The fortune of modulation in the process of CAP reform

Direct payments have progressively become the largest and most visible form of support in the CAP tool-box. Analyses on direct payments have always highlighted a large inequality in their distribution, both between Member States and, within them, among farmers and territories where, on one side, a relevant amount of payments is concentrated in the hands of a few beneficiaries; on the other, a small share of support is divided among many heads. The European Commission has faced the problem of the volume and the distribution of the direct payments with two main instruments: the modulation and the capping. Modulation was originally conceived as a temporary tool aimed at filling the gap between pillars, but in the last years it has changed shape and rules alongside with the CAP process path and it has become one of the milestones of the CAP tool-box. The capping has received high attention during each step of the recent CAP reform process, however, it has been never implemented so far. Both the instruments have relevant implications about the total amount of payments received by farms and by the Member States and about their distribution; however, the way they are implemented and combined together is crucial to fully evaluate their effects. The main goal of this paper is to reconstruct the evolution of modulation in the process of CAP reform, from the voluntary one launched by Agenda 2000 till the most recent proposal of the CAP Health Check, that combines in one single tool modulation and direct payments’ capping. Simulations of the most recent proposal of modulation show that the goal of Pillar 2 reinforcement has prevailed over the distributional one, through the creation of a sort of national envelope that shifts resources from Pillar 1 to Pillar 2, even though it is not very clear so far how and for what that envelope will be spent. Moreover, the capping goal within the progressive modulation is not very effective and only affects to some limited extent direct payments in few Member States.CAP Budget, CAP Pillars, Health Check, Rural Development Policies, Agricultural and Food Policy, Political Economy, Q18,

Italy from 1939

Over the seven decades considered in the chapter, the Italian wine industry has changed dramatically, from a dispersed production system mainly oriented to self- consumption of supply and the local market with low- value wines, to a modern industry able to satisfy an increasingly demanding domestic supply and very competitive international markets with a wide range of wines. The current situation is the result of a long process driven by many factors, acting inside and outside the sector, and mainly national and EU policies and changing domestic and international demand. The evolution of the sector happened in four different phases, marked by different drivers and characteristics. Each period is described focusing on grape growing, wine making, domestic consumption, exports and policies affecting the industry

EU wine policy in the framework of the CAP: post-2020 challenges

Abstract The EU Common Agricultural Policy (CAP), and with it the EU wine policy, is experiencing a reform process, started in 2018, in order to address ambitious environmental and social objectives, in conjunction with the goal of a competitive agricultural sector. Given the role of the EU in wine supply, the aim of this paper is to present the design, the rationale and the potential effect of the proposed reform with specific reference to wine sector. To better understand the forthcoming process, it is firstly presented how CAP and its wine policy evolved in terms of objectives and tools over time. The EU wine policy is a paradigmatic example of a combination between the horizontal measures, valid for all agricultural sectors, and vertical measures, peculiarly encompassing the whole wine supply chain. The reform proposal confirms, with some interesting modifications, the set of tools already operating in the sector; however, it calls for a planning of the implementation of the available tools for all products in a unitary frame represented by a national CAP Strategic Plan, applying a lean administrative procedure. In the hypothesis that the COVID-19 outbreak will not cause a radical change in the global agri-food system, the proposed planning process should stimulate shared strategies. These are intended to effectively coordinate, according to the principle of complementarity, the implementation of available policy tools, in order to obtain a better use of resources and a more balanced achievement of all policy objectives

Agricultural Expenditure in the Future European Union Budget

Agricultural and Food Policy, Agricultural Finance,

Video-Laparoscopic versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Background: Minimally invasive surgery in obese patients is still challenging, so exploring one more item in this research field ranks among the main goals of this research. We aimed to compare short-term postoperative outcomes of open and video-laparoscopic (VL) approaches in CRC obese patients undergoing colorectal resection. Methods: We performed a retrospective analysis of a surgical database including 138 patients diagnosed with CRC, undergoing VL (n = 87, 63%) and open (n = 51, 37%) colorectal surgery. As a first step, propensity score matching was performed to balance the comparison between the two intervention groups (VL and open) in order to avoid selection bias. The matched sample (N = 98) was used to run further regression models in order to analyze the observed VL surgery advantages in terms of postoperative outcome, focusing on hospitalization and severity of postoperative complications, according to the Clavien–Dindo classification. Results: The study sample was predominantly male (N = 86, 62.3%), and VL was more frequent than open surgery (63% versus 37%). The two subgroup results obtained before and after the propensity score matching showed comparable findings for age, gender, BMI, and tumor staging. The specimen length and postoperative time before discharge were longer in open surgery (OS) patients; the number of harvested lymph nodes was higher than in VL patients as well (p < 0.01). Linear regression models applied separately on the outcomes of interest showed that VL-treated patients had a shorter hospital stay by almost two days and about one point less Clavien–Dindo severity than OS patients on average, given the same exposure to confounding variables. Tumor staging was not found to have a significant role in influencing the short-term outcomes investigated. Conclusion: Comparing open and VL surgery, improved postoperative outcomes were observed for VL surgery in obese patients after surgical resection for CRC. Both postoperative recovery time and Clavien–Dindo severity were better with VL surgery

