Maarten W. Van Den Berg

Income inequality and happiness in 119 nations. In search for an optimum that does not appear to exist

textabstractINCOME INEQUALITY AND HAPPINESS IN 119 NATIONS All modern nations reduce income differences to some extent, and as a result there is an ongoing discussion about what degree of income inequality is acceptable. In this discussion libertarians oppose egalitarians and a principled consensus between these positions is not possible. Consensus can only be reached on the basis of a consequential ethic and one of these is the ‘greatest happiness principle’. In this paper the utilitarian approach is followed and the relation between income inequality and happiness in 119 nations is considered. Overall happiness is conceptualized as the‘subjective appreciation of life as a whole’ and is measured using responses to survey questions. We considered both average happiness and spread of happiness. We found little relationship between income inequality and average happiness in nations. There was no correlation with average happiness, a slightly positive correlation with average mood and a slightly negative correlation with average contentment. All these correlations became positive when wealth of the nation was controlled. Spread of happiness tended to be larger in income unequal nations, but this effect disappeared when wealth of the nation was controlled. Correlations reflect the balance of positive and negative effects; in the case of average happiness the positive effects prevailed and in the case of spread both effects balanced out. The data do not show a point where the balance shifts

Biodegradable stent placement before neoadjuvant chemoradiotherapy as a bridge to surgery in patients with locally advanced esophageal cancer

Dysphagia is the most common presenting symptom in patients with esophageal malignancy and contributes significantly to weight loss and malnourishment. An increasing number of patients with locally advanced esophageal cancer undergo treatment with neoadjuvant chemoradiotherapy (CRT) before surgery because this has been shown to improve survival. 1 Neoadjuvant CRT is, however, associated with acute inflammation and edema of the esophageal mucosa, which could increase symptoms of dysphagia and potentially further jeopardize nutritional status. 2 There are various options for nutritional support during neoadjuvant CRT,includingnasal-enteraltubefeeding,laparoscopic jejunostomy, and total parenteral nutrition. None of these options relieves dysphagia. Therefore, based on the good results of self-expandable stent placement in the palliative setting, self-expandable stents were introduced as a bridge to surgery during neoadjuvant treatment. Fully covered, self-expandable, metal and plastic stents (FSEMS and FSEPS) have been used with good results, but this is at the expense of additional endoscopic procedures either toremoveamigratedstent ortoextract thestent before surgery. 3-6 In addition, SEMSs may hamper dose planning of radiotherapy because of backscatter on CT. 7 Recently, biodegradable stents have been developed to treat refractory benign esophageal strictures. 8,9 These biodegradable stents have the potential to refute the problems encountered with FSEMSs and FSEPSs; migration is less likely because the stent is uncovered, and removal is not necessary because the stent will be resolved at the time of esophagectomy. The aim of this study was to evaluate safety and efficacy of biodegradable stent placement before neoadjuvant CRT as bridge to surgery in patients with locally advanced esophageal cancer and dysphagia.

A new fully covered metal stent with anti-migration features for the treatment of malignant dysphagia.

BACKGROUND AND STUDY AIMS A new esophageal stent with two anti-migration features was developed to minimize migration. The aim of this study was to evaluate the clinical efficacy and safety of this stent in patients with malignant dysphagia. PATIENTS AND METHODS A total of 40 patients with dysphagia due to a malignant obstruction of the esophagus were prospectively enrolled in this cohort study. RESULTS Stent placement was technically successful in 39 patients (98 %). The median dysphagia-free time after stent placement was 220 days (95 % confidence interval 94 - 345 days). Nine patients (23 %) experienced recurrent dysphagia due to tissue overgrowth (n = 2), stent fracture (n = 1), and partial (n = 5) or complete (n = 1) stent migration. A total of 16 serious adverse events occurred in 14 patients (36 %), with hemorrhage (n = 3) and severe nausea or vomiting (n = 3) being the most common causes. CONCLUSIONS This new stent design was effective for the palliation of malignant dysphagia and had a low rate of recurrent dysphagia. However, despite the anti-migration features, stent migration was still a major cause of recurrent dysphagia. Furthermore, treatment was associated with a high adverse event rate. Dutch Trial Registration (NTR 3313).

Has modernisation gone too far? Modernity and happiness in 141 contemporary nations

Modern society comes in for a great deal of criticism, such as about increasing individualisation, globalisation and technologisation, which is seen to reduce the quality of life. This claim was investigated in a comparative study of 141 present-day countries. Eight aspects of modernity were considered: industrialisation, size of the service sector, economic freedom, real income per capita, globalisation, level of education, political democracy and urbanisation. Happiness in different countries was measured as the average response to survey questions on life-satisfaction, affect and contentment. Analysis shows that people living in most modern countries are substantially happier than people in the less modern countries are. The patterns are generally linear. In a subset of western nations, greater modernity still goes with greater happiness. Although the advantages of societal modernisation may be finite, modernisation has not yet undermined human happiness.

Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial

BACKGROUND Dilation is the standard of care for recurrent benign esophageal strictures (BES). Biodegradable stents may prolong the effect of dilation and reduce recurrences. Efficacy and safety of dilation and biodegradable stent placement early in the treatment algorithm of recurrent BES were compared. METHODS This multicenter, randomized study enrolled patients with BES treated with previous dilations to ≥ 16 mm. The primary end point was number of repeat endoscopic dilations for recurrent stricture within 3 and 6 months. Secondary outcomes through 12 months included safety, time to first dilation for recurrent stricture, dysphagia, and level of activity. RESULTS At 3 months, the biodegradable stent group (n = 32) underwent significantly fewer endoscopic dilations for recurrent stricture compared with the dilation group (n = 34; P < 0.001). By 6 months, the groups were similar. The number of patients experiencing adverse events was similar between the groups. Two patients in the biodegradable stent group died after developing tracheoesophageal fistulas at 95 and 96 days post-placement; no deaths were attributed to the stent. Median time to first dilation of recurrent stricture for the biodegradable stent group was significantly longer (106 vs. 41.5 days; P = 0.003). Dysphagia scores improved for both groups. Patients in the biodegradable stent group had a significantly higher level of activity through 12 months (P < 0.001). CONCLUSION Biodegradable stent placement is associated with temporary reduction in number of repeat dilations and prolonged time to recurrent dysphagia compared with dilation. Additional studies are needed to better define the exact role of biodegradable stent placement to treat recurrent BES.

614 Oncological Follow up of the Stent-in 2 Trial: Cancer Recurrence After Curative Treatment of Malignant Colonic Obstruction

lesion size (p 0.022; OR 1.62) and incomplete snare excision (p 0.0001; OR 22.52) were independently associated with recurrence. Conclusions: WF-EMR of large SSA is safe and effective. It results in a relatively low recurrence rate. The vast majority of recurrence is detected at the first FU and is likely related to incomplete polyp resection. Presence of cytological dysplasia in a SSA is a risk factor for recurrence and complication. Endoscopists should aim for complete snare excision and avoid thermal ablation Significant factors related to clinically meaningful postprocedural