WHO Risk Assessment as of 10 May 2013

 

WHO RISK ASSESSMENT

Human infections with avian influenza A(H7N9) virus

10 May 2013

Summary

A total of 131 confirmed cases of human infection with avian influenza A(H7N9) virus have been reported to WHO by China National Health and Family Planning Commission and one case by the Taipei Centers for Disease Control (Taipei CDC). Although cases have been reported in both sexes and across a wide range of ages, most cases have occurred among middle-aged and older men. Thirty-two people  have died, and most of the other cases are considered severe. In addition to the case reported by Taipei CDC (with a history of recent travel from Jiangsu), cases have been reported from Anhui, Fujian, Henan, Hunan, Jiangsu, Jiangxi, Shandong and Zhejiang, and the municipalities of Beijing and Shanghai.

Much remains unknown about this virus, including the animal reservoir(s) in which it is circulating, the main exposures and routes of transmission, and the scope of the spread of this virus among people and animals. Investigations are ongoing and evidence is inconclusive. Nevertheless, human infection appears to be related to exposure to live poultry or contaminated environments because:

• The virus in humans is genetically similar to that found in animals and the environment (live bird markets).

• Most human cases (approximately three out of four patients) report a history of exposure to animals, mostly chickens.

• The virus has been detected in poultry in live bird markets.

• The number of human cases appears to have decreased after closure of live animal markets.

 

Whether other potential reservoirs of this virus may exist, including in other domestic and wild bird species, and mammalian species, has not yet been determined.  And although two family clusters have been reported, there is no evidence of sustained human-to-human transmission:

• Monitoring and testing of contacts (>2000 people) of confirmed cases has detected few infections.

• Testing of more than 20,000 people with influenza-like illness (ILI) in March and April has confirmed only six infections with H7N9. This finding suggests that milder cases of H7N9 infection are not occurring in large numbers.

 

This is the first time human infection with the avian influenza A(H7N9) subtype has been detected. Previously, sporadic cases of human infection with other influenza A(H7) viruses have been reported which were associated with outbreaks of infection in poultry. The few A(H7) human infections that have occurred generally resulted in mild illness and  conjunctivitis, with the exception of one death.

Genetic and laboratory characterization of avian influenza A(H7N9) viruses isolated from humans indicates that:

• The virus contains a group of influenza virus genes from multiple origins.

• Some genetic changes, including amino acid substitutions associated with increased affinity to alpha 2-6 receptors, suggest that H7N9 may have greater ability to infect mammals, including humans, than other avian influenza viruses.

• Sequence variations among the genes of the isolates suggest that there has been more than one introduction of this virus from animal into humans.

• Genetically, these viruses are in general expected to be sensitive to the neuraminidase inhibitors oseltamivir and zanamivir, but resistant to the antiviral drugs amantadine and rimantadine.

• The isolates have a haemagglutinin structure that is associated with low pathogenicity in birds.

 

The virus has not been reported to cause severe disease in poultry.  The absence of this signal limits the ability to easily detect the virus in birds, in contrast to avian influenza A(H5N1).

Risk assessment

This risk assessment supersedes the document posted on 13 April 2013.  It has been prepared in accordance with WHO’s published recommendations for rapid risk assessment of acute public health events and will be updated as more information becomes available.  The risk has not changed since the previous assessment.

What is the risk that more human cases will occur in the affected areas?

The understanding of the epidemiology of this outbreak and virus remains limited, including the main reservoirs of infection and the extent of geographic spread among animals. However, it is likely that most human H7N9 infections have been associated with contacts with animals or live bird markets. Further human cases should be expected.  Other avian influenza viruses such as H5N1 have demonstrated a seasonal pattern in which human cases have been less frequent in summer months and more frequent in winter months. It remains to be seen whether H7N9 infections will follow the same seasonal pattern.  Most human cases have resulted in  clinically severe illness.

What is the risk of human-to-human transmission?

