2017年10月19日 星期四

Checklists are boring, but death is worse

https://news.harvard.edu/gazette/story/2017/10/checklists-are-boring-but-death-is-worse/
SCIENCE & HEALTH > HEALTH & MEDICINE
Checklists are boring, but death is worse

In conversation with Malcolm Gladwell, surgeon-writer Atul Gawande explains how simple systems can save lives
October 16, 2017 | Editor's Pick Popular

By Alvin Powell, Harvard Staff Writer
EmailTwitterF new information that can save the lives of people who not long ago would have died. The challenge? Keeping it all straight.


Atul Gawande, a Harvard professor and surgeon and New Yorker staff writer, illuminated the problem by recalling a letter he received five years ago from a Texas man who was in a head-on collision at 70 miles an hour. The injuries were severe enough that years ago they might have killed the man, Gawande said. Instead, emergency responders were on the scene within minutes. Within a few more, the man was in a helicopter to a major hospital, where his spleen was removed, the bleeding was stopped, and his condition stabilized.

From there, Gawande said, the patient had to endure months of treatments addressing different injuries, but in time he got on with his life. That is, until he went to the beach one day and contracted an infection.

The spleen can be important in fighting certain infections, Gawande noted. That’s why patients who have it removed typically are given three post-procedure vaccinations. In this case, the man received only two. The third would have protected him from the bug he picked up at the beach. The man lost his feet, fingers, and nose. Then he lost his job and his ability to take care of his family.


‘We love rescue and the heroism of being able to save someone. The death that didn’t happen is invisible.’ — Atul Gawande

The incident was awful, but not isolated, said Gawande. He remembers one case at Brigham and Women’s Hospital in which the patient died. What’s needed, he said, are simple systems to help, such as the surgical checklist he developed at Ariadne Labs, which he founded and which is a joint center of the Brigham and the Harvard T.H. Chan School of Public Health.

Checklists, smartphone apps, or other interventions are penicillin-like in their life-saving potential, said Gawande, who spoke Friday at Faneuil Hall as part of HUBweek. His checklist takes aim at preventable surgical deaths, the estimated cause of as many as half of all surgery-related deaths. Recently published research on a checklist trial in South Carolina hospitals showed a reduction of 22 percent of all surgical deaths.

Though the systems can potentially save many lives, Gawande, in response to questions from author Malcolm Gladwell, said that they get little attention. Further, they meet resistance from a significant minority of doctors who feel they don’t need them.

It’s perhaps telling, Gawande said, that of the 25 percent of surgeons who said in a recent survey that the checklists were too long and unnecessary, 95 percent said that if they were having surgery, they’d want all the items on the checklist performed.

Gawande and Gladwell discussed whether the problem was related to heroism — or its lack. People get excited about saving someone who’s hurt, which is one reason surgeons are held in such high regard and demand such high salaries. There’s nothing dramatic about an injury that’s headed off, he noted, so even though the statistics tell of a life-saving impact, the work often goes unnoticed.

“We love rescue and the heroism of being able to save someone,” Gawande said. “The death that didn’t happen is invisible.”

空氣污染是某些疾病的重要原因 Researchers looked at the combined effects of air, water and soil pollution…

Studies have shown that pollution can be an important cause of diseases including asthma, cancer, heart disease, stroke and lung disease.

研究表明,空氣污染可能是哮喘,癌症,心臟病,中風和肺部疾病等疾病的重要原因。


Researchers looked at the combined effects of air, water and soil pollution…
NPR.ORG

馬兜鈴酸 引發近8成肝癌 醫籲別吃來路不明中草藥


馬兜鈴酸 引發近8成肝癌
基因突變增風險 醫籲別吃來路不明中草藥
2017年10月20日

【沈能元╱台北報導】國內最新研究證實,台人罹肝癌竟與中草藥的馬兜鈴酸成分息息相關。林口長庚醫院耗費三年、分析九十八名肝癌患者的基因,發現近八成有馬兜鈴酸才會引起的特殊基因突變,這突變也提高肝癌風險;醫師指,為避免罹患肝癌,切忌服用來路不明的中草藥,以防基因突變、細胞癌化。


