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."

Why Chinese surgeons do those bizarre transplants

by Peter Edwards
To the average newspaper reader, the story out of China seemed like science fiction or even a hoax: a man’s severed hand was transferred to his leg for a month to keep it alive, and then sewn back onto his arm.
To pioneering University of Toronto plastic surgery professor, Dr. Dimitri Anastakis, it was certainly impressive but not shocking.
“We’ve done comparable things at the University of Toronto,” Anastakis said in an interview.
“I’m impressed with the creativity,” Anastakis said. “I’m impressed with the drive to save the person’s hand and restore function. . . It’s particularly cool. . . In China, they do phenomenally creative work.”
The Xiaoxiang Morning Herald reported that 25-year-old Xiao Wei lost his right hand in an industrial accident in the central province of Hunan

"My department head sees 80 patients in a morning and prescribes Rmb100,000 worth of drugs. She definitely takes commissions." from drug companies

by Andrew Jack and Patty Waldmeir
Unshaven and dressed in a blue and grey striped T-shirt, Liang Hong looked nondescript on screen. But his words, broadcast on Chinese television last July, were explosive. He told two policemen how, as a vice-president of GSK, he had channelled concealed payments via a local travel agency.
On the same day, Gao Feng, a leading fraud investigator, held a highly unusual briefing for foreign journalists at which he likened the British-based pharmaceutical company to the “big boss” in a “criminal partnership”, paying up to Rmb3bn ($500m) to officials and doctors. He claimed it used 700 travel agencies, some in turn offering money and “sex bribery” to GSK executives to win their favour.

Shanghai pioneers mental health laboratory

Shanghai has set up a key mental health research laboratory to intensify efforts to diagnose and treat severe mental illnesses, which affect nearly 1 percent of China's population.
"Over the past 20 years, there has been little progress in the field," Xu Yifeng, president of the Shanghai Mental Health Center, said in a recent interview.
"The question of how to combine basic science and clinical research has not been solved."
The new lab, opened in November, will focus on solving a bottleneck in the study of severe mental illnesses through a combination of multiple disciplines, such as molecular and cell biology, brain imaging and bioinformatics, a method for processing biological data using computer science and mathematics.

Shanghai encourages public hospital staff to work in foreign-run private hospitals

Shanghai Health and Family Planning Commission said yesterday it is encouraging health professionals at state-owned hospitals to work at private medical facilities, while also encouraging foreign investors to set up fully owned units at the Shanghai free trade zone.
Currently, only those from Hong Kong, Taiwan and Macau can set up solely invested medical facilities in certain provinces and cities on the mainland, while foreign investors need local partners to set up joint venture facilities.
But that may change as Shanghai authorities are encouraging foreign enterprises to set up hospitals and clinics in the zone with their own investments.
Xu Jianguang, the commission head, said it only needs 40 days for a foreign firm to set up a health unit in the zone.

Caesarean risks disturb Chinese mothers longing for second child

Relaxation of China's one-child policy both delights and worries Wang Jingjing, who gave birth to a boy three years ago by Caesarean section and now yearns for a second child.
"I have consulted many obstetricians, but still can't make the decision on being pregnant again," said Wang, a white-collar employee in Hefei, capital city of east China's Anhui Province.
Like Wang, many Chinese mothers pleased by the loosening of the birth policy are now worried about the possibility that the Caesarean section they had might jeopardize a second child.
Last month, the government proposed allowing urban couples to have two children -- as long as either the husband or the wife is an only child. Previously, the policy required both of them to be a single child.

One in three Shanghai residents enrolled with family doctor

Some 5.88 million residents in Shanghai have joined the family doctor system, accounting for 32 percent of the city's population, according to the director of Shanghai Municipal Commission of Health and Family Planning, eastday.com reported Sunday.
Shanghai currently has more than 3,200 family doctors. The pilot family doctor program was launched in 2011.
The program aims to treat less urgent illnesses at community level, and relieve pressure on top-tier hospitals. The commission added that each resident in the city might have access to a family doctor by 2020.
Source: ECNS

China's medical system in need of radical surgery - SCMP editorial

When medical schools no longer attract the brightest minds, when doctors become the target of attacks, and when weapons of self-defence become necessary in hospitals, something is clearly amiss.
Worryingly, the symptoms are spreading on the mainland, so much so that they are further jeopardising the already ailing health care system in the world's most populous nation. The need for major surgery is evident.

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

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

Disillusioned medical students switch to other courses

Low salaries, workplace pressures and occasional violence by patients against doctors are dissuading an increasing number of top high school students from pursuing careers in medicine.
The situation has become so acute that some medical students are abandoning their studies for other majors or even choosing other careers after graduation.
According to the Chinese Medical Doctors Association, there were 17,243 cases of violent attacks against health care workers in China in 2010. The Chinese Hospital Association said there were an average of 27 attacks on medical staff in each hospital in 2012.
On October 25, an angry patient stabbed a senior doctor to death at a hospital in Zhejiang Province.
Patient violence often results from frustration and anger with the health care system.
A survey by the association found 78 percent of Chinese doctors don’t want their children to follow in their footsteps.

Hunan investigates hepatitis batches after two deaths

Health authorities of Hunan, central China, are investigating three cases of adverse reactions to hepatitis B vaccination, including two deaths.
A one-month-old boy died on December 6 in Hengshan County, two days after being vaccinated. Another eight months old died in Changning City on December 9, one day after vaccination for both hepatitis B and flu. A third newborn in Hanshou County showed a severe adverse reaction after being vaccinated on November 25, the Hunan Provincial Center for Disease Control and Prevention said Monday.

Hangzhou Resolution commits China to ethical organ donation

Just a month ago, Xia Qiang, a surgeon from Shanghai Renji Hospital, and his team made history by completing the first two transplant operations using organs donated by residents in the city.
Such operations are taking place with increasing frequency across China, showing a determination to move from sourcing organs from executed prisoners to acquiring organs from citizens willing to donate.
China is the top country in the world in terms of carrying out organ transplants as well as for having the most patients waiting for transplants. According to official figures from Chinese health authorities, more than 1.3 million patients wait for organ transplants each year while only 10,000 are lucky enough to get one. The rest try their luck in the underground black market.
Prior to 2010, the majority of Chinese organ transplants came from executed prisoners, prompting criticism from the international community.

