BJSM（British Journal of Sports Medicine）的Editorial：是时候破除一个流传已久的迷信了：锻炼身体能够减肥。而事实是、锻炼身体虽然的确有益于预防多种危害健康的重要疾病如糖尿病、心脏病与痴呆症等、但其对于减肥的效应却很小（minimal）。反之、添加糖与碳水化合物的摄入水平才是真正关键。

A recent report from the UK's Academy of Medical Royal Colleges described ‘the miracle cure’ of performing 30 min of moderate exercise, five times a week, as more powerful than many drugs administered for chronic disease prevention and management.1 Regular physical activity reduces the risk of developing cardiovascular disease, type 2 diabetes, dementia and some cancers by at least 30%. However, physical activity does not promote weight loss.

In the past 30 years, as obesity has rocketed, there has been little change in physical activity levels in the Western population.2 This places the blame for our expanding waist lines directly on the type and amount of calories consumed. However, the obesity epidemic represents only the tip of a much larger iceberg of the adverse health consequences of poor diet. According to the Lancet global burden of disease reports, poor diet now generates more disease than physical inactivity, alcohol and smoking combined. Up to 40% of those with a normal body mass index will harbour metabolic abnormalities typically associated with obesity, which include hypertension, dyslipidaemia, non-alcoholic fatty liver disease and cardiovascular disease.3 However, this is little appreciated by scientists, doctors, media writers and policymakers, despite the extensive scientific literature on the vulnerability of all ages and all sizes to lifestyle-related diseases.

Instead, members of the public are drowned by an unhelpful message about maintaining a ‘healthy weight’ through calorie counting, and many still wrongly believe that obesity is entirely due to lack of exercise. This false perception is rooted in the Food Industry's Public Relations machinery, which uses tactics chillingly similar to those of big tobacco. The tobacco industry successfully stalled government intervention for 50 years starting from when the first links between smoking and lung cancer were published. This sabotage was achieved using a ‘corporate playbook’ of denial, doubt, confusing the public and even buying the loyalty of bent scientists, at the cost of millions of lives.4 ,5

Coca Cola, who spent $3.3 billion on advertising in 2013, pushes a message that ‘all calories count’; they associate their products with sport, suggesting it is ok to consume their drinks as long as you exercise. However science tells us this is misleading and wrong. It is where the calories come from that is crucial. Sugar calories promote fat storage and hunger. Fat calories induce fullness or ‘satiation’.

A large econometric analysis of worldwide sugar availability, revealed that for every excess 150 calories of sugar (say, one can of cola), there was an 11-fold increase in the prevalence of type 2 diabetes, in comparison to an identical 150 calories obtained from fat or protein. And this was independent of the person's weight and physical activity level; this study fulfils the Bradford Hill Criteria for causation.6 A recently published critical review in nutrition concluded that dietary carbohydrate restriction is the single most effective intervention for reducing all the features of the metabolic syndrome and should be the first approach in diabetes management, with benefits occurring even without weight loss.7

And what about carbohydrate loading for exercise?
The twin rationales for carbohydrate loading are that the body has a limited capacity to store carbohydrates and these are essential for more intense exercise. However, recent studies suggest otherwise. The work of Volek and colleagues8 establishes that chronic adaptation to a high-fat low-carbohydrate diet induces very high rates of fat oxidation during exercise (up to 1.5 g/min)—sufficient for most exercisers in most forms of exercise—without the need for added carbohydrate. Thus fat, including ketone bodies, appears to be the ideal fuel for most exercise—it is abundant, does not need replacement or supplementation during exercise, and can fuel the forms of exercise in which most participate.8 If a high-carbohydrate diet was merely unnecessary for exercise it would be of little threat to public health, however, there are growing concerns that insulin-resistant athletes may be at risk of developing type 2 diabetes if they continue to eat very high-carbohydrate diets for decades since such diets worsen insulin resistance.

The ‘health halo’ legitimisation of nutritionally deficient products must end
The public health messaging around diet and exercise, and their relationship to the epidemics of type 2 diabetes and obesity, has been corrupted by vested interests. Celebrity endorsements of sugary drinks, and the association of junk food and sport, must end. The ‘health halo’ legitimisation of nutritionally deficient products is misleading and unscientific. This manipulative marketing sabotages effective government interventions such as the introduction of sugary drink taxes or the banning of junk food advertising. Such marketing increases commercial profit at the cost of population health. The Centres of Disease Control health impact pyramid is clear. Changing the food environment—so that individuals’ choices about what to eat default to healthy options—will have a far greater impact on population health than counselling or education. Healthy choice must become the easy choice. Health clubs and gyms therefore also need to set an example by removing the sale of sugary drinks and junk food from their premises.

It is time to wind back the harms caused by the junk food industry's Public Relations machinery. Let us bust the myth of physical inactivity and obesity. You cannot outrun a bad diet.

中文翻译：
本文地址：http://www.wjbb.com/know/1046
原文出处：http://bjsm.bmj.com/content/early/2015/04/23/bjsports-2015-094911.full  收起阅读 »

胖子需要的不是锻炼，少吃才是王道。心脏病学家马尔霍特拉博士如是说道。

医生们说道，体育锻炼对减肥的作用微乎其微，公共卫生信息传达应该聚焦在不健康饮食的危害。

在英国运动医学杂志（http://www.wjbb.com/know/1046）的一篇社论中，三名国际专家说，是时候“打破锻炼能减肥的谬误”了。

他们表示，尽管锻炼对消耗性疾病，如糖尿病、心脏疾病和老年痴呆症作用重大，但是其对肥胖的影响甚小。相反，摄入了过量的糖和碳水化合物才是导致肥胖的关键。

包括心脏病学家马尔霍特拉博士在内的专家们指责食品行业鼓吹运动能抵消不健康饮食所带来的危害的行为。
他们进一步将自己的战术策略比喻为“极为相似”烟草行业的大烟草事件，并说必须停止让明星代言含糖饮料，以及取消垃圾食品和运动之间的联系。

