Leukaemia donations missing | Asthma rates soar | Syphilis rates as high as 44% in sex workers

Leukaemia boy misses out on donations

One of the top stories in the Xinhua news this weekend is the story of a boy from Leshan in Sichuan with leukaemia who has missed out on most of the funds donated by wellwishers for his treatment. The family of the 8-year-oldcalled Lin Zhouzheng appealed for help in paying several hundred thousand yuan in medical bills after they ran out of money and even sold their house to pay for chemotherapy for their son. They were approached by a local man called Xu Ping who mounted a major publicity drive to raise money, and this netted more than 100,000 yuan. However, to date the boy's family have only received 7,000 in money from all the fundraising despite taking part in many media interviews, publicity appearances and having an army of volunteers working under Xu Ping. However, Xu Ping told reporters that the 110,000 yuan raised had only been pledges rather than actual donations - and he was still working to get companies and individuals to make good on their pledges.

Asthma rates soar in Shanghai

Asthma rates in Shanghai have increased four-fold over the last 15 years, with pollution being given much of the blame. A study of more than 27,000 residents of Pudong found that the prevalence of asthma was 1.4%, markedly higher than the 0.4% rate seen in the last major study carried out in 1997. Researchers from the Department of Respiratory Medicine at the Shanghai Putuo District People's Hospital carried out further pulmonary tests on 428 people with asthma and found that 53% had an FEV below 80% of normal and the severity of impaired lung function increased with age. The main triggers for asthma were dust exposure, cold air and respiratory tract infections.


STDs rates high in Jiangxi sex workers

More than 40% of female sex workers in Jiangxi have syphilis, a study has found. Researchers from the Department of Dermatology and STDs at the Affiliated Hospital of Nanchang University tested 361 street-based female sex workers and found that 44% had syphilis infection. About half of the sex workers had little education, a high proportion had been sex workers for several years and many failed to use condoms consistently. "Comprehensive interventions targeting this high-risk group, especially scaling up screening and ensuring consistent use of condoms during sex are needed," the researchers suggested.

What does Beijing's air pollution do to your lungs?

by Michael Woodhead
Breathing the polluted air in Beijing has the same effect on the lungs as being a heavy smoker, a study carried out before and after the 2008 Olympic Games has shown.
Researchers from Peking University have shown that residents of Beijing have impaired lung function – but that their lungs can revert to normal during clean air periods such as during the Olympic Games, when air pollution was artificially curbed for a few weeks.
The findings come from a novel series of lung function tests done on 200 Beijing residents before, during and after the 2008 Olympics.
Dr Lina Mu of School of Public Health at the University at Buffalo, New York, carried out the research in conjunction with colleagues at the School of Public Health, Peking University,
They found that ordinarily in Beijing, the mean PM2.5 (83 µg/m3) is more than three times higher than the WHO׳s safe limit of 25 µg/m3. At the same time, lung function of Beijing residents (as measured by peak expiratory flow or PEF) was well below the normal range for healthy lungs.  Lung function was impaired by 16-40% for men (PEF of 418 vs a healthy range of 500-700 L/min) and by 23-42% (PEF of 292 vs a norm of 380–500 L/min) for women.
During the Olympic Games the closure of factories and curbs on use of vehicles resulted in air pollution levels falling and particulate matter levels were reduced up to 60%. During this brief ‘clean air’ window lung function was observed to increase by 17% in females and 13% in males, “suggesting an improved airway status after 40 days of lowered exposure to air pollution.” The researchers said.
Interestingly, lung function improved more in non-smokers than smokers and in younger, female residents compared to male and older Beijing residents.
The clean air period in Beijing also saw a reduction in the number of Beijingers with rapid breathing (more than 20 breaths per minute) – a typical response to pollution and impaired lung function.
Lung function deteriorated back to unhealthy levels after the Olympics when factories were re-opened and pollution levels returned to their usual levels.
The researchers said their findings confirmed the adverse effect of particulate matter in the atmosphere on lung function.
“Deposition of particulate matter induces increased oxidative stress that not only results in DNA, lipid and protein damage, but also leads to the inflammatory responses,” they noted.
They said the pollution curbs implemented by the Chinese government during the 2008 Olympics had created conditions for a natural experiment that showed the impact of air pollution on Beijingers’ lung health.
They said the findings confirmed the adverse effects on lung health but showed that these cold be reversed – at least in some sections of the population. However, they also noted that long term exposure to air pollution in Beijing was likely to have more severe ongoing effects on lung health.
The study is published in Environmental Research.

