KHARKIV NATIONAL MEDICAL UNIVERSITY SOCIAL MEDICINE, PUBLIC HEALTH (BIOSTATISTICS) Methodical instructions to the practical lesson on the topic «Methodical basis of biostatistics and its role in healthcare system» for students in the specialty: – 222 “Medicine” – 228 “Pediatrics”, – 221 “Dentistry”. Kharkiv 2018 MINISTRY OF PUBLIC HEALTH OF UKRAINE KHARKIV NATIONAL MEDICAL UNIVERSITY DEPARTMENT OF PUBLIC HEALTH AND HEALTHCARE MANAGEMENT SOCIAL MEDICINE, PUBLIC HEALTH (BIOSTATISTICS) Methodical instructions to the practical lesson on the topic “Methodical basis of biostatistics and its role in healthcare system” for students in the specialty: – 222 “Medicine” – 228 “Pediatrics”, – 221 “Dentistry”. Затверджено вченою радою Харківського національного медичного університету. Протокол № 12 від 20.12.2018 Kharkiv KhNMU 2018 УДК 614.1:311 Social medicine, public health (biostatistics) : methodical instructions to the practical lesson on the topic “Methodical basis of biostatistics and its role in healthcare system” for students in the specialty 222 “Medicine”, 228 “Pediatrics”, 221 “Dentistry” / V.A. Ognev, P.O. Tregub, I.A. Chukhno. – Kharkiv : KhNMU, 2018. – 19 p. Drafters: Ognev V.A. Tregub P.O. Chukhno I.A. RECOMMENDATIONS FOR STUDYING THE TOPIC The aim of the class: to learn the content of the definition “biostatistics”, “statistical aggregate”, “observation unit”, “characteristics taken into account”, “representativeness” and other terms. Need to know: · program questions: · organization of statistical research; · principles of forming statistical aggregates for further analysis; · concept of general and selective aggregates; · classification of data types both quantitative and qualitative data; · characteristics of measurement scales; · general characteristic of statistical analysis methods, especially their usage; · generalization of statistical research results; · procedure for results’ reliability assessing; · concept of zero and alternative hypotheses, hypotheses’ testing. Need to be able to: –  define object of the research, generate and characterize general and selective aggregates; –  get general skills of formation of selective aggregates. Recommended literature Basic literature 1. Біостатистика / за заг. ред. чл.-кор. АМН України, проф. В.Ф. Москаленка. – К. : Книга плюс, 2009. − С. 12-31. 2. Социальная медицина и организация здравоохранения / под общ. ред. Ю.В. Вороненка, В.Ф. Москаленко. – Тернополь : Укрмедкнига. 2000. – С. 23-32. 3. Социальная гигиена и организация здравоохранения / под ред. Н.Ф. Серенко, В.В. Ермакова. – М. : Медицина, 1984. – С. 102-104. 4. Тестовые задачи по социальной медицине, организации здравоохранения и биостатистике : учеб.пособ. для студентов мед. ф-тов / под ред. В.А. Огнева. – Харьков : Майдан, 2005. – С. 9-14. 5. Лекционный курс кафедры. Additional literature 1. Альбом А. Введение в современную эпидемиологию / А. Альбом, С. Норелл. – Таллинн, 1996. – 122 с. 2. Власов В.В. Введение в доказательную медицину / В.В. Власов. – М. : Медиа Сфера, 2001. – 392 с. 3. Герасимов А. Н. Медицинская статистика / А.Н. Герасимов. – М. : ООО «Мед. информ. агентство», 2007. – 480 с. 4. Зайцев В.М. Прикладная медицинская статистика / В.М. Зайцев, В.Г. Лифляндский, В.И. Маринкин. – СПб.: ООО «Изд-во ФОЛИАНТ», 2003. – 432 с. 5. Общая теория статистики: учебник / под ред. чл.-корр. РАН И.И. Елисеевой. − 4-е изд., перераб. и доп. − М. : Финансы и Статистика, 2000. − 480 с. 6. Основы доказательной медицины / под ред. М.П. Скакун. – Тернополь : Укрмедкнига, 2005. – 244 с. 7. Реброва О.Ю. Статистический анализ медицинских данных. Применение пакета прикладных программ STATISTICA / О.Ю. Реброва. – М. : Медиа Сфера, 2002.–312с. 8. Сергиенко В.И. Математическая статистика в клинических исследованиях / В.И. Сергиенко, И.Б. Бондарева. – М. : ГЭОТАР-МЕД, 2001. – 256 с. Information resources 1. Население Украины. Демографический ежегодник. – К.: Госкомстат Украины –www.ukrstat.gov.ua 2. U.S. National Library of Medicine –Национальная медицинская библиотека США– http://www.nlm.nih.gov/ 3. Государственная научно-педагогическая библиотека Украины им. В.О. Сухомлинского–http://www.dnpb.gov.ua/ 4. Научная библиотека Харьковского национального медицинского университета – http://libr.knmu.edu.ua/index.php/biblioteki 5. Научная педагогическая библиотека им. К.Д. Ушинского Российской академии образования–http://www.gnpbu.ru/ 6. Национальная библиотекаУкраиныим. В.И. Вернадского –http://www.nbuv.gov.ua/ 7. Национальная научная медицинская библиотека Украины –http://www.library.gov.ua/ 8. Харковская государственная научная библиотека им. В.Г. Короленка – http://korolenko.kharkov.com 9. Центральная библиотека Пущинского научного центра РАН –http://cbp.iteb.psn.ru/library/default.html 10. Центральная научная медицинская библиотека Первого Московского государственного медицинского университета им. И.