FIRST FIRST Field Investigator Response Field Investigator - - PowerPoint PPT Presentation
FIRST FIRST Field Investigator Response Field Investigator Response and Surveillance Training and Surveillance Training INSERT PICTURE USED ON MANUAL COVER Course Facilitators Course Facilitators Jylmarie Jylmarie Kintz, MPH, CHES
INSERT PICTURE USED ON MANUAL COVER
Jylmarie
The Florida Center for Public Health Preparedness (FCPHP) Preparedness (FCPHP)
Hillsborough County Health Department
Pinellas County Health Department
Members of the Florida Association of County Health Officers County Health Officers
To help public health workers develop an increased awareness and knowledge of basic epidemiology. awareness and knowledge of basic epidemiology.
To increase the number of public health workers capable of participating in an outbreak investigation capable of participating in an outbreak investigation during a bioterrorism (BT) event or other public during a bioterrorism (BT) event or other public health threat. health threat.
To improve the capacity of the county health department to respond effectively during a BT event department to respond effectively during a BT event
Module 1: Describe the role of epidemiology in Describe the role of epidemiology in public health. public health.
Module 2: Demonstrate appropriate epidemiological Demonstrate appropriate epidemiological interviewing and effective communication interviewing and effective communication skills. skills.
Module 3: Participate in an outbreak investigation Participate in an outbreak investigation exercise. exercise.
Module 1: Self Self-
study, Web-
based
Modules 2 & 3: Instructor Instructor-
led, On-
site
Didactic
Role-
plays
Group activities
1. 1. Define Define epidemiology epidemiology’ ’s key terms and core s key terms and core concepts. concepts. 2. 2. Recognize Recognize the objectives of epidemiology in the objectives of epidemiology in public health practice and describe public health practice and describe your role. your role. 3. 3. Describe Describe how epidemiology is applied in the core how epidemiology is applied in the core processes of public health practice. processes of public health practice. 4. 4. Describe Describe examples of the use and application of examples of the use and application of epidemiology. epidemiology. 5. 5. Apply Apply the basic terms, concepts, and processes the basic terms, concepts, and processes
1. 1. State State the purpose of an interview. the purpose of an interview. 2. 2. Demonstrate Demonstrate the use of effective interviewing the use of effective interviewing techniques. techniques. 3. 3. Describe Describe the concept of bias and how it the concept of bias and how it influences interview results. influences interview results. 4. 4. Describe Describe the importance of identifying unusual the importance of identifying unusual
5. 5. Demonstrate Demonstrate appropriate cultural sensitivity, appropriate cultural sensitivity, confidentiality, and ethics when interviewing. confidentiality, and ethics when interviewing.
1. 1.
Recognize Recognize the steps in case investigation and in the steps in case investigation and in identifying exposed contacts. identifying exposed contacts. 2. 2. Describe Describe how initial cases might be recognized. how initial cases might be recognized. 3. 3. Demonstrate Demonstrate the ability to interpret fact sheets the ability to interpret fact sheets and mode of transmission sheets. and mode of transmission sheets. 4. 4. Describe Describe methods of collection and transportation methods of collection and transportation
5. 5. Apply Apply skills necessary to demonstrate the ability skills necessary to demonstrate the ability to identify additional cases and determine the to identify additional cases and determine the extent of a disease outbreak. extent of a disease outbreak.
Core Competency Domain #1: Analytic/Assessment Skills Analytic/Assessment Skills
Core Competency Domain #3: Communication Skills Communication Skills
Core Competency Domain #4: Cultural Competency Skills Cultural Competency Skills
Core Competency Domain #6: Basic Public Health Basic Public Health Science Skills Science Skills
Core Competency Domain #8: Leadership and Systems Leadership and Systems Thinking Skills Thinking Skills
Core Competency 7: Identify limits to own Identify limits to own knowledge/skills/authority and identify key system knowledge/skills/authority and identify key system resources for referring matters that exceed these resources for referring matters that exceed these limits limits
Core Competency 8: Recognize unusual events Recognize unusual events that might indicate an emergency and describe that might indicate an emergency and describe appropriate action. appropriate action.
Core Competency 9: Apply creative problem Apply creative problem solving and flexible thinking to unusual challenges solving and flexible thinking to unusual challenges within his/her functional responsibilities. within his/her functional responsibilities.
Diagnose and investigate health problems and health hazards in the community. and health hazards in the community.
Inform, educate, and empower people about health issues. about health issues.
Assure competent public health and personal health care workers. personal health care workers.
This course is approved for continuing education credit (CEC) for physicians, nurses, pharmacists, psychologists, (CEC) for physicians, nurses, pharmacists, psychologists, licensed mental health counselors, social workers, marriage licensed mental health counselors, social workers, marriage and family therapists, and certified health education and family therapists, and certified health education specialists. specialists.
To apply for CECs, you must demonstrate successful completion of all course requirements, as evidenced by completion of all course requirements, as evidenced by receiving a Certificate of Course Participation. receiving a Certificate of Course Participation.
CEC registration instructions will be provided to you at the end of the course. end of the course.
8:15 am Welcome and Course Overview 8:15 am Welcome and Course Overview 8:30 am Module 1 Review: The Role of Epidemiology in 8:30 am Module 1 Review: The Role of Epidemiology in Public Health Public Health 9:30 am Break 9:30 am Break 9:45 am Module 2: Interviewing and Communication 9:45 am Module 2: Interviewing and Communication Skills Skills 12:30 pm Lunch (Provided on 12:30 pm Lunch (Provided on-
site) 1:30 pm Module 3: Outbreak Investigations 1:30 pm Module 3: Outbreak Investigations 2:30 pm Break 2:30 pm Break 2:45 pm Module 3: Outbreak Investigations (continued) 2:45 pm Module 3: Outbreak Investigations (continued) 4:45 pm Wrap 4:45 pm Wrap-
Up / Closing Comments 5:00 pm Adjourn 5:00 pm Adjourn
Overview Module 1
Group activity
Time: 50 minutes
Modification of the TV game “ “Jeopardy. Jeopardy.” ”
The answers on the “ “J JEPI EPIrdy rdy” ” game board game board represent terms and concepts from Module 1. represent terms and concepts from Module 1. Refer to Refer to page 17 page 17 in your course manual for in your course manual for detailed instructions. detailed instructions.
1. 1.
As a team, answer the questions in each category. As a team, answer the questions in each category.
2. 2.
Use your manual to assist you. Use your manual to assist you.
3. 3.
Write your answer in the form of a question on Write your answer in the form of a question on your team your team’ ’s post s post-
it note.
4. 4.
Post your team Post your team’ ’s answers in the appropriate s answers in the appropriate places on the places on the J JEPI EPIRDY RDY boards. boards.
5. 5.
The team with the most The team with the most “ “points points” ” wins. wins.
Instructions: Instructions: As a team, determine how many As a team, determine how many points you will points you will “ “wager wager” ” on your final answer. Put
those points on the back of a post those points on the back of a post-
it note and post on the flip post on the flip-
chart next to your team’ ’s total s total points. points.
There are six key words within the definition of There are six key words within the definition of epidemiology which lend themselves to better epidemiology which lend themselves to better understanding of the field of epidemiology. understanding of the field of epidemiology. Please name three of 6 components. Please name three of 6 components.
What is a study study? ?
What is a distribution distribution? ?
What are determinants determinants? ?
What are health health-
related states states? ?
What are populations populations? ?
What is control control? ?
There are six key words There are six key words within the definition of within the definition of epidemiology which lend epidemiology which lend themselves to better themselves to better understanding of the field of understanding of the field of epidemiology. epidemiology. Please name three of 6 Please name three of 6 components. components.