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Background: Minimally invasive methods in colorectal surgery offer unquestionable advantages, especially in the context of obesity. The current study addresses the lack of scientific evidence on the long-term oncologic safety of video-laparoscopic (VL) approaches in excess-weight CRC patients undergoing surgery. Methods: We retrospectively analyzed a surgical database consisting of 138 CRC patients undergoing VL (n = 87, 63%) and open CRC surgery (n = 51, 37%). To reduce selection bias, a propensity score matching was applied as a preliminary step to balance the comparison between the two surgery groups, i.e., VL and open surgery. Data from patients treated by the same surgeon were used.to minimize bias. Additional Cox regression models were run on the matched sample (N = 98) to explore the observed benefits of VL surgery in terms of overall and cancer-free survival. The nonparametric Kaplan-Meier method was used to compare the two surgical approaches and assess the likelihood of survival and cancer relapse. Results: The study sample was mostly male (N = 86, 62.3%), and VL outnumbered open surgery (63% versus 37%). Both before and after the matching, the VL-allocated group showed better overall survival (p < 0.01) with comparable cancer-free survival over more than five years of median observation time (66 months). Kaplan Meier survival probability curves corroborated the VL significant protective effect on survival (HR of 0.32; 95% CI: 0.13 to 0.81) even after adjusting for major confounding factors (age, gender, comorbidity index, BMI, tumor localization, tumor staging, tumor grading, clearance, CRM). Findings on oncologic performance by tumor relapse were comparable but lacked significance due to the small number of events observed. Conclusions: Comparing CRC surgical approaches, VL allocation showed comparable cancer-free survival but also a better performance on overall mortality than open surgery over more than five years of median observation

Prevalence of the Absence of Cirrhosis in Subjects with NAFLD-Associated Hepatocellular Carcinoma

Background. Hepatocellular carcinoma (HCC) is most commonly considered as a complication of cirrhosis. However, an increasing number of HCC in subjects with non-alcoholic fatty liver disease (NAFLD) without cirrhosis is being reported. We conducted a meta-analysis to assess the prevalence of the absence of cirrhosis in NAFLD-associated HCC. Methods. Four databases were searched until March 2021 (CRD42021242969). The original articles included were those reporting data on the presence or absence of cirrhosis among at least 50 subjects with NAFLD-associated HCC. The number of subjects with absent cirrhosis in each study was extracted. For statistical pooling of data, a random-effects model was used. Subgroup analyses according to the continent, target condition and reference standard for the diagnosis of cirrhosis were conducted. Results. Thirty studies were included, evaluating 13,371 subjects with NAFLD-associated HCC. The overall prevalence of cases without cirrhosis was 37% (95%CI 28 to 46). A higher prevalence was reported in Asia versus Europe, North America and South America (45, 36, 37 and 22%, respectively) as well as in studies adopting histology only as the reference standard for the diagnosis of cirrhosis versus histology and other modalities (e.g., radiology, endoscopy, biochemistry or overt clinical findings) (53 and 27%, respectively). No difference was found between studies including subjects with non-alcoholic steatohepatitis (NASH) only, versus NAFLD with or without NASH (p = 0.385). One in three subjects with NAFLD-associated HCC presented without cirrhosis. This should be reflected in future guidelines and surveillance programs adapted to allow for the early detection of these cancers too

Public Health Response to the SARS-CoV-2 Pandemic: Concern about Ultra-Processed Food Consumption

Introduction: There is scientific consistency in the concept of ultra-processed foods (UPFs) as a descriptor of an unhealthy diet. The most recent literature points to troubling evidence that policies adopted to address the SARS-CoV-2 pandemic may have contributed to diverting eating habits toward a poorer diet. Considering the historically unique SARS-CoV-2 pandemic lockdown scenario, and the health burden imposed by UPFs on human health, it is critical to investigate how the epidemic has influenced UPF intake directly. Reviewing the literature, we aimed to assess the changes in the consumption of UPFs during the pandemic lockdown compared to previous habits in the general population. Methods: Consulting six databases, we examined articles investigating the consumption of UPFs according to the NOVA classification both before the SARS-CoV-2 pandemic and during lockdowns. In total, 28 reports were included in the final analysis. Results: A clear trend of an increasing consumption of sweets (chocolate, candy, cookies, pastries, cakes, desserts, and confectionery, 31.75% increase vs. 21.06% decrease), packaged fatty or salty snacks (23.71% increase vs. 20.73% decrease), and baked goods (bread products, pizza, and sandwiches, 28.03% increase vs. 13.5% decrease) emerged, versus a decrease in ready-to-eat dishes (16.2% increase vs. 22.62% decrease) and ready-made meals (10.6% increase vs. 31.43% decrease), such as instant soups, canned foods, fast food, and chips, as well as sugary drinks in general (14.55% increase vs. 22.65% decrease). No trend was observed for processed meat consumption. Conclusion: The current pandemic scenario raises concerns about the increased consumption of UPFs, especially sweets, snacks, and baked goods, and points to an urgent need to implement policy strategies to manage the trade in these foods from a preventive perspective