Brazil nightclub fire kills about 245 persons

South America

Brazil nightclub fire kills scores

At least 232 people have been killed in a fire at a nightclub in southern Brazil. Local media have reported that a band's pyrotechnics show caused the building to catch fire.

At least 232 people were killed in a fire at the Kiss nightclub in the southern city of Santa Maria early Sunday, according to Police Maj. Cleberson Braida. He says the bodies were brought to a gymnasium in the city.
The initial death toll was given as 245, but Braida said a new count of bodies brought to the gymnasium led to a lower count.

Brazil club fire claims at least 245 lives

Media reports say the fire broke out after 2:00 am (0400 GMT) when the nightclub was hosting a university party featuring a rock band.
"There was panic after the fire started and many revelers got trampled," Santa Maria fire chief Guido de Melohe is quoted as saying by Estadao newspaper. "The main cause of death was asphyxiation."
According to the newspaper O Globo, sparks from the band's pyrotechnic display hit the soundproof foam on the ceiling and caught fire.
"We have just taken the fire under control," Colonel Silvia Fuchs of the local fire department was quoted by the G1 website as saying. "Now we are removing the bodies."
In the wake of the tragedy, Brazilian President Dilma Rousseff has cut short her visit to Chile in order to return home. She was participating in the European Union and the Community of Latin American and Caribbean States summit (CELAC) in Santiago.
Santa Maria, a major university city, is 300 kilometers (187 miles) west of the state capital, Porto Alegre.
hc/pfd (Reuters, AFP, dpa)

巴西夜店大火 245人喪生

巴西南部聖塔瑪麗亞市一家夜總會，27日凌晨疑似因樂團煙火表演引發大火，造成至少245人不幸喪生，還有至少200人受傷。（路透）

疑樂團煙火秀 表演釀悲劇
〔編譯俞智敏、記者吳仁捷／綜合報導〕巴西南部城市聖塔瑪麗亞（Santa Maria）一家夜店，二十七日凌晨疑似因樂團煙火表演引發大火，當地警方表示有至少兩百四十五人不幸葬身火窟，還有至少兩百人受傷。原本在智利參加歐洲─拉美高峰會的巴西總統羅塞夫，聞訊後也立刻縮短行程，返國視察災情。這起事故是巴西近十年來死傷最慘重的夜店火災。
當地官員表示，救難人員已從火場中搬出兩百四十五具被大火燒得焦黑的屍體，運往附近的體育館等候辨識身分，大部份罹難者都是吸入濃煙窒息或遭踐踏死亡。聖塔瑪麗亞市警方指出，在這家Kiss夜總會表演的樂團成員或工作人員點燃火焰，結果火苗引燃天花板，並迅速在夜總會內蔓延開來，火勢在數秒內一發不可收拾。
舉辦大學晚會 數百人聚集
據巴西當地媒體報導，大火約在二十七日凌晨兩點左右發生，當時店裡正舉辦一場大學晚會，請來搖滾樂團表演，煙火秀則是表演的一部份。據稱火災發生當時，店裡可能有三百到五百人；一名警衛則說，當時可能有一到兩千人。火災發生後，所有人都驚慌推擠急著逃生，一名生還者表示，她能夠幸運逃出來，是因為當時她坐在靠近門口的貴賓區。
大學城聖塔瑪麗亞位於巴西南部，鄰近阿根廷與烏拉圭邊界，人口約二十五萬人。這場大火令人聯想到二○○三年美國羅德島州西沃維克「車站」夜總會大火造成一百人死亡，○四年阿根廷布宜諾斯艾利斯的夜店大火則造成近兩百人喪生，這兩起死傷慘重的火災起因都是樂團或觀眾在室內點燃明火，導致整間夜店付之一炬。
PUB大火教訓 我限明火秀
台中ALA PUB一百年三月六日發生的火災共奪走九條人命，案發後消防署即推動修改消防法，規範明火表演安全，內政部同年通過「明火表演安全管理辦法」，室內明火表演採「申請制」，違者可處三至十五萬元罰鍰。
新北市消防局火災預防科科長黃弟勝說，消防法於一百年五月四日修正公布，規定供公眾使用的建築物或中央主管機關公告的場所，除法令另有規定外，非經申請許可，不得使用明火表演，違者還可按次處罰。新規定施行後，彰化縣文化局於一百年七月舉辦活動時使用明火，就遭處罰；去年十月藝人蔡依林為酒商促銷，調酒秀時出現明火，酒商也被台北市消防局開罰。

台塑集團旗下 南亞空污數據造假

數據造假// 短報2億多空污費 南亞被搜索

南亞公司涉嫌與聯宙公司勾結，竄改空污自動連續監測系統數據，短繳2億5千至2億8千萬元空污費，檢警昨搜索南亞樹林廠，查扣電腦硬碟。 （記者謝佳君攝）

〔記者何瑞玲、王定傳、何玉華、劉力仁、張慧雯／綜合報導〕台塑集團旗下子公司再度涉嫌造假空污數據，短繳空污費，金額約兩億五千萬至兩億八千萬元！
樹林廠 涉竄改空污監測系統
台塑的桃園華亞汽電前年短報三億兩千多萬元，昨天檢警查出位在新北市樹林的南亞塑膠廠，也涉嫌與聯宙科技公司勾結，竄改廿四小時空污自動連續監測系統，以少繳空污費。
據了解，前年七月，台塑集團旗下位於桃園縣龜山鄉的華亞汽電公司，爆發造假空污數據短報空污費三億兩千多萬元案後，新北地檢署為了解轄區內有無類似案件，八月時就會同新北市政府環保局針對轄區七間監測工廠實施稽查，沒想到在南亞塑膠樹林廠稽查時，當場發現廠內人員正要動手刪除空污自動連續監測系統（ＣＥＭＳ）的數據，當下查扣電腦數據帶回解讀。
判讀近30萬筆資料 約談12人
環保局先判讀了近三十萬筆原始數據後，再比對該廠近年來排放數據，疑有短報情況，經送成大鑑定，確認九十六年到一百年四月，上傳新北市環保局的空污排放數據造假，函請檢方調查。
檢方認為事證明確，昨天指揮環保署北區督察大隊、新北市刑大偵八隊、環保局及樹林分局，到南亞樹林廠及聯宙公司搜索，並依詐欺圖利罪約談南亞塑膠副廠長李泰源、前廠長張國賢等七名幹部，及聯宙公司五名工程師到案。截稿前，南亞總經理吳嘉昭都無回應。
南亞樹林廠依規定設置廿四小時空污自動連續監測系統，全天監測煙道排放出來的NOx、SOx濃度數據，這些數據會自動傳到環保局查核，廠商則按照監測數據繳交空污費。
但檢警發現，南亞公司為規避空污費用，涉嫌與聯宙公司勾結，竄改電腦程式，提供在合格或接近正常值（氮氧化物或硫氧化物超過300ppm即超標）的造假數據給環保局，前後隱瞞近四年，初估短報兩億五千萬到兩億八千萬元。
檢警並查出，南亞樹林廠前廠長張國賢在環保局前年稽查有異狀時，即被南亞公司調職到桃園廠區，顯然南亞公司早知有「詭」。
檢警昨天已查扣南亞樹林廠的電腦硬碟，將請刑事警察局電腦專家進行還原。環保局也將重新核算近五年的空污費，並依規定追繳。新北市環保局昨天晚間指出，南亞樹林廠去年共繳交六百萬元空污費，若經檢調單位查證犯案屬實，依空污法處刑責外，還要重新核算最近五年的空污費，依規定追繳。
台塑華亞汽電 前年短報3.2億
事實上，這不是台塑集團所屬工廠第一次用此手法少繳空污費。前年桃園縣龜山鄉華亞汽電公司汽電廠，也更改自動監測系統的電腦程式，提供空污假數據、同年南亞錦興廠也以類似手法犯罪，兩案除了補繳空污費外，還被重罰，涉案人員也都被移送法辦。

Lifespan and the sexes 已開發國家的兩性平均壽命漸相近

已開發國家的兩性平均壽命相近

2013-01-21 Web only 作者：經濟學人

相關關鍵字：

• 已開發國家
• 兩性
• 平均壽命
• 睪固酮
• 經濟學人

女性的平均壽命仍舊高於男性，只是差距每年都在縮小，至少在富有國家是如此。例如，在英格蘭和威爾斯，1967年時，兩性的平均壽命差距為6.3年，現在已降至4.1年。而在多數已發展國家，兩性的平均壽命都在上升，只是近期男性上升的幅度高過女性。

根據研究，兩性平均壽命差異，有一半來自吸煙習慣；男性吸煙者較多，但過去半個世紀裡，戒煙的男性也多。另外1/5的因素則是酒精，但酒精其實是在拉大此差距，1979年時，男女死於酒精相關因素的比例為2:1，2009年則升至2.4:1。
第 三大因素則是肥胖，或是肥胖帶來的健康問題。表面上來看，兩性的肥胖率差別不大，但肥胖對女性的影響可能比較大；肥胖會提升高血壓和糖尿病的風險，而且女 性的升幅高於男性。另一方面，因心血管疾病而死亡的男女性都減少超過50%，但由於男性死亡人數是女性的2倍，所以男性死亡率的降幅也比較高。
不過，男性在生物學上仍舊不如女性。雌性靈長類擁有兩個X染色體，雄性則為X和Y各一個；雌性身上的「額外」X染色體可以避免另一個X染色體發生變異，雄性則沒有這樣的保護。
兩 性健康最大的生物學差異來自睪固酮，兩性都有睪固酮，只是男性的分泌量較多。睪固酮會增加侵略性和風險行為，也會壓抑免疫系統；這表性男性死於意外和暴力 的機會高於女性，自殺機會也比較高。因此，研究機構指出，就算男性採行更健康的生活方式，到了65歲之時，女性平均壽命還是會比男性高出1-2年。（黃維 德譯）
©The Economist Newspaper Limited 2013

Lifespan and the sexes

By The Economist
From The Economist
Published: January 21, 2013

In the rich world, men are closing the longevity gap with women.
Jan 12th 2013 |From the print edition

REG DEAN, who died on January 5th at the ripe age of 110, was unusual. Centenarians are rare in themselves, of course, but male centenarians particularly so. In Britain, where Mr Dean lived, five times as many women as men receive the famed card of congratulation from the queen when they celebrate their 100th birthdays. That may, however, cease to be the case in the future, for the fact that women tend to live longer than men, though still true, is less true than it was, and the gap is shrinking—in rich countries, at least—every year.