М. Сеченова –http://elibrary.ru/defaultx.asp BASIC THEORETICAL MATERIAL FOR PREPARATION FOR THE LESSON 1. Statistics as a science Statistics is an independent social science. It studies quantitative aspect of public events in close connection with their qualitative aspect in specific historical conditions. Statistics is divided into economic statistics (industrial statistics, of agriculture, construction, transport, connection, labor, etc.) and social statistics (politic statistics, culture statistics, biological statistics, science statistics, education, etc) It depends on the areas of economic activity, social phenomena and processes. Biostatistics is one part of the general statistics. Biostatistics studies general and particular patterns that are inherent in living nature, using statistical methods. Biological statistics exists as an independent discipline. But at the same time it is a part of the public health and is presented in this course due to the fact that biological statistics is a tool of social medicine and public health organization. Biological Statistics as a science includes Descriptive biostatistics and Inferential biostatistics. The purpose of the descriptive statistics is to collect and systematize data (including obtained generalized indicators) about the subject of study. Inferential biostatistics aims to obtain statistical conclusions based on the collected and systematized information about the object of research. Currently, biological statistics, as well as modern epidemiology, is a tool of a new direction in medical science – “Evidence Based Medicine”. This term was developed in the end of the ХХ century. Evidence Based Medicine combined epidemiology and biological statistics in a single unit. It allows to obtain accurate medical information about diseases’ spreading, their prevention, treatment, diagnostic, rehabilitation and other elements of health services of population. Medical statistics – is one of the field of biostatistics. It studies basic laws and tendencies of population’s health using statistical methods. or Medical statistics – is a kind of biostatistics, which examines population’s health, the organization of medical care for the population, as well as assessing quality and efficiency of health care establishments. Theoretical basis of Medical Statistics: general dialectic; economic science; medical science; general theory of statistics. Medical statistics is divided into sections, and has a number of objectives. Sections of medical statistics are: 1. Public health statistics studies quantitative aspect of health, both in general population and various population groups, depending on the complex of social and biological factors. 2. Healthcare system statistics studies medical network, personnel of healthcare system. It gives an opportunity to carry out an estimation of activity of public health services establishments and provide active actions for public health protection. 3. Organization and carrying out medical-social, clinical and experimental studies statistics. It supports organization and conduction of various statistical studies methodologically. As well as it allows to assess reliability of obtained results with justification of recommendations for healthcare system. Among objectives of medical statistics, the following must be emphasized: 1) study the state of population health (demographic processes, population morbidity, physical development and disability); 2) establishment and identification of cause-effect relationships morbidity, mortality, disability of population, depending on various factors and environmental conditions; 3) study and analysis data of personnel in healthcare system and a network of medical healthcare institutions with the aim of planning and determining population needs in various kinds of medical care; 4) evaluation of the quality and efficiency of healthcare institutions, as well as medical and recreational activities for morbidity and mortality prevention; 5) evaluation of the reliability of statistical studies’ results which were received after medical – social, clinical and experimental studies. The objects of statistical research must be defined. They can be various statistical aggregates, which are formed depending on the purpose of the study. Also they can be groups (born in a certain year, diseased, dead, etc.). 