A rural doctor's views on China's health reforms

Fengcheng Yuandu Clinic, a hospital in Yuandu township, Jiangxi province, is responsible for the health of 50,000 local residents and has gradually become a medical center serving surrounding areas in recent years.
Hospital Director Zou Huihua said he puts great effort into improving the quality of medical teams and the service of the hospital.
Ensuring the healthcare in townships like Yuandu and rural China is very important, Dr Zou said.
The Chinese government approved a series of proposals to improve the healthcare system in townships and villages during the most recent session of the CPC Central Committee congress held in November.
As an experienced doctor at the grassroots level for nearly 20 years, Zou believes what he has been doing is indeed meaningful.
"There are a lot of doctors in big cities," Zou said. "But in townships and villages they need people like me."

Transplant specialist calls on China to end use of organs from executed prisoners

by Professor Jeremy R Chapman, MD, FRACP, FRCP, Clinical Director, Division of Medicine and Cancer, Renal Unit, Westmead Hospital, Sydney, Australia and Past President, the Transplantation Society.

In 2011, China transplanted more organs than any other country except the United States. The source of those donated organs is a worldwide concern. A few hundred of the 10 000–12 000 organs came from intensive care units as donations after cardiac death; brain death is not legally recognised in China. An unknown number were sourced from living donors. The use of executed prisoners’ organs has been acknowledged by government officials, but despite efforts to change this, executed prisoners still comprise most organ donors. The Falun Gong movement and its supporters claim that they are targeted as organ donors through execution.

Despite at least 100 000 Chinese citizens needing transplants each year, internet advertisements for foreigners to purchase organ transplants continue, although banned by Chinese law in 2007. Sales of organs have continued, albeit at a reduced volume, reportedly with up to $1 million paid for “priority for liver transplant allocation”.

What is the reality and what should transplant and medical professionals and the Australian community do? 

Clinical news round-up from China

From the medical journals .... by Michael Woodhead

Trends in HIV treatment in Shanghai: antiretroviral treatment has been increasingly used in patients with higher CD4 counts since 2006 and stavudine regimens are prescribed less frequently.
“Strategies to facilitate early access to antiretroviral treatment and further reduction in stavudine use are needed,” says Dr Lu Hongzhou and co-researchers from the Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China .
Source: International Journal of STD and AIDS

Why do Chinese consumers opt for more expensive branded drugs over cheaper generics? Because they don’t trust cheaper drugs and the stores that provide them, according to a survey of 250 consumers by Dr Zhou Zhiliang of the China Pharmaceutical University, Nanjing.
Source: Health Marketing Quarterly

Pertussis is still circulating in China, and the reported incidence might be underestimated, according to a study of children in a regional town in Hebei by Dr Zhao Shuzhun of the Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Beijing.
Source: Epidemiology and Infection

How does the composition of surgical teams in the operating room affect surgical team performance and procedure times? Interesting results from Dr He Wenjing and co-researchers at the Department of Minimally Invasive Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong.
Source: Surgical Endoscopy

Nontyphoidal Salmonella pathogens are a common cause of serious gastrointestinal infections in children, and there is a worrying level of antibiotic resistance, according to a study by Dr Wang Xiaohong and co-researchers at the Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai. “Ongoing surveillance for Nontyphoidal Salmonella infection and antibiotic resistance is needed to control this pathogen in Shanghai,” they conclude.
Source: Foodborne Pathogens and Diseases

Human enterovirus 71 (EV71) was the major pathogen of Hand, Foot and Mouth Disease in Guangdong during the 2010 epidemic, a study from the Guangdong Provincial Centrr for Disease Control and Prevention, Guangzhou has found. The infection occurs mostly in children less than 3 years of age, who should have first priority to receive an EV71 vaccine, the researchers say.
Source: PLOS One

Syphilis is still an important cause of pregnancy loss and infant disability in China, particularly among women who do not receive prenatal care or have late or inadequate treatment, a study from Shenzhen has shown. Researchers from the School of Public Health, Central South University, Hunan, screened 279,334 pregnant women and identified 838 (0.3%) women infected with syphilis. About 8% of infants born to syphilitic mothers were diagnosed as having congenital syphilis and 25% of women had adverse pregnancy outcomes.
“These study results can inform antenatal programs on the importance of early syphilis testing and prompt and appropriate treatment,” the study authors said.
Source: Sexually Transmitted Diseases

Beijing clinicians find changes in cause of infective endocarditis

Beijing researchers have clarified the underlying heart disease and microbiological pathogens associated with infective endocarditis in Chinese patients.
In a study of 115 adult patients admitted with infective endocarditis to Peking University First Hospital, Dr Li Xiangyan and co-researchers found that the most common underlying heart diseases were congenital heart disease (24%) followed by degenerative valvular disease (17.4%).
Aortic (44%) and mitral (43.5%) valves were most frequently affected.

Chinese police arrest 1300 for illegal online drug sales

China's police on Saturday announced that over 1,300 people have been arrested as suspects involved in illegal drug sales online amid a special crackdown.
Chinese police launched a special combat, including three intensive raids, against illegal online drug sales and sales of fake drugs since June this year and to date police forces in 29 provincial-level regions have closed 140 unlicensed websites and online drug stores, according to a statement by the Ministry of Public Security.
Moreover, police has seized more than nine tonnes of raw materials for fake drug manufacture, the statement said.
The statement said illegal online sellers often use deceptive advertisements to lure buyers and most of the drugs were found to be made of starch or spoiled materials.
Some drugs contained illegal, psychedelic or poisonous ingredients that may harm user's health, it said.
Source: Xinhua

Baby abducted from Guangdong maternity hospital

The lucrative black market for babies in China is growing by the day.
Liu and her husband Duan, both aged 40, have been working in Dongguan City in Guangdong Province. In October, Liu came back to her hometown in Tongcheng County to prepare for her baby’s birth. On the night of Nov. 1, she went into labor and her family took her to Tongcheng People’s Hospital, where she was directly checked into the delivery room. She gave birth to a baby boy the following morning by caesarean section.