他们说，有证据表明高达40％的体重位于正常范围的人患有潜在的代谢异常疾病，这通常都是和肥胖有关系的疾病。
 

虽然公共卫生信息传达帮了倒忙，它认为保持健康的体重与摄入卡路里的数量有关，当它是热量的最要紧的来源 - 研究表明，与脂肪的卡路里，每额外消耗150的糖分热量，糖尿病增加11倍，。

同时他们指出了来自《柳叶刀》疾病的全球负担项目的证据，它显示不健康的饮食比缺乏锻炼、饮酒和吸烟更容易导致更多的健康问题。

“不科学”

马尔霍特拉博士说：“肥胖者需要的不是运动减肥，他们只需要少吃。 我最大的担忧是，传达给公众的错误的暗示他们只要运动，便可以想吃什么就吃什么。”

“那是不科学的，错的。你不能战胜不健康饮食的负面影响。”

但是另有人认为看轻锻炼的作用是有风险的。国家健康与保健知识研究所向来建议“均衡的饮食加上体力活动”，该机构的马克•贝克教授认为抹煞身体活动的重要性很是愚蠢。。

伊恩•赖特是“食品和饮料联盟”的总干事，他说：“体育锻炼的好处不是意有所指的食品行业炒作或阴谋。 健康的生活方式包括均衡饮食和锻炼。”

他说，食品和饮料行业是鼓励均衡饮食的，方式包括在产品包装上提供明确的营养信息以及提供含有额外的营养又少盐、少糖和少脂肪的产品。

“这篇文章好像是要破坏循证的政府公共健康咨询的根源，它肯定会令消费者困惑不已，”他说。

中文翻译：汤汤不爱吃糖
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正如歌里唱的：春天里百花香……。随着春天的来临，花草树木生机勃勃，竞相生长,开放的花儿飘香，阳春三月，在众多花香中有一种甜滋滋的味道，那就是槐花。

槐花，顾名思义，就是槐树上开的花。槐花没有开时为“槐米”，花开时为“槐花”。常见的槐花有三种：国槐花、洋槐花和红槐花。虽然都叫槐花，但它们的用途是有区别的：国槐花可以入药但不可以食用，洋槐花可以食用但不入药，红槐花仅供观赏，不可食用也不能入药。
 
洋槐花一般在每年阳历的4～5月份开花，一串串白色的花朵像一串串小铃铛挂在树上，花朵白中透绿，黄色的花蕊，满街飘着甜甜的香味，摘一朵小白花放在嘴里，味道甜甜的，记忆中是那么的甜美。

除了生吃，洋槐花有多种食用方法，槐花蜜就是来源于洋槐花，还可以用槐花做成饼、饺子等。

槐花芝麻饼：把洋槐花洗净沥水，切成碎末，和豆腐一起放在盆内，加入葱、姜末、盐、鸡蛋、淀粉调成馅。将馅做成圆饼，粘上一层芝麻，用油炸或煎熟就可以吃了。洋槐花芝麻饼色泽金黄，口感鲜脆。

槐花饺子：把槐花洗净，控干水分，和肉馅拌在一起，就可以包鲜美的槐花饺子啦。
 
炒槐花菜：把槐花洗净、晾干，用少许油快速煸炒，加一点盐和醋，一盘清新悦目，色香味俱佳的炒槐花就好了。

蒸槐花：把槐花洗净，加一些干面粉拌匀，蒸上几分钟就能吃了，可以直接吃，也可以拌蒜泥吃。

槐花汤：把水烧开，放进洗干净的槐花，再放入调好的淀粉或面糊即可。

从营养成分来看，洋槐花中含的碳水化合物和维生素比较多，并含有大量的酶，这是洋槐花甜美味道的原因。洋槐花还含有维生素B、E，铁、硒、钙、镁等人体所必需的矿物元素。洋槐花还含有大量的黄酮类物质，包括芸香甙、刺槐素、木犀草素、槲皮素等，具有抗炎、抗病毒，减少血管脆性等作用。由于不是经常吃槐花，吃的量也少，属于偶尔尝尝鲜，因此，洋槐花的这些作用也就得不到充分发挥。
 
本文地址：http://www.wjbb.com/know/1044
原文出处：http://weibo.com/p/2304185d5947690102w542
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Pregnancy provides an opportunity for evaluation of a woman's immunization status. Pregnant women are a vulnerable population. They have an altered immune response and, for some infections, are at increased risk of infection and at increased risk of severe outcomes once infected. The fetus, neonate and young infant can also be impacted by infections that can results in congenital abnormalities or severe illness.

One of the challenges of developing recommendations for pregnant and breastfeeding women is the lack of studies that would allow making evidence-based decisions. Only a few methodologically robust studies of vaccine administration in pregnant and breastfeeding women exist; most safety data available are derived from registries where outcomes are passively reported.

When considering vaccination for pregnant or breastfeeding women, it is important to distinguish between live and inactivated vaccines. There is no theoretical reason to suspect that inactivated vaccines would be associated with an increased risk of adverse events when administered during pregnancy or in breastfeeding women. Live vaccines, however, such as measles, mumps, rubella, varicella, and yellow fever, should generally not be given during pregnancy because of the theoretical risk of harm to the foetus if transmission of the vaccine virus to the fetus occurs.

Ideally, the immunization status of women intending to become pregnant should be reviewed and vaccines updated as necessary prior to conception. Live vaccines, for example, can be given to non-pregnant women with the advice to avoid pregnancy for at least 28 days following immunization. Some pregnancies are unplanned, however, and immunization status will need to be assessed during the pregnancy.

