Perceived benefit vs side effect

預防勝於治療相信大家都一定聽過，但現實中要讓病人或普羅大眾了解預防的重要性並非想像中容易。

骨質疏鬆好多老人都會有，不少年滿70歲的公公婆婆如果你捉去照DEXA scan和驗維他命D都會發現骨質密度過低以及維他命D不足。

但當你處方骨質疏鬆藥物時，例如上一代bisphosphonate時，很多病人都不喜歡，因為有反胃、胃痛和食道逆流的副作用。

常常我們都會聽到

「行得走得，無事無幹為什麼要食藥？為什麼要承擔副作用風險？」

「就血骨質疏鬆都未必會死，為什麼要為了不會死的病而冒險食藥？」

近來更愈來愈流行這種要求完全零風險的心態

的確，預防性治療是屬於non event的一種，非醫療相關行業的市民的perceived benefit vs risk跟醫護人員是完全兩回事的。

普羅大眾並不知道原來老人仆街後hip fracture一年內的死亡風險高達30%，平均每10個因仆街而髖關節骨折的老人便有3個會在一年來死去。即使幸運生存的老人亦可能因此失去行動功能，需要更多的支援，更有不少因未能照顧自己而要到護老院。

但對一些嚴重骨質疏鬆但未仆街的老人來說，他們依舊日日行街買餸無難道，你叫他們定期打骨針或飲可能會反胃的骨藥，他們真的會當你發神經。因為他們沒有經歷過老人仆街到底可以有多嚴重。

就骨質疏鬆藥
他們的perceived benefit — minimal
他們的perceived risk/cost — 打針貴、食藥反胃

但對醫護人員，特別是較有經驗的醫生或內分泌科醫生來說，老人仆街是生與死的對決

就骨質疏鬆藥
我們的perceived benefit — significant mortality and morbidity reduction
我們的perceived risk/cost — 打針貴、食藥反胃

是的，當你見識得多老人仆街的個案，你會發現預防是多麼重要的一件事。

但往往病人和家屬並不了解，只有當他們親身體驗過老人仆街之後髖關節骨折時，眼看老人因仆街而死去或從此行動不變時才會明白

「早知當初就吃藥打針」

但世事沒有早知，當他們親身體驗後，往往都已成定局，即使後悔莫及亦逆轉不了。

近排愈來愈多人不信任醫護人員，的確互信是雙向的，醫護人員要加強溝通令病人或家屬更加信任。但當一個人覺得所有醫護都加害你的時候，認為醫護的意見不可信，要求一定不存在的「零風險」治療或預防性治療時，便要承擔decision against medical advice的風險。

這個perception discrepancy在種種醫療情況都可見，如預防心臟病、中風、糖尿病、高血壓、高血脂、HPV、HIV、流感到今時今日的COVID等等。

There is so much a doctor can do
條路自己揀

Oyako Don #親子丼. With Chicken Thigh meat 雞腿肉. Surprisingly, for Dinner A La Carte this is only HKD $88, but for a lunch set its $200 with soup & some appetizer. Me & friend said we wud rather order this separately then! 【妖怪 ʸᵒᵏᵃⁱ, ᶜᵉⁿᵗʳᵃˡ, ᴴᴷ. ᴼᵖᵉⁿᵉᵈ ᵇʸ ˢᵘˢʰⁱ ˢᵃⁱᵗᵒ ᴴᴷ ᵍʳᵒᵘᵖ, ʷⁱᵗʰ ˢᵃⁱᵗᵒ ˢᵃⁿ ᵃˡˢᵒ ⁱⁿᵛᵒˡᵛᵉᵈ ᶠʳᵒᵐ ᵀᵒᵏʸᵒ】

Seeing this discrepancy also made us ordered the rice instead of the Chicken Soba 鳥そば (Ramen) to end the meal, especially the latter didn't look as Paitan 鶏白湯 or sophisticated like in Japan as we hoped.. The purist in us 🤔

