Food security in Brazil

The analysis of the experiences of Brazil's rural poor over the period of trade liberalisation reveals a complex picture. The impacts of trade liberalisation on the poor seem not to come only from the reduced tariff barriers, but rather from other policies that have accompanied trade liberalisation. In the liberalisation process there may be some groups of individuals that are likely to be disadvantaged, and additional complementary policies will sometimes be needed to enhance the impact from trade, including on poverty. Trade policy will have implications for food security through the link with incomes and expenditures. Any change in the trade regime will have a direct effect on both rural and urban incomes, and employment, and through these on income distribution. The situation of food insecurity and poverty affects about 44 million people in Brazil. The purpose of this study is to examine how the food security situation for the poor households will be affected by a recent proposal of tariff reductions for market access in the WTO negotiations of the Doha round. The study will also consider how the food security situation for the poor households respond to the Zero Hunger Program, which is a social assistance program and includes a combination of structural policies to tackle the underlying causes of poverty. The modelling approach used in the study is a disaggregated Brazilian social accounting matrix. Several household types are taken into consideration so that welfare implications on different income groups of different policy scenarios can be analysed. The analyses include three different scenarios, and the result of the simulations implies that the poor households will benefit and improve their possibilities for a better food security situation. The member states of the United Nations adopted in 2000 the Millennium Declaration as a renewed commitment to human development. The declaration includes eight Development Goals, each with quantified targets to be reach by each member states in 2015. Brazil's Zero Hunger Program is one step towards these Millennium Development Goals.Perioden under handelsliberaliseringen uppvisar en komplex bild för den fattiga landsbygdsbefolkningen i Brasilien och livsmedelsosäkerhet och fattigdom berör omkring 44 miljoner människor. Förändringar i handelsregimen leder till en direkt effekt på både inkomster och sysselsättning och genom dessa även på distributionen av inkomster. Handelspolitiken påverkar livsmedelssäkerheten genom sambandet mellan inkomster och utgifter. De mest betydande förändringarna genom liberaliseringen verkar inte enbart komma från de reducerade tullmurarna, utan snarare från andra politiska förändringar som åtföljt handelsliberaliseringen. Under liberaliseringsprocessen kan det eventuellt vara några grupper av individer som sannolikt kommer att behandlas ofördelaktigt och ytterligare kompletterande politik och handlingsprogram kan ibland behövas för att stärka den effekt av handeln som kan leda till en minskad fattigdom. Syftet med studien är att undersöka hur livsmedelssäkerheten för de fattiga hushållen kommer att påverkas av ett nyligen lagt förslag om tullsänkningar för marknadstillträde i förhandlingarna inom WTO:s Doharunda. Studien tar också hänsyn till hur livsmedelssäkerheten för de fattiga hushållen påverkats av Zero Hunger programmet, som inkluderar en kombination av strukturell politik för att ta itu med bakomliggande orsaker till fattigdom. En detaljerad social räkenskapsmatris (SAM-matris) har användts vid analysen av studien. SAM-matrisen tar hänsyn till flera olika hushållstyper, så att välfärdsförändringar inom olika inkomstgrupper genom olika politiska scenarier kan analyseras. Analysen inkluderar tre olika scenarier och resultatet av simuleringarna antyder att de fattiga hushållen kommer att få en bättre ekonomisk situation, vilket ökar deras möjligheter till en förbättrad livsmedelssäkerhet. Förenta Nationernas medlemsstater antog 2000 en millenniedeklaration, som ett initiativ till en förnyad förbindelse för mänsklig utveckling. Deklarationen inkluderar åtta kvantifierade utvecklingsmål, som medlemsstaterna arbetar för att uppnå till 2015. Brasiliens Zero Hunger program är ett steg närmare dessa mål i millenniedeklarationen

Appendiceal neoplasm risk associated with complicated acute appendicitisa population based study

PurposeAppendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis.MethodsThis nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals.ResultsAltogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n=250), and out of these, 41% (n=102) were complicated and 59% (n=148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, pPeer reviewe

Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion : a retrospective nationwide cohort study

Background Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion. Method All patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007-2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days' follow-up. Results The results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21-64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days' follow-up. Conclusion The results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence.Peer reviewe

The association between appendicitis severity and patient age with appendiceal neoplasm histology-a population-based study