Maternal Benefits

The objective of vaccination during pregnancy is to protect the mother and, potentially, the fetus and newborn. Pregnant women respond adequately to vaccines even though pregnancy is an immunologically altered state. Clinical trials of tetanus toxoid and inactivated polio vaccine administered during pregnancy have demonstrated normal adult immunologic responses. Vaccines recommended for the protection of a pregnant woman's health include:

inactivated influenza vaccine
hepatitis B vaccine for a woman with ongoing exposure risks
hepatitis A vaccine for a woman who is a close contact of a person with hepatitis A or who is travelling to an endemic area
tetanus toxoid and reduced diphtheria toxoid-containing vaccine if indicated
meningococcal vaccine in an outbreak setting or post-exposure
pneumococcal polysaccharide or conjugate vaccine for women in a high risk group due to underlying illnesses

acellular pertussis-containing vaccine (Tdap) for all pregnant women who are 26 weeks of pregnancy or greater who have not previously received Tdap vaccine in adulthood ; imunization should not be delayed until close to delivery since this may provide insufficient time for optimal transfer of antibodies and direct protection of the infant against pertussis

Maternal Safety

Inactivated vaccines are generally safe in pregnancy. Reactions following vaccination with inactivated vaccines are usually limited to the injection site. No increase in anaphylactic reactions or events that might induce preterm labour has been observed. Vaccines that contain thimerosal are considered safe in pregnancy and the National Advisory Committee on Immunization (NACI) has concluded that there is no safety reason to avoid the use of thimerosal-containing vaccines for pregnant women.

Benefits of Immunization in Pregnancy for the Fetus and Infant

The beneficial effects of maternal vaccination for the newborn have been well documented. Maternal vaccination protects the mother from vaccine-preventable diseases that she otherwise may transmit to her fetus or infant. In addition, protective concentrations of maternal antibodies may be transferred to the fetus transplacentally, with the majority of transfer occurring during the third trimester. Maternal antibodies typically have a half-life of 3 to 4 weeks in the newborn, and progressively decrease during the first 6 to 12 months of life. Recommended infant immunization schedules take into consideration the potential effect that maternally transferred antibodies may have on infant vaccinations.

Safety of Immunization in Pregnancy for the Fetus/Infant

There is no theoretical reason to suspect that adverse events will occur in the fetus or infant following maternal vaccination with inactivated vaccines during pregnancy. There are no published data indicating that currently authorized inactivated vaccines are teratogenic or embryotoxic, or have resulted in specific adverse pregnancy outcomes.

In general, live attenuated viral or bacterial vaccines are contraindicated in pregnancy, as there is a theoretical risk to the fetus; however, when benefits outweigh risks, vaccination with a live attenuated vaccine may be considered (e.g., yellow fever vaccine in a pregnant woman travelling to an endemic area).

Imunization During Pregnancy (refer to Table 1)
Recommended vaccines
Inactivated influenza vaccine

All pregnant women, at any stage of pregnancy, should be considered high priority for receiving inactivated influenza vaccine, because of their increased risk of influenza-associated morbidity, evidence of adverse neonatal outcomes associated with maternal influenza, evidence that vaccination of pregnant women protects their newborns from influenza and influenza-related hospitalization, and evidence that infants born during the influenza season to vaccinated women are less likely to be premature, small for gestational age, and low birth weight. Live attenuated influenza vaccine should not be given to pregnant women, as discussed in the previous section.

There is good evidence demonstrating the safety of inactivated influenza vaccine during pregnancy. Active surveillance following influenza vaccination during pregnancy has not shown evidence of harm to the mother or fetus associated with influenza immunization. Although the cumulative sample size of these studies is relatively small, particularly for immunisation in the first trimester, passive surveillance has not raised any safety concerns, despite widespread use of influenza vaccine in pregnancy over several decades. Surveillance following the use of both adjuvanted and unadjuvanted pH1N1 vaccine in more than 100,000 pregnant women in Canada and almost 500,000 pregnant women in Europe did not reveal any safety concerns.

Women who did not receive influenza vaccination during pregnancy should receive influenza vaccine post-partum before discharge from hospital if it is influenza season.

Refer to Influenza Vaccine in Part 4 for additional information.

Hepatitis B vaccine

All pregnant women should be routinely tested for hepatitis B surface antigen (HBsAg). A pregnant woman who has no markers of hepatitis B (HB) infection but who is at high risk of HB should be offered a complete HB vaccine series at the first opportunity during the pregnancy and should be tested for antibody response. HB vaccine can be used safely in pregnancy and should be administered when indicated, because acute HB in a pregnant woman may result in severe disease for the mother and chronic infection in the infant. The safety of combined hepatitis A-hepatitis B vaccine given during pregnancy has not been studied in clinical trials; however, there is no theoretical reason to suspect an increased risk of adverse events to mother or infant. Refer to Hepatitis B Vaccine in Part 4 for additional information.
 
Vaccines that may be indicated
Hepatitis A vaccine

The efficacy and safety of hepatitis A vaccines given during pregnancy has not been studied in clinical trials, but there is no theoretical reason to suspect an increased risk of adverse events to the mother or the infant. Hepatitis A can cause severe disease in pregnancy, and the vaccine should be considered for pregnant women when potential benefits outweigh risks, such as for post-exposure prophylaxis or for travel to high risk endemic areas. Refer to Hepatitis A Vaccine in Part 4 for additional information.

Tetanus toxoid, diphtheria toxoid, acellular pertussis vaccines

Susceptible pregnant women may receive tetanus toxoid-reduced diphtheria toxoid-containing vaccine (Td) if indicated. Follow-up data on pregnant women who have received tetanus toxoid-containing vaccine (often in the first trimester) have not revealed an increased risk of adverse events. There is no theoretical reason to suspect an increased risk of adverse events to mother or infant following the administration of Td vaccine.

