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Field Epidemiology

Epidemiology Must Be Applied in the Field to Be EffectiveEpidemiology Must Be Applied in the Field to Be Effective

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History

Actual practice of field epidemiology over a century in US and abroad

It has not been defined in professional (i.e., epidemiologic and medical dictionaries

The constellation of problems faced by epidemiologists who are called upon to investigate urgent public health problems gives shape to the definition of field epidemiology

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What is Field Epidemiology?

Application of epidemiology under the following set of general conditions:

The problem is unexpected.

A timely response may be demanded.

Public health epidemiologists must travel to and work in the field to solve the problem.

The extent of the investigation is likely to be limited because of the imperative for timely intervention.

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Definition

Field epidemiology is the application of epidemiologic methods to unexpected health problems when a rapid on-site investigation is necessary for timely intervention

(M. Gregg, Field Epidemiology, 2002).

Differences with planned epi studies

1. Often starts without clear hypotheses => use of descriptive studies

2. There is an immediate need to protect the community’s health and address its concerns => Drives it into realm of public health action

3. Requires one to consider when the data are sufficient to take action rather than to ask what additional questions might be answered by the data

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Concepts & methods

• Derive from: – Clinical medicine– Epidemiology– Laboratory science– Decision theory– Skill in communications– Common sense

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Unique challenges

1. Data sources– Abstracted from variety of sources– Variable completeness & accuracy

2. Small numbers– No prior calculate sample size

3. Specimen collection– May not always be available

4. Publicity– Outbreaks often generate considerable local

attention

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Unique challenges (cont’d)

5. Reluctance to participate– Persons at risk (life or interests)

6. Conflicting pressure to intervene– The need for further investigation vs. the need for

immediate intervention– Opinion of affected persons & others can interfere

with the optimal scientific approach

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Standards for FE investigations

• FE sometimes perceived to represent “quick & dirty” epidemiology– Inherent nature of circumstances * do not provide rationalization for epidemiologic shortcuts

• A better description: “quick & appropriate”

• Goal: maximizing the scientific quality of investigation considering limitations

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Who are field epidemiologists?

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• Disease detectives invited on-site to study diseases in order to better understand and control them.

• Helping the investigation team to: Define, find & interview cases Coordinate the collection and analysis of

specimens Apply statistical methods to assess factors

responsible for illness Recommend control measures.

Training programs

• In 1951 the CDC founded:– Epidemic Intelligence Service (EIC)– 2-year on-the-job training program in practical,

applied epidemiology– 3 weeks, 8-hour-a-day course in:

• Basic epidemiology• Biostatistics• Public health practice

– The EIC officers has been available (24 hours a day) on call to go into the field to help state and local health officials.

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Field Epidemiology Training Program

• Public Health Agency of Canada's CFEP was previously known as the Field Epidemiology Training Program (FETP).

• It was established in 1975 to provide specialized training for health professionals in the practice of field epidemiology.

• It was modeled after the EIC of CDC.

• It was the first FETP of which there are now close to 30 in so many countries.

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Start year of FETPs in some countries:

Canada …………………………….…1975

Spain ………………………….………1992

Germany……………………….…….. 1996

India ……………………………….…. 2001

France ………………………….….… 2002

Pakistan ……………………………... 2006

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During training, trainees…

• Conduct epidemiological investigations and field studies to understand and control outbreaks, chronic disease clusters, health impacts of disasters and environmental health issues

• Conduct epidemiological and statistical analyses of large & complex datasets

• Design, implement and evaluate disease surveillance systems

• Provide public health information to the media and the public

• Present their work at scientific conferences and publish their work in peer-reviewed journals

• Train other health professionals directly and indirectly

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Skills & competencies:

• The FETP aims to develop skills and competencies that are not easily taught in academic or workplace settings.

• Field Epidemiologists must complete eight Professional Experience Guidelines (PEGs) in order to graduate from the two-year program.

• The PEGs encourage the development of critical

competencies in epidemiologic process, communication and professionalism.

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PEG 1:

Conduct at least one field investigation of a disease outbreak or other potentially serious public health problem that requires a rapid response. This can be infectious or non-infectious in nature should involve direct contact with persons affected.

The Field Epidemiologist will become proficient in the conduct of outbreak investigations by assuming increasing responsibility for such field studies. Second year Field Epidemiologists often have the opportunity to supervise junior trainees in the field.

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PEG 2:

Design, conduct, and interpret an epidemiologic analysis of a new or existing database.

Make appropriate public health recommendations based on the results of the analysis.

The data set should be of sufficient size and complexity to allow assessment of potential confounders or effect modifiers.

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PEG 3:

Design, implement, revise or evaluate a public health surveillance system.