In this Module you learned to: In this Module you learned to:
Define epidemiology’ ’s key terms and core concepts. s key terms and core concepts.
Recognize the objectives of epidemiology in public health practice and describe your role. health practice and describe your role.
Describe how epidemiology is applied in the core processes public health practice. processes public health practice.
Describe examples of the use and application of epidemiology. epidemiology.
Apply the basic terms, concepts, and processes of epidemiology. epidemiology.
Demonstrate appropriate epidemiological Demonstrate appropriate epidemiological interviewing and effective communication skills. interviewing and effective communication skills.
1.
State the purpose of an interview. the purpose of an interview. 2.
Demonstrate the use of effective the use of effective interviewing techniques. interviewing techniques. 3.
Describe the concept of bias and how it the concept of bias and how it influences interview results. influences interview results. 4.
Describe the importance of identifying the importance of identifying unusual occurrences. unusual occurrences. 5.
Demonstrate appropriate cultural sensitivity, appropriate cultural sensitivity, confidentiality, and ethics when interviewing. confidentiality, and ethics when interviewing.
The purpose of an The purpose of an epidemiological interview epidemiological interview is to elicit exposure is to elicit exposure information from the information from the person being interviewed person being interviewed without bias. without bias.
Communication Communication is the key to effective interviewing. is the key to effective interviewing. Two kinds of communication: Two kinds of communication:
Nonverbal
Verbal
Definition. Definition. Any communication that is not verbal or spoken. Any communication that is not verbal or spoken.
Eye contact
Facial expressions
Posture
Personal space and distance
Eye Contact Eye Contact
It is important to maintain eye It is important to maintain eye contact when communicating contact when communicating with interviewees. with interviewees. Key Elements: Key Elements:
Look at someone when you ask a question – – it is it is invitation for them to speak. invitation for them to speak.
Avoid eye contact when you do not want to be interrupted. interrupted.
Eye contact over 3 seconds without verbal communication is considered staring. communication is considered staring.
Facial Expressions Facial Expressions
A skilled interviewer will also be mindful A skilled interviewer will also be mindful
Key Elements: Key Elements:
Adopt a “ “neutral neutral” ” or non
judgmental expression when listening to emotional expression when listening to emotional statements. statements.
Do not express surprise, shock, disdain, disapproval, or disagreement. disapproval, or disagreement.
Avoid exaggerated facial expressions.
It is important that the It is important that the interviewer maintain interviewer maintain an an “ “interested interested” ” or open
posture during the posture during the interview process. interview process.
(continued)
Key Elements: Key Elements:
Orient your body towards the interviewee.
Do not cross your arms or legs.
Lean slightly forward to appear “ “interested interested” ” and and elicit information. elicit information.
Avoid placing clipboards, papers, books, bags,
Maintain a sitting or standing position that is not higher or lower than the interviewee. not higher or lower than the interviewee.
The physical distance between the interviewer and The physical distance between the interviewer and interviewee strongly influences the communication, interviewee strongly influences the communication, and is culture and is culture-
and gender-
specific. Key Elements: Key Elements:
18 inches to 4 feet is considered most effective across cultures and gender. across cultures and gender.
Touching such as pats on the back, arm, or leg can can “ “violate violate” ” culture and gender barriers. culture and gender barriers.
Instructions: Instructions: You will be paired with a partner You will be paired with a partner and provided the opportunity to practice and provided the opportunity to practice “ “closed closed” ” nonverbal communication and nonverbal communication and “ “open
” nonverbal communication. During each nonverbal communication. During each practice, remember how you feel and the ease practice, remember how you feel and the ease at which you were able to communicate. at which you were able to communicate. Please refer to Please refer to page 22 page 22 in your course in your course manual. manual.
Eye Contact: Eye Contact: Avoid eye contact completely or Avoid eye contact completely or “ “stare stare” ” at at your partner. your partner. Facial Expressions: Facial Expressions: Adopt a Adopt a “ “stone stone” ” face or over face or over-
exaggerate your facial expressions. Posture: Posture: Turn your body away from your partner, cross Turn your body away from your partner, cross your arms and legs, put objects between you and your your arms and legs, put objects between you and your partner, lean back, and sit or stand higher than your partner, lean back, and sit or stand higher than your partner. partner. Personal Space and Distance: Personal Space and Distance: Sit or stand either too Sit or stand either too close or far. close or far.
Eye Contact: Eye Contact: Use the 60/40 rule Use the 60/40 rule – – establish eye contact establish eye contact with your partner 60% of the time. with your partner 60% of the time. Facial Expressions: Facial Expressions: Use a Use a “ “neutral neutral” ” facial expression facial expression
’s expressions. s expressions. Posture: Posture: Orient your body towards your partner, do not Orient your body towards your partner, do not cross your arms and legs, remove objects from between cross your arms and legs, remove objects from between you and your partner, lean slightly forward, and sit or stand you and your partner, lean slightly forward, and sit or stand at the same level as your partner. at the same level as your partner. Personal Space and Distance: Personal Space and Distance: Sit or stand 18 inches to 4 Sit or stand 18 inches to 4 feet away from your partner. feet away from your partner.
Definition. Definition. The content or The content or what what is said, as well as your voice is said, as well as your voice
how it is said. It communicates feelings and it is said. It communicates feelings and attitudes. attitudes.
The way the content is conveyed impacts what conveyed impacts what the interviewee will hear. the interviewee will hear.
Content is more more than the than the actual words. actual words.
Brevity: Communications should be short, Communications should be short, simple, and to the point. simple, and to the point.
Organization: Communication content should Communication content should be well organized in a sequential manner. The be well organized in a sequential manner. The interview will have a interview will have a “ “structure structure” ” to it (introduction, to it (introduction, body, and conclusion). body, and conclusion).
Comprehension: The comprehension level The comprehension level must be adjusted for the specific interviewee. must be adjusted for the specific interviewee. Avoid the use of jargon and acronyms. Avoid the use of jargon and acronyms.
Repetition: During the interview process, it may During the interview process, it may be necessary to repeat questions or information. be necessary to repeat questions or information.
The voice communicates in The voice communicates in ways that have nothing to ways that have nothing to do with the actual words do with the actual words that are being said. that are being said.
Tone of Voice: A skilled interviewer will be A skilled interviewer will be mindful of their vocal tone (not being mindful of their vocal tone (not being judgmental or condescending). judgmental or condescending).
Volume: The loudness or softness of speech The loudness or softness of speech will be adjusted based on the needs of the will be adjusted based on the needs of the specific interviewee and the environmental specific interviewee and the environmental conditions. conditions.
Speed: Speech should be paced in a manner Speech should be paced in a manner so it is clear and can be understood by the so it is clear and can be understood by the specific interviewee. specific interviewee.
Inflection: Emphasis should be given to Emphasis should be given to certain key words or phrases to ensure certain key words or phrases to ensure understanding and understanding and not not change the meaning of change the meaning of a statement. a statement.
1.
Ask Open-
Ended Questions.
Questions that require more than a single word Questions that require more than a single word answer to encourage conversation answer to encourage conversation (Source: FDOH,
(Source: FDOH, 2004). 2004).
Move beyond simple “ “Yes Yes” ” or
“No No” ” responses. responses.
Allow the interviewee to provide more detailed answers. answers.
Give the perception there is no “ “right right” ” or
“ “wrong wrong” ” answer. answer.