也恐提高腎癌機率

林口長庚昨發表研究成果,主持研究的該院胃腸肝膽科主任謝森永說,國內每年新增肝癌患者一萬一千多人、八千人死亡,以往認為肝癌與肝臟慢性發炎、肝硬化有關,該研究蒐集一九九八到二○一三年、該院及台大醫院近百名肝癌病患資料,基因定序後發現,七十六人體內有馬兜鈴酸才會引起的獨特基因突變形態,顯示馬兜鈴酸與國人肝癌高度相關。
謝森永表示,馬兜鈴酸是現今已知致癌性最高的基因突變物質,「甚至高於紫外線及菸品中的尼古丁」,主因是馬兜鈴酸易和DNA結合,可直接接上DNA的核苷酸,進而造成基因突變,當馬兜鈴酸經肝臟代謝,就會增加肝癌風險。此研究成果已發表在國際知名的《科學轉譯醫學期刊》,醫界也發現馬兜鈴酸可能提高腎臟、膀胱、泌尿道等癌症機率。
長庚中醫部主任陳俊良說,馬兜鈴酸常用在減重、消水腫及治療關節炎,台灣二○○三年已禁用含馬兜鈴酸的中藥材,如關木通、馬兜鈴、天仙藤等,但中國尚未禁用,提醒不應服用來路不明的中草藥,有減重或治療關節炎等需求的女性更要注意。 

B肝C肝要更注意

台灣肝癌醫學會名譽理事長王鐘貴說,長期服用來路不明的中草藥,恐造成肝臟慢性發炎,並引發肝硬化、肝癌,尤其是已患B、C型肝炎或肝硬化者,千萬勿吃不明中草藥。 

預防肝癌注意事項

●一般民眾及慢性肝炎、肝硬化患者,勿服用來路不明的中草藥
●切忌喝酒過量,也別吃發霉的玉米、花生等,以免增肝癌風險
●已有慢性肝炎、肝硬化者,應遵從醫師處方,按時服藥控制病情
●B、C型肝炎帶原者或病人,3∼6個月應做1次腹部超音波或抽血
●接種B肝疫苗可預防B肝,並降低肝癌威脅
資料來源:謝森永醫師、陳俊良醫師 

2017年10月17日 星期二

"失眠"的"治療"

.......對於失眠的治療,目前有幾種方式,我們可以採用非藥物,以及藥物的方式處理。
在非藥物的治療上,目前可以使用認知行為治療(Cognitive-Behavioral Therapy,CBT)。通常這種方式會比藥物的治療有效且持久。
不過,在認知行為治療方法裡,首先要找出造成患者失眠的原因是什麼,並且也要讓患者知道,其實,足夠的睡眠時間因人而異,也就是每個人入睡與睡飽所需要花的時間並不一樣,就算需要花三十分鐘才能入睡,也是正常。
另外,如果夜間醒過來上廁所後睡不著,這也是正常,並不需要過度擔心與害怕。我們會建議睡前兩個小時不要喝水,或不要飲用含咖啡因、酒精性飲料,可以降低夜間如廁的頻率。
另外,睡眠的環境也很重要,一個安靜、溫馨而且舒適的睡眠環境是培養睡意的必要條件。

張醫師暖心提醒

對於失眠的長輩,請戒掉在床上看書、看電視的習慣,因為這些事情都很容易讓大腦處在活躍的思考狀態。
睡前在床上做這些事情就比較難以入睡,除非在床上看的是會容易讓人感到昏昏欲睡的書,如微積分,就另當別論。

腹式呼吸比數羊有效

另外,如果在日常生活裡,能夠找到適合自己的放鬆方式,那麼,對於克服失眠,也會有幫助,如「腹式呼吸」(Diaphragmatic Breathing)或「轉移注意力」都是不錯的方式。
腹式呼吸就是深呼吸,也有人稱為橫膈膜呼吸。當我們呼吸時,由鼻子吸氣,但是用嘴巴吐氣,而且吐氣時,最好可以超過五秒鐘。慢慢的吐氣,在吐氣時,想像把心中所有的悶氣都吐出來。
如果在失眠時,能夠做腹式呼吸,放鬆緊繃的神經,等到身體放鬆了,自然就容易睡著。
腹式呼吸絕對比數羊還有效。曾經有病人說,她每次睡不著就數羊,但隨著時間滴滴答答的過去,數的羊越來越多隻,卻還是沒辦法睡著時,她就會變得更焦慮。她會一直去看鬧鐘,看現在是幾點,而自己還剩下多少時間可以睡,反而就更睡不著,結果到最後她就一直數羊數到天亮。

