Search

Describes a study that analyzed how students in three different Swedish university programs conceived of the meaning of problem-based learning and how they experienced their studies within a problem-based learning program. Discusses learning in context, social interaction, meta-cognitive reasoning and self-directed learning, and academic cultures. (Author/LRW)

Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2-4h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour. A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt. Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls. Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have. Keywords: Suicidal behaviour; Adolescent girls; Nicaragua; Perceived causes of suicide; Grounded theory; Content analysis

In order to deepen the understanding of risk factors associated with HIV infection in the Kagera region of Tanzania and to investigate the potentials of communicating with the people in planning for interventions, two studies were performed in the districts of Bukoba Urban, Bukoba Rural and Muleba in 1989. The HIV prevalence of these areas ranged between 4.5% and 24.2% according to the prevalence study performed earlier in 1987. The studies involved the community in ward meetings on the one hand, and previously studied individuals on the other hand. The studies aimed both at conveying to the people the results of a previously performed study and at collecting new data using a combination of quantitative and qualitative methods in order to better understand the associated risk factors, perceived or real, and what suggestions the community could offer for reducing HIV transmission in the region. From the initial study, awareness about AIDS was found to be universal. Change of sexual partners and infection with syphilis were found to be the major risk factors for HIV-1 infection. From the ward meetings people suggested a variety of solutions for interventions which we have categorized as either 'hard' or 'soft'. The 'hard' solutions involved suggestions such as isolation, imprisonment, castration and killing of AIDS victims, while the 'soft' solutions involved sympathetic handling of the sick and educating the people about the modes of transmission and how best to prevent infection. There was a greater tendency for the low HIV prevalence rural communities to suggest the 'hard' solutions than the high HIV prevalence urban ones which tended to suggest the 'soft' solutions. However, with the changing dynamics of HIV infection in the region towards higher HIV prevalence in rural areas, it is likely that the 'soft' solutions will gain acceptance and become adopted for interventions throughout the region. The information obtained from these studies has provided lessons that can be used for rational counselling as well as for guiding the implementation of IEC activities geared at interventions. It is also suggested that there should be further research into new strategies or their combinations which could be crucial in prevention such as those of community participation, empowerment of women and solidarity in AIDS intervention work. Key words - risk factors, HIV infection, feedback study, perceived risk, community participation, Tanzania

A population-based study on the prevalence of HIV-1 infection in the Kagera region was performed in 1987. The study was based on a multistage cluster sampling technique covering the age-group 15-54 years. The study showed considerable variation of prevalence of HIV-1 infection in the areas studied. A total of 2475 adults were studied and the overall prevalence of HIV-1 infection in the region was 9.6% with a higher prevalence in the urban area (24.2%) compared to that in the rural areas (4.9%). In the present analysis, information on individuals collected during the prevalence study has been used to characterize smaller geographical areas of several villages (wards) and to form the basis for an aggregated analysis of geographical and social patterns relevant to HIV-1 transmission in the studied areas of the region. Kagera region is a heterogeneous society with respect to, for example, religion, ethnic groups and family patterns. There was a moderately strong positive correlation between HIV-1 prevalence and frequent change of sexual partners on the ward level. In Bukoba town the prevalence varied remarkably among the wards, with the lowest prevalence in the ward having the highest social status. In the rural areas, however, the prevalence in the wards decreased considerably with increasing distance from Bukoba town. This aggregated analysis of socio-geographical patterns of HIV-1 transmission characteristics has provided us with information for prioritizing areas of HIV/AIDS intervention in the Kagera community.

Summary: Background: Although extracorporeal shockwave therapy (ESWT) is a common treatment for horses with back pain, effects on mechanical nociceptive threshold (MNT) and multifidus muscle cross sectional area (CSA) in the spine are unknown. Objectives: To evaluate effects of ESWT on spinal MNT and multifidus muscle CSA in horses with thoracolumbar pain. Study design: Non‐randomised trial. Methods: Thoracolumbar spines of 12 horses with thoracolumbar pain were radiographed to document existing pathology. Each horse received three ESWT treatments, 2 weeks apart (days 0, 14, 28). Palpation scores were documented (days 0, 45 and 65). Ultrasonographic CSA of left and right multifidus muscles was recorded at T12, T14, T16, T18, L3 and L5 (days 0, 45 and 65). MNT was measured at the same spinal sites every 7 days (day 0–56). Results: Mechanical nociceptive threshold in 10/12 horses (83%) was greater at each time point compared with day 0 (P < 0.05). Mechanical nociceptive threshold increased at all time points at six sites in 2/12 (16%), at five sites in 3/12 (25%), at four sites in 4/12 (33%) and at one site in 1/12 (8%; P < 0.05). Mechanical nociceptive threshold average per cent increase from day 0 to 56 was 64% for the thoracic region (T12–T18) and 29% for the lumbar region (L3–L5). There was no statistical difference in MNT from day 35 to 56 (P = 0.25). A bimodal analgesic trend was observed following ESWT. Degree of radiographic change was not associated with response to treatment. No significant change in multifidus muscle CSA was observed. Main limitations: Small study size and lack of control group. Conclusions: Three treatments of ESWT 2 weeks apart raised MNT over a 56‐day period in horses with back pain, but did not influence change in CSA of the multifidus muscle. While ESWT appears justifiable for analgesia, physiotherapeutic techniques may be necessary in conjunction for concurrent muscle rehabilitation. [ABSTRACT FROM AUTHOR]

Department of Anthropology, University of New Hampshire, U.S.A. Division of Epidemiology, Department of Public Health and Clinical Medicine, University of Umea, Sweden Department of Kiswahili, University of Dar-Es-Salaam, Tanzania Department [...]

Pallister-Hall syndrome (PHS) is a rare malformative disorder that is due to truncating functional repressor mutations in GLI3. Since the seminal publication in 1980, hypothalamic tumors have been recognized to be a cardinal feature of PHS. In their original description of the neuropathologic features of PHS, Clarren et al. coined the term “hamartoblastoma” to characterize what they deemed to be a dual malformative and neoplastic mass of the hypothalamus. In subsequent published cases/series of PHS, the term “hamartoma” was often substituted for hamartoblastoma given what appeared to be a benign natural history of this lesion. Additional confusion in the literature has ensued since most hypothalamic hamartomas (HH) encountered on the clinical neuropathology service are “isolated” in nature (ie, no other congenital malformations) and present in a very different and stereotypical fashion with gelastic seizures and/or precocious puberty. While genomic investigations of isolated HH have begun to uncover a mutational profile of these cases, GLI3 mutations have only been recognized in a small subset of isolated HH. Herein, we describe the autopsy findings from a 21-week gestational age fetus with features of PHS. Moreover, we provide a detailed description of the hypothalamic tumor affecting this fetus and propose a novel subclassification of HH, distinguishing syndromic from isolated forms based upon the presence or absence of neocortical-like areas. [ABSTRACT FROM AUTHOR]