Open Open-
Ended Questions “ “What brings you to the What brings you to the clinic today? clinic today?” ” “ “What kinds of meats have What kinds of meats have you recently eaten? you recently eaten?” ” “ “What symptoms are What symptoms are members of your family members of your family experiencing? experiencing?” ” “ “What symptoms do you What symptoms do you have? have?” ” Closed Closed-
Ended Questions “ “Are you here for a flu shot Are you here for a flu shot today? today?” ” “ “You haven You haven’ ’t eaten any t eaten any uncooked meat, have you? uncooked meat, have you?” ” “ “No one else in your family No one else in your family is sick, are they? is sick, are they?” ” “ “Do you have a headache? Do you have a headache?” ”
“Tell me about. . . Tell me about. . .” ”
“Start at the beginning and tell me about. . . Start at the beginning and tell me about. . .” ”
“What specifically is going on? What specifically is going on?” ”
“Could you describe how you are feeling? Could you describe how you are feeling?” ”
“What changes in your health have you noticed? What changes in your health have you noticed?” ”
2.
A A “ “neutral way of searching for a suitable answer neutral way of searching for a suitable answer” ”
( (Aschengrau Aschengrau & Seage, 2003) & Seage, 2003).
.
Probing is useful when the interviewee’ ’s answer s answer is not clear, or when the interviewee has not is not clear, or when the interviewee has not understood the question. understood the question.
Probing is important because it allows the interviewer to obtain more information without interviewer to obtain more information without influencing the response. influencing the response.
Do not place blame on anyone.
Allow for multiple responses.
Avoid “ “yes yes” ” or
“no no” ” responses. responses.
Are usually brief, but elicit a long response. response.
Elaborate: “ “Tell me a little more about that, Tell me a little more about that,” ”
“you started to say something about _____, you started to say something about _____, is there anything else? is there anything else?” ”
Exemplify: “ “Can you give me an example of Can you give me an example of that? that?” ”
Explain: “ “I am not sure if I got all of that, can I am not sure if I got all of that, can you explain it one more time? you explain it one more time?” ”
Specify: When a respondent says something When a respondent says something that requires more information. that requires more information.
Restate: Repeat part or all of the interviewee Repeat part or all of the interviewee’ ’s s response in such a way to encourage response in such a way to encourage elaboration or explanation. It allows people to elaboration or explanation. It allows people to clarify their ideas and listen to what they just clarify their ideas and listen to what they just said in a way that is non said in a way that is non-
evaluative.
(continued)
Instructions: Instructions:
You will be paired with a partner. Please identify who will You will be paired with a partner. Please identify who will assume the role of assume the role of “ “Interviewer Interviewer” ” and who will be the and who will be the “ “Interviewee. Interviewee.” ” Your goal as the Your goal as the “ “Interviewer Interviewer” ” is to is to Ask Open Ask Open-
ended Questions Questions. . Your task as the Your task as the “ “Interviewee Interviewee” ” is to reward the Interviewer is to reward the Interviewer when they ask Open when they ask Open-
ended Questions by responding to the
ended Question, DO NOT RESPOND. DO NOT RESPOND. Please refer to Please refer to page 26 page 26 in your course manual. in your course manual.
Case: Meningitis Case: Meningitis
Interviewer: : The patient is a college freshman living in The patient is a college freshman living in the dorm of a renowned University. The student was the dorm of a renowned University. The student was taken to a hospital earlier in the day with symptoms of taken to a hospital earlier in the day with symptoms of
potential of being very contagious, University authorities potential of being very contagious, University authorities have sought help from the health department. have sought help from the health department.
Interviewee: : You are a freshman college student and You are a freshman college student and are feeling VERY bad. You have symptoms of: sudden are feeling VERY bad. You have symptoms of: sudden headache, fever, a stiff neck, nausea and vomiting. You headache, fever, a stiff neck, nausea and vomiting. You are also experiencing a bit of confusion and your eyes are also experiencing a bit of confusion and your eyes are quite sensitive to the lights. are quite sensitive to the lights.
Instructions: Instructions:
You and your partner will now switch roles. The You and your partner will now switch roles. The “ “Interviewer Interviewer” ” will become the will become the “ “Interviewee. Interviewee.” ” The The “ “Interviewee Interviewee” ” will become will become the the “ “Interviewer. Interviewer.” ” Your goal as the Your goal as the “ “Interviewer Interviewer” ” is to is to Use Probing Use Probing. . Your task as the Your task as the “ “Interviewee Interviewee” ” is to reward the Interviewer is to reward the Interviewer when they probing effectively by responding to the question. when they probing effectively by responding to the question. If the Interviewer does not probe well, respond with a If the Interviewer does not probe well, respond with a “ “Yes, Yes,” ” “ “No No” ” or other succinct and brief response.
Please refer to Please refer to page 26 page 26 in your course manual. in your course manual.
Case: Meningococcemia Case: Meningococcemia
Interviewer: : The patient is a teacher at a local The patient is a teacher at a local elementary school. The teacher was taken to a hospital elementary school. The teacher was taken to a hospital earlier in the day with symptoms of meningococcemia, a earlier in the day with symptoms of meningococcemia, a contagious blood infection disease that can lead to contagious blood infection disease that can lead to kidney and heart failure and also result in severe kidney and heart failure and also result in severe disability or death. School authorities have sought help disability or death. School authorities have sought help from the health department. from the health department.
Interviewee: : You are a teacher at a local elementary You are a teacher at a local elementary school and are feeling VERY bad. You have symptoms school and are feeling VERY bad. You have symptoms
vomiting, and lethargy. vomiting, and lethargy.
Definition. Definition. The difference that occurs from The difference that occurs from
soliciting, recording, or soliciting, recording, or interpreting information during interpreting information during face face-
to-
face or telephone interviews. interviews.
Interviews are subjective, no matter how many , no matter how many
hard the interviewer attempts to maintain hard the interviewer attempts to maintain
Interviewers are human, and all carry with them , and all carry with them some assumptions about different types of some assumptions about different types of people. people.
Interviewers should try to conduct each interview conduct each interview the same the same while working to minimize the effects while working to minimize the effects
There are two common There are two common types of interview bias: types of interview bias:
Environment
Past experiences
The physical setting The physical setting where the interview where the interview
success of the interview. success of the interview.
Time: Consider the Consider the amount of time required to amount of time required to effectively gather the effectively gather the information needed, as well information needed, as well as, the time of day. as, the time of day.
Distractions: Noise, Noise, lighting, temperature, lighting, temperature, furniture, etc. all influence furniture, etc. all influence the interview. the interview.
Physical Arrangement: The arrangement of desk and The arrangement of desk and chairs can impact perceptions chairs can impact perceptions
Sitting side-
by-
side or at the corners of a desk communicate corners of a desk communicate a more a more “ “equal equal” ” power level. power level.
Avoid sitting directly across a desk or table from the interviewee. interviewee.
Past Experiences Past Experiences The The interviewee interviewee’ ’s past experiences s past experiences in both interview in both interview situations and with medical staff impacts how well they situations and with medical staff impacts how well they may listen or respond. may listen or respond.
Be aware that some Be aware that some resistance or lack of resistance or lack of responsiveness by the responsiveness by the interviewee may be due interviewee may be due to their past experience. to their past experience.
Past Experiences Past Experiences The The interviewer interviewer’ ’s past experiences s past experiences can influence the verbal and can influence the verbal and nonverbal components of the nonverbal components of the epidemiological interview. epidemiological interview.
Stereotyping
First impressions
Interviewee “ “noise noise” ”
Nonverbal bias
Avoid stereotyping. Be conscious of your
Be conscious of your
religion, race, appearance think, act, or religion, race, appearance think, act, or respond. respond. Strategy: Strategy: Minimize the Minimize the influence your opinions and influence your opinions and personal beliefs may have on personal beliefs may have on the interview by focusing on the the interview by focusing on the interview sheet and the need for interview sheet and the need for information. information.
