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is for Epi

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  1. is for Epi Epidemiology basics for non-epidemiologists

  2. Session VPart I Epidemiology Specialties Applied

  3. What to Expect. . . Learn about the application and practice of three epidemiology specialties: • Disaster epidemiology • Environmental epidemiology • Forensic epidemiology

  4. Learning Objectives • Be able to distinguish disaster, environmental, and forensic epidemiology specialties • Recognize the common epidemiological methods used among the three featured specialties • Recognize the special considerations or conditions faced by epidemiologists in each specialty • Appreciate how the context of law, media, business, and communities impacts epidemiology practice

  5. Disaster Epidemiology

  6. Overview • Rapid Needs Assessments (RNAs) • GIS and GPS Technology • Hurricane Isabel: 2003 • RNA methods and lessons learned • Hurricane Charley: 2004 • Evolution of RNA methods and lessons learned

  7. Rapid Needs Assessment After Natural Disasters • Identify need for food, water, power, shelter, access to medical care • Determine the magnitude of the need in order to plan and implement relief efforts. Purpose

  8. Rapid Needs Assessment Background • RNA methodology developed by WHO and CDC • Used after hurricanes and other disasters, e.g., earthquake in Ankara, Turkey (1999), ice storm in Maine (1998), and hurricane in the Dominican Republic (1998) • Two-stage random sampling methodology allows generalization to sample area from only 210 completed surveys

  9. Needs Assessment Sample Selection • Select a sample area • Storm path, damage reports, service areas • Randomly select 30 population weighted geographic clusters in sample area • Randomly select 7 households within each geographic cluster • 210 total surveys, 10 survey teams

  10. Hurricane Isabel: September 18, 2003

  11. Rapid Needs Assessment:Hurricane Isabel • Thirty census clusters selected for a survey across 14 counties • Ten assessment teams comprised of • Public Health Regional Surveillance Teams (PHRSTs) • UNC School of Public Health students • State agency volunteers • Organized deployment using incident command system (ICS) structure

  12. Rapid Needs Assessment Objective was to collect data about: • External or flood damage to homes • Access to household utilities • Incidence of hurricane-related illness and injury • Access to food and water • Access to medical care or medication • Immediate needs

  13. Survey Instrument • One-page survey instrument • 24 questionnaire items • 33 data fields • Accompanied by a one-page “explanatory notes” form for interviewers

  14. Interview Process

  15. Interview Process • Assessment teams deployed in official vehicles to assigned census block area • From starting point, moved sequentially along roadways to collect data from seven households per cluster • Data collection was paper-based • Total of 210 interviews completed

  16. Isabel RNA Results • 2% of households flooded • 32% of households damaged • 65% of households had no electricity • 30% of households using a generator

  17. Isabel RNA Results • 43% of households used bottled water • That is 40,000 people • 13% of households no access to 3-day food supply • That is 12,000 people

  18. Lessons Learned • Need for better randomization in second stage • Use of paper questionnaires required double data entry

  19. Can new technologies address these issues? Options: • Perhaps geographic information systems (GIS) could be used in the 2nd stage randomization. • Skip the paper and enter the data directly into a handheld computer.

  20. What is GIS? • Set of tools that collect, store, retrieve, transform, and display spatial data • Used to construct maps that communicate spatial data • Raster-based: Data and image stored in a regularized grid made of pixels [Satellite] • Vector-based: Data and image stored separately in map layers (points, lines, polygons) – [Epi Map, ArcView] • Map layers share a common coordinate system (e.g., x - y)

  21. GIS Mapping Example: John Snow’s Broad Street Pump Investigation

  22. GPS (Global Positioning System)

  23. Field Data Collection EPI Info GIS Wireless: WIFI 802.11 or Bluetooth Field Team 4 Field Team 5 Field Team 1 Field Team 2 Field Team 3 Field data collection using IPAQ Pocket PCs equipped with GPS, GIS software and data collection forms.

  24. Hurricane Charley: August 9-14, 2004

  25. Changes in RNA Methodology • Electronic field data collection • Use of GIS to randomly select households for interviews • Use of GIS and GPS to route interviewers to field data collection sites

  26. Hurricane Charley RNA Assessment Area Map made in Arcview 9.0

  27. Selection of Census Block Groups Map made in Arcview 9.0

  28. HP IPAQ Pocket PC running ArcPad GIS software ArcPad Routing Function

  29. ArcPad programmed to automatically insert cluster # in database for complex samples analysis ArcPad form programmed to automatically insert census block group population in survey Assigns a unique case ID or incident #

  30. Field Data Collection EPI Info GIS Wireless: WIFI 802.11 or Bluetooth Field Team 4 Field Team 5 Field Team 1 Field Team 2 Field Team 3 Field data collection using IPAQ Pocket PCs equipped with GPS, GIS software and data collection forms.

  31. Hurricane Charley RNA Results • 203 surveys completed • Training, data collection, analysis, report writing completed in 24 hours • Findings showed little impact from the hurricane • Estimated 1.4% of households without power • 6% of homes damaged but habitable • 2.5% of homes flooded with 1-12 inches water

  32. Lessons Learned • Prepare data collection forms in advance, if possible • Provide mobile GIS training to potential field data collectors • Consider alternatives for second-stage randomization procedure; e.g., tax parcels

  33. Conclusions • RNAs fulfill vital public health function • Use of incident command system (ICS) was vital to rapid deployment of resources • Handheld computers, GIS and GPS adds value to field data collection in RNA • Eliminates double data entry • Provides routing and direction-finding for field teams • Improved randomization through GIS • Ability to quickly analyze and map data

  34. Environmental Epidemiology

  35. Environmental Health Services • Food Safety Services • Sewage and Water Services • Wastewater Engineering • Marina Program • Sludge • Shellfish Sanitation

  36. Restaurant • Any place where food is prepared for service • Any place where food is served

  37. Three Primary Activities Permitting Inspecting Enforcement

  38. Permits • Method of regulation of operating through the “administrative lifting” of a legislative prohibition

  39. Denial of Permit • Deny if not in compliance • Notify owner • Give reasons why denied • Assess what needs to be done • Owner has right to appeal

  40. Inspections Staple of public health enforcement Similar to searches As often as necessary to ensure compliance Recorded on inspection form

  41. Types of Inspections • Pre-opening • Routine • Critical Procedures • Follow-up • Training • Complaint

  42. Inspections / Sampling Restaurants Milk Investigations Recalls Outbreaks Inspections versus Investigations

  43. Types of Enforcement Action • Permit suspension • Permit revocation • Impoundment

  44. Substantial Public Health Threats • Sewage back-up • Loss of water or contaminated supply • Loss of electrical power • Fire or flood • Communicable disease in foodservice worker • Loss of refrigeration • Other situation deemed by authorities