This paper is a provisional report from an ongoing field experiment in Uppsala, Sweden, with the aim to reduce the number of serious childhood accidents. Groups of parents have been systematically trained to function as child-environment supervisors. The experiences have been very positive so far. The child-environment supervisors have proved to possess good knowledge about how to prevent accidents. A large number of hazards have been detected and successfully eliminated. The groups are now taking an active part in the planning of new housing estates. The findings also indicate that the Child Health Organization should be able to play a more active role in the work of environmental improvement for the safety of children. A suggestion for a collective strategy for such activity has been worked out.
The Danish children's oral health care service has been so successful in achieving its objectives that it will need to change and adapt in order to survive. It is suggested that the service should gradually become community-based rather than child-based. This process can be commenced by introducing treatment for the elderly, the handicapped and the indigent, converting the school clinics to municipal oral health units. Although it is important that private practice is maintained, private dentists should be encouraged to work in the system part-time, leading teams of supporting auxiliary personnel trained within an integrated system. Eventually, the facilities could form the basis of primary health care centres. The lessons to be learnt from the Danish experience have a wider application to other countries. In developing countries it is obvious that they should first place limited dental resources into public health prevention and only invest in expensive treatment clinics as funds become more available. Manpower planning should ensure that personnel are not overtrained for the needs of the community. In developed countries, increasingly more resources will need to be channelled into adult dental care, and dental education must lead the profession into this new era. Difficult though these changes will be, the stable relationships that have developed between the various arms of the service under the guidance of the Danish Dental Association, will ensure that the profession will survive and flourish for the benefit of the Danish people.
OBJECTIVE: To study factors of importance for infants' use of health and medical care. DESIGN: We studied the medical records of the mother during pregnancy (at the health centre, at the antenatal clinics, and at the department of obstetrics and gynaecology) and of her infant during the first 18 months of life (at the health centre, at the child health clinic, and at the departments of paediatrics and oto-rhino-laryngology). We also interviewed the mother when her infant was 18 months old. SETTING: Teleborg health centre, Växjö, southern Sweden. SUBJECTS: 206 infants and their mothers. MAIN OUTCOME MEASURES: Medical visits, to doctor or district nurse, during the infants' first 18 months of life, and factors of potential importance for those visits. RESULTS: A stepwise linear multiple regression analysis showed that the following factors were of importance for the infant's use of health and medical care: number of mother's visits to the health and medical services during pregnancy, mother being a primipara, and mother being a blue-collar worker. The model (12.98 + 0.52* (no. of mother's visits) + 2.19 (if primipara) + 1.48 (if blue-collar worker)) was able to explain 8.6% of the number of infant's visits. CONCLUSION: The studied factors explained only a minor part of the infants' use of health and medical care.
The aim of this study was to evaluate some aspects of care given within the preventive Child Health Services (CHS) during the first 18 months of life. A national random sample performed on child health records of 172 Swedish preschool children born between 1982 and 1987 was analysed regarding services recorded as having been provided and used within and beyond the national programme of health surveillance. Most families had made visits within the core programme of health surveillance to an optimal or at least sufficient extent. First-time parents visited the CHS more frequently than did more experienced parents. Procedures within the programme, such as growth monitoring, hip examination and immunizations, were documented to have been optimally performed on a majority of the children. Conversely, screening for hearing impairment and assessment of developmental milestones were performed less frequently, as were health information and postnatal parental education. To improve the quality of care, national recommendations ought to be more specific regarding both the performance and the documentation of the service.
To obtain baseline data on the health status and use of health services of children exposed to violence in their families.
The study used data from the first cycle of the National Longitudinal Survey of Children and Youth (1994/95). According to parental reports, 8.6% of children (n = 1,648; representing 329,657 children) aged 2 to 11 years witnessed some violence in their families. They were compared to children who were reported to have never witnessed any violence at home.
Children exposed to domestic violence had lower health status and more conditions or health problems which limited their participation in normal age-related activities than children in non-violent families. Despite this, they had no more contacts with family practitioners in the previous year and even fewer contacts with pediatricians than comparison children. They did, however, have more contacts with "other medical doctors," public health nurses, child welfare workers, and other therapists than comparison children. In addition, more child witnesses regularly used prescription medication than children not exposed to violence at home.
These baseline findings suggest that exposure to domestic violence has an adverse impact on children's health and use of health services. As future cycles become available, these children will be followed to determine the long-term impact on these outcomes.