Immunization with Tdap to date has been shown to be safe in pregnant women and allows high levels of antibody to be transferred to newborns during the first two months of life when the morbidity and mortality from pertussis infection is the highest. All pregnant women at 26 weeks of pregnancy or later, who have not received a dose of pertussis-containing vaccine in adulthood, should be encouraged to receive Tdap vaccination. Immunization should not be delayed until close to delivery since this may provide insufficient time for optimal transfer of antibodies and direct protection of the infant against pertussis.   In special circumstances, such as a pertussis outbreak, all pregnant women who are 26 weeks gestation or greater may be offered Tdap vaccination, irrespective of their immunization history based on the advice of local public health officials.  Refer to Tetanus Toxoid, Diphtheria Toxoid and Pertussis Vaccine in Part 4 for additional information.
Top of PagePoliomyelitis vaccine

Inactivated poliomyelitis vaccine (IPV) may be considered for pregnant women who require immediate protection and are at increased risk of exposure to wild poliovirus. Limited data have not revealed an increased risk of adverse events associated with IPV vaccine administered to pregnant women. There is no theoretical reason to suspect an increased risk of adverse events to mother or infant following IPV administration. Refer to Poliomyelitis Vaccine in Part 4 for additional information.

Pneumococcal vaccine

Recommendations for pneumococcal vaccines in pregnancy and for breastfeeding women are the same as for non-pregnant and non-breastfeeding adults. Pneu-P-23 is recommended for adults at high risk for invasive pneumococcal disease;  additionally, Pneu-C-13 is recommended for adults who are immunocompromised. There is no evidence to suggest a risk to the fetus or to the pregnancy from maternal immunization with inactivated vaccines, therefore, women who are breastfeeding can be vaccinated with Pneu-P-23 or Pneu-C-13 vaccine, if indicated. Refer to Pneumococcal Vaccine in Part 4 and Immunization of Immunocompromised Persons and Immunization of Persons with Chronic Diseases in Part 3 for additional information.

Meningococcal vaccine

Conjugate meningococcal vaccines have not been studied in pregnancy; however, there is no theoretical reason to suspect adverse events to mother or infant will occur and may be given in circumstances when the benefits outweigh the risks. Conjugate meningococcal vaccine should be considered for pregnant women in circumstances such as travel to a high risk area; post-exposure prophylaxis against a vaccine preventable strain if indicated; or during an outbreak if indicated. Refer to Meningococcal Vaccine in Part 4 for additional information.

Rabies vaccine

If a pregnant woman has had a potential exposure to rabies, post-exposure prophylaxis should be given. If pre-exposure prophylaxis is indicated for work or travel purposes, in general, avoidance of risk should be considered and pre-exposure immunization delayed unless substantial risk of exposure remains. Refer to Rabies Vaccine in Part 4 for additional information.

Other inactivated vaccines

Cholera and travellers' diarrhea vaccine, and Japanese encephalitis vaccine have not been studied in pregnant women. Administration of either vaccine to pregnant women may be considered only in high risk situations after evaluation of the benefits and risks. Inactivated parenteral typhoid vaccine should be used in high risk situations if protection against typhoid is required. Refer to vaccine specific chapters in Part 4 for additional information.
 
Vaccines not recommended
Human papillomavirus vaccine (HPV)

HPV vaccine is not recommended for use in pregnancy because data on efficacy and safety of HPV vaccination in pregnancy are limited. No adverse outcomes of pregnancy or adverse events to the developing fetus have been reported. Initiation of the HPV vaccine series should be delayed until after completion of pregnancy. If a woman is found to be pregnant after initiating the vaccination series, completion of the series should be delayed until after pregnancy. If a vaccine dose has been administered during pregnancy. No intervention is required if vaccine has been administered during pregnancy. Refer to Human Papillomavirus Vaccine in Part 4 for additional information.

Generally contraindicated vaccines
Measles-mumps-rubella vaccine

Measles-mumps-rubella vaccine (MMR live attenuated vaccine) is generally contraindicated in pregnancy because there is a theoretical risk to the fetus. However, in some situations, potential benefits may outweigh risks, such as during measles or rubella outbreaks, in which case vaccination may be considered. There is no evidence to date demonstrating a teratogenic or other risk from MMR vaccine. Inadvertent immunization with MMR vaccine is not a reason for pregnancy termination.

Pregnant women without documented evidence of prior immunization with a rubella-containing vaccine should be serologically screened for rubella antibodies. Those found not to be immune on serological testing should be vaccinated with one dose of MMR vaccine in the immediate post-partum period, before discharge from hospital (unless they have received Rh immune globulin [RhIg] - refer to Rh immune globulin and MMR vaccine). Women who have been appropriately immunized post-partum do not need to be serologically screened for rubella antibodies, either post-immunization or in subsequent pregnancies. Women who have been found to be serologically positive in one pregnancy do not need to be screened again in subsequent pregnancies.

Refer to Measles Vaccine, Mumps Vaccine, and Rubella Vaccine in Part 4 for additional information.

Univalent varicella vaccine

Varicella vaccine (a live attenuated vaccine) is contraindicated in pregnancy because there is a theoretical risk to the fetus; however, there is a lack of evidence to demonstrate a teratogenic or other risk from varicella vaccine. Inadvertent immunization with varicella vaccine is not a reason for pregnancy termination.

Pregnant women without documented evidence of prior immunization with 2 doses of varicella vaccine or evidence of varicella disease should be serologically screened for varicella antibodies. Those found to be susceptible to varicella should receive 2 doses of a univalent varicella vaccine, 6 weeks apart; the first dose should be given in the immediate post-partum period, before discharge from hospital (unless they have received Rh immune globulin [RhIg] - refer to Rh immune globulin). Once appropriately immunized, there is no need for serological confirmation of immunity.

