目前日期文章:201106 (5)

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What happened to the family doctor?

Family doctor

Family doctors are overwhelmed with patients, procedures and paperwork. Many are leaving the field, creating a scarcity of primary-care physicians. (Christopher Serra, For the Times / June 27, 2011)

 

 

 本文轉載自http://www.latimes.com/health/la-he-primary-care-doctors-20110627,0,6729644,full.story

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新竹市一高3學生,連續3個月喉嚨痛、高燒不退,雖不斷到處求診,卻查不出病因,因學生曾發生過多次性行為,醫生懷疑可能是愛滋病感染,建議帶小孩去篩檢。媽媽一開始覺得不可能,對篩檢極排斥,偶然看到醫院免費性病匿名篩檢,檢查後,發現兒子感染愛滋病,媽媽得知結果非常難過,但也只能接受醫生建議進行雞尾酒療法,所幸即早發現、治療,目前已經控制病情。

「愛滋病只有高風險行為,沒有高危險族群」,馬偕醫院感染科醫師蘇世強表示,一般人既定印象會認為只有性工作者、男同志、嫖客或是藥癮者才會感染愛滋,但事實上不戴保險套防護的性行為、與性交往史不明對象間的性行為,以及共用針具與稀釋液等不安全行為,才是愛滋病傳播的主因。

感染科醫師表示,愛滋病患者年齡逐年下降,20到29歲愛滋病患者約4成,30到39歲患者約佔3成5,但高中生得病的病例算是非常罕見。

馬偕新竹醫院目前提供「免費性病匿名篩檢」,民眾如果有問題,可撥打性病匿名預約專線03-611-9595轉2936王小姐,篩檢不需費用、也不用填寫基本資料,歡迎民眾多多利用。

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1. EHEC outbreak (from WHO: http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/ehec-outbreak-in-germany )

2. Enterohaemorrhagic Escherichia coli (EHEC) http://www.who.int/mediacentre/factsheets/fs125/en/

3. 腸道出血性大腸桿菌Q&A http://www.cdc.gov.tw/lp.asp?ctNode=2649&CtUnit=1532&BaseDSD=7&mp=1

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依據世界衛生組織及國際疫情資料顯示,德國自本(100)年4月25日至5月25日,已通報138例溶血性尿毒症候群(Hemolytic uremic syndrome)及血便病例,其中有5例已經確定受到腸道出血性大腸桿菌O104感染, 3名死亡,而且持續有疑似病例通報。依據德國當地衛生單位報告,目前正在調查本次爆發流行事件的原因,初步懷疑可能是蔬果受到細菌污染所致。

另外,瑞典、荷蘭及英國也有曾經至德國旅遊的民眾出現相關症狀。衛生署疾病管制局呼籲,民眾前往德國旅遊或商務活動,應儘量避免生食及食用可能未完全煮熟之食物,杜絕感染腸道出血性大腸桿菌之風險。


近年來腸道出血性大腸桿菌感染症曾在美、日等國造成大規模食因性感染,大多經由未煮熟之肉品或未經巴斯德滅菌之果汁、乳品引起。

該病之主要症狀與併發症:
1. 潛伏期約2~8天。

2. 疾病早期會出現水瀉、腹痛,病情惡化後出現嚴重腹瀉(平均每日腹瀉為3-30次)及血便(潛血─大出血),

3. 嚴重者:腎衰竭、血栓性血小板減少性紫斑症(主要為成人)、溶血性尿毒症候群(主要為小孩) 的症狀,嚴重  者            能導致長期洗腎或造成死亡

4. 死亡率約3%~5%。

5. 研究顯示,大多數的患者是食用受污染的牛肉(特別是中心溫度加熱不易之牛絞肉)、牛奶、飲用水或果汁。

由於腸道出血性大腸桿菌感染症屬食因性感染之疾病,且可循糞口途徑引起人與人間之傳染,疾病管制局特別提出以下幾點預防方法,並呼籲前往德國之民眾加強防範,以避免"病從口入":
一、避免生食,並確認食物已充分加熱煮熟,避免點用可能未完全煮熟之餐點。
二、避免飲用未經滅菌處理之生乳、果汁或生菜沙拉。
三、注意飲用水的衛生。
四、用餐前,上完廁所或接觸動物後,必須使用肥皂徹底洗手。

民眾若有其他傳染病相關問題,可撥打1922傳染病諮詢專線洽詢,或請參閱疾病管制局網站:http://www.cdc.gov.tw

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德國腸道出血性大腸桿菌疫情持續蔓延,世界衛生組織(WHO)呼籲,治療出血性大腸桿菌的病患,不宜倉促服用抗生素。

據外電報導,WHO流行病學專家艾里斯(AndreaEllis)在WHO總部日內瓦召開的記者會中,答覆記者提問時表示,支持當前避免使用抗生素的建議,自行用藥只會增加病菌的抗藥性。

