benefits of preauthorizations and approvals for treatments? What are the harms? Use the editorial to help frame your discussion.How would your learners design a system that might better balance necessary and helpful administrative controls and their potential harms? Do your learners think a model such as Australia's is better? Do they think the framework proposed by the ACP to evaluate the value of an administrative task is a good one?Do your learners worry that administrative hassles might drive them away from practicing medicine? How can they deal with them? Can they help bring about change?Make a list of the administrative tasks in clinical care specific to your hospital only (e.g., a form to place an order). What is the purpose of each? Can your learners identify tasks that might be safely eliminated without causing a problem? Can they propose a more efficient alternative approach? To whom should they take their ideas within your health system?MKSAP 17 QuestionA 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as needed. His inpatient plasma glucose values are 170 to 210 mg/dL (9.4-11.6 mmol/L). Results of all other laboratory studies are normal.Which of the following is the most appropriate treatment for this patient's diabetes while hospitalized?A. Basal and prandial insulinB. GlipizideC. MetforminD. Sliding-scale insulinCorrect AnswerA. Basal and prandial insulinEducational ObjectiveManage diabetes mellitus in a hospitalized patient.CritiqueThe most appropriate treatment for this patient's diabetes mellitus while hospitalized is a weight-based treatment plan that includes basal and prandial insulin. Hyperglycemia in the hospital is associated with poor outcomes. According to the American Diabetes Association and American Association of Clinical Endocrinologists, glucose goals in hospitalized patients in a non-ICU setting are premeal values less than 140 mg/dL (7.8 mmol/L) and random values less than 180 mg/dL (10 mmol/L). The American College of Physicians recommends avoiding values less than 140 mg/dL (7.8 mmol/L) to decrease the risk of hypoglycemic complications. The patient's plasma glucose values exceed the recommended guidelines and require treatment.Oral agents do not have safety or efficacy data for use in the hospital. Glipizide is an insulin secretagogue that can potentially induce hypoglycemia in the hospital setting, particularly with unpredictable changes in oral intake.With metformin use, hospitalized patients can develop poor organ perfusion, which can increase the risk of lactic acidosis. Intravenous contrast dye can also impair kidney function in the setting of metformin use in the hospital. Reinitiation of the patient's home regimen of metformin at or near the time of discharge is most appropriate after all procedures have been completed and organ function is stable and glucose levels have returned to baseline values.Sliding-scale insulin is nonphysiologic and can result in large fluctuations in blood glucose levels. Sliding-scale insulin is not recommended as the sole insulin therapy in the hospital setting.Key PointFor non-critically ill hospitalized patients with diabetes mellitus and hyperglycemia, a weight-based treatment plan that includes basal and prandial insulin is recommended.BibliographyAmerican Diabetes Association. (13) Diabetes care in the hospital, nursing home, and skilled nursing facility. In: Standards of Medical Care in Diabetes-2015. Diabetes Care. 2015 Jan;38 Suppl:S80-5.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 2 May 2017Volume 166, Issue 9Page: ED9KeywordsDiabetes mellitusGlucoseHealth careHyperglycemiaInpatientsInsulinIntent to treat analysisPatientsPolymyalgia rheumaticaTreatment guidelines ePublished: 2 May 2017 Issue Published: 2 May 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.Loading ...