養成一躺在床上就是「想睡覺」的習慣

「轉移注意力」是指躺在床上睡不著時,乾脆起床,做些輕微的活動,如整理衣物等,等到有睡意,再回床上睡。睡不著時,不要待在床上,盡量建立躺在床上就是「想睡覺」的習慣。

假如每次失眠的時候都躺在床上,腦海裡不斷地想著今晚又睡不著了,久而久之,以後看到床,就會聯想到睡不著的情境,然後莫名的恐慌,反而會讓失眠的情況更嚴重。
在藥物治療上,抗焦慮藥物、抗組織胺藥物、BZD(Benzodiazepine)與非BZD類的鎮靜藥物都可以治療失眠。在臨床上,我們會依照患者的身體情況與睡眠模式來選擇,並且調整藥物的劑量。
通常醫師對於入睡困難的患者,會偏向使用短效的藥物,這是因為短效型的藥物在服用後,很快就可以發揮效果。至於睡到一半很容易醒過來的患者,我們會搭配中效型或長效型的藥物,幫助他們一夜好眠。
造成失眠的原因,每個人都不一樣,需要針對每個人的情況處理。
如果家中的長輩深受失眠所苦,短暫的藥物治療對於症狀的改善,是有必要的,但是不單單只是請醫師開立安眠藥給他們使用,也可以與醫師討論,一起找出他們失眠的原因,這才是根本之道。
本文經授權轉載自寶瓶文化《照顧父母:不讓父母的小病痛,變成大危機

2017年10月16日 星期一

Why a little dirt is good for us

UC Davis researchers find some antiseptics and disinfectants we use everyday may be harmful to our health.
UC Davis研究人員發現我們每天使用的防腐劑和消毒劑可能會危害我們的健康.
Disinfectants can inhibit cellular energy production and even lead to an increased risk of Parkinson's disease.
UNIVERSITYOFCALIFORNIA.EDU

Travoys Arriving with Wounded at a Dressing-Station at Smol, Macedonia, September 1916 (1919, Art.IWM ART 2268)



音節
 
dis • in • fect • ant
 
発音
 
dìsinféktənt
[名詞]
  1. 1(主として手術道具など無生物体用の)消毒薬,消毒剤.
  2. 2((俗)) ((おどけて)) ソース,調味料.
━━ [形容詞] 消毒に用いられる,滅菌[殺菌]効果のある.
語源
1837.→DISINFECT

音節
 
an • ti • sep • tic
 
発音
 
æ`ntəséptik
レベル情報
 
社会人必須
[形容詞]
  1. 1殺菌の,滅菌の;殺菌力のある,消毒する,防腐(性)の. cf. ASEPTIC 1
    • antiseptic finish
    • 防腐加工.
  2. 2細菌のない,消毒[滅菌]された,無菌状態の.
  3. 3非常に清潔な.
  4. 4汚染のない.
  5. 5〈言葉などが〉冷淡な,人間味のない.
━━ [名詞] 消毒剤,防腐剤
    • apply an antiseptic
    • 消毒薬を塗る.
語源
1751

  • 《名詞》消毒剤

英國醫院供應食品飲品的熱量、含糖量、含脂量的"管制"


http://www.bbc.com/news/health-41630681?ns_mchannel=social&ns_campaign=bbc_england&ns
"Super-sized" chocolate bars are to be banished from hospital shops, canteens and vending machines, NHS England says.
Sweets and chocolate sold in hospitals should be 250 calories or under, the head of the body says.
Under the plans, most "grab bags" will be banned - with hospitals given a cash boost for facilitating the change.
The proposals would also see 75% of pre-packed sandwiches coming in at under 400 calories.
Pre-packed savoury meals and sandwiches must also contain no more than 5g of saturated fat per 100g.
And 80% of the drinks stocked must have less than 5g of added sugar per 100ml.

