我們都知道口罩的防護力比疫苗的防護力即使不是「有過之而無不及」至少也是「難分軒輊，同樣重要」！
從台灣群聚感染的確診者來看，絕大多數的群聚是發生在面對面相處或共同生活，而有不佩戴口罩相處的對象，例如：家人或親密接觸者。
反之，確診者帶給社區的群聚感染，案例相對是比較少的，尤其是不明感染源的個案，接觸者匡列之後，陰性的比例還是比較高。
種種現象，讓官員和很多專家，紛紛認為口罩產生的影響力非常大，國人願意高度配合佩戴口罩，也是很重要的防護力來源！
但是畢竟我們沒有做相關的實驗研究。
今天要和各位分享的，是IPA組織和頂尖大學共同在孟加拉所做的一個實驗報告，實驗的結果顯示，口罩的防護力確實很重要。

戴口罩可降低COVID-19病毒傳播率
The Impact of Mask Distribution and Promotion
on Mask Uptake and COVID-19 in Bangladesh
(IPA創新貧困行動 https://reurl.cc/2or2MO)

越來越多科學證據顯示口罩可以預防Covid-19，但在現實生活中不確實或不長期配戴口罩的個體行為造成口罩的功效無法被證實。

IPA組織、耶魯大學和史丹佛大學共同合作，在孟加拉600個村莊設計推廣並發放口罩，同時評估社區戴口罩對Covid-19防疫的影響：
結論發現整體上，口罩推廣措施促使每一百人中有29人戴口罩，並減少9% Covid-19 有症狀的確診數。

外科口罩在阻斷有症狀的Covid-19傳播上特別有效，並將 60 歲以上群組的有症狀確診數減少 35%。

在接受口罩推廣導入的村莊中(實驗組)，口罩使用率增加 29% (從對比村落的 13% 增加到實驗村落的 42%)。清真寺的口罩使用量增加最多(37%)。

Overall, the core intervention induced 29 out of every 100 people to wear masks, increased physical distancing and reduced the number of people with symptomatic SARS-CoV-2 infections by 9 percent. Surgical masks were especially effective in reducing symptomatic SARS-CoV-2 infections and reduced symptomatic infections in people 60+ by 35 percent.

In villages that received the intervention, mask use increased by 29 percentage points (from 13 percent in the comparison villages to 42 percent in treatment villages). Mask use increased most in mosques (37 percentage points). A pilot and our scale-up activities suggest that in-person public reinforcement is a critical part of the intervention.

【疾病知多D】女友發脾氣會不會是……？

面對女友無理取鬧，男友或許可能會不知所措。

不過其實女友未必真的無緣無故無「理」取鬧。

噯！別誤會！藥罐子倒是不知道誰對誰錯，只是想說其中一個理由可能是……

經前症候群(Premenstrual Syndrome, PMS)。

所謂「經前症候群」，主要是指女生在月經來潮前14天內所浮現的一些生理、心理症狀，例如頭痛、疲勞、體液瀦留(Fluid Retention)、水腫、乳房壓痛(Breast Tenderness)、易怒、焦慮、抑鬱，從而開始放負，一般會隨著月經來潮而逐漸消失。

實際上，經前症候群非常普遍。根據一些參考資料，平均大約75%的育齡女性便曾經經歷過經前症候群的症狀。[1]

說到經前症候群，一般建議調整生活習慣，有助紓緩經前症候群的症狀：[1][2]

第一，減少鈉質的攝取量，簡單說，便是「少鹹」，因為「鈉跟著水走」，所以鈉少水少，從而能夠紓緩體液瀦留、水腫的症狀。

第二，多做運動，因為這可能會增加內啡肽(Endorphin)的水平並產生跑者的愉悅感(Runner's High)，從而可能會提升正能量，擊退負能量。

除此之外，一般還可以服用一些維生素紓緩經前症候群的症狀。

例如維生素B6。
　　
維生素B6是人體的其中一種輔酶，主要負責生產血清素(Serotonin)的最後一個步驟。至於血清素是一種神經傳遞介質(Neurotransmitter)，主要負責協調人體的情緒。
　　
過往一些假設認為人體缺乏維生素B6可能會誘發經前症候群的抑鬱症狀。
　　
一項元分析(Meta Analysis)指出每天服用100mg維生素B6或許可能會紓緩經前症候群的症狀。[3]

