China is crazy for medical apps

The latest medical app craze in China is iBaby, developed by an entrepreneur from Harbin to provide antenatal, childbirth and childcare advice to Chinese women. The creator Lu Guotao featured on a recent Apprentice-style TV show on which he demonstrated how his app can link women up to advice via video and online help from obstetricians. Lu turned down offers from investors and went it alone to market the app, which he says now has tens of thousands of users in 31 provinces. Lu says he has had 10,000 obstetricians sign up to provide medical advice online via the app. The one stop platform for pregnancy advice also links women up with local clinics and offers links with merchandisers for pregnancy wares.

Lu says he was already a successful businessman when his wife became pregnant, but they were so busy attending to their work that she lost the baby through a miscarriage. Lu turned his grief into an energetic mission to help avoid such incidents again, by providing accessible information, advice and contacts for prospective parents.

He says the huge success of the app is not surprising given China's move towards relaxing the one child policy and also the opening up of the healthcare system to private investment and more flexibility in doctor roles.

The app has received backing from national obstetric experts including Professor Liu Xinghui, director of the West China Second Hospital, Sichuan University, Chengdu. Professor Liu offers weekly online lectures via the app. She says women can access a wide range of obstetric experience via the app.

Doctors tempted by offers from private hospitals

by MICHAEL WOODHEAD
As China tries to develop its private healthcare sector, some doctors are contemplating a move from their high workload, low paid public hospital positions to the private sector. One Shanghai obstetrician with 10 years' experience was interviewed by Caijing and said he was tempted to make the move to the widening private sector, but not for financial reasons. He said he could already earn 300,000Y (US$47,000) a year in the public hospital, counting bonuses, which was comparable to the private hospital salary. What attracted him to private work was the lower workload and the opportunity to have more patient continuity.

"In public hospitals every day you need to see hundreds of patients, and you have no energy left to do academic work, research and innovative practice. In the private hospitals there is reduced patient throughput and often the patient will follow you from start to finish - and this is a more valuable medical experience," said Dr Liu. "None of my friends who have switched to a private hospital have shown any regrets," he added.

Another reason for moving into the private sector is independence, say doctors. One said that private hospitals offered more clinical and financial autonomy than a public hospital where you worked under the authority of a 'big medical leader' and were also subject to the rigid career path and control of hospital management. In a private hospital there was more opportunity to select your patients, treatments and also have an equity stake in the business, he said.

However the doctor noted that there was less job security and often questionable quality of care and backup in private hospitals compared to the public system. He noted a clear divide between domestic and foreign-funded private hospitals. Foreign joint ventures tended to have little interaction with public hospitals as the quality of care was generally good. However he saw many 'referrals' of patients from private hospitals where patients had not been properly assessed or had spent tens of thousands of yuan for minor ailments. Most of the doctors in the tertiary public hospitals would opt for foreign-invested hospitals, he suggested.

Hypertension treatment outdated; Infants hit by Group B Streptococcal infections; Liver disease brings ruinously medical bills; Caesarean sections the norm; Li Keqiang unhappy with pace of health reforms

by MICHAEL WOODHEAD
Treatment of high blood pressure in China is quite backward because it is exactly that - treatment of just the raised blood pressure, with no attention to other cardiovascular risk factors. Cardiologists now emphasise that it is essential to treat a person's overall cardiovascular risk, not just focus on single risk factors such as blood pressure. But a study carried out in 274 hypertensive patients in Zhejiang found that  found that 28% were still smoking, 39% drank regularly and only 21% exercised frequently. The average salt intake per day was above the national recommended level of 6g. The study also found that most patients were taking only one drug for high blood pressure, which was inadequate to control their blood pressure. Many were taking 'herbal' medicines that actually contained out of date and dangerous western antihypertensives such as reserpine. As the authors conclude: "The study revealed outdated and inadequate treatment and health education for hypertensive patients, especially for those who have high risk scores for CVD. There is a need to review the community-based guidelines for hypertension management."

