Study of polypharmacy and associated problems among elderly patients

The study aims at the assessment of prescribing pattern for elderly patients, since they are more prone to prescription of multiple medications. The prescription of multiple medications leads to polypharmacy, more adverse drug reactions and nonadherence to treatment. The study was conducted on OPD basis in a rural health centre for a period of six months. Information pertaining to the age, sex, religion, monthly income, education level, any previous illnesses, or any chronic diseases, any drug treatment, adherence to the treatment, and self medication or non-allopathic treatment was collected. The study included 310 elderly patients, among which 51.9% were males and 48.1% were females. The prevalence of polypharmacy was 25.20%, more among elderly men (26.10%) than women (24.20%), the odds ratio (OR) was 1.11. The major fraction 35.81% of the patients was in the age group of 60-64 years. Only 59.3% were literate. 64.41% belonged to lower socioeconomic status. The cardiovascular diseases 139 (44.83 %) followed by arthritis 121 (39.03%), and diabetes 58 (18.71%) were the most common ailments. Antihypertensive drugs were prescribed in 26.13%, analgesics/antipyretics in 19.68%, and antidiabetic drugs in 18.71%. Non-adherence to therapy was seen in 49.68%. Self medication habits were seen in 23.90% patients, who most commonly used analgesics/antipyretics and antacids/anti-ulcer drugs. Polypharmacy is very common among elderly and interventions to improve the optimal use of medication in elderly could lead to reduction in the problems associated with polypharmacy.KEYWORDS: Non-adherence; Polypharmacy; Self medicationsInternet Journal of Medical Update 2012 January;7(1):35-3

Gender Dimensions on Farmers’ Preferences for Direct-Seeded Rice with Drum Seeder in India

This study measures the willingness of male and female farmers to pay for climate-smart technology in rice. Rice is the most important crop in India in terms of area, production, and consumption. It is also the biggest source of greenhouse gas emissions among all crops. Direct-seeded rice (DSR) with drum seeder, a climate-smart technology, requires less labor and water and is more climate friendly than transplanted rice; yet, its adoption is slow in India. The authors of this study carried out a discrete choice experiment with 666 farmers from the Palghar and Thane districts of Maharashtra to measure their willingness to pay for drum seeders—a key piece of equipment for adopting DSR. Both male and female farmers were surveyed to capture the heterogeneity in their valuation of the key attributes of drum seeders. Although both male and female farmers prefer cheaper drum seeders, the marginal valuation of different attributes of the drum seeder varies by the farmers’ gender. The authors also used the Women Empowerment in Agriculture Index (WEAI), developed by the International Food Policy Research Institute (IFPRI), to collect self-reported data on the role and say of women in agriculture. The respective gender roles in the family and on the farm seem to explain some of this difference. Men have a greater say over how the family spends the cash. Accordingly, men tend to have a higher willingness to pay for attributes that increase income (increase in yield) or reduce cash costs (reduction in the seed rate). Women contribute a large share of the labor for transplanting rice, much of which is unpaid work on family farms. Not surprisingly, therefore, women seem to value labor saving significantly more than their male counterparts. Further, the WEAI data show that although men in the family have more say, women do have an influence on decisions regarding crop production and the adoption of new technologies, to an extent. Therefore, to enhance the adoption of drum seeders, the product designers and extension workers should also target women

Patterns of knee, hip and hand osteoarthritis in Kenyatta National Hospital

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in sub-Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the disease.Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well as obesity prevalence in the patients with established disease.Design: A cross-sectional descriptive study.Methods: Patients with knee, hip and hand osteoarthritis were examined to describe the patterns of osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their body mass indices were also studied to determine the prevalence of obesity in this cohort of patients.Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants, 77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA (45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight (44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007.Conclusion: Knee OA was very common and the majority of the patients were overweight and obese. Bilateral OA was more prevalent in obese and overweight participants compared to normal weight participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for preventing as well as halting the progression of OA.EAOJ; Vol. 7: September 201

Integrated Parametric Graph Closure and Branch-and-Cut Algorithm for Open Pit Mine Scheduling under Uncertainty

Open pit mine production scheduling is a computationally expensive large-scale mixed-integer linear programming problem. This research develops a computationally efficient algorithm to solve open pit production scheduling problems under uncertain geological parameters. The proposed solution approach for production scheduling is a two-stage process. The stochastic production scheduling problem is iteratively solved in the first stage after relaxing resource constraints using a parametric graph closure algorithm. Finally, the branch-and-cut algorithm is applied to respect the resource constraints, which might be violated during the first stage of the algorithm. Six small-scale production scheduling problems from iron and copper mines were used to validate the proposed stochastic production scheduling model. The results demonstrated that the proposed method could significantly improve the computational time with a reasonable optimality gap (the maximum gap is 4%). In addition, the proposed stochastic method is tested using industrial-scale copper data and compared with its deterministic model. The results show that the net present value for the stochastic model improved by 6% compared to the deterministic model

Fertility rate of epileptic women at Kenyatta National Hospital

Background: Reproductive health issues of women with epilepsy (WWE ) are complex and multifaceted, and both epilepsy and antiepileptic drug (AE Ds) use may alter fertility and pregnancy outcomes in these women. Objective: To determine the fertility rate of women with epilepsy at Kenyatta National ospital (KNH). Design: Cross-sectional study. Setting: Neurology clinic, KNH, Nairobi, Kenya, between October 2006 and March 2007. Subjects: A total of 191 women with epilepsy (aged 15-49 years) who had been epileptic for at least one year were interviewed regarding their pregnancy and birth histories, and the information validated with medical records where available. Results: The general fertility rate (GFR) for reproductive-aged epileptic women for the three-year period (2003-2006) preceding the study was 46 livebirths per 1000 women-years (95% CI 35.13- 63.59). Conclusion: Fertility rate in epileptic women is decreased by two thirds (compared to that of general population of women in Kenya). Reasons for this are probably miltifactorial. East African Medical Journal Vol. 85 (7) 2008: pp. 341-34

Patterns of knee, hip and hand osteoarthritis in Kenyatta National Hospital

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in sub- Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the disease.Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well as obesity prevalence in the patients with established disease.Design: A cross-sectional descriptive study.Methods: we examined patients with knee, hip and hand osteoarthritis to describe the patterns of osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their body mass indices were also studied to determine the prevalence of obesity in this cohort of patients.Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants, 77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA (45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight (44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007.Conclusion: Knee OA was very common and the majority of the patients were overweight and obese. Bilateral OA was more prevalent in obese and overweight participants compared to normal weight participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for preventing as well as halting the progression of OA