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.     

Classroom sex composition and first-grade school outcomes: The role of classroom behavior

Using nationally representative data from the Early Childhood Longitudinal Study-Kindergarten Cohort (N = 21,409; 10,452 girls and 10,957 boys; mean age = 7.24 years), the association between first-grade classroom sex composition (CSC), measured as the percentage of female students, and end of the year academic (reading, mathematics) and socio-emotional (externalizing problems, internalizing problems, self-control, interpersonal skills) outcomes was examined. Using multilevel modeling techniques and controlling for prior achievement levels, CSC was positively associated with children’s reading achievement at the end of first grade; students performed better in reading in classes with a higher percentage of female students. CSC was also associated with three of the socio-emotional outcomes; controlling for prior levels, students in classrooms with a higher percentage of girls had better self-control and interpersonal skills and fewer internalizing problems. Classroom behavior mediated the effects of CSC on reading achievement and the socio-emotional outcomes. Implications for the composition of first-grade classrooms are discussed.     

Developing and testing a satisfaction survey for nursing home residents: the Ohio Experience

Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data--a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications.     

The development of social work education in Russia since 1995

This article presents the findings of a four-year survey on the development of social work education in Russia from 1995 to the present day. Through a series of questionnaires, interviews and discussions with Russian academics, practitioners and students, the study looks at a variety of issues including the high rate of attrition. It focuses on aspects of students’ practice placements such as the type, length and quality of practice placements, the students’ workload and the supervision provided. It also looks at the contribution that international collaboration has made to the development of social work education in Russia.

The survey concludes that there is a need to enhance the overall package for social workers and raise the status of the profession in order to retain qualified personnel. Longer practice placements which start in the first year and are adequately funded and supervised are seen as the key to retaining new graduates. It concludes that although international projects have made a difference to those participating at the time, it is difficult to disseminate these benefits beyond the immediate region. Now that international funding to Russia has been reduced it is critical that any remaining funding is accurately targeted and properly coordinated.     

Gay grows up:an interpretive study on aging metaphors and queer identity

This study is based upon qualitative research conducted with the Phoenix chapter of the Prime Timers, a social organization that offers older men in the gay community a space to communicate their general needs and desires. Using data collected through participant observation and informant interviews, the research demonstrates the ways in which the group's affiliates respond to queer sensibilities. The analysis argues that intergenerational communication is fettered by age stereotypes that generate communicative boundaries between young and old members of the gay community. The report then suggests that age-based breakdowns in communication prevalent in the gay community are further advanced by a difference in intergenerational approaches to survival.