The top three medical stories from China this week

Medical exam fraud: A medical examination cheating ring has been uncovered in Hebei after a 29 year old woman was found to be taking a postgraduate exam in place of someone else. The woman was arrested after it was found the ID card did not match the details of the doctor who was supposed to be taking the test, who was from Chengdu. The woman said she was paid 60,000 yuan (about US$9000) to take the test on behalf of another person. The woman, who was originally a doctor, said she had given up her job in 2013 after she discovered she could make more money through exam fraud.

Influenza deaths: There have been three severe cases including one death from severe H5N6 influenza in Guangdong and a further death of an overseas visitor from H1N1 influenza, according to media reports. Chinese media said that a a 25-year-old man from Shenzhen, was in a serious condition in hospital. A 26 year old woman died of the same infection in Shenzhen last week, while a third person in Zhaoqing, Guangdong was in a serious condition. Meanwhile a Guyanese man has died of H1N1 influenza in a Miami hospital after returning from China. The infections are presumed to have come from exposure to live poultry and it is not thought there is a high risk of human-to-human transmission.

Air pollution harms fetus: Pregnant women who are exposed to the high level of air pollution in China are likely to have low birth weight babies, a study shows. Exposure to high levels of PM2.5 particles, as found in China's smogs, was linked to a decrease in birth weight and an increased risk of low birth weight, according to a study by specialists at the Guangdong Women and Children Hospital, Guangzhou. The doctors said the effect of air pollution on fetal growth was similar to that seen with cigarette smoke, and was due to immature fetuses being more susceptible to air pollution because they are in critical periods of organogenesis.

Milk formula propaganda pushes Chinese women’s breast feeding rates down to 16%

by Michael Woodhead
Breast feeding rates among Chinese women have declined dramatically in the last decade, and are now as low as 16% for women living in urban areas, official figures show.
The proportion of women in China breast feeding up to six months declined from 67% in 1998 to 28%, according to an article in China Youth Daily.
Data from the National Health and Family Planning Commission show that breast feeding rates are now 16% for urban women and 30% is for rural women.
The dramatic reduction in breast feeding rates has been blamed on society attitudes, pressure from workplaces and extensive promotion of milk formulas to new mothers.
In theory, Chinese women are encouraged to breast feed with protections written into law that guarantee them two 30 minute breast feeding breaks at work without being penalized in their income. Breast feeding mothers are also guaranteed an additional one month of maternity leave by law.
However, although many women start breast feeding in hospital they soon stop because the reality of the workplace is that there is no encouragement to breast feed and often many obstacles. Most workplaces do not have places where mothers can breast feed and many women feel under pressure from employers against breast feeding.
The other major factor in deterring breastfeeding is the promotion of milk formula, experts say. Despite the introduction of milk formula advertising regulations in 2006, milk formula is still promoted aggressively and misleadingly to women in China. Claims are made that milk formula is ‘just as good’ as breast milk and more convenient.
Experts say it is difficult for public hospital maternity nurses and doctors to counter the extensive and well-funded ‘propaganda’ of the milk formula companies, which lead to many women being misinformed about the relative benefits of breast feeding and formula feeding. They recommend that breastfeeding should continue for at least for six months and up to the first birthday if possible.
Professor Zheng Lu of the department of community health at Tsinghua University said there was a need for more societal support for breast feeding. He said there was a need for nursing rooms in workplaces and other positive incentives for women to encourage breastfeeding.

My top10 medical stories from China for Saturday 22 February

1. Smoking with a water pipe confers a 'profound' risk of chronic obstructive pulmonary disease (COPD) among people in south west China and also carries a high risk from passive smoking, researchers have shown.

2. Patients with pneumonia of unexplained origin should be promptly investigated for H7N9 risk factors such as exposure to poultry and they should also be given pre-emptive antiviral treatment such as Tamiflu, the Beijing health department has ordered.

3. About 85% of Chinese doctors experience burnout, with those who are younger, unmarried and working in emergcncy medicine having the highest risk of serious burnout, a study shows.

4. Fertility clinics in China need to become more patient-friendly as they are perceived as too impersonal and lacking in transparency and respect for patient informed consent, researchers say.

