describe how epidemiological data influences changes in health practices

Epidemiologists would do well to remember GIGO (garbage in, garbage out) when delineating their data collection plans. Epidemic curves from environmentally spread diseases reflect complex interactions between the agent and the environment and the factors that lead to exposure of humans to the environmental source. Among 9,422 blood lead tests conducted during April 2013March 2016, 284 (3.0%) BLLs were 5 g/dL or higher; the probability of having BLLs of 5 g/dL or greater was 46% higher during the period after the switch from Detroit Water Authority to FWS than before the switch to FWS. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. bDays from vaccine dose to illness onset Use alternatives to joining data points with a line. Indicate underpopulated or depopulated areas. Ensures that you are fully versed in the basic dimensions of a health problem. Provide an example and explain what data would be necessary to make a change in practice. The x-axis represents a period of interest. For probability sampling procedures other than a simple random sample (e.g., stratified or cluster sampling), consult with a survey sampling expert. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. WebDQ9 : Describe how epidemiological data influences changes in health practices. Cookies used to make website functionality more relevant to you. Since this outbreak was recognized, the epidemic has spread through the mosquito vector as well as through sexual and perinatal transmission to multiple countries and continents around the world. All information these cookies collect is aggregated and therefore anonymous. Certain behaviors (e.g., drug addiction or mass sociogenic illness) might propagate from person to person, but the epidemic curve will not necessarily reflect generation times. This demonstrates how review of secular trends can bring attention to key events, improvements in control, changes in policy, sociologic phenomena, or other factors that have modified the epidemiology of a disease. The field epidemiologist must understand the characteristics of the study population and their ability and willingness to respond to various survey methods (e.g., access computers and Internet-based surveys). Norovirus (GII) infection was confirmed as the causative agent. Supports decisions for initiating or modifying control and prevention measures. Describe how epidemiological data influences changes in health practices. Plot the percentage of the total for the year represented by each interval; however, take care when interpreting the total percentage. Defined as a symptom that improved while away from the facility, either on days off or on vacation. On the opposite end of the scale, injuries and acute poisonings have instantaneous and obvious onsets. To avoid clutter and maintain undistorted comparisons, consider using two or more separate panels for different strata on the same graph. As a field epidemiologist, you will collect and assess data from field investigations, surveillance systems, vital statistics, or other sources. Cases of leptospirosis by week of hospitalization and rainfall in Salvador, Brazil, March 10November 2, 1996. In Figure 6.15, a distinctive pattern of rapidly increasing cholera death rates is apparent as the altitude approaches the level of the River Thames. When the agent is unknown, the time interval between presumed exposures and onset of symptoms helps in hypothesizing the etiology. Although it is logical to believe that a field investigation of an urgent public health problem should roll out sequentiallyfirst identification of study objectives, followed by questionnaire development; data collection, analysis, and interpretation; and implementation of control measuresin reality many of these activities must be conducted in parallel, with information gathered from one part of the investigation informing the approach to another part. Epidemiology was originally focused exclusively on epidemics of communicable diseases (3) but was subsequently expanded to address endemic communicable diseases and non-communicable infectious diseases. WebDescribe how epidemiological data influences changes in health practices. Ideally, the findings provide sufficient evidence to direct prompt and effective public health control and prevention measures. The important attributes of a public health surveillance system can and should be applied to data collected in response to an urgent event (see Introduction). Provide an example and explain what data would be necessary to make a change in practice. Although field epidemiologic investigations of an urgent public health problem are legally considered to be public health practice and not research (. An outbreak of dengue arising from a single imported case in a South China town reveals several of these features (Figure 6.6) (8). In 1951, the first conference of state epidemiologists determined which diseases should be nationally notifiable to the Public Health Service and later to CDC. If using color, use increasing intensities of the same hue. This is important so that we have a background, and average on these ailments that we may see within the healthcare practice. Compare frequency of