First impressions. It is only natural that first
It is only natural that first impressions influence our communication with impressions influence our communication with
positive or negative, based on a first impression. positive or negative, based on a first impression. Strategy: Strategy: Minimize the Minimize the influence of first impressions by influence of first impressions by focusing on maintaining an focusing on maintaining an
standing or sitting higher than standing or sitting higher than the interviewee. the interviewee.
Interview noise. Some interviewees want to
Some interviewees want to appear favorable or positive during the interview. appear favorable or positive during the interview. They may present information in a way that casts They may present information in a way that casts them in a favorable light and/or say things they think them in a favorable light and/or say things they think the interviewer wants to hear. the interviewer wants to hear. Strategy: Strategy: Be sure to ask for Be sure to ask for examples or specifics. Being examples or specifics. Being non non-
judgmental in your expressions and responses expressions and responses can help minimize this. can help minimize this.
Nonverbal bias. Undue emphasis might be Undue emphasis might be placed on interviewee nonverbal cues that have placed on interviewee nonverbal cues that have nothing to do with the interview (such as loudness nothing to do with the interview (such as loudness
given). given). Strategy: Strategy: Try to be aware of Try to be aware of your body language and your body language and nonverbal cues. Make sure nonverbal cues. Make sure your nonverbal communication your nonverbal communication is as neutral as possible. is as neutral as possible.
Listen actively.
Maintain eye contact, orient your body posture Maintain eye contact, orient your body posture towards the person, lean forward slightly, and nod towards the person, lean forward slightly, and nod your head or provide verbal cues that you are your head or provide verbal cues that you are listening (example: listening (example: “ “Uh, huh; Uh, huh;” ” “ “Yes, I see Yes, I see” ”). ).
Probe for more information.
When answers are vague or incomplete, use the When answers are vague or incomplete, use the probing techniques described earlier. probing techniques described earlier.
Repeat questions.
Sometimes people can not hear well or do not hear Sometimes people can not hear well or do not hear the question the first time it is asked. Repeat the the question the first time it is asked. Repeat the question when someone provides incomplete or question when someone provides incomplete or “ “off
target” ” answers. answers.
Paraphrase.
Restate the answer in different words and check for Restate the answer in different words and check for
clarify and elaborate on a previous answer. clarify and elaborate on a previous answer.
Use silence.
Sometimes not talking is Sometimes not talking is the best way to get the best way to get information or clarification. information or clarification. A pause of up to ten A pause of up to ten seconds invites the seconds invites the interviewee to continue interviewee to continue
intermittent eye contact as intermittent eye contact as appropriate. appropriate.
Key Elements: Key Elements:
Be ALERT!
Read over fact sheets so you'll be aware of modes of you'll be aware of modes of transmission. transmission.
Example: Example: If you are investigating encephalitis, it is If you are investigating encephalitis, it is important to know the disease can be transmitted by important to know the disease can be transmitted by mosquitoes, and standing bodies of water contribute to the mosquitoes, and standing bodies of water contribute to the breeding of mosquitoes. breeding of mosquitoes.
1.
Face-
to-
face clues. Look at the person you are Look at the person you are interviewing, what clues do you see? interviewing, what clues do you see?
Many clues about the disease being investigated can be observed from a face can be observed from a face-
to-
face interview.
A person being interviewed may say they have good hand good hand-
washing habits, but during a face-
to-
face interview you may observe that the person being interview you may observe that the person being interviewed has dirt under their fingernails. interviewed has dirt under their fingernails.
Observations such as this are prime examples of unusual information revealed during the interview unusual information revealed during the interview that needs to be noted. that needs to be noted.
2.
Environmental clues.
Be sure to consider all environment clues. Be sure to consider all environment clues.
Water resources. From where does From where does the water supply originate? the water supply originate?
Food resources. How is food stored? How is food stored?
Animal resources. What types of What types of animals are living in proximity? animals are living in proximity?
What is the interviewee’ ’s s
3.
People clues. Be sure to consider what interactions the person Be sure to consider what interactions the person being interviewed has had. being interviewed has had.
Have they traveled recently? recently?
Are there any pieces
give that are contradictory? give that are contradictory?
The Council on Linkages The Council on Linkages between Academia and between Academia and Public Health Practice Public Health Practice developed a list of core developed a list of core competencies for competencies for public health professionals. public health professionals. Among these are Among these are Cultural Cultural Sensitivity Sensitivity and and Cultural Cultural Competency Competency. .
In order to interview effectively, it is important to In order to interview effectively, it is important to practice practice cultural competence cultural competence by responding by responding specifically and sensitively to various cultural and specifically and sensitively to various cultural and diverse groups. diverse groups.
Slow down. When we speak quickly, we When we speak quickly, we
sounds that help a listener sounds that help a listener identify a word. identify a word.
Pay attention to your voice. Avoid a monotone pattern, Avoid a monotone pattern, and remember that louder and remember that louder does not help. does not help.
Less is better. Choose short words and Choose short words and use short sentences. use short sentences.
Rephrase and restate. If one way of saying If one way of saying something is not being something is not being understood, try using understood, try using different words. different words.
When in doubt, write it out. Some people understand written Some people understand written instructions, information, and/or instructions, information, and/or questions better than spoken questions better than spoken
Draw a picture. A picture is often worth a million A picture is often worth a million words. words.
Avoid acronyms and jargon. Use the most common words Use the most common words with most common meanings. with most common meanings.
Repeat and summarize. If a question is critical or If a question is critical or information is vital, repeat it at information is vital, repeat it at least 3 times during the course least 3 times during the course
Get help. When necessary, call When necessary, call someone else to help. someone else to help.
Check the message. ALWAYS have the ALWAYS have the listener re listener re-
tell the complete message to complete message to check for accurate check for accurate understanding. understanding.
Surveys and interviews can be intrusive even when conducted for public health safety. conducted for public health safety.
Questions about attitudes, beliefs, interests, values, behaviors and background data can be values, behaviors and background data can be seen as personal and possibly controversial. seen as personal and possibly controversial.
Survey and interview professionals must protect each participant each participant’ ’s well s well-
being to prevent harm and to get accurate information. to get accurate information.
HIPAA: HIPAA: The Health Insurance Portability and
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed into law on Accountability Act of 1996 (HIPAA) was signed into law on August 21, 1996. August 21, 1996.
The regulations protect medical records and other individually identifiable health information, whether it is individually identifiable health information, whether it is
(United States Department of Health and Human Resources, 2003, States Department of Health and Human Resources, 2003, http://www.hhs.gov/news/facts/privacy.html http://www.hhs.gov/news/facts/privacy.html). ).
Interviewer Interviewer’ ’s Responsibility. s Responsibility. The interviewer has an affirmative responsibility not to The interviewer has an affirmative responsibility not to discuss or disclose any information relating to the discuss or disclose any information relating to the interview to persons or parties who are not authorized interview to persons or parties who are not authorized to be privy to such information. to be privy to such information. During the Interview During the Interview -
Tell the interviewee that information exchanged during the interview will be treated information exchanged during the interview will be treated with respect, and that standards of confidentiality will be with respect, and that standards of confidentiality will be maintained. maintained.
The ethical principles which guide data gathering are The ethical principles which guide data gathering are rooted in two inalienable human rights: free speech and rooted in two inalienable human rights: free speech and privacy. privacy. Interview participants have the right to: Interview participants have the right to:
Speak freely, without constraint, even if others may not like what they say; and like what they say; and
Remain silent, or if they speak, to set limits on the personal information they divulge, and have what they personal information they divulge, and have what they say as individuals remain confidential (unless they say as individuals remain confidential (unless they consent to disclosure). consent to disclosure).
