China healthcare headlines - June 2015

Beijing to ban smoking in public place 

Smoking will be banned in public areas of Beijing such as restaurants, offices and on public transport from 1 June, but enforcement is in doubt. According to the new anti-smoking rules, smokers will face
fines of 200 yuan ($32.25) for smoking near hospitals and schools, while business can be fined up to 10,000 yuan ($1,600) for failing to enforce no-smoking areas.

Doctor killer executed

The man who stabbed a doctor to death at a Wenling hospital in a dispute over  surgery outcomes has been executed in Zhejiang. The man called Lian Enqing murdered an ENT specialist in October 2014 because he was upset about the poor results of surgery on his nose.

Air pollution triggers hospital admissions

Hospital admissions for respiratory problems increase dramatically when air pollution PM2.5 particle levels exceed a threshold of 200 µg/m³ according to researchers from Shandong.

Lian Enqing was sentenced to death last year for a fatal attack on an an ear, nose and throat specialist in Wenling, in the eastern province of Zhejiang. He attacked the doctor because he "felt displeased with his nose and claimed to be suffering respiratory problems", the official news agency Xinhua said - See more at: http://www.straitstimes.com/news/asia/east-asia/story/china-executes-patient-who-stabbed-doctor-death-over-nose-operation-report#sthash.mIPzSQ7W.dpuf

Lian Enqing was sentenced to death last year for a fatal attack on an an ear, nose and throat specialist in Wenling, in the eastern province of Zhejiang. He attacked the doctor because he "felt displeased with his nose and claimed to be suffering respiratory problems", the official news agency Xinhua said - See more at: http://www.straitstimes.com/news/asia/east-asia/story/china-executes-patient-who-stabbed-doctor-death-over-nose-operation-report#sthash.mIPzSQ7W.dpuf

Private hospitals blocked by public hospital chief

Despite being encouraged by central, the development of private hospitals is being blocked by the all powerful managers of major public hospitals, according to an article in Caixin. Analysts say that public hospitals are effectively operating as for-profit monopoly providers and they are loathe to give up their staff or patients to private newcomers.

Health minister's book published by Elsevier

Former health minister Chen Zhu is having a book publichsed by international medical publisher Elsevier. The book entitled Healthy China 2020: Strategic Research Report, is an in-depth review of China's past present and futre healthcare developments, with contributions frm many leading healthcare figures.

China's hospital league tables published

A league table of China's best hospitals, ranked by department, has been published by the China National Medical Information Center. The ranking tables put hospitals in the three major cities of Beijing, Shanghai and Guangzhou at the top of most lists, according to criteria for 19 different specialities.

Nurses inadequately trained | Child physical abuse common | Coal use causes black lung

Nurses lack adequate training

Only one in seven nurses in China undergoes a three year undergraduate training program, and many lack adequate training, medical educators have complained. In a letter to the Lancet, Liu Fengxia and colleagues at the Fourth Hospital of Hebei Medical University say that they are worried by the fact that most nurses in China not receive standard nursing training. Each year only 30,000 out of 186,000 graduate nurses earned standard bachelor degrees, they noted. Most nurses received only diplomas after brief training. The lack of education and the stressful working conditions mean that poorly trained nurses could make mistakes in patient care - and their lack of training may also be a factor in triggering violence against health staff.
"Nurses are intermediates between doctors and patients. In our practice, we have seen misunderstanding and mistrust between patients and doctors most probably due to of the inadequate training of nurses. A more comprehensive training system for nurses is needed," they write.

Physical punishment of children condemned

China's high rates of physical punishment of children amount to a culturally-accepted high level of child abuse, researchers have said. A major review found that 36% of children in China experienced physical abuse from parents, typically in the form of slapping and spanking for disciplinary reasons. They said the rates of physical punishment in mainland China were significantly higher than in other Asian countries, where the influence of western methods of parenting was stronger. The researchers said physical punishment was "culturally accepted" within Chinese society because the Confucian philosophy of parenting, which endorses parents’ authority and filial piety, is still prevalent in the minds of Chinese parents and children.
"A well-known proverb “gun bang di xia chu xiao zi” (also translated as “spare the rod, spoil the child”) indicates that the filial piety is achieved by strict physical discipline of children," they noted.
They said China's high rates of physical abuse were concerning because of the known associations with poor mental health and harmful behaviors, such as depressive disorders, anxiety disorders, eating disorders, childhood behavioral disorders, suicide attempts, drug use, and risky sexual behaviour.

