文献翻译——一氧化碳：环境公共健康监测

苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿1外文文献资料CarbonMonoxide:TheCaseforEnvironmentalPublicHealthSurveillanceAdditionalarticleinformationCarbonmonoxideisacommon,potentiallylethalgasproducedbytheincompletecombustionoffossilfuelssuchasnaturalorliquefiedpetroleumgas,oil,wood,andcoal.Itisoneoftheoldestdocumentedtoxicants.Mortalityandmorbidityfromacute,unintentional,non-fire-relatedcarbonmonoxidepoisoningisasubstantial,butoftenunrecognized,publichealthproblemintheUnitedStates.(Intentionalandfire-relatedcarbonmonoxidepoisoninghaveotherpublichealthpathwaysforsurveillance,prevention,andcontrol;theseeventsare,therefore,notaddressedinthisarticle.)ItisestimatedthateachyearintheUnitedStatesatleast15,200individualsseekmedicalattentioninanemergencydepartmentormissatleastonedayofworkduetocarbonmonoxidepoisoning.1However,thisestimatedoesnotaccountforthefullburdenofillness;thetoxiceffectsofcarbonmonoxideexposurearenonspecificandeasilymisdiagnosed.Symptomsmayincludeheadache,dizzinessandnausea,andathigherlevelsofexposuredisorientation,unconsciousness,anddeath.Theestimatealsodoesnotaccountforthosedirectlyadmittedtoahospital,thosepresentingtoothertypesofoutpatientclinics,whocallpoisoncontrolcenters,whodonotseekcare,orthosewhodieimmediatelyfromcarbonmonoxideexposureandreceivenomedicalcare.Carbonmonoxidepoisoningoccursbothastheresultofroutinedomestic,occupational,andrecreationalactivities,andinthewakeoflarge-scaledisasterssuchasthosecausedbyhurricanes,2,3floods,4andwinterstorms.5,6Itisalmostentirelypreventablebythecorrectinstallation,maintenance,andoperationofdevicesthatmayemitcarbonmonoxide,combinedwiththeappropriateuseofcarbonmonoxidedetectors(alsocalledcarbonmonoxidealarms).Ithasbeenestimatedthatcarbonmonoxidedetectorscouldpreventatleasthalfofalldeathsattributabletonondisaster-relatedcarbonmonoxidepoisoning.7In2004,sixstates苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿2(Alaska,Delaware,Florida,Maine,Mississippi,andMontana)includedaquestionaboutthepresenceofacarbonmonoxidedetectorinhomesontheirBehavioralRiskFactorSurveillanceSystem(BRFSS)questionnaires.(TheBRFSSisanongoingrandomtelephonesurveyofadult,noninstitutionalizedstateresidentsconductedbythe50statehealthdepartmentsaswellasthoseintheDistrictofColumbia,PuertoRico,Guam,andtheU.S.VirginIslandswithsupportfromtheU.S.CentersforDiseaseControlandPreventionCDC.)Thehouseholdprevalenceofdetectorsrangedfrom19.6%inFlorida(Personalcommunication,MelissaR.Murray,MS,BRFSSFloridaBehavioralRiskFactorSurveillanceSystem,FloridaDepartmentofHealth,January6,2006)to53.0%inAlaska(Personalcommunication,RebeccaS.Wells,SM,HealthSurveyLabManager,AlaskaDepartmentofHealthandSocialServices,December2,2005),dramaticallylowerthantheprevalenceofsmokealarmsinhomes;the1995BRFSSestimatedthat94%ofhomesintheUnitedStateshadatleastonesmokealarm.8Whilemortalityrelatedtocarbonmonoxidepoisoningappearstohavedeclinedoverthepasttwodecades,9,10theincidenceofcarbonmonoxidepoisoningasmeasuredbyrelatedcallstopoisoncontrolcentersandtreatmentwithhyperbaricoxygenappearstohaveremainedstablefrom1992to2002.11THENEEDTOESTABLISHENVIRONMENTALPUBLICHEALTHSURVEILLANCEOFCARBONMONOXIDETobemostusefulfordevelopinginterventionsforthepreventionofcarbonmonoxidepoisoning,surveillanceforcarbonmonoxideshouldgobeyondcollectinginformationonthehealthoutcomes.Anidealenvironmentalpublichealthsurveillancesystemcaptures,characterizes,anddisseminatesinformationonapopulationsstatusinregardtotheenvironmentalhazard,exposure,healtheffects,andinterventionsinadditiontohealtheffects.21Thiscomprehensivemodel,beingpromotedbytheCDCsEnvironmentalPublicHealthTrackingProgram(EPHTP),amongothers,aimstoprovidethespecificityofsurveillancedatarequiredfordesigninginterventionsthatcanbefocusedontheappropriatehazardsandpopulations.Bytrackinghazard,exposure,andinterventioninformationinadditiontohealtheffects,carbonmonoxidesurveillancesystemsmayyielddatathatmakethecasefortheinstallationofcarbonmonoxidedetectors,improvementsintheinstallation,operation,andmaintenanceofgasfurnacesandgenerators,orforoutreachtomedicalcareprovidersorspecificpopulationgroups.Thereareanumberofavailabledatasourcesthatmayproveusefulforhazardsurveillanceofcarbonmonoxideinambientair.Carbonmonoxide苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿3emissionsdatathatareavailablefromtheU.S.EnvironmentalProtectionAgency(EPA)NationalEmissionInventorydatabaseandconcentrationsfromairmonitoringstationdatathatareavailablefromtheEPAAirQualitySystemdatabasearereadilyavailable.ThereisagrowingbodyofliteraturethatshowsanecologicalassociationbetweenincreasedlevelsofambientaircarbonmonoxideandadverseCVD,22,23stroke,24andbirthoutcomes25,26thatsupportstheneedtoinvestigatelong-termeffectsofchroniclowdoseexposures.FewareasintheUnitedStates,however,donotattainfederalambientairstandardsforcarbonmonoxidelevels.27Twosourcesofpotentialhazarddataoncarbonmonoxidelevelsinindoorenvironments,currentlylargelyuntapped,aredataobtainedbyutilitycompaniesandfiredepartments.Utilitycompaniesarerequired,inmoststates,totakeandinvestigatecallsaboutpotentialgasleaksinhomes,communities,andworkplaces,andtheyfrequentlyconductenvironmentalsamplingforcarbonmonoxide.Firedepartmentsrespondtosimilarcallsaswellastocarbonmonoxidedetectoralarmsandalsotakecarbonmonoxidemeasurements.Whilethesedatamayrepresentarichsourceofhazardinformation,theiravailabilityisoftenlimitedbytheabsenceofelectronicdatasystemsand/orthewillingnessofthedataownerstoshareinformationwithhealthdepartments.Hazardsurveillancecanalsobeconductedonknownriskfactorsforcarbonmonoxideexposures.Forexample,population-basedsurveysofhousingandhousingconditionsmayidentifygeographicareasanddemographiccharacteristicsofresidentsexperiencingheatingandelectricitylossandwhoaredependentuponsupplementalheatingsources.28,29Exposuresurveillanceforcarbonmonoxidecanbeconductedusingdatafromlaboratorytestsforelevatedcarboxyhemoglobininblood,oftenconductedinemergencyroomsandhospitals.ThedevelopmentandrecentU.S.FederalDrugAdministrationapprovalofapulse-oximeter,30allowingforrapidnoninvasivemeasurementofcarboxyhemoglobin,mayfacilitatemoretimelyexposuremonitoringandmaythereforeincreasetheavailabilityandtheaccuracyofthesedata.Thistrackingcouldparalleltheuseofelectroniclaboratoryreportinginfrastructureforleadexposuretestresults.SuchsurveillancecouldbeconductedusingelectroniclaboratoryreportinginfrastructureestablishedbythePublicHealthInformationNetworkNationalElectronicDiseaseSurveillanceSystem(PHINNEDSS).Anothersourceofthesedatamaybepoisoncontrolcenters,whichmayreceivephysicianreportsfollowingconfirmedexposures.苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿4Multipledatasourcesexistforconductingrate-basedhealthoutcomesurveillanceofcarbonmonoxidepoisoning.Dataavailableinallormoststatesandterritoriesinclude:hospitaldischargedata,availablein90%ofstates;emergencydepartmentdata,availablein50%ofstates;31mortalitydata;poisoncontrolcentercalldata;andtheBehavioralRiskFactorSurveillanceSystem.Inmanyjurisdictions,case-basedsurveillancerequiresalegislativeorregulatorymandatedesignatingcarbonmonoxidepoisoningasareportablecondition.Oncesodesignated,surveillancesystemsforcarbonmonoxidepoisoningcanbedesignedtoidentifyandcollectinformationoncasesbasedonthoseprocessesestablishedforotherreportableconditionsthataredetectedthroughreportsfrommedicalcareproviders,laboratories,andhospitals.Patientidentificationshouldalsobeconductedwithfacilitiesthathouseandoperatehyperbaricchambers.SurveillanceonthedeliveryandeffectsofinterventionscanbeconductedusingsurveyssuchastheBRFSStoassesstheprevalenceofcarbonmonoxidedetectorsinhomes,orcanbebasedupontheevaluationofstateandlocalprogramsorpoliciestoreducecarbonmonoxideexposure,suchaslegislationmandatingcarbonmonoxidedetectorsinresidentialsettings.Establishingafullyintegratedenvironmentalpublichealthsurveillancesystemforcarbonmonoxidewillofferthepotentialforlinkinghealtheffects,exposure,andhazardinformation.Theselinkagescouldbeusedtoexploretheadverseeffectsofbothindoorandoutdoorairquality.Suchprojectscouldinvestigate:theimpactofthevolumeofportablegeneratorsalesandthefrequencyofcarbonmonoxidepoisoninginthecontextofdecreasinggeneratorprices,andincreasingpromotionofownership/useaspartofemergencypreparedness;theeffectivenessofmarketingstrategiesdata(forexample,theco-saleofoutdoorextensioncords)forprevention,bylinkinghealthoutcomedatawithmarketingdata;orlinkageofcarbonmonoxidepoisoninghealthoutcomedatawithhousingdatatounderstandtheroleofhousingageandcondition.THENEEDTOESTABLISHANATIONALSYSTEMFORENVIRONMENTALPUBLICHEALTHSURVEILLANCEOFCARBONMONOXIDEINTHEUNITEDSTATESAcoordinatednationalapproachtodevelopingcarbonmonoxidesurveillanceisneeded.Environmentalpublichealthsurveillance苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿5systemsshouldbesustainable,builtonevidence-basedstandards,andabletocollectandintegratescientificallyvaliddataonenvironmentalhazards,exposures,relatedhealthoutcomes,andinterventions.Asystemthatiscoordinatednationallywouldprovidethebasistodevelopandapplythesestandardsaswellastheresources,expertise,andtheincentivetoconductsurveillance.Suchasurveillancesystem,comprisedofacentralrepositoryofeitherraworaggregateddata,couldbringtogetherstateandlocaldatatobetterevaluatestate,regional,urban/rural,andothergeographicanddemographicvariabilityincarbonmonoxide-relatedhazards,exposures,andhealthoutcomes.Currently,thereisneitheranationalapproachnoranationalsystem.Thelackofacoherentnationwidesystemtotrackcarbonmonoxidepoisoninghascontributedtogapsinlocal,state,andnationalcapacitytoconductandevaluatepublichealthpracticeactivitiesforthepreventionofcarbonmonoxidepoisoning.Nationalpromotionandcoordinationofdevelopingstateandlocalcarbonmonoxidesurveillancesystemswouldenhancecapacityinthebasicpublichealthfunctionofbuildingandmaintainingsurveillancesystems;increasestaffknowledgeabouttheoccurrence,sources,andpreventionofcarbonmonoxidepoisoning;supportrelatedongoingpublichealtheffortssuchastheBRFSS;andpotentiallyincreasetechnicalcapacitytodevelopanintegratedenvironmentalpublichealthsurveillancesystem.Otherbenefitsofincreasingpublichealthcapacitytoconductsurveillanceforcarbonmonoxideinclude:improvingenvironmentalpublichealthpreparednessforemergencyresponse,improvingtheabilitytoplanandevaluatepreventionprograms,advancingenvironmentalpublichealthscienceandresearch,andfosteringcollaborationamonghealthandenvironmentalprograms.CONCLUSIONThechallengestoestablishinganationwidesystemforpublichealthsurveillanceareformidableandincludetheneedtostandardizedatacollection,analysis,anddisseminationmethodologiesandtheneedforresourcesatthenational,state,andlocallevels.Carbonmonoxidesurveillanceistechnicallyfeasible;thedatasourcesandthetechnicalexpertisetogather,analyze,anddisseminatethemexistinthecurrentpublichealthinfrastructure.Theleadingchallengesaretheneedfortherecognitionofcarbonmonoxidepoisoningasasignificantpublichealthissuebypublichealth苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿6practitioners,clinicians,andpolicymakers,andthesubsequentidentificationanddedicationofthenecessaryresources.苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿7中文翻译稿一氧化碳：环境公共健康监测辅文信息一氧化碳是一种常见的，潜在致命气体的化石燃料如天然或液化石油气，石油，木材和煤的不完全燃烧产生的。这是一个最古老的有毒物。死亡率和发病率的急性，无意识的，非火灾有关的一氧化碳中毒是实质性的，但往往在美国的公共卫生问题方面上还未确认（故意的、与火灾有关的一氧化碳中毒事件有其他公共卫生途径进行监控，预防，控制；因此，这些事件本文中未提及的。）据估计，在美国每年至少有15200个人由于一氧化碳中毒而在急诊就医，或至少错过一天的工作。这个估计对严重的疾病实例不负有责任，一氧化碳暴露的毒性作用是非特异性的，易被误诊。症状包括头疼，头晕，恶心，和更高水平的暴露的迷失，无意识，和死亡。这个估计也不对那些直接送入医院，向其他类型的门诊呼叫中毒控制中心，不寻求治疗的人，或那些因为一氧化碳暴露而死去的和因为没有接收治疗而死的人不负责任。一氧化碳中毒会给常规生活，职业，和娱乐活动，带来大规模的如飓风带来的洪水和暴风雪的灾害，正确的安装，维修，操作可能会产生一氧化碳的设备以及结合一氧化碳探测器的合理使用它几乎完全是可以预防的（也被称为一氧化碳报警器）。据估计，一氧化碳探测器可以防止至少一半的人死于一氧化碳中毒。2004年，六个州（阿拉斯加，特拉华，佛罗里达州，缅因州，密西西比州，和蒙大纳）对一氧化碳探测器对他们的行为风险监测系统（BRFSS）进行问卷调查其中存在问题。（BRFSS是一个正在进行的随机电话调查的成人的机构，国家居民由50州卫生部门以及那些在哥伦比亚区，波多黎各，关岛，并与疾病预防控制中心的人组成）。探测器的家庭的患病率范围从19.6%在佛罗里达州阿拉斯加的53%，大大低于在家庭烟雾报警器的患病率；1995BRFSS估计，在美国家庭94%至少有一个烟雾报警器。（个人通信，MelissaR.默里，MS，BRFSS佛罗里达州的行为危险因素监测系统，佛罗里达州卫生署，2006年1月6日）（个人通信，丽贝卡S.威尔斯，SM，健康调查实验室经理，阿拉斯加卫生与社会服务部，2005年12月2日）。从1992到2002。一氧化碳中毒相关的死亡率似乎已经在过去的二十年里几乎一直保持稳定，由于一氧化碳中毒发病的相关要求进行高压氧中毒控制中心和治疗。苏州大学本科生毕业设计（论文）附件：外文文献资料与中文翻译稿8需要建立一氧化碳环境公共卫生监测对一氧化碳中毒的预防干预措施的发展是最有用的，一氧化碳监测应超越对健康结果的信息收集。一个理想的环境公共卫生监测系统对捕获，表征，和传播对环境危害，暴露的状态信息，人口健康的有一定的影响，而且还会干预健康。该综合模型，由疾病预防控制中心的环境公共卫生跟踪程序促进（ephtp），其中，旨在提供特异性的监控所需的数据设计的干预措施，可以集中在适当的危害和人口通过跟踪煤气炉和发电机，或向医疗保健提供者或特定群体来获得危险性，暴露，影响健康的干预信息，一氧化碳监测系统可能会产生数据，使一氧化碳探测器在安装，操作和维护上得到改进。环境空气中的一氧化碳危害监测的可用的数据源可能证明是有用的。一氧化碳的排放数据从美国环境保护局（EPA）国家排放清单数据库中获得，浓度可从航空站的数据获得，也可从EPA空气质量监测系统数据库中获得。有越来越多的文献表明生态之间的关联程度的增加，空气中一氧化碳和不利的CVD中风和出生结果支持需要探讨慢性低剂量暴露的长期影响。在美国的一些地区，然而，没有达到联邦环境空气中的一氧化碳含量标准。在室内环境中的一氧化碳水平的潜在危险的两个数据源，目前主要是未开发的，是由公共事业公司和消防部门得到数据。公共事业公司是必需的，在大多数国家，家庭的探讨，潜在的天然气泄漏等方面人们要求在社区，和工作场所，经常进行一氧化碳环境取样。消防部门应对类似电话进行处理以及一氧化碳探测器报警测量一氧化碳。虽然这些数据可能代表了丰富的灾害信息源，其可用性通常是通过电子数据的系统和/或业主的数据与卫生部门信息共享的意愿没有限制。风险监控也可以称为进行一氧化碳暴露的风险因素检测。例如，人口为基础的调查，住房和住房条件可确定的地理区域和居民经历和电加热损失和那些依赖于辅助加热源的人口学特征。一氧化碳暴露检测可采用从血中碳氧血红蛋白升高的实验室试验数据进行的，经常在急诊室和医院进行。一个脉搏血氧仪器允许碳氧血红蛋白快速无创测量，随着最近美国联邦药物管理局的发展，可以更及时暴露监测数据以及可能增加可用性和数据的准确性。这种跟踪可以并行的使用铅暴露试验以及电子实验室报告的基础设施。这种监控可以使用电子实验室报告的基础设