目前日期文章:201208 (6)

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中華民國骨質疏鬆症學會於2008年至2011年派出骨質密度檢測巡迴車,在全省北、中、南、東,及金門地區,對50歲以上的骨鬆高風險群民眾,檢測骨質密度,共有1萬 7035名民眾受檢,發現僅有24%骨質正常,並有45%骨質減少、31%骨質疏鬆,同時男女骨鬆比率差不多,顯示不僅是婦女,中老年男性也要小心骨鬆問題。

大腿骨骨折是骨質疏鬆的重要指標之一,以大腿骨骨折發生率來看,台灣居世界第九、更是亞洲骨折風險度最高的區域。

為了找出高風險的骨折民眾,及早預防,學會已發展出屬於國人的骨鬆骨折風險評估工具 (FRAX),經回答體重、身高、年齡、骨密度等12個簡單問題後,即可計算出個人未來10 年內,全身或髖骨骨鬆性骨折的機率。

當全身骨鬆性骨折機率超過10%、或髖骨骨鬆性骨折1.5%就要注意,當分別超過20%或3%時則應積極治療。網址是 http://www.shef.ac.uk/FRAX/tool.jsp?lang=cht, 希望民眾多評估自身風險。

1. 世界衛生組織(WHO)骨折風險評估工具

2. FRAX



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疑似涉及迷姦和偷拍案的李宗瑞落網,再度引發社會對於女性被迷姦問題的重視。衛生單純表示,包括GHBFM2K他命被稱為三大迷姦藥物。它們都具有無色無味容易融於液體中,可以讓食用者15 分鐘內產生頭昏、全身發軟並昏迷的藥效。

GHB在台灣又叫做液態快樂丸或迷姦藥水,無色無味,使用前溶於水或飲料中服用,會使人快速昏睡及暫時性喪失記憶力,被使用這種藥品迷姦的被害人,經常醒來後完全不記得發生甚麼事,而且 GHB在人體內代謝相當快,常常無法及時被驗出。

FM2則是強效安眠藥,有很好的水溶性,有「強暴藥丸」之稱;濫用的劑量如果達到28毫克以上,還可能有致死危險;建議如果喝下飲料十幾分鐘後,感到昏昏欲睡以及身體狀況異常,就要趕緊求助呼救。

早期常用作麻醉藥品的K他命,具有興奮、抑制、迷幻、麻醉等多重藥性,如果服用超過48小時,也難於在尿液、血液中被檢測。

由於迷姦藥物多用在飲料內,建議年輕女性

      1. 不要隨便喝陌生人提供的飲料;

      2. 飲料如果離開過視線,也絕不要再喝;

      3. 如果喝下去後發現開始昏沉,第一時間就要趕緊呼救。


 麻醉藥品管制法規:

http://www.fda.gov.tw/files/list/%E8%AC%9B%E9%A1%8C%E4%B8%80%E7%AE%A1%E5%88%B6%E8%97%A5%E5%93%81%E7%AE%A1%E7%90%86%E6%B3%95%E8%A6%8F.pdf


 

 

 

 

 

 

 

 

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Pertussis (Whooping Cough)

http://www.cdc.gov/pertussis/about/index.html

 

百日咳

http://www.cdc.gov.tw/diseaseinfo.aspx?treeid=8d54c504e820735b&nowtreeid=dec84a2f0c6fac5b&tid=BA1E4B695CF4C89F

 

 

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Tdap for Pregnant Women: Information for  For Health Care Professionals

http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

*On This Page:*

  * Pertussis Epidemiology 
  * Seriousness of Pertussis for Mother and Infant 
  * Tdap Vaccine Safety for Mother and Infant 
  * Breastfeeding Safety after Tdap Vaccination 
  * Transfer of Pertussis Antibodies to Infant through Maternal Tdap Vaccination 

  * Pertussis Vaccine for Infant at Birth 
  * DTaP Effectiveness for Infant if Mother Vaccinated with Tdap during Pregnancy 
  * Postpartum Tdap Vaccination as an Option <#postpartum>
  * Cocooning 
  * Patients with Unknown or Uncertain Tdap Vaccination Status

In June 2011, the Advisory Committee on Immunization Practices (ACIP) voted to recommend that women's health care providers should implement a maternal Tdap vaccination program for women who have not previously received the vaccine. Health care providers should administer Tdap preferably during the third or late second trimester of pregnancy (after 20 weeks gestation).


