Evaluating postcranial macromorphoscopic traits to estimate population variation among modern South Africans

Population overlap and the variation within and among populations have been globally observed but is often difficult to quantify. To achieve this, numerous different methods need to be explored and validated to assist with the creation of an accurate biological profile. The current lack of databases for postcranial macromorphoscopic traits indicates the need to further investigate if the method can be employed repeatably in a forensic context. The current study aimed to assess the prevalence of eleven postcranial macromorphoscopic traits in a South African sample. A total of 271 postcrania of adult black, coloured, and white South Africans were assessed. The intra- and inter-observer agreement ranged from fair to almost perfect except for the accessory transverse foramen of C1, which had poor agreement between observers. Only seven traits differed significantly between at least two of the groups. Univariate and multivariate random forest models were created to test the positive predictive performance of the traits to classify population affinity. The classification accuracies for the univariate models ranged from 33.3% to 53.0% and ranged from 54.6% to 62.1% for the multivariate models. Based on the variable importance, the traits assessing spinous process bifurcation were the most discriminatory variables. The results indicate that the postcranial MMS approach does not outperform current methods employed to estimate population affinity. Further research needs to be done for the method to have practical applicability for medicolegal casework in South Africa.

Two-eyed Seeing for youth wellness: Promoting positive outcomes with interwoven resilience resources

Despite the challenges facing Indigenous youth and their communities due to historical and contemporary institutionalised racism in Canada, communities are drawing on the richness of their own histories to reassert their cultural heritage. Doing so supports mental health outcomes of young people in particular, as highlighted in a compelling body of research. The question facing many communities, however, is how they can facilitate such child and youth engagement in order to support related positive mental health outcomes. This article reports on findings from a Participatory Action Research (PAR) study conducted in a First Nations community in Unama'ki (Cape Breton), Atlantic Canada. The study, Spaces & Places, was a partnership between the community-based mental health service provider (Eskasoni Mental Health Services, EMHS), eight community youth (14-18 years old), and a team of academics. Situated within a resilience framework, the team explored the ways in which the community facilitated, or restricted, youth civic and cultural engagement. Foregrounded against a strong legacy of cultural reassertion within the community, findings highlight the core resilience-promoting resources that support positive youth development. Additionally, findings demonstrate how these resources provide meaningful support for youth because of the way in which they are intertwined with one another. Furthermore, cultural engagement is underpinned by the Two-eyed Seeing model, supporting youth to integrate their own culture with settler culture in ways that work best for them. Findings support community-based service structures, and underscore the importance of community resilience in the effective support of Indigenous children and youth.

Photovoice and Being Intentional About Empowerment

The intent of Photovoice is to produce research in collaboration with communities, ensuring that research is relevant to community needs and critically facilitates change required to address these needs. Accordingly, Photovoice extends research for knowledge production, emphasizing research for social change. Consequently, Photovoice stands to make an important contribution to relevant and impactful knowledge production with health promotion research. However, if the intent of Photovoice as reflected in its theoretical underpinnings is not accounted for from the outset, the value of the approach may not be fully realized. This article considers what the theoretical underpinnings of Photovoice are, how this relates to issues of power and empowerment theory, and how voice can be better ensured within a process that is intentional about empowerment and representation.

A Photovoice Exploration of the Lived Experience of Intersectional Stigma among People Living with HIV

Stigma research among people living with HIV (PLWH) has been increasingly interpreted through the framework of intersectionality, which comprehends the interwovenness of vulnerable individuals' identities. However, community-based participatory methods have not been widely employed to better understand these forms of stigma through an intersectional lens, despite such methods offering the opportunity for participants to define issues and solutions from their lived experiences. To advance this research, we employed photovoice to elicit grounded, visceral definitions of stigma for PLWH. Participants took pictures representing their identities and experiences with HIV and other stigmas and discussed them in groups and individual interviews, ultimately creating a virtual exhibit to educate and inspire others. Theme and narrative analysis uncovered patterns in the visual and textual data, revealing participants' experiences of HIV stigma based on their intersections of sexuality, race/ethnicity, illness, and roles and expectations in specific scenarios. Stigma also fostered the development of participants' strengths, such as resiliency, and new identities, such as educators. Participatory methods like photovoice, where participants can define intersectionality on their own terms, can help direct interventions to limit the PLWH's lived stigmas and increase effective coping.

