2012年5月25日 星期五

OSHA Inspections: Protecting Employees or Killing Jobs?

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OSHA Inspections: Protecting Employees or Killing Jobs?

Executive Summary:

As the federal agency responsible for enforcing workplace safety, the Occupational Safety and Health Administration is often at the center of controversy. Associate Professor Michael W. Toffel and colleague David I. Levine report surprising findings about randomized government inspections. Key concepts include:
  • In a natural field experiment, researchers found that companies subject to random OSHA inspections showed a 9.4 percent decrease in injury rates compared with uninspected firms.
  • The researchers found no evidence of any cost to inspected companies complying with regulations. Rather, the decrease in injuries led to a 26 percent reduction in costs from medical expenses and lost wages—translating to an average of $350,000 per company.
  • The findings strongly indicate that OSHA regulations actually save businesses money.

About Faculty in this Article:

HBS Faculty Member Michael W. Toffel
Michael Toffel is an associate professor in the Technology and Operations Management unit at Harvard Business School.
With an election looming and the economy continuing to struggle, the effectiveness of government regulation has become a political football. While advocates hold regulations up as necessary to protect public health and safety, critics see them as arbitrary and costly to business, reducing wages and killing jobs at a time when the United States can ill afford to lose them. Few regulatory agencies have a more direct effect on businesses than the Occupational Safety and Health Administration (OSHA), the federal agency responsible for enforcing regulations to keep workplaces healthy and accident-free.
"If people are skeptical of OSHA, it's likely based on anecdotes. The difference in our study is we are looking at hundreds of companies over a long period of time, and we find that those anecdotes are not typical."
—Michael Toffel
"Needless rules and onerous regulations are often roadblocks to economic growth and job creation," groused one congressman during a House subcommittee hearing on OSHA last year, sharing the private frustrations of many employers. The debate over the agency has gone on for years, in part because there has been little evidence to prove the case for either side. In order to get the biggest bang for taxpayers' bucks, OSHA typically inspects companies most likely to have problems, often following accidents and complaints, stacking the deck with companies that are worse than average.
"Where there is smoke, there is usually fire, so the fact that government inspectors find safety problems is not surprising," says Michael W. Toffel, an associate professor and the Marvin Bower Fellow at Harvard Business School.
At the same time, when problems are resolved, there's no way of telling whether the inspections themselves helped fix them, because the law of averages implies that a company with a bad year would usually improve the following year even without an inspection. "When they do find a problem, it's not entirely obvious that it wouldn't resolve itself anyway," he says.
Toffel has long studied the effectiveness of regulations, focusing on voluntary measures. When he and colleague David I. Levine heard of a program at California OSHA to conduct randomized inspections of workplaces, they realized they had the perfect real-world experiment to settle the debate over workplace inspections.
"When I learned that Cal-OSHA was conducting some of its inspections at random, I felt almost an obligation to analyze that experiment," says Levine, a professor at UC Berkeley's Haas School of Business. "To let these debates on OSHA and other regulatory agencies continue for another generation when this experiment had already been done seemed inexcusable."
Little did the researchers know at the time how difficult it would be to extract the data for analysis. That task fell to Toffel, who was still completing his doctoral studies at Haas when the research began in 2005. "We received all this data from Cal-OSHA on cassettes, the likes of which I have never seen," Toffel laughs. "They were Memorex tapes about three-quarters of an inch tall and six inches square. We had to hire someone to make them machine-readable."
The team brought on Matthew Johnson, then an HBS research associate who is now an economics doctoral student at Boston University, to help with the data analysis.
Thus began the long saga of extracting statistics on inspections and sorting out which were randomly assigned, which followed accidents, and which followed complaints. In addition, Toffel and Levine essentially became deputized by another California regulatory agency to gain access to workers' compensation data. Because the data were collected at the company level, the researchers limited their analysis to firms with only one plant, where the effects of an inspection on injury rates and costs could be clearly identified. Finally, they matched companies by size, industry, and other characteristics to end up with some 800 companies. Half of the companies had been subject to random inspections; half of them were eligible for inspections but not chosen.

Surprising findings

The results of their analysis, published in Science last week, are definitive: inspections worked. Compared with uninspected firms, the companies subject to random inspections showed a 9.4 percent decrease in injury rates. What's more, the findings were consistent for both large and small accidents. "We thought our results might have been driven by fewer big problems, like preventing storage racks from collapsing and other major accidents; or perhaps by a particularly dramatic decline in smaller injuries prevented by workers more regularly wearing personal protective gear," says Toffel, who worked as an environment, health, and safety manager in the private sector before pursuing his doctorate. "But we found it to be an across-the-board effect."
Just as important are the findings about the costs to companies of complying with regulations. Testing every measure they could find—jobs, wages, sales, and credit ratings among them—the researchers found no evidence (within the margin of error) of any cost to businesses that had been inspected. In fact, quite the contrary: the decrease in injuries led to a 26 percent reduction in costs from medical expenses and lost wages, translating to an average of $350,000 per company. While those costs would be felt most immediately by the firms' workers' comp insurance companies, over time that would translate to lower insurance premiums for the employers.
In other words, those who charge that OSHA regulations cost business money have it completely wrong. In fact, the regulations save money. The magnitude of the results surprised even Toffel and Levine, who expected perhaps a small savings if any. But the strength of the findings, they say, should persuade even skeptical antiregulatory critics.
"If people are skeptical of OSHA, it's likely based on anecdotes," Toffel says. "The difference in our study is we are looking at hundreds of companies over a long period of time, and we find that those anecdotes are not typical. If they know of a company that has been shut down, that is not typical." In fact, the inspected firms were just as likely to be in business at the end of the study period as the control firms.
Of course, a single study cannot settle the debate over regulation, or even the debate over OSHA. This study is limited to one regulatory agency in one state; other states and other agencies could show different results. One thing the research does show, though, is the value of randomized inspections as a way to help gauge regulations' effectiveness. What's more, say Toffel and Levine, the potential benefits from randomizing isn't limited to government inspections, but can also extend to the private sector in the form of randomizing the deployment of new safety, environmental, and quality programs.
But randomizing, of necessity, involves a trade-off. Focusing on short-term cost-effectiveness often leads managers to implement new programs at sites or at times when they think they will do the most good. But such targeted interventions make it impossible to evaluate the program's overall effectiveness, as one could with randomized deployment.
"There is a perceived cost in doing a portion of the work in a randomized fashion," Toffel says. "But if you want to learn, it requires an investment and some patience. You have to be willing to delay or forgo deploying a new program at some of the neediest sites in order to evaluate whether the program is effective." Or as Levine puts it: "It's costly to learn, but it's more costly to be ignorant."