Eight medical stories from China you should read

by Michael Woodhead

1. Beijing will start to enforce new anti-smoking laws with 200 yuan on-the-spot fines (up from 10 yuan) for people who smoke in public indoor shared areas, and institutional fines of 30,000 yuan (up from 5000 yuan). Cameras will be used to compensate for the lack of enforcement officers, especially after hours, the city government says.

2. The Chinese government has been accused of withholding medical care from dissidents. An article by Sophie Richardson in the WSJ says civil rights campaigner Cao Shunli is now in intensive care because she was denied access to medical care while detained for her efforts to promote a civil society.

3. A link has been found between damp housing in Shanghai and rates of asthma in children. Researchers from the University of Shanghai for Science and Technology say asthma symptoms could be reduced by 25% by simply keeping a child's window open at night.

4. A vaccine against enterovirus 71 developed by Sinovac Biotech has proved effective against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children, according to a study in 5000 children done by the Jiangsu Provincial Center for Disease Control and Prevention, published in the New England Journal of Medicine.

5. Eating shark fin is not only cruel and bad for the environment, it is also a health hazard because of high mercury levels in the product, researchers from Zhejiang have shown. After testing samples of shark fin they found that up to 33% contained toxic levels of mercury.

6. Antibiotics are widely overused by parents in rural China, with more than 60% dosing their children with antibiotics bought over the counter, Shanghai researchers have found. Most parents were ignorant about how antibiotics worked and had little idea hat they do not help viral infections.

7. Migrant workers have little access to healthcare and many of them put off seeing a doctor for illness, a survey in Shanghai has found. Two thirds of migrant workers said they had never had a medical check up and nearly 40% said they had ignored symptoms because they couldn't get to see a doctor.

8. Health workers in Guangdong have completed a successful pilot trial of a cervical cancer screening program using the ThinPrep cytological system. The program offered Pap test cancer screening to more than 40,000 women, and found that improvements are needed in basic education regarding cervical cancer screening for young and poorly educated women.

Five Chinese medical studies you should know about in January 2014

Soy bad for men's heart health
A high intake of soy may increase the risk of cardiovascular disease in men, contrary to the well known protective effect seen in women, a study from Shanghai has found.
Habitual high soy food intake over 10g per day was associated with up to a 20% higher risk of incident coronary heart disease in middle-aged and older Chinese men. The researchers said elevated plasma IL-8 and PAI-1 might be potential contributing factors.
International Journal of Cardiology

Chronic kidney disease and metabolic syndrome
In China the prevalence of chronic kidney disease s 4.6% in people with metabolic syndrome and 3.3% in people without metabolic syndrome, a study has found. The risk of chronic kidney disease was 50% higher with metabolic syndrome and the findings suggest an increasing prevalence of chronic kidney disease among Chinese adults with metabolic syndrome, according to researchers from the Department of Endocrinology, The First Affiliated Hospital of the Fourth Military Medical University, Xi'an.
Clinica Chimica Acta

Asthma rarely well controlled in China
Asthma tends to be poorly controlled in China compared to other countries in the region. A study has found that only 2% of asthma patients in China had their condition well controlled compared to 14% in Singapore. Patients whose asthma was not well-controlled tended to use more asthma medications, had more emergency hospital visits and hospitalisations for their asthma, and were more likely to miss days off work or school.
Respiratory Medicine

One in five have mild cognitive impairment
A survey of 10,276 Chinese people aged 65 years or older has found that 21% had mild cognitive impairment, and 6% had cognitive decline that was likely early Alzheimer's disease. Cognitive impairment was more common in rural areas 23% compared to urban areas (17%).Vascular-related mild cognitive impairment was the most common type, according to researchers from the Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing.
Alzheimers and Dementia

HIV screening needed
HIV screening and early identification is badly needed among high risk populations in China such as those with TB, according to researchers from the Shandong Provincial Chest Hospital, Shandong University, Jinan. They found a HIV prevalence of 0.28% among TB-referral patients in Shandong, but noted that HIV/TB co-infection rates are high in regions such as Xinjiang ( 4.5%) and Guangxi (4.3%) due to to high rates of injecting drug use and HIV infection, and most cases presented late as AIDS.
Journal of Infection

Chinese medical research ... from the journals

A text messaging scheme that sent lifestyle reminders to overweight adults in Beijing was effective in helping them lose weight. In a six months trial the texting service helped participants lose an average of 1.6kg and also reduced waist circumference, body fat and lowered their blood pressure by almost 2mmHg. The findings are published in Obesity.

