關於 chronic disease population ，我們在網路上蒐集到這些相關的討論、資訊與評價

如果你的親友有糖尿病，你就該看看這個！

甚麼是糖尿病腎病變?
因為許多原因讓腎絲球壓力過高造成受損，
白蛋白漏出腎絲球出現在尿中，
臨床上出現這些狀況會被診斷為「糖尿病腎病變」喔：

1.糖尿病多年，發現有中度蛋白尿
2.糖尿病多年，有蛋白尿與視網膜病變
3.糖尿病多年，腎功能明顯下降且有嚴重蛋白尿

洗腎透析患者當中，有一半以上是糖尿病腎病變（DN）
控制方法包括控制血壓、血糖、降低脂質和改變生活方式，
限制鹽和蛋白攝取，可以減緩病程的加速！

但仍有需多症狀如瘙癢、疲勞、抑鬱、焦慮、尿毒症瘀傷會影響生活品質。

如果你的親友有這些問題，可以考慮「中西共治」！

研究發現，中西醫會診治療腎病可延緩進入洗腎時間，
改善水腫、疼痛、失眠，皮膚搔癢等，提升患者生活品質喔！

那些研究?
1.Traditional Chinese medicine use is associated with lower end-stage renal disease and mortality rates among patients with diabetic nephropathy: a population-based cohort study.BMC Complement Altern Med (2019)

2. Chinese Herbal Medicine Improves the Long-Term Survival Rate of Patients With Chronic Kidney Disease in Taiwan: A Nationwide Retrospective Population-Based Cohort Study.Frontiers in pharmacology (2018)

研究提供了證據，中醫可作為糖尿病腎病患者的輔助治療選擇，
最後，
拒絕坊間不實廣告藥品、拒絕相信民間偏方，
找合格專業的醫治療，才是根本之道唷！

#中醫養生 #中醫 #中醫師 #中藥 #保健 #健康 #養生 #飲食 #針灸 #acupuncture #healthylifestyle #health #chinesemedicine #likeforlike #糖尿病 #糖尿病腎病變

酒糟是慢性皮膚發炎疾病，最近有不少文獻探討酒糟跟心血管、消化道、神經系統、自體免疫疾病，還有精神問題有關，甚至有研究認為酒糟越嚴重，跟那些系統性疾病的關聯性越大，但目前仍未有定論。

2015年台灣研究指出，跟酒糟病人顯著有關的心血管問題是血脂異常、冠狀動脈心臟病跟高血壓。去除高血壓、血脂異常、糖尿病因素後，發現冠心症是獨立跟酒糟相關的疾病，而且男性的酒糟患者比女性患者有更高機率合併這些系統性疾病。

後來在一個大規模的研究中發現，最常見跟酒糟有關的問題是憂鬱，再來依序為高血壓、心血管疾病、焦慮症、血脂異常、糖尿病、偏頭痛、類風濕性關節炎、幽門桿菌、潰瘍性結腸炎等等。至於精神問題中的憂慮跟焦慮在酒糟病人最常見，推論可能跟有同樣的發炎機轉有關。心血管疾病中，則以冠狀動脈心臟病跟酒糟病人最為相關，因此酒糟被認為是冠心症的獨立危險因子。然而，腸胃道疾病以目前的資料無法確切證實關聯性。

今年最新發表的一個統合性研究指出，在50442位酒糟病人中，有較高機率有血脂異常還有高血壓的情形，但並未發現跟缺血性心臟病、中風和糖尿病的關聯性。目前認為神經血管調節異常是酒糟跟高血壓的共同機轉，先前也有研究發現某些血壓藥可以舒緩酒糟症狀，或是讓酒糟變嚴重。如果酒糟病人罹患高血壓，首選降壓藥物會是carvedilol和spironolactone ; 降壓藥中的鈣離子阻斷劑會讓血管擴張，酒糟患者不宜使用。此外，酒糟病人的慢性發炎反應可能和血脂異常有關，因此有學者強烈建議若是酒糟病人同時有高血脂問題，首選藥物是statin類的藥，因為除了降血脂外，還有抗發炎的功效 ; 然而statin類的藥可否改善酒糟病人的皮膚症狀則有待更多研究。

那酒糟是癌症的危險因子嗎？西方國家的學者認為酒糟跟某些癌症的致病機轉有關，例如：非黑色素細胞癌的皮膚癌、甲狀腺癌、乳癌和肝癌，但以台灣今年發表的研究結果(65526位酒糟病人)看來，似乎沒找到酒糟跟特定癌症的相關性，或許跟不同種族的基因變異性有關。

整合以上文獻，台灣的酒糟患者在血壓、血脂和冠狀動脈心臟病方面似乎有多加注意的必要，當然其他系統問題也不能忽略。總之，美麗不只有外在的皮相，內在的健康也要多注意喔！

Ref :

1. Is rosacea a risk factor for cancer: A population-based cohort study in Taiwan. Dermatol Sin 2020;38:15-21.

2. Association Between Rosacea and Cardiometabolic Disease: A Systematic Review and Meta-Analysis. J Am Acad Dermatol. 2020 Apr 28;S0190-9622(20)30729-5.

