'Bring us the female condom': HIV intervention, gender and political empowerment in two South African communities

The quotation which heads this paper encapsulates two important issues in AIDS research in South Africa: the one is substantive, the other methodological. The link between them is the rapid spread of HIV/AIDS in the country and the indication not only that women are more at risk of infection than men, but that, as in many other parts of the world, much of their vulnerability is gender based. ‘Bring us the female condom’ sums up the response of one particular group of black South African women to AIDS education. Their demand was a reflection of their relative domestic and gender empowerment - and also a high degree of political mobilization. However, their position is not necessarily shared by other black women. But the call for the female condom went further: it was a challenge to rethink our position as researchers and particularly to face the implications of commitment to a participatory model of community based intervention research

The identification of markers of macrophage differentiation in PMA-stimulated THP-1 Cells and monocyte-derived macrophages

Differentiated macrophages are the resident tissue phagocytes and sentinel cells of the innate immune response. The phenotype of mature tissue macrophages represents the composite of environmental and differentiation-dependent imprinting. Phorbol-12-myristate-13-acetate (PMA) and 1,25-dihydroxyvitamin D3 (VD3) are stimuli commonly used to induce macrophage differentiation in monocytic cell lines but the extent of differentiation in comparison to primary tissue macrophages is unclear. We have compared the phenotype of the promonocytic THP-1 cell line after various protocols of differentiation utilising VD3 and PMA in comparison to primary human monocytes or monocyte-derived macrophages (MDM). Both stimuli induced changes in cell morphology indicative of differentiation but neither showed differentiation comparable to MDM. In contrast, PMA treatment followed by 5 days resting in culture without PMA (PMAr) increased cytoplasmic to nuclear ratio, increased mitochondrial and lysosomal numbers and altered differentiation-dependent cell surface markers in a pattern similar to MDM. Moreover, PMAr cells showed relative resistance to apoptotic stimuli and maintained levels of the differentiation-dependent anti-apoptotic protein Mcl-1 similar to MDM. PMAr cells retained a high phagocytic capacity for latex beads, and expressed a cytokine profile that resembled MDM in response to TLR ligands, in particular with marked TLR2 responses. Moreover, both MDM and PMAr retained marked plasticity to stimulus-directed polarization. These findings suggest a modified PMA differentiation protocol can enhance macrophage differentiation of THP-1 cells and identify increased numbers of mitochondria and lysosomes, resistance to apoptosis and the potency of TLR2 responses as important discriminators of the level of macrophage differentiation for transformed cells

Teaching and assessing consultation skills: an evaluation of a South African workshop on using the Leicester Assessment Package

BackgroundThe consultation is at the very centre of clinical practice. It is in the meeting between doctor and patient that the story is told (and in good practice properly heeded) and decisions are made about the cause and treatment of the patient's problem. Following one year of supervised internship, South African doctors are required to do a year of community service and these doctors mostly work in understaffed peripheral hospitals. A substantial component of this work is unsupervised consultations with patients suffering from new or complex continuing diseases. On graduation, these doctors therefore require a high level of consultation competence. They must be able to make accurate diagnoses and manage patients' problems reliably and efficiently.The Leicester Assessment Package (LAP) was originally developed to assess the consultation competence of general practitioners in the UK. It was subsequently adapted for use in undergraduate teaching. In 2002, the LAP was presented at a medical education conference in South Africa. As a result, the Department of Family Medicine at Pretoria University began using the LAP in the teaching and formative assessment of the consultation skills of senior students in outpatient clinics. In 2003, the University of the Witwatersrand introduced a four-year graduate entry medical curriculum. The Centre for Health Care Education was interested in assessing whether the LAP would be suitable for the summative assessment of the consultation performance of students during their third and four years of the new curriculum.A workshop course was organised to train senior clinicians from the Universities of Pretoria and the Witwatersrand in the use of the LAP as a means of teaching and assessing the consultation performance of South African medical students.MethodTwenty-two experienced South African medical educators participated in a three-day workshop. Their attitudes to the LAP and the forms of teaching that its use promotes were analysed by responses to pre- and post-workshop questionnaires with Likert-scale and free-text questions.ResultsThe participants were positive about the LAP at the end of the workshop. They all believed that it was a useful instrument, and a majority would apply this method in their own departments. There were continuing reservations about the feasibility of the method and some respondents felt it would require some adaptation, particularly to the criteria for awarding grades.ConclusionsThe workshop participants learnt to use an instrument developed in the United Kingdom that encourages an analytical approach to the assessment and teaching of consultation skills. They believed it would be useful in the contexts in which they worked.For full text, click here:SA Fam Pract 2006;48(3):14-14

