2008年3月23日 星期日

美國"貧富差距"兩極之預期生命差距越來越大

Gap in Life Expectancy Widens for the Nation


Published: March 23, 2008

WASHINGTON — New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.

Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.

One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.

The gaps have been increasing despite efforts by the federal government to reduce them. One of the top goals of “Healthy People 2010,” an official statement of national health objectives issued in 2000, is to “eliminate health disparities among different segments of the population,” including higher- and lower-income groups and people of different racial and ethnic background.

Dr. Singh said last week that federal officials had found “widening socioeconomic inequalities in life expectancy” at birth and at every age level.

He and another researcher, Mohammad Siahpush, a professor at the University of Nebraska Medical Center in Omaha, developed an index to measure social and economic conditions in every county, using census data on education, income, poverty, housing and other factors. Counties were then classified into 10 groups of equal population size.

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

The Democratic candidates for president, Senators Hillary Rodham Clinton of New York and Barack Obama of Illinois, have championed legislation to reduce such disparities, as have some Republicans, like Senator Thad Cochran of Mississippi.

Peter R. Orszag, director of the Congressional Budget Office, said: “We have heard a lot about growing income inequality. There has been much less attention paid to growing inequality in life expectancy, which is really quite dramatic.”

Life expectancy is the average number of years of life remaining for people who have attained a given age.

While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:

¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.

Smoking has declined more rapidly among people with greater education and income.

¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.

¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.

Even among people who have insurance, many studies have documented racial disparities.

In a recent report, the Department of Veterans Affairs found that black patients “tend to receive less aggressive medical care than whites” at its hospitals and clinics, in part because doctors provide them with less information and see them as “less appropriate candidates” for some types of surgery.

Some health economists contend that the disparities between rich and poor inevitably widen as doctors make gains in treating the major causes of death.

Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.

“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”

The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.

Robert E. Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said one reason for the growing disparities might be “a very significant gap in health literacy” — what people know about diet, exercise and healthy lifestyles. Middle-class and upper-income people have greater access to the huge amounts of health information on the Internet, Mr. Moffit said.

Thomas P. Miller, a health economist at the American Enterprise Institute, agreed.

“People with more education tend to have a longer time horizon,” Mr. Miller said. “They are more likely to look at the long-term consequences of their health behavior. They are more assertive in seeking out treatments and more likely to adhere to treatment advice from physicians.”

A recent study by Ellen R. Meara, a health economist at Harvard Medical School, found that in the 1980s and 1990s, “virtually all gains in life expectancy occurred among highly educated groups.”

Trends in smoking explain a large part of the widening gap, she said in an article this month in the journal Health Affairs.

Under federal law, officials must publish an annual report tracking health disparities. In the fifth annual report, issued this month, the Bush administration said, “Over all, disparities in quality and access for minority groups and poor populations have not been reduced” since the first report, in 2003.

The rate of new AIDS cases is still 10 times as high among blacks as among whites, it said, and the proportion of black children hospitalized for asthma is almost four times the rate for white children.

The Centers for Disease Control and Prevention reported last month that heart attack survivors with higher levels of education and income were much more likely to receive cardiac rehabilitation care, which lowers the risk of future heart problems. Likewise, it said, the odds of receiving tests for colon cancer increase with a person’s education and income.

2008年3月11日 星期二

Sex Infections: 美國14至19歲少女四分之一有性病

美國最新研究報告提出,美國14至19歲的少女中有四分之一的人患有性病,令人震驚。

美國聯邦疾病控制和預防中心的研究人員對838名來自美國各地的14至19歲少女的體檢結果進行檢查後發現黑人少女患性病的比例更高。

研究發現,可造成女性不孕甚至引發子宮頸癌的人類乳突病毒是最常見的性病,所有調查對象中有18%感染這一病毒。

排名其後的還有衣原體感染(4%)、滴蟲病(2.5%)和皰疹(2%)等。

聯邦疾病控制和預防中心表示,這次研究是醫學界首次對少女的常見性病問題進行類似研究。

數據顯示,黑人少女中有至少半數的人患有至少一種性病,而白人和西班牙裔少女中這個比例只有20%。

聯邦疾病控制和預防中心專家指出,對有性生活的婦女進行定期檢查、疫苗注射等預防措施是公共衛生部門的緊要任務。

該中心性病預防部門負責人指出,很多年輕人誤以為自己不會感染性病,因此忽略了身體檢查。

疾病控制和預防中心建議對所有25歲以下有性行為的女性每年進行衣原體檢查,另外給11至12歲女孩注射人類乳突病毒疫苗。

Sex Infections Found in Quarter of Teenage Girls


Published: March 12, 2008

The first national study of four common sexually transmitted diseases among girls and young women has found that one in four are infected with at least one of the diseases, federal health officials reported Tuesday.

