Histamine Intolerance—The More We Know the Less We Know. A Review

The intake of food may be an initiator of adverse reactions. Food intolerance is an abnormal non-immunological response of the organism to the ingestion of food or its components in a dosage normally tolerated. Despite the fact that food intolerance is spread throughout the world, its diagnosing is still difficult. Histamine intolerance (HIT) is the term for that type of food intolerance which includes a set of undesirable reactions as a result of accumulated or ingested histamine. Manifestations may be caused by various pathophysiological mechanisms or a combination of them. The problem with a “diagnosis” of HIT is precisely the inconstancy and variety of the manifestations in the same individual following similar stimuli. The diagnosing of HIT therefore requires a complex time-demanding multidisciplinary approach, including the systematic elimination of disorders with a similar manifestation of symptoms. Among therapeutic approaches, the gold standard is a low-histamine diet. A good response to such a diet is considered to be confirmation of HIT. Alongside the dietary measures, DAO supplementation supporting the degradation of ingested histamine may be considered as subsidiary treatment for individuals with intestinal DAO deficiency. If antihistamines are indicated, the treatment should be conscious and time-limited, while 2nd or 3rd generation of H₁ antihistamines should take precedence.     

How Can We Attract More Doctors to the Country?

ABSTRACT: Drawing on findings from an extensive survey of rural general practitioners in Victoria, this article explores proposals for improving the recruitment, training and retention of rural doctors. The study which included metropolitan comparison groups achieved a 75 per cent response rate, providing information representative of most GPs in Victoria. Main barriers to entering rural practice identified by rural doctors were spouse problems; lack of skills; city background and training; ignorance of country practice; lack of self confidence; and inadequate remuneration. Negative attitudes towards the country and general practice plus 'learned helplessness' picked up in medical school were rated by rural doctors as being of significant importance. Of 14 suggestions for improving recruitment, training and retention of rural GPs the following were rated as top priority; substantial clinical experience in rural hospitals and practices; reciprocal links between the country and medical schools; extra financial reward for isolated rural practice; establishment of Rural Medical Education Centres; and a program to meet the needs of the rural practitioner's spouse.     

林永雄:设备采购,我们注重售后服务

2006年4月27日下午，由上海医疗器械专科学校友会和深圳迈瑞公司组织举办的珠江三角洲地区医院设备科长足球友谊赛在深圳梅岭足球场进行。绿茵场上，广州市第十二人民医院设备科林永雄科长的出色表现引起了记者的注意。比赛之后，本刊记者在驻地对林永雄科长进行了采访。[编者按]     

COVID-19 and Youth Substance Use: We Need More than Good Intentions

The Journal of Behavioral Health Services & Research -     

Not All Greenness Is the Same: Associations with Health Are More Nuanced than We Thought

Open in a separate window

A growing body of evidence indicates that exposure to urban greenspaces, especially treed areas, benefits the health of city dwellers.^1–4 Now, new research in Environmental Health Perspectives finds that when it comes to those benefits, not all trees are the same.⁵ Investigators at Katholieke Universiteit (KU) Leuven, Belgium, and Sciensano (the Belgian Institute of Health) assessed people’s exposures to urban greenspace in relation to sales of medications for cardiovascular disease and mood disorders. The presence of larger trees was associated with lower overall medication sales, suggesting these trees “are more beneficial with respect to heart disease and mental health than smaller trees,” says co–first author Dengkai Chi, a PhD candidate in bioscience engineering at KU Leuven.Prior studies relating urban greenspace to health have generally relied on two-dimensional (2D) remote sensing, which depicts tree canopy cover but not the features of individual trees, such as the size of their crowns (the leaf-sprouting branches).^6,7 That reliance limited the ability of those studies to characterize human exposures to trees.Open in a separate windowThe authors of the new study used airborne LiDAR to distinguish trees from grass, shrubs, and other vegetation, and to characterize both canopy size and density of trees. Images, left to right: © GrB/stock.adobe.com; © Brian Scantlebury/stock.adobe.com.To improve upon the exposure assessment, Chi et al. used 3D remote sensing data generated by airborne light detection and ranging (LiDAR) systems.⁵ LiDAR reliably distinguishes trees from other types of vegetation,⁸ and Chi’s team used it to measure arboreal traits, such as the number of trees per hectare (also known as stem density), tree height, and crown volume. The researchers focused on 604 census tracts in Brussels and surrounding areas. Tracts had an average of 11,616 inhabitants per hectare.Medication sales data for the census tracts were obtained from the Belgian social security agency, which manages health insurance reimbursements for most of the country’s population. The team limited its analysis to medications purchased by adults who were 19–64 years of age between 2006 and 2014.The team then modeled relationships between medication sales and tree traits in single- and two-factor models. They used single-factor models to evaluate the relationship between medication sales and individual tree traits—namely, stem density or crown volume. Using two-factor models, the team evaluated how sales varied in relation to tree density, crown volume, and other traits collectively.After adjusting for socioeconomic status (which also is associated with sales of drugs for heart disease⁹ and mood disorders¹⁰), the researchers observed a curious result. The single-factor models showed that each unit increase in stem density and crown volume corresponded to lower medication sales. However, the two-factor model that included both stem density and crown volume showed that medication sales were, again, lower in areas with greater crown volumes but higher with greater stem densities.What might explain the discrepancy? According to Chi, the results demonstrate that large trees are associated with greater health benefits than even dense stands of smaller trees. “Large trees are more effective at reducing environmental stressors like urban heat, air pollution, and noise than smaller trees,” she says. “That makes them very important for health in urban areas.”Matilda van den Bosch, a physician with a doctorate in landscape planning currently working at the Barcelona Institute for Global Health, says medication sales are a valid proxy for disease prevalence in the population. “This is an important paper that makes the case for preserving large trees in cities,” says van den Bosch, who was not involved in the study. “Humans evolved in the natural environment, and we know that exposure to nature can activate the parasympathetic nervous system in ways that facilitate recovery from stress.”^11–14Cecil Konijnendijk, a professor of urban forestry at the University of British Columbia and visiting professor at KU Leuven, agrees. “We need to be more tree-inclusive in terms of how we design and manage our cities,” says Konijnendijk, who also was not involved in the study. “People talk about large-scale planting, but we need to start by protecting what we have. This paper helps to provides the evidence for why we should do this.”Konijnendijk and van den Bosch both say there is a need to replicate the current findings with additional research using individual-level data. In future studies, Chi says she will use airborne LiDAR and hyperspectral images to quantify other arboreal traits, such as tree species diversity, in relation to human health. “We want to really explore the potential of using this kind of 3D high-resolution sensing data in our research,” she says.Raf Aerts, co–first author of the study, adds, “Ideally, we would also like to move from aggregated census-tract level data to longitudinal individual health and exposure data. A national, European, or global tree exposure cohort would be ideal to study health effects of trees in more detail.”What do such findings mean for people who live in places where green things cannot grow? Despite a dearth of relevant research in arid or polar regions, there is evidence that greenspaces introduced into such areas may have positive effects.^15,16 “Several cultures have indeed adapted to nongreen habitats,” says Aerts. “However, from an evolutionary point of view, humans are a species of tropical and subtropical forest and savanna habitats. So there is an intrinsic link between humans and greenspace.”     

