Women and healthcare providers' perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study.

BACKGROUND: The development of medical-led care in obstetrics over the past decades has contributed to improving outcomes for both mother and child. Although efficiency has improved in complex situations, unnecessary interventions are still practiced in low-risk pregnancies, contrary to international recommendations. A shift to a less interventionist model of care has encouraged many countries to review their policies on maternal health care and develop models such as the "midwife-led unit" (MLU) where the midwife plays a predominant role with a minimum of routine intervention. Existing research has provided convincing evidence that MLUs lead to better maternal and neonatal outcomes when compared to traditional models. They not only improve the level of satisfaction amongst women, but are also associated with reduced healthcare costs. This study aimed to explore the perceptions of women and healthcare providers regarding the creation of an MLU in a Swiss university hospital. METHODS: A descriptive research study using qualitative methods was conducted among pregnant women and new mothers in a Swiss maternity unit, including also midwives and medical staff. Data collection was carried out through one-to-one interviews, focus groups, and telephone interviews (n = 63). After transcription, thematic analysis was performed. RESULTS: The triangulation of perceptions of women and healthcare providers indicated support for the implementation of an MLU to promote physiological delivery. Most women welcomed the idea of an MLU, in particular how it could help in offering continuity of care. Healthcare providers were optimistic about the implementation of an MLU and recognised the need for some women to have access to a less interventionist approach. From the women's perspective, barriers concerned the lack of awareness of midwives' full scope of practice, while barriers for midwives and obstetricians were related to the challenge to develop a good interprofessional collaboration. CONCLUSION: Alternative models to provide maternity care for low-risk women have been developed and evaluated widely in several countries outside Switzerland. This study showed that women and healthcare providers were favourable towards the development of a new care model, while taking into account the specific expectations and barriers raised by participants

Exploring taxonomic filtering in urban environments

Question: Several mechanisms have been proposed that control the spatio-temporal pattern of species coexistence. Among others, the species pool hypothesis states that the large-scale species pool is an important factor in controlling small-scale species richness through filtering of species that can persist within a species assemblage on the basis of their tolerance of the abiotic environment. Because of the process of environmental filtering, co-occurring species that experience similar environmental conditions are likely to be more taxonomically similar than ecologically distant species. This is because, due to the conservatism of many species traits during evolutionary diversification, the ability of species to colonize the same ecological space is thought to depend at least partially on their taxonomic similarity. The question for this study is: Under the assumption of trait conservatism, does environmental filtering lead to nonrandom species assemblages with respect to their taxonomic structure? Methods: The significance of taxonomic filtering in regulating species coexistence is tested using data from 15 local species assemblages from the urban flora of Rome ( Italy). To find out whether the taxonomic structure of the selected 'local' species assemblages was significantly different from random, we used a Monte Carlo simulation in which for each local species assemblage, the actual taxonomic diversity was compared to the taxonomic diversity of 1000 virtual species lists of the same size extracted at random from a larger 'regional' species pool. Results: We found that in most cases the local species assemblages have a higher degree of taxonomic similarity than would be expected by chance showing a phenomenon of 'species condensation' in a small number of higher-level taxa. Conclusions: Our observations support the species pool hypothesis and imply that environmental filtering is an important mechanism in shaping the taxonomic structure of species assemblages. Therefore, the incorporation of taxonomic diversity into landscape and community ecology may be beneficial for a better understanding of the processes that regulate species coexistence

L’expansion occidentale (XIe-XVe siècles). Formes et conséquences

Croisade, Reconquête, Drang nach Osten. Autant d'expressions contestées aujourd'hui par les historiens, mais qui n'en expriment pas moins différentes modalités d'un phénomène de grande ampleur : l'expansion occidentale au Moyen Âge. Du XIe à la « première mondialisation » de la fin du XVe siècle, ce vaste mouvement aura poussé pèlerins, marchands et chevaliers des rives de la mer Noire jusqu'aux conquêtes latines de Syrie-Palestine. C'est cette histoire passionnée, et souvent obscurcie par les arrière-pensées idéologiques, qu'éclairent les actes du XXXIIIe congrès de la Société des historiens médiévistes de l'Enseignement supérieur public, accueilli en mai 2002 à la Casa Velasquez, à Madrid. Ils permettent de mesurer tout ce qui sépare l'expansion médiévale de la colonisation moderne, dont la péninsule Ibérique fut l'un des premiers acteurs. Cela se vérifie tant du point de vue des fronts de la conquête, orientés au Moyen Âge vers l'Est et le Nord tout autant que vers le Sud, que du point de vue de ses conséquences territoriales, n'affectant que marginalement le peuplement. L'expansion occidentale ne saurait se réduire, au Moyen Âge, à l'élan inexorable d'États conquérants. Les études réunies ici permettent de restituer ce mouvement historique global dans la diversité de ses acteurs, dans la complexité de ses motivations et dans la variété de ses rythmes. Il en résulte une compréhension à la fois plus contrastée et plus sûre d'un fait historique qui appartient, qu'on le veuille ou non, au socle de l'identité occidentale