新疆维汉妇女HR-HPV载量与不同宫颈病变的相关性研究

目的:探讨高危人乳头瘤病毒(HR-HPV)在新疆维汉妇女不同宫颈病变的感染现状,分析其载量与不同宫颈病变的相关性。方法:对202例汉族妇女和160例维吾尔族妇女采用第二代杂交捕获(Hybrid capture,HC2)检测HR-HPV含量,标本的相对荧光光度值(RLU)与阳性定标域值(CO)的比值相当于标本中检出的病毒DNA负荷量(pg/ml)。结果:①在202例汉族患病妇女中,HR-HPV阳性者151例,阴性者51例;其中慢性宫颈炎HR-HPV阳性率为52.8%,CIN1、CIN2～3、宫颈鳞癌(SCC)患者HR-HPV阳性率分别为73.3%、91.6%、94.8%;在160例维吾尔族患病妇女中,HR-HPV阳性者90例,阴性者70例;其中慢性宫颈炎HR-HPV阳性率为35.2%,CIN1、CIN2～3、SCC患者HR-HPV阳性率分别为50.0%、74.3%、82.1%;认为HR-HPV感染率在维汉妇女不同级别宫颈病变有统计学差异(P<0.05);②HR-HPV载量在维吾尔族妇女不同宫颈病变组(慢性宫颈炎、CIN1、CIN2～3和SCC)的中位数为0.92、6.98、52.2和89.6;汉族妇女不同宫颈病变组的中位数为1.26、10.69、82.9和112,维汉妇女不同程度的宫颈病变HR-HPV载量之间有差异(P<0.05)。对同等级别宫颈病变中维吾尔族和汉族妇女HR-HPV载量检测,在慢性炎组差异无统计学意义(P>0.05);在CIN和SCC组均有统计学差异(P<0.05);可以认为维吾尔族和汉族妇女在CIN组和SCC组HR-HPV载量差异有统计学意义,且汉族妇女病毒载量高于维吾尔族妇女。③随着病毒载量的增加,维汉族妇女发生宫颈各级病变的风险性增加,两者之间存在明显的剂量反应关系。结论:HR-HPV感染是导致宫颈病变的主要因素。维汉妇女HPV病毒载量与宫颈病变之间存在一定的剂量反应关系。     

甘肃省徽县妇女人乳头瘤病毒感染与宫颈癌关系的研究

目的了解我国宫颈癌高发地区妇女生殖道人乳头瘤病毒(HPV)感染现状,研究HPV感染与宫颈癌的关系。方法随机选择1000名宫颈癌高发地区已婚妇女,进行宫颈液基细胞标本采集及细胞学诊断、阴道镜检查并取活体组织做组织病理学诊断。病理学检查发现散在或成群出现的凹空细胞即诊断为HPV感染,所有检查均双盲进行。结果1000例组织活检标本中发现宫颈鳞状上皮癌(SCC)2例,宫颈上皮内瘤变Ⅲ级(CINⅢ)4例,宫颈上皮内瘤变Ⅱ级(CINⅡ)16例,宫颈上皮内瘤变Ⅰ级(CINⅠ)111例,正常867例。HPV感染603例,总阳性率60.30%(603/1000)。SCC和CINⅢ病例中HPV阳性率为100%(6/6)。SCC和宫颈上皮内瘤变(≥CINⅠ)病例中HPV阳性率为81.95%(109/133),正常者HPV阳性率为56.98%(494/867),后两者之间具有显著性差异(x2=29.02,P<0.001)。结论该地区妇女HPV感染率明显增高并且宫颈癌及宫颈上皮内瘤变Ⅲ级病例中全部感染HPV,证明HPV感染是该地区宫颈癌高发的主要危险因素。     

高危型人乳头瘤病毒载量与宫颈癌前病变及宫颈癌的相关性分析

目的研究高危型人乳头瘤病毒(HPV)载量与宫颈癌前病变及宫颈癌的相关性。方法回顾性分析2015年9月-2016年9月在该院妇科治疗的宫颈癌前病变及宫颈癌患者296例,其中慢性宫颈炎患者136例,宫颈上皮内瘤变(CIN)Ⅰ期患者74例、CINⅡ~Ⅲ期患者65例,宫颈癌Ⅰ期患者13例,宫颈癌Ⅱ期患者8例。对患者进行HPV病毒载量检测和组织活检,分析病毒载量与病变程度的相关性。结果当病毒载量在100.0~999.9范围分布时,CINⅡ~Ⅲ期发生率明显高于CINⅠ期(P0.05);当HR-HPV载量在1 000.0~范围分布时,CINⅠ期发生率明显高于CINⅡ~Ⅲ期(P0.05)。当HPV载量为100 RLU/CO时认为患者为CIN及宫颈癌阳性,预测恶性病变的敏感度为73.4%,特异性为63.1%。结论 HPV可作为预测宫颈病变的常规检查手段,其对于预防宫颈高度病变具有重要价值。     