About the author

Boston-based writer Michael Blanding is a fellow at the Edmond J. Safra Center for Ethics at Harvard University and author of The Coke Machine: The Dirty Truth Behind the World's Favorite Soft Drink.

2012年5月17日 星期四

帶你看懂美國食品標簽(李淼) / 'Shape-ups' shoemaker fined $40 million

WSJ
帶你看懂美國食品標簽
李淼
春暖花開,家裡迎來了一撥兒又一撥兒從國內來旅遊度假的親朋。當個善於體察客人需求的好主人不容易,上周本人格外與時俱進地捧出各色自制果凍招待朋友家的小寶貝──“多吃點兒吧孩子,這裡面肯定沒皮鞋”。眾人先是笑成一團,然後就開始感慨美國食品的“安全”。

我們的幸福和不幸經常來自比較。朋友們印象中美國食品的“安全”,來源於與我們熟悉的那個常常沖破底限的國度的對比。而美國食品的“安全”,也僅僅是做到了“無害”而已。

前幾年,我父母在美國超市裡發現了好吃便宜的 peanut butter,我那貪嘴又愛財的老爸滿懷著對美國食品的一腔信任,開始源源不斷地往北京“走私”花生醬。老兩口上頓 peanut butter 拌涼面、下頓 peanut butter烙糖餅,把國內質量可疑的芝麻醬遠遠甩出幾萬

沒出幾個月,我眼看著視頻中老太太臉上的皺紋都撐平了,果然倆人的血壓血糖膽固醇齊齊飆升。直到聽我照著包裝上的營養成分表逐條翻譯出來後他們才恍然大悟, 這哪裡是“安全”食品,簡直就是一桶定時炸彈。那些正準備一箱箱往中國拎美國奶粉果醬蜂蜜糖果的,請參考我父母“沒文化真可怕”的教訓,在超市結賬之前稍停一分鐘,先認真看看包裝上的芝麻小字兒。
李淼
圖一

這瓶花生醬(見圖一)的食品標簽上包括美國聯邦法律規定食品包裝上必須標注的六部分內容:

1、 Identification

這一部分包括產品的名稱、內容量以及生產商/包裝商/經銷商的名稱和聯絡方式。如果該公司沒有在所處城市電話薄中進行登記,還必須標注出帶有門牌號的詳細地址。

2、 Ingredients

配料的名單必須按照內容量的比例由大到小排序。比如,這罐花生醬配料的順序就是roasted peanuts, sugar, hydrogenated vegetable oils, salt。我那有高血壓糖尿病的父母,如果當初試著去研究一下這個配料單,這瓶美國花生醬未必能戰勝中國產的“三無”芝麻醬。

美國有一種花花綠綠水果味道的早餐麥圈很受小孩子喜歡,叫 Froot Loops(見圖二)。
李淼
圖二


這種原名 Fruit Loops的麥片,標簽上的十幾種配料中,根本就沒有水果的痕跡。雖然迫於壓力改名,但是產品“水果”的形象強烈深刻,商家這“圈”讓消費者一鑽就是幾十年。

在食品配料中,美國目前並沒有明確法律要求針對“轉基因食品”進行標注。這方面立法最大的困難是對於Genetically modified這 一概念難以劃定界限以及龐大利益群體的阻撓。盡管民間呼吁不斷,立法提案層出,但最終還是紛紛落馬。因為沒有相關立法,強調非轉基因食品標簽上可能會出現 如下措辭:GMO free/not genetically modified/not genetically engineered/no using of biotechnology。

3、 Serving Size

為 計算營養成分而設定的每餐食用量。這是非常重要的一個數量,也是一個商家帶著消費者做腦筋急轉彎的題目。如果不細看這個數量,很容易被後面的每日攝入量誤 導。比如,一小盒哈根達斯冰淇林,營養成分標注的飽和脂肪含量為每日攝入量的50%,這已經很驚人了──不過可能你決定豁出去放縱自己一下,當你三口兩口 把整盒都幹掉的時候才發現 serving size那小字寫的是1/2 cup

4、 Nutrition Facts

美國於1990年起施行的營養標簽和教育法Nutrition Labeling and Education Act (NLEA)規定,食品根據每餐食用量標注營養成分含量。其中包括 calories, total fat/saturated and trans fat, cholesterol, sodium, total carbohydrates (dietary fiber and sugars) protein。除此之外,還需要針對主要的微量元素──維他命A、C和鈣、鐵──進行標注。如果食品的包裝上出現了關於某種特別維他命或礦物質的宣傳,那麼這種成分也必須被單列出。

5、 Daily Values
圖三

依 照美國食品和藥物管理局(Food and Drug Administration,FDA)的規定,營養標簽上還需包括每日攝入量百分比。這個總量是以每人每天攝入2000或2500卡路裡熱量計算的(不 適用孕婦、哺乳期婦女、四歲下兒童)。看懂這個計算就能讓我們避免被商品包裝上的營養宣傳口號誤導。比如,號稱零脂肪含量的這一小盒果凍粉(見圖三、圖 四)標簽上寫著每一個serving只有80個卡洛裡,糖的含量是一天攝入總量的6%。但是當我們抱著健康減肥的幻想,把一盒不含工業明膠的放心果凍做好 吃下去,會發現這一盒實際包括四個servings。做做乘法,就會發現你幾口輕易地吞下了一頓飯的熱量。
李淼
圖四


