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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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This article explores the relationship between parental psychological control and parental autonomy granting, and the relations between these constructs and indicators of adolescent psychosocial functioning, in a sample of 9,564 adolescents from grades 9 to 12. Participants completed a comprehensive parenting questionnaire as well as several measures of psychosocial adjustment. Confirmatory factor analyses of the parenting items revealed discrete factors for psychological control and autonomy granting, suggesting that these are distinct parenting constructs rather than opposite ends of a parental control continuum. Moreover, structural equation modeling showed that these factors were weakly correlated and differentially related to adolescent internalizing symptoms. Findings have implications for future conceptualization and measurement of psychological control and autonomy granting, and for research examining their effects on adolescent development.  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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Summary.  The association of poor education and poor health has been consistently observed in many studies and in various countries. Thus far, studies examining the mechanisms underlying this association have looked at only a limited set of potential pathways. This study simultaneously examines six distinctive pathways, which have been hypothesized to link education and health and found support from previous studies. A causal analysis of education and health was performed using structural equation models. Data were used from six phases of the National Child Development Study, which is based on following up an initial sample of 17416 children who were born in 1958. The association between education and health appears to be explained by a combination of mechanisms: adolescent health and adult health behaviours for men and women, adult social class among men and parental social class among women. We conclude that improvements in population educational attainment may not automatically lead to improvements in population health, and that health policies for improving health and reducing health inequalities need to target specific causal pathways.  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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