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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   
2.
This paper proposes ‘comprehensive neighbourhood mapping’ as a schema for gathering and interpreting information within a given geographical area which is informed by imaginative thinking about the safety of children and young people from sexual crime. It would build upon current forms of profiling by local authorities, health authorities and central Government. CNM would actively involve local people, in partnership with agencies, in ‘mapping’ danger points and support points. Eight components are discussed, including environmental issues, locations of sex offenders, sites where teenagers meet and share information, supportive individuals and organizations. Some issues for pilot projects are discussed, including the need to set up planning and implementation groups and to integrate CNM into wider child protection and community safety strategies. CNM is grounded in an ecological perspective which sees partnership approaches as essential and believes an overarching view of neighbourhood needs, based on detailed local information and understanding of how different forms of harm interconnect, is crucial in developing child protection strategies. At times of acute official anxiety about community ‘lynch‐mob’ reactions to known paedophiles, CNM aims to build communities which instead are informed and thoughtful about child protection. Copyright © 2002 John Wiley & Sons, Ltd.  相似文献   
3.
This article examines the current trends of proliferation of commercial gaming, especially in the United States, in the context of the third wave of legalization of gambling that has been experienced since the founding of the nation. The author looks at the historic foundations of the spread of casino-style gambling, and notes the types of casino gaming that have led the way in the current expansion. He also points out why it is reasonable to expect that this wave too may come crashing down, as general acceptance of wide-spread casino gaming in America may indeed be short-lived.Gambling and the Law® is a registered trademark of I. Nelson Rose.  相似文献   
4.
Plant protection products are used in agriculture to improve yields, but this use can cause contamination of the environment and is also likely to have adverse short and long term effects on agricultural workers. This poster describes a systems approach to reducing the risk of operator exposure to plant protection products through the introduction of ergonomics to the design process of large agricultural sprayers.  相似文献   
5.
The development of writing skills sufficient to meet the complexities of contemporary social work practice is a growing demand from employers and practice educators. The paper explores current pedagogical debate relating to student support and the development of writing skills and relates this debate to meeting the needs of social work students engaged in practice learning and professional practice. A number of questions are raised about current social work education in England and the needs of students entering from non-traditional academic backgrounds facing the increasingly rigorous demands of professional report writing. The discussion is then grounded in a practice example of staff from a university social work course and education guidance service working together to meet student need in respect of developing writing skills. The development, implementation and evaluation of a university writing skills programme for social work students are explored. The paper concludes by setting out a range of challenges arising from experience of the programme and a consideration of theory, and points to potential ways forward based on a social practice approach to teaching writing skills.  相似文献   
6.
Despite more than thirty years of debate, disagreement persists among research ethicists about the most appropriate way to interpret the U.S. regulations on pediatric research, specifically the categories of “minimal risk” and a “minor increase over minimal risk.” Focusing primarily on the definition of “minimal risk,” we argue in this article that the continued debate about the pediatric risk categories is at least partly because their conceptual status is seldom considered directly. Once this is done, it becomes clear that the most popular strategy for interpreting “minimal risk”—defining it as a specific set of risks—is indefensible and, from a pragmatic perspective, unlikely to resolve disagreement. Primarily this is because judgments about minimal risk are both normative and heavily intuitive in nature and thus cannot easily be captured by reductions to a given set of risks. We suggest instead that a more defensible approach to evaluating risk should incorporate room for reflection and deliberation. This dispositional, deliberative framework can nonetheless accommodate a number of intellectual resources for reducing reliance on sheer intuition and improving the quality of risk evaluations.  相似文献   
7.
Early in development, children explore and combine objects in increasingly complex ways. One manual skill, object construction, represents a major shift in how objects are explored relative to other objects. Despite recent connections with cognitive functioning such as spatial skills, the development of object construction ability has rarely been studied and its trajectory has not been adequately described. The purpose of this study was to describe the development of three types of object construction (stacking, nesting, and affixing) across 5 monthly infant visits and 7 monthly toddler visits using a longitudinal design and a large sample size. Infants (10–14 months, = 131) and toddlers drawn from the infant sample (18–24 months, = 65) were given sets of age‐appropriate toys each of which elicited at least one type of constructive play. We described success at different construction tasks and identified trends for construction skill for infant and toddler development using multilevel modeling. We found that each of the three construction actions developed in unique ways across the 10‐ to 24‐month period. Infant construction skill predicted the development of toddler skill, but toddler construction skill diverged from infant trajectories. We discuss the role of combination strategies in the development of object construction skill and how object construction could be related to other domains of development.  相似文献   
8.
The usefulness of logistic regression depends to a great extent on the correct specification of the relation between a binary response and characteristics of the unit on which the response is recoded. Currently used methods for testing for misspecification (lack of fit) of a proposed logistic regression model do not perform well when a data set contains almost as many distinct covariate vectors as experimental units, a condition referred to as sparsity. A new algorithm for grouping sparse data to create pseudo replicates and using them to test for lack of fit is developed. A simulation study illustrates settings in which the new test is superior to existing ones. Analysis of a dataset consisting of the ages of menarche of Warsaw girls is also used to compare the new and existing lack of fit tests.  相似文献   
9.
10.
Measuring access to water in the Sustainable Development Goals era involves taking into account the human rights framework. Therefore, its content should be considered to conceptualize the level of service through adequate indicators and to follow-up inequities reduction at global, national and local level. This research develops and tests a methodology to measure intra-community disparities based on human right to water normative criteria through a stratified sampling, splitting households served by community based organizations and those self-provided. This approach implies considering much reduced populations, thus special care needs to be taken with sample sizes and uncertainty of estimators. The proposed methodology is practical to locate and accurately characterize minority sectors within rural communities and allows moving beyond central-tendency estimators. It implies higher costs for field data collection than traditional approaches, but this can be assumed given the relevance of the approach from a human rights perspective, which calls for adequate tools for equity-oriented policy making at local level. The research point out how results might be used to shape decision-making processes.  相似文献   
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