These three points should bracket the exposure period. This is important so that we have a background, and average on these ailments that we may see within the healthcare practice. To avoid clutter and maintain undistorted comparisons, consider using two or more separate panels for different strata on the same graph. 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). For example, the consistent time interval between rotavirus vaccination and onset of intussusception (Table 6.1) helped build the hypothesis that the vaccine precipitated the disease (1). The feasibility of reaching participants through different modes. The ability to conduct an epidemiologic field investigation efficiently and effectively depends on understanding the interconnectedness of its parts. Describe how epidemiological data influences changes in health practices. Provide an example and explain what data would be necessary to make a change in practice. Age-specific mortality rates per 100,000 population/year: United States, 1910, 1950, and 1998. In addition, with the current calls for government transparency and accountability, field epidemiologists might be reluctant to release information too early, thereby risking additional exposures to the suspected source. A sample can be selected through probability sampling or nonprobability sampling (e.g., purposive sampling or a convenience sample). 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. Reduce embellishments that obstruct a clear vision of disease and potential exposures. Using three or more significant figures interferes with comparison and comprehension. For most conditions, when the rates vary over one or two orders of magnitude, an arithmetic scale is recommended. Cookies used to make website functionality more relevant to you. For example, a maternal mortality ratio and infant mortality rate use births in a calendar year as a denominator for deaths in the same calendar year, yet the deaths might be related to births in the previous calendar year. In addition, maps display a wealth of underlying detail to compare against disease distributions. When comparing two graphs of the same dependent variable, use scaling that improves comparison and resolution. Similarly, when the incubation period is known, you can estimate a time window of exposure and identify exposures to potential causative agents during that window. Recognizing disease patterns by personal attributes (e.g., age, sex, education, income, or immunization status) constitutes the fifth element in descriptive epidemiology. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Provide an example and explain what data would be necessary to make a change in practice. 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 It is the cornerstone of public health, and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare.Epidemiology has helped develop methodology used in Rate yourself using 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. Equal rates of change in time (e.g., a 10% decrease/year) will yield misleading, divergent lines on an arithmetic plot; a logarithmic scale will yield parallel lines. However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directing practical and appropriate public health action based on this science and causal reasoning.(2). On the opposite end of the scale, injuries and acute poisonings have instantaneous and obvious onsets. Home > Homework Answsers > Nursing homework help. Ensure that potential exposures are easily discerned and labeled. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Other ongoing surveys include the Youth Risk Behavior Survey, Pregnancy Risk Assessment Monitoring System, and National Health and Nutrition Examination Survey. Vectorborne diseases propagate between an arthropod vector and a vertebrate host. Match the term to the activity that best describes it. 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. If you know both time of onset and time of the presumed exposure, you can estimate the incubation or latency period. 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. Provide marginal averages, rates, totals, or other summary statistics for rows and columns whenever possible. Aspect ratios (data space width to height) of approximately 2:1 work well. Rates are normally displayed on area maps (e.g., patch or choropleth). CDC twenty four seven. Frequency refers not only to the number of health events such as the number of cases of Public Health Response: The broad scope of the outbreak and severity of illness required coordination of data collection across jurisdictions and use of multiple data sources to identify a common source. This task, called descriptive epidemiology, answers the following questions about disease, injury, or environmental hazard occurrence: The first question is answered with a description of the disease or health condition. Use graphic designs that reveal the data from the broad overview to the fine detail. See answer Advertisement ah6129783 Data influences changes in health practices provide a Advertisement Advertisement A statistical data display should include, at a minimum, F, female; M, male. Information about determining whom to select is covered in study design discussions in Chapter 7, but sample size is worth briefly mentioning here. The y-axis represents the rate of the health event. Collecting mortality statistics and classifying the causes of death dates to the 1500s in London, when the Bill of Mortality was periodically published (2). Use alternatives to joining data points with a line. Reported incidence rate of spotted fever rickettsiosis by county: United States, 20002013. For probability sampling procedures other than a simple random sample (e.g., stratified or cluster sampling), consult with a survey sampling expert. Possible confounders and effect modifiers. Therefore, writing