6、 Health Claims

這 部分是FDA對於商家五花八門自吹自擂行為進行的約束,具體的條文十分細致。比如 less fat/low fat/fat free 這三種脂肪含量的描述就被嚴格的定義:less fat指比同類普通食品減少25%或以上的脂肪;low fat 指每餐食用量少於三克脂肪;fat free指每餐食用量少於0.5克脂肪。這一文件可以在FDA網站上的“行業指南:食品標簽指南”(Guidance for Industry: A Food Labeling Guide)上找到。

最後要提醒大家的也是在美國食品標簽管理上顯得最混亂的一個區域──保質期。在美國購買的食品上都能找到生產商“自覺”標注的保質期。因為沒有統一格式,就需要我們用點心思來辨識。“Sell by 06/01/12”是生產商用來約束零售商的日期,並不代表這個食品到六月一日那天就不能食用。

"Best if Used By (or Before)06/01/12" 最佳食用期──是推薦給消費者在此日期前食用。這一食品過期後可能會缺失風味或營養,但不代表不能食用。 "Use By 06/01/12" 生產商判斷在此日後產品不再適合食用,應該立刻丟棄。"Closed/coded”日期是產品包裝的日期,多見於超市生鮮類食品。除此之外,有些餅幹類食 品的保質期是用火星文標注的,只能請消費者去廠家網站上自行破解。

為什麼這麼亂?因為除了嬰兒配方奶粉,美國沒有聯邦法律規定食品必須 標注保質期。仔細想想,實際上法律在這方面的“空白”也是為了保護消費者的利益──-即食品制造者無法以產品“超出保質期”為由推脫責任。在美國出售過期 食品違法嗎?答案是不。但是不會有人這麼做,因為消費者的健康安全是這個社會沒人敢觸碰的底限。





'Shape-ups' shoemaker fined $40 million; FTC cites bogus fitness claims

By Todd Sperry, CNN
May 17, 2012 -- Updated 0529 GMT (1329 HKT)
Skechers agrees to pay a $40 million fine over
Skechers agrees to pay a $40 million fine over "unfounded claims" about its Shape-ups shoes, the FTC says.
STORY HIGHLIGHTS
  • FTC official: Skechers' claims "went beyond stronger and more toned muscles"
  • They also said shoes would help "weight loss and cardiovascular health," official says
  • Customers who bought Skechers "toning" shoes will be eligible for refunds
  • Sales of toning footwear approached $1 billion industrywide in 2010, FTC says
Washington (CNN) -- For overweight Americans, and those looking for a healthier lifestyle, the claim was almost too good to be true -- wear Skechers Shape-ups footwear and watch the pounds melt away. At a news conference Wednesday, the Federal Trade Commission said the shoemaker's claims weren't true and alleged Skechers violated federal law by misleading consumers.
According to the FTC, Skechers agreed to pay a hefty $40 million fine to settle charges the California-based company deceived consumers by making "unfounded claims that Shape-ups would help people lose weight, and strengthen and tone their buttocks, legs and abdominal muscles."
The company enlisted high-profile celebrities Kim Kardashian and Brooke Burke to sell the shoes.
Besides Shape-ups, Skechers also made deceptive claims about other products including Resistance Runner, Toners and Tone-up shoes, the FTC alleges.
Stars don't get how 'Shape-ups' work
"Skechers' unfounded claims went beyond stronger and more toned muscles. The company even made claims about weight loss and cardiovascular health," said David Vladeck, director of the FTC's Bureau of Consumer Protection.

As part of the settlement, customers who bought Skechers "toning" shoes will be eligible for refunds either directly from the FTC or through a court-approved class-action lawsuit, officials said.

Wednesday's announcement was the culmination of a months-long investigation involving the FTC and attorneys general from 44 states and the District of Columbia.
FTC officials highlighted a Skechers television ad featuring the endorsement of chiropractor Dr. Steven Gautreau. In the ad, Gautreau cited an "independent" clinical study he conducted testing the shoes' benefits.

The FTC said the study results Gautreau promoted weren't factual, and alleged the company hid the fact that Gautreau is married to a Skechers marketing executive. The FTC also said Gautreau was compensated for his endorsement, which wasn't made clear in the commercial.
Skechers introduced Shape-ups in 2009, and sales peaked a year later. The FTC called Skechers an industry leader in the booming business of toning footwear. Estimated sales were close to $1 billion industrywide in 2010, the FTC said. The toning shoes Skechers sold cost between $60 and $100 a pair.
As part of an expensive campaign to promote the fitness benefits of Shape-ups, the company unveiled a scantly dressed Kim Kardashian peddling the shoes during the Super Bowl in 2011.
Brooke Burke's ads claimed the shoes would help improve her cousin's posture, mother's legs and give her brother a tighter core. Additionally, Burke's ad told consumers "the newest way to burn calories and tone and strengthen muscles was to tie their Shape-up shoe laces," the FTC said.
"The FTC's message, for Skechers and other national advertisers, is to shape up your substantiation or tone down your claims," Vladeck said.

Under the FTC's settlement, the company is barred from any advertising making similar claims unless it's backed up by scientific evidence.

What Skechers plans to do with the Shape-ups brand remains to be seen. An ad featuring Burke touting "the next generation of Shape-ups" remained on the company's website Wednesday morning.
According to the FTC, the commission files a complaint when it has "reason to believe" that the law has been or is being violated. The FTC says despite Skechers agreement to pay a fine, the complaint is not a court ruling or an admission that the company violated any law.




