Educational relationships : a study in midwifery

At its inception in 1902, formal midwifery training developed within hospital midwifery services. With the development of a theoretical base, training became education during the 1980s. During a period of economic and societal changes in the 1990s, midwifery education was incorporated into higher education, separating education from health service practice. There were consequences for midwifery education especially the structure of pedagogical relationships. This thesis looks at key sets of relationships in midwifery education between the three main groups of actors: academics, clinicians and students. In so doing, the inquiry utilises a grounded theory approach and embraces disciplines of education, social sciences, social psychology, management and philosophy. The study confirms the importance of relationships between the key actors as part of a student's learning experiences. However, these relationships have become more problematic as a result of the organisational separation between the academic and professional components. A framework is proposed to describe educational relationships in midwifery. The framework has six dimensions; (i) a core component of personal traits, (ii) a secondary component of social and communication abilities and four subsidiary components of (iii) professional expertise, (iv) personal knowledge, (v) education knowledge and skills and (vi) a vision for practice. Realisation of the components by one person of another within the three groups aids mutuality in understanding. General principles are offered that include notions of encounter, exchange, rules, boundaries, reciprocity and reinforcement that aid in constructions of relationships. Though these conditions, in themselves, aid the formation of learning relationships, two processes occur in these relationships through encounters, that is, complementation (a unity of meanings between actors) and complementarity (a matching of understandings). These require a forum for encounters. A model of education is proposed that offers just such a forum aiding positive encounters to promote learning between the three groups of actors. Features of this model are the development of teachers within clinical practice, accreditation of practitioners as educators and the education of students primarily in clinical situations with interactive learning

Informal Child Care and Adolescent Psychological Well-Being: Hong Kong’s “Children of 1997” Birth Cohort

<div><p>Background</p><p>Informal child care (child care by untrained family members, relatives or employees in the home) in Western populations is often associated with poorer psychological well-being, which may be confounded by socioeconomic position. We examined the association of informal child care, common in non-Western settings, with adolescent psychological well-being, using Hong Kong’s Chinese “Children of 1997” birth cohort.</p><p>Methods</p><p>Multivariable linear regression was used to examine the adjusted associations of informal child care (at 0.5, 3, 5 and 11 years) with parent-reported Rutter score for child behavior at 11 years, self-reported Culture-Free Self-Esteem Inventories score at 11 years and self-reported Patient Health Questionnaire-9 depressive symptom score at 13 years. Model comparisons were used to identify the best representation of child care, in terms of a critical period of exposure to informal child care (independent variable) at a specific age, combination of exposures to informal child care at several ages or an accumulation of exposures to informal child care.</p><p>Results</p><p>Child care was not associated with behavioral problems. A model considering child care at 3 years best represented the association of child care with self-esteem while a model considering child care at 5 years best represented the association of child care with depressive symptoms. Informal child care at 3 years was associated with lower self-esteem (-0.70, 95% confidence interval (CI) -1.26 to -0.14). Informal child care at 5 years was associated with more depressive symptoms (0.45, 95% CI 0.17 to 0.73).</p><p>Conclusion</p><p>In a developed non-Western setting, informal child care was associated with lower self-esteem and more depressive symptoms.</p></div

Associations of parental education with BMI z-score and WHtR z-score at 14 years in Hong Kong’s “Children of 1997” birth cohort.

<p>Associations of parental education with BMI z-score and WHtR z-score at 14 years in Hong Kong’s “Children of 1997” birth cohort.</p

Baseline Characteristics by Child Care from Hong Kong’s “Children of 1997 Birth Cohort” (Available Case Analysis).

<p>Abbreviation: n, number; SD, standard deviation.</p><p>^a6 months: 1^st quintile [1,801 (425)], 2^nd quintile [3,037 (429)], 3^rd quintile [4,714 (517)], 4^th quintile [7,182 (912)], 5^th quintile [15,087 (11,382)]; 3 years: 1^st quintile [1,798 (428)], 2^nd quintile [3,037 (429)], 3^rd quintile [4,736 (569)], 4^th quintile [7,208 (899)], 5^th quintile [15,087 (11,382)]; 5 years: 1^st quintile [1,799 (427)], 2^nd quintile [3,038 (428)], 3^rd quintile [4,715 (517)], 4^th quintile [7,181 (913)], 5^th quintile [15,087 (11,382)]; 11 years: 1^st quintile [1,801 (428)], 2^nd quintile [3,036 (428)], 3^rd quintile [4,715 (515)], 4^th quintile [7,180 (913)], 5^th quintile [15,091 (11,391)].</p><p>^bIn Hong Kong dollars (HK $7.80 = US$1).</p><p>Baseline Characteristics by Child Care from Hong Kong’s “Children of 1997 Birth Cohort” (Available Case Analysis).</p

Adjusted^a Association of Informal Care Compared to Parental Care with Psychological Well-Being (After Inverse Probability Weighting with Multiple Imputation).

