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The use of temporal-spatial analyses in the epidemiological investigation of endemic and epidemic waterborne gastroenteritis.

机译：时空分析在地方性和流行性水源性胃肠炎流行病学调查中的应用。

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Few approaches are available to study the relationship between drinking water and gastroenteritis in communities served by one common water source, or multiple sources where water undergoes extensive mixing within a distribution system. When the majority of the population is exposed to a common risk factor, it is very difficult, if not impossible, to assess the relationship between a disease and a risk factor of interest using traditional epidemiological techniques (cross-sectional study, case-control study, etc.). In this thesis, the results of two endemic studies and one epidemic study demonstrate the utility of temporal-spatial analytical techniques in the investigation of waterborne gastroenteritis.; Endemic waterborne disease investigations were conducted in two cities with vastly different approaches to drinking water supply management: Vancouver, British Columbia and Edmonton, Alberta. Whereas Vancouver's drinking water originates from protected watersheds and undergoes minimal treatment, Edmonton's drinking water is drawn from a river with much poorer water quality, but undergoes full conventional treatment. Using time-series analysis, evidence for a relationship between the daily turbidity of unfiltered drinking water and endemic gastroenteritis was identified in Greater Vancouver from 1992 to 1998. Statistically significant associations were found between daily visits to emergency rooms, physician offices', and hospitalizations, for gastroenteritis and daily water turbidity among consumers of each of Vancouver's three water supplies. Lag-times (i.e. time from the turbidity increase to the increase in health care utilisation) observed were both biologically plausible and relatively consistent across water supply areas, age groups, and health service data sets. The inclusion of a formal control group in a comparative logistic (case-control) regression approach added strength to the study findings, and supported the underlying hypothesis of causality.; Results of temporal-spatial analyses suggested very little impact, if any, of filtered drinking water from Edmonton's two water treatment plants on the level of endemic gastroenteritis among Edmonton residents from 1993 to 1999. The lack of significant temporal relationships between daily drinking water quality and health care utilisation associated with gastroenteritis, together with the lack of obvious spatial relationships between gastroenteritis and the two Edmonton water service areas, support the opinion that the high quality of Edmonton's drinking water adequately minimises the risk of waterborne endemic gastroenteritis. Furthermore, the lack of significant relationships between raw water turbidity and faecal coliform counts, and endemic gastroenteritis, support the effectiveness of the treatment processes utilised.; Analyses of a waterborne E. coli O157:H7/Campylobacter outbreak in Walkerton, Ontario in May 2000, demonstrated an association between water originating from one of three wells supplying the town at the time of the outbreak (Well 5), and the risk of developing gastroenteritis. The results of the Walkerton investigation provided strong evidence to support what is now considered the most likely series of events leading up to the infection of an estimated 1286 Walkerton residents with E. coli O157:H7 and/or Campylobacter. The results of the temporal-spatial analyses strongly support the theory that Well 5 was the primary, if not the only well involved in the outbreak.
机译：在由一个公共水源或在分配系统中水经过大量混合的多个水源服务的社区中，很少有方法来研究饮用水与胃肠炎之间的关系。当大多数人口面临共同的危险因素时，使用传统的流行病学技术（横断面研究，病例对照研究）很难（即使不是不可能）评估疾病与目标危险因素之间的关系。等）。本文通过两项流行病学研究和一项流行病学研究的结果证明了时空分析技术在研究水源性胃肠炎中的实用性。在两个城市的饮用水供应管理方法截然不同的地方进行了地方性水传播疾病调查：不列颠哥伦比亚省的温哥华和艾伯塔省的埃德蒙顿。温哥华的饮用水源于受保护的流域，并受到最少的处理，而埃德蒙顿的饮用水取自水质较差的河流，但经过全面的常规处理。使用时间序列分析，从1992年至1998年在大温哥华地区发现了未经过滤的饮用水的日常浊度与地方性肠胃炎之间的关系的证据。在急诊室，医师办公室和医院的日常就诊之间，存在统计学上的显着相关性，温哥华三大供水系统的消费者之间的肠胃炎和日常浑浊情况。观察到的滞后时间（即从浊度增加到使用卫生保健的时间）在生物学上是合理的，并且在供水区域，年龄组和卫生服务数据集之间相对一致。在比较逻辑（案例-对照）回归方法中纳入正式对照组，增加了研究结果的强度，并支持了因果关系的基本假设。时空分析的结果表明，从1993年至1999年，埃德蒙顿两家水处理厂的过滤饮用水对埃德蒙顿居民中地方性肠胃炎的水平影响很小。与胃肠炎有关的医疗保健利用，以及胃肠炎和两个埃德蒙顿水服务区之间缺乏明显的空间关系，支持了这样的观点，即埃德蒙顿饮用水的质量足以将水传地方性肠胃炎的风险降到最低。此外，原水浊度和粪便大肠菌群计数与地方性肠胃炎之间缺乏显着的联系，这支持所采用的治疗方法的有效性。水性<斜体> E的分析。 2000年5月在安大略省沃克顿市爆发的大肠杆菌（O157：H7）/弯曲杆菌（italy）弯曲杆菌（italic）暴发，证明了暴发时向该镇供水的三口井之一的水之间存在关联。 ，以及患上胃肠炎的风险。 Walkerton调查的结果提供了有力的证据，以支持目前被认为是导致最可能发生的一系列事件的事件，这些事件导致估计有1286名Walkerton居民感染 E。大肠杆菌 O157：H7和/或 Campylobacter 。时空分析的结果强烈支持这样的理论：5号井是主要的，即使不是唯一参与爆发的井。

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