In Shenzhen, researchers at the Children's Hospital have shown that invasive group B streptococcal infection is an important pathogen in infants under 90 days old, resulting in in high mortality and neurological sequelae. The streptococcal infection strains showed strong resistance to clindamycin and erythromycin.

Liver disease is an expensive condition that often sees families facing ruinous medical bills in China. A study carried out at a Kunming hospital found that the average yearly cost of medical treatment for hepatitis B was 19,496 RMB, while patients with cirrhosis faced bills of up to 46,061 RMB. While public medical insurance helped pay for some of the costs, catastrophic health expenditure occurred for families affected by all these illnesses.

China's high rate of caesarean sections will be difficult to bring down to more healthy levels, according to researchers. In a  survey of a112,138 women they found the cesarean delivery rate was 55% and as high as 66% in some regions. Two thirds of the cesarean deliveries were scheduled and performed before labour  and about 40%%  were performed without any recognised medical indications. About 57% of the caesareans were done on request of the mother.

Meanwhile, the progress of health reform is obviously too slow for the Premier Li Keqiang. This month he has called for more medical reform measures to overcome 'difficulties' in the healthcare system. In written instructions he identified problems areas that needed attention, such as hospitals should be prevented from being "financed by drug sales" He also said that more effort should be given to reform of county-level hospitals and more serious diseases needed to be covered by medical insurance. His orders came after reform measures were introduced across all county-level hospitals and are now being piloted in 100 city-level hospitals.

My January news blog ...

Regrettably, I am cutting back on my blogging about China medical news this year. I've been doing this for more than a year now, out of enthusiasm and my own personal interest in the area, but it's becoming too much of a burden on my time. And of course it is all unpaid. Unless there is a sponsor out there who wishes a regular stream of China medical news? After my day job doing much the same thing about Australian medical news I find it hard to sit down at home and do the writing for this blog. So from now on I shall probably only update the site about once a week. That is not enough to cover the many things happening in healthcare in China, but that's your lot. As they say in Yorkshire, you don't get owt for nowt.

This week I have been reading about how patients in Shanghai with chronic diseases will now be able to pick up their repeat prescriptions from community clinics instead of the big hospitals. It's a move intended to relieve the overcrowding at the tertiary hospitals and sounds like an obvious and sensible idea. Whether it will work or not depends on whether China's hospital-obsessed patients can be persuaded to show up at the low-status community clinics.

There are also moves to try curb China's high levels (approaching 50%) of caesarean section intervention in pregnancy. A feature article by Yang Wanli describes how some obstetricians in China are trying to persuade women to opt for natural birth. However, the barriers are a lack of available analgesia for women in labour and the industrial production-line mentality of China's hospitals.

Rural health is a major issue in China this month, with the State Council approving a plan to boost the rural medical workforce. The Council wants to see rural areas of China have qualified doctors replace the current 'barefoot' practitioners. However, well-meaning intentions will not fix the huge rural medical workforce problem in China. The simple problem is that university qualified doctors do not want to work in rural villages. The pay is pathetic, there is no status and the workload is high. As this article shows, the current rural medical workforce is mostly unqualified and often dangerously lacking in skills.

That's not to say that rural health is completely hopeless in China. There have been great achievements in some areas of public health such as immunisation and basic child health. However, as a major article by Chinese paediatricians the Archives of Diseases in Childhood shows, the next step for China is to try reduce the incidence of more complex diseases in children. China has done well in tackling the easily preventable causes of child disease, now it must turn its attention to the difficult stuff - the consequences of preterm birth, and the many congenital and metabolic diseases.

One problem with monitoring China's progress in child health is knowing whether or not the official  figures are true. Take measles vaccination for example. According to official reports, China has 95% measles vaccine coverage of infants. But when researchers analysed the causes of measles outbreaks in Hunan and Jiangsu that affected hundreds of children they found that the actual rates of measles immunisation more like 80%.

