Combating drought: food for all.
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Maternal and perinatal morbidity and transfer patterns were examined to assess the influence of the number of deliveries performed by each general practitioner obstetrician and the distance from specialist care. There were statistically significant differences in transfer patterns between urban and rural practitioners and between those practitioners delivering fewer than twenty per year and those delivering twenty or more per year. Antenatally, rural practitioners transferred more of their patients to the base hospital and those practitioners delivering fewer than twenty per year had higher transfer rates than those delivering twenty or more per year. During labour the transfer rate was lowest for rural practitioners delivering more than 20 babies per year. Urban practitioners in comparison to rural practitioners delivered a significantly greater proportion of women who were considered to have a moderate or high obstetric risk. No association was found between the number of deliveries undertaken by general practitioners both urban and rural and maternal and neonatal morbidity. The proportion of women and neonates who had a score which indicated a less favourable outcome for maternal and neonatal morbidity, was higher for urban practitioners than for rural practitioners.
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Telephone encounters received by two physicians in a private rural family practice setting were examined over a 61-day sampling period. A total of 1,264 calls were received during the study period, with 905 (71.6 percent) being received in the office setting. An average of 10.4 calls per physician were received each day, and a mean of 16.2 minutes per physician was spent each day with telephone encounters. Each call was brief, lasting 1.6 minutes (standard deviation 1.5 minutes); administrative and personal calls each lasted significantly longer than other call categories (F = 20.8, P = .0001). More chronic disease diagnoses tended to be handled during office when compared with nonoffice telephone encounters. The majority of calls (932, or 83.1 percent) did not require a face-to-face visit as judged by the physician. Of the office calls, 58.2 percent were handled by the physicians through a message system rather than a direct physician telephone call. It is estimated that uncharged care over the telephone saved patients in this practice up to $150,000 per year.
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During the 12-month period from September 1982 to August 1983, 9,317 live births and 58 maternal deaths were recorded in Melanda and Islampur upazilas in the Jamalpur district of rural Bangladesh, giving a maternal mortality rate of 62.3 per 10,000 live births. Maternal mortality was positively related to maternal age and parity, with the mortality risk rising very sharply beyond age 35 years, and beyond parity four among women aged 25-34 years in particular. The most common causes of maternal death were eclampsia (20.7 percent), septic abortion (20.7 percent), postpartum sepsis (10.3 percent), obstructed labor (10.3 percent), and antepartum and postpartum hemorrhage (10.3 percent). These findings indicate that family planning, by decreasing the likelihood of pregnancy after age 35 and parity four, can help reduce the proportion of women at risk of maternal mortality.
1712 men aged 40-59 at entry examination in 1960 and representing 98.8% of defined geographical samples in Northern and Central rural Italy, have been followed up for 25 years with continuous monitoring of mortality and causes of death and repeated examinations for the measurement of coronary heart diseases (CHD) incidence. In 25 years 810 men died from all causes and 198 from CHD. Incidence in CHD-free men at entry, has been 123 per 1000 for CHD death, 151 per 1000 for hard criteria CHD (deaths plus definite myocardial infarction alive) and 305 per 1000 for any criteria CHD (deaths plus definite myocardial infarction, plus possible myocardial infarction, plus angina pectoris, plus other manifestations.
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In cooperation with the Austrian National Institute for Statistics the incidence-rates of breast cancer in Austria in the period of 1971-1975 were investigated. The incidence-rate of breast cancer (50 new cases/year/100,000 women) is higher than the incidence-rate of cervical or endometrium carcinoma. The increasing risk of the higher age-groups, which is especially expressed by the incidence-rate of 145 in the age-group of 70 or more years, is pointed out. This findings are of great consequence to the system of preventive medical care. In urban areas the incidence of breast cancer seems to be higher than in rural district.
The problem of road traffic accidents in developing countries is now becoming a cause for concern. This is more so as preventive measures have not kept pace with economic progress and development. This paper reviews the present situation in West Malaysia, one of the better developed countries of the East, during the period 1970 to 1975. A comparative study has been made between the United States and Malaysia. To enable the urgency of the problem in developing countries to be appreciated the increases in the country's population and in the number of vehicles in use and their relation to the lesser increase in road mileage over the period of study have been discussed. The study has considered every aspect of the causative factors leading to traffic accidents, such as the effects of weather, seasonal variation, and road and lighting conditions. The common human errors leading to accidents have been discussed. Other factors, such as the ethnic distribution in Malaysia, and their relation to road accidents have shown the effect of the social structure on the problems. The data evaluated in this study make it clear that preventive measures are very necessary in underdeveloped as well as in developed countries.
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Identified and evaluated were a number of medical and sociological data, e.g. diagnosis, age, population of the place of residence, financially responsible agencies, on 1399 rehabilitees who were admitted to the Dortmund vocational re-training centre during the first five years of its operation (1971-1975). The primary diagnoses (highly identical with those indicative of vocational rehabilitation) and the overall diagnoses (primary and secondary diagnoses) were classified into disease groups according to the ICD and compared with the frequency distribution in the 1970 microcensus. Significance computations determined yearly deviations of the different data, i.e., a significantly steady increase in emotional disturbances. The classification of diseases and disabilities clearly shows the problem complex of adequate comprehensive therapy and medical care, and marks the role of medicine at a vocational re-training centre.
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In applications of statistical methods to medical diagnosis, information on patients' diseases and symptoms is collected and the resulting data-base is used to diagnose new patients. The data-structure is complicated by a number of factors, two of which are examined here: selection bias and unstable population. Under reasonable conditions, no correction for selection bias is required when assessing probabilities for diseases based on symptom information, and it is suggested that these "diagnostic distributions" should form the principal object of study. Transformation of these distributions under changing population structure is considered and shown to take on a simple form in many situations. It is argued that the prevailing paradigm of diagnostic statistics, which concentrates on incidence of symptoms for given disease, is largely inappropriate and should be replaced by an emphasis on diagnostic distributions. The generalized logistic model is seen to fit naturally into the new framework.
A likelihood ratio test is given for distinguishing skewness from commingled distributions, using a power transform to remove skewness appropriately for each of the alternatives tested. The alternative hypotheses postulate that the transformed data are from one normal or a mixture of two or three normal homoscedastic distributions. Since each mixture has unique asymmetry, skewness is estimated simultaneously with the means, proportions and variance of components. Commingling cannot be rigorously proven in this way, as some other transform may provide a better approximation to normality. However, the error of asserting admixture whenever there is skewness has been avoided, and estimates of admixture parameters provide a basis for more conclusive tests in relatives or other populations. Two examples are given, one in which adjustment for skeweness left evidence of commingling.
Two different nomograms corresponding to finite and infinite populations were devised to obtain a necessary, minimum sample size at a 95% confidence rate when the distribution of sample proportions calculated from binomial data was approximately normal. They could also be used for obtaining the 95% confidence limits of the population proportion from a sample proportion after having carried out a work.