Cultural differences require a different approach for end-of-life care in China

by Li Binli
China’s aging population has increased to approximately 200 million and is larger than that of the whole of Europe. So the number of older patients is increasing with time. Meanwhile, thousands of hospitals have established an ICU in the last 20 years, and this has brought about a grim problem. For example, more and more older patients, who would have died within a short period of time in the past, may now achieve long-term survival. For these patients, intensive care just means extended life or postponed death. These hopeless patients occupy an already scarce medical resource, and this makes it impossible for some critically ill patients to receive effective treatment. Owing to the influence of Chinese traditional ethics and the lack of corresponding laws and regulations, overtreatment of hopeless patients frequently takes place. In fact, it is a futile treatment. Chinese society needs to develop approaches to address the appropriate delivery of critical care to the increasing population of older people, especially those with chronic life-limiting disease.

Elderly Hunan villagers prefer suicide to living without medical care

Mo Qiulian ties up small bundles of firewood as she murmurs to herself: “Why haven’t I died?”
The 67-year-old villager has thought of killing herself many times since she had a stroke in March, followed by four months of lying in bed unable to move before regaining some mobility in her upper body.
Mo is one of many elderly residents in Kongtong Village of Hunan Province who say they will commit suicide one day.
They look forward in fear to a lack of medical care to deal with diseases as they get older. They are uncertain what the future holds, feeling insecure because their children left for the city and may never return, the Sanxiang City Express said yesterday.

Beijing private clinic offers Harvard Medical doctors

China's private health companies are seeking more opportunities to introduce high-quality medical services from overseas to the domestic market.
A flagship healthcare center operated by Ikang Guobin Healthcare Group opened at the LG Twin Towers in Beijing yesterday. It will target customers with higher incomes, with better private medical services.
The center has invited Tom Fox, vice-president of Harvard Medical School, to be its director. Physicians from the school will visit the center for regular treatment and consultation sessions.

Chinese genomic sequencing company worries Japan with cheap prenatal testing

Japanese medical authorities are expressing concern over prenatal testing for chromosomal abnormalities now offered by a Chinese company because it does not require clients to undergo counseling, which could lead to unnecessary abortions.
The Chinese company, BGI, recently entered the market and is offering the service in Japan at less than half the cost charged at facilities sanctioned by the Japanese Association of Medical Sciences (JAMS).
Fumiki Hirahara, a doctor of obstetrics at Yokohama City University who is well-versed in prenatal care, expressed concern over BGI’s program, citing the lack of counseling.
“If testing becomes common among expectant mothers, and they lack the mechanism to properly assess the accuracy of the results, it could prove detrimental for them (and their babies),” he said.
Hirahara said Japanese medical personnel started doing prenatal testing in April as part of clinical research, with an eye on evaluating the benefits of genetic counseling.

China considers national indoor smoking bans

China is planning a national regulation banning smoking in public indoor areas, and it is expected to be enacted next year, the Beijing News said Thursday, citing an official.
Yang Jie, deputy director of Tobacco Control Office for the Chinese Center for Disease Control and Prevention, made the remarks at a news briefing on the Chinese version of the Tobacco Atlas (fourth edition), a comprehensive volume of research on tobacco and smokers.
Yang said the regulation, following the Framework Convention on Tobacco Control, will ban smoking in all public places, including public vehicles, indoor workplaces, Internet bars and restaurants. Specific penalties for violations will be included in the regulation, he added.
More than 10 Chinese cities currently have smoking control rules, all of which ban smoking in public indoor areas, but implementation of the law is unsatisfactory, mostly because there is a lack of enforcement and awareness about the law.
The Tobacco Atlas, published by the American Cancer Society, says more than half of Chinese males smoke, and 12 percent of deaths in Chinese males can be attributed to tobacco. Every year, 600,000 people die from exposure to secondhand smoke in China, most of them women and children, it said.
Source: Beijing News

Cold blooded doctor comment angers relatives of dead Jiangxi woman

by Amy Li
The family of a 35-year-old woman who died giving birth last month is accusing a Jiangxi hospital of malpractice, and is considering launching a third-party investigation into the matter, Chinese media reported.
But what infuriated many Chinese bloggers more than the dispute over patient Li Xiaoyang’s death was what many called a “cold-blooded” comment from the doctor who operated on Li, Guangren hospital president Zhang Ning.
In an interview with Southern Metropolis Daily this week in Wuren county, Zhang allegedly said, “A hospital is the place where people die.”

Small hospitals used in cheap medication re-selling scam

Small-sized hospitals are plagued by touts who buy medicines at very low prices from patients with medical insurance, sell them and pocket the difference, the Beijing Evening News reported.
Some dealers even rent patients' medical insurance card to directly purchase medicines from the hospital. Websites are often set up as the final step in this medicine-recycling business. Most of the medicines are either sold online or to smaller unlicensed drugstores. Such illegal websites were banned in 2011.
Source: Global Times

Hospitals ordered not to refuse HIV patients

Medical institutions are not allowed to refuse HIV/AIDS patients for any reason, central government authorities said on Friday.
Local health authorities will strengthen supervision of practices and deal with violations, said a National Health and Family Planning Commission statement.
A recent circular jointly issued by the commission and five other central government departments demanded more efforts to protect the rights of those with HIV so they receive proper treatment, according to the statement.
Hospitals should provide treatment and if a patient is diagnosed with the HIV/AIDS infection, the institution that first received them should be responsible for treating them, the statement quoted the circular as saying.

HPV linked to oesophageal squamous cell carcinoma in China

Medical researchers have uncovered an alarming link between HPV virus and the quadrupling of a string of deadly cancers in China.
The deadly Human Papilloma Virus increases the risk of oesophageal squamous cell carcinoma (OSCC) in China by almost four- fold, according to research led by University of New South Wales (UNSW) academics.
In addition to causing cervical, anal and genital cancers, HPV has more recently been found to cause head and neck cancers. OSCC is a cancer where a possible link with HPV has been postulated in the past, but not resolved.
"The problem with OSCC is that there is no way to screen for it, so it is usually diagnosed quite late and has a very high mortality," said the first author of the paper, Surabhi Liyanage, a PhD candidate with UNSW Medicine.

