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51.

Aim

To assess the relationship between the duration of the second stage of labour and postpartum anaemia during vaginal birth.

Methods

An observational, analytical retrospective cohort study was performed at the “Mancha-Centro Hospital” (Spain) during the 2013–2016 period. Data were collected from 3437 women who had a vaginal birth. Postpartum anaemia was defined as a haemoglobin level below 11 g/dL at 24 h postpartum. A univariate analysis was used for potential risk factors and a multivariate analysis with binary logistic regression to control for possible confounding factors.

Findings

The incidence of postpartum anaemia was 42.0%. The risk of postpartum anaemia did not increase in nulliparous women whose duration of the second stage of labour exceeded 4 h. Compared with multiparous women who delivered between 0 and 3 h, multiparous women with a duration of the second stage of labour beyond 3 h were at higher risk of postpartum anaemia (OR = 2.43 [1.30–4.52]).

Conclusion

The duration of the second stage of labour beyond 4 h is safe for postpartum anaemia in nulliparous women. However in multiparous women, monitoring should increase if the second stage of labour exceeds 3 h given the increased risk of postpartum anaemia.  相似文献   
52.
Rhetorical questions emerging spontaneously in consultations can be used as a tool for developing self‐reflexivity and exploring the therapeutic alliance in the process of therapy with couples and families. This paper presents a technique based on the enunciation of rhetorical questions, which can point to an impasse in the process of therapy and contain a key to its resolution. The technique focuses on the distinctive feature of rhetorical questions as convening a paradoxical injunction: a question not intended as a question, while uttered as such. The technique in four steps is illustrated by examples from therapy, supervision, consultation, and self‐supervision. Its focus is the interlink between the therapeutic relationship and the process of therapy and it is informed by a second‐order cybernetics approach, dialogical practice, and the systemic literature on emotion. The technique can help develop curiosity in working with families, lead to unforeseen developments, and touch on prejudices not made explicit in previous therapeutic encounters. Whether we are acting as supervisors, therapists, or clients, the creation of a ‘secure enough’ context for rhetorical questions becomes critical to allow freeform exploration.  相似文献   
53.
In this work, we propose an optimization approach for constructing various classes of circulant combinatorial designs that can be defined in terms of autocorrelation. The problem is formulated as a so-called feasibility problem having three sets, to which the Douglas–Rachford projection algorithm is applied. The approach is illustrated on three different classes of circulant combinatorial designs: circulant weighing matrices, D-optimal matrices of circulant type, and Hadamard matrices with two circulant cores. Furthermore, we explicitly construct two new circulant weighing matrices, a CW(126, 64) and a CW(198, 100), whose existence was previously marked as unresolved in the most recent version of Strassler’s table.  相似文献   
54.
Despite the fact that rural education has always been one of the most important means of rural development, it has been ignored in many developing countries, with the result that rural development has not achieved great success. The problems of education in rural areas are not only related to the amount the country spends on education or to the system of education. The socio-economic condition of the individuals living in these areas and the form of rural education also play an important part. The present study deals with the socio-economic factors that influence the education level which is achieved. The assessments in the study are based on data gathered in a survey of 386 households carried out in the Aegean Region of Turkey. The work consists of three parts: the state of education in rural areas; the factors adversely affecting an individual’s decision to continue at school; and the employment situation of individuals who did not continue their education. In the results section, some suggestions have been made regarding the provision of employment opportunities to individuals who have not completed their education and who have had no job training.  相似文献   
55.
56.
Same parliaments, to form a committee of size $q$ , use a voting process like the following: every parliamentary member votes for one out of a fixed set of candidates, and those $q$ candidates receiving more votes are elected for the committee. Assuming total discipline of vote, this is a game form in which players are the parliamentary groups. We investigate, according to some natural hypotheses about preferences, the likely distribution of the members of this committee. The main results are: (a) when fractional votes are allowed, there is a complete agreement between the distribution among the groups of the elected candidates that are outcomes of a Nash equilibrium and the distribution that, according to the size of the groups, would compute the Jefferson-d’Hondt allocation rule, and (b) when fractional votes are not allowed, there is a near agreement for a majority of situations.  相似文献   
57.
This study of 114 workers in the hydrocarbon industry was conducted to identify the relationship between stress and musculoskeletal discomfort, and to view the roles played by such factors as age, schooling, obesity, workplace and job seniority. All factors except seniority were found to affect the presence of musculoskeletal discomfort in some area of the body.  相似文献   
58.
59.
The objective of this paper was to control ergonomic risks among female cashiers working in a department store belonging to the retail market. This study was conducted between May and November 2010. Participatory ergonomics was applied through knowing and understanding how the company works, establishing the work team (Ergo group), training the team in ergonomics-related topics, and making decisions and interventions. The sample was composed of 71 participants--mostly female cashiers--, and all of them have a musculoskeletal compromise, declaring pain or discomfort mainly in the neck, lower back, right wrist and shoulders. Among others, following problems were found: postural overload, repetitive work, manual load handling, mental fatigue, environmental discomfort, variable work schedules, extended working days, and absence of breaks. In the intervention, the main implemented changes were the redesign of workstation, complete change of chairs and keyboards, and the implementation of a rotation system, as well breaks for compensatory exercises. After that, an evident improvement of found problems was observed, therefore it can be concluded that participatory ergonomics is an attractive methodology, appropriate and efficient for solving and controlling ergonomic risks and problems.  相似文献   
60.
Social Indicators Research - In poverty measurement, differential weighting aims to take into account the unequal importance of the diverse dimensions and aspects of poverty and to add valuable...  相似文献   
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