2. Statistical aggregate and its properties Statistical aggregate is a large group, consisting of a large number of relatively homogeneous units of observation, which were taken together within certain limits of time and space for a particular purpose. Statistical population consists of observation units. Observation unit is every primary element of statistical aggregate. Observation unit is endowed with attributes of similarities and differences. These qualities are subjects of registration and further observation. That is why these features are called accounted or statistical. Accounted features can be classified: By the nature of expression: 1. attributive – signs of a descriptive nature (sex, profession, treatment outcome, and so on.); 2. quantitative – signs expressed by the number (height, weight, age). By the nature of variations: 1. alternative – two values can be taken (Is heredity burdened? The answer could be yes or no); 2. discrete or intermittent – quantitative signs. They take only certain values without intermediate ones. Usually they expressed by integers (number of floors in building – 1,2,3,4 etc.; number of children in family – 1,2,3,4, etc.); 3. increte or continuous – quantitative signs. They can take not only certain values but intermediate ones as well. (child's growth – 1m, 1m can be 15 cm, can be 1m 15cm. 5 mm, etc.). These values may be either integer or fractional. Due to time: 1. o0ne-time – characterizes object of study at a particular time (medical examination on March 1, 2002, census on January 1, 2002.); 2. interval – characterizes object of study for certain periods of time (month, year, etc.), for example, number of persons who was born or died since January 1st to December 31st. According to the method of measuring: 1. primary or accounted – characterizes unit as a whole. They may be qualitative and quantitative. They are obtained directly from observation unit (gender, height, weight, individual, etc.); 2. secondary or calculated are obtained by calculating primary characteristics, for example, the cost of medical services, cost-effectiveness, morbidity and mortality per 1000 population and others. Besides that, statistical features can be: 1. factorial – under the influence of this features other productive characteristics which are dependent on them change; 2. effective – features which change under the influence of factorial ones. E.g., child’s weight increases with the increasing of his/her age. In this case, age – is a factor and weight – is an effective feature. Overall, aggregate statistics are divided into general and selective: 1. General aggregate – consists of all observation units that may be allocated to it in accordance with intended purpose of the study. 2. Selective aggregate – is a part of a general statistical aggregate, selected by a special sampling method. It is intended for characteristic of general statistical aggregate. Representativeness is a peculiarity of selective aggregate. Representativeness – an ability of selective statistical aggregate to display with maximum reliably properties of all general statistical aggregate. There are certain requirements for forming a selective aggregate: 1. It has to have main characteristics of general statistical aggregate. 2. It has to be sufficient in volume, in order to express general properties of statistical aggregate more fully. To achieve representativeness, it is important to use a randomized approach. Randomization – is a selection of observation units into selected group or the group of comparison randomly. So that each patient could receive an equal chance to get into selective aggregate: impact group or group without impact. Randomization is a procedure which provides a random distribution of observation units. Random selection, mechanical selection, typological selection, serial selection, directional selection and others are the methods of providing random selection into selective aggregate. Simple random allocation – allows to select units of observation randomly (blind draw method, lottery, etc.). Mechanical allocation – carried out in accordance with a certain number of aggregate for a particular principle (every fifth, tenth or so.). Stratified sampling – all aggregate is divided into several groups, from which observation units are selected. E.g., study about incidence of urban and rural population can be divided into 2 groups. And observation units are selected from each group. Selection of observation units can be carried out proportionally or disproportionally depending on the size of each group. Cluster sampling – clusters (groups) are formed from all aggregates. These can be families which form selective statistical aggregate. Systematic allocation – people are selected based on the same experience, age or gender, and so on. It is important to comply certain technology and the sequence of performing statistical operations during statistical analysis. Therefore, prominent social hygienists A.F. Serenko and V.V. Yermakova offered to allocate in statistical aggregate features which must be described with the help of statistical methods, among them: 1. Distribution of a feature (frequency, proportion) – is expressed by relative values quantitatively. 