There is no evidence of sustained human-to-human transmission. However, two family clusters suggest that limited human-to-human transmission may occur where there is close contact between cases and other people, as occurs in families and potentially in healthcare settings. Moreover, the genetic changes seen among these viruses that suggest adaptation to mammals is of concern, and further adaptation may occur. Should sustained human-to-human transmission occur with an increased number of clinically severe cases, health systems are likely to be strained.

What is the risk of international spread of H7N9 by travelers?

There is no indication that international spread has occurred. An infected person, whether symptomatic or not, who travels to another country, could spread the infection.  However, as the virus does not

appear to cause sustained human-to-human transmission, extensive community spread is unlikely. If transmissibility were to increase, then the possibility of spread would likewise increase.

Does WHO recommend any travel precautions related to H7N9?

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions.

Resources

Liu D, S. W. (2013). Origin and diversity of novel avian influenza A H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses. Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60938-1/fulltext

Li Q, Z. L. (2013). Preliminary Report: Epidemiology of the Avian Influenza A (H7N9) Outbreak in China. New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1304617#t=article

Chen Y, L. W. (2013). Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome. Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60903-4/fulltext

Cuiling Xu, Fiona Havers, Lijie Wang, Tao Chen, Jinghong Shi, Dayan Wang, Jing Yang, Lei Yang, Marc-Alain Widdowson, and Yuelong Shu. (2013). Monitoring Avian Influenza A(H7N9) Virus through National Influenza-like Illness Surveillance, China. Emerging Infectious Diseases: http://wwwnc.cdc.gov/eid/article/19/8/13-0662_article.htm

Liu Q, L. L. (2013). Genomic signature and protein sequence analysis of a novel influenza A (H7N9) virus that causes an outbreak in humans in China. Microbes and Infection: http://www.ncbi.nlm.nih.gov/pubmed/23628410

WHO. (2012). Rapid Risk Assessment of Acute Public Health Events: http://www.who.int/csr/resources/publications/HSE_GAR_ARO_2012_1/en/

Additional Information

Most recent disease outbreak news can be found at: http://www.who.int/csr/don/en/index.html

Frequently Asked Questions and other information on human infections with avian influenza A(H7N9) are available at: http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/index.html

Public health relevant virological features of influenza A(H7N9) causing human infection in China: http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/influenza/publications/2013/public-health-relevant-virological-features-of-influenza-ah7n9-causing-human-infection-in-china

WHO - http://who.int/entity/influenza/human_animal_interface/influenza_h7n9/RiskAssessment_H7N9_10May13.pdf

Black Rice Salad with Lemon Vinaigrette

Ingredients

• 1 cup black rice (preferably Lotus Foods Forbidden Rice)
• Kosher salt
• 1/2 cup walnuts
• 1/4 cup Meyer lemon juice or 3 tablespoons regular lemon juice
• 2 tablespoons white wine vinegar
• 1 tablespoon agave syrup (nectar) or honey
• 1/4 cup extra-virgin olive oil
• 4 scallions, thinly sliced
• 1 cup frozen shelled edamame, thawed
• 1 cup grape tomatoes, halved
• 4 ounces green beans, thinly sliced (about 1 cup)
• Freshly ground black pepper

• Ingredient Info

  Black rice is available at natural foods and specialty foods stores and some supermarkets.

Preparation

• Preheat oven to 350°. Cook rice in a medium saucepan of boiling salted water until tender, 35-40 minutes. Drain well, spread out on a plate or a rimmed baking sheet, and let cool.
• Meanwhile, spread out walnuts on another rimmed baking sheet. Toast in oven, tossing once, until fragrant, 8-10 minutes. Let cool; chop.
• Whisk lemon juice, vinegar, and agave in a small bowl. Whisking constantly, gradually drizzle in oil. Season vinaigrette with salt.
• Toss rice, walnuts, scallions, edamame, tomatoes, green beans, and vinaigrette in a large bowl. Season with salt and pepper.

