Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality.Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994–2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.     

Occupational Sex Composition and Gendered Housework Performance: Compensation or Conventionality?

This article examines the association between occupational sex composition and housework, considering total housework time, time on male‐typed and female‐typed tasks, and the percent of total time spent on male and female tasks. Previous research examining male‐ and female‐typed chores independent of total housework suggests that couples compensate for gender‐atypical employment through gender‐typical housework performance, but this analysis of the National Survey of Families and Households (1992–1994) and the American Time Use Survey (2003–2013) demonstrates that assuming a quadratic association and failing to contextualize gendered housework performance within total housework performance obscures the true relationship between occupation and housework. In fact, women and men in gender‐atypical occupations perform a more gender‐atypical combination of chores. The influence of gender deviance neutralization in the housework literature may overshadow alternative explanations and model specifications. In particular, by assuming a quadratic association, researchers may impose, rather than test, gender deviance neutralization.     

Do Some Students Need Special Protection From Research on Sex and Trauma? New Evidence for Young Adult Resilience in “Sensitive Topics” Research

Institutional review boards (IRBs) have expressed concerns that certain individuals or groups, such as participants who are younger, ethnic minorities, or who have certain psychological or personality traits, may be particularly distressed when participating in “sensitive topics” research. This study examined the effects of several demographic and individual difference factors (i.e., age, sex, ethnicity, religiosity, Big Five personality traits, and baseline psychological distress levels) on reactions to participation in sensitive topics research. Participants were 504 undergraduates who completed an extensive battery of either trauma/sex questionnaires or cognitive tests and rated their positive and negative emotional reactions and the perceived benefits and mental costs of participating. They also compared research participation to normal life stressors. Our findings indicated that individual difference and demographic risk factors do not increase participant distress after participating in sex/trauma research over and above that experienced after participating in traditionally minimal-risk cognitive tasks. Participants generally found research participation less distressing than normal life stressors and even enjoyable.     

‘I want to be better than you:’ lived experiences of intergenerational child maltreatment prevention among teenage mothers in and beyond foster care

The growing body of research on teenage motherhood in foster care has largely focused on the risks involved for both mother and child, yet these mothers depict a much more complex picture of their own experience of becoming and being mothers. The current study employed interpretative phenomenological analysis to explore 18 in‐depth, qualitative interviews from six participants on the meaning and experience of motherhood among teenage mothers in foster care and in the years immediately after ageing out. This study focused on a particular dimension of motherhood: participants' efforts to break the cycle of child abuse and neglect with their own children. Two themes emerged as characteristic of these experiences: (i) treating children well/parenting differently and avoiding the system; and (ii) reducing isolation and enhancing support. Given the increased likelihood of the children of teen mothers – particularly those who have been maltreated – becoming involved with the child welfare system, study findings suggest possible strategies for disrupting cycles of intergenerational child welfare involvement generated by young mothers themselves. Practice implications for addressing possible substance abuse, mental health and relational and parenting needs are discussed.     

Influence of Proximity to Kin on Residential Mobility and Destination Choice: Examining Local Movers in Metropolitan Areas

A growing body of research has examined how family dynamics shape residential mobility, highlighting the social—as opposed to economic—drivers of mobility. However, few studies have examined kin ties as both push and pull factors in mobility processes or revealed how the influence of kin ties on mobility varies across sociodemographic groups. Using data on local residential moves from the Panel Study of Income Dynamics (PSID) from 1980 to 2013, we find that location of noncoresident kin influences the likelihood of moving out of the current neighborhood and the selection of a new destination neighborhood. Analyses of out-mobility reveal that parents and young adult children living near each other as well as low-income adult children living near parents are especially deterred from moving. Discrete-choice models of neighborhood selection indicate that movers are particularly drawn to neighborhoods close to aging parents, white and higher-income households tend to move close to parents and children, and lower-income households tend to move close to extended family. Our results highlight the social and economic trade-offs that households face when making residential mobility decisions, which have important implications for broader patterns of inequality in residential attainment.     

