From Public to Private Governance in the Food Supply Chains of Emerging Economies

Food and agricultural commodity value chains in developing and transition countries have undergone tremendous changes in the past decades. Companies and property rights have been privatized, markets liberalized, and economies integrated into global food systems. The liberalization and privatization initially caused the collapse of state-controlled vertical integration. More recently, private vertical coordination systems have emerged and are growing rapidly as a response to consumer demand for food quality and safety on the one hand and the farms' production constraints caused by factor market imperfections. In this paper we (a) demonstrate the importance of these changes, (b) discuss the implications for efficiency and equity and (c) provide empirical evidence on the effects in several developing and transition countries.Agricultural and Food Policy, Industrial Organization,

Trade, Standards and Poverty. Evidence from Senegal

The debate on trade and poverty is reinforced by recent studies on the role of standards. It is argued that increasing standards act as trade barriers for developing countries and cause further marginalization of the poor. This paper is the first to quantify income and poverty effects of such high-standards trade and to integrate labor market effects, by using company and household survey data from the vegetable export chain in Senegal. We find that exports have grown sharply despite increasing standards, resulting in important income gains and poverty reduction. Our estimates indicate that poverty is 14 % points lower due to vegetable exports. Tightening food standards induced a shift from smallholder contract-based farming to large-scale integrated estate production, altering the mechanism through which poor households benefit: through labor markets instead of product markets. The impact on poverty reduction is stronger as the poorest benefit relatively more from working on large-scale farms than from contract farming.trade, poverty, standards, vertical coordination, contract farming, Food Security and Poverty, International Relations/Trade, F14, F16, I3, Q12, Q13, Q17,

Standards as Barriers and Catalysts for Trade and Poverty Reduction

The importance of food standards in global agricultural trade has increased strongly, but the effects are uncertain. Several studies argue that these standards imposed by high-income countries diminish the export opportunities for developing countries and concentrate the benefits of trade with processing and retailing companies and large farms, thereby casting doubt on the development impact of international agricultural trade. Other argue that the standards can be catalysts for growth. In this paper we critically review the arguments and empirical evidence on the link between increasing food standards, developing country exports and welfare in those countries. We conclude that the evidence is often weaker as claimed. We also provide new insights from two recent survey-based empirical studies. We conclude that standards can be a catalyst for trade, growth and poverty reduction in developing countries.Food Security and Poverty, International Relations/Trade,

Globalization, Privatization, and Vertical Coordination in Food Value Chains in Developing and Transition Countries

Food and agricultural commodity value chains in developing and transition countries have undergone tremendous changes in the past decades. Companies and property rights have been privatized, markets liberalized, and economies integrated into global food systems. The liberalization and privatization initially caused the collapse of state controlled vertical integration. More recently, private vertical coordination systems have emerged and are growing rapidly as a response to consumer demand for food quality and safety on the one hand and the farms' production constraints caused by factor market imperfections. In this paper we (a) demonstrate the importance of these changes, (b) discuss the implications for efficiency and equity and (c) provide empirical evidence on the effects in several developing and transition countries.Industrial Organization,

Governance and Surplus Distribution in Commodity Value Chains in Africa

The governance of food markets is a crucial element for efficiency and distributional effects. In this paper, we use a conceptual model to show that this governance itself is endogenous in an environment of weak contract enforcement and imperfect markets, and importantly depends on the value in the chain. We relate the predictions of the theory to empirical evidence on differences in supply chain governance in Africa across different commodity types. In doing so we offer an explanation as why private sector governance systems with interlinked market transactions have emerged for higher value crops but not for staple food crops. We discuss the efficiency and equity effects and the implications for policy.Agribusiness,

Increasing Incidence of Mucormycosis in University Hospital, Belgium

To determine why incidence of mucormycosis infections was increasing in a large university hospital in Belgium, we examined case data from 2000–2009. We found the increase was not related to voriconazole use but most probably to an increase in high-risk patients, particularly those with underlying hematologic malignancies

Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain

Anidulafungina; Cost-efectivitat; Aspergil·losi invasivaAnidulafungina; Coste-efectividad; Aspergilosis invasivaAnidulafungin, Cost-effectiveness; Invasive aspergillosisObjective: According to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System. Methods: An economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables. Results: According to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763–16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively. Conclusion: According to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan-positive patients in Spain who have hematologic disease or hematopoietic stem cell transplant, compared with VOR monotherapy

Caspofungin for treatment of invasive aspergillosis in Germany: results of a pre-planned subanalysis of an international registry

<p>Abstract</p> <p>Background</p> <p>This study is a pre-planned country-specific subanalysis of results in Germany from a multinational multicenter registry to prospectively assess real-world experience with caspofungin administered for treatment of proven or probable invasive aspergillosis (IA).</p> <p>Methods</p> <p>Data from patients treated with caspofungin for a single episode of IA were collected. Effectiveness was determined by the local investigator as favorable (complete or partial response) or unfavorable (stable disease, failure or death) at the end of caspofungin therapy. Descriptive statistics with binomial exact confidence intervals were employed.</p> <p>Results</p> <p>Forty-two consecutive patients were identified in three German centers. Three patients (7%) had proven IA and 39/42 (93%) had probable IA (modified European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria). Forty-one patients had pulmonary IA and one had tracheal IA. Caspofungin monotherapy was received by 36/42 patients (86%); of these, 26/36 (72%) received salvage therapy. A favorable response was observed in 29/42 patients (69%; 95% CI 53 to 82%); of these, 21/29 (72%) had a complete and 8/29 (28%) a partial response. Favorable response rate was 69% in patients with monotherapy (95% CI 52% to 84%; 25/36 patients), and 67% in patients receiving combination therapy (95% CI 22% to 96%; 4/6 patients). Favorable response rate in patients with first line therapy was 64% (95% CI 31% to 89%; 7/11 patients), and 73% in patients with second line therapy (95% CI 54% to 88%; 20/30 patients). No adverse events were reported. In total, 35/42 patients (83%; 95% CI 69 to 93%) survived seven days after completion of caspofungin therapy.</p> <p>Conclusions</p> <p>These real-life findings in Germany are consistent with the international findings from this registry and with findings from randomized studies.</p

Treatment and timing in invasive mould disease

Invasive mould disease is a growing threat for immunocompromised patients. The optimum time to use mould-active antifungal agents is much debated. Current approaches to antifungal prophylaxis, early treatment (empirical and pre-emptive therapy) and treatment of documented mould infections in onco-haematology patients are discusse