To evaluate the economic impact of the routine US childhood immunization schedule: diphtheria and tetanus toxoids and acellular pertussis; tetanus and diphtheria toxoids; Haemophilus influenzae type b conjugate; inactivated poliovirus; measles, mumps, and rubella; hepatitis B; and varicella vaccines. Decision tree-based analysis was conducted using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported for 1995-2001. Costs were estimated using the direct cost and societal (direct and indirect costs) perspectives. Program costs included vaccine, administration, vaccine-associated adverse events, and parent travel and time lost. All costs were inflated to 2001 US dollars, and all costs and benefits in the future were discounted at a 3% annual rate. A hypothetical 2001 US birth cohort of 3,803,295 infants was followed up from birth through death. Net present value (net savings) and benefit-cost ratios of routine immunization. Routine childhood immunization with the 7 vaccines was cost saving from the direct cost and societal perspectives, with net savings of 9.9 billion dollars and 43.3 billion dollars, respectively. Without routine vaccination, direct and societal costs of diphtheria, tetanus, pertussis, H influenzae type b, poliomyelitis, measles, mumps, rubella, congenital rubella syndrome, hepatitis B, and varicella would be 12.3 billion dollars and 46.6 billion dollars, respectively. Direct and societal costs for the vaccination program were an estimated 2.3 billion dollars and 2.8 billion dollars, respectively. Direct and societal benefit-cost ratios for routine childhood vaccination were 5.3 and 16.5, respectively. Regardless of the perspective, the current routine childhood immunization schedule results in substantial cost savings.

Estimating the economic burden of food-induced allergic reactions and anaphylaxis in the United States

PurposeTo assess the direct and indirect costs of infectious conjunctivitis and quantify medical costs due to conjunctivitis transmission in families.MethodsIn this retrospective claims analysis from the OptumHealth Care Solutions, Inc. database (1998–2016), beneficiaries with or without at least one diagnosis of infectious conjunctivitis were identified. Direct and indirect costs (in 2016 US$) during the 60 days post conjunctivitis diagnosis (or imputed date for controls) were compared using cost differences in linear regressions. For transmission cost analysis, the total cost of each conjunctivitis episode was the sum of the primary episode (seed patient) and the secondary episode (infected family members) costs. A generalized estimating equation model adjusted for seed patient characteristics was used to assess the impact of number and rate of transmissions on episode cost.ResultsHealth care resource utilization and direct costs were significantly higher for patients with conjunctivitis (n=1,002,188) versus controls (n=4,877,210): 1.67 all-cause visits per person per month (PPPM) versus 0.79 visits PPPM, respectively; total mean direct cost of $396.04 PPPM versus $289.63 PPPM, respectively. The cost of medically related absenteeism was $105.42 (95% confidence interval [CI], $104.18–$106.75) higher for patients with conjunctivitis than for controls. Episode cost, without transmission due to seed patient, was $669.43 (95% CI, $654.67–$684.85); it increased with each additional infected family member and with increased infection transmission time between family members.ConclusionConjunctivitis was associated with a notable economic burden in terms of direct medical costs and medically related absenteeism. Family health care costs increased with transmission time and with each family member infected with conjunctivitis.

Valuing oral health: Accomplishments and challenges

Aim: Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients.Methods: This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients’ sociodemographic and socioeconomic characteristics was performed. Results: At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4). Conclusions: The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies.

To estimate the current and future economic burdens of Type 1 and Type 2 diabetes in the UK. A top-down approach was used to estimate costs for 2010/2011 from aggregated data sets and literature. Prevalence and population data were used to project costs for 2035/2036. Direct health costs were estimated from data on diagnosis, lifestyle interventions, ongoing treatment and management, and complications. Indirect costs were estimated from data on mortality, sickness, presenteeism (potential loss of productivity among people who remain in work) and informal care. Diabetes cost approximately £ 23.7bn in the UK in 2010/2011: £ 9.8bn in direct costs (£1bn for Type 1 diabetes and £ 8.8bn for Type 2 diabetes) and £ 13.9bn in indirect costs (£ 0.9bn and £ 13bn). In real terms, the 2035/2036 cost is estimated at £ 39.8bn: £ 16.9bn in direct costs (£ 1.8bn for Type 1 diabetes and £ 15.1bn for Type 2 diabetes) and £ 22.9bn in indirect costs (£ 2.4bn and £ 20.5bn). Sensitivity analysis applied to the direct costs produced a range of costs: between £ 7.9bn and £ 11.7bn in 2010/2011 and between £ 13.8bn and £20bn in 2035/2036. Diabetes currently accounts for approximately 10% of the total health resource expenditure and is projected to account for around 17% in 2035/2036. Type 1 and Type 2 diabetes are prominent diseases in the UK and are a significant economic burden. Data differentiating between the costs of Type 1 and Type 2 diabetes are sparse. Complications related to the diseases account for a substantial proportion of the direct health costs. As prevalence increases, the cost of treating complications will grow if current care regimes are maintained.