'Obesity epidemic'

In April, NHS England said it would ban sugary drinks if hospital outlets did not cut down on the number they sell.
Mr Stevens said the NHS was "stepping up" to combat an issue that was causing "an epidemic of obesity, preventable diabetes, tooth decay, heart disease and cancer".
"In place of calorie-laden, sugary snacks we want to make healthier food an easy option for hospital staff, patients and visitors."
NHS staff are also being targeted as part of the move to tackle unhealthy eating, including those on overnight shifts.
It is estimated that nearly 700,000 of the NHS's 1.3million staff are overweight or obese.
NHS premises have huge footfall from the communities they serve, with one million patients every 24 hours.
The Royal Voluntary Service, the biggest hospital retailer across the UK, said it had already begun introducing healthier choices and had seen fruit sales go up by a quarter.
Public Health England says hospitals have an "important role" in addressing obesity and not just dealing with the consequences.
Campaigners says more action is till needed.
Helen Dickens from Diabetes UK said: "We look forward to seeing more information on how it will work in practice.
"However this is just one piece of the puzzle when it comes to tackling obesity. We need to go much further, which is why we are also calling for the Government to toughen restrictions on junk food marketing to children, end price promotions on unhealthy foods and introduce mandatory front of pack food labelling."

2017年10月15日 星期日

Dr. Shigeaki Hinohara: if you must retire, do it well after age 65

Dr. Shigeaki Hinohara, credited with building the foundations of Japanese medicine and helping make Japan the world leader in longevity, often practised what he preached.
The physician, chairman emeritus of St. Luke's International University, and honorary president of St. Luke's International Hospital recommended several basic guidelines for living a long, healthy life in an interview with Japan Times journalist Judit Kawaguchi. Among them: Don't retire. And if you must, retire much later than age 65.
In the interview he explained that the retirement age in Japan was set at 65 years old back when the average life expectancy was 68. Now, people are living much longer — the average life expectancy in Japan as of 2015 was almost 84 years — and so they should be retiring much later in life too.

Until a few months before his death on 18 July in Tokyo, The New York Times reports, Hinohara continued to treat patients, kept an appointment book with space for five more years, and worked up to 18 hours a day. He was 105 years old.
"He believed that life is all about contribution, so he had this incredible drive to help people, to wake up early in the morning and do something wonderful for other people," Kawaguchi, who considered Hinohara her mentor, told the BBC. "This is what was driving him and what kept him living."
"He always had today's goals, tomorrow's, and the next five years'," she said.
Hinohara's other guidelines for living well included:
Worry less about eating well or getting more sleep, and have fun. 

"We all remember how as children, when we were having fun, we often forgot to eat or sleep. I believe that we can keep that attitude as adults, too. It's best not to tire the body with too many rules such as lunchtime and bedtime."
If you want to live long, don't be overweight. 

"For breakfast I drink coffee, a glass of milk, and some orange juice with a tablespoon of olive oil in it. Olive oil is great for the arteries and keeps my skin healthy. Lunch is milk and a few cookies, or nothing when I am too busy to eat. I never get hungry because I focus on my work. Dinner is veggies, a bit of fish and rice, and, twice a week, 100 grams of lean meat."
Don't blindly follow what your doctor says. 


"When a doctor recommends you take a test or have some surgery, ask whether the doctor would suggest that his or her spouse or children go through such a procedure. Contrary to popular belief, doctors can't cure everyone. So why cause unnecessary pain with surgery? I think music and animal therapy can help more than most doctors imagine."
To conquer pain, have fun. 

"Pain is mysterious, and having fun is the best way to forget it. If a child has a toothache, and you start playing a game together, he or she immediately forgets the pain. Hospitals must cater to the basic need of patients: We all want to have fun. At St. Luke's we have music and animal therapies, and art classes."
Always take the stairs and carry your own belongings. 
"I take two stairs at a time, to get my muscles moving."

