Chapter 1

Introduction

1.1 WHAT IS BIOSTATISTICS?

Statistics is a eld of mathematical sciences that deals with data. Biostatistics is a branch of statistics that emphasizes the statistical applications in the biomedical and health sciences. It is concerned with making decisions under uncertainties that occur when the data are subjected to variation. Some of the sources of variation are known and can be controlled, whereas some other sources are not known and cannot be controlled. Human beings vary in many aspects. There exist inherent differences among all of us in our physiology, biochemistry, anatomy, environment, lifestyles, pathogenesis, and responses to various dental and medical treatments. The word statistics is used both to refer to a set of data and to a eld of study. Advancing technology has enabled us to collect and safeguard a wide variety of data with minimal effort, from patients demographic information to treatment regimens. Nowadays it is not uncommon for clinics, small or large, to have an efcient and impressive database management system that handles massive amounts of patient records. Clinicians, researchers, and other health sciences professionals are constantly collecting data on a daily basis. It is difcult to make sense of this confusing and chaotic array of raw data by visual inspections alone. The data must be processed in meaningful and systematic ways to uncover the hidden clues. Processing the data typically involves organizing them in tables and in clinically useful forms, displaying the information in charts and graphs, and analyzing their meaning, all in the presence of variability. The methods of statistical analysis are powerful tools for drawing the conclusions that are eventually applied to diagnosis, prognosis, and treatment plans for patients. The following are some examples in which biostatistics is applied to answering questions raised by researchers in the eld of health sciences.

1. In dental sciences, gingival recession represents a signicant concern for patients and a therapeutic problem for clinicians. A clinical study was conducted to evaluate and compare the effects of a guided tissue regeneration procedure and connective tissue graft in the treatment of gingival recession defects. 2. Dental researchers conducted a study to evaluate relevant variables that may assist in identifying orthodontic patients with signs and symptoms associated with sleep apnea and to estimate the proportion of potential sleep apnea patients whose ages range from 8 to 15 years. 3. Candidiasis is a common infection among the immunocompromised patients. The most causative agent is Candida albicans, which is a fungus that produces chlamydospores. C. albicans can be harbored in the bristles of a toothbrush and possibly reinfect the patient during treatment. A study was conducted to determine the effectiveness of the three most popular mouthrinses against C. albicans that is harbored in the bristles of a toothbrush. 4. The medical research on attention decit hyperactivity disorder (ADHD) is based almost exclusively on male subjects. Do boys have greater chances of being diagnosed as having ADHD than do girls? Is the prevalence rate of ADHD among boys higher than that among girls? 5. Coronary angioplasty and thrombolytic therapy (dissolving an aggregation of blood factors) are well-known treatments for acute myocardial infarction. What are the long-term effects of the two treatments, and how do they compare? Most of the scientic investigations typically go through several steps. 1. Formulation of the research problem 2. Identication of key variables 3. Statistical design of an experiment
1

Biostatistics for Oral Healthcare

4. Collection of data 5. Statistical analysis of the data 6. Interpretation of the analytical results Vast amounts of resources, time, and energy are being dedicated by health sciences professionals in the pursuit of research projects such as those described in the examples above. Statistics is an absolutely indispensable tool, providing the techniques that allow researchers to draw objective scientic conclusions.

1.2 WHY DO I NEED STATISTICS?

Students raise the question, Why do I need statistics? as often as many people say, I hate going to the dentist. Unfortunately, many students have had an unpleasant experience in mathematics and statistics while in school. These individuals are as likely to dislike statistics as patients are to dislike dental procedures after a bad experience with a previous dental treatment. Students who are pursuing a professional degree in the elds of health sciences, such as dentistry, dental hygiene, medicine, nursing, pharmacy, physical therapy, and public health, are often required to take at least one statistics course as part of the graduation requirements. An important part of students training is to develop an ability to critically read the literature in their specialty areas. The amount of statistics used in journal articles in biomedical and health sciences can easily intimidate readers who lack a background in statistics. The dental and medical journal articles, for example, contain results and conclusions sections in which statistical methods used in the research are described. Health science professionals read journals to keep abreast of the current research ndings and advances. They must understand statistics sufciently to read the literature critically, assessing the adequacy of the research and interpreting the results and conclusions correctly so that they may properly implement the new discoveries in diagnosis and treatment. As reported by DawsonSaunders and Trapp [1], many published scientic articles have shortcomings in study design and analysis. A part of statistics is observing events that occur: birth, death due to a heart attack, emergence of premolar teeth, lifetime of a ceramic implant, spread of inuenza in a community, amount of an

increase in anterior-posterior knee laxity by exercises, and so on. Biostatistics is an essential tool in advancing health sciences research. It helps assess treatment effects, compare different treatment options, understand how treatments interact, and evaluate many life and death situations in medical sciences. Statistical rigor is necessary to be an educated researcher or clinician who can shun the overgeneralization, objectively criticize, and appreciate the research results published in the literature. Learning should be fun. The study of statistics can be fun. Statistics is not sadistics. It is an interesting subject. In fact, it is a fascinating eld. Sir William Osler was quoted as saying that medicine is a science of uncertainty and an art of probability. It is no wonder that in dental schools and medical schools, as well as other post-graduate health science professional schools, statistics is an integral part of the curriculum.

1.3 HOW MUCH MATHEMATICS DO I NEED?

Some students come to statistics classes with mathematics anxiety. This book is not intended to entice students and train them to become expert statisticians. The use of mathematics throughout the book is minimal; no more than high school or college level algebra is required. However, it is fair to say that with greater knowledge of mathematics, the reader can obtain much deeper insights into and understanding of statistics. To dispel anxiety and fear of mathematics, plain English is used as much as possible to provide motivation, explain the concepts, and discuss the examples. However, the readers may feel bombarded with statistical terms and notation. Readers should not let this discourage them from studying statistics. Statistical terms in this book are clearly dened. Denitions and notation are the language by which statistical methods and results are communicated among the users of statistics.

1.4 HOW DO I STUDY STATISTICS?

Statistics books cannot be read like English, history, psychology, and sociology books, or like magazine articles. You must be prepared to read

Introduction

slowly and carefully and with great concentration and thought. Do not hesitate to go back and review the material discussed in the previous sections. Statistics is unique in that the concept being introduced in the current section is often the foundation for the concepts to be introduced in the following sections. It is a good idea to frequently review the materials to gain deeper insight and enhance your understanding. It is not necessary to memorize the formulas in the book. Memorization and regurgitation will not help you learn statistics. Instead of spending time memorizing the formulas, strive to understand the basic concepts. Think of a few relevant examples in

your discipline where the concepts can be applied. Throughout the study of this book, ask yourself a couple of questions: What is the intuition behind the concept? How could I explain the formula to my brother in the sixth grade so that he can understand? These questions will force you to think intuitively and rigorously.

1.5 REFERENCE
1. Dawson-Saunders, Beth, and Trapp, Robert G. Basic & Clinical Biostatistics. Second Edition. Appleton & Lange. 1994.