Population pharmacokinetics and pharmacodynamics of lumefantrine in young Ugandan children treated with artemether-lumefantrine for uncomplicated malaria

Background. The pharmacokinetics and pharmacodynamics of lumefantrine, a component of the most widely used treatment for malaria, artemether-lumefantrine, has not been adequately characterized in young children. Methods. Capillary whole-blood lumefantrine concentration and treatment outcomes were determined in 105 Ugandan children, ages 6 months to 2 years, who were treated for 249 episodes of Plasmodium falciparum malaria with artemether-lumefantrine. Results. Population pharmacokinetics for lumefantrine used a 2-compartment open model with first-order absorption. Age had a significant positive correlation with bioavailability in a model that included allometric scaling. Children not receiving trimethoprim-sulfamethoxazole with capillary whole blood concentrations <200 ng/mL had a 3-fold higher hazard of 28-day recurrent parasitemia, compared with those with concentrations >200 ng/mL (P =. 0007). However, for children receiving trimethoprim-sulfamethoxazole, the risk of recurrent parasitemia did not differ significantly on the basis of this threshold. Day 3 concentrations were a stronger predictor of 28-day recurrence than day 7 concentrations. Conclusions. We demonstrate that age, in addition to weight, is a determinant of lumefantrine exposure, and in the absence of trimethoprim-sulfamethoxazole, lumefantrine exposure is a determinant of recurrent parasitemia. Exposure levels in children aged 6 months to 2 years was generally lower than levels published for older children and adults. Further refinement of artemether-lumefantrine dosing to improve exposure in infants and very young children may be warranted. © 2016 The Author.

Young adults’ perceptions of and affective bonds to a rural tourism community

Many rural areas, in Sweden and worldwide, experience population decline where the young leave for education and work in urban areas. Employment has declined in several rural industries, such as agriculture, forestry, and fishing, while growing in other industries are often located in urban areas. Politicians and organizations have put much hope in tourism as a tool of rural development, but can tourism help reverse the rural out-migration trend among young adults? This paper explores how tourism affects young inhabitants’ perceptions of and affective bonds to a rural area in Sweden, the ski resort of Sälen. Students from the 1993–1995 elementary school graduating classes were interviewed about their migration history, childhood, and view of and ties to Sälen. The respondents experience that tourism contributes to a more vital community incorporating influences from elsewhere, but without eliminating the positive aspects of rural life. The regular flow of people – tourists, seasonal workers, and entrepreneurs – passing through Sälen presents opportunities to extend one’s social network that are widely appreciated by respondents. The high in and out mobility constitutes a key part of Sälen’s character. Contributions from tourism – such as employment, entertainment, leisure, and opportunities to forge new social relationships – are available during the adult transition, the life phase when rural areas are often perceived as least attractive. Even though out-migration occurs in Sälen, and some respondents still find Sälen too small, tourism has clearly increased the available opportunities and contributed significantly to making Sälen more attractive to young adults.

Young adults in rural tourism areas

This thesis examines how tourism affects conditions for young adults in rural areas. Such a study lies at the intersection of research about tourism impacts, adult transition, and rural areas. The aim is to examine how largescale tourism affects the opportunities for young adults living in rural areas; their perception of place and the perceived opportunities and obstacles that tourism provides. The thesis utilizes a mixed method approach. A quantitative study based on micro-data on individuals identifies the patterns and magnitudes of the mechanisms by which tourism affects population change among young adults. Interview methods are used in the case study area, Sälen, to investigate these mechanisms in depth. Finally, the rural–urban dichotomy is explored in a conceptual study that asks how tourism affects the perception of a local village as either rural or urban. Young inhabitants in rural areas are rarely considered in tourism research; therefore, the main contribution of this thesis is that it illuminates how tourism affects conditions for young adults in rural areas. The thesis reveals a substantial impact on the adult transition, mainly due to easier access to the labor market and a good supply of jobs during the high season. Further, the large number of people passing through creates flows of opportunities to make friends, get a job, or just meet people. All of these factors contribute to high mobility in these places, and to the perception of them as places where things happen. The high mobility in Sälen implies that fixed migrant categories (such as stayers and leavers) are largely insufficient. The tourism environment creates a space that is always under construction and continually producing new social relations mainly perceived as opportunities. Conceptualizing this as a modern rurality is a way to move beyond the often implicit notions of urban as modern and rural as traditional.