Three out of every 10 Chinese children develop asthma, a major survey has found. A survey of almost 464,000 children found that the incidence of asthma was 3% overall, and slightly higher in males than in females. The highest rates were seen in preschool children (3-5 years old) and in East China. More than 60% of children with asthma had an attack in the previous year  and went to hospital for emergency treatment. Bronchodilators were used by 71% of asthmatic children while 59% used an inhaled corticosteroid and 75% used antibiotic, according to the study by the National Cooperative Group of Childhood Asthma.

Dengue fever is on the increase in China and the risk is rising in line with temperatures, a study from Guangdong has found. Researchers at the Guangzhou Center for Disease Control and Prevention found that the rate of dengue fever had increased from 0.33 per 100 000 people in 2007 to 1.34 per 100,000 in 2012. The risk of disease increased with rises in temperature, humidity and wind, researchers report in Biomedical and Environmental Sciences.

Chinese thoracic specialists collaborate with US counterparts

The Chinese Thoracic Society and the American College of Chest Physicians (CHEST) have formally agreed to collaborate to develop and launch fellowship programs in pulmonary and critical care medicine in China.

This joint initiative seeks to unify the specialties of pulmonary and critical care in China to improve patient care. In the past three decades in the United States, the fields of pulmonary and critical care medicine have evolved into the combined subspecialty of Pulmonary and Critical Care Medicine (PCCM).

In 2012, the leadership of the Chinese Thoracic Society proposed a partnership to collaborate with CHEST in establishing PCCM as a recognized subspecialty in Chinese medicine and to take the lead in critical care throughout China. The partnership will rely on the experience of CHEST clinicians to address issues of integrated ICU programs, leadership within critical care medicine, and training for subspecialists.

"We look forward to assisting the Chinese Thoracic Society to develop and launch this vital initiative. Currently, ICUs in China are often organized as general ICUs or as areas that focus on diseases of specific organ systems, and physician staff ranges from recent medical school graduates to skilled intensivists. Pulmonary physicians play varied roles, from ICU director to consultant, to no role at all. This collaboration will address, define, and prepare Chinese clinicians in the PCCM subspecialty and will have a profound impact on patient care," said Darcy Marciniuk, MD, FCCP, and Immediate Past President of the American College of Chest Physicians.

A steering committee representing both organizations has been established to design training programs with standardized curricula and requirements for trainees and faculty. Programs are estimated to begin in late 2014.

Source: American College of Chest Physicians

No link between MSG and asthma, Nanjing study shows

Large study found no link between MSG consumption and asthma

by Michael Woodhead
The first major population study to look at the possible role of MSG and asthma has found no link between the consumption of monosodium glutamate and asthma rates.
Dr Shi Zumin, a researcher from the Department of Nutrition and Foodborne Disease Prevention at Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, undertook a study of MSG and asthma because emerging evidence shows that diet is related to asthma.
In a study of data from 1486 Chinese men and women who participated in the Jiangsu Nutrition Study, MSG intake and dietary patterns were assessed in 2002. Information on asthma history was collected during followed-up in 2007.
Of the study population, 1.4% reported ever having asthma. MSG intake was not positively associated with asthma. However, there was a significant positive association between ‘traditional’ (high loadings on rice, wheat flour, and vegetable) food pattern and asthma. No link with asthma was seen with a diet rich in meat and alcohol, nor for a 'sweet tooth' diet high in cake, milk, and yoghurt, or a ‘vegetable rich’ diet high in whole grain, fruit, and vegetables.
Dr Shi says a MSG was first reported  to be linked to asthma attacks in 1981 after a person developed asthma after ingesting a meal in a Chinese restaurant. However, small clinical trials on MSG and asthma have yielded inconsistent results, with some suggesting that MSG intake was a trigger factor for asthma, while others showing no  link.
He notes that the prevalence of asthma in the Chinese population is lower than Western populations, and the prevalence of asthma (1.4%) in the study was consistent with that of other studies
"In our [study], even though the mean MSG intake is high compared with many developed countries, we did not observe a significant increased risk of asthma," he concludes.
Source: PLOS One

Chronic cough most often caused by asthma, Guangzhou study shows

One in three patients with chronic cough have asthma-related cough, a study from Guangzhou has found.
Dr Lai Kefang and colleagues in the Guangzhou Institute of Respiratory Diseases at the First Affiliated Hospital of Guangzhou Medical University examined the causes of chronic cough in 640 patients from five regions of China.
   They found that  the most common causes were included asthma (cough-variant asthma VA, 33%)，upper airway cough syndrome (19%), eosinophilic bronchitis (17%) and atopic cough (13%).
Collectively, these four causes accounted for 75% to 88% of chronic cough without significant variation across all regions. Gastroesophageal reflux-related cough was identified in 5% of cases of chronic cough.
Source: Chest

News in brief ...

