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2008/9/30
以下是今天美国CDC发布的针对中国三聚事件的旅行建议：不要消费任何的中国的所有品牌的奶制品（从奶粉到牛奶，酸奶，从饮料到食物，糖果点心。。。）。实话说，我看完以后鼻子酸酸的，我觉得自己的国家和民族因为这件事情蒙受了耻辱，这是每一个中国人不应该忘记的。可是偏偏有那么一些人，不论教育程度，社会阶层，经济状况，他们失去了做人的最基本的道德良知。不仅让成千上万的无辜儿童成了受害者，也让中国人，中国制造遭受质疑和抵制。任凭那奥运光芒万丈，神七气势恢宏，这耻辱是永远遮掩不了的，也不能被忘却的！
Melamine in Chinese-Manufactured Infant Formula
This information is current as of today, September 29, 2008 at 14:30
Updated: September 29, 2008
In September 2008, the Chinese government announced that the industrial chemical melamine was discovered in infant formula produced in China. Melamine has since been found in other dairy products produced in China, including frozen yogurt dessert and canned coffee drink. Melamine, in high doses, is a chemical that can cause health problems, such as kidney disease. As of September 22, 2008, contaminated milk products in China have caused nearly 40,000 infants to be brought in for medical care, with almost 12,900 hospitalizations, and at least three infant deaths in China. Similar health problems have been reported in Hong Kong and Singapore but have not been confirmed.
Advice for Travelers to China
If you are traveling to or are currently in China, especially if you are traveling with an infant, you should take the following steps so that you and your family can avoid the risk of melamine exposure.
- Because of uncertainties related to dairy products in China at this time, CDC recommends that you do not consume any dairy products produced in China, including:
- All brands of infant formula
- Milk or other drinks that contain milk products
- Food, such as yogurt or ice cream that could be milk-based or contain a large amount of milk or milk products.
- Please note that many foods and drinks contain milk products, such as candies, crackers, and desserts. Look for these ingredients on the food or drink label:
- milk
- milk powder
- whey
- lactose
- casei
It is important to note that dairy products produced in the United States and imported into China for sale are not affected.
- If you are traveling to China and are planning to bring your infant or child, please carry any needed formula or other milk products with you. Do not use any milk products produced in China.
- If you are pregnant and have already ingested some of these listed products or you are breastfeeding while ingesting the listed products, discontinue their use. Effects on the unborn child are unknown. Melamine only stays in the body for a few days. The effects on the kidneys of the formula-fed infants in China are thought to result from continuous use of the products over many days.
- See a doctor right away if you have any of the following symptoms or think that an infant may have any of these symptoms
- stomach pain
- vomiting
- fever
- irritability or excessive crying in infants or children
- blood, crystals, or particles in urine
- painful urination
- little or no urine
- swelling of hands, feet, or face
While abroad, you can contact the local U.S. Embassy or Consulate if you think you may need assistance.
- Consular personnel at U.S. Embassies and Consulates abroad and in the United States are available 24 hours a day, 7 days a week, to provide assistance to U.S. citizens.
- To contact the U.S. Embassy or consulate in the country where you are visiting:
- If you have recently returned to the United States from China and think you or your child may have been exposed to melamine, talk to your doctor. If you or your child has any of the symptoms listed above, see a doctor right away.
Special advice for U.S. travelers going to China to adopt an infant
If you are planning a trip to China to adopt an infant, please carry any needed formula or other milk products with you. Do not use any milk products produced in China. When you return home, please have your child evaluated by a pediatrician as soon as possible and inform the pediatrician that your child was adopted from China and that there is therefore the possibility that the child may have been exposed to contaminated milk products before being placed in your care.
