Assessing multiple goods and services derived from livestock farming on a nation-wide gradient.

Livestock farming is an essential activity in many rural areas, where it contributes to the maintenance of soil fertility and farmland biodiversity, as well as to a set of social public goods including food security, rural vitality and culture. However, livestock sustainability assessments tend to focus primarily on environmental and economic dimensions; therefore, these valuations might be limited because they do not consider the complete set of associated goods and services (GS). Hence, a need exists to recognise the multiple contributions provided by livestock to human well-being and society. The objective of this study was to analyse the provision of multiple GS derived from livestock across regions in France and empirically demonstrate sets of GS that repeatedly appeared together. We designated these multiple GS provided by livestock as contributions to productive, environmental, rural vitality and cultural benefits that human populations derive directly or indirectly from livestock agroecosystems. First, we combined expert knowledge with results of a literature review to define a bundle of GS provided by livestock. We then described indicators that quantified each good or service and screened national databases to determine the availability of supporting data. Finally, we assessed the GS and their relationships (synergies or trade-offs) on a nation-wide gradient in France at the department level (Nomenclature of Territorial Units for Statistics 3). Four main categories of GS were considered: provisioning (e.g. food quantity and quality), environmental quality (e.g. biodiversity, landscape heterogeneity, water quality), rural vitality (e.g. employment, rural dynamism) and culture (e.g. gastronomy and landscape heritage). Four major types of GS bundles were identified, which suggested strong contrasts among French rural areas in terms of the nature of the GS that occurred together and their levels of provision. GS bundles in France had a non-random spatial distribution. This study represents an initial step towards developing a methodology to consider GS bundles provided by livestock. Nonetheless, further research is needed to understand socio-economic, environmental, political and geographic determinants of the composition of GS bundles.

[Health care activity in a headache-specific clinic]. / Actividad asistencial en una consulta específica de cefalea.

INTRODUCTION: It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units. AIM: To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic. PATIENTS AND METHODS: All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed. RESULTS: In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 +/- 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tension-type headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment. DISCUSSION: After several years' operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics.

Evaluation of the left ventricular performance through equilibrium radionuclide angiocardiography.

In patients with severe heart failure due to acute myocardial infarction (AMI) breathing with PEEP can be of additional therapeutic value. This study was designed to assess the effects of CPAP through face mask with 15 cm H2O on left ventricular performance in AMI patients, using equilibrium radionuclide angiocardiography (ERA). In response to lung inflation, high levels of PEEP have been shown to decrease heart rate and stroke volume. The sum of the TPF pathological prolongation and the Mean-FR reduction suggests a decrease in the left ventricular compliance determined by the restriction imposed by the positive pressure. The global systolic performance is preserved.

[Airway continuous positive pressure in acute respiratory failure caused by Pneumocystis carinii pneumonia]. / Presión positiva continua de la vía aérea en la insuficiencia respiratoria aguda debida a neumonía por Pneumocystis carinii.

OBJECTIVE: To evaluate the efficiency of continuous positive airway pressure through a face mask in acute respiratory insufficiency (ARI) secondary to Pneumocystis carinii pneumonia. DESIGN: Prospective study. SETTING: Multidisciplinary ICU. PATIENTS: Fifteen patients with ARI secondary to Pneumocystis carinii pneumonia were studied. INTERVENTIONS: Initially al patients received high flow oxygen therapy through a face mask for 60 minutes (Pre-CPAP phase); then CPAP through a face mask, with identical FiO2 and for a similar period of time (Pst-CPAP phase). At the end of each phase the following parameters were evaluated: respiratory rate, heart rate, arterial gases, acid-base balance, and respiratory muscle motility. MEASUREMENTS: After oxygen therapy all fifteen patients had similar variables. After 60 minutes with CPAP through a face mask, significant improvements were noted for respiratory rate, heart rate, muscular effort, PaO2, SaO2, and PaO2/FiO2 (p < 0.001) in eleven patients, who survived after a mean stay of 8.5 days in the ICU with no evidence of major complications. In contrast, CPAP failed in four patients as respiratory rate, heart rate and vigorous muscle effort remained unchanged and, although PaO2 and SaO2 increased, the obtained values were significantly lower than in the remaining patients. Consequently, they underwent intubation and mechanical ventilation and after a mean stay of fourteen days with this ventilatory option died. CONCLUSIONS: These results confirm that CPAP through a face mask is an effective means to improve oxygenation in patients with Pneumocystis carinii pneumonia who develop hypoxemic respiratory insufficiency. Its early introduction in hospital protocols can help improving the prognosis in certain patients with severe PCP and avoid their admission to ICU, which would be thus preserved for those patients requiring mechanical ventilation.

[Acute respiratory failure in chronic obstructive lung disease. Effective weaning and excess base]. / Fallo respiratorio agudo en la enfermedad pulmonar obstructiva crónica. Desconexión eficaz y exceso de base.

To establish whether the weaning from assisted mechanical ventilation (AMV) should be accompanied by continuous respiratory support (synchronized intermittent mandatory ventilation [SIMV]) or discontinuous support (O2 in T) in patients affected by chronic obstructive lung disease (COLD) who are recovering from acute respiratory failure (ARF), and also to identify any possible predictive value of gasometric measurements. Sixteen patients with COLD and ARF were studied prospectively during their stay in the intensive care unit. Ten had acute bronchitis, 3 had left ventricular failure and 2 had pneumonia. In 1 case the etiology was unknown. The following protocol was used for the first attempt at weaning: 1) SIMV for 30 min, 2) return to rest period with AMV for 2 hours, 3) O2 in T-tube for 30 min. After 30 min both SIMV and O2 in T had produced a rise in PaCO2 to 55.1 and 54.6 mmHg, respectively (p < 0.001), with a subsequent lowering of pH to 7.32 and 7.36 (p < 0.001). When weaning was well tolerated, pH decreased significantly due to an increase in PaCO2 with both techniques, while base excess (BE) remained stable. Values of pH also decreased significantly when weaning was poorly tolerated, and the fall was greater with SIMV; increases in PaCO2 were similar, but decreases in BE were significant. When pH is kept within normal range by a high BE, the withdrawal of AMV, accompanied by either support system, is usually well-tolerated.