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61.

Aim

To assess the relationship between the duration of the second stage of labour and postpartum anaemia during vaginal birth.

Methods

An observational, analytical retrospective cohort study was performed at the “Mancha-Centro Hospital” (Spain) during the 2013–2016 period. Data were collected from 3437 women who had a vaginal birth. Postpartum anaemia was defined as a haemoglobin level below 11 g/dL at 24 h postpartum. A univariate analysis was used for potential risk factors and a multivariate analysis with binary logistic regression to control for possible confounding factors.

Findings

The incidence of postpartum anaemia was 42.0%. The risk of postpartum anaemia did not increase in nulliparous women whose duration of the second stage of labour exceeded 4 h. Compared with multiparous women who delivered between 0 and 3 h, multiparous women with a duration of the second stage of labour beyond 3 h were at higher risk of postpartum anaemia (OR = 2.43 [1.30–4.52]).

Conclusion

The duration of the second stage of labour beyond 4 h is safe for postpartum anaemia in nulliparous women. However in multiparous women, monitoring should increase if the second stage of labour exceeds 3 h given the increased risk of postpartum anaemia.  相似文献   
62.

Background

The rates of breastfeeding worldwide are slowly improving since 1996. Europe is still trailing behind the global breastfeeding incidence and prevalence rates. Thus, breastfeeding promotion, protection, prolongation and support have become an important challenge as breastfeeding sharply decreases in the first six months of life.

Objectives

The aim of this project is to determine, assess and identify the real impact of breastfeeding support networks in Murcia (Spain).

Methods

After searching unsuccessfully for a validated questionnaire, a specific one was developed and validated for measuring the impact of formal and informal support networks through five dimensions: satisfaction, consultation, experience, problems and support. The questionnaire was provided to 500 mothers with experience in breastfeeding, who brought their children to baby paediatricians between 2 June and 27 November 2014. Upon completion of the survey and fieldwork, a detailed statistical analysis was conducted.

Results

The degree of satisfaction perceived by the users of the services of support breastfeeding networks is remarkable. In addition, mothers who clarified their doubts and discussed their problems with health professionals and/or breastfeeding support networks were more likely to breastfeed for a longer duration compared to those who did not (p = 0.005). Furthermore, mothers who sought support in breastfeeding are more likely to breastfeed for more than 6 months (p < 0.0005).

Conclusion

Based on this information, we conclude that breastfeeding support networks have a positive influence in the duration of a women’s decision to breastfeed.  相似文献   
63.
In this study, we conceptualize personal initiative as a collective construct and adapt and validate a scale to evaluate it with a sample of 308 Spanish participants belonging to 91 work teams. Personal initiative at group level is a behavioural syndrome in which the team shows an approach to work that is self-initiated, proactive, persistent, capable of modifying the atmosphere and pro organization. As a predictive variable, we analysed the climate for initiative as well as personal initiative at group level. The resulting variables that were analysed referred to organization and team performance, with the team productivity and innovation as the criteria, analysing radical innovation. The scale has suitable psychometric properties. The results show that there is a relationship between the two predictive variables. Furthermore, personal initiative at group level is related to team productivity, while the climate for initiative is related to innovation.  相似文献   
64.
Rhetorical questions emerging spontaneously in consultations can be used as a tool for developing self‐reflexivity and exploring the therapeutic alliance in the process of therapy with couples and families. This paper presents a technique based on the enunciation of rhetorical questions, which can point to an impasse in the process of therapy and contain a key to its resolution. The technique focuses on the distinctive feature of rhetorical questions as convening a paradoxical injunction: a question not intended as a question, while uttered as such. The technique in four steps is illustrated by examples from therapy, supervision, consultation, and self‐supervision. Its focus is the interlink between the therapeutic relationship and the process of therapy and it is informed by a second‐order cybernetics approach, dialogical practice, and the systemic literature on emotion. The technique can help develop curiosity in working with families, lead to unforeseen developments, and touch on prejudices not made explicit in previous therapeutic encounters. Whether we are acting as supervisors, therapists, or clients, the creation of a ‘secure enough’ context for rhetorical questions becomes critical to allow freeform exploration.  相似文献   
65.
ABSTRACT

