McElvenny D M, Mounstephen A H, Hodgson J T, Osman J, Elliott R C, Williams N R
Epidemiology and Medical Statistics Unit, Health & Safety Executive, Bootle, Merseyside L20 3QZ, UK.
Occup Med (Lond). 2003 May;53(3):201-8. doi: 10.1093/occmed/kqg039.
Clusters of disease arising in workplaces cause concern among the management of the company, the workers affected and their families and friends. Chance is the most likely explanation for their occurrence, although a number of real workplace hazards have been identified through their observation and investigation. Employers have a duty to investigate such occurrences in order to assess whether some unknown or unidentified hazard is at work and to take the appropriate action. Several papers have been published over the last 15 years or so that set out a method for investigating workplace clusters of disease. Aims This paper presents the steps in the approach taken by the Health & Safety Executive in Great Britain.
An initial step identifies the relevant stakeholders at the outset, in order to maintain a realistic expectation of what the investigation can hope to achieve and to open a dialogue. The main steps in the assessment are: (1) identifying cases; (2) determining the other parameters of the investigation; (3) statistically assessing the cluster; (4) examining potential exposures and assessing their biological plausibility; and (5) determining the overall significance of the cluster. The approach is illustrated throughout by examples.
工作场所出现的疾病群引起了公司管理层、受影响的工人及其家人和朋友的关注。虽然通过观察和调查已经确定了一些实际的工作场所危害，但这些疾病群的出现最有可能的解释是偶然因素。雇主有责任对这类事件进行调查，以评估是否存在一些未知或未被识别的危害在起作用，并采取适当行动。在过去15年左右的时间里，已经发表了几篇论文，阐述了一种调查工作场所疾病群的方法。目的本文介绍了英国健康与安全执行局所采用方法的步骤。
第一步是在一开始就确定相关利益相关者，以便对调查能够期望取得的成果保持现实的期望，并开启对话。评估的主要步骤包括：（1）识别病例；（2）确定调查的其他参数；（3）对疾病群进行统计评估；（4）检查潜在暴露因素并评估其生物学合理性；（5）确定疾病群的总体重要性。文中通过实例对该方法进行了说明。
