China medical news roundup: Friday 8 November

 FPG a poor screening tool for metabolic syndrome

 Researchers from Xian have shown that HbA1c is  a better screening tool for metabolic syndrome and prediabetes compared to fasting plasma glucose in Chinese patients.

In 2009, a unified definition of metabolic syndrome (MetS) was proposed, of which, the glycemic component is defined on the basis of fasting plasma glucose (FPG) level. Recently, the American Diabetes Association recommended the use of glycated hemoglobin (HbA1c) as an alternative to FPG to define prediabetes. Dr Sun Xingxing and colleagues at the Fourth Military Medical University, Xi’an aimed to compare the performance of HbA1c and FPG in the definition of glycemic component of the MetS among Chinese adults. They conducted a cross-sectional analysis of 7641 Chinese adults. Overall, 1136 (14.9%) of participants had metabolic syndrome according to FPG >= 5.6 mmol/l, and 1640 (21.5%) had metabolic syndrome according to HbA1c >= 5.7%. Compared with individuals with FPG-based diagnosis of metabolic syndrome, individuals with HbA1c-based diagnosis of metabolic syndrome were older, had higher levels of LDL-cholesterol, magnesium, and transferrin, and lower levels of uric acid. Of those found to have metabolic syndrome according to either FPG or HbA1c, overlap between HbA1c- and FPG-based diagnosis of metabolic syndrome was limited (n = 768, 38.2%).

“We note limited overlap and poor agreement between FPG- and HbA1c-based diagnosis of metabolic syndrome. Screening for metabolic syndrome through introduction of HbA1c in addition to FPG could contribute to identification of more people with metabolic syndrome,” the researchers concluded.

Full study: BMC Public Health

New medical graduates wary of working as doctors

Wang Jun, who is studying for a master's degree in clinical medicine, is confused about his future career and will soon have to make major decisions about his life.

"I was depressed by the mounting prejudice against doctors and the deep distrust held by the public. I even began to doubt my decision to study medicine," the 25-year-old second year student said.

Wang, like many other medical graduates, is worried about pay, workload and the deteriorating working environment.

More than 600,000 medical school students have graduated each year over the past few years, but only 20 percent of them have become clinicians, said Li Ling, a professor in health economics of the National School of Development at Peking University.

"The phenomenon is not accidental and has been getting increasingly serious based on our survey across the country," Li said, adding that "educational resources have been wasted as a large amount of medical talent has flowed out of the industry."

Wang Jun said he will go abroad to get a job in a hospital after graduating from Shandong University next year.

"It's hard to give up what you've been working on for a few years," he said. "It's true that the overseas medical industry is very competitive, but the overall environment probably will make me feel better."

Li Ling attributes the outflow of medical talent to the worsening environment of the industry.

"Those who chose to become a doctor as their profession are somewhat idealistic with the aspiration of healing the wounded and rescuing the dying," Li said. "However, some of them gave up their medical career as they disagreed with the profit-oriented operation in hospitals."

Liu Yanhua, who became a doctor at the NO.89 Hospital of the People's Liberation Army two years ago, said only five out of the 55 medical graduates in her class became clinicians. The rest are either pursuing further education, in pharmaceutical sales or switched to other sectors.

Doctor-patient tension is another reason why the profession is less attractive.

The incidence rate of medical disputes in China has increased annually by 22.9 percent since 2002. Patient-doctor conflicts have escalated into violent or even fatal attacks.

Among the 34 attacks against doctors involving patients or their relatives that happened from February 2012 to September 2013, five doctors were killed, a microblogger in the medical circle wrote on his Sina Weibo account.

In addition, the heavy workload and relatively low income has also contributed to the outflow of medical practitioners.

"It's common to work around the clock when there are plenty of patients, moreover, mental stress is even heavier than physical fatigue," said Xiao Jinyi, who has been working in a Beijing hospital for four months.

However, the heavy workload has failed to bring doctors attractive salaries. Xiao said new staff like her earn no more than 5,000 yuan (821 U.S. dollars) each month.

"Doctors in our hospital have left because of intense pressure or bleak career development prospects," Xiao added.

The supply of medical graduates has outstripped demand thanks to China's college enrollment expansion drive since 1998, which has also led to the outflow of medical talent.