Beijing to provide more hospital beds for elderly

A new model that provides both healthcare and elderly care for senior citizens was proposed recently in Beijing. More than 9,000 healthcare institutions are expected to get licenses to offer beds to the elderly.
Beijing has 608 hospitals and 1,897 community health service centers. Even if only half of them each provide 20 beds, it will result in an increase of 25,000 beds.
More than 80,000 beds are available for the elderly in the city, but almost 30 percent of beds are unoccupied. Most people prefer locations that offer good medical services and avoid those with bad reputations. Thus, some places are almost full while others have 50 percent of their beds unoccupied.

Dodgy drug makers will be blacklisted in China

China will blacklist producers of illicit food, drugs, medical appliances and cosmetics, according to a draft regulation published on Thursday.
Information on producers who "have seriously violated laws and regulations concerning food, drugs, medical appliances and cosmetics management and received administrative penalties" will be made public through government websites, says the draft regulation, which was issued by the China Food and Drug Administration.

Medical staff must study law to fix patient disputes

Guangzhou city bureau of health is seeking a legal remedy under a plan that asks its medical workers to study the law amid rising doctor-patient disputes, Guangzhou-based Nanfang Daily reported.
According to the plan, legal science will be an important part of educating medical workers in the city.
The moves hopes to boost awareness among staff of their legal rights as well as allowing them to settle disputes.
On Monday, more than 100 people smashed Guangzhou Elizabeth Women's Hospital, resulting in injures to six members of the medical staff, after an expectant mother suffered complications and lost her child. In October, two doctors and a nurse from the No 2 Hospital affiliated to Guangzhou University of Medical Science were seriously injured after they were attacked by family members of an elderly woman who died in the hospital.
Guangzhou is the first city to ask medical staff to study the law.
Source: China Daily

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.

Chinese H7N9 flu virus mutates to become resistant to antivirals

In a new study published today, researchers have discovered that the Chinese bird flu strain, A(H7N9), has a mutation immunizing it to common anti-viral drugs. While this doesn’t necessarily herald cause for concern of a pandemic, the researchers recommend using anti-viral drugs with caution.
Many seasonal influenza strains become less transmissible after they become resistant to drugs such as Roche’s Tamiflu. But the scientists found that the avian influenza strain, doesn’t work in the same way. It maintains its ability to be transmitted, even after it develops an immunity to drugs. The researchers urge doctors to make wise choices when handing out anti-viral medications for H7N9 cases — they should avoid using common drugs like Tamiflu, which could help build resistance in the virus, the researchers suggested.

Impressions of an American medic on a Chinese hospital ward round

Blog post by Dr Zachary Sholem Berger: "I sat in on rounds at Peking Union Medical College Hospital, my host and one of the top-ranked hospitals in China. The General Internal Medicine Division is renowned for its ability to treat the hardest cases and consistent high reputation, which becomes a self-fulfilling prophecy in certain respects (sound familiar?).
The similarities are not all that interesting: the team sits round a table and talks about the new patients, then walks through the wards seeing the old patients. Questions are asked to put medical students on the spot (in American English we have a word for that). The differences, however, are somewhat instructive.

Hospital clinicians face infection risk from procedures

Hospital clinicians face a high risk of respiratory infection when performing high-risk procedures such as airway suctioning, a Chinese study has found.
In a prospective study of 481 hospital healthcare workers in China, those who performed a high risk procedure had a threefold increase in the risk of respiratory infections.
The findings should inform occupational health and safety policies, say the researchers from the Beijing Centre for Disease Prevention and Control.
Source: Epidemiology and Infection

Reference values for bone mineral density developed for Chinese infants

Clinicians from Hubei have developed reference values for lumbar bone mineral density in healthy Chinese infants and young children. 
In a study of almost 12,000 healthy children aged 0 to 3 years who underwent regular physical examinations at the Child Health Care Clinic of Hubei Maternal and Child Health, researchers obtained BMD measurements of the lumbar spine (L2–L4) with dual-energy X-ray absorptiometry and a questionnaire. They also obtained BMD values for 379 preterm infants The results showed that lumbar BMD significantly increased with age among both boys and girls, with fastest growth observed during the first postnatal year. There was no significant difference in lumbar BMD between boys and girls of similar age, either among healthy reference children or preterm infants. However, BMD values in preterm infants were significantly lower than those in term infants 3 to 8 months old after adjustment for gestational age.
There were significant positive associations between lumbar BMD of healthy children and the child's age and current weight, mother's weight gain during pregnancy, birth weight, children's outdoor activity duration and children's physical activity duration.
Source: PLOS One

'Cancer street' set up by Hunan outpatients having treatment

Half a kilometer in length, the narrow Jiatong Street that cuts through the Hunan Provincial Tumor Hospital and Hunan Normal University Medical College has been dubbed "Cancer Street," as it is populated by hundreds of cancer patients seeking treatment at the hospital. 
It began with some patients who rented apartments in the street for long-term medical treatment, and after some time it naturally developed into a neighborhood accommodating hundreds of patients, most of whom live here for a couple of months at a time.
The street has fully adapted to its population. Small hotels full of tenants occupy this area, with groceries, eateries and pharmacies serving their needs. It looks like a common, rundown yet lively backstreet seen in most cities, but look closer and the vegetable shops here also sell stoves and woks to tenants, clothing shops offer wigs to those losing hair from radioactive treatment, and pharmacies and clinics are also a source of psychological support for patients fighting the fear of cancer.
On a fine day, tenants spread white bedding under the sun, like those in the hospital. Coming from all over the province, the tenants usually share their experiences in combating the diseases and try to encourage each other.
Some patients who have recovered and left Jiatong Street call it the "old place" that they will visit again, but not everyone will be fortunate enough to reminisce about this place.
Source: Global Times

