Agriculture
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OBJECTIVE: To determine whether children in rural areas have worse health than children in urban areas after liver transplantation (LT). STUDY DESIGN: We used urban influence codes published by the US Department of Agriculture to categorize 3307 pediatric patients undergoing LT in the United Network of Organ Sharing database between 2004 and 2009 as urban or rural. Allograft rejection, patient death, and graft failure were used as primary outcome measures of post-LT health. Pediatric end-stage liver disease/model of end-stage liver disease scores >20 was used to measure worse pre-LT health. RESULTS: In a multivariate analysis, we found greater rates of allograft rejection within 6 months of LT (OR 1.27; 95% CI 1.05-1.53) and a lower occurrence of posttransplantation lymphoproliferative disorder (OR 0.64; 95% CI 0.41-0.99) in patients in rural areas. The difference in allograft rejection was eliminated at 1 year of LT (OR 1.18; 95% CI 0.98-1.42). Rural location did not impact other outcome measures. CONCLUSION: We conclude that rural location makes a negative impact on patient health within the first 6 months of LT by increasing the risk for allograft rejection, although patients in rural areas may have lower rates of developing posttransplantation lymphoproliferative disorder. Long-term adverse health effects were not seen.

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Journal Articles
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Journal Publisher
J Pediatr
Authors
KT Park
KT Park
R Bensen
B Lu
P Nanda
C Esquivel
K Cox
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Background

Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat.

Methods

The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat.

Results

In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries.

Conclusions

Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.

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Journal Articles
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Globalization and Health
Authors
Brian K Chen
Ben Seligman
John W Farquar
Jeremy Goldhaber-Fiebert

Center for Medical Technology Policy
4712 Keswick Rd
Baltimore, MD 21210

(410) 963-8876
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Founder and Director of Center for Medical Technology Policy
Stanford Health Policy Adjunct Affiliate
MD, MSc

Sean Tunis, MD, MSc. is the Founder and Director of the Center for Medical Technology Policy in Baltimore, Maryland.  CMTP's main objective is to improve the quality and relevance of clinical and health services research by providing a neutral forum for collaboration among experts, stakeholders and decision makers.   Dr. Tunis advises a wide range of domestic and international health care organizations on issues of comparative effectiveness, evidence based medicine, clinical research, reimbursement and health technology policy.

Through September of 2005, Dr. Tunis was the Director of the Office of Clinical Standards and Quality and Chief Medical Officer at the Centers for Medicare and Medicaid Services (CMS).  In this role, he had lead responsibility for clinical policy and quality for the Medicare and Medicaid programs, which provide health coverage to over 100 million US citizens.  Dr. Tunis supervised the development of national coverage policies, quality standards for Medicare and Medicaid providers; quality measurement and public reporting initiatives, and the Quality Improvement Organization program.  As Chief Medical Officer, Dr. Tunis served as the senior advisor to the CMS Administrator on clinical and scientific policy.  He also co-chaired the CMS Council on Technology and Innovation

Dr. Tunis joined CMS in 2000 as the Director of the Coverage and Analysis Group.  Before joining CMS, Dr. Tunis was a senior research scientist with the Technology Assessment Group, where his focus was on the design and implementation of prospective comparative effectiveness trials and clinical registries.  Dr. Tunis also served as the Director of the Health Program at the Congressional Office of Technology Assessment and as a health policy advisor to the U.S. Senate Committee on Labor and Human Resources, where he participated in policy development regarding pharmaceutical and device regulation. 

He received a B.S. degree in Biology and History of Science from the Cornell University School of Agriculture, and a medical degree and masters in Health Services Research from the Stanford University School of Medicine.  Dr. Tunis did his residency training at UCLA and the University of Maryland in Emergency Medicine and Internal Medicine.  He is board certified in Internal Medicine and holds adjunct faculty positions at Johns Hopkins, Stanford and the University of California San Francisco Schools of Medicine.

Sean Tunis, MD, MSc. is the Founder and Director of the Center for Medical Technology Policy in San Francisco, where he is working with health care decision makers and stakeholders to support the rapid evaluation and effective use of new medical technologies. He is also a Principal at Rubix Health, which consults with early-stage life sciences companies on reimbursement strategy deigned around developing reliable evidence of product value.

