Province Of Residence Research Articles

Educational inequalities in suicide in the highly volatile economy of Argentina.

Little is known about how economic fluctuations affect educational inequalities in mortality in low- or middle-income countries. The objective of this study is to analyze the temporal variations in educational differentials in suicide in four Argentinian provinces. Data on suicides for ages 25years and over and three age groups (25-44, 45-64, and 65 +) in four Argentinian provinces during the period 1999-2013 were linked to population data and information on the educational level of the deceased. Regression models were estimated using age, sex, year, province of residence, educational level, and economic character of the year (expansion or recession) as explanatory variables. The educational gap in suicide mortality widened since the expansion following the crisis of 1999-2002, and then only decreased in 2005 and 2011. For ages 45-64, the confidence intervals of the suicide rate overlapped each year, and the suicide rate of the middle-high education population exceeded the suicide rate of the low-education population in 2 recession years, 1999 and 2002. Considering the years of economic expansion or recession as a dichotomous variable, at ages 45-64 differences in suicide rates by educational level disappeared during years of recession, while they were present in years of expansion. Suicides rise during economic downturns but these periods could reduce the educational gaps of suicide mortality by increasing the vulnerability of adults of high educational level to changes in the economy.

Do differences in work disability duration by interjurisdictional claim status vary by industry and jurisdictional context?

ObjectivesTo examine whether differences in work disability duration between out-of-province and within-province workers differed by industry and jurisdictional context.MethodsWorkers’ compensation data were used to identify comparable lost time, work-related injury...

Social determinants of chronic ill-health in contemporary South Africa: a social disadvantage approach

ABSTRACT In recent years South Africa has had to deal with the problem of multiple disease burdens. Non-communicable diseases (NCDs) are rising and emerging as the leading causes of death in the country. Existing empirical evidence suggests that different social conditions influence health outcomes in a population. In the present study, a social disadvantage approach was employed to examine demographic and socioeconomic gradients in self-reported diagnosed chronic conditions. Analyses were based on a sample of 45,913 adults aged 18 years and older drawn from the 2018 South African General Household Survey data, using multivariate regression techniques to assess the distribution and predictors of chronic ill- health in South Africa. The reported burden of chronic ill-health was 17.3%. Factors independently associated with the risk of NCDs included increasing age, population group, lower wealth index, lower education, urban residence and province of residence. The findings confirmed the existence of socioeconomic gradients as well as a gender gap in chronic ill-health, to the detriment of vulnerable sub-groups. Policy implications are discussed.

Spending Impact of COVID-19 Stimulus Payments: Evidence from Card Transaction Data in South Korea

We analyze the impact of South Korea’s one-off COVID-19 stimulus payments on spending using high-frequency, offline card transactions data based on 3.42 billion transactions in Seoul. The Korean stimulus payment policy is distinct because the government mandated the payments to be used only in the province of residence and in the pre-specified sectors (e.g., excluding online transactions and large retailers). We find evidence that the stimulus payments increased card spending in Seoul. Consistent with the spending restrictions, the policy impact is driven by Seoul residents and the sectors allowed by the government. The spending response to the stimulus payments are weaker in areas with higher average income and more cumulative COVID-19 cases, suggesting the importance of liquidity constraints and risk avoidance. Our back-of-the-envelope calculation suggests that households spend 29% of stimulus payments in the first six weeks. We also find that the stimulus payments flowed more to the sectors and areas suffered less during the pandemic, making the economic impact of COVID-19 more unequal.

Kesenjangan Kepesertaan Jaminan Sosial Tenaga Kerja Di Indonesia : Analisis Data Sakernas 2018

Increasing the participation of Labor Social Security in Indonesia has become the government's commitment. However, until now, there are still many workers who have not participated in labor social security. This paper aims to analyze the gap in the social security membership of workers in Indonesia. Data for analysis is SAKERNAS, August 2018 issued by BPS. Data analysis was carried out by descriptive analysis with both tables and graphics. The results of the analysis show that the participation of workers in labor security in Indonesia is 41.45%. Disparities in labor social security membership occurred in the formal and informal sectors of 48.92% and 1.13%, respectively. Disparities in labor security membership also occur according to main industry, province of residence, gender, and level of education. By sector, the lowest participation occurred in the construction and accommodation sector (20.26%), while the highest participation was in the electricity and gas sector (72.26%). For workers with a diploma education and above, labor security participation is 64.34%, while in junior high school and below, the participation is 19.55%. The participation of labor security in casual workers is still low. Limited income is the main obstacle for informal sector workers and free workers to participate in Labor Social Security. For this reason, it is necessary to think about a subsidized financing scheme so that labor social security does not burden the informal sector workers.

