Good on paper: the gap between programme theory and real-world context in Pakistan's Community Midwife programme

Objective To understand why skilled birth attendance—an acknowledged strategy for reducing maternal deaths—has been effective in some settings but is failing in Pakistan and to demonstrate the value of a theory-driven approach to evaluating implementation of maternal healthcare interventions. Design Implementation research was conducted using an institutional ethnographic approach. Setting and population National programme and local community levels in Pakistan. Methods Observations, focus group discussions, and in-depth interviews were conducted with 38 Community Midwives (CMWs), 20 policymakers, 45 healthcare providers and 136 community members. A critical policy document review was conducted. National and local level data were brought together. Main outcomes Alignment of programme theory with real-world practice. Results Data revealed gaps between programme theory, assumptions and reality on the ground. The design of the programme failed to take into account: (1) the incongruity between the role of a midwife and dominant class and gendered norms that devalue such a role; (2) market and consumer behaviour that prevented CMWs from establishing private practices; (3) the complexity of public–private sector cooperation. Uniform deployment policies failed to consider existing provider density and geography. Conclusions Greater attention to programme theory and the ‘real-world’ setting during design of maternal health strategies is needed to achieve consistent results in different contexts

Blaming Bill Gates AGAIN! Misuse, overuse and misunderstanding of performance data in sport

Recently in Sport, Education and Society, Williams and Manley (2014) argued against the heavy reliance on technology in professional Rugby Union and elite sport in general. In summary, technology is presented as an elitist, ‘gold standard’ villain that management and coaches use to exert control and by which players lose autonomy, identity, motivation, social interactions and expertise. In this article we suggest that the sociological interpretations and implications offered by Williams and Manley may be somewhat limited when viewed in isolation. In doing so, we identify some core methodological issues in Williams and Manley’s study and critically consider important arguments for utilising technology; notably, to inform coach decision making and generate player empowerment. Secondly, we present a different, yet perhaps equally concerning, practice-oriented interpretation of the same results but from alternative coaching and expertise literature. Accordingly, we suggest that Williams and Manley have perhaps raised their alarm prematurely, inappropriately and on somewhat shaky foundations. We also hope to stimulate others to consider contrary positions, or at least to think about this topic in greater detail. More specifically, we encourage coaches and academics to think carefully about what technology is employed, how and why, and then the means by which these decisions are discussed with and, preferably, sold to players. Certainly, technology can significantly enhance coach decision making and practice, while also helping players to optimise their focus, empowerment and independence in knowing how to achieve their personal and collective goals

Understanding the process of psychological development in youth athletes attending an intensive wrestling camp

This study used a grounded theory methodology to understand if and how psychological development in youth athletes was facilitated by an ‘intensive’ summer wrestling camp experience. The theoretical sampling approach involved 10 athlete participants of the camp, nine parents of athletes, the director of the camp, and four camp staff members, who took part in a series of interviews before, during, and after the camp. Two researchers were also embedded in the camp and attended all sessions, took detailed notes, collected camp materials, and conducted observations. Following a grounded theory analysis approach, a model is presented that outlines how youth participants’ developed psychological qualities from the coach created hallenges and adversity that were systematically designed to facilitate sport performance enhancement and life skills. Variations emerged in psychological antecedents and characteristics, how the challenging wrestling camp environment was interpreted and experienced, and how learning was transferred to sport and life domains outside of the wrestling camp. This study provided insight into a unique youth sport context that was able to simultaneously develop psychological qualities to be used as sport performance enhancement and life skills

On pains and fear in childbirth: dimensions of listening

OBJETIVOS: desenvolver algumas reflexões sobre os possíveis efeitos benéficos de uma escuta responsiva à verbalização da presença de dor, medos e seus correlatos na cena do parto tomando como base dados empíricos de pesquisa realizada em maternidade situada na cidade de São Paulo, Brasil. MÉTODOS: estudo descritivo, de metodologia qualitativa, referenciado no quadro teórico da Psicologia Social, Psicanálise e Lingüística, utilizando entrevistas semi-estruturadas com 20 parturientes e sete doulas e observação de rotinas da maternidade. RESULTADOS: a análise, apoiada em categorias estabelecidas (subjetividade auto-referida, intersubjetividade, acolhimento, apropriação da experiência) mostrou, entre outros pontos, a importância e a valorização da interlocução qualificada no processo da parturição. Processo esse referido pelas parturientes como experiência de elevado grau de estresse, com vivências de dor, medos e ansiedades, porém mitigados pelo apoio recebido. CONCLUSÕES: a análise permitiu compreender as relações interpessoais como campo de interlocução e acolhimento percebidos pelas mulheres do estudo capazes de produzir efeitos favoráveis sobre as vivências do estresse materno, configurando-se como recurso técnico, qualificado e valioso, oferecido à parturienteOBJECTIVES: to reflect on the possibilities raised by listening to the life-experiences related by parturient women concerning pain on delivery, using empirical data from research carried out in a Maternity ward in the city of São Paulo, Brazil. METHODS: a descriptive study, with a qualitative methodology, based on the theoretical framework of Social Psychology, Psychoanalysis and Linguistics was carried out, by means of semi-structured interviews with parturient women and midwives, in addition to observation of maternity routines. RESULTS: one of the findings of the analysis, based on established categories (self-referred subjectivity, intersubjectivity, the appropriation of experience), was the importance of accurate interlocution in the course of the parturition process. This process was mentioned by the parturient women as an experience accompanied by a high level of stress, involving pain, fear and anxiety, although these may be mitigated by the support received. CONCLUSIONS: the analysis shed light on the role of interpersonal relationships involving dialogue and physical contact experienced by these women in reducing the stress of childbirth, suggesting that these constitute a valuable and effective resource that should be offered to parturient woma

