[Sexual medicine in primary care--development in the years 1980-1990-2004]. / Sexualmedizin in der ärztlichen Grundversorgung: Entwicklungen 1980-1990-2004.

Sexual disorders are common in community samples. Even so these problems are not often addressed by primary care physicians. In 1980, 1990, and 2004 three cohorts of primary care physicians in the German speaking part of Switzerland were asked to answer a questionnaire on the prevalence of sexual problems and disorders in their patients and their knowledge in sexual medicine. The prevalence of sexual disorders in primary care is underestimated by primary care physicians. Female doctors and female patients address sexual problems more often than male doctors and patients. Lack of sexual interest and erectile dysfunction are the most frequent sexual disorders in primary care. In 2004 the participating doctors assess their knowledge in sexual medicine at a higher level compared to 1980. The training of primary care physicians in primary care should further be improved.

[Suspected fetal malformation in ultrasound examination: The partner's distress and attitudes towards ultrasound. Technology]. / Verdachtsdiagnose einer fetalen Entwicklungsstörung im Ultraschall: Gefühle und Einstellungen zur Ultraschall-Technologie aus Sicht der Partner.

AIM: The involvement of fathers in the preparation for birth was a major progress in modern obstetrics. The present study investigates how fathers evaluate the ultrasound examination during pregnancy and how much they are stressed by the diagnosis of a possible fetal developmental disturbance. METHOD: In a specialized ultrasound center at the University Hospital in Zurich 54 couples who came in with the diagnosis of a possible fetal developmental disturbance were interviewed for their emotional stress and attitudes towards ultrasound examinations during pregnancy. RESULTS: Levels of state anxiety were significantly above the norm for both men and women. However, male partners felt less stressed and experienced less anxiety than the pregnant women. Men were also more optimistic about the health status of the unborn baby. There were no differences in attitudes towards ultrasound examination between women and their male partners, however, men rated their experiences with ultrasound examinations more critical and knew less about it. The support of ultrasound as a routine examination method during pregnancy was high in both sexes. CONCLUSION: The diagnosis of a possible fetal developmental disturbance is a big emotional distress for pregnant women and the fathers of the baby. It does not result in a negative attitude towards ultrasound examination, though.

[Psychosomatic research in primary health care--ideal concept and reality]. / Psychosomatische Forschung in der Grundversorgung--idealvorstellungen und Realität.

UNLABELLED: The cooperation between research institutions and primary care doctors can be seen as a possible model for practical research in psychosomatic medicine. Cooperation experience with a study in the field of sexual medicine are reported as well as recommendations regarding the planning and implementation of similar studies are given. 7455 Swiss physicians specialized in psychiatry, internal or general medicine were asked to fill out a survey on "sexual dysfunction and anti-depressants". They were also asked if they were willing to interview their patients on the same issue. 1100 physicians agreed to answer the doctors survey and 62 were interested in interviewing their patients. However, only 12 physicians actually did. In 55 telephone interviews doctors mentioned as their main reasons for not participating: lack of time and their hesitation to discuss sexual issues with depressive patients. CONCLUSION: The collaboration in research projects means a considerable effort on the side of primary care doctors. Therefore, their cooperation should be rewarded appropriately, e.g. time could be counted as further training.

[Ultrasound examinations in the context of suspected fetal malformations: satisfaction of concerned women and their appraisals]. / Die Ultraschall-Untersuchung bei Verdacht auf fetale Entwicklungsstörungen: Zufriedenheit und Bewertungen aus Sicht der betroffenen Frauen.

UNLABELLED: BACKGROUND AND RESEARCH QUESTIONS: Fetal malformations can be detected at an early stage during pregnancy by today's ultrasound technology. This study examined how pregnant women appraise the application of ultrasound technology when a fetal malformation is suspected and how this appraisal is influenced by the confirmation or rejection of the diagnosis and by the subsequent course of the pregnancy. METHOD: In a prospective study 86 pregnant women for whom a fetal malformation had been suspected in an ultrasound examination were assessed at three points in time: before the ultrasound examination at a specialized centre, one to two weeks after the examination, and four weeks after giving birth or after the premature termination of pregnancy. Assessments were conducted by means of questionnaire and semi-structured interviews. RESULTS: 96.4 % of pregnant women advocated routine ultrasound examinations, irrespective of whether the suspected malformation was confirmed or not and irrespective of whether the pregnancy was continued or terminated prematurely. The women rated as being most important the medical goals of the examination (e. g. determination of the child's health status) and less so the subjective and personal goals (e. g. visualization of the child). Communicative competence in the context of the examination (e. g. quality of information) were judged less favourably than technical competence (e. g. performance of the exam). 94.2 % of the women believed that the cost of the ultrasound exam should be carried by health insurances. DISCUSSION: The findings of the study show the strong significance which prenatal ultrasound examinations have for pregnant women. Acceptance of ultrasound technology is high even when the examination results cause psychological stress. However, they also indicate that more attention should be given to aspects of communication and interaction in training and application of ultrasound technology.