Read More http://www.bonappetit.com/recipes/2013/05/black-rice-salad-with-lemon-vinaigrette#ixzz2TGtqbiz4

Checkmark

APP NAME:	Checkmark
PLATFORMS:	iPhone
PUBLISHER(S):	Snowman
VERSION REVIEWED:	1.0.1
GENRE(S):	Productivity
RELEASE DATE:	July 17, 2012
DOWNLOAD

When iOS 5 came out, there were a lot of features that we couldn’t have been happier to see come to our devices, Reminders being one of them. With a built-in application that allowed us to set a notification based on time or location, we thought we might finally have the best solution from the company itself. While Reminders is indeed a good app, there are a few things that could be better.

Checkmark, on the other hand, looks to fill in the holes that Reminders has left hanging around the operating system. This robust get-things-done application offers the same solution that Apple’s app does, but takes things a few steps beyond, cementing its status as possible King of Checklist Apps (a category I just made up, but whatever).

As I said, whatever you can do with Reminders, you can do with Checkmark. Want to have a time/date based reminder notify you? Check. Location based reminders? Check again. Checkmark does what the Reminders app do, but in my opinion, Checkmark’s alerts are a little more superior to Apple’s solution. I will say that I’ve run into some timing issues with Reminders, as it would either not go off at all, or too early. Granted, the sample size I’ve been using Checkmark has been a little smaller in comparison, but it hasn’t given me one misstep along the way.

Location based reminders, however, weren’t always an exact science. The app had slight difficulty recognizing locations for me when I first started using it, but the more I used it, the more accurate it became. Whether that was by design or just a fluke I’m not sure. Regardless, that was probably the most frustrating thing to me at first, since I use location reminders as often as I breathe. The geofence locations you can set for Checkmark are actually pretty large, but also have the option to be quite specific so you don’t worry about a reminder going off when you’re just passing by. This was the best feature for me once my location reminders started making sense, since I’m usually in the same congested area of my city quite often.

Since Apple’s native Reminders app doesn’t have geofencing, only immediate location notification, it was nice having this option in Checkmark. If I know I’ll be driving near a certain place at some point, it’s a great thing being certain I’ll get a notification regardless of whether or not I’m actually at that address. This was something else I really liked about location reminders in Checkmark; that I didn’t have to add the address to my contacts list in order to create a notification, unlike with Reminders. All I have to do is directly add the location right into the category and it does the rest for me.

For a lot of users, one of the highlights might be Checkmark’s ease of use. Instead of tapping away to create one simple reminder, your number of taps is drastically reduced to just a couple or few. With Reminders, it would take an inordinate number of tapping and more tapping, which is not the case with Checkmark. In the grand scheme of things, are those extra taps really going to affect my life? No, but the convenience Checkmark gives the user with less time spent actually creating an event is wonderful.

The biggest drawback to my use of location based reminders is that my iPhone’s battery depletes at a fast rate. This is going to happen no matter which app I’m using as long as it’s constantly updating my location, so it wasn’t as if I noticed a major difference in battery depletion between Reminders and Checkmark. But if this is your first time using location reminders, be forewarned: you can expect your battery charge to last about half as long as it did before, depending on how many you have set, and the frequency of which you set them.

 

In all, Checkmark is a wonderful solution to whatever your remembering needs might be. Could you get by with the native Reminders app? Absolutely, but would you enjoy Checkmark a little bit more? You just might. The ease of use is where it shines best, but even its interface is a delight to interact with. The design is intuitive, and the colors and aesthetics will have your eyes glistening with joy as you look upon them. Is that a bit dramatic? No. It looks that good.

Checkmark is $2.99, and since that’s not the typical price for an app like this, I’m sure a few users might be hesitant. In my opinion, though, it’s worth it to have such a wonderfully designed and useful app, especially if you’re going to use it frequently.

http://appchronicles.com/checkmark-review-replace-your-iphone-reminders-app-with-this-one/

 

https://itunes.apple.com/us/app/checkmark/id524873453?mt=8&ign-mpt=uo%3D4

Dementia series

Sadie McQuillan was a dementia sufferer; There are 19,000 dementia patients currently living in Northern Ireland

BBC News Northern Ireland is looking at the issue of dementia this week: our health correspondent Marie-Louise Connolly tells her personal story of her grandmother’s battle with the illness.

