Can we rely on simulated patients' satisfaction with their consultation for assessing medical students' communication skills? A cross-sectional study.

BACKGROUND: In medical education, teaching methods offering intensive practice without high utilization of faculty resources are needed. We investigated whether simulated patients' (SPs') satisfaction with a consultation could predict professional observers' assessment of young doctors' communication skills. METHODS: This was a comparative cross-sectional study of 62 videotaped consultations in a general practice setting with young doctors who were finishing their internship. The SPs played a female patient who had observed blood when using the toilet, which had prompted a fear of cancer. Immediately afterwards, the SP rated her level of satisfaction with the consultation, and the scores were dichotomized into satisfaction or dissatisfaction. Professional observers viewed the videotapes and assessed the doctors' communication skills using the Arizona Communication Interview Rating Scale (ACIR). Their ratings of communication skills were dichotomized into acceptable versus unacceptable levels of competence. RESULTS: The SPs' satisfaction showed a predictive power of 0.74 for the observers' assessment of the young doctors and whether they reached an acceptable level of communication skills. The SPs' dissatisfaction had a predictive power of 0.71 for the observers' assessment of an unacceptable communication level. The two assessment methods differed in 26% of the consultations. When SPs felt relief about their cancer concern after the consultation, they assessed the doctors' skills as satisfactory independent of the observers' assessment. CONCLUSIONS: Accordance between the dichotomized SPs' satisfaction score and communication skills assessed by observers (using the ACIR) was in the acceptable range. These findings suggest that SPs' satisfaction scores may provide a reliable source for assessing communication skills in educational programs for medical trainees (students and young doctors). Awareness of the patient's concerns seems to be of vital importance to patient satisfaction.

Interpersonal conflict and physical abuse in relation to pregnancy and infant birth weight.

Women's experiences of different kinds of abusive behavior by their partners were studied in relation to birth weight of the women's infants and other pregnancy outcome measures. Eighty-four women who delivered a low-birth-weight (< 2500 g) infant (cases) and 90 women who delivered an infant with higher birth weight (controls) were interviewed in a case-control study. Information about the partners' behavior during conflicts were obtained by use of a modified Conflict Tactics Scale. Different interpersonal conflict behaviors were categorized as negative verbal interaction or moderate or severe physical abuse. Women who had experienced moderate or severe violence in a relationship also had experienced negative verbal interaction from their partner. Low birth weight was not associated with experiences of any interpersonal conflict behavior in the total sample (OR 0.75, 95% CI 0.42-1.37). Among women with a low birth weight infant, mean birth weight was 261 g lower among those who reported any interpersonal conflict behavior during pregnancy. Birth of a low-birth-weight infant was not associated with abuse in a wide sense. Also, such abuse was unassociated with a variety of other complications during pregnancy, lifestyle characteristics, or pregnancy outcome measures.

Prevalence of physical and sexual abuse before and during pregnancy among Swedish couples.

BACKGROUND: To estimate the prevalence of threats and actual acts of physical and sexual abuse during pregnancy. METHODS: Two hundred and seven pregnant Swedish women married to or cohabiting with Swedish men were randomly selected from three antenatal clinics in the city of Göteborg, Sweden. A standardized questionnaire was used for personal interviews about the women's experience of physical and sexual abuse by a husband or a boyfriend at some point in the past, during the last year and during current pregnancy. RESULTS: Twenty-seven point five percent of the women reported that they had been exposed to physical violence at some point in the past by their husband/boyfriend. Twenty-four and a half percent of the women had experienced some form of threat, physical or sexual violence during the last year. At some time (once or more) during their current pregnancy, the proportions of women who had been exposed to the following categories of violence, were as follows: 14.5%-symbolic violence, 14.5%-threats of mild violence, 2.9%-threats of moderate violence, 2.9%-threats of serious violence, 11%-mild violence, 4.3%-minor violence, 2.4%-moderate violence, 4.3%-serious violence and 3.3%-sexual violence. CONCLUSIONS: This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy. There is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies.

Pregnancy and delivery for women with a history of child sexual abuse.

OBJECTIVE: To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse. METHOD: In a case control study, 82 women with birth of a low birth weight infant (< 2500 g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse. RESULTS: Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44-2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight. CONCLUSIONS: Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.

Anxiety, physical abuse, and low birth weight.

