综合防治措施控制湖沼垸内水网型血吸虫病效果观察

在湖沼境内水网型血吸虫病重疫区,江河水位及钉螺扩散问题,在短时间内难以解决,居民接触疫水频繁,血吸虫新感染及重复感染严重,这是湖沼地区血吸虫病流行特点。为有效控制血吸虫病传播,降低疫情,1993-2005年在潜江市王场镇14个流行村实施综合治理措施的效果观察,现报告如下。     

日本血吸虫再感染危险因素的探讨

目的 探讨山丘型疫区日本血吸虫再感染的有关危险因素。方法 选取一山丘型疫区,随访观察居民吡喹酮普治后疫水接触及血吸虫再感染状况,对可能影响血吸虫再感染的有关因素进行非条件logistic回归分析。结果 多因素非条件logistic回归分析结果显示再感染与下列因素有关:化疗前每克粪便虫卵数(OR=2.066,95％CI:1.173～3.639),性别(OR=4.260,95％CI:1.275～14.235),4～10月份疫水接触平均指数B(OR=1.138,95％CI:1.045～1.240),性别与4～10月疫水接触平均指数B间的交互作用(OR=0.875,95％CI:0.817-0.982)。结论 性别、化疗前感染度、疫水接触的持续时间及暴露面积与再感染的发生有关,其中性别与疫水接触之间尚存在弱的拮抗作用。     

鄱阳湖重疫区血吸虫病健康教育效果评价

为了探讨健康教育在重疫区血吸虫病防治中的作用,将疫区居民分成小学生、成年妇女和成年男性３ 种目标人群,于基线调查后,分别对其采取针对性的干预措施,并将结果与对照组比较。结果表明,干预后实验组上述３ 种人群血防知识水平均显著提高;小学生和成年男性对血吸虫病检查与化疗态度的正确率,以及成年妇女血防价值观正确率均明显上升;成年男性血吸虫病检查和化疗的依从性明显提高;除成年男性外,小学生和成年妇女疫水接触率和血吸虫感染率显著下降。健康教育可有效地控制成年妇女,尤其是小学生血吸虫感染,并能提高成年男性血吸虫病检查和化疗的依从性     

高山型血吸虫病疫区疫水暴露与感染率关系

目的观察高山型血吸虫疫区疫水暴露与血吸虫感染率之间的剂量．反应关系，评价3项常用疫水暴露指标的优缺点和适用性。方法2001年11月在高山型血吸虫病疫区随机抽取1033名常住居民，采用Kato-Katz3片法和3送3检孵化法诊断血吸虫病感染。用回顾问卷方式法调查当年4～10月疫水暴露频次（频次），平均疫水暴露时间（指数A）和平均疫水暴露强度（指数B）。结果3项疫水暴露指标与血吸虫感染率之间均存在剂量．反应关系。在既往调查血吸虫感染率≥10％的自然村中，频次与感染率之间存在典型的剂量．反应关系（X^2趋势=17．76，P〈0．01），在感染率〈10％的自然村指数A与感染率的剂量．反应关系明确（X^2趋势=11．08，P〈0．01）。其他条件下疫水暴露指标与血吸虫感染率的关系呈波动状态，剂量．反应关系不明确。结论在高山型血吸虫疫区，频次可用于感染率较高人群的疫水暴露评价。指数A可用于感染率较低人群的疫水暴露评价。     

邛海高山型血吸虫病流行区不同人群疫水暴露方式和时间

目的 了解高山型血吸虫病流行区不同人群暴露疫水的方式和时间,为制定血吸虫病防治策略提供依据。方法 2001年11月,用回顾问卷方式调查邛海周边按职业分层随机抽取的1054名常住居民于2001年4至10月疫水暴露的方式、频次和持续时间。结果种植水稻、烟及蔬菜的农民疫水平均暴露时间（中位数16～18min／d）和平均暴露强度（中位数2．41～2．5）大于其他人群的平均暴露时间（中位数3．74～7．39min／d）和平均暴露强度（中位数0．81～1．52）,种植烟叶的农民疫水暴露频次（中位数2．040次／d）高于其他职业,学生儿童组暴露的频次和时间不高,但暴露强度很高（中位数2．34）。4至6月份是该地区的农忙季节,也是成年人疫水暴露的高峰季节。而学生儿童组疫水暴露的高峰季节在7、8月,主要是戏水和游泳。妇女的暴露时间和暴露强度均高于男性。结论 西昌高山型血吸虫病流行区不同人群疫水暴露方式、时间和暴露强度不同。在4至6月通过生产性接触疫水,是成年人易感的高峰季节,在7至8月通过非劳动方式接触疫水,是学生儿童易感的高峰季节。     

