聯合新聞網 2012/07/07 陳冲說，醫療資源不當浪費，嚴重影響健保成敗，「如果我們不拿出決心，就健保支出面作適當的調整，例如，考慮小病健保不予涵蓋等想法。」如果不建立這種觀念，很難根本解決健保的問題... 【聯合報╱記者李順德、詹建富／台北報導】 行政院長陳冲向衛生署長邱文達透露一個構想：未來小病可能不再納入健保給付範圍。陳冲說，他最近看到ＣＮＮ報導，美國人平均一年上醫院四次，台灣人卻多達十四次；究竟是台灣人身體特別差，還是把上醫院當成生活的一部分？陳冲說，醫療資源不當浪費，嚴重影響健保成敗，「如果我們不拿出決心，就健保支出面作適當的調整，例如，考慮小病健保不予涵蓋等想法。」如果不建立這種觀念，很難根本解決健保的問題。 陳冲日前聽取邱文達所提醫療照護產業（健康照護升值白金方案）的專案報告，作了上述表示。 他表示，醫院的內、外、婦、兒科及急診室「五大皆空」的現象亟待解決。醫院的五大皆空，指的是包括醫療糾紛訴訟及暴力威脅大增，加上超時工作、薪資低等問題，引發醫護人力嚴重不足危機。 陳冲說，二代健保修法處理了收入面問題，但支出面會引導醫療行為，也影響五大科醫師人力的投入，更值得重視；未來應考慮健保制度及醫療法的檢討。 衛生署長邱文達表示，已逐步執行「提升五大科及偏鄉醫療十二大策略」，包括評鑑項目減少、生育事故救濟上路、推動醫療過失刑責明確及合理化、提供五大科住院醫師補貼，及挹注五大科偏遠地區醫療。 衛生署也將提「三年三百億醫療改革計畫」，於近期召開「全國醫療改革高峰會議」，希望將五大科問題，在三年內作一次大幅改革。
Thursday, July 12, 2012
Newly isolated 'beige fat' cells could help fight obesity
July 12, 2012 in Medical research Dana-Farber Cancer Institute researcher Dr. Bruce Spiegelman has isolated a new type of energy-burning fat cell in adult humans which may have therapeutic potential for treating obesity. Credit: Dana-Farber Cancer Institute Scientists at Dana-Farber Cancer Institute have isolated a new type of energy-burning fat cell in adult humans which they say may have therapeutic potential for treating obesity. Called "beige fat," the cells are found in scattered pea-sized deposits beneath the skin near the collarbone and along the spine in adult humans. Because this type of fat can burn off calories – rather than store them, as "white fat" cells do – beige fat cells might spawn new therapies for obesity and diabetes, according to researchers led by Bruce Spiegelman, PhD, of Dana-Farber. Spiegelman is the senior author of a report scheduled for advance online publication on July 12 by the journal Cell. The print issue of Cell will publish on July 20. The study found that beige fat is genetically distinct from "brown fat," which also burns calories to generate heat. Brown fat is found in small mammals and human infants, where it protects against harm from cold. White fat, on the other hand, stores calories, and excess white fat contributes to obesity. An interview with author Bruce Spiegelman from Harvard Medical School regarding a paper publishing in Cell, "Beige Adipocytes are a Distinct Type of Thermogenic Fat Cell in Mouse and Human." Existence of this third type of fat (in addition to white and brown) had been proposed in a paper by Spiegelman's lab in 2008, but the Dana-Farber team is the first to isolate them and to determine their unique genetic profile. In the new report, Spiegelman's team, led by first author, Jun Wu, PhD, also found that beige cells are specifically targeted by the hormone irisin, which muscle cells express during exercise. In 2009, three research groups reported that the deposits found in adult humans contained brown fat, but the new research has identified them as beige fat by their genetic makeup. "Going forward, it means that what you want to study for potential therapies are the beige fat cells in these 'hotspots' we're all walking around with," said Spiegelman. Even in small amounts, brown and beige fat can burn large amounts of calories. "The therapeutic potential of both kinds of brown fat cells is clear," the authors write in the Cell article, "as genetic manipulations in mice that create more brown or beige fat have strong anti-obesity and anti-diabetic actions." Researchers are already seeking ways to exploit human brown fat for human benefits. Both types of fat contain energy-burning organelles called mitochondria, which contain iron and are the cause of the brown and beige hues. A key difference is that brown fat cells express high levels of UCP1 – a protein required by mitochondria to burn calories and generate heat – while beige cells normally express low levels of it. Beige cells can, however, turn on high levels of UCP1 in response to cold or certain hormones like irisin, enabling beige fat to burn calories nearly as effectively as brown fat. Spiegelman has published a series of discoveries about the different fat cell types. Brown fat cells, he found, are born from stem cells precursors that also produce muscle cells. Beige fat, however, forms within deposits of white fat cells from beige cell precursors. Earlier this year, he reported the discovery of irisin, produced by muscular exercise, and which can convert white fat to brown fat. In the new Cell report, Spiegelman says that irisin specifically stimulates white fat to produce beige fate. Dana-Farber has licensed both discoveries to Ember Therapeutics, a biotech company founded by Spiegelman, which plans to develop irisin as a therapy for obesity and diabetes. In addition to Spiegelman and Wu, authors include researchers from, Maastricht University Medical Center in the Netherlands, Goteborg University in Sweden, and the University of Turku in Finland. More information: Wu et al.: "Beige Adipocytes are a Distinct Type of Thermogenic Fat Cell in Mouse and Human." DOI:10.1016/j.cell.2012.05.016 Journal reference: Cell Provided by Dana-Farber Cancer Institute