Early and surgical menopause associated with higher Framingham Risk Scores for cardiovascular disease in the Canadian Longitudinal Study on Aging.

Objective:In women, the risk of cardiovascular disease (CVD) is higher in the postmenopausal period. The effect that menopausal type, natural versus surgical, or the age at natural menopause has on CVD needs further investigation. To this end, we assessed the association between menopausal type and timing and the 10-year office-based Framingham Risk Score (FRS) in women from the Canadian Longitudinal Study on Aging.Methods:We included women aged 45 to 85 years from the Canadian Longitudinal Study on Aging Comprehensive cohort of seven Canadian provinces who were menopausal at the time of recruitment and had no prior CVD. Poisson regressions were used to evaluate the association between menopausal characteristics and the FRS. Natural menopause was defined as the cessation of menstrual periods for at least 1 year in women with no history of hysterectomy. Surgical menopause was defined as hysterectomy with or without oophorectomy prior to natural menopause. As main covariates, we examined age, education, province of residency, and hormone therapy.Results:A total of 10,090 women (8,200 natural menopausal and 1,890 surgical menopausal) were eligible for the study. In the multivariable model, surgical menopause was associated with a higher mean FRS compared with natural menopause (CVD risk 12.4% vs 10.8%, P < 0.001). Compared with women with age at natural menopause from 50 to 54 years (CVD risk 10.2%), natural menopause before age 40, 40 to 44, or 45 to 49 had a higher CVD risk (12.2%, 11.4%, and 10.6%, respectively, P < 0.001).Conclusions:Our study supports an association between menopausal type and timing on CVD risk prediction and highlights the need to be judicious about surgical menopause. Preventative interventions for CVD should be considered in surgical menopausal women and women with an age at natural menopause less than 45 years.Video Summary:.

Global Dialysis Perspective: South Africa.

South Africa is an upper middle–income country with a population of 59.6 million people (1). Gauteng is the most densely populated province, and houses 26% of the population, followed by KwaZulu-Natal (19%), and the Western Cape (12%). About 29% of the population are <15 years old and 9% are ≥60 years. Approximately 13% of the population are seropositive for HIV. Life expectancy is estimated at 68.5 years for females and 62.5 years for males, whereas the infant mortality rate is 23.6 per 1000 live births. In 2019, the gross national income per capita was approximately $6040 (Atlas method, current US$), with 8% of the country’s gross domestic product spent on health care (2). Despite the transition to democracy in 1994, a high level of inequality remains, reflected in a Gini coefficient of 0.63 and an unemployment rate of 30% (2,3). This inequality is also reflected in a two-tiered health system. Access to a well-resourced private health care sector depends on the ability to pay for services, usually via medical insurance. Treatment for CKD is included in the set of “prescribed minimum benefits” that all registered medical insurance schemes in South Africa are obliged to provide for their members. The majority of South Africans (84%), however, are dependent on an under-resourced, government-funded, public health care sector. Public health care facilities use a sliding scale, where the fees charged are dependent on income. Indigent patients are able to access services free of charge (4). South Africa is faced with a high burden of infectious diseases (such as tuberculosis and HIV infection), noncommunicable diseases, maternal and childhood diseases, and injury-related diseases (5). These factors drive an epidemic of AKI and CKD. Two studies have estimated the population prevalence of CKD in South Africa. Adeniyi et al. (6) reported the …

Association of Severe Trauma With Work and Earnings in a National Cohort in Canada