The Effect of Intermittent Fasting and Caloric Restricted Diet on Diabetic Rats

The present study was aimed to investigate the effect of intermittent fasting and caloric restricted diet (RD) for 8 weeks on diabetic rats. Forty-nine adult male albino rats were divided into two main groups; the first main group was fed only on basal diet and served as negative control group and the second main group: diabetic rats were induced by a single intra-peritoneal injection of freshly prepared STZ (60 mg/kg BW) then divided into 6 subgroups: Subgroup (1) was fed only on basal diet and was served as positive cont. Subgroup (2) was fed on RD only. Subgroups (3, 4) were fed on basal diet and were deprived of food except water from 5 p.m. to 8 a.m. twice a week and every other day, respectively. Subgroups (5, 6): were fed on RD and intermittent fasting twice a week and every other day, respectively. The results indicated that RD and intermittent fasting significantly decreased the final body weight, feed intake and body weight gain % values as compared to the positive control rats. Diabetic treated rats had significant increase (p<0.05) in insulin concentration and lower glucose levels as well as an improvement in liver functions and lipid profile as compared to the positive control group. Conclusion: the findings suggest that intermittent fasting and caloric restricted diet could have a potential role in managing diabetes

Study of Serum Uric Acid levels in patients with Acute Myocardial Infarction and Its correlation with the severity assessed by Killip Classification and 2D Echocardiogram

BACKGROUND : Cardiovascular disease especially coronary artery disease is a part of major disease burden pan India. Coronary artery disease has attained epidemic proportions in India. In a developing country like India, for patients with acute Myocardial Infarction, a simple, cheap and easily available serum marker like uric acid could be an excellent tool in predicting the prognosis and long term management strategies. Our study was aimed at establishing a relationship between the levels of serum uric acid in various types of acute myocardial infarction and correlation of its levels with the degree of myocardial dysfunction as assessed by echocardiogram and the Killip, GRACE and TIMI scores. MATERIALS AND METHODS : it was prospective observational study conducted at Government Mohan Kumaramangalam Medical College Hospital during July 2015 to January 2016. 100 consecutive patients admitted to the Medical ICU, Coronary care unit and medical wards were evaluated with detailed history, examination and laboratory investigations. Serum uric acid levels were assessed on day 0 and day 3 of admission. Patients were followed up for a period of 7 – 15 days or discharge whichever was earlier to assess the major in hospital adverse cardiac events. RESULTS : In our study, the proportion of Hyperuricemics in acute MI was found to be 59%. 55 cases were STEMI and 45 cases were NSTEMI. 74.5% of STEMI had Hyperuricemia whereas it was only 40% in NSTEMI (p value 9mg/dl was observed in 100% (n=9) of the patients who succumbed to death. 24 per cent of the patients in study population had serum uric acid levels more than 9 mg/dl and 91.96% of this group belonged to Killip classes III and IV. The mean SUA levels in Killip classes III and IV were 9.72mg and 12.46 mg/dl respectively as compared to 5.68mg/dl and 7.36 mg/dl in Killip classes I and II (p value 0.0005). Statistically significant positive association was found between Hyperuricemia and Smoking (p value 0.003), Hypertension (p value 0.001) and Heart blocks (p value 0.003). No significant association was observed between and serum uric acid levels and diabetes mellitus (p value 0.119) nor with dyslipidemia (p value 0.508). The mean TIMI score in general was higher in hyperuricemic patients in both STEMI (7.56±2.5 vs 5.64±2.3) and NSTEMI (4.89±0.9 vs 3.89±0.8). The mean risk of in-hospital mortality in patients with hyperuricemic patients was 9.44% higher as compared to normouricemic patients (p value 0.0005). 100 percent (n=16) of the patients with serum uric acid > 9mg/dl had ejection fraction less than 30%. CONCLUSION : Serum uric acid levels were elevated in patients with acute myocardial infarction. There is a strong correlation between serum uric acid at the time of admission and in-hospital mortality and short term mortality in patients with acute myocardial infarction. Serum uric acid levels in a patient with acute myocardial infarction can be used as an independent predictor of mortality and morbidity in the form of major adverse cardiac events. Serum uric acid levels has a statistically significant linear relationship with TIMI and GRACE scores. Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction

Identifying signals of suffering by linking verbal and facial cues.

Here, the authors describe microanalytically the two main behavioral states in suffering (enduring and emotional suffering) so that in subsequent research, appropriate comforting responses to ease and relieve suffering can be identified for each behavioral state. Their objectives were to describe the facial expressions of enduring and emotional suffering, and to link them with verbal narrative and thus develop a microanalytic description of each behavioral state. Using Ekman's modified EMFACS, they videotaped interviews with 19 participants and coded co-occurring verbal text and expressions. They also documented differences between each behavioral state and the transitions from enduring to emotional suffering. Enduring and emotional suffering are distinct and identifiable behaviors. These formerly implicit behavioral cues can be used in clinical assessment and research