人群血吸虫感染率的调查分析

本文报告血吸虫病重流行区的人群血吸虫感染率的分布规律。不同疫区的群体感染与职业接触疫水的频数关系，及各年龄组的感染率分布情况；并对有螺分布区的感染率与常年定居村民的感染率作相关分析，为今后查治血吸虫病提供科学依据。     

中国公民健康素养(66条)解读(四)

正在血吸虫病流行区,应当尽量避免接触疫水;接触疫水后,应当及时进行检查或接受预防性治疗释义:血吸虫病是严重危害人体健康的寄生虫病、传染病,人和家畜接触了含有血吸虫尾蚴的水体(简称"疫水"),就可能会感染血吸虫病。血吸虫病的感染集中发生在每年的4~10月。预防血吸虫病应做到:不要接触有钉螺(血吸虫病传播的中间宿主)滋生的湖、河、塘及水渠的水体,不要在     

中国人群日本血吸虫再感染及其危险因素的Meta分析

目的 研究中国血吸虫病疫区人群血吸虫再感染及其危险因素。方法 计算机检索PubMed、CNKI、VIP和万方数据库,查找所有分析中国血吸虫病疫区人群血吸虫再感染及其危险因素的观察性研究。按纳入排除标准筛选文献、资料提取和质量评价,进行Meta分析。结果 共纳入18项研究,感染率研究对象12 604人,再感染率研究对象3 128人。血吸虫总感染率和总再感染率合并值分别为20.8%和 21.0%,两者差异比较,Z=1.12,P=0.26.再感染因素包括基线感染度、疫水接触指数、住址至感染性钉螺堤垸距离和年龄,其合并OR值及95%CI分别为3.58(1.56～8.22)、 2.37(1.08～5.22)、1.72(0.41～7.30)和0.48(0.19～1.23).结论 血吸虫总感染率和总再感染率差异无统计学意义。基线感染度、疫水接触指数、住址距有感染性钉螺堤垸距离是血吸虫再感染危险因素,年龄是其保护因素。     

血吸虫病垸内型和洲岛型流行区居民接触疫水方式聚类分析

目的 对血吸虫病垸内型和洲岛型两类流行区居民接触疫水的方式进行分类。方法 采用队列随访调查的方法收集居民疫水暴露的情况，并用系统聚类法中样品聚类(Q型)进行聚类分析。结果 垸内型疫区疫水接触方式被划分为4类，洗手脚、玩水、洗衣菜、其它、捕鱼虾、放鸭鹅、采莲藕和放牛为第一类；涉水、游泳和打草为第二类；犁地和下水田分别为第三类和第四类；洲岛型疫区疫水接触方式分为5类，洗手脚、洗菜、打湖草和放鸭鹅合为第一类；放猪羊、其它、洗衣物和玩水合为第二类；下水田、游泳和捕鱼虾分别为第三、四、五类。结论 这种分类的方法比较符合实际，在生物学上的解释也较为合理，并使SuppQI指标在问卷快速筛检血吸虫病高危人群中的应用变得简单可行。     

