Reading Robert and beyond: Narrative analysis of the story of a sexually abused Catholic man

<p><span>This article seeks to contribute to the understanding of what is at stake in counselling religious male victims of sexual abuse. We analyse the narrative of �Robert�, a sexually abused Roman Catholic man who later committed suicide. We focus on issues that concern many sexually abused males, such as talking and relationships, agency and responsibility, emotions of guilt, shame and anger, sexual identity, God-talk and God-images. In terms of a triangulating case study, we then confront this narrative analysis with some biographical elements gathered from other sources, from which we complement and critique the analysis.</span></p

Encruzilhadas do caminho no rastro do sagrado: a teologia prática como hermenêutica da religião vivenciada

The diversity within the discipline of Practical Theology is so large that it can accommodate many different contexts and challenges. The risk is, however, that it loses its coherence. Drawing on a range of recent introductions to Practical Theology and on ongoing discussions in the International Academy of Practical Theology, this paper tries to describe both the common ground and the major decision points (or forks in the road) where practical theologians diverge. The common ground is described as “hermeneutics of lived religion”, which marks the distinction from social sciences of religion on the one hand and other theological disciplines on the other. The forks in the road regard how broad the object is defined, how praxis and theological theory are related, how the researcher is positioned vis as vis the object, and how the primary audience is understood. This framework helps to clarify the complexities of the field and to position oneself in that field.A diversidade dentro da disciplina da Teologia Prática é tão grande que ela pode acomodar muitos contextos e desafios diferentes. Porém, o risco é que ela perca a sua coerência. Valendo-se de um leque de introduções recentes à Teologia Prática e de discussões continuadas na Academia Internacional de Teologia Prática, este artigo tenta descrever tanto o território comum como os principais pontos decisivos (ou as encruzilhadas no caminho) sobre os quais teólogos/as prático/as divergem. O território comum é descrito como “a hermenêutica da religião vivenciada”, que marca a distinção entre as ciências sociais da religião, por um lado, e outras disciplinas teológicas, por outro lado. As encruzilhadas no caminho consideram a definição da abrangência do objeto, como práxis e teoria teológica estão relacionadas, como o/a pesquisador/a se posiciona vis à vis o objeto e como se entende o público primário. Essa estrutura ajuda a esclarecer as complexidades do campo e a se posicionar naquele campo

Molduras para os deuses: o significado público da religião de um ponto de vista cultural

Este artigo analisa formas religiosas presentes na cultura, na cultura pop e na mídia. Ao passo que nossas sociedades se debatem com o lugar e o papel da religião, especialmente com as forças mais radicais e perigosas, a esfera cultural continua carregada de temas e imagens religiosas. Não está claro, entretanto, como a religião funciona e é retratada na cultura pop em geral e nos meios de comunicação em particular. Esse é um desafio importante para os/as teólogos/as contemporâneos/as e outros/as pesquisadores/as da religião. Faz-se necessário reconsiderar os próprios conceitos de “religião” e “religioso”, porque não está claro que os conceitos tradicionais de religião ainda façam sentido quando tentamos entender a religião nessas esferas não religiosas. Como deveríamos distinguir entre conteúdos e funções religiosas e não religiosas se essa distinção talvez não seja mais tão central ou sequer possível ainda? Como podemos inclusive começar a definir o próprio conceito de “religião”? Para fazer isso, tomar-se-á como ponto de partida a perspectiva da desinstitucionalização da religião. A partir dessa perspectiva, examinar-se-á o modo como instituições não religiosas assumem funções religiosas, servindo como fontes e meios de sentido, consolo e comunidade. O passo seguinte será uma exposição dos padrões religiosos que podemos encontrar na cultura pop, desenterrando, por assim dizer, o material religioso necessário para uma exegese cultural. E, finalmente, far-se-á uma reflexão sobre o sentido e a função de formas religiosas em meios de comunicação não religiosos: o que acontece quando formas religiosas são emolduradas ou enquadradas no contexto dos noticiários, do entretenimento ou do comércio globais