More Information
For more information about melamine and the current situation, see the following links:
U.S. Food and Drug Administration (FDA)
World Health Organization (WHO)
Chinese Center for Disease Control and Prevention (China CDC)
2008/9/28
最近在影院看了一部电影，叫做Nights in Rodanthe。影评打分不高，但是看了trailer，心想或许是部爱情的教育片，就兴冲冲去了。电影放到一半，影院里就开始有观众大声啜泣。越到后来哭得人就更多了。我心里暗自郁闷，因为用自己的标准看来，这显然就是一部定位不清，情节老套，表演痕迹太重的两星片（五星最高）。我问同样觉得这部片子还不错的Ken，为什么。他说美国人生活简单，情感也简单，所以很容易就感动了。心里暗暗不爽，一定要去图书馆把汤姆汉克斯的毁灭之路（隆重向老爸推荐）和小Qing推荐的She's Gotta Have It 借来看看。美国的图书馆，收了纳税人的钱提供的服务真的很好，CD，DVD，图书，电子书全部免费借阅。最近在听A woman in Charge，又从网上下了很多电子书。以前太爱买书和碟了，搬来搬去很麻烦，电子书带起来就方便一些。居无定所和经常travel的痛苦就在于此，很多美的东西只能看在眼里，记在心里，不能常常带在身边。 2008/9/27 The following information had been summarized by Dr. ROME from Thailand:
A. MPH course B. 3 years basis (June 2009-May 2012) C. Internet base course D. 4 time face-toface with supervisors duration 1 week from JHSPH at Hong Kong or Singapore E. Qualified is public health grad + 2 years experience F. TOEFL 600 paper/250 CBT G. Need GRE So terrible! 
Exciting MPH degree opportunity for Asia Pacific Rim region The Johns Hopkins Bloomberg School of Public Health has established a Master of Public Health degree for health professionals in the Asia Pacific Rim region. The three-year program will begin with a two-week face-to-face class session in Baltimore, MD, in June 2009. The bulk of the subsequent course work will be completed on-line. An annual institute where selected face-to-face courses are taught will be held beginning in 2010 in either Singapore or Hong Kong. To learn more about this exciting opportunity, click http://www.jhsph.edu/academics/degreeprograms/mph/prospective_students/MPH-Asia%20Pacific%20Rim < http://list.alumni.jhu.edu/t/123560/316592/25519/0/> . 2008/9/26
http://nccphp.sph.unc.edu/focus/vol5/issue4/5-4ClusterInvestigations_issue.pdf
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Describe cluster investigations of non-infectious health events
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Discuss key factors which should be considered before carrying out a cluster investigation
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Outline the basic steps of a cluster investigation
Investigation of clusters of non-infectious disease is a critical public health function. Cluster investigations can result in major epidemiologic breakthroughs as they link specific exposures to diseases. For example, in the early 1960s, several European countries saw a marked increase in the number of infants born with a severe limb deformity called phocomelia. The deformities were linked to maternal use of thalidomide, a sleeping pill and treatment for morning sickness during pregnancy. The drug was never marketed in the US, but the problem, in part, led Congress to enact legislation in 1962 that began the rigorous testing now required for approval of pharmaceutical products in this country.
Several other notable investigations have linked a non-infectious disease cluster with a specific exposure, but these are the exceptions. Few investigations have added to our knowledge of disease causes or provided a credible explanation of why the cluster of diseases occurred.
Why is this? First, in many non-infectious disease cluster investigations, an apparent geographic or temporal excess in the number of cases cannot be confirmed. In part that is because many non-infectious diseases reported as clusters (e.g., cancers, birth defects) are common in the community, and supposed clusters reflect normal disease patterns. Also, confounding factors such as older age might account for a seemingly higher occurrence rate. Some diseases like brain cancer might look alike to the community but have different pathogenic processes (i.e., a primary brain tumor or brain metastases that have spread from cancer in another organ). Although such cases might be grouped together in time and space, they are not really linked.
Second, establishing a definitive cause-and-effect relationship is often impossible because of small case numbers, problems in isolating a single potential exposure, and difficulty in reconstructing exposure histories due to long gaps between exposure and symptom onset. Finally, legitimate questions raised by a cluster investigation often require a separate large-scale epidemiologic study, which may be difficult to carry out .
To increase the chances of successfully investigating a non-infectious disease cluster and to ensure that the cluster investigation proceeds smoothly from one action to the next, an agency needs a standardized step-wise process for receiving and evaluating cluster reports. This generally includes a centralized tracking system, data collection tools, clear lines of communication, specific actions to be taken at each step and criteria for proceeding with or concluding the investigation.