人乳头状瘤病毒DNA载量与子宫颈病变的关系

目的 研究妇女生殖道感染高危型人乳头状瘤病毒(HR-HPV)的载量与子宫颈上皮内瘤变(CIN)的关系。方法 收集参加横断面普查研究的1997名35～45岁已婚妇女的子宫颈脱落细胞,采用第二代杂交捕获试验(HC2)进行HPV DNA检测,病毒载量由样本的相对光单位(RLU)与标准阳性对照(PC)之比(RLU/PC)来衡量,按照log_(10)RLU/PC分为阴性(<0)、低度载量(0～1.12)、中度载量(1.13～2.23)和高度载量(2.24～3.37)。子宫颈病变按照病理诊断分为正常、CIN1、CIN2～3和子宫颈癌(SCC)。采用非条件多项式logistic回归分析病毒载量与子宫颈病变级别的关系。结果 100％(12/12)的SCC、97.3％(72/74)的CIN2-3、58.3％(74/127)的CIN1、11.5％(205/1784)的正常对象HR-HPV DNA检测阳性,各组阳性对象的中位log_(10)RLU/PC分别为2.60、2.32、2.18和1.18。从低度病毒载量与CIN1的危险比值比(OR)为3.8(1.9～7.3)至高度病毒载量与CIN2～3的OR值为865.9(200.1～3738.0),显示出感染病毒载量与子宫颈病变程度呈正相关(P<0.001)。结论 子宫颈HR-HPV病毒载量是影响SCC及癌前病变的重要危险因素。     

HR-HPV检测在子宫颈细胞学意义不明确的非典型鳞状细胞患者中应用的临床价值

目的探讨高危型人乳头瘤病毒(HR-HPV)检测在子宫颈细胞学意义不明确的非典型鳞状细胞(ASC-US)患者中应用的临床价值。方法对2014年4月-2015年9月在该院行液基细胞学(TCT)检查出ASC-US患者448例进行分析,比较ASC-US患者组织病理检查结果和HR-HPV检查结果的差异,比较ASC-US患者病理检查结果与HR-HPV检查阳性DNA载量的关系,以及HR-HPV检测对ASC-US患者筛检宫颈上皮内瘤变(CIN)和子宫颈癌(SCC)的效能的分析。结果 448例ASC-US患者病理结果为CINⅠ35例(7.81%),CINⅡ66例(14.73%),CINⅢ8例(1.79%),SCC 3例(0.67%),病理结果阴性336例(75.0%);病理结果阳性的患者中HR-HPV检测阳性率(91例,77.78%)高于病理结果阴性的患者(26例,22.22%),且差异具有统计学意义(P0.05);117例HR-HPV检测阳性的患者HPV病毒低载量(1-10RLU/CO)19例(16.24%),HPV病毒中载量(10-100RLU/CO)72例(61.54%),HPV病毒高载量(100RLU/CO)26例(22.22%),不同病理结果患者的HR-HPV病毒载量的差异具有统计学意义(χ2=63.650,P0.001);HR-HPV检测对非典型鳞状细胞患者筛检宫颈上皮瘤变和宫颈癌的灵敏度77.78%,特异度90.96%,阳性预测值77.78%,阴性预测值92.26%,准确率88.52%。结论HR-HPV检测和HPV病毒载量检测对非典型鳞状细胞患者的分流管理有重要的临床价值。     

