Gong Xi Fa Cai! Medical news in the Year of the Sheep

Chinese New Year is upon us, with businesses closing up for a long holiday and most Chinese families looking forward to a reunion. But of course people still get sick at Spring Festival and the Chinese media has been full of stories praising the heroic and dedicated doctors and nurses who forego the holiday and put duty ahead of family to stay at work.  There are stories of doctors working solo for 24 hours to keep up with all the demand during the Spring Festival. From Hubei there is the story of the man bitten by his rabid pet dog who went to the hospital and was hugely relieved to find that the infectious diseases doctor was on duty to give him a rabies injection. At Fuzhou Hospital on New Years Eve the medical and nursing staff gather together to have the "big family banquet" that they would normally have with their families at home.  And there is even a story of the doctor at a Zhejiang leper colony who was urged by his ailing patients to go home and see his family rather than spend New Year on duty at the sanatorium.

Not all doctors have been heaped with praise at Chinese New Year, however. In Guangzhou there has been an uproar among the medical community after the city authorities sent anti-corruption teams in to raid hospitals just before Spring Festival. The city disciplinary affairs committee said the inspection teams were looking for evidence of bribes and 'hongbao' (red envelopes) given by patients to doctors. The raids have so far turned up little evidence of bribery, and doctors have been indignant at being suspected of corruption. They objected to having their everyday items such as snacks being documented - and also being questioned in detail about the origin of their possessions - and even for receipts for goods. Doctors said the actions of the inspectors went beyond their powers and the actions should have been a matter for the police. One doctor said a public hospital was not a place where bribes could be openly given or solicited among colleagues - and he was also indignant that many doctors had prepared hongbao or gifts for their families which were assumed by inspectors to be bribes from patients.

Chinese New Year is also a peak risk time for influenza in China. In Guangdong it has been reported there have been 53 cases and 13 deaths from  H7N9 avian influenza. In neighbouring Hong Kong there has also been a very severe flu season caused by the regular influenza H3N2 strain which has been causing as many as 18 deaths per day in the city. There have been reports of shortages of antivirals such as Tamiflu in Hong Kong, and the flu vaccine this year has been ineffective because the H3N2 strain of flu is a new mutation that is not covered by the vaccine. Of course influenza does not stop at the border, so we can only assume that the flu toll has been equally high in mainland China.

Another major infectious disease under the microscope this week is the recent outbreak of measles  affecting more than 1200 people in Beijing. Infectious disease specialists in the capital found that most of the cases originated in wholesale clothing markets popular with  locals and international visitors - so an MMR vaccination might be a pre-requisite if you are going to the Silk Market. The analysis found that many of the cases occurred in migrant workers who (unlike Beijing residents and tourists) had low levels of measles vaccination. The researchers recommended that outreach services be set up to vaccinate migrant workers in Beijing and "the offer of measles vaccine to workers as they register to live and work in the commodity markets might be a reasonable strategy to prevent future measles outbreaks."

In other news this week - the high demand for blood products in China is driving  a thriving black market in organised gangs of donors, organised by the so-called "blood heads" who are paid thousands of RMB for supplying blood. In the field of diabetes, some Chinese endocrinologists have been blasted in the pages of the Lancet for writing a review article that recommended the use of expensive new drugs as first line treatment for diabetes. Their critics say the endocrinologists failed to mention the more effective and cheaper drugs such as metformin - and the Chinese doctors also failed to mention their financial conflicts of interest with the Big Pharma makers of the expensive new drugs.

And finally, the quality of medical education in China has been questioned in several articles published this week. The Year of the Sheep is a milestone for China's medical educators in that they are now requiring a standard 5+3 medical degree + internship program be implemented nationally. However, some commentators have said that the new system will be no better than the current haphazard postgraduate 'Masters' programs if medical graduates receive insufficient clinical experience and supervision. They also say that the internship scheme should include 'exit examinations' to ensure that trainees have actually acquired the specialist skills they have trained in. Coincidentally this week Shanghai media report that trainee doctors get little experience in anatomy because there is a national shortage of donated cadavers. Chinese culture prohibits citizens from 'donating their bodies to science' as is done in the west. This means that Chinese medical graduates get all their anatomy learning from textbooks and have very little "hands on" experience. This is worrying for students going into specialties such as surgery - as they may never have practiced techniques such as cervical spine surgery before being asked to do the real thing. Not surprising then that a special anatomy cadaver training class at Shanghai's Fudan University was heavily oversubscribed.

新年快乐!

Diabetes in China: the numbers are staggering

by Michael Woodhead

The Lancet Diabetes & Endocrinology journal is this month running a series of articles focusing n type 2 diabetes in China.  

The numbers make for grim reading: more than 12% of Chinese are reported to have diabetes (100 million people) according to US criteria (although there is some dispute over whether these  criteria may result in overestimates).  Because of the lack of awareness and lack of adequate screening and intervention programs, many of the Chinese with diabetes are undiagnosed, untreated, or uncontrolled. 

The articles say that Chinese people are especially prone to type 2 diabetes at relatively low levels of overweight, and Chinese people are more susceptible to [insulin producing] beta cell failure and deficits in insulin production. The blame, unsurprisingly, is put on China's rapid development and shift to lifestyle factors such as eating an unhealthy diet and doing less exercise. 

A second article says that there are also problems with provision of prevention and treatment programs for diabetes in China. As well, there is little research on the best forms of drug therapy for Chinese people with diabetes. Newer [and more expensive] anti-diabetes agents such as the gliptins seem ideal, but they are not currently accessible or widely used by most doctors.