Computerized fetal heart rate analysis in early preterm fetal growth restriction

Objective: To assess the value of computerized cardiotocography (cCTG) with calculation of fetal heart rate (FHR) short-term variability (STV) in early preterm fetal growth restriction (FGR) for prevention of fetal death and neonatal asphyxia, neonatal morbidity, and 2-year neurodevelopmental impairment. Methods: This was a retrospective cohort study of all women who were admitted to the Amsterdam University Medical Center-AMC between 2003 and 2015 due to FGR and/or pre-eclampsia, and who were delivered by prelabor Cesarean section, or had a fetal death, before 32 weeks' gestation. STV of all available cCTG registrations during the 5 days preceding fetal death or delivery was calculated retrospectively, and FHR decelerations were classified visually as absent, 1–2/h or recurrent (> 2/h). Adverse outcome endpoints were defined as fetal death, neonatal asphyxia at birth (including fetal death), neonatal death, major neonatal morbidity and 2-year neurodevelopmental outcome. A simulation analysis was performed to assess the incidence of adverse outcome using two thresholds for cCTG: (1) highly abnormal (STV < 2.6 ms before 29 weeks and < 3.0 ms thereafter, and/or recurrent FHR decelerations); and (2) moderately abnormal (STV < 3.5 ms before 29 weeks and < 4.0 ms thereafter, and/or recurrent FHR decelerations). Three management strategies were assessed using a strict schedule for the frequency of cCTG recordings: (1) cCTG without use of fetal arterial Doppler; (2) cCTG with additional fetal arterial Doppler after 29 weeks; and (3) cCTG with additional fetal arterial Doppler after 27 weeks. Results: Included were 367 pregnancies (3295 cCTG recordings), of which 20 resulted in fetal death and 347 were delivered by Cesarean section before the onset of labor. Cesarean delivery was indicated by fetal condition in 94% of cases and by maternal condition in 6%. Median gestational age at delivery was 30 (interquartile range (IQR), 28–31) weeks and median birth weight was 900 (IQR, 740–1090) g. Six cases of fetal death were not anticipated by standard practice using visual assessment of CTG. A last highly abnormal cCTG was associated with fetal death and with neonatal asphyxia (including fetal death; n = 99), but not with major neonatal morbidity and 2-year neurodevelopmental outcome. Moderately abnormal cCTG had no significant association with any endpoint. Simulation analysis showed that a strategy that combined cCTG results with umbilicocerebral ratio or umbilical absent or reversed end-diastolic flow could detect all fetal deaths. Conclusions: Computerized CTG in combination with fetal arterial Doppler, with a strict protocol for the frequency of recordings, is likely to be more effective than visual CTG assessment for preventing fetal death in early preterm FGR

Spiritual experiences of continuity and discontinuity among parents who lose a child

This is a study of parents' spiritual experience of the loss of a child. Many parents experience continuing bonds with their deceased child as well as forms of posttraumatic growth. Twelve parents of children dying after severe illness were interviewed about their experiences. The interviews contain stories about premonitions, the intensity of the moment of the child's death and the child's presence after death. Thematically the stories reflect the dialectics of continuity and discontinuity in the relationship with the child. This is interpreted in terms of attributing meaning, significance and comprehensibility. © 2012 Koninklijke Brill NV, Leiden, The Netherlands

The fragile spirituality of parents whose children died in the pediatric intensive care unit

Spiritual care is recognized as a relevant dimension of health care. In the context of pediatric palliative end-of-life care, spirituality entails more than adhering to a spiritual worldview or religion. Interviews with parents whose critically ill child died in the pediatric intensive care unit revealed features of a spirituality that is fragmentary and full of contradictions. This type of spirituality, which we refer to as fragile, speaks of parents’ connectedness with the deceased child and the hope of some kind of reuniting after one’s own death. Acknowledging that fragments of spirituality can be part of parents’ experiences in their child’s end-of-life stage can be a meaningful contribution to compassionate care

Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Hypertensive disease in pregnancy remains the leading cause of maternal mortality in the Netherlands. Seventeen percent of the clinical pregnancies are complicated by hypertension and 2% by preeclampsia. The Dutch Society of Obstetrics and Gynaecology (NVOG) has developed evidence-based guidelines on the management of hypertension in pregnancy and chronic hypertension. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in the different hospitals. An explanation is that the NVOG has no general strategy of practical implementation and evaluation of its guidelines. The development of an effective and cost effective implementation strategy to improve adherence to the guidelines on hypertension in pregnancy is needed.</p> <p>Methods/Design</p> <p>The objective of this study is to assess the cost effectiveness of an innovative implementation strategy of the NVOG guidelines on hypertension including a computerised decision support system (BOS) compared to a common strategy of professional audit and feedback. A cluster randomised controlled trial with an economic evaluation alongside will be performed. Both pregnant women who develop severe hypertension or pre-eclampsia and professionals involved in the care for these women will participate. The main outcome measures are a combined rate of major maternal complications and process indicators extracted from the guidelines. A total of 472 patients will be included in both groups. For analysis, descriptive as well as regression techniques will be used. A cost effectiveness and cost utility analysis will be performed according to the intention-to-treat principle and from a societal perspective. Cost effectiveness ratios will be calculated using bootstrapping techniques.</p