Instructions: Instructions: You will be put into teams of 2, with each person taking a
You will be put into teams of 2, with each person taking a turn as turn as Interviewer Interviewer and and Interviewee
. You will be assigned a different role for each interview scenario, and provided information specific t for each interview scenario, and provided information specific to your role.
Your goal as the Interviewer Interviewer is to put into practice all the skills is to put into practice all the skills discussed in this module discussed in this module – – Nonverbal communication, Verbal Nonverbal communication, Verbal communication, Other Communication Factors (Environmental, communication, Other Communication Factors (Environmental, Interviewer Experiences, Cultural), Ask Open Interviewer Experiences, Cultural), Ask Open-
Ended Questions, and Use Probing. and Use Probing.
Your goal as the Interviewee Interviewee is to reward the Interviewer when is to reward the Interviewer when they demonstrate communication competence across all skills they demonstrate communication competence across all skills. At . At the end of the interview experience, you will be asked to p the end of the interview experience, you will be asked to provide rovide the Interviewer with feedback. the Interviewer with feedback. Please refer to Please refer to page 34 page 34 in your course manual. in your course manual.
Exercise 3: Exercise 3:
Pulling it All Together Pulling it All Together-
Skills Practice
Pulling it All Together Skill Practice Pulling it All Together Skill Practice
General Information General Information: : A person comes to the health A person comes to the health department with a rash on their chest, face, and hands. department with a rash on their chest, face, and hands. Roles Roles: : Please refer to your Please refer to your specific information sheets. specific information sheets.
Interviewer – – pages 36 pages 36-
38
Interviewee – – page 39 page 39
Pulling it all Together Skill Practice Pulling it all Together Skill Practice
General Information General Information: : There have recently been several
There have recently been several cases of Hepatitis A in your county. The cause of the outbreak cases of Hepatitis A in your county. The cause of the outbreak has not been determined, but investigators are focusing on the has not been determined, but investigators are focusing on the hygiene practices of restaurant workers during the first week hygiene practices of restaurant workers during the first week August at the I.M. Gross Diner, a local restaurant. August at the I.M. Gross Diner, a local restaurant.
Roles Roles: : Please refer to your specific
Please refer to your specific information sheets. information sheets.
Interviewer – – pages 41 pages 41-
44
Interviewee – – page 45 page 45
Pulling it all Together Skill Practice Pulling it all Together Skill Practice
General Information General Information: : There has been a suspected case of
There has been a suspected case of bacterial meningitis in a college freshman living in campus bacterial meningitis in a college freshman living in campus housing of a local college. The student, an international housing of a local college. The student, an international student, was taken to a hospital earlier in the day with student, was taken to a hospital earlier in the day with symptoms of meningitis. As the bacterial form of this disease symptoms of meningitis. As the bacterial form of this disease has the potential of being contagious, the college has sought has the potential of being contagious, the college has sought help from the health department. help from the health department.
Roles Roles: : Please refer to your specific information sheets.
Please refer to your specific information sheets.
Interviewer – – pages 47 pages 47-
49
Interviewee – – page 50 page 50
In this Module you learned to: In this Module you learned to:
State the purpose of an interview.
Demonstrate the use of effective interviewing techniques. interviewing techniques.
Describe the concept of bias and how it influences interview results. how it influences interview results.
Describe the importance of identifying unusual occurrences. identifying unusual occurrences.
Demonstrate appropriate cultural sensitivity, confidentiality, and sensitivity, confidentiality, and ethics when interviewing. ethics when interviewing.
Please refer to your manual Please refer to your manual page 53 page 53 for complete instructions. for complete instructions.
1. 1. A buffet has been set up for you. A buffet has been set up for you. 2. 2. Go through the buffet and Go through the buffet and “ “fill your plate. fill your plate.” ” 3. 3. When you get back to your seat, turn each food item over When you get back to your seat, turn each food item over and note any instructions for you on the back. and note any instructions for you on the back. 4. 4. Place your food photos in the Place your food photos in the “ “stomach stomach” ” envelope. envelope. 5. 5. Keep your Keep your “ “stomach stomach” ” envelope with you for use later in this envelope with you for use later in this module. module. STOP: STOP: At this point, the activity will stop and be resumed later At this point, the activity will stop and be resumed later in the presentation. in the presentation.
Participate Participate in an outbreak investigation exercise. in an outbreak investigation exercise.
( (Blackmore Blackmore, Carina, Gill, Julia, Kintz, Jylmarie, and Teates, Kathryn. 20 , Carina, Gill, Julia, Kintz, Jylmarie, and Teates, Kathryn. 2003.
The County Health Department Epidemiology Guide to Disease Surveilla County Health Department Epidemiology Guide to Disease Surveillance and nce and Investigations.
Florida Department of Health)
A multi A multi-
step process for determining the for determining the dynamics of a dynamics of a disease outbreak and disease outbreak and implementing control implementing control and prevention and prevention measures to control measures to control the situation. the situation.
1. 1. Prepare for field work. Prepare for field work. 2. 2. Establish the existence of an outbreak. Establish the existence of an outbreak. 3. 3. Verify the diagnosis. Verify the diagnosis. 4. 4. Define and identify cases. Define and identify cases. 5. 5. Describe and orient the data in terms of time, Describe and orient the data in terms of time, place, person. place, person. 6. 6. Develop hypothesis. Develop hypothesis. 7. 7. Test hypothesis. Test hypothesis. 8. 8. Refine and carry out additional studies. Refine and carry out additional studies. 9. 9. Implement control and prevention measures. Implement control and prevention measures. 10.
Communicate findings.
(CDC EXCITE, 2004) (CDC EXCITE, 2004)
A. A. Research the disease. Research the disease. B. B. Gather the supplies and Gather the supplies and equipment you need. equipment you need. C. C. Make necessary Make necessary administrative and personal administrative and personal arrangements. arrangements. D. D. Consult with supervisor or team leader to Consult with supervisor or team leader to determine your role in the investigation and who determine your role in the investigation and who your local contacts will be once you arrive on the your local contacts will be once you arrive on the scene. scene.
More information on foodbourne foodbourne pathogens and pathogens and natural toxins can be found in natural toxins can be found in The Bad Bug Book The Bad Bug Book. .
(see pp. 114-
115 in Resource section).
(see p. 108 in Resource section). Resource section).
(see p. 109 in Resource section). Resource section).
whether personal protective equipment (PPE) is whether personal protective equipment (PPE) is required required (see pp. 110
(see pp. 110-
111 in Resource section).
Make necessary administrative and personal Make necessary administrative and personal arrangements. arrangements.
Consult with supervisor or team leader to Consult with supervisor or team leader to determine your role in the investigation. determine your role in the investigation.
information. information.
(see pp. 112 112-
113 in Resource section).
Instructions: Instructions: Use the Use the “ “Specimen Collection Table and Fact Specimen Collection Table and Fact Sheets Sheets” ” found from found from pages 58 pages 58-
68 in your course manual to in your course manual to answer the following six questions: answer the following six questions: 1. 1. Which disease has symptoms of headache, stiff neck and fever? Which disease has symptoms of headache, stiff neck and fever? 2. 2. Is there a treatment for anthrax? Is there a treatment for anthrax? 3. 3. Which disease is caused by a virus that is transmitted in Which disease is caused by a virus that is transmitted in respiratory droplets? respiratory droplets? 4. 4. Describe the special preparations and container specifications Describe the special preparations and container specifications used when transporting a Gonorrhea culture. used when transporting a Gonorrhea culture. 5. 5. Describe the container used to transport a Legionella Antibody Describe the container used to transport a Legionella Antibody Serology. Serology. 6. 6. Who gets legionellosis? Who gets legionellosis?
