THE CARING DILEMMA IN MIDWIFERY

The caring dilemma, first described by Reverby in 1987, denotes the tension caused by being obliged to provide care without the right to determine how that care is to be provided. Such a dilemma is salient in the practice of midwifery based on a continuity of care model that has recently emerged or been implemented in various jurisdictions. Briefly, this model involves the provision of care by a single midwife or pair of midwives to a woman throughout her pregnancy, birth and post-natal period. Continuity of care necessitates that midwives be on call for significant lengths of time to ensure attendance at the woman's birth. It is the on-call nature of this form of midwifery work that most significantly poses a caring dilemma for midwives. In this paper, we trace both the structural and experiential aspects of the caring dilemma through an examination of midwifery in the Canadian province of Ontario. Our analysis reveals that despite being a salient feature of midwifery practice, some work structures can be created to mediate the caring dilemma experienced by midwives.

Le dilemme de la prise en charge, que Reverby a évoqué la première fois en 1987, dénote la tension que cause le fait d’être tenu d'offrir une prise en charge sans avoir le droit d’établir de quelle manière l'offrir. L'exemple des sages-femmes, dont la pratique repose sur un type de soin continu qui est récemment apparu ou qu'on vient de mettre sur pied dans diverses administrations, illustre très clairement ce dilemme. Pour résumer, ce modèle veut qu'une femme enceinte soit prise en charge pendant sa grossesse, à son accouchement et durant sa période postnatale par une ou deux sages-femmes. La continuité de la prise en charge oblige les sages-femmes à être sur appel durant des périodes prolongées pour que la femme qui accouche bénéficie de leur présence. Pour les sages-femmes, c'est la nature même de leur travail effectué sur appel qui engendre, de façon cruciale, le dilemme de la prise en charge. Dans cet article, nous abordons les aspects structurels et expérimentaux que représente le dilemme de la prise en charge par le biais d'une étude sur la pratique du métier de sage-femme dans la province canadienne de l'Ontario. Notre analyse révèle que, si le dilemme de la prise en charge est inhérent à la profession de sage-femme, il n'empêche que des structures professionnelles peuvent être mises en place pour en atténuer les aspects négatifs.     

Productivity of highly skilled immigrants: economists in the postwar period

Prior work finds declining immigrant quality in the postwar period that is linked to source-country and skill-composition changes associated with the 1965 Immigration Act. This paper uses a unique panel of foreign- and native-born American Economic Association members to show that the highly skilled experienced a similar shift away from European migrants toward those from Asia. However, the findings do not indicate that this change in source-country composition has been accompanied by a decline in quality; rather, the most recent cohorts of foreign-born economists appear to be more productive than their native counterparts.     

Jewish Involvement in Shaping American Immigration Policy, 1881–1965: A Historical Review

This paper discusses Jewish involvement in shaping United States immigration policy. In addition to a periodic interest in fostering the immigration of co-religionists as a result of anti-Semitic movements, Jews have an interest in opposing the establishment of ethnically and culturally homogeneous societies in which they reside as minorities. Jews have been at the forefront in supporting movements aimed at altering the ethnic status quo in the United States in favor of immigration of non-European peoples. These activities have involved leadership in Congress, organizing and funding anti-restrictionist groups composed of Jews and gentiles, and originating intellectual movements opposed to evolutionary and biological perspectives in the social sciences.     

Efficacy of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia: a systematic review

We conducted a systematic review to evaluate the efficacy and adverse effects of newer drugs used to treat lower urinary tract symptoms (LUTS). The drugs were either Food and Drug Administration (FDA) approved for benign prostatic hyperplasia (BPH) or not FDA approved for BPH but have been evaluated for treatment of BPH since 2008. We searched bibliographic databases through September 2017. We included randomized controlled trials (RCTs) lasting one month or longer published in English. Outcomes of interest were LUTS assessed by validated measures. Efficacy was interpreted using established thresholds indicating clinical significance that identified the minimal detectable difference. Twenty-three unique, generally short-term, RCTs evaluating over 9000 participants were identified. Alpha-blocker silodosin and phosphodiesterase type 5 inhibitor tadalafil were more effective than placebo in improving LUTS (moderate strength evidence) but these drugs had more adverse effects, including abnormal ejaculation (silodosin). Anticholinergics were only effective versus placebo when combined with an alpha-blocker. Evidence was generally low strength or insufficient for other drugs. Evidence was insufficient to assess long-term efficacy, prevention of symptom progression, need for surgical intervention, or long-term adverse effects. Longer trials are needed to assess the effect of these therapies on response rates using established minimal detectable difference thresholds, disease progression, and harms.     