2012年5月16日 星期三

健康“黑名單” TOP10全台有超過六成兒童曾在遊戲設施受傷,高達九十六%的公園滑梯不合格



〔記者胡清暉、王昶閔、范正祥/台北報導〕昨天是全國兒童安全日,靖娟兒童安全文教基金會召開記者會 批評,政府對兒童安全投注的資源明顯不足,每個孩子的安全預算一天只分到兩元,靖娟抽查五都共五十個公園的遊戲場,更發現九十六%的滑梯不合格,潛藏墜 落、骨折、窒息等風險。

靖娟基金會花了兩個月進行「兒童安全總體檢」。董事長林志嘉質疑,兒童安全日已五年,去年又通過「兒童及少年福利與權益保障法」,但政府的兒童安全政策仍缺乏延續性的規劃,官方應擬定「兒童安全政策白皮書」。

靖娟執行長林月琴指出,政府從九十七年到一○一年,平均每童每年分得的兒童安全預算僅約七百二十九元、等於每天只兩元,明顯不足。

她並質疑,內政部兒童局在業務規劃上太過於便宜行事,規避需長期規劃及跨部會協調的工作,且對遊戲安全缺少作為;國健局在「兒童及青少年保健」計畫執行工作中,竟包括老人跌倒預防,更讓人不解。

靖娟另公布,全台有超過六成兒童曾在遊戲設施受傷,兒童進公園最常玩的是溜滑梯,但也最常讓兒童受傷。靖娟對五都的五十座公園抽檢就發現,高達九十六%的公園滑梯不合格,僅有兩座符合國家標準要求。

林月琴強調,滑梯的安全規格應包括護欄、防護柵欄不得低於九十七公分,滑梯外側要有五十三公分的淨空範圍,避免孩子手腳伸出時撞到或骨折,滑出段長度不得小於二十八公分、斜度須介於零至負四度,滑出段要提供足夠高度,讓孩子站立。
針對靖娟批評兒安預算過低,國健局官員澄清說,許多兒童安全工作經費是散編各處。至於兒青預算遭指挪至老人防跌,國健局表示,防跌工作不分老人、兒童、孕婦或殘友都可獲益,為免誤會,相關預算於兩年前已切割。
內政部兒童局長張秀鴛回應指出,在「兒童及少年福利與權益保障法」第二十八條和二十九條的條文中,以及現行「各行業附設兒童遊樂設施安全管理規範」,都有關於兒童遊戲安全的規範,各直轄市和縣市政府也都扮演相當的角色,絕非部分人士所批評的無作為!
張秀鴛指出,如果外界認為必須將相關文字入法才算是對兒童遊戲安全有所明確規範,兒童局願意傾聽各界意見。


揭秘健康黑名單

黑名單”TOP10(組圖)
cid:5c3b20e9$1$13716ee85b4$Coremail$emily_zhan$163.com
第一名:缺乏運動。
2/3的受調查者達不到每週3次、每次30分鐘以上的運動標準。運動量不足會引起肥胖、高血壓、動脈硬化、冠心病、腰痛等一系列疾病。人們應至少保持每週運動35次,每次30鐘。
小常識
推薦“慢運動”――慢運動現在越來越受白領青睞,因其具有塑身、減壓、美容、治病等功效,所以成為不少白領族的首選。對於壓力大的白領,特別是女性來說,慢運動是更適合的一種運動。很多白領經常加班加點工作,忙了一天之後,如果下了班還要繼續去健身房到跑步機上瘋狂跑上40分鐘或者一個小時,反而可能對身體造成一定的傷害。而這時候做一些“慢運動”,比如瑜伽、太極、散步,能夠使人的心情從焦躁變得安靜。
事實上,“慢半拍運動 ”早已在國外流行起來,很多人長期堅持“每天一萬步”的健身方法。在離家還有一段距離的時候,下車步行回去;週末到近郊散步,在耐心慢慢走的同時,收穫身心的健康和愉悅。

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第二名:蹺二郎腿。
這個看似舒服的小動作,會使腿部血流不順,容易造成靜脈血栓、脊椎側彎、腰椎間盤突出。北京醫院心內科副主任劉德平指出,患高血壓、糖尿病、心臟病的人,長時間蹺二郎腿會使病情加重。
小常識
疾病一:可能引發腿部靜脈曲張或血栓塞。蹺二郎腿時,被墊壓的膝蓋受到壓迫,容易影響下肢血液迴圈。兩腿長時間保持一個姿勢不動,容易麻木,如果血液迴圈再受阻,很可能造成腿部靜脈曲張或血栓塞。特別是患高血壓、糖尿病、心臟病的老人,長時間蹺二郎腿會使病情加重。
疾病二:影響男性生殖健康。蹺二郎腿時,兩腿通常會夾得過緊,使大腿內側及生殖器周圍溫度升高。對男性來說,這種高溫會損傷精子,長期如此,可能影響生育。建議蹺二郎腿最好別超過10分鐘,如果感覺大腿內側有汗漬滲出,最好在通風處走一會兒,以儘快散熱。
疾病三:導致脊椎變形,引起下背疼。人體正常脊椎從側面看應呈“S”形,而蹺二郎腿時容易彎腰駝背,久而久之,脊椎便形成“C字形,造成腰椎與胸椎壓力分佈不均。長此以往,還會壓迫到脊神經,引起下背疼痛。
疾病四:出現骨骼病變或肌肉勞損。蹺二郎腿時,骨盆和髖關節由於長期受壓,容易酸疼,時間長了可能出現骨骼病變或肌肉勞損。坐公?r如果遇到急刹車,交叉的兩腿來不及放平,容易導致骨關節肌肉受損脫臼。

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第三名:坐廁看報。
坐在馬桶上讀書看報,勢必延長排便時間,造成肛門充血,從而引起痔瘡發作。此外,肛門充血還會誤導神經系統,刺激“排便感應器”,使肛門長期感到墜脹。所以,如廁時還是不要“一心多用”為妙。
小常識
蹲廁時讀書看報,會干擾大腦對排便傳導神經的指揮,延長排便時間。現代醫學研究證實,蹲廁超過3分鐘即可直接導致直腸靜脈曲張淤血,易誘發痔瘡,且病情的輕重與時間長短有關。蹲廁時間越長,發病幾率越高。因為久蹲不起會使腹壓增高,引起靜脈血回流不暢,導致直腸上靜脈擴張,靜脈群關閉不嚴,靜脈叢壁變薄膨出。經常如此,就容易導致痔瘡形成。
此外,廁所裡一般光線不充足,在裡邊看書。讀報,也容易損害眼睛。
醫生建議,在衛生間“方便”時,應力爭在5分鐘內結束“戰鬥”,同時不斷進行提肛訓練,這樣才能有效防治痔瘡等疾病。

