谈到营养，可以说是仁者见仁智者见智，许多人都有自己的一套“营养经”。有人说，鸡鸭鱼肉有营养，因为其中的蛋白质丰富、容易被吸收利用；有人说，素食好，可以排毒养颜、防病强身；又有人说，山珍海味、燕窝鱼翅有营养；有人说牛奶有营养，豆制品有营养；还有人说，粗茶淡饭、豆腐白菜最有营养……。于是，有关饮食营养健康的“奇招妙计”不断流行，今天是“茄子、绿豆热”，明天是“泥鳅、地瓜潮”，…….。折腾来、折腾去，忽然发现，钱没少花，健康没有什么改善。

营养确实重要，从生命的孕育、出生，到生长发育，…..，防病、抗病，健康的维护，都离不开充足、全面、均衡的营养。说营养是生命和健康的物质基础一点都不夸张。

说营养很重要，那么营养从哪里来？营养就来自各种各样的食物。我们吃下去各种各样的食物，从食物中获得身体所需要的营养。因此，营养其实就是“吃”的学问。“会吃”，就能吃出营养、吃出健康；“不会吃”，就会吃出疾病。

“吃”是门实践的学问，看似简单，真正会“吃”，还是需要花点功夫学习。首先，需要学习一些基础的营养知识，包括食物的分类、每类食物的营养特点，还应该了解合理营养的原则。然后，根据这些知识和家庭的具体情况合理选择、购买食物，通过对食物科学的搭配和烹调，才能从食物中获得充足、均衡的各种营养物质。因此，营养的关键在于把营养知识应用到一日三餐的合理膳食和营养搭配中。

首先，要重视早餐，每天吃早餐，吃好早餐。

不吃早餐会影响学习、工作效率。早餐中要有谷类食物、动物性食物、奶类或奶制品，还要有蔬菜水果。早餐可以“晚”做。为了节省时间，在头一天的晚上就把第二天早上要吃的食物准备好。例如，把水果洗好、切好，用保鲜膜包好放在冰箱。要注意：在为孩子准备早餐的同时，家长也应该和孩子一起享用早餐，来营造一种健康生活方式的家庭氛围。

如果午餐能回家吃，那是太幸福不过啦。对于在城市中生活的上班族来说，午餐基本上是凑合。单位有食堂的大家都反映不好吃、油水少，其实，午餐饭菜中的油水少有利于控制体重啊。吃盒饭吧，盒饭中蔬菜的量很少，主食和肉类相对来说较多，能量往往超过我们的需要。不知从什么时间开始的，大家都不从家里带便当了。其实，从家里带饭的做法很好，方便、合口，能量不过量，营养较全面。

晚餐要尽量在家里吃。晚餐的食物种类应该以谷类食物为主，最好有粥，小米、大米、杂粮粥都可以。动物性食物适量，以鱼，牛羊肉为主。鱼以海鱼为首选，深海鱼最好，如三文鱼、平鱼。最好用清蒸、清炖、红烧的方法，少用油炸。肉以牛、羊肉为首选，同样重量的牛羊肉中所含的脂肪比猪肉少。牛肉可以红烧、咖喱等。羊肉可以清炖，可以放些萝卜；豆制品每周1-2次。蔬菜应该每顿都有。要选深颜色的蔬菜，用急火快炒，或上汤的方法烹调。餐后，可以来点坚果，杏仁、葵花籽、榛子、小胡桃、核桃等都可以，少量为宜。水果每天都要吃的，品种不限。

讲“营养”不是件难事。关键就在于持之以恒，一日三餐的实践。

本文作者：马冠生
本文地址：http://www.wjbb.com/know/1349
原文出处：http://weibo.com/p/2304185d5947690102x77i 收起阅读 »

38周还没入盆咋办？

科普多了也会有副作用，入盆本来是个很专业的名词，但是现在被科普得很多孕妇在进入36周以后的每次产检时最关心的一个问题就是胎儿有没有入盆？是否需要爬楼梯来促进胎头入盆？

所谓的“入盆”指的是在妊娠晚期，胎儿头部通过母体的骨盆入口进入骨盆腔，胎位相对固定，胎儿活动度减少，入盆是分娩的前奏。

一般情况下，胎儿入盆以后准妈妈会感觉到胎儿的位置在下降，胎动会比以前相对减少，由于胎头入盆后会压迫到膀胱，一般情况下会导致尿频的症状更加明显。

一般情况下，初产妇入盆后2周左右就可能分娩，经产妇则往往是在临产前后入盆。

但是，并不是所有的初产妇都会在38周入盆，入盆不是临产的必要条件，大家没有必要过度关注是否入盆。对于没有入盆的初产妇准妈妈来说，只要临产有了宫缩，胎儿头部会很快入盆的。

鼓励准妈妈在整个孕期和分娩前保持一定的运动量，目的是让分娩过程更顺利，而不是促进胎头入盆。

茉莉花苞茶可以软化宫颈吗？

在怀孕生孩子方面，网上有很多传播很广的谣言，其中喝茉莉花苞茶可以软化宫颈，使孩子生起来很顺利的说法就是其中之一。随着谣言借助互联网上妈妈社区的广泛传播，茉莉花苞茶已经成为网店上或微店上的热销产品。

“喝茉莉花苞茶可以软化宫颈”的说法始于何处，始于何时不太清楚，其来源肯定是中医的说法。但是你去搜索中外文献，肯定是没有大样本、多中心的随机对照的研究来支持这一说法。有的只是妈妈们的个人经验分享，有些经验分享后面可能就会跟着售卖茉莉花苞茶的网页链接。

在产科临床实践中，促进宫颈软化成熟是一件大事情，即使是在临床上普遍使用的机械方法和处方药也无法很有效地达到我们的要求，更不要去说喝茉莉花苞茶了。

医生一般是不会去推荐喝茉莉花苞茶去软化宫颈的，除非你有大样本、多中心、随机对照的研究来证明它的有效性。

宝宝生下来多久可以乘飞机？

在我门诊就诊的准妈妈中会有一部份人到美国或其他国家去分娩，这些准妈妈经常会问孩子生好以后多久可以乘飞机回国。

关于新生婴儿多大可以乘飞机，其实在儿科界并没有确切的说法。有些儿科医生会说如果新生儿健康，一切正常，在出生2-3天以后就可以乘飞机了，但是航空公司一般不会让你这么早就乘飞机。