Skip to next paragraph
Chester Higgins Jr./The New York Times

Cecile Richards of Planned Parenthood hailed a study.

Nearly half the African-Americans in the study of teenagers ages 14 to 19 were infected with at least one of the diseases monitored in the study — human papillomavirus (HPV人類乳突病毒), chlamydia衣原體感染, genital herpes 皰疹and trichomoniasis (毛)滴蟲病, a common parasite.

The 50 percent figure compared with 20 percent of white teenagers, health officials and researchers said at a news conference at a scientific meeting in Chicago.

The two most common sexually transmitted diseases, or S.T.D.’s, among all the participants tested were HPV, at 18 percent, and chlamydia, at 4 percent, according to the analysis, part of the National Health and Nutrition Examination Survey.

Each disease can be serious in its own way. HPV, for example, can cause cancer and genital warts.生殖器溼疣

Among the infected women, 15 percent had more than one of the diseases.

Women may be unaware they are infected. But the diseases, which are infections caused by bacteria, viruses and parasites, can produce acute symptoms like irritating vaginal discharge,陰道分泌物 painful pelvic inflammatory disease 骨盤發炎 and potentially fatal ectopic pregnancy. 異位懷孕 The infections can also lead to longterm ailments like infertility and cervical cancer.

The survey tested for specific HPV strains linked to genital warts and cervical cancer.

Officials of the Centers for Disease Control and Prevention said the findings underscored the need to strengthen screening, vaccination and other prevention measures for the diseases, which are among the highest public health priorities.

About 19 million new sexually transmitted infections occur each year among all age groups in the United States.

“High S.T.D. infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk,” said Dr. John M. Douglas Jr., who directs the centers’ division of S.T.D. prevention.

The president of the Planned Parenthood Federation of America, Cecile Richards, said the new findings “emphasize the need for real comprehensive sex education.”

“The national policy of promoting abstinence-only programs is a $1.5 billion failure,” Ms. Richards said, “and teenage girls are paying the real price.”

Although earlier annual surveys have tested for a single sexually transmitted disease in a specified population, this is the first time the national study has collected data on all the most common sexual diseases in adolescent women at the same time. It is also the first time the study measured human papillomavirus.

Dr. Douglas said that because the new survey was based on direct testing, it was more reliable than analyses derived from data that doctors and clinics sent to the diseases center through state and local health departments.

“What we found is alarming,” said Dr. Sara Forhan, a researcher at the centers and the lead author of the study.

Dr. Forhan added that the study showed “how fast the S.T.D. prevalence appears.”

“Far too many young women are at risk for the serious health effects of untreated S.T.D.’s, ” she said.

The centers conducts the annual study, which asks a representative sample of the household population a wide range of health questions. The analysis was based on information collected in the 2003-4 survey.

Extrapolating from the findings, Dr. Forhan said 3.2 million teenage women were infected with at least one of the four diseases.

The 838 participants in the study were chosen at random with standard statistical techniques. Of the women asked, 96 percent agreed to submit vaginal swabs for testing.

The findings and specific treatment recommendations were available to the participants calling a password-protected telephone line. Three reminders were sent to participants who did not call.

Health officials recommend treatment for all sex partners of individuals diagnosed with curable sexually transmitted diseases. One promising approach to reach that goal is for doctors who treat infected women to provide or prescribe the same treatment for their partners, Dr. Douglas said. The goal is to encourage men who may not have a physician or who have no symptoms and may be reluctant to seek care to be treated without a doctor’s visit.

He also urged infected women to be retested three months after treatment to detect possible reinfection and to treat it.

Dr. Forhan said she did not know how many participants received their test results.

Federal health officials recommend annual screening tests to detect chlamydia for sexually active women younger than 25. The disease agency also recommends that women ages 11 to 26 be fully vaccinated against HPV.

The Food and Drug Administration has said in a report that latex condoms are “highly effective” at preventing infection by chlamydia, trichomoniasis, H.I.V., gonorrhea 淋病

( -rrhea/-rrhoea )and hepatitis B.

