不明原因疾病的流行病学调查方法.pptVIP

疾病聚集报告增多原因 健康知识的传播 电影：“Erin Brockovich”（布罗克维奇/ 永不妥协/ 伊人当自强） 互联网： 信息渠道 分享信息 传播谣言、怀疑、恐慌 “A little knowledge is a dangerous thing.” “一知半解，更加危险”（英谚） 疾病聚集报告增多原因 健康知识的传播 对政府的不信任 （美国）政府刻意掩盖 个别流氓科学家的作为 Tuskegee（Alabama） 事件（1943-1973） 一粒老鼠屎害了一锅粥 疾病聚集报告增多原因 健康知识的传播 对政府的不信任 非传染病发病率增加 传染病的减少 人均寿命增加 疾病监测的加强 环境污染、行为危险因素 报告能力和发现意识 现场流行病学（暴发疫情）调查步骤 组织准备 核实诊断 确定暴发或流行的存在 建立病例定义 核实病例并计算病例数 描述性分析（三间分布） 建立并检验假设 迅速采取控制措施 完善现场调查 报告交流反馈 美国四个州的无痛性甲状腺炎调查 内布拉斯加 Nebraska 1984 42 个病例 Elevated T4 and symptoms（焦虑、呼吸短促、心悸、心跳加快、体重减轻） 6 Counties Case control study for Dietary iodine Cold and cough medicines “viral illness” 53% vs 32% p=0.05 Viral cultures, HLA typing, Urinary Iodine June 1985 a specialist reports 8 cases from a neighboring state Initial steps Verify the diagnosis Is this a laboratory error? Will other specialists confirm the diagnosis? Interview Patients Notify adjacent states Find more hyperthyroisism Symptoms of 28 patients with elevated T4 Widened Case Finding Survey of patient records from medical clinics (4 states) for past 18 months Telephone survey of doctors in area Letters to all doctors in area Describe the outbreak Request reporting Case definition applied to all reports T4, free T4 or T3 25% higher than upper limit of normal for the laboratory ≥ 2 of the following: Sleeplessness, nervousness, headache, increased heart rate, palpitations, short of breath, fatigue, sweating, tremor, diarrhea, heat intolerance, weight loss. Excluded Grave’s disease, T4 replacement Case finding identified 121 cases that fit the definition. Thyrotoxicosis by month Incidence of thyrotoxicosis per 10,000 by county New information Experts opinion Viral cause Iodine-induced hyperthyroidism Information from new cases Family of 5 4 cases ate meat 1 non-case a vegetarian Food from one store all national except local “beef trimmings” Was beef contaminated with iodine? The second case control study showed a very specific association 受关注的程度不一样：领导关注度 截至5月19日第362人次 国家类专家：国家共派49批170人次， 国家临