Sensitivity of questions. 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. The example spot map of a dengue outbreak uses larger dots to represent cases clustered in time and space and numbers these clusters to reference to a table (not shown). However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. However, sometimes the population is unknown, costly to determine, or even inappropriate. This expected or target case count is now corrected for the population and can be compared with the actual observed case counts. The x-axis represents a period of interest. View the full answer Step 2/2 Final answer Previous question Next Commonly in descriptive epidemiology, you organize cases by frequency of clinical findings (Table 6.2) (3). 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. Ensures that you are fully versed in the basic dimensions of a health problem. This is important so that we have a background, and average on these ailments that we may see within the healthcare practice. Like Tweet +1 Click icon to see a sample Essay Format & Features Many investigation activities must be conducted in parallel and are interdependent and iterative, with results informing edits or amendments. On the opposite end of the scale, injuries and acute poisonings have instantaneous and obvious onsets. Similarly, prevalent case counts divided by the population from which they arose produce a proportion (termed prevalence). Vectorborne diseases propagate between an arthropod vector and a vertebrate host. Use six or fewer tick mark labels on the axes. New data collected in the context of field investigations should be evaluated for attributes similar to those for surveillance data, such as quality, definitions, timeliness, completeness, simplicity, generalizability, validity, and reliability (1). You will be subject to the destination website's privacy policy when you follow the link. Cases can be plotted on a base map (Figure 6.13 [14]), a satellite view of the area, a floor plan, or other accurately scaled diagram to create a spot map. Upright bars in each interval represent the case counts during that interval. Like the practice of medicine, the practice of epidemiology is both a science and an art. Defined as a symptom that improved while away from the facility, either on days off or on vacation. An important initial step in collecting data as part of a field investigation is determining the mode of data collection (e.g., self-administered, mailed, phone or in-person interview, online survey) (29). A mixed mode of survey administration (e.g., mailed survey with phone follow-up) might be less expensive to conduct than a phone-only survey, but it also increases study complexity. Pay special attention to ensuring that survey instruments can be used across multiple sites in the event that the outbreak involves multiple jurisdictions. Clearly indicate scale divisions and scaling units. This will be modified by the variability of contact between humans and the reservoir animal and, for vectorborne zoonoses, contact with the arthropod vector. Always check whether data sources are providing incident (new events among the population) or prevalent (an existing event at a specific point in time) cases. This area also had been affected by an outbreak of dengue fever. Whether the tables or graphs help the investigator understand the data or explain the data in a report or to an audience, their organization should quickly reveal the principal patterns and the exceptions to those patterns. To indicate divergence from an average range, use white for the center range and deepening intensities of two different hues for divergent strata on opposite extremes. The last three questions are assessed as patterns of these data in terms of time, place, and person. Therefore, writing a protocol before embarking on any data collection is paramount. Length and complexity of the survey. Tabulate the frequency of clinical signs, symptoms, and laboratory findings among children with chickenpox in Cincinnati, Ohio. In field investigations, tradeoffs exist between these attributes; for example, a more timely collection of data might lead to lower quality data, fewer resources might mean less complete data, and retrospective analysis of preexisting data might be more cost-effective, although prospective data collection from case-patients might enable more targeted questions about specific exposures. Illness resulting from exposure to environmental contaminants is another area of public health importance requiring surveillance. Students of journalism are taught that a good news story, whether it be about a bank robbery, dramatic rescue, or presidential candidates speech, must include the 5 Ws: what, who, where, when and why (sometimes cited as why/how). In addition, maps display a wealth of underlying detail to compare against disease distributions. Changes in the shape of primary care, and the range of symptoms and illnesses managed by different members of the primary health care team, can influence understanding of: the epidemiology of disease in the community; the need for different health care services; and how primary care epidemiology is done. Six biologic differences in humanvectorhuman propagation affect the size and the shape of the epidemic curve (Box 6.7). All information these cookies collect is aggregated and therefore anonymous. Contrast this with chronic diseases that can have exposures lasting for decades before development of overt disease. Frequency refers not only to the number of health events such as the number of cases of Solved Describe how epidemiological data influences changes They help us to know which pages are the most and least popular and see how visitors move around the site. 