武汉地区HPV感染与宫颈病变的关系初探

目的:探讨武汉地区人乳头瘤病毒(human papillomavirus,HPV)感染常见基因型、多重感染与宫颈病变的关系。方法:用HPV基因芯片检测武汉市城区1 430例妇女宫颈脱落细胞HPV基因亚型,对569例HPV阳性者按病理结果分成5组:慢性炎症组、宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅰ组、CINⅡ组、CINⅢ组和宫颈癌组。分析HPV感染状况、HPV基因型分布、多重感染在各组宫颈疾病中的意义。结果:1 430例标本中检出HPV阳性569例,HPV总感染率为39.79%(569/1 430),宫颈病变中检出的HPV高危亚型在各病理组中分布不一,CINⅢ组和宫颈癌组以16、18型最多见。多重感染共138例,HPV多重感染检出率在炎症组为17.48%(54/309)、CINⅠ组为23.70%(32/135),CINⅡ组为36.07%(22/61),CINⅢ组为44.44%(20/45)、宫颈癌组为52.63%(10/19)。CINⅢ组及宫颈癌组HPV多型感染率明显高于CINⅡ组、CINⅠ组及慢性炎症组(P<0.05)。结论:武汉地区HPV感染的基因型别、多重感染与宫颈组织不同程度病变密切相关。     

568例青海地区妇女人乳头瘤病毒感染状况分析

目的:通过对568例青海地区妇女人乳头瘤病毒(HPV)感染状况分析,为HPV防治研究提供线索和依据。方法:采用导流杂交技术和组织病理检查,分析568例青海地区妇女HPV感染状况,检测15种HPV基因型,探讨不同宫颈病变程度与高危型人乳头瘤病毒(HR-HPV)关系。结果:1 568例感染者多集中在19~39岁的年龄段,占74.47%。在不同地区中,西宁地区妇女HPV感染率为56.34%,其次为海东地区,为20.07%,而果洛地区最低,为1.41%。不同民族间,汉族感染率>藏族>土族>其他民族>蒙古族>回族。从职业来看,农牧民HPV感染者占很高的比例,为71.30%。2共检出13种基因型,其中HPV感染排在前5位的依次是HPV 16、11、18、33、45,分别占33.10%、15.14%、13.38%、9.15%和5.98%。3宫颈上皮内瘤变(CIN)CINⅡ以上,其HR-HPV感染率均在90%以上,尤其12例SCC患者,其HR-HPV率为100.00%,并经趋势χ2检验,CINⅡ、CINⅢ以及鳞状细胞癌(SCC)感染率间差异无统计学意义(P>0.05),但与其他不同病变程度的感染率间差异有统计学意义(P<0.05)。结论:加强妇女HPV检查,了解HR-HPV感染及宫颈的细胞学、组织学变化规律,将有利于防治宫颈疾病的发生。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

目的 研究妇女生殖道感染高危型人乳头瘤病毒(HR-HPV)的载量与各级子宫颈上皮内瘤变(CIN)的关系.方法 汇总1999-2008年间在我国14 6个城市地区和8个农村地区开展的以人群为基础的子宫颈癌筛查横断面研究的数据.共有18 186名17～59岁的妇女参加了筛查,并收集子宫颈脱落细胞用于HR-HPV DNA检测.采用第2代杂交捕获试验(he2),病毒载量由样本的相对光单位与标准阳性对照之比(RLU/PC)来衡量.根据HR-HPV载量,除阴性组[0,1.00)以外,将阳性对象分为3组:低度载量[1.0,10.00),中度载量[10.00,100.00)和高度载量≥100.00.子宫颈病变按照病理诊断分为正常、轻度宫颈上皮内瘤变(CIN 1)、中度宫颈上皮内瘤变(CIN 2)、重度宫颈上皮内瘤变(CIN 3)和子宫颈癌(SCC).采用非条件多项式logistic回归分析病毒载量与子宫颈病变级别的关系.结果 HR-HPV感染率为14.51%(2515/17 334),其中100.00%(29/29)的SCC、97.63%(206/211)的CIN 3、93.43%(199/213)的CIN 2、75.04%(421/561)的CIN 1和10.17%(1660/16 320)的正常妇女HR-HPV DNA检测阳性.HR-HPV感染阳性的SCC、CIN 3、CIN 2、CIN 1和官颈正常妇女的病毒载量中位数分别是320.85、158.05、143.70、125.34和9.64.各级病变中病毒载量的分布差异有统计学意义(X2=6190.40,P<0.01);病毒载虽越高,CIN程度越高(X2=5493.35,P<0.01).低、中和高度载量组与阴性组相比,发生各级CIN的危险性均增加[OR(95%C/):CIN 1为9.01(6.31～12.87)、24.96(18.23～34.17)和68.42(51.40～91.08),CIN 2为26.44(12.07～57.95)、98.53(49.54～195.98)和322.88(168.62-618.27),CIN 3+为72.89(24.02～221.18)、343.58(121.81～969.09)和>999.99(473.38～>999.99)],有明显的剂量反应关系(X趋势2势分别为3115.05、2413.95和3098.57,P值均<0.01).HR-HPV阳性人群各年龄组内,HR-HPV中、高度载量组患CIN 2+的危险性高于低载量组[OR值(95%CI):<35岁组为4.71(1.23～18.09)和15.06(4.40～51.49),35岁～组为4.01(1.62～9.90)和14.09(6.15～32.28),40岁～组为3.06(1.52～6.16)和7.78(4.05～14.95),≥45岁组为3.50(1.36～9.01)和7.57(3.13～18.30)],且随病毒载量升高,危险性升高(X趋势2分别为51.33、66.28、53.64和51.00,P值均<0.01);高载量40岁～组患CIN 2+的风险最大[OR值(95%CI)为2.02(1.15～3.52)].结论 子宫颈HR-HPV病毒载量与子宫颈癌及癌前病变级别、CIN 2+患病率高度相关;中、高度病毒载量是SCC、CIN 2和CIN 3的主要危险因素,其对于35岁以上女性的致病风险更大.综合考虑年龄和病毒载量将有助于医生有效地分类管理患者或筛查妇女.     