A well trained staff and adequate resources are needed to respond to cluster reports in a coordinated, consistent, and timely way. Investigators should be familiar with the epidemiology, natural history, and diagnosis of the disease; possess skills in environmental or biological sampling; have access to adequate laboratories; and have experience in recognizing patterns in space and time.
In addition, any perceived problem must be addressed responsibly and sympathetically, even if no underlying disease cluster actually exists. Communications officials should be consulted about what, when, how, and to whom information is provided. Community residents, health professionals, and government representatives should be involved in both the investigation and communication efforts, because they can make communications more credible, bring a greater understanding of the situation, and help the agency make better decisions.
STEP 1: Initial ascertainment of cluster
To begin a cluster investigation, investigators should collect the following data:
· identifying information from the person reporting the cluster (name, address, phone number, organization);
· demographic information (person, place, time) for cluster cases (number of suspected cases, sex, race, age at diagnosis or death [if appropriate]); geographic area; and time period of concern;
· clinical information on cluster cases (diagnosis date, basis for diagnosis, relevant medical histories, status of cases [deceased, hospitalized, recovered], suspected exposures); and
· identifying information for cluster cases (name, location, phone number, contact person, attending physician’s contact information).
Investigators should enter the information into a tracking system; computer programs such as EpiInfo, Microsoft Access, or Microsoft Excel can be used for this. They should also notify other health department staff (e.g., supervisor, subject matter experts, communications/public relations staff) of the investigation as well as local health officers in the jurisdiction where the cluster occurred, and staff from agencies with jurisdiction or expertise in the area (e.g., departments of labor, environment, or ecology). Staff should then seek information on the causes of the disease under investigation and discuss how this information compares with the reported cluster.
After gathering this initial information, investigators must decide whether to continue the investigation. Criteria for continuing the investigation typically include:
· clinically similar health events without a plausible alternative etiology (e.g., a cluster of lung cancer cases with no history of smoking);
· an apparent excess occurrence of such health events;
· a plausible temporal association with the possible exposure(s);
· a disease present in a particular demographic group in which it is not normally found (e.g., Kaposi’s sarcoma in young homosexual men); or
· one or more cases of a very rare disease.
STEP 2: Assessment of excess occurrence
Estimating Excess Occurrence. Investigators must confirm whether the number of cluster cases is greater than expected in a given population during a certain time period. To determine whether there is an excess occurrence of a non-infectious disease, investigators must estimate an occurrence rate based on the number of people with the health event (numerator) and the total population at risk (denominator). The population at risk consists of all people in the geographic area where the supposed exposure occurred over a designated time period.
STEP 3: Determining the feasibility of an etiologic study
Before embarking on an etiologic study to examine the association between an observed cluster and a particular exposure, investigators must determine the epidemiologic and logistical feasibility of a study.
It is essential to first construct a testable hypothesis based on the investigation so far and knowledge of the relevant literature. The hypothesis should be clearly stated and should include the target population, health event(s), and exposure(s) of interest.
Step 4: Conducting an etiologic investigation
If you have successfully carried out all the steps described above, it’s time to proceed with an etiologic study. For such a resource-intensive endeavor to be worthwhile, however, it should generate knowledge about the broader epidemiologic and public health issues raised, not merely explain a specific cluster. Begin by writing a formal study protocol describing the data collection elements and methods to be used. Lay out the steps in data collection, processing, and quality assurance, and develop an appropriate plan of data analysis. At this point, study design decisions will be unique to the study, and further guidance is outside the scope of this FOCUS issue.
Most non-infectious disease clusters result from coincidence and chance, but they can still serve a useful purpose. They allow public health officials to interact with the community, be responsive to public needs, and learn about exposures. Occasionally, cluster investigations allow investigators to develop new hypotheses about previously unsuspected exposure-disease relationships. But they can also be an unproductive drain on scarce public health resources. The search for knowledge must be balanced with the need to fulfill ongoing public health responsibilities. In many cases, resources would be better invested in lab-based sciences and large epidemiologic studies in which small potential risks and complex biological phenomena can be investigated.
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