brain cancer among anatomists with frequency in general population, ____ 3. However, a persons measurements can fluctuate above or below these cutoff values. The analyses and results are only as good as the quality of the data collected (remember GIGO!). Collecting mortality statistics and classifying the causes of death dates to the 1500s in London, when the Bill of Mortality was periodically published (2). During the same period, Dr. John Snow, known as the father of modern epidemiology, mapped deaths from cholera in London and determined the Broad Street Pump as the source of contaminated water (4). This propagated pattern has four principal characteristics (Box 6.6). In fact, epidemiology is often described as the basic science of public health, and for good reason. Differentiate them with labels, legends, or keys. If the study comprises the entire study population, it is a census; a subset of the study population is a sample. Stratifying seasonal curves can further expose key differences by place, person, or other features (Figure 6.12) (12). However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. Subsequent chapters discuss the details of data analysis. For instance, an epidemiological study may collect data on the number of people who answer, Yes when asked if someone in their household has trouble hearing. Organizing data columns and rows by the magnitude of the marginal summary statistics is often helpful. This data looks at the when, where, why, and how of diseases, injuries, and environmental hazards (CDC, 2018). Dots, onset times, case identification numbers for indexing with a line listing, or other symbols might represent disease cases (Box 6.10). These factors have potential impact on population health states similar to that of risk factors on disease occurrence. View the full answer Step 2/2 Final answer Previous question Next Thank you for taking the time to confirm your preferences. Use graphic designs that reveal the data from the broad overview to the fine detail. More than that becomes confusing clutter. Nonetheless, many epidemiologists still use the term disease as shorthand for the wide range of health-related states and events that are studied. Cholera deaths per 10,000 inhabitants and altitude above the average high-tide level, by district in London, England, 1849. These can then be compared among groups, against expected values, or against target values. Contact between severe acute respiratory syndrome (SARS) cases among a group of relatives and health care workers: Beijing, China, 2003. It reveals the location of the first case in the business district and the large initial cluster surrounding it (Figure 6.13) (14). Generation periods between waves of an outbreak are usually longer than with simple person-to-person transmission because two sequential incubation periods, extrinsic in the vector and intrinsic in the human, are involved. Many of the steps to conducting a field investigation rely on identifying relevant existing data or collecting new data that address the key investigation objectives. Instructions on conducting the interviews, especially if there are multiple interviewers: Include the importance of reading the questions verbatim, term definitions, the pace of the interview, answers to frequently asked questions, and ways to handle urgent situations. Source: Adapted from Ajloun Non-Communicable Disease Project, Jordan, unpublished data, 2017. Saving Lives, Protecting People, Principles of Epidemiology in Public Health Practice, Third Edition, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, U.S. Department of Health & Human Services, ____ 1. Match the term to the activity that best describes it. Provide an example and explain what data would be necessary to make a change in practice. This protocol can include the following: Train staff collecting data on the protocol, reviewing instructions carefully and modifying as needed. If the denominator of the population unit is known, spots of different size or shading (Box 6.10) can represent rates or ratios. Furthermore, EHRs contain potentially useful data on healthcare use, treatment, and outcomes of a diseaseelements not typically assessed by more traditional public health data sources. Cates W. Epidemiology: Applying principles to clinical practice. A data space where the data are organized and displayed to indicate patterns. Legal considerations, including statutes, rules, and regulations. Control measures targeting the larva and adults of the mosquito vectors Aedes aegypti and A. albopictus began late in the first generation. Recommend that close contacts of a child recently reported with meningococcal meningitis receive Rifampin, ____ 6. Epidemiologic data are paramount to targeting and implementing evidence-based control measures to protect the publics health and safety. WebDescribe how epidemiological data influences changes in health practices. As an alternative to plotting onset by calendar time, plotting the time between suspected exposures and onset can help you understand the epidemiologic situation. The epidemic curve accompanying the severe acute respiratory syndrome (SARS) contact diagram (Figure 6.2, panel B) illustrates these features, including waves with an approximate 1-week