The Khwe of Namibia, foragers between game, tourism and politics

__Abstract__ In this paper we examine the plight of the Khwe Bushmen, a group of (former) hunter-gatherers in the Bwabwata National Park in Northern Namibia. The Khwe have lived for a long time in the area of Bwabwata, so are highly affected by the park’s conservation activities that altered their environment seriously. Although they were historically hardly involved in decision making on or the implementation of such activities, this was supposed to change with the rise of Community-Based Natural Resource Management (CBNRM) in the 1990s. Yet, many of its aims did not materialize and the approval of the Kavango Zambezi Transfrontier Conservation Area (KAZA TFCA) in 2011 aimed at increased conservation in the area. An important element in these plans is to boost ‘green economic’ growth by increasing tourism, also involving the Khwe Bushmen. As a theoretical starting point, we use Ingold’s dwelling perspective, based on hunter-gatherer ontologies, in which the world comes into being because an organism/person is continuously interacting with his/her environment, through bodily activity. Dwelling is contrasted with building, in which (wo)man constructs the world cognitively before (s)he can live in it. We apply a third notion, namely lodging, to refer to a situation in which people live in an essentially foreign environment. We argue that today many changes in the environment of the Khwe are triggered beyond their control, instead of through their interaction with their environment. In this concept, the environment is dominant and the people have no option but to adapt to changes in their environment outside their control. Using these three notions of dwelling, building and lodging we analyse various conservation and tourism developments in the environment of the Khwe, historically as well as more recently. In so doing, we show the transformation of the cultural understanding the people have of their environment, of their interaction with it (and with the various actors and stakeholders) and with each other

Discrepancies Between Perceptions of the Parent-Adolescent Relationship and Early Adolescent Depressive Symptoms:An Illustration of Polynomial Regression Analysis

Adolescence is a critical period for the development of depressive symptoms. Lower quality of the parent-adolescent relationship has been consistently associated with higher adolescent depressive symptoms, but discrepancies in perceptions of parents and adolescents regarding the quality of their relationship may be particularly important to consider. In the present study, we therefore examined how discrepancies in parents' and adolescents' perceptions of the parent-adolescent relationship were associated with early adolescent depressive symptoms, both concurrently and longitudinally over a 1-year period. Our sample consisted of 497 Dutch adolescents (57 % boys, M (age) = 13.03 years), residing in the western and central regions of the Netherlands, and their mothers and fathers, who all completed several questionnaires on two occasions with a 1-year interval. Adolescents reported on depressive symptoms and all informants reported on levels of negative interaction in the parent-adolescent relationship. Results from polynomial regression analyses including interaction terms between informants' perceptions, which have recently been proposed as more valid tests of hypotheses involving informant discrepancies than difference scores, suggested the highest adolescent depressive symptoms when both the mother and the adolescent reported high negative interaction, and when the adolescent reported high but the father reported low negative interaction. This pattern of findings underscores the need for a more sophisticated methodology such as polynomial regression analysis including tests of moderation, rather than the use of difference scores, which can adequately address both congruence and discrepancies in perceptions of adolescents and mothers/fathers of the parent-adolescent relationship in detail. Such an analysis can contribute to a more comprehensive understanding of risk factors for early adolescent depressive symptoms.</p

Smart shops: a survey of products, claimed effects and medical-toxicological relevance