In the years before her illness, Sadie’s hair was always perfect. A traditional “set” that was naturally silver in colour. Her complexion was silky, there was a hint of pink about her cheeks.

Sadie loved jewellery, especially earrings and pearls. Her twin sets were immaculate as were her matching handbags and shoes. Small in stature, she enjoyed the odd glass of Guinness or a sherry.

Living in the shadow of Clonard monastery on the Falls Road in Belfast, Sadie was active and a social butterfly. But in 1972, her husband Joe took a sudden heart attack and died. Afterwards, the light went out in Sadie’s eyes.

Several years later Sadie, the woman I called granny, was diagnosed with early onset dementia.

So far, she’s the only person I have personally known with the disease. But I can distinctly remember her slow decline and the horrendous impact it had on my own mother.

Hidden

When I was younger, my granny looked after us on a Friday. We usually had baked apple cakes or her favourite, currant squares.

Sometimes she was able to make lunch and dinner but other times she forgot.

We noticed she left pots on the stove without turning the ring off.

Losing her handbag and purse were regular occurrences.

After collecting her pension, there was always the weekly trauma of remembering where she had left or hidden it.

In the 1980s, it was extremely difficult to get a diagnosis for dementia or Alzheimer’s. Her family made regular trips to the GP with her. Initially, doctors said she was just a little forgetful and not to worry.

Eventually Sadie began to wander from home, then one day she forgot who we were.

My granny spent the next 14 years living in residential then nursing care.

Sadie passed away in 2006. While it was her heart that gave way in the end, she had been ill for over 25 years with dementia.

There are 19,000 people like Sadie currently living in Northern Ireland.

Memories of my granny are still vivid. I tend to think of the happy times when she would let me play with her box of jewellery or re-arrange the many ornaments and pictures she had on her sideboard.

Even in her dementia she was never short of a quick retort, which often left us wondering who was fooling whom.

BBC - http://www.bbc.co.uk/news/uk-northern-ireland-22513111#?utm_source=twitterfeed&utm_medium=twitter

‘Weight loss gut bacterium’ found

Slimming bacteria?

Bacteria that live in the gut have been used to reverse obesity and Type-2 diabetes in animal studies.

Research, published in Proceedings of the National Academy of Sciences, showed that a broth containing a single species of bacteria could dramatically alter the health of obese mice.

It is thought to change the gut lining and the way food is absorbed.

Similar tests now need to be take place in people to see if the same bacteria can be used to shed the pounds.

The human body is teeming with bacteria – the tiny organisms outnumber human cells in the body 10 to one.

And there is growing evidence that this collection of bacteria or “microbiome” affects health.

Obesity

Studies have shown differences between the types and numbers of bacteria in the guts of lean and obese people.

“

We did not completely reverse the obesity, but it is a very strong decrease in the fat mass”

Prof Patrice CaniCatholic University of Louvain

Meanwhile gastric bypass operations have been shown to change the balance of bacteria in the gut.

Researchers at the Catholic University of Louvain, in Belgium, worked with a single species of bacteria Akkermansia muciniphila. It normally makes up 3-5% of gut bacteria, but its levels fall in obesity.

Mice on a high fat diet – which led them to put on two to three times more fat than normal, lean, mice – were fed the bacteria.

The mice remained bigger than their lean cousins, but had lost around half of their extra weight despite no other changes to their diet.

They also had lower levels of insulin resistance, a key symptom of Type-2 diabetes.

Prof Patrice Cani, from the Catholic University of Louvain, told the BBC: “Of course it is an improvement, we did not completely reverse the obesity, but it is a very strong decrease in the fat mass.

“

I don’t think it’s feasible that you can eat cream cakes and chips and sausages all day long and then eat bacteria to reverse all that”

Prof Colin HillUniversity College Cork

“It is the first demonstration that there is a direct link between one specific species and improving metabolism.”

Surprise

Adding the bacteria increased the thickness of the gut’s mucus barrier, which stops some material passing from the gut to the blood. It also changed the chemical signals coming from the digestive system – which led to changes in the way fat was processed elsewhere in the body.

Similar results were achieved by adding a type of fibre to diets which led to an increase in the levels of Akkermansia muciniphila.

