RepoMed (Medizinische Hochschule Hannover)
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Overcoming Shame to Vocalise During Childbirth: A Qualitative Interview Study.
Full text linkAim To explore women's experiences of vocalisation during childbirth and the interplay with their feelings of shame. Design This interpretive, qualitative study is grounded in a social constructionist theory of gender, which provides a lens for examining the role of vocal toning in childbirth. Methods Between November 2023 and March 2024, 18 women in Germany were interviewed postpartum either at home or virtually. Semi-structured interviews were analysed using reflexive thematic analysis. Results Two themes were generated: 'the shame of being heard' and 'the value of my voice'. The findings demonstrate challenges women faced when vocalising during childbirth due to feelings of shame. Overcoming social norms were key; previous experience with vocalisation was an advantage. Vocal expression was also facilitated by a safe, supportive birth environment. Conclusion Shame influences behaviour during childbirth. A key factor appears to be whether women feel safe and uninhibited in their vocal expression, which can be supported through empathic birth companions. Additionally, vocalising with others can contribute to normalising the experience and reducing feelings of shame. Implications for the profession care The findings suggest that healthcare professionals can help women overcome shame to use vocalisation as a tool to navigate the challenges of childbirth. Reporting method Reporting adhered to the SRQR checklist. Patient and public involvement This study did not include client or public involvement in its design, conduct, or reporting
Towards a universal implementation of labor companionship: a synthesis of the policy and facility environment of eight low-and-middle income countries.
No full textBackground Labor companionship, the presence of a woman's person of choice during childbirth, has benefits to both woman and baby and is recommended by the World Health Organization since 2012. However, implementation remains sub-optimal, especially in low-and-middle-income countries (LMICs). This study aimed to understand the maturity of labor companionship implementation in eight low-and-middle income countries with focus on the policy and facility environment. Methods This was a multi-country study nested in two hospital-based implementation research studies: Action Leveraging Evidence to Reduce perinatal mortality and morbidity in Sub-Saharan Africa (ALERT) study and the QUALIty DECision-making by women and providers for appropriate use of caesarean section (QUALI-DEC) study. We included 48 hospitals from eight countries: Argentina, Burkina Faso, Thailand and Viet Nam (QUALI-DEC) and four from each of Benin, Malawi, Tanzania and Uganda (ALERT). We used data from (i) a document review, including national policy documents and (ii) health facility readiness assessment, including physical layouts of maternity wards, all collected between December 2019 and April 2021. Our analysis included two steps, (1) a structured data abstraction with coding to pre-defined categories to analyse the national polices and available resources on a facility level which informed the (2) categorization of implementation maturity in three implementation phases modelled by the framework by Bergh et al. and the logic model developed by Bohren et al. Results Three of the eight countries lacked any national-level companionship policies, four had some mentioning and only one had detailed guidance on roles of labor companions and implementation guidelines. The physical outlines of maternity wards varied greatly, and lack of space was one of the main implementation barriers to all countries except Argentina. We classified Benin, Thailand and Viet Nam in the pre-implementation phase because of missing guidelines and limited implementation; Burkina Faso, Malawi, Uganda and Tanzania in the early implementation phase; and Argentina in the institutionalization phase where policies and facility resources were conducive. Conclusion Successful implementation was supported by concrete and contextualized implementation guidance. To move to high implementation levels, supporting policies, guidelines and structural changes in the maternity wards are needed
Cognitive biases as Bayesian probability weighting in context
Full text linkHumans often exhibit systematic biases in judgments under uncertainty, such as conservatism bias and base-rate neglect. This study investigates the context dependence of these biases within a Bayesian framework. Forty-eight participants made subjective probability judgments in 12 scenarios requiring the integration of prior probabilities and evidence likelihoods. Results show that task context mediates the weighting of priors and evidence: small-world scenarios (e.g., urn problems) emphasize priors, thus amplifying the conservatism bias, whereas large-world scenarios (e.g., taxi problems) increase sensitivity to evidence, leading to base-rate neglect. Presenting probabilistic information as relative frequencies rather than probabilities did not attenuate these biases. To explain these findings, we propose the Adaptive Bayesian Cognition (ABC) model, which describes how individuals dynamically adjust the weighting of priors and evidence. By integrating normative Bayesian principles with psychological insights, the ABC model recasts cognitive biases as adaptive strategies shaped by capacity constraints and meta-learning in specific contexts. These findings bridge cognitive psychology, behavioral economics, and computational modeling to provide a unified framework for understanding subjective probability, probability weighting, and decision making under uncertainty. This work also informs the design of decision support systems
Epigenetic profiling of innate lymphoid cells and intestinal epithelial stem cells in homeostasis and mucosal inflammation
Full text linkIn-Vitro-Untersuchung zur Passungsgenauigkeit und Oberflächenrauigkeit von im CAD/CAM-Verfahren hergestellten Seitenzahnkronen aus Dentalkunststoff, Empress-Keramik und Lithiumdisilikat-Keramik
Full text linkTrimethylamine-N-oxide formation, the bacterial taxa involved and intervention strategies to reduce its concentration in the human body
Full text linkThis study reviews the different steps involved in trimethylamine-N-oxide (TMAO) formation, a gut microbiota (GM)-derived compound that promotes cardiovascular and chronic kidney disease. The formation of TMAO is a metaorganismal process, where trimethylamine (TMA), produced from the dietary precursors betaine, L-carnitine and choline by various members of GM, is absorbed and subsequently oxidized by hepatic flavin-containing monooxygenases before entering the circulation. We provide an updated database on members of GM exhibiting different biochemical pathways and give comprehensive insights into tested as well as hypothetical treatment options to reduce TMAO concentrations in the body. Different angles involving nutrition, TMA-producing bacteria, and their enzymes, as well as host enzymes, are discussed. The study underlines the importance to design personalized therapies taking individual features, such as dietary habits and GM composition, into account. Given the multistep nature of TMAO formation, individualized precision multi-target strategies, for instance, reducing dietary precursors in combination with specific modulations of GM limiting growth/activity of TMA-producing bacteria, might be most successful
Therapeutischer Einsatz von Cannabinoiden bei kritisch kranken Patienten: eine Umfrage unter Intensivmedizinern in Deutschland
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