Refer to Varicella (Chickenpox) Vaccine in Part 4 for additional information, including post-exposure prophylaxis with varicella zoster immune globulin for pregnant women exposed to varicella.

Other live attenuated vaccines

The use of other live attenuated vaccines during pregnancy must be evaluated on the basis of the individual risk and benefit. Live attenuated oral typhoid vaccine is contraindicated in pregnancy because of the lack of data on safety or efficacy; inactivated typhoid vaccine should be used if indicated. Live attenuated intranasal influenza vaccine should not be given to pregnant women; inactivated influenza vaccine should be used if indicated. Live oral polio vaccine (OPV) should not be administered to pregnant women; inactivated polio vaccine should be used if indicated. In addition, OPV is not available in Canada. BCG vaccine has not been studied in pregnant or breastfeeding women. BCG vaccine should not be given during pregnancy although no harmful effects of BCG vaccination on the fetus have been observed.

If a pregnant woman must travel to an area at high risk of yellow fever transmission and a high level of mosquito protection is not feasible, yellow fever (YF) vaccine may be administered when the risk of exposure is high and the travel cannot be postponed. In one study of women given YF vaccine early in pregnancy, there was slight increased risk of minor malformations (mainly skin) in the babies; no increased risk of major malformations was found. Since seroconversion rates following YF vaccine are lower during pregnancy; post-immunization serology should be considered. Inadvertent immunization with YF vaccine is not a reason for pregnancy termination.

Smallpox vaccine may be considered for a pregnant woman in the highly unlikely event of a high risk exposure.

Refer to vaccine specific chapters in Part 4 for additional information.

Live attenuated vaccines and Rh immune globulin

A risk-benefit assessment is needed for post-partum women who have received RhIg and require MMR or varicella vaccine. Immune globulin administration may impair the efficacy of live attenuated vaccines, such as MMR and varicella, as measles, rubella, and varicella antibodies may be present in the RhIg preparation. The risk of lowered vaccine efficacy in the long term needs to be weighed against the need for protection in the short-term. To optimize response to vaccine, rubella-, measles- or varicella-susceptible women who receive RhIg in the peri-partum period should generally wait 3 months before being vaccinated with MMR or varicella vaccine.

However, if there is a risk of exposure to rubella, measles, or varicella, a risk of recurrent pregnancy in the 3-month post-partum period, or a risk that vaccines may not be given later, MMR, univalent varicella vaccines or both may be given prior to discharge with a second dose at the recommended interval if indicated. If only one dose is needed, serologic testing for rubella and varicella should be done 3 months later and women who have not mounted an antibody response should be revaccinated. In the event that a post-partum woman receives MMR or varicella vaccines prior to receiving RhIg and a second dose is not indicated, serologic testing for rubella, varicella or both should be done 3 months later and the woman revaccinated if she has not mounted an antibody response.

Biologic products during pregnancy

There is no known risk to the fetus or pregnant woman from administration of immune globulin for passive immunization. Immune globulin products should be administered to pregnant women as required.

In general, women should not receive immune modulators, such as infliximab or rituximab, during pregnancy. IgG immunoglobulins are known to pass the placental barrier and there is a risk that this treatment could deplete B-cells in both pregnant women and their fetus. It is particularly important not to administer live vaccines to pregnant women who receive monoclonal antibodies, such as TNF inhibitors. Refer to Immunization of breastfed infants for additional implications for the infant.

In general, women should not receive immune modulators, such as infliximab or rituximab, during pregnancy. IgG immunoglobulins are known to pass the placental barrier and there is a risk that this treatment could deplete B-cells in both pregnant women and their fetus. It is particularly important not to administer live vaccines to pregnant women who receive monoclonal antibodies, such as TFN inhibitors. Refer to Immunization of breastfed infants for additional implications for the infant.
 
Immunization of Household Contacts of Pregnant Women

A pregnant household member is not a contraindication for routine vaccination of her household contacts. On the contrary, pregnancy should be used as an opportunity to update immunization of susceptible household contacts. MMR and varicella-containing vaccines should be administered when indicated to children and other household contacts of pregnant women. Infants living in households with a pregnant woman can be vaccinated with rotavirus vaccine, as indicated. The risk of infection and disease from rotavirus vaccine virus is low because most women of childbearing age have pre-existing immunity to rotavirus through natural exposure and rotavirus infection during pregnancy is not known to pose a risk to the fetus.

In the unlikely event of vaccination against smallpox, extreme precautions should be taken for unvaccinated pregnant household and other close contacts of persons receiving smallpox vaccine to eliminate viral transfer to these contacts. Such precaution can include isolation of the vaccinee from his or her pregnant household contacts until the vaccine scab falls off.
 
Immunization during Breastfeeding (refer to Table 1)

Immunization of breastfeeding women

In general, routinely recommended vaccines may be safely administered to breastfeeding women. There are limited data available regarding the effects of maternal vaccination on breastfed infants; however, there have been no reported adverse events thought to be vaccine-related. There is no evidence that immunization during breastfeeding will adversely influence the maternal or infant immune response.

Annual influenza vaccination is recommended for breastfeeding women. Live attenuated influenza vaccine has a similar or lower immune response than inactivated influenza vaccine in adults; inactivated vaccine is preferred if the breastfeeding woman has a chronic health condition.

Women who are breastfeeding can be vaccinated with Td, Tdap, pneumococcal, meningococcal, hepatitis A, hepatitis B, IPV, rabies, typhoid, MMR, varicella and cholera vaccines, if they are indicated. HPV vaccine may be administered to breastfeeding women.

