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961.

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   
962.
China’s middle-aged and older women suffer from poorer health than men. Using national baseline data from the China Health and Retirement Longitudinal Study (CHARLS), a survey conducted from 2011 to 2012, this article applies logistic models to investigate the association between female fertility history (parity, early childbearing, late childbearing) and middle-aged and late-life health. We find that parity is related to the mid-late-life health of women. Women with four children or more are more likely to suffer from activities of daily living (ADL) impairment and poorer self-rated health than those with one to three children. Early childbearing is associated with ADL impairment; however, the correlation is mediated by socioeconomic status. Early childbearing is related to self-rated health in later life by an indirect-only mediation effect via educational attainment and personal income.  相似文献   
963.
自媒体的出现修正了媒体资源分布失衡的弊端,促使个体身份发生角色转变,进而使话语权的行使形成了“话语权利”与“话语权力”两个维度.前者是言论自由在网络空间的体现,后者是个人言论衍生为媒体式表达后形成的超个体权力.“话语权利”的行使应当受国家对言论自由所设的界限限制,“话语权力”的赋予则使自媒体成为国家新闻管理体制下的“准媒体”,其作为互联网新闻信息服务提供者,应当受到约束与规制.  相似文献   
964.
经典剧作是我国优秀传统文化的代表,是中国人民智慧的结晶,也是中华民族优良品德的集中体现。做好经典剧作的对外传播,有利于将客观、真实的中国介绍给世界,消除个别国家对我国国家形象的误解,对于我国的社会主义现代化进程和在国际社会树立良好的大国形象,具有积极的推动作用。  相似文献   
965.
This study investigated divorce during China's social and economic transformation period from 1970 to 2012. Specifically, the study examined the trend development of divorce and demonstrated how marriage formation type and individual socioeconomic characteristics were associated with the likelihood of divorce across time. Event‐history analysis was applied to longitudinal data from the China Family Panel Studies (2010–2012 waves). The results showed a threefold increase in divorce from the pre‐1990s to the 1990s. Surprisingly, the trend shifted to a plateau toward the 2000s. When cohabitation was in its rapidly diffusing stage in the 1990s, individuals who cohabited prior to marriage had a substantially higher likelihood of divorce. As cohabitation became increasingly common in the 2000s, its effect on divorce weakened. The role of socioeconomic characteristics in divorce also varied across time. This study enriches the knowledge of family dynamics in contemporary Chinese society.  相似文献   
966.
Zhiqi Chen  Gang Li 《Economic inquiry》2018,56(2):1346-1356
We examine a merger between two competitors in a Bertrand‐Edgeworth model. We find that the effects of merger depend on the tightness of capacity constraints. The combination of two firms has no price effect if and only if the capacity constraints of all firms are binding both before and after the merger. However, a merger may turn a binding capacity constraint into a slack one, which results in higher prices. In an industry where excess capacity drives the premerger prices of all firms to the marginal cost, a merger may cause prices to rise even though aggregate capacity remains constant. (JEL L13, L40)  相似文献   
967.
968.
An oriented graph \(G^\sigma \) is a digraph without loops or multiple arcs whose underlying graph is G. Let \(S\left( G^\sigma \right) \) be the skew-adjacency matrix of \(G^\sigma \) and \(\alpha (G)\) be the independence number of G. The rank of \(S(G^\sigma )\) is called the skew-rank of \(G^\sigma \), denoted by \(sr(G^\sigma )\). Wong et al. (Eur J Comb 54:76–86, 2016) studied the relationship between the skew-rank of an oriented graph and the rank of its underlying graph. In this paper, the correlation involving the skew-rank, the independence number, and some other parameters are considered. First we show that \(sr(G^\sigma )+2\alpha (G)\geqslant 2|V_G|-2d(G)\), where \(|V_G|\) is the order of G and d(G) is the dimension of cycle space of G. We also obtain sharp lower bounds for \(sr(G^\sigma )+\alpha (G),\, sr(G^\sigma )-\alpha (G)\), \(sr(G^\sigma )/\alpha (G)\) and characterize all corresponding extremal graphs.  相似文献   
969.
目前,学术界对选取何种风险调整贴现率期限结构还存在争议,导致对同类投资项目得 出不同的管理指引意见. 针对这一争议,本文通过划分资本产出方式, 寻找影响贴现率结构的 主要因素. 研究表明,不确定的宏观经济产出和项目非系统风险共同影响风险溢价系数, 同时 风险溢价系数决定贴现率期限结构. 其中,当风险溢价系数大于某确定阈值, 贴现率随时间递 增; 其余情况表现为递减.  相似文献   
970.
以"顾客"为关注焦点是新时期高校必须深入理解并加以强化的办学理念,其满意度测评机制的建立和实施是关系高校潜在生命力的重要因素.  相似文献   
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