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 (Cuban) Voice of the (Curaçaoan) People: The Making (And Taking) of a Collective Memory

At the turn of the 20^th century, Afro-Curaçaoans developed an affinity for Cuban culture that influenced the manner to which they came to define their own collective memory. Cuba was raised to mythological status, appropriated and adapted to fit Curaçaoan daily life, enabling a new and inventive sense of belonging. This essay speaks to the intricacies involved in memory-making , with the Cuban-inspired memory of memories on Curaçao introduced as a relative category. It points to the variegated and tenuous nature of memory, showing how the past, when negotiated with the present, can shape group goals and demarcate membership.     

国有商业银行资本市场业务研究

本文首先从国际金融界混业经营 ,国内银行、保险、证券三业互相渗透共同发展 ,我国资本市场发展对银行传统业务的冲击 ,以及加入 WTO挑战的需要等方面论述了国有商业银行拓展资本市场业务的客观现实性。其次 ,从资本市场规模、银行和证券公司、基金、保险公司的业务合作领域 ,以及合作的层次和市场发展潜力等方面阐述了国有商业银行进行资本市场业务创新的动因及其目前在资本市场业务方面存在的问题和解决办法。进而分析了进一步拓展资本市场业务从建立战略同盟、壮大资金实力和实现综合经营有效切入的问题     

民族法制的中国经验及其贡献

在中国，平等、团结、互助的社会主义民族关系已经建立并进一步巩固发展，这是实施民族区域自治制度的结果，它为当代国际社会解决民族问题提供了有益的经验。这些经验是对民族团结概念作宪法安排以建构公民认同；以少数民族干部制度作为沟通的制度性安排；自治权作为发展权的制度设置以实现各民族的共同繁荣发展；设立少数民族聚居区的独特安排，保证了民族关系历史与现实的统一；以多元与一体并存的发展形式，保证各民族语言文化的平等共同发展。     

Les formes d'emploi atypiques et leur effet sur les comités d'entreprise en Israël: une liminalité permanente

En Israël, les comités d'entreprise s'adaptent à l'économie néolibérale et aux évolutions qui en découlent sur le marché du travail en admettant de plus en plus le recours aux emplois atypiques, tout en essayant de lutter contre ce nouvel avatar de l'économie capitaliste pour protéger les droits des travailleurs. Tiraillés entre ces deux positions, ils sont pris dans un transitoire qui dure, une «liminalité» permanente, qui réduit leur rôle à la recherche de compromis et de solutions circonstancielles. La résistance aux effets pervers des formes d'emploi atypiques reste donc circonscrite et dispersée, ce qui conforte encore les pratiques en question.     

Social embeddedness in a harmonized Europe: the social networks of European migrants with a native partner in Belgium and the Netherlands

Although intra‐European migration is often considered relatively easy to realize given European citizens' right to freedom of movement, settlement in another European country can still be experienced as socially disruptive. Insights in the insertion processes of European migrants, nevertheless, remain rather scarce. In this study, we analyse the social networks of European nationals with a native partner in Belgium and the Netherlands. The analysis is based on survey data from the EUMARR project (n = 576). First, we study the size and composition of European migrants' local family and friendship networks, and the frequency of contact with these networks. Second, we connect intra‐EU movers' insertion routes to investments in transnational networks in their home country. The results reveal how size, composition and contact with the local and transnational network change over time. Children help to maintain contact with both the local and transnational family network and form a bridge for parents to meet own friends in the host country. Moreover, having own friends and own family around matters for contact frequency with the local networks.     

ON THE EVOLUTION OF TOTAL FACTOR PRODUCTIVITY IN LATIN AMERICA

Because of several policy distortions, including import‐substitution industrialization, widespread government intervention, and both domestic and international competitive barriers, there has been a general presumption that Latin America has been much less productive than the leading economies in the last decades. In this paper we show, however, that until the late 1970s Latin American countries had high productivity levels relative to the United States. It is only after the late 1970s that we observe a fast decrease of relative total factor productivity (TFP) in Latin America. We also show that the inclusion of human capital in the production function makes a crucial difference in the TFP calculations for Latin America. (JEL O11, O47, O54)     

TOWARDS AN ANTHROPOLOGY OF TOURISM?

VALENE L. SMITH (ed.). Hosts and Guests, The Anthropology of Tourism. Philadelphia: University of Pennsylvania Press, 1977     

Parenting Assessment in a Psychiatric Mother and Baby Unit

Correspondence to Dr Gertrude Seneviratne, Section of Perinatal Psychiatry, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: G.Seneviratne{at}iop.kcl.ac.uk Summary Courts and social services often seek the advice of mental healthprofessionals in deciding whether a mentally ill mother shouldremain the primary carer of her infant. This paper describesthe referral pathways, outcomes at discharge and subsequently,of a sample of mothers referred for parenting assessments toa psychiatric Mother and Baby Unit. A further aim was to examinefactors predicting outcome. A casenote study of sixty-one consecutivereferrals for in-patient parenting assessment over a six-yearperiod is described. Social Services were contacted to establishdevelopments at least nine months after discharge. Fewer thanhalf of the mothers were discharged together with their babiesat the end of the assessment period, and at follow-up, lessthan a third were still caring for their children. Diagnosisof the mother's illness was the main factor determining whethershe continued to care for her child both at discharge and atfollow-up; mothers with depression were more likely to remainprimary carers. Variations in the timing and process of referralsrelated to a lack of antenatal planning were associated withincreased rates of separation of mother and infant before theassessment. The findings illustrate the need for more integratedco-ordination between professionals in mental health and children'sservices to ensure early planning for mothers and infants atrisk.