2. Middle level of characteristic – Mode (Мо), Median (Ме), Mean (Х). 3. Variety of characteristic – limit (Lim), amplitude (Am), middle-quadratic deviation (sigma) (δ), variation coefficient (Сυ). 4. Representation of characteristic – average error of Mean (mх), average error of relative value (mр), etc. 5. Relation between characteristic – correlation coefficient ( r ), regression coefficient (Rx/y). Specification of statistical characteristics allowed to combine statistical methods of studying various phenomena into an ensemble and determined their sequence. 3. Department of Information and Analytics In health care system there were created information-analytical centers, departments and divisions (based on the level of health care establishment) for providing collection, storage and analysis of statistical information. Department of Information and Analytics – provides this type of work in health care establishments. Department of Information and Analytics (division) of medical statistics is a subdivision of a treatment-and-preventive institution. Qualified specialists who has medical or economical education and obligatory work experience work in this division. The main objective of this division is a formation of a unified system of medical and statistical accounting and reporting. Also Department of Information and Analytics makes the implementation of systematic control over quality input of approved medical statistical documentation and ensure reliability of information. Implementation of the new technologies of accounting and reporting documentation processing is one more area of activity of this department. Main directions of the activity: · organizational, methodological and consulting assistance for structural subdivisions of health care establishment; · organization of collection, processing and analysis of medical statistics and data about network, personnel, results of the health care establishments’ activity. This can be done using state reporting requirements and materials of state statistics authorities; · supervision of the national, regional and local public health programs implementation; · information and analytical materials preparation. TEST TASKS 1. Different types of statistics began to form in the structure of general statistics during the course of its development. What statistics does medical statistics belong to? A Economical B Education statistics C Political D Science statistics * E Social 2. Statistical aggregate is a large group of relatively homogeneous items, actions, phenomena. They are taken together within certain limits of time and space. What is the integral part of a statistical aggregate? * A Observation unit B Part of the statistical aggregate C Record characteristic D Signs which have to be studied E Statistical sign 3. Social phenomena are studied under a variety of descriptive accounting features that characterize unit of observation. What is the name of these signs? * A Attributive B Discrete C Increte D Momentary E Quantity 4. Population phenomena are studied under taking into account a large variety of accounting signs that characterize unit of observation. What is the name of the signs which can have only two values? * A Alternative B Attribute C Discrete D Momentary E Quantity 5. Each observation unit has a wide variety of accounting signs. How are accounting signs that characterize object of study, which is being studied at a certain time called? A Alternative B Attribute C Discrete * D One-time E Quantity 6. Statistical aggregate consists of the units of observation. They are characterized by registration signs. How are quantitative sign, which can take only certain values called? A Alternative * B Discrete C Increte D Interval E Momentary 7. The necessity to identify impact of environmental factors of studied phenomenon often arises during studying of population’s morbidity and mortality. What is the name of registration signs, which cause other dependent characteristics to change? A Alternative B Discrete C Effective D Factorial * E Increte 8. A variety of factors are examined to develop a set of preventive measures to preserve and improve public health. How are accounting signs which change under the influence of signs interrelated with them called? A Alternative B Discrete * C Effective D Increte E Factor 9. A part of statistical aggregate, which is selected by a special sampling method and is intended to describe general statistical aggregate is often used during conducting of the statistical research. What is the name of this part? A General statistical aggregate B Main array C Monographic description D Selective array * E Selective aggregate 10. Selective statistical set is a part of the general statistical aggregate, which