Predictors of health care use by adults 50 years and over in a rural South African setting

KIMBACKGROUND: South Africa's epidemiological transition is characterised by an increasing burden of chronic communicable and non-communicable diseases. However, little is known about predictors of health care use (HCU) for the prevention and control of chronic diseases among older adults. OBJECTIVE: To describe reported health problems and determine predictors of HCU by adults aged 50+ living in a rural sub-district of South Africa. DESIGN: A cross-sectional study to measure HCU was conducted in 2010 in the Agincourt sub-district of Mpumalanga Province, an area underpinned by a robust health and demographic surveillance system. HCU, socio-demographic variables, reception of social grants, and type of medical aid were measured, and compared between responders who used health care services with those who did not. Predictors of HCU were determined by binary logistic regression adjusted for socio-demographic variables. RESULTS: Seventy-five percent of the eligible adults aged 50+ responded to the survey. Average age of the targeted 7,870 older adults was 66 years (95% CI: 65.3, 65.8), and there were more women than men (70% vs. 30%, p<0.001). All 5,795 responders reported health problems, of which 96% used health care, predominantly at public health facilities (82%). Reported health problems were: chronic non-communicable diseases (41% - e.g. hypertension), acute conditions (27% - e.g. flu and fever), other conditions (26% - e.g. musculoskeletal pain), chronic communicable diseases (3% - e.g. HIV and TB), and injuries (3%). In multivariate logistic regression, responders with chronic communicable disease (OR=5.91, 95% CI: 1.44, 24.32) and non-communicable disease (OR=2.85, 95% CI: 1.96, 4.14) had significantly higher odds of using health care compared with those with acute conditions. Responders with six or more years of education had a two-fold increased odds of using health care (OR=2.49, 95% CI: 1.27, 4.86) compared with those with no formal education. CONCLUSION: Chronic communicable and non-communicable diseases were the most prevalent and main predictors of HCU in this population, suggesting prioritisation of public health care services for chronic diseases among older people in this rural setting

Laboratory simulation of cometary x rays using a high-resolution microcalorimeter

X-ray emission following charge exchange has been studied on the University of California Lawrence Livermore National Laboratory electron beam ion traps EBIT-I and EBIT-II using a high-resolution microcalorimeter. The measured spectra include the K-shell emission from hydrogenlike and heliumlike C, N, O, and Ne needed for simulations of cometary x-ray emission. A comparison of the spectra produced in the interaction of O8+ with N2 and CH4 is presented that illustrates the dependence of the observed spectrum on the interaction gas.Comment: 11 pages, 2 figure

Гераклиты – карбонатные образования газовых источников и грязевых вулканов миоцена

Морфологические признаки, минералогия, геохимия и состав газовой фракции гераклитов подтвердили их генетическую общность с современными карбонатными образованиями метановых источников и грязевых вулканов Черного моря. Присутствие в гераклитах битумов, метана и этана может служить индикатором наличия нефти и газа на Гераклейском полуострове и прилегающему к нему шельфе.Морфологічні ознаки, мінералогія, геох!мія i склад газової фракцїї гераклитів підтвердили їх генетичну спільність із сучасними карбонатними утвореннями метанових джерел i грязьових вулканів Чорного моря. Присутність у гераклітах бітумів, метану i етану може слугувати як індикатор наявності нафти й газу на Гераклейськом niвocтpoвi i прилеглому до нього шельфі.Morphological attributes, mineralogy, geochemistry and structure of gas fraction Geraklit have confirmed their proximity to modern carbonate formations of methane sources and mud volcanoes in the Black sea. Presence of bitumen, methane and ethane in Geraklites serves as indicator of occurence of oil fields and gas on the Geraklejskij peninsula and adjoining to them a shelf

HI in the Outskirts of Nearby Galaxies

The HI in disk galaxies frequently extends beyond the optical image, and can trace the dark matter there. I briefly highlight the history of high spatial resolution HI imaging, the contribution it made to the dark matter problem, and the current tension between several dynamical methods to break the disk-halo degeneracy. I then turn to the flaring problem, which could in principle probe the shape of the dark halo. Instead, however, a lot of attention is now devoted to understanding the role of gas accretion via galactic fountains. The current $\rm \Lambda$ cold dark matter theory has problems on galactic scales, such as the core-cusp problem, which can be addressed with HI observations of dwarf galaxies. For a similar range in rotation velocities, galaxies of type Sd have thin disks, while those of type Im are much thicker. After a few comments on modified Newtonian dynamics and on irregular galaxies, I close with statistics on the HI extent of galaxies.Comment: 38 pages, 17 figures, invited review, book chapter in "Outskirts of Galaxies", Eds. J. H. Knapen, J. C. Lee and A. Gil de Paz, Astrophysics and Space Science Library, Springer, in pres

Sleepwalking into lock-in? Avoiding wrongs to future people in the governance of solar radiation management research

This paper argues for two ways in which we can avoid the reckless endangerment of future people in the governance of solar radiation management (SRM) research, which could happen through lock-in to SRM deployment from research. SRM research is at an early stage, one at which the mechanisms of lock-in could start to operate. However, lock-in fit to endanger future people could be slowed or stopped through targeted governance. This paper argues that governance of SRM research that does not include provisions to detect, slow, or stop lock-in fails the test of an intergenerationally adequate precautionary principle, and that research governed without these provisions cannot itself be justified as a precaution against the impacts of climate change

Modeling Combination Interventions to Prevent Human Immunodeficiency Virus in Adolescent Girls and Young Women in South Africa (HIV Prevention Trials Network 068)

