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Determinants of maternal mortality in south-western Nigeria: Midwives’ perceptions
Get PDFBackgroundMaternal mortality remains one of Nigeria's most significant public health challenges. In order to address this issue sustainably, it is necessary to consider the perceptions of all stakeholders involved, including midwives.ObjectivesTo examine the determinants of maternal mortality in south-western Nigeria from the midwife's perspective.DesignA cross-sectional study was employed using mixed methods with a semi-structured questionnaire and an in-depth interview guide.ParticipantsQuantitative data were obtained from 215 midwives using a convenience sampling technique. Qualitative data were obtained from 25 midwives from five government health centres, selected using a stratified sampling technique.MethodsQuantitative data were analysed using SPSS Version 20 using descriptive and inferential statistics with 95 % confidence intervals, while qualitative data were analysed using thematic analyses.FindingsThe mean age and work experience of the participants were 35.2 ± 9.3 years and 8.4 ± 7.0 years, respectively. The midwives perceived that the main determinants of maternal mortality were postpartum haemorrhage (86.5 %), hypertensive disorder in pregnancy (80.9 %), mismanagement at mission homes/traditional birth attendant centres (MH/TBAs) (79.1 %) and sepsis (70.1 %). Some of the priority target areas to improve the well-being of pregnant women as identified by the midwives, were increased awareness of pregnancy danger signs (97 %), destigmatising caesarean section (CS) (96 %), regulation of MH/TBAs (92 %), and increased accessibility of hospitals (84 %). Findings from the qualitative data also affirmed that regulating MH/TBAs, destigmatising CS and subsidising healthcare expenses were prerequisites to curbing maternal mortality. Inferential analysis revealed that determinants such as unsafe abortion (p < 0.001), ectopic pregnancy (p = 0.001), domestic violence (p = 0.023), malaria (p = 0.029), short interbirth interval (p = 0.03), and patients’ negative perceptions of CS delivery (p = 0.036) were more commonly perceived to be associated with maternal mortality by younger midwives (age 17–34 years) compared with older midwives
Gender (in)equity in global mental health research: A call to action
Get PDFIn this commentary, we build on work by Gurung and colleagues which highlighted gender inequity in the global mental health research workforce in Nepal (Gurung et al., 2021). We seek to increase awareness of the under-representation of women in global mental health research and its consequences, and we call for change. By women, we refer to all people who identify as women, including trans people. The commentary is informed by conversations with women who are global mental health researchers in the Global North and South at various stages of their careers
Family adversity and health characteristics associated with intimate partner violence in children and parents presenting to health care: a population-based birth cohort study in England
Get PDFBackgroundLittle is known about the clinical characteristics of children and parents affected by intimate partner violence (IPV) presenting in health-care settings. We examined the associations between family adversities, health characteristics, and IPV in children and parents using linked electronic health records (EHRs) from primary and secondary care between 1 year before and 2 years after birth (the first 1000 days). We compared parental health problems in in children and parents with and without recorded IPV.MethodsWe developed a population-based birth cohort of children and parents (aged 14–60 years) in England, comprising linked EHRs from mother–child pairs (with no identified father) and mother–father–child triads. We followed the cohort across general practices (Clinical Practice Research Datalink GOLD), emergency departments, outpatient visits, hospital admissions, and mortality records. Family adversities included 33 clinical indicators of parental mental health problems, parental substance misuse, adverse family environments, and high-risk child maltreatment-related presentations. Parental health problems included 12 common comorbidities, ranging from diabetes and cardiovascular diseases to chronic pain or digestive diseases. We used adjusted and weighted logistic-regression models to estimate the probability of IPV (per 100 children and parents) associated with each adversity, and period prevalences of parental health problems associated with IPV.FindingsWe included 129 948 children and parents, comprising 95 290 (73·3%) mother–father–child triads and 34 658 (26·7%) mother–child pairs only between April 1, 2007, and Jan 29, 2020. An estimated 2689 (2·1%) of 129 948 children and parents (95% CI 2·0–2·3) had recorded IPV and 54 758 (41·2%; 41·5–42·2) had any family adversity between 1 year before and 2 years after birth. All family adversities were significantly associated with IPV. Most parents and children with IPV had recorded adversities (1612 [60·0%] of 2689) before their first IPV