The Ministry of Health has limited power to implement health system reforms in the provinces

Provincial leaders may block China's health reforms

by Michael Woodhead
The second phase of China's health reforms being pushed by the State Council may stall because the real reforms must be made at local level where the Ministry of Health has little sway, a new report claims.
The report by health analysts and economists notes that China's social sectors are heavily decentralised and the Ministry of Health has limited influence on the detailed design and implementation of the health service reforms at provincial level.
The report says provincial leaders in China are mostly driven by economic progress and revenue generation; whereas health is generally regarded as consuming, not generating revenue.
The analysts say a new health management information system and performance-based management of health staff may enhance oversight
"However, parallel reforms in governance, financing, and accountability are also needed in China, to ensure achievement of the equity objective of its health service reforms, "they conclude.
"Pursuing health service reform in China has the potential to improve equity by bringing standardised primary care and public health to those whose health status implies they need it most. However, it will only succeed if sub-national governments are accountable for related public resource allocation, and if vertical monitoring of the quality, equity, efficiency, and effectiveness of the health sector is improved. In addition to HSR, reforms are also needed to align the responsibilities, capacity, and monitoring of all sub-national authorities with health-related national policies, standards, and regulations, and to improve their accountability to the population. These additions go beyond the influence of the Ministry of Health, but accord with the evident priority assigned to health service reform by multiple national authorities, the benefits to other sectors, and the increasing focus of the state on evaluating local government's commitment to public welfare. "
Read more: PLOS Medicine

Hepatitis B the most common infection in Chinese donor blood

Hepatitis B virus infection is the primary threat to blood safety in China, but the increasing prevalence of syphilis might also be a potential threat, researchers say
Researchers from the  School of Public Health at the Fourth Military Medical University,  Xi’an, analysed trends in the prevalence of transfusion-transmissible infectious pathogens among Chinese, first-time, voluntary blood donors from 1999 to 2009 to evaluate the potential for disease transmission.
Blood donations from 263 000 first-time blood donors were analysed. The overall prevalence rates of infection were 1.16% for hepatitis B, 0.5% for HCV, 0.02% for HIV, and 0.3% for syphilis. There was a significant decrease in the trend for hepatitis B and hepatitis C infections, while a significant increase was found for syphilis. The prevalence of HIV infection remained low and stable during the study period.
Read more: International Journal of Infectious Diseases

Asthma in China: less common but less well controlled 

Asthma is less common in China than in the west, but it is poorly controlled where it does exist, a study from provincial Jinan has suggested.
A survey of more than 13,400 people in urban and rural areas of Jinan found that the prevalence of asthma was 1.1%. A history of allergies, asthma family history, household size, and age were independent factors related to asthma.
Dr Wang Dexiang and colleagues fro the Department of Respiratory Medicine, Qilu Hospital, Shandong University, also found that among patients with asthma, control of the condition was poor in a high proportion of patients and even worse in those living in rural areas.
"The asthma prevalence for all ages in Jinan was relatively low compared with that in western countries, however, local asthma control fell markedly short from the goals of GINA (Global Initiative for Asthma) criteria for asthma management, which may be attributed to the poor adherence to GINA guidelines, especially the underuse of preventative medication of inhaled corticosteroids," the researchers say.
Read more: Respirology

Rural migrants get substandard antenatal care in Shanghai

Many migrant women in Shanghai do not receive adequate antenatal care  a new study shows.
Researchers from the School of Public Health at Fudan University interviewed 767 migrant women who had been living in Shanghai for more than six months and who had a baby in hospital there. They foun d that only half had adequately utilised antenatal care (i.e., made five or more antenatal care visits), although 90% made at least one antenatal care visit. Only 20% of migrant women visited an antenatal care centre during the first trimester (12 weeks).
Antenatal care was used most by older migrant women and migrant women whose husbands held Shanghai residency status. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks.
The researchers say that improving utilisation of antenatal care is a critical strategy for achieving China's Millennium Development Goal of decreasing the maternal mortality ratio.
"While overall utilisation has increased recently in China, an urban vs. rural disparity in access remains," they note.
They suggest that more tailored health education is needed for migrant women and their husbands to improve maternal health. Financial support should also be e provided to improve the utilisation of antenatal care, they add.
Read more: BMC Public Health