The articles conclude by saying that any solution to the diabetes epidemic in China must be based on multiple strategies: there needs to be healthcare reform to make diabetes prevention and treatment more widely available through primary care and through initiatives such as diabetes nurses. There are need to be major preventive health campaigns to promote healthier eating and activity, to reduce the risk factors for diabetes in China. The articles also note that health reforms are needed to provide adequate health insurance cover and reimbursement for treatment of diabetes patients in China

Doctors refuse red envelope pledge | Online pharmacies to be allowed | Chinese diabetes patients don't adjust diet

Famous doctor won't sign bribe pledge
One of China's leading doctors has refused to sign the government's anti-bribery pledge against accepting red envelopes, saying it is an ineffective and damaging document. SARS hero Professor Zhong Nanshan said the no red envelopes pledge was not a legally-binding document and its ethical pledges were already contained in the Hippocratic Oath that doctors already swore when they graduated from medical school. He said that if doctors signed the pledge it would be a tacit admission of guilt that all doctors were accepting bribes for preferential treatment, which was not the case. He added that signing the pledge also sent the wrong signal that doctors were to blame for the high costs of medical bills, which he said were actually driven by systemic problems such as the linking of hospital doctors incomes to overservicing and the lack of government funding for government hospitals.

Online pharmacies permitted from 2015
Online sales of prescription medicines in China may begin within months, according to the China Food and Drug Administration. The regulatory agency is expected to announce new policies that will allow  online prescription medicine sales as early as January 2015. Pharmaceutical retailers have said the opening up of online medicine sales will open up a potential 10 billion yuan market for drugs. However, the expected increase in  online pharmacies will have a major impact on bricks and mortar pharmacies, they have warned.

Diabetes patients don't adjust diet
Chinese people with diabetes have little idea how to manage their diet so as to better control their condition, a new study shows. A survey of 100 people with type 1 diabetes by researchers at Peking University People's Hospital found that less than half had ever seen a dietician and few monitored or adjusted their diet to help control their blood glucose levels. The study found that while 64% were aware of carbohydrate counting', only 12% ever used the technique

China's rural timebomb: half a billion elderly people with chronic diseases and no care

by Michael Woodhead
A survey of elderly villagers in rural parts of China has revealed some of the monumental healthcare problems the country faces.

Simply put, China is on track to have almost half a billion elderly people by 2050 and most of them will have chronic diseases but no treatment. The research carried out in 4400 households in rural areas of nine provinces found that a staggering 58% of elderly people are illiterate and many of them have been 'left behind' by children who have moved to towns or cities in search of work.

For almost 70% of elderly people their annual income was below 5000 yuan ($810).  And worryingly, they had high rates of chronic diseases: 18% had diagnosed hypertension, 3% had diabetes and 6% had asthma. However, these figures are likely to be underestimates because very few elderly people are getting health checks - only 3% had any kind of health preventive check in the past few weeks. Only 2% of patients had their blood pressure checked.

Not surprising then that substantial proportions of those people with chronic diseases are not receiving any kind of treatment - 25% of people with hypertension and a third of those with diabetes were untreated, the study found.

Published in the journal International Health, the findings show that China has huge numbers of vulnerable people with high health needs who are missing out on basic preventive care and treatment, says the author of the study, Dr Dai Baozhen of the Department of Health Policy and Management at Jiangsu University.

Dr Dai says one of the main reasons for this sorry state of affairs is the lack of funding for preventive health in rural China. Most rural residents are covered by the New Cooperative Medical Insurance Scheme, which provides modest reimbursement for inpatient treatment for acute illness. However, the New Cooperative Medical Insurance Scheme does not cover much outpatient treatment and does not reimburse village clinics for preventive health checks such as measurement of blood pressure or diabetes checks. Even if it did, the scheme also fails to cover the basic 'disease management' approaches needed to curb chronic diseases.

What this means in practice is that many people in rural China have chronic diseases such as hypertension and diabetes that are easily detected and which can be prevented and treated by simple and widely-available therapies. However, most elderly people miss out on the basic preventive and disease management approaches and so their chronic diseases are allowed to progress unchecked until patients develop later stages of disease that are more debilitating and more difficult (and expensive) to treat.

But as Dr Dai points out, there is no point in offering health checks if there is no capacity to provide follow up with early treatment and preventive programs.

"Until now, the New Cooperative Medical Insurance Scheme has not been structured to provide payment for prevention, promotion services and disease management for chronic conditions, and no health intervention (e.g. health education and promotion) is provided for groups at high risk of developing chronic conditions," he writes.

Dr Dai concludes that with adequate funding, the New Cooperative Medical Insurance Scheme could provide early identification and management of chronic conditions and thus help prevent a huge burden of disease in some of China's most vulnerable and deprived people.

The top 8 medical news stories from China for Thursday 1 May

1. A person's blood group may influence their survival from cancer according to oncologists in Guangzhou. In a study of patients with oesophageal cancer they found five year survival rates were 50 % for patients with blood type A, 45% for type B, 51% for type O, and 61% for type AB.

2. The incidence rate of type 1 diabetes is increasing at a rate of 14.2 % per year in Shanghai and if present trends continue, the number of new type 1 diabetes cases will double from 2016 to 2020, researchers say.

3. Chinese neurologists say people with atrial fibrillation may be able to avoid the need to take lifelong anticoagulant drugs to prevent stroke by using a minimally invasive surgery procedure called left atrial appendage closure (using a system created by Boston Scientific Corp - could be an advertorial).

4. The introduction of the New Cooperative Medical Scheme (NCMS) has increased access to healthcare for elderly people, but not had any effect on their overall health, a study from Nanjing University shows. The study found that the health cover did not affect overall health status and did not reduce the out-of-pocket spending of elderly people.

5. An outbreak of hand, foot, and mouth disease that hospitalised 1844 children in Central China from 2011 to 2012 was caused by a mixture of co-circulating coxsackievirus A16 (CVA16). and enterovirus I71 (EV71). This may have contributed to the genomic recombination between the pathogens say researchers from Wuhan University.