recording. The probability of IPV was 0·6 per 100 children and parents (95% CI 0·5–0·6) with no adversity, increasing to 4·4 per 100 children per parents (4·2–4·7) with one adversity, and up to 15·1 per 100 parents and children (13·6–16·5) with three of more adversities. Mothers with IPV had a significantly higher prevalence of both physical (73·4% vs 63·1%, odds ratio [OR] 1·6, 95% CI 1·4–1·8) and mental health problems (58·4% vs 22·2%, OR 4·9, 4·4–5·5) than mothers without IPV. Fathers with IPV had a higher prevalence of mental health problems (17·8% vs 7·1%, OR 2·8, 2·4–3·2) and similar prevalences of physical health problems than those without IPV (29·6% vs 32·4%, OR 0·9, 0·8–1·0).InterpretationTwo in five of the children and parents presenting to health care had recorded parental mental health problems, parental substance misuse, adverse family environments, or high-risk presentations of maltreatment in the first 1000 days. One in 22 children and parents with family adversity also had recorded IPV before age 2 years. Primary and secondary care staff should safely ask about IPV when parents or children present with family adversity or health problems associated with IPV, and respond appropriately
A Duoethnographic Study of Power and Privilege in the Psychotherapeutic Space: Dialogical Research as Professional Development
Get PDFWe are three psychotherapists, also trainers at different universities in the United Kingdom, who came together to explore the application of duoethnography as a research method in the context of counselling and psychotherapy. The focus of our dialogues was on privilege and power as experienced between client and therapist in the therapeutic relationship, mirroring the social worlds we each come from and return to. The article presented here is written largely in the form of ‘speaking turns,’ reflecting the dialogical nature through which data were generated. We met periodically through Microsoft Teams to record our dialogues and furthered our exchange via email communications and other text messages. We came together explicitly mindful of and valuing our differences – one woman and two men; our ethnocultural heritages being Greek, African, and English, with different trajectories towards our professional positions; and we highlight differentials in privilege emerging along lines of gender, race, and class. Emergent themes include: ‘the visible – invisible spectrum of privilege,’ ‘the historic present,’ and ‘power with versus power over.’ As an ongoing, highly relational form of encounter, this project highlighted the benefits this approach can bring in the ongoing development of therapists. Participation facilitated the revelation of more unconscious or unarticulated material. We found the duoethnography depended upon our mutual negotiation of trust and preparedness to be vulnerable in the encounter. Recognising that each dialogue brings unique configurations of similarity and difference, we thus argue for greater uptake of duoethnography methods in counselling and psychotherapy training and research
Inaccessible and stigmatizing: LGBTQ+ youth perspectives of services and sexual violence
Get PDFLesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) young people are subject to high rates of sexual violence globally, significantly impacting their lives and psychological wellbeing. However, service use for sexual violence support is low for LGBTQ+ groups and there is no current research exploring LGBTQ+ young peoples’ experiences and perspectives of support services in the UK. To understand service utilisation for LGBTQ+ young people who have experienced sexual violence, a mixed methods exploration of survey data (N = 36) and individual interviews (N = 7) was conducted with LGBTQ+ young people aged 16–25. Participants reported a high prevalence of multiple types of sexual violence (e.g., 86.11% subject to sexual assault) and low reporting to any service (30.56%). Content analysis identified interpersonal, service, and sociocultural factors that limit service utilisation and sexual violence reporting. Two themes were identified through thematic analysis: ‘safety and acceptance’ which discussed participants’ positive experiences of services, and the theme ‘services as hard to reach’ explored how discrimination, heteronormativity, and victim-blaming impacted service accessibility. Implications for best practice for services supporting LGBTQ+ young people subject to sexual violence are discussed and a model is presented to address service utilisation
The National Student Survey and the ‘Customerization’ of University Students: A Qualitative Study of UK Higher Education
Get PDFHas the National Student Survey ‘customerized’ the UK’s university students? This article examines the ‘customerization’ of university students in the UK and the impacts of reciprocity and social exchange behaviour on National Student Survey outcomes. Using a multi-method qualitative approach, the findings suggest that the National Student Survey is an imperfect barometer for measuring teaching quality and academic standards at universities. It finds that students are being treated as customers so they will give their universities positive evaluations in the National Student Survey. The findings also reveal that the discretion and decisions of students are mostly based on reciprocity, according to which students are willing to complete the National Student Survey favourably only if they get good grades and received ‘VIP treatment’. The article concludes by explaining the implications of its findings on practice and recommending an agenda for future research