The agency noted that condoms seemed less effective against genital herpes and syphilis. Protection against human papillomavirus “is partial at best,” the report said.

2008年3月10日 星期一

Massage Therapy

A Touch of Grace:
Massage Therapy
Aids Retired Nuns

Bronx Nursing Home
Finds Drug Alternative;
'Oh, This Is Heaven'
By LUCETTE LAGNADO
March 10, 2008; Page A1

shock (HAIR)



BRONX, N.Y. -- Here at the Providence Rest nursing home, which caters mostly to retired nuns and devout Roman Catholics, Harold Packman has developed an important expertise: Giving massages to women who may have spent a lifetime shying away from this kind of physical contact.

Women like Sister Mary Austin Cantwell. Recently, Sister Cantwell, 67 years old and wearing some traditional vestments, rolled in on her motorized scooter for an appointment. Mr. Packman gingerly lifted the hem of the nun's black skirt and started rubbing her arthritic knee.

[Harold Packman]

"Oh, this is heaven," Sister Cantwell exclaimed as he applied cream to her afflicted joint. "I am in heaven."

Sister Cantwell is a bit of an exception: She lets Mr. Packman make contact directly with her knee without any intervening garment. Many other patients are more vigilant, arriving in long dresses, support hose, and bulky long-sleeved sweaters that are not to be disturbed.

hosiery Show phonetics
noun [U] (ALSO hose) FORMAL
a word used especially in shops for items such as socks, tights and stockings:
Women's hosiery you'll find on the second floor, Madam.



Providence Rest hired Mr. Packman, a licensed massage therapist, as part of an unusual experiment to cut its use of antipsychotic drugs. These controversial drugs -- which are often used as "chemical restraints" to sedate agitated patients -- have set off a national debate over whether nursing homes are misusing them. Newer versions, known as "atypical" antipsychotics, can increase the risk of death in elderly people with Alzheimer's disease, the Food and Drug Administration has warned.

Providence Rest's alternative treatments sound like something from a pricey spa, not a nursing home in the Bronx. Instead of antipsychotics, it has developed regimens involving aromatherapy, long, soothing bubble baths, use of medicines thought to have fewer, less severe side-effects -- and Mr. Packman's rubdowns.

Startling Results

The results are startling. Nationwide, some 30% of nursing-home patients are put on antipsychotics, according to federal data, but Providence Rest has cut its own use down to 2% or 3%. That's the lowest rate of any nursing home in New York, and among the lowest in the country, according to the New York Association of Homes & Services for the Aging.

"Harold is a very big factor" in that success, says Jocelyn Ronquillo, Providence Rest's medical director and leader of its anti-antipsychotics drive. When she arrived at the home, usage of antipsychotic drugs was at 22% to 23%, Dr. Ronquillo says.

Mr. Packman's strongest weapon in persuading clients to acquiesce to his touch may be the fact that he's as old as -- or older than -- most of the women he treats. "There are advantages to looking like I do," says Mr. Packman, who is 85, although with his sprightly gait and shock of white hair doesn't look a day over 80.

"Patients say, 'You have no idea how much pain I have,' and I say, 'Oh yes I do.' "

Providence Rest, which is run by an order of nuns, mainly cares for lay Italian Catholic women and some retired sisters, though there are a few males and non-Christians. All residents have crucifixes in their rooms. Many hail from the old country.

Patients arrive for their massages in wheelchairs and never disrobe or even lie down. At the most, some might merely let him lift up a trouser leg.

No matter. Mr. Packman, who has been a massage therapist for nearly a half-century, insists he can get the job done while respecting the boundaries. To put patients at ease, he banters like a borscht-belt tummler, delivering a stream of corny old jokes.

"What is such a rotten joint doing in a nice kid like you?" he says to Sister Cantwell's knee. She chuckles, even though she's heard that one before -- at her last massage.

Back when Providence Rest went looking for a massage therapist with a specialty in geriatrics, Mr. Packman was the only one it could find. He joined in 2002 as the home began testing its alternative approach to managing patient pain and agitation. Among other things, Providence Rest substitutes antidepressants and Alzheimer's drugs for antipsychotics, believing them to have fewer, less-drastic side-effects.

On a typical day Mr. Packman, who works part time, might see as many as 12 to 15 patients.

"Rosa, buon giorno," he calls out as Rosa Rizzo, 93, arrives bundled up in a flowing dress and a woolen sweater that she won't remove. In fact, she won't let him so much as roll up her sleeves, despite severe pain in her arm and shoulder.