Reconsidering interactive resilience processes in mental health: Implications for child and youth services

Research consistently demonstrates resilience as an interactive process, drawing on personal assets together with relational and contextual resources, to support improved outcomes in contexts of nonnormative adversity. What remains unclear are the dynamics of this process and what drives it. This article draws on a prior scoping review of the literature to conceptually explore the positioning of the individual within this dynamic interplay of risks, resilience, and sociocultural context as it pertains to child and youth mental health. The paper begins by summarizing findings from this scoping review, highlighting core resilience elements and processes. These are then considered in relational to the global meaning theory, situating meaning-making as a key mechanism that mediates the interaction between individuals and their ecologies. Drawing on the literature, this article considers how this interaction shapes the particular ways in which resilience then manifests itself in the lives of individuals and becomes available as a resource to assist in the promotion of mental health.

Adaptation and Psychometric Properties of the Spanish Version of Child and Youth Resilience Measure (CYRM-32)

Resilience is defined as a dynamic process that entails a positive adaptation to contexts of adversity. According to the ecological model, resilient behavior emerges as a result of the interaction between individual, relational, community and cultural variables. The Child and Youth Resilience Measure (CYRM-28), developed in Canada and based on the ecological model, has been validated in several countries. The objective of this article is to present the cultural adaptation (studies I and II) and validation (study III) in Spanish at risk youth. A three-study mixed-method design was selected. Study I includes translations and a confirmatory and exploratory factor analysis of a sample of 270 Spanish young persons (56.9% boys) aged between 12 and 18 years (M = 14.65; SD = 1.27) from an urban public elementary school. Study II uses semi-structured interviews with adolescents identified as resilient and presents a content analysis and a reformulation of items with experts. Study III includes the confirmatory factor analysis, internal consistency, test-retest, convergent and discriminant validity, and multivariate analysis of variance to explore group differences of the resulting scale CYRM-32. The sample consisted of 432 at-risk young persons (54.9% boys) aged between 12 and 19 years old (M = 14.99; SD = 2.23). The results confirm the adequate psychometric properties of the CYRM-32 scale. From the original scale, 4 items were eliminated, 5 were reformulated presenting very low saturations. Meanwhile, 6 items were added to the cultural adaptation phase, resulting in a 32-item scale. The confirmatory analysis confirms the 3 factors expected in the CYRM-32 scale with good reliability indexes (Cronbach's α total scale 0.88, family interaction 0.79, interaction with others 0.72 and individual skills 0.78). The scale has convergent and discriminant validity in relation to the Brief Resilient Coping Scale, Coping Scale for Adolescents and Self-Concept. Significant differences were found in the scores of the CYRM-32 scale for the ethnic variable [F(71. 358) = 1.714, p < 0.001], while no differences appear according to age and gender. This finding confirms the importance of culture in the resiliency processes. The CYRM-32 scale has good psychometric properties and is a new alternative for measuring resilience in Spanish at-risk youth.

Eskasoni First Nation's transformation of youth mental healthcare: Partnership between a Mi'kmaq community and the ACCESS Open Minds research project in implementing innovative practice and service evaluation

AIM

ACCESS Open Minds (ACCESS OM) is a pan-Canadian project aimed at improving youth mental healthcare. This paper describes implementation of the ACCESS OM objectives for youth mental health service transformation within a pre-existing Fish Net Model of transformative youth mental healthcare service in the First Nation community of Eskasoni, on Canada's east coast.

METHODS

We describe an adaptation of the ACCESS OM service transformation objectives through the complementary blending of Indigenous and Western methodologies. This concept of "Two-Eyed Seeing" is illustrated as central to engaging youth in the community and attending to their mental health needs and wellness.

