在怀孕以后，相信夫妻之间讨论最多的话题之一就是以后孩子会长得像谁，其实孩子会长得像谁不仅仅是阿姨妈妈们喜欢谈论的话题，科学家们也试图进行研究来回答这个问题。

从理论上讲，我们从父亲和母亲遗传了同等数量的基因，我们长得像谁取决于这些基因混合的程度。但是，说孩子会更像爸爸的说法略占上风，支持这种说法的理由来自于进化论的说法和实验室的研究。

首先是进化论的说法，这种理论认为，在人类的进化过程中，孩子出生以后，母亲肯定知道这孩子是自己的，但是父亲无法肯定孩子是自己的。从自私和维护家庭血统的角度来讲，父亲会把所有的资源给肯定是自己的孩子，唯一靠谱一些的标准就是长得像自己的孩子，成千上万年的进化就会有利于长得更加像父亲的孩子。

另外一个支持孩子会像父亲更多一些的理论是，虽然在受孕时孩子遗传了父亲和母亲各一半的同等数量的基因，但是在使用这些基因时，父亲基因的用量会更多一些，这是实验室研究的发现。

理论归理论，现实是真的如此吗？

你先别急着去照镜子，看孩子的脸，看你老公的脸，等我说完了你再去琢磨。

遗传是有道理的

遗传是有道理的，遗传是基本靠谱的，一个孩子的长相是由以下几个方面来决定的：头发、眼睛、鼻子等面部特征和身高。

头发

中国人都是黑头发，除非你找个欧美人或非洲人，不然的话头发都是一样的，都是黑色。

眼睛

眼睛最突出的特征是颜色（虹膜的颜色），从基本色来讲，人类眼睛的颜色分为三种，棕色、蓝色和绿色，当然还有由各种混合的颜色。对于中国人来讲，只有不同深度的棕色。所以区分眼睛遗传自谁，只能看大小，形状和单双眼皮，眼睛像谁都有可能。

不过如果有一个人的家族里面都是小眼睛的话，估计你生再多的孩子基本上都会是小眼睛，不过这种比较强大的基因在人群中并不算多见。

鼻子

鼻子的大小和形状不是单一基因决定的，这取决于多种基因，中国人的鼻子不像白人的鼻子那么高，都差不了多少，既可以像爹，也可以像妈。

其它面部特征

除了头发、眼睛和鼻子以外，其它的面部特征就更难说了，一般是在爸爸和妈妈家里向上各看三代，看哪些面部特征在整个家族里是非常强大的，孩子遗传这些强大的面部特征的可能性就更大。

例如，如果父亲的家族都是国字脸，母亲的家族什么脸型都有，估计你们家孩子生出来多数是国字脸，无论生几个孩子，都是国字脸的可能性也很大。如果父亲的家族都是国字脸，母亲的家族都是圆脸，那就很难说了，这就要看谁拼得过谁了。

身高

中国人的说法是：爹矮矮一个，娘矮矮一窝。

美国人的说法是：取父亲和母亲身高的平均值，如果是儿子的话，在平均值上加2英寸（1英寸相当于 2.54 厘米，2英寸相当于5厘米左右），如果是女儿的话，在平均值上减去5厘米。

当然，这只是遗传的潜力，决定身高的重要因素还有营养和健康状态，如果营养状态好，身体健康的话，身高一般会超过计算的平均值。

智商

孩子的智商IQ像谁更多？很多的研究好像是认为孩子的智商更加多的是遗传自母亲，理由如下。

首先，和智商相关的基因主要位于X染色体，母亲有两条X染色体（XX），父亲有一条X染色体（XY），孩子从母亲遗传X相关基因的可能性会更大。另外，有些基因被称为“条件基因”，例如有些基因只有是来自母亲的话，才有可能起作用，如果是来自父亲的话，就会被失活，和智商相关的基因就被认为是属于这一类。

其次，很多的人群研究也证实了这一点，来自格拉斯哥Glasgow超过 12,000 人的长期研究发现，在包括各种重要的种族、社会和经济因素中，母亲的智商是预测孩子智商的最佳指标。

当然，不能就这么简单的说父亲的遗传物质不重要，父亲的遗传物质不影响智力。研究发现，父母双方对于孩子大脑的发育都有贡献，只不过是分工不同。母亲的遗传物质支持大脑皮层的发育，这一部分大脑是负责比较高级的认知功能，例如语言、记忆、绘画、思想和智力；来自于父亲的遗传物质负责大脑边缘系统的发育，其主要功能是控制呼吸、消化、情绪、饥饿和性反应等人类的生理本能。

尽管大脑皮层负责比较高级的认知功能，但是大脑的边缘系统对于人类的思考、感受和解决问题的能力方面也很重要，所以不应该把大脑皮层和边缘系统的功能分离开来去看。

人类40-60%的智力是遗传的，后天的环境（包括父母的教养）对于智力的发育也很重要。研究显示，如果孩子在成长的过程中能够和母亲有很好的身体和情感上的接触，保持良性亲密关系的话，在解决问题时，孩子会有很好的自信心和好奇心，也不会容易沮丧和放弃。

男生在选择女朋友的时候，可以有不同的标准，可以是B&B（Brain&Beauty），可以是B&B（Brain&Breast），可以是B&B（Breast &Buttock），也可以是B。

Brain:大脑，Beauty:美女，Breast:乳房，Buttock:臀部

为了下一代的智商，你在找老婆的时候可要仔细想想好，究竟是B呢？还是B&B呢，还是B&B呢？

遗传是不讲道理的

遗传是有道理的，遗传是基本靠谱的，遗传有时也是不讲道理的，也是不太靠谱的。孩子长得可以像爹，也可以像妈，也可以像隔壁老王。

龙生九子各不同，同一个爹妈生出来的孩子可以完全长得不一样。

有的是生十个孩子，都像是同一个模子里刻出来的。

有好多我接生的孩子，老公是白人，太太是中国人，孩子生出来就是一个纯种的白人，看上去完全和中国妈妈没有关系，以后长大一些，抱着TA在街上走的话，别人还以为她是保姆，或是抱的是别人的孩子。