5. The stigma of mental illness in Chinese culture means that patients with schizophrenia often do not understand their medication and are unwilling to take any anti-psychotic medication, according to a study from the Guangzhou Psychiatric Hospital.

6. H. Pylori infection rates are over 90% among people in their thirties in Jiangsu, which may explain high rates of gastric cancer in the region, say researchers from Nanjing.

7. Babies in Shenyang have increased rates of neurodevelopmental deficits because their mothers were exposed to high levels of organophosphorous pesticides during pregnancy, according to a study in PLOS One.

8. Adenovirus has emerged as a significant cause of serious pneumonia in China, with a study showing that 5% of cases are attributable to the virus.

9.  People with tuberculosis are also at high risk of HIV, with rates of around 3% in groups tested in TB patients from Guangxi, Henan and Sichuan, say Chinese researchers.

10. A mediation service for patients involved in medical disputes with hospitals is to be launched in Shanghai and it will be open to patients where compensation claims exceed 30,000 yuan ($2900) regardless of whether the hospital refers them.

Iron and vitamin supplements not needed to improve pregnancy outcomes: Chinese study

Prenatal iron–folic acid and other micronutrient supplements provide no extra benefit to Chinese women in perinatal mortality or other infant outcomes beyond any benefit conferred by folic acid alone , a major study has shown.
In a randomized double-blind controlled trial, 18 775 nulliparous pregnant women with mild or no anemia were enrolled from five counties of northern China from May 2006 through April 2009. Women were randomly assigned to daily folic acid (400 μg) (control), folic acid–iron (30 mg), or folic acid, iron, and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery.  Compared with daily prenatal folic acid, supplementation with iron–folic acid with or without other micronutrients did not affect the rate of perinatal mortality or other adverse maternal and infant outcomes except  for third-trimester maternal anemia.
Source: JAMA Internal Medicine.

A million Chinese babies a year born with congenital defects

As the Chinese Lunar New Year (February 10 this year) approaches, doctors and nurses in the Anhui Provincial Children's Hospital have one urgent wish: That the parents of an infant they just treated would come to the hospital to retrieve their daughter, nicknamed Yuanyuan—a name given to the baby by doctors.
When Yuanyuan was found abandoned at the hospital's entrance on December 15 last year, the then three-day-old was bundled in a quilt, with a note saying that she had been diagnosed with congenital esophageal atresia, a birth defect interrupting the passage between the esophagus and stomach.
Yuanyuan was weak, her lips blue from cold and oozing white foam, a nurse who was on duty told local Web portal Anhuinews.com.
"If not operated upon in time, she would have died," said Liu Guanghui, Director of the Neonatology Department of the hospital, who said that food was entering her windpipe and mixing with inhaled air, causing vomiting, bloating and pneumonia.
Doctors operated on Yuanyuan to repair the defect. Jin Danqun, a doctor in the hospital's Intensive Care Unit, said that the girl had recovered completely, and grew from 2.7 kg to 3.5 kg during her month in the hospital.
"Now that Yuanyuan has been cured, we wish her parents will take her home. Do not leave such a young child parentless," Jin said.
Growing defects
Each year, about 900,000 babies with congenital defects are born in China, accounting for 5.6 percent of all newborns, according to a report on the prevention and treatment of birth defects released by the Ministry of Health in September 2012.
Some of the most common birth defects in China in the past decade are congenital heart diseases, extra or webbed digits, cleft lip or palate, neural tube defects, hydrocephalus (water on the brain), club foot and microtia, according to the report.
Like Yuanyuan, many babies with birth defects, especially those born to poor families, are abandoned by their biological parents.
The report shows that perinatal period birth defect incidence in the country has been on the rise. The overall incidence rose from 107.79 per 10,000 live births in 2000 to 153.23 per 10,000 live births in 2011.
But the trend differs for specific types of defect, the report says. The incidence of some pernicious birth defects sensitive to intervention measures has gradually declined. For instance, the incidence of neural tube defects dropped from 27.4 per 10,000 live births in 1987, the most prevalent defect that year, to 4.5 per 10,000 live births in 2011, the eighth most prevalent. During the 2000-11 period, the incidence of neural tube defects went down by 62.4 percent in China's urban areas and 72.8 percent in rural areas.
In the same period, the incidence of congenital heart diseases increased sharply partly due to progress in diagnosis, the report says. In 2011, the incidence of congenital heart diseases was 3.56 times that of 2000.
The report also reveals that as infant mortality caused by infectious diseases has dropped, birth defects have risen to be the second largest cause of infant mortality in China, attributing to 19.1 percent of infant deaths.
There are a wide variety of congenital defects and they can be caused by different factors. "So far, at least 8,000-10,000 types of birth defects have been identified in China, 25 percent of which are inherited, 10 percent are caused by environmental factors and the causes of 65 percent remain unknown," Zheng Xiaoying, Director of Peking University's Institute of Population Research said.
Source: China Youth Daily.