6. The whistleblower 'Corridor Doctor' doctor of Mianyang who worked in a corridor after being suspended from her job for two years, has now been sacked. Authorities said Dr Lan Yuefeng had been absent for almost two years and had been disruptive and uncooperative. Her colleagues rejected charges of overservicing at the hospital and went on strike claiming she had made false allegations and damaged their reputation.

7. Health authorities in Beijing are urging adults to have measles vaccination after a surge in cases in thecity. They say there has been a spike in cases in the past two months, and more than half of the infected are in adults, probably because protection from childhood vaccination has waned.

8. Radiologists in Sichuan claim that resting-state functional MRI could be useful in providing early and accurate diagnosis of ADHD. In a study published in Radiology, Dr Qiyong Gong of the West China Hospital of Sichuan University, showed that the boys with ADHD had altered structure and function in certain areas of the brain, such as the orbitofrontal cortex and the globus pallidus. that play in executive inhibitory control - the ability to control inappropriate behaviors or responses.

Daqing strikes gold with diabetes prevention study

by Michael Woodhead
The oil town of Daqing in north China is now becoming famous for something quite different - preventing diabetes. 
Results from a 23-year study conducted in the city have show that people at risk of diabetes can avoid progressing to the disease and almost halve their risk of death by adopting a healthier diet and doing more exercise.
The findings from the study, published in the Lancet Diabetes & Endocrinology this week have been hailed as a breakthough by international experts because they answer many of the difficult questions about how diabetes may be prevented and its harms minimised.
The study started in 1986, when 577 people with impaired glucose tolerance were assigned to either an intervention group that received advice on diet and/or exercise, or a control group. The lifestyle coaching sessions lasted for six years during which participants received regular encouragement to eat more vegetables and consume less sugar and alcohol, and encouraged them to do more physical activity in their spare time.
Now after more than 20 years of follow up, researchers have found that the people who received the lifestyle advice had a cardiovascular death rate of 1% compared to 20% in the control group. The overall death rate was 28% in the lifestyle group compared to 38% in the control group. Rates of progression to diabetes were 73% in the lifestyle group and 90% in the control group.
"These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes," said lead study author Professor Li Guangwei of the Department of Endocrinology at the China-Japan Friendship Hospital, Beijing.
Commenting on the findings, Professor Nicholas Wareham of Cambridge University said the study was a "real breakthrough, showing that lifestyle intervention can reduce the risk of long-term cardiovascular consequences of diabetes." He said the study showed that lifestyle change could be achieved in the real world and it was notable that the effects were particularly strong in women.

Chinese people with diabetes have poor insulin injection techniques

by Michael Woodhead
People with type 2 diabetes have poor insulin injection techniques that cause bruising, bleeding and lumps in the skin, a Nanjing study has found.
A survey of the injection techniques of 380 patients with diabetes from 20 centres across China found that their injection techniques with insulin pens were poor and they often re-used single use needles.
The survey found that 36% of patients had lipohypertrophy (fatty lumps under the skin) and 57% of patients had bleeding and bruising, and abdominal lipohypertrophy at injection sites. The re-use of single use needles was a major factor in lipohypertrophy, and there was also a link with rolling the insulin pen while pulling out the needle after injection.

"The bleeding and bruising at the injection sites may be associated with suboptimal absorption of injected insulin. Improved education in optimal insulin injection technique, including reducing needle reuse and correct rotation of injection sites should be emphasized, the researchers concluded..

The study was conducted by Lou Qingqing  and Ji Jiajia at the Jiangsu Province Hospital, Nanjing. The findings are published in Current Medical Research and Opinion.

China's 'diabetes epidemic' debunked

A study that appeared to show that China is experiencing a rapid rise in diabetes has been debunked by critics who say the apparent increase in diabetes was caused by the researchers measuring a different variable.
In September Dr Xu Yu of the Shanghai Jiaotong University School of Medicine published  a study in JAMA which showed that the prevalence of diabetes had increased to 12% of adults Chinese. The prevalence of 'pre-diabetes' was said to be at 50%. However in a letter published in JAMA this week Dr Kristine Faerch of the Steno Diabetes Center, Denmark, says the alarming figures published Dr Xu are a false alarm caused by the measurement of different parameters, not a true change in the rates of diabetes.
Dr Faerch says the rates of diabetes were increased by adding the HbA_1c criterion to the diagnosis of diabetes and using the lower diagnostic threshold for impaired fasting glucose of 100 mg/dL instead of 110 mg/dL.
When more conventional methods of measuring diabetes are used, the rates of diabetes are unchanged from the last study done two years ago, at around 9.7%, she notes. Also the rates of pre-diabetes will be 15% rather than the 50% suggested by Dr Xu's study, she adds.
Another letter in JAMA says Dr Xu's study would also overestimate levels of diabetes because it ignored non-residents of cities such as migrant workers, college students, and military personnel who would likely have lower levels of diabetes.

Diabetes linked to liver cancer: Beijing study

Diabetes is strongly linked with the increased risk of liver cancer, especially in patients with hepatitis B infection, researchers from Peking Union Medical College Hospital have shown.

Their study found a strong association between diabetes and hepatocellular carcinoma regardless of the prevalence of hepatitis B and C infection, cirrhosis, gender, and age. However, there was also a synergistic interaction between diabetes and HBV in cancer occurrence. “Therefore, diabetes patients with HBV infection represent a very high hepatocellular carcinoma risk population and should be considered for hepatocellular carcinoma close surveillance program” the researchers said in PLOS One.

