Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial

BACKGROUND: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.

METHODS: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.

RESULTS: Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).

CONCLUSION: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.

"When I saw walking I just kind of took it as wheeling": interpretations of mobility-related items in generic, preference-based health state instruments in the context of spinal cord injury

Background : In health economic analyses, health states are typically valued using instruments with few items per dimension. Due to the generic (and often reductionist) nature of such instruments, certain groups of respondents may experience challenges in describing their health state. This study is concerned with generic, preference-based health state instruments that provide information for decisions about the allocation of resources in health care. Unlike physical measurement instruments, preference-based health state instruments provide health state values that are dependent on how respondents interpret the items. This study investigates how individuals with spinal cord injury (SCI) interpret mobility-related items contained within six preference-based health state instruments.

Methods : Secondary analysis of focus group transcripts originally collected in Vancouver, Canada, explored individuals’ perceptions and interpretations of mobility-related items contained within the 15D, Assessment of Quality of Life 8-dimension (AQoL-8D), EQ-5D-5L, Health Utilities Index (HUI), Quality of Well-Being Scale Self-Administered (QWB-SA), and the 36-item Short Form health survey version 2 (SF-36v2). Ritchie and Spencer’s ‘Framework Approach’ was used to perform thematic analysis that focused on participants’ comments concerning the mobility-related items only.

Results : Fifteen individuals participated in three focus groups (five per focus group). Four themes emerged: wording of mobility (e.g., ‘getting around’ vs ‘walking’), reference to aids and appliances, lack of suitable response options, and reframing of items (e.g., replacing ‘walking’ with ‘wheeling’). These themes reflected item features that respondents perceived as relevant in enabling them to describe their mobility, and response strategies that respondents could use when faced with inaccessible items.

Conclusion : Investigating perceptions to mobility-related items within the context of SCI highlights substantial variation in item interpretation across six preference-based health state instruments. Studying respondents’ interpretations of items can help to understand discrepancies in the health state descriptions and values obtained from different instruments. This line of research warrants closer attention in the health economics and quality of life literature.

Excessive alcohol use and its association with risky sexual behaviour: a cross-sectional analysis of data from Victorian secondary school students

Objective
Estimate the prevalence of sexual behaviour and alcohol use and examine the association between excessive alcohol use and risky sexual behaviour in late secondary students in Victoria, Australia.

Method
The sample of Year 11 students from government and independent schools participating in the 2008 International Youth Development Study (n=450) was representative of the Victorian school population. Logistic regression analyses examined the associations between sexual behaviour, binge and compulsive drinking, adjusting for socio-demographic, school and family factors.

Results
Under half (44%) the students had experienced sex in the past year, half (50%) had engaged in binge drinking in the past two weeks and 26% reported compulsive drinking in the past year. Of those who reported sex in the past year (n=197), 34% had sex without a condom at the last sexual encounter and 28% later regretted sex due to alcohol. The likelihood of experiencing sex was increased by binge (OR=2.44, 95%CI 1.44-4.12) and compulsive drinking (OR=2.15, 95%CI 1.29-3.60). For those sexually active, binge drinking increased the risk of having three or more sexual partners (OR=3.37, 95%CI 1.11-10.26) and compulsive drinking increased the likelihood of regretted sex due to alcohol (OR=4.43, 95%CI 2.10-9.31). Excessive drinking was not associated with condom non-use.

Conclusion and implications
Risky sex – multiple sexual partners and regretted sex due to alcohol – and excessive drinking are highly prevalent and co-associated among Victorian late secondary students.

An analysis of the role of teachers’ aides in a state secondary school: perceptions of teaching staff and teachers’ aides

In Victoria, Australia, one of the major roles of the teachers’ aide (TA) is to assist students with disabilities to access their education. Researchers have identified the inconsistencies in defining the roles of the TA, in a variety of settings, by TAs, teachers, parents, and other research participants. Four main themes that have been frequently reported in educational research related to the role of TAs formed the basis for this study: (a) inclusion in the school community, (b) curriculum, (c) classroom management, and (d) student support. Drawing on the results of a questionnaire administered to teachers and TAs at a government nonselective secondary school in Victoria, Australia, data were collected to explore the differing perspectives on the role of the TAs by the teaching staff and the TAs. In all, 65 individuals participated in this study. The participants formed 3 groups: TAs (n = 10), teachers (n = 49), and T/TAs (n = 6; participants in this group had worked as both a teacher and TA). The results of the study showed a diversity of views across the 4 themes. In 3 of the 4 themes that included inclusion, classroom management, and student support, the 3 groups agreed on the role of the TA. In the remaining theme, curriculum, opinions varied significantly. The results of the study reveal that a concerted effort to clarify the role of TAs would be beneficial to all stakeholders.

