Who provides health care to children and adolescents in the United States?

Face-to-face visits by children and adolescents in office-based practice in the mid-1970s were studied. Pediatricians, family physicians, and general practitioners accounted for 35%, 6%, and 30%, respectively, of all child visits. Although 40% to 45% of preventive and medical encounters were with pediatricians, only 12% of visits for minor surgery, 20% of visits for psychosocial problems, and 9% of visits for combined medical-surgical reasons were to pediatricians. Only in very young children did pediatricians provide a substantial proportion of care for each of the types of visits. For some common diagnoses (acne, refractive error) most care was provided by specialists other than primary care specialists, but less than 16% of all preventive care visits (including routine eye examinations) was provided by specialists other than primary care physicians. A substantial proportion of the prenatal care and management of minor trauma was provided by family physicians and general practitioners. Although the limitations of the study (including an average response rate of 55%, exclusion of certain specialties and institutional physicians, sampling at different times of the year, lack of control for area of location of practice, and lack of information about response rates of different types of physicians within each specialty) preclude definitive conclusions, the findings raise important questions for future study.

Treatment of hypertension in pregnancy by relaxation and biofeedback

In a study of the effectiveness of systematic relaxation training alone or combined with biofeedback in the treatment of hypertension in pregnancy, 60 women were seen weekly for 6 weeks. 18 were given relaxation therapy alone (group A), 18 relaxation plus biofeedback (group B), and there were 24 controls. Whereas two-thirds of the control group had to be admitted to hospital during their pregnancies, less than a third of each experimental group had to be admitted. The experimental groups also had significantly lower systolic and diastolic blood pressure than the control group. There were no significant differences between groups A and B in hospital admission rates or blood-pressure measurements.

Morbidity in childhood--a longitudinal view

We examined all the morbidity experienced in a six-year period by a total of 2591 children who were continuously enrolled in a prepaid medical plan. The children had received 19,291 diagnoses, each of which was assigned to one of 14 types of morbidity, and the frequency of each type was determined. Although the typical child had at least one problem in 5 of the 14 types of morbidity in the six-year period, over 20 per cent of children had at least 8 different types of problems during that time. Children with a greater variety of acute problems and more frequent acute problems were also more likely to have nonacute problems during the six-year period. Conversely, children with nonacute problems had more acute problems than other children. Our findings indicate that morbidity, like use of health services, occurred in clusters in this population of children. Therefore, an understanding of the cause and projected outcome of morbidity among children will be incomplete if the focus is only on specific diseases or specific types of illnesses.

Preventive care and overall use of services. Are they related?

The relationship between the use of services of children constantly enrolled in a prepaid group practice medical plan for six years and the completeness of their preventive care were examined. Children who were consistently low users of services were more likely to be lacking one or more components of standard preventive care, particularly general health assessments in older children and vision, hearing, and tuberculosis screening in younger children. Teenage children who were low users were at some risk of not receiving their tetanus-diphtheria immunization on time. The relationship between low use of services and incomplete preventive care persisted after controlling for the severity of morbidity, although children with more severe morbidity were somewhat less likely to be missing preventive care. Health facilities and practitioners should pay special attention to assessing the need for standard preventive care in children who are infrequent users of services.

Comparisons between inner-city and private school adolescents' perceptions of health problems

A youth health survey was administered to 247 students in an inner-city ghetto high school and 404 students in a private boarding school. Significant differences between the two socioeconomic groups were found for responses about health information, health concerns and problems, and health status and service utilization. Sex-related issues were of greater concern to the private school youth and they desired more help with depression-sadness and birth control. Inner-city youth had more health worries and indicated a desire for more help with physical problems such as toothaches, headaches, and stomach aches, and social problems such as racial discrimination and parent relations. From a list of 22 health problems, the inner-city youth ranked dental problems, acne, and health worries highest while the private school youth ranked depression-sadness, tiredness, and acne highest. Regardless of social class, most adolescents perceived large gaps in their health education. One implication of our data is that the specific self-reported needs and concerns of adolescents should be considered in planning health services and education programs.

Psychophysiological ante-natal predictors of post-natal depressed mood

Forty-seven women were studied during the course of pregnancy in an attempt to predict which of them would later rate themselves as suffering from depressed mood post-natally. Psychometric and physiology measures were used in the three trimesters of pregnancy and six weeks after birth. The psychometric measures used ante-natally and post-natally comprised the Hostility and Direction of Hostility Questionnaire, and Locus of Control Scale, the DSSI/SAD sub-scale to measure anxiety, and the Zung Self-Rating Scale to measure depression. Psychophysiological measures used water heart-rate and blood pressure. Post-natal ratings of depression were associated with a high ante-natal score on overall hostility. Women with high anxiety and hostility ratings had a more pronounced response to the sound of a baby crying than to noise of similar frequency and intensity. This more pronounced heart response was also related to later post-natal depression ratings. However, by far the most useful predictive measure was the Hostility and Direction of Hostility Questionnaire: its predictive power in the first trimester of pregnancy was almost as good as in the third trimester.

On hemispheric differences in evoked potentials to speech stimuli

Eight subjects listened to lists of speech sounds (pa or ba) or pure tones (250 or 600 c/sec). Within each list one of the sounds (the "frequent") occurred more often than the other (the "target") in a ratio of approximately 4:1. Subjects were required to count the targets in each list; concurrently, evoked responses to both targets and frequents were being separately averaged from electrodes at vertex at symmetrical left and right parietal locations. The evoked responses show the expected sequence of deflections at all three electrode sites, including large P3 waves (about 350 msec latency) to the target stimuli. However, the left and right hemispheric responses to speech or tones, either frequent or target, were strikingly similar, both to the eye and by statistical tests intended to reveal differences between them.