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Archive for February, 2012

抗精神病藥安全性不同 選擇須謹慎


抗精神病藥安全性不同 選擇須謹慎

 

 

新研究發現,抗精神病藥(Antipsychotic drugs)又稱強安定藥或神經阻滯劑會增加癡呆症患者死亡風險,但不是針對所有這類型的藥,某些抗精神病藥風險性更高。

 

2008年,美國食品和藥物管理局(FDA)發布黑盒(black box)警告所有新老抗精神病藥,描繪了該類藥治療老年癡呆症相關的精神病导致死亡風險提高。但最新的研究發現死亡風險因藥品的不同以及劑量的多少而大不相同。

 

參加研究的是75445名年齡均在65歲以上的老人,2001年至2005年期間他們開始在養老院使用抗精神病藥。研究人員對病人使用的氟呱啶醇,阿立呱唑,奧氮平,喹硫平,利培酮和齊拉西酮療效進行檢查,並排除使用較少的其他抗精神病藥物

 

研究人員表示,6598名患者在服用抗精神病藥開始的6個月內死於非致癌病因,氟呱啶醇比利培酮的致死風險高一倍,奎硫平的風險性又比利培酮更低。其他抗精神藥風險與利培酮相差不大。由於研究人群中利培酮使用最為廣泛,因而將它作為參照藥物。而且服用劑量越高,死亡率越高。

 

“收集的證據也不能充分說明氟呱啶醇的風險性,喹硫平可能較其他非典型藥物更為安全,這些研究結果還需要在其他研究中得到反響。”

 

哈佛醫學院Krista Huybrechts 稱,這些抗精神病藥物通常用於老年癡呆症患者過激破壞性行為,持續增長的老年癡呆症人數使得這些抗精神病藥還將繼續。

 

研究人員表示未來的研究將是鑒定非藥物幹預的治療,以及這些代替藥物如何應用在老年癡呆症上。

 

這項研究發表在周四(2月23日)英國醫學雜志上。

 

相關網頁→ 醫藥日報

染流感併發心肌炎險死 接種疫苗重要

 

國小五年級李小弟在1月10日出現急性腹痛、嘔吐等症狀,曾至他院看診,腹痛及嘔吐症狀未見好轉,1月12日凌晨四點多由家人帶至童綜合醫院急診室就醫,到院時生命徵象不穩定合併低血壓、心跳快及休克現象,經心臟超音波檢查發現有「心包膜積水合併急性心肌炎」,小兒重症醫療團隊緊急給予「心包膜放管抽水與裝置葉克膜體外循環機」,經過45天醫療團隊的細心照護,心肺功能完全恢復。

 

童 綜合醫院副院長遲景上表示,李小弟到院時病情嚴重,安排住進小兒加護病房,經檢查發現心臟功能下降,併發心肌炎與心臟衰竭,緊急由小兒科高崇智醫師給予心 包膜放管抽水,及由小兒外科郭敏勇主任啟動維生系統葉克膜積極救治,經過兒科醫療團隊的努力,患者病情逐漸好轉,1月27日中午拔除葉克膜,2月10日拔 除氣管內管並脫離呼吸器可自行呼吸,並轉至一般病房,經過45天的治療,心肺完全康復。

國內因流感疫情併發的死亡案例,讓感染流感的病患與家屬提心弔膽,不過面對流感疫情下,仍有成功救治的案列。高崇智醫師說,這位小朋友為典型的B型流感合併心肌炎的重症個案,在此呼籲每年應儘速給予嬰幼兒及老年人接種流感疫苗,以預防此類重症案例再度發生而造成不幸。

 

相關網頁→ uho優活健康網

Subsidised medical transport on MediWheels for needy

SINGAPORE: It’ll be easier and cheaper for the frail elderly and disabled to move around the neighbourhood, with a new programme called MediWheels.

The initiative is being tried out for six months in Ang Mo Kio-Hougang division.

It’ll be rolled out to Ang Mo Kio Group Representation Constituency and Sengkang West Single Member Constituency if it is well-received.

Prime Minister Lee Hsien Loong launched the programme on Sunday.

Wheelchair-bound or bed-bound residents can use the private medical transport service when they go for medical appointments.

Ang Mo Kio grassroots organisations, which will manage the programme, are working with private medical transport service providers Green Crescent Ambulance and Caring Fleet to provide the services.

A two-way trip will cost S$5 to S$30, much cheaper than the normal rates of S$50 to S$180.

Those who need someone to accompany them can use its medical concierge service.