Pertussis Epidemiology

In 2010, 27,550 cases of pertussis were reported in the United States;
3,350 of those cases were in infants younger than 6 months of age ? 25
of those infants died. Studies have shown that when the source of
pertussis was identified, mothers were responsible for 30?40% of infant
infections.


Seriousness of Pertussis for Mother and Infant

It's expected that vaccinating your patients with Tdap during pregnancy
will prevent more infant hospitalizations and deaths from pertussis than
cocooning alone.

Pertussis can cause serious and sometimes life-threatening complications
in infants, especially within the first 6 months of life. In infants
younger than 1 year of age who get pertussis, more than half must be
hospitalized. The younger the infant, the more likely treatment in the
hospital will be needed. Of those infants who are hospitalized with
pertussis about 1 in 5 will get pneumonia and 1 in 100 will die.

Adolescents and adults can also experience complications from pertussis.
They are usually less serious in this age group, especially in those who
have been vaccinated. Common complications in adolescents and adults are
often caused by the cough itself, including urinary incontinence (28%),
syncope (6%) and rib fractures (4%).

Tdap Vaccine Safety for Mother and Infant

In addition to vaccinating your patients with Tdap, you should educate
them about encouraging others ? including dads, grandparents and other
caregivers ? to get vaccinated with Tdap at least two weeks before
coming into contact with their infants.

ACIP concluded that there is no elevated frequency or an unusual
occurrence of adverse events among pregnant women who have received Tdap
vaccine, or in their newborns. Tdap vaccine is recommended after 20
weeks gestation because that optimizes antibody transfer and protection
at birth. *The immune response to the vaccine peaks two weeks after
administration.*

Both tetanus and diphtheria toxoids (Td) and tetanus toxoid (TT)
vaccines have been used extensively in pregnant women worldwide since
the 1960s to prevent neonatal tetanus. Td and TT vaccines administered
during pregnancy have not been shown to harm either the mother or
baby/fetus.


Breastfeeding Safety after Tdap Vaccination

Breastfeeding is not a contraindication for receiving Tdap vaccine. Tdap
vaccine can and should be given to women who plan to breastfeed.
Breastfeeding is fully compatible with Tdap vaccination, and preventing
pertussis in mothers can reduce the chance that the infant will get
pertussis. Also, by breastfeeding, mothers can pass antibodies they?ve
made in response to the Tdap shot on to their infants, which may reduce
an infant?s chances of getting sick with pertussis. This is especially
important for infants younger than 6 months of age, who have no other
way of receiving enough pertussis antibodies, since they are not fully
protected until their third dose of DTaP vaccine at 6 months of age.

Transfer of Pertussis Antibodies to Infant through Maternal Tdap Vaccination

Transplacental transfer of maternal pertussis antibodies from mother to
infant may provide protection against pertussis in early life, before
beginning the primary DTaP series. There is evidence of efficient
transplacental transfer of pertussis antibodies to infants. The
effectiveness of maternal antibodies in preventing infant pertussis is
not yet known, but pertussis antibodies can protect against some disease
and the severe outcomes that come along with it. *And, a woman
vaccinated with Tdap vaccine during pregnancy will also herself be
protected at time of delivery and will be less likely to transmit
pertussis to her newborn infant.*


Pertussis Vaccine for Infant at Birth

There are currently no pertussis vaccines licensed or recommended for
newborns at birth. The best way to prevent pertussis in a young infant
is by vaccinating the mother during pregnancy.

DTaP Effectiveness for Infant if Mother Vaccinated with Tdap during Pregnancy

By vaccinating a woman with Tdap during pregnancy her infant will gain
pertussis antibodies during the most vulnerable time ? before three
months of age. However, providing this early immunity may also interfere
with the infant?s immune response to DTaP vaccine. The infant?s immune
response to DTaP may not be as strong, but the clinical implications may
not be significant. The benefits of vaccinating during pregnancy and
protecting a newborn outweigh the potential risk of blunting the
infant?s response to DTaP vaccine. Since infants are at greatest risk of
severe disease and death from pertussis before 3 months of age ? when
their immune systems are least developed ? any protection that can be
provided is critical. Infants should receive their DTaP vaccines on
schedule </vaccines/schedules/hcp/index.html>, starting at 2 months of age.


