ABSTRACT
This study, based on the self-determination theory, investigates the link between university students' social peer and teacher integration and intrinsic motivation development. Both integration contexts are expected to contribute to the student's development, either additive or compensatory. The analyses rely on a nationally representative sample of 7,619 German university students (NEPS data set) and cover the time between the 3rd and 5th semesters in a longitudinal design. Person-centered analytical tools were applied to tap interindividual differences in the motivational trajectories as well as in integration profiles. Latent transition analyses revealed distinct links between the motivational trajectories (Increase [n = 532], Moderate Decrease [n = 2580], Decrease [n = 4,507]) and the integration profiles (Highly Integrated [n = 2,492], Moderately Integrated [n = 3832], Isolated [n = 1,144], Peer Deprivated [n = 151]), pointing to additive effects of teacher and peer integration. Positive trajectories were more likely in the Highly than in Moderately Integrated profiles. The two profiles pointing to below-average integration levels (Isolated and Peer Deprivated) showed the same probabilities for rather negative trajectories. The results are discussed against the backdrop of self-determination theory and additive vs. compensatory effects of teacher and peer integration, proposing a threshold model.
ABSTRACT
BACKGROUND: Headache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups have largely ignored headaches not fulfilling any specific set of ICHD criteria, although such headaches appear to be common. A new approach to these is needed: here we introduce, and investigate, a diagnostic category termed "undifferentiated headache" (UdH), defined in young people as recurrent mild-intensity headache of < 1 h's duration. METHODS: We conducted a nationwide cross-sectional survey in 31 schools in six regions of Turkey selected by mixed convenience-based and purposive modified cluster-sampling. A validated, standardised self-completed structured questionnaire was administered by a physician-investigator to entire classes of pupils aged 6-17 years. RESULTS: Of the identified sample of 7889 pupils, 7088 (89.8%) participated. The 1-year prevalence of UdH was 29.2%, of migraine (definite and probable) 26.7%, and of tension-type headache (TTH) (definite and probable) 12.9%. UdH differed with respect to almost all headache features and associated symptoms from both migraine and TTH. Burden of headache and use of acute medication were lower in UdH than in migraine and TTH. Headache yesterday was less common in UdH than migraine (OR 0.32; 95% CI 0.28-0.37) and TTH (OR 0.64; 95% CI 0.56-0.77). Quality of life (QoL) was better in UdH (33.6 ± 5.2) than in migraine (30.3 ± 5.6; p < 0.001) and TTH (32.4 ± 5.3; p < 0.001), but worse than in pupils without headache (35.7 ± 4.7; p < 0.001). CONCLUSIONS: This large nationwide study in Turkey of pupils aged 6-17 years has shown that many children and adolescents have a headache type that does not conform to existing accepted diagnostic criteria. This new diagnostic category of presumably still-evolving headache (undifferentiated headache) is common. UdH differs in almost all measurable respects from both migraine and TTH. Although characterised by mild headaches lasting < 1 h, UdH is associated with significant adverse impact on QoL. Longitudinal cohort studies are needed to evaluate the prognosis of UdH but, meanwhile, recognition of UdH and its distinction from migraine and TTH has implications for epidemiological studies, public-health policy and routine clinical practice.