Traumatic injury disproportionately affects adults of working age. The ability to work and earn income is a key patient-centered outcome. The association of severe injury with work and earnings appears to be unknown. To evaluate the association of severe traumatic injury with subsequent employment and earnings in long-term survivors. This is a retrospective, matched, national, population-based cohort study of adults who had employment and were hospitalized with severe traumatic injury in Canada between January 2008 and December 2010. All acute care hospitalizations for severe injury were included if they involved adults aged 30 to 61 years who were hospitalized with severe traumatic injury, working in the 2 years prior to injury, and alive through the third calendar year after their injury. Patients were matched with unexposed control participants based on age, sex, marital status, province of residence, rurality, baseline health characteristics, baseline earnings, self-employment status, union membership, and year of the index event. Data analysis occurred from March 2019 to December 2019. Changes in employment status and annual earnings, compared with unexposed control participants, were evaluated in the third calendar year after injury. Weighted multivariable probit regression was used to compare proportions of individuals working between those who survived trauma and control participants. The association of injury with mean yearly earnings was quantified using matched difference-in-difference, ordinary least-squares regression. A total of 5167 adults (25.6% female; mean [SD] age, 47.3 [8.8] years) with severe injuries were matched with control participants who were unexposed (25.6% female; mean [SD] age, 47.3 [8.8] years). Three years after trauma, 79.3% of those who survived trauma were working, compared with 91.7% of control participants, a difference of -12.4 (95% CI, -13.5 to -11.4) percentage points. Three years after injury, patients with injuries experienced a mean loss of $9745 (95% CI, -$10 739 to -$8752) in earnings compared with control participants, representing a 19.0% difference in annual earnings. Those who remained employed 3 years after injury experienced a 10.8% loss of earnings compared with control participants (-$6043 [95% CI, -$7101 to -$4986]). Loss of work was proportionately higher in those with lower preinjury income (lowest tercile, -18.5% [95% CI, -20.8% to -16.2%]; middle tercile, -11.5% [95% CI, -13.2% to -9.9%]; highest tercile, -6.0% (95% CI, -7.8% to -4.3%]). In this study, severe traumatic injury had a significant association with employment and earnings of adults of working age. Those with lower preinjury earnings experienced the greatest relative loss of employment and earnings.

Understanding cancer survivors' reasons to medicate with cannabis: A qualitative study based on the theory of planned behavior.

BackgroundPrior to nonmedical cannabis legalization in Canada, individuals were only able to access cannabis legally through licensed producers with medical authorization. Now with an additional legal access system designed for nonmedical purposes, it is unclear what factors influence cancer survivors’ decisions to medicate or not medicate cannabis as a complementary therapy to alleviate their cancer symptoms.MethodsWe recruited cancer survivors via social media. Interested individuals were purposively sampled to ensure maximization in terms of age, sex, and province of residence. Constructs of the Theory of Planned Behavior were explored during the telephone interviews as participants described what influenced their decisions to medicate or not medicate cannabis to manage their symptoms.ResultsInterviews were conducted with 33 cancer survivors. All individuals believed that cannabis would manage their cancer symptoms. Those that chose to medicate with cannabis provided a variety of reasons, including that cannabis was a more natural alternative; that it reduced their overall number of prescription drugs; and that safer products had become available with the legalization of nonmedical cannabis. Some individuals also indicated that support from physicians and validation from family and friends were important in their decision to medicate with cannabis. Individuals who opted not to medicate with cannabis raised concerns about the lack of scientific evidence and/or possible dependency issues. Some also felt their physician's disapproval was a barrier to considering cannabis use.ConclusionsThe findings revealed that recreational legalization made using cannabis appear safer and easier to access for some cancer survivors. However, physicians’ censure of cannabis use for symptom management was a barrier for survivors considering its use.

Mental Disorder Symptoms Among Nurses in Canada.