艾里斯也提醒,更應避免使用止瀉藥,否則只會讓病菌滯留在體內

此外,不同於一般所認知,幼童與老年人較易感染大腸桿菌,這波源自德國的疫情,患者多是青壯年、尤以女性居多,艾里斯解釋,這可能與飲食習慣有關。她說,有可能某種食物是女性所偏好,以致婦女攝取比較多,且任何食源性的疾病疫情,都與攝取的食物有關,改變主要感染群的對象。

根據WHO發布的最新疫情通報,截至2日止,已有捷克、美國、德國、丹麥、英國、荷蘭、挪威、西班牙、瑞典、瑞士、奧地利、法國傳出疫情。

累計溶血性尿毒症候群的患者共有552人,其中12人不幸死亡,出血性大腸桿菌患者累計1271人,有6人不幸死亡。

WHO提醒,隨著這波疫情蔓延,務必勤洗手及妥善料理食物,以防交叉感染,尤其任何生食置放在料理檯上,可能會感染其他食物,也會使細菌藉此為媒介,感染其他的食物。

英國南安普敦大學(University of Southampton)的微生物學家研究發現,若置放1000萬個大腸桿菌於乾燥的面上,10分鐘內全部死光,若置放於潮濕的銅面,大腸桿菌也將於45分鐘內死亡。

WHO說,在配置食物的區域置放銅,可有效消滅病原體,減少交叉感染的風險,並防止感染擴散。

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今年國際麻疹疫情嚴峻,歐美先進國家及鄰近之中國大陸、日本、東南亞地區,均有眾多病例報告,尤其是歐洲麻疹疫情自去年持續至今,導至麻疹疫情擴散至其他地區國家;截至今年5月,已有18個歐盟會員國共通報超過10,000例麻疹病例,其中4例死亡;而美國、日本及中國,至5月中旬止,亦分別傳出有80、206及5761名病例。

此外,今年越南北部亦發生大規模之德國麻疹流行疫情,估計超過千名病例。由於每年約有高達數萬到數百萬人次的國人赴前述國家旅遊、探親或從事經貿活動,疾管局呼籲民眾,前往上開地區前,最好先接種麻疹-腮腺炎-德國麻疹混合疫苗(MMR疫苗),做好自我保護,同時避免將病毒帶回國內。


為有效降低國人出國感染的機會,進而有效避免國內疫情發生,依據我國血清抗體調查及感染與傳播高危險群相關資訊,該局針對赴麻疹或德國麻疹流行地區者提出預防接種建議如下:


一、前往歐洲、中國大陸、東南亞等麻疹流行地區:

1. 1歲以下嬰兒應避免前往。
2. 1-6歲之學齡前幼兒,如未完成接種MMR疫苗者,應於接種兩週後再前往。
3. 年齡介於18至30歲之大專院校教職員生、軍人、醫事機構及教托育機構人員,強烈建議接種MMR疫苗兩週後再前往。

二、前往越南、中國大陸等德國麻疹流行地區:
1. 1歲以下嬰兒及不具德國麻疹抗體之孕婦,應避免前往。
2. 1-6歲之學齡前幼兒,如未完成接種MMR疫苗者,應於接種兩週後再前往。
3. 年齡介於20至50歲,若共同生活或工作活動場所會接觸孕婦及尚未接種MMR疫苗之嬰幼兒者,應於接種MMR疫苗兩週後再前往。

 

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世界衛生組織(WHO)旗下的國際癌症研究署(IARC)五月卅一日發表報告,首度將手機列入人類致癌因子分類表,屬於2B級「可能為致癌因子」,與咖啡、汽油引擎廢氣、電焊煙霧以及極低頻電磁場同級。

由十四國卅一名科學家組成的工作小組從五月廿四日起,在法國里昂召開八天會議,評估暴露在電磁場(包括使用手機)環境中人和動物等所受健康影響的所有科學證據,並認為基於現有的有限數據,長期常用手機可能增加罹患「神經膠質瘤」(glioma)的風險。

神經膠質瘤是腦瘤一種,屬惡性腫瘤。工作小組報告中提到二○○四年後的一項研究顯示,連續十年平均每天講手機卅分鐘,罹患神經膠質瘤幾率將增加四○%。

IARC將致癌因子分為五個級別:1級確定為致癌因子、2A級極有可能為致癌因子、2B級可能為致癌因子、3級無法歸類為致癌因子,以及4級極有可能為非致癌因子。

工作小組主席南加大薩梅特博士表示,現有證據足以支持可能致癌結論,需要密切關注。

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世界衛生組織首度承認,手機可能致癌。由於兒童頭蓋骨發育尚未完整,對於國人幾乎人手一機的現象,國內醫界建議,政府應該比照英國、德國,限制十四歲以下兒童禁止使用手機,以免危害健康。

手機可能致癌的爭議已討論多年,昨天終於獲世衛證實。世界各國一直有學術研究,指經常使用手機有致癌之虞,較明確的數據是全世界手機使用普及率最高的以色列,發現手機慣用手那一側,發生腮腺癌的比率較高,與使用手機高度相關。