No H7N9 mutation: health ministry

No mutation of H7N9 bird flu has been monitored yet and transmission from animals remains the only way in which humans have picked up the virus, China's health authority said on Tuesday.
Speaking at a press conference, Yao Hongwen, spokesman for the National Health and Family Planning Commission, noted that there have continued to be sporadic reports of H7N9 infections.
China confirmed three new cases this month, with two in Hong Kong and one in east China's Zhejiang Province, and Yao said that local authorities have tightened prevention measures.
The spokesman promised that the commission will continue to strictly control infection sources and release relevant information on a timely basis.
The mainland has so far reported a total of 140 H7N9 cases, including 87 patients who have recovered.
Source: Global Times

Six Guangzhou hospital staff injured in dispute over pregnancy death

Six hospital staff members were injured, three seriously, when they were attacked with sticks over a medical dispute on Monday, Nanfang Daily reported.
The incident occurred around 3 pm on Monday at a mourning hall in Elizabeth Women’s Hospital in Guangzhou, Guangdong province.
An officer with health bureau in the city’s Liwan district told the paper that relatives of an eight-month expectant mother caused damage to the hospital and injured six medical workers after 26-year-old expectant mother, surnamed Peng, suffered complications. Doctors were unable to save the baby. The distraught family blamed the doctors and became violent.
A witness, surnamed Li said the disturbance lasted more than 20 minutes and relatives and friends of the family beat hospital staff with sticks, the report said.
Police detained suspects and an investigation is underway.
Source: China Daily

Police station set up in Zhejiang hospital to deter attacks on doctors

by Yan Yiqi
Police in Taizhou, Zhejiang province, have started patrols at hospitals in the city to ensure the safety of medical staff and to maintain order.
The patrols follow increased doctor-patient disputes that include a doctor in the city being fatally stabbed by a disgruntled patient in October.
Taizhou Municipal Hospital is the first one where police officers and security equipment have been stationed.
Three police officers are assigned per 100 medical staff and security guards at the hospital are equipped with stab-proof vests and gloves and tear gas in case of emergencies, said Xu Guocai, deputy director of the Jiaojiang district police department in Taizhou.

Coeliac disease widespread in China

Coeliac disease is more common than has been reported in China, according to a new study by researchers from Nanchang University.
Coeliac disease is an autoimmune disorder caused by genetically susceptible individuals consuming food and drinks made from wheat, barley or rye and therefore containing gluten. Gluten proteins can induce inflammation in the small intestine, hindering the uptake of nutrients, and can also disturb the normal functioning of other organs. In the Western world, prevalence of the disease is between 0.5 and 2 percent of the population. Despite the fact that China is the world’s largest wheat producer and has a high and rapidly increasing consumption of wheat and gluten-containing products, coeliac disease was considered to be rare in China and had not been studied thoroughly.

One in four Chinese households face 'catastrophic' medical bills

by Michael Woodhead
Up to one in four households in some parts of China  experience catastrophic medical expenses, a study from Shanghai has found.
Dr Li Xiaohong and co-researchers from the School of Public Health, Fudan University analysed data from a survey of 11,577 households conducted in eastern China in 2008.
They found the incidence of household catastrophic medical expenses ranged from 9% to 25%. Households were more likely to experience catastrophic medical expenses if they were in rural areas, had a family member with chronic diseases, had a child younger than five years old, had a person at home who was at least 65 years old, and had a household member who was hospitalised.

Shanghai Family Planning official arrested in GSK corruption investigation

A family planning official of Shanghai has been suspended from his job amid claims he is connected to an ongoing investigation into UK drug company GlaxoSmithKline.
Huang Fengping was vice director of the city's Commission of Health and Family Planning, but his name was removed from the commission's official website late last week.
A source with knowledge of the matter told Shanghai Daily yesterday that Huang had been taken away by the Ministry of Public Security and that its investigation was in connection with economic issues related to the GSK bribery scandal.
Officials from the commission declined to comment yesterday.

Telehealth trialled in Xinjiang regional hospitals

Liu Xiaohong, deputy director of the cardiovascular medicine department of Karamay Central Hospital, successfully worked with Wang Yan, an expert from Wuhan Tongji Hospital, through a teleconsultation platform to develop ideal treatment plans for two cardiovascular patients.
The two elderly patients have been diagnosed with coronary heart disease and chronic obstructive pulmonary disease, respectively, and have been given proper treatment after a series of check-ups, including electrocardiograms and CT scans, and teleconsultation video conferences.
This is not the first time that Karamay Central Hospital has integrated telecommunication technology with diagnosis and treatment. It is cooperating with more than 20 famous hospitals from around China to deliver high-quality medical service and care.
Source: China Daily

Fujian man hijacks ambulance to take girlfriend to hospital

A man named Shi was detained in Fujian province last week after he hijacked an ambulance in an effort to get his ill girlfriend to the hospital, according to reports.
Police said the man will be serving 20 days' detention for "disturbing order at a workplace" after he attacked the ambulance's driver so that he could steer the vehicle.
Netizens are now debating whether or not the man's actions were just, with many praising his determination to help the girl, who was suffering from gas poisoning.
"This just goes to prove that in China you have to do things yourself," one user said.
The woman had originally been admitted to the Xiamen Hospital of Traditional Chinese Medicine but had to be transferred to another hospital with more suitable equipment. Shi, who was impatient after filling out lengthy paperwork, assaulted the ambulance driver so that he could get her to the next location more quickly.
The doctor in the ambulance said in reports that the woman's life had not been in danger.
Source: Shanghaiist

A gloomy future for medical students in China

Article in The Lancet by Dr Zeng Jie of the Mental Health Institution of the Second Xiangya Hospital, Central South University, Changsha, Hunan

 

in The Lancet:According to the Chinese Medical Doctor Association, there were 17 243 cases of violent attacks against health-care workers in 2010, in China. On Oct 25, a patient beat a senior doctor (head of the Ear, Nose, and Throat department) to death, adding a new victim on this too-long list.