Exercise 2: Exercise 2: Research the Disease Research the Disease
Verify that a suspected Verify that a suspected
Check Syndromic Surveillance. Check Syndromic Surveillance. Before you can decide Before you can decide whether an outbreak exists, whether an outbreak exists, you must you must first first determine the expected number of cases determine the expected number of cases for the area in the given time frame. for the area in the given time frame.
A.
Visit several of the people who became ill to gain a better understanding of the disease and those better understanding of the disease and those affected by it. affected by it. B.
Gather critical information by asking questions, such as: such as:
What were your exposures before becoming ill?
What do you think caused your illness?
Do you know anyone else with the disease?
Do you have anything in common with others who have the disease? who have the disease?
possible, the specific nature of possible, the specific nature of the disease. the disease.
Ensure that the problem has been properly diagnosed. been properly diagnosed.
For outbreaks involving infectious or toxic infectious or toxic-
chemical agents, be certain that the agents, be certain that the increase in diagnosed cases is increase in diagnosed cases is not the result of a laboratory not the result of a laboratory mistake. mistake.
This step involves four sub This step involves four sub-
steps: A. A. Define cases Define cases B. B. Identify cases Identify cases C. C. Survey the population Survey the population D. D. Organize the information Organize the information
A. A. Define cases. Define cases. Establish a Establish a case definition case definition, or standard , or standard set of criteria, for deciding whether a person should be set of criteria, for deciding whether a person should be classified as having the disease or health condition classified as having the disease or health condition under study. under study. A case definition usually includes A case definition usually includes four four components: components: 1. 1. Clinical information about the disease. Clinical information about the disease. 2. 2. Characteristics of the people who are affected. Characteristics of the people who are affected. 3. 3. Information about the location or place. Information about the location or place. 4. 4. A specification of time during which the outbreak A specification of time during which the outbreak
A A false
false-
positive case occurs when the case definition is
met, but the person actually does met, but the person actually does not not have the disease in have the disease in question. question.
Ideally, the case definition should be broad enough to include most, if not all, of the actual cases, without include most, if not all, of the actual cases, without capturing what are called "false capturing what are called "false-
positive" cases.
Recognizing the uncertainty of some diagnoses, investigators often classify cases as investigators often classify cases as “ “confirmed, confirmed,” ” “ “probable, probable,” ” or
“possible. possible.” ”
1. 1. Confirmed Case Confirmed Case Usually requires laboratory Usually requires laboratory verification. verification. 2. 2. Probable Case Probable Case Usually has the typical Usually has the typical clinical features of the clinical features of the disease without laboratory disease without laboratory confirmation. confirmation. 3. 3. Possible Case Possible Case Usually has fewer of the Usually has fewer of the typical clinical features. typical clinical features.
Early in an investigation, a loosely defined or broad case definition that includes confirmed, broad case definition that includes confirmed, probable, and even possible cases is often used probable, and even possible cases is often used to allow investigators to capture as many cases to allow investigators to capture as many cases as possible. as possible.
Later on, when hypotheses have come into sharper focus, the investigator may tighten the sharper focus, the investigator may tighten the case definition by dropping the case definition by dropping the “ “possible possible” ” category. category.
Many outbreaks are first recognized and reported by concerned health care providers or citizens. reported by concerned health care providers or citizens. Epidemiologists must "cast the net wide" to determine Epidemiologists must "cast the net wide" to determine the true size and geographic extent of the problem. the true size and geographic extent of the problem. Sources for identifying cases: Sources for identifying cases:
Physicians' offices
Clinics
Hospitals
Laboratories
There are two methods for identifying cases: 1) There are two methods for identifying cases: 1) Active surveillance Active surveillance, and 2) , and 2) Passive surveillance Passive surveillance. .
Public health officials may decide to Public health officials may decide to alert the public directly usually alert the public directly usually through the local media. through the local media. Example Example: : In outbreaks caused by a In outbreaks caused by a contaminated food product, media contaminated food product, media alerts help the public avoid the alerts help the public avoid the implicated product and suggest they implicated product and suggest they see a physician if symptoms of the see a physician if symptoms of the disease occur. disease occur.
Disadvantages: Not timely. Does not provide useful information when early intervention is necessary. Disadvantages: Labor-intensive. Advantages: Not labor-intensive. Advantages: Provides timely, up-to-date information. Data has less variability. Methods: Information requested by letter and/or scheduled reports. Methods: Face-to-face and/or phone interviews. Occurs when health care providers report notifiable diseases on a case- by-case basis to the local or state health agency, based upon a published list of conditions. Occurs when health care providers report notifiable diseases on a case-by-case basis and on a regular schedule due to outreach from local, state, or federal agencies.
Passive surveillance: Active surveillance:
C.
Survey the population. Interviews are conducted with Interviews are conducted with the population of a potential the population of a potential exposure when: exposure when: 1. 1. An outbreak affects a population in a restricted An outbreak affects a population in a restricted setting, such as a tour bus, school, or workplace. setting, such as a tour bus, school, or workplace. 2. 2. A high proportion of cases are unlikely to be A high proportion of cases are unlikely to be
mild or without symptoms. mild or without symptoms.
Collect Information
Identifying information
Demographic information
Clinical information
Risk factor information
Organize Information
Standard case report form
Questionnaire
Data abstraction form
Characterize an outbreak by: Characterize an outbreak by: 1.
Time 2.
Place 3.
Person Characterizing an outbreak by these variables is Characterizing an outbreak by these variables is called called descriptive epidemiology descriptive epidemiology. .
Note: Note: This step may occur several times within the course of This step may occur several times within the course of the outbreak. the outbreak.
Graph by the number of cases and their date of Graph by the number of cases and their date of
– called an called an “ “Epi curve Epi curve. .” ”
Indicates the time course of an epidemic.
Gives a simple visual display of the outbreak's magnitude and time trend. magnitude and time trend.
Tells the status of the course of epidemic.
Identify the epidemic’ ’s s course. course.
Project the epidemic’ ’s s future course. future course.
Provide an estimate of the probable time period the probable time period
Draw inferences about the epidemic pattern. the epidemic pattern.
How do I interpret an epi curve? How do I interpret an epi curve?
In order to interpret an epi curve, the overall shape must In order to interpret an epi curve, the overall shape must be considered. The shape is determined by the: be considered. The shape is determined by the: A.
Pattern of the epidemic (e.g., whether it has a common source or person common source or person-
to-
person transmission). B.
Period of time over which susceptible people are exposed. exposed. C.
Minimum, average, and maximum incubation periods for the disease. periods for the disease.
Epidemiology curve of human West Nile virus encephalitis cases in Florida in 2001.
Surveillance Results From The First West Nile Virus Transmission Season In Florida, 2001 C. G. M. BLACKMORE, L. M. STARK, W.C. JETER, R. L. OLIVERI, R. G. BROOKS, L. A. CONTI, AND S. T. WIERSMA in http://www.ajtmh.org
Steep up-
slope and a gradual down gradual down-
slope.
People are exposed to the same source over the same source over a relatively brief a relatively brief period. period.
All cases occur within
Single Source Epidemic Single Source Epidemic – – Point source Point source
The epidemic curve can be used to identify a likely period of exposure in a point period of exposure in a point-
source epidemic of a known disease. known disease.
Continuous Common Source Epidemic Continuous Common Source Epidemic
Duration of exposure is prolonged.
Epi curve will have a plateau instead of a peak.
Propagated Epidemic Propagated Epidemic Curve has a series of progressively taller peaks Curve has a series of progressively taller peaks
Outliers: Outliers: Cases that stand apart Cases that stand apart
Early Case Early Case
Background (unrelated) case.
A source source of the epidemic
Person who was exposed earlier exposed earlier than most than most
Late Case Late Case
Unrelated to the outbreak. to the outbreak.
