Effect of training on the resuscitation practices of traditional birth attendants

Training programs in more modern methods of birth asphyxia resuscitation were started for traditional birth attendants (TBAs) in 54 villages (population 62,427) of Raipur Rani Block near Chandigarh, India during 1989-1991. A continuing training program by the primary health center staff at 4 focal villages, for one day each month, had been in progress for several years. About 80-100 TBAs attended these sessions. Resuscitation methods included gravity drainage of secretions, physical stimulation by flicking at the soles of the feet, cleaning the mouth by a finger wrapped in gauze, mouth-to-mouth breathing, cardiac massage, and prevention of heat loss by wrapping the baby in multiple layers of cloth. In 1988, 31 TBAs also received advanced training in the use of the mucus extractor and bag-and-mask ventilation. Two trained field workers visited the villages once a fortnight to contact child workers, TBAs and health workers, and checking the local register of vital events to record births. Family members and/or the TBA who assisted at the delivery were interviewed, and a detailed birth history was recorded for stillborn and asphyxiated babies. TBAs assisted with the delivery of 1884 babies (93.7%). Of these, 31 asphyxiated babies and 30 recently stillborn babies were eligible for the resuscitation survey, but information could not be collected for 2 of the stillborn infants. Both traditional and modern resuscitation methods were used in 30 cases (51%), modern methods only in 13 (22%), traditional methods in 2 (3%), and no resuscitation effort was made in 14 cases (24%). Among 21 cases delivered by the trained TBAs, mucus traps and bag-and-mask were used in 33.3% and 42.6%, respectively. Instillation of onion juice and warming of placenta were practiced in a significantly higher proportion of cases by traditionally trained TBAs than by those who had received advanced training. Adoption of modern resuscitation methods by the TBAs demonstrates that they are likely to change their practices.     

Practices and beliefs of traditional birth attendants: lessons for obstetrics in the north?

The majority of mothers in countries in Africa, Asia and Latin America are supported by Traditional Birth Attendants (TBAs) during pregnancy and childbirth. TBAs do more than just deliver babies. As part of the local community they are acquainted with the women and their families with whom they share the cultural ideas about how the birth has to be prepared for and performed. They know the local medicines and rituals which are used before, during and after delivery. The work of the TBAs is adapted and strictly bound to the social and cultural matrix to which they belong, their practices and beliefs being in accordance with the needs of the local community. Therefore they may not be able to assist women at childbirth outside their own socio-cultural environment. Comparison of the practices and beliefs of TBAs in Africa, Asia and Latin America revealed a large variation among the different cultures of the three continents. Surprisingly, in spite of the cultural differences there were clearly some common practices and beliefs which may occur in all three continents. It is assumed that these common practices are due to the expression people give to the basic events of life such as pregnancy, labour and lactation. A short review of common practices is presented as they may be of value in obstetrical practice in the northern countries.     

Training birth attendants in the Sahel

A small-scale training programme for birth attendants in a remote area of Burkina Faso was evaluated two years after it had been started. The evaluation methods included interviews with trained birth attendants and the analysis of health service statistics and survey data. The findings showed that the programme had been moderately successful in imparting knowledge and overcoming cultural inhibitions about assisted deliveries. However, the effectiveness of the programme was severely curtailed by structural deficits in the health system, especially lack of skilled staff, supervision and transport. In deprived areas such as the Sahel, it is probably the health centre, the hospital and the referral system that should be the first priority for improvement, rather than grass-roots practices.     

What in the world is being done about TBAs? An overview of international and national attitudes to traditional birth attendants

Many of the half million women per year who die in childbirth are attended by traditional birth attendants (TBAs). Whether they fare better when such an attendant is trained remains uncertain; even the World Health Organization seems to have tempered its enthusiasm for TBA training recently. With some nations outlawing the practice of TBAs and others actively promoting it, there seems to be no consensus on what to do about this major and continuing workforce in maternity care. By themselves TBAs cannot reduce maternal mortality, whether they are trained or not. They need skilled, equipped and available support. As the professional group who must co-operate with TBAs and provide that support, midwives must, collectively and individually, assess, state and act on their attitude towards TBAs.     

Filariasis in northern Ghana: some cultural beliefs and practices and their implications for disease control

All four possible trihalomethanes (THMs) containing bromine and chlorine, as well as perchloroethylene (PCE), were evaluated for their ability to produce DNA strand breaks, alpha 2u-globulin rich renal deposits, and testosterone changes in male F-344 rats. Rats received daily equimolar doses (0.75 or 1.5 mmol/kg) of THMs or PCE (1000 mg/kg) in 4% Emulphor vehicle by oral gavage for 7 days. No significant DNA strand breaks were produced by any THM or PCE treatment. PCE treatment produced increased hyaline droplet formation in renal tubules. However, all THM treatments reduced or eliminated the appearance of renal hyaline droplets. All four THM treatments also produced a decrease in serum testosterone concentrations on day 7, which might account for decreased hyaline droplet formation. No significant increase in cell proliferation, measured by [3H]thymidine incorporation in vivo, appeared in this 1-week study.     