Prof Cani said it was “surprising” that just one species, out of the thousands in the gut, could have such an effect.

He said this was a “first step” towards “eventually using these bacteria as prevention or treatment of obesity and Type-2 diabetes” and that some form of bacteria-based therapy would be used “in the near future”.

Prof Colin Hill, a microbiologist at University College Cork, said: “It’s a very exciting study, we’ve had lots linking bacteria and weight gain but this is the first time an intervention seems to work.

“I don’t think it’s feasible that you can eat cream cakes and chips and sausages all day long and then eat bacteria to reverse all that.”

He said it was more likely that the research would lead to understanding of exactly what happens in the gut, which could lead to tailored dietary advice for people trying to lose weight.

BBC - http://www.bbc.co.uk/news/health-22458428#?utm_source=twitterfeed&utm_medium=twitter

Fewer Falklands War suicides than feared, study suggests

The MoD investigated the circumstances of 21,432 Falklands veterans 30 years after the war

The claim that more Falklands veterans have killed themselves since the war ended than died in action is not borne out by statistics, a study says.

Some 255 UK personnel died in action, but a veterans group has said the suicide toll since 1982 exceeds that.

However, the Ministry of Defence has found 95 deaths were recorded as suicides or open verdicts.

The MoD said every suicide was a tragedy and urged veterans of any conflict needing support to seek help.

In 2002, The South Atlantic Medal Association, which represents veterans, said it was “almost certain” the number of suicides exceeded the conflict death toll.

It placed the blame predominantly on a lack of care for those suffering post traumatic stress disorder.

‘Self-harm’

“

We would encourage any Falklands veterans or serving personnel who need help to come forward to access the wide range of support available”

SpokesmanMinistry of Defence

But the MoD has now investigated the circumstances of 21,432 Falklands veterans three decades after the end of the conflict, and found that as of 31 December 2012, some 1,335 had died.

That compares with an estimated 2,079 deaths that would have been expected among men of a similar age and background who did not serve in the forces, according to the MoD.

Of those Falklands veterans, 7% of deaths – or 95 individuals – were due to “intentional self-harm and events of undetermined intent (suicides and open verdict deaths)”.

That finding means that on average across the whole 30-year period, veterans were actually 35% less likely to kill themselves than the equivalent group of British men with no military background.

An MoD spokesman said: “Every suicide is a tragedy and our thoughts remain with the families and relatives of all those lost who bravely served in the Falklands conflict.”

He said the government had committed £7.2m to improving mental health support for military personnel, including creating a 24-hour helpline in conjunction with charity Combat Stress.

The spokesman added: “We would encourage any Falklands veterans or serving personnel who need help to come forward to access the wide range of support available.”

The study also found:

• 78% of veterans’ deaths (1,046) were the result of disease, while 19% (247 deaths) were the result of external causes of injury
• Cancer was the primary cause of disease-related deaths, with 455 cases recorded
• But veterans were 30% less likely to die from cancer and 40% less likely to die from disease in general than men with no military background over the period since 1982
• Of the 1,335 Falklands deaths, 140 occurred while the individual was still in service – the rest died after leaving the Armed Forces

The MoD said military personnel were likely to have higher levels of fitness and lower levels of ill health than the general UK population, which could account for the lower incidence of death from disease observed by the study.

The death toll of 255 from the Falklands War includes 237 UK servicemen, along with four personnel from the Royal Fleet Auxiliary, six from the Merchant Navy and eight Hong Kong sailors.

BBC - http://www.bbc.co.uk/news/uk-22523317#?utm_source=twitterfeed&utm_medium=twitter

Hospital probes E German ‘human guinea pig’ drug tests

Many medical files from communist times have not been thoroughly researched

A top Berlin hospital plans to investigate the conduct of drug trials in the former East Germany amid allegations that some patients were used as human guinea pigs.

Communist officials allowed Western firms to test new drugs on about 50,000 people, often without their knowledge, the news magazine Der Spiegel says.

Now the Charite hospital says it will stop shredding old patient records and investigate what happened.

