The ethos of caring within midwifery: A history of ideas study.

BACKGROUND: The midwifery profession in Sweden has a history since the early 1700s when government training for midwives began. Midwifery is historically well described, but the idea of caring within midwifery is not described. AIM: The aim was to describe the patterns of ideas of caring as they appeared in midwifery during the first half of the 20th century. RESEARCH DESIGN: This study has a hermeneutic approach and the method is history of ideas. Sources of material are taken from the journal Jordemodern (Midwifery), textbooks for midwives, and midwifery regulations. The study has a caring science perspective according to Eriksson. Ethical considerations: This study is conducted in accordance with the ethical guidelines for good scientific practice issued by The Finnish Advisory Board on Research Integrity. The special demands on approach to the analyzed text in history of ideas have been met. FINDINGS: Three themes were identified: Serving as a way of life, Acting in a redemptive spirit, and Having independence with heavy responsibility. The various themes are not refined, but current ideas are woven into the weave that were characteristic of midwifery during the first half of the 20th century. CONCLUSION: History of ideas is a fruitful method for understanding and re-finding valuable cultural goods. We can once more stress the manner of being within the midwife's profession where inner values, ethos, shape the manner of conduct in the care of women in childbirth.

The meaning of caring in prenatal care from Swedish women's perspectives.

AIM: To deepen understanding of the meaning of caring in prenatal care from Swedish women's perspectives. METHOD: Ten women, who had given birth between 1 and 2 months previously, were interviewed. The women have taken part in the routine programme that constitutes maternity care Sweden. A hermeneutic approach inspired by Gadamer was used to analyse the data and gain a deeper understanding of the women's experiences. FINDINGS: Three themes were identified in the hermeneutical analysis. The themes highlight an existential and ontological aspect for caring as experienced of the women in the study: invitation and caring promise, witnessing and confirmation, and caring emerges in vulnerability. CONCLUSION: The life-changing gravidity and vulnerability motivates caritative care during pregnancy. Reception of caring is not just a superficial feeling, but gives a new understanding of life on an ontological level. In a genuine caring relationship, the pregnant woman not only receives something but also a power and an opportunity to go further and find her own inner strength.

Expecting a child: pregnancy in light of an ontological health model.

AIM: To make visible the existential character of pregnancy by searching for its health dimensions as it is described in the ontological health model. METHOD: Eight women were interviewed two or three times during their pregnancy and one time shortly after birth. The women have taken part in the routine programme that constitutes maternity care in Sweden. A hermeneutic approach inspired by Gadamer was used to analyse the data. An ontological health model was used to interpret the findings. FINDINGS: Nine themes on a rational and a contextual level were clustered to three themes on an existential level: A new life stage, The new life takes shape and Health is jeopardised. Contents of these themes were interpreted together with an ontological health model. Expecting a child means to do, be and become in expectation of the new life. Suffering and health are two different dimensions in a woman's life during pregnancy; they are integrated with one another and ever-present. It is in the meeting with the inevitable, life-changing gravidity and vulnerability that the integrative movement creates the new. Longing is the desire that provides motivation to continue.

Real-time PCR-assay in the delivery suite for determination of group B streptococcal colonization in a setting with risk-based antibiotic prophylaxis.

OBJECTIVE: Intrapartum antibiotic prophylaxis (IAP) reduces the incidence of neonatal early onset group B streptococcal infections. The present study investigated if an automated PCR-assay, used bedside by the labor ward personnel was manageable and could decrease the use of IAP in a setting with a risk-based IAP strategy. METHODS: The study comprises two phases. Phase 1 was a multicenter, randomized, controlled trial. Women with selected risk-factors were allocated either to PCR-IAP (prophylaxis given if positive or indeterminate) or IAP. A vaginal/rectal swab and superficial swabs from the neonate for conventional culture were also obtained. Phase 2 was non-randomized, assessing an improved version of the assay. RESULTS: Phase 1 included 112 women in the PCR-IAP group and 117 in the IAP group. Excluding indeterminate results, the assay showed a sensitivity of 89% and a specificity of 90%. In 44 % of the PCR assays the result was indeterminate. The use of IAP was lower in the PCR group (53 versus 92%). Phase 2 included 94 women. The proportion of indeterminate results was reduced (15%). The GBS colonization rate was 31%. CONCLUSION: The PCR assay, in the hands of labor ward personnel, can be useful for selection of women to which IAP should be offered.

Linking the Klein-Bell Activities of Daily Living Scale to the International Classification of Functioning, Disability and Health.

OBJECTIVE: The main objective of this study was to link the Klein-Bell activities of daily living (KB) Scale to the International Classification of Functioning, Disability and Health (ICF), in order to validate the KB Scale content-wise. DESIGN: A qualitative approach was used with directed content analysis. METHODS: Concepts in the KB Scale items were linked to ICF categories according to established rules. This was followed by 4 analyses: examination of the linked categories' frequency distribution; comparison of these categories with core sets for spinal cord injury (SCI) and occupational therapists; calculation of content density, content diversity and range of linked categories; and calculation of agreement between two independent linkage versions. RESULTS: All except one identified KB Scale concept could be linked to ICF categories. The occupational therapists Core Sets were most consistent with linked categories in the KB Scale. Content density, content diversity and range varied between the different KB Scale dimensions. Agreement was reliable for the whole KB Scale and for 5 of 6 dimensions. CONCLUSION: The ICF has provided a valuable reference to identify and quantify the concepts in the KB Scale. Furthermore, comparison between the KB Scale and ICF Core Sets provides insights into areas covered by these instruments.