Postpartum Tdap Vaccination as an Option

Not all hospitals routinely vaccinate with Tdap postpartum, so you can
make sure your patients and their infants are protected.

Vaccination with Tdap during pregnancy is ideal. However, if a woman
does not get vaccinated during pregnancy, administer the vaccine
immediately postpartum, before she leaves the hospital or birthing
center. Also advise your patient that other adults who will be around
her newborn, such as husbands grandparents, older siblings, and
babysitters, should also be vaccinated.

Cocooning

The strategy of protecting infants from pertussis by vaccinating those
in close contact with them is known as "cocooning." ACIP has recommended
cocooning with Tdap vaccine since 2005 and continues to recommend this
strategy for all those with expected close contact with newborns.
Cocooning enhances maternal vaccination to provide maximum protection to
the infant. In addition to vaccinating your patients, you should educate
them about encouraging others ? including dads, grandparents and other
caregivers - to get vaccinated with Tdap at least two weeks before
coming into contact with their infants.

Full implementation of cocooning has proven to be a challenge;
vaccinating during pregnancy provides the best opportunity to protect
infants from pertussis.


Patients with Unknown or Uncertain Tdap Vaccination Status

ACIP recommends that if Tdap vaccination status cannot be confirmed with
written, dated records, the patient is considered unvaccinated and is
therefore eligible to be vaccinated with Tdap. Tdap should be
administered regardless of when Td was last received.


References

 1. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who
    was the source?
    <http://www.ncbi.nlm.nih.gov/pubmed/15545851>External Web Site
    Policy /Pediatr Infect Dis J./ 2004;23:985-89.
 2. CDC. Updated Recommendations for Use of Tetanus Toxoid, Reduced
    Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine in Pregnant
    Women and Persons Who Have or Anticipate Having Close Contact with
    an Infant Aged Less than 12 Months ? Advisory Committee on
    Immunization Practices (ACIP), 2011
    <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm?s_cid=mm6041a4_e%0d%0a>.
    /MMWR/. 2011;60(41):1424-6.
 3. Cortese MM, Bisgard KM. Pertussis. In: Wallace RB, Kohatsu N, Kast
    JM, ed. Maxcy-Rosenau-Last Public Health & Preventive Medicine,
    Fifteenth Edition. /The McGraw-Hill Companies, Inc./; 2008:111-14.
 4. Tanaka M, Vitek CR, Pascual FB, et al. Trends in pertussis among
    infants in the United States, 1980-1999
    <http://jama.jamanetwork.com/article.aspx?volume=290&issue=22&page=2968>External
    Web Site Policy. /JAMA/. 2003;290:2968-75.
 5. Wendelboe AM, Njamkepo E, Bourillon A, et al. Transmission of
    /Bordetella pertussis/ to young infants
    <http://www.ncbi.nlm.nih.gov/pubmed/17414390>External Web Site
    Policy. /Pediatr Infect Dis J/. 2007;26:293-99.

 

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儘管絕大多數人都打過百日咳疫苗,但長大成人後已無保護力,再加上一般健康成年人感染百日咳即使沒治療,二至三個月就會自行痊癒。但極易透過空氣和飛沫傳染,新生兒是感染百日咳高危險,三個月以下幼兒一旦感染,致死率高達八成五,家長務必提高警覺。

國內一歲以下幼兒感染百日咳個案近幾年逐年增加,甚至出現致死 案例。由於幼兒感染百日咳的主要傳染者幾乎都是父母親、家人、保母等,台灣婦產科醫學會秘書長黃閔照建議,產婦和家人甚至保母,最好都能施打百日咳疫苗。

疾病管制局統計,去年一歲以下幼兒感染百日咳個案有36例,比2008年的13例增加近兩倍,也比2009年的25例、2010年的24例多出十幾例。今年1到7月,一歲以下幼兒百日咳確定病例已有14例。

