Preface

Preface in english and in french in special volume of the Ngaoundéré-Anthropos Review: “Acteurs de l’Histoire au Nord-Camroun. XDè et XXè siècles”

Magic and love on the road to higher education

Artikkel i tidsskriftet Ngaoundere-anthropos : revue de sciences sociales = social sciences reviewIn this article, I undertake an analysis ofthe role that Western education plays in two young Cameroonian women's lives: Fanta is Muslim, Therese is Christian. Through an analysis of their narrative about their own education and careers and ofthe cultural conditioning oftheir search for higher education. I try to grasp how Western education as a globalfield ofknowledge is coordinated with the local systems of knowledge. In this perspective Western education is currently constructed as a new kind oflocal «magic» i.e. techniquefor the assurance ofa new legitimate social position for women. This new position is less dependent on subordination to fathers and husbands than the existing positions for married Muslim and Christian women. The analysis also reveals aspects ofthe process oftransformation that affects the female identities as well as local women’s networks. The young women are striving with loneliness and they are being confronted with the challenges of the construction of new kinds of women's networks.Dans cet article j'entreprends une analyse du role que I Education occidentalejoue dans la vie de deuxJeunes camerounaises: Fanta est musulmane, et Therese chrétienne. A travers I 'histoire racontée de leur education et de leurs Carrieres, des effets culturels sur leur quéte pour I’enseignement supérieur. J’essaie d’appréhender comment l’éducation occidentale prise dans sa globalité comme un domaine de la connaissance est coordbnnés avec les systémes locaux de la connaissance. Dans cette perspective l’éducation occidentale est actuellement congu comme un genre de «magie» local, c ‘est-å-dire une technique pour garantir une nouvelle position social légitime pour lesfemmes. Cette nouvelle position dépend moins de leur dépendance vis å vis de leurs péres et de leurs époux que des positions actuelles des épouses musulmanes et chrétiennes. L 'analyse révéle aussi des aspects de la méthode de transformation qui affecte les identités feminines aussi bien que des groupes de femmes. Des jeunes femmes s’efforcent dans la solitude et se trouvent confrontées aux défis de la construction de nouveaux groupes defemmes

Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer

Background Abdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal symptoms. Methods Over a 10-day period, 493 GPs in Norway, Denmark, Sweden, Belgium, the Netherlands, and Scotland, recorded consecutive consultations: sex, date of birth and any specified abdominal symptoms. For patients with abdominal symptoms, additional data on non-specific symptoms, GPs’ diagnostic suspicion, and features of the consultation were noted. Data on all cancer diagnoses among all included patients were requested from the GPs eight months later. Findings Consultations with 61802 patients were recorded. Abdominal symptoms were recorded in 6264 (10.1%) patients. A subsequent malignancy was reported in 511 patients (0.8%): 441 (86.3%) had a new cancer, 70 (13.7%) a recurrent cancer. Abdominal symptoms were noted in 129 (25.2%) of cancer patients (P < 0.001), rising to 34.5% for the 89 patients with cancer located in the abdominal region. PPV for any cancer given any abdominal symptom was 2.1%. In symptomatic patients diagnosed with cancer, GPs noted a suspicion of cancer for 85 (65.9%) versus 1895 (30.9%) when there was no subsequent cancer (P < 0.001). No suspicion was noted in 32 (24.8%) cancer patients. The GP's intuitive cancer suspicion was independently associated with a subsequent new cancer diagnosis (OR 2.11, 95% CI 1.15–3.89). Laboratory tests were ordered for 45.4% of symptomatic patients, imaging for 10.4%, referral or hospitalization for 20.0%: all were more frequent in subsequent cancer patients (P < 0.001). Interpretation Abdominal symptoms pointed to abdominal cancers rather than to other cancers. However, the finding of abdominal symptoms in only one third of patients with an abdominal cancer, and the lack of cancer suspicion in a quarter of symptomatic cancer patients, provide challenges for GPs’ diagnostic thinking and referral practices

The Gendered North-South University Collaboration: Experiences and visions

Bidrag til Women`s world 99 i Kvinnforsks skriftserieThe universities in the North and the South are as all institutions, gendered. That means that the ambitions of the universities reflect ideologies, which attribute different values to male and female students and teachers. These ideologies are also embodied in the various institutions, for example in the mandates of the programmes for North-South university collaboration. This article is based on our experiences from such a programme, namely the Anthropos project, financed by the Norwegian University Committee for Developing Research and Education (NUFU)

Abdominal symptoms and cancer in the abdomen:prospective cohort study in European primary care