The importance of degree versus type of maltreatment: a cluster analysis of child abuse types

The author conducted secondary data analysis of 3 previously reported studies (D. J. Higgins & M. P McCabe, 1998, 20(K)b, 2(X)3) to examine whether respondents are best classified according to their experience of separate maltreatment types (sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence) or whether their experience reflects a single unifying concept: child maltreatment.

Easier analysis and better reporting : modelling ordinal data in mathematics education research

This article presents an examination of the use of Rasch modelling in a major research project, 'Improving Middle Years Mathematics and Science' (IMYMS). It is unarguable that it is important to take students' perceptions, or views, into account when planning learning and teaching for them. The IMYMS student perceptions survey is an attempt to make visible these student viewpoints, and report them in a way that is accessible to teachers and researchers involved in the project. The project involves four clusters of schools from urban and regions of Victoria to investigate the role of mathematics and science knowledge and subject cultures in mediating change processes in the middle years of schooling. There are five secondary and twenty-eight primary schools. The project has generated both qualitative and quantitative data, with much of the qualitative data being ordinal in nature. Reporting the results of analyses for a range of audiences necessitates careful, well-designed report formats. Some useful new report formats based on Rasch modeling -the Modified Variable Map, the Ordinal Map, the Threshold Map, and the Annotated Ordinal Map - are illustrated using data from the IMYMS project. The Rasch analysis and the derived reporting formats avoid the pitfalls that exist when working with ordinal data and provide insights into the respondents' views about their experiences in schools unavailable by other approaches.

Primary and secondary mathematics practice: how different is it?

This paper describes the practices of ninety-nine teachers at the beginning of their involvement in a large-scale project investigating the influence of subject cultures on school and teacher change. Data collected from these teachers, using the IMYMS. Components of effective teaching and Learning mapping procedure, were analysed to investigate similarities and differences in primary and secondary teachers’ perceptions of their practice in mathematics. Results of the analysis show different patterns across a range of components of effective teaching and learning.

A first priority when working with teachers is to help them become aware of and make problematic aspects of their current practice …. Only then would they have reason to attempt to reform their instructional practices when working with us. (Yackel, 1994, p. 386)

A method for the quantitative analysis of the layering of HIV-related stigma

HIV-related stigma is regarded as one of the major barriers in the development of effective prevention and care programs; but the stigma associated with HIV stigma is not a singular entity. The stigma of the infection is layered with other stigmas, such as those associated with the routes of transmission (e.g., sex work and injecting drug use) and personal characteristics (e.g., race, religion, ethnicity and gender). In developing programs and policies to overcome HIV-related stigma, cognisance needs to be taken of all the sources of stigma, and how they may interact. A novel method is described for examining the layers of HIV/AIDS-related stigma, and secondary data are adapted to illustrate this. The importance of understanding the layering of stigma for the development of effective interventions is also discussed.

Non-Schmid behaviour during secondary twinning in a polycrystalline magnesium alloy

The present work combines electron backscattering diffraction and Schmid analysis to investigate secondary twinning in the magnesium alloy Mg–3Al–1Zn. Inspection of the misorientations between the parent and ^{{1011} - {1012}} doubly twinned volumes reveals that there are four possible variants. One of these variants (the one that forms a misorientation with the matrix characterized by 38°^⟨1210⟩ ) is favoured much more than the others. This variant involves the activation of secondary twinning systems quite inconsistent with Schmid-type behaviour. For the secondary twin to grow significantly it must take on a shape enforced by the primary twin. This is non-optimal for strain compatibility. It is argued that the 38°^⟨1210⟩ variant occurs most because it provides the closest match between the primary and secondary twinning planes, thus minimizing the compatibility strain.

