Report on the key problems facing a researcher seeking data from the CDC and other sources...

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Report on the key problems facing a researcher seeking data fromthe CDC and other sources in an outbreak investigation. Propose atleast three (3) methods for overcoming these problems.

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PROBLEMS FACING BY A RESEARCHER Emerging infections continue to disrupt the health care system and are becoming increasingly complicated to detect and treat successfully In addition the public health system is continually reminded of the challenges posed by the unexpected whether it is the next influenza pandemic or a bioterrorist act In 1988 the Institute of Medicine IOM recommended that every public health agency regularly and systematically collect assemble analyze and make available information on the health of the community including statistics on health status community health needs and epidemiologic and other studies of health problems IOM 1988 p 141 Thus one of the essential public health services is the diagnosis and investigation of health hazards in the community Health departments at the federal state and local levels often with the aid of the academic community can perform these functions if they have the appropriate level of resources adequately trained personnel and established systems of reporting and communication Each sector offers unique capabilities and each sector faces some common and uncommon challenges but most infectious disease outbreak investigations follow the same general approach 1 identification of the circumstances that indicate the need for an investigation eg more than the expected number of cases of a particular disease 2 investigation 3 determination of the cause of the circumstances ie the reason that the excess cases of disease occurred and 4 response which usually includes the control of the outbreak and recommendations and coordination of responseboth public and privatefor the prevention of further disease Within each investigation are several components which may include but are not limited to epidemiological laboratory and environmental assessments Each component may also require coordination at several levels from the local to the state private and federal In general federal resources through the Centers for Disease Control and Prevention CDC and the US Food and Drug Administration FDA are available to assist in investigations but they only do so if state and local public health agencies have in place the infrastructure to detect and report unusual disease occurrences Concise and timely communication between each component is critical to a good investigation METHODS TO OVERCOME PROBLEMS Conducting research in an emergency situation such as an outbreak of disease poses ethical challenges These challenges differ according to the type of research epidemiologic or clinical and for the latter whether the disease outbreak can be anticipated in advance We address these three situations proposing different potential solutions for each In an outbreak situation public health authorities undertake a rapid response in an effort to document the existence and magnitude of a public health problem in the community and to implement appropriate measures to address the problem 1 This rapid response will in some cases preclude the possibility of clearance by a research ethics committee since the time required to develop and submit a detailed research protocol and respond to any requested modifications by the committee followed by rereview would thwart the very purpose of the response According to one prominent view to require a full written protocol and submission to an ethics review board would not be in the interests of the individuals or the community because the resulting delays would frequently cause excess disease and death 2 These authors suggest however that emergency response consent forms could be developed and used in these situations Other individuals engaged in public health practice have voiced concern See Answer

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