RESULTS

The ACCESS OM Eskasoni First Nation Youth Space acts as a central location for the site team and its activities, which expand into the rest of the community to facilitate early identification of youth in need. Rapid access to care is promoted via barrier-free availability through a central intake crisis and referral centre, and ease of contact through social media and other modalities. Youth are given the choice between standard Western mental health services, or Indigenous methods of improving well-being, or a combination of the two.

CONCLUSIONS

The ACCESS OM framework has shown early results of being a positive addition to the Eskasoni community. Local leadership and community buy-in are identified as key factors to success. Further exploration, research, and evaluation of this transformation is ongoing. Successful implementation of this model in Eskasoni could act as a model for youth mental health programmes in other First Nations across Canada.

Restructuring Educational Systems and Promoting Social Justice for Young People Involved in Drug Trafficking in Brazil

Abstract. Economic changes in the context of globalization have left adolescents from Latin American contexts with few opportunities to make satisfactory transitions into adulthood. Recent studies indicate that there is a protracted period between the end of schooling and entering into formal working activities. While in this “limbo,” illicit activities, such as drug trafficking may emerge as an alternative for young people to ensure their social participation. This article aims to deepen the understanding of Brazilian youth’s involvement in drug trafficking and its intersection with their schooling, work, and aspirations, connecting with Sustainable Development Goals (SDGs) 4 and 16 as proposed in the 2030 Agenda for Sustainable Development adopted by the United Nations in 2015 .

Validity and reliability of the Mexican resilience measurement scale in families of children with chronic conditions

Background

The resilience to face disease is a process of positive adaptation despite the loss of health. It involves developing vitality and skills to overcome the negative effects of adversity, risks, and vulnerability caused by disease. In Mexico, the Mexican Resilience Measurement Scale (RESI-M) has been validated with a general population and has a five-factor structure. However, this scale does not allow evaluation of resilience in specific subpopulations, such as caregivers.

Method

This study investigated the psychometric properties of RESI-M in 446 family caregivers of children with chronic diseases. A confirmatory factor analysis (CFA) was performed, internal consistency values were calculated using Cronbach’s alpha coefficient, and mean comparisons were determined using t-tests.

Results

The expected five-factor model showed an adequate fit with the data based on a maximum likelihood test. The internal consistency for each factor ranged from .76 to .93, and the global internal consistency was .95. No average difference in RESI-M and its factors was found between women and men.

Conclusion

The RESI-M showed internal consistency and its model of five correlated factors was valid among family caregivers of children with chronic diseases.

Positive youth development practices and better outcomes for high risk youth

This paper reports on the findings from a New Zealand longitudinal study of outcomes for a group of high risk, service-using youth (13-21 years, n=495). Consistent use of positive youth development practices (PYD) (rather than the total number of services used) predicted better outcomes. Patterns of risk and resilience endured over time. Individual risks undermined outcomes while resilience had a significant positive impact on outcomes. Contextual risks predicted increases in individual risks, but service delivery that adopted PYD practices contributed to reductions in levels of contextual risks over time. Youth with higher individual and contextual risks were less likely to report PYD service experiences. Individual risks were highest for indigenous youth (Māori) at entry to the study, levels which dropped significantly over time. White (Pākehā) youth had the lowest resilience and highest contextual risks over the course of the study. These differential patterns in risks and resilience indicate a need for services to adapt their responses to youth based on ethnicity and overall study findings confirm that when used consistently across service systems PYD-oriented service delivery produces better outcomes for high risk youth.

