Experiences of non-progressive and augmented labour among nulliparous women: a qualitative interview study in a Grounded Theory approach

<p>Abstract</p> <p>Background</p> <p>Non-progressive labour is the most common complication in nulliparas and is primarily treated by augmentation. Augmented labour is often terminated by instrumental delivery. Little qualitative research has addressed experiences of non-progressive and augmented deliveries. The aim of this study was to gain a deeper understanding of the experience of non-progressive and augmented labour among nulliparas and their experience of the care they received.</p> <p>Methods</p> <p>A qualitative study was conducted using individual interviews. Data was collected and analysed according to the Grounded Theory method. The participants were a purposive sample of ten women. The interviews were conducted 4–15 weeks after delivery.</p> <p>Results</p> <p>The women had contrasting experiences during the birth process. During labour there was a conflict between the expectation of having a natural delivery and actually having a medical delivery. The women experienced a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. Reconciliation between the contrasting feelings during labour was achieved. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control.</p> <p>Conclusion</p> <p>A dialectical process was identified in these women's experiences of non-progressive labour. The process is susceptible to interaction with the midwife; especially her support to the woman's feeling of being in control. Midwives should secure that the woman's recognition of the fact that the labour is non-progressive and augmentation is required is handled with respect for the dialectical process. Augmentation of labour should be managed as close to the course of natural labour and delivery as possible.</p

Current management of the gastrointestinal complications of systemic sclerosis.

Systemic sclerosis is a multisystem autoimmune disorder that involves the gastrointestinal tract in more than 90% of patients. This involvement can extend from the mouth to the anus, with the oesophagus and anorectum most frequently affected. Gut complications result in a plethora of presentations that impair oral intake and faecal continence and, consequently, have an adverse effect on patient quality of life, resulting in referral to gastroenterologists. The cornerstones of gastrointestinal symptom management are to optimize symptom relief and monitor for complications, in particular anaemia and malabsorption. Early intervention in patients who develop these complications is critical to minimize disease progression and improve prognosis. In the future, enhanced therapeutic strategies should be developed, based on an ever-improving understanding of the intestinal pathophysiology of systemic sclerosis. This Review describes the most commonly occurring clinical scenarios of gastrointestinal involvement in patients with systemic sclerosis as they present to the gastroenterologist, with recommendations for the suggested assessment protocol and therapy in each situation

Part of the Disease Or Part of the Cure&quest; Chinese Investments in the Zambian Mining and Construction Sectors

China's role in African development is much debated among academics as well as among private sector organisations, trade unions and politicians. Notwithstanding the recent upsurge of interest, the lion's share of the current studies on ‘China in Africa’ is still based on a combination of aggregate figures and sporadic information from news agencies. Although much of the hysteria surrounding the ‘China in Africa’ debate has now evaporated – at least from the scholarly debate – the local debate is highly politicised and of a very dichotomous nature: China is either seen as benign or malign to African development efforts. This paper seeks to go beyond this dichotomous view by examining the multifaceted nature of Chinese investments in two sectors of the Zambian economy. It argues that these investments to a large extent resemble other foreign investments but the sheer size and growth of the investments trigger local reactions.Le rôle de la Chine dans le développement en Afrique fait objet d’un débat ardent, non seulement aux Etats Unis et en Europe mais également prend de l’ampleur en Afrique. Ce débat ne se limite pas aux écrits universitaires mais concerne aussi des organisations du secteur privé, des syndicats et des hommes politiques. En dépit de cet intérêt croissant, la plupart des études actuelles sur ‘la Chine en Afrique’ sont encore basées sur de statistiques agrégées et d’informations sporadiques en provenance des agences de presse. De plus, le débat est dichotomique: les activités de la Chine sont perçues comme ayant des effets soit positives, soit négatifs sur les pays africains. Cet article cherche à dépasser cette vision en examinant les multiples aspects des investissements chinois dans deux secteurs de l’économie zambienne. Il cherche ainsi à contribuer à notre compréhension des conséquences domestiques de la présence de plus en plus importante de la Chine en Afrique.European Journal of Development Research (2009) 21, 644–661. doi:10.1057/ejdr.2009.23

Disentangling How Landscape Spatial and Temporal Heterogeneity Affects Savanna Birds

In highly seasonal tropical environments, temporal changes in habitat and resources are a significant determinant of the spatial distribution of species. This study disentangles the effects of spatial and mid to long-term temporal heterogeneity in habitat on the diversity and abundance of savanna birds by testing four competing conceptual models of varying complexity. Focussing on sites in northeast Australia over a 20 year time period, we used ground cover and foliage projected cover surfaces derived from a time series of Landsat Thematic Mapper imagery, rainfall data and site-level vegetation surveys to derive measures of habitat structure at local (1-100 ha) and landscape (100-1000s ha) scales. We used generalised linear models and an information theoretic approach to test the independent effects of spatial and temporal influences on savanna bird diversity and the abundance of eight species with different life-history behaviours. Of four competing models defining influences on assemblages of savanna birds, the most parsimonious included temporal and spatial variability in vegetation cover and site-scale vegetation structure, suggesting savanna bird species respond to spatial and temporal habitat heterogeneity at both the broader landscape scale and at the fine-scale. The relative weight, strength and direction of the explanatory variables changed with each of the eight species, reflecting their different ecology and behavioural traits. This study demonstrates that variations in the spatial pattern of savanna vegetation over periods of 10 to 20 years at the local and landscape scale strongly affect bird diversity and abundance. Thus, it is essential to monitor and manage both spatial and temporal variability in avian habitat to achieve long-term biodiversity outcomes