Approaches to investigating clusters: By example, childhood leukaemia near Sellafield
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Summary
There is occasionally concern about suspected clusters of disease in geographically localised areas among members of the general public or other groups. These occurrences need a systematic approach to their investigation. Such an approach needs to consider the definition and characteristics of the cluster and of the putative environmental cause for concern. Depending on the outcome of these considerations there will be different actions, possibly involving epidemiological studies. The necessary components of the approach and resulting actions are outlined in this paper, and illustrated by the example of childhood leukaemia rates around the Sellafield nuclear plant.
Keywords
Public Health Epidemiological Study General Public Systematic Approach Localise AreaInvestigations de «clusters»: Les leucémies infantiles dans la région de Sellafield comme exemple
Résumé
Les «clusters» de maladie peuvent être à l'origine d'une préoccupation considérable dans la population. Quelle peut être la réaction la plus appropriée de l'épidémiologue? Une approche systématique est présentée dans cet article, depuis la caractérisation du «cluster» jusqu' à la planification d'études épidémiologiques éventuelles. Chacun de ces pas est illustré par l'exemple concret d'une situation similaire survenue dans la région de Sellafield à propos de l'accroissement des leucémies infantiles autour de l'usine de retraitement de produits nucléaires.
Das Vorgehen bei ungewöhnlichen Krankheitshäufungen (Clusters), dargestellt am Beispiel der Häufung von Kindheitsleukämien von Sellafield
Zusammenfassung
Clusters von Krankheitsfällen können in der Bevölkerung grosse Besorgnis verursachen. Wie geht der damit konfrontierte Epidemiologe am besten vor? Es wird ein systematisches Vorgehen in Stufen vorgeschlagen, von der Überprüfung der Diagnosen und der Abgrenzung des Clusters bis zur allfälligen Planung von epidemiologischen Studien. Die einzelnen Schritte werden anhand der Häufung von Kindheitsleukämien im Umfeld von Sellafield dargestellt.
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