Background: Combination interventions may be an effective way to prevent human immunodeficiency virus (HIV) in adolescent girls and young women. However, current studies are not designed to understand which specific interventions and combinations will be most effective. We estimate the possible impacts of interventions on a combination of factors associated with HIV. Methods: We used the g-formula to model interventions on combinations of HIV risk factors to identify those that would prevent the most incident HIV infections, including low school attendance, intimate partner violence, depression, transactional sex, and age-disparate partnerships. We used data from the HIV Prevention Trials Network (HPTN) 068 study in rural South Africa from 2011 to 2017. We estimated HIV incidence under a potential intervention that reduced each risk factor and compared this to HIV incidence under the current distribution of these risk factors. Results: Although many factors had strong associations with HIV, potential intervention estimates did not always suggest large reductions in HIV incidence because the prevalence of risk factors was low. When modeling combination effects, an intervention to increase schooling, decrease depression, and decease transactional sex showed the largest reduction in incident infection (risk difference,-1.4%; 95% confidence interval [CI],-2.7% to-.2%), but an intervention on only transactional sex and depression still reduced HIV incidence by-1.3% (95% CI,-2.6% to-.2%). Conclusions: To achieve the largest reductions in HIV, both prevalence of the risk factor and strength of association with HIV must be considered. Additionally, intervening on more risk factors may not necessarily result in larger reductions in HIV incidence

The rms-flux relations in different branches in Cyg X-2

In this paper, the rms-flux (root mean square-flux) relation along the Z-track of the bright Z-Source Cyg X-2 is analyzed using the observational data of Rossi X-ray Timing Explorer (RXTE). Three types of rms-flux relations, i.e. positive, negative, and 'arch'-like correlations are found in different branches. The rms is positively correlated with flux in normal branch (NB), but anti-correlated in the vertical horizontal branch (VHB). The rms-flux relation shows an 'arch'-like shape in the horizontal branch (HB). We also try to explain this phenomenon using existing models.Comment: Accepted for publication in Astrophysics & Space Scienc

Is the Sun Embedded in a Typical Interstellar Cloud?

The physical properties and kinematics of the partially ionized interstellar material near the Sun are typical of warm diffuse clouds in the solar vicinity. The interstellar magnetic field at the heliosphere and the kinematics of nearby clouds are naturally explained in terms of the S1 superbubble shell. The interstellar radiation field at the Sun appears to be harder than the field ionizing ambient diffuse gas, which may be a consequence of the low opacity of the tiny cloud surrounding the heliosphere. The spatial context of the Local Bubble is consistent with our location in the Orion spur.Comment: "From the Outer Heliosphere to the Local Bubble", held at International Space Sciences Institute, October 200

Prevalence and Associations, by Age Group, of IPV Among AGYW in Rural South Africa

The prevalence of intimate partner violence (IPV) is alarmingly high among South African adolescent girls and young women (AGYW). Limited data exist exploring how IPV prevalence and its risk factors differ by age. Study data were from the baseline visit of HPTN 068, a randomized controlled trial (RCT) conducted from 2011 to 2015 in Mpumalanga, South Africa. A cohort of 2,533 AGYW, aged 13 years to 20 years, answered survey questions on demographics and behaviors, including their experiences of physical and sexual violence ever and in the past 12 months. We calculated the prevalence of IPV and related risk factors, as well as prevalence ratios with 95% confidence intervals, stratified by age. Nearly one quarter (19.5%, 95% CI = [18.0, 21.2]) of AGYW experienced any IPV ever (physical or sexual) by a partner. The prevalence of any IPV ever among AGYW aged 13 years to 14 years, 15 years to 16 years, and 17 years to 20 years was 10.8%, 17.7%, and 32.1%, respectively. Key variables significantly associated with any IPV ever across all age groups included borrowing money from someone outside the home in the past 12 months, ever having had vaginal sex, ever having had anal sex, and consuming any alcohol. Few statistically significant associations were unique to specific age groups. The history of IPV among the youngest AGYW is a critical finding and should be a focus of prevention efforts

Community collective efficacy is associated with reduced physical intimate partner violence (IPV) incidence in the rural province of Mpumalanga, South Africa: Findings from HPTN 068

Background Intimate partner violence (IPV) is a human rights violation and is associated with a variety of adverse physical and mental health outcomes. Collective efficacy, defined as mutual trust among community members and willingness to intervene on the behalf of the common good, has been associated with reduced neighbourhood violence. Limited research has explored whether community collective efficacy is associated with reduced incidence of IPV. This is of particular interest among adolescent girls and young women (AGYW) in sub-Saharan Africa, where the burden of HIV is greatest and IPV is common. Methods We collected longitudinal data among 2533 AGYW (ages 13-20) enrolled in the HPTN 068 cohort in Mpumalanga province, South Africa between 2011 and 2016. We included participants from 26 villages where community surveys were collected during the HPTN 068 study. Collective efficacy was measured at the village level via two population-based cross-sectional surveys in 2012 and 2014. Multivariable Poisson generalised estimating equation regression models estimated the relative risk ratio (RR) between village collective efficacy scores and subsequent physical IPV 12 month incidence, adjusting for village-level clustering and covariates. Results Thirty-eight per cent of the cohort (n=950) reported at least one episode of recent physical IPV during follow-up. For every SD higher level of collective efficacy, there was a 6% lower level of physical IPV incidence (adjusted RR: 0.94;95% CI 0.89 to 0.98) among AGYW after adjusting for covariates. Conclusions Community-level interventions that foster the development of collective efficacy may reduce IPV among AGYW