2017年10月14日 星期六

浸泡在農藥化肥裡的國度中國土壤狀況調查實錄2017;中國稻米產區重金屬污染嚴重;中國鎘大米 (cadmium rice) 2014




|浸泡在農藥化肥裡的國度中國土壤狀況調查實錄

中國14億人,平均到每一個人,我們每年每人要吃掉2.67公斤農藥!1980年,中國農藥產量不過4萬噸;三十年過去了,農藥產量翻了近百倍!
在中國,農藥企業近4000家,工信部批准的上規企業1506家,研製農藥種類有1000多種,而常見的害蟲卻只有20餘種!據衢州市植保站站長徐南昌分析:每年大量使用的農藥僅有0.1%左右可以作用於目標病蟲,99.9%的農藥則進入生態系統。最終這些農藥通過食物鏈,都會進入到我們身體!
化肥:50KG/年/人

http://chinadigitaltimes.net/chinese/2017/03/%E5%8D%8E%E5%A4%8F%E6%96%87%E6%91%98%EF%BD%9C%E4%BB%98%E6%B0%B8%E5%86%9B%EF%BC%9A%E6%B5%B8%E6%B3%A1%E5%9C%A8%E5%86%9C%E8%8D%AF%E5%8C%96%E8%82%A5%E9%87%8C%E7%9A%84%E5%9B%BD%E5%BA%A6-%E4%B8%AD%E5%9B%BD/



******

中文
英文
中英对照

時報看中國

中國稻米產區重金屬污染嚴重

河南省的一名農婦在制鉛廠附近的農土中勞作。
Sim Chi Yin for The New York Times
河南省的一名農婦在制鉛廠附近的農土中勞作。

一項研究顯示,中國重要的稻米產地遭受了嚴重的重金屬污染,而農田靠近工礦企業的情形正對中國的食物鏈構成重大威脅。
在《「有色」米——湖南衡東縣稻米重金屬污染調查》(Cadmium Rice: Heavy metal pollution of China』s rice crops)一文中,綠色和平組織東亞分部(Greenpeace East Asia)的研究人員對湖南省一座有色金屬冶煉工業園附近的農田、閑置土壤、地表水和稻米進行了採樣。湖南是中國水稻產量最高的省份。
在這項研究中,研究人員發現,一些點位的土壤鎘含量超過國 家健康標準200倍。這是一條新的證據,表明在幾十年的快速工業化和經濟高增長後,中國部分土壤出現了嚴重退化,而此類證據正在越積越多。本項研究採集的 所有稻米樣品中,只有一份里的鎘含量沒有超出中國設定的食品安全標準。
自從2013年廣東省的一份政府報告稱44%的稻米樣品出現了鎘含量超標,並引起人們的關注以來,「鎘米」在中國已經成為了廣為人知的名詞。不過,綠色和平組織的這項研究把「鎘米」概念擴展到了「砷米」、「汞米」和「鉛米」上。在這四種有毒物質中,只有汞的含量顯得相對安全。
隨着「快速的城市化進程,中國正在奮力搶救足夠的耕地,並保持較高的糧食自給水平。但除了產量之外,中國是否能保持土壤的健康仍是一個問題,」綠色和平組織的媒體主任唐大旻通過電子郵件接受採訪稱。
該研究試圖查明鎘的來源——近期的另一項政府研究顯示,中國7%的土壤遭受金屬污染。
綠色和平組織指出,很多採礦和冶煉大省同時也是產糧大省。從該組織提供的兩張地圖中可以看到,用色彩標出的省份中,金屬冶煉區和產糧區彼此靠得很近。
「鎘污染的主要來源是冶煉廠的排放,」廣東省生態環境與土壤研究所的土壤專家陳能場表示。他的說法跟綠色和平的研究結論相吻合。
研究稱:「根據閑置土壤樣本的分析結果,五種金屬元素(砷、鎘、鉛、錳和鋅)的濃度彼此間有顯著的關聯性,表明很可能來自同一個主要的污染源。這五種金屬在該區域閑置土壤中濃度的升高,很可能主要是由此工業園的排放造成的。」
文中稱,這些稻米的「鎘含量最值得關注,除了一個樣本之外,其他樣本的鎘含量均超過了食品安全國家標準規定的稻穀中鎘含量限值(0.2 mg/kg),最高的一個樣本超出22倍」。
在接受電話採訪時,陳能場說:「通過食物攝入鎘是一個小劑 量慢性中毒的過程。人體累積鎘的速度非常緩慢,但排泄和排出鎘的速度更慢。鎘的半衰期大約是17至38年,也就是說,要花這麼長的時間才會減少一半。一旦 進入人體,鎘基本上就會一直留在體內——就算不是一輩子,至少也會有大半輩子。」
「被人體吸收的鎘大約有三分之一會累積在腎臟,另外四分之一累積在肝臟。這對人體健康的危害非常巨大。一般來說,一個人一生不能攝入超過2克的鎘,」他說。
德博拉·布盧姆(Deborah Blum)上周在《紐約時報》的Well博客中寫道,稻米是中國人最喜愛的糧食,但也極易受到污染,因為它很容易從土壤中吸收金屬。
稻米是「世界上最廣泛消費的糧食之一,也是大自然中非常容易吸收金屬化合物的物種之一,」布盧姆寫道。她指出,美國也存在鎘和砷污染稻米的問題。但是,研究發現,德克薩斯州稻米中的污染水平「沒有高到足以引發警報的地步」。