periodicity. Describe how epidemiological data influences changes in health practices. Public Health Problem: To support a rapid response, field epidemiologists need to determine the most efficient, timely, and cost-effective method for data collection during an outbreak. mosquitoes was identified in northeastern Brazil. Saving Lives, Protecting People. Below are three key terms taken from the definition of epidemiology, followed by a list of activities that an epidemiologist might perform. This type of curve can be made for any time cycle (e.g., time of day, day of week, or week of influenza season). Epidemiology is a scientific discipline with sound methods of scientific inquiry at its foundation. What type of contact information is available? Official websites use .gov Share sensitive information only on official, secure websites. This will save time in the long run; many epidemiologists have learned the hard way that a survey question was not clear or was asking about more than one concept, or that the menu of answers was missing a key response category. How much? is expressed as counts or rates. Seasonal patterns might be summarized in a seasonal curve (Box 6.8). These three points should bracket the exposure period. This can be as simple as finding that a health event is affecting only a limited age group or as complicated as comparing age-specific rates among multiple groups. Enables generation of testable hypotheses regarding the etiology, exposure mode, control measure effectiveness, and other aspects of the health problem. To assess adverse effects from a vaccine or pharmaceutical, consider using total doses distributed as the denominator. For example, the map of spotted fever rickettsioses in the United States effectively displays multiple levels of risk for human infection (Figure 6.14) (15). Information specialists can answer your questions in English or Spanish. For example, understanding the distribution of vectors for each infection and patterns of the diseases in animals is paramount. provide an example and explain what data would be necessary to make a change in practice. When starting data entry, check several records against the completed survey instrument for accuracy and consider double data entry of a sample of surveys to check for errors. This means that the results of such a study may be quite different from a study in which actual hearing (audiometric) tests are administered to each person in a household. After the outbreak peaks, the exhaustion of susceptible hosts usually results in a rapid downslope. The disease or health condition onset time is the preferred statistic for studying time patterns. The Internet survey took more up-front time and resources to prepare but less staff time for data collection and data entry. Instructions for recruiting and enrolling participants in the survey, including obtaining consent for participation. The predominant survey conducted in all states is the Behavioral Risk Factor Surveillance System, a random-digit dialed household survey of noninstitutionalized US adults. Bar charts usually need a zero level because viewers judge magnitude by the length of the bar. Take-Home Point: Collecting data over time and understanding changes in environmental exposures (e.g., various drinking water sources) was key to identifying a source of communitywide elevated BLL in children and supporting recommended control measures (e.g., filters on tap water). A trend line of best fit underlying the data markers. bDuring the previous 12 months. On maps representing land areas, indicate longitude and latitude and orientation (i.e., by using a northward-pointing arrow). Dot plots, box plots, and bar charts are easier to understand and read if aligned horizontally (with the numeric axis horizontal). Epidemiology is also used to search for determinants, which are the causes and other factors that influence the occurrence of disease and other health-related events. Extreme aspect ratios distort data. Changes in technology also challenge data collection. Survey initiation, timeliness of response, and attack rates were comparable. Such changes range from laboratories moving to nonculture diagnostic methods for isolating infectious pathogens, which decreases the epidemiologists ability to link cases spread out in space and time, to increasing use of social media to communicate, which limits response rates from time-honored methods of data collection, such as landline telephones. Source: Adapted from: Ajloun Non-Communicable Disease Project, Jordan, unpublished data, 2017. Use the smallest possible administrative area that the numerator and denominator will allow. You will be subject to the destination website's privacy policy when you follow the link. Close-ended questions could include cascading questions, which can be an efficient way to get more detailed information as one filters down through a hierarchy of questions (e.g., first you ask the participants state of residence, then a menu of that states counties drops down). The observed pattern might represent variability in the distribution of the underlying population. If the survey is interviewer-administered, it should include fields for interviewer name and interview date. Determinant: any factor, whether