其实，孩子刚生出来的时候都长得差不多，不会太好看，泡在羊水里那么久，你还能指望TA多好看，以后慢慢长开了，就会看得出差别了，当然也会有少数小宝贝一出生的时候就看上去很漂亮的。

人类有46条染色体，2万多个基因，孩子从父亲和母亲那里各获得23条染色体，按照不同的组合方式，理论上讲一对夫妻可以生育几十万亿个不同的孩子，所以预测孩子长得像谁是很困难的。

人类的长相特征基本上都是多基因遗传性的，是很多基因共同起作用的，另外环境因素也起着很大的作用。

孩子最后像谁？我总结出一个“3N”决定论：Nature（天赐的遗传物质）， Nurture（后天的教养），Nutrition（营养等外界因素的影响）。

孩子像谁的故事

做产科医生会遇到各种各样的孩子像谁的故事，讲几个给大家听听。

1.准外婆坚持要让我亲自给她女儿做手术，理由是段医生长得帅，想让小宝宝出生时第一眼就看到我。

2.我曾经在澳门工作过一年多，有一次和一位葡萄牙医生一起做手术，孩子出来以后，大肚婆问葡萄牙医生孩子长得像谁，这位葡萄牙医生很搞笑地说（他会讲广东话）：像医生！

3.有一次在做剖宫产时，妈妈要求孩子出来时要给她看看长得是什么样子，当护士把孩子抱给她看时，她惊呼道：天呐，怎么这么难看！手术室里爆发出一阵笑声。

因为护士常规给妈妈第一眼看的不是脸，是屁股，是为了让妈妈确认孩子的性别，然后才给她看脸，不知道她是太紧张还是眼神不济，朦胧之中把孩子的屁股当成脸了。

————  分 割 线 ————

王菲：

既然男人都坏，为什么不找一个帅的

涛哥：

既然看产科男医生，为什么不找一个帅的

帅帅的，坏坏的

帅也是一种罪过

本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1649
原文出处：http://apps.weibo.com/5076516542/8s0ZkcjX 收起阅读 »

 每年11月1日是西方传统节日万圣节（AllHallows），而它的前一夜，也就是10月31日夜晚就叫做万圣夜（Halloween）。在西方国家，每当万圣夜到来之时，孩子们便会穿上五颜六色的化妆服，戴上千奇百怪的面具，提着一盏用南瓜雕刻的“杰克灯”走家串户去敲门，乐此不疲地玩着“Trick or Treat”的恶作剧，也就是向大人们索要糖果，不给的话就捣乱。现在国内往往把10月31日这天叫做万圣节，其实是不准确的。

万圣节是与灵异事物有关的节日，与我们传统的中元节有点类似，万圣夜被认为是鬼怪世界最接近人间的时间。关于万圣节的来历，相传是源自古代凯尔特民族，是他们祭祀亡魂的时刻，既求避免恶灵干扰，也以食物祭拜祖灵和善灵以祈平安渡过严冬。

【万圣节与南瓜的渊源】

说到万圣节，最先联想到的东西大概就是南瓜了！它既能用来制作杰克灯，也是烹制南瓜派的主要食材。杰克灯相传是一个叫杰克的人发明的，最初是以芜菁制成，后来移民到美国的爱尔兰人发现用当地常见的南瓜制作杰克灯更容易也更好看，于是便演化成了如今最普遍的南瓜杰克灯。做法很简单，就是将南瓜掏空，在外面雕刻出人脸形状或鬼怪头像，并在里面放置点燃的蜡烛即可，寓意是赶走那些来到世间夺生的鬼魂。

除了有趣的南瓜灯，好吃的南瓜派也是万圣节不可缺少的象征性食物。南瓜派以南瓜为原料，配以奶酪、黄油、奶油、鸡蛋、白糖、盐、肉桂粉等成分做好了烤制而成。看到这些食材，是不是隔着屏幕都能闻到刚烤好的南瓜派的香味了？

【大南瓜的大营养】

南瓜属于葫芦科南瓜属植物，种植广泛，在我国不同地区又叫番瓜、倭瓜、金瓜等。

南瓜的大营养体现在哪里呢？首先看南瓜这颜色，你能想到哪种营养素？没错，必须是胡萝卜素！南瓜中的胡萝卜素含量很高，它在体内可以转化成维生素A，对维持正常的视觉功能、上皮组织健康、增强免疫力、抗癌等具有重要作用。

南瓜富含水溶性膳食纤维，能帮助改善肠道功能，预防和治疗便秘。南瓜还属于高钾低钠食物，特别适合中老年人和高血压患者食用。

另外，南瓜含有丰富的多糖成分。南瓜多糖能有效改善糖尿病人的糖代谢和脂代谢紊乱。一般人常吃南瓜对健康大有益处。但是不是说糖尿病人更该使劲吃南瓜呢？显然不是。具有降糖功能的只是南瓜中的一种成分，就南瓜整体而言，因其血糖生成指数（GI）为75，属于高GI食物，糖尿病人仍不可多食。

【南瓜怎么吃】

俗话说，老南瓜当粮，嫩南瓜当菜。作为一位跨界选手，南瓜的吃法可真是不少，蒸煮炒煎都不在话下。

蒸：可以说是最简便的吃法。把南瓜切成带皮的小块，直接蒸熟即可。这种做法既简单又营养，属于首选吃法。

煮：去皮切块后与谷物一起煮粥，尤其在这寒冷的季节里，喝上一碗热腾腾香喷喷的南瓜粥，实在是一种享受！

炒：比较嫩的南瓜适合当菜炒着吃，炒南瓜咸中带甜，别有一番滋味。

煎：可以做成南瓜饼。这样的可口小食比较容易受到孩子的欢迎。但这种做法往往需要添加油和糖才能保证口感，所含的能量偏高，只适合偶尔解解馋。
 
本文作者：马冠生
本文地址：http://www.wjbb.com/know/1648
原文出处：http://weibo.com/p/2304185d5947690102yamv? 收起阅读 »

