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Introduction Tenofovir Disoproxil Fumarate (TDF) is the most widely used Anti-Retroviral Therapy (ART) drug due to its potency, safety profile and World Health Organization (WHO) recommendation. TDF causes proximal tubular renal dysfunction (PTRD) leading to Fanconi syndrome, acute kidney injury and chronic kidney disease. Modest rates (2–4%) of TDF related toxicity based on estimated Glomerular Filtration Rate (GFR) have been described, while TDF-induced PTRD has been reported to be 22%. TDF toxicity is more likely among African patients, it is reversible and TDF may be renal dosed in patients with dysfunction. The objective of this study was to assess proximal tubular renal dysfunction, global renal function, and their determinants among patients on TDF versus TDF-sparing regimen. Methods This was a cross-sectional study among people living with HIV/AIDS (PLWHA) attending the Academic Model Providing Access to Healthcare (AMPATH) program. The primary outcome of interest in this study was PTRD while the secondary outcome of interest was estimated GFR. PTRD was defined as any two of beta-2 microglobulin in urine, metabolic acidosis, normoglycemic glucosuria and fractional excretion of phosphate. Student’s t-test, chi-square and their non-parametric equivalents were used to test for statistical significance. Univariate and multivariate logistic regression analysis was carried out. Results A total of 516 participants were included in the final analysis, 261 on TDF while 255 were on TDF-sparing regimens. The mean (SD) age of all participants was 41.5 (12.6) years with majority being female (60.3%). The proportion of PTRD was 10.0% versus 3.1% in the TDF compared to TDF-sparing group (P3 (P = 0.20) for the TDF compared to TDF-sparing group. TDF users were more likely to have PTRD compared to non-TDF users, adjusted Odds Ratio (AOR) 3.0, 95% CI 1.12 to 7.75. Conclusion There was significant PTRD in the TDF compared to TDF-sparing group without significant difference in estimated GFR. The clinical significance of these findings may not be clear in the short term.

This chapter discusses the educational system in Sweden. In 1940, the Conservative Minister of Education in Sweden appointed a School Committee representative of experts from school and universities. The question of creating a connection between elementary and secondary schooling soon became central to the work of the Committee. The elementary school teachers wished to extend common schooling, whereas the secondary school teachers favored the traditional parallel system that allowed them to teach in a selective lower secondary school. The familiar arguments for early transfer of pupils to a selective school were repeated—that pupils could pass the public school examinations earlier, that scholastic abilities were detectable at the age of 11 or 12, that the intellectual development that took place at that age gave the opportunity for prompt introduction to a more academic curriculum, and that greater homogeneity in the school would make teaching easier and more profitable. In 1957, another School Commission was appointed, which carried out further investigations and produced its main report in 1961, fortunately available at some length for readers of English in J. Orring's work, Comprehensive School and Continuation Schools in Sweden . What had started as an experiment had become a changeover in system of schools; in 1949, 14 school districts with 2,483 pupils were involved, but by the end of 1961, some 330,000 pupils in 295 districts were at work with the nine-year school.

This chapter discusses the educational system in Denmark. Denmark is very conservative in its approach to the reorganization of the structure of the school system. Rural interests have been strongly represented in Parliament by Venstre , the farmers' party, which has led the opposition to raise the school-leaving age and to reorganization, which would lead to the end of the traditional village school. Compulsory education commences at the beginning of the school year for children who have reached seven years of age, and ceases at the end of the school year when they are 14 years of age. A child who reaches seven years of age during the first six months of the school year may be admitted to school on request by the parents and according to the availability of a room. School attendance is not compulsory. Private schools are recognized by the authorities if they fulfill many specified conditions, which makes then indistinguishable from public schools in pattern of schooling.

This chapter discusses the traditional and contemporary policy of Scandinavia. The most important historical influence on education in Scandinavia has been the Lutheran religion. The Reformation Statutes of the 1530s established a system of schooling that survived with little alteration until the end of the 19th century. Clergy supervision or participation in the administration of education survived until 1933 in Denmark and 1958 in Sweden, and it still plays a limited role in Norway. Religion is a compulsory subject today in all schools, and though the family may no longer go to church on Sundays, the role of the family in education is conceived in terms of the Lutheran tradition. Lutheranism accepted the supremacy of the State, and as it became the religion of all the people except for an insignificant minority, State and Church were one foundation. All education was supervised by the clergy for at least three reasons; the purpose was to train persons for the Church and teach religious instruction, the minor offices of the Church were to be used to support or supply teachers, and the clergy were the only persons able to provide a universal system of administration. After 1945, the policy regarding education was to be formulated coherently to take account of all contemporary circumstances and in the light of help from educational research.