洞庭湖区外出务工人员血吸虫病感染情况调查

目的了解血吸虫病非流行区和流行区外出务工人员(农民工)流向、工种、工作生活环境及其行为学,分析外出打工者血吸虫病感染现状及造成血吸虫病传播或再流行的潜在危险。方法分别从非流行区和流行区外出务工人员中,随机抽取500人以上进行问卷调查,然后进行血清学和病原学方法检查。结果非流行区调查外出务工人员577人,血清检查阳性率15.53%,粪检阳性率1.89%,务工期间有99.8%的人员接触过疫水;流行区调查外出务工人员529人,血清检查阳性率32.82%,粪检阳性率3.40%,务工期间98.9%的人员未接触疫水。结论非流行区外出人员在血吸虫病流行区务工期间,以务农为主接触疫水时间多,容易形成血吸虫病新感染;流行区外出人员中的血吸虫病人或传染源,在城市工厂打工,接触疫水感染血吸虫病机率少,造成当地血吸虫病传播或再流行的可能性小,但对有螺无病区、历史流行区、不知情疫源地,是造成血吸虫病再流行的潜在危险因素。     

Water use and health in Mueda, Mozambique

A comparison of domestic water use in 2 villages in Mueda, Mozambique, indicated that a reduction in the length of the water collection journey from 5 h to 10 min was associated with an increase in average water consumption from 4.1 to 11.1 litres per person per day. Bathing and washing clothes accounted for 70% of the increased total. Bathing of children was a regular nightly event in the village with a water supply but almost unknown in the other. Water used for food preparation also increased, suggesting that scarcity of water may also influence diet. A major benefit of water supply is the saving of women's time and effort from water collection. In Mueda, it was an average of 1 3/4 h per day. More than half the time saved was spent on other household tasks, particularly grinding cereals, and on other productive work. Women spent much of the remainder with their children. A trachoma survey, organized as a training exercise for medical students, found a 19% prevalence of trachoma in the village with a water supply, while the prevalence was twice this figure in another village with no supply.     

Resistance to reinfection after treatment of urinary schistosomiasis

The process of reinfection after treatment was studied in a cohort of subjects in a focus of intense Schistosoma haematobium infection. Detailed observations were made at water contact sites of cercarial densities and of water contact by members of the cohort. Individual values of a cumulative index of exposure to infection were calculated using these observations and assumptions which were made about the effect of different water contact activities on the entry of cercariae into the skin. Among groups of subjects with an apparently similar intensity of exposure to infection, reinfection tended to be much heavier in children under 10 years of age than in 10 to 14-year-olds, while only light infections were found in the few adults who became reinfected. This trend for reinfection to decrease with increasing age, after an allowance for variation in exposure, was highly significant (p less than 0.001). These observations suggest that subjects in this area slowly acquire an increasing degree of immunity to the acquisition of S. haematobium infection which is effective in the absence of a mature egg laying infection.     

Participatory action research: community diagnosis and intervention in controlling urinary schistosomiasis in an urban community in Ibadan, Nigeria

Schistosomiasis is second only to malaria and is endemic in Nigeria. It has been reported that the infection is more prevalent, irrespective of gender, in the age group 5 to 14 years. It is least among the age group 26 and 55 and occurs mostly in the rural areas in the country. The infection is spreading from the rural areas to various urban communities, particularly the agricultural and fishing populations. In Ibadan, capital of Oyo State in southwestern Nigeria where the focus of this study is made, the infection has been reported among children and adolescents in six Local Government Areas. Students of Advanced Diploma in Health Education (ADHE) of the Department of Health Promotion and Education, during a community diagnosis exercise among primary schools in two communities in Ibadan, met with this problem. The purpose of this study is to mobilize the affected communities, with both internal and external resources through a participatory-action process, to combat the infection which is one of their major problems. Since the providence of schistosomiasis in target communities is age related, investigations were concentrated in 17 Primary Schools in the two communities. The investigation involved laboratory confirmation by collecting 147 urine samples from a total population of 676 children and examining them microscopically for the schistosoma ova. In addition, the quality of stream water and their vector presence were assessed. The key intervention strategy used was community mobilization of both internal and external resources of targeted communities. The striking outcome of the intervention study is that the outbreak of schistosomiasis in the communities was formally reported to the Federal Ministry of Health and the Oyo State Ministry of Health. All infected pupils were treated, the long awaited water scheme to replace the broken pipes was completed, and two new water supply schemes were implemented by the communities. Further, the communities displayed sign boards prohibiting community members from fetching water from "Dandaru" river for daily domestic needs. It is concluded that the combined efforts of all the actors helped the community to enjoy improved water supply and reduced their exposure to infection from the stream, which was the source of the infection.     