This article discusses two forms of discrimination against indigenous people: ventriloquism and open racism, and argues that a transition from paternalism to open intolerance has taken place in Ecuador in the context of governmental emphasis on natural resource extraction. Ventriloquism, when non-Indians speak for indigenous people, is analysed through the Sumak Kawsay (Good Living) policies of the government of Rafael Correa (2007–2017). Public racism is examined by looking at government repression against indigenous leaders and communities and Presidential speeches. The article concludes that the state’s ventriloquist and racist discourses and practices are equally rooted in the country’s colonial past. These findings are contrasted with the writings of scholars that have called the government of Mr. Correa decolonizing. The article examines the ways in which decolonial theorists informed and promoted the policies of this regime, and argues that decolonial scholars have been insufficiently self-critical and reflective of their own complicity with the state’s repressive project vis-à-vis indigenous communities.  相似文献   
66.
67.
The aim of this paper is to obtain new sharp inequalities for a large family of topological indices, including the second variable Zagreb index \(M_2^{\alpha }\), and to characterize the set of extremal graphs with respect to them. Our main results provide lower bounds on this family of topological indices involving just the minimum and the maximum degree of the graph. These inequalities are new even for the Randi?, the second Zagreb and the modified Zagreb indices.  相似文献   
68.
Same parliaments, to form a committee of size $q$ , use a voting process like the following: every parliamentary member votes for one out of a fixed set of candidates, and those $q$ candidates receiving more votes are elected for the committee. Assuming total discipline of vote, this is a game form in which players are the parliamentary groups. We investigate, according to some natural hypotheses about preferences, the likely distribution of the members of this committee. The main results are: (a) when fractional votes are allowed, there is a complete agreement between the distribution among the groups of the elected candidates that are outcomes of a Nash equilibrium and the distribution that, according to the size of the groups, would compute the Jefferson-d’Hondt allocation rule, and (b) when fractional votes are not allowed, there is a near agreement for a majority of situations.  相似文献   
69.
If voters vote strategically, is it useful to offer them the possibility of expressing nuanced opinions, or would they always overstate the intensity of their preferences? For additive voting rules, say that a ballot is extremal if it is neither abstention-like nor can be expressed as a mixture of the available ballots. We give a sufficient condition for strategic equivalence: if two rules share the same set of extremal ballots (up to an homothetic transformation), they are strategically equivalent in large elections. This condition is also necessary for the strategic equivalence of positional rules. These results do not hold for small electorates.  相似文献   
70.
In the same way that many aspects of gender cannot be understood aside from their relationship to race, class, culture, nationality and/or sexuality, the interactions between gender and aging constitute an interesting field for academic research, without which we cannot gain full insight into the complex and multi-faceted nature of gender studies. Although the American writer and Columbia professor Carolyn Gold Heilbrun (1926-2003) is more widely known for her best-selling mystery novels, published under the pseudonym of Amanda Cross, she also authored remarkable pieces of non-fiction in which she asserted her long-standing commitment to feminism, while she also challenged established notions on women and aging and advocated for a reassessment of those negative views. To my mind, the Kate Fansler novels became an instrument to reach a massive audience of female readers who might not have read her non-fiction, but who were perhaps finding it difficult to reach fulfillment as women under patriarchy, especially upon reaching middle age. Taking her essays in feminism and literary criticism as a basis and her later fiction as substantiation to my argument, this paper will try to reveal the ways in which Heilbrun's seemingly more superficial and much more commercial mystery novels as Amanda Cross were used a catalyst that informed her feminist principles while vindicating the need to rethink about issues concerning literary representations of mature women and cultural stereotypes about motherhood.  相似文献   
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