Assessing the health impact of transnational corporations: its importance and a framework.

BACKGROUND: The adverse health and equity impacts of transnational corporations' (TNCs) practices have become central public health concerns as TNCs increasingly dominate global trade and investment and shape national economies. Despite this, methodologies have been lacking with which to study the health equity impacts of individual corporations and thus to inform actions to mitigate or reverse negative and increase positive impacts. METHODS: This paper reports on a framework designed to conduct corporate health impact assessment (CHIA), developed at a meeting held at the Rockefeller Foundation Bellagio Center in May 2015. RESULTS: On the basis of the deliberations at the meeting it was recommended that the CHIA should be based on ex post assessment and follow the standard HIA steps of screening, scoping, identification, assessment, decision-making and recommendations. A framework to conduct the CHIA was developed and designed to be applied to a TNC's practices internationally, and within countries to enable comparison of practices and health impacts in different settings. The meeting participants proposed that impacts should be assessed according to the TNC's global and national operating context; its organisational structure, political and business practices (including the type, distribution and marketing of its products); and workforce and working conditions, social factors, the environment, consumption patterns, and economic conditions within countries. CONCLUSION: We anticipate that the results of the CHIA will be used by civil society for capacity building and advocacy purposes, by governments to inform regulatory decision-making, and by TNCs to lessen their negative health impacts on health and fulfil commitments made to corporate social responsibility.

Ottawa 25 years on: a more radical agenda for health equity is still required.

This article revisits our 1995 assessment of the international health promotion agenda. Then we concluded that a more radical agenda for change was required in which responses were both technically sound and infused with an appreciation of the imperative for a change in politics and power. We conclude that this message is even more relevant in 2011 in an era when the continuing rise of transnational corporations (TNCs) poses a major threat to achieving improved and more equitable health. We support and illustrate this claim through the example of food and agriculture TNCs where the combination of producer subsidies, global trade liberalization and strengthened property rights has given increasing power to the corporate food industry and undermined national food security in many countries. We argue that a Health in All Policies approach should be used to monitor and enforce TNC accountability for health. Part of this process should include the use of a form of health impact assessment and health equity impact assessment on their activities. Civil society groups such as the People's Health Movement have a central role to play in monitoring the impacts of TNCs.

Prognostic value of tissue Doppler-Derived E/e' on early morbid events after cardiac surgery.

BACKGROUND: The tissue Doppler-derived surrogate for left ventricular diastolic pressure, E/e', has been used to prognosticate outcome in a variety of cardiovascular conditions. In this study, we determined the relationship of intraoperative E/e' to the use of inotropic support, duration of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), and total hospital stay (H-LOS) in patients requiring cardiac surgery. The records of 245 consecutive patients were retrospectively reviewed to obtain 205 patients who had intraoperative transesophageal echocardiography examinations prior to coronary artery bypass grafting and/or valvular surgery. Cox proportional hazards and logistic regression models were used to analyze the relation between intraoperative E/e' or LVEF and early postoperative morbidity (H-LOS, ICU-LOS, and MV) and the probability that a patient would require inotropic support. With adjustments for other predictors (female gender, hypertension, diabetes, history of myocardial infarction, emergency surgery, renal failure, procedure type, and length of aortic cross-clamp time), an elevated E/e' ratio (>or=8) was significantly associated with an increased ICU-LOS (49 versus 41 median h, P = 0.037) and need for inotropic support (P = 0.002) while baseline LVEF was associated with inotropic support alone (P < 0.0001). These data suggest that the tissue Doppler-derived index of left ventricular diastolic filling pressure may be a useful indicator for predicting early morbid events after cardiac surgery, and may even provide additional information from that of baseline LVEF. Further, patients with elevated preoperative E/e' may need more careful peri- and postoperative management than those patients with E/e' <8.

Post-hurricane Rita mosquito surveillance and the efficacy of Air Force aerial applications for mosquito control in east Texas.

Post-Hurricane Rita mosquito surveillance was carried out in 4 east Texas counties to determine mosquito abundance, species composition, and need for mosquito control. Subsequently, aerial applications of naled (Dibrom) for mosquito control were made by the Air Force Aerial Spray Flight, while continued surveillance documented the efficacy of the applications. Psorophora columbiae was the predominant species in landing counts. Twenty-two mosquito species were represented in light trap collections with Aedes atlanitcus/tormentor, Culex nigripalpus, Ae. vexans, and Ps. columbiae making up 91% of the total. A total of 102,001 ha (252,052 acres) were aerially treated based on high mosquito abundance, exposure of first responders and residents to nuisance biting, and local interruption of electric utilities. A significant 90% decline in mosquito abundance was observed posttreatment.

Ixodid ticks associated with feral swine in Texas.

Ixodid ticks were collected from feral swine in eight Texas ecoregions from 2008-2011. Sixty-two percent of 806 feral swine were infested with one or more of the following species: Amblyomma americanum, A. cajennense, A. maculatum, Dermacentor albipictus, D. halli, D. variabilis, and Ixodes scapularis. Juvenile and adult feral swine of both sexes were found to serve as host to ixodid ticks. Longitudinal surveys of feral swine at four geographic locations show persistent year-round tick infestations of all gender-age classes for tick species common to their respective geographic locations and ecoregions. Amblyomma americanum, A. cajennense, A. maculatum and D. variabilis were collected from 66% of feral swine harvested through an abatement program in seven ecoregions from March to October in 2009. These results indicate westward geographic expansion of D. variabilis. Summary results show feral swine are competent hosts for ixodid species responsible for the transmission of pathogens and diminished well-being in livestock, wildlife, and humans.

Field collection and genetic classification of tick-borne Rickettsiae and Rickettsiae-like pathogens from South Texas: Coxiella burnetii isolated from field-collected Amblyomma cajennense.

We are reporting the first known isolation of the Q-fever agent Coxiella burnetii from field-collected cayenne ticks Amblyomma cajennense in North America. Q-fever affects a number of domestic ungulates where it can lead to abortion in sheep and goats. There is far less known about the disease's effects on wild species, primarily because of the tendency of the disease to self resolve and to provide long-term immunity to subsequent infections. The first recovery of C. burnetii in North America was from the tick species Dermacentor andersoni. Since the original isolation C. burnetii has been recovered from five other North American tick species. The currently accepted mode for the majority of human infections is inhalation. The Centers for Disease Control and Prevention, Division of Viral and Rickettsial Diseases, Rickettsial Zoonoses Branch asserts the Q-fever agent as requiring as few as one organism to cause disease via inhalation in susceptible humans. However, with more and more isolations from ticks, evidence linking C. burnetii and ticks is mounting. The true role of tick species as competent vectors is still unconfirmed. Preemptive field collections of possible vector arthropods, hosts, and reservoirs can provide invaluable baseline environmental data that will prove supportive in follow-up studies and abatement efforts.