This study was undertaken to calculate epilepsy-related direct, indirect, and total costs in adult patients with active epilepsy (ongoing unprovoked seizures) in Germany and to analyze cost components and dynamics compared to previous studies from 2003, 2008, and 2013. This analysis was part of the Epi2020study. Direct and indirect costs related to epilepsy were calculated with a multicenter survey using an established and validated questionnaire with a bottom-up design and human capital approach over a 3-month period in late 2020. Epilepsy-specific costs in the German health care sector from 2003, 2008, and 2013 were corrected for inflation to allow for a valid comparison. Data on the disease-specific costs for 253 patients in 2020 were analyzed. The mean total costs were calculated at €5551 (±€5805, median = €2611, range = €274-€21667) per 3months, comprising mean direct costs of €1861 (±€1905, median = €1276, range = €327-€13158) and mean indirect costs of €3690 (±€5298, median = €0, range = €0-€11925). The main direct cost components were hospitalization (42.4%), antiseizure medication (42.2%), and outpatient care (6.2%). Productivity losses due to early retirement (53.6%), part-time work or unemployment (30.8%), and seizure-related off-days (15.6%) were the main reasons for indirect costs. However, compared to 2013, there was no significant increase of direct costs (-10.0%), and indirect costs significantly increased (p<.028, +35.1%), resulting in a significant increase in total epilepsy-related costs (p<.047, +20.2%). Compared to the 2013study population, a significant increase of cost of illness could be observed (p=.047). The present study shows that disease-related costs in adult patients with active epilepsy increased from 2013 to 2020. As direct costs have remained constant, this increase is attributable to an increase in indirect costs. These findings highlight the impact of productivity loss caused by early retirement, unemployment, working time reduction, and seizure-related days off.

Simple SummaryProstate cancer is the second most common malignancy among men, and the number of new cases is projected to increase substantially in the coming years. To assess the current state of knowledge on the economic burden of this disease, we conducted a literature review that included 31 studies. Our analysis focused on estimates of direct costs—such as treatment, adjuvant and neoadjuvant therapies, and supportive and palliative care—as well as indirect costs. However, the vast majority of studies addressed direct costs only, highlighting a clear gap in the literature. This accentuates the need for further comprehensive reviews and the development of standardized methodologies to enable reliable comparisons across studies.Background: Prostate cancer is the second most common malignant cancer among men, and according to the predictions, the estimated number of new cases will substantially grow in the coming years. Therefore, the costs of the disease will increase as well. Methods: We conducted a literature review of the state of knowledge about the costs of treatment and the economic burden of prostate cancer. The vast majority of studies were focused on direct costs only, which clearly shows the literature gap. Results: We focused on the estimates of direct costs, i.e., treatment of prostate cancer, adjuvant and neoadjuvant treatment, and supportive and palliative care, and indirect costs. Cost-effectiveness analyses indicated that docetaxel combined with androgen deprivation therapy (ADT) was the most cost-effective strategy for metastatic hormone-sensitive prostate cancer (incremental cost-effectiveness ratio (ICER): USD 13,647). In contrast, novel therapies such as PARP inhibitors and whole-genome-sequencing-guided treatments were not cost-effective unless drug prices were reduced by 47–70%. In the United States, 5-year cumulative treatment costs ranged from USD 48,000 for conservative management to over USD 91,000 for radiotherapy, while out-of-pocket expenses averaged AUD 1172 in Australia. Indirect costs were also considerable, with Slovakia reporting an increase in sick leave costs from EUR 1.2 million in 2014 to EUR 2.1 million in 2022. Conclusions: Metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer were the most frequent categories for various treatment cost evaluations. A few specific combinations of drugs were cost-effective only under the condition of dropping the unit prices of a medication. Further summarizing, reviewing, and developing a methodology for standardized comparisons are needed.