is selected by a special sampling method. It is intended to describe general statistical population. What is the peculiarity of selective aggregate? A A small number of observations B Directional selection C Dissimilarity of aggregate * D Representativeness E Sensitivity 11. It was found that a sign has a bimodal (two-humped) distribution during graphic imaging of 12 years old pupil’s growth. What does this distribution indicate? * A Its dissimilarity B Its insufficiency C Its representativeness D Its sensuality E Its specificity 12. Statistical aggregate is a group that consists of a large number of relatively homogeneous observations units, taken together within certain limits of time and space. What can be an observation unit? A Aggregate of individuals or phenomena that are studied B Certain contingents of persons C Certain objects, phenomena * D Seperate individual, separate phenomenon E Separate research method 13. Official records were used during studying of hospital morbidity statistics: patient’s card who left day-and-night care, medical case history and others. What is the name of the observation unit in this case: A Call to emergency medical care which hospitalized patient. * B Case of hospitalization who was treated in day-and-night care. C Case of referral for hospitalization D Referral for hospitalization from family doctor E Self-referral into day-and-night care 14. Morbidity with temporary disability is one of the population’s morbidity types. What should be taken as a observation unit in this kind of disease studying? * A Case of disability due to worker’s illness or worker who has received work incapacity certificate B Case of full loss of ability to work due to A.R.V.I. C Case of full loss of ability to work due to quarantine. D Plant worker E Plant worker hospitalized into day-and-night care 15. Infant mortality is one of indicators that characterize state of public health. What can be taken as a observation unit in the study of this mortality? A Case of child’s death in antenatal period. B Case of child’s death in perinatal period C Case of child’s death in postnatal D Case of child’s death during the first month of life. * E Case of child’s death till one year of life 16. Determine the observation unit in the study of the average length of hospital stay of patients, depending on time of their delivery to day-and-night care and clinical form of disease: A Aggregate of individuals or phenomena that are studied B Certain contingent of people C Certain objects, phenomena * D Separate individual E Separate research method 17. Statistical method is widely used in social medicine and health care. Determine the main objectives of this method A Assessment of medical care cost B Assessment of outpatient care cost C Development of disease prevention biological methods D Development of environmental parameters * E Determining of public health level patterns 18. Medical statistics is studying issues related to medicine, hygiene and health care. Determine one of the medical statistics sections: A Analysis of studied phenomena dynamics B Determination of derived values C Medical and social expertise * D Public health statistics E Sanitary assessment of projects 19. Medical statistics includes number of sections. Which of the following is one of its sections? A Determination of derived values * B Health care system statistics C Medical and social expertise D Sanitary assessment of projects E Studied phenomena dynamics analysis 20. Statistical information obtaining during research has to comply with certain requirements. Determine one of these requirements: A Collection of data by correspondent method B Collection of data by census C Collection of data through questionnaires D Current events’ registration * E Qualitative data homogeneity 21. Statistical information has to comply with certain requirements. What is the requirement for this information? A Collection of data by correspondent method B Collection of data by census C Collection of data through questionnaires D Current events’ registration * E Data integrity 22. The growth of mortality from myocardial infarction has been seen in region D. during last 5 years. The situation requires an assessment of cardiac day-and-night care efficiency in the region. Determine the observation unit in this case: * A Cardiac day-and-night care B Case of hospitalization to cardiac day-and-night care C Doctors-cardiologists complement D Providing with diagnostic equipment of cardiac day-and-night care E Timeliness of requests for medical aid to cardiac day-and-night care 23. Determine the observation unit in study of the average length of hospital stay of patients with appendectomy, depending on transportation time to day-and-night care and clinical form of appendicitis: A Average duration