Water is fundamental to human well-being and economic growth. Measuring how water contributes to sustainable development is an important aspect of the United Nations Sustainable Development Goal (SDG) 6, 'Water and sanitation for all'. This importance is especially significant for water-scarce developing countries such as South Africa. Appropriate indicators can support decision-making and highlight key issues on inequality, unemployment and sustainability. In this paper, additional indicators for SDG 6.4 on water-use efficiency are proposed that focus on how individuals and households benefit, both directly and indirectly, from the allocations and use of water resources. The Berg Water Management Area (WMA) in the southwest corner of South Africa is used as a case study to illustrate the results. Residential per capita water use and municipal water losses were determined for all towns in the area. Figures for jobs and income per unit of water use were calculated for the heavily water-dependent industries, namely, agriculture, agriprocessing, freshwater aquaculture, mining and steel processing. This approach to measuring the socioeconomic benefits of water use are relevant for other countries seeking to measure the role that water plays in achieving inclusive sustainable development, and could be included in the final SDG 6 indicator suite. SIGNIFICANCE: • New measures of water-use efficiency based on jobs and income are proposed. • New indicators are proposed for SDG 6. • Water use, jobs and annual income are estimated for all heavily water-dependent sectors in the Berg WMA.

BACKGROUND: Primary care (PC) is the foundation of the Kenyan health care system, providing comprehensive care, health promotion and managing all illnesses across the lifecycle. In the private sector in Nairobi, PC is principally offered by the general practitioners, also known as family doctors (FDs). The majority have no postgraduate training. Little is known about how patients perceive their capability. AIM: To assess patients' perceptions of the scope of practice of FDs working in private sector PC clinics in Nairobi and their awareness of the new category of family physicians (FPs) and the discipline of family medicine. SETTING: Private sector PC clinics in Nairobi. METHODS: A descriptive survey using a structured, self-administered questionnaire. Simple random sampling was used to recruit 162 patient participants. RESULTS: Of the participants, 30% knew the difference between FPs and FDs. There was a high to moderate confidence that FDs could treat common illnesses; provide lifestyle advice; family planning (66%) and childhood immunisations (64%). In adolescents and adults, low confidence was expressed in their ability to manage tuberculosis (58%), human immunodeficiency virus (55%) and cancer (33%). In the elderly, there was low confidence in their ability to manage depression (55%), anxiety (57%), urinary incontinence (57%) and diabetes (59%). There was low confidence in their ability to provide antenatal care (55%) and Pap smears (42%). CONCLUSION: Patients did not perceive that FDs could offer fully comprehensive PC services. These perceptions may be addressed by defining the expected package of care, designing a system that encourages the utilisation of PC and employing FPs.

The occurrence of a unilateral second plantaris muscle was discovered during the anatomical dissection of a 47 year old female with Huntington Chorea Disease. The cadaver was found to possess bilateral plantaris muscles and a distinct anomalous muscle morphologically resembling a second plantaris on the medial right leg. The inner and outer bellies of the anomalous plantaris arose proximally from the medial condyle of the femur and formed a short tendon that fused distally with the tendon of the lateral plantaris muscle.

Un segundo músculo plantar unilateral fue descubierto durante una disección anatómica de rutina, en una mujer de 47 años de edad con Enfermedad de Huntington Chorea. En la cara medial de la piena derecha, el cadáver presentaba, bilateralmente, el músculo plantar y un músculo anómalo, morfológicamente distinto, que se asemejaba a un segundo músculo plantar. Los vientres medial y lateral del músculo plantar anómalo se originaban del cóndilo medial del fémur y formaban un tendón corto que se fusionaba con el tendón del músculo plantar lateral.

The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug "load" between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some 177 patients resident for 30 or more days over a 19 month period of 2978 patient-months data were tabulated. A monthly repeated-measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. Results: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. Conclusion: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total "load" of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility.

El propósito de este estudio fue determinar si había diferencias en las tasas de hospitalización debido a la carga de agentes psicoactivos en una residencia de ancianos entre los que utilizan psicotropos con los que no o los habían usado antes; determinar si el diagnóstico de demencia y el cambio en el uso y carga de medicamentos psicotrópicos y psicoactivos influye en las tasas de hospitalización. Métodos: Se realizó un estudio observacional de una cohorte retrospectiva de historiales de pacientes, cambios de situación en la residencia e informes del farmacéutico en una residencia de ancianos avanzada de más de 100 camas. Se tabularon datos de 177 residentes de 30 días o más durante un periodo de 19 meses, tabulándose un total de 2978 pacientes-mes. Se realizó un método de medidas repetidas de cambios de situaciones clínicas, enfermedades y medicación, para determinar la demografía, el uso de medicamentos y las hospitalizaciones de cada paciente. Resultados: Las tasas de hospitalización variaron de 0,04 a 0,07 por paciente/mes para el uso de cualquier psicoactivo en los que tenían o no diagnóstico de demencia. La tasa de hospitalización durante el periodo de estudio para los que no usaban actualmente psicotropos o psicoactivos fue de 0,02 y 0,03 por paciente/mes para los que tenían diagnóstico de demencia y los que no, respectivamente, aunque el 86% de esta muestra había usado psicotropos o psicoactivos antes del periodo de observación. Conclusión: Se ofrece evidencia preliminar que sugiere que los psicotropos y psicoactivos y la carga total de estos medicamentos puede estar asociada al aumento en la tasa y el riesgo de hospitalizaciones en una residenciad e ancianos avanzada.