Nutritional beliefs and practices in primigravid Mexican-American women

One hundred and thirty-one young Mexican-American women were interviewed and assessed nutritionally at their first obstetrical visit in a city-county hospital. About half had an intake of less than the recommended allowance for one or more nutrients or were frankly anemic, as judged by hemoglobin levels. The majority demonstrated little accurate information concerning foods as sources of nutrients. Considerable confusion was shown in their answers to questions concerning newborn birth weight, diet, and maternal weight gain. The fundamentals of prenatal education regarding nutrition for these patients must begin with foods and their relative values, emphasize the dependence of the fetus on maternal diet, and clarify the relationship of weight gain to obstetrical health. Ideally, such an educational effort should begin in early childhood.     

Knowledge, beliefs, and practices in relation to malaria transmission and vector control in Guatemala

As part of an effort to involve community members in malaria control activities, we studied knowledge, beliefs, and practices of residents of both the Pacific coastal plain and northeastern Guatemala related to malaria transmission and Anopheles albimanus control. Most residents recognized the role of mosquitoes in malaria transmission, but few knew how mosquitoes acquired their infections or understood the risk of having an untreated person in their midst. If this were more widely known, residents might put greater pressure on infected patients to seek timely and appropriate antimalarial treatment. Seventy-three percent of families owned one or more bed nets; however, even though most informants believed that bed nets help protect against malaria, the major reason for using them was to prevent nuisance mosquito bites. It is concluded that efforts should be made to promote bed net use by seeking ways to make them more affordable and by emphasizing their effectiveness as a barrier to nuisance mosquitoes. Although residents have a very positive opinion of the National Malaria Service spray teams, it is proposed that cooperation might be improved if malaria workers would emphasize the fact that house spraying reduces the numbers of nuisance mosquitoes and other pest insects, rather than focusing solely on malaria prevention, which most informants believed was less important. This study emphasizes the importance of understanding community beliefs and practices when planning or evaluating vector control activities.     

Attitudes and the availability of knowledge concerning traditional beliefs.

Adults and school children in Jamaica were asked to supply a traditional "belief in response to an open-ended question, assent by having them signify their agreement or disagreement. A significantly positive relation between availability of knowledge and assent was demonstrated. That relation persisted even when the form of questioning was experimentally manipulated. Various attributes of higher status in Jamaica and greater ability on performance tests were found to be associated with assent but not with availability of knowledge." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes, beliefs, and practices regarding smoking and smoking cessation among African-American physicians and dentists

African-American physicians and dentists in metropolitan Atlanta were surveyed to assess smoking cessation practices and perceptions. Questionnaires were mailed to 373 physicians and 90 dentists. A total of 154 questionnaires were returned, for an overall response rate of 33.3%. More physicians than dentists considered smoking a "very serious" threat to patients' health, and physicians were more likely to document smoking status in charts and to counsel smokers to quit. Physicians also were approached more frequently by patients seeking cessation advice. Both types of practitioners considered the nicotine patch, formal cessation programs, and behavior modification/psychotherapy to be among the most effective cessation methods, and nicotine gum and acupuncture to be among the least effective. These results indicate African-American physicians are much more involved than dentists in promoting smoking cessation among patients. Advice of health professionals generally is viewed as a powerful influence for African-American patients. Further work is needed to utilize fully the power of health care providers, especially dentists, in the fight against tobacco-related morbidity and mortality.     

Attitudes, beliefs, and practices of nursing students concerning HIV/AIDS: implications for prevention in women

Nursing students are a group of predominantly young women who may be sexually active but who are well educated and presumably health conscious. It might be expected, therefore, that they are not a population at risk for sexually acquired HIV infection. Recent studies indicate that heterosexual women constitute the fastest growing population of persons with AIDS in the United States and Canada (Health and Welfare Canada, 1993b; Wofsky, 1992) and that women and adolescents will constitute the next surge of the AIDS epidemic (Novello, 1993). First-year nursing students in a major Canadian city were surveyed regarding HIV-related knowledge, attitudes, beliefs, and behaviors. The women were highly knowledgeable about HIV transmission but 15% to 25% reported high risk sexual behavior. The results reinforce that knowledge is not enough to prevent HIV infection among young women and that interventions must be based on an understanding of the social context of women's lives.     

Recovered memories of childhood sexual abuse: Clinicians' practices and beliefs.

The issue of recovered memories of childhood sexual abuse (CSA) has stirred up a great deal of controversy in the field of psychology and in the public media. Recent court trials and television specials suggest that recovered and false memory cases occur often. Clinicians completed a survey designed to determine the prevalence of recovered memories for CSA in their clinical practices and to assess whether the recovered memory controversy had affected their treatment of female CSA victims. Despite the publicity the debate over memories of CSA has attracted, few cases of so-called recovered memory were reported. Even fewer cases of so-called false memory were reported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Good and poor practices in psychotherapy: National survey of beliefs of psychologists.