[Suspected fetal malformation in ultrasound examination: effects on the psychological well-being of pregnant women]. / Die Verdachtsdiagnose einer fetalen Entwicklungsstörung in der Ultraschall-Untersuchung: Auswirkungen auf das psychische Befinden schwangerer Frauen.

OBJECTIVE: Today's ultrasound technology permits the detection of foetal malformations during pregnancy. This study examined pregnant women's psychological responses to a suspected fetal anomaly and the subsequent course of psychological well-being. METHOD: 86 pregnant women with a suspected fetal malformation were assessed by means of questionnaires three times: before an ultrasound examination at a specialized centre, one to two weeks after the examination, and four weeks after giving birth or after premature termination of the pregnancy. Anxiety (STAI), depression (HADS-D) and feelings towards the child were assessed. RESULTS: A suspected fetal malformation results in psychological stress with anxiety and depression levels significantly higher than in normal samples. Regardless of either confirmation or rejection of the diagnosis of a malformation, stress decreases significantly after the ultrasound examination at the specialized centre. Only women who decide to terminate the pregnancy prematurely show increasing levels of stress in this period. Four weeks after giving birth or termination of pregnancy the assessed psychological parameters of all participants fall within the normal range. CONCLUSIONS: A suspected fetal malformation results in immediate psychological stress but not in an enduring psychological disorder. Women facing immediate premature termination of pregnancy exhibited the highest stress levels. The psychosocial distress caused by the diagnosis of a fetal malformation should be taken into consideration in the psychosocial consultation and treatment of concerned women and their partners.

[Communication competence in ultrasound examination in pregnancy]. / Kommunikative Kompetenz bei der Ultraschalluntersuchung in der Schwangerschaft.

INTRODUCTION: 293 physicians in the German-speaking part of Switzerland were questioned about their practices of providing information during prenatal ultrasound examinations. Physicians were asked both how they provide information about the examination procedure itself as well as how they inform the pregnant woman if a fetal anomaly is detected. METHOD: In January 2000, a questionnaire was mailed to a sample of 500 physicians with a specialized qualification in pregnancy ultrasound examinations. The response rate was 59.2%. RESULTS: 90.1% of the physicians reported that they offer information consultations for routine ultrasound examinations. 50.2% mentioned in their answers to an open question that the screening for fetal anomalies is a component of their consultation. Female physicians mentioned this aspect significantly more often than male physicians. Regarding difficulties in the communication of a diagnosis of fetal malformation, the physicians reported most frequently the excessive strain on the pregnant woman, but also their own feelings of helplessness. The subjective emotional stress was considered as high; female physicians with experience of motherhood reported the highest levels of stress. CONCLUSIONS: Screening for fetal anomalies is a difficult and often neglected subject when providing information on prenatal ultrasound examinations. The communication of the diagnosis of a fetal anomaly is not only emotionally stressful for the parents, but also for the physicians and requires high levels of communication competence. These communication aspects should be considered in the training for ultrasound examinations during pregnancy.

[Psychological aspects of ultrasound examinations during pregnancy]. / Psychologische Aspekte der Ultraschalluntersuchung während der Schwangerschaft.

The acceptability of ultrasound examinations during pregnancy has been documented in many studies. Yet there is little empirical evidence for the postulated psychological benefits of ultrasound examinations. Although seeing the baby is most often rated as a moving experience, there are no proven long-term effects of ultrasound visualization on bonding with the fetus or on pregnant women's health-related maternal behaviour. There is evidence to support the notion that attenuated anxiety and stress immediately following the examination are likely artefactual - a reflection of increased anxiety before real-time scan. Review of the literature indicates no evidence as to whether antenatal detection of fetal abnormalities leads to improvement in coping or only prolongs the phase of psychological stress and mourning. This articles provides an overview of current research on psychological effects of prenatal ultrasound examination.