In England and Wales, the biggest peacetime difference between the life expectancies at birth of the two sexes was 6.3 years. That was in 1967. It is now 4.1 years, and falling. In the early 1980s women who made it to 65, the traditional age of retirement for British men, could expect to live four years longer than their male counterparts. The gap now is less than three years (see chart), though there is still some way to go before things return to the nine-month gap that prevailed in the 1840s, when records began. Other industrialised countries, except Japan and Russia, show something similar.

This trend is superimposed on another: that life expectancy in most developed countries has been improving for both sexes. But of late it has been improving more for men than for women.

A report about to be published by the Longevity Science Advisory Panel (a group of scientists and actuaries set up by Legal & General, an insurance company) examines the factors behind these trends. The biggest by far is changes in the use of tobacco.

All are equal
Around half the difference in the longevity of the sexes can be explained by smoking. One reason why Russia bucks the trend towards equal life expectancies for the two sexes (women there live 12 years longer than men) is that its men have not followed their Western confrères and cut down on the cancer sticks.

In Britain in the 1960s, when the habit was commonplace, men were much more likely to be smokers than women. But they have also been more likely than women to give up cigarettes over the past half-century. As a result, between 1979 and 2009 male smoking-related deaths fell by 64% and the male-to-female ratio of such deaths fell from 2.1 to 1.7. Deaths from cancers of the lung, trachea and bronchus in particular fell by 39% between 1991 and 2005 among Englishmen over 49. For women the comparable figure was 3%.

A further fifth of the longevity gap between the sexes is explained by alcohol. In this case, however, the gap is widening. In 1979 two men died from alcohol-related causes for every woman who succumbed. In 2009 it was 2.4.

A third important factor is obesity—or, rather, the physiological complications obesity brings, such as high blood pressure and type-2 diabetes. On the face of things, there is little difference between the sexes in this area: 15.6% of women in the EU are obese, compared with 15.4% of men. But obesity may have a greater impact on women because it increases the risks of both hypertension and diabetes in their sex more than it does in men. And men are also closing the gap in another area related to obesity and high blood pressure: coronary heart disease. In England, deaths from this fell more than 50% between 1991 and 2005 for both men and women. But, because heart disease kills twice as many men as it does women, the reduction in the male mortality rate has been greater.

All of which is good news if you are male. Men do, nevertheless, have the deck stacked against them by biology. One way the cards are marked is that female mammals (women included) have two X chromosomes, whereas males have an X and a Y—the latter being a runty little thing with only a small complement of genes. Females' "spare" X chromosome protects them from genetic mutations on the other one. Males have no such protection. Women are thus carriers of, but rarely suffer from, diseases like haemophilia which are caused by the mutation of X-chromosome genes. In birds, by contrast, it is the males who have matched chromosomes while females sport the runt. As a result, male birds tend to outlive their mates.

A further biological difference between the sexes is in the lengths of their telomeres. These are sections of DNA that protect the ends of chromosomes from decay. Men's telomeres are shorter than those of women, and also degrade more quickly. Both of these attributes have been linked to reduced lifespans.

But some are more equal than others
The biggest biological difference between health of the sexes, however, can be summed up in a single word: testosterone. Testosterone is the hormone that more or less defines maleness (though women have it too, in lesser quantities). It promotes both aggression and risky behaviour. It also suppresses the immune system, which is why castrated tomcats and rams live longer than those that have not been neutered. The same applies to people. A study on eunuchs found they live 13.5 years longer than men who are intact.

Testosterone-driven behaviour means that men are more likely than women to die in accidents, and more likely to die from the violence of others. They are also more likely to kill themselves. These things are particularly true of young adults. Men are two-and-a-half times more likely to die in their 20s than women are. Testosterone may also explain the differences between the sexes in risky behaviours like smoking and drinking.

But blaming testosterone for male risk-taking explains only the "how", not the "why". For that, you must turn to evolutionary biology. It is no coincidence that the gap between the sexes' mortality is widest in people's 20s. This is the peak period for reproduction. Men are fighting each other, and showing off to the girls, in a competition whose prize is, in an evolutionary sense, immortality itself—the passage of their genes to the next generation.

To stake a claim in the afterlife, as any religion will tell you, you must make sacrifices in the present one. In actuarial terms, therefore, the Longevity Science Advisory Panel reckons that even if men adopt healthy lifestyles, women will continue to outlive them. A gap of between one and two years of life expectancy (at age 65) will persist indefinitely. That, if you are a man, might seem unfair. But if it does, then think of it as the price of eternity.

From the print edition: Science and technolog
©The Economist Newspaper Limited 2013

倫敦百年蛻變的啟示 (John Kay)

倫敦百年蛻變的啟示 (John Kay)

倫敦百年蛻變的啟示

作者：英國《金融時報》專欄作家約翰•凱

倫敦地鐵(London Underground)150週年紀念日適時地提醒我們，維多利亞女王時代的祖先們至今仍在影響著我們的生活。1858年，泰晤士河是露天的下水道，反常的天氣導致了所謂“大惡臭”(the great stink)的發生。臭烘烘的氣味令倫敦的諸多地區無法居住。坐落在河畔的議會大廈(Houses of Parliament)更是重災區。

要求整治的呼聲高漲。接下來十年，工程師約瑟夫•巴澤爾杰特(Joseph Bazalgette)主持修建了龐大的地下下水道系統。該工程不僅解放了倫敦人的鼻子，還提升了倫敦的形象；其中最引人注目的當屬泰晤士河兩岸河堤的建成。北河堤如今是倫敦的交通要道，並承載著數座花園。河堤之下是地鐵線和倫敦的主下水道。泰晤士河南岸的下水道之上是從市政廳(County Hall)至塔橋(Tower Bridge)的步行道，在這裡能觀賞到世界上最為壯觀的河景。

150年來，這些下水道滿足了英國首都的需要。直到最近，它們的容量才開始面臨壓力，不久將在地下深處開挖新的泰晤士河隧道。這種工程所需的技術在巴澤爾杰特的時代尚不存在：巴澤爾杰特修建下水道系統的20年前，布魯內爾(Brunel)父子修建了泰晤士河的第一條河底隧道，但它總長不及四分之一英里，施工過程勞民傷財。

但假如巴澤爾杰特的計劃要接受現在的評估程序審查，很難想像它還能實現。儘管河堤對倫敦具有巨大的意義，但其修建存在諸多負面影響。例如，薩默塞特府(Somerset House)面向泰晤士河一側的大門曾經蔚為壯觀，如今偏居主路一隅，頗為冷清。律師學院(Inns of Court)的花園也不再直通泰晤士河。程序的障礙將會多如牛毛，工期的拖延將會沒完沒了。

工程還要接受英國財政部現代評估程序標準的評判，這一程序要求根據預期壽命對工程帶來的好處進行仔細的衡量。我想那樣的話，使用壽命要達到幾百年才行，因為對下水道的需要似乎是會一直存在的，但這些好處將以每年3.5%的速度折舊。

公務員們將奉命調查有害氣味對房產價值的影響。不過，首要問題還是對健康的影響——但他們會得出嚴重錯誤的結果，因為維多利亞女王時代的醫生們往往高估瘴氣的危害，而低估污染水致病的影響。統計學家和顧問們會估計，如果馬車能在河堤上通行，而不用擠過亂糟糟的艦隊街(Fleet Street)，將能節省多少時間。他們很難分析地鐵交通，因為那時根本沒有地鐵。

但不論如何，他們的估計恐怕既不正確也不重要。一個突出的事實是，如果倫敦居民每次出門時都有強烈的作嘔感，那麼倫敦將無法成為偉大的商業和金融之都。

經濟史學家羅伯特•福格爾(Robert Fogel)計算出，按同樣的運輸量、火車比馬車和駁船節約的運輸成本衡量，美國19世紀的鐵路發展僅僅貢獻了該國國內生產總值(GDP)的2.7%。爭論仍在繼續：到底是數據的渺小表明鐵路對美國經濟發展不重要，還是這種計算根本就是愚蠢的？我傾向於後一種觀點。

對開展類似分析的要求，來源於人們的合理擔憂：大型項目的提倡者通常沒有對項目的機會成本予以足夠重視。

人們完全可以要求有關方面提供實施項目的詳細根據，並在可行時要求對實施根據進行量化。不過，具體的量化容易失實、離題；如果沒有鐵路，如果“大惡臭”依然存在，也就不會有現代世界。關鍵問題是，我們是否為後世留下了更好的城市、更好的環境。巴澤爾杰特和他的同代人做到了——但我不太確定我們能不能做到。

譯者/劉鑫

Who Made That Dental Floss?

