The futures of pastoralism in the Horn of Africa: pathways of growth and change.

This paper reviews pastoralism in the Horn of Africa region with reference to the basic socio-economics of pastoralism, and the use of mobile livestock production to generate income and food for human consumption. The paper also examines long-term trends in pastoralist areas which, at first sight, appear to be contradictory. The first trend is the growth of a substantial domestic and export trade in livestock and meat across the region, driven largely by supplies from pastoralist areas and local and international demand. This trend indicates robust and responsive livestock production and marketing in pastoralist areas, despite recurrent drought, conflict and weak governance. In contrast, the second trend sees increasing levels of poverty and destitution in pastoralist areas, and continued high levels of human malnutrition. The co-existence of economic growth and increasing poverty in 'high-export' areas is explained by human population growth, drought, and the private control of pastures and water by wealthier producers. All of these factors combine to push poorer producers out of pastoralism. In areas with lower market orientation, other forms of declining land access are often evident, including the appropriation of land for mechanised farming, hydroelectric schemes, and bush encroachment. These changes, plus population growth and drought, also push people out of pastoralism. In all areas, pastoralism will continue to be the main economic activity but, at the same time, increasing numbers of people are seeking other livelihoods.

Cet article consacré au pastoralisme dans la Corne de l'Afrique au regard de ses principales caractéristiques socio-économiques décrit les utilisations du bétail nomade pour générer des revenus et produire des aliments destinés à la consommation humaine. Les auteurs analysent également les tendances à long terme des régions d'élevage pastoral, qui apparaissent à première vue comme étant contradictoires. La première tendance observée dans cette région a trait à la croissance d'un commerce important d'animaux et de viandes destiné aux marchés nationaux et d'exportation, sous l'impulsion conjointe de l'offre émanant des zones d'élevage pastoral et de la demande tant locale qu'internationale. Cette tendance démontre l'existence dans les zones d'élevage pastoral de capacités de production et commerciales robustes et adaptables, en dépit des épisodes récurrents de sécheresse, des conflits sociaux et d'une gouvernance déficiente. En revanche, la deuxième tendance révèle une aggravation croissante de la pauvreté et de la précarité dans les zones d'élevage pastoral, accompagnées d'une malnutrition importante et persistante dans les populations humaines. La coexistence d'une croissance économique et d'une plus grande pauvreté dans des zones à dominante exportatrice s'explique par la croissance démographique, par les sécheresses et par la mainmise des producteurs les plus riches sur les terres de pâture et sur l'eau. Ces facteurs cumulés détournent du pastoralisme les éleveurs les plus pauvres. Dans les régions à vocation exportatrice moins prononcée, le déclin de l'accès aux pâturages prend d'autres formes clairement identifiables, par exemple l'appropriation des terres en vue de leur exploitation mécanisée, la production d'énergie hydraulique ou l'extension de la brousse. Ces changements s'ajoutant à la croissance démographique et à la sécheresse rendent le pastoralisme beaucoup moins attractif pour les individus. Certes, le pastoralisme restera la principale activité économique des régions étudiées mais en même temps, de plus en plus de gens vont s'orienter vers d'autres moyens de subsistance.

Los autores pasan revista al pastoreo en la región del Cuerno de África, haciendo referencia a sus fundamentos socioeconómicos y a la producción de ganado móvil como medio de generar ingresos y alimentos para el consumo humano. Además, señalan la existencia de tendencias a largo plazo en las zonas de pastoreo que, a primera vista, parecen contradictorias. La primera es el auge de un comercio nacional o exportador de ganado y carne de considerables dimensiones en toda la región, impulsado básicamente por los suministros procedentes de las zonas de pastoreo y por la demanda local e internacional. Esta tendencia pone de manifiesto procesos robustos y flexibles de producción y comercialización de ganado en las zonas pastorales, pese a la recurrencia de sequías y conflictos y a la mala gestión de los asuntos públicos. La segunda tendencia, en acusado contraste, pone de manifiesto niveles crecientes de pobreza e indigencia en las zonas de pastoreo y niveles constantemente elevados de malnutrición humana. La concurrencia de crecimiento económico y pobreza en aumento en zonas eminentemente exportadoras se explica por el crecimiento de la población humana, las sequías y el control privado de los pastos y el agua que ejercen los ganaderos más pudientes. Todos estos factores se combinan para expulsar del pastoreo a los productores pobres. En zonas menos orientadas hacia el mercado aparecen a menudo otras causas de acceso decreciente a la tierra, como la apropiación de suelo para la producción agrícola mecanizada, la instalación de centrales hidroeléctricas o el avance de la maleza. Estos cambios, sumados al crecimiento demográfico y a la sequía, también inducen a las personas a dejar el pastoreo. Y aunque este seguirá siendo la principal actividad económica en todas las zonas, cada vez hay más gente que busca otras formas de ganarse la vida.

Cardiac assessment of patients with late stage Duchenne muscular dystrophy.