The tests took place in the 1980s.

Der Spiegel says it got the information from former East German health ministry records, the old Stasi secret police files, the former state’s pharmaceutical authority and private collections.

Drug companies from West Germany, Switzerland and the US allegedly offered up to 800,000 Deutschmarks (about 400,000 euros; $520,000) per clinical study – foreign exchange that was much needed in the underfunded East German health service.

Ethical questions

In a statement, the Charite hospital said that “as a first step, Charite has stopped the usual shredding of decades-old files after expiry of the storage period. This is in order to reconstruct the course of action in particular cases as fully as possible.”

Prof Volker Hess of Charite’s medical history institute said the conduct of the East German clinical trials should be re-examined, to find out the degree of patient consent and how undesirable side-effects were handled. The study should also compare East Germany’s medical procedures with those that were standard in the West at the time, he said.

Germany’s Union of Research-based Pharmaceutical Companies (VFA) welcomed the idea of researching the old East German clinical trials. The VFA’s members account for about two-thirds of the German pharmaceutical market.

“According to our knowledge, the standards for clinical trials in the GDR corresponded to the prevailing standards at the time,” said the VFA’s chief executive Birgit Fischer. “GDR law provided guidelines for clinical tests which were comparable with those of Western states and the US.”

More than 50 East German hospitals were involved in the clinical trials, Der Spiegel reports. It says the Western drug companies that took part included Bayer, Schering, Hoechst and Sandoz, which is now part of Novartis.

In statements to the Associated Press news agency, spokesmen for Novartis and Bayer said their clinical trials, to their knowledge, conformed with ethical and legal standards.

BBC - http://www.bbc.co.uk/news/world-europe-22522328#?utm_source=twitterfeed&utm_medium=twitter

減肥莫忘早餐 巧吃高纖高蛋白食物

減肥莫忘早餐吃得巧，建議可以多攝取高纖維、高蛋白質，低糖、低油脂的食物。

健康減肥三餐不能少！許多民眾為了求快速瘦身，會自動省略早餐，連同午餐一塊吃，或是乾脆不吃晚餐，隔天早餐才瘋狂吃個飽，營養師提醒，三餐定時定量，是減肥飲食控制的不二準則，尤其早餐是一整天活力的泉源。攝取高纖、高蛋白的食物，不僅助於減肥，也不會因奶茶、漢堡等升糖指數高的食物，引起精神不振、嗜睡症狀。

NG早餐成減肥夢魘

北市聯合醫院和平婦幼院區營養師黃雅慧表示，許多研究已證實，每天攝取早餐是提升一整天專注力的關鍵，而早餐吃得巧，也能避免吃下過多的熱量，提高肥胖的風險。

黃雅慧營養師提到，許多上班族們為了求方便快速，常選擇培根蛋餅、蔥抓餅或薯餅蛋堡等高澱粉、高油脂的食物做為早餐主食，搭配奶茶、紅茶等糖分含量高的飲料，不僅攝取過多的熱量，影響減肥大計，短時間也讓你升糖指數升高，白天就昏昏欲睡。

減肥早餐怎麼吃？

想要吃得健康，又不至於攝取過高熱量，建議從審視早餐內容開始。正確的早餐應先考量腸胃狀況，可以在早起時先喝一杯溫開水暖胃，接著攝取高纖、高蛋白的食物，例如低升糖指數的水果、全穀糙米類、豆漿、低脂鮮奶、水煮蛋等，都是不錯的選擇。

據研究指出，多吃高纖食物能夠促進腸蠕動，改善胃腸道功能，預防便秘；也能降低升糖反應，避免餐後血糖含量上升，讓精神不濟；最重要的是可控制體重，有助於減肥。

另外，減肥時早餐要吃得巧，千萬不能完全不吃，以免降低人體代謝的速度，但也不能吃得過度豐盛，又是飯糰、又是蛋餅再配上水果、豆漿等，不僅增加腸胃道負擔，也會延後午餐時間，惡性循環下連晚餐跟著遞延，到睡前才進食，反而容易變胖，建議宜吃7分飽。

