Rôles,impacts et services issus des élevages en Europe. Synthèse du rapport d’expertise scientifique collective

L’élevage, secteur majeur pour l’économie de nombreux territoires et structurant beaucoup de paysages ruraux européens, fait l’objet de controverses, depuis au moins une décennie, notamment du fait des dommages environnementaux qu’il engendre. Dans un tel contexte, il est apparu nécessaire d’étayer les débats en faisant le point sur l’état des connaissances scientifiques relatives aux rôles, impacts et services environnementaux, économiques et sociaux issus des élevages européens et leurs produits. Pour ce faire, les ministères français en charge de l’Environnement et de l’Agriculture ainsi que l’Agence de l’environnement et de la maîtrise de l’énergie (Ademe) ont sollicité l’Inra pour réaliser une expertise scientifique collective (ESCo) abordant conjointement les multiples conséquences sur les milieux et le climat, l’emploi et le travail, les marchés et certains enjeux sociaux et culturels, de la production et de la consommation humaine de produits d’origine animale (bovins, ovins, caprins, porcins et avicoles). L’analyse de ces diverses dimensions s’appuie sur les démarches d’évaluation rapportées dans la littérature scientifique internationale. Abordées, dans un premier temps, de manière analytique et globale, les connaissances ont ensuite été mobilisées par « bouquet de services » au sein de territoires contrastés. Les relations entre les différents impacts ou services permettent d’identifier des compromis et des leviers d’action envisageables pour les systèmes d’élevage. Livestock production is a sector of major economic importance that defines many European rural areas. It has become the focus of controversy over the past decade or more, particularly with regard to the environmental impacts it causes. In this context, it seemed useful to support this debate with a critical review of the state of scientific knowledge on the role, impacts, and services – environmental, economic, and social – associated with European livestock production. Accordingly, the French ministries responsible for Agriculture and the Environment, in cooperation with the French Environment and Energy Management Agency (ADEME), requested INRA to undertake a collective scientific assessment addressing the many consequences – for the environment and the climate, for employment and labor, for markets, and for a variety of social and cultural issues – related to the production and human consumption of animal products (cattle, sheep, goats, pigs, and poultry). Analysis of these diverse dimensions was based on assessment methods utilized and described in the international scientific literature. Using a broad, analytical overview as a starting point, the review proceeded by identifying the "service bundles" associated with livestock production in contrasting areas

Potentially inappropriate medication among community-dwelling older adults : A public health issue in Burkina Faso

PIM is defined as a lack of demonstrated indication, high risk of side effects, and a sub-optimal cost effectiveness and/or cost benefit. Little data on potentially inappropriate medications (PIM) in older adults with comorbidity are available in sub-Saharan Africa. The aim of this study was to assess the prevalence and the factors associated with the use of PIM in community-dwelling older adults in Burkina Faso. In 2012, we did a cross-sectional household survey which included 389 older adults in Bobo-Dioulasso. Updated 2012 Beers criteria were used to assess the PIM in older adults aged ≥ 60 years. Medications from formal medical source (prescribing) and informal source (informal market, over-the counter and traditional medicines) were included. A multivariate analysis was performed to determine factors associated with the use of PIM. Proportion of older adults used at least one PIM was 59% (196/332). The most common PIM were traditional medicines 28.97% (62/214), diclofenac 21.03% (45/214) 17.5% (45/214), ibuprofen 7.76% (38/214), aspirin 7.01% (15/214), nifedipine 5.61% (12/214) and reserpine 5.61% (12/214). Polypharmacy (≥ 3 drugs), is the independent factor associated with PIM. Our findings highlight the need to think about integrated health care system in order to reduce the PIM among older adults with multiple comorbidities..Keywords: potentially inappropriate medication, older adults, comorbidit

Direct cost of care for hypertensive patients in Burkina Faso

In Burkina Faso, the high blood pressure represents the first cardiovascular risk factor. Few data are available about the costs paid by hypertensive patients for public policies guidance. This study aimed to estimate the direct average cost for hypertensive patient care according to their income in urban area in Burkina Faso. In 2015, from January to December, we performed across-sectional study in the different levels of health care system in Bobo-Dioulasso. Study included hypertensive patients (more than 18 years old) who are regularly followed-up for at least twelve months and without complication of hypertension. We carried outa randomcluster sampling with a consecutive recruitment of the patients. One-way-ANOVA test was performed to compare the monthly average income and the direct average cost for hypertensive patient care. One hundred and fifty six (156) non-complicated hypertensive patients were included. The direct average cost was of 74 626.9 FCFA per patient-year (138 USD), IC95% [66 303.4 FCFA (123 USD) – 82 950.3 FFA (154 USD)] patient-year, corresponding to 6219 FCFA (11.5USD) per patient-month. The drugs represented 66.9% of the wholetotal costs. The monthly low income was associated with the high direct average cost for hypertensive patient care. Free health care policies are implementing in West Africa. Considering equity of access to health care by poorest, a subsidy of antihypertensive drug could be a great opportunity to reduce financial barrier to care for hypertensive patients, and so, avoiding its complications.Keywords: hypertension, direct cost, income, sub-saharan Africa