Ross A G, Yuesheng L, Sleigh A C, Williams G M, Hartel G F, Forsyth S J, Yi L, McManus D P
Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The University of Queensland and The Queensland Institute of Medical Research, Herston, Brisbane.
Acta Trop. 1998 Nov 30;71(3):213-28. doi: 10.1016/s0001-706x(98)00063-1.
We introduce a new method, activity diaries, in order to evaluate human water contact among fishing communities in an area moderately endemic for Schistosoma japonicum in the Dongting Lake region of Southern China. Two hundred and forty-nine subjects (76% male) were followed prospectively over a 9-month-period in order to verify exposure and reinfection. Exposure was determined crudely with questionnaires, direct 12-h water observations, and more precisely with activity diaries and an adjusted exposure model which took into account the time of day, the duration of contact and the percent body surface area in contact with water. Cohort subjects filled in activity diaries for an average of 85 days as compared with 2 days for the direct water observations. The typical unadjusted mean daily water contact (duration) based on the activity diaries was 53 min with 62% of this time spent in fishing. In contrast, the direct water observations revealed an average daily duration of 149 min with 53% of the time spent in fishing. Human water contact patterns (min/day) by site, activity and body part exposed were examined with the activity diaries. Individuals in the 36-49-year-old age range had the highest degree of water contact. Most of this daily contact occurred by males on the hands (mean+/-S.D.; 83.53+/-67.80 min/day) while fishing (mean+/-S.D.; 87.84+/-8.88 min/day) on the lake (mean+/-S.D.; 85.98+/-69.90 min/day). There was a strong positive log correlation (r=0.95) between the crude and adjusted (based on our derived exposure model) diary outcomes for the entire study sample, however, at higher exposure levels this relationship was differentially weaker (r=0.70). Results from this study suggest that current methods used in evaluating schistosomiasis exposure in China may overestimate and bias measures of the risk of infection. Activity diaries adjusted for the time of day, duration and the percent body surface area exposed are cost-effective and practical instruments to accurately quantify human exposure in the vast lake regions of Southern China where most of the endemic schistosomiasis japonica occurs.
我们引入了一种新方法——活动日记，以评估中国南方洞庭湖地区日本血吸虫中度流行区渔民社区人群与水的接触情况。249名受试者（76%为男性）在9个月的时间里接受了前瞻性跟踪，以核实暴露情况和再感染情况。通过问卷调查、12小时直接水观察粗略确定暴露情况，更精确地则通过活动日记和一个调整后的暴露模型来确定，该模型考虑了一天中的时间、接触持续时间以及与水接触的体表面积百分比。队列受试者填写活动日记的平均时间为85天，而直接水观察的平均时间为2天。基于活动日记，未经调整的典型每日水接触（持续时间）平均为53分钟，其中62%的时间用于捕鱼。相比之下，直接水观察显示平均每日持续时间为149分钟，其中53%的时间用于捕鱼。利用活动日记研究了按地点、活动和暴露身体部位划分的人群水接触模式（分钟/天）。年龄在36至49岁之间的个体水接触程度最高。这种每日接触大多发生在男性在湖中捕鱼时手部（均值±标准差；83.53±67.80分钟/天）（均值±标准差；87.84±8.88分钟/天）（均值±标准差；85.98±69.90分钟/天）。对于整个研究样本，粗略日记结果与基于我们推导的暴露模型调整后的日记结果之间存在很强的正对数相关性（r = 0.95），然而，在较高暴露水平下，这种关系差异较弱（r = 0.70）。本研究结果表明，中国目前用于评估血吸虫病暴露的方法可能高估并使感染风险测量产生偏差。针对一天中的时间、持续时间和暴露体表面积百分比进行调整的活动日记是具有成本效益且实用的工具，可准确量化中国南方大部分日本血吸虫病流行的广大湖区人群的暴露情况。
