空调作为风险增加使用卫生服务 外文专业翻译.docx

《空调作为风险增加使用卫生服务 外文专业翻译.docx》由会员分享，可在线阅读，更多相关《空调作为风险增加使用卫生服务 外文专业翻译.docx（23页珍藏版）》请在第一文库网上搜索。

1、Commentary:Air-conditioningasariskforincreaseduseofhea1thservicesMarkJ.Mende11,PhDBACKGROUNDOccupantsofofficebui1dingswithair-conditioningsystems(e.g.,centra1venti1ationwithcoo1ingofair)consistent1yreport,onaverage,moresymptomsintheirbui1dingsthandooccupantsofbui1dingswithnatura1venti1ation.Thishasb

2、eenthefindinginindividua1studiesfrommanystudiesoverthe1ast20years,andinthreereviews.1-3Thesymptomsinthesestudieshaveinc1udedmucousmembraneirritation,breathingdifficu1ties,irritatedskin,andConstitutionaVneuro1ogicsymptomssuchasheadacheandfatigue.Thissetofnon-specificsymptoms,oftenreferredtoasbui1ding

3、-re1atedsymptomsorsickbui1dingsyndrome,hasnotbeen1inkedtospecificknowndiseases.Theassociationofair-conditioningwithincreasedsymptomshasreceived1itt1erecognitionoutsidethewor1dofindoorenvironmenta1research.Thismaybebecausethehea1thoutcomesstudiedhavebeensubjective1yassessedand1imitedtoacute,nonspecif

4、icsymptoms,andbecausespecificenvironmenta1exposureshavesti11notbeenc1ear1yimp1icatedasthecausa1factors.Avai1ab1eevidence,a1thoughnotconc1usive,suggeststhatthispatternisnotduetoanassociationofair-conditioningsystemstoeither1essoutdoorairventi1ation,poorertherma1contro1,or1ackofopenab1ewindows.3Themos

5、t1ike1yexp1anationseemstobethatventi1ationsystemsinbui1dings,especia11ythosewithair-conditioningsystemsorhumidificationsystems,disseminatecontaminantsintotheindoorair.Whatthesecontaminantsmightbe,andthroughwhatbio1ogicresponsemechanismstheycauseaconste11ationofnon-specificsymptoms,isnotyetc1ear.Amor

6、e1ike1yexp1anationisthatthemoistureinair-conditioningandhumidificationsystemsresu1tsinmicrobio1ogicexposuresthatcausehea1theffectsthroughmechanismsthatareirritant,toxic,ora11ergic.Verysubstantia1evidencenowexiststhatthepresenceofvisib1emoistureandmo1dinmanykindsofbui1dings(associatedwithcondensation

7、,1eaks,f1oodsorothermoistureincursionsintotheinteriororenve1opesofbui1dings)isconsistent1yassociatedwithincreasedriskofrespiratorysymptomsandasthma.4-7Itison1yrecent1y,however,thatresearchershave1inkedspecificmetricsofexposuretomicrobio1ogicmateria1sofvariouskindsinindoorairanddust(e.g.,endotoxin8an

8、dbeta-1-3-g1ucans9,10)withincreasedhea1thrisks;themetricsusedhistorica11yformeasuringexposurestoairbornecu1turab1emicroorganismshavenotgenera11ycorre1atedwithhea1thrisksindoors.Furthermore,areasinair-conditioningsystemsdesignedtoremainmoist,suchasthecoo1ingcoi1sanddrippans,aresupportiveenvironmentsf

9、orthegrowthofundesirab1emicroorganisms,aredirect1yinthepathofa11airsupp1iedtooccupantstobreathe,andareoftennotwe11-maintained.However,surprising1y1itt1eresearchattentionhasbeenfocusedonthispotentia11ytroub1ingissue:on1yafewstudieshaveassessed1inksbetweenmoistureinventi1ationsystemsandhea1theffectsam

10、ongoccupants.11,12.Mu1tip1eassociationswerefound,inc1udingareportedoddsratio(95%confidenceinterva1of4.8(2.0-12)forincreasedwheeze,shortnessofbreath,andcoughinre1ationtoanindexofmoistureintheventi1ationsystem.11Recent1y,however,Menzies13reportedstart1ingfindingsfromab1inded,contro11edinterventiontria

11、1,whichtestedu1travio1etirradiationofcoo1ingcoi1sanddrainpansintheventi1ationsystemsofofficebui1dingswithoutknownbui1ding-re1atedhea1thprob1ems.Thestudyfoundsubstantia11yreducedsymptomswhenu1travio1etradiationwasturnedon,especia11yamongatopiesandnonsmokers.Never-smokers,forinstance,hada60%reductioni

12、n1owerrespiratorysymptomsduringtheUVconditions,versusa30%reductionamongcurrentsmokers.Thefindingssuggestthatmicroorganismsgrowingonthemoistsurfacesinconventiona1air-conditioningsystemsmaycauseasubstantia1increaseinbui1ding-re1atedrespiratoryandothersymptomsduringnorma1conditionsintypica1bui1dings.Th

13、efindingsa1soimp1yincreasedresponsivenessamongatopiesandnonsmokerstothemicrobio1ogicexposuresduringnorma1conditions,presentingasincreasedrespiratoryandmuscu1oske1eta1symptoms.Suchapatternsuggestshypersensitivitypneumonitis,arareandpotentia11yseriousimmuno1ogica11y-mediateddiseasewithasimi1arpattern,

14、asabio1ogicmode1forthisapparent1ymorecommonand1essseverehea1theffect.Hypersensitivitypneumonitis-1ikei11nesscausedbyindoorworkenvironmentshasbeendocumentedrepeated1y,14-17genera11yre1atedto1eaks,butisconsideredrare.The1iteratureonnon-specificbui1ding-re1atedsymptomsinoffices,consistent1y1inkedwithce

15、rtaintypesofventi1ationsystems,hasassumedthatthesesymptomscausesomediscomfortandreducedworkefficiencybutreso1veawayfromthebui1dings.The1iteratureonvisib1emoistureandmo1dinbui1dingssuggestsimmuno1ogicresponsessuchasasthmaora11ergies,invo1vingeithertriggeringorinitia1sensitisation.4-7ThefindingsofMenz

16、ies,13inturn,suggestthatcontaminantsfromair-conditioningsystemsincommercia1bui1dingsmaycauseanimmuno1ogica11y-mediatedresponseinasubstantia1proportionofoccupants.Anumberofstudiesa1sosuggestthatbui1dingswithinadequateventi1ationmayincreasethetransmissionofinfectiousrespiratorydiseasesamongoccupants,18,19a1thoughthis1inkhasnotbeenwe11-documented.Anecdota1reportstoinvestigatorsofuprob1e7officebui1dingsoftenmentionfrequentinfectiousrespiratoryi11nessorsinusinfectionsthatdonotreso