And finally, for those who put their faith in western healthcare companies helping improve the health of China, take a cautionary look at the sorry tale of GSK. A well regarded company in the west, GSK was the subject of high profile bribery allegations and a court case that jailed one of its British executives for  his role in the bribes to doctors and hospitals. Now the company is reported to be cutting the jobs of 1000 employees in China following the downturn in its business there (including a 60% drop in revenue).

Doctors pour scorn on China's medical TV shows: point out five most egregious mistakes

by Michael Woodhead
One of China's most popular TV shows is the medical drama "Young Doctors". Modelled on similar hugely popular shows from Korean TV, the show is all about the lives and loves of a handful of beautiful, smart and successful young doctors. 
China's real young doctors are not impressed - but they are laughing. On the medical social media site DXY. net they have been pointing out the many ridiculous factual errors and goofs in the show. The top five are:

1. Hand hygiene howler: Ming Ming has donned sterile gloves but then adjusts her glasses - an obvious no-no from an infection control point of view

2. Scans all wrong: - holding X-ray pictures the wrong way round - pointing to a chest X-ray and and diagnosing a broken leg, looking for pneumonia in a CT scan of the head ...

3. White coat wearing - on the TV show, doctors never button up their white coats, but wear them open and flapping like fashionable casual wear.

4. Novel medical theories: mahjong can prevent Alzheimers, people wake up from prolonged vegetative state.

5. Miracle patients: man with tracheal obstruction on breathing machine can speak quite clearly with beautiful dialogue.

However, China's medics are more impressed with the other medical drama The Obstetrician. Written by a playwright, it is nevertheless quite authentic as it relies on real cases histories and the scriptwriters consulted medical professionals over the technical details.

Anything on telly? "The Obstetrician"

by Michael Woodhead
Writer Zhang Zuomin is proud of his new TV series "The Obstetrician" which airs tonight on Jiangsu TV.
He says it is different from the usual medical soap operas focused on romantic liaisons in the hospital - this one is authentic and focused on the medical cases and technical details, he says. Zhang isn't a doctor but he says the dialogue is authentic based on his experience of working in a hospital as a security guard before he went to Fudan University to study Chinese.  He says the TV series focuses on real medical cases and is realistic down to the drug doses used and the medical procedures as described in the medical journals. When working in a hospital Zhang said he noticed that doctors have their own jargon, quite unlike the official language used in textbooks. He has adopted this in the script and says he wanted to show the real day-to-day working life of doctors rather than focus on trivial affairs and melodramatics. Zhang says he became frustrated watching other medical TV dramas on TV as they were phoney. To add extra authenticity he got a doctor friend to review each script and make suggestions. The drama and tension comes more from the conflicts in the medical cases, although the relationships between doctors are also important as they often have different approaches and opinions on medical cases, he says.

China: medical procedures are now dictated by fortune tellers

by Michael Woodhead 
In the west, patients often do their ‘homework’ by consulting medical books and websites before seeing a doctor – but in China patients are doing their homework with fortune tellers. A new report shows that patients are relying on fortune tellers to decide what date they will have an operation, when to have a caesarean section and even to guide cosmetic surgery for a more ‘fortunate’ face.
At a Liaoning Hospital, head of nursing Ren Yumei says about 80% of women choose to have a caesarean section birth, and many of them are done so they can select the ‘auspicious’ date and time selected for their child’s birth from fortune tellers consulting the books of the “Great Immortals’.
“Many women and their families demand not just the day but the hour of birth according to horoscopes, they won’t accept any deviation,” she says.
In Anshan, head surgeon Wang Yongshen says the same thing is now happening with patients requiring elective surgery. Patients demand a specific time for the operation – sometimes even in the early hours of the morning.
“Even when they know that surgery in the middle of the night is likely to be less safe and effective they opt for it because of the influence of the fortune tellers,” he says. And when hospitals refuse these unscientific requests, patients turn to smaller private clinics that are happy to cash in on the new fad for ‘auspiciously timed medical procedures’, even though their medical standards are often suspect.
Obstetric nurse Ren Yumei says she is concerned to see mothers and families putting their baby’s health at risk by forcing an early delivery just to have a ‘lucky’ birth timing. She says the health risks of premature birth are well known, including respiratory and developmental problems as well as blood and cardiovascular risks.
A surgeon at a cosmetic clinic in Shenyang says he even sees patients who wish to change their appearance based on advice from fortune tellers. He had one young man who insisted on having surgery to give him a bigger chin because this would make him appear more bold and daring, in accordance with his horoscope, according to an adviser. He went ahead with the operation despite medical advice that it would restrict his jaw movement.
Professor Zhang Bao of the Tianjin Institute for Social Sciences says the new trend is anti-scientific and a remnant of ‘old thinking’ superstitious ignorance. He said the two schools of thought could not co-exist and there would be a collision between the two.
He said many ‘fortune tellers’ were in business for personal gain and they made extravagant claims that had no regard for the welfare of the patient. He said such practices should be strictly supervised and exposed for what they are. If they continued to provide harmful advice fortune tellers should be prosecuted and punished, he said.
The original report is published by Xinhua.

