WONCA International Classification Committee

ABORTION RATE

The estimated annual number of abortions per 1,000 women of reproductive age (defined as age 15-44).

ABORTION RATIO

The estimated number of abortions per 100 live births in a given year.

ACCURACY

The extent to which results of measurements agree with reality as measured by a chosen "gold standard" procedure. Accuracy can be used as comprehensive term for sensitivity and specificity together.

ACTIVITIES OF DAILY LIVING (ADL) SCALE

A scale devised to score physical ability/disability; used to measure outcomes of interventions for various chronic disabling conditions such as arthritis. The scale is based on scores for responses to questions about mobi-lity, self-care, grooming, etc. . The WONCA/COOP charts can be used to measure aspects of ADL.

ACUTE

Has two meanings depending on relation to health or exposure.
1. Referring to health - recent onset, sometimes loosely used to mean severe eg. acute pain.
2. Referring to exposure - brief, intense, sometimes referring to brief exposure of high inten---sity.
Used about the duration of a health problem it refers to a duration less than 4 weeks.

ADJUSTED RATES

Adjustment is often performed on rates or relative risks, commonly because of differing age distribu-tions in populations that are being compared. Rates may be adjusted using the age-specific health problem frequency of each group and a standard age distribution reference population (direct standar-dization). An alternative is to use the age distribution of groups and the expected health problem frequency from a reference group to calculate expected total morbidity or mortality (indirect standardization).

ADJUSTMENT

A summarising procedure for rates or measures of association in which the effects of differences in composition of the population being compared have been minimised by statistical methods. Age is a variable for which adjustment is most often carried out.

ADMINISTRATIVE CARE

Services which derive from the responsible position accorded to health care providers by the commu-nity, eg. certify-ing fitness for certain functions (driving, work, sports), unfitness for certain func-tions, and death, where necessary following a clinical examina-tion. Witnessing of signatures and attestations about character are further examples.

ADVERSE REACTION, SIDE EFFECT

Any undesirable or unwanted consequence of a preventive, diagnostic or appropriate or inappropriate treatment.

AETIOLOGY

Knowledge of causes of a health problem.

AFTER HOURS VISIT

A consultation or a home visit conducted after the normal working hours as defined for that practice. Must be clearly stated when it is used in studies.

AGE

The age in years of the patient at his/her last birthday.

AGE DEPENDENCY RATIO

See DEPENDENCY RATIO.

AGENT (OF A HEALTH PROBLEM)

A factor, such as a microorganism, chemical substance or form of radiation, whose presence, excessive presence, or (in deficiency diseases) relative absence is essential for the occurrence of a health problem. A health problem may have a single agent, a number of independent alternative agents (at least one of which must be present) or a complex of two or more factors whose combined presence is essential for the develop-ment of the disease.

AGE GROUPS

WONCA standard age groups in years : Less than 1 year; 1 to 4 years; 5 to 14 years; 15 to 24 years; 25 to 44 years; 45 to 64 years; 65 to 74 years; 75 years and over. 5- yearly cohorts are increasingly used for children and the elder-ly.
Standard division points should be retained (for example : 5-9 years, 10-14 years, 65-69 years, 70-74 years, 75-79 years, 80-84 years and 85 years and over).

AGE-SEX REGISTER

The list of all patients in a practice by age and sex. The primary purpose of this register is to provide a defined popula-tion against which rates of observed occurrence in a practise may be cal-culated. In the absence of a defined practice list only patients regularly attending and who regard themselves as patients of the practice, should provide the defined population.

AGE-SPECIFIC FERTILITY RATE

The number of births occurring during a specified period to women of a specified age group, divided by the number of person-years lived during that period by women of that age group. When an age-specific fertility rate is calculated for a calendar year, the number of births to women of the specified age is usually divided by the mid-year population of women of that age.

AGE-SPECIFIC RATE

A rate for a specified age group. The numerator and denominator refer to the same age group. The rate is often expressed per 100 or per 1,000 for a general practice population or 100,000 or 1,000,0000 for the total population.

AGE STANDARDIZATION

A procedure for adjusting rates, eg. death rates, designed to minimize the effects of differences in age composition when comparing rates for different populations.