黃雅慧營養師補充，依每個人的生活作息狀況，將吃早餐的時間往前拉，身體代謝的機能也會提早開始啟動，早餐跟午餐的中間，最好不要再吃點心，早午餐同為減肥大敵，若早餐比較晚吃，則可適度減少份量。

【華人健康網 記者黃子倫／台北報導】 http://www.top1health.com/Article/101/13213

產後補血補氣！滴雞精+粉光蔘調理

孕婦在懷孕期間需要營養補充，中醫師認為，補血補氣，對產後調理有加分效果。

國人晚婚情況日益嚴重，以致出現許多高齡產婦，這一些高齡產婦的孕期照護更加需要關切。中醫師指出，高齡孕婦在產後經常會出現腰痠、掉髮、水腫，以及疲倦等臨床症狀，在坐月子期間，不妨使用藥膳調整體質，可獲得改善，或是適度以雞精添加粉光蔘的「滴雞精」食補，同時補血補氣，對產後調理有加分效果。

中醫師陳玫妃指出，門診中常遇到產後3至6個月的婦女因為腰酸背痛、掉髮過多、經量過少，乳汁過少或月經異常、不定期子宮出血、容易疲倦等病症來就醫，診斷後大多是產後調理不足，所導致的病痛。

產後滴雞精補血　富含蛋白質

許多產婦認為只要注重飲食、吃的好，就是坐好月子，其實孕婦產後體質調理，還是需要依照不同症狀，才能達到調理效果。以中醫觀點來說，產後婦女體質多屬於「多虛多瘀」，因此坐月子需要補血與補氣，藉由雞隻食補即可以達到補血的效果，這也是為什麼坐月子一定要吃雞進補的道理。

目前現代產婦比較沒有時間坐月子，加上不懂得照顧調理，又嫌傳統燉補麻油雞沒有時間，此時，符合簡便又營養的滴雞精，成為不錯選擇，尤其含豐富膠質、小分子蛋白質、天然胺基酸，營養好吸收，再加入上等可補氣的粉光蔘，保護更加倍。

粉光蔘補氣虛　抗產後壓力

「粉光蔘」也可以叫「西洋蔘」或「花旗蔘」，味甘、微苦、性涼，一般用它來補氣養陰、清火生津，屬於「涼補」的藥材，適合體質較燥熱的人使用。現代研究也顯示，粉光蔘具有抗缺氧、抗疲勞之效，對中樞神經有鎮靜安神作用；對壓力所引起神經衰弱、免疫下降等，都有不錯的效果。

目前已經有同時含有濃度高的雞精與粉光蔘的滴雞精，可達到補血與補氣的效果，而且低熱量 (14大卡/ 60g)、零脂肪、不含膽固醇，產婦不必擔心坐月子吃出一身油。食用方式簡單易上手，只需要將整包滴雞精(勿拆)，浸泡於熱水中，溫熱5分鐘即可飲用。或是可以將滴雞精到入磁碗中，電鍋放入半碗水跳起即可飲用。

 

國內有生技業者推出含有低雞精與粉光蔘成分的營養補充食品，受到許多高齡產婦所青睞。（攝影／黃志文）

 

