The Right to Informed Choice. A Study and Opinion Poll of Women Who Were or Were Not Given the Option of a Sterilisation with Their Caesarean Section

BACKGROUND: In The Netherlands, caesarean sections (CSs) are rarely combined with tubal occlusion (TO), partly because discussing CS/TO near delivery is considered unethical and earlier hypothetical counselling--i.e. suppose you happen to need a CS--is rare. This results in more unintended pregnancies and is inconsistent with informed choice. We explored whether TO should indeed not be made routinely available to eligible women. METHODS AND FINDINGS: A questionnaire was mailed to 515 Para ≥2 who underwent in the past ≥1 CS. 498 (96.7%) responded. They were on average 35.3 years old, had 2.5 children, had undergone 1.6 CSs, and 3.3 years had passed since their index delivery, either a CS (393) or vaginal birth (105) after a previous CS. 87% of the 498 believed that pregnant mothers with ≥1 children should be routinely counselled about CS/TO. Indeed, 58% and 85% respectively, thought women/couples expecting their second or third child should still be given the TO option days before delivery, if omitted earlier. Counselled women, 138/498 (27.8%), were far more often satisfied than those without CS/TO option. 33/393 had a CS/TO. None indicated regret in the questionnaire. Another 119 also would have elected a CS/TO if given that option. Therefore, 152 (38.7%) of 393 Para ≥2 had or would have liked a concurrent TO. 118/119 wrote they still regretted missing this opportunity. The exception's husband had had a vasectomy. 100/119 were good TO candidates: they were ≥28 years when they delivered an apparently healthy baby of ≥37 weeks. The current contraceptive use of these 100 suggests that this group will have at least 8 unintended pregnancies before age 50. CONCLUSION: The experiences and opinions of previous potential candidates for a CS/TO do not support the reluctance of Dutch obstetricians to counsel pregnant Para ≥1 about the TO option for a (potential) CS

Designing open access, educational resources / Développer des ressources éducatives en libre accès

The recent bourgeoning of open educational resources has meant greater access to materials with open licenses in the public domain than ever before. Open educational resources are learning tools, such as textbooks, that are freely available and typically accessed online. Despite the expansion of open educational resources, many educators are still unacquainted with the nature and process of producing such resources. The purpose of this discussion paper is to share our experience in developing an open educational e-textbook for students in post-secondary programs for nursing and other health professions while highlighting practical tips for educators. The exemplar referenced in this paper focuses on vital signs’ measurement, a familiar concept for nurse educators, and a topic ubiquitous in healthcare. This paper is suited for any user curious about designing open educational resources with consideration of key elements to produce quality and educational resources that support excellence in nursing pedagogy. We begin by providing a background to our specific project followed by a discussion of the planning phase, the design phase, and other considerations. The e-textbook falls under a Creative Commons license and can be accessed for free by educators and learners. Résumé Le développement récent de ressources éducatives en libre accès a permis une accessibilité beaucoup plus grande, comme jamais auparavant, au matériel avec licences ouvertes dans le domaine public. Les ressources éducatives en libre accès sont des outils d’apprentissage, comme les manuels scolaires, qui sont offerts gratuitement et qui sont généralement accessibles en ligne. En dépit de la prolifération des ressources éducatives libres, bon nombre de professeurs sont toujours peu familiers avec la nature et le processus de production de telles ressources. L’objectif de ce texte de discussion est de partager notre expérience du développement d’un e-manuel de formation en libre accès, pour les étudiants inscrits dans les programmes postsecondaires pour la profession infirmière et les autres professions de la santé, tout en soulignant des conseils pratiques pour les professeurs. L’exemple, cité en référence dans ce texte, est axé sur la prise des signes vitaux, un concept familier aux infirmières enseignantes et un sujet omniprésent dans le domaine de la santé. Cet article convient à toute personne curieuse d’en apprendre davantage sur la conception des ressources éducatives en libre accès en tenant compte d’éléments clés afin de produire des ressources éducatives de qualité qui appuient l’excellence de la pédagogie en soins infirmiers. Nous établissons d’abord le contexte du projet particulier suivi d’une discussion sur la phase de planification, la phase de conception et sur d’autres éléments à considérer. Le e-manuel relève d’une licence Creative Commons et est accessible gratuitement pour les professeurs et les étudiants