Nurses face regular exposures to potentially psychologically traumatic events as part of their occupational responsibilities. Cumulative stress due to repeated exposure to such events is associated with poor mental health and an increased risk of developing clinically significant symptoms consistent with some mental disorders. The current study was designed to estimate rates of mental disorder symptoms among nurses in Canada and identify demographic characteristics that are associated with increased risk for mental disorder symptoms. An online survey was conducted with Canadian nurses in both English and French. Participants were recruited largely through the Canadian Federation of Nurses Unions (CFNU) member unions, non-CFNU member unions, and social media. The survey assessed current mental disorder symptoms using well-validated screening measures. A total of 4267 participants (93.8% women) completed the survey. Almost half of participants screened positive for a mental disorder (i.e., 47.9%). No gender differences emerged. Significant differences in proportions of positive screens based on each measure were found across demographic groups (e.g., age, province of residence, type of nurse). The rate of positive screens appears much higher than mental disorder prevalence rates in the general Canadian population, but there were important methodological differences. The current results provide potentially important information to support researchers and healthcare administrators to investigate possible ways to mitigate and manage mental health in nursing workplaces.

Perceived Stress Levels in Pakistani Dental Students During COVID-19 Lockdown

Objective: The objective of this study is to assess the stress levels of Pakistani dental students through an established stress assessment tool during lockdown for COVID-19 pandemic.&#x0D; Materials and methods: A cross-sectional quantitative study using a self-administered, voluntarily filled online questionnaire was conducted on undergraduate dental students from first to fourth (Final) years of dental institutes across Pakistan, accredited by the Pakistan Medical &amp; Dental Council (PMDC). Study questionnaire contained questions on demographic details; gender, province of college, province of residence and perceived stress scale of 10 questions. It also contained questions about the presence of any symptoms relevant to a particular type of stress. i.e. emotional stress, physical (body related) stress, behavioral stress and cognitive stress. Descriptive statistics were calculated for gender, residence of participants, location of institutes, levels of stress and symptoms signifying a particular stress type. Multiple variables of each stress type were compared with categories of perceived stress scores using chi square test.&#x0D; Results: 706 dental students responded. 53.5% were going through high stress levels, 43.4% were going through moderate stress levels while 2.9% were having low stress levels. Majority of the participants with moderate and high stress levels were from institutions located in provinces with increased number of COVID-19 positive cases. Among moderate and highly stressed participants, more than 68% were females. A significant number of dental students reported symptoms pertaining to emotional, physical, cognitive and behavioral stress due to the COVID-19 disease.&#x0D; Conclusion: Majority of Pakistani dental students are suffering from moderate to high stress levels specially in provinces with a higher number of COVID-19 affected reported cases. There are considerable effects on emotional, physical, cognitive and behavioral states of Pakistani dental students due to the spread of this disease.

Hepatozoon canis in hunting dogs from Southern Italy: distribution and risk factors

Hepatozoon canis is a hemoprotozoan organism that infects domestic and wild carnivores throughout much of Europe. The parasite is mainly transmitted through the ingestion of infected ticks containing mature oocysts. The aims of the present survey were to determine the prevalence of H. canis in hunting dogs living in Southern Italy and to assess potential infection risk factors. DNA extracted from whole blood samples, collected from 1433 apparently healthy dogs living in the Napoli, Avellino, and Salerno provinces of Campania region (Southern Italy), was tested by a quantitative real-time polymerase chain reaction (qPCR) assay to amplify H. canis. Furthermore, the investigated dog population was also screened by qPCR for the presence of Ehrlichia canis, a major tick-borne pathogen in Southern Italy, in order to assess possible co-infections. Two hundred dogs were H. canis PCR-positive, resulting in an overall prevalence of 14.0% (CI 12.2–15.9). Breed category (P < 0.0001), hair coat length (P = 0.015), and province of residence (P < 0.0001) represented significant risk factors for H. canis infection. The presence of H. canis DNA was also significantly associated with E. canis PCR positivity (P < 0.0001). Hunting dogs in Campania region (Southern Italy) are frequently exposed to H. canis, and the infection is potentially associated with close contact with wildlife. Further studies are needed to assess the pathogenic potential of H. canis, as well as the epidemiological relationships between hunting dogs and wild animal populations sharing the same habitats in Southern Italy.