Background: Different abdominal symptoms may signal cancer, but their role is unclear. Aim: To examine associations between abdominal symptoms and subsequent cancer diagnosed in the abdominal region. Design and setting: Prospective cohort study comprising 493 GPs from surgeries in Norway, Denmark, Sweden, Scotland, Belgium, and the Netherlands. Method: Over a 10-day period, the GPs recorded consecutive consultations and noted: patients who presented with abdominal symptoms pre-specified on the registration form; additional data on non-specific symptoms; and features of the consultation. Eight months later, data on all cancer diagnoses among all study patients in the participating general practices were requested from the GPs. Results: Consultations with 61 802 patients were recorded and abdominal symptoms were documented in 6264 (10.1%) patients. Malignancy, both abdominal and non-abdominal, was subsequently diagnosed in 511 patients (0.8%). Among patients with a new cancer in the abdomen (n = 251), 175 (69.7%) were diagnosed within 180 days after consultation. In a multivariate model, the highest sex- and age-adjusted hazard ratio (HR) was for the single symptom of rectal bleeding (HR 19.1, 95% confidence interval = 8.7 to 41.7). Positive predictive values of >3% were found for macroscopic haematuria, rectal bleeding, and involuntary weight loss, with variations according to age and sex. The three symptoms relating to irregular bleeding had particularly high specificity in terms of colorectal, uterine, and bladder cancer. Conclusions: A patient with undiagnosed cancer may present with symptoms or no symptoms. Irregular bleeding must always be explained. Abdominal pain occurs with all types of abdominal cancer and several symptoms may signal colorectal cancer. The findings are important as they influence how GPs think and act, and how they can contribute to an earlier diagnosis of cancer

Forty Years of Arctic Primary Care Research on the Early Diagnosis of Cancer

Usually, before a patient with cancer can be treated in a hospital, a general practitioner (GP) must suspect the diagnosis and refer the patient. GPs often worry that they could have done better for some of their cancer patients. Had there been an unreasonable delay of diagnosis? In the arctic, rural/urban city of Tromsø, this question became the subject of several scientific articles. Symptoms was an evident gateway to thinking about cancer in patients. In later years, there has been an explosion of good research studies about early diagnosis both in primary and secondary care. Through a northern gaze, the reader will be guided through a journey covering forty years of primary care-based research aiming at earlier diagnosis of cancer. Summing up, suggestions are given for: How to react upon signals from the body? And for the GP: 1. Explain unusual symptoms. 2. Add results from clinical findings and testing to symptoms. 3. Refer when the probability based on symptoms and findings exceed 3%. 4. Consider ‘fast track’ when you seriously suspect cancer. 5. Think of early diagnosis of cancer as an important, challenging and interesting part of your effort to serve the patients who consult you

Piger og drenge i et nordnorsk bygdesamfund

Innlegg på symposium i Ålsgårde, 12. 14. juni 198

Optimal starting point for antiretroviral HIV treatment in a town in Cameroon: a randomised controlled study

BACKGROUND: Optimal starting point for antiretroviral treatment (ART) has been uncertain. METHODS: Parallel group, single blind, randomised controlled study of adult HIV positive patients consulting at the Protestant Hospital, Ngaoundere, Cameroon in 2007-8. Simple randomisation of patients in WHO clinical stage 1-2 to start of ART early or deferred, i.e. when CD4 counts dropped below 350 versus 250 cells/mm(3), or when they reached clinical stage 3-4. Clinical follow-up every three months were offered for all patients. Main outcomes were clinical stage, CD4 differences and mortality. Of 424 consulting patients, most were excluded, mainly because they were already in WHO stage 3-4. Forty-four patients were randomised. RESULTS: In the ‘early’ group two patients died and five were lost to follow-up. In the ‘deferred’ group, six patients died and nine were lost to follow-up (Hazard ratio for death by early compared to deferred treatment 0.26, 95% confidence interval 0.05-1.29). Of the patients lost to follow-up, three patients in the ‘early’ group and four patients in the ‘deferred’ group were known to be alive when the study ended. Fourteen patients in the early group and 11 in the deferred group started ART. Twenty-two patients were evaluated clinically six to seven months after the study period was terminated. Except for one patient with AIDS, these were all still in clinical stage 1-2. CONCLUSIONS: In our small sample, relative risk for death did not differ significantly, but deferred treatment seemed to carry no increased survival or other clinical advantage. During the study period, other studies made WHO change its guidelines to conform to our early treatment. The tendency in our study lends support to this policy. TRIAL REGISTRATION: ISRCTN22114173 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2458-14-828) contains supplementary material, which is available to authorized users