Through September of 2005, Dr. Tunis was the Director of the Office of Clinical Standards and Quality and Chief Medical Officer at the Centers for Medicare and Medicaid Services (CMS). In this role, he had lead responsibility for clinical policy and quality for the Medicare and Medicaid programs, which provide health coverage to over 100 million US citizens. Dr. Tunis supervised the development of national coverage policies, quality standards for Medicare and Medicaid providers; quality measurement and public reporting initiatives, and the Quality Improvement Organization program. As Chief Medical Officer, Dr. Tunis served as the senior advisor to the CMS Administrator on clinical and scientific policy. He also co-chaired the CMS Council on Technology and Innovation

Dr. Tunis joined CMS in 2000 as the Director of the Coverage and Analysis Group. Before joining CMS, Dr. Tunis was a senior research scientist with the Lewin Group, where his focus was on the design and implementation of prospective comparative effectiveness trials and clinical registries. Dr. Tunis also served as the Director of the Health Program at the Congressional Office of Technology Assessment and as a health policy advisor to the U.S. Senate Committee on Labor and Human Resources, where he participated in policy development regarding pharmaceutical and device regulation.

He received a B.S. degree in History of Science from Cornell University, and a medical degree and masters in Health Services Research from the Stanford University School of Medicine. Dr. Tunis did his residency training at UCLA and the University of Maryland in Emergency Medicine and Internal Medicine. He is board certified in Internal Medicine and holds adjunct faculty positions at Johns Hopkins and Stanford University School of Medicine.

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The full effects of decisions made today about many environmental policies -including climate change and nuclear waste- will not be felt for many years. For issues with long-term ramifications, analysts often employ discount rates to compare present and future costs and benefits. This is reasonable, and discounting has become a procedure that raises few objections. But are the methods appropriate for measuring costs and benefits for decisions that will have impacts 20 to 30 years from now the right ones to employ for a future that lies 200 to 300 years in the future?

Rather than simply disassemble current methodologies, the contributors examine innovations that will make discounting a more compelling tool for policy choices that influence the distant future. They discuss the combination of a high shout-term with a low long-term diescount rate, explore discounting according to more than one set of anticipated preferences for the future, and outline alternatives involving simultaneous consideration of valuation, discounting and political acceptability.

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Books
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RFF Press (Washington) in "Discounting and Intergenerational Equity"
Authors
Kenneth J. Arrow
Kenneth J. Arrow
Paul R. Portney
John P. Weyant
Number
0-915707-89-6
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Most pesticide illnesses go untreated. Many are nor serious enough to require medical attention, others are not treated because agricultural workers lack access to health care. Additional analysis of physical report of occupational injuries and illnesses in California agriculture continues to rise. Only a fraction of these reports involve pesticides. Surveys of field workers indicate that there are many more pesticide illnesses than are reported by physicians. Most survey methods can report symptoms, but cannot confirm the incidence of illness. Some studies have found seasonal depression in the blood cholinesterase of field workers, but the physiological significance of such depression is uncertain.

Clinical tests and specific antidotes are needed to treat illnesses induced by pesticides other than cholinesterase inhibitors. The clinical significance of pesticide residues in human fluids and tissue has yet to be defined. Research is needed to standardize cholinesterase testing, and to find the means to assay the enzyme independent of its activity, so that baseline tests will not be needed. Research is needed on the neurotoxic effects of organophosphate insecticides, including the use of psychological tests and evaluation with EMG and EEG.

Field workers reentry standards are based on studies of foliar induced, and extrapolation forma few evaluation of human health effects. Research is needed to see if current standards are adequate, and to evaluate the risk assessment models used in setting reentry intervals. More research is needed to develop methods and equipment which better protect the pesticide applicator.

There are few studies which suggests that pesticides cause adverse long-term health effects in human populations, including cancer and birth defects. Such research is fraught with methodological difficulties. Research is needed to evaluate the new California program which is attempting to close the date gap of tests involving experimental animals.

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Working Papers
Publication Date
Journal Publisher
California Institute for Rural Studies, Davis CA, Series title: Working paper / Working Group on Farm Labor and Rural Poverty
Authors
Paul G. Barnett
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