 从古至今，无论是传统观念、还是男性实际所扮演的角色、承担的责任，以及他们较之女性先天的生理性优势，使女性自然而然地被定性为“弱势群体”，而男性是一个家庭的主要生产力，是名副其实的“顶梁柱”。

男性所承受的各种压力大，健康也在不知不觉中受到侵害。为号召世界各国对男性健康的关注，世界卫生组织确定每年的10月28日为“世界男性健康日”。中国从2000年开始，每年10月28日，开展“男性健康日”宣传活动。并从2001年开始，由国家人口计生委办公厅下发《关于开展男性健康宣传日活动的通知》并确定活动主题。呼吁整个社会再多一点对男性健康的关注、呼吁每个家庭再多一点对男性健康的关爱。



健康是由很多因素促成的，而营养是健康的基础，因此，关注男性健康首先要从合理膳食、均衡营养做起。以谷类为主，食物多样，天天吃蔬菜和水果，常吃豆类及乳制品，每天适量的鱼、蛋和瘦肉，这是必须遵循的饮食基本原则。

1、食物多样：不吃或少吃甜食，营养搭配合理，每天吃富含膳食纤维、维生素和矿物质的蔬菜水果。水果含有丰富的膳食纤维，能促进肠道蠕动，防治便秘，预防肠癌的作用；水果含较多的果胶，这种可溶性膳食纤维有降低胆固醇作用，有利于预防动脉粥样硬化，还能与肠道中的有害物质促使其排出体外。水果中还含有黄酮类物质、芳香物质等植物化学物质，它们具有特殊生物活性，有益于机体健康。

鸡、鸭、鱼、肉等动物性食物提供优质的蛋白质，可以增强机体的免疫力。奶类制品富含钙质，有益于骨骼健康。牡蛎等海产品中含有丰富的锌，有益于男性功能和健康。

2、清淡饮食低脂少盐：要以植物性食物为主。脂肪量过多会引起肥胖，增加患动脉粥样硬化、结肠癌、前列腺癌等的危险。饮食要清淡，盐摄入过多会增加高血压的危险。切记：胖不是福，腰粗不是风度，而恰恰是疾病的表现。膳食不要太油腻，不要太咸，不要摄食过多的动物性食物和油炸、烟熏、腌制食物。

3、常吃坚果：坚果营养丰富，除富含蛋白质和脂肪外，还含有大量的维生素E、叶酸、镁、钾、铜、单不饱和脂肪酸和多不饱和脂肪酸及较多的膳食纤维，对健康有益。每周吃少量的坚果可能有助于心脏的健康。每天来点花生、核桃、松子等，为你的健康增值。

4、饮酒适量：经常过量喝酒，会使食欲下降，食物摄入量减少，引起多种营养素缺乏、急慢性酒精中毒、酒精性脂肪肝，严重时还会造成酒精性肝硬化。过量饮酒还会增加患高血压、中风等疾病的危险；并可导致事故及暴力的增加，对个人健康和社会安定都有害。

5、足量饮水：成年人身体的60—65%是水分，肝、大脑、皮肤含70%的水，骨骼含水45%，血液含水80%。水的作用就是润滑作用，关节润滑剂、唾液、消化道分泌的胃肠粘液、呼吸系统气道内的粘液、泌尿生殖道粘液等的生成都离不开水。喝水时间应分配在一天中的任何时刻，原则是少量多次，每次200毫升左右。

6、天天运动：运动不仅有助于保持健康体重，增加男性的风采和魅力，还能够降低患高血压、中风、冠心病、2型糖尿病、结肠癌、乳腺癌和骨质疏松等慢性疾病的风险；同时还有助于调节心理平衡，有效消除压力，缓解抑郁和焦虑症状，改善睡眠。建议每天至少步行6000步。
 
本文作者：马冠生
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 在和疾病斗争的过程中，人的免疫力发挥着至关重要的作用。人体免疫力的高低受多种因素的影响，其中营养因素起着十分重要的作用，它是维持人体正常免疫功能和健康的物质基础。营养不良会导致机体免疫系统功能受损，对病原体的抵抗力下降，从而促进感染的发生和发展。因此，通过合理营养可以改善人体的免疫状况，增强对疾病的抵抗能力，对预防疾病的发生有重要的意义。与机体免疫功能关系密切的营养素有蛋白质、维生素A、维生素C、维生素E、铁、锌和硒等。

1、蛋白质

蛋白质是机体免疫功能的物质基础。蛋白质摄入不足影响组织修复，使皮肤和粘膜的局部免疫力下降，排除病原菌的能力减弱，容易造成病原菌的繁殖和扩散，降低抗感染能力。随着生活条件的改善，蛋白质缺乏已经不常见，但节食、偏食的人中容易出现。动物性食物中所含的蛋白质（也包括大豆及其制品中所含的蛋白质）进入机体后，比植物性蛋白质更容易被人体所充分利用。因此，每天要适量吃一些动物性食物。

2、维生素A

维生素A对机体免疫系统有重要的作用。维生素A缺乏可以引起呼吸、消化、泌尿、生殖上皮细胞角化变性，破坏其完整性，容易遭受细菌侵入，增加机体对呼吸道、肠道感染性疾病的易感性。富含维生素A的食物主要有动物肝脏，比如羊肝、猪肝、鸡肝等，植物性食物只能提供维生素A原类胡萝卜素，维生素A原类胡萝卜素在体内可以转换为维生素A。胡萝卜素主要存在于深绿色或红黄色的蔬菜和水果中，比如胡萝卜、菠菜、芹菜、芒果、红薯等。平常选用蔬菜应该至少有一半以上的深色蔬菜。

