No abstract

Despite the impressive strides in health information, mortality statistics are the only source of data at the national, state, and local level that is consistently available and that satisfies the basic criteria of coverage and continuity. The Neither the accuracy of the reporting as defined by the study methods nor the interpretation of the results appears to be very heartening. The study determined that only 65 per cent of the observed underlying causes named on the death certificates fell into the groups that were defined as indicating good agreement. Using site-specific cancer as categorized by the three-digit ICDA codes, the study found substantial variability in accuracy of underlying cause among the separate site-specific cancer categories. In discussing the sources of disagreement, the study identified the physician or coroner as the most common source for discrepancy, and concluded there is a need to raise the level of awareness of physicians and coroners to pay greater attention to entries of cause of death.While this detailed cancer specific study is largely directed toward epidemiological applications, it raises a number of broader issues about the quality, use, and evaluation of current cause of death information.Any measure of "accuracy" used to evaluate death certificate information is wholly dependent on the performance requirements determined by a specific user. An epidemiologist following a relatively rare disease will have an exacting requirement for accuracy, whereas the community health planner may well be satisfied with the relative rank or magnitude of a disease specific entity. The epidemiologist will use the death certificate as a point of departure; and the planner will use it as an appropriate end point.Upgrading the system and its accuracy is a variable thing, since the death certificates serve such diverse user audiences. On the one hand, access to the certificate becomes a major obstacle to the epidemiologic clinician, or disease specific investigator who would not rely on the certificate except as a starting point for a detailed study. This situation is illustrated in the cancer mortality findings in that site-specific cancers appearing in the poor accuracy groups (Groups 2-4) are relatively rare. Any rigorous study of rare phenomena would invariably turn toward a comprehensive case finding approach without sole reliance on either hospital or death records.On the other hand, to the community health planner, the intended use of mortality data may be to characterize time trends in broad disease groupings and demographic shifts. Using larger aggregations of specific 3-digit ICDA groupings will tend to lessen errors in accuracy. The proportional mortality (Table 8) of Percy, Stanek, and Gloeckler give some assurance that the hospital and death certificate results are

This pattern suggests that GGLE undergoes three phases of growth, peak and stability and decline. Japan will soon be seeing its GGLE gradually shrinking in the foreseeable future. The continuing increases in Happiness, HDI and GEM are associated with a decrease in GGLE, which should be carefully taken into consideration.

The HVAT has 11 simple questions. It may be self-administered and is available on the Internet: http://www.DHAC.com. The physician may err if his decision in favor of cataract surgery is based only on visual acuity. The HVAT has the potential to guide the decision-making process between patient and physician.

This study reports the results of a 1986 national survey of mental health, alcohol, and substance abuse services within health maintenance organizations in the United States. Ninety-seven percent ofresponding health maintenance organizations (HMOs) offered mental health service coverage and two-thirds of responding HMOs offered alcohol and substance abuse service coverage. Annual mean mental health hospitalization was 36.90 days per 1,000 members and annual mean ambulatory mental health utilization was 0.29 physician encounters per member. (Am J