Hospitals refuse amyotrophic lateral sclerosis baby

A woman with Lou Gehrig's disease is due to give birth soon, but she is still not sure whether any hospital in Beijing will take the risk of performing a Cesarean section on her.
As a teenager, Lyu Yuanfang, 31, was diagnosed with Lou Gehrig's disease, also known as amyotrophic lateral sclerosis, or ALS, a fatal, incurable neuromuscular disease that progresses rapidly.
A native of northwest China's Gansu Province, she arrived in Beijing with her husband Luo Zhongmu last month and rented a home in the city's northeast Chaoyang District. Since then, she has been searching for medical facilities willing to assist her delivery.
"We don't know anyone here in Beijing, and all the hospitals we visited said they were unable to operate on an ALS patient," Luo told Xinhua in an interview on Monday.
Lyu is now 34 weeks pregnant and test results show that the fetus is healthy. Doctors have urged her to have a C-section before the fetus reaches 36 weeks, in case her own health deteriorates and threatens both herself and the baby.
Before they arrived in Beijing, a Sino-Canadian joint-venture hospital for women and infants offered Lyu free prenatal tests and delivery services.
But after a series of tests, the hospital's management decided Lyu's case was too risky, as the hospital has neither the proper equipment nor respiratory and neurological disease specialists.
"We readily agreed to help and exempt her from all medical charges, because we did not know her case was so serious," a senior manager of the hospital said on condition of anonymity. "We are apparently not qualified to perform China's first Cesarean section on an ALS patient."
Wu Shiwen, a neurologist with the General Hospital of Armed Police Forces, said Lyu's disease may cause respiratory system failures during delivery.
"The risk is high -- actually it's too risky for an ALS patient to be pregnant at all," said Wu.
Source: People's Daily