没有泳衣时，我们就裸泳

此文是针对大学生就业所写,但本文的观点对于每个职场中人都是有益的. 即便失业离你还很遥远,即便金融危机还未波及你所在的行业,但我们不能否认,生活充满太多的变数,在危机没有到来之前,做好应对危机的准备,是有百利而无一害的,也免得困难真正来临时,自己沮丧、绝望.     

More Skin,More Sun,More Tan,More Melanoma

Although personal melanoma risk factors are well established, the contribution of socioeconomic factors, including clothing styles, social norms, medical paradigms, perceptions of tanned skin, economic trends, and travel patterns, to melanoma incidence has not been fully explored. We analyzed artwork, advertisements, fashion trends, and data regarding leisure-time activities to estimate historical changes in UV skin exposure. We used data from national cancer registries to compare melanoma incidence rates with estimated skin exposure and found that they rose in parallel. Although firm conclusions about melanoma causation cannot be made in an analysis such as this, we provide a cross-disciplinary, historical framework in which to consider public health and educational measures that may ultimately help reverse melanoma incidence trends.Despite advances in its detection and treatment, melanoma remains the primary cause of mortality from skin disease in the Western world.1,2 Improvements in the early detection of melanoma and changes in reporting practices contributed, in part, to the increase in melanoma incidence in recent decades; however, these factors alone cannot entirely account for the steady rise in tumor incidence and mortality observed during the 20th century. Several personal risk factors for developing melanoma are well established, including family history, multiple moles, fair skin, blue eyes, red hair, and freckles.3 Environmental exposures, chiefly from UV radiation, including outdoor sunburns and indoor tanning exposure, also have been associated with increased melanoma risk.4,5 On a population level, the contribution of changing socioeconomic factors is an intriguing variable that has not yet been fully explored, particularly the evolution of clothing styles, social norms, economic trends, available leisure time, and medical paradigms regarding UV radiation. We explore the historical relation between these factors and US melanoma incidence in the 20th century. Our goal is to illustrate how changes in fashion, perceptions of tanned skin, and socioeconomic factors have led to increased UV exposure and likely contributed to the escalation of melanoma in 20th-century America.We have divided the 20th century into 4 periods, each illustrating historical forces contributing to increases in societal exposure to UV radiation. To assess fashion and clothing trends, we reviewed artwork, consumer advertisements, and sources describing Sears department store clothing catalogs.6–9 We also studied historical events and publicly available data regarding Americans’ leisure time and participation in outdoor activities. In an effort to illustrate the association between changing clothing styles, skin exposure to UV radiation, and the increasing melanoma incidence, we estimated skin exposure with the “rule of nines,” a standardized system traditionally used to assess percentage of body surface affected by burns.10 We then examined the relation between skin exposure and melanoma incidence. Although they may not capture all regional, geographic, and individual subpopulation variations in UV exposure and cancer incidence rates, we used data from the Connecticut Tumor Registry,11,12 the oldest available US cancer registry, from its inception in 1935 to the present and the Surveillance Epidemiology and End Results (SEER) national cancer database, which incorporates population-level data from 9 to 17 different regions in the United States, depending on the time period analyzed.11,13,14 Because the average age at diagnosis of melanoma during these decades is 50 to 60 years and early-life UV exposure is known to contribute to subsequent melanoma development, we used a postexposure lag time of 50 to 60 years in our analysis. We also explored additional societal factors that (1) led to the dramatic shift in perception of tanned skin from unattractive to desirable, (2) compelled the public to continue tanning despite evidence of the carcinogenic effects of UV exposure, and (3) sustained the indoor tanning fad of the late 20th century.     

多歧路行路难

唐钢医院的一位大夫告诉记者,目前要把医院从集团剥离出来,表面上看,人员安置是最大障碍,实际上还是医改政策不成熟、不完备的问题。目前我国医疗卫生体制改革正在进行,城镇职工医疗保险制度改革还没有完全到位,一些地方卫生区域规划也没有能将所有的卫生资源(其中包括企业医院)进行统筹规划,客观上影响了企业医院分离的难度。