Exposure and cumulative risk assessment to non-persistent pesticides in Spanish children using biomonitoring

The main objective of the present research is to evaluate the exposure to pesticides in children (n = 568) from the Valencian Region (Spain). Six non-specific and 20 specific metabolites of organophosphate pesticides (OPs), herbicides (Herb), and pyrethroids (Pyr) were analyzed in urine samples. The biomarkers with the highest detection frequencies (>70%) were diethyl phosphate, p-nitrophenol, 3-phenoxybenzoic acid, and 3,5,6-trichloro-2-pyridinol, whose geometric mean concentrations (ng·ml-n1) were 1.53, 1.03, 1.51 and 1.19, respectively. Robust regression models showed that the province of residence and the recent consumption of vegetables, legumes and cereals were some of the most important predictors of pesticide exposure. Pesticide risk assessment is estimated using two different strategies: one based on the pesticides' mode of action (MoA); and the other based on cumulative assessment groups (CAGs), proposed by EFSA. The estimated daily intakes (EDIs) ranged from 0.08 (chlorpyrifos) to 1.62 μg·kg bw-1 (λ-cyhalothrin). The MoA approach resulted in hazard quotients ranging from 0.01 (chlorpyrifos) to 0.65 (λ-cyhalothrin), and a hazard index for OPs lower than 1. Similarly, the risk assessment based on CAGs led to total margins of exposure (MOETs) far from 100. In conclusion, both risk assessment strategies does not reveal any evidence of a potential health risk due to pesticide exposure in Spanish children.

Cannabis use and stigma among Canadian high school students: Results from the 2015 and 2017 Cancer Risk Assessment in Youth Survey

BackgroundAdolescent cannabis use is perceived as a risky behavior, has been linked with many negative health outcomes, and is increasingly being connected with stigma. MethodsThe purpose of this study is to investigate how cannabis use is associated with potentially stigmatizing markers of identity among adolescents two waves of a repeat cross-sectional survey (2015 N = 12,110; 2017 N = 15,191) of high schools students in seven Canadian provinces. Students were asked about ever use of cannabis, as well as “stigma markers”, including their current living arrangement, mother’s education, and ethnicity. Multivariable logistic regression models were used to examine associations between cannabis use and stigma markers. ResultsAfter adjusting models for grade, gender, and province of residence, students who did not live with their mothers had higher odds of cannabis use relative to students living with their mothers [OR = 1.94, 95% CI 1.62–2.31]. Low maternal education was also significantly associated with cannabis use, as was ethnicity (students who identified as Indigenous had 3.38 (95% CI 2.29–4.99) times higher odds of using cannabis compared to students who identified as “white” in 2017). Findings related to attending school in a rural (vs. urban) area (2015 OR = 1.33 95% CI 0.99–1.78; 2017 OR = 1.44 95% CI 0.9 to −2.15) and low SES (2015 OR = 0.99, 95% 0.98–1.00; 2017 OR = 1.00, 95% CI 0.98–1.01) were more marginal. ConclusionsFuture research should explore cannabis initiation experiences among vulnerable groups to better understand potential stigma triggers.

Prevalence and Risk Factors Associated with Anemia among Women of Childbearing Age in Rwanda.

Anemia among women of child bearing age is a global public health problem. In developing countries such as Rwanda, women and their children may be particularly susceptible to anemia. The main objectives of this study were to assess the prevalence of anemia among women of reproductive age in Rwanda and to identify the risk factors associated therewith. The current study considered socio-economic, demographic and environmental factors and the 2014/2015 Rwanda Demographic and Health Survey data was used for this purpose. Due to the complexity of the sampling design, the present study used survey logistic model that takes account of sampling weight, stratification and clustering. The SAS statistical software was used for the analysis of the results. The anemia status was assessed among 6 680 women aged between 15 and 49 years old and the prevalence of anemia among women of this child bearing age group, was found to be 19.2%. The study also revealed that body mass index, contraceptive use, use of mosquito bed nets, marital status, wealth quintile of the household, size of the household, literacy, tobacco use, type of cooking fuel, type of toilet facilities, type of source of drinkable water, and province of residence, were all factors associated with anemia among women of reproductive age in Rwanda. Hence the current study highlights several health, geographical and socio-economic issues that can assist health care professionals and other relevant authorities in fostering an environment that reduces the risk of anemia for women and children.