在副作用上，每天服用高劑量(>2000mg)的維生素B6可能會損害神經，從而可能會誘發周邊神經病變(Peripheral Neuropathy)。

不過就算只是200mg的維生素B6，同樣可能會誘發神經病變。[4]

最後……除了經前症候群之外，還有經前不悅症(Premenstrual Dysphoric Disorder, PMDD)。

「經前不悅症」其實可以說是經前症候群的進化版，情況一般會較嚴重，往往足以對患者的工作、社交構成負面的影響。

根據一些參考資料，平均大約3至8%的育齡女性便曾經患上經前不悅症。[1]

在用藥上，選擇性血清素再回收抑制劑(Selective Serotonin Re-uptake Inhibitors, SSRI)一般是首選[1]，例如Citalopram、Escitalopram、Fluoxetine、Paroxetine、Sertraline。

不過除了選擇性血清素再回收抑制劑之外，其實還有三環類抗抑鬱藥(Tricyclic Antidepressant, TCA)，例如Clomipramine。
　　
不過相較而言，三環類抗抑鬱藥的副作用一般較多，所以一般只會視為次選。
　　
嗱！嗱！嗱！話雖如此，不過藥罐子倒是不建議女生動輒拿「經前症候群」、「經前不悅症」做發脾氣的擋箭牌。

（如欲了解更多用藥資訊，歡迎看看「小小藥罐子」網誌。）

💊💊💊💊💊💊💊
BLOG➡️http://pegashadraymak.blogspot.com/
IG➡️https://www.instagram.com/pegashadraymak/
YT➡️https://www.youtube.com/channel/UCQOMojMd6q7XnESMWwldPhQ

📕📕📕📕📕📕📕
著作➡️藥事知多D、用藥知多D、藥房事件簿、家居用藥攻略（各大書店有售）

Reference:
1. Steiner M, Pearlstein T, Cohen LS, et al. Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: The role of SSRIs. J Womens Health. 2006;15:57-69.
2. Grady-Weliky TA. Premenstrual dysphoric disorder. N Engl J Med. 2003;348:433-438.
3. Wyatt KM, Dimmock PW, Jones PW, et al. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999;318:1375-1381.
4. British National Formulary. BMJ Group and RPS Publishing. 56th ed. 2008:531.

