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Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: For several decades childbirth educators and midwives have focused on the alleviation or reduction of pain and suffering during the childbirth experience (Brown, Douglas & Flood 2001:1). Nursing professionals who care for labouring women require current, evidence-based knowledge regarding pain management options, including mode of action, benefits, risks and efficacy (Florence & Palmer 2003:238). Objectives: This study examined the effects of non-pharmacological pain relief strategies for pain management during labour. Search methods: The researcher conducted a search between February and May 2010 on PubMed, CINAHL and CENTRAL for randomised controlled trials published from inception to 2010. The Medical Search Headings (MeSH) included non-pharmacological, alternative, pain management, labour, pregnant, complementary, randomised, randomly, midwifery, natural birth, relaxation, breathing, positioning, hypnosis, water birth, acupuncture, aromatherapy. Selection criteria: The studies included reported on pregnant women, primigravida or multigravida, term (37 weeks and more), spontaneous labour (first or second stage) without any complications in previous or current pregnancies. The researcher searched for randomised controlled trials with an intervention and a control group. Due to financial restrictions the researcher assessed studies that were published in English only. Interventions were childbirth education, continuous support, relaxation, breathing techniques, movement and positioning, music, manual healing, aromatherapy, hydrotherapy, hypnosis and acupuncture. Data collection and analysis: Meta-analysis was performed using Relative Risks and 95% Confidence Interval for dichotomous outcomes and Weighted mean differences and 95% Confidence Interval for continuous outcomes. Review Manager (RevMan), a statistical software was used. Where meta-analyses were impossible results were presented in narrative form. The outcome measures were a decreased need for pharmacological pain relief, maternal satisfaction with the overall childbirth experience, length of labour (normal or shorter progress), incidence of postnatal depression, incidence of postpartum haemorrhage, an Apgar score of more than seven at five minutes, resuscitation of the neonate and admission to the neonatal intensive care unit. Results: Thirteen (13) eligible RCT’s were included in the systematic review. Four trials involved hydrotherapy (n=585), two trials involved acupuncture (n=480), two trials involved childbirth education (n=6398), one trial involved continuous support (n=2844), one trial involved aromatherapy (n=513), one trial involved maternal positioning (n=2547), one trial involved music, massage and relaxation (n=90) and one trial involved hypnosis (n=82). In the Freeman trial (1986) women in the hypnosis group required less pharmacological pain relief 15/29 compared to women in the control group 20/36. Women in the intervention group also experienced greater satisfaction with the childbirth experience 15/29 (52%) compared to women in the control group 8/36 (23%). The trials of acupuncture showed a decreased need for pharmacological pain management in Skilnand (2002) (n=208) for epidural 11/106 (10%) for the intervention and 27/102 (26.5%) for the control group as well as Pethidine 15/106 (14%) for the intervention and 36/102 (35%) for the control group. In the Borup trial (2009) it was reported that acupuncture during labour reduced the need for pharmacological pain management for the intervention group 185/314 (58.9%) compared to control 124/149 (83.2%) without affecting the birth outcome. The secondary outcome of length of labour (minutes) in the Skilnand trial is significantly in favour of the acupuncture group with a mean value of 212 (SD, 155), compared to the control group with a mean value of 283 (SD, 225) with a p-value of 0.01. Conclusions: Acupuncture may relieve labour pain and also shorten the duration of labour, and women experience greater satisfaction with the childbirth experience. Hypnosis may decrease the need for pharmacological pain relief requirements, and may also increase an overall maternal satisfaction with the childbirth experience. There is insufficient evidence about the benefits of childbirth education, continuous support, aromatherapy, music, massage, movement and