of patient’s stay in day-and-night care B Clinical form of appendicitis C Patient who is admitted to day-and-night care * D Patient who is admitted to day-and-night care E Terms of patient’s transportation 24. Name the statistical observation unit in determining impact of sugar amount in blood during healing of wound surface in postoperative period: A Amount of sugar B Blood analysis * C Patient in postoperative period D Patient who has wound surface E Patient who was checked out for after treatment 25. Blood pressure (BP) was measured in the epidemiological study. By the beginning of the study instruction of BP measurement technique was carried out. But metrological verification of measuring instruments was not carried out. What errors are most likely to be encountered in conducting this study and affect reliability of results? A Informational B Logical C Methodological D Random * E System 26. The incidence of allergic diseases of children were studied through copying of data from medical records in the pediatrics polyclinic. According to the research program every third story of a child's growth was selected in registry for formation of total sample. Specify which method of selective aggregate forming was used by researchers: A Directional * B Mechanical C Random D Serial E Typological 27. Socio-hygienic research was carried out in city N. According to the research program all population of the city was divided by place of residence (by area), and then persons from each group were selected in proportion to observation unit. Specify a method of selective aggregate forming was used by researchers: * A Cluster allocation B Directional C Mechanical D Random E Serial 28. An increase of mortality from stroke was marked in region A. Situation requires an assessment of day-and-night care neurological departments’ effectiveness in the region. Determine the observation unit in this case: A Doctors-neurologists complement * B Neurological departments’ day-and-night care C Providing of population with places in day-and-night care of neurological departments D Providing with diagnostic equipment of neurological day-and-night care E Timeliness of requests for medical aid to neurological day-and-night care 29. Statistical studies in medicine and health care are carried out mainly in selective aggregates. What requirement this aggregate has to comply with? A Presence of a "zero" hypothesis B Presence of grouping characteristic C Qualitatively heterogeneous aggregate D Studied characteristic oscillation’s absence * E Sufficient number of observations 30. Structural units that provide collection, storage and analysis of medical information have important meaning in the health care system. What is the name of the division that provides this type of work in the health care establishments? A Center of statistics * B Department of Information and Analytics C Division of statistics D Office of collection, storage and analysis of information E Office of statistics CONTROL QUESTIONS 1. What is “statistics” in the modern sense, it’s main signs? 2. History of statistics’ occurrence. 3. Medical statistics, it’s tasks. 4. Medical statistics’ divisions. 5. Concept of statistical aggregate. 6. Concept of carried signs. 7. Classification carried signs. 8. Types of statistical aggregate. 9. Methods of selective statistical aggregate formation. 10. Properties of statistical aggregate. 11. Characteristic of statistical aggregate properties. 12. Types of signs distribution in statistical aggregate 13. Department of Information and Analytics CONTENTS Recommendations for studying the topic ………………............................... 3 Basic theoretical material for preparation for the lesson.……………….….. 5 1. Statistics as a science……………………………………..……... 5 2. Statistical aggregate and it’s properties……….………………… 6 3. Department of Information and Analytics………………………. 8 Test tasks……………………………………………………………………. 9 Control questions…………………………………………………………… 16 Educational publication SOCIAL MEDICINE, PUBLIC HEALTH (BIOSTATISTICS) Methodical instructions to the practical lesson on the topic: “Methodical basis of biostatistics and its role in healthcare system” for students in the specialty: 222 “Medicine”, 228 “Pediatrics, 221 “Dentistry”. Drafters: Ognyev Viktor Tregub Pavlo Chukhno Inna Translated by Chukhno I.A., Allastal A. Responsible to sign-off Ognev V. Формат А5. Ризографія. Ум.друк. арк. 1,12. Тираж 150 прим. Зам. № 18-33678. ______________________________________________________________ Редакційно-видавничий відділ ХНМУ, пр. Науки , 4, м. Харків, 61022 izdatknmu@mail.ru, izdat@knmu.kharkov.ua Свідоцтво про внесення суб’єкта видавничої справи до Державного реєстру видавництв, виготівників і розповсюджувачів видавничої продукції серії ДК № 3242 від 18.07.2008 р. 17 _1547921588.unknown