【疾病知多D】杞人會不會患上焦慮症呢？

《列子．天瑞》裡記載一個故事，內容是這樣的：
　　
杞國有人，憂天地崩墜，身亡所寄，廢寢食者。
　　
對，這便是「杞人憂天」的故事。
　　
其實杞人會不會患上焦慮症呢？
　　
常言道：「天跌落黎當被冚。」所以現在人們顯然不會「憂天地崩墜」，不過難免會有其他憂慮，以致「身亡所寄，廢寢食者。」
　　
無論如何……
　　
《聖經．馬太福音》說：
　　
所以不要為明天憂慮；因為明天自有明天的憂慮。（第6章34節）
　　
話雖如此，不過別忘記，這段經文其實還有下文……
　　
一天的難處一天當就夠了。（第6章34節）
　　
這就是說，今天的難處今天還是要當的！
　　
那憂慮來了，例如失意、失戀、失業，大家會怎麼辦？
　　
暴走？抓狂？打機？掃街？血拼？摔東西？還是……
　　
《黃帝內經．素問．陰陽應象大論》說：
　　
人有五臟，化五氣，以生喜怒悲憂恐。
　　
跟「喜」、「怒」、「悲」、「恐」一樣，「憂」本來是人其中一種與生俱來的情感，所以「憂」自身不是一種罪，更加不是一種病。
　　
不過《黃帝內經．素問．陰陽應象大論》還說：
　　
憂傷肺。
　　
所以過分憂慮既傷心，又傷身，更加可能會悶出病來。
　　
暫時姑且撇開中醫不說，在西醫上，過度憂慮便可能會悶出焦慮症。
　　
至於其中一種較常見的焦慮症主要是「廣泛性焦慮症(Generalized Anxiety Disorder, GAD)」。
　　
在用藥上，抗抑鬱藥(Antidepressant)一般是首選，主要是選擇性血清素再回收抑制劑(Selective Serotonin Re-uptake Inhibitors, SSRI)（例如Escitalopram、Paroxetine）、血清素與去甲腎上腺素再回收抑制劑(Serotonin–norepinephrine Reuptake Inhibitors, SNRI)（例如Duloxetine、Venlafaxine）。
　　
雖然暫時還是不太清楚具體的作用原理，不過有研究指出這些抗抑鬱藥可能會調節神經傳遞介質(Neurotransmitter)受體的活化，例如血清素(Serotonin)、多巴胺(Dopamine)、去甲腎上腺素(Norepinephrine / Noradrenaline)，理論上，便可能會紓緩廣泛性焦慮症的症狀。[1]
　　
至於不同的抗抑鬱藥各自有不同的副作用。
　　
舉例說，

Escitalopram的副作用主要是失眠、噁心、疲勞。
　　
Paroxetine的副作用主要是嗜眠(Somnolence)、噁心、口乾、無力(Asthenia)。

Venlafaxine的副作用主要是嗜眠、噁心、口乾。

除了選擇性血清素再回收抑制劑、血清素與去甲腎上腺素再回收抑制劑之外，其實還有三環類抗抑鬱藥(Tricyclic Antidepressant, TCA)，例如Imipramine。

不過相較而言，三環類抗抑鬱藥的副作用一般較多，例如嗜睡、直立性低血壓(Orthostatic Hypotension)，所以一般只會視為次選。
　　
最後說回「杞人憂天」的故事，其實只需要告訴杞人「天，積氣耳，亡處亡氣。若屈伸呼吸，終日在天中行止，奈何憂崩墜乎？（《列子．天瑞》）」並逐步釋除杞人隨之而來的憂慮，杞人便「舍然大喜。（《列子．天瑞》）」
　　
說到底，心病還須心藥醫，解鈴還須繫鈴人。簡單說，治標重要，治本更加重要。

（如欲了解更多用藥資訊，歡迎看看「小小藥罐子」網誌。）

💊💊💊💊💊💊💊
BLOG➡️http://pegashadraymak.blogspot.com/
IG➡️https://www.instagram.com/pegashadraymak/
YT➡️https://www.youtube.com/channel/UCQOMojMd6q7XnESMWwldPhQ

📕📕📕📕📕📕📕
著作➡️藥事知多D、用藥知多D、藥房事件簿、家居用藥攻略（各大書店有售）

Reference:
1. Shelton RC, Brown LL. Mechanisms of action in the treatment of anxiety. J Clin Psychiatry. 2001;62(Suppl 12):10-15.

Recipe at: http://www.themeatmen.sg/tofu-pudding-with-salted-gula-melaka-caramel

Our Tofu Pudding is a humble morsel of heaven which features not just any ordinary salted caramel, but Salted Gula Melaka Caramel - which really shines against the subtle creamy flavour of the tofu!

To make our silky pudding, we blend milk, thickened cream, collagen-based gelatin, and icing sugar with tofu, then let the strained mix set in the fridge. We’ve specially chosen the Steamed version of the Vitasoy Organic Sprouted Tofu for a smoother, luscious texture thanks to its Nigiri-seawater extracts. We also love the fact that it has 25% more calcium than other tofu products. The low calorie count is perfect for offsetting the decadence of the dish, and a sprouted product will aid in digestion and nutrient uptake.

