Sensitizing students to functional limitations in the elderly: an aging simulation.

BACKGROUND AND OBJECTIVES: Using activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as a focus, faculty at Eastern Virginia Medical School provide an aging simulation exercise for a mandatory fourth-year clerkship in geriatrics. The specific aims of the simulation are to 1) experience the physical frailties of aging, 2) develop creative problem-solving techniques, 3) identify feelings regarding the experience of functional loss, and 4) develop proactive clinical approaches to the care of the elderly. METHODS: Students are assigned one of four diagnoses (Parkinson's disease, rheumatoid arthritis, advanced diabetes, or stroke) and are then impaired to simulate the frailties of the condition, using a variety of clothes, bindings, and other devices. In their "impaired states," they perform ADLs and IADLs, such as paying bills, organizing their pills, shopping, toileting, dressing, and eating. RESULTS: Evaluation results show the aging simulation to be the highest rated program in the clerkship. A pre- and post-course survey on attitudes toward the elderly showed a statistically significant improvement in students' attitudes toward the elderly following the course. CONCLUSIONS: Simulation exercises in aging are useful activities for helping students better understand the feelings and needs of the elderly.

The doctor, the patient: a first-year course for personal and professional growth.

BACKGROUND AND OBJECTIVES: Medical education has tended to focus primarily on the biomedical aspects of care while neglecting the human side of patients and students. To help students become aware of student, patient, and family issues that may impact the doctor-patient relationship, a first-year course was developed. METHODS: This course consists of 12 didactic sessions and 10 small-group meetings led by family medicine faculty. Topics include self-assessments, analysis of videotaped doctor-patient interactions, genogram development, and family systems. Students have evaluated the course for content, strengths, weaknesses, and impact. RESULTS: This course was highly rated by the students. The students reported gaining insight into personal issues that might impact their interaction with patients. Students also became aware of the importance of family issues to their patients' health and well-being. CONCLUSIONS: Through courses like this, students may gain deeper insight into issues that impact them, their patients, and the doctor-patient relationship.

Knowledge of pregnancy symptoms among abortion patients: is race a predictor?

This cross-sectional study characterizes first-trimester abortion patients who perceived inadequate knowledge of pregnancy symptoms and identifies net predictors of inadequate symptom knowledge. Data were collected at an abortion facility in Hampton Roads, Virginia. Study subjects were women surveyed on the day of their abortions, prior to termination procedures. Self-reported knowledge of pregnancy symptoms was the study's dependent variable. Of 342 women, 120 (35%) perceived inadequate symptom knowledge. These women more often were young, black, single, and poorly educated. Only black race was a net predictor of inadequate symptom knowledge when study variables were entered into a multiple logistic regression. Black race was the only net predictor of inadequate symptom knowledge among first-trimester abortion patients. This racial difference was not explained by socioeconomic or access factors. Future research should consider an alternative hypothesis, the possibility that more effective communications with black abortion patients are needed. Additionally, health-care providers should not presume that first-trimester abortion patients are familiar with pregnancy symptoms and should not stereotype patients who perceive knowledge limitations with regard to socioeconomic status.

Family relationships and depressive symptoms preceding induced abortion.

This study examines the association between depressive symptoms preceding induced abortion and dissatisfaction with family relationships. In a cross-sectional survey, 304 women undergoing a first-trimester abortion completed a short version of the Center for Epidemiologic Studies Depression Scale, the Family APGAR, and a researcher-designed questionnaire. Bivariate analyses revealed that depressive symptoms decreased as measures of age, educational attainment, Family APGAR scores, marriage, and subjective health increased. Depressive symptoms increased as measures of denial, difficulties communicating with male partners, pregnancy symptoms, contraceptive use, and dissatisfaction with choosing abortion increased. Controlling for the effects of these significant bivariate associations, increased depressive symptoms were independently predicted by Family APGAR scores, age, communications difficulties, pregnancy symptoms, contraceptive use, and denial. Low Family APGAR scores exhibited the strongest overall effect. Clinicians who encounter women experiencing depressive symptoms preceding abortion may wish to explore family relationships and the possibility of underlying family dysfunction.

PIP: A cross-sectional survey of 304 young women about to undergo a 1st-trimester abortion at a Virginia clinic revealed a significant association between a pre-abortion depressive response and dissatisfaction with family relationships. The mean age of study participants was 24.3 years (range: 14-43 years); 83% were unmarried and 41% were Black. Depressive symptoms were measured by an abbreviated version of the Center for Epidemiologic Studies-Depression Scale (CES-D), while dissatisfaction with family relationships was assessed through use of the Family APGAR test. A researcher-designed questionnaire provided data on sociodemographic factors. The mean CES-D score was 16.82 (maximum possible score, 36), and the mean Family APGAR score was 6.63 (maximum possible, 10). Bivariate analysis revealed highly significant (p 0.001) associations between CES-D scores and Family APGAR scores, young age, lower educational attainment, and denial regarding the reality of the pregnancy. Also significantly correlated (p 0.01) with depression were poor subjective physical health and being unmarried. Lesser but significant (p 0.05) associations were found between depression and problems communicating with one's male partner, contraceptive use, dissatisfaction with the abortion decision, and the experience of symptoms of pregnancy. Multiple regression analysis indicated that increased depressive symptoms were independently predicted by low Family AGAR scores, young age, communication problems with the male partner, pregnancy symptoms, contraceptive use, and denial. The variables analyzed explained 25% of the variance in CES-D scores. Although long-term psychological adjustment to induced abortion is generally positive, over 50% of women are estimated to experience depressive symptoms prior to the procedure--a phenomenon that has not received adequate attention from family practitioners. Since problematic family relationships are often concealed from physicians, supportive exploration of the possibility of underlying family dysfunction should become a part of pre-abortion health care.