Purpose Recent studies have reported alarming appendiceal tumor rates associated with complicated acute appendicitis, especially in patients presenting with a periappendicular abscess. However, the data on histology of appendiceal tumors among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. We have previously reported the association of increased appendiceal tumor prevalence with complicated acute appendicitis in this population-based study. The objective of this secondary analysis was to evaluate the association of both appendicitis severity and patient age with appendiceal tumor histology. Methods This nationwide population-based registry study (The Finnish Cancer Registry) was conducted from 2007 to 2013. All appendiceal tumors (n = 840) and available medical reports (n = 504) of these patients at eight study hospitals were previously evaluated, identifying altogether 250 patients with both acute appendicitis and appendiceal tumor. Results The severity of acute appendicitis was significantly associated with more malignant tumor histology. The risk of adenocarcinoma or pseudomyxoma was significantly higher among patients with periappendicular abscess (OR 15.05, CI 95% 6.98-32.49, p < 0.001) and patients presenting with perforated acute appendicitis (OR 4.09, CI 95% 1.69-9.90, p = 0.0018) compared to patients with uncomplicated acute appendicitis. Similarly, patient age over 40 years was significantly associated with the risk of adenocarcinoma and pseudomyxoma (OR 26.46, Cl 95% 7.95-88.09, p < 0.001). Patient sex was not associated with a more malignant appendiceal tumor histology (p = 0.67). Conclusion More malignant appendiceal tumor histology of adenocarcinoma or pseudomyxoma was significantly associated with patient age over 40 years and complicated acute appendicitis, especially periappendicular abscess.Peer reviewe

Parastomal Hernia : A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up

Background Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. Methods All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007-2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. Results In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007-2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0-146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. Conclusion The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.Peer reviewe

Den nya generationen

Den nya generationen – Inledaren: Ett positivt dilemma av Pia Prost – Att så meningsfulla frön i vardagen av Julia Ajanko – Skolliv i yttre skärgården av Kristin Mattsson – Finlands skärgårdsskolor av Pia Prost Vi är inte som andra vi! Livet i en skärgårdsskola av Sanna Järf Septemberbaby ger nytt liv i Sibbo skärgård av Thure Malmberg – Havet som framtid: De unga skärikvinnorna Linda och Ronja av Julia Ajanko – Norrskär av Pia Prost, Emmie Sjödahl, Mikael Nordström & Olav Jern – Skärgårdsbarnens hobbymöjligheter av Pia Prost – Giàno del Vecchio från Utö tror på skärgården av Julia Ajanko – Norsk skärgård – ett staket av klippor och rev av Kristina Svels – Barnfamiljer i skärgården av Dan Sundblom & Pia Liljeroth – Själös betydelse för havsforskningen av Jari Hänninen – Eldsjälar och livsverk av Kasper Westerlund – Skärgårdsfotograf Viveka Rabehl – Skärgårdsbarnens geografibok av Tove Eklund – Kongress om klimatsmarta öar på Mallorca av Julia Ajanko – Skärinytt – Knattelabbet och ö-expeditionen lär barn om livet i Skärgårdshavet av Pia Pros

Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial

BackgroundThe efficacy and safety of antibiotic treatment for uncomplicated acute appendicitis hasbeen established at long-term follow-up with the majority of recurrences shown to occurwithin the first year. Overall costs of antibiotics are significantly lower compared with appendectomyat short-term follow-up, but long-term durability of these cost savings is unclear.The study objective was to compare the long-term overall costs of antibiotic therapy versusappendectomy in the treatment of uncomplicated acute appendicitis in the APPAC (APPendicitisACuta) trial at 5 years.Methods and findingsThis multicentre, non-inferiority randomized clinical trial randomly assigned 530 adultpatients with CT-confirmed uncomplicated acute appendicitis to appendectomy or antibiotictreatment at six Finnish hospitals. All major costs during the 5-year follow-up were recorded,whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis.Between November 2009 and June 2012, 273 patients were randomized to appendectomyand 257 to antibiotics. The overall costs of appendectomy were 1.4 times higher(pCI: €3879 to €4463) resulting in cost savings of €1545 per patient (95% CI: €1193 to €1899;ppatients did not undergo appendectomy.ConclusionsAt 5-year follow-up antibiotic treatment resulted in significantly lower overall costs comparedwith appendectomy. As the majority of appendicitis recurrences occur within the first yearafter the initial antibiotic treatment, these results suggest that treating uncomplicated acuteappendicitis with antibiotics instead of appendectomy results in lower overall costs even atlonger-term follow-up.</p

Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study

The results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence.\nPrevious research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion.\nAll patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007-2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days' follow-up.\nThe results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21-64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days' follow-up.\nCONCLUSION\nBACKGROUND\nMETHOD\nRESULT

Parastomal Hernia: A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up

Background Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. Methods All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007-2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. Results In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007-2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0-146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. Conclusion The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.</p