As part of a larger study of behaviors and standards of psychologists and resources for guiding their actions, survey data were collected from 456 (231 male and 225 female) American Psychological Association members selected from Division 29 (Psychotherapy). Participants were asked to rate the degree to which they considered each of 83 behaviors to constitute good or poor practice. About one fourth (22) of the behaviors were considered to be uniformly "poor" by at least 60% of the participants. Only 2 behaviors were judged uniformly "good" by at least 50% of the participants. About one fourth (18) of the behaviors were difficult to judge (i.e., at least 20% of the participants indicated "don't know/not sure"). Participants tended to report that their behavior conformed to their standards of good practice and had a tendency to maintain stricter standards for judging whether a behavior was good or poor practice than for judging whether it was ethical or unethical. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Remembering childhood sexual abuse: A national survey of psychologists' clinical practices, beliefs, and personal experiences.

A national survey of 1,000 psychologists, to which 223 responded, assessed professionals' clinical practices and beliefs about the treatment of adult survivors of childhood sexual abuse (CSA), personal CSA history, and the phenomenon of clients remembering CSA in therapy. Results indicated that over 25% of therapists reported using guided imagery, dream interpretation, bibliotherapy regarding sexual abuse, referral to sexual abuse survivors' group, and free association of childhood memories as memory retrieval techniques with clients who had no specific memory of CSA. However, the majority of therapists reported that they had not seen any cases of adult clients entering therapy with no memory of CSA and subsequently recalling abuse in the course of therapy. A personal history of CSA was not associated with most clinical practices related to treating sexual abuse survivors. The implications for training and establishing scientific standards of psychological practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exclusion of children from family psychotherapy: Family therapists' beliefs and practices.

Surveyed 173 family therapists on beliefs and practices regarding the decision to exclude children from family psychotherapy (FPT). The tendency to exclude children from FPT was directly related to amount of coursework and supervision and perceived adequacy of training. 48 of 125 Ss who had received training with children reported that more than 25% of their practice involved children. Only 5 of 40 Ss who had not received such training reported this to be true. Similar results were found for adequacy of training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical practitioners and their practices in acute diarrhea

PURPOSE: To investigate the effect of perfluoro-octane on coagulation studies and on intraoperative hemostasis during vitreoretinal surgery in an animal model. METHODS: In vitro study--comparison of coagulation profiles (bleeding time, whole blood clotting time, partial thromboplastin time, and one-stage prothrombin time) of blood taken from healthy volunteers with and without the addition of perfluoro-octane. In vivo study--comparison of times taken to achieve hemostasis in a rabbit model with large retinal arterial bleeding in vitrectomized and aphakic eyes with and without intraocular injection of perfluoro-octane. RESULTS: In vitro study--perfluoro-octane had no significant effect on coagulation profiles. In vivo study--intraocular perfluoro-octane significantly reduced the time to achieve hemostasis (P < 0.01) at all infusion bottle heights in vitrectomized and aphakic rabbit eyes. CONCLUSIONS: Perfluoro-octane may be used to control bleeding during vitreoretinal surgery. A direct effect on the clotting cascade could not be demonstrated.     

Conceptual beliefs about human values and their implications: Human nature beliefs predict value importance, value trade-offs, and responses to value-laden rhetoric.

Beliefs that may underlie the importance of human values were investigated in 4 studies, drawing on research that distinguishes natural-kind (natural), nominal-kind (conventional), and artifact (functional) beliefs. Values were best characterized by artifact and nominal-kind beliefs, as well as a natural-kind belief specific to the social domain, "human nature" (Studies 1 and 2). The extent to which values were considered central to human nature was associated with value importance in both Australia and Japan (Study 2), and experimentally manipulating human nature beliefs influenced value importance (Study 3). Beyond their association with importance, human nature beliefs predicted participants' reactions to value trade-offs (Study 1) and to value-laden rhetorical statements (Study 4). Human nature beliefs therefore play a central role in the psychology of values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and developmental differences in exercise beliefs among youth, and prediction of their exercise behavior]

Research into the efficacy of psychotherapy has often reported equivalence in treatment outcome when comparing different therapies. These findings have been interpreted as evidence for what are variously termed placebo, common or nonspecific processes. We suggested that this issue is best examined in comparison of specific and nonspecific processes in the action of a specified therapy and disorder. No comparisons of this nature have yet been reported in relation to cognitive therapy for depression. This study compared specific processes (automatic thoughts and dysfunctional attitudes) and major common processes (satisfaction with therapy and client evaluation of therapist) in the action of a group cognitive therapy for depression. Sixty patients suffering from major depression received a 12 week course of group cognitive therapy. Results from hierarchical regression suggested that the specific processes of cognitive therapy were more associated with reduction in depression than common processes which contributed to the prediction of reduction in depression via specific processes.