Coal use leads to black lung

China's high use of coal for fuel has led to high rates of pneumoconiosis and "black lung", researchers say. In a Dow Jones report, clinicians said pneumoconiosis was common in mining workers and other coal-related industries, especially as workplace safety rules were often ignored in China. masks could help prevent pneumoconiosis but were often not provided to workers, they noted. The number of people diagnosed with pneumoconiosis has risen sevenfold from 2005 to 2013 to about 750,000, at an average pace of 35% annually, according to official data. And while treatment is available, it is often unaffordable for many low paid workers, labour activists note.

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

Leukaemia boy misses out on donations

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

Asthma rates soar in Shanghai

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


STDs rates high in Jiangxi sex workers

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

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

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

Husband wins 300,000 yuan compensation from Beijing hospital over wife's death from pneumonia

A Beijing man has won Y300,000  in compensation from the Harmony Hospital in Beijing after a four year legal battle over the death of his wife from complications of pneumonia. The man claimed that his wife had died following  a lung biopsy to investigate the cause of her breathing difficulties. He claimed 900,000 yuan in compensation for living expenses and funeral costs, and was initially 25,000 yuan settlement by the hospital, which denied responsibility for the death. However, the man appealed to a higher court and was awarded 300,000 yuan when the court found that hospital in providing follow up care to the 57-year old woman. The court heard that the woman had a chronic lung disease resembling asthma. and was admitted to the hospital for tests in May 2011. However, the tests were carried out by a junior doctor who ordered a biopsy which the husband claimed was not necessary to diagnose pneumonia. The court also accepted his claim that the follow-up care after the biopsy was lacking as the woman received little supervision and developed pneumothorax and died. The court found that the hospital did not make basic precautions such as doing a risk assessment on the patient for the procedure, or managing thoracic drainage competently. It also heard that the hospital had altered medical records to try cover up its malpractice, but the court did not accept the evidence for this.

6 clinical stories from China

1. Abuse of prescription and over-the-counter drugs is  common among Chinese high school students, a study from Guangzhou has shown. The survey of more than 20,000 students found that more than one in twenty had abused medical drugs at some time. The most common drugs of abuse were analgesics (4%), followed by cough syrups with codeine (2%) and valium or tramadol (1%). Peer pressure was one of the major influences in illicit use of prescription and OTC drugs, and it was also more common in children who already smoked, according to researcher Dr Wang Hui of the Guangzhou Centre for Disease Control and Prevention, writing in the journal Drug and Alcohol Dependance.


2. The agricultural practice of burning straw is a major overlooked contributor to smog and air pollution in Chinese cities, say respiratory physicians from the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. Burning straw caused PM2.5 levels to reach 194 μg/m3 in Nanjing, which far exceeded the daily average maximum allowable concentration of 75 μg/m3, they note in the American Journal of Infection Control. The pollution is linked to respiratory illness and infections such as pneumonia, they say, and thus needs to be regulated.

3. China has a north-south divide when it comes to hypertension in children, a new review has found. shows. Children and adolescents in the north China have hypertension rates of  18% (Beijing) or 23% (Shandong) whereas those in South of China including Shanghai and Changsha have hypertension rates ranging from 3% to 11%, according to researchers from School of Public Health, Shandong University, Jinan. The higher prevalence of hypertension in the north might be due to higher dietary salt intake they say in the International Journal of Cardiology. 

4. The inherited condition of highly-elevated cholesterol levels, familial hypercholesterolaemia, occurs in about one in 200 Chinese people but is rarely detected, a study from Jiangsu suggests. In a study of more than 9000 people they found that about 0.5% had the condition, which confers a very high risk of cardiovascular disease and early death. They suggest that screening to aid detection and family tracing is carried out by hospital cardiology departments.

5. Gastric cancers account for a fifth of all cancer deaths in China and are especially common in younger women, a study from Guangzhou has found. The review of more than 2000 cases of gastric cancer found that the malignancy was common in older men but was also frequently seen in women under the age of 40.  Most patients had advanced stage disease at diagnosis, suggesting that better detection and treatment of early gastric cancer  is needed.

6. Chinese children are at risk from inappropriate prescribing of medicines, say paediatricians in a letter to The Lancet this week. Dr Tang Wenchu and colleagues from the First People's Hospital of Huzhou University Medical College, Zhejiang, say about a third of medicines taken by children are indiscriminately prescribed, and children are also at risk because there are few paediatric formulations of medication in China. The lack of a national adverse drug reaction surveillance system also means that children may have side effects that are not acted on, they say.