Erectile dysfunction prevalence higher in HIV-infected men
July 12, 2012 in HIV & AIDS HIV infection in men is a strong, independent predictor of erectile dysfunction, regardless of age and body mass index, according to a study published in the July issue of The Journal of Sexual Medicine. (HealthDay) -- HIV infection in men is a strong, independent predictor of erectile dysfunction (ED), regardless of age and body mass index (BMI), according to a study published in the July issue of The Journal of Sexual Medicine. Stefano Zona, M.D., of the University of Modena and Reggio Emilia in Italy, and associates compared the prevalence of ED among young to middle-aged HIV-infected (444) and HIV-uninfected (71) men. ED was assessed using the International Index of Erectile Function questionnaire. Participants' serum testosterone; demographic characteristics; and their age, weight, height, and BMI were obtained. The researchers found that, compared with HIV-uninfected men, HIV-infected men of all decades of age had a higher prevalence of mild, moderate, and severe ED. HIV infection correlated significantly with ED in univariate analysis (odds ratio, 34.19) and remained the strongest predictor of ED in multivariate analysis (odds ratio, 42.26), after adjustment for age and BMI. "This study shows an increased ED prevalence in HIV-infected individuals and suggests that this condition is intrinsic in the clinical presentation of HIV infection," the authors write. "The onset of ED seems to occur earlier in HIV-infected men than in HIV-uninfected men, an aspect of clinical relevance when managing these patients." More information: Abstract Full Text (subscription or payment may be required) Journal reference: Journal of Sexual Medicine
Meditation Method a Matter of Taste
By Mary Elizabeth Dallas Friday, July 6, 2012 FRIDAY, July 6 (HealthDay News) -- People who want to learn to meditate should select a method that makes them feel comfortable, rather than choose a technique just because it's popular, a new study indicates. Researchers from San Francisco State University report that by finding a form of meditation that works for them, people are less likely to quit. As a result, they will enjoy the personal and medical benefits of the practice, including reduced stress, lower blood pressure and help with addiction. "Because of the increase in both general and clinical use of meditation, you want to make sure you're finding the right method," study author Adam Burke, professor of health education at San Francisco State and director of its Institute for Holistic Health Studies, said in a university news release. In conducting the study, the researchers compared nearly 250 user opinions on four popular meditation methods: Mantra, Mindfulness, Zen and Qigong Visualization. The participants were taught each method and asked to practice at home. At the end of the study, they were asked about their preferences for each technique. The two simpler methods, Mantra and Mindfulness, were preferred by 31 percent of the participants. Twenty-two percent chose Zen and 15 percent said they preferred Qigong. The study authors said their findings show that people new to meditation would benefit from a simpler and more accessible practice. They noted, however, that there is not one technique that is best for everyone. "It was interesting that Mantra and Mindfulness were found to be equally compelling by participants despite the fact that they are fundamentally different techniques," Burke said. Mindfulness recently gained widespread popularity, and is usually the only form of meditation someone new to meditation knows about, he added. "If someone is exposed to a particular technique through the media or a health care provider, they might assume because it's popular it's the best for everyone," Burke said. "But that's like saying because a pink dress or a blue sport coat is popular this year, it's going to look good on everybody." The study authors said more research is needed to determine if certain meditation methods are better at helping to treat specific health issues, such as addiction. They added that more studies also are needed to explore if there are ways to predict which method of meditation a person should practice. The study was published online July 7 in EXPLORE: The Journal of Science and Healing. SOURCE: San Francisco State University, news release, July 6, 2012 HealthDay
