State Federal-Funded Educational Institution of Higher Professional Training

I.M. Sechenov First Moscow State Medical University

of the Ministry of Health of the Russian Federation

N.A.Semashko Department of Public Health and Health Care

COURSE TASK

Public Health and the Methods of its Study

Variant 1

Student _______________________
______________________________
faculty ________________________
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course_________________________
group _________________________

  Group instructor
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Moscow – 2017
Authors:

Professor Ekkert N.V.

Associate professor Mikerova M.S.

Guidelines for the implementation of the course task:

On the basis of self-training tutorial, learned topics in classes and tutorial materials
and lectures, as well as using additional literature, including Internet materials, a
student should:
Part 1.
i) Define the problem in public health, choose a topic, formulate the goal (aim)
and objectives of the study, propose a plan (the object of study, the type and
method of observation) and the program of statistical research (unit of
observation, data collection and program development program material
(models of statistical tables) .
i) In the complex task to assess the situation in the city K. and to analyze the
state of health of the population of this city at the moment and in the dynamics
(if in the problem presented material), determine the possibility of graphic and
submit it, to make a brief summary of the analyzed material.

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 Part 1
Information

City K. is an industrial center in the Middle Volga in Russia. The city operates a
major river port, ship repair, and there are cement plants, agricultural machinery plant,
chemical fiber plant, a cannery, a textile mill. Industrial enterprises working at full
capacity and often complicate environmental conditions in the city. Housing
construction is slow pace. Green space in the city is not enough. There are no
opportunities for the development of physical culture and sports in this city.
Conducting cultural activities is difficult. City Department of Health, with the
participation of experts and specialists studied health. The results are shown below.
There are 100, 000 people in the city K., including the age group until 15 years –
25 000 children and teenagers, from 15 to 49 years – 50 000 citizens (including
women – 26 000), 50 years and older – 25 000 people.
Task: evaluate structure of the population of the city by the age, imagine the
results graphically, write a conclusion.

In this year born 1100 alive children (previous year – 1050 children), all of
women aged 15 - 49 years. 1450 people died during the year, including 12 children
until 1 year. The dynamic of demographic indicators in city K. is shown in Table 1.

Table 1
Dynamic of Demographic Indicators of the city K. (per 1 000)

Estimation
Indicators 1995 2000 205 2010 2016 of parameter

Birth rate 6.8 7.9 8.4 8.7

Death rate 16.3 15.7 15.3 14.8
Population
growth rate
Fertility rate 43.3 43.1 41.7 40.9
Infant mortality 15.8 14.9 13.8 13.1
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rate

Task: Assess the level and dynamics of demographic indices in city K., show
them graphically, make conclusion about the possible causes of demographic
situation.

Materials of study the causes of general mortality and infant mortality rates are
presented in Table 2.

Table 2
Leading causes of death of the population in city K.
(abs. number and % of total)

Number of deaths
Causes of death in the city K.
abs. number % of total

620
Diseases of the circulatory system

210
Accidents, injuries, poisoning

188
Malignant tumors

124
Diseases of the digestive system

185
Respiratory diseases

123
Other reasons

1 450 100.0
Total

Task: Analyze the main causes of death of the population of city K., provide
information graphically, write a conclusion.

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 Analysis of morbidity of adults and children residing in the city K. showed the
following. In the city K. 58 430 cases of diseases were registered among the
children aged 0 to 18 years in this year (including the first-ever diagnosis of 42 680
cases). The number of children aged 0 to 18 years is 30 000 (Table 3).

Table 3
Indicators of general morbidity of the population in different age groups
and places of residence (1000 population of corresponding age)

Children Adults
Indicators
city K. region city K. region
Primary morbidity 1 370 687 595

Prevalence 1 846 1 409 1 378

Task: analyze the incidence of child and adult population of city K., provide
information graphically, write a conclusion.

The dynamic of the indicators of the incidence and prevalence of respiratory

diseases of the population of city K. is presented in Table 4.

Table 4
Dynamics of indicators of general morbidity and primary morbidity
of the population of city K. (per 1 000 population)

Indicators 1994 1999 2004 2009 2015

Primary morbidity 1 025 986 930 891 844

Prevalence 1 491 1 570 1 602 1 634 1 759

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 Task: analyze dynamics of morbidity of population of city K., provide
information graphically, write a conclusion.

The structure of the prevalence of the population of city K. presented in Table 5.