"I Have Strong Hopes for the Future": Time Orientations and Resilience Among Canadian Indigenous Youth

In this article, we demonstrate how concepts of time and the future inform processes of resilience among Indigenous adolescents within an urban Canadian context. This study employed a modified grounded theory methodology by conducting 38 qualitative interviews with 28 Indigenous youth (ages 15-25) over the course of 1 year. The analysis revealed complex processes of and navigations between moments of distress and strategies for resilience. The distressing contexts in which Indigenous youth often find themselves can impact the development of their concepts of time and limit their abilities to conceptualize a future. A future time orientation (FTO) emerged as central to processes of resilience and was supported by (a) nurturing a sense of belonging, (b) developing self-mastery, and

Synthesis of high-purity precipitated calcium carbonate during the process of recovery of elemental sulphur from gypsum waste

We recently showed that the production of elemental sulphur and calcium carbonate (CaCO3) from gypsum waste by thermally reducing the waste into calcium sulphide (CaS) followed by its direct aqueous carbonation yielded low-grade carbonate products (i.e. <90 mass% as CaCO3). In this study, we used the insight gained from our previous work and developed an indirect aqueous CaS carbonation process for the production of high-grade CaCO3 (i.e. >99 mass% as CaCO3) or precipitated calcium carbonate (PCC). The process used an acid gas (H2S) to improve the aqueous dissolution of CaS, which is otherwise poorly soluble. The carbonate product was primarily calcite (99.5%) with traces of quartz (0.5%). Calcite was the only CaCO3 polymorph obtained; no vaterite or aragonite was detected. The product was made up of micron-size particles, which were further characterised by XRD, TGA, SEM, BET and true density. Results showed that about 0.37 ton of high-grade PCC can be produced from 1.0 ton of gypsum waste, and generates about 0.19 ton of residue, a reduction of 80% from original waste gypsum mass to mass of residue that needs to be discarded off. The use of gypsum waste as primary material in replacement of mined limestone for the production of PPC could alleviate waste disposal problems, along with converting significant volumes of waste materials into marketable commodities.

Patterns of individual coping, engagement with social supports and use of formal services among a five-country sample of resilient youth

BACKGROUND

Although resilience among victims of child abuse is commonly understood as a process of interaction between individuals and their environments, there have been very few studies of how children's individual coping strategies, social supports and formal services combine to promote well-being.

METHOD

For this study, we conducted a multi-phase analysis of a qualitative dataset of 608 interviews with young people from five countries using grounded theory strategies to build a substantive theory of young people's service and support use patterns. We started with an analysis of ten interviews (two from each country) and then compared these findings to patterns found in each country's full dataset.

RESULTS

The substantive theory that emerged explains young people's transience between individual coping strategies (cognitive and behavioral), reliance on social supports (family members, peers and teachers), and engagement with formal service providers whose roles are to provide interventions and case management. Young people's patterns of navigation were shown to be contingent upon the individual's risk exposure, his or her individual capacity to cope, and the quality of the formal and informal supports and services that are available and accessible.

CONCLUSION

Differing amounts of formal resources in low-, middle- and high-income countries influence patterns of service use. Implications for better coordination between formal mental health services and social supports are discussed.

The role of positive youth development practices in building resilience and enhancing wellbeing for at-risk youth

Services that utilise positive youth development practices (PYD) are thought to improve the quality of the service experience leading to better outcomes for at-risk youth. This article reports on a study of 605 adolescents (aged 12-17 years) who were concurrent clients of two or more service systems (child welfare, juvenile justice, additional education, mental health). It was hypothesised that services adopting PYD approaches would be related to increases in youth resilience and better wellbeing outcomes. It was also hypothesised that risks, resilience, service experiences and wellbeing outcomes would differ by age, gender and ethnicity. Youth completed a self-report questionnaire administered individually. Path analysis was used to determine the relationship between risk, service use, resilience and a wellbeing outcome measure. MANOVA was then used to determine patterns of risk, service use, resilience and wellbeing among participants based on their demographic characteristics. Services using PYD approaches were significantly related to higher levels of youth resilience. Similarly, increased resilience was related to increased indicators of wellbeing, suggesting the mediating role of resilience between risk factors and wellbeing outcomes. When professionals adopt PYD practices and work with the positive resources around youth (their own resilience processes) interventions can make a significant contribution to wellbeing outcomes for at-risk youth.

