Table Of ContentPrimary Health Care
in the Making
Edited by
Ulrich Laaser Raoul Senault Herbert Viefhues
With 87 Figures and 175 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo
Priv.-Doz. Dr. med. Ulrich Laaser
Deutsches Institut zur Bekämpfung
des hohen Blutdruckes
Postfach 10 14 09
D-6900 Heidelberg 1
Professor Dr. Raoul Senault
Centre de Medecine Preventive
F-54501 Vandoeuvre-les-Nancy Cedex
Professor Dr. med. Herbert Viefhues
UniversitätsstraBe 150
D-4630 Bochum 1
Library of Congress Cataloging in Publication Data
International Congress ofPreventive and Social Medicine (10th: 1983: Heidelberg,
Germany) Primary health care in the making. Bibliography: p. Ineludes index.
I. Community health services-Congresses. 2. Medicine, Preventive-Congresses. 3. Social
medicine-Congresses. 4. Health education-Congresses. I. Laaser, U. (Ulrich), 1941 -.
IL Senault, R. III. Viefhues, Herbert. IV. Deutsche Gesellschaft für Sozialmedizin.
V. Deutsches Institut zur Bekämpfung des Hohen Blutdruckes. VI. TitIe.
RA422.I63 1983 362.1 84-24050
ISBN-13: 978-3-642-69979-5 e-ISBN-13: 978-3-642-69977-1
DOI: 10.1007/978-3-642-69977-1
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Preface
Since the historieal conference held in Alma Ata in 1978, it has been possible to
observe a reorientation of the medical profession. More and more, issues of
health enter the stage and curative medicine is not just loosing ground but some
interest. 'How effective is health education?' and 'Whose task is primary pre
vention?' are questions which stimulate great concern and public debate. It
seems also to be the first time since the last decades of the 19th century that the
social dimension of health receives adequate consideration. Thus the reeent
publication of the so-called Black Report on Inequalities in Health (Penguin
1982) led to a heated discussion in Great Britain, certainly of relevance to many
other countries. The 6 years since 1978 are much too short a time to proceed far
towards 'Health for All', as the slogan of the World Health Organization puts it,
but the concepts are spelled out, vaguely but convincing to many of us. It is the
right time to discuss first experiences and to move from philosophy to empiri
eal work. This work - as it relates to the process evolving since Alma Ata - is
characterized by participation, cooperation and prevention:
Participation, because 'disease' concerns only the individual patient, his or
her family and immediate social environment, while 'health' concerns everyone
and should involve everyone. It is a task of the whole of society rather than the
domaine of a single profession or party.
Cooperation, because the promotion of health must take place in daily life,
subject to many influences and guided by goals and desires often unrelated to a
medical preception of health and disease. Therefore a better mutual under
standing between the medical and especially the social professions is of utmost
importanee.
Prevention, because some time during life health is succeeded by disease
and whatever we as physicians can do to prevent premature morbidity and
death, we are obliged to do it. The main motive for a preventive orientation of
the medical profession is not the doubtful economic benefit possibly accruing
from the retardation of chronic disease, it is simply an ethical one. For this
reason prevention became a major focus in general medicine irrespective of the
varying types of health care systems.
To bring good medical care elose to the people is the essenee of primary
health care, and nowadays this ineludes preventive medicine, equal cooperation
with other professions and participation of the patient in the diagnostic and
therapeutic decision making. StilI at the beginning of its modern development,
VI Preface
primary health care takes as many forms as there are countries and identified
deficiencies in the traditional delivery of health care. Primary Hea/th Care In
The Making is based on the proceedings of the Xth International Congress of
Preventive and Social Medicine with the theme preventive and social aspects of
primary health care. It was the first congress of its kind to be held in the Fed
eral Republic of Germany and is a highlight in the history of the German
Society of Social Medicine. The contributions mirror the differing stages of
development throughout the world and for several countries provide a detailed
insight into and description of their health problems and resources. This infor
mati on has not always been easily accessible, like from many countries in the
third world. Therefore, we have given special attention to the presentation of
their data and experience. There arefascinating similarities between attempted
solutions in developing as weIl as in developed societies, e.g. with regard to the
increasing role of medical assistant personal.
However, primary prevention relates to the general, healthy population and
in so far to daily lifestyles and habits, i.e. it reaches out beyond the organized
health care system. The more 'primordial' prevention is, the more it has to rely
on lay involvement and participation because there are no other ethical ways of
inducing motivation for lifestyle change. This is where modem education for
health through competenee comes in, where mutual aid or self-help and self
organization as new social developments become relevant for the promotion of
health. Promotion of health does not only relate to the system of health care,
but depends on many other conditions which influence the quality of life. In
this approach epidemiology acquires a new social dimension: we have to mea
sure the state of weIl-being, of functioning, and of coping efficiency of the indi
vidual, family, and community. We are not only asking for a healthy mind in a
healthy body, but a healthy person in a healthy society; we must build up a real
epidemiology of heal th (G. A. Canaperia).
