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21.

Background

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth.

Aim

To increase understanding of decision-making in complex home-like birth settings by exploring midwives’ and women’s perspectives and to develop a dynamic model integrating participatory processes for making shared decisions.

Methods

The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births.

Findings

The central phenomenon that arose from the data was “defining/redefining decision as a joint commitment to healthy childbirth”. The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife’s decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman’s decision, making an informed decision or taking the necessary decision.

Discussion and conclusion

To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice.  相似文献   
22.
Brand alliances represent a popular business strategy in many industries, because firms hope to evoke positive consumer evaluations of both the alliance’s product and the partner brands. However, extant research offers mixed findings regarding the effects of a brand alliance on its partner brands (i.e., spillover effects). In response, this study separates spillover effects into the effects of the alliance product on the partner brands (brand alliance effects) and the effects between partner brands (brand contrast effects), while also noting the potential moderating impact of perceived attitude- and product-based fit between partner brands on resulting spillover effects. Two experimental studies consistently reveal the existence of brand contrast effects; furthermore, the partner brand’s attitude-based fit reduces undesired brand contrast effects and positively moderates spillover effects in brand alliances, whereas product-based fit does not. Therefore, a third study identifies relevant drivers of partner brand’s attitude-based fit for different brand alliances (i.e., co-branding, ingredient branding, and joint advertising). The findings have notable implications for the design and management of brand alliances.  相似文献   
23.

Problem and background

Despite a generally affluent society, the caesarean section rate in Switzerland has steadily climbed in recent years from 22.9% in 1998 to 33.7% in 2014. Speculation by the media has prompted political questions as to the reasons. However, there is no clear evidence as to why the Swiss rate should be so high especially in comparison with neighbouring countries.

Aim

To describe the emerging expectations of giving birth of healthy primigravid women in the early second semester of pregnancy in four Swiss cantons.

Methods

Qualitative individual interviews with 58 healthy primigravid women, were audio recorded, transcribed and subjected to thematic analysis. Recruitment took place through public and private hospitals, birth centres, obstetricians and independent midwives. The main ethical issues were informed consent, autonomy, confidentiality and anonymity.

Findings

The three main themes identified were taking or avoiding decisions, experiencing a continuum of emotions and planning the care.

Discussion

Being pregnant was part of a project women had mapped out for their lives. Only three women in our sample expressed a wish for a caesarean section. One of the strongest emotions was that of fear but in contrast some participants expressed faith that their bodies would cope with the experience.

