Scandinavian Journal of Public Health

The purpose of the study was to determine how children's use of primary health care services was related to family resources (socio-economic status, marital and residential stability of the family, and core/periphery dichotomy). The population consisted of a random sample of 3201 children from 15 municipalities in the province of Uudenmaan Iääni in Southern Finland in 1979. Among two-parent families in the core regions total utilization of primary health care services was significantly higher among the children of workers and upper white-collar employees. Children of farmers and lower white-collar employees in the periphery exhibited low primary health care utilization. Children in upper white-collar employees' families (both two-and one-parent) in core regions frequently used private services. Among children of one-parent families, exceptionally high users of private services were children of upper white-collar mothers in core regions, and of municipal health services the children of working-class mothers in the periphery. Non-migrated children had a slight tendency to use health services more than migrated children. Differences in family resources thus cannot be ignored when children's utilization of primary health care services is studied.

A phenomenon of great concern in several Western countries is the number of patients with non-urgent ailments attending the often overloaded hospital emergency departments (EDs). With a view to providing these patients with more appropriate care, they were, in a trial at Huddinge Hospital, Sweden, advised and directed to other care facilities by a specially trained nurse.

A survey indicated that 84% of the patients who agreed to a referral followed the advice given. Referred patients were satisfied with the specific service at the ED to the same extent as were control patients receiving care according to the usual routines of the ED. Moreover, the former were more likely to have a positive general attitude towards the ED.

There was a positive relationship between improvement of presenting symptom and satisfaction with care at the ED, and between satisfaction and favourable attitude towards the ED. However, although patients were willing to engage in a primary health care oriented behaviour, they did not report improvement to the same extent as did ED treated patients and their general attitude towards primary health care facilities was not more favourable, at least not within a few weeks after referral.

The applicability of the ICD E code as a causal indicator of nonfatal injuries has been criticized. New codes have been developed to replace the ICD codes. We compared the coding reliability of the ICD E and place vs. the Nordic mechanism (M) and place codes. The mean accuracy (76 vs. 70%) (p < 0.002) and the intercoder reliability (84 vs. 69%) (p < 0.001) were better for the E than M code. The accuracy of the place codes was the same (83%). A short training improved (p < 0.001) the accuracy of all four codes. The replacement of the E code with the M code would not improve the reliability of data on causes of injuries.

In a study from northern Sweden, 139 patients with a history of a soft-tissue injury of the neck were studied. The incidence was 1 per 1000 inhabitants. Male patients in the age group 20-29 years were most commonly injuried. Traffic accidents constituted the major group with 96 (69%) and falls with 24 (17%). Forty-one cases received sickness benefit for a median time of 16 days for males and 25 days for females. Five persons were on sickleave for over a year. The calculated total cost of treatment and sickness insurance benefit was about 0.9 million SEK/year.

Over a one-year period prospectively a total of 1590 product-related accidents in the home in children (0-15 years), presented at the two hospitals, were registered in a well defined geographical area to analyze injury mechanisms, injury panorama and potential risk products. The incidence of accidents in children was 279 per 10,000 inhibitants per year. A tendency of a smaller incidence with age and a significant higher incidence in boys were found. The most common localization of lesion was upper extremities (41%) and face and skull (30%). Household furniture and constructional features of the house caused most accidents and an alarming high number of burns was registered.

Today different issues of medical ethics are in focus of the debate. A theoretical sequence starting at a “prepathogenic” level, ending in terminal care, is delineated to clarify the different characteristics of medical interventions. In this article we will discuss some ethical problems concerning interventions in the first parts of this sequence. Preventive measures at the population level are contrasted to the situation when the patient feels ill and calls for an intervention. Certain elements of paternalism are often interwoven in preventive medicine and health promotion.—The field of preventive medicine calls for a vivid theoretical and ethical discussion, which can mean better opportunities for effective prevention.

A brief summary of famine and drought from a historical perspective is given. In an attempt to estimate the magnitude of deaths due to the 1984-85 famine in Ethiopia, a survey was conducted among the resettled famine victims. The results show that the expected life at birth among the male and female famine victims was 6.2 and 5.7 years, respectively. When compared with the highest mortality rates ever recorded (that is Coale-Demeny, West Model Life Table level 1), the Ethiopian famine induced rate seems to be considerably higher. Regional variations between the two famine affected regions show that mortality in Tigrai was slightly higher than that of Wello. Also prefamine socio-economic differentials between households did not seem to have an effect on mortality. The results suggest that as much as 700,000 excess deaths might have occurred during the 1984-85 famine period in Ethiopia.