The Italian-born widow is more typical of the women Mr. Packman works with. "She had a very formal upbringing, as an Italian girl in an Italian family," he explains.

"Rosa, are you going to let me take off your sweater so I can work on your arm?" he asks.

"No," she replies curtly, waving him away.

curtly

Undaunted, Mr. Packman takes her arm -- woolen sleeve and all -- and proceeds to loosen the muscles. Then, he massages her fully clothed shoulders. "You don't want to take off your clothes? Fine. I go with it," he says.

Anyway, he says, young people today are too quick to bare all. In his private practice, "a lot of them don't hesitate, they take their whole nightie off," he says. "I tell them, 'I don't need all that.' "

The Last Frontier

But at Providence Rest, he says, modesty is the last frontier. The elderly, even patients with dementia, finds ways to make it clear they don't want to be touched in certain areas. And some patients simply refuse to have a massage by a man, so he has trained female assistants to handle those cases.

Still, there are a few patients who are willing to let their inhibitions, and perhaps an article of clothing, slip away. Among them is Helen Filardo, 89, who has been receiving regular treatment for soreness in her back, arms, legs, and even, lately, her hands.

As she arrives, she cheerfully announces: "I have to strip." So with some gentle assistance from Mr. Packman, she peels off her sweater and lets him massage her bare shoulder and back.

Write to Lucette Lagnado at lucette.lagnado@wsj.com

中國男性中風患者中,每七人就有一人吸煙

中國男性中風患者中,每七人就有一人是因吸煙而致病的,這是中國和美國的研究人員的最新調查結果。

世界范圍內,中風是導致死亡的第二大殺手。而在中國這個煙草大國,中風更成了威脅公眾健康的大問題。

這份研究報告刊登在美國心臟協會的期刊上。調查人員說,"如果能夠阻止吸煙或者戒煙,就能在中國減少5%的由於中風引起的死亡。"

有關調查人員說,"在對引起中風的因素調查當中,除了高血壓之外,吸煙可能是第二大因素。

有關人員對來自17個省份40歲以上的83,533名男性和86,336名女性進行了調查。其中60%的男性和13%的女性在1991年調查開始的時候是吸煙者。

調查人員對他們每人進行了平均8.3年的跟蹤調查。這些年來,有6,780個中風病例,其中3,979人因此死亡。

在排除了年齡,血壓等原因之後,吸煙造成了14.2%的中風病例和7.1%的中風男性死亡病例。

調查人員還發現,吸煙時間越長,吸煙越多,發生中風的幾率越大。

吸煙與中風之間的關係體現最為明顯地體現在缺血性中風,就是血塊凝結阻止了血液循環到大腦中。

受訪者中每天吸煙一盒或以上的習慣增加了51%的患缺血性中風幾率。

調查人員還發現吸煙造成出血性中風的幾率不是很大,每日吸煙一盒或以上,增加了20%的患有出血性中風幾率。

2008年3月9日 星期日

手機礙睡眠

Wayne State University in Michigan has released findings from the largest study on the effects from mobile phone usage on health. They found is that there are other possible non-cancer related effects linked to mobile phones.

Radio frequencies emitted from mobile phones have now been associated with disrupting normal sleep patterns and inducing more frequent headaches.


  1. Text Generation Gap: U R 2 Old (JK)



2008年3月7日 星期五

"良言一句三春暖"

英倫隨筆 BBC中文網記者 蘇平

抵抗抑郁最好的辦法是和人聊天

It's good to talk!大意是聊天真好!引申一下,可能和漢語中的"良言一句三春暖"異曲同工。

It's good to talk是英國電話公司早年的一句廣告詞。突然提起這句話,起因是上個星期英國披露的一項醫學研究成果:赫爾大學的研究人員稱,服用抗抑鬱藥很多時候根本不能改善症狀。
抑鬱與聊天,哪兒跟哪兒呀?乍聽起來,自己也覺得有點牽強。且聽我細講。

