Women's expectations and experiences with labour pain in medical and midwifery models of birth in the United States

BackgroundThis research focuses on how women understand and experience labour as related to two competing views of childbirth pain. The biomedical view is that labour pain is abnormal and anaesthesia/analgesia use is encouraged to relieve the pain. The midwifery view is that pain is a normal part of labour that should be worked with instead of against.AimsTo determine differences in the preparation for and experiences with labour pain by women choosing midwives versus obstetricians.MethodsPrenatal and postpartum in-depth semi-structured interviews were conducted with a convenience sample of 80 women in Florida (United States): 40 who had chosen an obstetrician and 40 who had chosen a licensed midwife as their birth practitioner.FindingsWomen in both groups were concerned with the pain of childbirth before and after their labour experiences. Women choosing midwives discussed preparing for pain through various non-pharmaceutical coping methods, while women choosing physicians discussed pharmaceutical and non-pharmaceutical pain relief.ConclusionsEqual numbers of women expressed concerns with childbirth pain during the prenatal interviews, while more women choosing doctors spoke about pain after their births. Women had negative experiences when their planned pain relief method, either natural or medical, did not occur. The quandary facing women when it comes to labour pain relief is not choosing what they desire, but rather preparing themselves for the possibility that they may have to accept alternatives to their original preferences.     

Designing Graphs to Communicate Risks: Understanding How the Choice of Graphical Format Influences Decision Making

Previous research suggests that the choice of graphical format for communicating risk information affects both understanding of the risk magnitude and the likelihood of acting to decrease risk. However, the mechanisms through which these effects work are poorly understood. To explore these mechanisms using a real‐world scenario, we examined the relative impact of two graphical displays for depicting the risk of exposure to unexploded ammunition during potential land redevelopment. One display depicted only the foreground information graphically (a bar graph of the number of people harmed), and a second depicted the foreground and background graphically (a stacked bar graph representing both the number harmed and at risk). We presented 296 participants with either the foreground‐only or the foreground and background graphical display and measured a broad set of outcome variables, examining (1) the graphical display effect on each of the outcome measures and (2) the pathways by which any display effects work to influence decision making. We found that the foreground‐only graphical display increased perceived likelihood and experienced fear, which produced greater worry, which in turn increased risk aversion. In addition, a positive evaluation of the communication materials increased support for policies related to land redevelopment, whether those policies were risk taking or risk mitigating. Finally, the foreground‐only graphical display decreased understanding of the risk magnitude, showing that approaches to accomplish one risk communication goal (promoting risk‐averse decisions) may do so at the expense of another goal (increasing understanding).     

The Effects of Urban Form on Ambient Air Pollution and Public Health Risk: A Case Study in Raleigh,North Carolina

Since motor vehicles are a major air pollution source, urban designs that decrease private automobile use could improve air quality and decrease air pollution health risks. Yet, the relationships among urban form, air quality, and health are complex and not fully understood. To explore these relationships, we model the effects of three alternative development scenarios on annual average fine particulate matter (PM_2.5) concentrations in ambient air and associated health risks from PM_2.5 exposure in North Carolina's Raleigh‐Durham‐Chapel Hill area. We integrate transportation demand, land‐use regression, and health risk assessment models to predict air quality and health impacts for three development scenarios: current conditions, compact development, and sprawling development. Compact development slightly decreases (?0.2%) point estimates of regional annual average PM_2.5 concentrations, while sprawling development slightly increases (+1%) concentrations. However, point estimates of health impacts are in opposite directions: compact development increases (+39%) and sprawling development decreases (?33%) PM_2.5‐attributable mortality. Furthermore, compactness increases local variation in PM_2.5 concentrations and increases the severity of local air pollution hotspots. Hence, this research suggests that while compact development may improve air quality from a regional perspective, it may also increase the concentration of PM_2.5 in local hotspots and increase population exposure to PM_2.5. Health effects may be magnified if compact neighborhoods and PM_2.5 hotspots are spatially co‐located. We conclude that compactness alone is an insufficient means of reducing the public health impacts of transportation emissions in automobile‐dependent regions. Rather, additional measures are needed to decrease automobile dependence and the health risks of transportation emissions.     