Cardiovascular risk factor profiles and their social gradient from adolescence to age 74 in a Swiss region

BACKGROUND: Few European studies have investigated how cardiovascular risk factors (CRF) in adults relate to those observed in younger generations. OBJECTIVE: To explore this issue in a Swiss region using two population health surveys of 3636 adolescents ages 9-19 years and 3299 adults ages 25-74 years. METHODS: Age patterns of continuous CRF were estimated by robust locally weighted regression and those of high-risk groups were calculated using adult criteria with appropriate adjustment for children. RESULTS: Gender differences in height, weight, blood pressure, and HDL cholesterol observed in adults were found to emerge in adolescents. Overweight, affecting 10-12% of adolescents, was increasing steeply in young adults (three times among males and twice among females) in parallel with inactivity. Median age at smoking initiation was decreasing rapidly from 18 to 20 years in young adults to 15 in adolescents. A statistically significant social gradient in disfavor of the lower education level was observed for overweight in all age groups of women above 16 (odds ratios (ORs) 2.4 to 3.3, P < 0.01), for inactivity in adult males (ORs 1.6 to 2.0, P < 0.05), and for regular smoking in older adolescents (OR 1.9 for males, 2.7 for females, P < 0.005), but not for elevated blood pressure. CONCLUSION: Discontinuities in the cross-sectional age patterns of CRF indicated the emergence of a social gradient and the need for preventive actions against the early adoption of persistent unhealthy behaviors, to which low-educated girls and women are particularly exposed.     

Washing machine usage in remote Aboriginal communities

The use of washing machines was investigated in two remote Aboriginal communities in the Anangu Pitjantjatjara homelands. The aim was to look both at machine reliability and to investigate the health aspect of washing clothes. A total of 39 machines were inspected for wear and component reliability every three months over a one-year period. Of these, 10 machines were monitored in detail for water consumption, hours of use and cycles of operation. The machines monitored were Speed Queen model EA2011 (7 kg washing load) commercial units. The field survey results suggested a high rate of operation of the machines with an average of around 1,100 washing cycles per year (range 150 and 2,300 cycles per year). The results were compared with available figures for the average Australian household. A literature survey, to ascertain the health outcomes relating to washing clothes and bedding, confirmed that washing machines are efficient at removal of bacteria from clothes and bedding but suggested that recontamination of clothing after washing often negated the prior removal. High temperature washing (>60C) appeared to be advantageous from a health perspective. With regards to larger organisms, while dust mites and body lice transmission between people would probably be decreased by washing clothes, scabies appeared to be mainly transmitted by body contact and thus transmission would be only marginally decreased by the use of washing machines.     

Pattern of water contact activities in relation to S. mansoni infection in rural area in Giza Governorate, Egypt

Schistosomiasis is associated with human behavior in relation to water. Study of different patterns of water contact activities would help in planning strategies for control. This study aims to describe patterns of water contact activities in relation to S. mansoni infection in El-Shobak El-Sharki village in Giza governorate, in Egypt. A sample of 695 households was taken from about 127 houses. They provided stools samples and a water contact questionnaire for different activities, regions, sites, time of the day, duration of activities, patterns in different age and sex groups. Univariate and multivariate analysis of data was done. It was found that, adult males had the highest prevalence rate, then adult females while children had the least (33.5%, 27.5% and 17.4% respectively, p-value < 0.0001). Infection rate is higher in those having water contact activities, with Odds Ratio (OR) 2.01 and 95% Confidence Intervals (CI) (.94-4.24). Other significant factors are, the site of activities, time of the day and duration of contact, with p-value < 0.05. The highest score for the different patterns of activities in adult males are mainly occupational as agriculture and irrigation, their OR (95% CI) are 2.82 (.91-5.94) and 2.58 (.89-5.41), respectively. As regards females, the highest score is for domestic daily activities as washing infant clothes and utensils, their OR (95% CI) is 2.19 (.91-4.73) and 1.83 (.80-4.16) respectively. Children have the least score, their activities is mainly recreational as swimming, OR (95% CI) is 1.77 (.79-4.02). Multiple logistic regression analysis revealed that, male's activities and their longer duration are highly significant factors with prevalence as the dependant variable, OR (95% CI) is 3.07 (.73-8.19) for activities, and is 3.67 (.31-9.38) for duration. It is concluded that, human exposure pattern, in general, favors the transmission of S. mansoni. Prevalence of infection coincides with water contact activities in different age, sex and farming occupation. So, the control of S. mansoni in Egypt is not a pure medical affair. It needs multidisciplinary upgrading actions to be taken in different sectors of agriculture and irrigation reform in Egypt.     