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. When two or more data sets are plotted in the same data space, Design point markers and lines for visual discrimination; and. Adhere to mathematical principles in plotting data and scaling axes. Rates are normally displayed on area maps (e.g., patch or choropleth). Arthropod populations can grow explosively and can decline even more rapidly. describe how epidemiological data influences changes in health Collecting mortality statistics and classifying the causes of death dates to the 1500s in London, when the Bill of Mortality was periodically published (2). Public Health Problem: During April 2014October 2015, residents of Flint, Michigan, were exposed to elevated lead levels in drinking water after the water source was switched from the Detroit Water Authority from Lake Huron to the Flint Water System (FWS) from the Flint River. Small sample size, resulting in inadequate power to detect differences between groups. Public Health Problem: In early 2015, an outbreak of Zika virus, transmitted by Aedes spp. For most conditions, a time characteristic of interest is the secular trendthe rate of disease over multiple years or decades. Provides timely information for decision-makers, the media, the public, and others about ongoing investigations. WebAn example of how epidemiological data influences changes in health practices is with the pandemic we are currently experiencing (Covid-19). Epidemiologists working in applied public health have myriad potential data sources available to them. Use graphic designs that reveal the data from the broad overview to the fine detail. Rates correct counts for differences among population sizes or study periods. Rather than increase to a peak, however, this type of epidemic curve has a plateau. In September 2009, the Oregon Public Health Division investigated an outbreak of gastroenteritis that occurred among more than 2,000 participants of a week-long, 475-mile bicycle ride. Epidemiologists assume that illness does not occur randomly in a population, but happens only when the right accumulation of risk factors or determinants exists in an individual. DQ-1 Describe how epidemiological data The line-listing in Table 6.1 has been sorted by days between vaccination and onset to reveal the pattern of this important timeevent association. Describe how epidemiological data influences changes in health practices. Indicate an interval of 12 incubation periods before the outbreak increases from the background and after it returns to background levels. Organize data by magnitude (sort) across rows and down columns. This puts each stratum on a flat baseline, enabling undistorted comparisons. Local, national, and global health threats are monitored by agencies such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), Epidemic curves for large geographic areas might not reveal the early periodicity or the characteristic increase and decrease of a propagated outbreak. WebHealthcare data improves communication between patients and healthcare providers and provides doctors with an in-depth understanding of specific health conditions. Epidemiology is the branch of medical science that investigates all the factors that determine the presence or absence of diseases and disorders. Age represents three different categories of determinants of disease risk (Box 6.11). 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. Do not insist on a zero level unless it is an integral feature of the data (e.g., an endpoint). The same is true in characterizing epidemiologic events, whether it be an outbreak of norovirus among cruise ship passengers or the use of mammograms to detect early breast cancer. New health policies in 1970 and 1995 that broadened coverage of Papanicolaou smear screenings for women were initially followed by steeper decreases and subsequent leveling off of the downward trend. Decrease the time interval size as case numbers increase. Scatter plots are versatile instruments for exploring and communicating data. Although the list comprises primarily infectious diseases, in 1995, the first noninfectious conditionelevated blood lead levelswas added (7). Epidemiological data plays a vital role in influencing changes in health practices. WebIn general, epidemiological data is a crucial instrument for influencing changes in medical procedures. If the denominator of the population unit is known, spots of different size or shading (Box 6.10) can represent rates or ratios. < Previous Chapter 5: Using Technologies for Data Collection and Management, Next Chapter 7: Designing and Conducting Analytic Studies in the Field>. cDefined as current use of asthma medicine or one or more of the following symptoms during the previous 12 months: wheezing or whistling in the chest, awakening with a feeling of chest tightness, or attack of asthma. 