Conversion of calcium sulphide to calcium carbonate during the process of recovery of elemental sulphur from gypsum waste

The production of elemental sulphur and calcium carbonate (CaCO3) from gypsum waste can be achieved by thermally reducing the waste into calcium sulphide (CaS), which is then subjected to a direct aqueous carbonation step for the generation of hydrogen sulphide (H2S) and CaCO3. H2S can subsequently be converted to elemental sulphur via the commercially available chemical catalytic Claus process. This study investigated the carbonation of CaS by examining both the solution chemistry of the process and the properties of the formed carbonated product. CaS was successfully converted into CaCO3; however, the reaction yielded low-grade carbonate products (i.e. <90 mass% as CaCO3) which comprised a mixture of two CaCO3 polymorphs (calcite and vaterite), as well as trace minerals originating from the starting material. These products could replace the Sappi Enstra CaCO3 (69 mass% CaCO3), a by-product from the paper industry which is used in many full-scale AMD neutralisation plants but is becoming insufficient. The insight gained is now also being used to develop and optimize an indirect aqueous CaS carbonation process for the production of high-grade CaCO3 (i.e. >99 mass% as CaCO3) or precipitated calcium carbonate (PCC).

Multiple service use: the impact of consistency in service quality for vulnerable youth

Little is known about the way in which variations in service quality influence outcomes when youth are clients of more than one service system. This article reports on a study of 1,210 adolescents (aged 13-17 years), half were concurrent clients of two or more services and half were not involved in two or more services. Youth completed a self-report questionnaire administered by a trained interviewer. It was hypothesized that youth reporting two positive service experiences would report lower risks, higher resilience, and better outcomes than youth reporting inconsistent or two negative service experiences and that their resilience, risks, and outcomes would be similar to those of youth not involved in two or more services. MANCOVA was used to determine the relationship among service quality and resilience, risk, and outcomes with four covariates that assessed family and neighborhood environments, history of abuse and neglect, and chronic need. Results indicate that service quality had an effect on resilience, risks, and outcomes. These relationships were mediated quite strongly by the influence of the risks youth faced in their neighborhoods and to a lesser extent by the other three covariates. Of the three dependent variables, risk appeared to be the most consistently influenced by all the covariates, and it also differentiated service experience groups. Results point to the importance of services developing strategies to effectively address risks confronted by youth and also to ensure that when more than one service is involved with youth, consistency in service delivery is achieved.

Does cancer risk increase with HbA1c, independent of diabetes?

Background:

The risks for several cancer types are increased in people with diabetes. Hyperglycaemia, hyperinsulinaemia, inflammation and altered hormonal concentrations are common characteristics between the two diseases and can all be linked to hyperglycaemia.

Methods:

Here, we use glycated haemoglobin (HbA_1c) as a biomarker for chronic hyperglycaemia. We explore whether cancer risk increases with HbA_1c, independent of diabetes, and, therefore, if risk is already increased below the diabetic HbA_1c range, by analysing data from current studies linking HbA_1c to risk of several cancer types.

Results:

The data reveal that chronic hyperglycaemia correlates with increased cancer risk for a number of cancers, except prostate cancer. Evidence is also provided that risk is already increased in the pre-diabetic and normal ranges for several cancers.

Conclusions:

These results merit urgent investigation into the risks and advantages of updating recommendations for stricter glycaemic control in diabetic and non-diabetic subjects, as this could help reduce the risk of cancer incidence and mortality.

Fatal air embolism during endoresection of choroidal melanoma

PURPOSE

To describe a case of intraoperative mortality because of air embolism during resection of a choroidal melanoma by pars plana vitrectomy.

METHODS

Retrospective interventional case report.

RESULTS

A 69-year-old man died unexpectedly at the time of pars plana vitrectomy. The operative technique involved the use of high-pressure air (60 mmHg) in the presence of traumatically exposed choroidal vasculature. Autopsy revealed a large air embolus in the right ventricle, which resulted in sudden cardiovascular collapse.

CONCLUSION

Air embolism is a rare complication of ophthalmic surgery. Infusion of air in the presence of traumatically exposed choroidal vasculature exposes the patient to the risk of air embolism. Ophthalmic surgeons and anesthetists should be aware of the possibility of air embolism during certain ophthalmic procedures, and appropriate intraoperative monitoring should be considered.

