The experience of giving birth with epidural analgesia

Problem and backgroundThere is a lack of literature about what constitutes good midwifery care for women who have epidural analgesia during labour. It is known that an increasing number of women receive epidural analgesia for labour pain. We also know that while women rate the painkilling effect of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used.QuestionHow do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need?MethodsA field study and semi-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth.FindingsInitiation of epidural analgesia can have considerable implications for women's experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence.Another important finding refers to the labouring woman's relationship with the midwife, which represents an essential influencing factor on the woman’ experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance.ConclusionAfter initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman's type of emotional reaction to epidural analgesia and her possible intricate worries.     

Young people leaving care in Sweden

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care‐leaving services are almost non‐existent. What then happens to young people when they leave a placement in out‐of‐home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family‐oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.     

Estimation of Conditional Ranks and Tests of Exogeneity in Nonparametric Nonseparable Models

Consider a nonparametric nonseparable regression model Y = ?(Z, U), where ?(Z, U) is strictly increasing in U and U ～ U[0, 1]. We suppose that there exists an instrument W that is independent of U. The observable random variables are Y, Z, and W, all one-dimensional. We construct test statistics for the hypothesis that Z is exogenous, that is, that U is independent of Z. The test statistics are based on the observation that Z is exogenous if and only if V = F_Y|Z(Y|Z) is independent of W, and hence they do not require the estimation of the function ?. The asymptotic properties of the proposed tests are proved, and a bootstrap approximation of the critical values of the tests is shown to be consistent and to work for finite samples via simulations. An empirical example using the U.K. Family Expenditure Survey is also given. As a byproduct of our results we obtain the asymptotic properties of a kernel estimator of the distribution of V, which equals U when Z is exogenous. We show that this estimator converges to the uniform distribution at faster rate than the parametric n^{? 1/2}-rate.     

Validation of the theory: satisfaction with time-delimited daily occupations

OBJECTIVES: This study examines the construct validity of the theory Satisfaction with time-delimited daily occupations (STO). The outcome of STO concerns how individuals perceive their occupational health status and to what degree the individuals experience satisfaction with their performance of time-delimited daily occupations. DESIGN: The "known-groups technique" was used for discriminating the occupational health status among four groups (n = 147) of full-time workers or sick-listed participants. A mailed ActivityLog-sheet was used for recording their occupational health 24 times during 24 hours. The computerized program ActivityLog was used for data registration. The data analysis were accounted by ANOVA, Tukey's HSD test with significance level of p < 0,05 using the SPSS program. RESULTS: The occupational health status did not differ significantly among the four groups, but the number of records concerning work (p = 0,00) and care (p = 0,02) time-delimited daily occupations were significantly different. The patterns of occupational health status during the 24-hour-records were visually separated for the four groups. CONCLUSION: There is need for refining the STO theory and then for undertaking further investigations of the STO construct validity.     

The sense-of-coherence and the capability of performing daily occupations in persons with chronic pain

OBJECTIVES: It may be helpful for occupational therapists who promote enabling occupations among persons with chronic pain, to understand the relationship between the persons feelings of meaningfulness, comprehensibility and manageability in life and their capability to perform daily occupations. AIM: The aim of this study was to describe and investigate how these concepts of person and occupational performance of 27 daily occupations in terms of "effort", "inconvenience", "avoidance", "give up", "frequency" and "satisfaction" were related to each other. DESIGN: A prospective correlative study was conducted. METHOD: A consecutive series of eighty-four patients with chronic pain completed a structured interview and responded to the self-assessment instruments Sense-of-Coherence Scale (SOC-13) and Capability of Performing Daily Occupations (CPDO). RESULTS: Weak but significant correlation (p < 0.05) were found between the SOC-13 sub-scale "manageability" and the specific occupations "physical exercise / training" (r = - 0.24), "climb stairs" (r = - 0.27) "social activity" (r= - 0.25) and "wash the laundry" (r = - 0.30), as well as between the SOC-13 sub-scale "meaningfulness" and the CPDO occupations "grocery shopping" (r = -0.22), "performing meals" (r = - 0.24), and "wash the laundry" (r = - 0.31) and the CPDO question "frequency of performing occupations" r = -0.22). The participants' mean value (mean = 58) of SOC-13 was below the other populations represented in a literature review. The mean values for CPDO (3.4-4.3) (optimal score is zero) showed that the participants perceived themselves having activity limitations concerning performance of daily occupations, and the performance area of work productive activities were experienced as more disabling. The degree to which the participants perceived themselves having a strong sense of coherence or being disabled by pain varied greatly both for the results of SOC-13 ( range 32-90 points) and CPDO (range 1.1-7.8 points). CONCLUSION: The expected significant relationship between a person's sense of coherence and the performance of daily occupations was partly verified with weak significant correlations. In clinical practice the assessment instruments are suggested to be of value in rehabilitation clinics for occupational therapists who work with people with chronic pain.     

