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Objective: When counseling women experiencing intimate partner violence (IPV), healthcare providers can benefit from understanding the factors contributing to a women's motivation to change her situation. We wished to examine the various factors and situations associated with turning points and change seeking in the IPV situation. Methods: We performed qualitative analysis on data from 7 focus groups and 20 individual interviews with women (61 participants) with past and=or current histories of IPV. Results: The turning points women identified fell into 5 major themes: (1) protecting others from the abuse=abuser; (2) increased severity=humiliation with abuse; (3) increased awareness of options=access to support and resources; (4) fatigue=recognition that the abuser was not going to change; and (5) partner betrayal=infidelity. Conclusions: Women experiencing IPV can identify specific factors and events constituting turning points or catalyst to change in their IPV situation. These turning points are dramatic shifts in beliefs and perceptions of themselves, their partners, and=or their situation that alter the women's willingness to tolerate the situation and motivate them to consider change. When counseling women experiencing IPV, health providers can incorporate understanding of turning points to motivate women to move forward in their process of changing their IPV situation.

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Neuritic plaques are the histologic hallmark of Alzheimer's disease (AD); however, the extent to which they are injurious to neurons is unclear. In order to investigate this problem, we intracellularly filled human dentate granule cells with Lucifer yellow in a lightly fixed slice preparation and studied the relationships between their dendrites and neuritic plaques. After counterstaining for plaques and drawing the filled granule cell dendrites, we found that there were significant differences in the morphology of dendrites in control and AD cases; granule cell dendrites from Alzheimer's cases were generally shorter, branched less profusely, and had fewer spines than those from age matched controls. Surprisingly, when dendrites traveled into plaques, they still bore spines and their morphology was distinct from that of the amyloid-stained dystrophic neurites surrounding them. Furthermore, within AD cases we found no significant differences between dendrites that were located directly beneath or passing through plaques and those that were located in plaque-free regions. We conclude that granule cell dendrites are not an integral component of plaques within their dendritic fields and that neuritic plaques have no direct effect on granule cells in the dentate gyrus.

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OBJECTIVE: To measure and compare patient satisfaction with care in resident and attending physician internal medicine ambulatory care clinics. DESIGN: A cross‐sectional survey using a questionnaire derived from the Visit‐Specific Satisfaction Questionnaire (VSQ) and Patient Satisfaction Index (PSI) distributed from March 1998 to May 1998. SETTING: Four clinics based at a university teaching hospital and the associated Veterans' Affairs (VA) hospital. PARTICIPANTS: Two hundred eighty‐eight patients of 76 resident and 25 attending physicians. RESULTS: Patients of resident physicians at the university site were more likely to be African American, male, have lower socioeconomic status and have lower physical and mental health scores on the Short Form‐12 than patients of university attendings. Patients of resident and attending physicians at the VA site were similar. In multivariate analyses, patients of university attending physicians were more likely to be highly satisfied than patients of university residents on the VSQ‐Physician (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.8) and the PSI‐Physician (OR, 10.1; 95% CI, 3.7 to 27.4) summary scores. Differences were not seen on the summary scores at the VA site. Two individual items displayed significant differences between residents and attendings at both sites: “personal manner (courtesy, respect, sensitivity, friendliness) of the doctor” (P≤ .03 at both sites) and “my doctor always treats me with the highest respect” (P < .001 at both sites). CONCLUSIONS: After controlling for patient characteristics, patients of resident physicians were less satisfied than those of attending physicians, especially in regard to the doctor's personal manner and respect toward the patient. Medical education should continue to emphasize the importance of these aspects of the physician‐patient encounter.