A method for the follow-up of clusters of adverse reproductive outcomes.
Clusters of adverse reproductive outcomes are reported with increasing frequency to public health authorities. Most are random events and only a very small proportion is likely due to identifiable environmental agents. Often, a preliminary study confirms the existence of a spatial and temporal excess but no biologically plausible cause is found. These cases require a follow-up of incidence to identify any continuing excess. A conceptually simple 'fixed window' technique of follow up is proposed. The power of the test is mainly influenced by the magnitude of the increase in rate, the number of adverse outcomes selected for observation and the acceptable false alarm rate. This technique has several advantages compared with other currently used methods. From a public health point of view, two important factors are to be considered in setting the parameters of the test: the delay in providing an answer for the community and the availability of resources for conducting environmental investigations.
Niyonsenga
T
T
Clinical Research Center, University Health Center of Estrie, Quebec, Canada. tniyonse@aix1.si.usherb.ca
De Wals
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P
D015982:Bias; D016000:Cluster Analysis; D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000209:etiology; D003627:Data Interpretation, Statistical; D004314:Down Syndrome / Q000453:epidemiology / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D018811:Maternal Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects; D011792:Quebec / Q000453:epidemiology; D015203:Reproducibility of Results; D012307:Risk Factors