John Kosa

The types of families that use an emergency clinic.

UTILIZATION of hospital emergency clinics is increasing constantly. At the Childrens Hospital Medical Center, for example, use of the emergency clinic has grown in ten years from 4,500 visits per year (1957) to more than 50,000 visits per year in 1967. The lack of available physicians in the community, the increase in insurance coverage for hospital emergency room visits, the constant availability of the emergency service, and the use of the emergency service by the physician are suggested explanations for this increased use.4 Not all families, however, use the emergency clinic for the same reasons or with the same degree of consistency. Some use it for true emergencies, others as a

On the reliability of family health information. A comparative study of mothers' reports on illness and related behavior.

Abstract Mothers, when questioned on various aspects of the health of the family unit or on the same aspect at different time periods, tend to give meaningful but not consistent information. Evidently they apply a selective censorship on each occasion, separate the reportable data and suppress the others. This censorship is affected by the norms of medical relevance and social desirability as well as the time-related variations in actual morbidity.

Use of the telephone by low-income families.

The telephone is essential to any pediatric practice. This report analyzes the behaviorof a group of low-income families participating in a comprehensive care program in terms of their use of the telephone to seek medical care or advice. These families used the telephone appropriately and in a pattern similar to that seen in a middle-class private practice.

Unnecessary and preventable hospitalizations: Report on an internal audit

In an internal audit of admission policy, 120 consecutive daily hospitalizations in a pediatric medical center were analyzed and the incidence of unnecessary and preventable admissions systematically ascertained. Two independent medical judges rated 2.5 per cent of the admissions as unnecessary, with an additional 15.8 per cent as of doubtful necessity, whereas almost 20 per cent of the admissions were rated as preventable. Unnecessary and questionably necessary hospitalizations occurred more frequently among patients having private physicians, suffering from chronic illness, and being admitted for diagnosis or on a scheduled basis. Preventable hospitalizations occurred more frequently among patients with lengthy illness prior to hospitalization, among patients of private practitioners, and those referred for scheduled admission. The role of internal audit and other recommendations are discussed.

Public knowledge of ipecac syrup in themanagement of accidental poisonings

Information given during a Poison Prevention Week increased the knowledge of and the willingness to use ipecac syrup but not the actual possession of the drug. Distribution by physicians significantly increased possession. There is need for the development of programs which will secure the interest and participation of the practicing physician.

Causal Locus of Illness and Adaptation to Family Disruptions

The hypothesis is tested that in special conditions religious beliefs can function as a stablizing force on personal and social systems. The sample was drawn from an urban hospital population, using criteria that produced a largely low-income sample of mothers. The data show that under the conditions of heightened psycho-situational stress and limited resources for adaptation, mothers who located causality of illness in God, in contrast to those who viewed illness as naturalistically determined, were more likely to report a marginal rather than a difficult or a smooth adaptation to family disruptions during illness. Theoretical implications of these findings are discussed.