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第四名:剛睡醒立刻下床。
英國拉夫堡大學睡眠研究中心教授吉姆霍恩指出,睡醒立刻起床,很可能導致血壓忽然變動,引發高血壓、中風等疾病。應躺5分鐘活動一下四肢和頭部再起床。
小常識
要緩解睡前和睡後心腦血管壓力變化對血管的傷害專家建議:
1、醒後不要馬上起來先床上再躺上半分鐘;
2、從床上坐起後床邊坐半分鐘;
3靠床邊站立半分鐘而後再下床活動這樣漸進性的活動可讓身體各器官適應變化減少猛然起床對血管的壓迫避免摔倒等危險有利於心律的穩定。

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第五名:連續使用電腦3小時以上。
長時間使用電腦會令人感到眼睛疲勞、肩酸腰痛,還會引發頭痛、食欲不振、失眠等問題。
微波危害:電腦的低能量X射線和低頻電磁輻射,可引起人的中樞神經失調。英國一項研究證實,電腦螢幕發出的低頻輻射與磁場,會導致719種病症,包括流鼻涕、眼睛癢、頸背痛、短暫失憶、暴躁及抑鬱等。對女性來說,還會出現痛經、經期延長等症狀,少數准媽媽還可能發生早產或流產。此外,長期從事電腦作業,精神緊張,心理壓力大,易全身疲勞,加上電磁輻射,女操作者乳腺癌的發病率比一般人要高出30%左右。有關研究還發現,電腦的電磁輻射還會致癌。
視力危害:眼睛長時間盯著一個地方,眨眼次數僅及平時的三分之一,從而減少了眼內潤滑劑的分泌。長期如此,除了會引起眼睛疲勞、重影、視力模糊,還會引發其他不適反應。最有效的方法是適當休息,多吃含維生素A的食物,補充視網膜上的視紫紅質,如胡蘿蔔、白菜、豆芽、豆腐、紅棗、橘子、牛奶、雞蛋、動物肝臟、瘦肉等。
組織傷害:操作電腦時重複、緊張的動作,會損傷某些部位的肌肉、神經、關節、肌腱等組織。除了腰背酸痛外,患上腕管綜合征者,除了手腕疼痛甚至麻痹外,這些症狀會延伸至手掌和手指。
呼吸系統危害:電腦散發的氣體會危害呼吸系統。英國過敏症基金會的研究人員最近發表的一份研究報告指出,辦公設備會釋放有害人體健康的臭氧氣體,其主要元兇是電腦、雷射印表機等。這些臭氧氣體不僅有毒,而且可能造成某些人呼吸困難。另外,較長時間待在臭氧氣體濃度較高的地方,還會導致肺部發生病變。

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第六名:彎腰搬重物。
首都醫科大學附屬北京朝陽醫院骨科主任海湧建議,彎腰搬抬重物,有可能損傷腰部肌肉以及腰椎間盤。最好蹲下來,將身體向前靠,使重力分擔在腿部肌肉上。
小常識
彎腰提取和搬運重物在日常生活和工作中極為常見,如工人搬運重物、婦女端放在地上的洗衣盆等。在這些情況中,如果不注意姿勢,尤其是平日難得有機會進行重體力勞動的腦力勞動者或家庭婦女,很容易造成腰骶部的損傷。
在彎腰提取和搬運重物時,最不利於腰骶部的姿勢就是直膝彎腰的提取和搬運重物。因這種姿勢下,腰椎由屈曲位直腰時,雖然臀大肌等其他部位的肌肉收縮,當彎腰超過90度時骶棘肌不起維持脊柱位置及保護韌帶的作用,所有脊柱後側的張力均由韌帶來承擔,起立時骶棘肌必須首先用較大的力量收縮,以伸展第5腰椎以上的軀幹而將重物搬起,故極易造成腰骶部扭傷,而且直膝彎腰搬提重物,物體重心離軀幹軸線遠,必然也會加重腰背肌肉、韌帶的負擔,造成腰骶部肌肉、韌帶的損傷。
正確姿勢:先將身體向重物儘量靠攏,然後曲膝、曲髖,再用雙手持物,伸膝伸髖,重物即可被搬起。這樣,主要依靠臀大肌及股四頭肌的收縮力量,避免腰背肌用力,腰部損傷的機會也減少了。另外,在搬移重物時,要注意使雙膝處於半屈曲狀態,使物體儘量接近身體,則可減少腰背肌的負擔,減少了損傷的機會。
多喝看不見的水:有的人看上去一天到晚都不喝水,那是因為由食物中攝取的水分已經足夠應付所需。食物也含水,比如米飯,其中含水量達到60%,而粥呢,就更是含水豐富了。翻開食物成分表不難看出,蔬菜水果的含水量一般超過70%即便一天只吃 500克果蔬,也能獲得300~400毫升水分(有兩懷呦)加之日常飲食講究的就是幹稀搭配,所以從三餐食物中獲得1500~2000毫升的水分並不困難。不如充分利用三餐進食的機會來補水吧,多選果蔬和不咸的湯粥,補水效果都不錯。

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第七名:用力排便。
排便過於用力可使心臟收縮加強,血壓會突然升高,誘發腦溢血。
小常識
老年人過分用力排便時,可導致冠狀動脈和腦血流的改變,由於腦血流量的降低,排便時可發生昏厥,冠狀動脈供血不足者可能發生心絞痛、心肌梗死,高血壓者可引起腦血管意外,還可引起動脈瘤或室壁瘤的破裂、心臟附壁血栓脫落、心律失常甚至發生猝死。
由於結腸肌層張力低下,可發生巨結腸症,用力排便時腹腔內壓升高可引起或加重痔瘡,強行排便時損傷肛管、可引起肛周疾病糞便嵌塞後會產生腸梗阻、糞性潰瘍、尿瀦留及大便失禁,還有結腸自發性穿孔或乙狀結腸扭轉的報導。