An outline of an asymmetric two-component theory of aspect

The paper presents the bases of an asymmetric two-component model of aspect. The main theoretical conclusion of the study is that (grammatical) viewpoint aspect and situation aspect are not independent aspectual levels, since the former often modifies the input situation aspect of the phrase/sentence. As it is shown, besides the arguments and adjuncts of the predicate, viewpoint aspect is also an important factor in compositionally marking situation aspect. The aspectual framework put forward in the paper is verified and illustrated on the basis of the aspectual system of Hungarian and some examples taken from English linguistic data

Symphysiotomy in Zimbabwe; Postoperative Outcome, Width of the Symphysis Joint, and Knowledge, Attitudes and Practice among Doctors and Midwives

BACKGROUND: Obstructed labour remains one of the leading causes of maternal and foetal death and morbidity in poorly resourced areas of the world, where the 24 hours availability of a caesarean section (CS) cannot be guaranteed, and the CS related mortality rate is still high. In these settings, reinstatement of symphysiotomy has been advocated. The objectives were, in1994; to study perioperative and long-term complications of symphysiotomy and compare them to those related to CS for similar indications, in 1996; to measure the symphyseal width after symphysiotomy and compare it to that after normal vaginal delivery, and, in 1998; to assess knowledge, attitudes and practice related to symphysiotomy among doctors and midwives in Zimbabwe. METHODS AND FINDINGS: Thirty-four women who had undergone symphysiotomy and 29 women who had undergone a CS for obstructed labour were interviewed. The symphyseal widths of 19 women with a previous symphysiotomy were compared to that of 92 women with previous normal vaginal deliveries, using ultrasound technique. Forty-one doctors and 39 midwives, in three central hospitals and seven district hospitals in Zimbabwe, were interviewed about symphysiotomy. None of the 34 women reported serious soft tissue injuries or infections post symphysiotomy. Long-term complications after symphysiotomy do not differ notably from those after CS for similar indications. The intra-articular width of the symphysis pubis is increased after a symphysiotomy. Seventy-nine of the 80 interviewed health care workers knew about symphysiotomy. One obstetrician had performed symphysiotomies. Two-thirds of the participants considered symphysiotomy an obsolete and second-class operation, but lifesaving and appropriate in remote areas of Zimbabwe. Ten of 13 midwives in remote areas wanted to carry out symphysiotomies themselves. CONCLUSIONS: No severe complications due to symphysiotomy were revealed in this study. The results suggest that a modest permanent enlargement of the pelvis post symphysiotomy (together with the absence of a scarred uterus) may facilitate subsequent vaginal delivery. Doctors and midwives working in district hospitals have a more positive attitude to symphysiotomies than the colleagues in central hospitals. Obstetricians (who would have to do the teaching), working in the large urban hospitals almost exclude symphysiotomy as an alternative management in Zimbabwe

Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia – a descriptive study

BACKGROUND: Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. METHODS: Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. RESULTS: Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. CONCLUSIONS: In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity

Therapeutic effects of dietary intervention on neuroinflammation and brain metabolism in a rat model of photothrombotic stroke

INTRODUCTION: A possible target for stroke management is modulation of neuroinflammation. Evidence suggests that food components may exert anti-inflammatory properties and thus may reduce stroke-induced brain damage. AIM: To investigate the efficacy of a diet, containing anti-inflammatory ingredients, as treatment for focal ischemic brain damage induced by photothrombotic stroke in the somatosensory cortex of rats. RESULTS: Brain lesions were surrounded by strong astrogliosis on both day 7 and day 21 after stroke and were accompanied by a trend toward globally decreased glucose metabolism on day 7. The investigational diet applied 2 weeks before the ischemia did not affect astrocyte activation on day 7, but reduced it at day 21. The investigational diet applied immediately after the ischemia, increased astrocyte activation on day 7 and completely reversed this effect on day 21. Moreover, postischemic intervention increased glucose metabolism in somatosensory cortex ipsilateral to the lesion on day 7. CONCLUSION: This study reveals potentially beneficial effects of a diet containing elevated amounts of anti-inflammatory nutrients on the recovery from ischemic brain damage. Therefore, dietary intervention can be considered as an adjuvant therapy for recovery from this brain pathology