a protocol before embarking on any data collection is paramount. Data presentation is interchangeable with tables. Expert Answer Epidemiology is a discipline that plays a urgent part in portraying health status, distinguishing hazard factors, and exami View the full answer 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). Nowhere are data more Describe how epidemiological data influences changes in health practices. Moreover, with slowly developing health conditions, a discernable onset might not exist. We take your privacy seriously. Often, a periodicity equivalent to the generation period for the agent might be obvious during the initial stages of the outbreak. The media can play important and sometimes conflicting roles during an outbreak. bDays from vaccine dose to illness onset Provide an example and explain what data would be necessary to make a change in practice. Dot chart (A) and bar chart (B) comparison of mean body mass index among adults, by age group and sex: Ajloun and Jerash Governorates, Jordan, 2012. This area also had been affected by an outbreak of dengue fever. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (31) has specific language allowing for the use of personal health information by government agencies to perform public health activities. The predominant survey conducted in all states is the Behavioral Risk Factor Surveillance System, a random-digit dialed household survey of noninstitutionalized US adults. Although the list comprises primarily infectious diseases, in 1995, the first noninfectious conditionelevated blood lead levelswas added (7). WebEpidemiology is concerned with the frequency and pattern of health events in a population. WebEpidemiology is concerned with the frequency and pattern of health events in a population: Frequency refers not only to the number of health events such as the number of cases of Pay special attention to ensuring that survey instruments can be used across multiple sites in the event that the outbreak involves multiple jurisdictions. A data space where the data are organized and displayed to indicate patterns. Key terms in this definition reflect some of the important principles of epidemiology. See Answer. 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). In most descriptive analyses, the epidemiologist will determine disease rates by age. After the data are organized and displayed, descriptive epidemiology then involves interpreting these patterns, often through comparison with expected (e.g., historical counts, increased surveillance, or output from prevention and control programs) patterns or norms. A rapid decrease in dengue cases follows this decrease in vector density. Collecting data during a field investigation requires the epidemiologist to conduct several activities. As an alternative to using tables, charts (Box 6.12) (e.g., dot charts) (Figure 6.16, panel A) or horizontal cluster bar charts (Figure 6.16, panel B) improve perception of the patterns in the data, compared with a table. Many outside parties are not familiar with the legal authority that public health agencies have to investigate and control diseases and exposures that affect the publics health and safety. 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). The outbreak grew to involve 714 case-patients in 46 states; 166 (23%) were hospitalized and 9 (1%) died. Represent dependent variables on the vertical scale and independent variables on the horizontal scale. Relating disease with these events in time can support calculation of key characteristics of the disease or health event. Plotting only numerators loses the advantage of both the spot map (indicating exact location and detailed background features) and the area map (indicating rates). 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). Differentiate them with labels, legends, or keys. If this means that you must exclude the zero level, exclude it, but note for the reader that this has been done. These cookies may also be used for advertising purposes by these third parties. 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. What type of contact information is available? Other scenarios that challenge epidemiologists trying to access external data include concern by healthcare systems that requests for data on hospitalizations, clinic visits, or emergency department visits breach privacy of protected health information; concern by school officials that access to information about children during an outbreak associated with a school activity violates provisions of the Family Educational Rights and Privacy Act (32); and concerns by businesses that case-patients in an outbreak associated with a particular food item or establishment might pursue legal action or lawsuits. To approximate the time of exposure, count backward to the average incubation period before the peak, the minimum incubation period from the initial cases, and the maximum incubation period from the last cases. 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. Organizing descriptive data into tables, graphs, diagrams, maps, or charts provides a rapid, objective, and coherent grasp of the data. 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. Guidelines for Graphical Data Presentation, Characteristics of Propagated Epidemic Curves, Factors Affecting Patterns of HumanVectorHuman Transmission Across Time, Guidelines Regarding Data Display Area Of Epidemiologic Maps, Three General Interpretations of Age Distributions, Centers for Disease Control and Prevention. In the healthcare field we use epidemiological data when doing a View the However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. They help us to know which pages are the most and least popular and see how visitors move around the site. 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). 