STATISTICS SANITARY

From Big Medical Encyclopedia

STATISTICS SANITARY — the industry of statistics studying quantitative patterns of a state and dynamics of health of the population and a health system, and also developing methods of a statistical analysis clinical and datas of laboratory. The village of the village collects, accumulates and analyzes information connected with health care, is a basis of system of the account (see. Account medical ) and the reporting (see. Reporting medical ). It is one of methods social hygiene (see). Recently it is called even more often medical statistics.

The village of the village plays an important role in development of medical science and assessment of activity of bodies and healthcare institutions for management of health care (see). It widely uses information collected by other industries of statistics (demographic, social, environmental controls, housing-and-municipal, work, culture and education, budgets etc.).

The village of the village consists of two main sections: statistics of health of the population and statistics of health care (resources of health care and their use).

The statistics of health of the population includes development and creation of methods of studying and assessment of the state of health of the population (see) and its separate contingents, detection of nature of bonds of level of health of the population with environmental factors. The statistics of health care reveals quantitative characteristics of resources of health care (shots and material and technical resources) and their uses in continuous communication with qualitative aspect of activity of bodies and healthcare institutions, and also provides with necessary information an operating controls health care for scientific justification of the actions directed to improvement of the state of health of the population.

The methodological basis of the Soviet S. of page is made by the Marxist-Leninist doctrine, dialectic and historical materialism.

Basic features of the Soviet S. of page is its close connection with practice of health care, originally scientific and reliable character.

The Soviet S. page differs from bourgeois in the purposes, installations and tasks. It in every possible way promotes performance of problems of socialist health care in struggle for life and health, for decline in mortality and extension of life of the Soviet citizens. The excessive matematizirovaniye, replacement of the analysis of vital processes with difficult mathematical formulas and pseudoscientific interpretation are alien to it.

Characteristic feature of bourgeois S. of page is the biologization of public processes. Widely «theories» expatiate on independence patol. processes at people, diseases and death from social conditions and their communication generally with the geographical environment, climate, adverse hereditary factors, so-called inborn biological differences, etc.

History

the Statistics as science arose in 17 century in England in the form of school of political arithmeticians, to a cut J. Graunt, W. Petty belonged. The ideas and methods of political arithmetics began to get into Russia in 18 century. Before S.'s emergence by the village as separate industry of scientific statistics in works of domestic researchers (I. K. Kirilov, V. N. Tatishchev, M. V. Lomonosov, P. I. Rychkov) there were data relating to the state of health of the population and medical institutions. It should be noted works of the doctor D. Bernoulli about smallpox inoculations, about mortality and probability theory. M. V. Lomonosov for the first time stated the idea of division of statistics on the main and current and indicated the need of periodic collecting and data processing of the main statistics. It made the extensive program of demographic and economic studying of Russia. M. V. Lomonosov possesses statements on a number of the major demographic problems, in particular about child mortality.

In the middle of 18 century at the initiative of hl. directors of medical office of Item 3. By Kondoidi medico-topographical descriptions — prototypes of future sanitary and statistical works on a dignity began to be carried out on places. to the description of the inhabited places. The first act in Russia relating to a question of the obligatory notice on infectious diseases belongs to the same period. Activity of the academician L. Yu. Kraft in the field of statistics of the population, the doctor S. G. Zybelin on studying of nek-ry indicators of health of the population and influence of living conditions on them belongs to the end of 18 century.

Sanitary and statistical works of the first half of 19 century had character of medico-topographical descriptions (e.g., the description of Riga of O. Gong, the Tagil mountain district — I. Ya. Gorlova, notes about Moscow of V. P. Androsov, the description of St.-Petersburg of S.F. Gajewski).

From 80th 19 century were widely adopted complex sanitary and statistical researches. They represented sanitary and statistical descriptions of the cities, rural areas, living conditions and work of workers. These are G. I. Arkhangelsky's works, E. M. Dementiev, A. V. Pogozhev, V. V. Svyatlov-sky, P. A. Peskov, N. I. Tezyakov, D. N. Zhbankov, F. F. Erisman.

S.'s development by page was promoted by strengthening of territorial statistics (see. Territorial medicine), creation of the centers for studying of incidence of the population. Territorial dignity. the statistics aimed to reveal mass pathology of the population (first of all the peasantry and handicraftsmen), but it could not rise to the class analysis of the studied phenomena. Founders of the Russian territorial dignity. statistics (E. A. Osipov, P. I. Kurkin, I. I. Molleson, etc.) considered that its main objective is studying of the state of health of the population (a sanitary condition of the population) on the basis of the account and the analysis of data of the general incidence of the population on materials of negotiability in to lay down. institutions. The special place in the Russian sanitary and statistical science belongs to P. I. Kurkin — the inspirer and the territorial S.'s theorist of page who created considerable network of the local sanitary and statistical organizations together with the employees.