Six of the top medical news stories from China

1. China has a huge shortage of midwives, and would need a further 800,000 to meet the WHO standard of one for every thousand women of child-bearing age, according to a new report. Health officials say the problem will worsen as China adopts a two child policy.

2. Efforts to control pneumococcal disease and Haemophilus influenzae type b (Hib) in children by vaccination are failing due to low immunisation rates and delayed immunisation, a study from Shanghai shows. A review of vaccination records for 28,000 children up to the age of seven found that 51% had one dose of Hib vaccine and 11.4% had one dose of pneumococcal vaccine. Only 8.2% of children had Hib vaccine at the right time and only 0.5% had timely pneumococcal vaccine. Rates were particularly poor for migrant children, the study found.

3. Rates of hypertension have increased in China and yet treatment and control of the condition remain poor, according to researchers from Shandong. In a study of more than 4000 people they found that the incidence of hypertension increased from 2.9 per 100,000 people in 1991–1997 to 5.3 in 2004–2009 Antihypertensive treatment and control rates for hypertension were 5.7% and 1.7% in 1991–1997 and 19.9% and 7.6% in 2004–2009, respectively.

4. The rate of disabilities from road crashes in China has skyrocketed as the number of cars on the road has increased over the last two decades. The incidence rate for road traffic disabilities increased over time from 1.50 per 100,000 people in 1980 to 11.2 per 100 000 persons in 2005, according to Professor Zheng Xiaoying of the Institute of Population Research, Peking University.

5. Malaria is still a major problem in central China especially during floods and rainy periods of the summer. A study from Mengcheng County, Anhui found that there were 3683 malaria were notified during the study period of May to October 2007 Most of the cases occurred a week to a month after flooding and waterlogging. Public health action should be taken to control the potential risk of malaria epidemics after wet weather, the researchers from Shandong University said.

6. The recent outbreaks of H7N9 avian influenza also resulted in many mild and asymptomatic infections as well as severe life threatening cases, researchers from Guangdong have reported. Their surveillance program noted 21 cases of infection in Guangzhou, China in 2013 and 2014, of which several were mild or asymptomatic infection. Family clusters occurred, suggesting limited person-to-person transmission of the H7N9 virus, they said.

China's latest medical soap - a bit too sudsy?

"The Male Obstetrician" (产科男医生) is China' new medical soap opera, and its first episode has met with mixed reviews. It stars the real life recently-wed celeb couple Li Xiaolu and Jia Nailiang as the two doctors in the obstetrics department of a major hospital. Viewers have praised the medical details of the show, saying it may educate and enlighten people about the realities of what really goes on in an obstetrics department. However, they have also ridiculed the storylines, such as a scene in which a pregnant woman in a coma hears the sound of mahjong and is brought back to consciousness and is then able to deliver her baby. Critics say the new show is not as heavy as previous medical shows that focus on the dramas of heroic doctors and the tensions they face in diagnosing cases and struggles between patients and doctors. The new show is said to be lighter and more humorous, with much petty squabbling between the male and female leads.

