My weekly medical news blog for 7th February

There have been few takers for GP training places in Nanjing. The city's community health centres need to recruit 110 family doctors to fill their positions but have only had 49 applicants. Under new health ministry regulations, all doctors including GPs must have the 5+3 education and training (5 years undergraduate and 3 years postgraduate.) However, despite offering a masters degree and a one month placement with GPs in Taiwan, most medical graduates have given the GP training scheme the cold shoulder. The reason is the low status and poor pay of 'community doctors'. After eight years training, GPs can expect to earn only about 80,000 yuan (US$13,000) a year, which is much lower than hospital-based specialists earn. Also there is no chance of promotion or career progression and GPs are expected to move around many clinics in suburbs and villages. Health educators say the Chinese government needs to put more emphasis and resources into primary care if it is to develop a healthcare gatekeeper system similar to those used successfully in developed countries.

Most of the 'research' published by China's doctors is rubbish and there's a simple reason for this - the publish-for-promotion system. To gain promotion (and often just to stay in the job) all China's doctors have to meet a certain quota of  papers published in medical journals. The problem is that most of China's doctors are way too busy treating patients to be doing research and writing up papers. Many are simply not interested. The result is a thriving industry in academic fakery and plagiarism. It is common knowledge that doctors hire 'publishing agents' and ghostwriters to source the articles that will be published under their name. Ironically, many of the articles are written by medical students, and so there is an inverted system whereby the most knowledgeable and experienced clinicians are publishing articles written by the least knowledgeable. The going rate is about 3000-4000 yuan for a good paper - payment on publication, of course. Experts say the system has become a wasteful farce, and they are calling for reform of the one-size-fits-all quote system, to divide doctors into three categories: 'craftsmen' (no research, just treating patients), physicians (some research) and medical scientists (more  research, fewer patients).

The government says it expects to see a dramatic increase in uptake of private medical insurance before 2020, with new policies encouraging Chinese citizens to take out private cover. Ma Xiaowei, deputy head of the health ministry, the National Health and Family Planning Committee, told a news conference this week that the central and provincial government would "encourage the development of various types of commercial insurance to increase people's ability to deal with risks posed by major diseases." He said private cover was needed to help fund demand for health services, with the number of people over 60 already exceeding 200 million. However Mr Ma didn't explain how people will be enticed to take out private health insurance given that there are currently virtually no private doctors or hospitals and very few services or benefits from having insurance.

Underpaid, overworked and under fire: that's the life of an emergency medicine specialist in Guizhou province, according to a Sina article this week. In China, emergency doctors accompany ambulances and are often first on the scene of trouble, even before police. One doctor said he often had to jump in and stop bleeding in stabbing victims while people were still fighting around him. Another said emergcny doctors were often faced with physical challenges such as getting critically ill patients down stairs of apartment blocks with no lifts. Emergency doctors said they worked 24 hour shifts then had a day off during which they mostly slept, and there was no time for leisure, holidays or study. The stress of daily life as an emergency doctor meant there were high rates of burnout - and doctors were considered grizzled veterans if they lasted three years, they said.

In clinical news, new research shows that older Chinese are consuming more calories - and eating more unhealthy food - than their counterparts of the previous generation. A study from nine provinces found that the average daily energy intake had increased among older Chinese adults from 1379 total kilocalories in 1991 to 1463 kilocalories in 2009. The increases had come from greater consumption of high fat and high carbohydrate foods such as plant oil, wheat buns, and wheat noodles.

Chinese are also consuming more polluted air and it is killing them as much as smoking. A study carried out by the School of Public Health in Peking University found that there were
257,000 premature deaths related to PM2.5 pollution in 31 major Chinese cities. This made air pollution a major killer equivalent to smoking. Conditions such as lung cancer and stroke triggered by air pollution killed about 18,000 people in Beijing alone in 2013, the researchers said.

And finally, a study from Shanghai as shown that the number of cervical cancer diagnoses in the city has increased six fold in the last decade. Data from 13,518 women with gynaecological cancers  from 2003 to 2013 showed that the number of women with diagnosed gynaecological cancers increased by almost sixfold with the increase largely due to the increase of women with newly diagnosed cervical cancer. The study also showed that the age of diagnosis of cervical cancer had increased.