Heidelberg, December 1984
H. Viefhues R. Senault u. Laaser
Contents
PartI
The Physician and Primary Health Care
A. Changing Mentality in Medical Training
B. Paceagnella
Changing Mentality in Medical Education 3
R. Senault and J. P. Deschamps
Medical Education: Proposals for the Future 11
E. Musil
Education in Social Medicine 14
J. Gofin, N. Mainemer, and S. L. Kark
Community Health in Primary Care - A Workshop on Community-
Oriented Primary Care ................. . 17
R. Rothenberg, V. R. Coleman, and P. Zabetakis
Seminars in Clinical Preventive Medicine 22
T. D. Dublin
The Migration of Physicians to the United States - A Study of
Candidates for ECFMG Certification, 1969-1982 .... 25
B. Primary Health Care by the Physician and Allied Personnel
B. Kosanke
Cooperation Between Different Professions and Lay Personnel 31
F. Holldack-Heckmann
The Group Medical Practice - A Prospect for Doctors and Patients? 34
U. Hoffmann
Division of Tasks and Cooperation: Learning Processes in Inter-profes-
sional Group Practices . . . . . . . . . . . . . . . . . . . 38
B. Meifort and H. Paulini
Legal, Institutional and Educational Conditions for Interdisciplinary
Teamwork Between Allied Health Professions . . . . . . . . . 42
VIII eontents
A. Geiger
Social Work in Health Care Services 46
A. A. Talbot, P. Curtis, L. MacLaren, A. F. Sanchez, and R. Bissonette
Telephone Medicine: A Training Need in a Technological Society 49
F. Fontana and A. Orsini
Family CounseHing Serviees in the Veneto Region ofltaly:
Structural and Functional Aspects . . . . . . . 60
C. Brühne-Scharlau and F. W. Schwartz
Health CounseHing - A Pilot Programme . . . 67
G. Wendt
Primary Prevention by the General Practitioner? 70
H. Noack
Medical and Psychosocial Problems in Primary Care .... 74
H. E. Kerek-Bodden, P. Kramer, E. Schach, and F. W. Schwartz
Mental Health Problems in the Offiees of General Practitioners
and Interuists . . . . . . . . . . . . . . . . . . . . . 80
M Heydthausen and F. Koch
Diagnostic Language in Primary Health Care - A Structural and
Semantic Analysis of Diagnoses on Health Service Medical Cards 86
H.-D. Klimm
Early Detection of Disorders of Peripheral Circulation in General
Practice: A Model for a Research Project of the German Society
for General Medicine .................. 90
R. LaessIe and R. EHmann
Effects of the Social Situation on Health and Utilization of Medical Care
Services: Results from the Munich FoHow-up Study ........ 95
R. Ellmann and R. LaessIe
Social Class and Utilization of Primary Medical Care Services:
Class-Specific Patterus of Utilization Behaviour in the Munich
Follow-up Study .................. . 100
M Patel
Choice of Best or Cheapest Drugs: A Note on Regulating Drug Supplies 105
W. Koenig, U. Keil, J. Stieber, A. Döring, S. J. Pöppl, and M. Mraz
Epidemiology of Digitalis Use - Results from a Random Sample
of the Munich Population ................. 109
Part II
Special Groups for Primary Health Care 117
A. Maternai and Child Care
M. Nikoli6, M. Gec, G. Nikoli6, and G. Sbutega
Some Relevant Ecological Factors and Their Influence on Pregnancy 119
Contents IX
M. Gec, M. Nikolic, V. Sulovic, and G. Sbutega
Some MaternaI and Social Factors in Relation to the Birth Weight
ofInfants ...................... 122
M. H. Schmidt and G. Esser
The Diagnosis of "MinimaI Brain Dysfunction" - Implications
for Social Medicine ................. . 125
B. Childhood and Adolescenee
L. Neradovic, D. Plecas, and M. Havelka
Physical Fitness of Obese Children and Its Relationship to Age, Sex
and Nutritional Intake ................... 128
B. Legetic, M. Planojevic, V. Grujic, and J. Pisarev
Knowledge, Habits and Standpoints of Novi Sad Adolescents in Relation
to Cardiovascular Diseases and Possibilities of Their Prevention as Part
of a Comprehensive Community Cardiovascular Control Programme 132
U. Laaser and P. Allhoff
Review of the Results and Recommendations of the Cologne Study 135
S. G. Gerberich, M. Hays, 1. S. Mandel, R. W. Gibson,
and C. 1. Van der Heide
Analysis of Suicides in Adoleseents and Young Adults:
Implieations for Prevention . . . . . . . . . . . 137
D. Repovs
"Health Education" - A New Subject in the Secondary Schools of SR
Slovenia, SFR Yugoslavia .................. 146
R. Fehr and E. o. Krasemann