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. WebThey concluded that epidemiological data helps to plan and strategizes in the prevention and management of epidemic diseases or illnesses. Nowhere are data more If using color, use increasing intensities of the same hue. 6).docx - Describe how epidemiological data As with survey development, borrowing from previous data collection protocols can be helpful. Information about determining whom to select is covered in study design discussions in Chapter 7, but sample size is worth briefly mentioning here. Voice: (800) 241-1044 Rates, Ratios, and Alternative Denominators. For example, understanding the distribution of vectors for each infection and patterns of the diseases in animals is paramount. The choice between tables and charts depends on the purpose, the audience, and the complexity of the data. 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). The application period for EIS Class of 2024 is now open through June 5, 2023. These secondary cases might appear as a prominent wave after a point source by one incubation period, as observed after a point source hepatitis E outbreak that resulted from repairs on a broken water main (Figure 6.4) (7). Public Health Problem: In November 2008, CDCs PulseNet staff noted a multistate cluster of Salmonella enterididis serotype Typhimurium isolates with an unusual DNA fingerprint (pulsed-field gel electrophoresis [PFGE] pattern). The media can be useful in alerting the public to an outbreak and assisting with additional case finding. 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. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. These three points should bracket the exposure period. Although public health departments have access to notifiable disease case data (primarily for communicable diseases) through mandatory reporting by providers and laboratories, data on chronic diseases and injuries might be available only through secondary sources, such as hospital discharge summaries. Strictly speaking, in computing rates, the disease or health event you have counted should have been derived from the specific population used as the denominator. By September, an increased number of infants with microcephaly was reported from Zika virusaffected areas. Compare food histories between persons with, ____ 2. CDC twenty four seven. 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. Take-Home Points: Internet-based surveys permit efficient data collection but should be designed to maximize complete responses. Coordination of epidemiologic studies (e.g., common methods, questionnaires), having a national database of PFGE patterns to identify outbreak-associated isolates, and an FDA product trace-back were key to identifying the cause, which resulted in a widespread product recall (and eventual criminal liability of the peanut butter producer). Lack of generalizability because of selection bias, variable participation rates. Examples of clinical data sources include medical record abstraction, hospital discharge data (e.g., for cases of hemolytic uremic syndrome) (15), syndromic surveillance systems (16) (e.g., for bloody diarrhea during an Shiga toxinproducing Escherichia coli outbreak) (17), poison control center calls (e.g., exposure to white powder during anthrax-related events) (18), and school and work absenteeism records (e.g., New York City school absenteeism in students traveling to Mexico at the beginning of the influenza A[H1N1] pandemic) (19). Make sure overlapping plotting symbols are distinguishable. If you know both time of onset and time of the presumed exposure, you can estimate the incubation or latency period. Use spot maps to reveal spatial associations between cases and between cases and geographic features. Describing Epidemiologic Data | Epidemic Intelligence Service | CDC Epidemiology is not just the study of health in a population; it also involves applying the knowledge gained by the studies to community-based practice. But in the 1960's a possible role for epidemiology in the study of clinical practice emerged. Organizing descriptive data into tables, graphs, diagrams, maps, or charts provides a rapid, objective, and coherent grasp of the data. WebEpidemiological data influences changes in health practices because it estimates the individual chances and risks of disease, and if an individual has a high risk of contracting a certain disease he or she may be forced to change some health practices. For self-administered surveys, the format needs to be friendly, well-spaced, and easy to follow, with clear instructions and definitions. Epidemiologists would do well to remember GIGO (garbage in, garbage out) when delineating their data collection plans. For example, when a patient with diarrheal disease presents, both are interested in establishing the correct diagnosis. Because corrosion control was not used at the FWS water treatment plant, the levels of lead in Flint tap water increased over time. We take your privacy seriously. Indeed, the term health-related states or events may be seen as anything that affects the well-being of a population. Two important qualifications apply to person data assessments. How much? is expressed as counts or rates. We take your privacy seriously. Many an epidemiologist has bemoaned a misinterpreted question, confusing survey formatting, or a missing confounding variable resulting in study questions without meaningful results. The epidemiologist must keep in mind that the primary purpose of a field investigation into an urgent public health problem is to control the problem and prevent further illness. 