Reversal of the seasonality of temperature-attributable mortality from respiratory diseases in Spain

A growing number of epidemiological studies have recently assessed temporal variations in vulnerability and/or mortality attributable to hot and cold temperatures. However, the eventual changes in the seasonal distribution of temperature-attributable mortality remain unexplored. Here, we analyse countrywide daily time-series of temperature and mortality counts from respiratory diseases by sex, age group and province of residence during the period 1980–2016 in Spain. We show the complete reversal of the seasonality of temperature-attributable mortality, with a significant shift of the maximum monthly incidence from winter to summer, and the minimum monthly incidence from early and late summer to winter. The reversal in the seasonal distribution of the attributable deaths is not driven by the observed warming in both winter and summer temperatures, but rather by the very large decrease in the risk of death due to cold temperatures and the relatively much smaller reduction due to hot temperatures. We conclude that the projected decrease in the number of moderate and extreme cold days due to climate warming will not contribute to a further reduction of cold-attributable respiratory deaths.

Rubella seroprevalence using residual samples from the South African measles surveillance program: a cross-sectional analytic study

ABSTRACT Introduction: South Africa is yet to introduce rubella-containing vaccines (RCV) into its routine immunization schedule. Selecting the target population when introducing RCV should take into account the ages of susceptible individuals in the population. We aimed to determine the seroprevalence of antibodies to rubella and characterize immunity gaps among individuals of all ages in South Africa. Methods: We tested for rubella immunoglobulin G (IgG) antibodies with a commercial enzyme-linked immunosorbent assay. We used residual samples collected from 2016 through 2018 as part of the national measles surveillance program. We only tested samples that were negative for measles and rubella immunoglobulin M (IgM) and explored the association between rubella susceptibility (IgG negative) and predictor variables (year of sample collection, age, sex, and province of residence) using logistic regression analysis. Results: We obtained results for 6057 records. Rubella susceptibility was highest among Individuals aged zero to 11 months (81.9%), followed by children 1 to 5 years old (71.5%), 6 to 10 y old (40.9%) and 11 to 15 y old (31.25) while the smallest proportion of susceptible individuals was among those 16 to 49 y old (19.9%). Females were less likely to be susceptible to rubella compared to males (OR = 0.79 (95%CI: 0.71–0.87), P < .001) in unadjusted analysis but this effect was not observed after adjusting for age and province. In multivariable logistic regression, age (OR = 6.24 (4.52–8.63), P < .001) and province of residence (OR = 0.97 (95%CI: 0.95–0.99), P = .01) were associated with rubella susceptibility. Conclusion: In the absence of rubella vaccination in the Expanded Program on Immunization in South Africa, the bulk of individuals susceptible to rubella are children under 16 y old. About 20% of individuals 16 to 49 y old are susceptible to rubella. This susceptibility gap must be born in mind during RCV introduction.

Real-World Observational Study on the Characteristics and Treatment Patterns of Allergic Asthma Patients Receiving Omalizumab in Canada.

BackgroundOmalizumab is a treatment option for pediatric and adult patients with moderate to severe allergic asthma poorly controlled with standard inhaled therapies. Clinical trials and observational studies have demonstrated the efficacy of omalizumab. There is limited real-world evidence on the characteristics and treatment patterns of Canadian asthma patients receiving omalizumab.ObjectiveWe profiled Canadian omalizumab users to estimate time to omalizumab discontinuation and to assess changes in concurrent medication usage before, during, and after therapy.MethodsThis was a retrospective, observational, cohort study that analyzed data from Canadian prescription claims databases. An algorithm was used to select naïve users of omalizumab with an inferred diagnosis of GINA 5-asthma who made a claim for omalizumab from February 1, 2007, to June 2, 2015. Demographic and baseline characteristics were assessed at index. Outcomes examined over the analysis period included (i) daily omalizumab dose per patient and per claim; (ii) omalizumab discontinuation (defined as ≥100-day gap in making omalizumab claims) and its potential predictors (ie, age, sex, province of residence, drug insurer; assessed by Cox Proportional Hazards Model); and (iii) for patients who discontinued omalizumab, changes in concurrent medication usage before, during, and 6 months after omalizumab usage.ResultsThe final study cohort consisted of 1160 patients (mean age: 45.8 ± 15.2 years; 64.7% female). During the first year of omalizumab therapy, 29.5% of patients discontinued treatment. The singular characteristic that predicted omalizumab discontinuation with statistical significance was age group (20‒34 years vs 12‒19 years; hazard ratio 1.75, 95% confidence interval 1.11–2.76; P<0.05). There were significant reductions in the use of some concurrent inhaled and oral asthma medications during and/or after omalizumab use (P<0.05).ConclusionNearly one-third of patients who initiated omalizumab in Canada for refractory, moderate to severe allergic asthma discontinued treatment during the first year.