美国航空公司一般的规定是：

新生儿一般要出生7天以后才可以乘飞机，有些航空公司允许再早一些的新生儿乘飞机（需要医生的书面证明），有些航空公司则规定新生儿要满14天才可以乘飞机。由于每家航空公司的政策会有不同，因此最好在购票之前和航空公司联系了解相关的政策。

通常情况下，一个成人可以免费带一个婴儿乘飞机（双胎的话要两个大人购票才可以两个孩子都免费），但是为了舒适和安全，专家会推荐给孩子买婴儿票，并配合符合相关法规的，可以适合飞行的婴儿座椅。

在飞行之前，除了和航空公司联系确认细节以外，最好能事先准备好宝宝的出生证明，准备好新生宝宝的旅行包，包括配方奶粉（或事先挤出并保存的母乳），尿片，湿纸巾，宝宝衣物，宝宝毛毯等。

在飞机起飞和下降过程中，会有压力改变导致的不适，特别是耳压改变引起的不适。这时可以给宝宝哺乳，用奶瓶给宝宝吸吮或给宝宝安慰奶嘴，来减轻这种耳部的不适。
 
本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1348
原文出处：http://mp.weixin.qq.com/s?__biz=MzA4MjUxNTkwNg==&mid=400809488&idx=1&sn=67cbac58ce651e6bbd641312485cd720&scene=0#wechat_redirect 收起阅读 »

最近到冬天了，很多女性都会抱怨穿太多会显得身形臃肿、腿太粗。减体重、塑体型被称为女人的终生事业。经常有女星爆肥的照片被曝光，甚至还有网络段子“五月不减肥，六月张惠妹”。明星是活在镁光灯下，被民众拿着放大镜去审视的。但年轻女性因为服用减肥药而猝死、生病的新闻也屡屡被曝出。

很多女性选择节食减肥，但有些人为了追求快捷不惜选择服用减肥药来达到目的。这种方法不十分可取。保持健康体重不能依靠药物，应该从膳食和运动两个方面做起，才能达到既能保持健康体重，又不对健康带来负面影响的目的。

一个人的体重是否属于健康范围，可以用体重指数（BMI）来评价。体重指数的计算是这样的：一个人的体重（千克）除以身高（米）的平方。例如，你的体重为60千克（公斤），身高为1.67米，那么你的体重指数为60÷（1.67×1.67）=21.5千克/米2。

我国成年人健康体重的范围为18.5-23.9千克/米2，大于等于24千克/米2为超重，24~27.9千克/米2为偏胖，大于等于28千克/米2为肥胖。小于等于18.5 千克/米2为偏瘦。

体重过低或过高都是不健康的表现，都会缩短寿命。体重过低说明身体的营养不良，可以影响未成年人身体和智力的正常发育；成年人体重过低可出现劳动能力下降、骨量丢失和骨折、胃肠功能紊乱、免疫力低下、女性月经不调和闭经、贫血和抑郁症等。体重在健康范围内者患各种疾病的危险性小于消瘦者或超重和肥胖者。体重超重可以明显增加心脑血管病、肿瘤和糖尿病的发病的危险性，肥胖的人还易患骨关节病、脂肪肝、胆石症、痛风、阻塞性睡眠呼吸暂停综合征、内分泌紊乱等多种疾病。

一个人的体重取决于能量摄入和能量消耗之间的平衡。食物为我们提供所需要的能量，人的基本生命活动和各种身体活动消耗能量。所以，进食量和身体活动量是维持能量平衡的两个决定性因素。当进食量大于身体活动量时（也就是吃的太多，而活动太少），多余的能量就会在体内以脂肪的形式积存下来，增加体重，久而久之就会使人发胖；如果进食量少于身体活动量时（就是吃的偏少，活动量偏大），能量不足可以引起体重降低，时间长了就会造成体重过低或消瘦。所以，为了保持健康的体重，提倡食不过量，天天运动。白岩松分享的经验：如果你在吃下一餐饭时感到饿了，说明你上一餐吃的正合适。如果不饿，说明你上一餐吃多啦。

健康的饮食行为和运动习惯是控制体重或减肥的必需措施。对于肥胖的人，饮食调整的原则是在控制总能量摄入的基础上平衡膳食。严格控制油脂和精制糖，适量控制精白米面和肉类，保证蔬菜水果和牛奶的摄入。运动可以帮助保持瘦体重、减少身体脂肪，建议超重或肥胖的人每天累计达到8千到1万步活动量。靠减肥药控制体重，体重可能暂时控制了，健康永久被损坏了。
 
本文作者：马冠生
本文地址：http://www.wjbb.com/know/1347
原文出处：http://weibo.com/p/2304185d5947690102x6qu 收起阅读 »

感恩节（英语：Thanksgiving Day）是美国和加拿大共有的节日，原意是为了感谢上天赐予的好收成。

加拿大的感恩节则起始于1879年，是在每年10月第二个星期一。美国自1941年起，感恩节是在每年11月的第四个星期四，像中国的春节一样，在这一天，成千上万的人们不管多忙，都要和自己的家人团聚，而火鸡则是感恩节的传统主菜。

火鸡是美洲特产，体型比家鸡大3～4倍，长800～1100毫米。与肉鸡相比，火鸡肉的口感要略粗一些，但在营养成分上有“一高二低”的特点。

一高，是蛋白质含量高，并含有丰富的铁、锌等矿物质和维生素；

二低，是脂肪和胆固醇含量低，100克不带皮的火鸡胸肉含有28克蛋白质，0.2克的饱和脂肪和115千卡能量；而相同重量的猪肉含有5.5克饱和脂肪和225千卡能量。

目前我国居民肉类摄入仍然以猪肉为主，由于猪肉的脂肪含量较高，饱和脂肪酸较多，不利于心脑血管病、超重、肥胖等疾病的预防，因此应调整肉食结构，适当多吃鱼、禽肉，减少猪肉摄入。