Despite the Oyako visually looking like it had more overcooked 米青 than 蛋黃, in fact the taste was fine, especially the grilled Chicken meat & also sauce seasoning of rice, the chicken needed a sprinkle of salt to elevate its good chicken flavor. Tastes better than it looks. Another foodie friend of mine @Sakenoguy also pointed out that technically, this should be called a #親子重 Oyako-Ju instead 👏🏻👏🏻 Score 7/10

WRITING TASK 1 DẠNG BAR CHART
Hello mọi người. Hãy cùng cô luyện tập đề một đề Task 1 trong cuốn Cam 15 Test 1 nhé.
Ngoài ra, cô gửi tặng bạn 20 bài mẫu Bar chart khác > Download bằng cách click vào link này nha: https://m.me/286585161523028?ref=BaimauBarchart
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The bar chart illustrates the habits of buying and drinking two beverages: coffee and tea for urban residents in five cities of Australia in the last 4 weeks.

Overall, in most cities, people preferred drinking coffee or tea in a cafe shop to buying fresh or instant coffee, except Adelaide where drinking instant coffee was a bit more prevalent.

In Sydney, Melbourne and Hobart, the percentages of city dwellers visiting a cafe for coffee or tea in last 4 weeks were highest, making up about 65% each. Residents in Brisbane also liked this habit of drinking coffee and tea most, but its figure was much lower, at just over 55%. Although this habit ranked second in the remaining city - Adelaide, the figure was still high, at merely under 50%.

As for the habit of buying coffee, instant coffee was chosen more often than fresh coffee in all five cities. The data for the former habit in Brisbane, Adelaide and Hobart well exceeded the figures for the latter, with the discrepancy in each city being about 15% or over. However, in Sydney and Melbourne, the differences of the two habits of buying the surveyed beverages were less significant. The percentage of each habit of buying coffee varied around 45% in each of those two cities.
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Lưu ý là bar chart này hoàn toàn không có sự thay đổi theo thời gian nên bạn chỉ sử dụng cấu trúc câu so sánh nhé
Sử dụng thì hiện tại đơn khi không có thời gian nhắc tới trên biểu đồ

Chúc các bạn học tốt nhé <3

The differences in leg length can range from a fraction of an inch to several inches. The greater the difference, the more likely it is that the person will experience issues with gait, posture, and pain.

CLM Tit Tar Day at Mid Valley Branch (Holdings)
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#masterchrisleong #chrisleong #datoserichrisleong #bonesetting #tittar #tabibtulang #clm #clmethod #midvalley #sunwaydamasara #setiaalam #sripetaling #ampang #bone #tulang #梁润江 #跌打 #师父 #鐵打 #师傅

長引く腰痛...もしかしたら仙腸関節かも？
仙腸関節痛のストレッチはこちら！
現代人に多い悩みを解決しましょう。

1つ目 梨状筋 60秒
2つ目 大臀筋 60秒
3つ目 骨盤今日 60秒

○○撃退シリーズ第8弾！

第1弾はヘルニア編→https://www.youtube.com/watch?v=p3aPN_p_kZY&t=13s
第2弾は反り腰編→https://www.youtube.com/watch?v=_B1ibBE7dSg&t=53s
第3弾は猫背編→https://youtu.be/F-gckqTmuTw
第4弾は二重アゴ編→https://youtu.be/nyoeSsIhXHY
第5弾はくびれ編→https://youtu.be/le3m1cEiqfM
第6弾は頭痛編→https://youtu.be/Q3_HYARYTUw
第7段はストレートネック編→https://youtu.be/IxHis6CDOVA