SAT-211 SURVIVAL OF SOUTH AFRICAN PATIENTS ON RENAL REPLACEMENT THERAPY

In South Africa, the majority of patients rely on a resource-constrained public healthcare system, where access to renal replacement therapy (RRT) is strictly rationed. The prevalence of RRT in the public health care sector (68 per million population, pmp) is less than one-tenth the prevalence in the private healthcare sector (798 pmp). Data on the outcomes of RRT, such as survival, may influence policies and resource allocation. Our aim was to evaluate, for the first time, the survival of South African patients on RRT. We were particularly interested in the effect of healthcare sector on survival and, given South Africa’s HIV epidemic, the effect of HIV on survival. SARR data were used to estimate 1-year survival in patients on RRT. The incident cohort included patients who initiated treatment between January 2013 and September 2016. The prevalent cohort included those on RRT on 31 December 2015. Data were collected on potential risk factors for mortality, including age, ethnicity, primary renal diagnosis (PRD), first RRT modality, HIV status, healthcare sector (public or private), and province of residence . Failure events included stopping treatment without recovery of renal function, and death. Patients were censored if they were alive on RRT at 1 year, recovered renal function, or were lost to follow-up. The Kaplan-Meier method was used to estimate one-year survival. Multivariable Cox regression was used to examine the association of potential risk factors with survival in incident patients, while logistic regression was used in prevalent patients. In the incident cohort (n=6187), the mean age was 51.8 years, 54% were black, 44% were diabetic, 10% were HIV positive, and 82% had haemodialysis (HD) as their first RRT modality. Overall 1-year survival was 90.4% (95%CI 89.6-91.2). Higher mortality was independently associated with older age, end-stage kidney disease (ESKD) of unknown aetiology, and province of residence. More specifically, patients residing in Eastern Cape, Free State, Mpumalanga and Northern Cape had worse one-year survival compared to those residing in the Western Cape. There were no differences in mortality based on ethnicity, diabetic status or healthcare sector. One-year survival was 95.7% and 93.8% in HIV-positive and HIV-negative patients, respectively. One-fifth had no data on HIV-status and the survival in this group was considerably lower at 74.8% (p<0.001). In the prevalent cohort (n=10155), baseline characteristics and one-year survival were similar to that of the incident group. Higher mortality was independently associated with older age and diabetes mellitus. Furthermore, higher mortality was associated with HD as a treatment modality when compared to kidney transplantation. The survival rates of South African patients who access chronic dialysis and transplantation services are comparable to those in better-resourced countries. Although the RRT prevalence in the public health sector is low, the survival of those patients who are accommodated is good, and this should encourage government to increase access to life-sustaining RRT. It is still unclear what effect, if any, HIV status has on patient survival.

Predictors of sexual risk behaviour among unmarried persons aged 15-34 years in South Africa

ABSTRACT South Africa accounts for the largest share of the global HIV epidemic, both in the number of people living with HIV and in new infection rates. In the context of the high prevalence of HIV/AIDS and its ensuing adverse socio-economic impact, in South Africa, this study aimed at examining the factors that impact the sexual risk-taking behaviours of unmarried persons aged 15–34 years in the country. Specifically, the study sought to examine the effects of selected sociodemographic factors on the condom use and sexual partnership behaviours of three age cohorts: 15–19-year-olds (adolescents), 20–24-year-olds (emerging adults), and 25–34-year-olds (young adults). The results showed that being male, wealthy, and living in an urban area generally protected against sexual risk-taking behaviours among respondents. Furthermore, early sexual debut, province of residence, and unemployment are risk factors for unsafe sexual practices among respondents. These demographic predictors showed varied effects depending on the age cohort of respondents. The findings support targeted interventions to improve sex education for adolescents and emerging adults in South Africa.