誰發明了牙線？

PAGAN KENNEDY 報道 2013年01月19日

Jens Mortensen for The New York Times

在19世紀早期，先鋒牙醫利瓦伊·斯皮爾·帕姆利(Levi Spear Parmly)鼓勵病人用絲線清潔牙縫，這種革新方法能夠保護牙齦、預防齲齒。但是“人們就是不能理解”，美國國家牙醫學博物館的館長斯科特·斯旺克 (Scott Swank)博士這樣說。他說，在那個年代，臼齒腐爛很常見，“人們覺得牙齒脫落很正常”。
另外，維多利亞時代的人們很喜歡牙籤。飯後，紳士們拿出皮製的盒子，從天鵝絨襯裡中取出金制的牙籤，開始清潔牙齒。查爾斯·狄更斯(Charles Dickens)有一個牙籤，上面鑲着象牙，鐫刻着他名字的首字母，還能像小望遠鏡一樣縮回到套中。用牙線清潔牙齒可能更有效，但是它怎麼能跟閃閃發亮的 牙籤相比呢？那時候，絲線都是纏在線軸上的，不好處理，必須得用小刀割成合適的長度。更大的問題是，用牙線的話，你得把手指伸到嘴裡。

相關文章

• 誰發明了3D眼鏡？
• 誰發明了家用驗孕棒？
• 誰發明了香煙過濾嘴？
• 誰發明了奧運五環？
• 誰發明了辦公室格子間？
• 誰發明了細高跟鞋？

19世紀70年代，阿薩赫爾·舒特萊夫(Asahel Shurtleff)申請了第一個牙線支架專利，從而促進了牙線的普及。這個支架是一個旁邊伸出U型叉子的線軸。那個叉子相當於一個迷你的金屬手，引導牙 線在牙齒間穿行。這就是你現在能在藥店里買到的便攜式牙線支架的前身。
此後，設計師們給我們設計出了泡泡糖口味的牙線、“戈爾-特克斯”(Gore-Tex)纖維做的牙線以及牙齒形狀的支架，所有這些都是為了讓用牙線 清潔牙齒看上去很有趣，或者至少不是太難。另外，最近的研究表明：用牙線清潔牙齒可能是最簡單的其中一種預防齲齒的方法。但是，斯旺克說：“人們仍然不夠 重視。或許是因為他們不想把手放到嘴裡。”兩個世紀過去了，我們仍然忘記或者討厭使用牙線這個最有效的方法。
加里·羅馬(Gary Roma)正在製作一部關於牙線的紀錄片。
你真的在拍攝一部關於牙線的長篇電影嗎？在拍完關於門擋的記錄片之後，我決定繼續挖掘平凡事物的意義。
你在電影中拍到了一隻猴子用細線清潔牙齒的畫面，你是怎麼做到的？那是機緣巧合。當時我正在動物園裡拍攝另一部影片。恰好在這個時候，一隻猴子抓住一根繩子，扯下一根線，開始清潔牙齒。
你採訪了兩個試圖用牙線越獄的囚犯。他們具體是怎麼做的？他們用幾英里長的牙線編了兩個繩梯，爬上了40英尺高的獄牆。
你計劃在網上銷售古董牙線盒來為你的電影籌資，是這樣嗎？我可能是世界上收集牙線最多的人——大概收集了200件。我計劃把它們拍賣了，這樣我就能雇個編輯來剪輯100小時長的關於牙線的鏡頭。

本文最初發表於2012年10月21日。
翻譯：王艷

Design

Who Made That Dental Floss?

By PAGAN KENNEDY January 19, 2013

In the early 1800s, a pioneering dentist, Levi Spear Parmly, urged patients to clean between their teeth with silk thread — a revolutionary technique that could protect the gum line and prevent tooth decay. But “people just didn’t get it,” says Dr. Scott Swank, curator of the National Museum of Dentistry. In an era during which rotting molars were the norm, he says, “people expected their teeth to fall out.”

The Victorians also loved their toothpicks. After dinner, a gentleman would produce a leather box, reach into its velvet-lined interior, withdraw his gold pick and begin grooming. Charles Dickens owned a toothpick inlaid with ivory and engraved with his initials; it retracted into its own handle like a tiny spyglass. Flossing might have been more effective, but how could it compete with the flash of the toothpick? Back then, silk thread came in unwieldy spools and had to be cut into lengths with a knife. Worse, using it required you to put your fingers into your mouth.
 In the 1870s, Asahel Shurtleff helped to civilize floss when he patented the first dispenser: a bobbin of thread with a U-shaped prong sticking out of its side. The prong worked like a tiny metal hand, guiding floss between the teeth. His invention anticipated the portable floss holders you can now buy in drugstores.
Designers have since given us bubble-gum-flavored floss, Gore-Tex strands and tooth-shaped dispensers — all in an attempt to make flossing seem fun or at least not too difficult. Recent studies, meanwhile, have revealed that flossing might be one of the simplest ways to ward off tooth decay. Yet, Swank says: “People still don’t care. Or they don’t want to put their hands in their mouths.” Two centuries on, flossing remains the quintessential thing that we forget — and hate — to do.
FLOSS ON FILMGary Roma is producing a documentary about dental floss.
You’re seriously working on a feature-length movie about floss? After making my documentary about doorstops, I decided to continue mining the mundane for meaning.
You managed to catch on film a monkey, flossing with a piece of string. How? Serendipity. I was filming in a zoo for another project. On cue, a monkey grabbed a rope, pulled out a strand and began flossing.
You interviewed two inmates who tried to escape from a prison using dental floss. What was their method? They used several miles of floss to create two braided rope ladders, enabling them to scale a 40-foot prison wall.
Is it true that you’re planning to raise money for your movie by selling vintage floss containers online? I likely have the largest dental-floss collection in the world — nearly 200 pieces. I plan to auction it off so I can hire an editor to whittle down 100 hours of floss footage.

糞便療法：腸道感染病人的福音

糞便療法：腸道感染病人的福音

DENISE GRADY 報道 2013年01月18日

這種療法可能駭人聽聞，但是療效很好。
把健康人的糞便灌入病人的腸道，就可以迅速治癒一種嚴重的腸道感染。造成這種感染的病菌很危險，抗生素常常無法控制。

按圖放大

Gretchen Ertl for The New York Times

梅利莎·卡布雷爾使用抗生素接受牙科診療後被感染。關於糞便療法，她說：「如果不是接受了這種療法，還不知道我現在會怎樣。」

這項新研究報告的高級作者約斯伯特·凱勒博士。

一項新研究發現，這種植入療法治癒了16名反覆感染艱難梭菌(Clostridium difficile)的患者中的15名。而在兩個各13人的對照組中，抗生素只治癒了一組患者中的3個人，及另一組患者中的4個人。這種療法之所以奏效， 似乎是因為恢復了腸道的正常菌群平衡，平衡的腸道菌群消滅了艱難梭菌。
這是植入療法與常規的抗生素療法之間的首次對照研究，研究是在荷蘭進行的。周三，《新英格蘭醫學雜誌》(New England Journal of Medicine)發表了這項研究的報告。
多年來，糞便灌注療法偶爾會被用作無計可施時最後的辦法，來治療這種令人虛弱的頑固感染。美國每年有1.4萬人死於這種感染。它通常是抗生素導致 的，抗生素會殺滅正常的腸道細菌，使人易於感染艱難梭菌。而艱難梭菌在許多醫院裡都很常見，病人接觸到艱難梭菌時，就會受到感染。
常規療法是使用更多抗生素，但約20%的病人會病情複發，而且他們中的許多人會反覆發病，出現嚴重腹瀉、嘔吐和高燒癥狀。
研究者稱，全球已有約500名感染此病的患者接受了糞便療法的治療。該療法使用鹽水等液體稀釋糞便，然後使用灌腸器、結腸鏡或從鼻腔插入通向胃部或小腸的軟管，將稀釋物注入腸道。
糞便會包含數百甚至數千種細菌，研究者還不知道哪些細菌具有療效。所以，目前糞便必須基本上完整施用。
多個醫學期刊曾報道過，這種療法的成功率很高，而且對那些患病數月的患者，產生了近乎神奇的療效。但是此前，還一直有懷疑的餘地，因為在此之前沒有開展過將這種怪誕療法與其他療法相對比的對照實驗。
這項新研究首次給出了懷疑者所要求的那種證據。該療法的支持者稱，他們希望這一結果能有助於讓糞便療法成為醫學界的主流療法，因為有些患者除此之外無法醫治。
羅德島普羅維登斯女子醫院(Women’s Medicine Collaborative)的腸胃病專家科琳·R·凱利博士(Dr. Colleen R. Kelly)說，“我們這些實施糞便療法的人知道它的療效多麼好。只是說服別人很困難。”凱利博士沒有參與上文所述的荷蘭研究。
她補充道，“這份論文很重要，希望它能鼓勵醫生們改變治療模式，多實施這種療法。”
艱難梭菌是個全球性問題。過去十年里，這種細菌出現了毒性越來越強的變種。在美國，每年有30萬住院的患者感染艱難梭菌。研究者們估計，醫院內外的病例總數可能有300萬例，治療花費每年逾10億美元。
糞便療法經常用於治療牛馬的腸道疾病。介紹中國傳統醫學的書籍中，也提到過四世紀時，讓患者口服糞便治療腹瀉的案例。一本書中將其稱為“黃龍湯”。
1958年，科羅拉多大學(University of Colorado)的本·艾斯曼博士(Dr. Ben Eiseman)發表了一篇報告，介紹了通過糞便灌腸為四名患者治療威脅生命的腸道感染的事例。
這項新研究報告的高級作者約斯伯特·凱勒博士(Dr. Josbert Keller)是荷蘭海牙哈加醫院(Hagaziekenhuis)的腸胃病專家。他說，在開展這項研究之前，他和他的同事已經對10個病例實施了糞便移植，而且幾乎全都產生了效果。
“在治療過頭四五名患者後，我們開始考慮，不能再繼續使用這種偏方一樣的療法而沒有證據了，”凱勒說，“大家都在笑話。”
研究人員對感染艱難梭菌數月之久，服用抗生素後至少複發一次的成年患者展開了研究。這些患者被隨機分配到三個小組裡，其中只有一個小組的16名患者 接受了糞便灌注。患者接受了四天萬古黴素(vancomycin)治療，清洗腸道，之後通過鼻管將糞便溶液灌注至小腸中。第二組13名患者清洗腸道並使用 了14天萬古黴素。第三組也有13名患者，僅使用萬古黴素治療。
糞便捐獻者接受了一系列疾病的檢查，從而確保不會讓患者感染。糞便被置於攪拌器內與鹽水混合，之後經過過濾。據凱勒博士描述，產生的溶液很像巧克力奶。
凱勒說，患者十分迫切地想要接受糞便療法，研究人員必須承諾，分配到只使用抗生素小組的患者，如果藥物無效，可以隨後接受糞便療法，患者才同意參加研究。
在接受糞便療法的16名患者中，有13名在接受第一次灌注後就痊癒了。另外三位患者又接受了來自不同捐獻者的灌注，其中兩人痊癒。而另外兩組沒有接受這種療法的患者，26人中只有7人痊癒。
最初未接受灌注而僅採用抗生素、之後又複發的患者中，有18人隨後又接受了灌注，其中有15人痊癒。
研究本來打算包括更多患者，但研究期限不得不縮短。原因是，由於抗生素組的患者與接受灌注的患者相比健康狀況極差，再繼續研究，難免違背道德。
對於那些已經嘗試過這種療法的醫生來說，實驗結果並不意外。明尼蘇達大學(University of Minnesota)腸胃病專家亞歷山大·霍魯茨博士(Dr. Alexander Khoruts)說，他已經對100多位感染艱難梭菌的患者進行了灌注療法。他說90%的情況下，首次灌注就能奏效，其餘的10%則在第二次接受治療後痊 癒。他說，這種療法可以利用冷凍再解凍後的大便溶液進行。