Source: China Daily

Harsh working conditions for doctors

Working conditions are poor for doctors in China. They often have to work overtime, but still can't satisfy patients' needs and are frequently criticized for seeking personal profit.
"While 80 percent of Chinese patients live in villages, 80 percent of high-quality medical resources are in cities," said Han Xuejun, director of the Medical Disputes Mediation Committee of Shanxi Province. "This makes it expensive and difficult for people to see doctors, which is the underlying cause of the frequent conflicts between patients and doctors."
Every year, a huge number of patients swarm into big cities to see doctors, which increased their workloads. According to a survey conducted by dxy.cn, China's largest medical study website, more than one quarter of Chinese doctors are prone to cardiovascular diseases; the possibility of male doctors aged 35 years and above having high pressure is twice that of ordinary people; and more than 70 percent of doctors suffer neck and back pain.
However, the harsh working conditions for doctors have evoked little public sympathy. Patients are increasingly discontent with the medical system, complaining that public hospitals are too profit-oriented and often ask patients to undergo excessive examinations and unnecessary treatment or simply transfer those with complicated symptoms to other hospitals.
On the other hand, the doctors feel they are not understood. "The public demands on doctors and nurses are too high, but they know little about how to diagnose or cure diseases," said Liu Yang, a director of the Shanxi Provincial Health Department.
Doctors worldwide are currently only know the causes of about one quarter of the diseases humans beings suffer from. Of these diseases, only one tenth can be cured, while for the rest, doctors can only reduce the symptoms.
Wang Jie, who was injured during the knife attack in Zhejiang, said he could understand the patients' anxiety to be cured. "It's the wish of all doctors to cure patients' diseases, but not everything is possible."
The grave situation for doctors has meant fewer and fewer medical students are willing to work in hospitals, especially rural hospitals. Every year, Chinese universities enroll about 600,000 medical students, but only one sixth of them will become doctors, said Li Ling, a professor at the National School of Development at Peking University.
According to Bai Jigeng, director of Shanxi Provincial Children's Hospital, it takes too many years for a medical student to become a real doctor. Before working in hospitals, medical students have to study theory for five to eight years. But that alone is not sufficient. They have to spend another 10 years gaining firsthand experience in a hospital. When they finally become competent, they are too often too old to work in clinical departments or perform surgeries.
"What we need are skillful therapists, not doctors with just a high level of education," Bai said.

Source: Women of China

Test developed for dapsone hypersensitivity in leprosy

Dapsone is used in the treatment of infections and inflammatory diseases. The dapsone hypersensitivity syndrome, which is associated with a reported mortality of 9.9%, develops in about 0.5 to 3.6% of persons treated with the drug. Currently, no tests are available to predict the risk of the dapsone hypersensitivity syndrome.

Dr. Fu-Ren Zhang and colleagues from the Shandong Provincial Institute of Dermatology and Venereology, Jinan performed a genomewide association study involving 872 participants who had received dapsone as part of multidrug therapy for leprosy (39 participants with the dapsone hypersensitivity syndrome and 833 controls), The analysis showed that SNP rs2844573, located between the HLA-B and MICA loci, was significantly associated with the dapsone hypersensitivity syndrome among patients with leprosy (odds ratio, 6.18; P=3.84×10⁻¹³). HLA-B*13:01 was confirmed to be a risk factor for the dapsone hypersensitivity syndrome (odds ratio, 20). The presence of HLA-B*13:01 had a sensitivity of 85.5% and a specificity of 85.7% as a predictor of the dapsone hypersensitivity syndrome, and its absence was associated with a reduction in risk by a factor of 7. The researchers say HLA-B*13:01 is present in about 2-20% of Chinese people, but is largely absent in Europeans and Africans.

“HLA-B*13:01 was associated with the development of the dapsone hypersensitivity syndrome among patients with leprosy,” they concluded.

Read the full study at NEJM 

Methadone program cuts HIV in Hubei

The introduction of methadone maintenance treatment (MMT) clinics for drug abusers in Hubei province from 2007 to 2011, has reduced the incidence of HIV. The proportion of HIV infection among drug abusers decreased relatively quickly from 12% to 2%. However, the methadone program had a high drop-out rate and poor information management was also identified as a particular problem that now needs to be addressed.

“Drop-out from MMT programs may reflect social issues the clients encounter, and consequently, sustainable MMT development requires incorporation of social measures that help MMT clients return to society without discrimination, especially through family cooperation and employment opportunities,” researchers concluded.

Full study at: Substance Abuse Treatment, Prevention and Policy

 

Shanghai hospital denies using celebrity pictures to promote cosmetic surgery

A Shanghai hospital that was ordered to compensate a Taiwan celebrity for using photographs of her without permission yesterday reiterated claims that it’s all a case of mistaken identity.

Singer and actress Annie Yi took legal action against the Shanghai Wanzhong Hospital after she discovered it was using her picture on its website to promote plastic surgery.

In the first trial, Shanghai Wanzhong was ordered to pay Yi more than 144,000 yuan (US$23,640), after its claims that the pictures were of someone else were rejected.

But yesterday at the Shanghai No. 1 Intermediate People’s Court, the hospital insisted again that the photographs were of a woman called Rao Dongdong.

It said the photos had all been digitally processed to ensure they had a consistent likeness.

It also said the two websites that used the pictures were not Wanzhong sites, but those of business partners.

After discovering nine unauthorized photographs in June last year, Yi demanded that the hospital remove the pages, apologize and pay compensation. Wanzhong took down the pages but refused the other demands, saying the woman in the photographs was Rao. Yi then brought a law suit, accusing Wanzhong of infringement and demanding compensation of more than 1.54 million yuan (US$252,616), plus a public apology. In the first trial, the court ruled that the woman in the photographs didn’t resemble Rao.

