784 research outputs found

    Decoupling social status and status certainty effects on health in macaques: a network approach.

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    BackgroundAlthough a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank) and relational components (perceived social status, dominance interactions). In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models) and dominance certainty (the relative certainty vs. ambiguity of an individual's status), allowing for a more complex examination of how social status impacts health.MethodsBehavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects). Subjects' general physical health (diarrhea) was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)).ResultsDominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea.DiscussionSocial status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one's social status in status-health research. This work also suggests that in order to fully explore the mechanisms for how social life influences health, more complex metrics of social systems and their dynamics are needed

    Pedagogies for critical thinking at universities in Kenya, Ghana and Botswana: the importance of a collective 'teaching culture'

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    While critical thinking is widely regarded as a key outcome of higher education, research has shown that in practice it is only developed when certain conditions are in place, relating to the pedagogical approach, the nature of the curriculum and the level of challenge, amongst other factors. This article reports on findings from a four-year mixed methods study in Botswana, Ghana and Kenya, aiming to investigate the factors underpinning the successful development of critical thinking amongst undergraduate students. A two-stage critical thinking assessment was conducted with students in 15 sites, showing that only some of the institutions were ensuring significant gains in students’ critical thinking, even when endorsing learner-centred methods. The study points to the central importance of teaching orientations amongst lecturers, involving a deep shift in approaches to knowledge, and a facilitation rather than a transmission approach

    Adherence to cardiovascular medication : a review of systematic reviews

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    Work supported by Medical Research Council (MRC) [MR/N013166/1 to K.H.L.]Background: Use of cardiovascular medication has increased over time, especially for primary and secondary prevention, with polypharmacy common. Methods: Review of published systematic reviews of the factors and outcomes associated with adherence to cardiovascular medication using MEDLINE, Embase, CINAHL and PsycINFO databases. Quality was assessed using the AMSTAR tool. Results: Of 789 systematic reviews identified, 45 met the inclusion criteria and passed the quality assessment; 34 focused on factors associated with adherence, and 11 on outcomes. High heterogeneity, both between and within reviews, precluded meta-analysis and so a pooled estimate of adherence levels could not be derived. Adherence was associated with disease factors, therapy factors, healthcare factors, patient factors and social factors, though with some inconsistencies. In total, 91% of reviews addressing outcomes reported that low adherence was associated with poorer clinical and economic endpoints. Conclusions: Factors from across five key domains relate to non-adherence to cardiovascular medications, and may contribute to poorer clinical outcomes. Interventions to improve adherence should be developed to address modifiable factors and targeted at those at highest risk of non-adherence. Adherence research is highly heterogeneous to-date and efforts to standardize this should be implemented to improve comparability.Publisher PDFPeer reviewe

    Conceptualising Higher Education and the Public Good in Ghana, Kenya, Nigeria, and South Africa

