Pediatric clinical faculty structure and teaching hospital function.

An organization of clinical faculty has been formed at Rainbow Babies and Childrens Hospital, Cleveland, Ohio, to help coordinate the mutual goals but sometimes conflicting needs of practicing pediatricians and a teaching hospital. The organization has been active in developing and conducting educational experiences for students, house officers, and practitioners. It has contributed to efforts to improve ambulatory and inpatient care. Collaborative clinical research projects involving practitioners and academicians are planned. We know of no other existing similar organization. We propose that other institutions with similar needs consider this mechanism to help improve their academic and patient care programs.

Feeding patterns of urban black infants.

Feeding patterns of 116 urban black infants were studied from 3 weeks to 6 months of age. Dietary data were collected using a diet history and a food frequency checklist completed by trained interviewers at each well child clinic visit at 3 weeks and at 2, 4, and 6 months of age. At 3 weeks, 20% of the infants were solely breast fed, 58% were formula fed, and 22% were partially breast fed. Twenty percent of 3-week-old infants were receiving baby foods. This increased to 48% at 2 months, and to 72% at 4 months. By 6 months of age, 98% of infants received baby foods. Nursing mothers tended to introduce baby foods later than formula-feeding mothers. This is consistent with other studies. Commercially prepared baby foods were used much more commonly than were foods prepared at home. Infant cereal was most often introduced first, followed by strained juices, strained fruits, strained vegetables, combination dinners, desserts, and plain meats, in that order. Table foods contributed very little to caloric intakes of infants less than 4 months of age. Liberal amounts of water and sugar water were given to infants in this cultural group.

Predicting low birthweight and complicated labor in urban black women: a biopsychosocial perspective.

This study explored demographic, biomedical and psychosocial factors as predictors of two adverse pregnancy outcomes: intrapartum complications and low birthweight, in 140 urban black pregnant women. The intrapartum complication rate was 18%. A four factor equation (low family functioning, advanced maternal age, working during pregnancy, and short stature) predicted intrapartum complications (80% sensitivity, 67% specificity and 35% positive predictive value). The low birthweight rate was 14%. Four factors (low family functioning, stressful events, Quetelet's Index, and cigarette smoking) predicted low birthweight (65% sensitivity, 84% specificity and 42% positive predictive value). Family functioning, alone, predicted low birthweight with 65% sensitivity, 64% specificity and 31% positive predictive value. Family functioning, was the only predictor for both outcomes. Family functioning and other psychosocial risk factors may potentially improve identification of high risk pregnant urban black women.

Education of residents in the pediatric office.

Practicing pediatricians can contribute a much-needed dimension to the education of those primary care physicians who will care for children by teaching medical students and residents in their offices. This article is intended to help the prospective pediatrician-teacher plan, conduct, and evaluate productive educational experiences in his office. Approaches to planning primary care educational experiences are discussed. Considerations for developing an efficient practice into an effective educational setting are also presented. Effective teaching strategies based upon principles of adult learning are suggested. The importance of a systematic approach to education, which entails defining objectives and evaluating the students' learning ', is emphasized.

Family function, respiratory illness, and otitis media in urban black infants.

Associations between maternal perceptions of family functioning and rates of infant presentation for respiratory illness and otitis media were analyzed using data collected prospectively in a sample of 114 urban black mother-infant pairs. Family functioning was evaluated using the Family APGAR, truncated versions of Olson's FACES II cohesion and adaptability subscales, and a shortened version of Hudson's Index of Family Relationships. Lower maternal scores of family function were significantly associated with higher rates of physician visits for infant respiratory illness and otitis media during the first 15 months of life. This correlation persisted when controlled for breast feeding. Maternal perceptions of family function, including those tested antenatally, may be useful in identifying infants in similar populations who are at risk for increased frequency of visits to the family physician for respiratory illness and otitis media.

A clinical trial to reduce the rate of low birth weight in an inner-city black population.

BACKGROUND: The goal of our study was to measure the effectiveness of a home-based intervention for prevention of low birth weight with 154 high-risk, low-income black women attending a prenatal clinic in Cleveland. METHODS: Based on previous research, risk was defined by clinic registration between the 17th and 28th weeks of gestation, low family functioning score, and experience of at least one stressful life event prior to registration. Optional factors included being a smoker, a low maternal weight-height ratio, being age 27 or older, and a previous premature birth. A 21-item family function screen previously validated in a similar population was the primary determinant of psychosocial risk. Low birth weight was defined as weight less than 2,500 g regardless of gestational age. RESULTS: There was no decrease in the rate of low birth weight for women who received four home visits focusing on smoking, drug and nutrition education, support, and links with community services, compared to women who received no visits. The number of prenatal visits was significantly higher in the intervention group, but an increased number of prenatal visits did not correlate with a reduced rate of low birth weight. Despite previous research, the family function screen was not an effective predictor of low birth weight in our study. A revised equation involving a history of previous premature birth, smoking, and a low maternal weight-height ratio did predict low birth weight. CONCLUSIONS: These findings question the utility of short-term psychosocial interventions for influencing low birth-weight rates in low-income black clinic populations. The family function screen was not cross validated. Integration of any psychosocial intervention with the routine prenatal care occurring in the obstetrical clinic is suggested for future research.