“After the photos were posted online, people asked Yi if she had undergone plastic surgery, which had a negative effect on her image,” Yi’s lawyer told Shanghai Daily.

The court didn’t return a verdict.

Source: Shanghai Daily

Call for government to beef up security to prevent hospital attacks

Dozens of members of the National Committee of the Chinese People's Political Consultative Conference (CPPCC) submitted a proposal to the committee on stepping up security against attacks on hospital staffers by patients and visitors, in a bid to control the rising menace of such assaults, The Beijing News reported on Wednesday.

Ling Feng, director of the neurosurgery department of Beijing's Xuanwu Hospital and a CPPCC member, along with 30 other CPPCC members, had submitted the proposal on November 1 and sought an emergency response system for victims.

Ling said that there should be "zero tolerance" for violence against medical practitioners and security regulations in hospitals should be improved. He also suggested that hospitals should be managed by the government as public places and their security should be handed over directly to the police rather than make them the responsibility of private security guards hired by hospital management.

"Currently, the security standard in hospitals is lower than that of public places. If a person disturbs order in a public place that person could be detained," Deng Liqiang, director of the legal department at the Chinese Medical Doctor Association (CMDA), told the Global Times on Wednesday.

"But according to regulations at hospitals, people will only be punished if they physically hurt or kill someone."

Over the past few years, incidents involving violence against doctors have been on the rise as reported from various parts of China, at least six cases since October.

A doctor in Wenling, East China's Zhejiang Province, was stabbed to death by a patient on October 25, in a recent such case. Two other medical practitioners were also injured.

Ling said in an interview with China Central Television (CCTV) on October 31 that she felt obliged to initiate the proposal after the Wenling incident.

"I feel sad for my colleague and the murderer should be punished by law," Ling said in the interview.

The proposal said the "fundamental solution" to clashes between patients and the medical fraternity is to speed up healthcare reform. The violence hurts the morale of medical workers, the proposal added.

"The key issue here is that the government needs to invest more, not only to improve the working environment for medical practitioners, but also to step up security in hospitals," a practicing doctor from Beijing told the Global Times, on condition of anonymity.

In his survey conducted at hospitals across 11 provinces in August, Yin Dakui, head of the CMDA, found that 78.01 percent of doctors said they did not expect their children to take to their profession in future, CCTV reported.

Source: Beijing News

US volunteer medics say Chinese lack health literacy

China needs effective campaigns to educate its public about basic healthcare knowledge immediately, according to an American volunteer medical team working in Northeast China's Jilin Province.
Tom Yeh, a heart physician from the Garfield Medical Center and the volunteer team leader, said that American doctors have offered free clinics in China for decades, but not always in the same way as Chinese American doctors from the Garfield Medical Center,  who have been doing so at their own expense for more than a decade.
Yeh went to Northwest China's Xinjiang Uyghur Autonomous Region for his first volunteer activity in 2001. He said the current Chinese healthcare system can be improved by enriching medical resources in rural areas and opening up to private hospitals.
He believed that there is great potential in the Chinese medical market once more private investment can be put into the field to provide more medical facilities.
Another problem lies in the unbalanced development in the Chinese medical system, as medical facilities and treatment are sophisticated in big cities while those in towns and villages remain poor, said Yeh.
Members of the volunteer group agreed that the most pressing issue for the Chinese medical system is to popularize healthcare knowledge among the public, which could be of great help in disease prevention and treatment.
David Chu, a surgeon also from the medical center, said the mortality rate of breast cancer patients is low in the US because of good education and dissemination of knowledge, but the breast cancer rate is on the rise in China, partially attributable to the absence of effective outreach campaigns to disseminate related healthcare knowledge.
Su Xiaojian, a recovery nurse, said that many patients know nothing about prevention, and have no awareness of preventing diseases from their daily meals. For example, some high blood pressure patients take medicine for treatment and eat salty food at the same time, Su added.
The difference in medical systems between China and the US has led to a divergence in nursing styles.
Li Mingmei, head nurse of the medical center, said American nurses provide both medical and mental care for patients while Chinese nurses take care of patients according to the doctors' instructions.
The medical team also noticed some progress in the Chinese medical system, such as senior citizens over the age of 70 being able to see doctors without registration, and being able to call an ambulance 24 hours a day and be sent to hospitals for free.
Li Xuhua, a respiratory doctor also from the Garfield Medical Center, said ambulance costs, unlike China, are very high in the US and some Chinese-Americans will not call 911 unless the situation is extremely serious.
Erik Jiang, Chief Business Development Officer at Garfield Medical Center, said that their medical volunteer team has regularly organized at least two activities overseas every year since 2001.
The team has been to some poor and remote areas in China, including the Xinjiang Uyghur Autonomous Region, Qinghai, the Tibet Autonomous Region, Guizhou, Sichuan, Yunnan in China, and also Peru, Chile, Nepal, India and Cambodia, said Jiang.

Source: Global Times