Antenatal predictors and use of coping strategies in labour

Abstract

One aim of antenatal preparation is developing coping strategies for use (luring labour. However, the existing literature suggests that attendance at classes is not associated with lower pain or distress, possibly because receiving training cannot be assumed to be associated with subsequent practice.

This study aimed to assess whether attenders at classes actually used their taught strategies in their labours, whether use was associated with psychological benefits and whether antenatal measures could predict subsequent use. Concepts from the theories of planned behaviour and self efficacy were used to attempt to predict use of three types of coping strategy.

Use was high for breathing strategies but poor for relaxation and posture. Proportion of use of breathing and relaxation showed weak associations with lower fear. Whilst intentions did act as significant predictors for use of posture and relaxation only small proportions of the variance were accounted for and other antenatal measures showed little predictive capacity.

Reasons why women in labour may fail to take behavioural consequences from their antenatal beliefs are considered. Predicting health-related behaviours where maintenance rather than just initiation is involved may require greater consideration of intra-situational and emotional factors. Modifications of antenatal preparation to facilitate use of strategies are discussed.     

Exploring patient perspectives of prediabetes and diabetes severity: a qualitative study

Abstract

Objective: This qualitative study sought to identify and describe patients’ variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis.

Design: Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients’ perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients.

Results: Perceptions of disease severity fell into two groups: high and low severity. Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients’ beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) fears; (ii) clinician communication; and (iii) social comparisons.

Conclusions: Beliefs about severity are influenced by patients’ fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.     

Perceived responsibility for disease onset affects HIV/AIDS Education

Abstract

Ninety-nine participants were assigned to one of three experimental conditions in which they viewed an AIDS education videotape that systematically manipulated whether or not the educator would be perceived as responsible for HIV infection. Participants were administered pre and post-video affect measures, and an HlV/AIDS knowledge test after watching the video. Participants who viewed the speaker who acquired HIV through a blood transfusion (perceived not responsible) and those who viewed the speaker who did not reveal mode of acquisition (control) performed significantly better on the knowledge test compared to those who viewed the speaker who acquired HIV through unprotected sexual inttrcourse (perceived responsible). In addition. male participants in the perceived responsible condition reported a significant increase in sensation-sceking after viewing the video. Finally, females experienced a significantly greater increase in anxiety as a result of seeing the video than did males. Implications of these tindings for the design and implmentation of AIDS education programs were discussed.     

Associations Between Participant Ratings of PREP for Strong Bonds and Marital Outcomes 1 Year Postintervention

After completing a relationship education program, collecting participant evaluations of the program is common practice. These are generally used as an index of “consumer satisfaction” with the program, with implications for feasibility and quality. Rarely have these ratings been used as predictors of changes in marital quality, although such feedback may be the only data providers collect or have immediate access to when considering the success of their efforts. To better understand the utility of such ratings to predict outcomes, we evaluated links between participant ratings and changes in self-reported marital satisfaction and communication scores 1 year later for a sample of 191 Army couples who had participated in a relationship education program delivered by Army chaplains (PREP for Strong Bonds). Overall ratings of general satisfaction with the program and the leader did not predict changes in marital outcomes 1 year later, whereas higher ratings of how much was learned, program helpfulness, increased similarity in outlook regarding Army life, and helpfulness of communication skills training predicted greater change in communication skills 1 year later. Higher ratings of items reflecting intent to invest more time in the relationship, and increased confidence in constructive communication and working as a team with the spouse predicted greater increases in both marital satisfaction and communication skills 1 year later. The constructs of intention and confidence (akin to perceived behavioral control) suggest that the Theory of Planned Behavior may be particularly useful when considering which Army couples will show ongoing benefit after relationship education.     

Walking in the lost child's tracks: revisiting the therapeutic nature of reclaiming