positioning, breathing and relaxation. / AFRIKAANSE OPSOMMING: Agtergrond: Vir talle dekades het die verloskundiges en vroedvroue gefokus op die verligting of vermindering van pyn en lyding gedurende die ervaring van kindergeboorte (Brown, Douglas & Flood 2001:1). Professionele verpleegkundiges wat omsien na vrouens wat kraam het die huidige, bewyslewerende kennis aangaande pynbestuuropsies nodig, insluitende die wyse van optrede, voordele, risiko en effektiwiteit (Florence & Palmer 2003:238). Doelstellings: Hierdie studie het die effekte van nie-farmakologiese pynverligtingstrategieë vir die beheer van pyn gedurende die kraamproses nagevors. Ondersoekmetodes: Die navorser het gedurende Februarie en Mei 2010 ’n ondersoek gedoen na PubMed, CINAHL en CENTRAL vir ewekansigbeheerde proewe gepubliseer vanaf die aanvang tot 2010. Die Mediese Ondersoekhoofde het farmakologiese, alternatiewe, pynbeheer, kraam, swangerskap, komplementêre, ewekansigheid, toevalligheid, verloskunde, natuurlike geboorte, ontspanning, asemhaling, posisionering, hipnose, watergeboorte, akupunktuur en aromaterapie ingesluit. Seleksie kriteria: Die studies het navorsing oor swanger vroue, primigravida of multigravida, tydperk (37 weke en meer), spontane kraam (eerste of tweede stadium) sonder enige komplikasies in vorige of huidige swangerskappe ingesluit. Die navorser het ewekansigbeheerde toetsing met ’n intervensie en ’n kontrole groep ondersoek. As gevolg van finansiële beperkings het die navorser studies wat alleenlik in Engels gepubliseer is, geassesseer. Intervensies soos die opvoeding oor kindergeboorte, deurlopende ondersteuning, ontspanning, asemhalingstegnieke, beweging en posisionering, musiek, handegenesing, aromaterapie, hidroterapie en akupunktuur is bestudeer. Data-insameling en analise: Meta-analise is uitgevoer deur gebruik te maak van Relatiewe Risiko’s en 95% Betroubaarheidsinterval vir tweeledige uitkomste en Gewigdraende gemiddelde afwykings en 95% Betroubaarheidsinterval vir deurlopende resultate. Review Manager (RevMan), ’n statistiese sagteware is gebruik. Waar dit ontmoontlik was om meta-analise uit te voer, was resultate gepresenteer in narratiewe vorm. Die uitkomste meting is ’n afname in die behoefte vir farmakologiese pynverligting, moederskapbevrediging met die algehele geboorteskenkervaring, die duur van die bevalling (normale of korter vordering), gevalle van postnatale depressie, voorkoms van postpartum bloeding , ’n Apgartelling van meer as sewe teen vyf minute, resussitasie van die neonaat en toelating tot die neonatale intensiewe sorgeenheid. Resultate: Dertien (13) geskikte ewekansigbeheerde proewe is ingesluit in die sistematiese oorsig. Vier proewe het hidroterapie (n=585), twee proewe akupunktuur (n=480), twee proewe die opvoeding van kindergeboorte (n=6398), een proef deurlopende ondersteuning (n=2844), een proef aromaterapie (n=513), een proef moederlike posisionering (n=2547), een proef musiek, massering en ontspanning (n=90) en een proef het hipnose (n=82). Die proef vir hipnose het ‘n afname in die behoefte vir farmakologiese pynbeheer met 15/29 vroue in die hipnose groep en 20/36 vroue in die kontrole groep getoon. Vroue in die hipnose groep het ook groter bevrediging gevind met die ervaring van die geboorteskenking met 15/29 (29%) in vergelyking met 8/36 (23%) in die kontrole groep. Die proewe vir akupunktuur het ’n afname in die behoefte vir farmakologiese pynbeheer Skilnand (2002) (n=208), met ‘n gemiddelde waarde van 11/106 (10%) vir epiduraal en 15/106 (14%) vir Pethidien in die intervensie groep en ‘n gemiddelde waarde van 27/106 (26.5%) vir epidural en 36/102 (35%) in die kontrole groep. Borup (2009) (n=384) toon ook ‘n afname in die behoefte van farmakologiese pynbeheer met ‘n waarde van 185/314 (58.9%) in vergelyking met die kontrole groep 124/149 (83.2%). Die sekondêre uitkomste van die duur van die kraamproses (minute) in Skilnand (2002), is noemenswaardig ten gunste van die akupunktuurgroep met ’n gemiddelde waarde van 212 (SA, 155) in die intervensie groep en ’n gemiddelde waarde van 283 (SA, 225) in die kontrole groep met ’n p-waarde van 0.01. Gevolgtrekkings: Akupunktuur mag kraampyn verlig en ook die duur van die kraamproses verkort, vandaar dat vrouens groter bevrediging mag ervaar met die ervaring van geboorteskenk. Hipnose mag die begeerte na farmakologiese pynverligting verminder en sodoende vroue groter ervaring met geboorteskenk mag ervaar. Daar is onvoldoende bewys aangaande die voordele van die opvoeding van kindergeboorte, deurlopende ondersteuning, aromaterapie, musiek, massering, beweging en posisionering, asemhaling en ontspanning.