翻譯：梁英、王童鶴

Disgusting, Maybe, but Treatment Works, Study Finds

By DENISE GRADY January 18, 2013

The treatment may sound appalling, but it works.
Transplanting feces from a healthy person into the gut of one who is sick can quickly cure severe intestinal infections caused by a dangerous type of bacteria that antibiotics often cannot control.

A new study finds that such transplants cured 15 of 16 people who had recurring infections with Clostridium difficile bacteria, whereas antibiotics cured only 3 of 13 and 4 of 13 patients in two comparison groups. The treatment appears to work by restoring the gut’s normal balance of bacteria, which fight off C. difficile.
The study is the first to compare the transplants with standard antibiotic therapy. The research, conducted in the Netherlands, is being published Wednesday in The New England Journal of Medicine.
Fecal transplants have been used sporadically for years as a last resort to fight this stubborn and debilitating infection, which kills 14,000 people a year in the United States. The infection is usually caused by antibiotics, which can predispose people to C. difficile by killing normal gut bacteria. If patients are then exposed to C. difficile, which is common in many hospitals, it can take hold.
The usual treatment involves more antibiotics, but about 20 percent of patients relapse, and many of them suffer repeated attacks, with severe diarrhea, vomiting and fever.
Researchers say that worldwide, about 500 people with the infection have had fecal transplantation. It involves diluting stool with a liquid like salt water and then pumping it into the intestinal tract via an enema, a colonoscope or a tube run through the nose into the stomach or small intestine.
Stool can contain hundreds or even thousands of types of bacteria, and researchers do not yet know which ones have the curative powers. So for now, feces have to be used pretty much intact.
Medical journals have reported high success rates and seemingly miraculous cures in patients who had suffered for months. But until now there was room for doubt, because no controlled experiments had compared the outlandish-sounding remedy with other treatments.
The new research is the first to provide the type of evidence that skeptics have demanded, and proponents say they hope the results will help bring fecal transplants into the medical mainstream, because for some patients nothing else works.
“Those of us who do fecal transplant know how effective it is,” said Dr. Colleen R. Kelly, a gastroenterologist with the Women’s Medicine Collaborative in Providence, R.I., who was not part of the Dutch study. “The tricky part has been convincing everybody else.”
She added, “This is an important paper, and hopefully it will encourage people to change their practice patterns and offer this treatment more.”
C. difficile is a global problem. Increasingly toxic strains have emerged in the past decade. In the United States, more than 300,000 patients in hospitals contract C. difficile each year, and researchers estimate that the total number of cases, in and out of hospitals, may be three million. Treatment costs exceed $1 billion a year.
Fecal therapy has often been used to cure gut trouble in cows and horses. Books on traditional Chinese medicine mention giving it to people by mouth to cure diarrhea in the fourth century; one book called it yellow soup.
In 1958, Dr. Ben Eiseman, of the University of Colorado, published a report about using fecal enemas to cure four patients with life-threatening intestinal infections.
The senior author of the new study, Dr. Josbert Keller, a gastroenterologist at the Hagaziekenhuis hospital in The Hague, said that before conducting the research, he and his colleagues had performed the transplant in about 10 cases, and it almost always worked.
“After the first four or five patients, we started thinking, we can’t go on doing this kind of obscure treatment without evidence,” Dr. Keller said. “Everybody is laughing about it.”
The researchers studied adults who had been suffering from C. difficile for months and had had at least one relapse after antibiotics. They were picked at random to be in one of three groups. Only one group, 16 people, had the transplant: they took the antibiotic vancomycin for four days, had their intestines rinsed and then had the fecal solution pumped into their small intestines through a nose tube. A second group, 13 people, had the intestinal wash and 14 days of vancomycin, and a third, also 13, had only vancomycin.
The donors were tested for an array of diseases to make sure they did not infect the patients. Their specimens were mixed with saline in a blender and strained, to produce a solution that Dr. Keller said resembled chocolate milk.
Dr. Keller said patients were so eager to receive transplants that they would not join the study unless the researchers promised that those assigned to antibiotics alone would get transplants later if the drugs failed.
Among the 16 who received transplants, 13 were cured after the first infusion. The other three were given repeat infusions from different donors, and two were also cured. In the two groups of patients who did not receive transplants, only 7 of 26 were cured.
Of the patients who did not receive transplants at first and who relapsed after receiving antibiotics only, 18 were subsequently given transplants, and 15 were cured.
The study was originally meant to include more patients, but it had to be cut short because the antibiotic groups were faring so poorly compared with the transplant patients that it was considered unethical to continue.
The results come as no surprise to doctors who have tried the procedure. Dr. Alexander Khoruts, a gastroenterologist at the University of Minnesota, said he had performed the transplants in more than 100 patients with C. difficile. He said that it worked the first time in 90 percent, and that the other 10 percent were cured with a second treatment. The procedure can be done with a stool solution that has been frozen and thawed, he said.

鄭州富士康車禍

BEIJING—An accident involving two shuttle buses transporting Hon Hai Precision Industry Co. employees in China left seven dead and more than 20 injured, highlighting the constant personnel management challenges faced by a company that runs production facilities the size of small cities.
Taiwan-based Hon Hai—which also uses the name Foxconn and assembles gadgets for companies ranging from Apple Inc. to Sony Corp.—said the two shuttle buses were transporting employees from a facility in the city of Zhengzhou in China's central Henan province to off-campus residences on Thursday morning when the accident occurred. It occurred near the industrial park where the ...

1月17日8時22分，鄭東新區鋼鐵物流園區內發生一起兩車相撞事故，造成7人死亡，20餘人受傷。車禍中死傷人員多數為富士康員工。 17日8時22分，鄭州富士康接送工人上班的客車，與另一輛客車相撞，其中一輛車撞到了另一輛的中間部位，導致車輛側翻。

救災梯短差，束手無策

----

「救災梯就差一點五公尺，成了生死關鍵！」新竹新埔鎮林姓屋主喪生火窟，燒出巷道救災設備不足的缺失；由於巷道窄，雲梯車無法駛入，消防車上的救災梯，高度又搆不到五樓，造成不幸。
消防人員指出，雲梯車為特種車，至少要有六公尺寬才能進出，全新竹縣六公尺以下巷道共有兩百八十條，有九千多棟房屋散落其間；新竹市有四百廿九條；全台這種巷道的數字更可觀，巷道救災裝備問題，值得相關單位正視。

圖／聯合報提供

狹小巷弄該如何救火？消防員表示，目前消防使用的救災梯，最長可到三樓，若巷道寬度在三公尺以上，消防車可直接進入。如果火場是五樓高，救災梯可架在消防車上，高度可再往上增加約一樓。 如果火場狀況許可，救災梯可再加掛長梯，約可再延伸兩公尺，但救災梯加掛長梯，不是任何環境都許可，仍有地形上的限制，因為加掛的長梯前端是「彎勾」必須勾掛在女兒牆上，如果是整塊平面牆就沒辦法掛上。
新竹林姓屋主受困火場，據救援的消防人員說，因現場平面牆找不到施力勾掛點，消防人員帶了加掛長梯上去，但受限環境用不上，「就差了一點五公尺」，只好灌水攻入，就在這時發生火災最怕的「閃燃現象」，造成憾事。
新竹縣為因應小巷道救災，已購置兩輛小型的雲梯車，分別位於湖口分隊（高度十七公尺）與關西分隊（高度廿二公尺），外型類似小貨車，四公尺內的巷弄都可進入，但數量顯然不足，「遠水救不了近火」，只能支援就近鄉鎮。
另外，新竹前晚這場火，不少人質疑為何不能架設氣墊，讓受困的林姓屋主跳到氣墊上逃生，新竹縣消防局表示，目前的氣墊都是大型，不適合巷道，未來將採購長、寬三公尺、厚一點七公尺的小型氣墊，各消防分隊皆配備一組，全縣共十四組，在消防搶救時都要隨車攜帶。

Too Many Pills for Aging Patients 老年人吃太多葯了

老年人吃太多葯了

JANE E. BRODY 報道 2013年01月12日

打印 轉發 寄信給編輯 字號

我的阿姨92歲了，簡直就是個移動藥房，而一個月前她差點讓這間藥房給害死了。這個小插曲也讓美國醫療系統花費了數十萬美元。
老年人的過度用藥是一個非常常見的問題，堪稱公共衛生危機，從而危及越來越多的老年人的福祉。很多人都在大把大把地定期吃藥，包括處方葯和非處方葯；而這可能會帶來嚴重甚至是致命的副作用及藥物相互作用。