China has the highest rate of caesarean births in the world: time to act

by Michael Woodhead
Almost half of Chinese women give birth by caesarean section, a rate that is three times higher than the 15% recommended by WHO, according to two Chinese clinicians writing in The Lancet this week.
Dr Mi Jie and Dr Liu Fangchao of the Capital Institute for Paediatrics in Beijing say China has an urgent need to reduce the number of caesarean births because they have a high risk of related complications or death, and because babies delivered by caesarean section are more likely to have respiratory problems, obesity, and other metabolic diseases.
The doctors list five non-medical reasons why China has a 42% rate of caesareans:

1. Women fear pain and loss of vaginal tone after natural birth. They see caesareans as safer faster and less painful.
2. Women wrongly believe that they will regain their pre-pregnany figure better after caesarean birth.
3. Chinese women like to choose a 'lucky' date to have their baby by caesarean.
4. Doctors prefer to schedule the caesarean for convenience and to avoid medicolegal disputes with vaginal birth
5. Caesareans are more profitable for hospitals (12000 yuan vs 6000 yuan for natural birth).
The authors of the letter to the lancet call on the government to take control the rate of caesarean section in China,
"The Chinese government should develop specific policies and measures, such as use of rate of caesarean section without medical necessities as one of the hospital’s overall rating components, and popularising of natural childbirth," they write.
Hospitals and communities should promote health education in women of reproductive age to provide a more accurate idea of delivery," they conclude.

Big changes seen in Chinese women's reproductive health

by Michael Woodhead
Chinese women reach puberty earlier, have children later, have more abortions and are much less likely to breastfeed than their mother's and grandmother's generations, a major new study has shown.
The generational changes in Chinese women's reproductive factors have been shown in data the China Kadoorie Biobank cohort study that recruited 300 000 women born between 1930 and 1974 from 10  urban and rural regions of China
The findings showed that the average age that women started menstruating declined from 16.1 years of age to 14.3 years. Not surprisingly given the one child policy, the average number of children Chinese women had fell from five to one (from six to one in rural areas). The average age at first birth increased from 19 years to 26 years in cities and from 18 to 24 in rural areas.
Breastfeeding rates and duration of breastfeeding also showed major declines in both urban and rural women.
The proportion of women having an abortion increased so that 68% of urban and 48% of rural women had a  pregnancy terminated after 1980.
The average age for onset of menopause increased from 48 to 49.3 years.
The researchers said the changes not only affected women's reproductive health but also may have an influence on their risk of breast cancer and cardiovascular disease rates.
The findings are published in the International Journal of Epidemiology.

Shenzhen 'fake doctor' jailed for two years for running sex-selective abortion clinic

A woman with no medical qualifications who ran a sex-selection abortion clinic from her own Shenzhen apartment has been jailed for two years.
The woman was prosecuted after one of her clients had a botched abortion that left her infertile. A Shenzhen court was told that the woman called Liu Mo had offered a 'quick and painless' abortion for 800 RMB to a woman who came to her clinic after having a scan showing she was pregnant with a female foetus. Her family had pressed her against having a girl and Liu Mo performed an abortion. However the procedure was done badly and the woman had severe haemorrhage and was taken to the public Renmin hospital in Shenzhen. Doctors there were able to stop the bleeding but told the woman she would most likely be unable to have children.  According to Sohu, the fake doctor was sentenced to two years in prison and fined 5000 RMB.

China medical news for Thursday 30 January

Blood lead levels still hazardous for Chinese children
Blood lead levels for children have decreased in recent years but are still at unhealthy levels, a study carried out in 11 cities has found. The blood sampling survey of 12 000 children under six years of age found that average blood lead levels dropped by 16% (from 46μg/L in 2004 to 39μg/L in 2010). The prevalence of elevated blood lead levels dropped by 87% (from 9.8% in 2004 to 1.3% in 2010). Factors associated with high blood levels included eating popcorn, chewing fingernails, sucking fingers, being cared for at home or at a boarding nursery, the study in the World Journal of Pediatrics found.

