可计算一般均衡模型的建立及其在评价空气污染健康效应对国民经济影响中的应用

目的 建立我国的可计算一般均衡模型(computable general equilibrium model，CGE)，并评价空气污染造成的健康损害对国民经济的影响。方法 利用我国124个部门投入产出表及中国能源平衡表，构建了1个39个生产部门及32种产品的可计算一般均衡模型。立足于宏观经济角度的可计算一般均衡模型以空气污染造成的劳动力损失和超额医疗费用支出作为模型变量，模拟了健康效应对国民经济系统产生影响的机制。结果 建立了我国的可计算一般均衡模型。2000年我国空气污染的健康效应导致国内生产总值(GDP)的损失约0.38‰(95％可信区间0．162‰～0．511‰)。结论 空气污染不仅威胁居民的健康和生活质量，同时也严重影响国民经济的发展。     

环境污染健康损害评价指标体系探索

为解决环境污染健康损害诉讼中评价指标这一关键问题,构建了环境污染健康损害评价指标体系。依健康的定义将健康损害评价分为生理评价和心理评价两部分。其中生理评价指标分为暴露指标、效应指标和易感性指标3大类,暴露指标则分为摄入量指标和暴露标志物指标两个方面,效应指标又分为一般人群健康指标和效应标志物指标两个方面。为了提高指标体系的可操作性,补充了5类主要器官健康损害生物标志物。     

环境污染健康损害评价指标体系探索

为解决环境污染健康损害诉讼中评价指标这一关键问题,构建了环境污染健康损害评价指标体系.依健康的定义将健康损害评价分为生理评价和心理评价两部分.其中生理评价指标分为暴露指标、效应指标和易感性指标3大类,暴露指标则分为摄入量指标和暴露标志物指标两个方面,效应指标又分为一般人群健康指标和效应标志物指标两个方面.为了提高指标体系的可操作性,补充了5类主要器官健康损害生物标志物.     

健康公平性评价方法对比研究

[目的]用不同的方法对农民健康的公平性进行评价,了解各种方法的优缺点,为健康公平性评价提供方法学依据。[方法]用极差法、基尼系数、集中指数和Logistic回归对云南省三个县农民的健康公平性进行评价。[结果]极差法没有利用所有数据,得到的结果较粗略;基尼系数不涉及人口分层,不能反映经济状况的不平等或其它因素的不同对健康状况的影响;集中指数对社会经济阶层的人口构成敏感,但属于单因素分析法;Logistic回归可同时分析多个因素对健康的影响。[结论]如果只考虑一个因素对健康的影响,可用集中指数;但要考虑多个因素的影响时,用多因素分析方法。     

用于环境污染健康影响评价的一种健康指数计算方法

本文介绍了一种用于环境污染健康影响评价的健康指数计算方法。用于环境污染健康影响评价的实践证明该方法的评价结果是合理的,可用于缺少健康指标正常值情况下多个样本、多项指标的环境污染健康影响的研究。     

应用标准化效应指数评价健康教育的效果

目的：介绍用标准化效应指数评价健康教育效果的方法。方法：通过实例分析和标准化效应指数的计算来说明它的应用方法。结果：实例分析结果说明该营养教育有效，知识、态度、行为及KAP的标准化效应指数分别为1．65，0．31，0．48及1．67。结论：应用标准化效应指数评价健康教育的效果，方法简便、可信，不同研究间的结果可直接比较。     

环境污染健康影响评价规范(征求意见稿)

第一章总则 第一条为科学准确、客观公正地评价环境污染对人群健康造成的损害,制定本规范. 第二条本规范适用于针对在一定区域内发生的环境污染事件及突发性环境污染事故造成人群健康损害所进行的环境污染健康影响评价.     

环境污染健康影响评价规范

按语：近来年环境污染危及公众健康的事件（或事故）时有发生，为了规范和统一评价工作，以期科学、准确、客观、公正地评估环境污染事件（或事故）对人群健康造成的损害，以保障公众的健康效益，卫生部卫生法制与监督司起草了《环境污染健康影响评价规范》（征求意见稿）...     

