關於 still have some cough ，我們在網路上蒐集到這些相關的討論、資訊與評價

目前新冠肺炎疫苗在全球的施打已經超過一億劑，我們期待新冠肺炎病毒感染的速率持續的緩和，能讓世界各地的生活盡快恢復正常，然而國外也陸續傳來施打疫苗後產生不良反應的案例，針對接種疫苗的利弊風險，各國的政府和專案也開始有許多討論。

在台灣，AZ疫苗已經開打幾週了，在這段期間有很多病人問我能不能去接種AZ 疫苗，我想從一位婦產科醫師的角度出發，跟大家分享自己的觀點，讓大家在跟醫師們討論需不需要接種時，能先有初步的觀念。

AZ疫苗可能造成的不良反應

目前國際上接種AZ 疫苗後出現嚴重不良反應的案例有兩種最受矚目：一種是嚴重的過敏反應；另外一種則是凝血過多或不足的反應。

這兩種不良反應的發生率都小於10萬分之一，很難在疫苗臨床試驗階段被發掘出來，因此只能在疫苗流通到市場後，依靠健全的通報系統蒐集更完整的數據，才有機會分析疫苗與不良反應之間的關聯。

以嚴重過敏反應來說，任何疫苗都可能因為載體的關係產生嚴重的過敏反應，所以病人在施打疫苗過後的30分鐘內，一定要留在施打的醫療院所接受觀察。AZ疫苗中使用的為Polysorbate80 或類似的分子，如果你之前曾經因為接種疫苗而有過敏反應，應該要在接種前詢問醫師AZ疫苗的載體與該次引起過敏的疫苗載體是否相同，以利避免風險。

另外一種不良反應與與血液相關，這一點比較受爭議。在2500多萬個施打的個案中，出現86 個血液異常的不良反應，大部份的這些個案都是女性而且發生在施打的頭2個禮拜。德國、法國和義大利等20幾個國家因此一度暫停施打AZ疫苗，雖然機率不大，但誰都不想冒這個險。但有些歐洲國家和澳洲最近又恢復施打，但建議50歲以下接種其他疫苗 (也有國家說30歲以下) 原因是不同專家對於這些異常凝血的不良反應與AZ疫苗的相關性有不同的見解。

婦女接種AZ疫苗前宜停看聽

對於目前正在服用避孕藥或女性荷爾蒙的女性來說，施打AZ疫苗會不會增加血栓的風險呢? 坦白說，目前資訊還不是非常完整，所以我暫時無法評論，但後續會密切注意最新的研究報告，有進一步消息，會再跟大家分享。

對於目前正在備孕，或是即將成為準媽媽的女性來說，更是需要持續追蹤這款疫苗的不良反應，因為如果病患在懷孕期間不幸感染新冠肺炎，因此發生嚴重呼吸道疾病的機率高達未孕女性的3倍，而且因為媽媽發燒或肺炎病毒造成胎兒發育不良的機率也大幅增高。相對的，在AZ臨床試驗中施打疫苗後發現懷孕的女性約有一萬人，正接受持續的密切追蹤，截至目前為止尚無證據顯示AZ疫苗會對母親或胎兒健康造成嚴重影響。這些案例和研究資訊告訴我們，女性朋友們在施打這個疫苗前更需要審慎的個別的情況，才能跟醫師有充份的溝通和討論。

誰該接種AZ疫苗?誰需要小心?

那麼在實務上究竟應不應該建議接種AZ疫苗呢?我認為決定的因素有幾個:

病人接觸新冠肺炎的風險
台灣目前沒有社區感染，感染病毒的機會並不高，只是境外移入仍存在風險，短期來說，若是爆發社區感染才開始接種疫苗，也需要等三個禮拜以上才能形成有效地保護力。而長遠來說，國人還是需要接種疫苗達到一定比率才能安全的開放國門。若是因為工作需要出國的朋友，就應該依目的地的盛行率做決定，像是在歐美地區，接種疫苗的好處明顯的大於壞處；而像我一樣的醫護人員，在工作上比較有可能接觸到病毒帶原者，感染的風險也會較高，也應該考慮接種疫苗，增加保護力。

病人是否罹患慢性病
研究顯示有高血壓、糖尿病或BMI >30的病患在感染新冠肺炎病毒後，更容易而產生嚴重的呼吸道疾病，因為健康上的風險高，上述慢性病的病患也可以考慮接種疫苗。若有上述問題但懷孕的婦女，則應與婦產科醫師討論其利弊。