During the last few years the use of herbal drugs of abuse, so-called 'smart products' and eco-drugs has increased. Many of these products have psychoactive effects. The variety of smart products sold in the so-called smart shops is enormous and this is still a growing market. The increased availability of these products and the continuing appearance of new products on the market, has led to increased awareness of the possible negative health aspects associated with the use of these products. At present, the Dutch Inspectorate for Health Protection, Commodities and Veterinary Public Health is testing the activities of these smart shops and the products for adherence to the regulations. This document, prepared by the National Poisons Control Centre (NVIC) of the National Institute of Public Health and the Environment (RIVM), serves as a practical aid to the Inspectorate in evaluating the various smart products. Four important groups of smart products can be discerned: the energizers, relaxing herbs, aphrodisiacs and products with hallucinogenic properties. For each of these groups the following items are described: the various product appearances, usage, the (desired) effects of the product according to smart shop information brochures, a description of the original plants (most of these products are derived from plants), the active ingredients in the product, and to the best of our knowledge, the pharmacology and medical toxicology of these ingredients and products. Further monitoring of the use of these smart products and the health effects they cause, should make clear to which specific group of smart products most attention should be paid from a medical point of view.Het gebruik van zogenaamde smartproducts en eco-drugs neemt de laatste jaren steeds meer toe. Het aanbod van producten die in de smartshops worden verkocht is zeer divers. Veel van de aangeboden middelen hebben psychoactieve effecten. Bovendien is het een uiterst dynamische markt, waar regelmatig nieuwe producten ontwikkeld en verkocht worden. Door deze groeiende markt wordt ook van overheidswege aandacht besteed aan de gezondheids- en maatschappelijke risico's van het gebruik en de verkoop van deze middelen. In het huidige beleid ten aanzien van deze middelen ligt de nadruk op gezondheidsbescherming met behulp van voorlichting, monitoring en onderzoek. In dit kader toetst in 1999 de Inspectie Gezondheidsbescherming, Waren en Veterinaire Zaken de activiteiten van smartshops en andere verkooppunten, alsmede de verhandelde waar, aan de warenwettelijke kaders. Zonodig wordt nieuwe jurisprudentie opgebouwd. Dit rapport, geschreven op verzoek van en in samenwerking met de Inspectie Gezondheidsbescherming, Waren en Veterinaire Zaken dient de Inspectie tot een praktisch hulpmiddel bij het evalueren van de vele verschillende producten die op de markt aanwezig zijn. Op grond van het belangrijkste beoogde effect dat deze middelen na gebruik zouden verschaffen, zijn de producten ingedeeld in een van de vier te onderscheiden functionele groepen, te weten de "energizers", "relaxing herbs", "afrodisiaca" en "hallucinogene producten". Per product(-groep) worden besproken: de verschillende productvoorkomens en wijze van gebruik, het in de smartshop gepropageerde doel van gebruik, de plantaardige herkomst van het product, en de samenstellende verbindingen met voor zover bekend hun farmacologische werkingsmechanismen en toxiciteit. Daarbij is gebruik gemaakt van de humaan medisch-toxicologische kennis zoals die op dit moment voorhanden is. Verdere monitoring naar de effecten van het gebruik zal inzichtelijk moeten maken naar welke productgroepen vanuit medisch oogpunt in de toekomst de meeste aandacht zal moeten uitgaan

Development of parent- and teacher-reported emotional and behavioural problems in young people with intellectual disabilities: Does level of ID matter?

This study described similarities and differences in the 5-year stability and change of problem behaviour between youths attending schools for children with mild to borderline (MiID) versus moderate intellectual disabilities (MoID). A two-wave multiple-birth-cohort sample of 6 to 18-year-old was assessed twice across a 5-year interval using the Developmental Behaviour Checklist Primary Carer version (n = 718) and Teacher version (n = 313). For most types of problem behaviour youths with MiID and MoID showed similar levels of stability of individual differences, persistence and onset of psychopathology. Whenever differences were found, youths with MoID showed the highest level of stability, persistence and onset across informants. Mean levels of parent-reported, but not teacher-reported, problem behaviour, regardless of level of intellectual disability, decreased during the 5-year follow-up period. Youths with MoID and MiID are at risk for persistent psychopathology to a similar degree. Different informants showed to have a different evaluation of the level and the amount of change of problem behaviour, and should be considered complementary in the diagnostic process. © 2007 BILD Publications

A technical framework for costing health workforce retention schemes in remote and rural areas

<p>Abstract</p> <p>Background</p> <p>Increasing the availability of health workers in remote and rural areas through improved health workforce recruitment and retention is crucial to population health. However, information about the costs of such policy interventions often appears incomplete, fragmented or missing, despite its importance for the sound selection, planning, implementation and evaluation of these policies. This lack of a systematic approach to costing poses a serious challenge for strong health policy decisions.</p> <p>Methods</p> <p>This paper proposes a framework for carrying out a costing analysis of interventions to increase the availability of health workers in rural and remote areas with the aim to help policy decision makers. It also underlines the importance of identifying key sources of financing and of assessing financial sustainability.</p> <p>The paper reviews the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provides guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management.</p> <p>Results</p> <p>We show that while the debate on the effectiveness of policies and strategies to improve health workforce retention is gaining impetus and attention, there is still a significant lack of knowledge and evidence about the associated costs. To address the concerns stemming from this situation, key elements of a framework to undertake a cost analysis are proposed and discussed.</p> <p>Conclusions</p> <p>These key elements should help policy makers gain insight into the costs of policy interventions, to clearly identify and understand their financing sources and mechanisms, and to ensure their sustainability.</p

Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis

For the evaluation of non-palpable lesions of the breast, image-guided large-core needle biopsies are increasingly replacing needle-localized open breast biopsies. In this study, the diagnostic accuracy of this minimally invasive technique was evaluated by reviewing the available literature. Five cohort studies were included in a meta-analysis. Sensitivity rate, histological agreement between needle biopsy and subsequent surgery or long-term mammographic follow-up and clinical consequences for different disease prevalences were assessed. The sensitivity rate of large-core needle biopsy for the diagnosis of breast cancer was high (97%). The reclassified agreement rate between core biopsy and subsequent surgical biopsy or long-term mammographic follow-up was also high (94%). In case of 20% breast cancer prevalence among women referred after screening (as in the US), the risk of breast cancer despite benign large-core needle biopsy result is less than 1%. In European countries, however, prevalence of breast cancer among referred women is 60–70%. This would result in a risk of breast cancer despite benign large-core needle biopsy result of 4–6%. The results of this meta-analysis indicate that the image guided large-core needle biopsy is a promising alternative for the needle localized breast biopsy. However, additional research is needed to explore the limiting factors of the technique. Without such detailed knowledge, a benign histological diagnosis on large-core needle biopsy in countries with high prevalence of malignancy among referred women should be interpreted with caution. © 2000 Cancer Research Campaig