相对差距和法综合评价医院感染工作

目的：探讨综合评价医院感染控制工作的方法。方法：应用相对差距和法对1998年医院感染控制工作进行评价。结果：相对差距和法评价医院感染控制工作直观、易懂、计算简便，对不同指标赋予不同的权重，考虑了被评价单位在所有被评价单位中的位置。结论：相对差距和法是评价医院感染控制工作一种实用性强、计算简便、不易受主观影响的方法。     

环境污染健康影响评价方法

环境污染健康影响评价的技术路线和评价程序应包括以下几部分：·现场初步调查·环境污染健康影响的定性评价·环境污染健康影响的定量评价一现场初步调查（一）目的确认现场是否存在环境污染源及污染物,现场人群是否出现明显健康损害。应在较短时间内对事件的原因、经过...     

Public Awareness of Air Pollution and Health Threats: Challenges and Opportunities for Communication Strategies To Improve Environmental Health Literacy

Accurate, timely information can be a powerful tool to mitigate harmful effects of air pollution. While national guidelines for environmental risk communication – based on risk and crisis communication principles – exist, little is known how these are operationalized, nor about the effectiveness of existing communication efforts. Moreover, a growing literature on environmental health literacy suggests that communication about environmental risks must move beyond individual behavior education to empower communities to mobilize to reduce environmental threats. This study aimed to identify and critically evaluate public sources of information about the causes and controllability of air pollution and its health effects, and potential disparities in information reach and utility. The case study triangulated data from three sources: Systematic analysis of the public information environment, interviews with regional expert stakeholders, and interviews with community residents. Three themes emerged: 1) Lack of clarity about responsibility for communicating about air quality (information sources), 2) Existing air quality communication strategies lack critical information including risk mitigation behaviors and long-term health impacts (information quality), and 3) Existing air quality communications fail to reach vulnerable populations (information reach). This study demonstrates that air quality communication is lacking yet crucially needed. Information about air pollution and health risks focuses on individual risk behaviors but is disseminated using channels that are unlikely to reach the most vulnerable populations. We discuss opportunities to improve the reach and impact of communication of air quality health risks, an increasingly important global priority, situating our argument within a critical environmental health literacy perspective.     

Odor frequency and odor annoyance Part II: dose–response associations and their modification by hedonic tone

Objective Risk-assessment for environmental odors and the development of an appropriate guideline for protection against undue odor annoyance have long been hampered by the difficulties of assessing odor exposure and community annoyance responses. In recent years, however, dose–response associations between frequency of odor events and odor annoyance level in the affected population were established. However, the influence of hedonic tone (pleasantness–unpleasantness) and perceived odor strength (intensity) on the degree of odor annoyance have long been neglected in such studies and accompanying guidelines. In order to close this gap a pertinent field study was conducted in the vicinity of six odor emitting plants, two with pleasant (sweets production, rusk bakery), with neutral (textile production, seed oil production), and with presumably unpleasant odor emissions (fat refinery, cast iron production). Methods A standardized sensory method was developed (described in Part I in the accompanying paper) to quantify intensity and hedonic tone within the assessment of odor exposure by systematic field inspection with trained observers. Additionally, exposure-information, the degree of annoyance, and the frequency of general health complaints and irritation symptoms were collected from the exposed residents through direct interviews. Multiple logistic regression analysis was used to establish dose–response associations between odor frequency, intensity and hedonic tone as independent variables and annoyance or symptom reporting as the dependent variable. Results It is shown that exposure-annoyance as well as exposure–symptom associations are strongly influenced by odor hedonic. Whereas pleasant odors induced little to no annoyance, both neutral and unpleasant ones did. Additional inclusion of odor intensity did not improve the prediction of odor annoyance. Frequency of reported symptoms was found to be exclusively mediated by annoyance. The results are discussed in terms of environmental stress emphasizing the WHO-definition of health. Conclusions Based on these findings the existing German guideline against undue odor annoyance was modified. Parts of these findings were presented at the 15th Congress of the European Chemoreception Research Organization in Erlangen (2002), at the 43rd Congress of the German Society of Psychology in Berlin (2002), and at the at the 9th Meeting of the International Neurotoxicology Association in Dresden (2003).     

Inference for environmental intervention studies using principal stratification

Previous research has found evidence of an association between indoor air pollution and asthma morbidity in children. Environmental intervention studies have been performed to examine the role of household environmental interventions in altering indoor air pollution concentrations and improving health. Previous environmental intervention studies have found only modest effects on health outcomes and it is unclear if the health benefits provided by environmental modification are comparable with those provided by medication. Traditionally, the statistical analysis of environmental intervention studies has involved performing two intention‐to‐treat analyses that separately estimate the effect of the environmental intervention on health and the effect of the environmental intervention on indoor air pollution concentrations. We propose a principal stratification approach to examine the extent to which an environmental intervention's effect on health outcomes coincides with its effect on indoor air pollution. We apply this approach to data from a randomized air cleaner intervention trial conducted in a population of asthmatic children living in Baltimore, Maryland, USA. We find that among children for whom the air cleaner reduced indoor particulate matter concentrations, the intervention resulted in a meaningful improvement of asthma symptoms with an effect generally larger than previous studies have shown. A key benefit of using principal stratification in environmental intervention studies is that it allows investigators to estimate causal effects of the intervention for sub‐groups defined by changes in the indoor air pollution concentration. Copyright © 2014 John Wiley & Sons, Ltd.     