備孕或懷孕中的婦女
接種AZ疫苗後，有超過半數的人反應接種處疼痛、倦怠或頭痛的問題，而且大約有1成的人會發燒，雖然這些不良反應都是暫時的，很快就會消失，若希望盡可能避免懷孕初期發燒的情況，計劃懷孕或孕期中的女性可以考慮懷孕初期避開接種疫苗。有些證據顯示若接種第一劑後懷孕，在生產後才接種第二劑也能提供相同的保護，不需再重打第一劑。若孕期間接種其他疫苗如百日咳與流感疫苗則與AZ疫苗的施打需考慮間隔約兩個禮拜。

接種AZ疫苗有利有弊，除了關切衛福部及相關專家提出的建議，我們也可以就自己目前的狀態先想一想，在做決定前停看聽，如果有其他的問題，千萬別忘了跟你的醫師作討論喔！

The global “COVID-vaccinated” population has reached 100 million. In the process of reaching herd immunity via mass vaccination, more rare but serious adverse effects from these vaccines are being reported in the mass media. Discussions about the safety of vaccines arevigorous at both government and the community levels.

The AstraZeneca (AZ) vaccine has been used for COVID vaccination in Taiwan for a few weeks now. Many of my patients asked me if they are suitable for vaccination. So here I would like to share my thoughts with you as an obstetrician and gynaecologist.

Adverse reactions associated with the AZ vaccine

There are two types of adverse reactions being discussed the most in the international community: severe allergic reactions and blood-clotting problems. Both of these adverse reactions occur in the order of one in ten thousand, which were difficult to discover during the clinical trial stage. Therefore most of the data we see now are an accumulation of real-time data as we proceed with global vaccination.

The severe allergic reaction (such as anaphylaxis) can occur with any medication being administered to the human body. For vaccines it is usually the vehicle or the excipients molecule with which it is used to carry the active vaccine that incites the allergic reactions. Polysorbate 80 is a suspected culprit excipient used in the AZ vaccine. So if one has had severe allergic reaction in other vaccines that uses polysorbate 80 as its vehicles then it is possible the person can also be allergic to the AZ vaccine.

The abnormal blood-clotting reactions associated with the AZ vaccines are being discussed vigorously in both the scientific community and the media. In about 25 million recipients of the AZ vaccine, 86 cases of serious abnormal blood-clotting cases were reported by March 2021. Most cases occur within first 2 weeks of vaccination and most are women. Although the AZ vaccination was temporarily stopped in some European countries earlier in March, it has resumed since with some countries recommend vaccination in those 50 yo or above (some say 30 or above). Currently there is no international consensus amongst the experts.

Many professional bodies of obstetrics and gynaecology around the world have issued statements regarding vaccination against COVID19 in women planning pregnancy or breast feeding. Thus far most have only cautioned against the vaccination if there is serious concurrent comorbidities such as those who are immunocompromised or organ transplant. There does not seem to have report of additional risks of the vaccination during pregnancy. There is insufficient evidence to conclude if oral contraceptives and hormone replacement therapy are risk factors for developing vaccine-related blood clotting events. More time and data are required to tell.

So should women receive the AZ vaccine? These factors should be considered and discussed with your doctors.

Risk of contracting COVID
Contracting COVID during pregnancy is associated with 3-fold risk of serious complications. So immunisation against COVID should be prioritised if the area you live in carries high risk of infection.

Underlying chronic conditions
For those with hypertension, diabetes or high BMI, because higher risk of COVID related complications are expected, vaccination might offer risk-reducing benefits. but in women with diabetes or high BMI where high risk pregnancy is expected, one should discuss the risks and benefits with your own obstetrician.

Pregnancy
More than half of recipients will get injection site pain and about 10% will develop a fever. To avoid fever during early pregnancy one can avoid getting vaccination during this period. If one has become pregnant after the first dose, there is evidence that receiving a second dose after pregnancy still offers protection against COVID. for those who need flu or whooping cough vaccination during pregnancy, one should consider taking the COVID vaccine 2 weeks apart from the other vaccines.

Like all medicines/procedures, decision to receive the AZ vaccination is individualised based on the benefits and risks associated. It is important to review government updates on vaccination and this article hopefully provides some framework on which women can consult their physicians when considering the AZ vaccination.

How to protect yourself from novel coronavirus

How does the coronavirus spread?
‧ The COVID-19 coronavirus outbreak is a new illness and scientists are still assessing ( ) how it spreads from person to person, but similar viruses tend to ( ) spread via cough and sneeze droplets ( ).