Acarbose the first line drug for type 2 diabetes in rice-eating populations: Chinese study

by Michael Woodhead
Although metformin is the first line treatment for type 2 diabetes, the α-glucosidase inhibitor acarbose has been shown in a major Chinese trial be be a worthy alternative in patients with a marked postprandial glucose changes. 
In The Lancet Diabetes & Endocrinology, Professor Yang Wenying and colleagues from the Department of Endocrinology, China-Japan Friendship Hospital, Beijing, report the findings of a randomised controlled trial that compared the α-glucosidase inhibitor acarbose with metformin as initial treatment for type 2 diabetes.
In a study known as the MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment) trial they recruited 788 adult Chinese patients who were newly diagnosed with type 2 diabetes. Patients were randomly assigned to receive metformin (up to 1500 mg sustained release preparation) or acarbose (titrated gradually up to a maximum of 100 mg three times a day). At the end of the 48-week study period, acarbose was found to be as effective as metformin in terms of its HbA1c-lowering effect , and both treatment regimens achieved weight loss, although patients in the acarbose group lost slightly more weight (−0·63 kg). Patients assigned to the acarbose group also had a more favourable lipid profile, with improved HDL and lower triglycerides at 48 weeks. As expected, treatment with acarbose was associated with less postprandial hyperinsulinaemia than with metformin.
An accompanying editorial says alpha-glucosidase inhibitors remain most popular in Asian countries such as China, where rice forms a major component of the diet and the dietary contribution of carbohydrate is high.
“The results of this large study indicate that the efficacy of acarbose could be related to the carbohydrate content in the patients' diet, which suggests that acarbose would be more effective in populations with a high carbohydrate intake,” it said.
Source: The Lancet Diabetes & Endocrinology

OGTT reveals high rate of diabetes in hypertensive patients - Beijing study

by Michael Woodhead

There is a high prevalence of diabetes and newly-detected diabetes among Chinese hypertensive outpatients, Beijing researchers have shown.

About one in four hypertensive outpatients had concomitant diabetes, and approximately one in three cases were newly detected , their study found.

Dr Wang Wei and co-researchers at the Beijing An Zhen Hospital, Capital Medical University and the Beijing Institute of Heart, Lung and Blood Vessel Diseases say that additional testing of 2-hour plasma glucose with an oral glucose tolerance test (OGTT) should be added to fasting plasma glucose (FPG) assay to improve the detection rate of diabetes, especially in elderly patients.

In a study of 4942 patients attending hypertension outpatient clinics in 46 hospitals in 22 provinces of China, the researchers measured fasting plasma glucose in all patients and also did 2-hour plasma glucose testing in those without a history of diabetes.

The study found that the prevalence of diabetes was 24% (both previously and newly diagnosed cases). Among the 1202 patients with diabetes, one third were newly detected. In patients aged <45 years, 53% of cases of diabetes were newly detected. Of the 417 cases of newly detected diabetes, 55% were identified using FPG tests and the remaining 45% by 2-hPG tests. More than a quarter of patients with newly detected diabetes had FPG <6.1 mmol/L and 16.5% had FPG <5.6 mmol/L. Among the elderly patients, 32.4% had normal FPG (<6.1 mmol/L) and 24.5% had optimal FPG (<5.6 mmol/L).

The detection rate of newly diagnosed diabetes was higher in patients with low educational level, low level of medical insurance, obesity and high triglycerides.

The researchers say that currently only the fasting plasma glucose assay is routinely used in China because of its technical convenience and low cost. However, they say their findings show that adding 2-hour plasma glucose to the routine FPG assay would increase detection rates by 4.5%, and by more than 6% in the elderly.

Source: BMJ Open

Four-fold increase in diabetes rates among rural Chinese

Lifestyle changes have led to increasing incidence of diabetes among China's rural population, a senior medical official warned Friday.
The incidence rate of diabetes among adults in China's rural areas has increased from 1.8 percent in 2002 to 8.4 percent in 2010, said Wang Linhong, a senior official with the Chinese Center for Disease Control and Prevention, at a seminar held in Beijing.
The incidence rate in the countryside increased faster than in cities, though the rate was still lower than that of cities, Wang said, adding that the rural population has become a priority in diabetes control and prevention.
The national incidence rate of diabetes among adults increased from 2.69 percent in 2002 to 9.7 percent in 2010, while the rates for 2011 and 2012 were not available, according to Wang.
With rapid urbanization over the past few decades, rural people's livelihood has improved quickly, while modern agriculture requires less physical labor.
Unhealthy diet and less exercise have caused obesity and higher blood lipid levels among the rural population, which could lead to diabetes, Wang said.
Additionally, rural people are much less aware of diabetes than their urban counterparts, he said.
Nationally, only 36.1 percent of diabetes patients were aware of their condition, and 34.7 percent used medication to control their condition, according to Wang.
"Diabetes has become a major challenge for China's public health and a main task of our programs to control chronic diseases," he said.
In 2012, the Chinese government launched a plan on the control and prevention of chronic diseases from 2012 to 2015, which included efforts to increase the awareness and medication of diabetes. 

Source: Global Times

China medical news roundup for Thursday 14 November

Beijing cardiologist uses microblog to educate a wider audience

On the walls of the inpatient wards of Beijing Anzhen Hospital, a large sign reads, "Please follow Yu Zhenqiu's micro blog for hypertension intervention".

Yu, the director of the hypertension department, said the micro blog helps him reach as many sufferers of high blood pressure as possible. Within his working hours, he can see no more than 30 patients even if he skips lunch.

"For the great majority who cannot see top specialty doctors like me at the country's large key hospitals, micro blogs might offer help."

His frequent postings on high blood pressure prevention and intervention tips, and answers to frequently asked questions, have brought Yu about 70,000 followers on Sina Weibo, a popular micro-blogging website.

Apart from information on free-hypertension consultation sessions, he also replies to questions online.

"Many of my postings have been forwarded thousands of times, a result that could never be achieved by treating patients in the hospital," he said.