Rise in China's caesarean rates 'alarming'
The overuse of cesareans is rising alarmingly in China and has become a real public health problem, a review by researchers in Beijing has concluded. The current national caesarean rate is near 40%, and there has been a rapid rise of cesarean sections in recent years, say researchers from the School of Public Health at Peking University. Nonclinical factors such as financial incentives for hospitals were considered as the main drivers fueling the rise of cesareans. However the change in health services to focus on specialised care and marginalizing primary care have also played a role, they say in the International Journal of Women's Health.  

Dengue fever changes in Guangdong
The pattern of dengue fever outbreaks in Guangdong is changing, infectious disease specialists have found. The disease appears to be becoming endemic although outbreaks are caused by the milder types of dengue, researchers report. The prevalance varies between 2-5% and serotypes are now more varied, according to the study in PLOS One.

Puberty arrives earlier for Chinese girls
The age of onset of puberty is now at least a year earlier for Chinese girls compared to those of 1984, a study from the Capital Institute of Pediatrics, Beijing, has found. The research in the World Journal of Pediatrics found that the age of onset of puberty for urban girls had decreased by 4.2 months per decade, and that of rural girls by 9.6 months per decade from 1980 to 2004.

Fish pedicures a hepatitis risk
Aqua pedicures where tiny fish nibble away at dead skin on bathers feet may spread blood diseases such as HIV and hepatitis B, a Ningbo newspaper says. Dr Wang Jiahua, a dermatologist at a local hospital, said there were risks of infection, citing a patient whose legs became hot and swollen days after his first fish pedicure.He suggested a one month interval between fish pedicures and antibiotic ointment to protect skin where wounds are found.

Medical research in China: seven samples from this week's journals

China's medical education system is broken
Chinese medical education is not fit for purpose, a review by Dr  Wu Lijuan of the School of Public Health, Capital Medical University, Beijing, finds. Too many students have to get a an additional Masters or even a Doctorate in academic medicine to get a position at a hospital, and miss out on valuable clinical training. At the same time the clinical component of many degrees is not recognised by some institutions and has to be repeated.
Medical Education Online.

Chinese ethnicity protects against pre-eclampsia
A study of of 67 746 pregnant Chinese women found that 1.92% nulliparous women developed pre-eclampsia. The prevalence of mild and severe pre-eclampsia was 1.42% and 0.49%, respectively. The study authors said the prevalence of pre-eclampsia in China was low compared with Causcasians, perhaps due to differences in BMI or lifestyle.
Journal of Human Hypertension.

Allergic triggers in Guangzhou
The main allergic triggers among allergic people in Guangzhou are cow's milk, eggs in younger children and then the house dust mite allergens Der pteronyssinus and Der farinae in later years, a four year observational study has found.
Multidisciplinary Respiratory Medicine.

New cause of hand foot and mouth disease in Guangdong
An unusual enterovirus type, CVA6, has been identified as a new and major serotype associated with an hand foot and mouth disease epidemic in Guangdong.
Essential Microbiology.

Annual health checks urged for rural residents
About two out of three elderly have physical examinations by a healthcare professional at least annually, a survey of more than 1100 people from four provinces has found.However, rural residents suh as farmers were only half as likely to have a regular check up, prompting the study authors to suggest that  government and public health institutions should assist farmers to acquire the habit of having annual physical examinations. "Village doctors should be supported in delivering health information to the elderly in rural areas," they said.
BMC Healthcare Research.

Rats the source of hemorrhagic fever in China
There are about 1.4 million cases of hemorrhagic fever with renal syndrome every year in China and rats seem to be the main reservoir for infection, a study shows.Trends in cases were associated with the local rodent reservoir, climatic factors and socioeconomic conditions suggesting that it may be possible to develop an "early warning system" for the control and prevention of hemorrhagic fever, researchers said.
PLOS Neglected Tropical Diseases.

What are the most cost effective treatments for myocardial infarction in China?