Thesis (MTh)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: ABSTRACT This paper presents a proposal of carrying out sustainable relief and development activities from the church perspective. With reference to the Nkhoma Synod Relief and Development Project, the paper suggests that awareness brings about self-reliance; and forms a concrete foundation for any community project. The first chapter gives an introduction to the whole presentation. This includes research problem statement, hypothesis, motivation, and possible value of the study. Chapter 2 looks at meaning of development and what role should the church take in order to empower and improve the life of the local community. Chapter 3 analyses the relief programme initiated by Nkhoma Synod. The chapter looks at some problems that made the projects initiated by the church and government in Malawi not to work. Chapter 4 looks at some steps of how the church of Nkhoma Synod can initiate her programmes in order to be successful. The chapter first looks at the meaning of church and mission, then it goes to look at what do we mean when we talk of self-reliance of the local community. Eventually, chapter suggests how best can the church in Nkhoma Synod approach relief and development programme to bring about self-reliance. The chapter looks at the role of the change agents and the community. The final part that is chapter 5 contains some concluding remarks. The paper concludes with remarks that the people themselves must see that coming together to work in small groups is not only to their own advantage but also leads to increase solidarity and strengthens the people as a group.

One of the newer techniques to be utilized in the treatment of a variety of behavioral disorders is anxiety-relief conditioning (Thorpe, Schmidt, Brown, and Castell, 1964; Solyom and Miller, 1967; Wolpe and Lazarus, 1966). In its theoretical formulation, reciprocal inhibition by anxiety-relief is similar to Wolpe's reciprocal inhibition by progressive relaxation (Solyom and Miller, 1967). Whereas Wolpe's method utilizes Jacobsonian relaxation principles to provide the medium through which anxiety is reciprocally inhibited, the procedure employed in anxiety-relief conditioning utilizes the relief following termination of an aversive stimulus to set an occasion which will permit reciprocal inhibition to take place. Many of the problems encountered in relaxation induction and control are thus avoided (Wolpe, 1958; Thorpe et al., 1964). Anxiety-relief conditioning appears to have been successful in patients that previously had been unsuccessfully treated by psychotherapy and chemotherapy for as long as 20 years (Myers, 1957; Thorpe et al., 1964; Solyom and Miller, 1967). Solyom and Miller reported successfully treating six of seven phobic patients who complained of severe depression, difficulty in interpersonal relationships and anxiety attacks when meeting people, as well as excessive fear of crowded places. These patients had an average length of illness of 11.1 years, ranging from 2 to 20 years. Patients were treated for a mean of 19.5 sessions with no evidence of symptom substitution or reappearance of the phobic fear upon follow-up (Solyom and Miller, 1967). Although the authors cited above have all reported case studies of successful therapeutic applications of anxiety-relief conditioning techniques, there have been few experimental studies of the efficacy of this technique. A recent experiment failed to refute the hypothesis that noxious stimulation and/or habituation, rather than aversion-relief, contribute to the beneficial therapeutic effects noted. This study left unanswered the question of which variables contribute to aversion-relief conditioning (Solyom, L., McClure, Heseltine, Ledwidge, and Solyom, C., 1972). The present study was undertaken to further explore the relevant variables in aversion-relief conditioning. It was hypothesized that reduction of fear to a phobic stimulus would be significantly greater among subjects who viewed the phobic stimulus while experiencing the pleasant sensation associated with aversion-relief than among subjects who viewed the phobic stimulus after the effects of aversion-relief had presumably dissipated.

