Biomedical subjects
Publications and source records attributed to D J Soule.
During the 1981-1982 academic year a study was undertaken to assess medical students' opinions on various occupational/personal/demographic issues. Results demonstrated that a typical USD School of Medicine student was family medicine oriented, wanted to enter private practice, and viewed his/her calling into medicine as primarily altruistic in nature.
This study examines the responses experienced in the perinatal period by parents who have had an infant subsequent to a stillbirth. Interview findings from eight couples in a stillbirth study group (SSG) who had this experience and eight couples in a comparison group (CG) whose live-born children were delivered at similar time intervals as the SSG were compared. In contrast to a comparison group, half of the SSG mothers did not make preparations for their babies until after delivery and seven of eight SSG mothers wanted the hospital staff to recognize their previous loss and give them special understanding. The parents in the SSG reported that because of their loss, they were likely to spend more time (p less than 0.01), to be more attentive to fussing (p less than 0.01), and to hold their babies more (p less than 0.01). Over half of the SSG parents also noted that after having another baby, they experienced greater relaxation, happiness, and closeness with their spouse. After their subsequent baby, the SSG parents observed that thinking about the stillbirth was easier, but resented being told by others to feel grateful.
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The emotional responses of eight families who lost a singleton newborn were compared with those of eight families who lost a twin. The mean gestational age of the babies in both groups was 31 weeks. At a mean time of 15 months following their loss, parents were sent a questionnaire which requested that they report their responses during the first six weeks following their baby's death and their present response to this experience. Embedded in the questionnaire was a 20-item depression symptom inventory. Analysis of variance indicated that although mothers experienced significantly more depressive symptoms than fathers (F = 59.48, P = .001) and that all symptoms had diminished greatly over time (F = 6.02, P = .032), there was no significant difference between the parents who had lost a twin and those who had lost a singleton. However, family, friends, and hospital staff frequently ignored or downplayed the death of the twin assuming that the grief of the parents would be minimal because of the surviving twin. Results of this study indicate that the presence of a living twin in no way lessens the grieving process and that a conscious effort needs to be made to allow parents to express openly their feelings of loss when a twin dies.
A stillborn baby represents a unique loss because parents must mourn fantasies of an anticipated newborn rather than memories of a shared experience. A self-help group can facilitate parents' mourning process following a stillbirth. With family-to-family contact and group discussions, the reality of the stillbirth is validated, the empty feelings of the loss the parents are experiencing are acknowledged, and the guilt the couples are feeling is eased. Reports from parents indicate that restoration of hope for the future and improved marital communication are the most beneficial aspects of their participation in the group. The phases of mourning described by Bowlby and Parkes have been observed in the group studied here as over time the parents resolved their loss and reoriented their lives.
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This study indicates that for these patients studied from Johnson County, Iowa, the County Home residents have more unmet basic dental needs than do patients from Goodwill Industries or Community Action programs. The mean cost of treating the dental needs of a County home resident was found to be approximately twice that of providing dental services to the other two social service agencies. This cost differential comes about as a result of two major factors: (1) the County Home residents seen have more unmet basic dental needs, and (2) they have proportionately more unmet dental needs in specialty areas that cost more per unit of treatment (i.e. periodontics, fixed prosthodontics, and removable prosthodontics). The mean treatment cost per patient seen from each of these agencies is $851.77 for County Home residents, $407.97 for Goodwill Industry clients, and $341.21 for Community Action clients. A follow-up of this study in regard to specific circumstances that contribute to the higher incidence of dental treatment needs of the Johnson County Home residents is recommended. Such additional information would be helpful to the effective design of dental health programs for implementation at the community level.
A flow chart (illustration) depicts the delivery process whereby county home residents either receive or do not receive dental treatment. Also included are the major findings of the survey, given in triangles A, B, and C. The initial step involved in this delivery process is that of recognizing a need. If the need is not recognized, it remains unmet and the patient receives no treatment (terminate). If the need is recognized, a treatment decision is required. If the decision is negative, the need remains unmet and the patient receives no treatment. If the decision is positive, the patient proceeds toward the goal of receiving dental treatment. However, potential delivery problems exist and the patient may have to overcome one or more of these before proceeding toward the goal. If problems do exist and are not resolved, the patient either does not receive treatment or treatment is delayed until satisfactory solutions are found. The first finding, A, shows that more than 72% of dental needs were identified because of some dental emergency experienced by the patient, 39.3% of needs were identified through routine checkups, 16.4% by a county home requirement, 14.8% through a state requirement, and 4.9%, "other." The second finding, B, shows that the county home steward makes the decision about whether dental treatment should be rendered in more than 85% of the homes. Physicians made 54.1% of the dental treatment decisions; nurses, 31.1%; dentists, 26.2%; patients, 24.6%; patient's family, 13.1%; supervisor or trustee, 4.9%; and "other," 3.3%. The third finding, C, represents delivery problems. More than 44% of the stewards said that the patient's mental or physical disabilities were a delivery problem; 39.3% indicated availability of dentists; 36.1% said reluctance of patient; 19.7% responded inadequate funding; and 14.8% indicated "other." A hypothetical county home resident can be dentally characterized as an emergency patient whose need for treatment is determined by a county home steward, and the main problem in obtaining treatment, according to the steward, is the patient's own inability to receive treatment because of mental or physical disabilities, or both.
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