Coal burning and tuberculosis make COPD a common condition for non-smokers in China

In western countries chronic obstructive pulmonary disease is seen as predominantly a disease of smokers - and the only way to halt its progression is to stop smoking. 
In China however, thousands of non-smokers shows signs of non-reversible airways obstruction - and the reasons seem to be the country's ubiquitous use of dirty coal for cooking and heating. A study of 300,000 Chinese adults who have never smoked has found that one in twenty (5%) have COPD, with the condition more common in women than in men.
The main factors associated with COPD were low income, lack of education, living in a rural area and a prior history of tuberculosis.   However, another major factor was cooking with coal.
The study researchers, from the Chinese Academy of Medical Sciences, Beijing, and Oxford university, said the link between low income and lung disease might be due to higher exposure to infections and to air pollution.
The findings are published in the European Respiratory Journal.

Pneumoconiois: China's neglected occupational disease

by Michael Woodhead
Delegates at the National Peoples Congress have called for a compensation fund to be set up for China's leading cause of occupational disease - dust-induced pneumoconiosis. 
Many people were moved recently by the high-profile case of a young Henan man who suffered from the disabling condition, and he was lucky in winning media attention for his case, and securing 30,000 yuan to pay for his treatment costs. However, representatives say that for the vast majority of patients with pneumoconiosis in China there is no such happy ending. Despite being the leading occupational disease, most of the patients are migrant workers, of whom as many as 600,000 are thought to have penumoconiosis. Since most migrant workers are on low wages, few can afford treatment and the disease progresses to the point where they suffer a slow and painful death. For some patients the pain and disability are so much that they commit suicide.
A few local governments have set up schemes to help pay for the treatment of pneumoconiosis, but most patients live in impoverished rural areas where funds are not available for treatment.
At the NPC, one delegate who is the head of the Changsha Hospital, Dr He Binsheng proposed a simple policy that would help end many of the problems with pneumoconiosis patients once and for all. DR He said the answer was to set up a pneumoconiosis treatment fund and also a dust-disease inspection board to supervise high risk industries and prevent further cases from happening. The fund would help pay for the treatment of patients and also provide some social support for their families. Governments could co-operate to set up regional pneumoconiosis treatment and rehab centres for those who are rendered unable to work through pneumoconiosis disability, he said.
Dr He was supported by a Hunan deputy, who said compensation should come from a workplace injury compensation scheme.

Eight medical stories from China you should read

by Michael Woodhead

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

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

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

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

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

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

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

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

Beijing respiratory wards overflow with smog-related illness

by Michael Woodhead
The heavy smog that has hung over Beijing for days has seen many patients turn up at the city's hospitals with respiratory complaints. The Sino-Japanese Friendship Hospital was overflowing with patents on infusions yesterday and respiratory specialists said the worst was yet to come. The infusion room, where patients are given IV infusions was 100% full and there was an overflow 'ward' in the outside corridor where camp beds had been set up to cater for the extra patients and their families. Doctors said most of the patients had conditions such as pneumonia. The director of respiratory medicine at the hospital, Dr Lin Jiangtao said he expected the problem to worsen over the next week as the adverse effects of the smog tended to be delayed. The patients most affected were those with chronic obstructive pulmonary disease, asthma and heart disease, he said. The accumulation of pollution particles in the lungs tended to cause bronchoconstriction and chest tightness and other breathing difficulties, he said. The exact mechanism was not clear but China was now starting studies to investigate this process, he said.
Authorities in China said this week that one seventh of the country was covered in the thick smog and it was expected to last for about five days.

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.

Pollution decreases Chinese men's sperm | H5N1 virus carried by wild birds | Adenovirus threat to PLA | Tuberculosis control failing

Pollution reduces Chinese men's fertility
The high levels of pollution found in Chinese cities are reducing the quality of men's semen, a study form Chongqing has shown. Researchers from the the Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing measured air pollution levels in Chongqing and in surrounding rural areas. They found an inverse correlation between measures of pollution such as PM10, SO2 and NO2 and semen quality. Published in the journal Environmental Pollution, their findings show that the highest sperm concentrations were seen in rural areas, whereas the lowest were seen in downtown areas of Chongqing. Conversely, the highlest levels of pollution were seen in urban areas, peaking in winter months.
"Exposure to higher concentrations of PM10, SO2, and NO2 in urban ambient air may account for worse semen quality in urban males," the researchers concluded.

Migratory birds carry pathogenic influenza virus
Wild birds migrating through Yunnan have been found to carry the highly pathogenic influenza H5N1 virus. A sampling of birds trapped by researchers found that the average carriage rate of H5N1 was 5%, but in some species such as cuckoos the rates were as high as 22%. The researchers said the birds could be possible vectors of influenza, especially if they shared ponds and drinking water with domestic birds. The findings are published in the Virology Journal.