Some Results of the "Schülerstudie Gesundheitserziehung Hamburg" 150
H. Hildebrandt
An Eeologieal Concept of Health Promotion in Child and Youth Work-
Projekt Gesundheit/Bund Deutscher Pfadfinder ....... 156
P. Franzkowiak
Growing Up into the 1980s: An Ecologieal Framework for Health
Promotion for Youth . . . . . . . . . . . . . . . . 161
C. The Oeeupational Setting
W. Maschewsky
Industrial Jobs and Coronary Heart Disease . . . . . . . . . 167
M. T. Tenconi, A. Taceola, C. Mercuri, G. B. Gotti, M. R. Spina,
and G. Bellotti
Coronary Prone Behaviour Related to Occupational Stress in a Sample
of Male Workers ...................... 170
I. Weber and J. Siegrist
Work Stressors and Coronary Risk: Two Perspectives 175
X Contents
K. Undeutseh and C. Halhuber
Some Aspeets of the Return to Work After Myoeardial Infaretion 179
W. Huber, E. Marquard, and W. K. Sehreiber
Voeational Rehabilitation in Hypertension and Renal Diseases 183
S. Poser, P. Deneeke, H. Friedrich, and R. Sehipper
Oeeupational Performance of Patients with Multiple Sclerosis .... 188
S. Koifman, V. L. G. Blank, and 1. A. M. Souza
Mortality and Aeeidents in the Eleetrieal Industry 192
1. S. Vobeeky, 1. Vobeeky, and D. Shapeott
Nutritional Habits and Their Relation to Health in the Oeeupational
Environment ...................... . 197
U. Canaris and 1. Töppieh
AIcohol in the Working Environment 205
D. Environmental Risks
1. van Reek
Air PoUution and Health Indieators: Regional Findings
for the Netherlands .............. . 209
P. Lereher and W. W. Kofler
Possibilities and Limits of Data Drawn from the "Gesundenunter
suehung" for an Epidemiologieal Study of the Conneetion Between
Air Quality and Chronie Bronchitis ............. 215
W. Jedryehowski, M. Krzyzanowski, and B. W ojtyniak
Biologieal Effeet of the Air Quality Measured at the Population Level 223
E. The Chronically III
U. Gerhardt
Family Rehabilitation in Chronie Illness 227
B. Luban-Plozza
Family Psyehology and "Family Confrontation" 230
G. Mall
Who Treats the ChronieaUy Ill: The General Praetitioner
or the Internist? . . . . . . . . . . . . . . . . 235
A. Füller
CompIianee - A "Risk Faetor" for Chronie Diseases? 240
1. Ananijevic-Pandey and H. Vlajinae
Non-fatal Myoeardial Infaretion in Women Under 50 Years of Age,
with Referenee to Oral Contraeeptive Use in Belgrade .... 244
M Arndt, D. RühIand, R. Keferstein, and W. Pireher
Rehabilitation After Surgery for Chronie Vaseular Disease:
Goal and Reality ...................... . 249
Contents XI
1. Reseh
Multiple Sclerosis and Geophysieal Faetors 252
1. Kunow
Chronie Mental Illness: Social Faetors and Rehabilitation Outeomes 256
G. Krüger, H. Biehl, B. Krumm, and C. Sehubart
Longitudinal Pattem of Aftereare in a Cohort of Reeent Onset
Sehizophrenics ................ . 261
H. D. Brenner, W. Böker, K. Andres, and W. G. Stramke
Efforts at Compensation with Regard to Basic Disorders
Among Schizophrenics ............ . 267
L. von Ferber, H. 1. Jesdinsky, A. Sehröer, and H. 1. Trampisch
Identification of Specific Pattems of Work Incapacity Related
to Chronic Illness: Analysis of Data Gathered by the Health Insurance
Funds in Westem Germany ................ . 274
F. Migrants in Germany
A. Geiger and F. Hamburger
Migration and Health 281
C. Schöning-Kalender
Sickness in the Process of Migration ............... 284
I. Theilen
Illness and Health of Turkish "Citizens" in West Germanyas Seen Against
the Baekground of Their Personal Life Narratives ......... 288
H. Mergerian and W. Bommer
Studies on Social Hygienic Problems Appertaining to Foreign Children
and Their Families in the Federal Republic of Germany . . .. 294
M. Akkent, G. Franger, and N. Gültepe
The Living Conditions and Education of Turkish Infants in the
Federal Republic of Germany: Report on a Model Project in N ümberg 297
F. Poustka
Are New Counselling and Psychotherpeutic Pattems Necessary
for Children of Foreign Employees (Guest-workers)? Results of an
Epidemiologieal Study . . . . . . . . . . . . . . . . . . 300
1. Korporal, 1. A. Marmor, and A. Zink
Migration and Health - Thoughts on Pa st and Current Research 304
Partm
Health Education in Primary Health eare 311
A. Educationfor Health through Participation
T. Fülöp
Health for All by the Year 2000: A Challenge for the Education
of Health Personnel ................. . 313