昆明地区高危HPV病毒载量与宫颈病变和宫颈癌相关性

目的了解昆明地区高危人乳头瘤病毒(human papilloma virus,HPV)载量与宫颈病变和宫颈癌相关性。方法选取昆明地区妇女两万余例,用杂交捕获Ⅱ(second-generation Hybrid Capture,HC-II)方法检测高危型HPV-DNA,选取3608例进行阴道镜下多点活组织检查送病理检查,宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)患者以宫颈锥切术后病理检查结果为准,宫颈癌患者以术后病理检查为准,分析HPV病毒载量与宫颈病变级别的相关性。结果宫颈炎2420例(67.07%),CINⅠ448例(12.42%)、CINⅡ376例(10.42%)、CINⅢ280例(7.76%)、宫颈癌84例(2.33%)。经秩和检验,5组间的HPV病毒载量比较,差异有统计学意义(H=185.597,P<0.05);CINⅠ与宫颈炎、宫颈癌和CINⅡ的病毒载量比较,差异均无统计学意义(P>0.05);余下各组两两比较差异有统计学意义(P<0.05)。年龄和HPV病毒载量均是宫颈病变和宫颈癌的危险因素。CINⅡ以上病变随着病毒载量的升高,阳性率逐渐增高。而宫颈癌主要集中在中度级别病毒载量之间发病。结论不同宫颈病变级别间HPV病毒载量有差别,HPV病毒载量可作为诊断CINⅡ以上病变的指标。     

人乳头状瘤病毒16、18型在宫颈病变进展中的表达意义

目的探讨人乳头状瘤病毒(humanpa pillomavirus,HPV)16、18型在宫颈病变进展中表达意义。方法采用实时荧光定量聚合酶链反应(Real timefluorescence qaantitativePCR,PQ-PCR)分别对健康检查妇女480例、宫颈炎116例、宫颈上皮内瘤样病变(cervicalintraepithelial aeoplasia,CIN)Ⅰ级(轻度宫颈不典型增生)48例、CINⅡ级(中度宫颈不典型增生)56例、CINⅢ级(重度宫颈不典型增生及宫颈原位癌)52例进行HPV16、18型的定性、定量检测。结果健康检查者以及宫颈炎、CINⅠ、Ⅱ、Ⅲ级患者感染HPV16阳性率分别为0.63%、25.8%、30.6%、60.7%、71%,HPV16型阳性标本平均拷贝数分别为6.3×102、4.1×104、8.9×105、5.6×106、3.8×107;随着宫颈病情的进展HPV16型阳性率逐渐升高(P0.01),感染率和病毒载量之间有正相关关系(rs=1,P0.01);HPV18阳性率分别为0.41%、7.8%、14.6%、10.7%、7.7%,HPV18型阳性标本平均拷贝数分别为1.2×103、4.6×104、5.4×104、3.6×103、6.9×104,宫颈炎、CINⅠ、Ⅱ、Ⅲ级患者HPV18阳性率均比健康检查者明显增加(P0.01),宫颈炎、CINⅠ、Ⅱ、Ⅲ级患者HPV18阳性率差别无统计学意义(P0.05),感染率和病毒载量之间无正相关关系(rs=0,P0.05)。结论宫颈病变程度与HPV16、18型感染密切相关,且宫颈病情进展和HPV16型病毒DNA负荷呈正相关。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.