The third edition of the Sands (Stillbirth and Neonatal Death Charity) Guidelines will be published in June 2007. This article discusses some of the issues that are covered. These are: The current debate about whether parents should see and hold their baby following a stillbirth or late miscarriage and the principle of choice. The increased risk of perinatal mortality in some minority ethnic groups and the need to provide culturally sensitive care and professional interpreters. The importance of recognizing and meeting the needs of bereaved fathers. The Human Tissue Authority Codes of Practice and asking for consent for post mortem examination. The experience of women having a mid-trimester miscarriage and whether they should be cared for in a gynaecology ward or a labour ward.
This minireview concerns a new observation on mirror writing. An uncommon form of writing, mirror writing is seen among healthy individuals, but it can also follow a variety of neurological diseases; it is nearly always carried out with the left hand and is more easily undertaken by left-handers. We have found that a particularly high prevalence of left-handed mirror writing has been reported among those whose native languages are traditionally written in a leftward direction, including Chinese, Japanese, and Hebrew. Innate left-handers and those whose languages are written leftward thus share an unusual facility for left-handed mirror writing, an observation that may have implications for understanding hemisphere specialization in relation to handedness.
The article focuses on the results of vocational integration over the last two decades and on actual results from client-surveys as presented by the Arbeitsgemeinschaft Deutscher Berufsförderungswerke (ADB) (working group of the German vocational retraining centres) and the Berufsförderungswerk Heidelberg (BFW Heidelberg, the vocational retraining centre in Heidelberg). Process quality of vocational rehabilitation can be indicated by data like the number of persons dropping out of their training - the ratio to be found in the vocational retraining centres is on a lower level than in other institutions of vocational training. Clients have changed: during the last decade the average age of the clients in the BFW Heidelberg has increased by 3 years, there is a higher proportion of women, but there also are more clients with psychological disorders. A new group of clients is growing - non-handicapped persons who pay for their training themselves. Process quality has improved, with graduates of the BFW Heidelberg saying significantly more often that they can use much or very much of the training courses' contents within their later occupational activities -- the proportion increases with the level of training they had undergone. Additionally the proportion of those is growing who see themselves in an -- according to their training -- adequate occupational situation. These are certainly positive results referring to the indicators of process quality. Concerning outcome quality one has to take the levels of occupational integration into account. Compared with the results of German vocational retraining centres overall, graduates of the Heidelberg centre constantly had a higher level of vocational integration over the last 20 years, one of the reasons being that the vocational training offered in Heidelberg reaches up to the level of degree of a university of applied sciences. The situation on the job market strongly influences occupational integration: it is evident that a high rate of unemployment will extend the time span necessary for placement. But in the long run occupational integration proves to be amazingly high. Variables that influence the results are: level of disability, sex, age and marital status. The level of vocational qualification is a characteristic with high evidence: integration of graduates at the level of "Fachschule" (highly skilled technician or the like) is 10 % higher and that of graduates at the level of "Fachhochschule" (university of applied sciences) another 10 %. Participation in vocational rehabilitation generally is highly estimated -- estimation as given two years after the training increases with the level of qualification. In the Heidelberg centre progress is seen in expanding the proportions of special target groups (which of course is politically aimed at): women now account for some 30 %, there are more elderly clients and for example also more clients with psychological disorders. The vocational integration of these various groups has to be regarded under different aspects. For e...
The death of a baby around the time of birth is a major catastrophe for parents. Their grief is likely to be profound and long lasting. Many parents welcome the opportunity to create memories of their dead baby and treasure the brief time during which they were able to see or hold him or her. NICE guidance consists of four documents which make different statements about parents seeing and holding their baby. Lack of consistency about an important aspect of practical care and the potential for choice to be removed, is unhelpful to parents and to the professionals caring for them. Informed choice must remain the overriding principle of care.
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