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To an increasing extent ethical controversies affect and sometimes obstruct public health work and epidemiological research. In order to improve communication between the concerned parties a model for identification and analysis of ethical conflicts in individual-based research has been worked out in co-operation between epidemiologists and moral philosophers. The model has two dimensions. One dimension specifies relevant ethical principles (as beneficence, non-maleficence, autonomy and justice). The other dimension specifies the groups of persons involved in the conflict under consideration (for example: the study-population, individuals who may benefit from the results, the researchers and their personnel, the community at large). The model has been applied to the problem of legitimacy of case-register research and to problems in psychiatric health services research as well as epidemiological research.

Life table methods were applied to analyses of longitudinal data on the use of medical care during the first 5 years of life among all 1701 children born in a Swedish semirural municipality. Cumulative proportions of the children who had used particular types of medical care or prescription drugs at least once by certain ages were estimated. By the fifth birthday, 98% had made at least one visit to any physician and 82% at least one visit to a paediatrician. By the fifth birthday at least one prescription for antibiotics had been purchased at a pharmacy by 82%; and 33% had been admitted to inpatient hospital care at least once (excluding immediate postnatal care). Acute conditions and more chronic diseases were also studied using these methods. At least one visit to a physician at a primary health care centre had been made for acute otitis media in 65% of 5 year olds and for atopic dermatitis in 8%.

In a study of variations in use of inpatient care for nonspecific enteritis in six pediatric departments in the Uppsala region of Sweden considerable differences in both admission rate and length of stay were revealed. The department with the highest use of hospital days for enteritis devoted nine times as many days per unit of population than did the department with the lowest use. It was concluded that differences in admission rate were only partly explained by differences in incidence of disease in the various catchment areas. A high admission rate was linked with relatively liberal indications for admission. This did not result in shorter mean stay, however. Differences in disease characteristics, and geographic, social, departmental, and other factors were investigated in determining causes for variation in length of stay, and the simultaneous effect of these variables on length of stay was studied by multiple regression analysis. A significant proportion of the individual variation in length of stay proved to depend on admitting department policy. In fact, local policy differences seemed to have had a greater effect on length of stay than did combined demographic, geographic, social, and disease characteristics.