Especially long incubation periods long incubation periods. .
May indicate exposure later exposure later than most of the people affected. than most of the people affected. Secondary cases Secondary cases
May have become ill after being exposed after being exposed to someone who was part of to someone who was part of the initial outbreak. the initial outbreak.
1.
Time 2.
Place 3.
Person
Provides information on the geographic extent of the problem. the problem.
Shows clusters or patterns that provide patterns that provide clues to the identity and clues to the identity and
Plot, on a spot map, the area where the affected area where the affected people may have been people may have been exposed. exposed.
Looks like clustering
Person-
to-
person spread
Example: Hospital or nursing home
Looks like a scattering of cases
Example: Dining hall or workplace Spot map shows number of cases. Spot map shows number of cases. May show May show clusters or patterns that reflect water supplies, wind clusters or patterns that reflect water supplies, wind currents, or proximity to a,restaurant or grocery store. currents, or proximity to a,restaurant or grocery store.
If the size of the overall If the size of the overall population varies population varies between the areas you between the areas you are comparing, the spot are comparing, the spot maps can be misleading. maps can be misleading.
Reported cases of rabies in the United States, 1999. From: Microbiology and Immunology Online, School of Medicine, University of South Carolina, http://pathmicro.med.sc.edu/virol/rabies.htm
Define populations by: Define populations by:
Personal characteristics, such as: , such as:
Age
Race
Sex
Medical status
Exposures, such as: , such as:
Occupation
Leisure or work activities
Use of medications, tobacco, drugs
When developing a hypothesis be sure to: When developing a hypothesis be sure to: A. A. Address the following: Address the following:
Source of the agent.
Mode (vehicle or vector) of transmission.
Exposures that caused the disease.
Should be proposed in a way that can be tested. B. B. Ask: Ask:
What do you know about the disease itself?
What is the agent’ ’s usual reservoir? s usual reservoir?
How is the disease usually transmitted?
What vehicles are commonly implicated?
What are the known risk factors?
Two approaches you can use, depending on Two approaches you can use, depending on the nature of your data: the nature of your data: 1. 1. Compare the hypothesis with the established Compare the hypothesis with the established facts. facts.
Used when your evidence is so strong that the hypothesis does not need to be tested. hypothesis does not need to be tested. 2. 2. Test the hypothesis through Test the hypothesis through analytic analytic epidemiology epidemiology studies. studies.
Compare the Hypothesis Compare the Hypothesis with the Established Facts with the Established Facts
Example: Example: In 1991, there was an In 1991, there was an investigation of an outbreak of vitamin investigation of an outbreak of vitamin D intoxication in Massachusetts. All of D intoxication in Massachusetts. All of the affected people drank milk the affected people drank milk delivered to their homes by a local delivered to their homes by a local
the dairy was the source, and the milk the dairy was the source, and the milk was the vehicle of excess vitamin D. was the vehicle of excess vitamin D. When investigators visited the dairy, When investigators visited the dairy, they quickly recognized that far more they quickly recognized that far more than the recommended dose of than the recommended dose of vitamin D was inadvertently being vitamin D was inadvertently being added to the milk. No further analysis added to the milk. No further analysis was necessary. was necessary.
Two types of analytic studies: Two types of analytic studies: 1. 1. Cohort Studies Cohort Studies: :
Compare groups of people who have been exposed to suspected risk factors with groups who have not been suspected risk factors with groups who have not been exposed. exposed.
The best technique for analyzing an outbreak in a small, well well-
defined population.
2.
Case-
Control Studies: :
Compare people with a disease (case-
patients) with a group
In most outbreaks the population is not well defined, and so cohort studies are not feasible. In these instances, you cohort studies are not feasible. In these instances, you would use the case would use the case-
control study design.
Ask both case-
patients and controls about their exposures.
Example: Example: A cohort study would be A cohort study would be used in an outbreak of gastroenteritis used in an outbreak of gastroenteritis among people who attended a social among people who attended a social function, such as a wedding, when a function, such as a wedding, when a complete list of wedding guests was complete list of wedding guests was
attendee would be asked the same set attendee would be asked the same set
(e.g., what foods and beverages were (e.g., what foods and beverages were consumed at the wedding) and whether consumed at the wedding) and whether specific symptoms were experienced. specific symptoms were experienced.
1. 1. Collect information Collect information 2. 2. Calculate an attack Calculate an attack rate rate 3. 3. Identify the source of Identify the source of the outbreak the outbreak 4. 4. Calculate relative risk Calculate relative risk Steps for conducting a cohort study: Steps for conducting a cohort study:
1.
Collect information
Use the Investigation Worksheets provided by DOH Worksheets provided by DOH to collect data. to collect data.
Ask the same set of questions with each person to avoid with each person to avoid interview bias. interview bias.
Focus on: 1.
Identifying information 2.
Demographic information 3.
Clinical information 4.
Risk factor information
After collecting information, After collecting information, calculate an attack rate for calculate an attack rate for people who ate a particular people who ate a particular Item Item ( (exposed exposed) ) and an attack and an attack rate for those who did not eat rate for those who did not eat that item that item ( (not exposed) not exposed). . Attack Rate: Attack Rate: Number of new cases of disease that develop per the number in a healthy population at risk at the start of the period.
The number of people who ate the item and The number of people who ate the item and became ill divided by the total number of people became ill divided by the total number of people who ate the item. who ate the item.
The number of people who did not eat the item but The number of people who did not eat the item but became sick divided by the total number of people became sick divided by the total number of people who did not eat the item. who did not eat the item.
Look for an item with: Look for an item with:
A high attack high attack rate rate among those among those exposed, exposed, and and
A low attack low attack rate rate among those among those not exposed (so the difference not exposed (so the difference
for the two exposure groups is for the two exposure groups is high). high).
In addition, most people who became ill should have consumed the item, so that the exposure could explain most cases.
4.
Calculate relative risk The mathematical association The mathematical association between exposure and illness for between exposure and illness for each food and beverage. each food and beverage. Relative risk calculation: Relative risk calculation: Attack rate for people Attack rate for people who were exposed who were exposed divided by divided by the attack rate for the attack rate for those not exposed.
(Continued) (Continued) Please refer to page 84 in your course manual.
Epidemiologists often use Attack rates to describe the Attack rates to describe the risk of illness in various risk of illness in various groups. groups.
Attack rates are calculated by dividing the number ill by the total dividing the number ill by the total number of people in each group. number of people in each group.
These rates are generally expressed as percentages. expressed as percentages.
Refer to pages 83 & 85 of your course manual for the attack rate calculation information.
The items within the attack rate table will be filled in The items within the attack rate table will be filled in based on what you did and did not based on what you did and did not “ “eat eat” ” from the buffet from the buffet and whether or not you are and whether or not you are “ “ill. ill.” ” For each food item, information will be entered into the For each food item, information will be entered into the appropriate cell on the attack rate table for those of you appropriate cell on the attack rate table for those of you who are: who are:
Ill and who ate the food item
Ill and who did not eat the food item
Not ill and who did not eat the food item
Not ill and who ate the food item
An attack rate chart is provided in your manual on An attack rate chart is provided in your manual on page 85 page 85. .
Baked Baked Potato Potato Ice Cream Ice Cream Chicken Chicken Corn Corn Filet Filet Mignon Mignon Croissant Croissant Broccoli Broccoli Relative Relative Risk Risk Attack Attack Rate Rate Did not Did not Eat & Eat & Well Well Did not Did not Eat & Ill Eat & Ill Attack Attack Rate Rate Ate & Ate & Well Well Ate & Ate & Ill Ill Food Item Food Item
Food items that were eaten: Food items that were eaten: You will calculate attack rates for You will calculate attack rates for each food item that was eaten. These attack rates represent each food item that was eaten. These attack rates represent the risk of getting ill for people who ate each of the food item the risk of getting ill for people who ate each of the food items. s.
