Drijver M, Woudenberg F
Public Health Service (GGD) Haarlem, The Netherlands.
Eur J Epidemiol. 1999 Oct;15(9):863-9. doi: 10.1023/a:1007534317825.
Public health services often have to deal with reported clusters of adverse health events. An important characteristic of disease clusters is that the involved community often is concerned about environmental factors influencing health. To facilitate cluster investigations, a stepwise protocol was developed in the Netherlands, based on international literature. Essential is the two-way approach, consisting of a disease-track and an environment-track. Attention to potential environmental exposures is as important as attention to the reported diseases, not only because environmental pollution often is the reason of public concern and thus relevant for risk communication, but also for deciding about the boundaries of the population at risk. Moreover, environmental information is necessary for judgement of the plausibility of a causal relation and for advising measures to prevent exposure. Within this two-way approach, three stages are distinguished: orientation stage, verification stage and quantification stage. Only if an increased risk as well as an elevated exposure is verified, under certain conditions a case-control study may be useful to study causality between exposure and adverse health events. During all stages of the investigation, good risk communication strategies have to be taken into account. However, even then it might be difficult to prevent conflicts, because of the differing interests between experts and the community involved. One of the most important aspects that determine judgements about risks by threatened people, is controllability; that is why community participation is essential. Therefore it can be concluded that cluster management is a mutual endeavour for experts, public and media, where experts are judged on three characteristics: expertise, credibility and empathy.
公共卫生服务部门经常需要处理报告的不良健康事件聚集情况。疾病聚集的一个重要特征是，相关社区通常会关注影响健康的环境因素。为了便于进行聚集性调查，荷兰根据国际文献制定了一个逐步的方案。关键在于双向方法，包括疾病追踪和环境追踪。关注潜在的环境暴露与关注报告的疾病同样重要，这不仅是因为环境污染往往是公众关注的原因，因而与风险沟通相关，还因为它有助于确定危险人群的范围。此外，环境信息对于判断因果关系的合理性以及就预防暴露的措施提供建议是必要的。在这种双向方法中，分为三个阶段：定向阶段、核实阶段和量化阶段。只有在核实了风险增加以及暴露增加的情况下，在某些条件下病例对照研究才可能有助于研究暴露与不良健康事件之间的因果关系。在调查的所有阶段，都必须考虑良好的风险沟通策略。然而，即便如此，由于专家和相关社区之间存在不同利益，仍可能难以避免冲突。受威胁人群判断风险的最重要因素之一是可控性；这就是社区参与至关重要的原因。因此可以得出结论，聚集性管理是专家、公众和媒体的共同努力，其中对专家的评判基于三个特征：专业知识、可信度和同理心。
