Trade-offs in linking adaptation and mitigation in the forests of the Congo Basin

Recent discussions on forests and climate change have highlighted the potential for conservation of tropical forests to contribute synergistically to both mitigation (reducing emissions of greenhouse gases) and adaptation (increasing capacity to cope with changing climate conditions). Key mechanisms through which adaptive advantages might be gained include the potential for forest resources to support livelihoods in the context of climatic strains on agriculture and the protection that intact forest ecosystems might provide against landslides, flash floods and other hazards related to extreme weather. This paper presents findings from field research with forest communities in three areas of the Congo Basin in Central Africa, in which the adaptive role and potential of forests in these respects is critically analysed. The investigation was carried out through a combination of structured and semi-structured qualitative techniques within six villages in Cameroon, Equatorial Guinea and Rwanda. The findings of the research highlight the need to understand both the limits of synergy, and the constraints and trade-offs for rural livelihoods that may be associated with a forest conservation agenda driven by the additional impetus of carbon sequestration. The search for synergy may be conceptually laudable, but if forest management actions do not take account of on-the-ground contexts of constraints and social trade-offs then the result of those actions risks undermining wider livelihood resilience

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone