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.     

THE HARDER THE TASK,THE HIGHER THE SCORE: FINDINGS OF A DIFFICULTY BIAS

Studies have found that going first or last in a sequential order contest leads to a biased outcome, commonly called order bias (or primacy and recency). Studies have also found that judges have a tendency to reward contestants they recognize with additional points, called reference bias. Controlling for known biases, we test for a new type of bias we refer to as “difficulty bias,” which reveals that athletes attempting more difficult routines receive higher execution scores, even when difficulty and execution are judged separately. Despite some identification challenges, we add to the literature by finding strong evidence of a difficulty bias in gymnastics. We also provide generalizations beyond athletics. (JEL L10, L83, D81, J70, Z1)     

Normalizing Denominational Statistics with Demographic Data: The Case of the United Church of Canada

In the Canadian context, one type of data has been underutilized in the study of contemporary religious trends: church collected statistics. The present article explores the advantages and limitations of such data by analyzing the evolution of key church indicators of the United Church of Canada over the past four decades. Figures regarding church membership, child baptisms, and funerals are examined and compared with demographic data from four Canadian regions. Results show that virtually all United Church statistics are in decline with regard to larger society since the 1970s. However, there are regional variations, most notably in the Atlantic provinces, which show later and lesser rates of decline.     

FamilyLive: Parental Skill Building for Caregivers with Interpersonal Trauma Exposures

Mental health treatments for emotionally traumatized children incorporate family and caregiver-child therapy sessions to promote child recovery and minimize developmental disruption. Such sessions require that caregivers regulate their emotions to remain productively engaged in the therapeutic process. However, caregivers with histories of unresolved interpersonal trauma have difficulty with emotional regulation. Interpersonal trauma also negatively affects the ability to reflect on one’s own and others’ feelings and intentions. This limitation interferes with caregiver engagement in psychotherapy relationships aimed at supporting child trauma work. FamilyLive is an innovative caregiver-focused family therapy model that uses a one-way mirror, a specially trained reflecting team, structured routines and individualized verbalizations to address this complex clinical phenomenon. Guided by the literature on attachment and trauma, FamilyLive has yielded anecdotal successes and positive pilot results. FamilyLive is a viable approach to engaging caregivers with histories of interpersonal trauma in trauma-focused child and family therapy relationships.     

Assessing the Validity and Reliability of the Perceptions of the Consent to Sex Scale

Although sexual assault prevention education tends to focus on consent promotion as a means to reduce rates of sexual assault, little is known about how college students consent to sexual activity. The current study aimed to better understand college students' consent via the systematic development of the Consent to Sex Scale (CSS), utilizing mixed methods via three phases and two waves of data collection. In Phase 1, qualitative data were collected from college students (n = 185) to provide a foundation for item writing. In Phase 2, closed-ended items were written for a quantitative instrument and reviewed by a team of experts. In Phase 3, a quantitative survey, including items written in Phase 2, was administered to college students (n = 685); the measure was assessed for its psychometric properties. Exploratory factor analysis was utilized, resulting in a five-factor solution. The CSS and corresponding factors demonstrated high internal consistency reliability and expected gender differences, supporting the construct validity of the measure. The CSS assesses college students' cues for indicating consent to sex, a construct not addressed by previous measures. The validated scale may be useful in future research to better understand how consent relates to other behaviors or constructs.     

Percentile Related Bounds and Estimator for the Mean of the Negative Binomial Distribution

Upper and lower bounds are obtained for the mean of the negative binomial distribution. These bounds are simple functions of a percentile determined by the shape parameter. The result is then used to obtain a robust estimate of the mean when the shape parameter is known.     

Period Parity Progression Ratios and Birth Intervals in England and Wales, 1941–1971: A Synthetic Life Table Analysis

A method is presented for analysing maternity history data to provide period estimates of parity progression ratios, birth intervals and related indices. This is applied to a sample of the marriage and maternity histories from the Census of England and Wales of 1971 and shows: (a) a general increase through the 1950s and into the 1960s in period estimates of marriage and parity progression ratios, especially in the progression from first to second birth; (b) a general acceleration of fertility with, again, the second birth interval becoming particularly short and compact; and (c) very steep declines in third and fourth birth progression ratios from the mid-1960s. Birth interval distributions altered during the period examined. Decomposition of a progression-based total fertility index shows change in the ratios for lower birth orders to have dominated the fertility upswing and declines in ratios for higher birth orders to have initiated the subsequent decline.