When schooling experiences are respectful of children’s rights: A pathway to resilience

This article reports findings from the Pathways to Resilience study, South Africa. Rooted in a social ecological understanding of resilience, this mixed-methods study investigated resilience processes of black South African youths from poverty-stricken, rural contexts. School-attending youths ( n  =  951) completed the Pathways to Resilience Youth Measure (PRYM), which included one resilience measure and two school experience measures. Independent sample t-tests showed that youth reporting agency-supportive school environments ( n  =  137) had significantly higher resilience scores than youth with opposite experiences ( n  =  330; t(465)  =  −15.379, p  =  0.000). Likewise, youths reporting school staff respect ( n  =  171) recorded significantly higher resilience scores than youth who experienced disrespect ( n  =  277; t(446)  =  −14.518, p  =  0.000). Subsequently, 130 resilient youths participated in focus groups and/or visual participatory activities to further explore their pathways to resilience. An inductive content analysis of these data illustrated that teacher-facilitated youth agency, aspirations for higher education and employment, and coping with neglect and cruelty, supported resilience processes. Overall, findings suggest that when schooling experiences are supportive of child rights, resilience processes are promoted. This conclusion urges school psychologists and school communities toward transactional practices that support positive youth development in child rights-centred ways.

Ethnocultural factors, resilience, and school engagement

In this article we examine how cultural and community factors interact with individual level factors to predict school participation. Participants were 497 Atlantic Canadian youth purposefully selected because of their concurrent use of more than one government service or community program at the time they were interviewed. Results revealed that contextual factors associated with resilience (e.g. cultural adherence and involvement in one’s community) affect school engagement more than individual or relational factors among this population. Furthermore, these contextual resilience factors showed a pattern of differential impact, with the greatest influence occurring in the lives of visible minority youth. Findings suggest that improvements in school engagement are likely to result from school-based efforts to enhance children’s experience of their culture and involvement in community activities. Sampling youth outside regular classroom settings and including meso- and exo-systemic factors in studies of school engagement may help to identify protective processes not previously discussed in the literature.

Patterns of service use, individual and contextual risk factors, and resilience among adolescents using multiple psychosocial services

BACKGROUND

Very little research has examined the relationship between resilience, risk, and the service use patterns of adolescents with complex needs who use multiple formal and mandated services such as child welfare, mental health, juvenile justice, and special educational supports. This article reports on a study of 497 adolescents in Atlantic Canada who were known to have used at least 2 of these services in the last 6 months. It was hypothesized that greater service use and satisfaction with services would predict both resilience, and better functional outcomes such as prosocial behavior, school engagement and participation in community.

METHODS

Youth who were known to be multiple service users and who were between the ages of 13 and 21 participated in the study. Participants completed a self-report questionnaire administered individually. Path analysis was used to determine the relationship between risk, service use, resilience, and functional outcomes. MANOVA was then used to determine patterns of service use and service use satisfaction among participants.

RESULTS

Findings show that there was no significant relationship between service use history and resilience or any of the three functional outcomes. Service use satisfaction, a measure of an adolescent's perception of the quality of the services received, did however show a strong positive relationship with resilience. Resilience mediates the impact of risk factors on outcomes and is affected positively by the quality, but not the quantity, of the psychosocial services provided to adolescents with complex needs.

CONCLUSIONS

Results show that resilience is related to service satisfaction but not the quantity of services used by youth. Coordinated services may not increase resilience or be more effective unless the quality of individual services is experienced by an adolescent receiving intervention as personally empowering and sensitive to his or her needs.