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第八名:喝水太少。
衛生部中國健康教育中心專家田向陽表示,每人每天最好喝夠 2升水,晨起和三餐之間都應適當補水。
小常識
清晨慎補水:許多女人把起床後飲水視為每日的功課,圖它潤腸通便,降低血粘度,讓整個人看上去水靈靈的。可是早晨怎樣補水才更健康呢?其實,沒有一定之規,早餐補水也要因人而異。
消瘦,膚白,體質寒涼的人,早晨不適合飲用低於體溫的牛奶,果汁或冷水,可以換作溫熱的湯、粥。
鮮榨果汁不適合早晨空空的腸胃,即使是在夏季也要配合早餐一起飲用。
早晨補水忌鹽,煲的濃濃的肉湯、鹹咸的餛飩湯都不適合早晨,這只會加重早晨身體的饑渴。
餐前補水最養胃:吃飯前還要補水嗎?那不是會沖淡胃液影響消化嗎?西餐有餐前開胃的步驟,其道理在於利用湯菜來調動食欲,潤滑食道,為進餐做好準備。那麼,飯前補水也就有著同樣的意義,進固體食物前,先小飲半杯(100毫升),可以是室溫的果汁、優酪乳,也可以是溫熱的冰糖菊花水或淡淡的茶水,或者是一小碗濃濃的開胃湯,都是很好的養胃之法。

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第九名:喜吃燙食。
吃得過熱都會有損腸道和身體機能,平時多吃和體溫相近的食物,可以延緩腸胃老化,助人延年益壽。
小常識
飲食進入胃腸,口腔和食管是必經之路。而“高溫”飲食接觸消化道、口腔黏膜會使其上皮發生破損、潰爛、出血等,如果反復受到不良刺激,就可能誘發癌症。因此,習慣於吃燙飯,喝熱飲的人口腔、食管患癌的風險高。
專家建議,40歲以後要少吃麻辣燙。喜歡吃麻、辣、燙食物等而產生的口腔白斑與口腔癌的發生密不可分。它之所以會轉化為癌,主要和局部受到物理、化學刺激有關。這也是40歲以後最好少吃麻、辣、燙食物的關鍵所在,否則這些重口味食物會對口腔不斷產生刺激,繼而直接誘發口腔癌。
因此,人過40應注意口腔有無白色的無法消除的粗糙斑塊,若黏膜有粗糙、有異物感或味覺發生改變,應儘早求醫。如有白斑,要常注意白斑變化,如白斑周圍是否出現紅斑、斑塊變硬,伴有出血、潰瘍等現象要特別警惕。

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第十名:喝過量咖啡或茶。
適量的咖啡和茶對身體有益,過量卻會刺激腸胃,影響睡眠。
小常識
關於咖啡:從最近國外媒體的報導來看,咖啡或許正引領著最新的健康飲食潮流。不過,別以為把手中的咖啡從中杯升級到超大杯,你就會變得更健康。大多數研究者都認為,並沒有足夠證據顯示咖啡的好處已經達到要鼓勵那些不喝咖啡的人改變習慣的程度。
此外,也沒有一個人找到了對健康最為有益的每天咖啡飲用量。對咖啡的反應更是因人而異:一小杯咖啡能讓一個人變得焦慮緊張,但有些人就是喝上10杯,也還能整夜酣睡。咖啡與健康的關係,目前還沒有嚴謹的論證,專家認為喝咖啡的好與壞因人而異。
關於喝茶:實際上茶分三類,綠茶、紅茶、烏龍茶。這三種茶由於寒熱之性不一樣,對人體好還是不好,要看你的體質類型。綠茶都是涼性的,紅茶是熱性的,烏龍的性質是介於紅茶和綠茶之間,是平性的。喝茶要適當,茶喝多了就和吃某一種食物吃偏了是一樣的。很多陽虛體質的人是喝綠茶喝出來的。綠茶喝得時間長了會出現虛寒症。如果已經習慣了喝茶,建議喝烏龍茶,因為它的性質比較平和。

 

2012年5月15日 星期二

為何不強制穿救生衣?!管理當局和學校的罪過 必須懲罰

管理當局和學校的罪過  必須懲罰


操練龍舟翻船 國一生溺斃

吳偉銘的桌上擺滿了同學寫的祈福紙條。 (記者胡健森攝)
吳沙國中七年三班學生吳偉銘,昨天在練習划龍舟時不幸翻船溺斃。(記者胡健森攝)
吳姓學生就是與隊友同坐在這艘訓練用的龍舟上,卻不幸發生翻船意外而溺斃。(記者胡健森攝)
經過四十分鐘的搜救,搜救人員終於在水面下六、七公尺深的地方找到吳生,趕緊拉上救生艇送醫。(記者胡健森攝)
〔記 者胡健森、楊宜敏/宜蘭報導〕宜蘭縣吳沙國中龍舟隊昨天上午在宜蘭橋附近宜蘭河域練習時,發生翻覆意外事件,十二名落水學生都未穿救生衣,其中十一人自行 游上岸或被教練救起,但七年級學生吳偉銘卻失去蹤影,搜救人員四十分鐘後,才從六、七公尺深的河底,拉起已無生命跡象的吳偉銘,送醫仍告不治。
吳偉銘昨天上午在三位教練陪同下,與同校十多名輕艇隊、龍舟隊同學,一起至熟悉的宜蘭橋附近河域練習,結束練習要將龍舟划回臨時碼頭時,轉彎時突然失去平衡、進水,龍舟瞬間翻覆。