The official statistics of 19 century included obligatory registration of epidemic diseases (the decree of 1842), the births and death. In 1867 in St.-Petersburg the obligatory medical registration of causes of death which gradually extended and for other cities is entered.

The service C. of page was in the cities in embryo. Only in the capital statistical bureau created by Ue. E. Jansson nek-ry sections C. of page — hospital statistics, epidemic statistics were put. On official materials, in 1912 only in 13 provincial cities of Russia there were statistical bureaus.

In the first years of existence of the Soviet health care fight against epidemics, elimination a dignity became its main objective. effects of wars, hunger and ruin, expansion of network of medical and sanitary institutions (see. Health care ). These tasks were also a basis of creation of the Soviet S. of page. In 1920 the first release «Rules and forms of medico-statistical registration» was published, in to-rykh the unified methodical bases of registration of personnel of network of medical and sanitary institutions and their activity, a basis of the accounting of the diseases registered in out-patient and polyclinic institutions and in-tsakh, bases of the uniform nomenclature and classification of diseases and causes of death and so forth were for the first time laid.

After the end of civil war of one of the main tasks of bodies of health care there was a studying a dignity. conditions of the population for the purpose of the organization of work on improvement of conditions of its work and life. At the initiative of R. I. Sifman, G. A. Bash-kis selective forwarding sanitary and statistical researches of birth rate, mortality, incidence were organized.

The population census of the USSR created 1926 favorable conditions for further studying of demographic processes (see. Demographic statistics, Population census). From the works which had great social and hygienic value it is necessary to allocate S. A. Novoselsky and V. V. Payevsky's work on studying of mortality and life expectancy of the population of the USSR (see Life expectancy, Mortality).

The organization and strengthening of the current account and reporting was the main objective of this period. Need of obtaining information for planning led to carrying out special registration and statistical works of census type (e.g., in 1930 under the leadership of A. B. Shevelyov and B. Ya. Smulevich the all-Union census of institutions and shots of health care, in 1934 — a census of patients in hospitals and medical personnel was conducted). For collecting, generalization, the analysis of statistical information and improvement of methodical work in this area in the mid-thirties were created scientific and methodical bureaus C. of page. In the subsequent in a number of federal republics of function of bureau C. of page were assigned to organizational and methodical departments of regional hospitals (see). Thanks to activity of bureau C. of page the system of regularly formed summary state-of-the-art reviews about the state of health was created: population and health care of the republics (areas). Since 1938 it began to be carried out: review of system of the account and reporting of medical institutions for the purpose of expansion of the indicators lighting quality of medical service of the population." Introduction of the new reporting in 1949 and implementation of a statistical analysis in activity of doctors and healthcare institutions was result of this review. A lot of work in this direction was carried out by E. A. Sadvokasova, L. A. Brushlinska, A. M. Merkov.

Studying of the state of health of the population was one of the major problems of the Soviet S. of page; it was carried out as by data acquisition via channels of the official reporting, and by carrying out special scientific research.

The important place among sanitarnostatistichesky Researches of the state of health was taken by works on studying of physical development of the population, on development of a technique of the correct assessment of its indicators as criteria of health of separate individuals, and also indicators of disturbance of health of the whole groups of the population (see. Physical development ).

Creation of standards of physical development of various age, sexual and ethnic groups of the population necessary for individual assessment of anthropometrical measurements (R. B. Kogan, A. G. Tseitlin, D. I. Aron, A. B. Stavitskaya) was result of works on statistics of physical development.

In statistics incidences (see) three groups of questions were allocated: studying of prevalence of separate diseases and the social factors causing them; studying of incidence with temporary disability; studying of the general incidence. Questions of the first group were generally studied by forces of tubercular, venereologic, oncological and other in-t of a clinical profile. At the same time in addition to the general registration of diseases and causes of death materials of specially conducted examinations of the population were attracted (P. A. Kuv-shinnikov, A. M. Merkov, A. V. Chaklin, etc.).