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. These might include detailed administrative boundaries or a longitude-latitude grid. Ensure that scaling applies accurately to all features in the map area, especially indicators of location of disease and potential exposures. It reveals the location of the first case in the business district and the large initial cluster surrounding it (Figure 6.13) (14). Mean daily temperatures of less than 68F (<20C) typically arrest multiplication of infectious agents in the arthropod. 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. Extreme aspect ratios distort data. For self-administered surveys, the format needs to be friendly, well-spaced, and easy to follow, with clear instructions and definitions. Use visually prominent symbols to plot and emphasize the data. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Secure .gov websites use HTTPS The underlying epidemiologic process might produce disease distributions within and among social groupings that range from strong aggregation to randomness or uniformity. Source: Adapted from Ajloun Non-Communicable Disease Project, Jordan, unpublished data, 2017. 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. With the advent of personal computers in most households and smartphones in many pockets (23), epidemiologists are evaluating the utility of the Internet and social media as data sources for identifying outbreaks or case finding during outbreak investigations. Compare the association of cases during these pre-and post-epidemic periods with the main outbreak. Having a written data collection section as part of the overall study protocol is essential. Information about place of affected persons might include residence, workplace, school, recreation site, other relevant locales, or movement between fixed geographic points. You can use empirical cutoff points (e.g., BMI 26 for overweight). A cover sheet with attempts to contact, code status of interview (e.g., completed), and notes can be helpful. Ideally, code response categories in advance and on the instrument to facilitate data entry and analysis (e.g., yes = 1, no = 0). Epidemiological research WebThey concluded that epidemiological data helps to plan and strategizes in the prevention and management of epidemic diseases or illnesses. After the outbreak peaks, the exhaustion of susceptible hosts usually results in a rapid downslope. Although some existing data sources (e.g., death certificates) cover many disease outcomes, others are more specific (e.g., reportable disease registries). Nonetheless, accessing data sources that are not specifically collected and maintained by public health authorities can be challenging. 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. Official websites use .gov Uncontrolled confounding or bias introduced in the association between exposure and outcome because of third variable. Close-ended questions usually are used for outbreak investigations. This chapter focuses on the collection of quantitative data (see Chapter 10 for qualitative data collection). Adapting preexisting protocols and questionnaires will facilitate a timely response and consistency across jurisdictions. Like Tweet +1 Click icon to see a sample Essay Format & Features They can have various response categories (e.g., nominal, numeric, Likert scales). Stratifying seasonal curves can further expose key differences by place, person, or other features (Figure 6.12) (12). The continuing common source epidemic curve will increase sharply, similar to a point source. Defined as a symptom that improved while away from the facility, either on days off or on vacation. Question: Describe how epidemiological data 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. Discussing up front the purpose of the investigation and the data collection processes will prove invaluable in the long run when collaborators are needed during case finding, data collection, implementation of control measures, and communication with affected populations and the public. Cookies used to make website functionality more relevant to you. Many an epidemiologist has bemoaned a misinterpreted question, confusing survey formatting, or a missing confounding variable resulting in study questions without meaningful results. T5DQ1 Describe how epidemiological data influences changes in health practices. In the example diagram, closeness and quality of relationships, timing between onsets, and places of contact are all displayed through different symbols and shading (Figure 6.2) (5). Cases of salmonellosis among passengers on a flight from London to the United States, by time of onset, March 13 14, 1984. Provide an example and explain what data would be necessary to make a change in practice. The counts of incident or prevalent cases can be compared with their historical norm or another expected or target value. Online order forms or electronic grocery receipts may be useful in identifying names of customers to contact to determine illness status. Many investigation activities must be conducted in parallel and are interdependent and iterative, with results informing edits or amendments. Although field epidemiologic investigations of an urgent public health problem are legally considered to be public health practice and not research (. This data looks at the when, where, why, and how of diseases, injuries, and environmental hazards (CDC, 2018). Cases of jaundice, by week of onset: Jafr, Maan Governorate, Jordan,June October 1999. 