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.     

Supportive Housing for Addicted,Incarcerated Homeless Adults

ABSTRACT

Homeless populations often suffer from mental illness, substance abuse, and criminality. Interventions, such as supportive housing, can have positive impacts, although benefits can be limited. This study examined outcomes for clients (N = 102) of a new supportive housing intervention. Use of formal treatment, jail contact, and community stability were compared pre- and post-housing. Jail bookings and residential substance abuse treatment significantly declined post-housing, while clients improved in income level, access to food, and housing stability. Results from official justice and treatment system data suggest that supportive housing can lead to significant changes. Future research is necessary to understand the relationship between client characteristics and outcomes.     

Battling the Plantation Mentality: Memphis and the Black Freedom Struggle

Theodore Evergates, Feudal Society in the Bailliage of Troyes under the Counts of Champagne, 1152–1284 (1976), xii+274 (Johns Hopkins University Press, Baltimore and London, £11.20).

Pierre Guichard, Structures sociales ‘orientales’ et ‘occidentales’ dans l'Espagne musulmane (1977), 426 (Editions Mouton et cie, Paris and La Haye, 176F).

J. S. Cockburn (ed.), Crime in England 1550–1800 (1977), xiv+334 (Methuen, £10.00, paperback £6.95).

Jack Goody, Joan Thirsk and E. P. Thompson (eds), Family and Inheritance. Rural Society in Western Europe, 1200–1800 (1976), vi+421 (Cambridge University Press, Cambridge, £8.80); Peter Laslett, Family Life and Illicit Lore in Earlier Generations. Essays in Historical Sociology (1977), vii+270 (Cambridge University Press, Cambridge, £15.00, paperback £4.95).

David C. Itzkowitz, Peculiar Privilege: A Social History of English Foxhunting, 1753–1885 (1977), 248 (The Harvester Press, Hassocks, £10.50).

Alfred F. Young (ed.), The American Revolution: Explorations in the History of American Radicalism (1976), xv+481 (Northern Illinois University Press, DeKalb, Illinois, paperback, n.p.).

Clive Bush, The Dream of Reason: American Consciousness and Cultural Achievement from Independence to the Civil War (1977), xi+397 (Edward Arnold, £14.95).

Albert Soboul, Problèmes paysans de la Révolution, 1789–1848 (1976), 446 (François Maspéro, Paris, 50F.).

James H. Bater, St Petersburg. Industrialization and Change (1976), xxiii+474 (Edward Arnold, £14.95).

Nicholas V. Riasanovsky, A Parting of the Ways: Government and the Educated Public in Russia 1801–1851 (1977), viii+323 (Clarendon Press, Oxford, £12.00).

J. Michael Phayer, Sexual Liberation and Religion in Nineteenth‐Century Europe (1977), 176 (Croom Helm, £7.50).

John Woodward and David Richards (eds.), Health Care and Popular Medicine in Nineteenth‐Century England (1977), 195 (Croom Helm, £7.95).

Jörg Calliess, Militär in der Krise. Die bayerische Armee in der Revolution 184849 (1976), vi+224 (Harald Boldt, Boppard am Rhein, DM 40).

Trygve Tholfsen, Working Class Radicalism in Mid‐Victorian England (1976), 332 (Croom Helm, £9.95).

Daniel Field, The End of Serfdom: Nobility and Bureaucracy in Russia, 1855–1861 (1976), xiii+472 (Harvard University Press, Cambridge, Mass, and London, £11.90).     

Formative research methods to understand patient and provider responses to heart attack symptoms

Formative research is often required for program planning, and for reducing uncertainty about generalizability of program effects. This article describes and justifies methods of formative research conducted for the REACT study (Rapid Early Action for Coronary Treatment), a multi-center collaborative randomized community trial aimed at reducing patient delay in seeking care for acute myocardial infarction (AMI). Formative research cast light on patient and community members’ decision-making process in seeking help for AMI, as well as barriers and facilitators of this process. Investigators at all five REACT Field Centers participated in the formative research. The process consisted of: (1) developing a common theoretical framework for the study intervention; (2) conducting a literature review and qualitative research to identify and address gaps in knowledge; and (3) developing a common protocol for the REACT study that accommodated the diversity of the target communities in terms of services, resources, history, and ethnicity. Analysis employed triangulation, defined as an explicit search for heterogeneous data sources to reduce uncertainty about forces at work and opportunities for intervention across settings and populations. Because the collection and interpretation of data went in stages, staff of several REACT Field Centers had independent input to the overall synthesis, then shared and revised the results. Advantages and limitations of this approach are discussed.     

Substance Use,Distress, and Adolescent School Networks

This study examined the associations of substance use, psychological distress, and mental health services receipt with the structure and content of adolescent school‐based networks. Using data from the National Longitudinal Study of Adolescent Health, we found that substance use was associated with receiving more, but making fewer, peer nominations. It also was associated with less favorable network characteristics, such as low GPA. Services receipt was associated with receiving and making fewer nominations, less favorable network characteristics, and a lower likelihood of reciprocated best friendships. Psychological distress had fewer significant associations. All associations were modest in magnitude. Our results suggest the importance of considering multiple indicators of socioemotional problems and multiple dimensions of social networks in research on adolescent peer relations.