The statistics of incidence with temporary disability evolved from the accounting of all cases of disability (see) caused by diseases and was entered into the USSR in the form of the report of the All-Union Central Council of Trade Unions in 1925. Since then it is under authority of trade-union bodies, in-depth studies of incidence with temporary disability allowed to reveal a number of the features it connected with influence of professional and production, social and hygienic and other factors on its level and tendencies. The most significant works in this area belong to F. D. Markuzon, N. A. Vigdorchik, A. K. Hotsyanov.

Attempts to recover studying of the general incidence on the basis of a territorial technique were made in the first years of existence of the Soviet health care. In 1926 and in 1937 the continuous research of the general incidence was conducted in Moscow, in 1931 — in Leningrad.

In 1935 — 1936 mass studying of the general incidence of the population of a large number of industrial centers was conducted.

In 1939 — 1940 in connection with the general population census which was taking place in 1939 incidence in a number of the cities and the areas of the USSR was studied. L. A. Brushlinskaya, G. N. Kaminsky, P. I. Kurkin, B. Ya. Smulevich, G. A. Bat-kis, P. M. Kozlov took part in this work S. M. Bogoslovskiyu.

Data acquisition about the general incidence through reports to lay down. institutions by method of the continuous account, practicing in the 50th, did not make success. As a result of A. M. Merkov, E. A. Sadvokasova, V. A. Mozglyakova, V. K scientific research. Ovcharova was created a technique of selective studying of incidence, on a cut in 1969 — 1971 studying of the state of health of the population of the USSR is carried out.

Bases of a statistical research

the Statistical research includes receiving, processing and the analysis of statistical data on the state of health of the population and health care with use of both all-statistical, and special methods of a research.

The statistical research according to the general theory of statistics is conducted in the strict sequence and logical interrelation. Investigation phases: 1) organization of a statistical research; 2) acquisition (statistical observation); 3) group and report of data; 4) transformation of the report; 5) analysis; 6) conclusions and graphic design.

The organization of a statistical research includes development of the plan, program and registration document. The plan of a research provides accurate definition of a subject, purpose, research problems, subject to observation, a sampling unit, time and way of a research. Subject to observation — set, about a cut statistical data shall be collected. A sampling unit — the component of an object of a research which is the carrier of signs, notifiable. The program of observation — the list of the signs which are subject to studying and registration.

Statistical observation can be centralized and decentralized, one-time and current.

Group and the report of statistical data — an initial partition of all set on homogeneous parts on attributive (descriptive) or variation signs with the subsequent generalization of isolated cases in the form of times-rabotochnykh of the tables completed with absolute numbers. Tables can be simple, group and combinational.

Transformation of the report consists in calculating processing with obtaining relative sizes (intensive, extensive indicators, indicators of visualization, indexes) and average sizes. Intensive indicators — indicators of frequency, distribution (on 100, 1000, 10 000 and 100 000 patients or inhabitants etc.). Extensive indicators — indicators of distribution, specific weight (as a percentage to a result). Indicators of visualization represent a ratio of indicators in different territories and in dynamics.

Average sizes characterize by one number set. They are found during the processing of a variational series (see. Variation statistics). The obligatory size accompanying average is the devirage quadratic deviation (and — sigma) — a criterion of variability, a koleblemost of a sign.

The statistical analysis includes a number of the techniques allowing to estimate, compare indicators and to reveal patterns in the studied phenomenon: standardization of indicators, assessment of reliability of statistical sizes and their distinctions, correlation analysis, dynamic comparisons etc.

Standardization is the statistical method allowing to exclude influence of heterogeneity of structure of two compared groups on the general indicators. The standardized indicators speak about what could be the general indicators of the studied phenomenon on condition of identical structure of the compared groups.

Assessment of reliability of the received results is carried out on the basis of calculation of an error of indicators, or an error of average sizes (±т), definitions of confidential borders and a confidence coefficient (t). Mean error is an error of a representativeness (presentability); it depends on number of observations and shows in what limits (±) the indicator can fluctuate. Its calculation, for example for a relative indicator, is carried out on the following formula:

m = ± √ (Pq/n),

where P — the size of an indicator, q — the return to an indicator the size equal either 1 — P, or 100 — P (if the indicator is expressed in %), or 1000 — P if the indicator is expressed in per mille, etc., n — number of observations.

In order that results of calculation corresponded to that degree of probability (reliability), about a cut it is required to receive conclusions, the size of a mistake (±т) should be increased by the so-called confidence coefficient (t) showing in how many time the result (indicator) exceeds the mistake. The t is higher, the probability of conclusions is higher; so, at t = 1 probability of results is equal to 68,3%, at t = 2 is equal to 95,5%, t = 3 is equal to 99,7%.