Identification and rationalization of secondary twin variants in a magnesium alloy

The present work combines electron backscatter diffraction, transmission electron microscopy and Schmid analysis to investigate secondary twinning in the magnesium alloy Mg-3AI-1Zn. Inspection of the misorientations between the parent matrix and {1011} - {1012} doubly twinned volumes reveals that there are four possible variants. One of these variants characterized by 38°< 1210 > misorientation with the matrix is favoured much more than the others. This variant involves activation of the secondary twinning systems that are quite inconsistent with the Schmid-type behaviour. For the secondary twin to grow significantly it must take on a shape enforced by the primary twin, however, this is not optimal for strain compatibility. It is argued that the 38° < 1210 > variant occurs most frequently because it provides the closest match between the primary and secondaty twinning planes, thus minimizing the compatibility strain. This conjecture is confirmed by the simulations of twin activity m ellipsoidal grains performed using the visco-plastic self-consistent crystal plasticity model.

Power and production in site-based management: the responses of women secondary principals to structural reform in South Australian education

After describing and analysing the purpose and shape of structural reform in Australia, the author uses the data gained from interviews with 16 South Australian women principals, to examine its effects on the work of principals. She uses her analysis to issue some warnings about the current moves to Local School Management in South Australia

Ethiopian-Australian students experience of secondary schooling in the Australian education system in the state of Victoria

This paper is aimed at investigating the secondary school experiences of Ethiopian (Ethio)-Australian students living in Melbourne. A qualitative methodology was employed using interviews and observations as data collection instruments. Secondary school students, their teachers and parents acted as participants of the study. The findings of the study included a deeper understanding of the exclusionary forces that contributed to the students' attendance and learning in the secondary schools when they relocated between schools and countries. Based on the data collected and the analysis made, appropriate recommendations were forwarded to teachers, parents, schools and policy makers.

Adolescent girls in physical education and sport : an analysis of influences on participation

