History of perinatal loss and maternal–fetal attachment behaviors

BackgroundMaternal–fetal attachment (MFA) is an important requirement for optimal maternal–infant adaptation. Current studies showed conflicting findings about whether a history of perinatal loss (fetal/neonatal death) affects maternal attachment in pregnancy.Research question“Does a history of perinatal loss affect maternal–fetal attachment behaviors?”MethodsOne hundred women with and without a history of PL were recruited using a convenience method of sampling, from prenatal care services affiliated to Shahid Behesti University of Medical Sciences. Data collected by questionnaires from a convenience sample of multiparous women in the 3rd trimester of pregnancy with no surviving children were compared with data from a selected cohort of primigravid women. The two groups of women were matched for health and literacy. The data collected included demographic characteristics and responses to 24 questions in five groups of behaviors on the Persian version of Cranly's Maternal–Fetal Attachment Scale. Data were analyzed by SPSS 13 and using t, ANOVA, Chi square, Pearson correlation and Mann–Whitney tests.FindingsFinding showed that total score of MFA for women with a history of PL (68.95 ± 9.20%) is not significantly different from this score for women without such a history (71.22 ± 11.75%; p < 0.05). Women with a history of PL had a significantly lower score for a subgroup of behaviors “differentiation of self from fetus” compared to women without of a history of PL (78.25 vs. 83.21%; p < 0.05). But, there were no statistically significant differences between two groups respecting to other subgroups of behaviors between two groups.ConclusionIn this study, a history of pregnancy loss was found to be associated with disturbances in the group of maternal–fetal attachment behaviors related to “differentiation of self from fetus” in a subsequent pregnancy.     

Stability and Validity of the Holden Psychological Screening Inventory (HPSI) in Psychiatric Inpatients

Abstract

Forty-seven psychiatric inpatients in a Canadian psychiatric hospital participated in an evaluation of the stability and validity of the Holden Psychological Screening Inventory (HPSI). Stability coefficients over a 1-month period were .85, .79, and .66 for the HPSI Psychiatric, Social, and Depression Symptomatology scales, respectively, and coefficient alpha reliabilities for these scales ranged between .76 and .89 across both time periods. Staff rating composite scales corresponding to the self-report HPSI scales had stability coefficients of .74, .85, and .82, respectively. As well, they had inter-rater reliabilities that ranged between .65 and .84 across both time periods. The 3 staff rating composites at time 1 correlated equivalently with the corresponding 3 primary HPSI scales at times 1 and 2 (p > .05). Similarly, the 3 staff rating composites at time 2 correlated equivalently with the corresponding 3 primary HPSI scales at times 1 and 2 (p > .05). Over a 1-month period, HPSI scale scores were very stable and correlations with criterion ratings were stable. Using a confirmatory factor analysis, with each of the 3 dimensions defined by the time 1 and 2 measures for the 3 HPSI scales and 3 staff rating composites, evidence for discriminant as well as convergent validity was obtained. In summary, the self-report HPSI and the staff rating composite measures evidenced sufficient reliability and validity to meet the requirements for routine clinical assessment work with psychiatric inpatients. Additionally, the stability data provide effects of retesting baseline data for assessing treatment outcome in this population.     

Remote access and care: A comparison of Queensland women's maternity care experience according to area of residence

BackgroundThis study fills a gap in the literature with a quantitative comparison of the maternity care experiences of women in different geographic locations in Queensland, Australia.MethodData from a large-scale survey were used to compare women's care experiences according to Australian Standard Geographical Classification (major city, inner regional, outer regional, remote and very remote).ResultsCompared to the other groups, women from remote or very remote areas were more likely to be younger, live in an area with poorer economic resources, identify as Aboriginal and/or Torres Strait Islander and give birth in a public facility. They were more likely to travel to another city, town or community for birth. In adjusted analyses women from remote areas were less likely to have interventions such as electronic fetal monitoring, but were more likely to give birth in an upright position and be able to move around during labour. Women from remote areas did not differ significantly from women from major cities in their satisfaction with interpersonal care. Antenatal and postpartum care was lacking for rural women. In adjusted analyses they were much less likely to have booked for maternity care by 18 weeks gestation, to be telephoned or visited by a care provider in the first 10 days after birth. Despite these differences, women from remote areas were more likely to be breastfeeding at 13 weeks and confident in caring for their baby at home.ConclusionsFindings support qualitative assertions that remote and rural women are disadvantaged in their access to antenatal and postnatal care by the need to travel for birth, however, other factors such as age were more likely to be significant barriers to high quality interpersonal care. Improvements to maternity services are needed in order to address inequalities in maternity care particularly in the postnatal period.     