產後調理飲食3階段

中醫認為，產後可以食用「調理性飲食」來調理產婦的身體，調理性飲食在產後必須分成3階段：

第1階段：生血排惡露：自然產後第1至6天，剖腹產後第1至13天。此階段傷口未恢復，食物應以清淡為主，以雞湯、魚湯、排骨湯為主。

料理名稱：清雞湯。

方法：將烏骨雞腿成小塊，加水及生薑兩片煮沸至雞腿熟後，熄火放冷，置冰箱冷藏使雞湯上層油凝固、去油，加熱至煮沸食用。

第2階段：補氣養血顧筋骨：自然產後第7至13天，剖腹產後第14～20天。此階段可以開始吃大量麻油料理的食物。

料理名稱：麻油炒豬肝、麻油炒腰仔、麻油炒桂圓。

方法：老薑用麻油炒成淺褐色，加入腰仔、豬肝或桂圓翻炒數回即可。

第3階段：大補氣血調腎氣：自然產後第14天以後，剖腹產後第21天以後，此階段可以開始吃含有大量米酒的料理。

料理名稱：麻油雞湯。

方法：先將麻油在鍋中加熱，油熱後加入薑炒，再炒雞塊至七分熟，倒入等量的水與米酒，煮開後以小火再煮20至30分鐘。

【華人健康網 記者張世傑／台北報導】 http://www.top1health.com/Article/259/13224

真「肝」苦！B肝風險預測防肝癌

肝臟是「沉默的器官」，由於沒有痛覺神經，因此在風險預防特別棘手。醫師指出，B型肝炎在台灣帶原率約15%至20%，居世界第1位，如果帶原者未正確積極治療，B型肝炎病毒會從慢性肝炎演化成肝硬化，甚至成為肝癌，千萬不可輕忽。（影音／攝影記者黃志文）

 

健保局「B肝個案追蹤方案」，可收到每半年1次定期追蹤提醒，並可接受免費的腹部超音波及血液檢測。

 

肝膽腸胃科易修成醫師指出，肝病雖是國病，但台灣約有300萬名B肝帶原者，和30萬C型肝炎帶原者，不少帶原者都對「肝炎、肝硬化、肝癌三部曲」不以為意，往往等到有症狀才就醫，但就醫時常常已經太晚，不利治療。

肝病惡化與B肝病毒量有關

據衛生署統計，肝癌高居國人10大癌症死因第2位，每年約有8000多人死於肝癌；而肝癌患者中逾8成為B型肝炎帶原者，而B肝帶原者罹患肝癌的危險率，是非帶原者的98倍，因此正確防治肝炎，遠離危險因子，是一件刻不容緩的事。

肝功能指數GPT（又稱ALT）是肝細胞受傷害的指標，正常值約為40。不過，肝功能指數正常的人，也可能有輕微慢性肝疾病；對肝功能指數正常的B肝帶原者而言，肝病惡化原因與體內B肝病毒量有關。

 

台灣約有300萬名B肝帶原者，醫師易修成（右）呼籲，帶原者應定期進行肝功能指數、肝癌指數、肝臟超音波追蹤檢查。（攝影／黃志文）

 

B肝帶原者之肝癌風險預測

過去臨床認為病人的B型肝炎病毒量小於2000 IU/mL，就是不活動性帶原者，罹患肝癌風險比率會少，但是並不代表就絕對不會罹患肝癌。目前發現B型肝炎病毒量小於2000 IU/mL的低病毒量患者，如果再以另一個表面抗原濃度的B肝指標來觀察，可藉由表面抗原濃度的指標，來進一步區分病人得到肝癌風險的高低。

而評估B型肝炎患者將來發生肝癌的風險，是B型肝炎病程中的重要一環。目前已有肝癌風險預測工具：「健康B記本」APP可供下載：藉由性別、年齡、肝發炎指數（ALT）、e抗原和血中病毒量等五大危險因子，計算出風險分數，即可預測未來3年、5年、10年內的肝癌發生風險。

加入健保局B肝個案追蹤方案

但計算出的肝癌風險並非一成不變，是否定期追蹤及持續治療等因素，都可能影響風險值變化，患者可至醫療院所加入健保局「B肝個案追蹤方案」，可收到每半年1次定期追蹤提醒，並可接受免費的腹部超音波及血液檢測。

【醫師小叮嚀】：

由於長期使用抗病毒藥物，會導致抗藥性，因此除了肝硬化的病患外，對肝功能指數正常的帶原者不建議給予抗病毒治療。但B肝帶原者一生都將遭受慢性肝炎、肝硬化、肝癌的威脅，所以帶原者應定期進行肝功能指數、肝癌指數、肝臟超音波追蹤檢查，及早發現肝硬化或肝癌的情形，儘快治療；同時應找肝膽腸胃專科醫師正確就醫，可以提供完整治療，且目前治療也有健保給付，攸關自身健康權益，千萬不要輕忽。

【華人健康網 記者張世傑／台北報導】 http://www.top1health.com/Article/30/13217