Caregivers, young people with complex needs, and multiple service providers: a study of triangulated relationships

Five patterns of service provider-caregiver-adolescent interaction are discussed using qualitative interviews and file review data from 44 youth with complex needs who were clients of more than one psychosocial service (child welfare, mental health, addictions, juvenile justice, and special education). Findings show that young people and their families become triangulated with service providers, either engaging with, or resisting, interventions. For young people with complex needs involved with multiple service providers, both positive and negative patterns of interaction contribute to the complexity of caregiver-child interactions. According to young people themselves, the most functional of these patterns, empowerment, was experienced as protective when it helped them to meet their personal needs and enhance communication. In contrast, four problematic patterns produced triangulations described as conflictual or unsupportive. The implications of these patterns for family therapy are discussed with an emphasis on the therapist as both clinician and advocate for better services from multiple providers.

Radiological findings at a South African forensic pathology laboratory in cases of sudden unexpected death in infants

Objectives The work serves as a preliminary evaluation of the utility of the full-body radiography in examining cases of SUDI. Setting This paper reviews findings from full-body digital radiography in cases of sudden unexpected death in infants (SUDI) in 2008 at the Salt River Forensic Pathology Laboratory in Cape Town. Subjects Cases of SUDI referred to the mortuary and undergoing full-body digital radiography were reviewed (192 cases). Design Imaging reports were cross-referenced with death registry data. Manner of death, cause of death, whether an autopsy had taken place, and radiological findings, were recorded and analysed. Results The absence of bony fractures was recorded as an imaging finding in 40% of cases. The most common type of imaging pathology was lung disease. In cases where autopsies were performed and pathology was found on imaging, the findings of the two methods of examination were consistent. Conclusions Imaging may have served to assist CoD determination based on case history, and therefore full-body radiography may improve the workflow in busy forensic pathology laboratories. More detailed and consistent recording of imaging findings is required before stronger conclusions may be drawn regarding the utility of full body digital imaging of paediatric cases in forensic pathology laboratories.

Atherosclerotic lesions in the thoracic aorta: a South African anatomical and histological mortuary study

BACKGROUND

Worldwide, the prevalence of cardiovascular diseases such as atherosclerosis is on the increase. Younger people may be especially vulnerable owing to their exposure to risk factors such as drug abuse and HIV.

METHODS

The thoracic aortas of 149 South Africans under the age of 50 years were collected at the Salt River Mortuary, Cape Town, and examined macroscopically and microscopically for evidence of anomalies. The sample comprised predominantly males, and included black, coloured and white individuals.

RESULTS

A significantly higher level of macroscopic pathology was found in coloured males, although overall prevalence of pathology in this sample was lower than expected. A positive association was also found between body mass index and vascular pathology in the black and coloured population groups. Microscopic anomalies were common and present at high levels, irrespective of age and racial grouping.

CONCLUSIONS

The widespread prevalence of microscopic anomalies in all groups suggests that these are normal variations that result from haemodynamic forces. The higher prevalence of atherosclerotic lesions in coloured males, however, probably results from specific genetic conditions such as hypercholesterolaemia or lifestyle factors such as diet or tik abuse. The findings suggest that coloured individuals may be at increased risk of developing cardiovascular disease.

Using visual methods to capture embedded processes of resilience for youth across cultures and contexts

OBJECTIVES

We review the value of using visual data in a dialogue with youth, to reflect, explore and find language to better understand processes of resilience.

METHODS

The argument is demonstrated with examples from the Negotiating Resilience Project (NRP): an international study of 16 youth which uses video recording a day in the life of youth participants, photographs produced by youth, and reflective interviews with the youth about their visual data.

RESULTS

Three examples from the NRP are used to show the ways that visual methods can capture and elucidate previously hidden aspects of youth's positive psychosocial development in stressful social ecologies.

CONCLUSION

Incorporating images as research data can aid in understanding previously unarticulated constructions of youth resilience. When the researcher is reflexive about power dynamics and their role in co-constructing the research environment, visual methods have the potential to reduce power imbalances in the field, meaningfully engage youth in the research process, and help to overcome language barriers.

Incidence of seropositive myasthenia gravis in Cape Town and South Africa

BACKGROUND

Myasthenia gravis (MG) is a treatable autoimmune disease characterised by fatiguable weakness of skeletal muscles. More than 85% of MG patients have antibodies to the acetylcholine receptor (AChR) at the neuromuscular junction or are seropositive for MG (SPMG). In the developed world the incidence of MG has increased, particularly among older individuals, but no epidemiological studies have been done on SPMG in Africa.