Needy residents who have difficulty moving around can rent a scooter for just S$10 a month to go out of their house and move around in the neighbourhood.

About 20 scooters are available. Each costs between S$1,500 to S$3,000.

The programme is funded by Central Singapore Community Development Council and sponsors.

Central Singapore CDC is providing about S$120,000 to fund the programme.

Mayor of Central Singapore CDC Sam Tan said: “We thought this is (a) very, very important initiative, because in our society there are those who face mobility challenges and this is the time for us to give them more focus, more assistance.

“So I thought this is one very concrete project to show that the community cares, the people care. When the Ang Mo Kio- Hougang division proposed this project, we thought this is one very early pilot project we can work with them.

“We will not rule out in supporting other constituencies to serve the needs of their residents.”

Residents will be means-tested and the qualifying criteria will be similar to those applying for Community Care Endowment Fund Schemes.

MP for Ang Mo Kio GRC, Yeo Guat Kwang, who first proposed the programme said: “The criteria will be more flexible. I think we would have to draw a line at the moment to say it is S$2,000 and below (household income) but for anyone whose income is more than S$2,000, we are willing to look at case by case basis.”

So far, about 15 beneficiaries have signed up.

Fifty-six-year-old Yasin Mohd Ali, who goes for dialysis three times a week and has trouble walking, is renting a mobility scooter.

He said: “My block is at 924 (and) my dialysis centre is Block 628. It is about six bus stops away. So when I take a cab, it will cost me to and fro about S$13. So monthly, maybe it is more than S$100.

“So with this mobility scooter, I just rent about S$10 for one month, so it saves me a lot. Not only can I go for dialysis, I can go to the coffee shop or go for marketing whatsoever, so it helps me a lot.

CNA/ck

On high alert for HFMD

Ministry taking steps to ensure outbreak doesn’t occur in Sarawak

KUALA LUMPUR: THE Health Ministry has raised the hand, foot and mouth disease (HFMD) alert level to “high” in Sarawak after a surge in cases over the past week.

Its minister, Datuk Seri Liow Tiong Lai, said there were 806 cases in the state in just seven weeks this year compared with only 213 cases within the same period last year.

“This is an early announcement to urge the public to take hygiene and cleanliness seriously to avoid a HFMD outbreak,” he said after launching the Medan Maju Jaya health clinic at Taman Medan yesterday.

He said 295 cases were reported in Kuching, Bintulu (112), Betong (85), Samarahan (70) and Miri (65).

Liow claimed the situation was not an outbreak but could lead to one if not handled right.

“These are signs of an outbreak. But we have a standard operating procedure in handling past cases. When we detect an infection going around, the schools, for example, will be immediately closed down.”

HFMD-afflicted children exhibit symptoms such as breathing difficulties, diarrhoea, vomiting and loss of appetite.

Liow advised parents to take precautionary steps to limit its spread and ensure their children practised good hygiene.

“It it easily contracted by children as their immune system is lower than adults. Hygiene in kindergartens and nurseries should be given high attention.”

He said the samples taken from patients contained the Enterovirus 17 (E17) while one was found to have Coxsackie A16 (CA16), a virus that normally spread through contact with saliva and faecal matter.

Liow said he had directed the ministry’s directed-general to monitor and discuss methods of handling the disease so that it does not escalate into an outbreak.

On the students of Sekolah Menengah Sains Muzaffar Shah in Malacca who were quarantined at the school hostel after showing symptoms of influenza-like illness (ILI), he said the ministry was confident the situation could be handled.

Meanwhile, Liow said there was a prevalence of high mental health problems among Malaysians, especially children. “A lot of young people are under stress and they do not know how to handle it.”

The National Health Morbidity Survey in 2006 revealed that 11.2 per cent of adults had mental stress while 20.3 per cent of children and adolescents also faced the problem.

In 2011, the number of cases increased to about 12 per cent for adults while children also recorded slight increase.

Suicidal tendencies among youth aged between 16 and 24 were also at a worrying level at 20 per cent.

In view of this, he said, the ministry would extend the Healthy Mind Screening Programme to all schools this year.

“We will work with the Education Ministry to educate students on how to handle stress and provide them counselling in schools.”

Read more: NST

Free dental services for NKF patients

SINGAPORE: Needy patients of the National Kidney Foundation (NKF) can look forward to free dental service.

The NKF is working with Tzu Chi Foundation to provide the services at the Tzu Chi Free Health Screening and Medical Clinic in Jurong West.

They cover consultations, fillings, extractions, scaling and denture-making.