Risk factors for tuberculosis in older children and adolescents: a matched case–control study in Recife,Brazil

Background

Tuberculosis is a major disease worldwide and most research focus on risk factors for adults, although there is a marked adolescent peak in incidence. The objective of this study was to identify risk factors for tuberculosis in children aged 7 to 19.

Methods

A case control study matched by age with 169 cases and 477 controls. The study population consisted of adolescents and older children from Recife, Brazil. Cases were individuals diagnosed with tuberculosis in the control programme and controls were selected in the neighborhood of cases. Conditional logistic regression was used to identify risk factors.

Results

Cigarette smoking increased by 50% the risk of tuberculosis but that this was not statistically significant (OR?=?1.6). Other risk factors were sleeping in the same house as a case of tuberculosis (OR?=?31.6), living in a house with no piped water (OR?=?7.7) (probably as a proxy for bad living conditions), illiteracy (OR?=?3.7) and male sex (OR?=?1.8). The increase in risk with living in houses with no piped water was much more marked in males. The proportion of cases of tuberculosis attributed to contact with someone with TB was 38% and to illiteracy, lack of piped water and smoking, 20%.

Conclusion

Household contact with tuberculosis, social factors and male sex play the biggest role in determining risk of TB disease among children and adolescents in the study. We recommend further research on the relationship of cigarette smoking on tuberculosis in adolescents, and on whether the sex differentials are more marked in bad living conditions. Separate studies should be conducted in older children and in adolescents.

     

Pesticide safety behaviors in Latino farmworker family households

BACKGROUND: Studies to assess pesticide exposure of individuals living in agricultural settings suggest that farmworkers create a "take-home" pathway from the fields to the home that increases exposure risk for non-farmworker household members. METHODS: A survey was conducted with 142 Latino women in farmworker family households in North Carolina to identify predictors of adherence to pesticide safety behaviors that may affect take-home exposure risk. Behaviors included changing work clothes before entering the house, storing and washing contaminated work clothes separately from family clothing, and showering upon returning home. RESULTS: The number of farmworkers in the household was negatively associated with adherence to recommended changing, storing, and showering behaviors. Most workers followed recommended laundry procedures for work clothes. CONCLUSIONS: Results support existing evidence for a take-home pathway for pesticide residues in homes with several farmworkers. Pesticide safety education needs to reinforce behaviors that reduce take-home exposure in farmworker households.     

Seroepidemiology of varicella-zoster virus and reliability of varicella history in Turkish children, adolescents and adults

This study aimed to assess the age specific varicella-zoster virus (VZV) seroprevalence in Izmir, Turkey and to determine the reliability of a history of varicella to detect susceptible children, adolescents and adults. A questionnaire, including previous history of varicella, was completed for each participant and, in 590 of them, VZV-specific IgG was measured using an ELISA test. Overall, 28.5% of individuals were seronegative for VZV. By 5 years of age, only 25.5% of children were seropositive for VZV. Among adolescents and young adults, 18.8% and 11.7% were seronegative, respectively. The negative predictive value was 57.8%, decreasing with age (81.9% in children, 34.5% in adolescents and 8.3% in adults). In conclusion, a negative history of varicella is not a reliable predictor of varicella antibody status in adolescents and young adults. Serological testing before immunisation will be logical, rather than presumptive vaccination, for adolescents and adults with negative history of varicella.