火鸡料理多种多样，烧烤、煮汤都适合，只要再加点创意，烤火鸡还能变化新花样。火鸡的传统做法是在肚里塞满西芹、胡萝卜、洋葱等，皮上涂上酱料放入烤箱，烤的时间要在2小时以上。火鸡性味温和，为食草性禽类，所以常年都适合食用。

多项研究表明，失眠者体内色氨酸水平偏低，而火鸡及鸡肉中富含色氨酸，每天吃85克火鸡肉就可以满足色氨酸日需求量。虽然火鸡营养价值高，“膳食平衡宝塔”中明确指出，一个人每天摄入瘦肉75克，即一个拳头大小，而蔬菜，每天最好摄入500克左右。所以火鸡美味，也不要吃太多哟！
 
本文作者：马冠生
本文地址：http://www.wjbb.com/know/1346
原文出处：http://weibo.com/p/2304185d5947690102x6lh 收起阅读 »

对于中国的安珀警报，仅仅是志愿者是不够的。代表国家力量的关键岗位上的关键人员更为重要，比如，地铁安检员、火车站安检员、列车员、长途汽车司机、高速公路收费员、警察、旅馆、酒店的工作人员。这些关键位置上的人更为高效。

昨天朋友圈中刷屏的是这样一条消息：中国的安珀警报终于上线了。 

安珀（AMBER）警报，America's Missing： Broadcasting Emergency Response，即“美国失踪人口：广播紧急回应”的缩写，同时，也是1996年在美国德州阿灵顿被绑架杀害的九岁女童安珀·海格曼Amber Hagerman的名字。

在安珀·海格曼遭到绑架、强暴并杀害后，附近的社区民众得知当地法律机关拥有某些讯息，可能帮助在安珀被绑架后的短时间内得知她的所在位置，但相关单位却无意发布这些资讯。于是，上个世纪90年代，美国民间力量推动的安珀警报系统实施，通过广播、电视台、电子邮件、高速公路电子告示牌等发布警报。随着智能手机的普及，现在也通过手机短信发送，警报内容通常包含被绑架者的描述、绑架嫌犯的描述，以及绑匪车辆的描述和车牌号码等。

孩子失踪，越早介入，就越容易找回，所以预警的意义在于在最短时间、最小范围内启动最大搜寻力。在安珀系统的帮助下，美国失踪儿童寻回比例高达97.7%。此外，英国、加拿大、墨西哥、爱尔兰、马来西亚等国家也相继建立类似的快速寻找走失儿童的社会机制。在欧盟甚至建立了跨国界的儿童失踪应急响应系统。印度也已于2000年，由民间机构发动32万捐款人建立了类似系统。

中国的传统有着对男孩，对传宗接代的强烈偏好，这使得中国儿童拐卖是一个长久存在，甚至是基于文化传统的社会问题，拐卖儿童数量极大，家长对人贩子的痛恨极深，这一点从前不久“人贩子一律死刑”在朋友圈刷屏可以见一斑。所以，中国比国外更需要这个系统。

相对于安珀系统，中社儿童安全科技基金等共同发布的中国儿童失踪预警平台（CCSER），在智能手机与移动互联网的帮助下，不但有图片等多媒体资料，还可以在儿童失踪后，基于LBS定位技术，逐次按时间扩大发布范围，说人贩子陷入了人民战争的汪洋大海也不为过。

在中国这样一个国家，当地方宣传部门还在歌颂一个被拐卖妇女的自我放弃与牺牲的时候，民间机构来做这样一件事情，可以说是预料之外，情理之中，足以令相关部门汗颜。但是，必须指出的是，目前这个系统还不够好。有人质疑这个机构的公信力与对隐私的保护。从目前的情况看，现在的情况的确还有提高的空间。

CCSER的运营方，是NGO组织“中社儿童安全科技基金”。该基金成立时间不久，仅仅半年，资金实力不强，其负责人背景不够清晰，资历不足。而且，“中国儿童失踪预警平台”收集的用户隐私资料也有过多的嫌疑——除了孩子的特征，也包括家长姓名、身份证号、电话、手机号、家庭住址等等。

更何况，防止拐骗儿童，的确需要国家的强制力介入才能把事情做得更好。美国Scripps 公司观察了在2004年期间于美国发布的233件安珀警戒，发现大部分的警戒并未达到司法部的发布标准。其中117件是“家庭绑架”，通常是父母争夺监护权所致；有48起仅是儿童离家出走，或牵扯到家庭误会。比如，儿童在祖父母家。此外，还有恶作剧，目击者误会等情况，仅有70件是儿童被陌生人带走的违法行动。

为了避免屡发错误警报而让这个系统被人忽略，美国司法部发行了相关指引：司法机构必须确认绑架实际发生；儿童必须有受到重伤或死亡的危险；必须要有被绑架儿童、绑架嫌犯、或绑架嫌犯的车辆详细描述资料来发布警报；被绑架者必须是17岁以下（包含17岁）的儿童。

可以想象的是，中国的CCSER上线之后，如果仅仅靠民间组织的力量，将会很快淹没在“小孩去邻居家玩了”，“在超市走丢了又找到了”，“夫妻离婚争夺孩子”等等无效的警报之中。“烽火戏诸候”的事情不断发生之后，志愿者必然会厌烦并抛弃这个系统。

实际上，CCSER平台负责人就表示，如果注册用户发布的信息不符合系统规则，比如虚假消息，除了后台将此ID列入黑名单，排除出互助平台之外，没有任何办法。但如果有立法支持和公安机关的更多支持，对违法行为可以查处，负面影响会小很多。对于恶意发布警报的人，就可以进行强制性处罚，也可以调用公安部门户口登记，来核实孩子的真实情况。