岸邊3教練衝入水 還是來不及救
原本在岸上的三位教練見狀,紛紛跳入水中救學生,但十二名學生只有十一人平安上岸,吳偉銘失去蹤影,三位教練再度下水搜救,同時趕緊向一一九求助,宜蘭消防分隊前往搜救,因水質混濁,遲遲沒能發現吳偉銘的蹤跡。
約四十分鐘後,潛水人員在翻船處水面下約六、七公尺深的水域,找到沉在水中的吳偉銘,搜救人員趕緊將吳拉上救生艇,施以心肺復甦術,再轉送醫院急救,但仍回天乏術。

家屬悲問:為何不強制穿救生衣
吳媽媽說,吳偉銘參加龍舟隊訓練已經兩週了,她曾經詢問吳偉銘有沒有穿救生衣?當時吳偉銘答覆「只有第一天穿而已,後來的訓練都沒有穿」;她認為,如果教練有嚴格要求大家穿救生衣,即使船翻覆了,吳偉銘也不至於丟了性命。
宜蘭縣教育處長吳清鏞表示,穿救生衣會干擾划槳,縣府一向只有勸說,沒有硬性規定要穿著救生衣;就他瞭解,吳沙國中的輕艇隊及龍舟隊在平時訓練時,學生都有穿上救生衣,昨天因為增加訓練強度,模擬實際比賽狀況,才沒有讓學生穿救生衣。
吳沙國中去年蟬聯龍舟冠軍失利,學校今年想奪回冠軍杯,不料竟會在訓練時發生遺憾事件。

2012年5月7日 星期一

雪山隧道的死亡災難 逃生門車子的安全問題都沒人探討

昨天 雪山隧道的死亡災難 我看管理當局的說法有掩飾安全措施/設備的問題 的嫌疑
  逃生門設計必須自動彈回關起來


Taipei, May 8 — At least two people have died and 22 injured, seven of them seriously, in an accident which involved two buses and a car in a tunnel in Taiwan. The three vehicles collided Monday afternoon while dodging a stationary van in the tunnel.
 台灣的車子的安全問題都沒人探討


〔記者曾鴻儒、胡健森、卓冠廷/綜合報導〕雪山隧道昨天下午發生通車近六年來最嚴重的火燒車事故!距頭城端出口二.二公里處,一輛首都客運大客車追撞小客車後起火燃燒,造成兩死、三十一人輕重傷慘劇。高公局估計,雙向車道封閉,有一萬五千車輛受到影響。
高 公局官員說,依規定大車在隧道內安全距離是速限減二十,如果當時大車以最高速限九十公里行駛,安全距離就是七十公尺,小車安全距離是速限除以二,但原則上 都採最高標準,一律要求安全距離是五十公尺,目前無法證實首都客運和前方小 客車是否有保持安全距離,一切交由檢警調查。
箱型車爆胎 後方車閃避追撞
交 通部高速公路局從監視錄影帶發現,昨天下午一點廿七分,距離雪隧頭城端出口二.二公里、南下指標廿六公里處,一輛箱型車在外側車道先發生爆胎並緊急煞車, 同車道後方兩輛小客車與葛瑪蘭客運班車均立即往左駛入內側車道閃避,但葛瑪蘭班車後方的小客車閃躲不及,先擦撞葛瑪蘭班車後端後彈回,再遭後方的首都客運 大客車追撞。
首都客運追撞轎車 起火燃燒
消防人員說,首都客運將小客車撞成九十度翹起並著火,車內發現兩具疊在一起的焦屍,懷疑是家住宜蘭的李允恭、溫素嬌夫婦,其兒子前往認屍並採取檢體,檢警今天將比對DNA做最終確認。
引燃的火勢將兩車燒得只剩外殼,所幸大客車起火時,司機就讓二十名乘客從後方安全門逃生;葛瑪蘭客運上的三十四人,經民眾及警消人員協助也平安脫困;但整起火燒車事件仍有三十一人受傷,其中七人傷勢較重,均以吸入式嗆傷為主,重傷者為首都客運駕駛及乘客。
隧道竄濃煙 數百人一度受困
事 故發生後,坪林行控中心在下午一點廿九分封閉北上、南下兩車道,兩點零八分火勢撲滅後,高公局啟動軸流式、噴流式風機排煙,於兩點四十五分完成排煙。交通 部高公局局長曾大仁說,昨天事故現場後方約有一百五十名民眾逃生過程表現令人激賞,大家都知道要往後方疏散、進入人行與車行橫坑避難,讓事件傷亡可以減到 最低。
北上車道開放 南下漏夜搶修
昨晚七點十六分,北上車道已先開放單車道通行,但南下車道因為電力設備、纜線受損嚴重,高公局正漏夜搶修;希望能在今早恢復通車;如果今早仍無法恢復通車,公路總局已協調首都、葛瑪蘭客運自今天清晨五點起,每半小時發車一班,至坪林改走北宜公路前往宜蘭、羅東。
曾大仁說,雪隧在三月卅一日與四月一日才連續兩天進行實兵演練,演練內容就是大客車起火事故,對實際救援確有幫助。而事故確切原因有待檢警調查;原本高公局打算昨晚向媒體公布的隧道監視錄影帶,也已遭檢察官扣留。
這起火燒車事件,濃煙沿著隧道向外流竄,最後從隧道南端出口處冒出,相當嚇人。事故發生時後方十公里的隧道內,還有至少上 百輛的汽車、數百人受困其中進退不得,情況相當危急;距離事故現場最近的三十多人,因難耐高溫及濃煙,趕緊衝至人行橫坑,再下至人行導坑避難;三十一名傷 者分別被送往宜蘭陽明大學附設醫院、羅東博愛及聖母醫院、杏和醫院、汐止國泰醫院。

「原本以為會死!」搭乘葛瑪蘭客運的乘客張桓綸,昨天回想起意外仍心有餘悸,在車上先是感覺到車尾被撞擊,之後聽到司機高喊「火燒車!」眾人慌張逃生,一行人奔跑到地下聯絡道避難,拚命往有空氣的方向鑽,過程中一度濃煙密布,眼前漆黑一片,差點找不到「生命」的出口。 