This study investigates the influences on participation in physical activity of thirty adolescent girls from a metropolitan secondary school in Victoria. It seeks to understand how they perceived, experienced and explained their involvement or non involvement in both competitive and non competitive physical activity during four years of their secondary schooling. Participants experienced physical education as both a single sex group in Years 7 and 9 and a coeducational group in Years 8 and 10. They were exposed to a predominantly competitive curriculum in Years 7 to 9 and a less structured, more social, recreational program in Year 10. These experiences enabled them to compare the differences between class structures and activity programs and identify the significant issues which impacted on their participation. Large Australian population studies have revealed that fewer girls participated in sport and regular physical activity than boys. An important consequence is that girls miss out on the health benefits associated with participating in physical activity. Other research has found adolescence is the time that girls drop out of competitive sport. However, an important issue is whether girls who drop out of competitive sport cease to be involved in any physical activity. There are some studies which have reported good participation rates by adolescent girls in non competitive, recreational forms of physical activity and the possibility exists that they may drop out of competitive and into non competitive physical activity. This study primarily utilises a qualitative approach in contrast to previous studies which have largely relied upon the use of surveys and questionnaires. Whilst quantitative research has provided useful information about the bigger picture, there are limitations caused by reliance on the researchers' own interpretations of the data. Additionally there is no opportunity for any clarification and explanation of findings and trends by the respondents themselves. The current study utilized qualitative individual and collective interviews in three stages. Questions were asked in the broad areas of coeducation and single sex classes, preferences for competitive or recreational activity and body image issues. Some quantitative information focusing on nature and extent of current activity patterns was also gathered in the first stage. Thirty Year 10 girls participated in individual first interviews. Nine selected girls then took part in the second (individual) and third (collective) interview stages. Results revealed three groups based on the nature of physical activity involvement: [1] competitive activity group, [2] social activity group and [3] transition group. The transition group represented those who were in the process of withdrawing from competitive sport to take up more non competitive, recreational activity. The most significant difference between groups was skill level. On the whole those entering adolescence with the highest skill levels, such as those in the competitive group, were the most confident and relished competing against others. The social group was low in skill and confidence and had predominantly negative experiences in physical education and sport because their deficiencies were plainly visible to all. Similarly, a lack of skill improvement relative to those of 'better performers' affected the interest and confidence levels of those in the transition group. Boys' domination in coeducational classes through verbal and physical intimidation of the less competent and confident girls and exclusion of very competent girls was a major issue. Social and transition group members demonstrated compliance with boys' power by hanging back and sitting out of competitive activities. Conversely, the competitive group resisted boy's attempts to dominate but had to work hard to demonstrate their athletic capabilities in order to do so. Body image issues such as the skimpy physical education and sport uniform along with body revealing activities such as swimming and gymnastics, heightened feelings of self-consciousness and embarrassment for most girls. When strategies were adopted by social and transition group members to avoid any body exposure or physical humiliation, participation levels were subsequently affected. However, where girls felt confident about their physical abilities and body image, they were able to ignore their unflattering uniforms and thus participation was unaffected. Specific teaching practices such as giving more attention to boys, for example by segregating the sexes in mixed classes to focus attention on boys, reinforced stereotypical notions of gender and contributed to the inequities for girls in physical education. The competitive group were frustrated with having to prove themselves as capable as boys in order to receive greater teacher attention. The transition group rejected teacher's attempts to coerce them into participating in the inter school sports program. The social group believed that teachers viewed and treated them less favourably than others because of their limited skills. Girls were not passive in the face of these obstacles. Rather than give up physical activity they disengaged from competitive sport and took up other forms of activity which they had the confidence to perform. These activity choices also reflected their expanding social interests such as spending time with male and female friends outside school and increased demands on their time by study and part time work commitments. This study not only highlighted the diversity and complexity of attitudes and behaviours of girls towards physical activity but also demonstrated that they display agency in making conscious, sensible decisions about their physical activity choices. Plain Language Summary of Thesis Adolescent girls in physical education and sport; An analysis of influences on participation by Julia Whitty Submitted for the degree of Master of Applied Science Deakin University Supervisor: Dr Judy Ann Jones This study investigates the influences on participation in physical activity of thirty adolescent girls from a metropolitan secondary school in Victoria in order to understand how girls' perceived, experienced and explained their involvement or non involvement in both competitive and non competitive physical activity. Qualitative individual and collective interviews were conducted. Questions focussed on attitudes about coeducation and single sex classes, preferences for competitive or recreational activity and feelings about body image. Some quantitative information about the nature and extent of current activity patterns was also gathered in the first stage. Thirty Year 10 girls participated in individual first interviews. Nine selected girls then took part in the second (individual) and third (collective) interview stages. Results revealed three clearly different groups based on the nature of physical activity involvement (1) Competitive, (2) Social and (3) Transition (those in the process of withdrawing from competitive sport to take up more non competitive, recreational activity). The major difference between groups was skill level. Those entering adolescence with the highest skill levels were more competent and confident in the coeducational and competitive sport setting. Other significant issues included boys' domination, body image and teaching behaviours and practices.

Investigation of the postcure reaction and surface energy of epoxy resins using time-of-flight secondary ion mass spectrometry and contact-angle measurements

Time-of-flight secondary ion mass spectrometry (ToF-SIMS) was used to investigate correlations between the molecular changes and postcuring reaction on the surface of a diglycidyl ether of bisphenol A and diglycidylether of bisphenol F based epoxy resin cured with two different amine-based hardeners. The aim of this work was to present a proof of concept that ToF-SIMS has the ability to provide information regarding the reaction steps, path, and mechanism for organic reactions in general and for epoxy resin curing and postcuring reactions in particular. Contact-angle measurements were taken for the cured and postcured epoxy resins to correlate changes in the surface energy with the molecular structure of the surface. Principal components analysis (PCA) of the ToFSIMS positive spectra explained the variance in the molecular information, which was related to the resin curing and postcuring reactions with different hardeners and to the surface energy values. The first principal component captured information related to the chemical phenomena of the curing reaction path, branching, and network density based on changes in the relative ion density of the aliphatic hydrocarbon and the C₇H₇O⁺ positive ions. The second principal component captured information related to the difference in the surface energy, which was correlated to the difference in the relative intensity of the C_xH_yN_z⁺ ions of the samples. PCA of the negative spectra provided insight into the extent of consumption of the hardener molecules in the curing and postcuring reactions of both systems based on the relative ion intensity of the nitrogen-containing negative ions and showed molecular correlations with the sample surface energy.