除了预防假警报，国家的介入还可以使这个系统变得更高效。因为，对于中国的安珀警报，仅仅是志愿者是不够的。代表国家力量的关键岗位上的关键人员更为重要，比如，地铁安检员、火车站安检员、列车员、长途汽车司机、高速公路收费员、警察、旅馆、酒店的工作人员。这些关键位置上的人更为高效。

技术改变生活，中国版安珀警报如果应用得好，完全可能改变中国打拐的局面。但是，技术终究需要依靠人，没有人的能动性，再好的技术也会成为摆设。
 
本文作者：刘远举
本文地址：http://www.wjbb.com/know/1345
原文出处：http://news.ifeng.com/a/20151123/46355877_0.shtml 收起阅读 »

最近中国儿童失踪预警平台（China's Child Safety Emergency Response, CCSER）成了热门话题，儿童的健康成长关系着家庭的幸福、国家的未来，社会的和谐，然而儿童失踪一直是一个无法回避的社会问题（新浪的微博打拐和各大网站的404寻人页面都是利用社会力量寻找失踪儿童的案例），因此该平台的发布引起了网络上的广泛关注。
 
这个平台是基于微信平台的，所以很多人都在转发，可见大众还是很需要，但是叫好声中也有质疑。中国儿童失踪预警平台官方网站（ccser.org），2015年5月25日启动，11月21日上线，基于一个微信公共号。
 
某育儿网站的微信公共号就连续推送了四篇质疑CCSER的文章，称这个平台存在诸多疑问并提醒公众不要关注。的确，公益项目就应该坦荡荡地接受质疑，但这家育儿网站也是善于把握热门话题，顺势增加知名度的主，现在的营销也不容易。
 
CCSER负责人在接受羊城晚报的采访时谈到：

成型后的平台，采用的服务器和中国移动、中国联通、中国电信三大运营商一样；也和光大银行、民生银行等银行系统以及腾讯、京东、阿里巴巴等互联网巨头使用的是同一家服务器，且安全级别相同，此外对用户数据采用的是分别加密处理。

这里不仅就乐了，这看起来高大上牛逼的一塌糊涂。实际上我家宝宝（wjbb.com）租用阿里云的服务器，用这段描述也完全正确。还可以说用的是和淘宝/天猫同级房同线路，o(^▽^)o。
 
有一种务实叫实事求是。
 
安全第一，预防为主，这句标语耳熟能详。China's Child Safety Emergency Response确切来说应该翻译为“中国儿童失踪紧急响应平台”，是事发后急救，是个紧急预案，和预警完全没有关系，最多算是三级预防，就是急诊的角色。预警就个体而言，还需家长增强相关技能与知识，并有意识地灌输给儿童。不久前新闻上报道放学接孩子使用口令就是很好的例子（生人接孩子，必须说出密码）。
 
本文作者：wjbb.com 管理员
本文地址：http://www.wjbb.com/know/1344 收起阅读 »

如今各种外卖网站、APP在上班族中极为流行，坐在办公桌前一点，不用出办公室就能享用到“美食”，极大地方便了广大上班族。然而地沟油、过期食材、卫生条件不达标等问题频频被曝光，让外卖族们胆战心惊。但令人头疼的是，相当一部分上班族也是身不由己，午餐基本都是凑合！

一日三餐中，午餐起着承上启下的作用。经过一个上午紧张的工作，来自早餐的能量和营养已基本被消耗殆尽，需要及时补充，以便下午更好地工作。在80、90年代，不少单位都有食堂，给员工提供了便利。没有食堂的，很多人都是自带午餐，那时候的收入低，一年下来自带午餐可以节省不少银子。中午吃饭时，几个同事凑在一起，分享饭菜，聊着家常，其乐融融。不知从什么时候开始，自带午餐被人们无情地抛弃，在外就餐或者点外卖成为一种常态、时尚。
 
现在的上班族，懒得自己做饭，自带午餐的是凤毛麟角。解决午餐的办法主要是到食堂、餐馆就餐或点外卖。单位有食堂的属于幸福一族，尽管都说食堂的饭菜难以下咽，至少不用每天要想到哪里找食吃。没有食堂就比较纠结了，一到中午就得仨一团俩一伙的到处觅食，既不经济又不健康。还有些人，为了节省时间，为了让老板看着高兴，就叫外卖，边吃边工作。这些午餐方式都给健康带来了一些隐患。食堂、餐馆和外卖的饭菜大都偏咸、偏油，盐和油基本都超标，品种单一，蔬菜基本没有或很少，长期吃这样的饭菜，再加上久坐少动，会大大增加得慢性病的危险。

从健康和经济的角度考虑，自带便当无疑是一个很好的选择：

 1、自己亲手制作，安全卫生有保障。

 2、自己可以掌控用油、用盐量，实现清淡饮食。

 3、随心所欲搭配各种菜品，增加菜品的种类，达到食物多样、营养全面。

 4、省去了找餐厅或排队的麻烦，节约工作时间，可以利用这个时间散散步、见见阳光。
 
带便当的七个Tips:

 1、为自己准备一个漂亮的便当包。现在市场上有各种各样的便当包，不难为自己或家人选一个喜爱的包包。

 2、主食：想来中式的，可以选馒头、米饭、窝头或大饼，想来西式的，那就是面包啦。

 3、菜：省事点的，把肉类和菜放在一起做好，如芹菜香干、芹菜肉丝；也可以单一的肉类，红烧牛肉等。叶菜再加热后颜色、口感都不太好，不建议带。带可以生吃的蔬菜，西芹、黄瓜、小胡萝卜等，都是不错的选择。

 4、奶类：营养全面、可以提供丰富的钙，有利于骨骼健康。一盒牛奶或酸奶是便当包中的必备。喜欢西式餐点的，可以经常带点奶酪。

 5、水果：也应该是便当包中的必备物资之一。可以提供维生素、矿物质和丰富的膳食纤维。

 6、注意储存时间和温度。最好早晨制作便当，为节约时间可以前一天晚上准备好材料；如果前一天晚上制作，一定存放冰箱，并且在室温中冷却后放入。到单位后一定将便当存入冰箱。

