1. 1 /21 Field Epidemiology Epidemiology Must Be Applied in the Field to Be Effective

2. 2 /25 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

3. 3 /25 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.

4. 4 /25 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). 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).

5. 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 5 /25

6. Concepts & methods Derive from: –Clinical medicine –Epidemiology –Laboratory science –Decision theory –Skill in communications –Common sense 6 /25

7. 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 7 /25

8. 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 8 /25

9. 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 9 /25

10. Who are field epidemiologists? 10 /25 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.

11. 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. 11 /25

12. 12 /25 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.

13. 13 /25 Start year of FETPs in some countries:  Canada …………………………….…1975  Spain ………………………….………1992  Germany……………………….…….. 1996  India ……………………………….…. 2001  France ………………………….….… 2002  Pakistan ……………………………... 2006

14. 14 /25 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

15. 15 /25 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.

16. 16 /25 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.

17. 17 /25 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.

18. 18 /25 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’.

19. 19 /25 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.

20. 20 /25 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.

21. 21 /25 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.

22. " مشاهده " وبا در استان کردستان تاریخ انتشار : ۲۲ شهریور ۱۳۸۶ وزارت بهداشت، درمان و آموزش پزشکی گزارش می‌‌دهد "20 مورد وبا در استان کردستان مشاهده شده است." به گزارش ایسنا، ستاد هدایت بحران وزارت بهداشت، از تاریخ ششم شهریور ماه به مدت 14 روز بررسی پزشکی در استان کردستان انجام داده که نتیجه آن مشاهده 20 مورد وبا در شهرستان‌های بانه ، مریوان و سروآباد است. در عین حال عمومی تمامی این افراد مساعد گزارش شده است. همچنین ایسنا به نقل از این ستاد گزارش داد: "تحقیقات پزشکی نشان داده است که افراد مبتلا از میان افرادی بودند که به شکل قاچاق به کشور عراق مسافرت می‌کردند و در حال حاضر مرکز مدیریت مبارزه با بیماریها و بهداشت کردستان در این منطقه در آماده باش کامل به سر می‌برند و اوضاع را تحت کنترل قرار داده است." 22 /25 خبرگزاری دانشجویان ایران به نقل از ستاد هدایت بحران

23. ادامه ی خبر با این حال وزارت بهداشت پس قرار گرفتن خبر فوق بر روی خروجی ایسنا نمابری به این خبرگزاری فرستاده و تشکیل ستاد بحران را تکذیب کرده است. در این نمابر آمده است "تاكنون از ابتلای هموطنانمان در استان‌های مرزی به این بیماری گزارشی دریافت نشده است و همه موارد ابتلا عراقی بوده و از عراق برای درمان به ایران منتقل شده‌اند.” چندی پیش نیز ایرنا گفته‌ای از وزیر بهداشت ایران نقل کرده بود که حکایت از مشاهده آنفولانزای مرغی در ایران داشت. با این حال این وزارتخانه این نقل قول را تکذیب کرد و ایرنا نیز در توضیحی نوشت که مطلب منتشر شده مکتوب گفته‌های وزیر بهداشت بوده است. 23 /25

24. Still alive, still in need 24 /25

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