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To examine obstetrician-gynecologists' knowledge, opinions, and practice patterns related to cesarean delivery on maternal request.Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents' demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request.About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics.Most obstetrician-gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request.III.

The purpose of this study was to determine the management of postterm pregnancy by contemporary practicing obstetricians. A questionnaire investigating practice patterns pertaining to postterm pregnancy was mailed to 1000 randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in March 2004. The response rate was 52.2% (522/1000). Statistical analysis included the answers from the 420 practicing obstetricians. Males comprised 55.7% (234/420) of the responding obstetricians. The majority of responding obstetricians (95.4%) rated their residency training regarding management of postterm pregnancy as adequate or comprehensive. Forty-eight percent define postterm pregnancy as 42 weeks gestation or greater, whereas 43.1% consider 41 weeks gestation or greater to be postterm. Seventy-three percent routinely induce low-risk patients with singletons at 41 weeks gestation. If patients decline induction at 41 weeks or if the practitioner does not induce patients until after 41 weeks gestation, the majority of respondents (64.8% and 65.0%, respectively) start postterm pregnancy fetal testing in singletons at 41 weeks and obtain testing twice weekly. Most (64.6%) use cervical ripening agents when inducing both nulliparous and multiparous patients with unfavorable cervices. The majority of practitioners (97.3%) do not use prostaglandins when inducing postterm patients with one previous cesarean delivery. Although most respondents manage postterm pregnancy according to recent ACOG educational materials with regard to antenatal fetal surveillance and methods of induction, the majority induce patients with singleton postterm pregnancies at 41 weeks gestation rather than at 42 weeks gestation.

Obstetrician/gynecologists' career satisfaction with certain work-related activities was examined among clinicians who perform deliveries and clinicians who do not.A questionnaire was sent to 1500 member-fellows of the American College of Obstetricians and Gynecologists; 842 members (56%) responded. The questionnaire was designed to distinguish between obstetrician/gynecologists who perform deliveries and clinicians who do not in the areas of satisfaction with specific aspects of career and work-related activities. Data were examined initially by multivariate analysis of variance and subsequently by univariate analysis of variance if the multivariate test was found to be significant.Workload and personal control were the primary factors for which there was a significant difference in satisfaction between clinicians who perform deliveries and clinicians who do not (P.001). Obstetrician/gynecologists who do not perform deliveries reported working significantly fewer hours per week (P.001) and had more satisfaction with their work activities than the delivery group overall. Despite lowered satisfaction with certain career aspects among the delivery Group, the highest positive disposition ratings that was given by respondents were for surgery, vaginal delivery, and planned cesarean delivery, with gender differences observed in the level of disposition for these particular activities. The most negative rating was reported for on-call/in-hospital time.Although positive disposition is associated with the activity of vaginal and cesarean delivery overall, 2 primary contributing factors of dissatisfaction that were identified among obstetrician/gynecologists who perform deliveries were increased workload and decreased personal control.

Objective To estimate the current cervical cytology screening practices of American College of Obstetricians and Gynecologists (ACOG) Fellows, to establish a baseline for tracking future changes in practice. Methods Questionnaires were mailed to a random sample of ACOG Fellows (n = 599) and to a group of Fellows who have regularly participated in past ACOG surveys (n = 409). The questionnaires asked about current cytology screening and evaluation practices and presented clinical practice vignettes with additional questions. Descriptive statistical methods were used to evaluate the responses. Results Questionnaires were returned by 651 physicians (64.6%); 624 were complete. More than 94% of the respondents start cytology testing at age 18 years. Almost three fourths (74.2%) continue screening indefinitely. More than 80% use a liquid-based method of collection. Almost two thirds (65.1%) order human papillomavirus testing occasionally, usually (81.9%) for reports of atypical squamous cells of undetermined significance (ASCUS). Most Fellows in the sample perform colposcopy for an ASCUS result. Reports of atypical glandular cells resulted in variable approaches to further evaluation. Patient age and history were important variables for all test reports. Legal concerns were mentioned as important determinants of practice patterns. Conclusion In this sample of ACOG Fellows, most perform cervical cytology and evaluate abnormal results in accord with guidelines in place before the recommended changes in screening and evaluation were published in 2003.