Each Field Epidemiologist must evaluate the surveillance of a health event pertinent to their placement. The proposed evaluation plan and the results of the evaluation will be presented during the fall courses. For this learning objective, Field Epidemiologists should not design a hypothetical surveillance system. The learning in this exercise comes from being able to assess the public health impact or contribution of an existing surveillance system to the ‘real world’.

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PEG 4 to 8:

Submit for publication to a peer-review journal, a paper based on one of the studies did in previous PEGs.

Submit a report to the National Communicable Disease Report or Chronic Diseases in the country.

Give an oral presentation at a seminar sponsored by the FETP.

Prepare a presentation for a national or international scientific conference.

Respond appropriately to written or oral public health inquiries from the public or government officials. Participate in the preparation of ministerial briefings and responses to media inquiries.

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WHAT DO FIELD EPIS DO?

Duration Field Epi training lasts two years. (masters degree program)

Work Placements Field Epis are placed in federal, provincial, territorial and local health departments or public health agencies for the duration of their two years of training.

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Work Expectations

In their placements, Field Epis are required to: Work full-time (five days/week, during normal working hours). Must be willing and available to travel to the field on short

notice (24 to 48 hours) for several weeks at a time.

While on a field investigation: It is usual for Field Epis to work additional hours, including

evenings and weekends. Must have excellent teamwork, communication and conflict

resolution skills. Should never work alone while in the field; they always form

part of an outbreak investigation team. Are invited to participate in investigations; they must be able to

work collaboratively with their co-investigators in high-stress situations.

"مشاهده" وبا در استان کردستان ۱۳۸۶ شهریور ۲۲تاریخ انتشار:

20 وزارت بهداش�ت، درم�ان و آم�وزش پزش�کی گ�زارش می ده�د "مورد وبا در استان کردستان مشاهده شده است."

ت�اریخ • از بهداش�ت، بح�ران وزارت ایس�نا، س�تاد ه�دایت به گ�زارش ب�ه �م�دت � �روز بررس�ی پزش�ک�ی در �اس�تان 14ش�ش�م ش�هری�ور �م�اه

م�ش�اهده آن نتیج�ه ک�ه داد�ه ان�ج�ام در 20کر�دس�تان وب�ا م�ورد شه�رس�تان های� بان�ه ، مری�وان و س�روآباد �اس�ت. در ع�ین ح�ال عم�ومی

تمامی این افراد مساعد گزارش شده است. همچ�نین ایس�نا ب�ه نق�ل از این س�تاد گ�زارش داد: "تحقیق�ات پزش�کی •

نش�ا�ن داد�ه اس�ت ک�ه ا�ف�را�د مب�تال از می�ان اف�ر�ادی ب�ودن�د ک�ه ب�ه ش�کل ق�اچ�ا�ق ب�ه ک�ش�ور� �ع�را�ق� مس�ا�فرت� می� کر�دن�د و در �ح�ال� حاض�ر� مرک�ز م�دی�ریت �م�ب�ار�ز�ه ب�ا بی�ماری�ه�ا� و ب�هداش�ت� کرد�س�تان �در ا�ین� منطق�ه در آم�اد�ه ب�ا�ش کام�ل �ب�ه س�ر� می بر�ن�د �و �ا�وض�اع �را �تحت� کن�ت�رل ق�رار داده

است." 22 /25

خبرگزاری دانشجویان ایران به نقل از ستاد هدایت بحران

ادامه ی خبر

با این ح�ال وزارت بهداش�ت پس ق�رار گ�رفتن خ�بر ف�وق ب�ر روی خ�روجی را بح�ران تش�کیل س�ت�اد و� فرس�تاده این �خ�برگزار�ی ب�ه نم�ا�بری ا�یس�نا

تکذیب کرده است.اس�تان های در هموطنانم�ان ابتالی از "ت�اكنون اس�ت آم�ده نم�ابر این در م�ر�زی ب�ه این� بیم�ا�ری گزارش�ی� دری�افت ن�ش�ده ا�س�ت و ه�م�ه م�و�ارد ابتال

عراق�ی ب�وده و از عرا�ق برای� درمان به �ایران� منتقل �شده �اند.”

ای�ران نق�ل ک�رده ب�ود ک�ه چن�دی پیش ن�یز ایرن�ا گفته ای از وزی�ر بهداش�ت ح�ک�ایت� از �مش�اهده آن�ف�والنزای� م�رغی در �ای�ران داش�ت. ب�ا ا�ین ح�ال این و�زارتخان�ه این نق�ل ق�ول ر�ا تک�ذیب �ک�رد� و ایرن�ا� ن�یز �در توض�یحی� نوش�ت

.ک�ه مطلب من�تشر شده� مک�توب گفته ها�ی و�زیر به�داشت بوده است

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Still alive, still in need

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