 7、吃便当前加热透彻，以便杀菌消毒。
 
本文作者：马冠生
本文地址：http://www.wjbb.com/know/1343
原文出处：http://weibo.com/p/2304185d5947690102x6gr 收起阅读 »

人生无常，人生是由无数的偶然和概率构成的，连你来到这个世界都是偶然，是贡献给你一半基因的那个精子杀出重围，跑赢了另外2000万-6000万的精子，以极小的概率成就了你。医生做的很多工作就是减少我们发生不良事件的概率，就是work against odds。但很遗憾的是，很多的概率我们依旧逃不过 ，这就是所谓的命或者劫数（fate）。

产科是一个Risky（充满风险）的Bloody（血淋淋的）Business（学科），以前老一辈的说法是“怀孕生孩子是一只脚踏进棺材里，生的好的话这只脚可以拿出来；生不好的话，另外一只脚也会进去”。现在医学发达，让怀孕生孩子的风险降低了很多。但是风险依然存在，遗憾依旧会发生，医患双方应该是一个团队，来共同携手降低风险，而不是背道而驰。

以下是和怀孕生孩子相关的一些概率，以及和其他常见概率的比较。这些数据告诉我们，怀孕生孩子真的不是很多人想象的那么简单和容易，我们依然有很多的风险无法完全避免，我们依然有很多的工作需要去改善。

虽然有很多的风险，但是多数风险还是小概率事件，大势是好的，是安全的，大家不必过于担心。

孕产妇死亡率

2014年中国孕产妇死亡率为21.7/10万，上海的孕产妇死亡率6.74/10万。根据国际应验，孕产妇死亡率一般会有至少25%左右的漏报率，因此中国的孕产妇死亡率应该不止这个数。

婴儿死亡率

2014年中国婴儿死亡率为8.9/1000，上海的婴儿死亡率为4.83/1000。中国的围产儿死亡率为5.53/1000，上海的围产儿死亡率为2.44/1000。

这些数据在不同的年份，不同的区域会有上下浮动。

自然流产的概率

在整个人群中，临床妊娠的自然流产率大约为10-15%，其实如果把临床上无法察觉的“生化妊娠”也计算进去的话，流产率可以高达50-60%，甚至更高。随着年龄的增加，临床妊娠的流产率也会上升，在35岁时，流产率为25%，40岁时，流产率上升到35%左右。

怀孕其实就是一个不断试错的过程，不试不知道会不会错，错了还得接着试。

反复自然流产的概率

反复自然流产指的是连续两次及以上的自然流产，发生的概率为1-3%，有的文献报道的概率可能会略高一些。

不孕症的概率

在正常人群中，不孕症的发生概率大约为10-15%。

臀位的发生概率

到妊娠晚期，臀位的发生概率大约为4%。

早产的概率

中国的早产率为5-8%，低于国外的数据，这里有几个原因，一是中国早产的高危人群的确是少于国外，二是统计标准不一样。

妊娠期糖尿病的概率

几年前，在实施新标准之前，GDM的发生率为5%，在实施新标准以后，GDM发生率一跃升高到15-18%。

双胎的概率

自然情况下，双胎的概率为1/88，这些年随着辅助生殖技术的发展，双胎的发生率上升到1/50-60。双胎不仅仅是双重喜悦，也意味着是双重或者更高的风险和麻烦。

VBAC子宫破裂的概率

上次剖宫产此次妊娠阴道分娩，子宫自发破裂的概率为1%左右。

出生缺陷的概率

出生缺陷（包括结构缺陷和染色体异常）的概率为3-5%，其中出生时可以发现的缺陷为1%左右。

不同年龄孕妇生唐氏综合征孩子的概率

• 20岁，1/1441
• 25岁，1/1383
• 30岁，1/959
• 35岁，1/338
• 40岁，1/84
• 45岁，1/32

围产期子宫切除的概率

生孩子时，因为产后出血或其他原因导致不得不切除子宫的概率为1-2/1000。

脑瘫的概率

脑瘫的概率为1-2/1000。

死胎的概率

胎儿在宫内发生死亡的概率为4-6/1000。

生子宫肌瘤的概率

30岁以上女性子宫肌瘤的发生率为20%

宫外孕的概率

早孕期的超声检查很重要，因为在所有怀孕的人当中，大约有2%是可能致命的宫外孕。

乳腺癌的概率

我国城市乳腺癌的发病率为52/10万，农村为42/10万。按照美国的文献，大约12%（或者说1/8）的美国女性在一生中会被确诊为乳腺癌。终生风险表示的是不同女性的平均风险，而不是说对于任何一个女性风险都是这个值。

出车祸的概率

日本的万车死亡率是0.77，英国是1.1，加拿大是1.2，澳大利亚是1.17，法国是1.59，美国是1.77，而我国为6.2（据说真实的数据还不止这些）。

飞机失事的概率

1/300万，乘飞机是最安全的，比生孩子还安全。

羊水栓塞的概率

最后再说说羊水栓塞的概率，为什么要谈羊水栓塞？是因为羊水栓塞经常会被媒体报道，会引起惊天动地的纠纷，会在微信朋友圈里疯传。本来羊水栓塞是个很专业的名词，发生率只有1/8000-80000，完全是个小概率事件，结果被炒作的路人皆知，弄得不少孕妇心惊胆颤。

No matter what happened, the Sun also rise tomorrow.
不管你开心也好，不开心也好，明天太阳照样升起！
 
本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1342
原文出处：http://mp.weixin.qq.com/s?__biz=MzA4MjUxNTkwNg==&mid=400700623&idx=1&sn=d4b3be45d4b4db171643072ea9fb035e 收起阅读 »

 
AquAdvantage Salmon Approval

Based on a comprehensive analysis of the scientific evidence, as required by the Federal Food, Drug and Cosmetic Act (FD&C Act), the FDA has determined that AquAdvantage Salmon meets the statutory requirements for safety and effectiveness under the FD&C Act. The salmon are safe to eat, the introduced DNA is safe for the fish itself, and the salmon meet the sponsor’s claim about faster growth. Because the sponsor has met these requirements, the FDA must approve the application.