為預防新生兒感染百日咳,產婦懷孕後期或產後出院前,務必施打百日咳疫苗 (Tdap)。為求慎重,爸爸、其他家中成員也都應接種疫苗,最好連照顧寶寶的保母一併施打。建議家長聘請保母時,最好請保母出示百日咳疫苗接種證明,降低幼兒感染風險。


臨床顯示,三合一疫苗的保護期限約六至十年,幾乎百分之百的孕婦都沒有保護力,當然不能給胎兒任何抗體。生產後一旦自己感染百日咳,很容易傳給寶寶。

國內新生兒雖然都會施打百日咳疫苗,但六個月以下的寶寶正處於空窗期,雖然已經打了兩三劑,但體內仍不具免疫力,只要被感染就容易出現嚴重併發症,嚴重影響肺臟、腦部等功能

百日咳是一種古老疾病,近幾年有死灰復燃的跡象,日本、中國大陸都曾爆發大規模疫情,值得我國防疫單位重視。 美國、加拿大等國家最近一、兩年對百日咳防疫採「包覆政策」,建議孕婦懷孕滿三個月後補打百日咳疫苗,研究顯示對胎兒不會有任何影響。

台大醫院小兒感染科主任黃立民強調,小朋友感染百日咳,年紀越小越危險。以一歲以下幼兒為例,染病後咳嗽症狀 並不明顯,主要症狀為停止呼吸致腦部缺氧。等家長發現不對勁時送至醫院,通常已延誤治療時機。黃立民表示,這幾年收治不少幼兒百日咳重症個案,大部分都咳 到缺氧、抽筋,有些甚至出現嚴重後遺症,容易癲癇、腦神經發育遲緩,成為父母一輩子的遺憾。

 

http://www.cdc.gov/vaccines/pubs/preg-guide.htm

Tetanus, Diphtheria, and Pertussis (Tdap); & Tetanus and Diphtheria (Td)
  • Pregnant women who have not been previously vaccinated with Tdap should get one dose of Tdap during the third trimester or late second trimester (after 20 weeks gestation). If not administered during pregnancy, Tdap should be administered immediately postpartum.

 

  • Available data from... studies do not suggest any elevated frequency or unusual patterns of adverse events in pregnant women who received Tdap and that the few serious adverse events reported were unlikely to have been caused by the vaccine.

 

 

  • Wound Management: If a Td booster is indicated for a pregnant woman who previously has not received Tdap, Tdap should be administered.

 

  • Unknown or Incomplete Tetanus Vaccination: To ensure protection against maternal and neonatal tetanus, pregnant women who never have been vaccinated against tetanus should receive three vaccinations containing tetanus and reduced diphtheria toxoids. The recommended schedule is 0, 4 weeks and 6 to 12 months. Tdap should replace 1 dose of Td, preferably during the third or late second trimester of pregnancy (after 20 weeks gestation) of pregnancy.

 

  • Providers are encouraged to report administration of Tdap to a pregnant woman, regardless of trimester, to the appropriate manufacturer’s pregnancy registry: for Adacel® to sanofi pasteur, telephone 1-800-822-2463 and for Boostrix® to GlaxoSmithKline Biologicals, telephone 1-888-825-5249.

 

Related Page:

Tdap for Pregnant Women: Information for Providers

 

 

Guidelines for Vaccinating Pregnant Women

http://www.cdc.gov/vaccines/pubs/preg-guide.htm


 


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大型重機考照 (250cc 以上)

1. 年滿二十歲以上

2. 具普通重型機車駕照滿一年

3. 體檢合格  

       (1) 證件:身份證正本。

       (2) 相片:一吋正面半身照片二張  ( 附設:相片快照機)

       (3) 檢查時間:

           

    星期一 星期二 星期三 星期四 星期五 星期六
早上 8:30-12:00
下午 2:30-05:30 x x x x x
晚上 5:00-09:00 x x

         註:●:看診。  ×:休診。

         ◎ 汽機車駕照體檢者,  請於門診時間體檢


            

      (4) 檢查費:200元。

      (5) 檢查項目:

            1. 物理體格檢查
            2. 視力及雙眼視力檢測
            3. 辨色力檢查
            4. 聽力檢查
            5. 四肢活動能力檢測

            6. 視野檢查

            7. 夜視力檢查

 

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