Cognitive Enhancement and Social Mobility: Skepticism from India
Get PDFCognitive enhancement (CE) covers a broad spectrum of methods, including behavioral techniques, nootropic drugs, and neuromodulation interventions. However, research on their use in children has almost exclusively been carried out in high-income countries with limited understanding of how experts working with children view their use in low- and middle- income countries (LMICs). This study examines perceptions on cognitive enhancement, their techniques, neuroethical issues about their use from an LMICs perspective.Seven Indian experts were purposively sampled for their expertise in bioethics, child development and child education. In-depth interviews were conducted using a semi-structured topic guide to examine (1) understanding of CE, (2) which approaches were viewed as cognitive enhancers, (3) attitudes toward different CE techniques and (4) neuroethical issues related to CE use within the Indian context. All interviews were audio recorded and transcribed before thematic analysis.Findings indicate Indian experts view cognitive enhancement as a holistic positive impact on overall functioning and well-being, rather than improvement in specific cognitive abilities. Exogenous agents, and neuromodulation were viewed with skepticism, whereas behavioral approaches were viewed more favorably. Neuroethical concerns included equitable access to CE, limited scientific evidence and over-reliance on technology to address societal problems. This highlights the need for more contextually relevant neuroethics research in LMICs
The role of rehearsal and reminding in the recall of categorized word lists
Get PDFMost theories of free recall emphasize the importance of retrieval in explaining temporal and semantic regularities in recall; rehearsal mechanisms are often absent or limit rehearsal to a subset of what was last rehearsed. However, in three experiments using the overt rehearsal method, we show clear evidence that just-presented items act as retrieval cues during encoding (study-phase retrieval) with prior related items rehearsed despite well over a dozen intervening items. Experiment 1 examined free recall of categorized and uncategorized lists of 32 words. In Experiments 2 and 3, we presented categorized lists of 24, 48, and 64 words for free recall or cued recall, with the category exemplars blocked in successive list positions (Experiment 2) or randomized throughout the list (Experiment 3). The probability of rehearsing a prior word was affected by its semantic similarity to the just-presented item, and the frequency and recency of its prior rehearsals. These rehearsal data suggest alternative interpretations to well-known recall phenomena. With randomized designs, the serial position curves were reinterpreted by when words were last rehearsed (which contributed to the list length effects), and semantic clustering and temporal contiguity effects at output were reinterpreted by whether words were co-rehearsed during study. The contrast with the blocked designs suggests that recall is sensitive to the relative (not absolute) recency of targeted list items. We discuss the benefits of incorporating rehearsal machinery into computational models of episodic memory, and suggest that the same retrieval processes that generate the recalls are used to generate the rehearsals
Management accounting system: Insights from the decision making theories
Get PDFManagement accounting system (MAS) improves business growth through quality decision making process, but scholars have mixed views about MAS and constantly debate its efficacy. Drawing on the decision-making theories, the current research deviates from the debates and adopts a ‘think-outside-the-box’ approach, aiming to advance the knowledge of MAS's efficacy. Research data are gathered from the MAS literatures and cognate studies. Following the research findings, we identify a new pre-factor (thinking style) and incorporate it into the MAS. Specifically, decision makers' cognitive process is found to affect the design and implementation of MAS, as rational thinking style, administrative thinking style, and political thinking style may affect the MAS's efficacy differently. Research findings have brought valuable insights to the MAS literatures, by highlighting the strength and weakness of different thinking styles in designing management accounting system. Moreover, decision makers, such as organizational leaders and business managers, are encouraged to monitor their thinking styles: that is, with better understanding of thinking styles, decision makers can better utilize MAS and rectify the style-driven deficits in time