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.     

‘It's a magnifying glass for your relationship’: a thematic analysis of motivations,benefits, and challenges in consensually non-monogamous relationships

The last decade has seen an increase in public and academic interest in consensual non-monogamy (CNM). CNM involves sexual and/or romantic relationships between multiple partners, with the consent of all individuals involved. Engagement in CNM is estimated at 5% of the general population, although due to stigma with the strong idealisation of monogamy in many cultures, it is a hidden population. This qualitative study explores the motivations, benefits, and challenges experienced in CNM relationships, an area that has been understudied despite the resurgence of interest in it. While previous research has mainly focused on comparisons between CNM and monogamy or individual types of CNM such as polyamory, this study seeks to provide a broader understanding of CNM relationships. We employ a critical realist framework and thematically analyse semi-structured interviews with eight participants. The results identify three overarching themes: mononormativity and cultural norms; growth and responsibility; and diversity and complexity; each has several subthemes. These findings suggest that CNM provides opportunities for greater diversification of needs and increased community and individual growth. The study also highlights the challenges experienced in CNM relationships and the strategies used to manage them, such as personal responsibility for managing difficult emotions and temporarily closing a relationship at times for relationship security. A novel finding in this study is that some individuals involved in CNM have internalised cultural norms and the idealisation of monogamy and need to unlearn these norms. This study adds to the existing knowledge on CNM and is expected to be of interest to clinicians and researchers seeking to understand its motivations, benefits, and challenges. Relationship therapists will benefit from increased knowledge of how to work with clients interested or engaged in CNM relationships. Overall, this study supports previous findings that CNM is a viable, enjoyable, yet sometimes challenging type of relationship.     

What are the Risk Factors for Antisocial Behavior Among Low‐income Youth in CapeTown?

Research in high‐income countries has identified an array of risk factors for youth antisocial behavior. However, in low‐ and middle‐income countries, despite higher prevalence of offending and antisocial behavior, there is a paucity of prospective, longitudinal evidence examining predictors. South Africa is a middle‐income country with high rates of violence and crime, and a unique social context, characterized by striking income and gender inequality, and increasing number of children orphaned by AIDS. We tested predictors of antisocial behavior at community, family, and individual levels over four years. One thousand and twenty five adolescents from poor, urban South African settlements were assessed in 2005 (50 percent female; M = 13.4 years) and followed up in 2009. The sample analyzed consisted of the 723 youth (71 percent) assessed at both time points. We employed sociodemographic questionnaires and standardized scales. Validity of our antisocial behavior measure was supported by cross‐sectional associations with well‐evidenced concomitants of youth antisocial behavior, including drug taking and truancy. Regression analysis indicated that male gender and experience of community violence, but not poverty or abuse, predicted antisocial behavior. Despite many South African youth experiencing abuse and poverty at the family level, our findings suggest that high levels of violence in communities may be a more important factor contributing to the development of antisocial behavior, particularly among males.     

Does trust increase willingness to pay higher taxes to help the needy?

The article studies the causal effect of trust on the willingness to pay higher taxes to help the needy in a sample of 29 countries of Eastern and Southern Europe, and the former Soviet Union and Mongolia. It is hypothesized that interpersonal trust leads to a greater willingness to pay taxes to help the needy since (i) trust increases the likelihood of helping strangers; (ii) trust fosters solidarity and cooperation when working to solve common problems in society; and (iii) trust reduces suspicion with respect to the perceived misuse of redistributed money. Three key findings are that the more people trust each other, the more they are ready to support the welfare state; the effect of trust on welfare state support holds even in a contextual environment characterized by rather lower levels of trust and relatively underdeveloped systems of redistribution; and higher individual‐level trust fosters tax morale and helps deter tax evasion.     

Substance use disorders and referral to treatment in substantiated cases of child maltreatment

Parents with substance use disorders (SUD) require treatment and support in order to provide children with appropriate care and protection. Using the 2012 National Child Abuse and Neglect Data System (NCANDS), this paper analysed 464 313 substantiated child maltreatment reports to determine (i) the proportion and characteristics of reports involving substance abuse; and (ii) the child and caregiver/perpetrator (C/P) characteristics that predicted referral to treatment as recorded in service plans. Findings indicate that 12% (N = 53 234) of maltreatment reports involved C/P SUD. Yet, of those reports, only (19%) (N = 10 088) were referred to substance abuse treatment as part of their service plan, indicating a large gap between those who need treatment and those who receive it. This finding is important given that parental SUD is consistently linked to poorer child outcomes. Amongst other variables, reports indicate that C/P with co‐occurring emotional disturbance were three times more likely to be referred to treatment for SUD as part of service plans. Additional research is needed regarding the characteristics that distinguish C/P who receive referrals for SUD treatment in substantiated cases of child maltreatment.     

Bonding and Bridging Social Capital Development by Social Workers

ABSTRACT

Developing service users’ bonding and bridging social capital is an increasingly recognized role of social workers. A survey of 570 Chinese service users, sampled from 41 social service units in Hong Kong, provided data for the study. Results demonstrated convergent and discriminant validity in a confirmatory factor model about the measurement of bonding and bridging social capital development, mutuality, and assistance to the community. This evidence for the validity and usefulness of social capital development endorses social workers’ role in developing service users’ social capital. Further research needs to assess the generalizability of the present findings in other sociocultural settings.     

The deprivation experienced by disabled asylum seekers in the United Kingdom: symptoms,causes, and possible solutions

Disabled asylum seekers have been found to often experience extreme deprivation. Possible causes and solutions are explored, drawing on the experiences of disabled asylum seekers themselves as well as on a series of interviews with people working in the asylum and immigration sector. It is suggested that action is required to reduce immediate suffering, but that systemic change is needed to address the causes of this deprivation.     

Why social status matters for understanding the interrelationships between testosterone,economic risk‐taking,and gender

We conduct an extensive review of the literature on testosterone and economic risk‐taking behavior. In sum, there is evidence of a positive association between testosterone and economic risk taking, although it is unlikely to be a strong association given the abundance of null results. However, we argue that the existing literature may overstate the causal effects of testosterone on economic risk taking (or even report a spurious correlation) because this research has not considered the potentially confounding role of social status. Status could concurrently influence both testosterone and economic risk taking, given that testosterone is a social hormone with a reciprocal relationship with social status, and social status has been found to drive risk‐taking behavior. We also argue against using findings from this literature to make gender essentialist claims, primarily because social phenomena influence the size—and existence—of gender differences in economic risk‐taking behavior. We conclude with suggestions for future research.