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. Information bias, such as measurement error, self-report bias, and interviewer bias. When the row or column headings are numeric (e.g., age groups), they should govern the order of the data. Provide marginal averages, rates, totals, or other summary statistics for rows and columns whenever possible. However, a persons measurements can fluctuate above or below these cutoff values. After the initial case, 15 days elapsed until the peak of the first generation of new cases. The epidemic curve for a zoonotic disease among humans typically mirrors the variations in prevalence among the reservoir animal population. We know by now that determining the validity and relevancy of research articles is important in health practices, and for clinical areas this also means addressing the The averages and dispersions can be displayed in a table or visualized in a box-and-whisker plot that indicates the median, mean, interquartile range, and outliers (Figure 6.1) (5). This data looks at the when, where, why, and how of diseases, injuries, and environmental hazards (CDC, 2018). Provide an example and explain what data would be necessary to make a change in practice. Recommend that close contacts of a child recently reported with meningococcal meningitis receive Rifampin, ____ 6. Describe how epidemiological data influences changes These are widely dispersed, indicating that they did not acquire their infection from their local environs. When interpreting spot maps, keep in mind the population distribution with particular attention to unpopulated (e.g., parks, vacant lots, or abandoned warehouses) or densely populated areas. WebEpidemiological data influences changes in healthcare practices by allowing researchers to explore certain populations and determine distribution and determinants of health, to initiateinformed decisions about the control of health problems (Hannaford & It reveals the location of the first case in the business district and the large initial cluster surrounding it (Figure 6.13) (14). Spot maps that plot cases have a general weakness. In compiling questions, consider the flow, needed skip patterns, and order (e.g., placing more sensitive questions toward the end). These graphs can include line graphs, histograms (epidemic curves), and scatter diagrams (see Box 6.4 for general guidelines in construction of epidemiologic graphs). Statistics/Nursing - Describe how epidemiological data Existing data on health risk behaviors might be available from population-based surveys, but these surveys generally are conducted only among a small proportion of the total population and are de-identified. A more precise approach involves computing the average and dispersion of the individual measurements. Personal characteristics include demographic factors which may be related to risk of illness, injury, or disability such as age, sex, marital status, and socioeconomic status, as well as behaviors and environmental exposures. Data security, privacy, confidentiality, information technology controls. If the classification variable is numeric (e.g., age group), sort by the numeric category. Additional existing data sources can help identify cases, determine background rates of human illness, or assess exposures to disease-causing agents (e.g., pathogenic bacteria, vectors, environmental toxins) in a field investigation. As an alternative to plotting onset by calendar time, plotting the time between suspected exposures and onset can help you understand the epidemiologic situation. Source: Adapted from: Ajloun Non-Communicable Disease Project, Jordan, unpublished data, 2017. The media can play important and sometimes conflicting roles during an outbreak. In contrast, if the public believes an outbreak resulted from eating a specific food item or eating at a specific restaurant, that belief can preclude the field epidemiologists ability to obtain accurate data after a press release has been issued because it might cause self-report bias among study participants. With acute infections, poisonings, and injuries, you will often have precise exposure times to different suspected agents. A well-structured analytical table that is organized to focus on comparisons will help you understand the data and explain the data to others. By law, most states require laboratories that identify causative agents of notifiable diseases to send case information electronically to state public health agencies. When the pattern of the spots forms a compact, linear pattern, suspect a strong association between the two variables. In arranging analytical tables, you should begin with the arrangement of the data space by following a simple set of guidelines (Box 6.3) (1). Distinguish between place of onset, place of known or suspected exposure, and place of case identification. However, it is important to consider conducting some preliminary data analysis even before data collection is complete. During the 2016 epidemic of Zika virus infection, understanding the ecologic niche for the Aedes mosquito vector was important when investigating an increase in febrile rash illnesses (Box 4.2) (12). Reduce embellishments that obstruct a clear vision of disease and potential exposures. Now, with the recent explosion in molecular methods, epidemiologists can make important strides in examining genetic markers of disease risk. Is the objective to identify factors in the environment that might be causing disease (e.g., elevated lead levels in drinking water)?
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