Incidence des cancers et polypes colorectaux dans le canton de Vaud, 1983-2007: tendances et déterminants

Le cancer colorectal atteint, chaque année, plus d'un million de personnes dans le monde et plus de 500'000 en meurent [1]. Il affecte de manière très inégalitaire les différentes parties du monde. En effet, s'il constitue un problème de santé publique majeur dans des régions telles que l'Amérique du Nord, l'Europe ou l'Océanie (incidence supérieure à 50 pour 100'000), il est nettement plus rare dans certains pays d'Asie, d'Afrique ou d'Amérique du Sud (incidence inférieure à 10 pour 100'000) [2]. Aux Etats-Unis, on estime que 5 à 6% de la population générale présentera un cancer colorectal au cours de sa vie [3]. En Suisse, le cancer colorectal est le deuxième cancer le plus mortel, avec quelque 1'600 décès par an, après le cancer du poumon [4]. Avec 4'000 nouveaux cas annuels, il représente 11% de tous les cancers chez l'homme et chez la femme [5]. Le cancer colorectal est le troisième cancer le plus fréquent après celui du poumon et de la prostate chez l'homme, alors qu'il n'est précédé chez la femme que par le cancer du sein. Pour la période 2003-07, l'incidence en Suisse est estimée à 50 cas/100'000 hommes et 32 cas/100'000 femmes (taux standardisés selon la population européenne) [5] et son taux de survie relative à 5 ans est de 60%, ce qui en fait le taux le plus élevé d'Europe [6]. Le fait que l'incidence chez les migrants ait tendance à rattraper celle des indigènes en moins d'une génération suggère que les facteurs environnementaux jouent un rôle prédominant dans la carcinogénèse des tumeurs colorectales [7]. Cependant, d'autres facteurs, notamment génétiques, interviennent dans la survenue des cancers colorectaux. En effet, dans des conditions de vie similaires, on observe une incidence de cancers colorectaux différente entre différentes ethnies. Des études américaines ont par exemple montré une incidence plus élevée chez les noirs (48 pour 100'000) que chez les blancs (40/100'000) ou les hispaniques (26/100'000) [8]. Les hommes sont plus fréquemment touchés par le cancer colorectal que les femmes, avec un sexe ratio de 1,5 [9]. Les premiers cas de cancers colorectaux apparaissent à partir de 25 ans et l'incidence augmente de manière quasi exponentielle jusqu'à un âge de 75-80 ans, puis se stabilise [10]. L'âge moyen au diagnostic se situe entre 65 et 70 ans. Environ 66% des cancers colorectaux sont localisés dans le côlon (dans l'ordre décroissant: au niveau du sigmoïde, du côlon ascendant, descendant et transverse), 27% dans le rectum, 4% dans l'anus tandis qu'environ 4% restent multiples et indéfinis [10]. Notons encore, qu'à des fins de comparaisons épidémiologiques, les cancers du côlon, du rectum et de l'anus sont souvent regroupés dans l'unique groupe des tumeurs colorectales.

More than Words? An Analysis on the Language and Structure of General Election Manifestos of the British Labour Party 1983-2005

The topic of this study is the language of the educational policies of the British Labour party in the General Election manifestos between the years 1983-2005. The twenty-year period studied has been a period of significant changes in world politics, and in British politics, especially for the Labour party. The emergence educational policy as a vote-winner of the manifestos of the nineties has been noteworthy. The aim of the thesis is two-fold: to look at the structure of the political manifesto as an example of genre writing and to analyze the content utilizing the approach of critical discourse analysis. Furthermore, the aim of this study is not to pinpoint policy positions but to look at what is the image that the Labour Party creates of itself through these manifestos. The analysis of the content is done by a method of close-reading. Based on the findings, the methodology for the analysis of the content was created. This study utilized methodological triangulation which means that the material is analyzed from several methodological aspects. The aspects used in this study are ones of lexical features (collocation, coordination, euphemisms, metaphors and naming), grammatical features (thematic roles, tense, aspect, voice and modal auxiliaries) and rhetoric (Burke, Toulmin and Perelman). From the analysis of the content a generic description is built. By looking at the lexical, grammatical and rhetorical features a clear change in language of the Labour Party can be detected. This change is foreshadowed already in the 1992 manifesto but culminates in the 1997 manifesto which would lead Labour to a landslide victory in the General Election. During this twenty-year period Labour has moved away from the old commitments and into the new sphere of “something for everybody”. The pervasiveness of promotional language and market inspired vocabulary into the sphere of manifesto writing is clear. The use of the metaphors seemed to be the tool for the creation of the image of the party represented through the manifestos. A limited generic description can be constructed from the findings based on the content and structure of the manifestos: especially more generic findings such as the use of the exclusive we, the lack of certain anatomical parts of argument structure, the use of the future tense and the present progressive aspect can shed light to the description of the genre of manifesto writing. While this study is only the beginning, it proves that the combination of looking at the lexical, grammatical and rhetorical features in the study of manifestos is a promising one.

Excavaciones (1981-1983) en el poblado de Carretela (Aitona, Segrià, Lleida)

Con este artículo damos a conocer un poco más en profundidad un yacimiento al que muchas veces se ha hecho referencia en la bibliografía sin que existiera aún una publicación monográfica al respecto. Las excavaciones del poblado fechados a principios de los CC.UU. Antiguos, reflejan la sucesión de diversas ocupaciones de un mismo espacio habitado. El conocimiento de este período queda igualmente completado a partir de diversos estudios adicionales.