Writing posts is now a daily routine for him, such as washing his face and brushing his teeth, he said.

Yu, who is also deputy director of the China Hypertension Association, used traditional media first to share prevention and treatment tips and educational items about the disease, before moving online.

Full article at: China Daily

Chinese parents won't take sick kids to small hospitals

With a shortage of pediatricians and inadequate medical facilities, bringing children to hospital can cause a lot of stress to parents. Some experts have suggested a change in parents' attitude and adoption of an alternative medical model. Liu Zhihua reports.

There is a shortage of at least 200,000 pediatricians in China currently, according to K. K. Cheng, a professor with University of Birmingham, who specializes in epidemiology and the development of primary care in China.

Yang Dan, a Chongqing resident and mother to a 3-year-old boy says she detests taking her child to the hospital.

The air circulation is poor. The area is noisy. It is so overcrowded that parents have to hold their children in their arms for intravenous infusion procedures. There have been cases of parents losing their children in the disorganized environment.

Yet sending their children to small hospitals is out of the question, because they cannot provide quality healthcare, Yang believes. She says once her son was misdiagnosed even in the largest hospital in Ya'an, a medium-size city in Sichuan province.

With the disparity in healthcare quality between rural and urban regions, between a top-level hospital and a less-privileged one, most Chinese parents share the belief that small hospitals are incompetent.

Read more at China Daily

China lags on preventive health, says WHO

China should do more to curb a rise in non-communicable diseases like heart disease and diabetes that have long been neglected and now pose a risk to its economy, global health experts warned.

Non-communicable diseases challenge China’s economic development and cause a burden on society, said Bernhard Schwartländer, the World Health Organization’s representative in China, in a press briefing on Tuesday. “The cost of inaction, of doing nothing—in lives lost and social and economic prosperity foregone—is too great a price to pay,” he said.

He was joined by representatives of China’s National Health and Family Planning Commission and China’s Centers for Disease Control and Prevention.

Dr. Schwartländer said that high rates of smoking, lack of exercise and unhealthy diets have contributed to diseases. He said that the Chinese government should adopt policies to address problems, which have been overlooked and underfunded.

By 2015, the burden of death and health complications related to non-communicable disease will have cost $500 billion in the last decade, Dr. Schwartlander said. Reducing mortality only by addressing cardiovascular disease, reducing rates 1% per year in by 2040, would generate $10.7 trillion, he said.

Health care was largely left out of a reform agenda Chinese leaders revealed on Tuesday, though it briefly mentioned improving people’s welfare and strengthening reform of the medical and health system. China launched in 2009 an overhaul of its health-care system, establishing a universal insurance system to provide citizens more access to medical care.

China is struggling to deal with a population that is urbanizing, aging and is afflicted with chronic disease. Migration of millions of Chinese citizens to big cities from rural regions has spurred use of cigarettes, higher alcohol intake and increasingly sedentary lifestyles—all habits that lend to illness.

Now China is home to the world’s largest diabetes population, with the prevalence of 11.6% of the population-surpassing Russia’s population, said Li Guangwei, a professor at the Chinese Academy of Medical Sciences. Chronic disease is the cause of 85% of deaths in China, according to China’s Ministry of Health. By comparison, the U.S. Centers for Disease Control and Prevention says the rate is 70 per 100 in the U.S., while the World Health Organization says they represent 63% of deaths world-wide.

Funding remains a major issue, experts said. China’s health spending as a percent of GDP totaled 2.3% in 2011, compared to U.S. spending of 9.7%, according to the most recent data available from the World Bank.

Community clinics are overrun with patients and lack resources needed to address health problems, said Wang Bin, the deputy director the Disease Control and Prevention department of China’s National Health and Family Planning Commission.

Tobacco control remains underfunded, said Jiang Yuan, deputy director of the Tobacco Control Office of China’s CDC. The government allocated only 20 million yuan (about $3.3 million) last year for tobacco control, Ms. Jiang said.

Dr. Schwartländer said it isn’t likely that the China will reach the target set for it by the WHO to cut smoking rates in China by at least 30% by 2025. Currently 28% of people older than 15—301 million people—are smokers in China and smoking-related sickness kills more than one million Chinese citizens each year, according to WHO data. That compares to 43.8 million smokers in the U.S., according to the U.S. Centers for Disease Control and Prevention.

Experts said that the government should not shoulder all the responsibilities to improve health conditions and that citizens should adopt healthier lifestyles by eating less salt, exercising more and cutting bad habits like smoking and drinking . “People are the owners of their own health,” said Dr. Wang, adding, “We’re at an important window in China.”

Source: WSJ

MSG may protect against diabetes: Nanjing study

A Jiangsu nutrition study has made the intriguing finding that MSG intake is inversely related to risk of hyperglycaemia.

Researchers from the Jiangsu Provincial Center for Disease Control and Prevention in Nanjing conducted a prospective dietary study of 1056 healthy adults from 2002 to 2007. Fasting blood samples were collected at baseline and follow up. Hyperglycemia was defined as fasting plasma glucose >5.6 mmol/l.

During the follow-up they identified 125 cases of hyperglycemia and found that people with the highest intakes of MSG had a lower risk of hyperglycemia. People with a high MSG intake, had only one third the risk of hyperglycemia compared with people with a low intake of MSG, they found. There was a linear inverse association between MSG intake and change in blood glucose.

The researchers noted that MSG stimulates insulin secretion by acting on glutamate receptors and is especially likely to decrease the risk of hyperglycemia in overweight-related insulin resistance.

“However, based on this single study we do not recommend people increase MSG intake in order to prevent diabetes,” they commented.