Epidemiologische Erforschung und ökonomische Bewertung gesundheitlicher Umweltrisiken

In environmental health research, methods for quantitative analysis of human population studies data are gaining importance. In recent years, it has been realized that they can also provide an important link to the economic view on environmental health effects. In this review, fundamental concepts and methods from environmental epidemiology and health economics are presented and it is shown how they can be linked in order to support environmental policy decisions. In addition, the characteristics of environmental epidemiology and the role of epidemiologic studies in risk assessment are discussed. From the economic point of view, cost-of-illness studies and cost effectiveness studies are the main approaches, and we have placed special focus on methods of monetary valuation of health effects that are generally proposed in the environmental context. Two conceptually differing strategies to combine epidemiologic and economic evidence are presented: the environmental attributable fraction model as a top-down approach and the impact pathway approach which follows a bottom-up analysis strategy. Finally, two examples are used to illustrate the application of these concepts and methods: health risks caused by fine particle air pollution and their costs, and the cost-effectiveness of radon exposure reduction policies.     

Étude de la santé déclarée par les personnes riveraines de sources locales de pollution environnementale : une revue de la littérature. Seconde partie : analyse des résultats et perspectives

BackgroundEpidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. This second part presents the results of the studies.MethodsBased on a literature review (51 papers), this article presents an analysis of the contribution of self-reported health to epidemiological studies investigating local sources of environmental pollution. It discusses the associations between self-reported health and exposure variables, and other risk factors that can influence health reporting.ResultsStudies using self-reported health showed that local sources can be associated with a wide range of health outcomes, including an impact on mental health and well-being. The perception of pollution, especially sensory information such as odors, affects self-reported health. Attitudes referring to beliefs, worries and personal behaviors concerning the source of pollution have a striking influence on reported health. Attitudes can be used to estimate the reporting bias in a biomedical approach, and also constitute the main explanatory factors in biopsychosocial studies taking into account not only the biological, physical, and chemical factors but also the psychological and social factors at stake in a situation of environmental exposure.ConclusionStudying self-reported health enables a multifactorial approach to health in a context of environmental exposure. This approach is most relevant when conducted within a multidisciplinary framework involving human and social sciences to better understand psychosocial factors. The relevance of this type of approach used as an epidemiological surveillance tool to monitor local situations should be assessed with regard to needs for public health management of these situations.     

Odor frequency and odor annoyance. Part I: assessment of frequency, intensity and hedonic tone of environmental odors in the field

Objective Odors can be evaluated as being pleasant or unpleasant (hedonic tone), but this differentiation was not incorporated into environmental odor regulation. In order to study the hedonic-induced modification of dose–response associations for community odor annoyance a pertinent field study was conducted. This paper covers the first step, namely the development and validation of a standardized human observation strategy for the direct quantification of the frequency, intensity, and hedonic tone of environmental odors in the field. Methods Grids with equidistant observation points were located around six industrial odor sources, two with pleasant (sweets, rusk bakery), two with neutral (textile production, seed oil production), and two with unpleasant odor emissions (fat refinery, cast iron production). These points were visited by trained observers, screened for normal olfaction and reliable performance, in a systematic fashion for an observation time of 10 min duration. Exposure-related information from the observers in terms of frequency, intensity (six-point scale) and hedonic tone (nine-point scale) were compared to that of 1,456 residents using the same rating scales. Results Residents evaluated the industrial odors more intense and more unpleasant than the panelists. Furthermore, for the residents only negative relations between odor intensity and hedonic tone were found while for the observer pleasant odor became more pleasant with increasing intensity. Instead of three classes of industrial odors, namely pleasant, neutral and unpleasant, the responses allowed only for two odor classes, namely pleasant and not pleasant, the latter also covering the neutral category. Conclusions The developed methodology has been shown to yield valid information about odor exposure in the field. With regard to different application settings the discrepancies between external observers and affected residents are discussed in terms of different information processing strategies, namely stimulus-based (bottom-up) for the panel and memory-based and, thus, subject to cognitive bias for the residents (top-down). Parts of these findings were presented at the 15th Congress of the European Chemoreception Research Organization in Erlangen (2002), at the 43rd Congress of the German Society of Psychology in Berlin (2002), and at the at the 9th Meeting of the International Neurotoxicology Association in Dresden (2003).     