OBJECTIVE: To investigate the impact of career pressures on career satisfaction and satisfaction with job-specific activities among obstetrician- gynecologists. METHODS: A questionnaire was sent to 1,500 member-Fellows of The American College of Obstetricians and Gynecologists in June 2001. The analyses were designed to examine the relationship between career pressures in 3 domains on clinicians' professional satisfaction. RESULTS: Overall career satisfaction and satisfaction with job-specific activities were both inversely related to the perceived impact of career pressures. The major impact reported was that liability insurance costs would shorten the duration of the members' careers. Managed care had less impact than liability, with moderate concern surrounding the limitation of diagnostic and treatment options. Obstetrician-gynecologists were less satisfied with their careers and job-specific activities if they believed the cost or time of obtaining continuing medical education requirements to be a burden. CONCLUSION: Career pressures produced by liability insurance costs have more negative impact on clinicians' satisfaction with their professional lives and job-specific activities than managed care and requirements for continuing medical education.

A controversy exists regarding the classification of nonorganic failure to thrive within the psychiatric nomenclature. There are a number of DSM-III-R diagnoses that may be applied to NOFTT, including Reactive Attachment Disorder of Infancy (RADI) and Major Depressive Disorder (MDD). The behaviors characteristic of NOFTT are symptomatic of depression, and are similar to those exhibited by infants with anaclitic depression as well as those of the adult with depression. The correspondence of the behaviours of NOFTT and the DSM-III-R criteria for Major Depression are reviewed, as are the conceptual and therapeutic reasons to view NOFTT infants as suffering from Depression.

Research on ethnic group differences has suggested that (a) adolescents from various groups differ on a number of dimensions that have been related to risk for substance use initiation, and (b) adolescents of different groups choose different substances. However, there is little consensus regarding the reasons for such differences. There is an especially high rate of alcohol use among Hispanic adolescents, and Hispanics are at high risk for alcohol abuse. In light of ethnic group differences in both substance use and the precursors of substance use in adolescence, this study examined differences among black, Anglo, Puerto Rican, and Dominican adolescents in the relation between cigarette and alcohol use and psychosocial functioning. Comparisons between the Puerto Rican and Dominican subjects were of special interest due to preexisting differences between these groups that may be attributed to acculturation. Results provided evidence of the importance of acculturation in modifying psychosocial vulnerability, especially for alcohol use, with the Dominican group at highest risk.

This article combines a review and meta-analysis of research on IQ in schizophrenia, with emphasis on areas of convergence in the findings, as well as questions that remain to be answered. Taken together, the findings suggest that early-onset and adult-onset schizophrenia are associated with intellectual deficits across the lifespan. Preschizophrenic children, adolescents, and young adults perform below matched controls on a variety of standardized measures of intelligence. Significant IQ deficits are also apparent after the onset of the disorder. Moreover, IQ is positively related to several indices of prognosis, and, among hospitalized patients, there is negative within-subject covariance between intellectual performance and symptom severity. Although there is fairly consistent evidence that Verbal IQ is higher than Performance IQ among schizophrenic patients, a more specific pattern of subtest performance is not apparent. A central question raised by the results is whether IQ is an independently determined factor that can serve to mitigate the vulnerability of individuals who are constitutionally predisposed to schizophrenia, or whether intellectual deficit is one manifestation of the constitutional predisposition to the disorder. The findings also raise the question of possible sex differences in the developmental determinants of schizophrenia: Meta-analyses revealed that premorbid IQ deficits are more prevalent among males than females.

Sixty-six adults wrote essays describing the two worst events that had occurred to them during the preceding year and then completed the short-form of the Beck Depression Inventory (BDI). Causal explanations for bad events were extracted from the essays and rated by judges for internality (vs externality), stability (vs instability) and globality (vs specificity). Ratings were consistent across different attributions made by the same individual. Further, the internality, stability and globality of these unprompted attributions correlated with depressive symptoms as measured by the BDI. Taken together, the results support the attributional reformulation of the learned-helplessness model of depression.

In adulthood, depression is often accompanied by suicidal ideation or behavior. As a result, depression in adults is generally viewed as a sign of risk for suicide. However, according to a number of researchers, suicidal behavior in children and adolescents differs markedly from that in adulthood. Differences have been noted in frequency, gender distribution, and associated symptoms. This study examined age and gender differences in symptoms accompanying suicidal gestures and ideation in black children, aged 11–18, referred for psychiatric treatment. Results indicated that a difference exists in the types of symptoms associated with suicidal ideation as opposed to suicidal acts, and that these differences vary, depending on the age and gender of the child. Moreover, the findings indicate that depressed mood and other “internalized” symptoms are more common among disturbed children who manifest suicidal behavior than among those who do not.