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1.

Background

Second-degree tears are the most common form of perineal trauma occurring after vaginal birth managed by New Zealand midwives, although little is known about midwives’ perineal practice.

Aim

The aim of this study was to identify how midwives managed the last second-degree perineal tear they treated and the level to which their practice reflects National Institute for Health and Care Excellence guidelines.

Methods

An (anonymous) online survey was conducted over a six-week period in 2013. New Zealand midwives who self-identified as currently practising perineal management and could recall management of the last second-degree tear they treated were included in the analysis.

Findings

Of those invited, 645 (57.1% self-employed, 42.9% employed) were eligible and completed surveys. Self-employed midwives reported greater confidence (88.0% vs 74.4%, p < 0.001) and more recent experience (85.1% vs 57.4%, p < 0.001) with perineal repair than employed midwives. Midwives who left the last second-degree tear unsutured (7.3%) were more likely to report low confidence (48.9% vs 15.4%, p < 0.001) and less recent experience with repair (53.2% vs 24.7%, p < 0.001), and were less likely to report a digital-rectal examination (10.6% vs 49.0%, p < 0.001), compared to midwives who sutured. Care consistent with evidence-based guidelines (performing a digital-rectal examination, 59.4% vs 49.3% p = 0.005; optimal suturing techniques, 62.2% vs 48.7%, p = 0.001) was associated with recent perineal education.

Conclusions

Midwives’ management of the last second-degree perineal tear is variable and influenced by factors including: employment status, experience, confidence, and perineal education. There is potential for improvement in midwives’ management through increased uptake of evidence-based guidelines and through ongoing education.  相似文献   
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Recent studies have attempted to understand the processes involved in joint attention because of its relevance to both atypical and normal development. Data from a recent study of young children with autism suggests that performance on a delay nonmatch to sample (DNMS) task associated with ventromedial prefrontal functions, but not an A‐not‐B/delayed response task associated with dorsolateral prefrontal cortex, was related to joint attention skills (Dawson et al., 2002). Recent research also suggests that joint attention is associated with dorsalmedial brain systems linked to self‐monitoring (Mundy, 2003). This study investigated the relations among joint attention, DNMS, and self‐recognition performance in a longitudinal study of 39 normally developing toddlers from 14 to 18 months. The results indicated that development on the DNMS and self‐recognition tasks, but not a means end task, predicted joint attention at 18 months. Further analysis showed that the model was only significant for initiating joint attention (IJA). The implications of these results for the neuro‐development of IJA are discussed.  相似文献   
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Journal of Management and Governance - Alternative forms of disciplining the actionsof senior enterprise managers can becharacterized as shareholder or stakeholdergovernance. This paper analyzes...  相似文献   
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British Pakistanis continue to have earlier and higher fertility than other ethnic groups in the UK, despite a recent rise in educational and employment opportunities for British Pakistani women. In this paper we present findings from an interview-based study with 91 British Pakistani women and men in the Northeast of England, in order to throw some light on the reproductive choices and constraints that underlie this apparent demographic anomaly. Drawing on detailed reproductive narratives, we show that, contrary to common assumptions within the literature, relatively high and early fertility does not necessarily indicate a passive acceptance of ??cultural norms?? or a reluctance to engage with new social and economic opportunities. For some young women at least, early motherhood represents a deliberate and strategic choice: a way of managing different sets of family-building and other aspirations, embedded within a complex interplay of relationships between individuals, couples and wider families. This study contributes to the emerging ??inter-discipline?? of anthropological demography, which offers important insights into population processes that neither discipline can do alone.  相似文献   
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Food insecurity is a common social issue and households look to assistance from food pantries, which often have difficulty supplying fresh or nutritious food. A substantial amount of produce is left in the fields, which can be collected through gleaning. In a focus group with volunteer gleaners at a faith-based nonprofit organization that attempts to fill the gaps of food insecurity, the motivations, challenges, and benefits of volunteering were examined. Volunteering in gleaning generated a sense of collective purpose and community; it addressed deeply held religious and spiritual impulses; and it puts volunteers directly in contact with nature.  相似文献   
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Factitious Disorder Imposed by Another (FDIA) can be difficult to expeditiously identify. Understanding personality characteristics of FDIA perpetrators via psychological assessment may decrease the time between initial abuse and identification of FDIA. Personality characteristics of FDIA mother-perpetrators were examined through a comparative analysis of MMPI-2 profiles. It was predicted that mother-perpetrators would have significantly higher overall profile elevations on the MMPI-2 and elevations on specific clinical scales than a comparative control group. Results indicated that mother-perpetrators displayed significantly higher, elevations on the Psychasthenia (Pt) and Schizophrenia (Sc) scales and a trend toward significantly higher elevation on the Psychopathic Deviate (Pd) scale than the control group. These findings, along with the demographic information obtained, establish a preliminary foundation for understanding an overall profile of mother-perpetrators.  相似文献   
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Maternal education differences in children's academic skills have been strongly linked to parental investment behaviors. This study extended this line of research to investigate whether these same maternal education patterns in parenting are observed among a set of parenting behaviors that are linked to young children's health. Drawing on data from the Early Childhood Longitudinal Study, Birth Cohort (n = 5,000) and longitudinal models incorporating random effects, the authors found that higher levels of maternal education were associated with more advantageous health investment behaviors at each phase of early development (9 months, 2 years, 4 years, 5 years). Moreover, these disparities were typically largest at the developmental stage when it was potentially most sensitive for children's long‐term health and development. These findings provide further evidence of a developmental gradient associated with mothers' education and new insight into the salience of mothers' education for the short‐ and long‐term health and well‐being of their children.  相似文献   
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