Postcesarean pelvic floor dysfunction contributes to undisclosed psychosocial morbidity

OBJECTIVE: To estimate the prevalence and severity of postcesarean pelvic dysfunction. STUDY DESIGN: Using biopsychosocial interviewing at home, 184 postcesarean primiparas were compared to 100 vaginally delivered women regarding symptoms of stress incontinence, anal incontinence and dyspareunia. Delivery details were confirmed from medical records. RESULTS: Comparison of postcesarean vs. vaginally delivered women revealed stress incontinence in 33% vs. 54% and dyspareunia in 27% vs. 46%, both differences reaching statistical significance, unlike anal incontinence, which was manifest in 51% vs. 44%. When compared to emergency cesarean the relative risk of stress incontinence following an elective cesarean was 0.99 (0.71, 1.39), of dyspareunia 1.02 and of anal incontinence 1.05, indicating no statistically significant difference. Thirty (22%) stress incontinent and 4 (3%) fecally incontinent mothers used pads continuously, suggesting severe physical morbidity. Severe dysphoria (depression) was expressed by 41 (35%) stress incontinent mothers, 38 (30%) with dyspareunia and 34 (26%) with anal incontinence; the association of severe dysphoria with dyspareunia was statistically significant (OR = 2.504 [1.362, 4.602]). Few women came forward to seek help. CONCLUSION: Pelvic dysfunction was similar after elective or emergency cesarean. Compared to vaginal delivery, postcesarean stress incontinence and dyspareunia were less frequent but biopsychosocial morbidity could be severe.

Safety and health in mines: the rise of bureaucracy in the coal mining industry and its results as evidenced by the public enquiry into an accident at Houghton Main Colliery

This thesis is concerned with certain aspects of the Public Inquiry into the accident at Houghton Main Colliery in June 1975. It examines whether prior to the accident there existed at the Colliery a situation in which too much reliance was being placed upon state regulation and too Iittle upon personal responsibility. I study the phenomenon of state regulation. This is done (a) by analysis of selected writings on state regulation/intervention/interference/bureaucracy (the words are used synonymously) over the last two hundred years, specifically those of Marx on the 1866 Committee on Mines, and (b) by studying Chadwick and Tremenheere, leading and contrasting "bureaucrats" of the mid-nineteenth century. The bureaucratisation of the mining industry over the period 1835-1954 is described, and it is demonstrated that the industry obtained and now possesses those characteristics outlined by Max Weber in his model of bureaucracy. I analyse criticisms of the model and find them to be relevant, in that they facilitate understanding both of the circumstances of the accident and of the Inquiry . Further understanding of the circumstances and causes of the accident was gained by attendance at the lnquiry and by interviewing many of those involved in the Inquiry. I analyse many aspects of the Inquiry - its objectives. structure, procedure and conflicting interests - and find that, although the Inquiry had many of the symbols of bureaucracy, it suffered not from " too much" outside interference. but rather from the coal mining industry's shared belief in its ability to solve its own problems. I found nothing to suggest that, prior to the accident, colliery personnel relied. or were encouraged to rely, "too much" upon state regulation.

The experience of living with age related macular degeneration:A longitudinal study into the impact of age related macular degeneration on quality of life

In this thesis I contribute to the understanding of the experience of living with Age-Related Macular Degeneration (AMD) and its impact on quality of life through the use of a pragmatically guided mixed methods approach. AMD is a condition resulting in the loss of central vision in old age which can have a huge impact on the lives of patients. This thesis includes: literature reviewing; qualitative meta-synthesis; surveys and descriptive statistics; observation; and analysis of in-depth interviewing, in order to build a picture of what it is like for older people to live with AMD. I present the findings from six separate studies each designed to answer specific research questions. I begin with a mixed methods study to determine how well the most commonly used measure of quality of life for AMD patients’ represents patient experiences. I then go on to investigate the experiences of patients with AMD through a meta-synthesis of qualitative research and finally present four of my own empirical studies three of which investigate the experiences of patients with different types of AMD: early dry AMD, treatable wet AMD and advanced wet AMD and the final study investigates what it is like for a couple living together with AMD. Throughout the qualitative studies I use Interpretative Phenomenological Analysis (IPA) to develop an understanding of the experiences and life contexts of patients with AMD. Through rigorous analysis, I identify a range of themes which highlight the shared and divergent experiences of individuals with AMD and the need to acknowledge patients’ past, present and potential future life contexts and experiences when providing services to older people with AMD. I relate the findings of the six studies to the wider psychological literature on chronic illness and make recommendations for services for patients with AMD to be provided holistically within a lifeworld-led health care model.

