Potentially inappropriate prescribing in disabled older patients with chronic diseases: a screening tool of older persons' potentially inappropriate prescriptions versus beers 2012 criteria

Objective: To evaluate the prescription of potentially inappropriate medications [PIM], using the Screening Tool of Older Persons' potentially inappropriate Prescriptions [STOPP] and Beers criteria, to disabled older people

Subjects and Methods: One hundred and forty-one patients aged >/= 65 years with Barthel scale scores

Results: Of the 141 patients, 94 [66.7%] and 94 [66.7%] had at least one PIM identified by the STOPP and Beers criteria, respectively. In multivariate analysis, PIM identified by the Beers criteria were associated with the prescription of multiple medications [p = 0.013] and the presence of psychiatric diseases [p < 0.001], whereas PIM identified by the STOPP criteria were only associated with the prescription of multiple medications [p = 0.008]. The optimal cutoff for the number of medications prescribed for predicting PIM by using the STOPP or Beers criteria was 6. After adjustment for covariates, patients prescribed >/= 6 medications had a significantly higher risk of PIM, identified using the STOPP or Beers criteria, compared to patients prescribed <6 medications [both p < 0.05]

Conclusion: This study revealed a high frequency of PIM in disabled older patients with chronic diseases, particularly those prescribed >/= 6 medications

Spatial inequality in municipal solid waste disposal across regions in developing countries

The regional inequalities in socio-economical characteristics such as income, population density, age composition, unemployment rate and the education level may bring about variation in waste generation, recycling and collection. Using environmental Kuznets curve, the factors affecting municipal solid waste disposal are examined. The results demonstrate that an inverted N-shaped curve executes on municipal solid waste disposal for all regions. As personal disposable income increases, per capita municipal solid waste disposed firstly declines, then grows at the second stage and finally decreases again. All the explanatory variables including economic factors, social characteristics and geographical barriers are found to influence municipal solid waste disposal significantly. Each person increase in population density leads to an increase in municipal solid waste disposed by approximately 1.17 X 10-4 kg/day. Each percent increase in age composition results in a decrease in municipal solid waste disposed by approximately 0.0224 kg/day; in the unemployment rate causes a decrease of 0.0901 kg/day and in the education level results in a decrease of 0.01556 kg/day. In general, municipal solid waste disposal starts to increase at the first turning point of personal disposable income NT$ 198,000 [about US$ 6,280] and to decrease at the second point of NT$ 389,000 [about US$ 12,350] for all regions [pooled data]. The rural regions, however, cannot support the inverted N-shaped curve by the "reduced form" while urban regions have a significant outcome. This result implies that income can only explain a portion of variation while other social and geographical factors contribute a lot to identify the variation in municipal solid waste disposal between urban and rural regions

Environmental impact assessment framework by integrating scientific analysis and subjective perception

Environmental impact assessment is widely recognized as an effective tool for supporting the sustainable development of the environment through policy, plan and program decision-making processes. Traditional approach of environmental impact assessment generally focuses on scientific analysis and neglects subjective utilities on the project development. This paper proposes a framework of environmental impact assessment process by integrating subjective perception and scientific analysis. This framework suggests that environmental impacts and their consequent effects are analyzed and calculated based on the inventory analysis, but the non-market loss arising from the construction of the sensitive facility is estimated by contingent valuation method and the relative importance of affecting groups in affecting the ongoing of project development is evaluated by analytical hierarchy process. Eventually, a mathematical model is presented to determine the optimal compensation amount under a targeted refusal rate. Also, a case example is presented to illustrate this approach that integrates the objectively scientific assessment for potentially environmental impacts and individual subjective perception on the non-market value of environmental damages arising from the project development