Confidential borders (interval) of a relative indicator, or average size, determine by a formula: P ± tm (for relative indicators) and X ± tm (for average sizes), where X — average arithmetic size.

For measurement of communication of indicators of S. of page uses methods of the correlation and regression analysis, calculation of coefficients of association, an associativity and a chi-square.

Dynamics of the phenomena is considered by method of the analysis of a dynamic row. A dynamic row is a number of the statistical sizes arranged chronologically through certain time terms and showing time history of the studied phenomenon. As a result of statistical processing of a dynamic row receive rate of a gain, growth rate, the size of one percent of a gain. Carry out by way of leastsquares alignment of dynamic ranks and extrapolation of indicators.

In the analysis of the statistical material demanding definition of the factors influencing the size of indicators, and extents of their influence apply the dispersion, factor and discriminant analysis.

Methods of studying of health and health care are developed and applied according to the purpose and research problems taking into account the modern level of statistical researches, mathematics and computer facilities.

The most special part of statistical techniques of studying of health and health care are the first and second investigation phases (the organization of a research and acquisition). The technique of special researches also includes pooling of data and their transformation.

So, collecting material can be provided in a demographic research by use of an anamnestic method. The anamnestic method is a method of studying of the demographic phenomena (birth rate, mortality, child mortality) on the basis of poll, at Krom interviewed recollect the events taking place in their life.

A basis of many demographic works is use of a cohort method for formation of the studied set. A cohort — set of rather homogeneous persons combined by emergence of a certain demographic sign in the same span. The cohort method is widely used during the planning epidemiol. researches.

Methods of studying of incidence differ in way of data acquisition (continuous or selective), a basis of observation (on negotiability, on poll, including medical surveys) etc.

The statistics of health of the population includes four main sections: statistics of incidence, statistics of disability, sanitary and demographic statistics and statistics of physical development.

The statistics of incidence studies character and frequency of spread of diseases (combined or by separate diseases, among all population or among separate age, sexual, professional and other its groups).

Level of prevalence of diseases is defined in intensive indicators. It is measured both the frequency of again revealed diseases, and prevalence of all diseases for a certain period or for a certain date.

The structure (structure) of incidence is defined by the extensive indicators specifying what share is made by one disease or group of diseases in their total number accepted for 100 (sometimes for 1000). The incidence and its structure are various in different age and sex, professional and other groups of the population. The official statistics of incidence consists of system of registration, collecting, processing and the analysis of indicators inf. incidences, incidences of the hospitalized patients, incidences with temporary disability, the major not epidemic diseases and the general incidence. This information is used in management of health care.

Statistics disability (see) is under authority of bodies of social security and is formed on the basis of the conclusions and primary reports of VTEK. The main indicators is the frequency of primary exit to disability, distribution of disability (structure) on groups of weight and the general indicator of disability among the working part of the population. This information is important for bodies and healthcare institutions not only as one of indicators of assessment of health of the population, but also as basic data for the organization of further medical aid to disabled people as the basis for assessment and the analysis of quality of medical aid by the patient before their transition to disability.

The sanitary and demographic statistics includes data on birth rate, mortality, reproduction of the population, and also has data on number, structure and population shift (see. Demographic statistics ). Most often for assessment of the state of health use statistical data on mortality (povozrastny rates of mortality, child mortality, average duration of the forthcoming life, reason of mortality). A task of healthcare institutions for receiving qualitative analysis of the reasons of mortality is the correct and accurate filling of medical certificates on death (see). In the USSR there is an obligatory registration of all cases of death on the basis of the medical conclusions (medical certificates and in exceptional cases medical assistant's certificates of death). The coding of diagnoses and statistical processing of primary documentation centralized at the level of the republics and in some cases at the level of areas provide comparability of data and their completeness. In the analysis of mortality of the population in general the standardized indicators allowing to exclude influence of distinctions in age hollow vom structure of the population of certain territories at a size of these indicators are used. Indicators of probability of survival and average duration of the coming life by creation of so-called tables of mortality are calculated (see. Life expectancy , Mortality ). At assessment of the state of health of the population also indicators of reproduction of the population, and in particular birth-rate coefficients (see) and a natural increase of the population are calculated. At assessment of these indicators it is important to know structure of the population, a share in it of various vozrastnopolovy groups defining tendencies in indicators of birth rate. Birth rate is higher where with other things being equal as a part of the population the specific weight of young age groups, especially is higher than women of childbearing age. Thereof in demographic statistics, in addition to the general indicators of birth rate, are used so-called gross - and net - the coefficients of generation which are reflecting only the nature of reproduction and not depending on age and sex structure of the population (see. Birth rate ).