Natural births not likely because caesareans are profitable

Hospitals generate up to half their income from selling caesareans

The suite is adorned with an enormous rococo style sofa and a Mona Lisa portrait, and 28-year-old Wang, who gave birth to a son, said: "I wanted to stay in the White House because it's large and well decorated."
But Wang's presidentially-themed chamber at Beijing's Antai hospital -- an expensive private facility aimed at the capital's wealthy middle class -- was not the only unusual thing about the birth of her first child.
In a country where most urban professionals choose caesarean sections, she stands out for choosing to give birth naturally.
The proportion of Chinese mothers choosing caesareans more than doubled in less than a decade, from around 20 percent in 2001 to above 46 percent in 2008 -- and approaching two-thirds in cities, according to the latest World Health Organization figures for the country.
Across Asia caesarean rates have reached "epidemic levels", it said in a 2010 report.
Experts say that caesareans are necessary in many cases when a mother or baby has a health condition which would make a natural birth risky, but that the risks of elective operations are often greater than the benefits.
China's caesarean rate is "definitely too high", said Shenlang Tang, a researcher into Chinese healthcare at Duke University in the US, adding that "the key factor is hospital financing".
China has made huge strides in maternity care over the past decades, slashing its newborn death rate by almost two-thirds since the mid-nineties, largely by promoting hospital births.
But Chinese hospitals receive little government funding and generate almost half their incomes from selling operations such as caesareans, with other revenues coming mainly from diagnostic tests and medicines.
"The price of caesarean section based delivery can be up to three or four times that of a natural birth... which helps the hospital generate more revenue," Tang said.
China's "one child" family planning policy also plays a role, as parents with more money to invest in their only childbirth are more likely to splash out on the procedure, which they see as safer, Tang said.
"There are a lot of perceptions that if you have natural delivery it will affect your sex life," he added.
Some local governments in China have launched campaigns to promote natural birth, he said, but there is no clear central government policy on the issue.
In an attempt to encourage women to choose a natural birth, the Antai hospital offers water births and teaches expectant mothers hypnosis techniques to deal with the pain of labour.
It also charges just as much for natural childbirth as it does for a caesarean, removing incentives for doctors to promote the operation.
"Our major problem is that pregnant women in China are very scared of pain," Antai's director Chen Fenglin told AFP. "We found that even water birth couldn't reduce our patients' fear, which is why we introduced hypnosis," he said.
A red carpet runs from Antai's delivery room towards a series of recovery suites, including the western-themed White House, a room aimed at Muslims called the "Islamabad Palace," and a chamber inspired by Mongolian warlord Genghis Khan.
"Parents hope that their child can grow up to be an emperor or princess, or a president, so the rooms give the parents a beautiful dream," said Chen, who says his hospital has carried out more than 2,000 water births.
An automated piano outside the delivery room plays a wedding march when mothers walk past with their newborn baby. "We want to express that a birth is as joyful as a wedding," Chen said.
Its innovations have proved a hit with mothers such as Wang Dan, who are willing to pay its hefty fees.
"I felt really happy when the wedding music played, because some people are in a lot of pain after giving birth, but I was simply excited," she said, adding that she did not use an anaesthetic.
But downstairs from Antai's water-birth suite, the hospital's doctors are still busy performing caesareans.
Chen doubts China's caesarean rate will fall significantly, because of the financial incentives hospitals face.
"No matter how much you promote natural birth, it's ultimately a matter of economics," he said.
Source: AFP/MSN

Baby dies in incubator after Hebei hospital power cut

Power cut at the Xianxian Maternal and Child Health Hospital blamed for incubator death

Health authorities are investigating a hospital in Xianxian County of Hebei Province, where a newborn baby died in an incubator after a power failure cut off its heat and oxygen supply for about five hours, local media reported.
The baby boy's mother gave birth on December 2 at the Xianxian Maternal and Child Health Hospital. The boy looked strong but with his face looked pale, the doctor sent him to an incubator for oxygen therapy, the parents told Yanzhao Metropolis Daily.
But the next day, a power blackout occurred at the hospital from 1:40am to 6:30am, cutting off oxygen and heat to the incubator, the parents told the newspaper.
The baby's father, Li Dabing, said he was worried whether the baby would catch cold in the incubator when the power failure occurred, but a nurse told him not to worry, as power is usually restored after an hour.
"I was thinking about taking my baby out of that incubator, but the nurse wouldn't help remove the medical equipment, such as tubes, from his body," Li told the newspaper. "I feared that the baby may catch cold there as even I felt cold in cotton-padded clothes."
They waited until the hospital restored power after a worker started the emergency electricity generation system.
The parents said the baby was then found suffering symptoms of exposure to cold, as his face appeared very red, he had a fever and kept sneezing in the incubator.
The baby was pronounced dead last Wednesday, three days after it was born.
"I believe the death of my son is directly related to the hospital's power failure and the cutting off of the oxygen supply," Li said. "As a public hospital, how can the medical workers restore power five hours after the blackout started?"
A hospital vice director surnamed Luo said that the poor condition of the hospital's facilities was to blame for the five-hour-long power failure.
Source: Yanzhou Daily

News in brief ...

Cholera becoming resistant to antibiotics in China

Antibiotic resistance is observed with increasing frequency among epidemic Vibrio cholerae strains in China, researchers from Beijing have warned.
Since the 1990s strains of V. cholerae have shown a rapid increase in the prevalence of resistance to antibiotics such as  nalidixic acid, tetracycline and trimethoprim/sulfamethoxazole.
This study serves as a warning of the rapid dissemination of resistance in the past 20 years," say researchers from the State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing.
Read more: International Journal of Antimicrobial Agents.