Rat cities and beehive worlds: density and design in the modern city

Nestled among E. M. Forster's careful studies of Edwardian social mores is a short story called "The Machine Stops." Set many years in the future, it is a work of science fiction that imagines all humanity housed in giant high-density cities buried deep below a lifeless surface. With each citizen cocooned in an identical private chamber, all interaction is mediated through the workings of "the Machine," a totalizing social system that controls every aspect of human life. Cultural variety has ceded to rigorous organization: everywhere is the same, everyone lives the same life. So hopelessly reliant is humanity upon the efficient operation of the Machine, that when the system begins to fail there is little the people can do, and so tightly ordered is the system that the failure spreads. At the story's conclusion, the collapse is total, and Forster's closing image offers a condemnation of the world they had built, and a hopeful glimpse of the world that might, in their absence, return: "The whole city was broken like a honeycomb. [⋯] For a moment they saw the nations of the dead, and, before they joined them, scraps of the untainted sky" (2001: 123). In physically breaking apart the city, there is an extent to which Forster is literalizing the device of the broken society, but it is also the case that the infrastructure of the Machine is so inseparable from its social structure that the failure of one causes the failure of the other. The city has-in the vocabulary of present-day engineers-"failed badly.

Monocytes regulate the mechanism of T-cell death by inducing Fas-mediated apoptosis during bacterial infection.

Monocytes and T-cells are critical to the host response to acute bacterial infection but monocytes are primarily viewed as amplifying the inflammatory signal. The mechanisms of cell death regulating T-cell numbers at sites of infection are incompletely characterized. T-cell death in cultures of peripheral blood mononuclear cells (PBMC) showed 'classic' features of apoptosis following exposure to pneumococci. Conversely, purified CD3(+) T-cells cultured with pneumococci demonstrated necrosis with membrane permeabilization. The death of purified CD3(+) T-cells was not inhibited by necrostatin, but required the bacterial toxin pneumolysin. Apoptosis of CD3(+) T-cells in PBMC cultures required 'classical' CD14(+) monocytes, which enhanced T-cell activation. CD3(+) T-cell death was enhanced in HIV-seropositive individuals. Monocyte-mediated CD3(+) T-cell apoptotic death was Fas-dependent both in vitro and in vivo. In the early stages of the T-cell dependent host response to pneumococci reduced Fas ligand mediated T-cell apoptosis was associated with decreased bacterial clearance in the lung and increased bacteremia. In summary monocytes converted pathogen-associated necrosis into Fas-dependent apoptosis and regulated levels of activated T-cells at sites of acute bacterial infection. These changes were associated with enhanced bacterial clearance in the lung and reduced levels of invasive pneumococcal disease

The 'causes' of teenage pregnancy: review of South African research - Part 2

This article forms the second of a two-part series in which South African research on teenage pregnancy is reviewed. Part 1 of the series dealt with the consequences of teenage pregnancy; this paper reviews the 'causes' thereof. International literature is incorporated in the discussion by way of comparison. Contributory factors which have been investigated by South African researchers include: reproductive ignorance; the earlier occurrence of menarche; risktaking behaviour; psychological problems; peer influence; co-ercive sexual relations; dysfunctional family patterns; poor health services; socio-economic status; the breakdown of cultural traditions; and the cultural value placed on children. Preston-Whyte and colleagues present a revisionist argument, stating that early pregnancy may represent a rational life choice for certain adolescent women. The article is concluded with comments on methodological problems encountered in the South African research, and a discussion on the implications in terms of policy formulation

Constitutivism

A brief explanation and overview of constitutivism

Shallow waters: social science research in South Africa's marine environment

This paper provides an overview of social science research in the marine environment of South Africa for the period 1994–2012. A bibliography based on a review of relevant literature and social science projects funded under the SEAChange programme of the South African Network for Coastal and Oceanic Research (SANCOR) was used to identify nine main themes that capture the knowledge generated in the marine social science field. Within these themes, a wide diversity of topics has been explored, covering a wide geographic area. The review suggests that there has been a steady increase in social science research activities and outputs over the past 18 years, with a marked increase in postgraduate dissertations in this field. The SEAChange programme has contributed to enhancing understanding of certain issues and social interactions in the marine environment but this work is limited. Furthermore, there has been limited dissemination of these research results amongst the broader marine science community and incorporation of this information into policy and management decisions has also been limited. However, marine scientists are increasingly recognising the importance of taking a more holistic and integrated approach to management, and are encouraging further social science research, as well as interdisciplinary research across the natural and social sciences. Possible reasons for the lack of communication and coordination amongst natural and social scientists, as well as the limited uptake of research results in policy and management decisions, are discussed and recommendations are proposed.Web of Scienc