Physical development (see) it is studied on the basis of anthropometrical data and a number of physiological and functional criteria. There is individual and group assessment of physical development. Data on each inspected represent extent of physical development of an individual. They can combine in the generalized characteristics measured by average sizes: growth, weight (weight) of a body, circle of a breast etc. Degree of their variability is defined by devirage quadratic deviations, and reliability — mean errors. Correlation between separate parameters allows to judge proportionality of development. On the basis of the analysis of average values of physical development of the inspected groups of the population regional estimated tables (standards) applied in medical institutions, especially children's for assessment of physical development of individuals are under construction. Assessment of physical development in dynamics and in separate parameters in a crust, time is complicated owing to process of acceleration (see). Therefore groups of children on proportionality of development taking into account all components entering this concept are widely applied.

Statistics of health care — the section C. of page characterizing network and shots of bodies and healthcare institutions, their activity and volume of medical aid to the population.

Sources of information are reports and registration and medical documentation (see. Documentation medical ) healthcare institutions. The unity of the procedure of the registration and the account obligatory for all healthcare institutions, and also unity and reliability of the statistical reporting is the basis for registration and reporting work. The statistics of health care includes first of all questions of a condition of material resources of health care (network of institutions, their types, power, structure, placement, equipping), and also shots of doctors and paramedical staff (see Health care workforce). On the basis of the acquired information indicators of security with medical aid, shots, completeness of states of institutions are calculated. In statistical information on health care data on use of means and shots on the basis of the analysis of scheduled maintenance figure prominently, to lay down. activity, sanitary and anti-epidemic work of institutions, use of auxiliary and diagnostic services. The main sections of a statistical analysis of out-patient and polyclinic service are the analysis of attendance, an uchastkovost, medical examination. The stationary help is characterized by indicators of level of hospitalization of the population, use of bed fund, the list of patients, a hospital lethality (see) and duration of treatment. A specific place in information on activity of institutions is held by data on medical aid to various contingents (to children, teenagers, working, pregnant, suffering from tuberculosis, malignant new growths etc.). A number of indicators of service, specific to these contingents, is calculated. The statistics of health care can be divided into the following sections: 1) the statistics to lay down. - the prof. of the help to adult population; 2) statistics of security service of motherhood and the childhood (see); 3) statistics dignity. - the prof. of service (see Sanitarno-epidemio-logicheskaya service); 4) statistics of medical shots. Each of these sections contains the information characteristic of activity of the relevant institutions (specific indicators of work, volume and quality of medical aid) reflecting features and purpose of service. For the purpose of the analysis carry out comparison of the actual indicators to the established norms and standards, comparison with most reached and average levels on this type of institutions. An important element of a statistical analysis is consideration of interrelations of indicators both in establishment, and between healthcare institutions and other systems that also the nature of succession of medical care allows to reveal more stoutly features, and та^кже influence of various factors on the size of indicators and by that to establish possible ways of purposeful change them.

Wide use in health care of the COMPUTER (see. The electronic computer), modern transmission media of data turns statistics of health care into an operational information system (see the Automated control system, Informatsionnopoiskovaya system). In many republics and areas programs of operating control by use of bed fund, the analysis of list of the hospitalized patients, evaluation of the work of doctors in policlinics, the analysis of the course of medical examination etc. are carried out. Registers on doctors, on persons, TB patients, by cancer, etc. are entered. Use of the COMPUTER in health care allows to apply widely in the analysis of statistical data mathematical models (see. Mathematical methods, Modelling).

Statistical methods in clinical and laboratory pilot studies. Large number and variety of the quantitative indices received at inspection of various systems and human organs in a wedge, practice and in an experiment cause the necessity of their generalization and search of the most acceptable mathematical and mathematico-statistical criteria meeting scientific requirements of medicine. During the use of mathematico-statistical receptions of the analysis it is important to consider qualitative features of the studied subject and not to fall into excessive formalization and mathematization at interpretation of results of a research that can lead to wrong, senseless and even harmful conclusions.

The choice of mathematico-statistical receptions generally depends on the purposes and tasks, to-rye face the researcher, and deep understanding of essence of a subject. Matematikostatistichesky methods in medical scientific research are applied to determination of necessary number of groups of observation, the statement of reliability and reliability of the received results of observation, to studying of correlation and regression bonds, identification of degree of the importance of various factors, and also for the purpose of elimination of influence of the qualitative heterogeneity of groups of observation preventing definition of action of the major studied factor. In most cases the number of observations, to-rye clinical physicians (experimenters) can have on hand, it is limited owing to what it is necessary to use a sampling method (see. Sampling method).