China's medical demand for helium creates world shortage

A shortage of helium caused by increasing demand for MRI machines in China is beginning to affect other countries - and even Disneyland balloons.
Tokyo Disney Resort has suspended sales of Disney-character balloons, and at least one hospital in the country has suspended use of MRI because of a lack of helium .
In hospitals, liquid helium is used to cool electromagnets inside MRI machines
However gas wholesalers say helium stock have run out as demand for helium for hospital use has increased mainly in emerging countries such as China. This has resulted in an at least threefold increase in helium prices in the last decade, greatly increasing the cost of semiconductor production, which relies heavily on helium.
Furthermore, due to an accident at a helium production facility in the United States, the supply-demand balance has been very tight since July, according to an Iwatani division chief. The situation may not improve until next spring at the earliest, observers say.
Read more: Daily Yomiuri

Elderly Chinese suffer from untreated depression

Depression is a common condition among older patients attending primary care clinics in Beijing, and most people do not receive treatment, a study. has found.
 A study of 1275 adults aged over 60 years at a primary care clinic in urban China found that 11% had major depression, with depression more likely to occur in older people, females and those with a  lower educational level or living alone.
Less than 1% of these patients received treatments and yet more than 60% of patients with depression initially remained depressed throughout the 12-month follow-up period.
Read more: Journal of Affective Disorders.

Rural areas urgently need newborn hearing screening

Urgent measures should be taken by the Chinese government to promote newborn hearing screening in the rural areas, researchers say.
Newborn hearing screening has been successfully implemented in Chinese cities , but not in rural areas, according to the authors of a new report.
Researchers screened for hearing problems in 11,568 babies born in five rural areas of Hubei. Overall, about 92%  newborns had normal hearing but 8% had a high-risk of hearing loss. While 71% newborns passed the initial screening test, 58 infants were diagnosed as hearing loss, and the prevalence of congenital hearing loss among newborns in rural areas was 0.5% .
Read more: International Journal of Pediatric Otolaryngology

Spinal fractures increasingly common in elderly Chinese

There has been a five fold increase in spinal fractures among older people over the let decade, new findings from Sichuan show.
Doctors from the Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing reviewed hospital records on all patients who was 60 years of age or older with spinal fracture at two university-affiliated hospitals between January 2001 and May 2011.  A total of 996 patients with spinal fractures were identified, of whom 35% were males. The annual incidence of spinal fractures among the elderly rose from 24 to 130 cases per 100,000 hospital admissions between 2001 and 2010.
The causes of spinal fractures include traumatic spinal fractures (72%), osteoporotic fracture with no specific cause (27%) and spinal fracture caused by tumour and tuberculosis (2%).
The lumbar region was the most common region of spinal fracture, followed by the thoracic and the cervical regions. Lumbar spinal fractures and thoracic spinal fractures were more commonly seen as a result of accidental falls from low heights and osteoporotic spinal fractures respectively. Spinal fractures usually occur outdoors causing by accidental falls from low heights, most frequently happen on the road.
Read more: Injury

Hospitals tricked into buying shoddy dentures

An unlicensed denture processing factory in Beijing has been ordered to suspend production for allegedly using recycled metal materials to make dentures.
The Beijing Jingjiayi Denture Processing Centre is also accused of using illegal cleansing cream to whiten the dentures to meet the requirement of hospitals and clinics.
The factory, in the city's Tongzhou District, has been ordered to suspend production after a local law enforcement team found it had no license following an undercover investigation by the newspaper.
The investigation found the factory melted recycled residue of metal materials to make dentures and used shoe polish and furniture cleansing products to whiten and brighten the dentures.
Since the purity of the metal was lower, the dentures would unavoidably have small holes on them. The poorly-made dentures were also likely to cause irritation in the mouth and other oral diseases if they were not disinfected under strict conditions, according to Shao Dongsheng, a former prosthodontist with Beijing Stomatological Hospital.
The unlicensed dentures and false teeth were sold to small- and medium-sized hospitals and dental clinics in Beijing at low prices.
Read more: Shanghai Daily