北醫放射線科梁庭繼醫師表示,手機發射出的電磁波,和微波爐類似,原則上不會直接破壞細胞染色體,但手機使用時會放射頻率能量,間接影響染色體和細胞的新陳代謝,進一步造成病變;目前懷疑與腦神經膠質瘤較有相關,過去英國曾研究發現,使用手機超過十年,罹患腦瘤的機率增加。

小孩使用手機比成人更危險,研究發現,手機發出的電磁波可穿入成人頭蓋骨一公分內,但卻會「穿透」在發育中兒童的頭部,影響更大,家長太早讓孩子天天使用手機,其實是害了他們,政府應比照國外發布禁令,以免禍害下一代。

如何避免手機的危害?醫師建議,民眾可改用低能量或功能較簡單的手機,因為,越是功能複雜的手機如Iphone及三G手機,發射的電磁波越強,民眾接收時可改用免持聽筒,避免長時間講手機,以減少對身體的影響。

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(CNN) -- Radiation from cell phones can possibly cause cancer, according to the World Health Organization. The agency now lists mobile phone use in the same "carcinogenic hazard" category as lead, engine exhaust and chloroform.

Before its announcement Tuesday, WHO had assured consumers that no adverse health effects had been established.

A team of 31 scientists from 14 countries, including the United States, made the decision after reviewing peer-reviewed studies on cell phone safety. The team found enough evidence to categorize personal exposure as "possibly carcinogenic to humans."

What that means is they found some evidence of increase in glioma and acoustic neuroma brain cancer for mobile phone users, but have not been able to draw conclusions for other types of cancers

"The biggest problem we have is that we know most environmental factors take several decades of exposure before we really see the consequences," said Dr. Keith Black, chairman of neurology at Cedars-Sinai Medical Center in Los Angeles.

The type of radiation coming out of a cell phone is called non-ionizing. It is not like an X-ray, but more like a very low-powered microwave oven.

"What microwave radiation does in most simplistic terms is similar to what happens to food in microwaves, essentially cooking the brain," Black said. "So in addition to leading to a development of cancer and tumors, there could be a whole host of other effects like cognitive memory function, since the memory temporal lobes are where we hold our cell phones."

Wireless industry responded to Tuesday's announcement saying it "does not mean cell phones cause cancer." CTIA-The Wireless Association added that WHO researchers "did not conduct any new research, but rather reviewed published studies."

The European Environmental Agency has pushed for more studies, saying cell phones could be as big a public health risk as smoking, asbestos and leaded gasoline. The head of a prominent cancer-research institute at the University of Pittsburgh sent a memo to all employees urging them to limit cell phone use because of a possible risk of cancer.

"When you look at cancer development -- particularly brain cancer -- it takes a long time to develop. I think it is a good idea to give the public some sort of warning that long-term exposure to radiation from your cell phone could possibly cause cancer," said Dr. Henry Lai, research professor in bioengineering at University of Washington who has studied radiation for more than 30 years.

Results from the largest international study on cell phones and cancer was released in 2010. It showed participants in the study who used a cell phone for 10 years or more had doubled the rate of brain glioma, a type of tumor. To date, there have been no long-term studies on the effects of cell phone usage among children.

"Children's skulls and scalps are thinner. So the radiation can penetrate deeper into the brain of children and young adults. Their cells are at a dividing faster rate, so the impact of radiation can be much larger." said Black of Cedars-Sinai Medical Center.

In February, a study by researchers at the National Institutes of Health, revealed radiation emitted after just 50 minutes on a mobile phone increases the activity in brain cells. The effects of brain activity being artificially stimulated are still unknown.

Neurosurgeon and CNN chief medical correspondent Dr. Sanjay Gupta says Tuesday's announcement, "dealt a blow to those who have long said, 'There is no possible mechanism for cell phones to cause cancer.' By classifying cell phones as a possible carcinogen, they also seem to be tacitly admitting a mechanism could exist."

Manufacturers of many popular cell phones already warn consumers to keep their device away from their body and medical experts say there other ways to minimize cell phone radiation.

The Apple iPhone 4 safety manual says users' radiation exposure should not exceed FCC guidelines: "When using iPhone near your body for voice calls or for wireless data transmission over a cellular network, keep iPhone at least 15 millimeters (5/8 inch) away from the body."

BlackBerry Bold advises users to "keep the BlackBerry device at least 0.98 inch (25 millimeters) from your body when the BlackBerry device is transmitting."

The logic behind such recommendations is that the further the phone is from the body, the less radiation is absorbed. Users can also use the speakerphone function or a wired earpiece to gain some distance.

Users can text instead of talk if they want to keep the phone away from their faces.

Finally, cell phones emit the most radiation when they are attempting to connect to cellular towers. A moving phone, or a phone in an area with a weak signal, has to work harder, giving of more radiation. So users can avoid using their cell phones in elevators, buildings and rural areas if they want to reduce their exposure, experts say.

http://edition.cnn.com/2011/HEALTH/05/31/who.cell.phones/index.html?hpt=hp_t1

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