BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter XVIII. Highlights and Recommendations
355
On the medical certificate of cause of
death, in addition to Part I which is used
for recording the underlying cause and
events leading to death, Part II is provided
for recording other significant conditions
that unfavorably influenced the course of
the morbid process and thus contributed to
the fatal outcome. The Investigation has
made clear tie enormous importance of tie
associated causes, such as nutritional deficiency
and immaturity, in addition to the
underlying causes. Thus, completeness and
correct use of medical certification and the
inclusion of statements on botih underlying
and contributory causes are essential. The
multiple-cause approach is necessary in
order to establish the relationships between
agent andi host in mortality,
Combined efforts by clinicians and pathologists
will result in better definition of
the underlying cause and contributory conditions
and the chain of events leading to
death. Strengthening the important discipline
of pediatric pathology, including
clinical laboratory aspects, will enrich our
knowledge of the problems affecting maternal
and child health. Essentially, imaprovement
in certification of causes of death
and in basic sources of data depends on the
leadership provided by the medical profesion.
Computer facilities are now available for
tabulations of multiple causes and cross tabulations
of many factors involved in morbidity
and mortality. Vision and imagination
in the computer processing of vital
statistics and in the utilization of such data
could result in significant contributions to
medical knowledge. At the international
level recommendations by WHO in regard
to certification, tabulation, and analysis of
data on multiple causes are needed so that
comparable data will become available for
epidemiologic studies in the future.
EPIDEMIOLOGIC RESEARCH
The Investigation has served to uncover
the seriousness of the problems of nutritional
deficiency and immaturity in Latin
America. It has provided an overview of
other major community health problems,
some of which need clarification through
in-depth epidemiologic research while for
others practical research is required to demonstrate
the most realistic methods for
solving the problems.
The policy of combining epidemiologic
and community-centered research with preventive
actions is the sound and logical
approach. The Investigation has demonstrated
clearly the great diversity of patterns
of mortality in widely separated areas
of the Hemisphere. In medical education
programs, students should be made aware
of the importance of continuing the search
for greater knowledge of diseases and for
clues to their etiology. The discovery in the
last century of specific infectious bacterial
agents was only a beginning. Much more
must be learned to understand the etiology
and epidemiology of many diseases.
Different types of areas-those at high
altitude, and rural as well as urban localities-should
be included in geographic
studies of diseases. Analysis of their varied
characteristics may result in unexpected