近来,梳理门诊就诊的口腔肿物的患者资料,发现口腔黏膜的肿物多数发生在老人,口腔卫生条件较差,部分有修复不佳的假牙,烂牙等。由于保健意识不强,或者就医不便利等,就诊时多数已不是早期。加之,老人信息渠道不畅,不能意识到疾病的风险。建议大家适当的时候,观察一下老人的口腔情况,假牙是否合适,牙龈、舌头的侧面、上牙膛(上腭部)有无增生的东西,有无白色的斑块,有无长期没有愈合的溃疡。早发现,早治疗,远离口腔肿瘤。
Skip the Calcium, Save the PatientThe StudyXiao Q, Murphy RA, Houston DK, Harris TB, Chow W, Park Y. Dietary and supplemental calcium intake and cardiovascular disease mortality: The National Institutes of Health-AARP Diet and Health Study. JAMA Intern Med. 2013;1-8. [Epub ahead of print]IntroductionScant evidence supports the notion that calcium supplements alone significantly decrease the risk for osteoporotic fracture, yet these supplements remain one of the most popular treatments taken by adults in the United States. In addition, there is increasing evidence that calcium may contribute to a higher risk for cardiovascular disease (CVD). The current study uses a large cohort of adults to examine how dietary calcium and calcium supplements affect the risk for CVD among women and men.BackgroundA new review of supplement use, based on data from the National Health and Nutrition Examination Survey,[1] concluded that nearly one half of adults in the United States use dietary supplements, but relatively few of these individuals take supplements on the recommendation of their physician or other healthcare provider. This study found that 49% of a sample of US adults had used of supplements in the past 30 days. Factors associated with a higher rate of supplement use included female sex, non-Hispanic white race, and a subjective measurement of health as very good or excellent.Although the most popular reason for using supplements in this study was to improve or maintain health in general, "bone health" was cited by 25% of respondents as a reason for taking these agents. Products that contained calcium were the second most common supplements overall. However, only 23% of supplements were recommended by the individual's physician.What is the evidence for supplement use, particularly when it comes to calcium? A meta-analysis of 29 studies found that calcium use alone was associated with a nonsignificant reduction in the risk for fracture.[2] However, the use of calcium with vitamin D reduced the risk for fracture by 12%. Vitamin D alone at doses of 800 IU or more daily also significantly reduced the risk for fracture (relative risk, 0.84; 95% confidence interval [CI], 0.75-0.94).In another meta-analysis, total calcium intake did not alter the risk for hip or total nonvertebral fracture.[3] More disturbing was the finding that calcium supplementation was associated with a higher risk for hip fracture compared with placebo.Supplements are also frequently used to prevent poor health outcomes. There is limited evidence that high-dose treatment with vitamin D supplements can reduce the risk for incident cancer, particularly colorectal cancer.[4] However, little evidence suggests that treatment with calcium alone or calcium with vitamin D has an effect on the risk for cancer.Whereas the health benefits of calcium supplementation are questionable, growing evidence indicates that calcium supplementation may be associated with an increase in the risk for CVD. In a trial of over 1400 women who were randomly assigned to receive calcium citrate 1 g or placebo daily, the risk for the combined endpoint of myocardial infarction, stroke, or sudden death was nearly 50% higher in the calcium group during 5 years of treatment.[5] Although data from the Women's Health Initiative initially pointed to a lack of effect of calcium supplements on the risk for cardiovascular events, a separate analysis found that calcium supplements significantly increased the risk for these events, particularly myocardial infarction.[6,7] In a meta-analysis, the use of calcium supplements vs placebo was associated with a hazard ratio for myocardial infarction of 1.31 (95% CI, 1.02-1.67).[8] There were nonsignificant increases in the risks of stroke and a combined cardiovascular endpoint in women taking calcium vs placebo.The data regarding any relationship between dietary calcium and the risk for CVD is weaker than that for calcium supplements.[9] However, a recent study found a significant increase in the risk for mortality outcomes associated with calcium consumption among a cohort of 61,000 women who were followed for a median of 19 years.[10] Compared with more modest consumption of dietary calcium, calcium intake of over 1400 mg/day was associated with a hazard ratio of 1.49 (95% CI, 1.09-2.02) for death from CVD, as well as a higher risk for death from any cause (hazard ratio, 1.40; 95% CI, 1.17-1.67).The potential cardiovascular risk associated with calcium intake is an evolving field of inquiry. The current study uses a large database of older adults to add to the sum of evidence regarding this issue.
(1)口腔内的溃疡,2周以上尚未愈合。 (2)口腔粘膜有白色、红色和发暗的斑块。 (3)口腔与颈部有不明的肿块和淋巴结肿大。 (4)口腔反复出血伴有臭味,部位和原因不明。 (5)面部、口腔、咽部和颈部有不明原因的麻木与疼痛。如果上述症状发生在长期烟酒过度,假牙修复多年未定期复查者,尽早就医。
“我保证履行由于我的专业我自愿承担的治疗和帮助病人的义务。我的义务是基于病人所处的软弱不利的地位,以及他必然给予我和我的专业能力完全信任。所以,我保证把病人多方面的利益作为我的专业伦理的第一原则。由于承认这种约束,我接受下列义务,只有病人或病人的合法代理人才能解除我这些义务: ①将病人的利益置于我专业实践的中心,并在情况需要时置于我自己的自我利益上。 ②拥有和保持我的专业要求的知识和技能的能力。 ③承认我的能力的局限,只要我的病人病情需要,我应向我的各种卫生专业的同事求助。 ④尊重其他卫生专业同事的价值和信念,并承认他们作为个人的道德责任。 ⑤用同等的关切和献身精神关怀所有需要我帮助的人,不管他们有没有能力付酬。 ⑥主要为了我的病人的最佳利益,而不是主要为了推行社会的、政治的或财政的政策或我自己的利益而行动。 ⑦尊重我的病人的参与影响他或她的决策的道德权利,明确地、清楚地、用病人理解的语言说明他或她的疾病的性质,以及我建议采用的治疗的好处和危险。 ⑧帮助我的病人作出与他们的价值和信念一致的选择,不强迫,不欺骗,不口是心非。 ⑨对我听到、知道和看到的保守秘密,作为我关怀病人的一个必要部分,除非对别人有明确的、严重的、直接伤害的危险。 ⑩即使我不能治愈病人,也总要帮助他们,当死亡不可避免时,要帮助我的病人按照他或她自己的打算死亡。 决不参与直接的、主动的、有意识的杀死一个病人,即使为了仁慈的理由,或应国家的要求,或任何其他的理由。 为了覆行我对社会的义务,参与影响国民健康的公共政策决定,提供领导以及专家的和客观的证言。 将我所说和所信的付诸实践,从而在我的专业生涯中体现上述原则。