Surveillance and field investigations are usually sufficient to identify causes, modes of transmission, and appropriate control and prevention measures. But sometimes...
analytic studies employing more rigorous methods are needed. Often the methods are used in combination — with surveillance and field investigations providing clues or hypotheses about causes and modes of transmission, and analytic studies evaluating the credibility of those hypotheses. Clusters or outbreaks of disease frequently are investigated initially with descriptive epidemiology. The descriptive approach involves the study of disease incidence and distribution by time, place, and person. It includes the calculation of rates and identification of parts of the population at higher risk than others. Occasionally, when the association between exposure and disease is quite strong, the investigation may stop when descriptive epidemiology is complete and control measures may be implemented immediately. John Snow’s 1854 investigation of cholera is an example.
More frequently, descriptive studies, like case investigations, generate hypotheses that can be tested with analytic studies. While some field investigations are conducted in response to acute health problems such as outbreaks, many others are planned studies. The hallmark of an analytic epidemiologic study is the use of a valid comparison group. Epidemiologists must be skilled in all aspects of such studies, including design, conduct, analysis, interpretation, and communication of findings.
• Design includes determining the appropriate research strategy and study design, writing justifications and protocols, calculating sample sizes, deciding on criteria for subject selection (e.g., developing case definitions), choosing an appropriate comparison group, and designing questionnaires.
• Conduct involves securing appropriate clearances and approvals, adhering to appropriate ethical principles, abstracting records, tracking down and interviewing subjects, collecting and handling specimens, and managing the data. • Analysis begins with describing the characteristics of the subjects. It progresses to calculation of rates, creation of comparative tables (e.g., two-by-two tables), and computation of measures of association (e.g., risk ratios or odds ratios), tests of significance (e.g., chi-square test), confidence intervals, and the like. Many epidemiologic studies require more advanced analytic techniques such as stratified analysis, regression, and modeling.
• Finally, interpretation involves putting the study findings into perspective, identifying the key take-home messages, and making sound recommendations. Doing so requires that the epidemiologist be knowledgeable about the subject matter and the strengths and weaknesses of the study.
Evaluation Epidemiologists, who are accustomed to using systematic and quantitative approaches, have come to play an important role in evaluation of public health services and other activities. Evaluation is the process of determining, as systematically and objectively as possible, the relevance, effectiveness, efficiency, and impact of activities with respect to established goals.
• Effectiveness refers to the ability of a program to produce the intended or expected results in the field; effectiveness differs from efficacy, which is the ability to produce results under ideal conditions.
• Efficiency refers to the ability of the program to produce
the intended results with a minimum expenditure of time and resources. The evaluation itself may focus on plans (formative evaluation), operations (process evaluation), impact (summative evaluation), or outcomes — or any combination of these. Evaluation of an immunization program, for example, might assess the efficiency of the operations, the proportion of the target population immunized, and the apparent impact of the program on the incidence of vaccine-preventable diseases. Similarly, evaluation of a surveillance system might address operations and attributes of the system, its ability to detect cases or outbreaks, and its usefulness. Linkages Epidemiologists working in public health settings rarely act in isolation. In fact, field epidemiology is often said to be a “team sport.” During an investigation an epidemiologist usually participates as either a member or the leader of a multidisciplinary team. Other team members may be laboratorians, sanitarians, infection control personnel, nurses or other clinical staff, and, increasingly, computer information specialists. Many outbreaks cross geographical and jurisdictional lines, so co-investigators may be from local, state, or federal levels of government, academic institutions, clinical facilities, or the private sector. To promote current and future collaboration, the epidemiologists need to maintain relationships with staff of other agencies and institutions. Mechanisms for sustaining such linkages include official memoranda of understanding, sharing of published or on-line information for public health audiences and outside partners, and informal networking that takes place at professional meetings. Policy development The definition of epidemiology ends with the following phrase: “...and the application of this study to the control of health problems.” While some academically minded epidemiologists have stated that epidemiologists should stick to research and not get involved in policy development or even make recommendations, public health epidemiologists do not have this luxury. Indeed, epidemiologists who understand a problem and the population in which it occurs are often in a uniquely qualified position to recommend appropriate interventions. As a result, epidemiologists working in public health regularly provide input, testimony, and recommendations regarding disease control strategies, reportable disease regulations, and health-care policy.
As the book " Principles of Epidemiology in Public Health Practice "