Risks and benefits of selective (re)presentation of interviewees' talk:some insights from discourse analysis

Purpose: The purpose of this paper is to examine the quality of evidence collected during interview. Current UK national guidance on the interviewing of victims and witnesses recommends a phased approach, allowing the interviewee to deliver their free report before any questioning takes place, and stipulating that during this free report the interviewee should not be interrupted. Interviewers, therefore, often find it necessary during questioning to reactivate parts of the interviewee's free report for further elaboration. Design/methodology/approach: The first section of this paper draws on a collection of police interviews with women reporting rape, and discusses one method by which this is achieved - the indirect quotation of the interviewee by the interviewer - exploring the potential implications for the quality of evidence collected during this type of interview. The second section of the paper draws on the same data set and concerns itself with a particular method by which information provided by an interviewee has its meaning "fixed" by the interviewer. Findings: It is found that "formulating" is a recurrent practice arising from the need to clarify elements of the account for the benefit of what is termed the "overhearing audience" - in this context, the police scribe, CPS, and potentially the Court. Since the means by which this "fixing" is achieved necessarily involves the foregrounding of elements of the account deemed to be particularly salient at the expense of other elements which may be entirely deleted, formulations are rarely entirely neutral. Their production, therefore, has the potential to exert undue interviewer influence over the negotiated "final version" of interviewees' accounts. Originality/value: The paper highlights the fact that accurate re-presentations of interviewees' accounts are a crucial tool in ensuring smooth progression of interviews and that re-stated speech and formulation often have implications for the quality of evidence collected during significant witness interviews. © Emerald Group Publishing Limited.

An exploration of predatory behaviour in cyberspace:towards a typology of cyberstalkers

Over the last few years governments, law enforcement agencies, and the media have noted increases of online harassment. Although there has been a great deal of research into 'offline stalking', at this moment in time there has been no formal research that attempts to classify cyberstalkers. This study aimed to identify a classification of cyberstalkers by interviewing victims. Twenty-four participants were interviewed and their responses logged on a 76-item Cyberstalking Incident Checklist. A typology of cyberstalkers was developed.

What do people think about when they answer theory of planned behaviour questionnaires? A 'think aloud' study

Two studies aiming to identify the nature and extent of problems that people have when completing theory of planned behaviour (TPB) questionnaires, using a cognitive interviewing approach are reported. Both studies required participants to 'think aloud' as they completed TPB questionnaires about: (a) increasing physical activity (six general public participants); and (b) binge drinking (13 students). Most people had no identifiable problems with the majority of questions. However, there were problems common to both studies, relating to information retrieval and to participants answering different questions from those intended by researchers. Questions about normative influence were particularly problematic. The standard procedure for developing TPB questionnaires may systematically produce problematic questions. Suggestions are made for improving this procedure. Copyright © 2007 SAGE Publications.

Producing facial composite sketches in remote cognitive interviews:a preliminary investigation

Justice systems around the world are increasingly turning to videoconferencing as a means to reduce delays and reduce costs in legal processes. This preliminary research examined whether interviewing a witness remotely - without physical co-presence of the witness and interviewer - could facilitate the production of quality facial composite sketches of suspects. In Study 1, 42 adults briefly viewed a photograph of a face. The next day they participated in Cognitive Interviews with a forensic artist, conducted either face-to-face or remotely via videoconference. In Study 2, 20 adults participated in videoconferenced interviews, and we manipulated the method by which they viewed the developing sketch. In both studies, independent groups of volunteers rated the likeness of the composites to the original photographs. The data suggest that remote interviews elicited effective composites; however, in Study 1 these composites were considered poorer matches to the photographs than were those produced in face-to-face interviews. The differences were small, but significant. Participants perceived several disadvantages to remote interviewing, but also several advantages including less pressure and better concentration. The results of Study 2 suggested that different sketch presentation methods offered different benefits. We propose that remote interviewing could be a useful tool for investigators in certain circumstances. © 2013 Taylor & Francis.