“民心”决定论的困境——以秦亡汉兴为例

在中国历史上,朝代更迭与皇位易主通常需要诉诸于暴力战争,而战争胜负却并非由民心向背所决定。长期以来,平民百姓属于被统治阶层,与皇室、官僚相比明显弱势,缺乏有效的手段抵御外来侵害,也根本无力左右政局。“民心”决定论并不能准确解释中国历史上的政局变动。儒家对民心作用的鼓吹,只是价值追求,难以得到事实证据的有力支持。在秦汉交替的历史进程中,各路诸侯相互征战,并不顾及民众的感受,他们所采取的一系列政策,都是着眼于暴力战争的胜利,并以此决定最终的成败;这也是中国古代政权更迭的一般逻辑。     

Simultaneous inference of a misclassified outcome and competing risks failure time data

Ipsilateral breast tumor relapse (IBTR) often occurs in breast cancer patients after their breast conservation therapy. The IBTR status' classification (true local recurrence versus new ipsilateral primary tumor) is subject to error and there is no widely accepted gold standard. Time to IBTR is likely informative for IBTR classification because new primary tumor tends to have a longer mean time to IBTR and is associated with improved survival as compared with the true local recurrence tumor. Moreover, some patients may die from breast cancer or other causes in a competing risk scenario during the follow-up period. Because the time to death can be correlated to the unobserved true IBTR status and time to IBTR (if relapse occurs), this terminal mechanism is non-ignorable. In this paper, we propose a unified framework that addresses these issues simultaneously by modeling the misclassified binary outcome without a gold standard and the correlated time to IBTR, subject to dependent competing terminal events. We evaluate the proposed framework by a simulation study and apply it to a real data set consisting of 4477 breast cancer patients. The adaptive Gaussian quadrature tools in SAS procedure NLMIXED can be conveniently used to fit the proposed model. We expect to see broad applications of our model in other studies with a similar data structure.     

Testing the proportional odds assumption in multiply imputed ordinal longitudinal data

A popular choice when analyzing ordinal data is to consider the cumulative proportional odds model to relate the marginal probabilities of the ordinal outcome to a set of covariates. However, application of this model relies on the condition of identical cumulative odds ratios across the cut-offs of the ordinal outcome; the well-known proportional odds assumption. This paper focuses on the assessment of this assumption while accounting for repeated and missing data. In this respect, we develop a statistical method built on multiple imputation (MI) based on generalized estimating equations that allows to test the proportionality assumption under the missing at random setting. The performance of the proposed method is evaluated for two MI algorithms for incomplete longitudinal ordinal data. The impact of both MI methods is compared with respect to the type I error rate and the power for situations covering various numbers of categories of the ordinal outcome, sample sizes, rates of missingness, well-balanced and skewed data. The comparison of both MI methods with the complete-case analysis is also provided. We illustrate the use of the proposed methods on a quality of life data from a cancer clinical trial.     

租借法延期援助的政策动机及其后果

美国对华租借法延期援助的主要政策动机是帮助国民政府重建华北地区力量平衡,迫使国共双方通过谈判解决政治争端,建立一个统一的民主的国家。不料,国民政府自恃军力强大,误以为中共军队不堪一击,遂贸然挑起全国内战。租借法延期援助积聚的能量最终失控,彻底摧毁了预定的政策目标,导致杜鲁门总统对华政策彻底失败。     

The Event: An Underexamined Risk Concept

Some of the terms used in risk assessment and management are poorly and even contradictorily defined. One such term is “event,” which arguably describes the most basic of all risk‐related concepts. The author cites two contemporary textbook interpretations of “event” that he contends are incorrect and misleading. He then examines the concept of an event in A. N. Kolmogorov's probability axioms and in several more‐current textbooks. Those concepts are found to be too narrow for risk assessments and inconsistent with the actual usage of “event” by risk analysts. The author goes on to define and advocate linguistic definitions of events (as opposed to mathematical definitions)—definitions constructed from natural language. He argues that they should be recognized for what they are: the de facto primary method of defining events.     

Improving Ethical Knowledge and Sensemaking from Cases through Elaborative Interrogation and Outcome Valence

The case-based approach to learning is popular among many applied fields. However, results of case-based education vary widely on case content and case presentation. This study examined two aspects of case-based education—outcome valence and case elaboration methods—in a two-day case-based Responsible Conduct of Research (RCR) ethics education program. Results suggest that outcome information is an integral part of a quality case. Furthermore, valence consistent outcomes may have certain advantages over mixed valence outcome information. Finally, students enjoy and excel working with case material, and the use of elaborative interrogation techniques can significantly improve internally-focused ethical sensemaking strategies associated with personal biases, constraints, and emotions.     

Gaining hope and self-confidence—An interview study of women’s experience of treatment by art therapy for severe fear of childbirth

Background

Fear of childbirth is a serious problem that can have negative effects on both women and babies and to date treatment options are limited. The aim of this study was to elucidate the experience of undergoing art therapy in women with severe fear of childbirth.