A study from Beijing Anzhen Hospital and Capital University has found the most cost effective treatment for myocardial infarction in China would be optimum use of the four drugs aspirin, β-blockers, statins, and ACE inhibitors in all eligible patients, or unfractionated heparin in non–STEMI myocardial infarction. Other treatments such as reperfusion therapies in eligible patients with STEMI myocardial infarction and clopidogrel would be less cost effective, the study found. Use of all hospital-based AMI treatment strategies together would be cost-effective and reduce the total CHD mortality rate in China by about 10%. 

Circulation.

China's medical news headlines for Sunday 19 January

Hepatitis B vaccine given the all clear

The Shenzhen Bio Kangtai hepatitis B vaccine that was linked to the deaths of 17 infants has now been given the all clear by the Chinese state drug authorities. After an investigation the China Food and Drug Administration and the National Health and Family Planning Commission said the vaccine could be used again as no problems have been found with the hepatitis B vaccine. Authorities tested more than 1300 vaccine samples from six batches that were under suspicion. According to the People's Daily, the CFDA said all samples met the quality standards. The NHFPC said the 17 infant deaths were due to other problems, including severe pneumonia, kidney failure and suffocation.

In Guizhou, retired doctors asked to work in rural clinics

Retired medical specialists in Guizhou are being urged to lend their expertise to rural area clinics, according to China Daily. Professor Sun Fa of Guiyang Medical University told a meeting of the Chinese People's Political Consultative Committee that there were about 600 retired doctors from the province's five top hospitals of whom half were healthy enough to work in rural clinics.
He said they could help the more than 40,000 medical staff in township clinics, many of whom have only medical qualifications from secondary colleges or no degree at all.

Guangdong plans for baby boom

The new two-child family planning policy will not pose a big challenge to public services such as medical care, a top health and family planning official from Guangdong province has said.
Zhang Feng, the former director of the Guangdong population and family planning commission, said 1.1 million to 1.2 million babies are  born in the province each year. and the new policy will see about 130,000 more babies each year. "The baby boom will bring little social impact," he said at the province's annual legislative meeting.

China's smoking ban is unrealistic, says NBC report

A report by Ed Flanagan of the American NBC News says that the recent anti-smoking measures announced by the Chinese government may be as unsuccessful as previous attempts. The article says China has 350 million smokers and the habit is deeply ingrained in society. Previous attempts to curb smoking resulted in "No Smoking' signs being put up but they were widely ignored, says Flanagan. He says the Chinese media have given no details of how the new policy will be enforced. The move also face resistance from the powerful tobacco industry in China, he adds.

 New Yorker profiles China's gene factory BGI in Shenzhen

The New Yorker has an in-depth profile of the gene factory B.G.I., (Beijing Genomics Institute), which is said to be the world’s largest genetic-research centre, located in Shenzhen. The report by Michael Specter says BGI has 178 machines to sequence DNA, and produces at least a quarter of the world’s genomic data. This could help provide new solutions to disease and other areas such as agriculture, he writes.

China medical education gets internships | Saving for medical bills | Women have hysterectomies for profit

 China will set up a standardised internship training program in 2015 for medical graduates before they become qualified to be doctors, according to the National Health and Family Planning Commission. Officials said China does not currently have a national standard for training, and training to become resident doctors depends on the hospitals where they are employed, leading to differential medical levels across regions. The new standardised "5 + 3" year training system will ensure that graduates get experience in several branches of clinical medicine before getting a full licence to practice medicine. According to the Global Times, the training bases will first be set up in top level hospitals and some lower level hospitals based on the local situation. They will be subsidized by the governments and central finance.
 
One of the main reasons why Chinese people save so much is to prepare to pay for future medical bills, a report says. In China, 64% of people surveyed were actively saving for health issues, according to ECNS. Savings rates for health were higher in China compared to other countries surveyed, and Chinese people used diversified strategies in saving for health issues, with local currency, whole life insurance and pure term life insurance among the choices.

And in Taiwan it is claimed that  many of the 20,000 women who have a hysterectomy each year do so to gain thousands of dollars in infertility compensation from the Labor Insurance Fund.
According to the China Post, researchers said Taiwan had the largest percentage of “womb-less women”and this might be due to the lure of  infertility benefits amounting to more than NT$100,000for women under 45 who have a hysterectomy.

