A median survival time of about 9 months is generally reported among malignant pleural mesothelioma cases. Recently, better results in terms of survival and performance status have been reported in clinical trials that included highly selected patients. We describe the survival of pleural mesothelioma patients and the factors predictive of survival in an unselected, population-based setting. Pleural mesothelioma cases (4,100) registered from 1990 to 2001 by 9 Italian regional mesothelioma registries contributing to the network of the National Mesothelioma Registry were followed until December 31, 2005. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards regression) analyses of survival were carried out according to selected individual characteristics, including limited information on treatment in a subset of 578 cases. The median survival time was 9.8 months (95% confidence interval: 9.4-10.1). In multivariate analysis, younger age at diagnosis and epithelioid histotype were associated with significantly reduced hazard ratios. Positive effects of gender (women) and being diagnosed in a hospital with a thoracic surgery unit were of border-line statistical significance. No association with calendar period of diagnosis or asbestos exposure was present. Treatment was not associated with a statistically significant improvement in survival. This is the largest population-based study on survival in patients with pleural mesothelioma to date. Age and morphology were the main prognostic factors. Results regarding the effect of treatment were disappointing but may be useful to assess the future impact, at the population level, of recently introduced therapies.

Background: Carpal tunnel syndrome (CTS) is a socially and economically relevant disease caused by compression or entrapment of the median nerve within the carpal tunnel. This population-based case-control study aims to investigate occupational/non-occupational risk factors for surgically treated CTS.

Cropland use activities are major drivers of global environmental changes and of farming system resilience. Rotating crops is a critical land-use driver, and a farmers’ key strategy to control environmental stresses and crop performances. Evidence has accumulated that crop rotations have been dramatically simplified over the last 50 years. In contrast, organic farming stands as an alternative production way that promotes crop diversification. However, our understanding of crop rotations is surprisingly limited. In order to understand if organic farming would result in more diversified and multifunctional landscapes, we provide here a novel, systematic comparison of organic-to-conventional crop rotations at the global scale based on a meta-analysis of the scientific literature, paired with an independent analysis of organic-to-conventional land-use. We show that organic farming leads to differences in land-use compared to conventional: overall, crop rotations are 15% longer and result in higher diversity and evener crop species distribution. These changes are driven by a higher abundance of temporary fodders, catch and cover-crops, mostly to the detriment of cereals. We also highlighted differences in organic rotations between Europe and North-America, two leading regions for organic production. This increased complexity of organic crop rotations is likely to enhance ecosystem service provisioning to agroecosystems.

In some population-based studies, a shorter median survival was observed in peritoneal as compared with pleural, malignant mesothelioma, but in others, longer median survival times or higher proportions of long-term survivors were reported. Statistical instability could have caused these differences. We analyzed survival in peritoneal mesothelioma in a large and unselected population-based case series. Cases (338) registered from 1990 to 2001 by 9 Italian regional mesothelioma registries contributing to the network of the National Mesothelioma Registry were followed until December 31, 2005. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards regression) analyses of survival were performed according to selected individual characteristics, including limited treatment information in a subset of 194 cases. The results were compared with those obtained in a parallel study on pleural mesothelioma cases. Epithelioid histotype, younger age at diagnosis and, to a lesser degree, gender (women), and being diagnosed in a hospital with a thoracic surgery unit positively and significantly affected survival. The effect of treatment was positive but not statistically significant. No trend in the risk of death according to calendar period of diagnosis was present. Peritoneal mesothelioma cases had shorter median survival time than pleural cases, but a larger proportion of long-term survivors. Survival patterns after peritoneal and pleural mesothelioma differed markedly. Treatment was not associated with a statistically significant improvement in survival, but our study included cases first diagnosed before the introduction of the most recent therapeutic approaches. This provides a large historical comparison for future studies on survival trends at the population level.

The global demand for cacao has recently increased. To meet this demand, the cultivated area has been expanded in tropical forest areas and production has intensified by replacing traditional agroforestry systems with monocultures. This has led to a loss of biodiversity in cacaogrowing areas. More sustainable production systems such as agroforestry and organic managed systems are expected to yield less cacao, but by-crops and premium prices, respectively, might economically compensate for the lower yields. Here, we compared the productivity and the return on labor, that is the return per working day, of four different cacao production systems: agroforestry and monocultures under organic and conventional management. Cacao and by-crop yields, costs, revenues, and labor were registered during the first 5 years after establishment. Results show that cacao yields were, on average, 41% higher in monocultures, but the revenues derived from agroforestry by-crops economically overcompensated for this difference. Indeed, the return on labor across the years was roughly twice as high in the agroforestry systems compared to the monocultures. We found similar cacao yields and return on labor in conventional and organically managed agroforestry systems.However, in the monocultures, cacao yields were 48% lower under organic compared with conventional farming, but the return on labor was similar, mainly due to the higher costs associated to the conventional management. Overall, our findings show that cacao agroforestry systems have higher return on labor.

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Available data support asbestos exposure as the main risk factor in mesothelioma cases among blood relatives. Our finding of a low proportion of familial cases would not suggest the influence of a large genetic component for mesothelioma in blood relatives.