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[公共卫生服务中的传染病流行病学方法:作为实际工作、监测与流行病学之间桥梁的病例对照研究]

[Methods of infectious disease epidemiology for public health services: case control studies as bridge between practical work, surveillance and epidemiology].

作者信息

Reintjes R, Krumkamp R

机构信息

Fakultät Life Sciences, Hochschule für Angewandte Wissenschaften Hamburg.

出版信息

Gesundheitswesen. 2005 Dec;67(12):840-4. doi: 10.1055/s-2005-858896.

Abstract

Routine surveillance of infectious diseases is one important task of national public health services. Due to globalization the impact of international disease monitoring rises. The volume of traffic and trade is constantly increasing, which makes a spread of infectious diseases to distant places more likely then ever. This are challenges international infectious disease networks have to deal with. Thus, the role of investigation of disease outbreaks is not only relevant for local level; it furthermore prevents broader spread. To eliminate outbreak sources good epidemiological analyses have to be conducted. However, this often leads to extra time and personal resources. In addition classical studies, like case-control studies, underlay methodical limitations. Case-control studies, especially if conducted on the basis of notified cases from surveillance data, are susceptible to bias (like selection- and recall bias). Another study design, the case-case study (case-case comparison), provides an alternative, which is less affected by such limitations. In this approach a number of cases related within an outbreak, is compared with a group of infected individuals of the same disease, not belonging to the outbreak. Results from recently published studies lead to the assumption that this study design is adequate for the investigation of infectious disease outbreaks, captured by surveillance systems. The practical application of this study design makes it especially useful for local public health services and thus provides a bridge between surveillance, epidemiology and practical work in Public Health.

摘要

传染病的常规监测是国家公共卫生服务的一项重要任务。由于全球化,国际疾病监测的影响日益增大。交通和贸易量不断增加,这使得传染病比以往任何时候都更有可能传播到遥远的地方。这是国际传染病网络必须应对的挑战。因此,疾病暴发调查的作用不仅与地方层面相关;它还能防止疾病更广泛地传播。为了消除暴发源头,必须进行良好的流行病学分析。然而,这往往需要额外的时间和人力。此外,像病例对照研究这样的经典研究存在方法上的局限性。病例对照研究,尤其是基于监测数据中报告的病例进行的研究,容易出现偏差(如选择偏倚和回忆偏倚)。另一种研究设计,即病例 - 病例研究(病例 - 病例比较),提供了一种替代方法,受此类局限性的影响较小。在这种方法中,将一次暴发中相关的一组病例与同一疾病的一组不属于该暴发的感染个体进行比较。最近发表的研究结果表明,这种研究设计适用于对监测系统捕获的传染病暴发进行调查。这种研究设计的实际应用使其对地方公共卫生服务特别有用,从而在公共卫生的监测、流行病学和实际工作之间架起了一座桥梁。

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