Conjugal conflict and violence: a review and theoretical paradigm.

Conjugal violence has been described as having multiple etiologies. The variables are so numerous that intervention and research protocols are difficult to effect. This paper proposes a paradigm that establishes conjugal conflict and violence as separate entities. According to the paradigm, conjugal conflict is viewed as "an inevitable part of human association," whereas conjugal violence is determined to be a learned behavioral tactic that is employed as a coping strategy when an individual's conflict threshold potential is exceeded. Evidence will be offered that violence is learned from family of origin and from observing what is common or accepted practice in the community. Use of this paradigm would give primacy to community education programs that advance the concept of conflict resolution through rational discourse.

Perspectives on patient-doctor communication.

Until recently, the content, structure, and function of communication between doctors and patients has received little attention and has been excluded from the realm of scientific inquiry; as a result, most clinicians have had little formal training in communication skills. In this paper leaders in doctor-patient communication present four approaches that are currently used as the basis for clinical training and research, summarize the progress made in forming a consensus, and outline the implications of these perceptions for practicing physicians.

Psychosocial influences on new born outcomes: a controlled prospective study.

This paper reports the results of a prospective investigation of 100 women during their pregnancies to test the hypothesis that social and psychological factors influence pregnancy outcome after controlling for demographic, biomedical, and lifestyle variables. Subjects completed questionnaires that assessed family social supports, life events, and anxiety. In addition, data were collected on general biomedical and pregnancy risk, lifestyle practices including smoking and drinking, as well as demographic information. Four infant outcomes, birthweight, gestational age, and 1 and 5 min Apgar scores, were studied via hierarchical multiple regression analyses for their relationship to the social and psychological variables, after controlling for all other sets of variables. The results of these analyses showed that life events stress accounted for significant variation in birthweight, and social supports and anxiety were associated with the two pediatric Apgar scores. Gestational age bore a simple relationship to anxiety, with higher anxiety predictive of lower gestational age. Further analyses revealed that women with either low social supports or high anxiety were, on the average, younger, more often single, of lower education level, had less income, smoked more, and had higher general biomedical risk than women with adequate social supports or lower anxiety. This suggests the multiple ways in which social and psychological risk factors may be related to pregnancy outcome and emphasizes the need for well controlled studies in this area.

Designing a curriculum for training community-responsive physicians.

There is a need for physicians who will promote health for all, especially for the out-of-hospital patient and the medically underserved. Community-based medical education is central to the training of these physicians. Ad hoc programs have improved student awareness of community-oriented primary care (COPC) during the past two decades. These programs have included student-initiated clinics in medically underserved communities. Future goals to advance COPC should include recruitment of motivated students, longitudinal community-based training programs, research opportunities in COPC, and the development of a cadre of COPC role models.

Medical education's role in primary care/community health: a model from Kumasi, Ghana.

Providing primary care for the medically underserved is an international problem. In the developing world the problem is accentuated by the disparity between resources and needs. Although during the past few decades much has been accomplished worldwide to improve primary care, medical educators have not adequately responded to the challenge of preparing students to participate in community health services, education, and research. This paper describes a medical school program from the Department of Community Health, School of Medical Sciences, Ghana. It is a program designed to prepare medical students for primary care by making community health a curriculum component of all three years of medical education. The program has potential for replication in the industrial as well as the developing world.

Prediction of pregnancy complications: an application of the biopsychosocial model.

This paper describes a pilot study of biomedical and psychosocial risk and the outcome of pregnancy. Ninety-three pregnant women completed four instruments to identify three types of psychosocial risk: life events, family function and social support. Biomedical risk was identified through analysis of self-reported health histories and hospital records. Information on complications of pregnancy was obtained from hospital delivery records. Further complications data were obtained by a home interview at 6 weeks postpartum. In the sample studied, from an agricultural-university community in Eastern Washington, biomedical risk alone was not substantially related to complications. Psychosocial risk was related to both delivery and postpartum complications. Family function was the best single psychosocial predictor. The interaction between family function and biomedical risk also predicted complications reliability. A total of 11% of variance in postpartum complications could be explained jointly by biomedical and psychosocial risk. The results of the study suggest that psychosocial risk assessment alone and in interaction with biomedical risk assessment will offer significant improvement in the identification of women who may experience pregnancy complication.

Validity and reliability of the family APGAR as a test of family function.

This paper offers evidence to support the use of the Family APGAR as a reliable, validated, utilitarian instrument to measure a subject's satisfaction with five components of family function. Mean total Family APGAR scores for several population groups are reported along with associated validity and reliability studies. A study from Taiwan supports the use of the Family APGAR in student populations 10 years of age and older. Studies are now under way to examine the use of the Family APGAR to correlate family function satisfaction with utilization of medical facilities, somatization, compliance, and the outcome of health problems.

Medical education in Indonesia: primary care and community health.

Curriculum changes in medical schools in nonindustrialized countries are being aimed at producing graduates who have a better understanding of the assessment and management of community health problems. The rationale for such changes exists in the context of appropriately balancing a country's limited resources with unmet medical needs in rural and poverty areas. Indonesia's efforts to improve its medical students' qualitative and quantitative participation in community health activities are discussed. Student and faculty problems in the community health program of Udayana University Medical School in Denpasar, Bali, are cited. Knowledge gained from community health programs in Indonesian medical schools should be examined by U. S. medical educators who are seeking to improve the community orientation of American medical students.