OBJECTIVES

To determine the annual incidence rate (IR) of SPMG in the Cape Town (CT) municipality, and the crude annual IR of SPMG for the whole of South Africa (SA).

METHODS

Positive AChR antibody tests were identified between 1 January 2003 and 1 January 2005 for patients living in CT, and the age- and sex-specific incidences were calculated. To determine the national crude annual IR over the same period, positive assays were identified from the laboratories that process AChR assays for SA. National Census 2001 population statistics formed the denominators.

RESULTS

There were 65 positive assays in CT, and 230 nationwide. Based on these figures the annual IR for CT was 11.2 per million per year (95% confidence interval (CI) 8.7 - 14.3), and for South Africa 2.6 per million/year (95% CI 2.2 - 2.9). After a questionnaire response from CT neurologists regarding the routine use of the AChR antibody assay, the annual IR for CT was adjusted to 12.6 per million (95% CI 9.9 - 15.9) to incorporate those presumed to have SPMG without a confirmatory test. In CT, the IR in females was 15.3 per million/year (95% CI 11.2 - 20.4), and in males, 6.8 per million/year (95% CI 4.1 - 10.7). The CT IRs for blacks, coloureds and whites were not statistically different after adjusting for age and gender. The IR of SPMG in CT was 6 times greater in those presenting after the age of 50 years than in those with earlier disease onset (95% CI 3.7 - 9.7).

CONCLUSIONS

The annual IR of SPMG in CT is much the same as rates recorded recently in other developed countries, but the rest of SA has a much lower IR. A preponderance of MG starting after the age of 50 years reflects a worldwide trend, although the CT data showed a relatively lower-than-expected incidence for older males. IRs for SPMG vary widely in different regions in SA; this is likely to be related to differences in regional health care delivery, and underdiagnosis.

Cultural understandings of resilience: roots for wings in the development of affective resources for resilience

The authors examine one of the precursors of positive development: attachment. Attachment and the positive growth it portends for populations of children under stress underpins positive developmental outcomes now termed "resilience." Resilience may be understood as a process of adaptation to adversity that is scaffolded by environmental, cultural, social, psychologic, and physiologic processes. The authors focus on two methodologically different approaches to studying attachments that contribute to resilient functioning at two different phases of development (toddlerhood and adolescence). The authors examine the cultural differences found in manifestations of resilience in different countries and cultures. Organized around this theme of attachment, the authors identify adaptive factors in resistance to risk from adverse circumstances. The authors strive to identify how the adaptation involved in attachment relations can protect against vulnerability. The authors conclude with a description of the processes that might help us to understand situational, experiential, and personal resources that intersect to protect the developing individual against assaults on normal growth and development.

Unique pathways to resilience across cultures

An international mixed methods study of resilience of 14 sites in eleven countries identified seven tensions that youth resolve in culturally specific ways. Resolution of these tensions is foundational to experiences of resilience. This paper reports on the qualitative findings from interviews with 89 youth. Results support a culturally embedded understanding of positive youth development that better accounts for young people's resilience in western and non-western countries. Specifically, the seven tensions identified include: access to material resources, relationships, identity, cohesion, power and control, social justice, and cultural adherence. Findings show that no one pattern in the resolution of these tensions predicts resilience better than another. A case study of a Palestinian boy demonstrates the intersection of the seven tensions and the uniqueness of their resolution. The implications of this work for interventions is discussed.

Intracranial Arterial Dissection Related to HIV Infection. A Case Report with Histology

SUMMARY

There are many reasons for patients infected with human immunodeficiency virus (HIV) to develop cerebrovascular disease. The HIV virus itself however may be a cause of vessel wall pathology. We present a clinical and pathological study of a patient who was HIV positive and presented with a subarachnoid haemorrhage. Cerebral angiography and later histology confirm that there was extensive vessel wall injury with dissection and a false aneurysm of the right middle cerebral artery.