The FDA has also analyzed the potential environmental impact that an approval of the AquAdvantage Salmon application would have on the quality of the human environment in the United States and has issued its final Environmental Assessment and Finding of No Significant Impact.

How the AquAdvantage Salmon is different from other fish

AquAdvantage Salmon has been genetically engineered to grow more rapidly than its non-GE farm-raised Atlantic salmon counterpart. It does so because it contains an rDNA construct that is composed of the growth hormone gene from Chinook salmon under the control of a promoter (a sequence of DNA that turns on the expression of a gene) from another type of fish called an ocean pout. This allows the salmon to grow to market size faster than non-GE farm-raised Atlantic salmon.

Food safety evaluation

As part of its review of the application, during which the agency held an open public meeting, took public comment, and released draft environmental documents for public review, the FDA determined that food from AquAdvantage Salmon is as safe to eat as food from non-GE Atlantic salmon. In addition, the nutritional profile of AquAdvantage Salmon is comparable to that of non-GE farm-raised Atlantic salmon.

As part of its evaluation, the FDA examined data comparing three groups of fish: non-GE farm-raised Atlantic salmon from both the sponsor’s farm and from a different commercial farm, and AquAdvantage Salmon. This study compared key hormones (including estradiol, testosterone, 11-ketotestosterone, T3, T4 and insulin-like growth factor 1 (IGF1)) and found no biologically relevant differences.

Containment

Under the approval, AquAdvantage Salmon are subject to stringent conditions to prevent the possibility of escape into the wild. The salmon cannot be raised in ocean net pens: instead, the approval allows for them to be grown only at two specific land-based facilities: one in Canada, where the breeding stock are kept, and Panama, where the fish for market will be grown out using eggs from the Canada facility.

Both the Canada and Panama facilities have multiple and redundant physical barriers to prevent eggs and fish from escaping, including metal screens on tank bottoms, stand pipes, and incubator trays to prevent the escape of eggs and fish during hatching or rearing.

The tanks also have covers, nets, jump fences, and screened overflow tanks to prevent escape over the sides of the tanks or incubators. Tank netting also keeps predators such as birds from entering the fish tanks at the outdoor facilities in Panama. The facilities in Canada are indoors. All tank drains and stand pipes have covers or sleeves permanently attached to them.

In order to prevent eggs or small fish from passing through the pipes or plumbing, there is a closed septic system and additional screens and chlorine pucks are used to kill any escaped fish or eggs in the main drain area.

In addition, particularly at the Panama grow-out facility, there are geographical/geophysical containment features, including high river and ocean water temperatures, and other conditions that would not be supportive of salmon survival. The fish to be produced for food in Panama will be an all-female, reproductively sterile population.

The FDA has inspected the Canadian facility twice and, with a representative of NOAA’s National Marine and Fisheries Service, performed an extensive site visit of the Panamanian facility. Based on the agency’s review of these facilities, the agency is confident that the possibility for escape is highly unlikely, and that the procedures in place to monitor physical containment are appropriate. The FDA will maintain regulatory oversight over the egg production and grow-out facilities for the entire duration of the product lifecycle, and will conduct inspections to confirm that adequate physical containment measures remain in place. In addition, the Canadian and Panamanian governments have conducted and will continue to conduct inspections of the facilities.

Evaluation of environmental effects

In compliance with requirements of the National Environmental Policy Act (NEPA), the FDA evaluated whether approval of the application would result in significant impacts on the quality of the human environment in the United States.

Based on the multiple forms of physical and biological containment proposed by AquaBounty Technologies in the application, the FDA found that an approval of the application related to AquAdvantage Salmon would not cause a significant impact on the environment of the United States. This finding is based on the extremely low likelihood that AquAdvantage Salmon could escape from the Canada and Panama facilities and survive in an ocean or waterway to interbreed with wild Atlantic salmon. This is due, in part, to the physical and biological containment measures specified in the approved application. Based on the agency’s conclusion from the final Environmental Assessment, the agency issued a final Finding of No Significant Impact (FONSI).

Labeling of food products

The FDA recognizes that some consumers are interested in knowing whether the Atlantic salmon they buy is the product of genetic engineering. Under a draft Guidance released today in conjunction with the approval, manufacturers who wish to voluntarily label their food products as containing or not containing genetically engineered Atlantic salmon may do so as long as such labeling is truthful and non-misleading.

The FDA requires additional labeling of all foods, including foods from genetically engineered sources, when the food products are materially different from their conventional counterparts. Material differences include changes in features like nutritional profile, and functional properties, amongst others. The fact that a food is produced through the use of genetic engineering alone does not normally constitute a material fact requiring additional labeling under the FD&C Act.

Because the data and information evaluated show that food derived from AquAdvantage Salmon is not materially different from food derived from other Atlantic salmon, the FDA has determined that no additional labeling of food from AquAdvantage Salmon is required.
 
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本文地址：http://www.wjbb.com/know/1341
原文出处：http://www.fda.gov/AnimalVeterinary/DevelopmentApprovalProcess/GeneticEngineering/GeneticallyEngineeredAnimals/ucm473238.htm 收起阅读 »

General

1. What is different about AquAdvantage Salmon?

AquAdvantage Salmon has been genetically engineered to grow to market size more rapidly than its non-GE Atlantic salmon counterpart. It does so because it contains an rDNA construct that is composed of the growth hormone gene from Chinook salmon under the control of a promoter (a sequence of DNA that turns on the expression of a gene) from ocean pout (another type of fish). This allows the salmon to grow to market size faster.

2. What is the source of the data in the application?

For its review, FDA relied on the data provided in the application, as well as other sources of data and information, including articles from peer-reviewed journals, taking care to ensure the most relevant data and information received the most weight in the agency’s decision-making process.
The data in the application are provided by the company, because the burden of proof is on the sponsor, or company, to demonstrate safety and to validate the claim that is being made. As part of the review process, whenever the FDA had additional questions, the sponsor provided additional data or information.