Hospitals in China are deemed as dangerous working places, and being a medical practitioner has turned into a life-threatening job. The deteriorated relationship between health-care providers and patients not only affects the present generation of professionals, but also the future generation of doctors. National medical colleges warn that the number of medical students is decreasing, and medical students in their last year of MD or PhD programmes are hesitating to continue their career.

Harvard's Brigham and Women's Hospital to manage hospital in China

Harvard's Brigham and Women's Hospital had partnered with a Chinese real estate firm to build and manage a hospital in Guangdong.
Evergrande Group said on December 4 it has reached agreement with Harvard University to build a hospital in China, the real estate giant's latest effort to diversify its business structure.
Evergrande and Harvard have already started picking a location for the hospital, a source close to the partnership said. Shenzhen and Guangzhou, both in the southern province of Guangdong, were the top choices.
The new hospital will partner with Harvard's Brigham and Women's Hospital (BWH). Evergrande said it will provide the funding, and BWH will provide management and medical teams.
Elizabeth Nabel, head of BWH, will visit China soon to discuss the location and other details, Evergrande said.

Bad news for medical device companies in China

by Damjan Denoble
“Taking kickbacks has become a de facto rule in China’s grassroots health centres.”
On Tuesday, Xinhua attributed the above quote to Wang Rusheng, deputy director of a prefecture-level city in the Southern province of Guangxi, within an article devoted to highlighting a tide of corruption allegations involving medical device sales and rural health officials.
Medical device companies, watch out. If you are affiliated with a medical device company in any way this should cause for concern, given both that Xinhua, the official news agency of the PRC, is doing the reporting, and the GSK and related scandals have cast a light on foreign healthcare companies.

Workload and authorship criteria deter Chinese clinicians from doing research

Letter from Dr Zhang Han of the Second Military Medical University, Shanghai in The Lancet:

"With a growing burden of surgical procedures and very large numbers of patients, Chinese surgeons should have an important role in seeking consensus on global strategies through participation in international collaboration. However, many obstacles are hindering their enthusiasm for joint studies, including considerable extra workload in clinical research besides a heavy clinical burden, difficulties in participant enrolment due to the deteriorated doctor—patient relationship, language barriers, and limited opportunities to communicate and cooperate with international colleagues.
We appeal to health administrators in China for an increased awareness of the importance of collaborative research and for supportive policies. For instance, appropriate assessment of the achievement of these research collaborations is an important issue. The present academic evaluation system in China recognises and rewards the position of first and corresponding authors for published studies, and the contributions of other participants tend to be neglected. Hence, how to encourage the active participation of more surgeons in future international research collaboration is an issue worthy of discussion for health policy makers in China and worldwide."

Source: Lancet

Electromagnetic radiation not linked to miscarriage - Guangdong study

by Michael Woodhead
Exposure to extremely low-frequency magnetic fields does not seem to increase miscarriage risk, a Guangdong study has suggested.
Dr Wang Qiang and co-researchers from the Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, studied pregnancy outcomes among women in two towns in the Pearl Delta region with densely distributed power supply constructions. From 2010 to 2012, 413 women in the region who were at approximately 8 weeks of gestation or who planned to have a baby within one year were selected as candidate subjects. Exposure to magnetic fields was estimated by measurements at their front doors and in the alley in front of the subjects’ houses
The average residential exposure to magnetic fields was 0.099 µT. Miscarriage risk was found to be significantly associated with maximum levels of exposure to magnetic fields in alleys. After adjustment, the risk of maximum alley exposure to magnetic fields for miscarriage was 72% higher. However, No significantly increased risk of miscarriage was seen with the average front-door exposure to magnetic fields.,
The researchers said that although the miscarriage incidence was shown to be positively associated with the maximum alley magnetic field exposure, the association between miscarriage risk and the exposure to magnetic fields was not confirmed in the study. They noted that the intensities of exposure were relatively low. The average exposure level was only approximately 2 times higher than that of the general public (0.05μT). Among all 413 pregnant women, only 34 subjects (8.2%) were exposed to MFs above 0.4µT.
“We can’t confirm 50 Hz MF as one of the possible risks of miscarriage,” they conclude.
Source: PLOS One

Shenzhen the source of Hong Kong's H7N9 infections

by Lisa Schnirring
Health officials in Hong Kong today said they detected a second imported H7N9 flu case, in an 80-year-old man from the mainland, while mainland China reported another new infection, which sickened a 30-year-old man from Zhejiang province.
Both of the H7N9 cases reported this week have travel ties to Shenzhen, a major city just north of Hong Kong in China's Guangdong province. The new case in Zhejiang, about 800 miles northeast of Guangdong province, further boosts the province's status as China's hardest hit by the H7N9 virus.
Meanwhile, new scientific findings released today suggest that the virus doesn't latch on to human cells strongly enough to pose a pandemic threat, though the virus bears close monitoring for further changes.

Armed with SARS lessons, China fights H7N9 influenza

by Shannon Tiezzi
10 years after SARS, China is fighting another viral outbreak – and seems to be winning.
Hong Kong reported its second case of the avian flu strand known as H7N9 today, showing that the virus which first appeared in mainland China back in February continues to spread. To date, H7N9 has infected 138 in total. Of those, 45 have died.
According to reports, the first reported H7N9 case in Hong Kong was a 36 year old Indonesian domestic helper, while the latest case was an 80 year old man from Shenzhen. The Indonesian had also recently traveled to Shenzhen, leading Dr. Leung Ting-hung, Hong Kong’s controller of the Centre for Health Protection, to believe that both cases were contracted in the mainland city.
H7N9 has not been shown to spread easily from person to person, meaning the risk of a large-scale epidemic is fairly low. Still, Hong Kong is taking no changes. The city has increased its border checks and the government isolated 17 people who had been in close contact with the first H7N9 victim. To date, none of the quarantined group had tested positive for the virus.