3、维生素E

维生素E可以提高机体免疫功能，提高对感染的抵抗力。维生素E食物来源主要是植物油、植物种子的胚芽、坚果、豆类和谷类。

4、维生素C

维生素C是人体免疫系统所必需的维生素，可以从多方面增强机体对抗感染的能力，缺乏会使免疫系统功能降低。维生素C是胶原合成必不可少的辅助物质，可以提高机体组织对外来病原菌的阻挡作用。维生素C也可以促进淋巴母细胞的生成和免疫因子的产生。维生素C能促进干扰素的产生，抑制新病毒的合成，有抗病毒作用。新鲜的蔬菜、水果是维生素C丰富的食物来源。如鲜枣、青椒、猕猴桃、菠菜、山楂、柑橘、柚子、草莓等。

5、铁

铁缺乏时容易引起贫血，降低抗感染能力。富含铁的食物有：动物血、肝脏、大豆、黑木耳、芝麻酱中含铁丰富。

6、锌

锌具有多种生理功能，尤其对免疫系统的发育和正常免疫功能的维持有着不可忽视的作用。适量摄入锌可增强儿童、老年人及一些特殊病人的免疫功能，对胃肠道、呼吸道感染性疾病及寄生虫病的预防和治疗有重要作用。贝壳类海产品、红色肉类、动物内脏等是锌的良好来源。

7、硒

硒几乎存在于所有免疫细胞中，补硒可明显提高机体免疫力。近年来的研究发现低于最适量的硒摄入可损害免疫系统的发育和功能，使抗感染能力下降。已有研究表明，维生素E和硒对免疫系统的作用是彼此独立的，但同时给予维生素E和硒可对加强免疫反应起协同作用，反之，同时缺乏可导致免疫反应的明显下降。
 
本文作者：马冠生
本文地址：http://www.wjbb.com/know/1646
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 10月23日是农历二十四节气的霜降，这是秋季的最后一个节气。霜降来临天气变得更冷、露水会凝结成霜，树叶开始变黄并开始凋落，标志着秋天基本过去了，冬天开始了。我国绝大部分地区都有霜降，只是霜降的时间长短不一。

我国的传统注意养生，不同的季节有不同的养生原则。关于霜降，民间养生的说法是“一年补透透，不如补霜降”，从而说明了霜降时节养生保健的重要性。霜降时节，天气渐冷、秋燥明显，因此，第一，注意保暖。秋冻不是适合每个人，老年人、身体虚弱的就不要盲目秋冻啦；第二，防秋燥。喝足水，可以吃点蜂蜜，每天吃水果蔬菜，除了下面我们要说的柿子，梨、苹果等水果应天天吃；第三，秋不冻，但要动。秋高气爽，是开展运动的好时节，运动不仅有益身体健康，还有益心理健康。

俗话说：“霜降到，吃柿子”，柿子一般是在霜降前后完全成熟，这时候的柿子皮薄肉鲜味美，属于时令水果，也具有一定的营养保健价值。

柿子品种繁多，约有300多种。从色泽上可分为红柿、黄柿、青柿、朱柿、白柿子、乌柿等；从果形上可分为圆柿、长柿、方柿、葫芦柿、牛心柿等。柿子又可分为两大类：一是涩柿类；柿果在树上不能自身脱涩，采后必须通过人工脱涩或成熟作用才可食的有涩柿。把柿子和苹果等其他水果放在一起，可以促进柿子的成熟。二是甜柿类：柿果在树上能自身脱涩，摘下来就可以吃。

《本草纲目》中记载“柿乃脾、肺、血分之果也。其味甘而气平，性涩而能收，故有健脾涩肠，治嗽止血之功。从柿子的营养成分来看，成熟的柿子中含有15%的碳水化合物，丰富的膳食纤维，钙、磷等矿物质和胡萝卜素等多种维生素。柿子色泽鲜艳、柔软多汁、香甜可口、老少喜食。柿子既可以生吃，也可加工成柿饼、柿糕，还可以用来酿酒、制醋等。柿子不但营养丰富，而且有较高的药用价值。柿子对于预防心血管硬化具有非常给力的效果。新鲜柿子含碘很高，能够防治地方性甲状腺肿大。柿蒡、柿叶都是很有价值的药材。

柿子虽然维生素含量丰富，口感良好，但是吃柿子应适量而止，一般认为，在非空腹的情况下，每次吃柿子以不超过200克为宜。同时还要注意以下几点：

1、不空腹吃柿子和柿子皮。因为柿子中含有大量的鞣酸和果胶，空腹状态下容易在胃酸作用下形成胃柿石。但如果胃里“有底”，胃柿石就不会那么容易形成了。

2、不要与含有大量蛋白质的水产品同食。蛋白质在鞣酸的作用下，也容易形成胃柿石。

3、糖尿病患者、胃功能低下者不能吃，过度劳累、疲劳的情况下不宜吃柿子。第四，不宜同含纤维多的食物一起食用。
 
本文作者：马冠生
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 中国是近视眼大国，为了好看，有很多女性平时都会佩戴隐形眼镜，怀孕以后是否可以继续佩戴隐形眼镜也是经常会被问到的问题。

其实怀孕以后真的没有那么多的禁忌，绝大多数怀孕以前可以做的事情怀孕以后照样可以做，怀孕以后依然可以佩戴隐形眼镜，不过戴起来可能会有些不舒服。

怀孕以后你身体内的激素水平会发生很大的波动，在不同的孕周，血压也会出现波动，进入孕中晚期，你的身体还会出现不同程度的水肿。随着这些变化，你眼睛的形状也可能会发生改变，也会出现肿胀。

如果在怀孕前你一直佩戴隐形眼镜，怀孕以后依然可以佩戴。其中部分准妈妈眼睛的形状可能会改变，会出现眼睛的不适，包括眼睛干燥和隐形眼镜的大小不合适，这就需要进行相应的调整。

但是，由于生完孩子以后眼睛和角膜会恢复到孕前的状态，所以在孕期我们需要提供的是一个临时性的解决方案。

方案1  戴有框眼镜

即使你经常佩戴隐形眼镜，最好要准备至少一副有框眼镜，以备不时之需。怀孕以后，如果出现佩戴隐形眼镜不舒服的情况，最好把你的有框眼镜找出来，其实现在不少有框眼镜也很漂亮的，换个形象也挺好的。