In the end, it may not be about medicine Monday
, July 9, 2012 By Frederik Joelving NEW YORK (Reuters Health) - For cancer patients, a good death may have more to do with simple human values than with the latest medical treatments, a new study suggests. People who got treatment at intensive care units (ICU) or died in the hospital, for example, were more nervous and burdened by their symptoms in the week before they died than were other patients. By contrast, those who prayed or meditated, were visited by a pastor or had a good rapport with their doctor had a higher quality of life, as judged by family members or another caregiver. "The good news is that these are modifiable factors and not hugely expensive," said Holly G. Prigerson of the Dana-Farber Cancer Institute and the Harvard Medical School in Boston. "Maybe the best medicine for patients who are dying is developing a therapeutic alliance between doctors and patients - that is, an emotional connection, a feeling that there are shared goals," added Prigerson, who led the study. The new work adds to a growing body of evidence suggesting that potent drugs and aggressive medical care may end up doing more harm than good for patients with only months left to live. And it's the first study to take a stab at what makes for a good death - or, as the researchers say, the highest quality of life at the end of life. "I think we as a society are grappling with this issue of 'what is a good death?'" said Dr. Michele Evans, an oncologist at the National Institute on Aging in Baltimore, who co-wrote a commentary on the new findings, which were published Monday in the Archives of Internal Medicine.
"This paper starts that conversation," she told Reuters Health. Prigerson and her colleagues used data from a government-funded study called Coping With Cancer, which followed nearly 400 terminally ill cancer patients from across the U.S. Most were white and Christian, and their average age was 59. The patients were interviewed when they entered the study and they also completed a questionnaire about their relationship with their physician - including whether they trusted their doctors and felt they were being treated as a whole person. Their caregivers also were interviewed at the outset and again after the death of the patient - on average four months after enrolment in the study. Based on the caregivers' assessment of each patient's quality of life during their last week, the researchers then created statistical models to see what factors mattered most. (The caregiver's rating of quality of life, on a scale from 0 to 30, corresponded well with the patient's own assessment at the beginning of the study.) Ending their lives at a hospital or in the ICU was tied to a lower quality of life during the patients' last week, as was having a feeding tube or getting chemotherapy. The same was true for worry at the outset of the study. Religious activities like praying or meditating, however, were linked to a higher quality of life at the end, as were pastoral care and a sense of "therapeutic alliance." But there are caveats, said Alan Zonderman, a psychologist at the National Institute on Aging, who co-wrote the commentary on the study. The results can't tease out which factors were responsible by themselves for patients' quality of life toward the end. And the researchers were only able to explain a limited portion of what matters for an individual's wellbeing during his or her last days. Still, Zonderman told Reuters Health, "We can now say that there is evidence that a therapeutic alliance and the effort that goes into building it… that it's really a worthwhile thing to do and it does make a difference." Evans and Zonderman agreed that planning ahead and making sure doctors know a patient's preferences are important. "We have to identify when care is futile and when we move into a palliative mode," said Evans. "So many times we wait until the last minute." SOURCE: http://bit.ly/NW0TQd Archives of Internal Medicine, online July 9, 2012. Reuters Health
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