按圖放大

Yvetta Fedorova

相關文章

• 過度醫療讓人貧病交加
• 為什麼醫生開那麼多檢查？
• 過度醫療何其多

《美國老年病學會志》(The Journal of the American Geriatrics Society)最近刊發了一系列基於研究的準則，呼籲人們關注對老年人產生不幸影響的特定藥物。如果該準則被執業醫師及他們的患者所接受，應該有助於避免像我阿姨遭受的那種昂貴而傷身的災難。
老年人中的危機
3月初，阿姨因為極度的虛弱、嗜睡和思維混亂，在醫院小住了一陣。她被發現同時服用大量藥物和補劑：左旋甲狀腺素鈉(Synthroid)用於補充甲狀腺素；天諾敏(Tenormin)和奧美沙坦酯(Benicar)用於降血壓；來士普(Lexapro)用於抗抑鬱；美金剛(Namenda)用於控制阿爾茨海默症的癥狀；阿普唑侖(Xanax)用於夜間焦慮發作；蘇為坦(Travatan)滴眼液用於青光眼；複合維生素；維生素C；鈣和維生素D；低劑量阿司匹林；葉黃素補劑；還有科拉切(Colace)，一種軟化大便的葯。
醫院作出的診斷是：低鈉，提示停用已知引起此類副作用的來士普，使用抗抑鬱葯維拉佐酮(Viibryd)替代。注意到她的意識混亂，醫院的神經科醫生還加用了安理申(Aricept)，這是另一種治療阿爾茨海默氏症的藥物，但其實她僅僅是懷疑有這個病。
她的心臟科醫生把天諾敏的劑量加倍，停用了奧美沙坦酯，加入了另一種降血壓的阿普利素寧(Apresoline)。它令血壓急劇下降到了70/40（正常是120/80），這令她暈頭轉向，甚至坐也不起來，站也站不了。
住院10天後，快出院的時候，阿姨摔倒了，臉色發青。醫生給她做了心肺復蘇（這讓她斷了三根肋骨），在急診室做了復蘇後，又轉移到了重症監護病房。她在那兒三次出現痙攣。醫生給她用了苯妥英鈉(Dilantin)來控制發作。
她患上了雙側肺炎，看上去命不久矣。她已經簽署了“不搶救”的同意書。有一晚，她焦慮到難以入睡，醫院給了勞拉西泮(Ativan)，這種鎮靜葯令她昏睡了30小時。
神奇的是，抗生素和吸氧對她有效，她現在已經出院了，在一家康復中心休養，身體慢慢好轉，頭腦不那麼混亂，而且精力日益充沛。
我阿姨這樣的老年人是藥物的最大消費群體。65歲以上人群中，超過40%的人服用5種以上的藥物，而其中有三分之一的人每年會遭遇嚴重的不良反應，如摔倒導致骨折、定向障礙、排尿障礙，甚至心臟衰竭。
在老年病學會的支持下，11名專家組成的一個老年護理和藥理學跨學科小組已經更新了所謂的比爾斯標準（Beers Criteria，老年醫學中關於合理用藥的一個著名的標準，該標準在1991年公布後即被國際廣泛關注和引用——譯註），這是長期用於減少老年用藥相關 災難的指導守則。審閱了2000多項關於老年人用藥的高質量研究後，團隊強調了53種潛在不當使用的藥物或種類，並把它們分為三類：避免在老年人中使用； 避免在有特定疾病和癥狀的老年人中使用；如果確實沒有可接受的替代品，需在老年人中謹慎使用。
比如，鎮靜催眠葯——像我阿姨服用的勞拉西泮——會引起老年人嚴重的鎮靜作用、認知混亂和智力衰退；專家小組強調，應該用其他睡眠措施來替代，如草藥或其他非藥物方法，這會更安全。專家小組的結論是，許多有鎮靜作用的抗組胺藥物，統稱為抗膽鹼能藥物，應避免在老年人中使用，因為它們會引起如思維混亂、嗜睡、視力模糊、排尿困難、口乾、便秘等副作用。
口服的礦物油，如果不慎吸入，可引起吸入性肺炎；許多常用的消炎藥，包括如布洛芬(ibuprofen)和萘普生(naproxen)這樣的非處方葯，都會增加75歲以上老年人消化道出血的風險，65歲以上老年人服用強的松(prednisone)和華法林(warfarin)時有同樣的風險。
團隊還警告說，對80歲以上老年人來說，服用阿司匹林用於預防心臟病發作“弊大於利”，所有的抗抑鬱葯都會使血鈉降低到危險水平，這正是我阿姨遇到的問題。
團隊認為，這一標準應該被制度內外的醫生和病人廣泛使用。但專家也強調，指導守則不能用於推翻醫生對患者需求和價值取向的臨床判斷，也不能作為判斷醫療事故糾紛的依據。
患者的責任
老年病學會的健康老齡化基金(Foundation for Health in Aging)，做了一份一頁紙的“藥物和補劑日記”，可以幫助患者追蹤記錄他們服用的藥物種類和劑量。他們應該在就醫的時候出示這一表格。表格可點擊此處下載。
常見的情況是，人們有多種健康問題，而一個醫生不知道其他醫生開了什麼葯。新開的處方可能會引起藥物有害的相互作用，或者僅是因為同時服用的其他東西而抵消了藥效。
如果不能把使用的處方葯、非處方葯，以及包括酒精在內的軟性毒品毫無保留地告知醫護人員，這完全不會有任何好處，而是有潛在的壞處。此外，任何慢性病或此前發生過的藥物反應，也都不應向醫生隱瞞。
每次得到處方，患者應諮詢相關的副作用。如果出現了不好的或是意外的反應，或是藥物不起效的時候，應立刻告訴開處方的醫生。但是，在沒有諮詢過專業醫生之前，患者絕不能自行停止服藥。
未諮詢醫生之前，也不能在處方中自行任何添加藥物或補劑。即使看起來無害的布洛芬、對乙酰氨基酚（acetaminophen，解熱鎮痛葯）、聖約翰麥芽汁（美國流行多年的一種草藥——譯註），或某種非處方抗組胺藥物，在與特定的處方葯或既有病史相互作用時，也可能導致嚴重的副反應。
如果某種藥物躋身比爾斯標準，並不是說老年人一定會遇到不良反應。該葯可能對某些患者是基礎用藥，而且可能不存在更安全的替代品。說到底，醫生必須權衡用藥的利益和風險。

本文最初發表於2012年4月17日。
翻譯：Skandha

Too Many Pills for Aging Patients

By JANE E. BRODY January 12, 2013

My 92-year-old aunt was a walking pharmacy, and a month ago it nearly killed her. The episode also cost the American medical system several hundred thousand dollars.
Overmedication of the elderly is an all too common problem, a public health crisis that compromises the well-being of growing numbers of older adults. Many take fistfuls of prescription and over-the-counter medications on a regular basis, risking serious and sometimes fatal side effects and drug interactions.

• 过度医疗让人贫病交加
• 为什么医生开那么多检查？
• 过度医疗何其多

A series of research-based guidelines, recently updated and published in The Journal of the American Geriatrics Society, calls attention to specific medications most likely to have calamitous effects in the elderly. If adopted by practicing physicians and their patients, the guidelines should help to avert the kind of costly, debilitating disaster that befell my aunt.
A Crisis Among the Elderly
In early March, my aunt was hospitalized for an episode of extreme weakness, sleepiness and confusion. She was found to be taking a number of medications and supplements: Synthroid, for low thyroid hormone; Tenormin and Benicar, for high blood pressure; Lexapro, for depression; Namenda, for symptoms of Alzheimer's disease; Xanax, for nighttime anxiety attacks; Travatan eye drops, for glaucoma; a multivitamin; vitamin C; calcium with vitamin D; low-dose aspirin; a lutein supplement; and Colace, a stool softener.
Diagnosis at the hospital: low sodium, prompting a stoppage of Lexapro, known to cause such a side effect, and substitution of the antidepressant Viibryd. Noting her confusion, the hospital neurologist also added Aricept, another treatment for Alzheimer's disease, although she is only suspected of having this condition.
Her cardiologist doubled the dose of Tenormin, stopped the Benicar and added another blood pressure medication, Apresoline. This caused a precipitous drop in blood pressure to 70/40 (120/80 is normal), leaving her completely disoriented and unable to stand or sit up.
After 10 days in the hospital, as she was being discharged, my aunt collapsed and started turning blue. CPR was administered (which fractured three ribs), followed by resuscitation in the emergency room and then transfer to intensive care, where she suffered three seizures. She was put on Dilantin to control them.
She developed double pneumonia, and the end seemed near. A do-not-resuscitate order was issued. One night, when she was too agitated to fall sleep, she was given a dose of Ativan, a sedative, that left her unable to wake up for 30 hours.
Miraculously, she responded to antibiotics and administration of oxygen, and she has since been discharged to a rehabilitation facility where she is steadily getting stronger, less confused and refreshingly feisty.
Older adults like my aunt are the largest consumers of medications. More than 40 percent of people over age 65 take five or more medications, and each year about one-third of them experience a serious adverse effect, like a bone-breaking fall, disorientation, inability to urinate, even heart failure.
With the support of the geriatrics society, an interdisciplinary panel of 11 experts in geriatric care and pharmacology has updated the so-called Beers Criteria, guidelines long used to minimize such drug-related disasters in the elderly. After reviewing more than 2,000 high-quality research studies of drugs prescribed for older adults, the team highlighted 53 potentially inappropriate medications or classes of medication and placed them in one of three categories: drugs to avoid in general in the elderly; drugs to avoid in older people with certain diseases and syndromes; and drugs to use with caution in the elderly if there are no acceptable alternatives.
For example, instead of a sedative hypnotic - like the Ativan given to my aunt - that can cause extreme sedation, serious confusion and mental decline in older adults, the panel notes that an alternative sleep remedy, perhaps an herbal or nondrug option, is safer. Many sedating antihistamines, in a class of drugs called anticholinergics, should be avoided in older adults because they can cause such side effects as confusion, drowsiness, blurred vision, difficulty urinating, dry mouth and constipation, the panel concluded.
Mineral oil taken by mouth can, if accidentally inhaled, cause aspiration pneumonia, and many commonly used anti-inflammatory medications, including over-the-counter drugs like ibuprofen and naproxen, increase the risk of gastrointestinal bleeding in adults age 75 and older, as well as in those age 65 and older who also take medications like prednisone and warfarin.
In adults over age 80, the team warned, aspirin taken to prevent heart attacks "may do more harm than good," and any antidepressant may lower sodium in the blood to dangerous levels, as happened to my aunt.
The team said its criteria should be used by physicians and patients within and outside of institutional settings. But the experts also emphasized that the guidelines should not override a doctor's clinical judgment or a patient's needs and values, nor be used as grounds for malpractice disputes.
The Patient's Responsibility
The geriatric society's Foundation for Health in Aging has produced a one-page "drug and supplement diary" that can help patients keep track of the drugs and dosages they take. They should show the list to every health care provider they see. The form can be found at www.americangeriatrics.org/files/documents/beers/MyDrugDiary.pdf.
Too often, people with multiple health problems have one doctor who does not know what another has prescribed. A new prescription can lead to a toxic drug interaction, or simply be ineffective, because it is counteracted by something else being taken.
There is nothing to be gained, and potentially much to lose, by failing to disclose to health care professionals the use of prescribed, over-the-counter or recreational drugs, including alcohol. Nor should any chronic medical condition or prior adverse drug reaction be kept from your doctor.
Whenever a medication is prescribed, patients should ask about side effects to watch for. If a bad or unexpected reaction occurs or the drug does not seem to be working, the prescribing doctor should be told without delay. But patients should never stop taking a prescribed medication without first consulting a health care professional.
Nor should they add any drug or supplement to a prescribed regimen without first consulting a doctor. Even something as seemingly innocent as ibuprofen, acetaminophen, St. John's wort or an antihistamine purchased over the counter can sometimes lead to dangerous adverse reactions when combined with certain prescribed medications or pre-existing health problems.
But just because a drug is on one of the lists in the Beers Criteria does not mean every older person would be adversely affected by it. The drug may be essential for some patients, and there may be no safer alternative. When all is said and done, a doctor must weigh the benefits and risks.