Read the full study at: Clinical Nutrition

Anhui man on trial for urologist stabbing

An Anhui Province man has been accused of stabbing a doctor at a Songjiang district hospital that he believed had cheated him, district prosecutors said Tuesday.
The suspect, surnamed Huang, visited a military-run hospital in the district in 2012 to see a urologist, according to a press release from the Songjiang District People's Prosecutor's Office. The doctor found a cyst and advised Huang that he would need to have surgery to remove it or face potential health problems in the future.
Huang agreed, though reluctantly. The surgery cost him more than 20,000 yuan ($3,283), including the four-day hospital stay afterward. Several months later, Huang had recovered from the surgery, but still doubted whether it had been necessary, prosecutors said. He suspected that the urologist only suggested the surgery to help the hospital make money.
In April, Huang returned to the hospital seeking treatment for stomach pain. Another doctor prescribed him medication, but it failed to relieve his discomfort after more than 10 days. When Huang went back to complain, the doctor said that it might take more time for the medication to take effect.
Huang believed that the doctor was lying to him and only wanted his money, prosecutors said. He complained to the local health authority and to police, but nothing came of it.
In May, Huang returned to the hospital with a knife and stabbed the urologist, prosecutors said. He then went looking for the other doctor who treated him, but was stopped by hospital security guards. The urologist suffered minor injuries.
Huang confessed to stabbing the doctor and admitted that he had been unhappy with the hospital's care. 

Source: Global Times

Chinese medical news from the journals

Almost one in three Staphylococcus aureus strains found in humans by Yangzhou researchers were methicillin-resistant S. aureus (MRSA), with most being hospital-acquired MRSA. The superbugs were also found in food and animal samples. Writing in the journal Foodborne Pathogens and Diseases, the researchers say infection with multidrug-resistant MRSA strains acquired from food, animal, and human sources might also become a significant problem for human medicine.

One in four Chinese people with epilepsy has poor adherence to their anti-epilepsy medication and 70% have only moderate compliance, a new study shows. The reasons for nonadherence included forgetfulness (54%), being seizure-free for a period (49%), and fear of adverse drug effects (28%).
Epilepsy and Behavior.

Rotovirus and norovirus are the two most common causative agents for diarrhoea and vomiting in Chinese infants, a study from southeastren China has found. Rotovirus tended to cause more prolonged, frequent and severe illness and the viruses were seasonal, the study published in Pediatrics Infectious Diseases journal showed.

Smoking is a major risk factor for nonalcoholic fatty liver disease, especially in obese people, a Shanghai study has found. People who smoked and had a high BMI had a nine-fold higher risk of nonalcoholic fatty liver disease, their study in the Journal of Epidemiology showed. Passive smoking was also associated with a  25% increased risk of the disease, say researchers from the Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine.

China has made progress in the prevention and control of major non-communicable diseases but there are still large action gaps in the fight against epidemic non-communicable diseases according to members of the Subcommittee of the Non-Communicable Diseases, the Expert Committee on Disease Control and Prevention established by China’s Ministry of Health.
Global Health Action.

Chinese people who have a more varied diet and especially a diet rich in fruit have a much reduced risk of bladder cancer, a study in Cancer Causes and Control shows

Type 2 diabetes is associated with the increased risk of  liver cancer within five years after diagnosis in Chinese population, researchers at the State Key Laboratory of Oncogene and Related Genes and the Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine have shown.  Writing in Annals of Oncology, they say the finding suggests that hyperinsulinaemia rather than hyperglycaemia is more likely to be a primary mediator for this association.

China's RMB14 billion insulin market monopolised by three western pharma companies

Demand within the Chinese insulin market has grown at a fast pace in the past decade. Over the next five years, both production and demand will continue to grow.
China is the country with the largest number of diabetics. In 2011, the market scale of diabetes medicine in China approximated RMB13.8 billion, of which, insulin medicines comprising recombinant human insulin and insulin analog accounted for 52.8%.
Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body.
Insulin causes cells in the liver, skeletal muscles, and fat tissue to take up glucose from the blood. In the liver and skeletal muscles, glucose is stored as glycogen, and in adipocytes it is stored as triglycerides.
Due to high technological content and entry barriers, Chinese insulin market is monopolized by foreign corporations. In 2011, the combined market share of the three world-renowned pharmaceutical tycoons including Novo Nordisk, Eli Lilly and Company, and Sanofi Group hit 90% in the Chinese market.
By contrast, the largest domestic counterpart- Tonghua Dongbao Pharmaceutical -occupied merely 3.4% or so.
Denmark-based Novo Nordisk is not only the leader in global insulin industry, but also a major supplier in China's insulin market with the recombinant human insulin market share of 76% and the insulin analog market share of 53% in 2011.
America-based Eli Lilly and Company is the second embarking on Chinese insulin market, with the recombinant human insulin market share of 17% and the insulin analog market share of 8% in 2011.
Source: Companies and Markets