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

Medical care for rural elderly hampered by 'unfilial' shame and urban migration

Zhu Chengyu strolls around her countryside courtyard as a form of exercise. Old age and illness blight her daily life.
The 78-year-old woman, who lives in Zhuhe village of Dong'e County in eastern China's Shandong Province, has been admitted to hospital five times this year for asthma and heart disease.
Medical expenses costing thousands of yuan was partly covered by basic medical insurance. The remainder, around 2,000 yuan, was a large sum for Zhu.
She has no other source of earnings apart from a monthly pension of 65 yuan (10.5 US dollars) and an annual payment of 800 yuan, which she gets from renting her 2.5 mu (0.17 hectares) of crop land.
What worries Zhu most is when she becomes ill. Nobody is around to take her to hospital.
"My only son and his wife work as migrants in cities and seldom come back home," Zhu said. "I am left alone."

Medical publisher to expand in China

The medical journal publisher Elsevier announced today that it is strengthening and refocusing the scope of its long-standing relationship with China Science Publishing & Media Ltd. (CSPM) to create an international publishing platform for English-language medical journals that brings the expanding wealth of research originating from China to the world.
The announcement from Reed-Elsevier, which publishes medical journals such as The Lancet, comes at a time when China is emerging as a major contributor to the international scientific community, being the second most prolific publisher of research articles after the US and ahead of the United Kingdom.

Smoking cessation drugs are not available in China

Clinics to help smokers kick the habit are facing medication shortages.
A combination of behavioral intervention and medication can significantly increase the chances of a person quitting cigarettes, health experts said.
"Many can quit through just intervention, such as consulting a doctor or calling a hotline," said Fu Dongbo, a specialist with the World Health Organization.
"But for those heavily dependant, medication is an option, including nicotine replacement therapy."
Not many opt for the latter, though, judging by the 2010 Global Adult Tobacco Survey of China.
Based on 13,354 interviews nationwide, the study found 36.4 percent had tried to stop smoking in the previous 12 months, but less than 9 percent of them had used assistance, such as medication.
Part of the reason could be that Chinese smokers do not fully understand cessation therapy, according to a report by the WHO Collaborating Center for Tobacco or Health, based at Beijing's Chaoyang Hospital.

Maternity hospital staff accused of selling patient data to telemarketers

A hospital in Shangahi has suspended the head nurse of one of its maternity wards while it investigates suspicions that she has sold the personal information of new mothers, a senior official told the Global Times Thursday.
The suspension followed a Shanghai Television Station (STV) exposé that showed the nurse, who was not identified, considering a proposal to sell information about the new mothers to an undercover reporter posing as a company representative.
"We are not sure whether the nurse actually deals in information about new mothers," said the official, who works in the Party office of Shanghai Fengxian District Central Hospital. "We will release the results of our investigation soon."
The nurse told the STV reporter that she would like to make some money, but feared it was too risky to make such a deal at present, according to the hidden camera footage aired in the exposé Wednesday evening.

Sichuan doctor gets 11 years jail for taking kickbacks

A court in Chongqing sentenced a doctor to 11 years imprisonment for accepting bribes of more than 1 million yuan ($164,000), China News Service reported on Thursday.
Liang Fa, director of a medical department in a local hospital, was convicted of taking 1.07 million yuan in bribes from medical sales representatives from 2003 to 2013.
Doctors taking kickbacks has long been a problem for China's hospitals, as sales of medicine account for a large proportion of profit for many hospitals, and some doctors take bribes from medical companies to prescribe more of their products.
Source: China Daily

90% of Chinese people use medicines incorrectly

Up to 90 percent of Chinese people do not know how to use medicine correctly, according to a survey from the State Food and Drug Administration of China.
In 2012, the Network of State Adverse Drug Reaction Monitoring received 1.2 million reports on incidents of adverse drug reactions.
"Chinese people need to update their knowledge not only on drug usage, but also on drug use concepts," said Ji Lianmei, a licensed pharmacist with the Beijing United Family Hospital. Ji has been disseminating medical knowledge via Sina Weibo, a Twitter-like social networking service in China.

Woman advised to have abortion after being given wrong pill

A woman has been told she should have an abortion after a doctor mistakenly prescribed a contraceptive pill instead of the progesterone she needed.
There is a high possibility the fetus will be deformed, according to a report on jschina.com.cn yesterday.
Suzhou Municipal Hospital has admitted the error and offered to pay 26,600 yuan (US$ 4,290) compensation and to terminate the pregnancy.
But it has refused to accept responsibility if the 32-year-old, surnamed Chen, can't have another baby or if she suffers complications.
"There are many causes for infertility, which may not be related with taking the wrong medicine or receiving the abortion," said Chen Jian, a hospital vice president. "We can't give promises on uncertain things."
The couple criticized the hospital for its failure to accept responsibility.
Hospital officials said the couple can lodge a lawsuit if the two parties fail to reach an agreement.
The woman was one month pregnant when she was given the wrong medicine on November 20. She went back to the hospital five days later after feeling sick.
The doctor admitted his mistake right away, she said.
Experts asked by the hospital to do a group diagnosis suggested that she have an abortion because there was a high risk of deformity.
Source: Women of China

Second rate Korean cosmetic surgeons use China as a training ground

How dare the so-called “gold medal doctors” from South Korea do plastic surgery without China’s medical certification? Recently, we found some Korean plastic surgeons working in Shenyang City. Korean doctors were organized by beauty salons to make plastic surgeries in China, some of them even have little clinical experience Some beauty salons work as intermediary to organize Korean doctors to practice as plastic surgeons in China.