美美的结婚照已经拍好了，已经怀孕了，脸也开始变大了，身材已经开始臃肿变形了，你就不要再穷要好看活受罪了吧。

如果你的视力和屈光度发生了改变，以前的有框眼镜戴起来不合适，就索性再去配一副，反正也花不了多少钱的。

方案2  配新的隐形眼镜

如果你原来的隐形眼镜戴起来不舒服，又实在不愿意戴有框眼镜，那就去找验光师重新帮你测量屈光度，再配一副适合孕期佩戴的隐形眼镜。

注意事项

1. 有些孕妇会出现眼睛干燥的症状，如果佩戴隐形眼镜时出现眼睛干燥，可以使用相应的眼药水。有些眼药水含有不适合在孕期使用的成份，在选用眼药水时，需要请教眼科医生和产科医生。

2. 隐形眼镜的定期清洗很重要，可以预防眼睛的炎症。

3. 怀孕以后视力的轻度改变往往是正常现象，但是如果出现一些明显的不适，就需要引起重视，因为这可能是子痫前期的表现。子痫前期的主要临床表现是血压升高，主要的病理生理变化是全身小动脉的痉挛性收缩，眼底小动脉的收缩会导致视网膜的水肿、出血和渗出。这会引起视力的改变，引起重影、视物模糊、光敏感、飞蚊症等。一旦出现这种症状，应该及时告知产科医生，进行进一步的检查。
 
本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1644
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 Abstract

Today’s children and adolescents are immersed in both traditional and new forms of digital media. Research on traditional media, such as television, has identified health concerns and negative outcomes that correlate with the duration and content of viewing. Over the past decade, the use of digital media, including interactive and social media, has grown, and research evidence suggests that these newer media offer both benefits and risks to the health of children and teenagers. Evidence-based benefits identified from the use of digital and social media include early learning, exposure to new ideas and knowledge, increased opportunities for social contact and support, and new opportunities to access health promotion messages and information. Risks of such media include negative health effects on sleep, attention, and learning; a higher incidence of obesity and depression; exposure to inaccurate, inappropriate, or unsafe content and contacts; and compromised privacy and confidentiality. This technical report reviews the literature regarding these opportunities and risks, framed around clinical questions, for children from birth to adulthood. To promote health and wellness in children and adolescents, it is important to maintain adequate physical activity, healthy nutrition, good sleep hygiene, and a nurturing social environment. A healthy Family Media Use Plan (www.healthychildren.org/MediaUsePlan) that is individualized for a specific child, teenager, or family can identify an appropriate balance between screen time/online time and other activities, set boundaries for accessing content, guide displays of personal information, encourage age-appropriate critical thinking and digital literacy, and support open family communication and implementation of consistent rules about media use.
 
Introduction

Today’s generation of children and adolescents are growing up immersed in media, including broadcast and social media. Broadcast media include television and movies. Interactive media include social media and video games in which users can both consume and create content. Interactive media allow information sharing and provide an engaging digital environment that becomes highly personalized.

Media Use Patterns

The most common broadcast medium continues to be TV. A recent study found that TV hours among school-aged children have decreased in the past decade for children younger than 8 years.1 However, among children aged 8 years and older, average daily TV time remains over 2 hours per day.2 TV viewing also has changed over the past decade, with content available via streaming or social media sites, such as YouTube and Netflix.

Overall media use among adolescents has continued to grow over the past decade, aided by the recent increase in mobile phone use among teenagers. Approximately three-quarters of teenagers today own a smartphone,3 which allows access to the Internet, streaming TV/videos, and interactive “apps.” Approximately one-quarter of teenagers describe themselves as “constantly connected” to the Internet.

Social media sites and mobile apps provide platforms for users to create an online identity, communicate with others, and build social networks. At present, 76% of teenagers use at least 1 social media site. Although Facebook remains the most popular social media site,3 teenagers do not typically commit to just 1 social media platform; more than 70% maintain a “social media portfolio” of several selected sites, including Facebook, Twitter, and Instagram.3 Mobile apps provide a breadth of functions, such as photo sharing, games, and video-chatting.

Video games remain very popular among families; 4 of 5 households own a device used to play video games.Boys are the most avid video game players, with 91% of boys reporting having access to a game console and 84% reporting playing video games online or on a cell phone.

Benefits of Media

Both traditional and social media can provide exposure to new ideas and information, raising awareness of current events and issues. Interactive media also can provide opportunities for the promotion of community participation and civic engagement. Students can collaborate with others on assignments and projects on many online media platforms. The use of social media helps families and friends who are separated geographically communicate across the miles.

Social media can enhance access to valuable support networks, which may be particularly helpful for patients with ongoing illnesses, conditions, or disabilities.In 1 study, young adults described the benefits of seeking health information online and through social media, and recognized these channels as useful supplementary sources of information to health care visits.6 Research also supports the use of social media to foster social inclusion among users who may feel excluded or who are seeking a welcoming community: for example, those identifying as lesbian, gay, bisexual, transgender, questioning, or intersex. Finally, social media may be used to enhance wellness and promote healthy behaviors, such as smoking cessation and balanced nutrition.

Risks of Media

A first area of health concern is media use and obesity, and most studies have focused on TV. One study found that the odds of being overweight were almost 5 times greater for adolescents who watch more than 5 hours of TV per day compared with those who watch 0 to 2 hours.9 This study’s findings contributed to recommendations by the American Academy of Pediatrics that children have 2 hours or less of sedentary screen time daily. More recent studies have provided new evidence that watching TV for more than 1.5 hours daily was a risk factor for obesity, but only for children 4 through 9 years of age.10 Increased caloric intake via snacking while watching TV has been shown to be a risk factor for obesity, as is exposure to advertising for high-calorie foods and snacks.Having a TV in the bedroom continues to be associated with the risk of obesity.

Evidence suggests that media use can negatively affect sleep.Studies show that those with higher social media use15 or who sleep with mobile devices in their roomswere at greater risk of sleep disturbances. Exposure to light (particularly blue light) and activity from screens before bed affects melatonin levels and can delay or disrupt sleep.Media use around or after bedtime can disrupt sleep and negatively affect school performance.