3. What did the FDA consider to be the potential environmental impacts?

In compliance with requirements of the National Environmental Policy Act (NEPA), the FDA evaluated the potential effects on the environment of the United States from an approval of the application related to AquAdvantage Salmon. Specifically, the FDA asked the following four questions:

1. What is the likelihood that AquAdvantage Salmon will escape the conditions of confinement
2. What is the likelihood that AquAdvantage Salmon will survive and disperse if they escape the conditions of confinement
3. What is the likelihood that AquAdvantage Salmon will reproduce and establish if they escape the conditions of confinement
4. What are the likely consequences to, or effects on, the environment of the United States should AquAdvantage Salmon escape the conditions of confinement

Based on the multiple forms of physical and biological containment proposed by AquaBounty Technologies in the application, the FDA found that an approval of the application related to AquAdvantage Salmon would not cause a significant impact on the environment of the United States. This finding is based on the extremely low likelihood that AquAdvantage Salmon could escape into the environs surrounding the PEI and Panama facilities and survive in an ocean or waterway and interbreed with wild Atlantic salmon due, in part, to the physical and biological containment measures specified in the approved application, and thus affect the environment of the United States. Based on the agency’s conclusion from the final Environmental Assessment, the agency issued a final Finding of No Significant Impact (FONSI).

4. What kinds of physical containment does the approved application specify will be at the two facilities at which AquAdvantage Salmon will be raised?

The facilities in Canada and Panama have a series of multiple and redundant levels of physical barriers to prevent eggs and fish from escaping. The facilities use land-based tanks, not ocean net pens, which are not allowed under the approved application. The first level of barriers (Primary Containment) includes items such as metal screens on tank bottoms, stand pipes, and incubator trays to prevent the escape of eggs and fish during hatching or rearing. Tanks also have covers, nets, jump fences, and screened overflow tanks to prevent escape over the sides of the tanks or incubators. Tank netting also keeps predators such as birds from entering the fish tanks at the outdoor facilities in Panama. All tank drains and stand pipes have covers or sleeves permanently attached to them. In order to prevent eggs or small fish from passing through the pipes or plumbing there is a closed septic system and additional screens and chlorine pucks are used to kill any escaped fish in the main drain area.

Several additional sets of barriers, also in series (Secondary, Tertiary, and sometimes Quaternary Containment), add increased physical security to the Primary Containment measures described above. These barriers are designed to prevent fish from entering the drainage system or sedimentation pools and the local river (in the case of the Panama facility) and include floor drain covers, barrier screens inside the drains, drum and sock filters, and a series of sedimentation ponds with outlet filters.
To augment physical containment, strict security measures and equipment are in place at both facilities. This includes locked gates for entry and exit to the properties, the presence of guard dogs, perimeter fences with barbed wire, and monitoring systems.

Graphics describing these containment measures can be found at Figures 6 and 7 of the EA.

5. Why is FDA not requiring mandatory labeling of food from GE Atlantic salmon?

The FDA has determined that food from AquAdvantage Salmon is as safe and nutritious as that from non-GE Atlantic salmon. The Federal Food, Drug, and Cosmetic Act (FD&C Act) provides statutory authority for mandatory labeling of food if there is material information that must be disclosed within the meaning of sections 403(a) and 201(n) of the FD&C Act. Because the data and information evaluated show that AquAdvantage Salmon is not materially different from other Atlantic salmon, the FDA has determined that no additional labeling of food from AquAdvantage Salmon is required.

The FDA requires additional labeling in cases where it is necessary to ensure that the labeling is not false or misleading. For example, if a material difference, i.e., changes in the nutritional profile, cooking qualities, etc. was found to exist between a given product and its conventional counterpart additional labeling describing the material difference would be required. FDA has required a statement on low-fat margarine indicating that it is not suitable for frying.

As with all foods, a company may include voluntary information in labeling, provided the information is truthful and not misleading.

The FDA recognizes that some consumers are interested in knowing whether a food is derived from GE Atlantic salmon, so the agency is also publishing a draft guidance for food manufacturers who wish to voluntarily label their food products or ingredients derived from salmon as either containing or not containing GE Atlantic salmon. You can see the draft guidance here: http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/ucm469802.htm.

6. How will the FDA monitor AquAdvantage Salmon now that it has been approved?

All FDA-approved new animal drugs have post-market surveillance programs. For this application, the approval letter describes record-keeping and reporting requirements, including demonstrating the presence and stability of the AquAdvantage rDNA construct, ensuring that the triploidy process (a method used in finfish and shellfish to prevent their sexual maturation and to make them sterile) is within specifications, reporting of any adverse effects of the rDNA construct on animal health, and reporting of any instances of presumed infectious disease. In addition, the sponsor is required to monitor physical containment, including reporting of any likely or actual breaches of physical containment.

7. Does the agency expect this decision to pave the way for approvals of other genetically engineered animals?

The FDA cannot speculate on whether more producers of genetically engineered animals will submit applications based on this approval and cannot comment on whether other sponsors have already submitted such applications. The agency reviews each application on a case-by-case basis, and its own merits in order to determine whether the product is effective, safe for the animal and, in the case of applications for GE food animals, is safe for humans and animals to eat.

The rigorous review process includes seven elements of evaluation. Companies seeking an approval must provide data to substantiate each element:

• Product definition: a broad statement characterizing the GE animal and the claim being made for the GE animal;
• Molecular characterization of the construct: a description of the rDNA construct and how it is assembled;
• Molecular characterization of the GE animal lineage: a description of the method by which the rDNA construct was introduced into the animal and whether it is stably maintained over time;
• Phenotypic characterization of the GE animal: comprehensive data on the characteristics of the GE animal and its health;
• Durability plan: the sponsor’s plan to demonstrate that the modification will remain the same over time, and continue to have the same effect.
• Environmental and food/feed safety: the assessment of any environmental impacts, and for GE animals intended for food, that food from those GE animals is safe to eat for humans and/or animals;
• Claim validation: a demonstration that the GE animal does fulfill the product definition stated in the beginning of the review process.