BACKGROUND: Physical and sexual abuse has been associated with adverse pregnancy outcome in some studies. One cause may be physical trauma; others may be indirect, such as stress, anxiety, smoking or drug use in pregnancy. The aim of the present study was to assess the relationships among anxiety, history of abuse and low birth weight. METHODS: We performed a case control study comprising 85 women who delivered low birth weight (<2500 g) babies (cases) and 92 women with higher birth weight babies (control group). All mothers were interviewed. We assessed the extent of abuse using the Conflict Tactics Scale, and that of anxiety using the Trait-Anxiety Inventory. RESULTS: Women with low birth weight babies were not more likely to have higher scores on the anxiety scale or to have a history of abuse. On the other hand, mothers with a history of abuse had higher anxiety scores and more often smoked in pregnancy. CONCLUSION: Anxiety could be the intermediate factor between abuse and smoking in pregnancy.

Abuse history and health risk behaviors in pregnancy.

STUDY OBJECTIVE: To study the relation between a history of physical abuse and consumption of cigarettes and alcohol during pregnancy. METHODS: In a case-control study, 83 women who delivered a low birthweight (<2500 g) infant (cases) and 92 women with a newborn with birthweight > or =2500 g (controls) were interviewed about a history of sexual abuse, physical abuse by a partner, and about health behaviors during pregnancy. RESULTS: In all, 46 (26%) had a history of abuse. Birth of a low birthweight infant was not associated with a history of abuse. At time of first prenatal visit 35% of the women were daily smokers, 50%) of the abused and 29%, of the nonabused were smokers. An abuse history was associated with daily smoking when controlled for educational level (OR 2.29, 95%, CI 1.08-4.85). Ninety (51%) of the women reported consumption of alcohol during pregnancy. Abuse was associated with alcohol consumption in pregnancy when controlled for educational level (OR 2.57, 95% CI 1.22-5.39). CONCLUSIONS: Alcohol and tobacco use during pregnancy were associated with a history of abuse. Health care professionals should consider this potential correlation when use of tobacco and alcohol in pregnancy is brought up.

Physical abuse and low birthweight: a case-control study.

OBJECTIVE: To examine whether physical abuse of a woman by her partner was associated with low birthweight. DESIGN: A case-control study. SETTING: Department of Gynaecology and Obstetrics, University Hospital of Trondheim, Norway. PARTICIPANTS/SAMPLE: Eighty-six women who were delivered of a low birthweight (< 2500 g) infant (cases) and 92 women who were delivered of an infant with birthweight > or = 2500 g (controls). METHODS: An in-depth interview, either postpartum at the maternity ward or one year after delivery. Information about abuse was obtained by direct questioning and a modified version of the Conflict Tactics Scales. RESULTS: A total of 17% of the women had experienced abuse by a partner. While 7% had been abused by their current partner before the index pregnancy only one woman reported abuse during pregnancy. Relatively more mothers of low birthweight infants were abused (20%) compared with controls (15%), but the association was not statistically significant (OR 1.37, 95% CI 0.63-2.99). Abused women reported a higher consumption of alcohol and cigarettes in pregnancy compared with nonabused women. CONCLUSION: Abuse was not found to be a risk factor for low birthweight in this study.

PIP: A case-control study conducted at the University of Trondheim, Norway, in 1992-94 investigated the association between physical or sexual abuse by a male partner and low birth weight. 86 infants who weighed less than 2500 g at delivery were enrolled as cases, while 92 infants with a birth weight of 2500 g or above served as controls. Both the conflict tactics scale and direct questioning in the postpartum period or one year after delivery were used to measure domestic violence. A total of 31 women (17%) reported physical and/or sexual abuse by a current or former partner. Abused women were significantly more likely than their nonabused counterparts to be unemployed, to smoke, and to consume alcohol during pregnancy, but there were no differences between groups in terms of education, marital status, income, mean age at delivery, or mean pre-pregnancy weight. Relatively more mothers of low-birth-weight infants were abused than controls (20% and 15%, respectively), but the association was not statistically significant (odds ratio (OR), 1.37; 95% confidence interval (CI), 0.63-2.99). The association remained nonsignificant even after adjustment for potentially confounding factors such as cigarette smoking and alcohol consumption during pregnancy (OR, 1.35; 95% CI, 0.62-2.98).

[Contraception among women demanding abortion]. / Prevensjonsbruk blant abortsøkende kvinner.

PIP: Contraceptive usage was examined among all women seeking abortion in the 1st trimester at the women's clinic of the regional hospital in Trondheim, Norway, in 1985. Use of contraceptives at the time of conception was lowest among women under 25 years old. Women with 2 or more children had a higher proportion of contraceptive use than women with 1 or no child. While 61% of women seeking abortion had used contraception 6 months prior to conception, 38% were using contraception at the time of conception. It was particularly women who had used oral contraceptives who had stopped using contraception during the 6 months prior to conception. The study showed that unplanned pregnancy was much more often the result of nonuse of contraceptives than of failure of method. If the number of abortions is to be reduced further, the use of contraceptives must be increased. This may also have the effect of causing a further reduction in the birthrate.^ieng