中國時報報導,乘客張桓綸、張進忠與張志豪三人,滿臉燻黑地被送到羅東博愛醫院急救,各個臉上難掩逃亡過程中的驚恐。張進忠語氣顫抖著說:「事發現場就是亂!」濃煙密布、不知道該往哪裡逃,最後他與同車乘客逃到人行地下聯絡道。 

張志豪透露,濃煙逐漸從地面擴散,最後甚至伸手不見五指、動彈不得,「真的想過可能會死掉!」只要靠近聯絡道與隧道連接口,就被濃煙嗆得透不過氣,過程中還聽到地上傳來「砰!」的爆炸聲。 

「活著就值得慶幸!」而在葛瑪蘭客運車上,一名幸運逃生的台電工程師林世杰,僅受到吸入性嗆傷。他餘悸猶存表示,能活著真的很幸運,他沒看到車子燒起來,但直覺的就跟著大家跑,或許也因為這樣倖免於難。 

此外,張進忠指出,逃生期間不斷用手機向外求救,但救護車等了超過卅分鐘仍不來,最後還是被工程車載到隧道口,呼吸到有生以來最珍貴的第一口空氣。 

首都客運乘客潘賴烏毛則回想,當時感受到巨大撞擊後,車頭開始起火,車內尖叫聲四起,開始跳下車往後方跑,有人鮮血滿面頭也不回的奔跑,就怕黑煙向自己襲捲而來,一群人等了超過一個小時後,救護車才開到隧道內。 

被送至汐止國泰醫院的王明弘則向警方透露,當時他看見客運車爆炸之後,先用手機拍下驚險的一刻,但他後來發覺濃煙似乎離自己越來越近,他便與其他倉皇逃生的乘客一起拔腿就跑,也不知道自己跑了多久,終於到了隧道的避難空間,才停下來喘口氣。 

但由於隧道內溫度很高,很多人呼吸不到空氣,又擔心被濃煙嗆傷,某些乘客試圖往隧道反方向出口走,反而遇上亂成一團的車陣而又返回,王男回憶當 時,現場只能聽見尖叫聲、求救聲和喇叭聲,他因吸不到氧氣而顯得意識模糊,等到聽見救護車的聲音時,已是一小時後的事,隨即被救護人員送到醫院急救。

2012年5月1日 星期二

推動病歷中文化 抽筋等肌肉疼痛cramps 現象 現在還不知道原因

double up with a cramp, calf muscle,  抽筋等肌肉疼痛cramps 現象   現在還不知道原因


衛署承諾跳票/醫師環島 推動病歷中文化
為推動病歷中文化,醫師高克培昨日在消基會舉行記者會,宣布將以單車環島宣揚理念。 (記者方賓照攝)
心臟科醫師洪惠風十多年前就以中文書寫病歷,可以完整記錄病人主訴症狀。(記者劉信德攝)
心臟科醫師洪惠風十多年前就以中文書寫病歷,可以完整記錄病人主訴症狀。(記者劉信德攝)
〔記 者謝文華、王昶閔/台北報導〕推動「病歷中文化」十年的榮總醫師高克培,質疑衛生署遭監察院糾正後於九十八年承諾分階段施行病歷中文化,迄今兩年半卻仍跳 票;他強調,以中文書寫病歷能減少醫病糾紛,對醫病關係是雙贏!高克培將在三日退休第一天、六十三歲生日,從台大醫院出發,騎單車環島散播理念。消基會呼 籲民眾上「病歷中文化行動聯盟」臉書粉絲團力挺。
英文病歷 嗜睡誤寫成昏迷
消基會董事長蘇錦霞說,曾有病人誤吞釘書針,醫師竟把「釘書針(staples)」寫成「釘子(nail)」,也曾有醫師把「嗜睡(drowsy)」寫成「昏迷(comatose)」。
她指,德法日韓都採官方語言寫病歷,我國大法官解釋亦指「病人有調取『依其智識所能一望即知文字的病歷』的權利」,中文病歷可讓民眾一目了然,即時要求更正或不實記載,阻卻不肖醫師偽造病歷詐領保險費,撙節健保開支。
十年前教授之母來看診,高克培翻閱一疊英文病歷,卻因內容簡略、字跡潦草,坦言「不清楚令堂為何開刀?生什麼病?」引來教授指責,深受打擊而推動。
心 臟科醫師洪惠風曾依英文病歷記載「胸口不舒服」,翻成台語問病人「胸口『綁綁』?」病人怒斥:「我從沒感覺『綁綁』,是『匝匝』!」他驚覺以病人語言記錄 病歷的重要;十多年來,他針對病人主述病史、症狀以國、台語記錄,理學檢查、診斷及開藥以英文書寫,並以此要求住院醫師。
胸口匝匝 台語病歷貼近病患
洪惠風舉例,台語形容胸口ㄉㄨㄉㄨ、縮起來、綁綁、匝匝,症狀都不同,英文難翻精準,但診斷往往得靠這些細節。因此,他跟住院醫師說,像打臉書,病人怎麼說怎麼打,一起看電腦校正,也建議衛生署將中文病歷納入醫院評鑑加分項目。
高克培另發現,地區醫院住院患者的住院病歷,不少由護理師、助理撰寫,違反醫療法;建議仿照美國,由醫師口述國台語錄音、助理據此打字,再由醫師核簽。
衛署:已公告實施 違者開罰
衛生署官員表示,目前正持續推動病歷中文化工作,但前年已先行公告修正醫療法施行細則四十九條之一,要求醫院原則上應給予病人中文病歷摘要。民間監督健保聯盟發言人滕西華表示,衛生署應要求醫院大廳張貼大幅海報,否則病家根本不知有此權利可主張。
向醫院申請病歷「摘要」時,若未指定英文版本,醫院須一律給中文版本,否則就違反醫療法,依法衛生局可處一到五萬元罰鍰,限期改善,並得連續處罰。