If you want me to stay, pay

Devolution of political power is constantly on the political agenda in both Italy and Spain. Fiscal policy in these countries has granted specific privileges to some regions. Valle d’Aosta/Vallée d’Aoste,(VdA) and País Vasco-Euskadi (PV) have an extensive say over spending decisions, and receive nearly all regional tax revenues. Although both VdA and PV are among the richest regions in each country, both are net beneficiaries of the fiscal equalisation system. This preferential treatment is the outcome of a fiscal system with limits on taxing power and debt issuance, and is meant as a compensation for the lack of autonomy. It so prevents calls for more fiscal autonomy, or even outright secession. The economic effects of this asymmetric federalism are negative Although partial equalisation reduces excessive redistribution built in the fiscal equalisation system, more autonomy could pay off with more efficient government. Asymmetric federalism moreover creates a political impasse in the negotiation of a more efficient tax system and financing arrangement.

Trimodal therapy for invasive bladder cancer: is it really equal to radical cystectomy?

PURPOSE OF REVIEW: Trimodal therapy (TMT) is considered the most effective bladder-sparing approach for muscle-invasive urothelial carcinoma of the bladder (MIBC) and an alternative to radical cystectomy. The purpose of this article was to review and summarize the current knowledge on the equivalence of TMT and radical cystectomy based on the recent literature. RECENT FINDINGS: TMT consists of a maximal transuretral resection of the bladder, followed by a concurrent radiotherapy and chemotherapy, limiting salvage radical cystectomy to nonresponder tumors or muscle-invasive recurrence. In large population studies, less than 6% of the patients with nonmetastatic MIBC receive a chemoradiation therapy and this rate is stable. A growing body of evidence exists that TMT provides good oncologic outcomes with low morbidity when compared with radical cystectomy. TMT requires, however, a close follow-up because of the high risk of local recurrence and salvage radical cystectomy in up to 30% of the patients. Salvage radical cystectomy can be performed with adequate results but does not offer the same opportunity of reconstruction and functional outcomes than primary radical cystectomy. SUMMARY: Although radical cystectomy is still the treatment of reference for most of the patients with localized MIBC, TMT represents a reasonable alternative in highly selected patients. Any firm conclusion on the equivalence or superiority of one treatment to the other is still limited by the lack of randomized controlled trials and the heterogeneity of the available literature. Future studies and multidisciplinary approach are mandatory to optimize the patient selection and regimen of TMT.

Welfare loss with municipal amalgamations and the willingness-to-pay for the municipality name

Functional advantages and drawbacks are commonly mentioned to rationally justify or condemn municipality amalgamations. However, many consolidation projects are resisted by local governments or citizens on the grounds that amalgamation would dampen local identity. A municipality's name change is probably the most visible sign of the loss of community bond experienced by citizens at amalgamation time. This article aims to put a value on this loss by measuring citizen willingness to pay for their city name. This methodological approach innovates upon the literature on municipal amalgamation and place branding by exploiting the versatility of the so-called contingent valuation method (CVM). CVM confronts respondents, in a survey setting, with a hypothetical market in which a characteristic of interest is exchanged. Here the characteristic is the possibility to retain one's city name for an amalgamated jurisdiction. The article presents the estimates provided by a survey conducted in four Swiss cities.

Mind the Gap. Do Proportional Electoral Systems Foster a More Equal Representation of Women and Men, Poor and Rich ?

Female gender and low income are two markers for groups that have been historically disadvantaged within most societies. The study explores two research questions related to their political representation: 1) Are parties ideologically biased towards the ideological preferences of male and rich citizens? 2) Does the proportionality of the electoral system moderate the degree of underrepresentation of women and poor citizens in the party system? A multilevel analysis of survey data from 24 parliamentary democracies indicates that there is some bias against those with low income and, at a much smaller rate, women. This has systemic consequences for the quality of representation, as the preferences of the complementary groups differ. The proportionality of the electoral system influences the degree of underrepresentation: specifically, larger district magnitudes help closing the considerable gap between rich and poor.

Health Migration Policies and Ethical Controversies: the Case of African Nurses in the UK

The United Kingdom (UK) for last few decades has been faced with a growing need for health personnel and has therefore attracted professionals, particularly overseas nurses. The country has been characterised by a historical migration policy favourable to the recruitment of foreign health staff. However, in the context of deep shortage and high level of diseases and health system weakness, the international health professional recruitment from Sub Saharan Africa has created unprecedented ethical controversies which have pushed the UK to the centre of discussions because of its liberal policies towards international recruitment that have been considered as aggressive. While the 'brain drain' controversy is well known, less attention has been devoted to the specific international health migration controversy and the pivotal role of the UK in the diffusion of ethical code of practice. Using mainly the perspective of the policy analysis of controversy (Roe 1994) and the analysis of discourses (de Haas 2008), our paper comes back respectively to the nature of the controversy and the pivotal role of the UK. It also analyses how the implementation of UK ethical policies - Code of Practice, banned countries list of recruitment, restrictive immigration policies - have been considered as inefficient and unethical in their contents and their targets.

Labor Market Signaling and Self-Confidence: Wage Compression and the Gender Pay Gap

I extend Spence's signaling model by assuming that some workers are overconfident-they underestimate their marginal cost of acquiring education-and some are underconfident. Firms cannot observe workers' productive abilities and beliefs but know the fractions of high-ability, overconfident, and underconfident workers. I find that biased beliefs lower the wage spread and compress the wages of unbiased workers. I show that gender differences in self-confidence can contribute to the gender pay gap. If education raises productivity, men are overconfident, and women underconfident, then women will, on average, earn less than men. Finally, I show that biased beliefs can improve welfare.