ご質問、リクエスト気軽にどうぞ

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★関連動画の紹介★

→参考にした素敵な動画です！ぜひみてね！

しなやかな体を作る毎日の９分間ストレッチ【柔軟性を高めて代謝UP】
https://youtu.be/LXzpn0jN8Bg

【セルフでできる骨盤矯正　その１】〜自分の骨盤の歪みを知ろう！〜 HOW TO SELF-CHECK YOUR LEG LENGTH DISCREPANCY
https://www.youtube.com/watch?v=S4iyngxeg2k&t=26s

【10分】簡単！楽なのにすごい痩せるダイエットストレッチ | Muscle Watching × AIG損保
https://youtu.be/seKH2UDzXOg
ーーーーーーーーー

『超硬いシリーズ』他部位はこちら
自分の硬いところに合わせてやってみてね！！！
①股関節
【効果】腰痛予防 あぐらをかけるようになる 下半身むくみ予防　ハイパフォーマンス
→https://www.youtube.com/playlist?list=PLulTZBLbo7AjdCbhTTz8UzmZhml5ICb3w
②太もも
【効果】腰痛予防　長座ですわれるようになる　膝痛　オスグット予防　足がつる予防
→https://www.youtube.com/playlist?list=PLulTZBLbo7AiCI4cpgUapvfpdjPWY6aYC
③内もも
【効果】O脚改善　足をキレイに魅せる　横ぶれ予防　転倒予防
→https://www.youtube.com/playlist?list=PLulTZBLbo7Ag-wcUEvxOd2bNjt8ce3PvB
④足首
【効果】しゃがめるようになる　むくみ予防　捻挫予防　捻挫後のリハビリ
→https://www.youtube.com/playlist?list=PLulTZBLbo7AiYiNAhG1tHmpai0OfKqklC
⑤背中
【効果】猫背改善
→https://www.youtube.com/playlist?list=PLulTZBLbo7Ahy8u_DgNHzIYrAA5S86-4J
⑥肩甲骨
【効果】肩こり　頭痛　上半身のスポーツパフォーマンスアップ
→https://www.youtube.com/playlist?list=PLulTZBLbo7AgysK76v-5xzbQDRa5tAcMq

👑オガトレ動画Best５👑
【第１位】
股関節超硬い人向け！体を柔らかくするストレッチ！【10分一緒に画面を観ながら】
https://www.youtube.com/watch?v=3br07_9ZbyQ&t=21s
→ストレッチをしながら説明しています！1人では中々継続できない方、オガトレと一緒にちょっとずつやっていってみましょう！

【第２位】
股関節が『超・超・超』硬い人向け！体を柔らかくするストレッチ【あぐらができるようになる！】
https://youtu.be/1YcYOvUl0-M
→あぐらがかけないほど体が硬い人向け！かけるようになりますよ！

【第３位】
足首超硬い人向け！体を柔らかくするストレッチ！【10分一緒に画面を観ながら】
https://youtu.be/t3C-N5_828k
→一緒にストレッチシリーズの足首編！マッサージを多めに入れているので、一般の方や足首がかなり硬い方でも簡単にできます！

【第４位】
身長を伸ばすストレッチの 『秘密』 【本当に身長を伸ばしたい中高生だけ見てください】
https://youtu.be/o3iWK_UB3_8
→「身長 ストレッチ」で検索したそこのアナタ！ぜひみてね。

【第５位】
「腸腰筋」のストレッチ”だけ”８種類紹介！【股関節をもっと柔らかくしたい方向け】Iliopsoas stretch
https://youtu.be/xSMA0mpefEw
→マニアック向け！笑　柔らかい方専用です！

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#オガトレ #ストレッチ #骨盤矯正
楽曲提供：UUUMUSIC
◆本動画内の音楽については、効果音ラボの許可を頂いております。

What is GT-R?