It is hoped the free dental services will improve the dental condition of older kidney patients who sometimes have trouble eating.

Chairman of the NKF, Mr Gerard Ee, hopes that good dental health will lead to good nutrition.

About half of the NKF’s kidney patients aged 60 and above suffer from malnutrition.

Mr Ee said: “When they’re on dialysis, they need to consume more protein and our patients don’t realise that, sometimes it’s a matter of cost. But we realise that with our ageing population, our patients are older and some of them can’t afford to deal with their dentures, their fillings and things like that. They become malnourished. Luckily for now, we’re able to have the Tzu Chi foundation that is able to provide the free dental for our patients.”

Plans for the free dental service were announced at the official opening of the new Woh Hup-NKF Dialysis Centre at Ghim Moh on Sunday morning.

It is the first time the full cost of a dialysis centre is being sponsored by the main contractor and its sub-contractors.

CNA/fa

Indonesia reports fourth bird flu death of the year


The health ministry says that 154 people have died of bird flu in Indonesia since 2005 (AFP/File, Sonny Tumbelaka)

JAKARTA — A 12-year-old boy on the Indonesian resort island of Bali has died from bird flu, the fourth human death from the virus this year, an official said Saturday.

The boy developed fever on February 11 and was admitted to hospital five days later, the Indonesian health ministry’s head of animal-borne infectious disease control, Rita Kusriastuti, told AFP.

“He suffered shortness of breath and eventually died on February 21. Laboratory tests confirmed he died from the H5N1 virus,” she added.

Concerns about avian influenza have risen in Asia since China in late December reported its first fatality from the H5N1 virus in 18 months.

Indonesia has been the hardest-hit by bird flu, with 150 deaths reported between 2003 and 2011, according to the World Health Organization.

The health ministry said on its website that 154 people had now died of bird flu in Indonesia since 2005.

The virus typically spreads from birds to humans through direct contact, but experts fear it could mutate into a form that is easily transmissible between humans, with the potential to kill millions in a pandemic.

Read More: AFP

Smoky chicken with warm corn & potato salad

This chicken dish is full of fresh summer flavours, perfect for a quick and healthy midweek meal

  • Cook 12 mins
  • Prep 8 mins

Nutrition per serving

343 kcalories, protein 38.0g, carbohydrate 31.0g, fat 8.0g, saturated fat 1.0g, fibre 2.0g, salt 0.25g

Ingredients

Serves 4

  • 2 lb bag new potatoes
  • 2 large corn cobs
  • ½ red onion, thinly sliced
  • juice 1 lime
  • 2 tbsp olive oil
  • 2 garlic cloves, crushed
  • ½- 1 tsp sweet smoked paprika
  • 4 skinless chicken breasts, each halved across the middle to make 2 thin escalopes
  • small bunch coriander, leaves roughly chopped
  • lime wedges, optional, to serve

    Method

    1. Bring to the boil a saucepan of water big enough to hold all the potatoes and corn. Cook the potatoes for 12 mins, adding the corn after 6 mins, until both are tender. Drain well.
    2. Meanwhile, mix the sliced red onion with the lime juice and half the oil in a large salad bowl. Mix the remaining oil with the garlic, paprika and some seasoning in a shallow bowl, then toss in the chicken until thoroughly coated.
    3. Heat a griddle pan, then griddle the chicken for 3 mins on each side until cooked through. Tip the potatoes into the bowl with the onions. Stand a corn cob on one end on a chopping board, then slice down the length, cutting off the kernels in strips. Mix into the potato salad with the coriander and seasoning, then serve alongside the smoky griddled chicken, with lime wedges, if using.

 

Read More : GoodFood

Bibimbap With Tuna, Sweet Potato, Broccoli Rabe or Kale, and Lettuce

I keep the tuna in one piece when I marinate it and cook it, then slice it after it’s seared so it won’t be overcooked. If you want to reduce the calories and carbs here, substitute winter squash or another vegetable of your choice for the sweet potatoes.