3. Comorbidities in Rosacea: A Systematic Review and Update. J Am Acad Dermatol. 2018 Apr;78(4):786-792.e8.

4. Rosacea Is Associated With Chronic Systemic Diseases in a Skin Severity-Dependent Manner: Results of a Case-Control Study. J Am Acad Dermatol. 2015 Oct;73(4):604-8.

5. Cardiovascular Comorbidities in Patients With Rosacea: A Nationwide Case-Control Study From Taiwan. J Am Acad Dermatol. 2015 Aug;73(2):249-54

#酒糟

#共病症

#高血壓

#血脂異常

#冠狀動脈心臟病

#林政賢皮膚科

#從名畫看皮膚科

因為有不少朋友建議我，將日前臉書上“武漢肺炎發生率與致死率的國際比較”一文翻譯成英文，所以，就以英文版再次和大家分享，也謝謝大家的批評指教。

International Comparison of Incidence and Mortality Rates of COVID-19

In the statistics of the COVID-19 collected and published by the World Health Organization (WHO), only the numbers of confirmed cases and deaths of COVID-19 of affected countries are available, without taking the population of each country into consideration. It will result in a biased assessment of the COVID-19 risk for each country.
Better data for international comparison is incidence rates, which refer to the number of confirmed COVID-19 cases (numerator) divided by the number of the population (denominator) of a given country. As shown in Table 1. the incidence rate per 100,000 population was highest in Italy, Korean, Iran, and China (>5.0 per 100,000) and much lower in Japan, US and Taiwan (<0.5 per 100,000).



The number of confirmed COVID-19 cases in each country is not only related to its population but also dependent on the coverage rate of the COVID-19 virus test. The confirmed case number and incidence rate are relatively low for those countries where only the severe cases were tested for COVID-19 virus; and they are much higher for countries where severe, moderate and mild cases were tested for the virus.

Once a country changes its policy of virus testing, for example of testing only those who are seriously ill, the number of the confirmed cases and incidence rate will drop sharply in a short period of time, but its case fatality rate will rise accordingly.

The case fatality rate is the proportion (percentage) of confirmed COVID-19 cases who died from the disease. Its numerator is the number of confirmed cases who died from the disease, and its denominator is the total number of confirmed cases. It is for sure that the case fatality rate will be higher if the analysis is limited to severe cases, and it will drop dramatically if the analysis also includes moderate and mild cases.

As shown in Table 2, the case fatality rates are the same for severe (5%), moderate (0.5%) and mild (0.1%) COVID-19 confirmed cases in countries A, B, and C are the same, but
the overall case fatality rates per 1,000 confirmed cases are significantly different among the country A, where only test the severe cases (41 per 1,000), country B where both severe and moderate cases are tested (14 per 1,000), and country C where test all severe, moderate and mild cases (8 per 1,000).



Among the countries with more than 1,000 confirmed cases in Table 1, the overall case-fatality rates in Italy, China and Iran were all exceeded 3.5%. Obviously, the severe cases account for a relatively large proportion of confirmed cases. The overall case-fatality rate for South Korea and Germany was only 0.8% and 0.1%, respectively, where the moderate and mild cases account for a relatively large proportion.

When we see a rapid decline in the number of confirmed cases with a soared case fatality rate, we must first pay attention to the change in the country's virus testing strategy. The Director-General of WHO recently stated that all countries should be cautious for the case fatality rate of COVID-19 is rising! The conclusion that the Director-General was biasedly made without taking the change in the virus testing strategy into consideration. He made the matter worse by causing unnecessary panic!

In addition to the virus-detection strategy, some other factors such as age, chronic disease status, and quality of medical care also affect the case fatality rate. For examples, the fatality rate will be low if the patients in the hospital for isolation treatment are mostly young people, without chronic disease, and receiving good cares. If most patients are old, with chronic disease, and receiving inadequate cares due to limited hospital resources and manpower, the case fatality rate will become high.