Opportunities for preventing esophageal adenocarcinoma

VetenskapsrådetCancerfondenAccepte

Association between laparoscopic antireflux surgery and recurrence of gastroesophageal reflux

IMPORTANCE: Cohort studies, mainly based on questionnaires and interviews, have reported high rates of reflux recurrence after antireflux surgery, which may have contributed to a decline in its use. Reflux recurrence after laparoscopic antireflux surgery has not been assessed in a long-term population-based study of unselected patients. OBJECTIVES: To determine the risk of reflux recurrence after laparoscopic antireflux surgery and to identify risk factors for recurrence. DESIGN AND SETTING: Nationwide population-based retrospective cohort study in Sweden between January 1, 2005, and December 31, 2014, based on all Swedish health care and including 2655 patients who underwent laparoscopic antireflux surgery according to the Swedish Patient Registry. Their records were linked to the Swedish Causes of Death Registry and Prescribed Drug Registry. EXPOSURES: Primary laparoscopic antireflux surgery due to gastroesophageal reflux disease in adults (>18 years). MAIN OUTCOMES AND MEASURES: The outcomewas recurrence of reflux, defined as use of antireflux medication (proton pump inhibitors or histamine2 receptor antagonists for >6 months) or secondary antireflux surgery. Multivariable Cox regression was used to assess risk factors for reflux recurrence. RESULTS: Among all 2655 patients who underwent antireflux surgery (median age, 51.0 years; interquartile range, 40.0-61.0 years; 1354 men [51.0%]) and were followed up for a median of 5.6 years, 470 patients (17.7%) had reflux recurrence; 393 (83.6%) received long-term antireflux medication and 77 (16.4%) underwent secondary antireflux surgery. Risk factors for reflux recurrence included female sex (hazard ratio [HR], 1.57 [95%CI, 1.29-1.90]; 286 of 1301 women [22.0%] and 184 of 1354 men [13.6%] had recurrence of reflux), older age (HR, 1.41 [95%CI, 1.10-1.81] for age 61 years compared with 45 years; recurrence among 156 of 715 patients and 133 of 989 patients, respectively), and comorbidity (HR, 1.36 [95%CI, 1.13-1.65] for Charlson comorbidity index score 1 compared with 0; recurrence among 180 of 804 patients and 290 of 1851 patients, respectively). Hospital volume of antireflux surgery was not associated with risk of reflux recurrence (HR, 1.09 [95%CI, 0.77-1.53] for hospital volume 24 surgeries compared with 76 surgeries; recurrence among 38 of 266 patients [14.3%] and 271 of 1526 patients [17.8%], respectively). CONCLUSIONS AND RELEVANCE: Among patients who underwent primary laparoscopic antireflux surgery, 17.7%experienced recurrent gastroesophageal reflux requiring long-term medication use or secondary antireflux surgery. Risk factors for recurrence were older age, female sex, and comorbidity. Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent gastroesophageal reflux disease requiring treatment, diminishing some of the benefits of the operation.Swedish Research Council, D0547801Publishe

Esophageal adenocarcinoma after obesity surgery in a population-based cohort study

Background: Obesity is strongly associated with esophageal adenocarcinoma (EAC), yet whether weight loss reduces the risk of EAC is unclear. Objectives: To test the hypothesis that the risk of EAC decreases following weight reduction achieved by obesity surgery. Setting: Nationwide register-based cohort study. Methods: This study included a majority of individuals who underwent obesity surgery in Sweden in 1980-2012. The incidence of EAC following obesity surgery was compared to the incidence in the corresponding background population of Sweden by means of calculation of standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). The risk of EAC after obesity surgery was also compared with the risk in non-operated obese individuals by means of multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs, adjusted for potential confounders. Results: Among 34,437 study participants undergoing obesity surgery and 239,775 person- 15" years of follow-up, 8 cases of EAC occurred (SIR 1.6, 95% CI 0.7-3.2). No clear trend of decreased SIRs was seen in relation to increased follow-up time after surgery. The SIR of EACs (n=53) among 123,695 non-operated obese individuals (673,238 person-years) was increased to a similar extent as in the obesity surgery cohort (SIR=1.9, 95% CI 1.4-2.5). Cox regression showed no difference in risk of EAC between operated and non-operated participants (adjusted HR=0.9, 95% CI 0.4-1.9). Conclusions: The risk of EAC might not decrease following obesity surgery, but even larger studies with longer follow-up are needed to establish this association.The Swedish Research Council (SIMSAM), the Swedish Cancer Society, and the Nordic Cancer Union.Accepte

Decision-making processes of public sector accounting reforms in India—Institutional perspectives