Japanese encephalitis (JE) vaccine has not been studied in breastfeeding women. Administration of JE vaccine to breastfeeding women who must travel to areas where the risk of JE infection is high should be immunized only if the risk of disease outweighs the unknown risk of vaccination to the woman and her breastfeeding infant.

There are a few instances when vaccination is not recommended during breastfeeding. Probable transmission of yellow fever vaccine strain virus from a mother to her infant through breastfeeding has been reported; therefore, breastfeeding mothers should not generally be vaccinated with yellow fever vaccine , unless potential benefits outweigh risks, such as travel to areas in which the risk of transmission is high and mosquito protection is not feasible. It is not known whether BCG vaccine is excreted in human milk. Because live vaccine may be excreted in human milk, caution should be exercised when considering BCG vaccine while breastfeeding. Smallpox vaccine is not recommended for breastfeeding women because of the theoretical risk for contact transmission from mother to infant. If smallpox vaccine is used for any reason in a breastfeeding woman, breastfeeding and other close contact with the baby should be avoided until the scab has separated from the vaccination site.

Refer to vaccine specific chapters in Part 4 for additional information.

Immunization of breastfed infants

In general, infants who are breastfed should receive all recommended vaccines according to the routine immunization schedule. In developed countries, there is no evidence that transfer of antibodies in human milk can affect the efficacy of live attenuated vaccines in breastfed infants.

The one exception to this recommendation is for breastfeeding women who are receiving immunosuppressive monoclonal antibodies (such as infliximab or rituximab), or who were on these drugs during pregnancy. Because monoclonal antibodies are excreted in human milk, women should be advised to discontinue nursing until circulating drug levels are no longer detectable. Infants who have been exposed to monoclonal antibodies, either during pregnancy or from breastfeeding, should not receive BCG vaccine at birth and should have B cell enumeration. B cell enumeration should be normal before vaccination with BCG or live vaccines. Consultation with an immunologist is advised.

Refer to Immunization of Immunocompromised Persons in Part 3 for additional information regarding monoclonal antibodies and immunization.
 
中文翻译：
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原文出处：http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-04-eng.php 收起阅读 »

一年之计在于春，一天之计在早餐。早餐是一天之中的第一顿饭，也是最重要的一餐。但大家往往忽视早餐问题。

不吃早餐的N个理由

1、认识不到位

有些学生和家长认为，早餐吃不吃无所谓，不吃早餐或早餐吃得不好可以从午餐或晚餐中得到补充。

2、没有时间

现代生活节奏加快，工作和学习的负担很重，人们养成了晚睡晚起的作息习惯，过着“早餐马虎、午餐凑合、晚餐丰富”的生活方式，这种不健康的生活方式也影响到孩子。
 
3、没有胃口吃

确实，晚上学习到深夜，早餐不愿意起床，为了多睡一会儿，所以，根本就没有留出吃早餐的时间。急急匆匆起床后，人体的各个系统还没有完全运转起来，当然也没有胃口享受早餐啦！

4、控制体重

有些人认为，不吃早餐可以控制体重。其实，这是没有根据的。

不吃早餐的危害

1、营养摄入不足

不吃早餐，全天的能量和营养素摄入不足，导致蛋白质、钙、铁、锌、维生素A等营养素不足，出现营养缺乏症、缺铁性贫血等，甚至导致严重的营养不良。
 
2、影响学习工作效率

国内外的研究证实，不吃早餐和早餐质量不好的学生，上午第1、2节课就出现精力不集中、疲劳、思考问题不积极，第3、4节课时以上现象更加明显，不吃早餐或早餐吃得不好的同学中有1/3的人文化课不及格；早餐吃得好的学生，则精力充沛，思考积极，文化课不及格的比例明显比不吃早餐和早餐吃得不好的人低。

大脑能够利用的唯一能源是血中的葡萄糖，不吃早餐或早餐吃得不足的学生血糖水平相对较低，不能及时为大脑的正常工作提供充足的能源物质，从而影响学习成绩；另外，由于不吃早餐或早餐吃得不足，未到中午就饥肠辘辘，机体因为能量和某些营养素不足，产生应激反应而导致大脑的兴奋性降低，出现心慌、乏力、注意力不集中，使工作和学习效率大大降低，从而影响学习成绩。

3、增加患肥胖的危险

每周偶尔吃1次早餐的儿童青少年的肥胖率为18.6%，每周吃2-4次早餐的儿童青少年的肥胖率为13.5%，而每周至少吃5次早餐的儿童青少年的肥胖率为11.8%，尤其是不吃早餐或每周只吃1次早餐的男孩，其肥胖率高达24.3%。

不吃早餐，到吃午餐时饥肠漉漉，饥不择食，不知不觉吃下去过多的食物引起能量摄入过多，从而在体内转化为脂肪蓄积引起，也可能与其他肥胖相关因素有关所致。

每天吃早餐是健康的生活方式
 
1、四类食物

早餐提供的能量应占全天总能量的25-30％，原则是“营养全面、均衡”。要有谷类食物、动物性食物、奶类或奶制品，还要有蔬菜水果。一份营养质量好的早餐应该包括以上4 类食物，各类食物的量可因人而宜。

2、早餐晚做

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。

3、家人进餐

家长的言传身教对孩子饮食行为的形成起着重要的作用。调查发现，孩子吃早餐的频率与家长每周吃早餐的次数联系密切，家长吃早餐的频率越高，其孩子吃早餐的频率也越高。

在为孩子准备早餐的同时，父母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。
 
让我们一生的健康之计开始于每天的营养早餐吧！
 
本文地址：http://www.wjbb.com/know/1042
原文出处：http://weibo.com/p/2304185d5947690102w4qi 收起阅读 »

孕期，为撒要让性走开？！热爱八卦的人一定记得某明星在LP怀BB期间出轨，被万人唾骂，还要当众道歉的糗事吧！这么干的男人肯定不止他一个，只不过刚巧他被抓而已。很多男人一定会表示自己的无奈：因为太太有孕所以不得近身啊！要熬九个多月真的很难啊！切！拜托！以后不要拿这么“无知”的理由来搪塞好吧？怀孕期间是可以有性生活的！

对！你没看错，怀孕期间是可以AA的！我知道一定会有很多大姑大姨跳出来say NO NO NO! 我们还是来盘点下正方反方的理由WHY?

