CONFUSED DOCTORS
困惑的医生
The problem, according to Dr. Carissa Baker-Smith, an epidemiologist at the University of Maryland and the lead data scientist on the new American Academy of Pediatrics guidelines,[1] is that many of these issues go undetected until disaster strikes.
根据马里兰大学流行病学家和新成立的美国儿科学会指南的首席数据科学家卡丽莎·贝克-史密斯说法，关键的一点在于许多这样的问题直到疾病发生时才被会被发现。
She points to several studies that provided the definitive evidence that although heart disease often may not become apparent until adulthood, its seeds are planted in childhood.
她指出有多项研究提供了明确的证据证明，尽管心脏病在成年前通常可能会不明显，但是它的种子在童年期就种下了。
A study called Pathobiological Determinants of Atherosclerosis in Youth in the 1990’s and the ongoing Bogalusa Heart Study have measured the prevalence of narrowed and hardened arteries (atherosclerosis) in adolescents and young adults who died accidentally.
90年代一项叫做关于青少年动脉粥样硬化病理决定因素的研究和如今正在进行中的博加卢萨研究所研究发现，在意外死亡的青少年和年轻的成年人中研究发现动脉狭窄硬化（动脉粥样硬化）普遍存在。
Both studies show strong associations between atherosclerosis - a leading predictor of heart disease - and smoking, cholesterol levels and hypertension. "I really want people, especially parents, to understand that high blood pressure does occur in kids. We\\\\\\'re seeing adult disease in children," Baker-Smith says.
这两项研究表明动脉粥样硬化-心脏病的主要预测因子-与吸烟、胆固醇水平和高血压之间的存在紧密联系。贝克-史密斯说：“我真的希望人们明白，尤其是父母，高血压的的确确发生在孩子身上，我们在儿童身上看到了成年人的疾病。”
These results challenge the now-outdated notion that hypertension in kids was primarily the result of congenital conditions that affected the kidney and heart. Although genetics accounts for one-fifth of all high blood pressure cases in kids under 18, the remainder are "adult-style" hypertension issues, caused by a convergence of biological and environmental factors.
这些结果挑战了现在一种过时的观念，即小儿高血压主要是先天性疾病影响肾脏和心脏的结果。在18岁以下所有的小儿高血压病例中，尽管遗传因素占了1/5，余者全是“成人型”高血压问题，这种“成人型”高血压是由生物和环境因素综合作用的结果。
Large epidemiological studies by the Centers for Disease Control and Prevention have documented a rise in systolic blood pressure and in diastolic blood pressure in children between 1988 and 2000, which suggests the increase in pediatric hypertension isn\\\\\\'t just the result of heightened awareness. Although adults have a single cutoff[2] for potential blood pressure problems, determining that point is more complex for pediatricians because blood pressure in growing children varies by age, height and sex.
由疾病控制预防中心的大型流行病学研究证实，早在1988至2000年就有儿童收缩压和舒张压增高的现象，这表明儿童高血压现象的增加不仅仅是现在才意识到的结果。虽然对于成年人来说潜在高血压问题存在一个界限值，但是对儿科医生来说，由于在儿童成长中血压会因年龄、身高和性别的不同而不同，因此确定这一界限值更加困难.[3]
Even when doctors were vigilant about screening for blood pressure issues in children, they struggled to interpret those results. "A lot of doctors were very confused," says Dr. Suzanne Lazorick, a pediatrician and preventive medicine physician at Eastern Carolina University.
即使医生在对儿童高血压问题筛查时保持如此警惕，也很难解释这些结果。东卡罗来纳大学的儿科医师和预防医学医师苏珊妮·拉佐里克说：“很多医生也很困惑啊”。
Kaelber puts it more starkly. "If you reviewed electronic medical records [for children], you could see blood pressures recorded, but the pediatrician never diagnosed hypertension," he says. Physicians were unclear about what blood pressure level was too high,[4] so the condition in children went unnoticed.
卡尔伯博士对此所述更加了当。她说：“如果你回顾那些电子病历（指儿童的），你可以看到血压值被记录下来，但是儿科医师从来不诊断高血压。”医生并不清楚什么水平的血压才算是血压过高，所以儿童的病情就没有得到注意。
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These challenges led Kaelber and Dr. Joseph Flynn, a nephrologist at the University of Washington, to call for a revision of the 2004 guidelines they had authored.