Medical news from China's media

In the China Daily, womens' hospitals says they are being inundated with inquiries from women about having a second child following the amendment to the family planning policy in early November. One hospital, the Women's Hospital of Zhejiang University's School of Medicine has opened a consultation clinic for women considering a second child.

Xinhua reports that two more babies have died after receiving hepatitis B vaccinations, this time in Shandong province. However, the report does not say which brand of vaccine the cases are related to, even though the Shenzhen Bio Kangtai vaccine has been withdrawn.
According to the provincial Centre for Disease Control and Prevention they have also received a report of a baby that died in October after a hepatitis B vaccination.
At least twelve infants are reported to have died in China after receiving vaccines against Hepatitis B.

The People's Daily has a report on gay college students being targeted for HIV prevention measures, as the number of cases in young gay men in China is increasing dramatically. The article says that in
Guangzhou there have been 117 cases of HIV in 48 colleges or universities, according to  the Guangzhou Disease Prevention and Control Center. Ninety percent were infected via homosexual behavior, with high risk sexual activities being common. Students are being targeted for safe sex behaviour campaigns and also for HIV testing.

CRI reports that a tourist from mainland China has brought H7N9 influenza into Taiwan.
Disease control authorities said an 86-year old  tourist from Jiangsu was confirmed with H7N9 avian influenza. The man showed first symptoms on December 19 and has been hospitalized since Dec 24.
This is Taiwan's second case of H7N9, the first imported case  occurred in April this year.

Shaanxi obstetrician on trial for selling six babies to human traffickers

Zhang Shuxia, an obstetrician who allegedly sold new born children to human traffickers, is on trial at the Intermediate People's Court in Weinan City in northwest China's Shaanxi Province.
Zhang is charged with selling six children between November 2011 and July 2013 with one of them dying during the commission of the offence. Zhang allegedly gained tens of thousands of yuan from the trafficking.
On July 16, 2013, Dong Shanshan, a local resident in Shaanxi Province's Fuping County gave birth to a baby boy at the Fuping Maternal and Child Health Care Hospital. Zhang, who was deputy director of the hospital's maternity department, told her and her husband Lai Guofeng that the child suffered from syphilis and hepatitis B transmitted from the mother and would not survive.
Zhang did not let the couple see their baby but said he had already been taken away.
Lai questioned the doctor's diagnosis and took his wife to another county hospital for syphilis and hepatitis B tests the following day. Two days later, the test results showed his wife was free of both diseases.
On July 20, Lai contacted police who investigated and found the baby in central China's Henan Province 20 days after he was born.

Doctors prepare for surge in demand for maternity care

The government's relaxation of its birth rule to allow more couples to have a second baby provided an instant stimulus to maternity-care and fertility centers on the Chinese mainland.
Preparations for changes that will come with the new policy — which authorities expect to be implemented early next year — are now under way.
Late last month, the Obstetrics & Gynecology Hospital affiliated with the Zhejiang University took the national lead by opening a special consultation unit designed to help newly eligible couples have a healthy second child.

Hospitals launch second child clinics to deal with new family planning policy

by Hu Qingyun
After striving to get up at 4 am, and starting to queue at 6:30 am in the hospital hall, Wang Juan and her husband finally secured an appointment at 10 am with a famous obstetrician at a clinic specializing in second children in Hangzhou, Zhejiang Province.
The obstetrician asked thoroughly about Wang's health, including whether, like the majority of Chinese mothers, she gave birth to her first child through a Caesarean.
In a latest decision, the Communist Party of China (CPC) Central Committee allowed couples to have a second child as long as either the husband or the wife is from a one-child family. Previously, the policy required both to be single children.
The easing of the family planning policy delights but also worries Wang, who unlike her husband is an only child. She is the mother of a 3-year-old girl but now yearns for a second child.
"I'm 38 now. I have to consult obstetricians on whether it's OK to do so," said Wang, a white-collar employee in Hangzhou.