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.     

HRD in 2020: a hop-on,hop-off city tour

This article reports on the outcome of a Future Search Conference in the UK to consider human resource development (HRD) in 2020 and beyond. We firstly consider themes from the past into the present. This includes the persistence of solutions in HRD that are systematic, predictable, how apprenticeships in the UK have had to accommodate government policies to ameliorate youth unemployment and the long-standing difficulty for HRD of failing to demonstrate a return on investment (ROI) on activities. We then present four scenarios based on key questions for the future relating to value of HRD and whether this will be a future for HRD. Reponses to the questions form scenario logics which we present against the theme of city tour. Each scenario is explained against the presented logic with positive, negative, ambiguous and uncertain implications for HRD. We suggest that each scenario carries a glimpse of what might be.     

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social–emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood‐related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social–emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.     

The female aging body: A systematic review of female perspectives on aging,health, and body image

While most body image research has focused on young female populations, evidence has shown that as few as 12% of older women are satisfied with their body size. Recent studies have also highlighted how anti-aging discourses are promoting unrealistic body norms, which have shown to contribute to poor body image and altered health behaviors. A systematic review of empirical studies focused on older women’s perspectives of health, body image, and the aging body is presented. Findings support that body image is a persistent, lifelong issue for women and should be considered when implementing healthy aging policies and practices.     

Observational sketching as method

This paper explores the potential of observational sketching as a social science research tool, informed by our own recent experiments with observational sketching techniques and approaches. We first outline the historical roots of academic sketching and note a recent resurgence of interest in sketching in certain disciplines. We then introduce our own explorations in sketching as method, based on a year-long collaboration between an observational artist and a group of qualitative researchers with interests in creative methods. The paper outlines some of the lessons we learnt from our partnership, focusing on three themes: (i) ‘sketchiness’; (ii) ‘concentrated seeing’ and (iii) sketching as interaction. We conclude that observational sketching generates a refreshingly different form of visual data which has considerable potential to be used as a complement to other methods, including as a participatory method and as a useful tool for thinking.