Inequality,continuity and change: Andy Furlong's legacy for youth studies

ABSTRACT

This article introduces a special issue of the Journal of Youth Studies, dedicated to Professor Andy Furlong, the Journal's founding Editor. The central questions that drove Andy Furlong's scholarship were the relationship between continuity and change in young people's lives and about the place of youth in the reproduction of inequality across generations. These questions have been central to the wider field of Youth Studies that he helped to build. His work provided a powerful example of how to engage with these questions with a strong sense of social justice but the answers he gave, as with all such answers in sociology, are necessarily provisional. The articles collected in this issue bring empirical research and new concepts that build on this legacy, suggesting new ways to capture the experiences of young people across the multiple spheres of their lives and how disadvantage and inequality are made in the context of processes across time.     

Prioritizing Environmental Health Risks in the UAE

This article presents the results of a comparative environmental risk‐ranking exercise that was conducted in the United Arab Emirates (UAE) to inform a strategic planning process led by the Environment Agency‐Abu Dhabi (EAD). It represents the first national‐level application of a deliberative method for comparative risk ranking first published in this journal. The deliberative method involves a five‐stage process that includes quantitative risk assessment by experts and deliberations by groups of stakeholders. The project reported in this article considered 14 categories of environmental risks to health identified through discussions with EAD staff: ambient and indoor air pollution; drinking water contamination; coastal water pollution; soil and groundwater contamination; contamination of fruits, vegetables, and seafood; ambient noise; stratospheric ozone depletion; electromagnetic fields from power lines; health impacts from climate change; and exposure to hazardous substances in industrial, construction, and agricultural work environments. Results from workshops involving 73 stakeholders who met in five separate groups to rank these risks individually and collaboratively indicated strong consensus that outdoor and indoor air pollution are the highest priorities in the UAE. Each of the five groups rated these as being among the highest risks. All groups rated soil and groundwater contamination as being among the lowest risks. In surveys administered after the ranking exercises, participants indicated that the results of the process represented their concerns and approved of using the ranking results to inform policy decisions. The results ultimately shaped a strategic plan that is now being implemented.     

Individual Actual or Perceived Property Flood Risk: Did it Predict Evacuation from Hurricane Isabel in North Carolina, 2003?

Individual perception of risk has consistently been considered an important determinant of hurricane evacuation in published studies and reviews. Adequate risk assessment is informed by environmental and social cues, as well as evacuation intentions and past disaster experience. This cross‐sectional study measured perceived flood risk of 570 residents of three coastal North Carolina counties, compared their perception with actual risk determined by updated flood plain maps, and determined if either was associated with evacuation from Hurricane Isabel in 2003. Census blocks were stratified by flood zone and 30 census blocks were randomly selected from each flood zone. Seven interviews were conducted at random locations within selected blocks. Bivariate and multivariable analyses were conducted to produce crude and adjusted risk differences. Neither the designated flood zone of the parcel where the home was located nor the residents' perceived flood risk was associated with evacuation from Hurricane Isabel in the bivariate analysis. In the multivariable analysis, intention to evacuate and home type were important confounders of the association between actual risk and evacuation. The belief that one is at high risk of property damage or injury is important in evacuation decision making. However, in this study, while coastal residents' perceived risk of flooding was correlated with their actual flood risk, neither was associated with evacuation. These findings provide important opportunities for education and intervention by policymakers and authorities to improve hurricane evacuation rates and raise flood risk awareness.