The first genetically engineered animal that received FDA approval was a line of genetically engineered goats that produce a recombinant human anti-clotting protein in their milk. The FDA’s Center for Biologics Evaluation and Research also approved that protein (ATryn) as a human biological drug for the prevention of abnormal clotting in people with hereditary antithrombin deficiencies who are having surgery or giving birth.

For more information on the review process, see http://www.fda.gov/AnimalVeterinary/DevelopmentApprovalProcess/GeneticEngineering/ GeneticallyEngineeredAnimals/ucm113605.htm.

8. Are AquAdvantage Salmon more susceptible to disease than non-GE salmon?

No. Scientific data do not support the assertion that AquAdvantage Salmon are any more susceptible to disease than non-GE farm-raised Atlantic salmon under the aquaculture conditions in which they are raised.

9. Why is the FDA approving the AquAdvantage Salmon?

Under the Federal Food, Drug and Cosmetic Act, FDA is required to review applications for safety and effectiveness. Based on a comprehensive analysis of the scientific evidence, the FDA has determined that the AquAdvantage Salmon meets the statutory requirements for safety and effectiveness under the FD&C Act. The fish are safe for humans and animals to eat, the rDNA construct is safe for the animal, and the claim about faster growth made by the sponsor has been confirmed. Because the sponsor has met these and other statutory requirements, the FDA must approve the application.

The FDA has also analyzed the potential environmental impact that an approval of the AquAdvantage Salmon application would have on the U.S. environment and has published its final Environmental Assessment and Finding of No Significant Impact.

10. How are genetically engineered animals regulated?

Genetically engineered animals are regulated under the new animal drug provisions of the Federal Food, Drug, and Cosmetic Act (FD&C Act) because an rDNA construct that is intended to affect the structure or function of the body of the resulting animal meets the definition of a drug. Please see GFI 187 for a detailed description of the kinds of recommended for sponsor to submit, and that the agency will review.

The FDA held a Veterinary Medicine Advisory Committee meeting that addressed the application and a Part 15 hearing that addressed labeling of food from AquAdvantage Salmon, which were both open to the public, released draft environmental documents on the application, and solicited public comment in connection with all of these activities.

11. What is triploidy?

Triploid fish have three sets of chromosomes in the cells of their body instead of the more common two sets (referred to as “diploid”). Triploidy is a method used in certain plants and animals, including finfish and shellfish, to prevent their sexual maturation and thereby make them functionally sterile. In addition to providing a form of biological containment, this can redirect energy to growth instead of to reproductive development. The sponsor has proposed to induce triploidy by a method that is commonly used in commercial aquaculture -- shortly after they are fertilized, the fertilized eggs are put in a pressure chamber (a large stainless steel container resembling a very heavy-walled thermos bottle) and pressure is applied to them.

Containment

1. What is meant by “multiple redundant containment” in the context of AquAdvantage Salmon?

Multiple redundant containment means that there are several independent levels and types of barriers to prevent escape and establishment of salmon populations outside the land-based tanks in which the AquAdvantage Salmon are bred and raised. For example, for physical containment there are multiple screens and filters throughout both facilities. With respect to biological containment, there are two independent but complementary methods: producing only one sex of fish, and making the female fish sterile via triploidy induction (a method used in finfish and shellfish to prevent their sexual maturation and make them sterile). In addition, particularly at the Panama grow-out facility, there are geographical/geophysical containment features, including high river and ocean water temperatures, and other conditions that would not be supportive of salmon survival.

2. What is meant by biological containment?

Biological containment is a term that means limiting the reproductive ability of an animal. We use biological containment when we neuter our pet dogs or cats. More advanced methods of biological containment, or bio-confinement, use methods such as altering the chromosome number of an organism such as triploidy (a method used in finfish and shellfish to prevent their sexual maturation and make them sterile), and making single sex populations to induce sterility and/or prevent gene flow and reproduction in the environment.

3. What is meant by physical containment?

Physical containment refers to mechanical (or chemical) measures or barriers used at a facility to prevent the physical movement or escape of fish from that facility. Physical containment equipment includes screens with very small openings that allow water to flow through, but that will not allow the passage of eggs and fish. The mesh size of the screens range from 0.03 to 0.5 inches in diameter, which is roughly 10 to 100 times narrower than the fish is wide. Examples of these barriers include metal (usually stainless steel) and plastic screens, fine meshes, filters, and grates in the water drainage pipes and sumps that prevent eggs, fry (very small fish that have just hatched from eggs), and larger fish from being able to escape to the outside environment. Physical containment also includes tank covers and nets to prevent fish from being able to jump out of tanks and prevent predators such as birds from being able to remove them. (See EA Figure 6.)

4. What would happen if any of the AquAdvantage Salmon escaped from the Canadian facility? Would the fish survive and impact the environment of the United States?

In the highly unlikely event that any salmon escaped from the facility, the potential for survival would be extremely low. Eggs and young fish would not survive if they escaped because they can only live in fresh water. The location of the facility is near an estuary (a body of water in which fresh and salt water mix and that is “slightly salty”) and the sea itself. Both of these conditions are too salty for young life stages to survive. For an older, larger fish to escape, it would have to make its way past a series of barriers and screens whose openings are very small (0.03 to 0.5 mm), which is roughly 10 to 100 times narrower than the fish is wide (see Figure 6 of the EA). Even then, the fish’s survival would depend on the season of the year because the winters where the facility is located in Prince Edward Island (PEI), Canada, are very cold and the water temperature is sometimes at or even below freezing (this is possible because the water is salty). Even if one of these fish were somehow able to escape, it is extremely unlikely it would survive for long or become established in the local environment. This is because currently there are no native Atlantic salmon in the nearby river system or any of the other rivers in the area, despite intentional stocking attempts over many years, which indicates that conditions are inhospitable for survival.
 
中文翻译：
本文地址：http://www.wjbb.com/know/1340
原文出处：http://www.fda.gov/AnimalVeterinary/DevelopmentApprovalProcess/GeneticEngineering/GeneticallyEngineeredAnimals/ucm473237.htm 收起阅读 »