‧ When an infected person coughs or sneezes, they release droplets of saliva ( ) or mucus ( ). These droplets can fall on people in the vicinity ( ) and can be either directly inhaled or picked up on the hands then transferred when someone touches their face, causing infection. For flu, some hospital guidelines define exposure as being within 2 meters of an infected person who sneezes or coughs for 10 minutes or longer.

‧ Viruses can also be spread through droplets landing on surfaces such as seats on buses or trains or desks in school. However, whether this is a main transmission route depends on how long viruses survive on surfaces – this can vary ( ) from hours to months.

‧ There is anecdotal ( ) evidence that the virus can be spread by people before they have symptoms. Some other illnesses such as flu can be passed from one person to another before symptoms occur — but the extent ( ) to which this is happening with COVID-19 is not well understood yet.

How to protect yourself and others
‧ Wash your hands: wet your hands with clean, running water and apply soap. Lather ( ) your hands, including the backs, between your fingers, and under your nails and scrub ( ) for at least 20 seconds. Rinse ( ).

‧ Cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the bin ( ) and wash your hands. If you do not have a tissue to hand, cough or sneeze into your elbow ( ) rather than your hands.

‧ Face masks offer some protection as they block liquid droplets. However, they do not block smaller aerosol particles ( ) that can pass through the material of the mask. The masks also leave the eyes exposed and there is evidence that some viruses can infect a person through the eyes.

‧ Seek early medical help ( ) if you have a fever, cough and difficulty breathing, and share your travel history with healthcare providers.

‧ If visiting live markets in affected ( ) areas avoid direct, unprotected contact with live animals and surfaces that have been in contact with animals.

‧ If you are in an affected area avoid eating raw or undercooked ( ) animal products and exercise care when handling raw meat, milk or animal organs to avoid cross-contamination ( ) with uncooked foods.

‧ If you have returned from an affected area in the last two weeks, stay indoors and avoid contact with other people for 14 days. This means not going to work, school or public areas.

‧ If you have returned from an infected area and develop ( ) a high temperature, cough, runny nose, sore throat or difficulty breathing do not leave your home until you have been given advice by a doctor.

如何預防新型冠狀病毒感染

冠狀病毒是如何傳播的？
‧ 爆發疫情的COVID-19冠狀病毒是一種新疾病，科學家仍在評估它是如何在人與人之間傳播的，類似的病毒常是透過咳嗽和打噴嚏的飛沫傳播。

‧ 感染者咳嗽或打噴嚏時，會噴出唾液或黏液的飛沫。這些飛沫可能會落在附近的人身上，被直接吸入或沾到手上，然後在觸摸臉時帶到臉上而導致感染。就流感而言，一些醫院指南將「暴露」定義為：與連續打噴嚏或咳嗽十分鐘或更久的感染者，距離兩公尺以內。

‧ 病毒也可以透過掉落在物體表面的飛沫傳播，例如落在公共汽車、火車或學校課桌椅上的飛沫。但是，這是否成為病毒之主要傳播途徑，取決於該病毒在物體表面可存活時間之長短──從數小時至數月不等。

‧ 有傳聞證據顯示，該病毒可能有無症狀傳播的情況。有些疾病（例如流感），可以讓被感染的人在出現症狀前就傳染給別人──但COVID-19冠狀病毒無症狀傳染的程度仍然不明。

如何保護自己與他人
‧ 洗手：用乾淨的自來水洗手，並使用肥皂。將雙手（包括手背）、指縫以及指甲內搓揉起泡沫，搓洗至少二十秒鐘。然後沖水。
‧ 咳嗽或打噴嚏時，用衛生紙遮住口鼻，然後將衛生紙丟進垃圾桶並洗手。如果你沒有衛生紙，咳嗽或打噴嚏時請用手肘彎掩住，而不要用手。

‧ 口罩可以阻擋飛沫，因此可提供一定的保護。但口罩無法阻隔更小的、可穿過口罩材料的氣溶膠分子。口罩也無法保護到眼睛──有證據顯示某些病毒可透過眼睛感染人。

‧ 若有發燒、咳嗽和呼吸困難之情況，請盡快就醫，並將您的旅遊史告知醫療服務提供者。

‧ 若到疫區的活體市場，請避免直接、無防護地接觸活體動物，也要避免接觸放置動物的表面。

‧ 若您身處疫區，請避免食用生的或未煮熟的動物製品，處理生肉、牛奶或動物內臟時要小心，以免與未煮熟的食物交叉污染。
‧ 若您在最近兩週內自疫區返國，請待在屋裡十四天，並避免與他人接觸。也就是說，不要去上班、上學或去公共場所。

