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.     

Audiovisual Correlates of Interrogativity: A Comparative Analysis of Catalan and Dutch

Languages employ different strategies to mark an utterance as a polar (yes–no) question, including syntax, intonation and gestures. This study analyzes the production and perception of information-seeking questions and broad focus statements in Dutch and Catalan. These languages use intonation for marking questionhood, but Dutch also exploits syntactic variation for this purpose. A production task revealed the expected language-specific auditory differences, but also showed that gaze and eyebrow-raising are used in this distinction. A follow-up perception experiment revealed that perceivers relied greatly on auditory information in determining whether an utterance is a question or a statement, but accuracy was further enhanced when visual information was added. Finally, the study demonstrates that the concentration of several response-mobilizing cues in a sentence is positively correlated with the perceivers’ ratings of these utterances as interrogatives.     

A Telephone Intervention for Substance-Using Adult Male Perpetrators of Intimate Partner Violence

OBJECTIVE: To preliminarily evaluate telephone-delivered motivational enhancement therapy (MET) in motivating unadjudicated and nontreatment seeking intimate partner violence (IPV) perpetrators, who also use substances, to self-refer into treatment. METHOD: 124 adult men were recruited via a multimedia marketing campaign and were randomly assigned to the intervention (MET) or comparison group following a baseline assessment. Participants in the MET condition received a personalized feedback report on their IPV and substance-use behaviors, consequences, and social norms beliefs. RESULTS: Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, increasing motivation for treatment seeking, and changing perceived norms for IPV and substance abuse (SA). CONCLUSIONS: Applications for brief MET interventions to facilitate voluntary treatment entry among substance-using IPV perpetrators are discussed.     

Cox regression of clustered event times with covariates missing not at random

Motivated by a recent tuberculosis (TB) study, this paper is concerned with covariates missing not at random (MNAR) and models the potential intracluster correlation by a frailty. We consider the regression analysis of right‐censored event times from clustered subjects under a Cox proportional hazards frailty model and present the semiparametric maximum likelihood estimator (SPMLE) of the model parameters. An easy‐to‐implement pseudo‐SPMLE is then proposed to accommodate more realistic situations using readily available supplementary information on the missing covariates. Algorithms are provided to compute the estimators and their consistent variance estimators. We demonstrate that both the SPMLE and the pseudo‐SPMLE are consistent and asymptotically normal by the arguments based on the theory of modern empirical processes. The proposed approach is examined numerically via simulation and illustrated with an analysis of the motivating TB study data.     

Work-related factors associated with psychological distress among social workers

The current study assesses the association between several work-related factors and psychological distress among social workers (SWs) in Israel. The data were collected through structured questionnaires, administered to a sample of 494 SWs. The findings suggest that most of the examined work-related factors (namely, years of professional experience, personal work-related subjection to violence, burnout, compassion fatigue, and sense of coherence), with the exception of compassion satisfaction, significantly predicted psychological distress among SWs. The conclusion is that it is important to embed within the social work practice strategies for reducing sources of psychological distress (job demands) and increasing material, professional, and personal resources. Reducing the levels of psychological distress experienced by SWs will benefit not only themselves, but also their families and colleagues, as well as their clients. Moreover, this has potential benefits for the social work profession and for the general community.     

Phenomenology in End-of-Life Care: Implications for Philosophy and Clinical Practice

Care of the terminally ill and dying in the hospice setting is a growing practice field for social workers. Support to family, as well as the patient, is implicit in hospice care, adding to the reach and impact of the hospice social worker’s role. As people age and approach the end of life, they may encounter changes in their experience of time, space and of the material world. They often have to redefine the role of hope in their day to day lives. Based on these changing experiences and perceptions, phenomenology, with its focus on a patient’s subjective, lived experience, has implications for end-of-life care. The role of empathy and compassion are also explored in relation to existential experiences of the terminally ill through the lens of phenomenology and Eastern philosophy. To complement the Western biomedical model of care for the dying, insight from Eastern philosophical traditions, which view living and dying on the same continuum, and provide an expanded view of suffering bring comfort and understanding to how living and dying are processed within the phenomenology of patient experience and the hospice model of care. Case vignettes demonstrate social work theory and practice at the intersection of various interrelated phenomena when caring for those facing the end of life.     

Beards and Bloomers: Flight Attendants,Grievances and Embodied Labour in the Canadian Airline Industry, 1960s–1980s

This paper examines union grievances dealing with the body, appearance and demeanour fought by the Canadian Air Line Flight Attendants Association, on behalf of its female and male members over a 30‐year period. Taking a historical, materialist‐feminist approach, we examine how workers used the grievance system to resist regulations they believed contradicted their right to dignified labour. We ask how and why bodily regulation differed for men and women, and how this changed over time, as the union merged its male and female job occupations. Using arbitrated grievances, union records and discussion of these issues in the mass media, we show how both feminism and service union activism encouraged flight attendant resistance to airlines’ efforts to regulate the appropriate body and attire for male and female workers. The use of labour law offered workers some respite from regulation, but did not facilitate fundamental questions about the power of management to ‘dress’ its workers.