One of the most often found tasks in a research is the proof of any influence and the reaction corresponding on it or effect. For this purpose create experienced and control groups. The organization of experimental and control group is made with the maximum observance of requirements imposed to quality standard of comparable groups. Selection can be made by method of a random sample or use of selection for a way of balanced groups or pair selection (mine steam).

The sequence of carrying out a statistical part of a research is defined by the general principles of carrying out and stages of a statistical research. Shortcomings and mistakes during the definition of the purpose, tasks, programs of observation and the organization of a research cannot be corrected afterwards by statistical methods of processing.

Recently for development of material and analytical works the computer facilities are widely used (see. Electronic computer). Along with quite simple statistical methods of the analysis (a chi-square, Fischer's method — Styodenta, correlation, dispersion and factor analysis) the difficult mathematical methods demanding special knowledge and programs for computing works apply.

Scientific research in the field of sanitary statistics is conducted generally in the following directions: improvement of techniques of studying of the state of health and health care; studying of tendencies and patterns of the state of health of various groups of the population in interrelation with conditions and image of their life; use of opportunities of the COMPUTER and mathematics for deeper and purposeful problem solving of management of health care (information support).

An example of scientific research in the area C. of page is the complex studying of the state of health of the population of the USSR which is carried out in 1969 — 1971 dated for a population census (see). It not only gave interesting and important materials about the state of health of the population, but also considerably filled up methodical bases of studying and assessment of health of the population. As a result gained further development and complex estimates of the state of health on groups of health, distribution of the population to the differentiated groups of observation according to risk groups, development of complex indicators of a condition of individual and public health found broad application. Interest in a fizicheskokhm to development of adult population and the related questions of formation of physical development of generations, influences on it of a profession and available hron increased. diseases.

Use of systems analysis (see) in scientific research according to S. the page considerably expanded possibilities of studying of origins of diseases, assessment of incidences and mortality, forecasting of indicators of health and obtaining the statistical data which are scientifically proving actions for improvement of health and health care.

The sanitary statistics in the socialist countries takes the important place in system of their health care. Reflecting changes in the state of health of the population and development of health services, it reveals the positive transformations in society reached by the socialist states (see Health care, in foreign countries). The village of the village of the socialist countries the same as in the USSR, consists of statistics of health and statistics of health care. In the certain countries (NRB, GDR, ChSSR) broad development was gained the centralized processing of primary data by means of the COMPUTER and system of registers (kantserregistra, registers mentally sick and so forth).

The statistics of the general incidence is based on periodically conducted selective examinations of health of the population, at to-rykh is used both primary medical documentation, and data of surveys (subselection) of the population by doctors.

In ChSSR in the current order 20% of all certificates on temporary release from work are processed. The statistics of causes of death is widely used though it is function of bodies of the state statistics. The statistics of medical personnel, and also the statistical information on activity of healthcare institutions based on the obligatory reporting of all healthcare institutions is in details developed and analyzed.

The statistical health service in all socialist countries is an integral part of health service; it is presented by the national centers C. of page and the relevant divisions at the regional level and directly in healthcare institutions.

Specialists of the socialist countries carry out the collaborations directed to creation of a modern technique of studying of incidence and, in particular, on development of the complex integrated indicators of assessment of health of the population, the unified methodical basis of overseeing is created by health of children; the structure and a technique of the unified system of the centralized information processing about the hospitalized patients is developed; the uniform terminological dictionary according to S. of page and to other sections of social hygiene is formed.

Sanitary statistics in the capitalist countries. The statistics of the natural movement of the population as the most simply collected even in the conditions of private medicine is taken as a basis of studying of health of the population in the capitalist countries.

Such indicators of health of the population are necessary for a capitalist system, to-rye would shade a true picture of pathology of the population, creating illusion of high rates of increase in level of health and improvement of vital conditions of workers under capitalism, and a possibility of improvement of workers in capitalist about-ve. To such social order of capitalism substantially satisfies the general rate of mortality which is used separately from other criteria characterizing health.

Social requirements of workers forced ruling numbers of the capitalist countries to make concessions in the field of health care, carrying out a number of measures for prevention of diseases (first of all, infectious), on creation at least of the cut-down system to lay down. - the prof. of actions.