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    Higher education has been the object of policy attention in sub-Saharan Africa in recent years. It has been seen as key to unlocking the potential of the youth bulge, responding to the demands of a growing middle class and to transforming commodities-based economies into knowledge societies (World Bank 2009; Cloete, Maassen & Bailey 2015; Chuks, 2017). Yet despite significant expansions of enrolment – including widening participation by women, major barriers to access exist, reflecting inequalities based on class, gender, geographical location, ethnicity, religion, language and disability (AAI 2015; Morley & Lugg 2009; Morley & Croft, 2011). There are quality challenges in relation to teaching and learning, research, and governance. While some comment on a ’renaissance in African higher education’ (Higgs, 2016), and others on the effects and framings of colonial epistemicides (Nyamnjoh, 2012) key questions abound about relevance and power relations highlighting the need to decolonise the curriculum, structure, organisation and cultures of universities. The student protests in South Africa from 2015 highlighted problems of access and funding, but these are not isolated events. They expose an unresolved colonial legacy in these higher education systems. These processes raise questions not only of the public good relevance of higher education - beyond the obvious advantages conferred on those who manage to go to these institutions – but also of how higher education and its relationship with society may be conceptualised given these contexts (Lebeau and Milla, 2008; Mamdani, 2017). An overarching question is who is defining the public good and how? While many of the above issues are global e.g. universities throughout Latin America, Australasia, Asia and Europe are involved in similar debates and protests, this paper explores the relationship between higher education and the public good in the sub- Saharan African context through a consideration of some connections and disconnections. There appear to be two distinct ways in which higher education and the public good have been conceptualised are discussed. Firstly, higher education can be portrayed as instrumental in shaping a version of the public good where its qualifications, knowledge production, innovation, development of the professional classes, and expertise are perceived to lead to particular manifestations of public good, delineated as economic, social, political or cultural (McMahon 2009; Stiglitz 1999). The key arguments that underpin this conceptual framing speak to different levels of the public good, whether individual and community levels or the provision of ‘global public goods’ (Marginson 2007; 2013; Menashy 2009). However, a contrasting set of arguments portray the relationship between higher education and the public good as an intrinsic one, where the intellectual, physical and cultural experiences enabled through higher education express and enact the public good e.g. prejudice reduction, democratisation, critical thinking, active citizenship (Singh 2001; Calhoun 2006; Leibowitz, 2013; Marginson, 2011; Locatelli, 2017). Important here are considerations of the historical conjuncture that shapes experiences of higher education at a particular time and what these may mean. In considering the connections and disjunctures between these two formulations and the way writings on higher education in contemporary Africa have engaged with this debate, the paper makes an argument for discussing the importance of processes that link instrumental and intrinsic visions of higher education and the public good. The analysis of these from a rigorous review of literature leads to a delineation of some different views of time, space and evaluation. The paper argues that these contestations need to be read contextually. Higher education in sub-Saharan Africa has moved through phases, from the establishment of flagship national universities in the post-independence period for state bureaucracy formation (Teferra, 2017), to the emergence of developmental universities with a commitment to indigenising knowledge and benefiting marginalised populations, through more recent tendencies towards the marketisation of public institutions and the significant growth of the private sector (Assié-Lumumba & CODESRIA 2006; ADEA & AAU 2004; Coleman 1986; Mamdani, 2007; McCowan 2016). Appreciating these contextual factors in shaping the role and functioning of higher education and thus its relationship to the public good is a central theme in our analysis. We suggest that mainstream conceptualisations of higher education and the public good are underpinned by particular understandings of the nature and form of higher education and how knowledge is acquired, developed and disseminated – orientations that may be very far from the reality of highly unequal, socially stratified, and politically complex societies within which higher education is deeply embedded. Thus a reconceptualisation of the public is required by these contexts and some challenge to conceptualisations of the private, given the strong obligations of individuals to extended families, and the sharing of the benefits of higher education amongst their communities of origin. The paper concludes with a consideration of what may be important in conceptualising higher education and the public good in the African context and the value of such thinking for broader debates on the role of higher education

    Indigenous higher education in Mexico and Brazil: between redistribution and recognition

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    Indigenous groups in Latin America face a double exclusion from higher education, with low levels of access to institutions and little acknowledgement of their distinctive cultural and epistemological traditions within the curriculum. This article assesses current policies in Mexico and Brazil towards indigenous populations in higher education, considering the various responses to the challenge, including affirmative action programmes in mainstream universities, intercultural courses and autonomous institutions. These policies and initiatives are analysed using the theoretical frames of redistribution and recognition, focusing on demands for formal equality and material wellbeing on the one hand, and a distinctive cultural and educational space on the other. While state-sponsored policies focus primarily on the redistributive element, initiatives based on recognition come largely from autonomous organisations, raising a series of dilemmas and tensions around educational justice for indigenous populations in the region

    Editorial

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    Economic evidence for nonpharmacological asthma management interventions: A systematic review

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    Asthma management, education and environmental interventions have been reported as cost‐effective in a previous review (Pharm Pract (Granada), 2014;12:493), but methods used to estimate costs and outcomes were not discussed in detail. This review updates the previous review by providing economic evidence on the cost‐effectiveness of studies identified after 2012, and a detailed assessment of the methods used in all identified studies. Twelve databases were searched from 1990 to January 2016, and studies included economic evaluations, asthma subjects and nonpharmacological interventions written in English. Sixty‐four studies were included. Of these, 15 were found in addition to the earlier review; 53% were rated fair in quality and 47% high. Education and self‐management interventions were the most cost‐effective, in line with the earlier review. Self‐reporting was the most common method used to gather resource‐use data, accompanied by bottom‐up approaches to estimate costs. Main outcome measures were asthma‐related hospitalizations (69%), quality of life (41%) and utility (38%), with AQLQ and the EQ‐5D being the most common questionnaires measured prospectively at fixed time points. More rigorous costing methods are needed with a more common quality of life tool to aid greater replicability and comparability amongst asthma studies
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