Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: A randomised feasibility study

BackgroundSevere perineal tears sustained during childbirth cause significant distress and morbidity amongst women. The objective of this study was to compare the use of straight scissors for cutting an episiotomy with the use of curved scissors, which are designed to curve away from the anal sphincter.MethodsWe used a single-centre, randomised feasibility trial. The intervention was the use of curved scissors. Women were recruited during a prenatal visit and randomised in the delivery suite, when it became clear that an episiotomy was required. The feasibility outcomes were the proportion of women able to be recruited, randomised and followed up. We also calculated the incidence of obstetric anal sphincter injury when either straight or curved scissors were used to cut an episiotomy. Other outcomes assessed were pain, length of hospital stay, perineal infection and perineal dehiscence.ResultsOf the 155 patients recruited in the prenatal period, only 20 (12.9%) were eventually randomised at birth. The main reasons for the high loss were that women either did not have a vaginal delivery (38, 24.5%), or they did not need an episiotomy (72, 46.5%). Rates of obstetric anal sphincter injury and other outcomes were similar between groups.DiscussionAnal sphincter injury during childbirth remains an important problem. Although the use of curved scissors provides a theoretical solution, we found that the high attrition rate made feasibility of conducting a suitably powered, randomised trial using the current design untenable. Alternative strategies have been suggested to make any future study more viable.     

Caseworkers as a source of hope leading to perceptions of academic success for transitional age foster youth

Research among adolescent samples has consistently demonstrated that a hopeful mindset is associated with resilience and global well-being. Further, research suggests that hope is influenced from an early age from connections with supportive caregivers. However, because older youth in the child welfare system may lack supportive caregivers, alternative sources of hope may be needed. To test a theory that supportive child welfare caseworkers can serve as external sources of hope, we conducted a cross-sectional study of youth in the child welfare system from a single state (N = 149). Using surveys with established scales to measure the variables of interest, the study tested a structural equation model of (1) youth's external hope in their caseworker as a driver of (2) internal hope in themselves leading to (3) more positive perceptions of academic success. Perceptions of academic success were chosen as the final consequence of the model because academic success has been linked to many other variables of well-being across the lifespan. The results indicate that the proposed structural model fits the data well (χ² = 327.9, df = 150; P < 0.001; root-mean-square error of approximation [RMSEA] = 0.09 [90% confidence interval – CI: 0.076, 0.103]; comparative fit index [CFI]: 0.920; standardized root-mean-square residual [SRMR]: 0.05). The results indicate that youths' hope in themselves had origins in external hope in the caseworker. Moreover, the final consequence was an increase in perceptions of academic success. Such results have implications by revealing how case management services can positively influence foster youths' hope and thereby influence their academic success.     

Minority comparison model: Effects of Whites’ multiracial evaluation on symbolic racism and racialized policy preferences

Most Racial Studies primarily focus on African Americans without paying attention to nonblack minorities, and it fails to capture recent increase in racial diversity. Based on previous theories and empirical findings, we propose a new model, minority comparison model, which accounts for theoretical shortcomings in Racial Studies. This model (1) captures psychological processes that compare blacks and nonblacks, and (2) explores the effects of whites’ multiracial evaluation on racialized policy preferences. Drawing on a 2008 national representative sample, this study finds that whites who have positive stereotype of nonblacks (e.g., Hispanics and/or Asians) but negative stereotype of blacks show substantially higher symbolic racism and stronger opposition to Affirmative Action, whereas whites who have positive stereotype of blacks but negative stereotypes of nonblacks have stronger opposition to expansive immigration policy. Our study offers new ways of understanding and accounting for symbolic racism in modern context, and shows how whites’ preferences in racialized policies are influenced by multiracial evaluation.     