最恐怖的理由——怀孕后同房会引起流产的！

真的还是假的？[可怜]绝大多数情况下是假的！大家一定都看过妇女之友Tony哥@ 段涛医生的关于流产的科普大作吧（没看过的赶紧去补！）基本精神如下：绝大多数流产是与胚胎质量相关的，不好的胚胎当然要流掉而不是留下；好的胚胎又跑又跳也不会掉，否则计划生育科就轻松多了。因此大家可以用脚趾头想一想，如果同房一次就要掉的胚胎，想来质量也不会好到哪里去！所以张家阿婆告诉你的那个同房一次就不幸流产的故事可能是真滴，但事情的真相是其实不同房也是会流产滴！

本着科学精神，必须强调我们现在讨论的是正常的妊娠情况，对于少数那些有过反复流产史，或者明确诊断前置胎盘的，或者已经有先兆流产现象的准妈妈来说应该让性事暂缓。

最正经的理由——孕期同房会增加感染风险导致早产！

也许是真的，虽然孕期在宫颈管内仍然存在粘液屏障保护宫内环境，但不洁性生活仍然有可能导致宫内感染，继而引起流产、早产。但是，确保自己干净才能同房是纯爷们应该有的道德品质啊！而且戴个质量好点的套子就能更大程度地保障AA的纯洁性了！顺便吐槽两句，中国爷们怎么大多不喜欢套子呢？这玩意又能避孕，又能防病，还能延长AA时间，这么多好处你们造吗？[偷笑]

最HIGH的理由——孕晚期性生活可以帮助催产！

真的！即使教科书上没有写（估计是不敢写）！因为AA会促进释放催产素，少量催产素可能会诱发宫缩。另外，精液中富含的天然前列腺素也可以帮助宫颈成熟，其实产科常用的催产药物之一就是前列腺素制剂。记得《Sex and City》里那位为了早点把孩子生出来而拖着男友每天AA的超女吗？当时我就想，这样的催产方式既安全又爽，不知是否能够在中国推广呢？

再次提醒，如果你有早产史，医生可能会建议你在孕期的最后3个月避免性生活，依据同上。

总之，在英国、美国和很多其他国家，医生们都认为在正常情况下怀孕期间是可以同房的。除了收入和工作量以外，中国医生已经和国际很接轨了，所以我们也认为在怀孕期间是可以同房的，而且为了更好地稳固亲密关系，维持家庭稳定，正常的妊娠情况下应该保持一定频度的性生活，既能减少准妈妈担忧LG出轨的焦虑，也能缓解准爸爸的难言之苦，而且AA带来的愉悦心情可以说是宝宝很好的胎教。对于那些有过不良产史而且医嘱不能性生活的夫妇来说，其他的亲密行为如亲吻、抚摸或者帮助打飞机其实都是可以的，不是条条大路通罗马吗?[酷]
 
本文地址：http://www.wjbb.com/know/1041
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美国胸科协会第9版指南指出，所谓经济舱综合征是myth流言，坐经济舱跟头等舱导致的深静脉血栓几率无差别。最危险的座位是靠窗的座位，深静脉血栓风险增高近2倍（通常难以活动）。少喝水或喝少量酒都不增加风险，关键是活动。这些人更要注意：服避孕药的女性；70岁以上；烟民；癌症患者；肥胖等。建议6小时以上旅途的，尽量靠走廊坐。
 
6.0 长途旅行者

6.1.1 对容易增加静脉血栓栓塞症风险的长途旅行者（包括有过静脉血栓栓塞史、近期手术或外伤、恶性肿瘤、怀孕、使用了雌激素、高龄、行动不便、严重肥胖、以及患有已知的血栓形成倾向障碍），我们建议其经常活动，锻炼小腿肌肉，如有可能则坐过道的位置（2C等级）。

6.1.2 对容易增加静脉血栓栓塞症风险的长途旅行者（包括有过静脉血栓栓塞史、近期手术或外伤、恶性肿瘤、怀孕、使用了雌激素、高龄、行动不便、严重肥胖、以及患有已知的血栓形成倾向障碍），我们建议在旅途中穿戴合适的膝下GCS（GCS-GRADUATED COMPRESSION STOCKING：逐级加压弹力袜），为踝部提供15-30mm Hg的压力。对其他所有长途旅行者，我们不推荐使用GCS（2C等级）。

6.1.3 对长途旅行者，我们不推荐使用阿司匹林或抗凝剂来预防静脉血栓栓塞症（2C等级）。

中文翻译：晴天绿海
本文地址：http://www.wjbb.com/know/1040
原文出处：http://journal.publications.chestnet.org/article.aspx?articleid=1159399 收起阅读 »

我们经常食用的蔬菜种类有很多，它们的颜色不一样，有的颜色深，有的颜色浅，颜色不同的蔬菜营养也不同。

根据颜色深浅可以把蔬菜分为深色蔬菜和浅色蔬菜两大类。一般来说，深色蔬菜中营养物质的含量要多于浅色蔬菜，深色蔬菜中胡萝卜素、核黄素和维生素C的含量较浅色蔬菜高，而且含有更多的植物化学物。
 