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). Nonetheless, many epidemiologists still use the term disease as shorthand for the wide range of health-related states and events that are studied. Include a legend or key to clarify map features (e.g., disease cases, rates, and exposures). Adhere to mathematical principles in plotting data and scaling axes. Although engaging stakeholders, such as other public health agencies, community partners, industry leaders, affected businesses, healthcare practitioners, customers, and regulatory agencies, early in an investigation is time-consuming, including them is essential. An important and potentially time-saving step is to review prior epidemiologic investigations of similar illnesses and, whenever possible, use or adapt existing protocols, including standard data collection approaches and case definitions. < Previous Chapter 3: Conducting a Field Investigation, Next Chapter 5: Using Technologies for Data Collection and Management >. Instead, put them just outside the data region. Participants came from throughout Oregon and other states, and were of higher socioeconomic status and technology-savvy. Measures the progress of control and prevention programs. Organizations can develop interventions and therapies that are suited to the needs of the public by gathering and analyzing data to For most conditions, a time characteristic of interest is the secular trendthe rate of disease over multiple years or decades. Use columns for most crucial data comparisons. Indicate underpopulated or depopulated areas. Align columns of numbers on the decimal point (or ones column). When using transformed data (e.g., logarithmic, normalized, or ranked), represent equal units of the transformed data with equal distances on the axis. This will be reflected by an instability of the epidemic curve. Is the objective to identify a point source (e.g., a contaminated food item) of an outbreak to recall the product? A propagated pattern arises with agents that are communicable between persons, usually directly but sometimes through an intermediate vehicle. To calculate incidence, special care therefore is needed to avoid counting the same person every time a fluctuation occurs above or below the cutoff point. Epidemiologists work with other scientists to find who is infected, why they were infected, Epidemiological data influence health practices change, such as creating awareness on health crises that are likely to occur in a particular population. Let the difference in shading of map areas define and replace detailed internal boundary lines. Place patterns include geographic variation, urban/rural differences, and location of work sites or schools. The resulting rate allows epidemiologists to compare disease occurrence across different populations. Provide an example and explain what data would be necessary to make a change in practice. These are widely dispersed, indicating that they did not acquire their infection from their local environs. Graphs are most frequently used for displaying time associations and patterns in epidemiologic data. 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. In creating epidemiologic maps, you should follow certain basic guidelines (Box 6.9). Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 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). Norovirus (GII) infection was confirmed as the causative agent. By law, most states require laboratories that identify causative agents of notifiable diseases to send case information electronically to state public health agencies. Cases of Salmonella enterica serovar Heidelberg infection, by illness onset date: Colorado, July 10 August 17, 1976. The x-axis represents a period of interest. Of note, administration of antimicrobials, immunoglobulins, antitoxins, or other quickly acting drugs can lead to a shorter than expected outbreak with a curtailed downslope. Epidemiological data plays a very important role in starting research, evaluating research, and creating a change. Take-Home Point: This outbreak involved many jurisdictions and evolved over a several months. This arrangement facilitates sorting to reorganize cases by relevant characteristics. WebDescribe how epidemiological data influences changes in health practices. Second, age is a strong independent determinant for many causes of morbidity and mortality. We take your privacy seriously. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Variations in slopes (e.g., bimodal or a broader than expected peak) might indicate different ideas about the appearance, persistence, and disappearance of exposure to the source. DQ1 Describe how epidemiological data influences changes in health practices. WebHLT- 362 Topic 5 DQ 1 Describe how epidemiological data influences changes in health practices. 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. The last three questions are assessed as patterns of these data in terms of time, place, and person. Let's take A description of the purpose of the investigation for participants. The urgency of most field investigations requires that the epidemiologist act quickly but thoughtfully. Voice: (800) 241-1044 Like the practice of medicine, the practice of epidemiology is both a science and an art. Provide an example and explain what data would be necessary to make a change in Epidemiologic data are paramount to targeting and implementing evidence-based control measures to protect the publics health and safety. The dot chart is the most versatile and the easier to understand, particularly as categories increase in number. For certain conditions, a description by season, month, day of the week, or even time of day can be revealing. In addition, debrief interviewers about issues they might have encountered (e.g., if participants cannot understand certain questions, those questions might need rewording). These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. < Previous Chapter 5: Using Technologies for Data Collection and Management, Next Chapter 7: Designing and Conducting Analytic Studies in the Field>.
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describe how epidemiological data influences changes in health practices