Exploring Ambivalence in Family Ties: Progress and Prospects

The 2002 exchange on ambivalence in the Journal of Marriage and Family (Vol. 64, No. 3), published under the editorship of Alexis Walker, prompted an impressive array of research on family ties, in particular intergenerational relationships. Following a discussion of the concept's theoretical underpinnings, the author argues that advancing the concept of ambivalence rests on realizing its multilevel potential by addressing the interplay of shifting contradictions experienced by individuals and in relationships and embedded in social institutions and in macro‐level arrangements and processes. She considers progress and limitations in a critical review of predominant applications of ambivalence and then investigates research that advances ambivalence as a bridging concept across multiple levels of analysis. Work on atypical family ties, dependency, contradictory cultural expectations due to migration and social change, families and the welfare state, and on climate change and disability promotes the multilevel potential of ambivalence and points to ways to advance its promise in theory and practice.     

The Kaleidoscope of the Sociology of Aging Seen through the French-Speaking Field

How does French-language sociology deal with aging? This is the question posed by this contribution, which explores articles published within the past fifteen years in various French-language scientific journals. Through a systematic review of the scientific literature, we analyze the evolution of topics in the sociology of aging through five well-known French-language journals of sociology. Three of them are generalist journals (Revue française de sociologie, Revue suisse de sociologie, Recherches sociologiques et anthropologiques), from France, Switzerland, and Belgium respectively. The remaining two journals, both from France, are specifically devoted to the study of aging (Gérontologie et société, Retraite et société). The results invite further exploration of the influence of the national contexts in which French-speaking European sociologies are structured.     

GamTest: Psychometric Evaluation and the Role of Emotions in an Online Self-Test for Gambling Behavior

Recent increases in the number of online gambling sites have made gambling more available, which may contribute to an increase in gambling problems. At the same time, online gambling provides opportunities to introduce measures intended to prevent problem gambling. GamTest is an online test of gambling behavior that provides information that can be used to give players individualized feedback and recommendations for action. The aim of this study is to explore the dimensionality of GamTest and validate it against the Problem Gambling Severity Index (PGSI) and the gambler’s own perceived problems. A recent psychometric approach, exploratory structural equation modeling (ESEM) is used. Well-defined constructs are identified in a two-step procedure fitting a traditional exploratory factor analysis model as well as a so-called bifactor model. Using data collected at four Nordic gambling sites in the autumn of 2009 (n = 10,402), the GamTest ESEM analyses indicate high correspondence with the players’ own understanding of their problems and with the PGSI, a validated measure of problem gambling. We conclude that GamTest captures five dimensions of problematic gambling (i.e., overconsumption of money and time, and monetary, social and emotional negative consequences) with high reliability, and that the bifactor approach, composed of a general factor and specific residual factors, reproduces all these factors except one, the negative consequences emotional factor, which contributes to the dominant part of the general factor. The results underscore the importance of tailoring feedback and support to online gamblers with a particular focus on how to handle emotions in relation to their gambling behavior.     

Semi‐parametric Estimation in a Single‐index Model with Endogenous Variables

We consider a semiparametric single‐index model and suppose that endogeneity is present in the explanatory variables. The presence of an instrument is assumed, that is, non‐correlated with the error term. We propose an estimator of the parametric component of the model, which is the solution of an ill‐posed inverse problem. The estimator is shown to be asymptotically normal under certain regularity conditions. A simulation study is conducted to illustrate the finite sample performance of the proposed estimator.     

Sterile water injections for childbirth pain: An evidenced based guide to practice

Background

About 30% of women in labour suffer from lower back pain. Studies of sterile water injections for management of low back pain have consistently shown this approach to be effective. The objective of this evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower back pain in labouring women.