Discrimination,Sleep, and Stress Reactivity: Pathways to African American-White Cardiometabolic Risk Inequities

This review provides a model explicating two related physiologic and behavioral pathways through which the chronic daily stress of the expectation and experience of discrimination exposure can shape life course cardiometabolic risk trajectories: sleep and stress reactivity. We argue that these two pathways work together jointly to shape African American-White disparities in cardiometabolic morbidities. The body’s ongoing anticipation of experiencing racism-related stressors disrupts sleep, a behavior highly responsive to stress reactivity, which is also elevated during stressful conditions. The constant feedback between sleep disruption and the body’s stress response can lead to higher allostatic load and disproportionate exposure to stress-related illness among African Americans earlier in their life course.     

Assessing Politicized Sexual Orientation Identity: Validating the Queer Consciousness Scale

Building on psychological theories of motivation for collective action, we introduce a new individual difference measure of queer consciousness, defined as a politicized collective identity around sexual orientation. The Queer Consciousness Scale (QCS) consists of 12 items measuring five aspects of a politicized queer identity: sense of common fate, power discontent, system blame, collective orientation, and cognitive centrality. In four samples of adult women and men of varied sexual orientations, the QCS showed good test-retest and Cronbach’s reliability and excellent known-groups and predictive validity. Specifically, the QCS was positively correlated with identification as a member of the LGBTQ community, political liberalism, personal political salience, and LGBTQ activism and negatively correlated with right-wing authoritarianism and social dominance orientation. QCS mediated relationships between several individual difference variables and gay rights activism and can be used with both LGBTQ people and allies.     

The role of eviction in veterans’ homelessness recidivism*

Eviction is one of the leading causes of homelessness in the U.S.A. Though permanent supportive housing (PSH) helps participants maintain housing, some still leave due to eviction. This study aimed to determine whether eviction is an important predictor of recidivism and time to return to homelessness for participants exiting PSH. The characteristics and post-exit service use of 2802 Veteran PSH participants were analyzed based on exit reason. A Cox proportional hazards survival analysis modeled risk factors for returning to homelessness within 360 days of exit. Compared with other exiters, evicted Veterans remained in the program for less time, were less likely to be receiving service-connected compensation, and used more services – particularly mental health and substance use services – following their exit, and those who returned to homelessness did so more quickly. Identifying participants who might benefit from more intensive services, project-based housing, or income supports may prevent evictions and subsequent returns to homelessness.     

Family Caregiver Communication in the ICU: Toward a Relational View of Health Literacy

We interviewed 18 family caregivers about their communication experiences in the ICUs at an urban hospital. Analysis of their narratives suggests health literacy is important in family caregiver/healthcare provider communication, especially as complicated illnesses move the caregiver deeper into decision making. Using the domains of Yuen et al.’s conceptual model of caregiver health literacy (2015), we identified three themes within the context of ICU communication: agency, coordinated communication, and caregiver’s evolving role. We saw family caregivers negotiating domains of health literacy as they built upon knowledge of the patient’s needs, their rights as family caregivers, and the hierarchy of the professional staff. We found that these narratives represent co-created, or relational communication, rather than individual health literacy skills. Conceptualized in the transaction of relationship, health literacy is enacted; it is socially constructed and is the scaffolding upon which family caregivers make decisions, care for their loved one, and care for themselves.     

Mental illness etiology beliefs among African American men with serious mental illness and their social support networks

Semi-structured qualitative interviews were conducted with 26 African American men with serious mental illness who were consumers of community mental health services and 26 members of their social support networks. All participants were asked what they believed had caused the consumers’ mental illness. Consumer participants most commonly identified chronic life stressors as a causal factor, while social supports most often identified intrinsic factors such as genetics or biology as causes of mental illness. Some support participants believed that unintentional drug use had precipitated the onset of mental illness or had no causal theories. The fact that some support participants could not identify a causal explanation may indicate failure on the part of mental health care systems to engage with consumers’ social support networks and provide education about mental illness and its causes. The implications of etiology beliefs on mental health service utilization are discussed.