中國的路與橋的安全 (獨眼)

建築

人民需要安全地在城市行走

獨眼為紐約時報中文網撰稿 2013年01月11日

回顧2012年中國與公共建築安全有關的新聞，會發現這一年稱得上“路面坍塌”年和“橋樑垮塌”年。
就在開年不到一個月的時候，1月5日早上，河北保定一家KTV門前，一輛小麵包車從鋪裝路面開過，地面又突然塌陷，整部車掉入近50平方米的水坑。 根據《中國日報》發佈的新聞圖片，坑裡滿滿全是水，從水量和水質來看，應該不是污水和雨水，而是自來水，恐怕地下的供水管破裂有一段時間了。地下供水管破 裂導致的路面坍塌，一般是因為跑冒滲漏出來的水將周圍的土質泡軟，土壤可溶物質流失、顆粒之間的空隙進一步縮小，在人們沒有察覺的時候，地下土已經變得像 泥漿、流沙一樣，向下淌，形成了完全無支撐力的空腔。在這些地面上，地磚、瀝青路面、表層路基都是強撐局面，隨時可能塌掉。

按圖放大

2012/CFP

2012年12月26日，太原市并州路與并州西街交叉口突然坍塌，並造成地下煤氣管道泄漏。

按圖放大

Hao Bin/European Pressphoto Agency

2012年8月24日，哈爾濱陽明灘大橋南面匝道引橋側塌，4輛大貨車墜橋，造成三死五傷。

從2012年4月北京發生了一名女性掉進人行道深坑，並被破裂的熱力管線湧出的熱水燙傷並致死的惡性事件之後，中國各地關於道路坍塌的報道就絡繹不 絕，隨便一搜“地面塌陷”四個字就能看到在馬路上、人行道上甚至普通人的家裡出現了一個個大坑、深洞，人、生活物品、車都被拽下去。

導致地面塌陷的原因有不少，地下管道破裂只是其中之一。一般的地下金屬管道由於建造的時間、用料質量的差別，壽命相差很大，有的一兩年就需要維修， 壽命最長的大概也只有20年左右，外加上防腐塗層和管道陰極保護也只能延長十幾年壽命。現在城市地下土壤及水環境的惡化、細菌密集、氯鹽融雪劑滲透、瀝青 等封閉路面形成的氧濃度差、金屬間電極的腐蝕電池作用，都對管道有着很強的破壞力；尤其是北方城市，寒冷氣候里，脹凍的循環變化會讓管道的情況惡化加速。 中國改革開放之後重新進行一輪建設的城市中，大多數老舊的地下管道在最近這幾年正好到了容易發生問題的時間段，2012年－2013年正好到了一個集中爆 發的時間點 。
路面坍塌的第二種常見情況，是周圍動土工程導致土壤鬆動基礎承載力驟減。2012年9月，北京地鐵安遠門站B出口出現了40平方米地面塌陷，雖然塌 陷並不太深，只有十幾厘米，但與地下工程關係很大。而可能影響地基緊實度的工程不止地鐵，建造超高層大廈的時候，往往需要動用機械在地下挖深樁，機械長時 間的強力震動能夠把周圍一定範圍的土基全部振松。中國還有一些地區，比如，廣州的白雲區，曾經是礦業開採頻繁的地區，採礦導致地下存在採空區域，這種情況 在進行城區建設的時候未得到妥善處理，加上當地土壤的岩溶特質，2008年曾經發生過多起、大面積的地面塌陷。

這些城市中的兔子洞，通常在坍塌之前，地面上已經出現了裂縫，但並沒有人特別重視這種信號。

與地面塌陷一樣值得注意的是橋樑的安全。2012年8月，哈爾濱陽明灘大橋的引橋在僅有4輛貨車通行的情況下側塌，場面令人毛骨悚然。官方公布的事 故原因是貨車超載，近500噸的重量集中在引橋單邊，導致荷載的集中和不均衡，只有少量媒體報道提到了多名不具名的專家對橋樑設計的質疑。

以目前中國的工程驗收水平，許多城市建設工程發生事故，是因為設計的不合理與不適用，而非用了豆腐渣的材料。橋樑設計和它背後的結構設計都是複雜的 學問，這些設計的基本原則是儘可能保證橋樑的安全：一方面結構設計要滿足國家標準對構築物各部分承載能力的規定，標準里根據構築物的重要等級提出了不同的 計算加權係數，來確保最終建成的構築物的承載能力大於它可能遇到的荷載，這就像要穩妥地舉起100公斤的杠鈴，我們規定必須由能舉起110公斤甚至140 公斤的人來做；另外一方面，結構設計的一個重要學問在如何設置“多餘約束”——一根繩可以吊起來的東西，要多拴上兩根繩，這不僅為力的傳導提供更多選擇， 避免那唯一的一根繩斷掉之後會造成無法挽回的局面。這本應該像橋樑的兩道安全屏障。

可是在中國橋樑設計的實踐中，前者標準不難達到，但結構力學的情況卻可能很複雜，一旦多餘約束設置無效甚至缺少多餘約束的保護，仍然可能會由於突然的力和力矩的作用發生毀滅性的事故。

哈爾濱陽明灘大橋的引橋使用了獨柱式的支撐方式，2004年，北京市市政工程設計研究總院副院長穆祥純在論文《論城市橋樑結構的安全度和耐久性問 題》中提到要對這種結構小心，單側高荷載情況下，可能發生支座脫空。再加上，根據公開資料，陽明灘大橋中間為了節省預算修改過一次設計，工期也從3年改為 18個月。這座問題大橋揭示出一種危險的做法：結構設計能達到國家標準的時候，但在 “多餘約束”方面偷工減時。

除了設計方面的問題，中國城市中的橋還面臨著嚴重的老化問題。一般橋樑使用25年，基本就已經進入了老化期，需要重新整修維護，何況在最近的25年 里，中國城市是在以飛一般的速度發展。許多橋樑正在超負荷服役。以北京為例，1970年代末到1980年代初設計建造的二環路立交橋，即使早期建造質量過 關，現在的行駛量已經遠遠高於了當初的設計標準。那個時代誰能想到北京每個月會有新增兩萬輛汽車——這還是在北京施行了“搖號政策”之後的數量，北京目前 平均每月搖號分配兩萬個車輛指標。

翻看有關北京立交橋的論文，看到的信息讓人嚇一跳。比如，在2011年4月發表於《市政技術》期刊的《復興門立交橋拉壓支座更換技術》一文，提到 2008年對北京復興門立交橋的原有支座進行了現場檢測及荷載實驗，結果發現“在車載環境下，梁體隨時有開裂、斷裂的風險”，“車行荷載將造成梁體損壞及 墩台拉裂”。2012年10月，北京路政局網站上有關1991年建成的萬柳橋大修結束的消息中則提到，它在2010年的橋樑結構檢測里被評定為D級，按照 《公路橋樑承載能力檢測評定規程》的說法，D級意味着“缺陷影響了結構的工作性能和整體性”，與E級的“危橋”只一線之隔。

幸運的是，北京自2004年發現道路橋樑的安全問題之後就在不斷進行維修，根據媒體報道，北京2012年進行了“十路七橋” 的大修。北京市交通委員會的網站上仍然在進行道路橋樑維修工程的招標，看上去，2013年的維修工作仍然在進行。但是北京之外呢？

橋樑老化的原因，竟然和前文所述地下管道有相似之處。在寒冷地區，對橋樑產生威脅的重要原因之一是除冰鹽的腐蝕，這些融雪劑造成的鹽環境，會加快混 凝土的破壞速度，而在南方，酸雨又起到了同樣的破壞作用；再者，由於一些早期橋樑設計對防水不重視，容易導致結構滲水、漏水、積水，鋼筋鏽蝕、混凝土脹 裂。

