Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: A randomised feasibility study

BackgroundSevere perineal tears sustained during childbirth cause significant distress and morbidity amongst women. The objective of this study was to compare the use of straight scissors for cutting an episiotomy with the use of curved scissors, which are designed to curve away from the anal sphincter.MethodsWe used a single-centre, randomised feasibility trial. The intervention was the use of curved scissors. Women were recruited during a prenatal visit and randomised in the delivery suite, when it became clear that an episiotomy was required. The feasibility outcomes were the proportion of women able to be recruited, randomised and followed up. We also calculated the incidence of obstetric anal sphincter injury when either straight or curved scissors were used to cut an episiotomy. Other outcomes assessed were pain, length of hospital stay, perineal infection and perineal dehiscence.ResultsOf the 155 patients recruited in the prenatal period, only 20 (12.9%) were eventually randomised at birth. The main reasons for the high loss were that women either did not have a vaginal delivery (38, 24.5%), or they did not need an episiotomy (72, 46.5%). Rates of obstetric anal sphincter injury and other outcomes were similar between groups.DiscussionAnal sphincter injury during childbirth remains an important problem. Although the use of curved scissors provides a theoretical solution, we found that the high attrition rate made feasibility of conducting a suitably powered, randomised trial using the current design untenable. Alternative strategies have been suggested to make any future study more viable.     

Normalizing Denominational Statistics with Demographic Data: The Case of the United Church of Canada

In the Canadian context, one type of data has been underutilized in the study of contemporary religious trends: church collected statistics. The present article explores the advantages and limitations of such data by analyzing the evolution of key church indicators of the United Church of Canada over the past four decades. Figures regarding church membership, child baptisms, and funerals are examined and compared with demographic data from four Canadian regions. Results show that virtually all United Church statistics are in decline with regard to larger society since the 1970s. However, there are regional variations, most notably in the Atlantic provinces, which show later and lesser rates of decline.     

Staff Development as a School Climate Intervention to Support Transgender and Gender Nonconforming Students: An Integrated Research Partnership Model for School Counselors and Counselor Educators

ABSTRACT

This article posits that an integrative research partnership model can assist school counselors in addressing the marginalization of transgender students in schools through staff development. A methodological integration of action research and program evaluation through quantitative and qualitative data collection is explained, and a collaborative process is highlighted. A case example is provided to demonstrate the use of the design.     

FamilyLive: Parental Skill Building for Caregivers with Interpersonal Trauma Exposures

Mental health treatments for emotionally traumatized children incorporate family and caregiver-child therapy sessions to promote child recovery and minimize developmental disruption. Such sessions require that caregivers regulate their emotions to remain productively engaged in the therapeutic process. However, caregivers with histories of unresolved interpersonal trauma have difficulty with emotional regulation. Interpersonal trauma also negatively affects the ability to reflect on one’s own and others’ feelings and intentions. This limitation interferes with caregiver engagement in psychotherapy relationships aimed at supporting child trauma work. FamilyLive is an innovative caregiver-focused family therapy model that uses a one-way mirror, a specially trained reflecting team, structured routines and individualized verbalizations to address this complex clinical phenomenon. Guided by the literature on attachment and trauma, FamilyLive has yielded anecdotal successes and positive pilot results. FamilyLive is a viable approach to engaging caregivers with histories of interpersonal trauma in trauma-focused child and family therapy relationships.     

The crisis of neoliberalism and the future of international institutions: A comparison of the IMF and the WTO

The current crisis of neoliberalism is calling into question the relevance of key international institutions. We analyze the origins, nature, and possible impacts of the crisis through comparing two such institutions: the International Monetary Fund (IMF) and the World Trade Organization (WTO). Both originated in the post-World War II U.S.-led hegemonic order and were transformed as part of the transition to global neoliberalism. We show that while the IMF and the WTO have been part of the same hegemonic project, their distinct institutional features have put them on significantly different trajectories. Historical differences in the two institutions’ systems of rules have placed the IMF in a more vulnerable position than the WTO, which provides clues to the future contours of global economic governance.

---

Preschoolers' Attachment to Mother and Risk for Adjustment Problems in Kindergarten: Can Teachers Make a Difference?

Based on attachment theory, two aims were addressed. Firstly, we tested whether close teacher–child relationships may buffer children who are less securely attached to their mothers against negative outcomes, such as aggressive behavior. Secondly, our study evaluated whether teacher sensitivity may protect less securely attached children against forming less close relationships with their teachers. In a sample of 127 children, mother–child attachment was observed in preschool. In kindergarten, teacher sensitivity was observed, and teacher–child closeness and child aggressive behavior were rated by the teacher. Results of multilevel hierarchical regression analyses first showed that with high teacher–child closeness, less securely attached children are no longer at risk for more aggressive behavior. Secondly, it was found that with high teacher sensitivity, less securely attached children are no longer at risk for developing less close relationships with their teachers.