Tuberculosis control failing because of migrant workers and the elderly
Doctors in rural Jiangsu say tuberculosis control is a problem because of difficulty in diagnosing and treating the disease in migrant workers and the elderly. These two groups were repeatedly documented as the main obstacles in effective tuberculosis control by doctors in a rural county near Suzhou. When interviewed by researchers, doctors also expressed their frustration with the lack of new drugs for treating tuberculosis patients. They said elderly patients were less health conscious and more prone to side effects, so doctors had to put extra effort into convincing elderly patients to adhere to TB treatment. Migrant workers were another probelm for TB control because they were often poorly educated, had little awareness of TB and had difficulty completing long term treatment because of their transient lifestyle. Difficulties also arose because migrant workers were poor and not covered by local health insurance schemes to pay for medical treatment and drugs for TB.
"Migrant workers coming from rural parts of China present a gloomy prospect for TB control in China," the researcher from the School of Public Health, Nanjing Medical University said in PLOS One.

Respiratory virus threat to PLA
Clinicians in Sichuan have reported that a novel adenovirus is posing a serious threat to the health of China's military. The human adenovirus 55 (HAdV-55) has caused outbreaks of sever acute respiratory disease among adults and seems to be common in military trainee institutions. In an analysis of the virus found in samples from almost 200 young Chinese infected in recent years they found that it often caused severe pneumonia. They charactrised the makeup of the virus and warned that it posed a threat, but more research was needed to understand its diversity, dissemination, and transmission in China.

Beijing stent success | COPD prevented | Private hospital investor reluctance | Generic companies head for the door

Coronary stent success in Beijing
Chinese cardiologists have come up with a novel answer to the perennial problem of late stent thrombosis with coronary stenting. To avoid  thrombus formation after the use of bare metal or drug eluting stents, Chinese researchers from the Department of Cardiology, Beijing Chaoyang Hospital, have tested stents coated with biodegradable polymers. In a three-year clinical trial whose results are published in the Archives of Medical Sciences they have shown that the stents were just as effective as durable polymer coated stents in reducing major  cardiac events and have the same rate of thrombotic event rates. Biodegradable stents may have the advantage of needing less antiplatelet drug use to prevent thrombus formation they write.

Chinese trial finds new compound to prevent COPD
Another groups of Chinese researchers have come up with a solution to the difficult problem of preventing exacerbations of COPD. In a one year clinical trial carried out at 34 Chinese hospitals they tested the effects of the anti-inflammatory compound N-acetylcysteine compared to placebo in over 1000 patients with COPD.  They found there1·16 COPD exacerbations per patient-year in the treatment group and 1·49 exacerbations per patient-year in the control group. Thus N-acetylcysteine reduced exacerbations by 22%. The treatment was generally well tolerated, according to the study results published in Lancet Respiratory Medicine.

No rush to invest in private hospitals
In the SCMP, Zhuang Pinghui writes that investment in private hospitals on the mainland is set to rise following the relaxation of regulations,  but don't expect a gold rush- there are still many obstacles. The article says the government wants to see more private investment but private hosptals have problems claiming health insurance rebates and getting permission to buy major items of equipment such as  scanners. This means private healthcare might become just a niche product for the China's rich.

China not attractive to foreign generic companies
In Forbes, Benjamin Shorbert looks at what made one the world's biggest generic manufacturers, Actavis, quit China's $82 billion drug market. He suggests it was due to the increasing pressure on drug prices and the Chinese government's favouritism for local companies and penchant for targeting foreign pharma companies for unpleasant attention. I know things have been tough for Actavis but I think it must be a typo when he says the company only made $7 profit in China last year.

Five Chinese medical studies you should know about in January 2014

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

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

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

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

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

Wuhan pollution causing cancer in children, says oncologist

by Michael Woodhead
The increasingly severe pollution and smog in Wuhan is having "terrible consequences" for  the health of local people, a cancer specialist has to the Wuhan political consultative conference.
Dr Liu Li of the Xiehe Hospital Cancer Centre told the Wuhan conference that cancer rates in the city had increased in the last 10 years and tumours were now being seen at a much younger age.
Dr Liu said the number of beds at the hospitals cancer centre has doubled to more than 1000 in the last decade, but they were still at 100% occupancy. He said the incidence and mortality of cancer in Wuhan were without precedent, and it was shocking to see infants presenting with tumours.
To see an infant needing chemotherapy can only make you cry" he told the conference.
Lung cancer is the most common type of cancer we see and the contributory factors are complex, but air pollutio is no doubt theimportant  'assasin'," he said.
According to the Hubei Daily, Dr Liu called on environmental protection department to take urgent action to address the smog problem. One example is the common practice of burning rubbish, he said, which causes large amounts of ash and hazardous particles to be released into the air.
"Air pollution is now a critical threat to population health in Wuhan, he said.