Conclusion

Bringing together the three languages and cultures produced a truly “Swiss” study showing contrasts between a matter of fact approach to pregnancy and the concept of fear. Such a contrast is worthy of further and deeper exploration by a multi-disciplinary research team.  相似文献   
24.
As recent events have shown, simultaneous crop losses in different parts of the world can cause serious risks to global food security. However, to date, little is known about the spatial dependency of lower than expected crop yields from global breadbaskets. This especially applies in the case of extreme events, i.e., where one or more breadbaskets are experiencing far below average yields. Without such information, risk management approaches cannot be applied and vulnerability to extremes may remain high or even increase in the future around the world. We tackle both issues from an empirical perspective focusing on wheat yield. Interdependencies between historically observed wheat yield deviations in five breadbaskets (United States, Argentina, India, China, and Australia) are estimated via copula approaches that can incorporate increasing tail dependencies. In doing so, we are able to attach probabilities to interregional as well as global yield losses. To address the robustness of our results, we apply three different methods for constructing multivariate copulas: vine copulas, ordered coupling using a minimax approach, and hierarchical structuring. We found interdependencies between states within breadbaskets that led us to the conclusion that risk pooling for extremes is less favorable on the regional level. However, notwithstanding evidence of global climatic teleconnections that may influence crop production, we also demonstrate empirically that wheat production losses are independent between global breadbaskets, which strengthens the case for interregional risk pooling strategies. We argue that through interregional risk pooling, postdisaster liabilities of governments and international donors could be decreased.  相似文献   
25.
Regarding the requirements and conditions of professional??s work, their particular needs for reflection and continuing education are revealed. Continuing professional development (CPD) is an appropriate approach for this type of reflection. On the background of a rather small body of empirical research, we argue that the method of mutual visitation can fulfil the requirements of CPD. We report a case study about three mutual visitations of dental practitioners in Germany to describe and evaluate their experiences. The data reveal conditions helping to achieve a successful mutual visitation: their embedding in a professional learning program, the right combination of participants, a proper preparation and competencies to give and to take feedback.  相似文献   
26.
27.
Climate Change and Human Health: Estimating Avoidable Deaths and Disease   总被引:2,自引:0,他引:2  
Human population health has always been central in the justification for sustainable development but nearly invisible in the United Nations Framework Convention on Climate Change negotiations. Current scientific evidence indicates that climate change will contribute to the global burden of disease through increases in diarrhoeal disease, vector-borne disease, and malnutrition, and the health impacts of extreme weather and climate events. A few studies have estimated future potential health impacts of climate change but often generate little policy-relevant information. Robust estimates of future health impacts rely on robust projections of future disease patterns. The application of a standardized and established methodology has been developed to quantify the impact of climate change in relation to different greenhouse gas emission scenarios. All health risk assessments are necessarily biased toward conservative best-estimates of health effects that are easily measured. Global, regional, and national risk assessments can take no account of irreversibility, or plausible low-probability events with potentially very high burdens on human health. There is no "safe limit" of climate change with respect to health impacts as health systems in some regions do not adequately cope with the current climate variability. Current scientific methods cannot identify global threshold health effects in order for policymakers to regulate a "tolerable" amount of climate change. We argue for the need for more research to reduce the potential impacts of climate change on human health, including the development of improved methods for quantitative risk assessment. The large uncertainty about the future effects of climate change on human population health should be a reason to reduce greenhouse gas emissions, and not a reason for inaction.  相似文献   
28.
The Eurozone crisis has led to a long and remarkable protest wave. Civil society raised its voice against the ever-harsher austerity measures implemented to deal with the crisis. The article focuses on the role of civil society and its potential to contribute new perspectives to the debate. Such a contribution would depend on two preconditions: 1. Civil society actors need to mobilize successfully to make their voices heard. 2. Civil society actors contribute a perspective that differs to the perspectives of actors from institutionalized politics. Both preconditions are analyzed empirically for two countries that are in very different situations in the crisis scenario: Greece and Germany. Greece has been hit most severely by the crisis; Germany is the most prominent country defining the crisis management, and it provides the largest share of credit guarantees for “crisis countries.” Social movement theory is used to explain the differing evolution of protests in the two countries. In the early phase of the crisis, the established landscape of political parties in both countries offered few opportunities for their citizens to vote in opposition to the crisis management, which is conducive to extra-parliamentary protest. Differences in deprivation, discursive opportunities and the resource basis of mobilization structures can explain differences in protest frequency but also to some extent the evolution of protest over time. Taking up Habermas’ argument regarding the specific perspective of civil society actors in the public debate, we then analyze to which extent the arguments of civil society actors deviate from those of more institutionalized actors. A discursive actor attribution analysis unveils that civil society actors are more sensitive to social problems and grand systemic questions. Moreover, civil society actors are less hesitant to blame actors on the EU level and other EU Member States, even though their overall contribution to the crisis debate is rather marginal.  相似文献   
29.
Business coachings have become one of the most important instruments in human resource-development. However, scientific examinations of risks and side effects of coachings are still limited. This article presents first empirical results regarding negative effects of coaching for clients. Further, we explore which negative effects result from coachings for coaches. 20 coaching experts were questioned within a problem-centered interview. Results show that negative effects for coaches and clients are multifaceted. Causes of negative effects for coaches and clients partly overlap, for instance when considering the differentiation between psychotherapy and coaching.  相似文献   
30.
Although the impact of internationalization on firm performance is still controversial, we find that internationalization does not have an ongoing positive performance effect. The international expansion of MNEs needs to be managed carefully, especially after a certain level of international involvement is surpassed. One theoretically highly accepted, but empirically neglected, driver of the success of international business is the establishment of an appropriate international organizational structure. This paper is the first to empirically address the question of how international organizational structure decisions affect performance by means of a new analysis technique — a causal analysis based on neural networks. Referring to UNCTAD's 100 most international corporations, the key finding of this study is that successful high internationalization involves a transnational structure in which elements of centralization and decentralization are well balanced.  相似文献   
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