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surveillance & monitoring (Surveillance: ongoing systematic collection…
surveillance & monitoring
Surveillance: ongoing systematic collection, & analysis of data in process of monitoring event
Monitoring: systematic collection & analysis data, diff from surveillance (intermittent)
Rationale: public health decisions made on disease info: (revalence, severity, incidence, increment, distribution, risk factor distribution, trends – condition still a prob?, effectiveness prev interventions)
Uses surveillance systems: estimate magnitude, detect emerging probs, doc spread, test hypotheses, planning, epi & lab research, describe natural hx, monitor change risk factors, detect changes in practices, assess prevention activities
Surveillance chronic diseases: antecedent exposures before manifestation illness, immediate spread unlikely, surveillance risk factors less difficult (if more indirect), surveillance relies on systems for other purpose (e.g. claims data from ACC or from AOHS, SDS)
Special considerations chronic conditions: latency (exposures before illness), ecologic analysis (risk factors at pop or area e.g. water F- & caries), ‘epidemic’ last decades (detection change slow e.g. PD)
Risk factor surveillance: useful approach chronic diseases (long latency preclude immediate evaluation e.g. mesothelioma after asbestos exposure ∴programmes target risk directly, multifactorial aetiology prevent accurate link between exposures, interventions & outcomes, risk factors related e.g. smoking & alc)
Fts good systems: important probs, efficient op, simple, flexible, acceptable, sensitivity, predictive value +ve, representative, timely, link to public health programmes (proportion persons identified as cases who have prob under surveillance)
Examples surveillance systems: NZ SDS caries, US Centers for Disease Control Behavioral Risk Factor Surveillance System (BRFSS)
NZ system: annual collection data caries kids, year 8 1980 (permanent), 5 yr olds 1988 (deciduous), time series
Uses NZ data: monitor changes caries (ethnic & SES diff), policy, research (Lee & Dennison 2004 Thomson 1993, Thomson 2002)
Lee & Dennison (2004): surveillance data test hypotheses effects water F- on caries, comparative analysis routinely collected SDS data, Wellington (fluoridated) 3060 5-year-olds, 2631 12-year-olds, Canterbury (nonfluoridated) 4970 5-year-olds, 4285 12-year-olds
Thomson (1993): surveillance data 1st analysis ethnic diff OH among NZ kids, findings confirmed suspicions
Thomson (2002): time series surveillance data effects of social policy, ecological data
1990-91 structural “reforms”: welfare benefits cut $25/week, “market rents” state housing, Employment Contracts Act → “labour market flexibility” → gr prevalence poverty, incr # disadvantaged households
BRFSS (USA) - Behavioral Risk Factor Surveillance System: state-based, US-wide system surveys, run by Centers for Disease Control 1984, info risk behaviours, preventive practices & access, chronic conditions, > 400,000 interviewed annually, largest telephone survey
Obesity 2002 vs 2008 vs 2016, edentulism
Monitoring: not ongoing; intermittent, no explicit link to ongoing health or clinical activities, still useful, “snapshot” pop disease status 1 point in time
Considering systems: 4 “rules of thumb” applied to surveillance data - good better than nothing, room for improvement, not everything that shines is gold, perfection is enemy of good
Surveillance for whom? (Who wants answers? collects info? reports on it?), limited availability resources (time, funding, people), duplication effort, gaps in efforts, which data to collect?