A family physician-counselor program for medical students.

BACKGROUND: Impairment among medical students has increased over the past decade, thus requiring programs to identify and manage student needs. METHODS: At Eastern Virginia Medical School, first-year medical students are assigned personal physician-counselors from the Department of Family and Community Medicine. These physicians provide health care and assist students in identifying and managing new or preexisting medical and psychosocial problems. Students meet with their physician-counselors during the first week of school to develop rapport and to complete a screening history and genogram. Subsequent small group meetings help students adjust to life in medical school. RESULTS: Psychosocial problems such as alcoholism, mental illness, substance addiction, and sexual abuse have been identified among students and/or their families, and management strategies have been initiated. This program has been evaluated highly by both faculty and students. CONCLUSIONS: This program has been helpful in identifying problems and implementing treatment strategies for medical students.

Psychosocial determinants of late prenatal care: the Health Belief Model.

This paper presents a theoretical framework for investigating psychosocial determinants of delayed prenatal care among disadvantaged women. This framework is based on the Health Belief Model (HBM), which postulates that beliefs concerning prenatal care are modified by psychological and social attributes and may predispose one to delay prenatal care enrollment. The HBM has a number of advantages for family medicine researchers in comparison to other models; its use in future investigations can provide the understanding necessary for overcoming psychosocial deterrents to entry into prenatal care.

Determinants of delayed pregnancy testing among adolescents.

BACKGROUND: Pregnant teenagers often prolong the interval between suspecting and confirming that they are pregnant. Prior studies suggest a number of potential determinants for this delay but do not specify which ones are most salient. METHODS: In a cross-sectional survey, 123 pregnant teenagers, 64 of whom maintained their pregnancies and 59 of whom had abortions, completed a short version of the Center for Epidemiologic Studies Depression Scale, the Family APGAR test, and a study-specific questionnaire. RESULTS: Significant bivariate determinants of delayed pregnancy testing included young maternal age, black race, lower educational attainment, lack of pregnancy symptoms, continuing the pregnancy, and denial. Only denial, however, retained a significant net effect on delayed testing (P < .05) when the effects of these six variables were modeled using multiple linear regression. CONCLUSIONS: These results suggest that psychological barriers are the most salient determinants of delayed pregnancy testing among the teenagers surveyed in this study. Some teenagers may not volunteer information about a suspected pregnancy. Providers, therefore, should directly question teenagers about sexual activity and discuss the importance of early testing when pregnancy is suspected. Findings also suggest further research that would increase understanding of adolescent health behavior in pregnancy and identify effective clinical and educational interventions.

Parental attitudes toward physicians providing AIDS education to children.

This study was designed to determine whether parents would like their children to receive AIDS education from a family physician. Two hundred parents with children between the ages of five and 18 years completed a researcher-developed instrument assessing their opinions on AIDS education for their children. Seventy-six percent of the parents expressed a desire for their children to receive AIDS education from a physician. Topics requested by the parents included avoiding IV-drug abuse, safe sex, and sexual abstinence. The mean age at which the parents felt education should begin was 10.6 years (mode = 9.0 years). Based on the results of this study, physicians may wish to begin introducing AIDS education in routine patient visits with adolescents and pre-adolescents (ages 9-12), thus contributing to primary prevention.

Laboratory differences in cervical cytology.

This prospective study was designed to determine if there is a difference in reporting endocervical cells in Papanicolaou smears among laboratories used by an urban, academic family practice. A review of the literature found no studies comparing Papanicolaou smear results among laboratories with respect to the presence of endocervical cells. In this study, three laboratories evaluated a total of 140 Papanicolaou smears from women aged 16 to 83 (mean = 33.8) for endocervical cells. The presence of endocervical cells was reported for 88 smears (62.9%) ranging from 42/83 (50.6%) to 21/23 (91.3%) among laboratories. Results of an analysis of variance revealed a statistically significant difference in the frequency of reporting endocervical cells (p less than .001) among the laboratories. Analysis of covariance controlling for effects of several factors known to influence the outcome of Papanicolaou smears (age, days since last menstrual period, method used to obtain smear, and experience of clinician obtaining smear) failed to explain this difference.