Table 5
Structure of the primary morbidity and prevalence of the population of city K.
(% of total)

Primary
Prevalence
Name classes and diseases morbidity
% of % of
rank rank
total total

Certain infectious and parasitic diseases 4.9 3.2

Neoplasms 1.3 2.8
Endocrine, nutritional and metabolic
1.6 3.1
disorders
Mental and behavioral disorders 3.4 7.4
Diseases of the nervous system 2.6 4.0
Diseases of the eye and adnexa 5.0 6.9
Diseases of the ear and mastoid process 2.6 2.1
Diseases of the circulatory system 4.6 12.2
Respiratory diseases 40.8 24.0
Diseases of the digestive system 4.5 7.7
Diseases of the skin subcutaneous tissue 6.1 5.0
Diseases of the musculoskeletal system and
5.2 7.6
connective tissue
Diseases of the genitourinary system 4.4 6.1
Injury, poisoning and certain other
11.9 6.3
consequences of external causes
Other 1.1 1.6
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 Total 100.0 100.0

Task: analyze the structure of morbidity of population of city K., provide

information graphically, write a conclusion.

In this year dentists of the Moscow Central Research Institute of Dentistry were
held continuous epidemiological study of the prevalence of periodontal disease of
residents of the city K. and town M. Frequency of periodontitis (per 1,000
inhabitants) in K. was noticeably higher. There are the differences in the age structure
of the population of city K. and town M. (Table 6).

Table 6
Distribution of urban residents of the city K. and town M.
and periodontitis patients by age groups

The city K. The town M.

Age the number of the number of the number of the number of

residents patients with residents patients with
periodontitis periodontitis
up to 15 25,000 500 30,000 660
years
15-49 years 50,000 3,000 50,000 3,200

50 years and 25,000 8,500 20,000 7,000

older
Total 100,000 12,000 100,000 10,860

Task: using an appropriate statistical method analyze the influence the age
structure of the population of the city K. and the town M. on the incidence of
periodontal disease, write a conclusion.

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 Doctors of the maternity home in the city K. analyzed the rates of physical
development of children born by the women of different age groups (Table 7).

Table 7
The results of measuring the body weight of children
born by the women the age over 35 years

Body Weight (in kg.) Number of Children

2.2 2
2.5 1
2.8 2
3.1 4
3.4 9
3.7 12
4.0 9
4.3 3

Task: calculate the average weight of babies born by women the age over 35
years, indicators of the variety, make a conclusion.

Children born by women aged 20-29 years had an average body weight of 3.2 kg
( = 0.3 кг, СV = 9.1 %, m = 0.03 кг).

Task: Compare a diversity of body mass index of children born by women of

different age groups, write conclusions. Assess the impact of women's age on body
weight at birth and write conclusions.

Doctors conducted a research of state of health of students (n=360) from the

college to identify myopia. Myopia was diagnosed by 80 students.

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 Task: calculate a frequency of myopia among students using an appropriate
statistical method to make a prediction about the frequency of myopia for the total
population of students of colleges in the city K.

Doctors conducted a study of influence of length of service on hearing loss in

riveters in order to reduce the occupational morbidity of shipyard workers and to
develop preventive measures (Table 8).

Table 8
Influence of length of service on hearing loss among dockyard workers

Task: using an appropriate statistical method, analyze the influence of work

experience on hearing loss at the shipyard riveters, write a conclusion

The number of people with hearing

Length of service (years)
loss (per 100 workers)
Less than 5 years 2.0
5-9 19.2
10-14 48.0
15-19 81.4
20-24 98.1
25 and more 95.5
Gastroenterologist of the student polyclinic of The Medical University conducted
a study of caries risk factors in students and evaluated the power of their influence on
the occurrence and outcome of the diseases (Table 9).

Table 9
Incidence of caries in students of the Medical University of the city K. depending
on the presence of risk factors
(per 100 students)

Task: evaluate the index of the relative risk of caries for each factor and write
conclusions.
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 The program of the prevention of caries was developed by health department
specialists to reduce prevalence of caries among students of the city K.

The incidence
Risk Factors of caries Relative Risk
(RR)
Poor oral hygiene

+ 28.0
- 10.0
Dietary habits (sugar
consumption, soft
drinks)

+ 35.0
- 15.0
Dental plaque

+ 40.0
- 12.0
Smoking
+ 25.0
- 12.0

Task: develop a plan of measures for the city administration, medical and
preventive health care organizations, educational institutions to prevent caries among
students (depending on the stage of prevention).
457 physicians of all specialties and 846 nurses work in the medical
organizations of the city K. There are 957 beds at the hospital and the maternity
hospital (Table 10).

Table 10
Dynamic of the availability of doctors, nurses and hospital beds
in the medical organizations of the city K. (per 10 000 population)

Indicators 2004 2009 2014

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 Ratio of physicians 37.8 41.4
Ratio of nurses 92.5 87.2
Ratio of beds 97.3 96.6

Task: evaluate the providing of the population of the city K. with doctors, nurses,
beds at medical organizations, draw a graphs, write conclusions.

Task: Make a general conclusion about the state of health of the population
of the city K.

Part 2
i) Choose a dental speciality
ii) Describe the functions and tasks of doctor
iii) Choose an oral disorder, justify its medical and social significance
iv) Specify the structure of the economic damage due to this disorder

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i) Apply SWOT-analysis of the dental medical organization, describe the
possible strengths and weaknesses, opportunities and threats.

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