[Problems in the utilization of morbidity statistics on hospitalized persons].
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With regard to the planning of treatment capacities in prosthetic dentistry the authors try to find a practicable classification for partially dentulous arches. They make explanations on the classifications, which are known yet. The combination of the EICHNER and KENNEDY classifications as well as an own modification of the KENNEDY system seem to be the best methods for morbidity analysis in this moment.
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The planning of health services consists of a process that generally involves the following steps: (a) situational analysis, or the description, definition and statement of the problem, its characteristics and dimensions in relation to population and time; (b) the formulation of alternative tactical approaches to the handling and solution of the problem; (c) decision analysis or the selection of a plan; (d) discussion and implementation of the plan selected; (e) evaluation of the results achieved in relation to the problem, situations or populations concerned. This paper discusses the content of a programme of mental health services research for collecting and analysing the information needed to apply these processes to the planning of mental health services, monitoring the manner in which the plan is being implemented, and assessing its effectiveness in achieving short-term and intermediate objectives and long-term goals. Statistical and epidemiological information play an important role in these processes, particularly in the situational analysis and the evaluation processes. Illustrations have been provided of types of data that are produced in the national mental health statistics programme in the United States. Difficulties in using such data to answer questions concerning the needs for mental health services, and manpower requirements for delivering services to meet these needs are discussed. In many instances, currently available data are quite inadequate for answering key issues such as these, plus others related to living arrangements of the population, the effect of services on the persons who receive them, their families and the communities in which they live. Thus, much still remains to be done to develop systematic, comparative morbidity statistics on the incidence, duration and prevalence of mental disorders in the general population, on the needs for mental health services, and on the effectiveness of our efforts to prevent disorders that can be prevented, and to reduce the amount of disability and distress caused by those that cannot be prevented or terminated. A series of problems have been identified, the solutions to which would assist materially in providing data that would narrow gaps between available knowledge and that which is needed. The importance of establishing well-staffed research units at the catchment area level with stable funding to accomplish this is underscored. It is a matter of the greatest urgency that adequate resources--financial, manpower, scientific and administrative--be made available to solve these problems. If this is not done, then effordts to document quantitatively the effectiveness of programmes to prevent and control mental disorders will continue to suffer from many of the same shortcomings that have impeded our past and continue to impede current efforts to accomplish this.
British morbidity statistics are reviewed to try to estimate the size of the problem of the painful back. National Insurance figures yield an estimated 13.2 million working days lost in one year, though only 68% of this is identified in routinely published statistics. Other bodies of data (G.P. consultations, outpatient and inpatient flows, spinal supports supplied) indicate use of services by sufferers. The difficulties in retrieval caused by the structure of the international Classification of Diseases (ICD) and the effects of the latest revision of it are examined.
Attempts of introducing uniform techniques for the collection of statistical data on the prevalence of periodontal diseases have been made by FDI and WHO in order to arrive at valid, reproducible, and internationally comparable results. The WHO Manual of the International Classification of Diseases. Application to Dentistry offers a five digit classification of all oral diseases for statistical purposes. In contrast to morbidity statistics, epidemiological surveys must be based on adequate samples, representative for the entire population or distinct strata thereof. FDI is actually preparing guidelines for the conduct of clinical trials in periodontal diseases, comparable to those on caries incidence, indicating the proper use of indices. For the epidemiological assessment of periodontal diseases, the WHO Basic Methods (1962, 1971) have recommended the use of simple ratios of persons affected with signs of the disease. Data collected in four extensive dental surveys in Polynesian and Melanesian populations in the South Pacific served as an example to show the variety of valid information provided by these basic methods. The main results showed an early appearance of pocket formation at ages 10 to 14, preceded in a statistically significant way by calculus formation and gingivitis. A constant pattern in the sequence of attack of the various teeth by pocket formation was shown to be specific for these island populations; males were consistently more affected than females. The character of periodontal diseases prevalent among Polynesians and Melanesians was recognized to be a "dirt pyorrhea" accompanied by progressive subgingival calculus deposition and destructive periodontitis.
Of 123 teeth treated by direct pulp capping 110 could be rechecked clinically and radiographically after periods of 1 1/2 to 7 years, 4 on the average. In 25 cases a change in endodontic treatment has been recorded on the files: In 18 cases biopulpectomy was performed for symptomatic (pain) reasons considered as failure of the capping treatment; in 5 cases biopulpectomy was indicated for periodontal and prosthetic reasons (not considered as failure); in 5 cases of the 110 rechecked necrosis and periapical involvement was diagnosed. The rate of failure thus was 22 cases or 17%. This relatively high ratio of unfavorable results (Tab. VII) is in part due to lack of operative skill of the students while progressing tooth morbidity statistically established in the Genevan population also was taken into account. Advancing tooth ages according to graph figure 6 in accordance with other recent surveys were found to constitute no impediment for direct pulp capping. The success of this endodontic treatment is best ascertained by observing a strict selection of the case and the observance of an exacting operative procedure, namely: - Only accidentally exposed pulps without symptoms of previous spontaneous pain (Category I) are liable to successful conservation by direct pulp capping using calcium hydroxide. Previously painful pulps (Category II) according to Table VIII are either indirectly capped using corticosteroids particularly in young teeth or after exposure subject to coronal or radicular pulpotomy (Category III). Rigorous aseptical procedure and lasting hermetical sealing of the calcium hydroxide pulp dressing are additional prerequisites for success.
This study is an epidemiological approach of psychoses based on morbidity statistics from french psyschiatric hospitals for the years 1968, 1971 and 1975. It compares some of the most interesting census and first admission data for the following categories: manic-depressive psychoses, chronic schizophrenia and paranoid states on the one hand, neurotic conditions, personality disorders and non-psychotic depressions on the other. Major trends are analysed. Two of them seem particularly interesting: 1) the decreasing number of cases classified as manic-depressive psychoses; 2) the diminishing proportion of females in most instances. Some explanatory hypotheses are suggested.
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Autocategorization is a new technique appropriate for studies involving relative frequencies of illness diagnoses using the International Classification of Diseases. It is ideally suited for emergency department illness patterns. The technique uses the standard chi-square statistical test, but is novel in objectively determining the aggregation of diseases into categories for analysis. The numbers of observed occurrences of the various diseases are used. without applying any a priori judgements, to decide whether a disease should be analyzed alone, or aggregated with others. This technique, because it is based on the ICDA code, will permit comparisons between various studies while retaining the statistical validity of the individual studies.
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This paper concerns general right censoring and some of the difficulties it creates in the analysis of survival data. A general formulation of censored-survival processes leads to the partition of all models into those based on noninformative and informative censoring. Nearly all statistical methods for censored data assume that censoring is noninformative. Topics considered within this class include: the relationships between three models for noninformative censoring, the use of likelihood methods for inferences about the distribution of survival time, the effects of censoring on the K-sample problem, and the effects of censoring on model testing. Also considered are several topics which relate to informative censoring models. These include: problems of nonidentifiability that can be encountered when attempting to assess a set of data for the type of censoring in effect, the consequences of falsely assuming that censoring is noninformative, and classes of informative censoring models.
In multi-clinic studies it is hard to maintain a uniformly high quality of measurement and coding. Systematic errors almost always occur, in spite of the best of intentions and the most rigid protocols. It is the statistician's responsibility to plan for the detection of these errors, as well as to try to avoid them and not be misled by them. The practice of examining the univariate and multivariate sample frequency distributions of the variables under study, with an eye open for anything that looks puzzling, can be very helpful in detecting and trying to correct systematic errors that would bias the analysis. Examples are given from a 21-clinic study on pregnancy and child development.
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