Smoking deprivation | Suicidal ideation in school students | Obesity surgery | Oestrogen in the environment

About 7% of Chinese people smoke so much their spending on cigarettes deprives the household of essential items like food, a study from Beijing has found. Low-income smokers were more likely to have smoking-induced deprivation.

Suicidal ideation occurs in one in three Chinese high school girls and 20% of boys, a study of 5249 students in Anhui Province of China has found.

Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy are safe and effective for the treatment of morbid obesity, resulting in 63% and 76% loss of excess weight, a study from Nankai Hospital of Tianjin Medical University has shown.

The waist circumference cut off for high risk of central obesity and metabolic syndrome is 85 cm for women and 90 cm for men, researchers from Shandong have shown.

In Shanghai, almost one-in-five boys are obese and 8% of girls are obese. The prevalence of combined overweight and obesity is 49% for boys and 31% for girls aged 8-15-years, according to a study that found rates of obesity started to increase from age 10 years.

Oestrogen hormones are widely used in animal rearing in China and this leads to high levels of the hormones in excreted manure which is then used on crops, perpetuating the environmental contamination and human exposure, researchers from the State Key Laboratory of Water Environment Simulation, Beijing have shown.

The highly pathogenic strain of H7N9 avian influenza is quite different from other H7N9 strains seen in China and appears to have come about by re-assortment with the H9N2 strain, according to researchers from the Guangdong Provincial Center for Disease Control and Prevention.

Infliximab is safe and effective in Chinese patients with ulcerative colitis, resulting in 85% response rates and 62% remission rates after 30 weeks of treatment. However, relapse rates are high, say researchers from the Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou.

China medical news headlines for Saturday 25th January

Bribery and medical profiteering targeted in new campaign
Chinese authorities have launched a major national campaign targeting bad practices in medical services, including excessively high prices for drugs. According to the Global Times the reform campaign will stress better monitoring of drug production and marketing and address inappropriate practices within medical institutions and among medical practitioners. Medical ethics will be further promoted, and bribery in marketing of drugs will be addressed. Deaprtments taking part include the National Health and Familiy Planning Commission. The campaign calls for violators to be identified and cases of bad medical practice to be punished  in a serious way.

STDs a major problem in sex workers
Urgent efforts are needed to tackle the high rates of sexually transmitted diseases among prostitutes in Jiangsu, researchers say. A study of sex workers in Yangzhou and Changzhou found that 15% were infected with chlamydia, 5% had gonnorhoea, 5% had syphilis and 0.2% had HIV infection. The findings are published in PLOS One.

Dietary advice for obese students
Shanghai students should be given dietary advice and better access to health food at school to combat the rising trend in obesity, a political adviser has suggested. According to Shanghai Daily, Chen Lei said 17% of Shanghai school students were obese, three times the national average. Over half of the parents he surveyed expressed dissatisfaction with lunch provided by schools, which often included fried food such as pork and chicken.

Fujian hospital chief arrested for bribery
The president of a hospital in Fujian province has been removed from his post for accepting bribes. ECNS reports that Lu Kaiming, who also served as the vice chairman of the Municipal Committee of the Chinese People's Political Consultative Conference in the city of Sanming, has been detained and investigated for law infringement and serious disciplinary violations. Authorities have confiscated his illegal gains and he will be transferred to a local judicial organ for his alleged crime.

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.