Four new cases of H7N9 in Guangdong

Health authorities in south China's Guangdong Province are on high alert against H7N9 bird flu after four new human cases were confirmed this week.
From Sunday to Thursday, the province confirmed four new cases -- two in Yangjiang City, one in Dongguan and one in Shenzhen, raising the total cases in the province to six. The newly confirmed four are all in a critical condition.
"According to expert assessments, Guangdong faces an extremely high risk of sporadic human H7N9 infections this winter and next spring," said Zhang Yonghui, head of the provincial center for disease control and prevention.
The cases may occur at any time across the province and the Zhujiang River Delta region deserves special attention," Zhang added.

PM2.5 causes cardiopulmonary harm: expert

Chinese pulmonologist Zhong Nanshan said on Saturday that PM2.5 not only increases the risk of lung cancer, but also can cause overall damage to the human heart and lung, the Guangzhou-based New Express reported.
Zhong said research on the relationship between PM2.5 and lung cancer has been done for dozens of years in Western countries, and results show lung cancer deaths would increase by 17 to 25 percent for each 10μg per cubic meter rise in the concentration of PM2.5.
A research report issued by the World Health Organization on Nov 17 said smog may cause bladder cancer as well, and current studies in China have found that particulate matters can enter the bloodstream and cause damage to the heart and lung, Zhong added.
However, China hasn't conducted any long-term research on smog's influence on human health. PM2.5 concentration in China is five times, or even 10 times, higher than in foreign countries' studies, Zhong said. "I would like to lead the research."

Quarter of a million premature deaths in China due to coal

Emissions from coal plants in China were responsible for a quarter of a million premature deaths in 2011 and are damaging the health of hundreds of thousands of Chinese children, according to a new study.
The study by a US air pollution expert, commissioned by Greenpeace, comes as many areas in northern and eastern China have been experiencing hazardous levels of air pollution in recent weeks.
In some eastern cities including Shanghai, levels were off the index that tracks dangerous pollution, with schools closing and flights being cancelled or diverted. Sales of air purifiers and face masks have soared with many retailers selling out of stock as residents try to protect themselves from the poisonous smog. In Jiangsu and Zhejiang provinces visibility was reduced to less than 50 metres earlier this week and in the city of Nanjing a red alert for pollution was maintained for five consecutive days.

Respiratory hospital admissions up with Shanghai smog

Shanghai's hospitals all reported a rise in the number of patients with respiratory problems over the past few days.
Huadong Hospital said there had been a 30 percent increase.
Dr Zhou Min of Ruijin Hospital’s respiratory disease department said outpatients increased 20 to 30 percent, with emergency cases up 50 to 60 percent. “Winter is always the peak time for patients with respiratory syndromes due to the cold weather, while the poor air quality can trigger asthma and lung infections,” she said.
Children, the elderly and people with weak immunity should stay indoors, she said.
Shanghai Children’s Hospital said it had seen more than 5,000 outpatient and emergency cases this week, a quarter more than the same period of last year.
A recent cold front and the haze were said to be the major cause of respiratory infections and asthma in children while almost a third of them suffered from diarrhea.
Doctors say children under 7 usually have weak immunity and are more likely to develop symptoms in winter. They advise parents to make sure their children stay warm.
Source: Shanghai Daily

Simple screening tool for OSA by Shanghai doctors

by Michael Woodhead
A new simple screening tool developed by Shanghai clinicians means the diagnosis of obstructive sleep apnoea (OSA) should no longer be time-consuming, labour-intensive and inaccessible for Chinese patients.
Dr Guan Jian and co-researchers at the Department of Otolaryngology, The Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, evaluated the efficiency of Epworth Sleepiness Scale and a new established prediction model for screening OSA were in a test cohort of 2,032 participants.
The new screening model included factors such as age, waist circumference, Epworth Sleepiness Scale score, and minimum oxygen saturation (SaO2). In use it proved to have a high sensitivity (89%) and specificity (90%) It was also found to have significantly better overall performance than the Epworth Sleepiness Scale alone .
“A practical screening model comprising minimum SaO2 and other parameters could efficiently identify undiagnosed obstructive sleep apnoea from the high-risk patients,” the researchers said.
"The high sensitivity and specificity of the final screening model indicated a simple and practical method for screening adults at high risk of obstructive sleep apnoea. This will facilitate targeted initiation of preventive measures for minimizing the major health-related consequences in China."
Full study: PLOS One