Background. Duchenne muscular dystrophy (DMD) patients used to die mainly from pulmonary problems. However, as advances in respiratory care increase life expectancy, mortality due to cardiomyopathy rises. Echocardiography remains the standard diagnostic modality for cardiomyopathy in DMD patients, but is hampered by scoliosis and poor echocardiographic acoustic windows in adult DMD patients. Multigated cardiac radionuclide ventriculography (MUGA) does not suffer from these limitations. N-terminal proBNP (NTproBNP) has shown to be a diagnostic factor for heart failure. We present our initial experience with plasma NT-proBNP measurement in the routine screening and diagnosis of cardiomyopathy in adult mechanically ventilated DMD patients.Methods. Retrospective study, 13 patients. Echocardiography classified left ventricular (LV) function as preserved or depressed. NT-proBNP was determined using immunoassay. LV ejection fraction (LVEF) was determined using MUGA.Results. Median (range) NT-proBNP was 73 (25 to 463) ng/l. Six patients had an NT-proBNP >125 ng/l. Seven patients showed an LVEF <45% on MUGA. DMD patients with depressed LV function (n=4) as assessed by echocardiography had significantly higher median NT-proBNP than those (n=9) with preserved LV function: 346 (266 to 463) ng/l versus 69 (25 to 257) ng/l (p=0.003). NT-proBNP significantly correlated with depressed LV function on echocardiogram and with LVEF determined by MUGA.Conclusion. Although image quality of MUGA is superior to echocardiography, the combination of echocardiography and NT-proBNP achieves similar results in the evaluation of left ventricular function and is less time consuming and burdensome for our patients. We advise to add NT-proBNP to echocardiography in the routine cardiac assessment of DMD patients. (Neth Heart J 2009;17:232-7.).

[Assessment of late pregnancy terminations, 2004-2007]. / Toetsing van late zwangerschapsafbreking, 2004-2007.

OBJECTIVE: To provide an inventory of the reported late terminations of pregnancy because ofa severe anomaly of the unborn child, i.e. termination after 24 weeks of pregnancy, in The Netherlands for the period 2004-2007. DESIGN: Inventory and descriptive. METHOD: A description is given of the various assessment procedures for the termination of pregnancy after 24 weeks. A distinction is made between abortion for lethal foetal abnormalities (category 1) and severe functional impairments with a limited chance for survival of the unborn (category 2). The level of caution exercised in decision making and performing category 1 terminations is assessed by the professional group, namely by the assessment committee for Late Pregnancy Termination of the Dutch Association for Gynaecology and Obstetrics. Since 15 March 2007, late pregnancy terminations that fall under category 2 have by law been assessed by a national central committee of experts. An overview of the reported cases of late terminations of pregnancy in the Netherlands for the period 2004-2007 is given. RESULTS AND CONCLUSION: The number of reported terminations of pregnancy after 24 weeks (n = 72) has declined considerably since the early 1990s. A possible explanation is that due to increasing technological improvements and the implementation of prenatal screening in early preg-nancy, an abortion can be performed before the 24th week of pregnancy if any severe abnormalities are observed.

Resource support and heart patient recovery.

This prospective study examines the effects of resources utilized by myocardial infarction (MI) and coronary artery bypass (BY) patients in the recovery process. The resource support model incorporates formal (institutionalized) and semi-formal (mutual aid) services along with informal assistance (social networks). Patient interview data were collected on 147 MI and 159 BY patients at hospitalization and at 3 months. Sociodemographic, illness and resource data were obtained, and hospital records were abstracted. Two outcomes were evaluated: activity limitations and work capacity. Bivariate and multivariate analyses were used to assess individual and resource effects. Multivariate analyses revealed that, for MI patients, a higher level of activity prior to hospitalization and a shorter hospital stay were significantly related to recovery. A smaller social network with greater frequency of contact enhanced recovery. For BY patients, recovery was significantly associated with higher social class higher level of activity prior to hospitalization and fewer health care visits. Outcome based on work capacity revealed that MI patients who were younger in age, male sex and who had fewer prescribed medications were more likely to recover. By patients had a similar pattern as that observed for MI patients in terms of age and sex. Co-morbidity had a negative effect on recovery. Those with less affective informal support were more likely to have recovered. The resource support model employed in this prospective study proved to have mixed results. However, the model may be a useful multifactorial framework for examining the effects on patient recovery over a longer duration.

Prediction of 24-h energy expenditure and its components from physical characteristics and body composition in normal-weight humans.

The applicability of body composition as estimated by the bioimpedance method to predict energy expenditure (EE) was studied. Ten healthy subjects underwent measurement of body composition and 24-h energy expenditure (24-h EE) twice in a respiration chamber on a fixed program. The 24-h EE and its components, sleeping EE (SEE), basal EE (BEE), and daytime EE, for an individual were very reproducible (coefficient of variation 2.3%, 1.4%, 5.0%, & 3.1%, respectively). The variability of 24-h EE among subjects was 11.4% but only 4.1% when adjusted for differences in lean body mass (LBM). LBM was the best determinant of 24-h EE, BEE, and SEE and accounted for 91-93% of the interindividual variance of EE. The prediction equations were 24EE (kcal/d) = 390 + 33.3 LBM (r2 = 0.93, P = 0.000001), SEE (kcal/h) = 9.8 + 1.1 LBM (r2 = 0.92, P = 0.000001), and BEE (kcal/h) = -3.1 + 1.35 LBM (r2 = 0.91, P = 0.000002). In conclusion, 24EE, BEE, and SEE can be predicted with a high degree of precision from LBM as estimated by bioimpedance in normal-weight subjects.