Children who overuse online media are at risk of problematic Internet use, and heavy users of video games are at risk of Internet gaming disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,lists both as conditions in need of further research. Symptoms can include a preoccupation with the activity, decreased interest in offline or “real life” relationships, unsuccessful attempts to decrease use, and withdrawal symptoms. The prevalence of problematic Internet use among children and adolescents is between 4% and 8%,21,22 and up to 8.5% of US youth 8 to 18 years of age meet criteria for Internet gaming disorder.

At home, many children and teenagers use entertainment media at the same time that they are engaged in other tasks, such as homework.A growing body of evidence suggests that the use of media while engaged in academic tasks has negative consequences on learning.

Media Influence

Evidence gathered over decades supports links between media exposure and health behaviors among teenagers.The exposure of adolescents through media to alcohol,28,29 tobacco use,30,31 or sexual behaviors is associated with earlier initiation of these behaviors.

Adolescents’ displays on social media frequently include portrayal of health risk behaviors, such as substance use, sexual behaviors, self-injury, or disordered eating.Peer viewers of such content may see these behaviors as normative and desirable.Research from both the United States and the United Kingdom indicates that the major alcohol brands maintain a strong presence on Facebook, Twitter, and YouTube.

Cyberbullying, Sexting, and Online Solicitation

Cyberbullying and traditional bullying overlap, although online bullying presents unique challenges. These challenges include that perpetrators can be anonymous and bully at any time of day, that information can spread online rapidly, and that perpetrator and target roles can be quite fluid in the online world. Cyberbullying can lead to short- and long-term negative social, academic, and health consequences for both the perpetrator and the target. Fortunately, newer studies suggest that interventions that target bullying may reduce cyberbullying.

“Sexting” is commonly defined as the electronic transmission of nude or seminude images as well as sexually explicit text messages. It is estimated that ∼12% of youth aged 10 to 19 years have ever sent a sexual photo to someone else. The Internet also has created opportunities for the exploitation of children by sex offenders through social networking, chat rooms, e-mail, and online games.

Social Media and Mental Health

Research studies have identified both benefits and concerns regarding mental health and social media use. Benefits from the use of social media in moderation include the opportunity for enhanced social support and connection. Research has suggested a U-shaped relationship between Internet use and depression, with increased risks of depression at both the high and low ends of Internet use. One study found that older adolescents who used social media passively (eg, viewing others’ photos) reported declines in life satisfaction, whereas those who interacted with others and posted content did not experience these declines.Thus, in addition to the number of hours an individual spends on social media, a key factor is how social media is used.

Social Media and Privacy

Content that an adolescent chooses to post is shared with others, and the removal of such content once posted may be difficult or impossible. Adolescents vary in their understanding of privacy practices; even those who know how to set privacy settings often don’t believe they will work.Despite efforts by some social media sites to protect privacy or to delete content after it is viewed, privacy violations and unwelcome distribution are always risks.

Parent Media Use and Child Health

Social media can provide positive social experiences, such as opportunities for parents to connect with children via video-chat services. Unfortunately, some parents can be distracted by media and miss important opportunities for emotional connections that are known to improve child health.53,54 One research study found that when a parent turned his or her attention to a mobile device while with a young child, the parent was less likely to talk with the child.Parental engagement is critical in the development of children’s emotional and social development, and these distractions may have short- and long-term negative effects.

Conclusions

The effects of media use are multifactorial and depend on the type of media, the type of use, the amount and extent of use, and the characteristics of the individual child. Children today are growing up in an era of highly personalized media use experiences, so parents must develop personalized media use plans for their children that attend to each child’s age, health, temperament, and developmental stage. Research evidence shows that children and teenagers need adequate sleep, physical activity, and time away from media. Pediatricians can help families develop a Family Media Use Plan (www.HealthyChildren.org/MediaUsePlan) that prioritizes these and other health goals.

Recommendations

Pediatricians

Work with families and schools to promote understanding of the benefits and risks of media.

Promote adherence to guidelines for adequate physical activity and sleep via a Family Media Use Plan (www.HealthyChildren.org/MediaUsePlan).

Advocate for and promote information and training in media literacy.

Be aware of tools to screen for sexting, cyberbullying, problematic Internet use, and Internet gaming disorder.

Families

Develop, consistently follow, and routinely revisit a Family Media Use plan (see the plan from the American Academy of Pediatrics at www.HealthyChildren.org/MediaUsePlan).

Address what type of and how much media are used and what media behaviors are appropriate for each child or teenager, and for parents. Place consistent limits on hours per day of media use as well as types of media used.

Promote that children and adolescents get the recommended amount of daily physical activity (1 hour) and adequate sleep (8–12 hours, depending on age).

Recommend that children not sleep with devices in their bedrooms, including TVs, computers, and smartphones. Avoid exposure to devices or screens for 1 hour before bedtime.

Discourage entertainment media while doing homework.

Designate media-free times together (eg, family dinner) and media-free locations (eg, bedrooms) in homes. Promote activities that are likely to facilitate development and health, including positive parenting activities, such as reading, teaching, talking, and playing together.

Communicate guidelines to other caregivers, such as babysitters or grandparents, so that media rules are followed consistently.

Engage in selecting and co-viewing media with your child, through which your child can use media to learn and be creative, and share these experiences with your family and your community.

Have ongoing communication with children about online citizenship and safety, including treating others with respect online and offline, avoiding cyberbullying and sexting, being wary of online solicitation, and avoiding communications that can compromise personal privacy and safety.

Actively develop a network of trusted adults (eg, aunts, uncles, coaches, etc) who can engage with children through social media and to whom children can turn when they encounter challenges.

Researchers, Governmental Organizations, and Industry

Continue research into the risks and benefits of media.

Prioritize longitudinal and robust study designs, including new methodologies for understanding media exposure and use.

Prioritize interventions including reducing harmful media use and preventing and addressing harmful media experiences.

Inform educators and legislators about research findings so they can develop updated guidelines for safe and productive media use.
 
