Farmers’ Perceptions of and Adaptations to Climate Change in Southeast Asia: The Case Study from Thailand and Vietnam

The perceptions of climate change and adaptation choices made by farmers are important considerations in the design of adaptation strategies by policy makers and agricultural extension services. This paper seeks to determine these perceptions and choices by farmers in already poor environmental regions of Thailand and Vietnam especially vulnerable to climate change. Overall findings were that farmers do perceive climate change, but describe it in quite distinct ways and that location influences how farmers recognize climate change. Our 2007 and 2013 surveys show that farmers are adapting, but it is difficult to determine if specific practices are “climate smart”. Further, adaptation measures are informed by perception and, at least in the case of Vietnam, perceptions are shaped by the respondent’s characteristics, location variables and recent climate related shocks. Finally, the three climate variables of rainfall, temperature, and wind are the most important factors in explaining specific adaptation measures chosen by farmers. Farmer participation is an essential part of public actions designed to allow adaptation to climate change. Our research can also contribute to understanding farmer constraints and tailoring good overall strategies to the local heterogeneity of vulnerable locations

Heavy menstrual bleeding in women on anticoagulant treatment for venous thromboembolism: Comparison of high- and low-dose rivaroxaban with aspirin

Contains fulltext : 232761.pdf (Publisher’s version ) (Open Access)BACKGROUND: Rivaroxaban may induce heavy menstrual bleeding. It is unknown if this effect is dose related or if rivaroxaban is associated with more menstrual bleeding than aspirin. OBJECTIVES: To demonstrate and compare menstrual patterns and actions taken among women receiving aspirin and two doses of rivaroxaban. METHODS: The EINSTEIN-CHOICE trial compared once-daily rivaroxaban 20 mg, rivaroxaban 10 mg, and aspirin 100 mg for extended treatment of venous thromboembolism in patients who had completed 6 to 12 months of anticoagulant therapy. In 362 women with menstrual cycles, menstrual flow duration and intensity assessed at days 30, 90, 180, and 360 were compared with those before starting anticoagulant therapy. RESULTS: Menstrual flow duration increased in 12%-18% of the 134 women given 20-mg rivaroxaban, in 6% to 12% of 120 women given 10-mg rivaroxaban, and in 9% to 12% of 108 women given aspirin. Corresponding increases in flow intensity were 19% to 24%, 14% to 21%, and 13% to 20%. The odds ratios (ORs) for increased menstrual flow duration were 1.36 (95% confidence interval [CI], 0.62-2.96) for rivaroxaban 20 mg versus aspirin, 0.77 (95% CI, 0.33-1.81) for rivaroxaban 10 mg versus aspirin, and 0.57 (95% CI, 0.26-1.25) for rivaroxaban 10 mg versus 20 mg. The ORs for increased menstrual flow intensity were 1.41 (95% CI, 0.67-2.99), 1.07 (95% CI, 0.49-2.34), and 0.76 (95% CI, 0.37- 1.57), respectively. CONCLUSIONS: There were no statistically significant differences in menstrual hemorrhage patterns between women treated with 10 or 20 mg of rivaroxaban and aspirin. Compared with 10-mg rivaroxaban or aspirin, 20-mg rivaroxaban showed numerically more often increased menstrual flow duration and intensity

Treatment of Uterine Bleeding During Chemotherapy

The administration of gonadotoxic agents (e.g. during chemotherapy) in premenopausal women can lead to vaginal bleeding disorders and pose a difficult treatment situation for oncological specialists. This chapter describes practical treatment options for serious vaginal bleeding events by considering hormonal and non-hormonal drugs (such as e.g. oral contraceptives, GnRH agonists, tranexamic acid). A distinction is made between prevention of bleedings and treatment for acute bleeding, stating possible medications, medical combinations and dosages. Radiological or surgical interventional procedures are also discussed, although they are rarely used

The added-up albumin enhances the diuretic effect of furosemide in patients with hypoalbuminemic chronic kidney disease: a randomized controlled study

<p>Abstract</p> <p>Background</p> <p>Chronic kidney disease (CKD) with edema is a common clinical problem resulting from defects in water and solute excretion. Furosemide is the drug of choice for treatment. In theory, good perfusion and albumin are required for the furosemide to be secreted at the tubular lumen. Thus, in the situation of low glomerular filtration rate (GFR) and hypoalbuminemia, the efficacy of furosemide alone might be limited. There has been no study to validate the effectiveness of the combination of furosemide and albumin in this condition.</p> <p>Methods</p> <p>We conducted a randomized controlled crossover study to compare the efficacy of diuretics between furosemide alone and the combination of furosemide plus albumin in stable hypoalbuminemic CKD patients by measuring urine output and sodium. The baseline urine output/sodium at 6 and 24 hours were recorded. The increment of urine output/sodium after treatment at 6 and 24 hours were calculated by using post-treatment minus baseline urine output/sodium at the corresponding period.</p> <p>Results</p> <p>Twenty-four CKD patients (GFR = 31.0 ± 13.8 mL/min) with hypoalbuminemia (2.98 ± 0.30 g/dL) were enrolled. At 6 hours, there were significant differences in the increment of urine volume (0.47 ± 0.40 <it>vs</it> 0.67 ± 0.31 L, <it>P</it> < 0.02) and urine sodium (37.5 ± 29.3 <it>vs</it> 55.0 ± 26.7 mEq, <it>P</it> < 0.01) between treatment with furosemide alone and with furosemide plus albumin. However, at 24 hours, there were no significant differences in the increment of urine volume (0.49 ± 0.47 <it>vs</it> 0.59 ± 0.50 L, <it>P</it> = 0.46) and urine sodium (65.3 ± 47.5 <it>vs</it> 76.1 ± 50.1 mEq, <it>P</it> = 0.32) between the two groups.</p> <p>Conclusion</p> <p>The combination of furosemide and albumin has a superior short-term efficacy over furosemide alone in enhancing water and sodium diuresis in hypoalbuminemic CKD patients.</p> <p>Trial registration</p> <p>The Australian New Zealand Clinical Trials Registration (ANZCTR12611000480987)</p