Food items that were not eaten: Food items that were not eaten: You will calculate attack rates You will calculate attack rates for each food item that was not eaten. These attack rates for each food item that was not eaten. These attack rates represent the risk of getting ill for people who did not eat eac represent the risk of getting ill for people who did not eat each h
Baked Baked Potato Potato Ice Cream Ice Cream Chicken Chicken Corn Corn Filet Mignon Filet Mignon Croissant Croissant Broccoli Broccoli
Relative Relative Risk Risk Attack Attack Rate Rate
Did not Did not Eat & Eat & Well Well Did not Did not Eat & Ill Eat & Ill Attack Attack Rate Rate Ate & Ate & Well Well Ate & Ate & Ill Ill Food Item Food Item
Relative risk: Relative risk: You will calculate the relative risk for each food You will calculate the relative risk for each food
“Ate Ate” ” group by the attack rate in the group by the attack rate in the “ “Did not eat Did not eat” ” group for each group for each food item. food item.
Baked Potato Baked Potato Ice Cream Ice Cream Chicken Chicken Corn Corn Filet Mignon Filet Mignon Croissant Croissant Broccoli Broccoli Relative Relative Risk Risk Attack Attack Rate Rate Did not Did not Eat & Eat & Well Well Did not Did not Eat & Ill Eat & Ill Attack Attack Rate Rate Ate & Ate & Well Well Ate & Ate & Ill Ill Food Item Food Item
Effect of recall
Misclassification
Other
Two types of analytic studies: Two types of analytic studies: 1.
Cohort Studies 2.
Case-
Control Studies: :
Compare people with a disease (case-
subjects) with a group of people without the disease with a group of people without the disease (controls). (controls).
In most outbreaks the population is not well defined, and so cohort studies are not feasible. In defined, and so cohort studies are not feasible. In these instances, you would use the case these instances, you would use the case-
control study design. study design.
Ask both case-
subjects and controls about their exposures. exposures.
Calculate an Odds Ratio: Calculate an Odds Ratio:
Used to quantify the relationship between relationship between exposure and disease. exposure and disease.
Does not prove that a particular exposure caused particular exposure caused a disease. a disease.
Is very helpful in evaluating possible vehicles of possible vehicles of disease. disease.
Step 1: Step 1: Look at your data in a 2 Look at your data in a 2× ×2 table. 2 table. 80 80 d=70 d=70 c=10 c=10 No No 146 146 106 106 40 40 Total Total 66 66 b=36 b=36 a=30 a=30 Yes Yes Ate at Ate at Restaurant Restaurant “ “A A” ”? ? Total Total Controls Controls Case Case-
subjects
Step 2: Step 2: The odds ratio is calculated as ad/bc The odds ratio is calculated as ad/bc. .
The odds ratio for Restaurant The odds ratio for Restaurant “ “A A” ” equals 30 equals 30 × × 70 / 36 70 / 36 × × 10 = 10 = 5.8. 5.8.
80 80 d=70 d=70 c=10 c=10 No No 146 146 106 106 40 40 Total Total 66 66 b=36 b=36 a=30 a=30 Yes Yes Ate at Ate at Restaurant Restaurant “ “A A” ”? ? Total Total Controls Controls Case Case-
subjects
This means that people who ate at Restaurant “A” were 5.8 times more likely to develop Hepatitis A than were people who did not eat there.
WORD OF CAUTION: WORD OF CAUTION:
Even though the Odds Ratio Even though the Odds Ratio Calculation indicates that people who Calculation indicates that people who ate at Restaurant ate at Restaurant “ “A A” ” were 5.8 times were 5.8 times more likely to develop Hepatitis A than more likely to develop Hepatitis A than were people who did not eat there. . . were people who did not eat there. . .
without comparing its odds ratio to other possible sources.
many of the people who were exposed also ate at Restaurant A.
The odds ratio is calculated as ad/bc The odds ratio is calculated as ad/bc. .
d= d= c= c= No No Total Total b= b= a= a= Yes Yes Did you eat the Did you eat the Filet Mignon? Filet Mignon? Total Total Controls Controls Case Case-
subjects
This means that people who ate the Filet Mignon were ____ times more likely to get sick than were people who did not eat the Filet Mignon.
Additional epidemiological studies. Additional epidemiological studies. When analytic When analytic epidemiological studies do not confirm the hypothesis, the epidemiological studies do not confirm the hypothesis, the hypothesis must be reconsidered and refined. New vehicles hypothesis must be reconsidered and refined. New vehicles
time to meet with case time to meet with case-
subjects to look for common links, visit their homes to look at the products on their shelves, and visit their homes to look at the products on their shelves, and to obtain additional samples. to obtain additional samples. Note: Note: Steps 6 Steps 6 – – 7 would be repeated when the hypothesis 7 would be repeated when the hypothesis is refined and/or additional studies are conducted. is refined and/or additional studies are conducted.
Once the hypothesis is confirmed, control and prevention Once the hypothesis is confirmed, control and prevention measures need to be implemented as soon as possible. measures need to be implemented as soon as possible.
Control measures should be Control measures should be aimed at: aimed at:
Specific links in the chain of infection (the agent, the source, infection (the agent, the source,
Interrupting transmission or exposure. exposure.
Reducing susceptibility.
1. 1. Oral briefing for local health authorities. Oral briefing for local health authorities. 2. 2. Written report. Written report.
The oral briefing should be attended by the local health authorities and people responsible for health authorities and people responsible for implementing control and prevention measures. implementing control and prevention measures.
This presentation is an opportunity to describe what was done, what was found, and what should be was done, what was found, and what should be done about it. done about it.
The findings should be presented in a scientifically
The conclusions and recommendations should be supported by facts. supported by facts.
Follows the usual scientific format of introduction, background, methods, results, discussion, and background, methods, results, discussion, and recommendations. recommendations.
Provides a blueprint for action.
Serves as a record of performance, a document for potential supporting or refuting legal issues, and a potential supporting or refuting legal issues, and a reference if the health department encounters a reference if the health department encounters a similar situation in the future. similar situation in the future.
Serves the broader purpose of contributing to the scientific knowledge base of epidemiology and scientific knowledge base of epidemiology and public health when it becomes part of the public public health when it becomes part of the public health literature. health literature.
Recognize the steps in case investigation and in identifying exposed contacts. exposed contacts.
Describe how initial cases might be recognized.
Demonstrate the ability to interpret fact sheets and mode of transmission sheets. transmission sheets.
Describe methods of collection and transportation of human, animal, and environmental samples. animal, and environmental samples.
Apply skills necessary to demonstrate the ability to identify additional cases and determine the extent of a disease additional cases and determine the extent of a disease
Module 1: Describe the role of epidemiology in Describe the role of epidemiology in public health. public health.
Module 2: Demonstrate appropriate Demonstrate appropriate epidemiological interviewing and effective epidemiological interviewing and effective communication skills. communication skills.
Module 3: Participate in an outbreak investigation Participate in an outbreak investigation exercise. exercise.
Take a minute to reflect on the course content.
Identify the 2 most important lessons that you learned. learned.
Share with a partner.
Learner Post-
Test
Course Evaluation
Course Certificate Recommended Trainings: Assuring Cultural Recommended Trainings: Assuring Cultural Competence; Understanding Compassion Fatigue. Competence; Understanding Compassion Fatigue. Additional Course Offerings: Additional Course Offerings: www.FCPHP.usf.edu www.FCPHP.usf.edu