Drought-stricken NE Brazil is studied in the context of four regional units: the semiarid lowlands of the interior sertao, which have the maximum precipitation fluctuations; the well-watered Cariri ...valley, which experiences harvest shortages during abnormally dry years; the coastal fringe, which suffers during years of widespread drought; and the highlands of Baturite, where dry spells are noticed only through an influx of migrants from low-lying and drought-stricken areas. Adjustment to drought is, in general, low; it depends on the degree of drought awareness, which is also quite low. Affluent individuals are more inclined to make adjustments to droughts, although the likelihood of their being affected is less than among poor individuals. Middleclass individuals are more inclined to react to threats of an impending drought than to act under actual drought conditions. If age is taken into consideration, middle-aged individuals show greater awareness of drought conditions and a higher propensity to making adjustments than aged or youthful populations. Women are less inclined to make adjustments than men, and married people less than singles. Large families, probably compelled by the constraints, are especially prone to undertake changes in living conditions when a drought strikes. In general, the choices provided by economic feasibility, the possibilities of mitigating drought effects through technological know-how, and the social input of marriage and family size are very important parameters in shaping the character of the adjustments to drought.
Increasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily ...available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria defining the inappropriate use of medications in a nursing home population. The criteria were designed to use pharmacy data with minimal additional clinical data so that they could be applied to chart review or computerized data sets. The 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, histamine2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics. These criteria may be useful for quality assurance review, health services research, and clinical practice guidelines. The method used to establish these criteria can be used to update and expand the guidelines in the future.