中文翻译：
本文地址：http://www.wjbb.com/know/1643
原文出处：http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2592 收起阅读 »

 Abstract

Infants, toddlers, and preschoolers are now growing up in environments saturated with a variety of traditional and new technologies, which they are adopting at increasing rates. Although there has been much hope for the educational potential of interactive media for young children, accompanied by fears about their overuse during this crucial period of rapid brain development, research in this area still remains limited. This policy statement reviews the existing literature on television, videos, and mobile/interactive technologies; their potential for educational benefit; and related health concerns for young children (0 to 5 years of age). The statement also highlights areas in which pediatric providers can offer specific guidance to families in managing their young children’s media use, not only in terms of content or time limits, but also emphasizing the importance of parent–child shared media use and allowing the child time to take part in other developmentally healthy activities.
 
Introduction

Technologic innovation has transformed media and its role in the lives of infants and young children. More children, even in economically challenged households, are using newer digital technologies, such as interactive and mobile media, on a daily basis1 and continue to be the target of intense marketing. This policy statement addresses the influence of media on the health and development of children from 0 to 5 years of age, a time of critical brain development, building secure relationships, and establishing health behaviors.

Infants and Toddlers

Children younger than 2 years need hands-on exploration and social interaction with trusted caregivers to develop their cognitive, language, motor, and social-emotional skills. Because of their immature symbolic, memory, and attentional skills, infants and toddlers cannot learn from traditional digital media as they do from interactions with caregivers,and they have difficulty transferring that knowledge to their 3-dimensional experience.The chief factor that facilitates toddlers’ learning from commercial media (starting around 15 months of age) is parents watching with them and reteaching the content.

The interactivity of touchscreens enables applications (apps) to identify when a child responds accurately and then tailor its responses, thereby supporting children at their levels of competence. Emerging evidence shows that at 24 months of age, children can learn words from live video-chatting with a responsive adult or from an interactive touchscreen interface that scaffolds the child to choose the relevant answers. Starting at 15 months of age, toddlers can learn novel words from touchscreens in laboratory-based studies but have trouble transferring this knowledge to the 3-dimensional world. However, it should be noted that these experiments used specially designed apps that are not commercially available.

Many parents now use video-chat (eg, Skype, FaceTime) as an interactive media form that facilitates social connection with distant relatives. New evidence shows that infants and toddlers regularly engage in video-chatting, but the same principles regarding need for parental support would apply in order for infants and toddlers to understand what they are seeing.

In summary, for children younger than 2 years, evidence for benefits of media is still limited, adult interaction with the child during media use is crucial, and there continues to be evidence of harm from excessive digital media use, as described later in this statement.

Preschool Media and Learning

Well-designed television programs, such as Sesame Street, can improve cognitive, literacy, and social outcomes for children 3 to 5 years of age and continue to create programming that addresses evolving child health and developmental needs (eg, obesity prevention, resilience). Evaluations of apps from Sesame Workshop and the Public Broadcasting Service (PBS) also have shown efficacy in teaching literacy skills to preschoolers.Unfortunately, most apps parents find under the “educational” category in app stores have no such evidence of efficacy, target only rote academic skills, are not based on established curricula, and use little or no input from developmental specialists or educators. Most apps also generally are not designed for a dual audience (ie, both parent and child). It is important to emphasize to parents that the higher-order thinking skills and executive functions essential for school success, such as task persistence, impulse control, emotion regulation, and creative, flexible thinking, are best taught through unstructured and social (not digital) play,as well as responsive parent–child interactions.

Digital books (also called “eBooks,” books that can be read on a screen) often come with interactive enhancements that, research suggests, may decrease child comprehension of content or parent dialogic reading interactions when visual effects are distracting.Parents should, therefore, be instructed to interact with children during eBook reading, as they would a print book.

Health and Developmental Concerns

Obesity

Heavy media use during preschool years is associated with small but significant increases in BMI,18 may explain disparities in obesity risk in minority children,19 and sets the stage for weight gain later in childhood.Although many studies have used a 2-hour cutoff to examine obesity risk, a recent study of 2-year-olds found that BMI increased for every hour per week of media consumed.It is believed that exposure to food advertising and watching television while eating (which diminishes attention to satiety cues) drives these associations.

Sleep

Increased duration of media exposure and the presence of a television, computer, or mobile device in the bedroom in early childhood have been associated with fewer minutes of sleep per night.

Even infants exposed to screen media in the evening hours show significantly shorter night-time sleep duration than those with no evening screen exposure. Mechanisms underlying this association include arousing content and suppression of endogenous melatonin by blue light emitted from screens.

Child Development

Population-based studies continue to show associations between excessive television viewing in early childhood and cognitive,language,and social/emotional delays, likely secondary to decreases in parent–child interaction when the television is on37 and poorer family functioning in households with high media use. An earlier age of media use onset, greater cumulative hours of media use, and non-PBS content all are significant independent predictors of poor executive functioning in preschoolers.Content is crucial: experimental evidence shows that switching from violent content to educational/prosocial content results in significant improvement in behavioral symptoms, particularly for low-income boys.Notably, the quality of parenting can modify associations between media use and child development: one study found that inappropriate content and inconsistent parenting had cumulative negative effects on low-income preschoolers’ executive function, whereas warm parenting and educational content interacted to produce additive benefits.

Child characteristics also may influence how much media children consume: excessive television viewing is more likely in infants and toddlers with a difficult temperamentor self-regulation problems, and toddlers with social-emotional delays are more likely to be given a mobile device to calm them down.

Parental Media Use

Parents’ background television use distracts from parent–child interactions and child play.Heavy parent use of mobile devices is associated with fewer verbal and nonverbal interactions between parents and children and may be associated with more parent-child conflict. Because parent media use is a strong predictor of child media habits,reducing parental media use and enhancing parent–child interactions may be an important area of behavior change.