Interethnic Relationships: The Role of Social Network Diversity

We examine the degree to which ethnic diversity in social networks relates to the frequency of interethnic romantic relationships for 318 college students. In a multinomial logit, we find that the odds of having an interethnic relationship once or twice, versus never, increase significantly if the respondent has a relatively ethnically diverse friendship network, is male, and supports interethnic dating. The odds of having an interethnic relationship often, versus once or twice, are significantly higher for persons of color and when the friends of the respondent's parents are relatively diverse ethnically. Findings from open‐ended data also provide support for a social network perspective, and point to the processes by which networks, gender, and ethnicity shape interethnic courtship.     

An application of a multi‐stage strategy involving confidence intervals to evaluate whether a response rate is favourable or not

In early clinical development of new medicines, a single‐arm study with a limited number of patients is often used to provide a preliminary assessment of a response rate. A multi‐stage design may be indicated, especially when the first stage should only include very few patients so as to enable rapid identification of an ineffective drug. We used decision rules based on several types of nominal confidence intervals to evaluate a three‐stage design for a study that includes at most 30 patients. For each decision rule, we used exact binomial calculations to determine the probability of continuing to further stages as well as to evaluate Type I and Type II error rates. Examples are provided to illustrate the methods for evaluating alternative decision rules and to provide guidance on how to extend the methods to situations with modifications to the number of stages or number of patients per stage in the study design. Copyright © 2004 John Wiley & Sons, Ltd.     

Majority Rules? The Effects of School Ethnic Composition on Substance Use by Mexican Heritage Adolescents

This article examines key aspects of the school environment - its composition by ethnicity and acculturation - as important social contexts for understanding Mexican immigrant and Mexican American adolescents' drug use norms and behaviors. Results are presented based on surveys completed by Mexican-background students from 35 Phoenix. Arizona middle schools, whose enrollment ranged from a numerical minority to an overwhelming majority. Multivariate mixed models tested for the influence of school ethnic composition measures on substance use outcomes, while accounting for individual level predictors and for the nesting of data at the school level. The proportional representation of Latinos in the school was not a factor in an individual's drug use norms or drug use for the sample overall. Once students were broken down by acculturation status, however, ethnic composition had an effect. Less acculturated Mexican heritage students in schools with higher proportions of Latino students reported less substance use and less adherence to pro-drug norms. Further investigation using other measures of ethnic composition suggested that these effects were attributable to the larger presence of less acculturated Latinos in the school rather than more acculturated Latino students. These school-level effects support the individual-level results indicating that less acculturated Mexican American students face less daunting substance use risks. The results suggest that ethnic group size, but not necessarily numerical predominance, matters and that within-group differences influence the effect of a particular ethnic group's presence in the school. In other words, the majority does not always rule. These findings are interpreted using the concepts of segmented assimilation and school level social capital.     

Dignified Joking: Humor and Demeanor in a Public Speaking Club*

An investigation was made of the joking that occurs during meetings of a club which gathers weekly to practice public speaking. In this setting, humor is expected as part of a good speaking performance. It is assumed that the use of humor can establish rapport with an audience and aid in persuasion. This paper describes how such joking must be managed to avoid both a potential disintegration of the club's focused gathering and an undermining of the face-work involved in doing public speaking.     

Social and psychological exclusion

The New Deal for Lone Parents is one policy in the UK which aims to reduce benefit dependency and enable lone parents to opt into a scheme which offers help and advice on jobs, benefits, training and childcare with the hope of improving job readiness. In tandem with this scheme there exists a myriad of community intervention initiatives whose aim may not be as explicit, but whose value can be equally empowering in raising self-awareness and self-esteem. This study examines the experiences of lone parents who participate in such schemes and contrasts this with the experiences of those who do not. The study shows that community-based schemes may not offer the best option for all lone mothers, but can provide an effective staging post for some towards a position of job readiness.

Poverty and social exclusion affect many different aspects of people's lives. They exist when people are denied opportunities to work, to learn, to live healthy, active and fulfilling lives …

Department of Social Security, September 1999, p. 3     

Beliefs, death, anxiety, denial, and treatment preferences in end-of-life care: a comparison of social work students, community residents, and medical students

This study examined cultural and religious beliefs, death anxiety, denial, and medical treatment preferences in end-of-life care in a sample of social work students, community residents, and medical students in a mid-western city of 49,000. Results indicated that most social work students, community residents, and medical students preferred palliative as opposed to life-prolonging care during terminal illness. The three groups differed in cultural and religious beliefs and all three reported a moderate amount of death anxiety. Students reported less denial of terminality than community residents. Implications for personal and professional preparation to provide end-of-life care are discussed.