看到道路坍塌和橋樑垮塌的新聞，我總會想起一個很老的電腦遊戲：《模擬城市》。我是遊戲中的“市長”，我把商店、小住宅乃至高樓大廈放在喜歡的地 方，指定那一片是工廠、這一片是CBD，我建造摩登大都市或風情小鎮，總有那麼幾分鐘它們看上去美不勝收，在其中生活的小人兒安居樂業，作為“市長”，我 的屬下、市民、報紙媒體都在對我歌功頌德，我不由得心花怒放，成就感遍布全身。可惜，很快，整個城市沒有什麼合適的地方繼續進行建造，而不得不進入運轉和 維護的階段，我這個“市長”，每幾分鐘都會收到路面破損、立交橋堪憂的急報，不得慌忙地花錢派人去做耗時間的整修。當我完全喪失耐心的時候，我的城市平面 上會同時出現好幾個大黑洞，不時從音箱里會傳出急救車和有人落難的哀號。

黑洞的出現，像一些看不見的暴徒，隨時衝出來，搗毀人民在城市中的安全感。在遊戲里，我從有錢修而不願意去修，自以為多建魁偉的高樓就能讓別人繼續 歌頌我；之後沒人買賬，沒有人願意待在喪失基本安全感的城市裡；最終因為我懶得進行基礎設施維護的城市，居住人口銳減，經濟實力逐月下降，我沒錢修也無力 再修；城市最後變成了灰突突的一片，黑色的大洞填滿了所有街道，也吞噬了市民所有的信心。

遊戲並非現實，卻有可能言中現實。道路坍塌和橋樑坍塌頻發是一個信號，希望中國的城市決策者和設計者不要等到惡性事故頻發到無法挽回時，再回想“也 許之前應該那樣做”，道路和橋樑的問題無非是檢測和維護，不是沒有工具和方法，不論是設計上的問題，還是各種複雜情況導致的老化與失效，都不是不能事先發 現端倪並加以預防。

獨眼是建築評論人，受過建築設計專業訓練，做過文化遺產保護工作。目前主要從事小說創作、撰寫書評及建築評論。

站著辦公 開會

站著辦公 降低體重

更新時間 2013年 1月 9日, 星期三 - 格林尼治標準時間12:18

專家稱，從坐著辦公改成站著辦公，有助於降低肥胖，提高身體血液循環。

健康專家建議，整天坐辦公室的人應該改變習慣，站著辦公。

英國徹斯特大學（University of Chester)的運動科學家巴克利（J Buchley）稱，每天站著辦公3小時，一年可以消耗3.6公斤的肥膘。

身體力行，巴克利自己的辦公桌是一張1940年代的老古董，只能站著辦公。
巴克利說，人們沒有必要那麼長久的坐著。
他說，現代人在辦公室坐著，在車裏坐著，在客廳的電視機前坐著，這很不自然，因為人類身體結構的設計是為了站立和行走。

站著的作家

巴克利說，站立三個小時可以消耗144大卡。
巴克利稱，從坐著辦公改成站著辦公，有助於降低肥胖，提高身體血液循環。
現代的辦公桌可以調節桌面，讓人們舒適的站著打字、發電郵。
提倡站著辦公巴克利並不是第一人。
美國著名作家海明威在1950年寫的一封信中就說，「寫作和旅遊如果不能擴大你的視野的話，至少可以擴大你的屁股，我喜歡站著寫東西」。
最新的一系列研究也顯示，長久坐著不動可能造成的健康威脅。
去年秋天的一份報告說，長久坐著會增加患糖尿病的危險。
此前的一份報告稱，不愛活動的生活方式造成的死亡與吸煙相當。

山西苯胺泄漏事故 ﹐洗選蛋(驗出氟甲磺氯黴素)

Chemical Spill Pollutes Shanxi Politics
After a dangerous chemical spill polluted north China waterways and delays in reporting it raised the specter of the second cover-up of an industrial accident in weeks in Shanxi province the problem is seeping into the political system.

In the latest incident, nine tons of a 39-ton spill of the chemical aniline from a plant in Shanxi flowed by river deep into neighboring provinces before local authorities went public with the news. Days earlier, Shanxi authorities conceded officials in another part of the province had also taken their time in disclosing a deadly Dec. 25 railway tunnel cave-in that killed eight workers.

The aniline discharge killed fish in the Zhouzhang River. When news of the spill was made public on Saturday, five days after the incident, the Hebei province city of Handan shut off water supplies for many residents. State media said the pollution was detected in Henan province as well.

The political damage may be more long-lasting than the risk to human and animal health from the aniline, which is used in dyeing, agriculture fertilizers and rubber manufacturing. News of cover-ups in China increasingly prompt searching for someone to blame and Shanxi now has a top official with widespread name recognition: Li Xiaopeng, the son of an unpopular former Chinese premier, Li Peng. The younger Mr. Li became acting governor of the province late last year after a career in the power sector, which gorges on Shanxi coal for its electrical plants.

State media said Mr. Li expressed contrition about the railway tunnel collapse, which occurred just as he was assuming his new office. He visited the site and promised a full investigation.

Now blame is falling onto Mr. Li for delays in reporting the chemical spill, though there is no evidence top levels of the provincial government were aware of the accident when it took place. On Sina Corp. SINA -0.36%’s Weibo microblog service, one writer said Monday that Mr. Li “should resign as an apology to the people.”

So far, clear political fallout from the chemical spillage has been localized to the city of Changzhi , where the initial spill was detected on Dec. 31. It was blamed on faulty equipment at a plant run by state-owned Shanxi Tianji Coal Chemical Industry Group. The company sacked four of its employees.

Zhang Bao, Changzhi’s mayor, appeared at a news conference early Monday to explain delays in informing the public.

In his nationally broadcast comments, Mr. Zhang said that the initial reading of a 1.5 ton spill appeared manageable by the company. But officials failed to realize how poor company management, faulty equipment and open rainwater drains would conspire to send the chemicals into the river.

“[We] never imagined that such a small accident could turn into a big environmental pollution incident,” Mr. Zhang said.

苯胺泄漏事故攪動山西政壇

在

一種危險化學品發生泄漏並污染中國北方水道之後﹐有關部門延遲報告此事﹐這引發外界對山西省數週來可能第二次瞞報工業事故的關切。這一問題已經滲入中國的政治體系。

相關報導

山西發生苯胺泄漏事故 河流被污染

在這起最新事故中﹐山西一家化工廠有39噸化學品苯胺發生泄漏﹐其中九噸流入河道並給相鄰省份造成了嚴重影響。但事故發生後多日﹐有關部門一直沒有披露這一消息。幾天前﹐山西省政府承認﹐該省另一地區的官員同樣瞞報了去年12月25日發生的一起導致八名工人死亡的鐵路隧道爆炸事故。

泄漏的苯胺毒死了濁漳河中的魚群。上週六有關此次苯胺泄漏的新聞才得以披露（此時距事故發生已經過去五天）﹐就在這天河北邯鄲切斷了很多居民的自來水供應。中國官方媒體報道說﹐河南省境內也檢測出污染物。

Xinhua/Zuma Press

相比事故給人和動物的健康帶來的風險﹐苯胺泄漏在政治上的危害可能更持久。苯胺主要用於印染、化肥和橡膠製造。在中國﹐有關瞞報事故的新聞開始日漸促使有關方面找到事故責任人﹐而山西省目前的代省長則擁有廣泛的知名度﹐這就是中國前總理李鵬的兒子李小鵬。李小鵬在去年年末成為山西省代省長﹐此前他在電力行業任職。發電廠所需的大量煤炭主要來自山西。

中國官方媒體報道說﹐李小鵬對鐵路隧道爆炸事故感到悲痛、震驚和憤慨。這一事故發生時﹐李小鵬剛剛履新。李小鵬前往事故現場並承諾徹查此事。

現在外界則因此次遲報苯胺泄漏事故指責李小鵬﹐雖然沒有證據表明事故發生時山西省政府高層清楚事故的具體情況。新浪微博一位用戶週一表示﹐李小鵬應該辭職﹐以表示對人民的道歉。

到目前為止﹐此次苯胺泄漏事故在政治上造成的明確影響還侷限在長治一地。去年12月31日此次泄漏事故最初就是在這裡被發現的。事故原因是國有企業山西天脊煤化工集團有限公司(Shanxi Tianji Coal Chemical Industry Group.)在當地的一家化工廠的設備發生故障。該公司有四名責任人被撤職。

長治市市長張保週一早上現身新聞發佈會﹐解釋遲報事故的原因。

在這場被國內媒體廣泛報道的發佈會上﹐張保說天脊公司最初上報的泄漏量為1.5噸﹐該公司認為事故規模可控。但有關負責人未能意識到該公司對自身設備、設施管理不善﹐造成外泄苯胺通過雨水、污水管道流入濁漳河﹐造成污染。