While International Financial Reporting Standards (IFRS) convergence has been the face of the global accounting standardisation movement for the past few decades, accounting reforms in the public sector had started to gain momentum from the late 1990s. This paper examines the reasons for the adoption of public sector accrual accounting reforms in India. It explores the various sources of pressure influencing these reforms and the ways in which these pressures are balanced and addressed by key decisionmakers in the national and transnational contexts of an emerging economy like India. This study finds that demands for greater accountability from the public in the national context (demand pressures) as well as requests for greater transparency from international financial institutions in the transnational context (supply pressures) are two major sources of pressure that are balanced by the state in its quest for greater legitimacy. This is demonstrated through a triggering event such as political scandals evoking responses from the government to reinforce its weakened legitimacy by adopting public sector accounting reforms. Extant literature on public sector accounting reforms, mostly focuses on the phases where the standards are being actually implemented by the country. Studies exploring decision-making processes that lead to actual implementation of accrual accounting reforms are limited. This study contributes to existing literature by examining the decision-making process that ensues before the actual use of international standards in public sector accounting reforms and demonstrates the significant role that institutional influences play in defining such decision-making processes. The role of these institutional influences also draw attention to the probable disparities between rationales and actual reasons for government accounting reforms undertaken by developing countries

Crise de abastecimento de água em São Paulo e falta de planejamento estratégico

Embora a crise no abastecimento de água na Região Metropolitana de São Paulo (RMSP) tenha se manifestado de maneira mais intensa no verão de 2013-2014, ela revela um problema crônico que vem afetando toda a Região nos últimos dez anos. Esse problema foi gerado pela falta de um planejamento estratégico que considere questões climatológicas que podem indicar, com meses de antecedência, problemas de recomposição dos níveis dos mananciais, permitindo que ações sejam empreendidas com razoável antecedência, reduzindo os impactos para a população. Este estudo mostra como é possível utilizar informações climáticas na gestão estratégica do sistema de abastecimento da RMSP.Though the crisis in the water supplying system in the Metropolitan Region of São Paulo (RMSP) was more intensively felt in the 2013-2014 summer, it reveals a chronic problem that has been affecting the whole RMSP for the past ten years. This problem is originated from the lack of a strategic planning that takes into consideration climate issues that could, months before, foresee problems to restore the levels of water resources, allowing measures to be implemented within a reasonable anticipation, therefore reducing the impacts on the population. This study shows how it is possible to use climate information in the strategic management of the water supply in the RMSP

Impact of Dupoto-e-Maa education project on dropout rate and academic performance

Background: A study conducted in the Kajiado Central District of Kenya in 2006 showed that there was a high dropout rate among primary schoolgoing children and that their academic performance was poor. The Dupoto-e-Maa education project was implemented in 2007 to address issues related to drop out rate and academic performance. Objectives: The evaluation therefore investigated the extent to which the project had influenced dropout rate and academic performance in the public primary schools in Kajiado Central District. Method: The evaluation adopted a mixed methods approach: cross-sectional survey and case study designs. The benefit of the approach is the richness of information obtained through triangulation. The respondents included head teachers, school management committees, teachers, pupils, quality assurance and standards officer and project staff. A sample size of 183 respondents was selected using purposive sampling and stratified random sampling procedures. Head teachers of the sampled schools participated as key informants. The instruments of data collection included questionnaires, an interview guide, a document analysis guide, a focus group discussion guide and an observation guide. Results: The findings indicate that the Dupoto-e-Maa education project had influenced dropout rates. The direction of the findings seems to suggest that academic performance trends are unpredictable since fluctuations are evident, though the programme could have encountered some challenges that may have limited its achievement on this variable. Conclusion: The study recommended that there is need to increase the number of non-governmental organisations modelled around the Dupoto-e-Maa education project so as to reduce dropout rate and improve pupil academic performance. The findings could also inform government policy in terms of recruitment and placement of teachers in schools in arid and semi-arid lands. Project funding could be increased to improve visibility and sustainability of project activities

An overview of Conservation Agriculture in the dry Mediterranean environments with a special focus on Syria and Lebanon

Conservation Agriculture (CA), comprising minimum or no mechanical soil disturbance through no-till seeding, organic soil mulch cover, and crop diversification is now practiced on some 157 million ha worldwide, corresponding to about 11% of the global cropped land. CA adoption in the Middle-East is low compared to other regions. Lack of knowledge on CA practices and systems discourages farmers from giving up ploughing. The main reason why farmers in the Middle-East have begun to apply the no-till system has been the cost reduction in fuel, labor and machinery required for land preparation. Soil and water conservation concerns do not appear to be the main drivers in the Middle-Eastern farmers’ decision to adopt or not to adopt CA. The adoption and uptake of CA by Middle Eastern farmers has been slow but it is nonetheless occurring gradually. Collection of information and research parameters related to agricultural practices are needed for designing a suitable soil and water conservation program for sustainable production intensification. Governmental policy encouraging the adoption and spread of CA systems in the Middle-East region is certainly a necessary condition for uptake. The objective of this article is to review the current status of adoption and spread of CA in the Middle-East, focusing mainly on Syria and Lebanon, and the potential beneficial consequences that can be harnessed through CA systems under rainfed conditions in both countries. The benefits include: higher factor productivity, yield and income; improved soil properties; climate change adaptation, including reduced vulnerability to the erratic rainfall distribution; and reduction in machinery, fuel and labor costs