Contribution of case-crossover design to the analysis of short-term health effects of air pollution: reanalysis of air pollution and health data

BACKGROUND: During the last decades, numerous studies have shown significant links between short-term exposure to air pollution and health. Time series design have been widely used in order to study these associations. In recent years, the case-crossover design has been applied to the analysis of acute effects of environmental exposures, especially air pollution. The aims of this paper are to describe the case-crossover design and to compare this approach with time series design to assess the association between air pollution and health. METHODS: In the case-crossover approach, a case-control study is conducted whereby each person who had a health event (case period) is matched with himself/herself on a nearby time period where he/she did not have the event (control period). Review of the literature shows that the referent selection strategies can be associated to a bias in the estimation of the health effect of air pollution. In comparison with time series design, the case-crossover design is easier to conduct, and individual factors can be taken into account. Nevertheless, it is not possible to take into account the overdispersion in the health indicator with this approach. RESULTS AND CONCLUSION: In conclusion, we suggest to use time series analysis with population data and case-crossover design with individual data.     

Road-traffic pollution and asthma - using modelled exposure assessment for routine public health surveillance

Asthma is a common disease and appears to be increasing in prevalence. There is evidence linking air pollution, including that from road-traffic, with asthma. Road traffic is also on the increase. Routine surveillance of the impact of road-traffic pollution on asthma, and other diseases, would be useful in informing local and national government policy in terms of managing the environmental health risk.Several methods for exposure assessment have been used in studies examining the association between asthma and road traffic pollution. These include comparing asthma prevalence in areas designated as high and low pollution areas, using distance from main roads as a proxy for exposure to road traffic pollution, using traffic counts to estimate exposure, using vehicular miles travelled and using modelling techniques. Although there are limitations to all these methods, the modelling approach has the advantage of incorporating several variables and may be used for prospective health impact assessment.The modelling approach is already in routine use in the United Kingdom in support of the government's strategy for air quality management. Combining information from such models with routinely collected health data would form the basis of a routine public health surveillance system. Such a system would facilitate prospective health impact assessment, enabling policy decisions concerned with road-traffic to be made with knowledge of the potential implications. It would also allow systematic monitoring of the health impacts when the policy decisions and plans have been implemented.     

南宁市新装修居室空气污染状况及其对人群健康的影响

目的了解南宁市新装修居室空气污染状况及其对人体健康的影响。方法按照GB/T18883—2002《室内空气质量标准》对南宁市2002—2006年130户新装修居室内空气中甲醛、苯、甲苯、二甲苯和放射性水平进行检测;对25户室内空气中甲醛浓度超标的居室进行跟踪检测,并对居民健康状况进行问卷调查。结果130户新装修居室空气样本甲醛浓度合格率为25.6%,氨浓度合格率为27.1%,平均浓度超标倍数分别为3.88倍和1.35倍;而放射性水平及苯、甲苯、二甲苯浓度合格率分别为99.6%,97.6%,89.5%,91.9%。25户室内空气甲醛浓度超标居室入住6～12个月后空气甲醛浓度低于人住时(P<0.01)。健康状况问卷调查结果显示,居民入住时均有不同程度的不良反应出现,其中以咽喉疼痛的发生率最高,达92%。结论甲醛和氨是南宁市新装修居室环境中最主要的污染物,新装修居室空气污染已对人体健康产生一定程度的影响。     

Solutions to health care waste: life-cycle thinking and "green" purchasing

Health care waste treatment is linked to bioaccumulative toxic substances, such as mercury and dioxins, which suggests the need for a new approach to product selection. To address environmental issues proactively, all stages of the product life cycle should be considered during material selection. The purchasing mechanism is a promising channel for action that can be used to promote the use of environmentally preferable products in the health care industry; health care facilities can improve environmental performance and still decrease costs. Tools that focus on environmentally preferable purchasing are now emerging for the health care industry. These tools can help hospitals select products that create the least amount of environmental pollution. Environmental performance should be incorporated into the evolving definition of quality for health care.