Anti-obesity campaign falters in a country accustomed to famine

Older people in China remember the Great Famine of 1958-61, when 15 million to 45 million people died of hunger and related causes.
Today, nearly every street corner in Beijing and many other cities seems to boast a McDonald's. There are KFC outlets in almost every Chinese city, 3,700 in all. Meanwhile, newly minted members of the Chinese middle class have rushed to buy cars, leaving bicycles that were once a major source of exercise rusting on the street. Pizza Hut is considered a fancy date-night restaurant, T.G.I. Friday's has several branches in Beijing, and cans of Coca-Cola are sold at every corner stand.
With fast food and rising affluence, a country only a generation removed from hunger is getting fat. How fat? According to the World Health Organization, the percentage of adults who are overweight and obese rose from rose from 25 percent in 2002 to 38.5 percent in 2010 in a population of 1.37 billion. Urban dwellers account for much of this. WHO projects that 50 to 57 percent of the Chinese population will be too heavy by 2015. (By comparison, 69 percent of Americans age 20 and older are overweight or obese.)
There's a standing joke, notes Lyn Wren, a physician with International SOS Beijing Clinic, that "Chinese waistlines are growing faster than the GDP."
Given how impoverished the country was not long ago and how impoverished parts of it still are, "having a problem where people are eating too much — it can seem a little churlish to complain about that," says Paul French, the Shanghai-based author of "Fat China: How Expanding Waistlines are Changing a Nation." French and co-author Matthew Crabbe found that even as recently as five years ago, obesity wasn't recognized as a problem by health professionals in China.
The Chinese Health Ministry has said it encourages healthful eating programs in schools and the construction of more playgrounds to promote exercise. And the Chinese Center for Disease Control and Prevention makes vague references to "health promotion" and providing "scientific guidance for healthy diets," but nationwide campaigns about eating healthfully and exercising are not evident.
In fact, pushing the population to lose weight, exercise and cut back on unhealthful foods seems to strike a discordant note to some inside the government, French says. "When I talked to government officials, their argument was: Right now we're trying to tell them to do and not do a lot of things," such as not spitting on the street, not dropping trash everywhere and not driving "like complete idiots."
"They know they can only tell people to do some things . . . before they get fed up."
Read more: Washington Post

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

Obesity increases, one in seven Shanghai children overweight

In the last five years there has been a significant increase in the prevalence of obesity in children and adolescents in Shanghai, a study shows.
The high percentage of overweight and obesity in the young age groups is of particular concern, according to researchers who say urbanization might be a causative factor for the increase in obesity prevalence in Chinese children in the Shanghai area.
They studied 70 582 students in 2003 and 86 355 students in 2008 from schools from within the two Shanghai districts. The standardized prevalence of overweight significantly increased from 12.75 to 14.2%, and the prevalence of obesity significantly increased from 3.35 to 3.94%  during the study period. The prevalence of obesity decreased with age in both boys and girls, and the prevalence of obesity and overweight in boys was significantly higher than that in girls. Interestingly, the prevalence of overweight and obesity in the urban area was also significantly higher than that in suburb area.
Read more: Pediatric Diabetes

Urban Chinese: 15% are obese and 19% are overweight

Obesity and overweight have become epidemic in urban populations in China; and associations of risk factors with obesity differ between men and women.
A sample of 25,196 urban adults aged 18 to 74 years in Northeast China was selected and measurements of height, weight and waist circumference were taken from 2009-2010. Definitions of overweight and obesity by the WHO were used. The overall prevalence rates of general obesity and overweight classified by BMI were 15.0% (15.7% for men and 14.3% for women) and 19.2% (20.8% for men and 17.7% for women), respectively, and the overall prevalence rate of abdominal obesity was 37.6% (31.1% for men and women 43.9% for women). The elderly and those who had a history of parental obesity, alcohol drinking, or former cigarette smoking were at high risk of obesity classified by BMI or waist circumference, whereas those with a higher level of education, higher family income, or a healthy and balanced diet were at low risk of obesity. Men with a higher level education level, a white-collar job, a cadre job, or higher family income were the high risk group, and women with a higher level of education or higher family income were the low risk group.

Read more: BMC Public Health

Obesity epidemic declared as 40% of Shanghai residents overweight

Shanghai is acting to head off an "obesity epidemic" as health authorities warn of a rising tide of diabetes and weight-related diseases.Roughly 40 percent of adults in Shanghai are overweight or obese, and one-fourth of residents do not exercise enough, according to a report by the Shanghai Municipal Health Bureau, released on Monday."The rise in obesity among children and adults is very disturbing," said Li Guangyao, deputy director of the Shanghai Health Promotion Committee. "It will lead to many health problems and should be given attention."In a recent academic paper, sports scientist Colin Boreham found that over the past 20 years, the number of obese Chinese men has grown from 3 percent to 11 percent, while the number of obese women has increased from 5 percent to 10 percent.Abdominal obesity problems are particularly prominent, wrote Boreham, director of University College Dublin's Institute for Sport and Health.The ratio of men with abdominal obesity, meaning with a waist circumference of 90 cm or more, increased from 8 percent to 28 percent, while women with abdominal obesity, a waist circumference of 80 cm or more, increased from 28 percent to 46 percent.The findings of another survey, released at the end of 2011 by Shanghai health authorities, showed that the average weight of male residents has increased by 2.9 kg when compared with 2000. Over that same period, the average waistline of men has increased 2.3 cm.

Read more: China Daily