Controlling the hydration of the skin though the application of occluding barrier creams.

The skin is a barrier membrane that separates environments with profoundly different water contents. The barrier properties are assured by the outer layer of the skin, the stratum corneum (SC), which controls the transepidermal water loss. The SC acts as a responding membrane, since its hydration and permeability vary with the boundary condition, which is the activity of water at the outer surface of the skin. We show how this boundary condition can be changed by the application of a barrier cream that makes a film with a high resistance to the transport of water. We present a quantitative model that predicts hydration and water transport in SC that is covered by such a film. We also develop an experimental method for measuring the specific resistance to water transport of films made of occluding barrier creams. Finally, we combine the theoretical model with the measured properties of the barrier creams to predict how a film of cream changes the activity of water at the outer surface of the SC. Using the known variations of SC permeability and hydration with the water activity in its environment (i.e. the relative humidity), we can thus predict how a film of barrier cream changes SC hydration.

Doing everyday life--experiences of the oldest old.

The purpose of this article is to explore how a group of elderly people, living and managing on their own, describe and experience their everyday doings. Interviews and observations were conducted with 18 community-living people aged 85 and above. The experiences of 'Doing everyday life' are described in five overarching themes: 'Experiencing being old', 'Doings in everyday life', 'Patterns of the day', 'Altered doings', and 'The importance of time'. What is done during an ordinary day does not differ much from earlier in life, but how the doings are performed has changed. Being occupied and staying healthy and sound in mind was stressed as important in old age and even if reduced energy and functional constraints limited the doings, a strong volition to manage independently was expressed. The participants perceived society as regarding the elderly as useless and worthless. Knowledge emanating from the very old themselves is vital to diversify the image of elderly people and to offer interventions and support adapted to their needs and desires.

A review of research with elderly people as respondents reported in occupational therapy journals.

The aim of this article is to review research presented in occupational therapy journals with the elderly as respondents. With an increasing number of elderly people in society research including the elderly should play a vital role within occupational therapy especially since emphasis on subjective experience is an important factor in the core constructs of occupation. Through a review of six occupational therapy journals, covering the period 2001--2006, it was discovered that 15% of the total number of articles included the elderly as respondents. The published articles with the elderly as respondents were mainly quantitative with the most frequent subject being instrument developing and testing. Most studies had a population group of mixed ages, making it hard to draw conclusions concerning the elderly population. The conclusion is that more research of a qualitative nature reflecting the subjective perspectives of the elderly is needed, especially regarding the oldest age group since this is the fastest growing and there is still limited knowledge regarding their perspective on matters concerning their everyday lives and their doings. Technological developments are implied to benefit elderly people but more research and discussion is needed on how this will affect both the elderly and occupational therapy theory and practice.

Increased cell proliferation and neurogenesis in the hippocampal dentate gyrus of old GFAP(-/-)Vim(-/-) mice.

In response to central nervous system (CNS) injury, and more discretely so also during aging, astrocytes become reactive and increase their expression of the intermediate filament proteins glial fibrillary acidic protein (GFAP) and vimentin. Studies of mice deficient in astrocytic intermediate filaments have provided insights into the function of reactive gliosis. Recently we demonstrated robust integration of retinal transplants (1) and increased posttraumatic synaptic regeneration (2) in GFAP(-/-)Vim(-/-) mice, suggesting that modulation of astrocyte activity affects the permissiveness of the CNS environment for regeneration. Neurogenesis in the adult mammalian CNS is restricted to essentially two regions, the hippocampus and the subventricular zone. Here, we assessed neurogenesis in the hippocampus of 18-month-old GFAP(-/-)Vim(-/-) mice. In the granular layer of the dentate gyrus, cell proliferation/survival was 34% higher and neurogenesis 36% higher in GFAP(-/-)Vim(-/-) mice than in wildtype controls. These findings suggest that the adult hippocampal neurogenesis in healthy old mice can be increased by modulating astrocyte reactivity.

How children experience brief-exposure treatment of specific phobias.

Examined how 56 children who had received brief-exposure treatment for specific phobias experienced the treatment. It was also investigated whether there was a relation between the children's reported experiences before, during, and after the treatment and therapy outcome. Results indicated that the treatment was experienced as something positive, and the large majority of the children appreciated the pace and degree of control they had during treatment, as well as the therapist and the treatment outcome. The response patterns did not differ between sexes, diagnostic groups, mode of treatment, or age groups. The therapy outcome of the children was not found to differ according to the children's pretreatment expectations and feelings during the treatment, neither according to the children's evaluations of the pace of the treatment nor of the therapist's. However, children's reports about their feelings upon termination of the treatment and the satisfaction with the treatment differed significantly depending on the treatment outcome. Results and tentative explanations of these are discussed and implications for future lines of research are suggested.