event, characteristic, or other definable entity, that brings about a change in a health condition or other defined characteristic. Minimize frames, gridlines, and tick marks (610/axis is sufficient) to avoid interference with the data. Each person providing such an answer may interpret trouble hearing differently. We take your privacy seriously. Similar to developing a protocol, the most efficient and effective means for developing a survey instrument might be to identify an existing survey questionnaire or template that can be adapted for current use. Use separate, equally scaled epidemic curves to indicate different groups. < Previous Chapter 5: Using Technologies for Data Collection and Management, Next Chapter 7: Designing and Conducting Analytic Studies in the Field>. Take-Home Points: Internet-based surveys permit efficient data collection but should be designed to maximize complete responses. When using transformed data (e.g., logarithmic, normalized, or ranked), represent equal units of the transformed data with equal distances on the axis. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. After evaluating whether existing data can address the study objectives, the field epidemiologist must determine whether additional data need to be collected and, if so, what and how (Box 4.4). Contemp Ob/Gyn 1982;20:14761. When the row or column headings are numeric (e.g., age groups), they should govern the order of the data. BMI, Body mass index; F, female; M, male; SD, standard deviation. With acute infections, poisonings, and injuries, you will often have precise exposure times to different suspected agents. Take-Home Point: Increase in an unusual syndrome (microcephaly) prompted government health agencies to coordinate efforts to collect systematic case data, develop a standard case definition to use across jurisdictions, and conduct uniform laboratory testing for possible etiologic agents. Provide an example and explain what data would be necessary to make a change in practice. For most conditions, a time characteristic of interest is the secular trendthe rate of disease over multiple years or decades. The last two factors listed in the box will lead to irregular peaks during the progression of the outbreak and precipitous decreases. Days (2-day intervals) between onset of a case of severe acute respiratory syndrome and onset of the corresponding source case: Beijing, China, MarchApril 2003. Nowhere are data more Wednesday 10 The importance of developing a protocol, identifying roles and responsibilities of team members, and documenting all activities and processes should not be underestimated. Cases of Salmonella enterica serovar Heidelberg infection, by illness onset date: Colorado, July 10 August 17, 1976. Information was drawn in part from the Surveys and Sampling chapter in the earlier edition of this book (27) and from Designing Clinical Research (28). Of note, administration of antimicrobials, immunoglobulins, antitoxins, or other quickly acting drugs can lead to a shorter than expected outbreak with a curtailed downslope. Thank you for taking the time to confirm your preferences. Provide an example and explain what data would be necessary to make a change in practice. To search for these determinants, epidemiologists use analytic epidemiology or epidemiologic studies to provide the Why and How of such events. WebWith that being said, epidemiological data can have an impact on changes in health practices. Epidemiology is the study (scientific, systematic, data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (patient is community, individuals viewed collectively), and the application of (since epidemiology is a discipline within public health) this study to the control of health problems. Although the list comprises primarily infectious diseases, in 1995, the first noninfectious conditionelevated blood lead levelswas added (7). Pattern refers to the occurrence of health-related events by time, place, and person. An epidemic curve with a tight clustering of cases in time (1.5 times the range of the incubation period, if the agent is known) and with a sharp upslope and a trailing downslope is consistent with a point source (Figure 6.3) (6). Commonly in descriptive epidemiology, you organize cases by frequency of clinical findings (Table 6.2) (3). For foodborne outbreaks, most states and local jurisdictions publish data at least annually; however, for chronic diseases (e.g., cancer) or birth outcomes (e.g., microcephaly), expected baseline rates might have to be extrapolated by applying previously published rates to the population of concern. Your analytic findings must explain the observed patterns by time, place, and person. Multiple factors must be considered when identifying relevant data sources for conducting a field investigation. Exposure to lead has significant adverse health effects (e.g., developmental delays) particularly for young children with developing brains. These graphs can include line graphs, histograms (epidemic curves), and scatter diagrams (see Box 6.4 for general guidelines in construction of epidemiologic graphs). Data collection procedures, variables to be collected, procedures to safeguard participants.

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