Clinical hypothesis testing in family practice: a biopsychosocial perspective.

Recent studies of the clinical problem-solving process have demonstrated the importance of hypothesis generation and testing in shaping the nature of information gathering, differential diagnosis, and therapeutic decision making. Family physicians and other primary care physicians are often faced with complex and undifferentiated illness problems that require them to go beyond the traditional biomedical model and entertain an expanded range of psychosocial hypotheses. In this paper the authors draw upon clinically relevant behavioral and social science research and propose several biopsychosocial hypotheses that have proven useful in the management of family practice patients. Seven illustrative case studies are presented, and some implications of this biopsychosocial paradigm for practice, research, and teaching are discussed.

Development of an instrument to identify attitudes of family practice and other physicians: a pilot study.

Research has shown that characteristic attitudes can be attributed to certain medical specialties and can affect specialty selection. The purpose of this study was to develop an attitude scale that would discriminate between family practice and other physician groups on current health care issues. From a sample of 490 randomly selected physicians, 40 percent (N = 193) responded to the study instrument, a 44-item, five-point Likert scale in which physicians were asked their level of agreement on various statements. One-way analyses of variance were performed on responses to each item by family centered nature of practice and specialty. Ten statements were found to significantly differentiate physicians who were family centered from physicians who were not family centered. Statements showed that family centered practitioners were confident in their competence and in their role as an essential medical practitioner. They also expressed more awareness of a patient's response and total well-being. Responses also suggest that there is acknowledgement of supposed family medicine issues by all physicians.

Defining family in family medicine: perceived family vs household structure in an urban black population.

This paper explores two hypotheses: first, that household structure, the people who live in one's household, and perceived family, the people one considers members of one's family, are different entities among urban black pregnant women; and second, that the perceived family is a stronger predictor of social, psychological, and health outcomes than is household structure. The study data are from the first interview of a prospective study of a consecutive sample of 140 black pregnant women patients of a Cleveland, Ohio, university hospital family practice center. The study hypotheses are supported: household structure and perceived family differ in their size and the inclusion or exclusion of members of the family of origin and the father of the baby. Household structure is strongly correlated with demographic variables such as age, socioeconomic status, and household income, whereas perceived family is less strongly associated with these measures. Perceived family, but not household structure, is associated with family functioning, measures of psychological status, worries about household change, and better family and parental relationships during the woman's childhood.

Postgraduate training in ambulatory pediatrics. Program evaluation.

Ambulatory pediatric, adolescent medicine, and child development fellowship programs listed in the Ambulatory Pediatric Association (APA) newsletter were surveyed to gather information about the programs for prospective fellows, to develop a descriptive summary, and to determine the extent to which programs adhere to APA guidelines. Number and types of positions offered, criteria for admission to programs, program educational objectives and activities, and career choice of graduates were examined for the 73 programs offering 132 fellowship positions in 1976 to 1977. In general, APA guidelines were followed. Programs emphasized patient care experience in contrast to health care administration, research, and teaching.

Continuity of care in a university-based practice.

Effects of changes in a pediatric practice--expansion of the number of pediatricians and incorporation into a university hospital setting--on continuity of care and utilization were examined by means of a longitudinal study of a sample of 63 families. Continuity of care was measured by the following index: the number of visits with own physician divided by the total number of pediatric visits per year. Although continuity of well-child visits remained unchanged at the university setting, the continuity of sick visits declined markedly. An increased use of doctor visits for illness care was observed; its relationship with the decline in continuity is analyzed and discussed. While continuity is inherent in a small partnership practice, it is not so in a larger medical organization, particularly when involvement in patient care is part time. In such an organization, deliberate arrangements that enable patients with acute needs to receive care from their own doctors are needed.

Comprehensive pediatric care: the patient viewpoint.

Two meanings of the term comprehensive care are delineated. The first refers to a wide scope of health services, the second to a humanistic approach to the patient. Findings from a sample of patients from one pediatric practice suggest that the two meanings constitute two independent variables with respect to patient expeciations. Patient responses to questions regarding their expectations of the pediatrician revealed a tendency to hold a traditional disease orientation. Comprehensive care as a broad scope of health services that include mother guidance in child rearing is not a common goal for mothers utilizing the pediatric practice under study. On the other hand, a comprehensive approach by the pediatrician is a standard shared by most respondents in the sample: high priority is accorded the pattern of the personal physician with whom a patient forms a continuous doctor-patient relationship which instills in the patient trust that the physician's recommendations are based on thorough knowledge of the patient as an individual.