For the tuna:

12 ounces albacore tuna (usually 2 steaks)

1 tablespoon soy sauce

1 teaspoon brown sugar

1 tablespoon sesame oil

1 to 2 garlic cloves, to taste, minced or puréed

1 tablespoon minced ginger

2 scallions, finely chopped

Freshly ground pepper to taste

For the vegetables:

2 tablespoons rice vinegar

1 tablespoon sesame oil

2 large garlic cloves, minced or puréed

2 to 3 scallions, minced

1 tablespoon toasted sesame seeds

Salt to taste

Korean red pepper paste (kochujang) to taste (available at Korean markets)

3/4 pound broccoli rabe, rinsed, thick stems trimmed away, or kale, stemmed and washed

2 medium sweet potatoes, baked

Soy sauce to taste

1 tablespoon canola oil

1 heart of romaine lettuce, cut crosswise in thin strips (chiffonade)

For the rice and garnishes:

1 1/2 to 2 cups brown rice, barley, quinoa or another grain of your choice, cooked (keep hot)

4 eggs (optional)

Korean red pepper paste (kochujang) to taste (available at Korean markets)

2 sheets nori seaweed (kimgui), lightly toasted* and cut into thin strips (optional)

2 teaspoons toasted sesame seeds or black sesame seeds

* Toast nori sheets (if not toasted already) by quickly passing them over a gas flame (hold with tongs), until crisp.

1. Marinate the tuna. Mix together the soy sauce, sesame oil, garlic, ginger, scallions and pepper. Lay the tuna steaks in the marinade, turn over, cover and refrigerate for 30 minutes, turning the fish over every so often.

2. Mix together the rice vinegar, sesame oil, garlic, scallions, sesame seeds, chili paste and salt to taste in a small bowl or measuring cup. Set aside.

3. While the fish is marinating, blanch the broccoli rabe or kale. Bring a medium pot of water to a boil, add salt to taste, and blanch the broccoli rabe or kale for 2 to 3 minutes, until just tender. Transfer to a bowl of cold water, drain and squeeze out excess water.  Remove from the heat and toss in a bowl with 1 tablespoon of the vinegar and sesame oil mixture. Add salt or soy sauce to taste.

4. Cut the baked sweet potato into thick slices. Peel if desired. Keep warm. Toss the shredded romaine with 1 tablespoon of the vinegar-sesame mixture (or more to taste).

5. Heat a wok or large, heavy skillet over medium-high heat until a drop of water evaporates immediately on contact. Add the canola oil. Sear the tuna for 2 to 3 minutes on each side, depending on how rare or cooked you like it. Remove to a plate. Cut in thin slices across the grain.

6. Fry the eggs in the hot pan (or in a separate nonstick skillet) until the whites are set and the yolks are still runny. Season with salt and pepper.

7. Heat 4 wide soup bowls. Place a mound of hot grains in the middle of each one and surround with the sliced tuna and vegetables, as well as kimchi if desired, each ingredient in its own little pile. Place a fried egg and a small spoonful of chili paste on top of the rice and garnish with the toasted nori and sesame seeds. Serve at once. Diners should break the egg into the rice. Pass the chili paste and add more as desired.

Note: You can also arrange the food on a large platter and serve family style.

Yield: 4 servings.

Advance preparation: You can do this in whatever order is convenient for you. The grains can be cooked ahead and reheated. The vegetables can all be prepared ahead and refrigerated, then reheated before serving. It’s best to cook the tuna just before serving so it’s nice and hot. But since this is often a way to use leftovers, you can also reheat.

Nutritional information per serving: 462 calories; 20 grams total fat; 3 grams saturated fat; 5 grams polyunsaturated fat; 6 grams monounsaturated fat; 32 milligrams cholesterol; 43 grams carbohydrates; 8 grams dietary fiber; 227 milligrams sodium (does not include salt to taste); 29 grams protein

 

Read More : NYT

Simple diet changes to help cut heart disease risk

Written By Tanya Zuckerbrot

 

Heart disease kills an estimated 630,000 Americans each year. The most common type of heart disease is coronary artery disease (CAD), which can lead to heart attack. You can greatly reduce your risk for CAD through lifestyle changes, such as eating a heart-healthy diet.  There are many ways to do this:

 

Kick the salt shaker habit

 

On average Americans consume 3,500 mg of sodium each day, about three-quarters of which comes from processed and restaurant foods. Cutting sodium intake in half would prevent 150,000 deaths from cardiovascular disease each year, according to estimates from the National Heart, Lung, and Blood Institute. To reduce sodium intake, opt for more fruits, vegetables, and low-fat dairy foods.

 

Add heart-healthy fats

 

A diet rich in monounsaturated fats and omega-3 fatty acids can lower blood fats called triglycerides. The highest amounts of omega-3 fatty acids are found in cold water fish, such as wild salmon, mackerel, sardines, halibut or herring; the American Heart Association recommends at least two servings of fish per-week. Monounsaturated fats have been shown to lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. Good sources of monounsaturated fat include olive oil, avocado, nuts and nut butters.