<p>Abbreviation: CI, confidence interval, Ref, reference.</p><p>^aAdjusted for sex, mother’s birthplace, highest parental education, highest parental occupation at birth, household income per head at birth, maternal age at birth, parity, age of assessment and survey mode (PHQ-9 scores).</p><p>Adjusted<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0120116#t005fn002" target="_blank">^a</a> Association of Informal Care Compared to Parental Care with Psychological Well-Being (After Inverse Probability Weighting with Multiple Imputation).</p

Length/height and body mass index (BMI) growth curves from birth to 14 years by birth order in the Hong Kong’s “Children of 1997” birth cohort, Hong Kong, China, 1997–2010.

<p>Length/height and body mass index (BMI) growth curves from birth to 14 years by birth order in the Hong Kong’s “Children of 1997” birth cohort, Hong Kong, China, 1997–2010.</p

Glucose-6-Phosphate Dehydrogenase Deficiency and Physical and Mental Health until Adolescence

<div><p>Background</p><p>To examine the association of glucose-6-phosphate dehydrogenase (G6PD) deficiency with adolescent physical and mental health, as effects of G6PD deficiency on health are rarely reported.</p><p>Methods</p><p>In a population-representative Chinese birth cohort: “Children of 1997” (n = 8,327), we estimated the adjusted associations of G6PD deficiency with growth using generalized estimating equations, with pubertal onset using interval censored regression, with hospitalization using Cox proportional hazards regression and with size, blood pressure, pubertal maturation and mental health using linear regression with multiple imputation and inverse probability weighting.</p><p>Results</p><p>Among 5,520 screened adolescents (66% follow-up), 4.8% boys and 0.5% girls had G6PD deficiency. G6PD-deficiency was not associated with birth weight-for-gestational age or length/height gain into adolescence, but was associated with lower childhood body mass index (BMI) gain (-0.38 z-score, 95% confidence interval (CI) -0.57, -0.20), adjusted for sex and parental education, and later onset of pubic hair development (time ratio = 1.029, 95% CI 1.007, 1.050). G6PD deficiency was not associated with blood pressure, height, BMI or mental health in adolescence, nor with serious infectious morbidity until adolescence.</p><p>Conclusions</p><p>G6PD deficient adolescents had broadly similar physical and mental health indicators, but transiently lower BMI gain and later pubic hair development, whose long-term implications warrant investigation.</p></div

Characteristics of Respondents (n = 3,679) and Non-Respondents (n = 4,257) to Survey I in 2008–2009 of Hong Kong’s “Children of 1997 Birth Cohort” (Available Case Analysis).

<p>Abbreviation: n, number; SD, standard deviation.</p><p>^aCohen effect sizes have three levels: 0.1 for small, 0.3 for medium and 0.5 for large.</p><p>^bIn Hong Kong dollars (HK $7.80 = US$1).</p><p>Characteristics of Respondents (n = 3,679) and Non-Respondents (n = 4,257) to Survey I in 2008–2009 of Hong Kong’s “Children of 1997 Birth Cohort” (Available Case Analysis).</p

Joint associations of parental education and mother’s place of birth with BMI z-score and WHtR z-score at 14 years by sex in Hong Kong’s “Children of 1997” birth cohort.

<p>Joint associations of parental education and mother’s place of birth with BMI z-score and WHtR z-score at 14 years by sex in Hong Kong’s “Children of 1997” birth cohort.</p

Adjusted^a associations of G6PD status with time to first hospitalization for respiratory infections, gastrointestinal infections, other (non-respiratory or non-gastrointestinal) infections and all infections up until 12 years by age group in the Hong Kong’s “Children of 1997” birth cohort, Hong Kong, China, 1997–2010.

<p>Adjusted<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0166192#t003fn001" target="_blank">^a</a> associations of G6PD status with time to first hospitalization for respiratory infections, gastrointestinal infections, other (non-respiratory or non-gastrointestinal) infections and all infections up until 12 years by age group in the Hong Kong’s “Children of 1997” birth cohort, Hong Kong, China, 1997–2010.</p