‧ 若您從疫區回來後，出現發燒、咳嗽、流鼻涕、喉嚨痛或呼吸困難之情況，除非徵得醫生同意，請待在家別出門。

#高雄人 #學習英文 請找 #多益達人林立英文
#高中英文 #成人英文
#多益家教班 #商用英文
#國立大學外國語文學系講師

【韓式美容】山藥煎餅又名「抗老煎餅」

⭐山藥可補腎精有助抗衰老
⭐白色食物入肺亦有助養顏美白
#星期四食材

DIY山藥煎餅
瘦身美顏一take過
「韓國第一美女」金泰希今年40歲，育有兩女，仍然保持童顏般的肌膚及苗條身型，她曾公開養顏秘訣是經常吃自製的山藥煎餅，將山藥磨碎，加入麵粉攪拌搓成一片煎熟即可。山藥又名淮山，從中醫角度來看，山藥具補腎精、健脾胃、補肺氣的功效，適合脾胃虛弱、肺腎兩虛、陰虛內熱者食用，新鮮山藥的黏液富含多糖蛋白質，有助降血糖，所以亦適合做糖尿病患者的食療。山藥含有大量膳食纖維有助減肥，但同時含有澱粉質，所以食用山藥時注意適量減少米飯等主食，配合適當運動，減肥效果更佳。

山藥煎餅
材料：新鮮山藥半條、麵粉或地瓜粉3至4湯匙、鹽適量
做法：
1. 新鮮山藥去皮磨成蓉，注意要戴手套處理，因為山藥黏液會刺激皮膚引致痕癢。
2. 逐少加入麵粉或地瓜粉拌勻至稠身，加入適量鹽拌勻調味，搓成小餅狀。
3. 燒熱油鍋，加入山藥餅煎至兩面金黃色及熟透即成。

山藥／淮山 — 性平，具補腎精、健脾胃、補肺氣功效，適合肺腎兩虛的慢性咳喘、氣短哮鳴、脾胃虛弱引起的腹瀉、遺精盜汗、夜尿頻多者食用。要注意容易便秘者不宜食用。

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DIY Chinese yam pancake
Aid weight loss and enhance beauty in one go

Kim Tae Hee, one of Korea’s most beautiful women, is 40 years old this year. Though she is already a mother to two, she still manages to maintain the body shape and skin condition like that of a teenager.

She has once attributed her weight loss success and beauty secret to Chinese yam pancakes. In order to prepare this delicacy, we need to grind the Chinese yam into fine bits, mix it with some flour and turn the mixture into a paste. From there, we can start pan-frying the paste until it becomes the Chinese yam pancake.

From the perspective of Chinese Medicine, Chinese yam, also known as ‘wai san’ in Cantonese, can nourish the kidney, strengthen the spleen and stomach, and replenish the qi in the lungs. It is suitable for individuals who have a weak spleen and stomach, those with deficiency in the lungs and kidney, as well as people with the yin deficiency and internal body heat.

Fresh Chinese yam’s slimy mucus-like substance contains protein and polysaccharides that can help reduce blood sugar levels. Hence, diabetic patients can incorporate into their diet.
Chinese yam also contains a large amount of dietary fiber that can help individuals shed some pounds, and at the same time, provide the carbohydrates we need in our diet.

Nevertheless, do cut down on the intake of rice if you wish to include Chinese yam into your diet. Exercise regularly as well, as it can help you achieve your weight-loss goal much faster.

Chinese yam pancake
Ingredients: 1/2 stick fresh Chinese yam, 3-4 tbsp flour or sweet potato flour, salt to taste
Preparation:
1. Peel Chinese yam and mash. Handle it with gloves on as the fresh Chinese yam’s slimy mucus-like substance may irritate the skin and cause itching.
2. Add flour or sweet potato flour gradually and mix well until thicken. Add salt to taste and knead into small pancakes.
3. Heat the pan with oil, add the pancakes and pan-fry until golden brown and cooked.

Chinese yam - mild in nature, can strengthen the spleen and nourish the stomach, replenish the lungs and promote fluid production. It is healthy for those with weakened spleen and stomach, chronic cough and asthma, diarrhea caused by weak spleen and stomach, nocturnal emission, night sweats, and frequent nocturia. It should be noted that people who are prone to constipation should not eat it.

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#男 #女 #我胖了 #減肥