 

Eat more fiber

 

Aim for 35 to 40 grams of dietary fiber per day. Fiber helps to lower cholesterol by binding with it and pulling it out of the system.  A study at the University of Kentucky found that people who added fiber to their regular diets were able to lower their LDL cholesterol levels by as much as 25 percent.  Fiber also aids in successful weight management; since fiber-rich foods are more filling, you’ll feel satisfied eating less throughout the day.

 

Spice it up

 

Numerous studies have shown that spices can help improve cardiovascular health. Cayenne pepper is known to strengthen the heart, arteries and capillaries and lower cholesterol levels. A study published in the Journal Diabetes Care found that half a teaspoon of cinnamon a day reduces LDL cholesterol levels. A USDA study found that, gram for gram, oregano has the highest antioxidant activity of 27 fresh culinary herbs. Garlic is known to help lower blood cholesterol and ginger is a natural blood thinner and anti-inflammatory agent.

 

Choose foods rich in antioxidants

 

Good heart health depends on open, flexible arteries that can deliver blood efficiently throughout the body. Dark chocolate and cocoa, as well as plant-based compounds found in red wine and green tea, are high in antioxidants, which help fight cell damage from free radicals in the bloodstream that can cause fatty plaque to build up on artery walls.

Read more: FoxNews

Skin cancer drug hopes raised by study

 


Melanoma is aggressive and dangerous

 

By Helen Briggs Health editor, BBC News website

 

A new treatment for advanced skin cancer almost doubles survival times, according to an international study.

Doctors say 132 patients in the US and Australia who were given the drug vemurafenib gained several extra months of life.

Research in the New England Journal of Medicine found those in the study lived an average of 16 months, compared with nine months on conventional treatment.

Vemurafenib (Zelboraf) has been approved for use in Europe.

The treatment is one of two drugs for late-stage melanoma, approved on fast-track in the US last year, which offer hope for patients with advanced melanoma.

Before that, there had been no new drugs for the cancer for more than a decade.

Malignant melanoma

  • Melanoma, also called malignant melanoma, is a type of skin cancer that is aggressive and dangerous
  • Melanoma is relatively rare and makes up 10% of all skin cancer cases
  • Melanoma is responsible for most deaths due to skin cancer
  • About 2,000 people die every year in England and Wales from melanoma
  • The main cause of melanoma is believed to be over-exposure to the sun
  • Over using sunbeds and sun lamps may also increase the risk of developing melanoma

Vemurafenib is suitable for about half of patients with advanced melanoma as it targets tumours that express a certain gene mutation.

Dr Antoni Ribas, a professor of haematology/oncology and a researcher at the Jonsson Cancer Center at the University of California-Los Angeles, said: “This study shows that Zelboraf changes the natural history of this disease. This data is beyond what I would have expected.

“We’re seeing a significant number of patients with durable responses to the drug, and that the whole group of treated patients is living longer.

“These results tell us that this drug is having a very big impact, and this changes the way we treat metastatic melanoma.”

According to the European Medicines Agency, the drug has been recommended for approval in Europe, pending final authorisation by the European Commission.

Elizabeth Woolf, head of Cancer Research UK’s information website Cancer Help UK, said: “This is an interesting, impressive but relatively small trial of a promising new-generation melanoma drug, which Cancer Research UK is proud to have played a role in developing.”

But she said there were still questions that remain unanswered, not least the cost.

We’re getting somewhere with these targeted drugs but we have a whole raft of research still to do address the issue of resistance”

Kate Law Cancer Research UK

“Everyone on the trial had the drug, so we cannot tell how large the benefits are, compared to people who didn’t have it, or had another treatment. And because the drug targets a particular gene fault, only half of all melanoma patients are eligible.

“About half of those treated seem to benefit, so it could potentially help roughly a quarter of patients with advanced melanoma overall.

“Looking at these uncertainties, and now that the drug is available to UK cancer patients, it will be interesting to see what price the manufacturer charges so as not to place too great a strain on already scarce NHS resources.”

Drug resistance

Cancer Research UK said once the drug was licensed in Europe, patients would be able to discuss treatment options with their doctor.

In England, patients will have to apply to the Cancer Drugs Fund, the charity said.

Kate Law, director of clinical and population research at Cancer Research UK, said the treatment was one of a new generation of cancer drugs targeted at patients with a specific genetic make-up.

While it offered hope, she said, it was not a cure as the cancer eventually became resistant to the drug.

She told the BBC: “This is not a cure – you’re talking an extra six months of life.

“We’re getting somewhere with these targeted drugs but we have a whole raft of research still to do to address the issue of resistance.”

Read More: BBC