"幸福丸"走紅
今天在英國,恐怕沒有人會否認抗抑鬱藥特別流行這個事實。據統計,2006年,英國醫生總計開出3100萬個抗抑鬱藥處方。抗抑鬱藥被戲稱為"幸福丸"、1990年代的"It pill"(時代丸),英國則被戲稱為"百憂解之國"(百憂解,Prozac,一種抗抑鬱藥)。
有數字顯示,大約五分之一的英國人患有程度不同的抑鬱症。自然,對於很多重症患者,藥物是必不可少、事關生死的治療手段。但是,相當一部分悲觀、消極的輕度抑鬱患者為什麼也動輒服藥呢?
抗抑鬱藥流行,不過也就是這一代人才經歷的現象。英國皇家家庭醫生學院的肯尼迪醫生說,祖父、祖母那一輩人心裡明白,不管起因是親人喪生、失業還是失戀,遭遇失望、不幸是人生躲避不開的一個組成部分。因此他們也就創造出了對應機制。

Factbox:
英國患抑鬱症的名人
詩人 William Blake
前首相 Winston Churchill
歌星 Elton John
演員/作家 Stephen Fry
歌星 Robbie Williams

比如說,英國有名的stiff upper lip(咬緊牙關忍著)的傳統。但是現在,人們的期望值改變了,每個人都覺得自己永遠也不應該不幸,他們要把不幸醫學化。
問問爺爺奶奶,他們會勸你,郁悶了,去散散步呼吸點新鮮空氣,洗個熱水澡吧﹔還不行,和人聊聊,哭一場﹔仍然緩不過來?在車庫裡砸點東西、踢踢沙袋怎麼樣?
但是,如果把人生的不幸看成醫學問題,吃藥,當然就成了首選的治療方案。

英國著名作家、電影人傑瑞米﹒湯瑪斯長期患有嚴重的抑鬱躁狂症。他認為,幸福丸泛濫,與現代人熱衷於走捷徑、追求即時滿足的心態有關。再加上,家庭醫生忙得四腳朝天,平均分配給每個病人的時間只有三分鐘,面對一個叫苦連天的病人,可能只有立刻拿筆開藥方。

聊天是奢侈
赫爾大學研究小組的負責人歐文﹒基爾希教授指出,抑鬱症患者完全可以通過非藥物手段使症狀得到改善。不同領域的專家曾先後提出過鍛煉、聽音樂、食療等治療抑鬱的手段。
抑鬱,是心病。抑鬱的人,一個重要的症狀是不能正確、客觀地分析和看待問題了。越想越想不開,越想不開越壓抑,如同當頭籠罩了一大團黑雲,怎麼都找不著北。這種病人,時常和親人、知己傾訴一番,其實就有可能幫助他們走出死胡同。

但問題是,現在,有人聊天,已經成了一種奢侈。
想看心理諮詢醫師?上個星期,自民黨稱,他們的調查顯示,在英國一些地區,人們需要排隊等兩年以上才能見上心理諮詢醫師。兩年!最堅強的人,聽了這個數字恐怕都會壓抑起來。

能和家人聊自己的煩惱的人不多見
和家人訴訴苦?七姑八姨的大家庭在英國早就成了過去時﹔隨著過去幾十年離婚率居高不下,現在,連兩口之家、四口之家的小家庭,也常常是支離破碎﹔個把兄弟姐妹也都忙,恐怕連自己的身心健康都推到了次要地位。
以前,教會是社區的中心,是人們尋求精神安慰的去處。教堂的門永遠開著,牧師的電話永遠有人聽,教友們定期聚在一起。但是,過去三、四十年,教會在社區中的影響越來越弱,這給社區留下了一個任何其他俱樂部都無法填補的真空。
眼下,現代通訊手段的發展,使得打電話都快要成歷史了。電子郵件、短信能夠保持聯繫,但卻沒有了面對面聊天時知己伸手可及的親切,也沒有電話聊天中聽得到摯友唏噓慨嘆的慰籍。

良言一句
中國有句俗話"良言一句三春暖",說的正是和人聊天有助於改善身心健康。
聊天可以排遣寂寞。人性喜群居,長期孤獨,更易導致心理障礙、抑鬱寡歡﹔聊天是戰勝心理障礙的良方。通過敞開心扉,既可緩解壓力,還可宣洩、疏導不良情緒。

再有一點信不信由你,聊天還能增強自信呢。聊天的範圍上可至天文地理,下可至家長裡短,大可至國家政治,小可至柴米油鹽﹔聊天中既可緬懷過去,又可憧憬未來﹔聊天,無異於給人提供一個展現自我的小舞台!
在赫爾大學公布研究成果的當天,英國政府宣佈,將培訓更多的心理諮詢醫師,更加有針對性地治療各種抑鬱症,改善為心理病人提供的社區服務。

下一次心情郁悶了,別忙不迭地吃藥,記住,It's good to talk。
(2008年3月5日)