GT-R is a vehicle developed with a main objective of use by the circuit the skyline that continues from the C10 Hacosca type (Macartun). It is a car like the assumption of the win in the race though it is a passenger car base, a mission installing equipment and an engine different from other grades of the skyline, and the influences on other domestic production sports cars, etc.Therefore, there are a lot of madly devoted fans, and the engineer also has a special sticking to. The name of GT-R for that is assumed, and there is a model not permitted either, and it assumes the existence of GT-R to be the one of more special crown. ｢There are three famous alphabets worldwide. It is G, T, and R. I will promise here. GT-R revives without fail. ｣Carlos Ghosn COO (at that time) made remarks on "GT-R concept" ahead by opening about presentation at the press conference on the Tokyo Motor Show in 2001. I can ask this car for the posture of Nissan that offers it because it entrusted such a content to Gorn where only a thorough rationalization strategy is often taken up. This promise is sold, and the mass production type is announced by the 40th Tokyo Motor Show on October 24, 2007 and Carlos Ghosn will be sold accomplishment Nissan and GT-R on December 6, 2007. Especially, it is known, and not only the country but also the world is 13 in the reputation of R from active distinguished services very much in an overseas race that has infiltrated by calling Godzilla (Godzilla) as for the name though it is from R32 type. Therefore, GT-R of R32, R33, and R34 is introduced to foreign countries though the skyline is almost a car only for the domestic sale by exporter's hand. As for the reputation, R33GT-R was sold to the model end very high as regular export in Britain though 100 V-spec was a limitation to R34GT-R similarly in addition by 100 limitation.

This is to receive the thing that eminence in Europe goes up by participating as "NISMO GT-R LM" to demand of saying to Nissan Motor Co., "It wants you to sell it also in foreign countries" strong, and 24 hour in Le Mans endurance race. There is a user who says that there are value (scarcity) more than Ferrari and status, too and the satisfaction rating to a practical side is very high though only the high income group was able to buy 10.8 million yen when converting it into Japanese yen in Britain because of the tariff by the thing that does (The price of a new car of V-specII of a domestic specification is 5 million 748 thousand yen) , saying that "The family is taken though it is efficient as the sports running can be done". Britain..car..performance..technology..high..externals..Tokyo..taxi..criticize..this..writing..Britain..joke..rather..face..usual..passenger car..contents..sports car..concept..fresh..assuming that..accept..thing..turn inside out..expression.It was received with good feeling in "Cargai (car favor)" actually. Both of these 200 total are sold all on several days.

Additionally, the individual was exported to Germany, France, Switzerland, the United States, Hong Kong, and UAE, etc. (To our regret, putting the car that had not suited the standard in the United States according to state might become the violation of the law, and there was a case where the trader was restrained to the police authority, and had been imprisoned, too). Moreover, Michael Clm active with SUPER GT also buys two R34GT-R in Japan, and it transports it to Monaco.

A British specification : with a domestic specification though is especially the enormous discrepancy. Type..locale..regulations..according to..correspondence..security..strengthen..headlight..halogen..valve..make..security..standard..suit..change..speed limiter..Europe..self-imposed restraint..value..improve..scale..speed..meter..adoption..country..specification..spec..adopt..genuine leather..seat..equip..Britain..specification..this..skin..hand..work..put..one..Japan..lineup..provide..red..epidermal..selection..tentatively..Japan..limitation..put on the market.

The name of GT-R still was not revealed at this point, and the flow of GT-A and GT-B that had been put up was drawn to a hot model of the second generation skyline, and there was a rumor of becoming GT-C, too, when marketing it founder GT-R in the Hacosca age was though the reference was exhibited to the prototype of the type in the previous year's 1968 Tokyo Motor Show put on the market immediately before marketing.

There are already a lot of owners of GT-R who dislike excessively putting the hand from the perfection as the tuning car high while stocked. Moreover, because the emblem of GT-R is applied to a standard model and a lot of tunings shown like GT-R are done by transplanting the bumper, it is possible to visit the popularity of the style of GT-R. To catch it ..engine power to keep.. firmly, great Modefai is often added to the exterior an of course favorite ..core.. tuning.