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    Medical surveillance is undertaken to identify changes in the distributions of diseases in order to prevent or control these conditions within a population.
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    A comparison of incidence rates across populations can help to determine characteristics of populations at higher (and lower) risk.
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    Surveillance of deaths is convenient because the information is virtually complete, standardized and inexpensive to obtain. Nevertheless, data collected from death certificates may be limited by omitted or inaccurate information.
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    Age adjustment is used to remove the influence of any age differences when comparing the disease frequencies of two populations.
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    Premature death measures the years of potential life lost to a particular disease, and therefore weighs most heavily deaths that occur at young ages.

image A 68-year-old female retired office manager presented with a dry, hacking cough of several months’ duration. She reported a history of smoking one pack of cigarettes per day for the past 30 years. To evaluate the patient’s cough, her family physician ordered a chest x-ray, which was unremarkable except for an increased density in the hilum (midcentral portion) of the lung fields. A sputum specimen was collected, and abnormally-appearing cells were noted on microscopic evaluation. Because these cells suggested a malignancy, a bronchoscopic examination was performed to allow direct visualization of the large airways. A partially obstructing mass was visible at the distal end of the right main stem bronchus. Brushings from this mass revealed cells consistent with a diagnosis of squamous cell carcinoma. Other diagnostic studies indicated that the cancer had spread to involve the brain and bones. Radiation therapy was administered to all sites of cancer involvement. Nevertheless, the patient’s condition rapidly deteriorated, and she died less than 6 months after diagnosis.

image In this chapter, attention is focused on one of the most basic functions of epidemiology: detection of the occurrence of health-related events or exposures in a target population.

The goal of this detection, or surveillance, is to identify changes in the distributions of diseases in order to prevent or control these diseases within a population. The term surveillance literally means “to watch over,” and traditionally medical surveillance activities were developed to monitor the spread of infectious diseases through a population. Today, however, surveillance programs have been applied to a wide variety of other conditions, such as congenital malformations, injuries, occupational health problems, and cancer, as well as other behaviors that affect health. Regardless of the type of outcome under consideration, medical surveillance activities involve the following key features:

  • 1. Continuous data collection and evaluation
  • 2. An identified target population (such as a community, a work force, or a group of patients)
  • 3. A standard definition of the outcome of interest
  • 4. Emphasis on timeliness of collection and dissemination of information
  • 5. Use of data for purposes of investigation or disease control.

The goals of medical surveillance depend on the state of knowledge about the causes of the condition of ...

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