AGING OF THE POPULATION

A demographic term, meaning an increase over time in the proportion of older persons in the population. It does not necessarily imply an increase in life expectancy or that "people are living longer than they used to". The principal determinant of aging in the population has been a decline in the birth rate : when fewer children are born than in previous years, the result, in the absence of a rise in the death rate at higher ages, has been an increase in the proportion of older persons in the population. In developed societies, however, mortality change is becoming a factor : little further mortality reduction can occur in the first half of life, so reductions are beginning to occur in the third and fourth quarters of life, leading to a rise in the proportion of older persons from this cause.

AGREEMENT

The extent to which the results of two observations agree under similar conditions, more observers or the same observer repeatedly. The observers should be blinded for each others assessments.
In a two-by-two table the value of agreement is the proportion of results that are assessed as positive by all observers plus the results that are assessed by all as negative divided by the total number of observations. The proportion agreement is not corrected for chance, as the measure kappa.

ALGORITHM, CLINICAL

An explicit description of steps to be taken in patient care in specified circumstances. This approach makes use of branching logic and of all pertinent data, both about the patient and from epide-miologic and other sources, to arrive at decisions that yield maximum benefit and minimum risk.

AMBULATORY CARE

Care provided to patients who are independently mobile. The care may be provided in general practice, in an outpatient department of a hospital or other health service delivery point.

ANALYTIC STUDY

A study designed to examine associations, commonly putative or hypothesized causal relationships. An analytic study is usually concerned with identifying or measuring the effects of risk fac-tors, or is concerned with the health effects of specific exposure(s). Con-trast descriptive study, which does not test hypotheses. The common types of analytic studies are CROSS-SECTIONAL, COHORT and CASE-CONTROL. In an analytic study, individuals in the study population may be classified according to "attributes" that may influence occurrence of health problems. Attributes may include age, race, gender, health problems, genetic, biochemical and physiological characteristics, economic status, occupation, residence and various aspects of the environment or personal behaviour.

ANCILLARY STAFF

Non-medical personnel working in a practice, including nurse or practice nurse, health visitor, me-dical so-cial worker, secretary, practice aide, receptio-nist, administrator, business manager, bookkeeper and others.

ANTICIPATORY CARE

Care devoted to anticipating the patient's future problems in trying to prevent them from occurring or diminishing potential damage.

APPOINTMENT SYSTEM

The system used by a physician to plan and regulate the timing of patient encounters. It may be complete, where no patients other than emergencies are seen except by appointment, or partial, where there is greater flexibility.

ASSESSMENT

1. Clinical assessment :
- General or complete assessment : A standardized procedure to determine the physical, mental, and social well-being of the patient with appropriate investigations, including a complete record of findings and advice to the patient.
- Specific or partial assessment : Includes a his-tory and de-tailed examination which relates to a specific diagnosis or problem with appropriate investigations, and including a complete record of findings, and advice for the patient.
- Functional assessment : The measurement, both objectively and/or subjectively, over a sta-ted period of time of a person's abi-lity to per-form and adapt to his/her environment.
2. Educational assessment :
- Obtaining information concerning a student's progress and level of attainment.
- Formative assessment : measures the progress of gains made by the student and informs him/her about the amount still to be learnt before educational objectives are achieved.
- Summative assessment : measures the achievement of the student at the end of an educational programme, usually for the purposes of awarding a certificate or diploma or to enable progress to the next stage.
3. Qualitative assessment :
- The thorough study and analysis of a known or suspected problem in quality of medical practice, designed to define causes and necessary action to correct the problem.

ASSOCIATION

Relationship between two or more persons, events, characteristics or other variables. A statistical association is present if the probability of occurrence of an event or charac-teristic or the quantity of a variable, depends upon the occurrence of one or more other events, the presence of one or more other charac-teristics or the quantity of one or more other variables. The presence of a statistical association does not necessarily imply a causal relation-ship. (For further statis-tical and epidemiological use of the term see JM Last : A Dictionary of Epidemiology).

ASSOCIATION OF PRACTICES

Practices of physicians who share prem-ises and/or staff, during regular office hours, but they do not share patients eg. list of patients.

ATTITUDES

States of readiness or predisposition; feeling for or against something which predisposes to particular responses. They involve emotions (feelings) and knowledge (or beliefs) about the object and emanate in behaviour. They are not inherited but learnt and, though relatively stable, are modifiable by education.

ATTRIBUTE

A qualitative characteristic of an individual or item.

AUDIT

An examination or review that establishes the extent to which a health problem, process or performance conforms to agreed standards or criteria.

AXIS

The direction or reference within a classification system. The ICPC is biaxial, with its primary axis representing body systems (chapters) and the other axis representing components (reasons for encounters, process and diagnosis).