This chapter discusses economics of education, kindergarten problems, education and training, reform of administration, national policy and planning, social problems, and international cooperation in Scandinavia. In Denmark, from 1950 to 1960, the total annual cost of operating the educational services rose from about £20 million to about £60 million, a trebling of the cost at a time when the gross national product doubled. Operating costs for education in 1960 already amounted to about 20% of total public civil operating expenditure, according to the major Danish report on the subject, Undervisningsbyggeri og Laererbehov , 1961–80. This report, published in January 1962, summarized all expansion programs and forecasts. The Norwegian long-term program for 1962–5 provided for the erection of new school buildings at a cost of £55 million at 1960 prices. Total gross investment in the nine-year school plan was estimated at £30 million, with a further £25 million for schools of further education. Estimates of operating costs varied, but they seemed likely to double within a decade.

This chapter focuses on Scandinavia. Scandinavia is usually mentioned in conversation as though it were one country, whenever the talk is about modern architecture or furniture, social welfare, or political democracy, and there are many reasons why Denmark, Norway, and Sweden may be regarded as a single expression of a way of life. When these three countries are linked with Finland and Iceland, they become part of a larger association called Norden—a larger unity. These countries share a common history, common traditions in law and customs, and the same religious background; the people live under similar responsible parliamentary governments, and hold similar views on action by the State or voluntary cooperative agencies in economic affairs, Metaphorically and literally, they speak the same language with minor variations.

This chapter discusses the social policies of Scandinavia. Scandinavia is usually regarded as a part of the world where there are few class distinctions. The stated aim in Scandinavia carried out by taxation policy is to bracket incomes so that there are no poor and no inordinately rich. A progressive income tax secures a more equal distribution of the national income and consumption. Taxes absorb a substantially growing proportion of the national income to provide, in particular, for expanding social services, which in Denmark rely on insurance contributions for less than 20 percent of financial support. Taking an example from Sweden, which as the richest of the Scandinavian countries is the one in which great differences in income might develop, figures for the 1961 tax year show that 10.2 percent of income earners had incomes of over £1,500 a year, 17.8 percent had annual incomes between about £1,000 and £1,500, 32.5 percent had incomes between £490 and £1,000, and the rest had lower cash incomes but often lived in rural areas where income assessments for tax purposes were no clear indication of a standard of living.

Publisher Summary This chapter discusses the land utilization, natural resources, population, economic policy, emigration, economic activity, and occupational structure of Scandinavia. Metropolitan Denmark has an area of about 17,000 square miles and is situated between latitudes 54° and 57°N., the latitudes of Scotland or Labrador. The largest land mass is the peninsula of Jutland, and the two main islands are Zealand, on which Copenhagen is situated, and Funen. Norway has an area of about 124,700 square miles, but area by itself has little meaning when it lies between latitudes 57° and 71°N., with a length in direct line from north to south of nearly 1,100 miles. For two-thirds of this length, the land is a narrow coastal region fret worked by the sea—an unforgettable tangle of rocky islands, fiords, and mountains with upland plateau, through which the sea is the most convenient means of communication. Again, the Gulf Stream has a marked effect on climate, giving a winter thermal anomaly of at least 10 degrees, so that ports are ice-free even in the vicinity of North Gape. Sweden is the largest Scandinavian country, about twice the size of Great Britain or Minnesota, with an area of 173,378 square miles, situated between latitudes 55° and 69°N.

This chapter discusses the party politics, central government, local government, and educational administration of Scandinavia. As far as social security and state action in economic affairs are concerned, almost all the countries of Western Europe have since 1945 accepted that the State must play a much larger part in the direction of these affairs. In Norway, the Labor party is the main political party and puts forward policies similar to those already described in the manifesto of the Danish Social Democrats. After 24 years in office, the Labor Government was defeated in 1963, on a censure motion about the management of state-owned industries. Denmark has 25 county authorities further subdivided into 1,300 rural districts. Copenhagen is controlled by an elected town council, which appoints an executive of the chief mayor, five other mayors, and five aldermen for day-to-day administration.

This chapter discusses education in Norway. It discusses the Folkschool, which is a traditional elementary or primary school. The purpose of the Folkschool is clearly set out in the first paragraphs of the law: “The task of the school, together with the home, is to work to make the pupils become good members of the community. The school shall help to give pupils a Christian and moral upbringing, develop their abilities and aptitudes, and give them a good general knowledge, so that they may become useful human beings both physically and mentally.” The immediate recognition of cooperation with the home and good of the community should be noted. Religious bodies objected during the debate on the Act to the relegation of “Christian and moral upbringing” to the second sentence, instead of being placed first in declaration as had been traditional.