这些挑战使得卡尔伯和华盛顿大学的肾病学家约瑟夫·弗林博士呼吁修订他们曾编写过的2004版指南。
Baker-Smith led a review of the 15,000-plus studies published since 2004 to create a rigorous base from which to distill findings. From there, they reviewed how well the current standards were working and what scientists were learning about high blood pressure in children and adolescents.
贝克-史密斯牵头审阅了自2004年以来发表的15000多篇综述，以建立一个能从中提炼精华的严谨的资料库。他们从审阅中回顾了当前标准发挥作用之好以及科学家们对儿童和青少年高血压的研究情况。
The finaldocument contains several major changes from previous recommendations, including how to measure blood pressure and how doctors diagnose hypertension, as well as the terminology to use.
最后修改出来的指南有不同于先前指南的几个重要内容的变更，包括如何测量血压和医生们如何诊断高血压，以及相关术语的使用。
Instead of screening for high blood pressure at every health care visit, the new guidelines say to screen only at annual well-child visits beginning at age 3. Many transient factors can affect blood pressure, including stress and caffeine, which could lead to inaccurate data and unnecessary testing. And doctors need several blood pressure readings to make a diagnosis of hypertension.
新的指南指出，高血压的筛查要从儿童3岁开始的年度随访中进行，而不是每一次的健康随访。许多暂时性的因素可能会影响血压，包括压力和咖啡因等，这些都可能导致数据的不准确或不必要的测量。这时医生就需要多次测量血压以做出高血压的诊断。
The panel also altered the transition from pediatric blood pressure tables to the 120/80 mmHg cutoff used for adults. The transition used to come at age 18, so a child could have abnormal blood pressure at the age of 17 years and 364 days and then be fine the next day, Kaelber says. The new tables begin transitioning children to adult markers at age 13, depending on height and weight. This provides more consistency and will ease the transition to adult blood pressure standards.
指南还改变了儿童血压标准向成年人血压标准120/80mmHg的年龄过渡。卡尔伯说，过去这一年龄过渡是18岁，所以一个小孩可能17岁时364天的血压值不正常，但是到了第二天就好了。新标准根据儿童的身高体重，将儿童到成人年龄过渡标定在了13岁。这使得判定标准更加一致，并使得儿童血压标准在向成人的转变中能缓慢过渡。
To de Jesus, the importance of the new guidelines in ensuring adequate diagnosis and treatment of childhood hypertension can\\\\\\'t be overstated.[5] When kids are young, they can completely reverse cardiovascular damage from hypertension or high cholesterol. By the time they reach adulthood, however, this ability diminishes.
新指南对儿童高血压的诊断和治疗制定了标准，对德热苏来说，这一点很重要，再怎么强调都不为过。在孩子们小的时候，他们就可以完全逆转由高血压或高胆固醇所致的心血管损伤。但是等到他们成年的时候，这种能力就降低了。
Kaelber, Flynn, Baker-Smith and colleagues also recalibrated the blood pressure tables to include only children with normal weights. Pediatricians decide if[6] a child\\\\\\'s blood pressure is high by comparing it with those of a group of healthy children.
卡尔伯、弗林、贝克和同事们也重新标定了血压基准，该基准是从正常体重的儿童人群调查得出。儿科医师判断一个小孩的血压是不是高，需要通过与基准组的健康儿童作比较。
But the growing numbers of children who are overweight and obese, two traits strongly linked to increased blood pressure, have skewed that benchmark data[7] . Using only normal-weight children provides a better definition for a healthy blood pressure, Baker-Smith says.
但是现在超重和肥胖的儿童越来越多，而这两点特征是与血压升高密切关联的，这就影响的基准数据的准确性。
The team also eliminated the need for echocardiograms (an ultrasound of the heart) unless the child requires medication, a change that reflects the growing number of hypertensive children without underlying congenital heart issues.
贝克-史密斯说，只有采用正常体重儿童的血压数据，才能更好的定义健康血压值。要是小孩在接受药物治疗，该小组还会给他做超声心动图（一种心脏超声）检查，这一方法的改变揭示出数目攀升的高血压儿童并没有隐匿的先天性心脏问题。
For those with more severe hypertension in need of medication, echo-cardiograms have revealed cardiac complications more usually seen in adults, such as left ventricular hypertrophy, a thickening of the heart muscle.