深色蔬菜是指深绿色、红色、桔红色、紫红色蔬菜，富含胡萝卜素尤其β-胡萝卜素，这是我国居民维生素A的主要来源。深色蔬菜还含有多种色素，如叶绿素、叶黄素、番茄红素、花青素等，以及芳香物质，丰富的活性色素赋予蔬菜特殊的色彩、风味和香气，有促进食欲的作用，并呈现一些特殊的生理活性。

深色蔬菜一般与阳光接触的时间更长，并且主要以叶类为主，膳食纤维的含量比浅色蔬菜要高，常吃有助于促进胃肠蠕动，预防疾病，促进健康。

常见的深绿色蔬菜：菠菜、油菜、芹菜、空心菜、茼蒿、韭菜等。

常见的红色、桔红色蔬菜：西红柿、胡萝卜、南瓜、红辣椒等。

常见的紫红色蔬菜：红苋菜、紫甘蓝等。
 
从营养学角度来说，各类蔬菜都应当吃，深色蔬菜的量最好能占到每天蔬菜量的一半，同时注意不要忽视浅色蔬菜，选蔬菜时也要品种多样，这样营养可以相互补充。

在蔬菜的加工、烹调过程中，如果方法不正确，会引起营养素的过多丢失。所以：

1、 应该先把蔬菜洗好后再切；

2、 炒蔬菜时，用急火快炒；

3、 做汤时，等水开后再下锅；

4、 不要把蔬菜炒或煮老了。
 
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血糖高的准妈妈们，合理控制体重是您一生的任务！《Diabetologia》期刊近期发表研究指出，曾患有妊娠性糖尿病的肥胖女性，如果产后体重增加，将会大幅加大其患二型糖尿病的风险。

标题：2型糖尿病的长期风险与BMI指数以及有妊娠糖尿病史的妇女其体重变化的关系：一项前瞻性队列研究

摘要

目标/假设： 建议有妊娠糖尿病史（GDM）的妇女产后要控制体重。本次研究的目的是检验肥胖症及体重变化如何影响有妊娠糖尿病史的妇女患2型糖尿病的长期风险。

方法： 我们从“肥胖与妇女健康研究”中选择了1991年至2001年间患有妊娠糖尿病的1,695名妇女作为研究对象，对其进行随访至2009年。每2年报告一次体重及2型糖尿病的发病率。我们把报告妊娠糖尿病病例的问卷调查时间作为基准。使用Cox比例风险模型预测风险比（HRs）及95%可信区间（95% CIs）。
 
结果：我们记录了259例18岁及以上的患有2型糖尿病的病例。参照基准BMI，BMI每增加1 kg/m2，2型糖尿病的校正风险比为1.16 (95% CI 1.12, 1.19)；参照最近的BMI，BMI每增加1 kg/m2，2型糖尿病的校正风险比为1.16 (95% CI 1.13, 1.20)。同时，对于妊娠糖尿病患者，体重每增长5Kg，2型糖尿病的患病风险就增加27%，(校正HR 为1.27；95%CI 1.04, 1.54)。与基准水平上BMI<25.0Kg/m2，并且体重增加不超过5Kg的患妊娠糖尿病的妇女相比，在基准水平上BMI≥30.0 Kg/m2并且体重增加大于等于5Kg的患妊娠糖尿病的妇女的校正HR为43.19 (95% CI 13.60, 137.11)。

结论/解释： 基准BMI，最近BMI以及产后妊娠糖尿病患者的体重变化与妊娠糖尿病向2型糖尿病转化的风险有显著的正相关。

关键词： BMI， 妊娠糖尿病， 2型糖尿病， 体重变化

中文翻译：@乐山乐水
本文地址：http://www.wjbb.com/know/1038
原文出处：http://www.diabetologia-journal.org/files/Bao2.zip 收起阅读 »

各位童鞋们，尤其是准妈妈们，关了电视放下手机去散步吧！《Diabetologia》期刊近期发表研究指出，每天看电视的时间越长，患糖尿病的风险就越高。

The impact of lifestyle intervention on sedentary time in individuals at high risk of diabetes

Abstract

Aims/hypothesis The Diabetes Prevention Program (DPP) lifestyle intervention successfully achieved its goal of increasing leisure physical activity levels. This current study examines whether the lifestyle intervention also changed time spent being sedentary and the impact of sedentary time on diabetes development in this cohort.

Methods 3,232 DPP participants provided baseline data.Sedentary behaviour was assessed via an intervieweradministered questionnaire and reported as time spent watching television specifically (or combined with sitting at work). Mean change in sedentary time was examined using repeated measures ANCOVA. The relationship between sedentary time and diabetes incidence was determined using Cox
proportional hazards models.

Results During the DPP follow-up (mean: 3.2 years), sedentary time declined more in the lifestyle than the metformin or placebo participants ( p<0.05). For the lifestyle group, the decrease in reported mean television watching time (22 [95% CI 26, 17] min/day) was greater than in the metformin or placebo
groups ( p<0.001). Combining all participants together, there was a significantly increased risk of developing diabetes with increased television watching (3.4% per hour spent watching television), after controlling for age, sex, treatment arm and leisure physical activity ( p<0.01), which was attenuated when time-dependent weight was added to the model.

Conclusions/interpretation In the DPP, the lifestyle intervention was effective at reducing sedentary time, which was not a primary goal. In addition, in all treatment arms, individuals with lower levels of sedentary time had a lower risk of developing diabetes. Future lifestyle intervention programmes should emphasise reducing television watching and other sedentary behaviours in addition to increasing physical activity.

Trial registration: ClinicalTrials.gov NCT00004992

Keywords Diabetes Prevention Program . Sedentary behaviour . Television watching . Type 2 diabetes

中文翻译：xiaoyie0504
本文地址：http://www.wjbb.com/know/1037
原文出处：http://www.diabetologia-journal.org/files/Rockette-Wagner.zip 收起阅读 »