The specified circumstance led to carrying out in these countries of works on data acquisition about health and information on health services. So, in Canada (1950 — 1951), Denmark (1951 — 1954) selective examinations of the general incidence were conducted; the separate, very generalized indicators characterizing health of the population are going to the USA on the basis of continuous selection; in Great Britain data on the general incidence were obtained on the basis of the account by general practitioners of negotiability behind medical aid (1955 — 1956; 1970). In many countries the statistics inf is organized. diseases, in the certain countries registers of cancer, inborn uglinesses are kept.

Rather big development was gained by statistics of the hospitalized patients that was promoted by implementation in practice of computer facilities. Works on the organization of statistics of doctors and other medical staff, institutions of primary medical aid and their activity are carried out.

Many methods of processing and the analysis of data have a certain value, statistical materials in the conditions of private health care are practically not used.

Sanitary statistics in developing countries. In villages, many of these countries of S., is in a stage of formation. The accounting of doctors and healthcare institutions is organized. In small territories selective account of the natural movement of the population is kept. By means of WHO special techniques of data acquisition about incidence, at least approximate, based even on messages of not medical personnel are created (heads, teachers etc.).

The sanitary statistics in activity of World Health Organization takes the important place. She inherited these functions from health service of the League of Nations and the International bureau of public hygiene (O G MB).

Activity of World Health Organization (see) in the area C. of page is carried out in the following directions: development of recommendations about the organization of systems of national S. of page; development of criteria, classifications, techniques, standard forms of statistical documents for their use in national programs; rendering to the countries technical assistance in creation of statistical services and in implementation of programs of preparation of national shots; collecting and publication of the international statistical information for health reasons population and to health services; ensuring statistical processing of the received materials. In 1948 the international conference of WHO approved the International Classification of Diseases (ICD) of the sixth review (see the Nomenclature and classification of diseases). From this point it became the classification of universal appointment intended for studying of incidence and mortality. The subsequent three reviews, in two the last of to-rykh actively participated the Soviet specialists, oriented classification to studying of incidence more and more. At the last review a series of the additional classifications intended for statistics of operations, laboratory researches, disability, disability, etc. is approved. In the USSR, as well as around the world, the ninth review of MKB works.

WHO collects from the countries a large amount of statistical materials in the form of publications of different frequency, and also annual questionnaires. The considerable share of this information is published in editions of WHO.

Military-medical statistics

This type of S. of page was created on the basis of practical requirements of medical support of troops (see. Medical support). Elements of the military-medical account began to appear in Russia in the second half of the 17th century, during origin of the military-medical organization of the Russian army and the organization of the hospital help to wounded soldiers. Obligatory submission of weekly sheets by regimental doctors about the movement of patients in regimental infirmaries and diseases which were found at them was entered in 1716 according to «Army regulations». In 1756 in the Russian army the monthly reporting and extraordinary medical reports of troops, and in 1763 — individual registration of patients in military medical institutions and the monthly medical reporting of military hospitals were entered.

Origin and the beginning of domestic scientific military-medical statistics belongs to the middle of the 19th century and is connected with a name and N. I. Pirogov's activity. S. P. Botkin's works, H were of great importance for development of domestic military-medical statistics. N. Sirotinina, V. A. Manassei-na, And. P. Dobroslavin, S. V. Shidlovsky, V. A. Levashev, A. A. Lipsky, G. M. Gertsenstein, etc., and in postrevolutionary years — 3. P. Solovyov, S. A. Novoselsky, A. F. Nikitin, L. B. Liberman, D. N. Lukashevich, L. S. Kaminsky, E. Ya. Belitskaya, etc. Representatives of the fields of military medicine, adjacent to it — V. A. Oppel, B. K. Leonardov, P. A. Kupriyanov, N. S. Molchanov, A.S. Georgiyevsky and others took great interest in development of scientific fundamentals of military-medical statistics.

The Soviet military-medical statistics received comprehensive check and registration as independent science and an obligatory subject of teaching in days of the Great Patriotic War of 1941 — 1945. Works and practical activities of E. I. Smirnov, H were of great importance in this respect. N. Burdenko, M. N. Akhutin, etc. The numerous and various military medico-statistical materials which are saved up during war were generalized and put in aboutto snov of the multivolume work «Experience of the Soviet Medicine in the Great Patriotic War of 1941 — 1945.» created in post-war years. The noticeable contribution to development of scientific fundamentals of military-medical statistics was made by scientists and teachers of VMA during the pre-war period.