Peers for diabetes program expands in China

American Edwin Fisher is on a mission to promote peer groups for diabetics across the world and has found great interest in China.
For most people with a sweet tooth, ice cream is a treat, but for someone suffering with diabetes, resisting it, and foods like it, can become a daily battle.
Lu Xin, 53, a Beijing resident and diabetic, has fought his culinary desires for 15 years, and like many in his situation has found it a difficult journey.
"Early this June, his situation became worse and even his eyesight was affected, because he constantly ignored his diet," his wife says.
It is a situation Edwin Fisher has seen with many diabetes sufferers over the past 40 years and one that led him to join Peers for Progress seven years ago.
Fisher is global director of the organization, which aims to create support networks for people with diabetes. These networks aim to help diabetics live a healthy lifestyle in terms of sleep, food, exercise and stress management.
In a year diabetics spend an average of six hours in a doctor's or other health professional's office, meaning the rest of the year they are on their own to deal with their health issues, says Fisher.
"It's very easy to get somebody to do the same things for a few days. The problem is that diabetes is for the rest of your life. That's where it's important for patient education and peer support, more mechanically, just support for people to continue to do things on the day-to-day basis that diabetes requires."
Fisher says he has heard many diabetics talk about the support they receive from friends, family or organizations.
"So I realize that self-management is very dependent on the people around us. In a supportive environment we can do a pretty good job of taking care of ourselves."
Peers for Progress was founded in 2006 by the American Academy of Family Physicians Foundation with funding from the Eli Lilly and Company Foundation. Fisher joined it from the start, promoting peer health support around the world.
"During those thousands of hours, people need to get answers to their questions, talk over how they are doing, and, sometimes, just get off their chests the frustrations that managing a chronic disease can provoke.
"The encouragement and occasional assistance of a peer - someone who understands the disease and what it's like to live with it - can have remarkable benefits."
Helping others is something Fisher was brought up with and encouraged to do by his parents.
"I think understanding how people behave and how people can help themselves create a better life sounds a very interesting and important question.
"I have always been very excited about the things that I was understanding, and very gratified by being able to take that knowledge, and use it to help people find a more satisfying life."
Since 2006 he has promoted Peers for Progress in nine countries and collaborated with more than 60 other organizations.
According to Fisher, there were many peer support groups before Peers for Progress began, but most ran on small and very stretched budgets. Lack of communication between programs and the absences of evaluation of their effectiveness were also issues.
"Our task is really to help all these programs to learn from each other and share information and improve.
"We have a whole website full of program material, program models that we are trying to help organizations around the world to use so they can improve their programs."
Despite cultural and economic differences between countries, the fundamental aspects of peer support programs are universal, says Fisher.
"It makes me feel a deeper commitment to promoting this program, because the more we talk to people about this, the more we see its results."
The largest response has been in China, which has about 92.4 million diabetics. Since 2008, leaders from Beijing, Shanghai, Nanjing, Anhui province, Hong Kong and Taiwan have worked with Peers for Progress to help promote its programs. In November, 40 representatives from 17 hospitals in 12 cities participated in a training exercise with Peers for Progress to learn how to develop programs for the tens of thousands of patients they serve.
"We have met many patients and professionals here. They have been very interested in peer support, and see it as a very practical strategy for providing help and a strategy that fits in well with China's emphasis on working together harmoniously."
According to Muchieh Maggy Coufal, senior program manager of Peers for Progress, who accompanies Fisher to China four to five times a year, the major issues their organization faces in China are related to the newness of the idea of peer support.
"The main challenge here is getting resources to get people to develop programs within their hospitals and community health centers," she says.
Fisher says that in China, peer support needs to take into consideration that many diabetes patients are concerned about being a burden to other people. But seeing people doing morning exercise together in the parks, he realized China has a tradition that is very compatible with Peers for Progress.
"I think there are ways in which China provides some unique challenges in terms of concerns about being a burden to other people, but also provides some unique energies in terms of a long tradition of a very healthy harmony in working together."
In Anhui province, retirees teamed up with Community Health Center staff to run monthly meetings for people with diabetes, and organized taijiquan classes, morning exercise groups, shopping trips and even fishing expeditions. There were benefits for diabetics' weight, blood pressure and blood sugar levels.
Sun Zilin, vice-president of the Medical School of Southeast University, says it has cooperated with Peers for Progress in several cities, including Nanjing and Tianjin, and plan to expand promotion efforts across the country.
"Patients with diabetes will easily feel anxious and impatient," he says. "I think peer support can help them be optimistic and increase their quality of self-management. Our task now is to find a way to effectively promote it in China."
In Africa, Uganda and South Africa, despite funding being ended, peer support programs have continued to thrive, with increasing numbers of participants, says Fisher.
Peer support is no panacea and could be improved in many cases by better integration with healthcare systems, he says.
"A key source of help may be just next door, a trained peer supporter. As one patient put it, 'The doctor and nurse tell me what to do, but the peer supporter helps me figure out how to do it'."
Fisher has ambitions to continue expanding the reach and scope of Peers for Progress. He wants it to include other chronic diseases besides diabetes and has been in talks with the Chinese Center for Disease Control and Prevention about expanding the program across China.
Source: China Daily

China clinical news in brief

Infant gastro infections may trigger convulsions

Benign convulsions may occur in infants with mild gastroenteritis, Chinese paediatricians have shown.
Dr Wang Yunfeng of the Department of Pediatrics at the Sino-Japan Friendship Hospital, Beijing says that benign convulsions are now recognized as a distinct clinical entity in many countries, but its occurrence in China has not yet been widely recognized by Chinese pediatricians.
In a retrospective study  in 48 infant patients with benign convulsions they found that the typical age of onset of gastroenteritis was between 13 months and 24 months. The episodes of convulsions occurred at a distinct autumn/winter peak, and the seizures mostly occurred within the first five days of gastroenteritis, especially within the first three days, peaking on day 2 (39.58%).
They found that in 80% of cases the infants had clustered seizures in their episodes. Most episodes were symmetric, generalized tonic-clonic  and brief. The seizures were induced by pain and/or crying in 40% of infants. Stool culture was positive for rotavirus in 54% of the patients. Almost half the infants still had clustered seizures after the administration of a single anticonvulsant drug. The seizures persisted even after the administration of two combined anticonvulsants in a quarter of episodes. All patients exhibited normal psychomotor development.
"Benign convulsions with mild gastroenteritis are not rare in China, and rotavirus infection is a major cause," the researchers conclude.
Source: World Journal of Paediatrics