The experience of sole mothers balancing paid work with care for a child with a disability

There are increasing numbers of families in Australia headed by sole parents, but little is known about the experiences of those who also care for a child with a disability. Additional caring responsibilities have previously been shown to impact on the work participation of parents. This study involved qualitative analyses of interview data conducted with sole mothers with school‐aged children with disability (N = 11). Thematic analysis revealed four themes that enabled and supported participation in the workforce: social support; managing appointments; characteristics of the workplace; and the role of the school. Results suggest the importance of practical help from family and friends in facilitating participation in paid employment. Additionally, the importance of flexible appointment scheduling on the part of service providers was highlighted, as well as the importance of workplace flexibility and supportive workplace cultures. Such factors were important in supporting sole mothers to balance work with care, with important implications for personal and family wellbeing.     

Emotional Climate in Families Experiencing Homelessness: Associations with Child Affect and Socioemotional Adjustment in School

This study examined associations among family‐level risks, emotional climate, and child adjustment in families experiencing homelessness. Emotional climate, an indirect aspect of emotion socialization, was indexed by parents’ expressed emotion while describing their children. Sociodemographic risk and parent internalizing distress were hypothesized to predict more negativity and less warmth in the emotional climate. Emotional climate was expected to predict observer‐rated child affect and teacher‐reported socioemotional adjustment, mediating effects of risk. Participants were 138 homeless parents (64 percent African‐American) and their four‐ to six‐year‐old children (43.5 percent male). During semi‐structured interviews, parents reported demographic risks and internalizing distress and completed a Five Minute Speech Sample about their child, later rated for warmth and negativity. Children's positive and negative affect were coded from videotapes of structured parent‐child interaction tasks. Socioemotional adjustment (externalizing behavior, peer acceptance, and prosocial behavior) was reported by teachers a few months later. Hypotheses were partially supported. Parent internalizing distress was associated with higher parent negativity, which was linked to more negative affect in children, and parent warmth was associated with children's positive affect. Neither emotional climate nor child affect predicted teacher‐reported externalizing behavior or peer acceptance, but parental negativity and male sex predicted lower prosocial behavior in the classroom. Future research directions and clinical implications are discussed.     

Web-Enhanced Preservice Training for Prospective Resource Parents: A Randomized Trial of Effectiveness and User Satisfaction

ABSTRACT

Traditionally, prospective resource parents must attend all preservice training in person. Although live sessions are necessary for screening applicants, instructional portions of training could be enhanced by Web-based sessions. This pilot study compares the effectiveness of online and classroom versions of one session from a widely used preservice training program. Ninety-two individuals enrolled in the program in two states were randomly assigned to a treatment group that viewed an online version of the class on child abuse and neglect or to a comparison group that took the same class in person. Written questionnaires were completed before and after the class. Significant group differences on knowledge of child maltreatment and empathy toward birth parents plus high user satisfaction were hypothesized. Analysis of covariance results showed the online training was more effective than the live training at increasing knowledge. Multivariate analysis of covariance findings on empathy were not significant but trended toward greater empathy for the online group. Feedback indicated high satisfaction with the online course. The finding that online instruction is more effective than live instruction has positive implications for practice, because Web-based training offers advantages like standardizing instruction, cutting agency and trainee costs, and providing greater flexibility.     

Short Notices

Michael Freeden, The New Liberalism: An Ideology of Social Reform (1978), xi+291 (Clarendon Press, Oxford, £10.00).

D. W. Howell, Land and People in Nineteenth‐Century Wales (1977), xv+207 (Routledge &; Kegan Paul, £6.95).

Murray Tolmie, The Triumph of the Saints: The Separate Churches of London 1616–1649 (1977), xii+251 (Cambridge University Press, Cambridge, £9.00).

George Huppert, Les Bourgeois Gentilshommes. An Essay on the Definition of Élites in Renaissance France (1977), xii+237 (University of Chicago Press, Chicago, £12.95).

Robert Currie, Alan Gilbert and Lee Horsley, Churches and Churchgoers ‐ Patterns of Church Growth in the British Isles since 1700 (1977), 244 (Clarendon Press, Oxford, £12.50).

D. Philips, Crime and Authority in Victorian England: The Black Country 1835–1860 (1977), 321 (Croom Helm, £8.50).

Brenda Swann and Maureen Turnbull, Records of Interest to Social Scientists 1919–1919: Employment and Unemployment (1978), v+590 (HMSO, paperback, £13.50).