Choledochal Malformation in Children: Lessons Learned from a Dutch National Study

Introduction: A choledochal malformation (CM) is a rare entity, especially in the Western world. We aimed to determine the incidence of CM in the Netherlands and the outcome of surgery for CM in childhood. Methods: All pediatric patients who underwent a surgical procedure for type I–IV CM between 1989 and 2014 were entered into the Netherlands Study group on choledochal cyst/malformation. Patients with type V CM were excluded from the present analysis. Symptoms, surgical details, short-term (30 days) complications were studied retrospectively. Results: Between January 1989 and December 2014, 91 pediatric patients underwent surgery for CM at a median age of 2.1 years (0.0–17.7 years). All patients underwent resection of the extrahepatic biliary tree with restoration of the continuity via Roux-en-Y hepaticojejunostomy. Twelve patients (12%) were operated laparoscopically. Short-term complications, mainly biliary leakage and cholangitis, occurred in 20 patients (22%), without significant correlations with weight or age at surgery or surgical approach. Long-term postoperative complications were mainly cholangitis (13%) and anastomotic stricture (4%). Eight patients (9%) required radiological intervention or additional surgery. Surgery before 1 year of age (OR 9.3) and laparoscopic surgery (OR 4.4) were associated with more postoperative long-term complications. We did not observe biliary malignancies during treatment or follow-up. Conclusion: Surgery for CM carries a significant short- and long-term morbidity. Given the low incidence, we would suggest that (laparoscopic) hepatobiliary surgery for CM should be performed in specialized pediatric surgical centers with a wide experience in laparoscopy and hepatobiliary surgery

Predicting growth curves of early childhood externalizing problems: Differential susceptibility of children with difficult temperament

Using an accelerated longitudinal design, the development of externalizing problems from age 2 to 5 years was investigated in relation to maternal psychopathology, maternal parenting, gender, child temperament, and the presence of siblings. The sample consisted of 150 children selected at age 2-3 years for having high levels of externalizing problems. Parenting was measured using observational methods, and maternal reports were used for the other variables. Overall, mean levels of externalizing problems decreased over time, and higher initial levels (intercept) were related to a stronger decrease (negative slope) in externalizing problems. Results showed that higher levels of maternal psychopathology were related to less decrease in early childhood externalizing problems. Parental sensitive behavior predicted a stronger decrease in externalizing problems, but only for children with difficult temperaments. A stronger decrease of externalizing problems in children with older siblings also pertained only to children with difficult temperaments. Thus, temperamentally difficult children appear to be more susceptible to environmental influences on the development of externalizing behaviors. Our results indicate that the role of siblings in early childhood externalizing problems deserves more research attention, and that intervention efforts need to take into account temperamental differences in children's susceptibility to environmental influences. © 2009 Springer Science+Business Media, LLC

A study of genetic and environmental influences on maternal and paternal CBCL syndrome scores in a large sample of 3-year-old Dutch twins.

Background. There is increasing evidence that behavioral problems are common in very young children, yet little is known about the etiology of individual differences in these problems. It is unclear to what degree environmental and genetic factors influence the development of early child psychopathology. In this paper, we focus on the following issues. Firstly, to what degree do genetic and environmental factors influence variation in behavioral problems? Secondly, to what degree are these underlying etiological factors moderated by sex and informant? We investigate these issues by analyzing Child Behavior Checklist (CBCL) data on 9689 3-year-old twin pairs. Methods. Rater Bias and Psychometric Models were fitted to CBCL/2-3 data obtained from mothers and fathers to determine the genetic and environmental contributions to the five CBCL syndromes:aggressive, oppositional, overactive, withdrawn, and anxious/depressed behavior. Results. Parental ratings are influenced by aspects of the child's behavior that are experienced in the same way by both parents and by aspects of the child's behavior that are experienced uniquely by each parent. There is evidence for high genetic contributions to all CBCL syndromes. Shared and non-shared environmental influences play significant roles as well. One exception is overactive behavior, which is influenced by genetic and non-shared environmental influences only. Conclusions. Variation in behavior problems in the very young shows high heritability. Individual raters offer unique perspectives that can have an impact on estimates of problem behavior and genetic architecture. Therefore, multi-informant approaches in the assessment of the very young will be useful to clinicians and researchers alike