对于这些高血压更为严重、需要药物治疗的孩子，超声心动图检查出在成年人身上才更多见的心脏并发症，如左心室肥大、心肌增厚。
Lastly, the guideline revision group changed the term "pre-hypertension," used to indicate children whose blood pressure was a concern but who didn\\\\\\'t meet clinical definitions of hypertension, to "elevated blood pressure."
最后，指南修订小组还将“高血压前期”的说法改为“血压升高”。“高血压前期”暗示一个小孩的血压该引起注意了，但是并没有达到临床高血压水平。
The new language is intended to sound an alarm. "Parents tend to hear pre-hypertension and think it\\\\\\'s not a problem because it\\\\\\'s before a disease, but that\\\\\\'s not what we\\\\\\'re trying to say," Lazorick says.
“血压升高”是为了听上去能给人以警报。拉佐里克说：“父母倾向于听到高血压前期，认为这不是病，因为还在疾病之前，但那并不是我们要表达的意思。”
The increasing reliance on ambulatory blood pressure monitoring devices could pose a challenge. Although these monitors provide increased accuracy, not all pediatricians have access to them. Ramping up[8] the availability of ambulatory monitoring will be key to putting the recommendations into practice, Lazorick says.
对动态血压检测设备的日益依赖可能会带来挑战。尽管这些检测仪器测得的准确性更高，但并非所有的儿科医师都能掌握使用。拉佐里克说，普及动态血压检测仪的使用是将上述建议转化为实践的关键。
Although some of these guidelines may seem more conservative-hypertension screening only at regular preventive care visits, reduced recommendations for echocardiogram - they actually decrease the potential for over-diagnosis of pediatric hypertension. "No one wants to give kids a diagnosis they don\\\\\\'t have or a treatment they don\\\\\\'t need," Baker-Smith says.
尽管指南中的一些内容可能看起来比较保守-只会在定期的预防保健时筛查高血压，建议减少做超声心动图-但这些实际上减少了对儿童高血压过度诊断的可能性。贝克-史密斯说：“没有人会想给孩子诊断出他们实际上并没有得的疾病，或者是给他们根本就不需要的治疗。”
No standards can eliminate the risk of overdiagnosis. But given that first-line treatment for children with high blood pressure is dietary and physical activity changes, Baker-Smith says this advice is low-risk and can benefit many children, even those without hypertension. Making these changes isn\\\\\\'t easy, especially in a culture awash in salty, fatty foods.
没有标准可以消除过度诊断的危险。但是鉴于儿童高血压的一线治疗是饮食习惯和运动行为的改变，贝克-史密斯说这个建议的风险就很低，并且对很多孩子都有好处，甚至是那些没有患高血压的孩子。做出这些改变并不容易，尤其是在一个高盐高脂的饮食文化中。
By starting early and modeling healthy behaviors, de Jesus says, parents can teach their kids to make good decisions about food and exercise as they get older and have more autonomy. "Even adults struggle to choose water over soda or juice. How can we expect a 10-year-old to do that?" Lazorick asks.
德热苏斯说，父母可以让孩子在早期就开始养成健康的行为习惯，这样在长大后就能教他们能在食物和锻炼方面做出好的决定，并能更加独立。拉佐里克说：“甚至大人们都会纠结是喝水还是苏打还是果汁。我们怎么能指望一个10岁的孩子那样做呢？”
But for children diagnosed with high blood pressure, having an adult disease requires growing up fast.
但是对于诊断出高血压的儿童来说，患成人疾病就需要尽快长大。
[1] 插入语，并不影响文章的理解，阅读的时候可以忽略，关键的主体还是the problem is that
[2] 截止点;界限
[3] 英文中的关联词可以用“although”表达虽然，但是的意思，但是在中文的关联词是必须要补充完整的，前面有虽然，后面就要有但是，所以这里就需要增词。
英文是先果后因，中文是先因后果，所以这里需要把because后面的内容翻译到前面来，因为。。。所以。。。
[4] 这句是省略了that 的宾语从句
[5] V，夸大，夸张；不会夸大，就是正常的意思，翻译标准符合医学英语的语言特点
[6] 条件状语从句
[7] Who、引导的定语从句修饰children，同上期讲的一样把定语翻译到中心词前面
词句的主语是“the growing numbers of children who are overweight and obese”谓语部分是“have skewed
”翻译的时候前面已经把主语翻译完整了，所以这里就可以用一个字概括“这”，影响了基准数据的准切性
[8] V．加强，加大，根据本文主体翻译成普及，非谓语动词（主动）
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