Remembering remotely:would video-mediation impair witnesses' memory reports?

Witnesses often experience lengthy delays prior to being interviewed, during which their memories inevitably decay. Video-communication technology - favored by intergovernmental organizations for playing larger roles in judicial processes - might circumvent some of the resourcing problems that can exacerbate such delays. However, whereas video-mediation might facilitate expeditious interviewing, it might also harm rapport-building, make witnesses uncomfortable, and thereby undermine the quality and detail of their reports. Participants viewed a crime film and were interviewed either one day later via video-link, one day later face-to-face, or 1-2 weeks later face-to-face. Video-mediation neither influenced the detail or the accuracy of participants' reports, nor their ratings of the quality of the interviews. However, participants who underwent video-mediated interviews after a short delay gave more accurate, detailed reports than participants who waited longer to be interviewed face-to-face. This study provides initial empirical evidence that video-mediated communication (VMC) could facilitate the expeditious conduct of high-quality investigative interviews. © 2013 © 2013 Taylor & Francis.

Communication in investigative and legal settings:integrated approaches from forensic psychology, linguistics and law enforcement

Communication in Forensic Contexts provides in-depth coverage of the complex area of communication in forensic situations. Drawing on expertise from forensic psychology, linguistics and law enforcement worldwide, the text bridges the gap between these fields in a definitive guide to best practice. •Offers best practice for understanding and improving communication in forensic contexts, including interviewing of victims, witnesses and suspects, discourse in courtrooms, and discourse via interpreters •Bridges the knowledge gaps between forensic psychology, forensic linguistics and law enforcement, with chapters written by teams bringing together expertise from each field •Published in collaboration with the International Investigative Interviewing Research Group, dedicated to furthering evidence-based practice and practice-based research amongst researchers and practitioners •International, cross-disciplinary team includes contributors from North America, Europe and Asia Pacific, and from psychology, linguistics and forensic practice

Communication in investigative and legal settings:introduction and contexts

Communication in investigative and legal settings is a vitally important area of practice and research. This chapter outlines the significant paradigm shift in interviewing practices, highlighting various studies that have been conducted that have demarked this change. We examine the role of linguistics in this paradigm shift and the importance of training across England and Wales and the Nordic countries in maintaining the professionalization of communication in forensic contexts. The authors outline the significance of maintaining international links across disciplines and summarize the details of each chapter within the book.

Exploring types and functions of questions in police interviews

There is a proliferation of categorization schemes in the scientific literature that have mostly been developed from psychologists’ understanding of the nature of linguistic interactions. This has a led to problems in defining question types used by interviewers. Based on the principle that the overarching purpose of an interview is to elicit information and that questions can function both as actions in their own right and as vehicles for other actions, a Conversational Analysis approach was used to analyse a small number of police interviews. The analysis produced a different categorization of question types and, in particular, the conversational turns fell into two functional types: (i) Topic Initiation Questions and (ii) Topic Facilitation Questions. We argue that forensic interviewing requires a switch of focus from the ‘words’ used by interviewers in question types to the ‘function’ of conversational turns within interviews.

Recall, verbatim memory and remembered narratives

Memory is central to investigative interviews with witnesses and suspects, yet decades of research have shown that remembering is subject to constructive and reconstructive processes that can adversely impact the reliability of accounts that are elicited at interview. In this chapter we first outline research concerning our memory for events (‘episodic memory’) before moving on to discuss the ways in which our attempts to validate and communicate those memories can bias what is eventually reported. We then focus on some of the implications this can have for investigative interviews, specifically the problem of ‘skill fade’ in interviewing, the impact of implicit beliefs about memory and issues surrounding the reliability of recollections of direct speech. We conclude that appropriately structuring the retrieval context is the key to achieving best memory evidence.

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.