張保說﹐我們從未想到這樣一個一般性安全生產事故會發展成環保大事故。



消基會抽檢／頂好洗選蛋 驗出氟甲磺氯黴素

頂好超市販售的洗選鮮雞蛋，被檢測出含有氟甲磺氯黴素，頂好超市已全面下架。 （記者陳志曲攝）

〔記 者謝文華、楊雅民、洪素卿／台北報導〕頂好超市販售的「特惠牌」盒裝洗選鮮雞蛋，經消基會採樣、驗出含氟甲磺氯黴素○．○○一至○．○○四ppm，違反 「不得檢出」規定。衛生署將了解究竟是飼養過程添加或交叉污染所致，若查證屬實，將依違反食品衛生管理法，開罰六萬以上、六百萬以下罰鍰。
毒性恐致血癌病變
消基會食品委員會召集人、台大教授陳明汝說，氯黴素毒性高，烹煮無法完全破壞，進入人體恐影響骨髓和紅血球增生，甚至導致再生性不良貧血、引發血癌前期病變，政府已在二○○二年禁用。
依規定，氯黴素可用來增加肉雞小雞抵抗力，不過仍有上市前的停藥期限制，但蛋雞則不可以此做為預防傳染病的藥物。
食品藥物管理局組長蔡淑貞表示，將要求地方衛生局再次抽檢，同時移交給農委會追查源頭。此外，所謂的包裝食品定義是食品需經過密封包裝、且拆封後無法還原才算，因此，盒裝蛋算是散裝食品。未來也會檢討雞蛋等與民生密切相關的散裝食品管理方式。
頂好下架接受退貨
頂好超市表示，被消基會檢出不合格的蛋是該公司自有品牌的雞蛋，每個月固定都會抽檢，目前供應商提供的檢驗報告均是合格的，並未檢出氟甲磺氯黴素，但昨日還是先將該雞蛋下架，並接受消費者退換貨。
消基會去年十月在北部賣場、雜貨店及超商購買二十件雞蛋，十四件盒裝、六件散裝，在沙門氏桿菌檢驗上全數合格，藥物殘留上，僅頂好超市所屬的惠康百貨經銷、香港牛奶國際商標公司委託製造的「特惠牌」盒裝蛋違規含氟甲磺氯黴素。
標榜含硒蛋 價格翻倍
調查另發現，有五件樣品宣稱或隱喻含硒，標榜「機能蛋」，硒檢出量介於每公斤九十至一五○微克，其餘十五件也含硒，每公斤五十微克以下。
消費者雜誌社發行人陳智義說，業者以含硒披上「營養」外衣，售價就從每顆單價三至六元，提高為八至十元，價格翻倍。陳明汝指，硒屬抗氧化劑，能預防癌症及心臟病，但對人體同時具有必要性與毒性，吃太多也可能中毒，其實一些蔬菜、肉類及五穀就含硒，不需要花較多錢買含硒蛋。
陳智義則表示，相關研究建議一天攝取硒為五十五微克、上限四百微克，一天吃十幾顆蛋才會過量，民眾毋須擔心。
陳明汝並提醒，蛋殼沾染糞便易受病菌污染，最好清洗乾淨，且最好不要生食。

Officials Warn Against Baby Sleep Positioners 請扔掉嬰兒防側睡枕

 

Officials Warn Against Baby Sleep Positioners

By ANAHAD O'CONNOR January 02, 2013

 

Health officials are warning parents not to use a special device designed to help keep babies in certain positions as they sleep. The device, called a sleep positioner, has been linked to at least 13 deaths in the last 15 years, officials with two federal agencies said on Wednesday.
"We urge parents and caregivers to take our warning seriously and stop using these sleep positioners," Inez Tenenbaum, the chairman of the Consumer Product Safety Commission, said in a statement.

按图放大

An example of a sleep positioner.

The sleep positioner devices come primarily in two forms. One is a flat mat with soft bolsters on each side. The other, known as a wedge-style positioner, looks very similar but has an incline, keeping a child in a very slight upright position.
Makers of the devices claim that by keeping infants in a specific position as they sleep, they can prevent several conditions, including acid reflux and flat head syndrome, a deformation caused by pressure on one part of the skull. Many are also marketed to parents as a way to help reduce a child's risk of sudden infant death syndrome, or SIDS, which kills thousands of babies every year, most between the ages of 2 months and 4 months.
But the devices have never been shown in studies to prevent SIDS, and they may actually raise the likelihood of sudden infant death, officials say. One of the leading risk factors for sudden infant death is placing a baby on his or her stomach at bedtime, and health officials have routinely warned parents to lay babies on their backs. They even initiated a "Back to Sleep" campaign in the 1990s, which led to a sharp reduction in sudden infant deaths.
With the positioner devices, if an infant rolls onto the stomach, the child's mouth and nose can press up against a bolster or some other part of the device, leading to suffocation. Even if placed on the back, a child can move up or down in the positioner, "entrapping its face against a bolster or becoming trapped between the positioner and the crib side," Gail Gantt, a nurse consultant with the Food and Drug Administration, said in an e-mail. Or the child might scoot down the wedge in a way that causes the child's mouth and nose to press into the device.
"The baby's movement may also cause the positioner to flip on top of the baby, trapping the baby underneath the positioner or between the positioner and the side of the crib," she said.
Of the 13 babies known to have suffocated in a sleep positioner since 1997, most died after they rolled from their sides onto their stomachs. The Consumer Product Safety Commission has also received dozens of reports of babies who were placed on their sides or backs, "only to be found later in hazardous positions within or next to the product," the F.D.A. said in a statement.
Many baby books for new parents specifically urge against using sleep positioners, and the American Academy of Pediatrics does not support their use for SIDS prevention. Though the F.D.A. has never approved the positioners for the prevention of SIDS, it has in the past approved a number of the devices for the prevention of gastroesophageal reflux disease and flat head syndrome. But the agency said that in light of the new safety data, it believed any benefits from using the devices were outweighed by the risk of suffocation.
As of Wednesday, the agency is explicitly advising parents to stop using sleep positioners, and it has asked manufacturers of the devices to submit clinical data showing that the benefits of their products outweigh the risk of serious harm. In addition to avoiding the devices, experts say, parents should keep things like pillows, comforters, quilts and bumpers away from their infants and their cribs. Soft bedding can increase the likelihood of a baby suffocating.
"The safest crib is a bare crib," Dr. Susan Cummins, a pediatric expect with the F.D.A., said in a statement. "Always put your baby on his or her back to sleep. An easy way to remember this is to follow the ABC's of safe sleep - Alone on the Back in a bare Crib."

請扔掉嬰兒防側睡枕

ANAHAD O'CONNOR 報道 2013年01月02日

美國衛生部官員警告各位家長，不要使用為保持嬰兒特定睡姿而設計的專門器械。兩名聯邦機構的官員於11月21日報告說，該器械稱為防側睡枕(sleep positioner)，在過去的15年內已導致了至少13名嬰兒的死亡。
“我們敦促家長和護理人員認真對待我們的警示，不要再使用此類防側睡枕。”美國消費品安全委員會(Consumer Product Safety Commission)主席伊涅絲·特南鮑姆(Inez Tenenbaum)在聲明中說。

按圖放大

嬰兒防側睡枕樣品。

相關文章

• 怎樣打針寶寶才不哭
• 嬰兒DNA檢測加快罕見病診斷
• 不必迷信母乳餵養

防側睡器械主要分為兩種。一種為水平墊，兩側有柔軟長枕；另一種為楔形，看起來與前一種很類似，只是略有傾斜，能讓嬰兒保持稍稍直立的睡姿。
防側睡枕的製造商宣稱，讓嬰兒保持特定睡姿可以避免諸多問題，包括胃食道返流和扁頭綜合征——頭骨一部分受壓導致的頭部變形。許多製造商還向家長們 宣傳，防側睡枕可以幫助降低嬰兒猝死綜合症（SIDS: sudden infant death syndrome，每年有數以千計的嬰兒因此死亡，以2-4個月大的嬰兒居多）的風險。
然而，從沒有任何研究顯示防側睡枕能夠阻止SIDS的發生。相反，衛生管理者說，它們倒確實可能提高嬰兒突然死亡的概率。致嬰兒猝死的首要危險因素 就是讓他們趴着睡覺，而衛生部官員經常提醒家長們要讓嬰兒平躺着睡。他們甚至還在上世紀90年代發動了“躺着睡大覺(Back to Sleep)”運動，此舉大幅度降低了嬰兒猝死案例。
如果嬰兒在使用防側睡枕時翻轉成趴着的姿勢，他們的嘴和鼻子就可能壓在側面的軟長枕或是其他部位上，從而窒息。即使一開始是躺着睡的，他們也會在枕 頭裡面上下移動。美國食品藥品監督管理局（Food and Drug Administration，簡稱FDA）護理顧問蓋爾·甘特(Gail Gantt)在一封電子郵件中提到：“他們可能把臉陷在軟長枕里，或卡在防側睡枕和嬰兒床床沿之間，”或者小孩子可能從楔形墊上頭朝下滑下來，把嘴巴和鼻 子壓在防側睡枕上。
“嬰兒會動來動去，防側睡枕可能翻到寶寶身上去，把寶寶卡在下面或是防側睡枕和床沿中間，”她說。
自1997年起13名因防側睡枕而窒息的嬰兒中，大多數因為翻轉成趴着的姿勢而窒息死亡。FDA在一份聲明中說，消費品安全委員會已接到十幾例報告，稱小孩子最初是平躺或側躺在防側睡枕上的，但後來被發現“正以很危險的姿勢處於枕頭內或旁邊”。
很多寫給年輕父母的育兒書籍都特別反對使用防側睡枕。美國兒科學會(American Academy of Pediatrics)也不支持利用防側睡枕預防SIDS的做法。儘管FDA從未認可防側睡枕有防止SIDS的功效，但它確實批准過一些用以預防胃食管返 流疾病和扁頭綜合症的器械。但鑒於新的安全性數據，FDA認為防側睡枕令嬰兒窒息的風險比它能帶來的任何益處都要嚴重得多。
自11月21日起，FDA明確建議家長停止使用防側睡枕，並要求製造商提供臨床數據以證明使用此產品的好處大於出現嚴重後果的風險。除了避免此類器械，專家說，家長應該確保枕頭、被褥、圍墊等物品遠離嬰兒和嬰兒床。柔軟的寢具會增加嬰兒窒息的風險。
“最安全的圍欄是‘無圍欄’，”FDA兒科專家蘇珊·卡明斯(Susan Cummins)醫生在聲明中說，“永遠要讓孩子平躺着睡。有種簡單的記憶法：按照‘安全睡眠ABC’來做：單獨、平躺、無圍欄。”

本文最初發表於2012年11月22日。
翻譯：孫舒雯