In 1943 in VMA it was created and the department of military-medical statistics (since 1976 works to a crust, time — department of automation of management and military-medical statistics), the cut was the organizer L. S. Kaminsky.

The military-medical statistics develops methods of a statistical research of mass processes and the phenomena of military-medical character and gives them the objective quantitative characteristic; she investigates and opens the most essential statistical regularities of military medicine and military health care and develops the specific recommendations submitted on increase in level and strengthening of health of the military personnel and improvement of medical providing troops (fleet) in relation to conditions and features of their activity in peace and wartime on the basis of methods inherent in it.

Object of studying of military-medical statistics are the level and changes in health of the military personnel, including sanitary losses (see. Sanitary losses) in wartime; forces and means of medical service (their network, state, activity); medical providing troops (fleet) and its efficiency. According to it the most important sections of military-medical statistics are: statistics of health of the military personnel, including statistics of their incidence, physical development, uvolnyaemost on diseases; statistics dignity. losses; hospital statistics; statistics of medical providing troops (fleet) in military and (separately) in peace time.

The fundamentals of scientific methodology of military-medical statistics are made by set of specific methods (techniques, receptions), with the help to-rykh are opened and described quantitatively (see. Mathematical methods) patterns of military medicine and military health care. Specific methods of collecting initial information, methods of its group and the report, mathematico-statistical processing and the analysis, graphic analysis and representation belong to their number (see Graphics). The special place during the planning and implementation of a military medico-statistical research is allocated to development of systems of the generalizing criteria (indicators) allowing to carry out assessment of bodies of interest.

The maintenance of military-medical statistics as branches of science, a subject of teaching and the industry of practical activities includes four main sections: general theory and methods; the military-medical account (see. Account medical ) and the reporting (see the Reporting medical); statistics of medical providing Armed Forces in wartime (development and submission of the statistical information characterizing a dignity. losses, and also network of divisions, parts and institutions of military-medical service on the battlefield, their state and activity); statistics of medical providing Armed Forces in peace time (development and submission of statistical information on level and changes in health of various groups of the military personnel who is in specific conditions of military work and life and also about a condition of parts and institutions of medical service, their activity).

Independent value has the appendix of the theory and methods of statistics to clinical, general-theoretical and preventive problems of military medicine that promoted development of such, e.g., sections of military-medical statistics as hospital statistics, etc.

Practical value of statistical materials is very big also in daily work of military-medical service. They are used in operating control by service in all its links for control of efficiency and quality of work of forces and means of medical service and their evidence-based assessment, at the routine and advance planning of medical providing troops (fleet), for ensuring the sequence and succession in evacuation of wounded and patients, at generalization and the analysis of experience of medical providing troops (fleet) in military and peace time. Important value methods of military-medical statistics in voyen - but - scientific work in the course of collecting have, data processing (see) and their analysis; at problem solving of machine diagnosis (see Diagnosis machine), forecasting (see), etc.

The special place belongs to methods of military-medical statistics during the studying of activity of military medical institutions — so-called hospital statistics. Its main contents is the analysis and assessment of data on bed fund of hospital (group of hospitals) and its use; the list of the sick (wounded) who were on treatment in hospital about the defined outcomes and duration of their treatment; about efficiency of lechebnodiagnostichesky work of hospitals.

The most important channel of collecting military-medical statistical information in peace and wartime is system of the military-medical account and reporting, under a cut understand evidence-based system of collecting, processing, the analysis of data and the corresponding list of documents (see. Military-medical documentation). The majority of documents of the medical account and reporting are formalized and constructed taking into account requirements of mechanization and automation of their processing by means of modern high-speed computers.

The collected and analyzed statistical materials periodically are led up to military-medical structure and form a basis for evaluation of the work of medical service, and also for the routine and long-term planning of actions for improvement of medical providing the Soviet Army and Navy.

The military-medical statistics opened, formulated and described quantitatively many major patterns of mass military-medical processes, knowledge to-rykh has crucial importance for the theory and practice of military medicine and medical providing troops (fleet) in military and peace time. E.g., treat their number: quantitative characteristics (size and structure) dignity. losses in different types of fight and operations; a state and changes in health of various groups and categories of the military personnel depending on specific conditions of their work and life; the movement struck and patients on stages of medical evacuation depending on weight of defeat, its character, localization, etc.; the main statistics (their level, dynamics) characterizing the volume, quality, efficiency of activity of military-medical medical, preventive and other institutions.



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L. S. Kaminsky, A. M. Merkov, I. S. Sluchayno, G. F. Church; L. E. Polyakov (soldier.).

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