MSG linked to snoring and sleep disordered breathing

People who consume MSG with their food are more prone to snoring and sleep disordered breathing, researchers from Nanjing have shown.
An analysis of data from 1227 Chinese people who participated in the Jiangsu Nutrition Study found that MSG intake was positively associated with snoring and a high probability of sleep disordered breathing such as sleep apnoea.
However, the association was not seen in in overweight people, according to Dr Shi Zumin and co-researchers at the Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centrr for Disease Control and Prevention, Nanjing.
People who had higher intakes were twice as likely to snore and three times more likely to have sleep apnoea, the study showed..
Source: Nutrition Journal

One in three people with diabetes have chronic kidney disease

Almost one in three Chinese people with type 2 diabetes have chronic kidney disease and albuminuria, a Nanjing study has found.
Dr Lou Qing-Lin and co-researchers from the Diabetes Care and Research Centre at the Jiangsu Province Institute of Geriatrics conducted a study of more than 15000 patients with type 2 diabetes in Nanjing between January 2008 and December 2009.
They found that the frequency of CKD and albuminuria was 31% and 29%, respectively.
Hypertension, anaemia and duration of diabetes were significantly associated with CKD.
"In conclusion, chronic kidney disease is common in the urban Nanjing Chinese with type 2 diabetes. Strategies to prevent or delay progression of kidney disease in diabetes should be carried out at the early disease course of type 2 diabetes," they conclude.
Source: Diabetes and Metabolism Journal

One child policy exacerbates diabetes epidemic in China

First borns gain more weight and gain it faster, which may create an epidemic of diabetes in China

Diabetes in China, which is emerging as a major health issue in the country is probably being aggravated by its one-child policy, experts observe.
The Chinese Government said that about 100 million families have just one child, which translates into an equal number of first borns, a status that researchers are finding may be linked to conditions that raise obesity risk, Chong Yap Seng, a scientist at Singapore’s National University Hospital, said.
Dr Chong and colleagues in Beijing and Southampton, England, are studying the biological mechanisms that have conspired with diet and lifestyle changes to produce 92.3 million diabetics in China, almost four times as many as in the United States.
Chong said that first borns gain weight faster and are bigger as adults, a trajectory that increases obesity risk and may explain why China’s diabetes prevalence has more than tripled in a decade, the report said.
Sales of diabetes medicines in China will expand 20 percent a year to reach 3.2 billion dollars by 2016, consulting firm IMS Health said, it said.
The one-child policy was introduced in 1979 to curb a population growing 1.4 percent a year and to promote prosperity, it added.
According to the report, some exceptions to the policy are allowed, such as permitting rural families to have a second child if the first is a girl. Those who can afford to can have a second or third baby by paying a fine.
Rising numbers of diabetics, though, are costing China’s economy 26 billion dollars annually in medical care and lost productivity, according to the International Diabetes Federation.
The prevalence of diabetes in China, a nation of 1.34 billion people, is 8.8 percent, the report said.
The U.S. has a diabetes prevalence of 9.3 percent and 24.1 million sufferers, according to federation estimates released last month.
Within 18 years, China is projected to have 130 million sufferers of Type 2 diabetes, the form of the disease in which the body stops responding properly to the hormone insulin, according to the Brussels-based federation.
The disease is already killing 1.2 million Chinese a year because of kidney failure, heart attack and other associated conditions, it said in a recent report.
A 2010 study by researchers in Brazil, Britain and Italy published in PLOS One found that birth order is associated with increased body mass, higher levels of fat and metabolic risk in young adult men in Brazil, the report added.
Source: Healthcare Asia

Waist and triglycerides predict diabetes risk

A combination of waist circumference and raised triglycerides can be used as a simple and inexpensive screening approach to identify people at increased risk of diabetes, Tianjin researchers have shown.
The hypertriglycedemic-waist (HTGW) phenotype is a simple and inexpensive screening parameter to identify people at increased risk for cardiovascular disease and it has now been shown to predict prediabetes and diabetes in Chinese urban adults.
Dr Zhang Meilin and co-researchers at the Department of Nutrition and Food Hygiene, School of Public Health, Tianjin screened healthy 2908 adults and followed them for three years.  There were 1533 new prediabetes and 90 new diabetes cases diagnosed during the follow-up period. The accumulated incidence of prediabetes and diabetes was 53 % and 3.%, respectively.
The risk of developing diabetes was 4.5 times higher in men and women who had the hypertriglycedemic-waist profile.
"The HTGW phenotype can be used as a simple screening approach to predict diabetes. By using this approach, it is possible to identify individuals at high-risk for diabetes, which is of great significance in reducing the incidence of diabetes among Chinese urban adults.
Source: BMC Public Health

Half a million Chinese are blind due to diabetic retinopathy

The prevalence of visual impairment due to diabetic retinopathy in Beijing residents was 0.25%

by Michael Woodhead
More than half a million older Chinese people have lost their sight due to diabetic retinopathy, a major study carried out by Beijing researchers has found.
Dr Qi You and colleagues from the Beijing Institute of Ophthalmology, Beijing Tongren Hospital screened a population of more than half a million rural residents near Beijing who were aged over 55. The study involved over 2500 ophthalmology technicians who carried out visual screening checks for retinopathy.
Of the  562,788 people screened, 54,155 (9.6%) had a visual acuity of <0.30 in at least one eye.
The most common cause of vision impairment was cataract, which was seen in 19,163 (3.4%) of people. Diabetic retinopathy was detected in 2.7% of the population screened. Visual impairment due to diabetic retinopathy was bilateral in 66% of these patients.
The prevalence of visual impairment associated with diabetic retinopathy was 0.25%, which is similar to the results of the previous Beijing Eye Study, in which 0.54% of people screened showed
severe non-proliferative or proliferative diabetic retinopathy.
"Transferred to the total population of China of 206 million subjects aged 55-85 years, it
indicates that 514,000 Chinese in that age group are blind due to diabetic retinopathy," they conclude.
Source: Clinical and Experimental Ophthalmology