The deep waters of land reform: land,water and conservation area claims in Limpopo Province,Olifants Basin,South Africa

Through investigating the reactions of commercial farmers to land and water reforms in the Trichardtsdal-Ofcolaco area, Limpopo Province, Olifants Basin, South Africa, from 1997 to 2006, it is shown that water claims are key to land redistribution processes, and that commercial farmers make strategic use of arguments for nature conservation and ecological stewardship to defend their claims to water. Given these observations, caution is warranted with respect to the implementation of land and water reforms as separate policy packages; it may be more effective to design water and conservation policies as an integral part of land reform programmes.     

Clinical characteristics,treatment patterns,and socio-economic burden of COPD in Bulgaria

Background: While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case.

Methods: A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed.

Results: A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times.

Conclusions: Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.