Conclusions: Clinical Implications

In summary, multiple developmental and health concerns continue to exist for young children using all forms of digital media to excess. Evidence is sufficient to recommend time limitations on digital media use for children 2 to 5 years to no more than 1 hour per day to allow children ample time to engage in other activities important to their health and development and to establish media viewing habits associated with lower risk of obesity later in life.In addition, encouraging parents to change to educational and prosocial content and engage with their children around technology will allow children to reap the most benefit from what they view.

As digital technologies become more ubiquitous, pediatric providers must guide parents not only on the duration and content of media their child uses, but also on (1) creating unplugged spaces and times in their homes, because devices can now be taken anywhere; (2) the ability of new technologies to be used in social and creative ways; and (3) the importance of not displacing sleep, exercise, play, reading aloud, and social interactions. Realistically, pediatric providers will need to know how to help parents find resources finding appropriate content, tools for monitoring or limiting child use, ideas for play or activities in which to engage rather than digital play, and how parents can limit their own media use (see HealthyChildren.org for examples); each of these can be built into the Family Media Use Plan (see the American Academy of Pediatrics guide to developing a plan at www.healthychildren.org/MediaUsePlan).

Recommendations

Pediatricians

Start the conversation early. Ask parents of infants and young children about family media use, their children’s use habits, and media use locations.

Help families develop a Family Media Use Plan (www.healthychildren.org/MediaUsePlan) with specific guidelines for each child and parent.

Educate parents about brain development in the early years and the importance of hands-on, unstructured, and social play to build language, cognitive, and social-emotional skills.

For children younger than 18 months, discourage use of screen media other than video-chatting.

For parents of children 18 to 24 months of age who want to introduce digital media, advise that they choose high-quality programming/apps and use them together with children, because this is how toddlers learn best. Letting children use media by themselves should be avoided.

Guide parents to resources for finding quality products (eg, Common Sense Media, PBS Kids, Sesame Workshop).

In children older than 2 years, limit media to 1 hour or less per day of high-quality programming. Recommend shared use between parent and child to promote enhanced learning, greater interaction, and limit setting.

Recommend no screens during meals and for 1 hour before bedtime.

Problem-solve with parents facing challenges, such as setting limits, finding alternate activities, and calming children.

Families

Avoid digital media use (except video-chatting) in children younger than 18 to 24 months.

For children ages 18 to 24 months of age, if you want to introduce digital media, choose high-quality programming and use media together with your child. Avoid solo media use in this age group.

Do not feel pressured to introduce technology early; interfaces are so intuitive that children will figure them out quickly once they start using them at home or in school.

For children 2 to 5 years of age, limit screen use to 1 hour per day of high-quality programming, coview with your children, help children understand what they are seeing, and help them apply what they learn to the world around them.

Avoid fast-paced programs (young children do not understand them as well), apps with lots of distracting content, and any violent content.

Turn off televisions and other devices when not in use.

Avoid using media as the only way to calm your child. Although there are intermittent times (eg, medical procedures, airplane flights) when media is useful as a soothing strategy, there is concern that using media as strategy to calm could lead to problems with limit setting or the inability of children to develop their own emotion regulation. Ask your pediatrician for help if needed.

Monitor children’s media content and what apps are used or downloaded. Test apps before the child uses them, play together, and ask the child what he or she thinks about the app.

Keep bedrooms, mealtimes, and parent–child playtimes screen free for children and parents. Parents can set a “do not disturb” option on their phones during these times.

No screens 1 hour before bedtime, and remove devices from bedrooms before bed.

Consult the American Academy of Pediatrics Family Media Use Plan, available at: www.healthychildren.org/MediaUsePlan.

Industry

Work with developmental psychologists and educators to create design interfaces that are appropriate to child developmental abilities, that are not distracting, and that promote shared parent–child media use and application of skills to the real world. Cease making apps for children younger than 18 months until evidence of benefit is demonstrated.

Formally and scientifically evaluate products before making educational claims.

Make high-quality products accessible and affordable to low-income families and in multiple languages.

Eliminate advertising and unhealthy messages on apps. Children at this age cannot differentiate between advertisements and factual information, and therefore, advertising to them is unethical.

Help parents to set limits by stopping auto-advance of videos as the default setting. Develop systems embedded in devices that can help parents monitor and limit media use.
 
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原文出处：http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2591 收起阅读 »

不是，胃肠型流感不是流感。很多人使用“胃肠型流感”一词来描述恶心、呕吐或腹泻的疾病。 这些症状可以由许多不同的病毒、细菌或甚至寄生虫引起。 虽然呕吐、腹泻、恶心或“反胃”有时与流感相关 - 更常见的是儿童而不是成人 - 这些健康问题很少是流感的主要症状。 流感是一种呼吸系统疾病，而不是胃或肠道疾病。

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No. There is no recommendation for pregnant women or people with pre-existing medical conditions to seek special permission or secure written consent from their doctor for vaccination if they get vaccinated at a worksite clinic, pharmacy or other location outside of their physician's office. With rare exception, CDC recommends an annual flu vaccine for everyone 6 months and older, including pregnant women and people with medical conditions.

A variety of influenza vaccine products are available (Table 1). Vaccine providers should be aware of the approved age indications of the vaccine they are using and of any contraindications or precautions. Providers also should appropriately screen all people getting vaccinated for allergies to vaccine components or other contraindications. People who have previously had a severe allergic reaction to influenza vaccine or any of its ingredients should generally not be vaccinated.

There are some people who should not get a flu vaccine without first speaking with their doctor.

These include:

People who have a moderate-to-severe illness with or without a fever (they should wait until they recover to get vaccinated), and
People with a history of Guillain-Barré Syndrome (a severe paralytic illness, also called GBS) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Tell your doctor if you ever had Guillain-Barré Syndrome. Your doctor will help you decide whether the vaccine is recommended for you.
Pregnant women or people with pre-existing medical conditions who get vaccinated should get the flu shot.

If a person is vaccinated by someone other than their primary health care provider, the vaccinating provider should ensure that the patient and, if possible, the patient's medical provider have documentation of vaccination.

For a complete list of people who should not get the vaccine before speaking with their doctor, please review the influenza Vaccine Information Statement for the flu shot. ‘ 
 
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