Gula Melaka, which we use as a key ingredient for our own relish, is the Malay term for coconut or palm sugar. It yields a taste and consistency quite like brown sugar but stands out with its own unique character. For our sauce, we combine the sweet chunks of Gula Melaka and natural unsalted butter, whisk in some coconut milk, add a twist of pandan leaf and a sprinkle of salt to achieve that satisfying creaminess and sweet aroma.

Drizzle generously over the pudding when it’s ready, kick back and enjoy your guilt-free treat – it’s ‘living la vida local’ with no regrets!

#themeatmensg #simple #delicious

Join us on Facebook! - facebook.com/meatmen.sg

More awesome cooking videos playlist here:
Hawker Food http://bit.ly/2eCurrf
Zichar http://bit.ly/2fBYRwx
Meat http://bit.ly/2fZ37ss
Seafood http://bit.ly/2eCuJyl

If you like our videos, remember to click Like and Subscribe. http://bit.ly/2flNJ67
FACEBOOK http://bit.ly/2fRBBOj
YOUTUBE http://bit.ly/2eTptHS
INSTAGRAM @themeatmensg
E-MAIL contact@themeatmensg
WEB http://themeatmen.sg

The Honda turnip (Cub) is the car name of the motorcycle which Honda Motor produces, and number car models are produced as a series car model
* Super Cub 50 - Standard deluxe custom specifications
* Press turnip 50 - Standard deluxe specifications
* A little turnip - Standard cell specifications
* Super Cub 90 - Deluxe custom specifications

I am different from standard in the superior quality, and right and left get a rearview mirror by the metallic painting. In addition, the front carrier and blinker relay are equipped with, too.

In a meter large-sized as for the custom specifications a cell motor / corner type headlight, the meter part upper specifications (50cc model 4, speed transmission) such as the fuel meter equipment (the other turnips are equipped with by a nipple under the seat). To "the turnip freak" whom it strongly demands the atmosphere of the old & vintage motorcycle from for (release it precisely in 1982) in 1980's that custom specifications were added popularity lightly. "The red turnip" of the special specifications that the body color all in red based on this custom specifications was characteristic has been ever sold. The "red turnip" specifications have been still made a pula kit on 1/12 scales in 1983 by Bandai.

The press turnip is paper round specifications with the headlight equipped with brakes of the 250cc class in large-capacity previous basket, large-sized rear carrier, powerful side stands, reinforcement type swing arm, 重積載用. Three the speed rotaries corresponding to a frequent departure stop-style transmission (I am neutral and enter even if I do not completely stop) equipment. The luxurious equipment such as grip heaters is pounding the deluxe specifications. Before it, there was the turnip of the body of good Brightman yellow of the visibility called the news turnip series, but PRO replaced it as collection and delivery duties use afterwards.

The little turnip is conscious of the uptake of the woman user with the sale cancellation of Honda シャリィ and I give priority to easiness of handling by lowering the body and adopt 14 inches wheel, and, as for little turnip .3 speed model and specifications 4 with the cell motor, the speed transmission equipment becomes belonging to it. The displacement volume only as for 50cc.

A minor change with the car exhaust gas regulation reinforcement is performed on September 21, 2007 and adopts an electronic control fuel injection system (PGM-FI) to all 50cc series cars including the custom and I attach catalyzer in an exhaust pipe and adapt it to exhaust gas regulation in 2006. However, the best output compares it with 3.4ps and conventional carburetor specifications, and 0.6ps deteriorates, and, as for the fuel consumption, numerical value largely turns worse on 116.0km/L and in front of minor change and a thing of a competition catalogue value in 110.0km/L, a custom in standard superior quality. In addition, the crankcase part of the engine is done a black layout (the black painting) of. In addition, the little turnip was changed minor for on October 5, and the street specifications that let the body for common use equip with 17 inches wheel with this became the production end.