This paper outlines the research methodology used as part of a professional doctorate in psychoanalytic psychotherapy. The project researched the maternal state of mind following the loss of an infant or small child and the birth of the next baby. Three mothers were seen for psychoanalytic psychotherapy on a weekly basis as part of this research. They were encouraged to bring their new baby to sessions. The author describes how an interest in this area of research developed as a result of working as a child psychotherapist with 'replacement children' (Cain and Cain, 1964). An argument is made to show that the psychoanalytic method is unique and that the psychoanalytic setting may be considered an 'ideal laboratory' (Fonagy and Moran, 1993) for psychoanalytic psychotherapeutic research. Clinical material is used from one case study to show how material can be analysed and demonstrates the research methodology used within the project. The material explores the developing therapeutic relationship and focuses on the way one mother in the research group experienced the loss of a small child prior to the birth of her next baby. Cet article décrit brièvement la méthodologie de recherche employée dans le cadre d'un doctorat professionnel en psychothérapie psychanalytique. Le projet de recherche porte sur l'état psychique maternel à la suite de la perte d'un nourrisson ou d'un enfant en bas âge lorsque un nouveau bébé vient à naître. Dans le cadre de cette recherche, trois mères ont bénéficié d'une psychothérapie psychanalytique à raison d'une séance hebdomadaire. Il leur était proposé d'amener leur bébé aux séances. L'auteur décrit comment son intérêt pour ce champ de recherche s'est développé à partir de son travail de psychothérapeute d'enfants auprès d'"enfants de remplacement" [A. Cain & B. Cain 1964]. Elle affirme que la méthode psychanalytique à sa propre valeur et que le cadre psychanalytique peut être considéré comme un "laboratoire idéal" [P. Fonagy & G. Moran 1993] pour la recherche en psychothérapie psychanalytique. Le matériel clinique d'une étude de cas montre comment l'analyser et illustre la méthodologie de la recherche employée dans ce projet. Ce matériel explore l'évolution de la relation thérapeutique et traite en détail de la façon dont une des mères de l'échantillon a vécu la perte d'un enfant en bas âge avant la naissance de son bébé actuel. Questo articolo mette in rilievo la metodologia di ricerca utilizzata come parte di un dottorato professionale in psicoterapia psicoanalitica. Il progetto di ricerca studiava lo stato mentale materno conseguente la perdita di un neonato o bambino piccolo e la nascita del bambino successivo. Come parte della ricerca tre madri furono seguite una volta alla settimana in psicoterapia psicoanalitica, ed incoraggiate a portare alle sedute i loro nuovi bebe'. L'autore descrive come il suo interesse in questa area si e' sviluppato conseguentemente al suo lavoro come psicoterapeuta infantile con 'bambini sostituti' (Cain e Cain, 1964. Si cerca di mostrare l'unicita' del metodo psicoanalitico e come esso possa essere considerato un 'laboratorio ideale' (Fonagy e Moran, 1993) per la ricerca in psicoterapia psicoanalitica. Viene usato il materiale clinico di un caso per mostrare come esso possa essere analizzato e illustrare il metodo di ricerca usato nel progetto. Il materiale esplora la relazione terapeutica nel suo evolversi e si concentra sul modo in cui una madre nel gruppo di ricerca visse la perdita di un bambino piccolo precedente la nascita dell'altro bebe'. Dieser Artikel umreisst die Forschungsmethodik, die als Teil einer Doktorarbeit in psychoanalytischer Psychotherapie verwendet wurde. Das Projekt erforschte den müterlichen Gemütszustand nach dem Verlust eines Babys oder kleinen Kindes und der Geburt des nächsten Babys. Als Teil dieser Forschung wurden drei Mütter einmal wöchentlich in Psychotherapie gesehen. Sie wurden ermuntert, ihr Neugeborenes zu den Stunden mitzubringen. Die Autorin beschreibt, wie das Interesse in diesem Forschungsbereich sich als Folge ihrer Arbeit als Kinderpsychotherapeutin mit 'Ersatzkindern' entwickelt hatte. (Cain und Cain 1964). Es wird argumentiert, dass die psychoanalytische Methode einzigartig ist und das psychoanalytische Setting als ein 'ideales Labor' (Fonagy und Moran,1993) für psychoanalytische psychotherapeutische Forschung angesehen werden kann. Es wird klinisches Material einer Fallstudie benutzt, um zu zeigen, wie das Material analysiert werden kann und es demonstriert die Forschungsmethodik, die im Projekt benutzt wird. Das Material erforscht die sich entwickelnde therapeutische Beziehung und legt den Schwerpunkt auf die Art und Weise, wie eine Mutter in der Forschungsgruppe den Verlust eines kleinen Kindes vor der Geburt ihres nächsten Babys erlebte.     

The ‘Matchbox School’ (1927–1932): Anna Freud and the idea of a ‘psychoanalytically informed education’∗

Of all the applications of psychoanalysis to various fields, perhaps none has been as important – or as fraught – as the application of psychoanalytic insights to education. This paper re-constructs some of the early debates around psychoanalysis and pedagogy that Anna Freud engaged with during the 1920s in Vienna, when the whole question of what education should be became a central issue for politicians, pedagogues and psychoanalysts alike. The paper focuses on the period leading up to the creation of the so-called ‘Matchbox School’, operating under Anna Freud's guidance between 1927 and 1932, and describes the influence of pioneers such as Seigfried Bernfeld and August Aichhorn. Compared to her more well-known work at the Hampstead War Nurseries during the Second World War, Anna Freud's involvement with this earlier educational experiment is relatively neglected. Yet one can argue that this short-lived project not only laid the foundation for much of Anna Freud's later work; it also had some far-reaching consequences, both for psychoanalysis and for the practice of progressive education.     

Rural Embedded Assistants for Community Health (REACH) Network: First-Person Accounts in a Community–University Partnership

Community research and action projects undertaken by community–university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community–university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network. The REACH Network is a unique community–university partnership aimed at improving rural health services by identifying, implementing, and evaluating innovative health interventions delivered by local caregivers. The first-person accounts provide an insider’s perspective on the nature of collaboration. The unique perspectives identify three critical challenges facing the REACH Network: trust, coordination, and sustainability. Through consideration of the challenges, we identified several strategies for success. We hope readers can learn their own lessons when considering the details of our partnership’s efforts to improve the delivery infrastructure for rural healthcare.     

Education for Vocation in Public Life USA1

Abstract : The Lutheran sensibility is that life is a paradox, a dialectical tension, in the midst of which one must act and live. This sensibility informs an open and dialectical educational model for liberal arts education, which encourages a dynamic interaction of faith and learning. It supports a vocational understanding of public life that cultivates critical analysis while seeking to encourage citizenship for the common good.     

The effects of self-monitoring on the procedural integrity of a behavioral intervention for young children with developmental disabilities

The effects of self-monitoring on the procedural integrity of token economy implementation by 3 staff in a special education classroom were evaluated. The subsequent changes in academic readiness behaviors of 2 students with low-incidence disabilities were measured. Multiple baselines across staff and students showed that procedural integrity increased when staff used monitoring checklists, and students' academic readiness behavior also increased. Results are discussed with respect to the use of self-monitoring and the importance of procedural integrity in public school settings.