Objet sculpté ou gravé, associant l’image et le texte, le monument funéraire se charge des aspirations spirituelles, sociales et artistiques de groupes sociaux divers. Dans un souci de préservation mémorielle, gisants, dalles à effigie, sarcophages ossuaires, bas-reliefs aux représentations diverses (funérailles, absoute, Christ de pitié, crucifixion, Vierge de la Chandeleur), tombeaux monumentaux ou épitaphes, mettent le défunt en scène au terme d’un cheminement de vie culminant à la quête du salut éternel de l’âme. Cette volonté de laisser une trace, de perpétuer son souvenir au-delà de la mort, pousse le commanditaire à mettre en ordre ses affaires, avant d’immortaliser ses derniers espoirs et ses dernières volontés dans la pierre. La grande variété typologique du territoire étudié, compris entre la Petite Camargue et la Catalogne du Nord du XIe au XVe siècle, met en évidence les traditions artistiques funéraires locales, et les apports septentrionaux et plus méridionaux (Espagne, Italie) qu’elles intègrent. Cette approche globale du patrimoine funéraire du littoral méditerranéen et de la société apporte une meilleure compréhension des mentalités religieuses, des pratiques juridiques (testaments) et économiques (dons, legs pieux, fondations de chapelles et d’anniversaires) et enfin esthétiques (somptuosité, ostentation), au seuil du trépas. Le croisement de différentes sources écrites et numériques (base Palissy) conduit à l’élaboration d’un corpus prenant en compte les monuments funéraires retrouvés, mais également disparus dont on garde traces dans les productions anciennes. / Carved ou engraved objet, associating the image and the text, funeral monument embodies the spiritual and artistic aspirations of various social groups. In order to preserve memory, recumbent statues, tombstones with effigy, sarcophagus ossuaries, low-reliefs with various representations (funeral, absolution, Christ of pity, crucifixion, Virgin of the Candlemas), monumental tombs or epitaphs, present the deceased at the end of his journey through life, peaking at the quest of the eternal salvation of the soul. This will to leave a trace, to perpetuate one’s memory beyond death, pushes the one who ordered such tombstone into putting one’s affairs in order before immortalizing his last hopes and his last wills in the stone.The large typological variety of the studied territory, between little “Camargue’ and the north of “Catalogne”, of the 11th to the 15th centuries, highlights the local funerary artistic traditions and the northern contributions or the more southern ones in Europe (Spain, Italy) which they integrate. This comprehensive approach of the funeral heritage of the Mediterranean coastline and the society brings a better understanding of religious mentalities, legal practices (wills), and economic (gifts, pious legacy, foundations of chapels and death birthdays) and lastly esthetic ones(sumptuousness, ostentation) at the threshold of the death. The crossing of various written and digital sources (Palissy bases) has led to the development of a fascinating corpus taking into account the monuments that were found again, but also the ones that disappeared, whose traces are found in the old productions.

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Habil.-Schr.: Diss.--Universität Bern, 199? / Résumés en anglais et en français. Bibliogr. p. 140-141. Index.