‘Cadmium Rice’ Is China’s Latest Food Scandal
廣東抽檢大米米製品44%鎘超標
狄雨霏 2013年05月21日


北京——所謂「鎘大米」是指鎘含量超過國家安全標準的大米,「鎘大米」正讓中國處於最新的食品安全恐慌之中,在這個長期以來被不安全食品所困擾並深陷不安的國家引發了一場健康和公關危機。






上周,廣東省的有關當局發現,其檢查的大米或大米製品中,44%以上樣品的這種有毒金屬含量大大超過標準,這種有毒金屬主要出現在鋅礦石中,或較小程度地出現在硫鎘礦石中。有毒金屬對土壤的污染與鋅礦開採有密切聯繫。

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但廣州市食品藥品監督管理局後來關緊口風,稱「不便透露」涉事大米的品牌,使得消費者無法保護自己的健康。






這種做法讓許多人驚愕,也在新聞媒體和網絡上引發了批評狂潮。上周末,該機構鬆了口,公布了八個鎘含量嚴重超標的品牌和產品,而其查到的鎘含量超標的品牌和產品共有18種。政府方面說,這些發現來自今年第一季度 的食品安全抽檢,並沒有覆蓋市面上的所有大米。據官方媒體新華通訊社報道,不合格大米中鎘含量高達0.4毫克/千克,是中國安全限量的兩倍。






新華社和中共喉舌報紙《人民日報》給消費者提了一條實用、但也許只是短期有效的建議:「專家建議不要長期食用一個地方出產的糧食,應該儘可能分散化,降低風險。」






這在網上引發了一場熱鬧,網名們驚嘆黨報竟會給出這種建議。新浪微博上一個賬戶名為寧福神的人寫道,「這樣保證每個人都能吃上鎘大米。」






新華社和《人民日報》指出,從長遠來講,要通過治理土壤來 解決這一問題,中國很多地區的土壤都因工業廢料和採礦而受到污染。這兩家媒體還指出,治理土地需要更好的環境保護法和法律實施,以及更好的檢測系統。文章 還專門指出了鉛這種土壤污染物。製造手機、相機和電腦中的鎳鎘蓄電池需要鎘。作為主要的電池生產國,中國是鎘的主要消費國。


「大米中的鎘通常來自水稻生長的土地,而土地已被採礦和化學廢料所污染,」位於北京的中國農業大學的食品安全專家范志紅告訴官方媒體《環球時報》(Global Times)。


鎘是一種已知的致癌物質,會在體內累積,損壞腎、肺等器官,也能引發骨病。根據www.cadmium.org網站,不吸煙人群主要通過食物攝入鎘,而吸煙人群的攝入量可能是不吸煙人群的兩倍。


根據上述網站,鎘污染是全球性的問題:主要污染源是磷肥的使用、化石燃料的燃燒,以及鋼鐵生產。


《環球時報》的報道稱,大米污染是中國的長期問題,南京農業大學2011年的一項研究發現,全國範圍內大約有10%的大米含鎘量過高。













狄雨霏(Didi Kirsten Tatlow)是《國際先驅論壇報》(The International Herald Tribune)駐京記者。

翻譯:陶夢縈