Across Central Appalachia, you can see the message scrawled across bumper stickers, protest signs, and billboards: “Coal Feeds My Family”. The metaphor of coal feeding families is one that stresses ...the economic importance of this extractive industry to the economy of the industrialized rural mountain South. This essay examines the change in land-human relationships through the lens of food. A contrast is drawn between homesteading’s cultivation of life and coal’s energy economy of the dead. The energy economy of the preindustrial Appalachian farm is shown to be a slight alteration from the energy cycles of the Appalachian forest. The industrial energy economy of coal, on the other hand, severed Appalachian people from their traditional agricultural energy economy, from the results of their production, from the sources of their consumption, and from the very thing, the sun, which made the preindustrial economy possible. The coal energy economy was not only made possible through various technological innovations in production and consumption, but also by certain social relations and political structures. These relations and structures remain relatively intact, in spite of the rapid disintegration of the coal economy, and their inertia explains the popularity of the slogan “Coal Feeds My Family”.
Abstract
Background
The aim of this study was to define clusters of activity in a population-based cohort during the first 5 years after diagnosis in children with ulcerative colitis UC and to ...identify early prognostic risk factors.
Methods
All UC patients from the SIGENP IBD registry with a complete follow-up of at least 5 years were included. Active disease was defined every 6 months in the presence of at least one of the following: clinical activity Paediatric Ulcerative Colitis Activity Index ≥ 35; endoscopic activity Mayo score ≥ 1; faecal calprotectin > 250 µg/g; hospitalization; surgery; or treatment escalation. Formula-based clusters were generated based on four published questionnaire-based activity patterns in adults, plus one additional cluster.
Results
In total, 226 patients were identified. Forty-two 19% had moderate–severe chronically active disease, 31 14% chronic–intermittent, 75 33% quiescent, 54 24% active disease in the first 2 years after the diagnosis, then sustained remission, and 24 11% a remission in the first 2 years then an active disease. Mild disease onset along with a lower clinical severity not requiring the use of corticosteroids at 6 months were related to a quiescent disease course at the next follow-up (logistic model area under the curve 0.86 95% confidence interval 0.78–0.94; positive predictive value 67%; negative predictive value 70%). Eight per cent of patients needed surgery, none in the quiescent group p = 0.04.
Conclusions
More than one-third of children with UC present with a chronically active or intermittent course during the first 5 years of follow-up. A significant group of patients has active disease in the first 2 years and then sustained remission. Interestingly, after initial treatment, one-third of patients have well-controlled disease throughout.
Inflammatory bowel diseases (IBD) are often associated with extraintestinal manifestations (EIMs), which occur in approximately one third of patients. There is only few published data on the ...occurrence of these manifestations in children and adolescents, so most of the data are taken by studies in adult patients. The organs most commonly affected are joints, skin, eyes and biliary tract, although nearly every organ may be involved. Some of the EIMs are clearly related to intestinal disease activity (i.e., erythema nodosum, peripheral arthritis, orofacial lesions), whereas others occur independently (i.e., pyoderma gangrenosum, anterior uveitis/iritis, ankylosing spondylitis, primary sclerosing cholangitis). Many extraintestinal disorders may be direct inflammatory and metabolic complications of the intestinal inflammation (i.e., osteoporosis, growth retardation, nephrolithiasis, ureteral obstruction, thromboembolic disease). In this review we provide an overview on the prevalence and clinical aspects of the more commonly reported EIMs of Crohn's disease and ulcerative colitis in pediatric patients, focusing on specific issues of children affected by IBD (growth failure and metabolic osteopathy).
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