Resistant hypertension uncommon in China

by Michael Woodhead
The rate of resistant hypertension in China is much lower than previously thought, research from Beijing suggests.
Cardiologists from the Division of Hypertension, FuWai Hospital and Cardiovascular Institute, Peking Union Med College, made an analysis of resistant hypertension based on data from the Hypertension Optimal Treatment Study in China.
The study was conducted in 148 cities in mainland China in 2001- 2002 and included 54 590 hypertensive adult. Patients not achieving blood pressure (BP) target (<140/90 mmHg) within two weeks received preplanned additional drugs. Resistant hypertension was defined in the participants with uncontrolled hypertension after two weeks of treatment on Step 5.
The study found the rate of resistant hypertension was 1.9%. Patients with resistant hypertension tended to be male and younger than average be overweight and have metabolic syndrome, diabetes mellitus and history of myocardial infarction or stroke.
Study author Dr Ma Wenjun said the rate of resistant hypertension in China was much lower than the levels of around 20% previously reported by groups such as the AHA. This might be because the trial follow up period was relatively short and because a rigorous regimen of BP treatment and adherence was adopted. Neverthless, the finding that resistant BP was uncommon and occurred more in younger pateints deserves further attention, he said.
Full study: Journal of Hypertension

Hunan woman committed fraud to pay for dialysis

A young woman, who has uremia in Hengshan county, Hunan province, has been sentenced to six years and fined 100,000 yuan ($16,400) for cheating the new rural cooperative medical system out of more than 420,000 yuan to treat her kidney disease, Xiaoxiang Morning News reported.
Nie Shuihua, 24, was not jailed because she has to receive frequent dialysis treatment. But 16 of her relatives and neighbors were given sentences of two to three years and fined 4,000 to 5,000 yuan each for helping her get the money.
Nie, a farmer, was diagnosed with uremia in July 2012. As it was expensive to treat the disease in a hospital in Changsha, the capital of Hunan, Nie bought fake hospitalization invoices to be reimbursed by the rural cooperative medical system.
Asked why Nie resorted to deception, Tang Qiulian, Nie's mother, said that her daughter wanted only to survive.
Source: ecns

Independent practitioners change the face of China healthcare

Signs of progress among independent medical practitioners show possible direction of healthcare reform.Since opening his independent medical practice in Shanghai at the beginning of this year, Zhang Qiang, a cardiovascular surgeon, has adopted an entirely new lifestyle. Unlike most doctors in the country, who are employed by one public hospital at a time, he now works for several hospitals.
Zhang used to be head of the Vascular Surgery Department of East Hospital, which is affiliated with Tongji University in Shanghai. He resigned at the end of 2012 to pursue his new career path.

No, China's not privatising health care

by Shannon Tiezzi
China’s latest health care reforms aren’t as revolutionary as they first seemed.
Almost hidden within the lengthy decision of China’s recent Third Plenum, there was a brief plan for shoring up China’s healthcare system. Some of the provisions, especially a line about the government encouraging the growth of private medical institutions, raised hopes that China was seeking a revolutionary overhaul of the system. However, recent comments by ministers from China’s National Health and Family Planning Commission (NHFPC) have put a damper on these expectations.
In an interview People’s Daily, NHFPC Vice Minister Sun Zhigang clarified some of the bureaucratic-speak found in the Third Plenum’s report. While the report mentions encouraging the growth of private healthcare, Sun makes it clear that the priority will be on non-profit healthcare organizations, and these will largely be encouraged only at the “grassroots” level. In other words, the Chinese government will seek to encourage non-profit organizations to extend basic healthcare and sanitation to small towns and villages in the Chinese countryside, rather than opening China’s busy urban hospital sector to competition from private healthcare providers. Sun makes it clear that China envisions for-profit healthcare only as a “supplement” to non-profit care provided by both public and private sources.

China: Urban medical insurance scheme has surplus of US$125 bln

China's urban social medical insurance scheme reported an accumulated surplus of CNY764.4 billion (US$125.5 billion) at the end of 2012, a disclosure which has prompted calls for higher reimbursements for medical bills to be made from the fund or for the money to be used to subsidise commercial medical insurance premiums.
Mr Lei Haichao, the deputy director of the Beijing health bureau, speaking at a recent healthcare economics conference, said that except for 2010, the national-level urban basic medical insurance fund had reported a surplus rate of at least 20 percent since 1999. The peak rate to date is 35 percent which was attained in 2001. Of the accumulated surplus of CNY764.4 billion, CNY269.7 billion belonged to individual medical savings accounts with the remaining CNY494.7 billion maintained in a common pool.

Medical ills thwart insurers in China

by Nichola Zamiska
For years the Chinese government tended to the health of its people, offering basic but near-universal coverage.
But as the country opened up to the outside world and embraced capitalism, that health-care safety net was all but dismantled. Now, most Chinese are left to fend for themselves, paying out of pocket when they get sick. Savings are regularly wiped out by illness.
The government is struggling to find a solution -- and may have a partial answer in private health-insurance coverage, for those who can afford it. The problem is that, as in other developing countries, a loosely regulated health-care system, marred by rampant overprescription and other shortcomings, is slowing the development of private medical insurance in China. That, in turn, is limiting Beijing's options as it strives to rebuild the system.

Chinese doctors still unable to work at more than one location

by Zhang Pinghui
Doctors in China hope reforms outlined in Third Plenum will give them greater freedom to operate.
It is 6.30am, but Liu Yinglong’s waiting room is already packed with anxious parents expecting the top cardiac surgeon at Beijing’s Anzhen Hospital to check on their babies.
The demand for Liu’s expertise is so great he has to see about 30 patients before his official rounds start at 8am. Later in the day, his office is crowded once again with the sick and needy.
Liu, like many mainland doctors, has a huge workload, but his task has been made more even more complicated by the red tape restricting the work of medics on the mainland.
Liu said that only a fraction of the patients who ask for his help come from Beijing, but doctors are only allowed to register at one hospital or medical practice.
The result is that Liu spends his spare time treating patients in other parts of the country, but only as a ‘consultant’ as a way of getting round the regulations.

China's doctors under attack

by Huang Yanzhong
Practicing medicine in China has become an even more high-risk business. In ten days in October, China reported at least six attacks on healthcare workers.
In the most recent case, a man, unhappy with the results of an operation, fatally stabbed a doctor and wounded two others in a hospital of Zhejiang province. Rising violence against healthcare workers has not only discouraged doctors in China from adopting using medically necessary but risky procedures, but also—in conjunction with the problem of doctors’ low base salaries—provided strong disincentives for practicing medicine in China. According to a survey carried out by the Chinese Hospital Association (CHA), 29 percent of the healthcare workers prefer self-protecting medical procedures, 40 percent are considering changing professions, and 78 percent do not want their children to become a healthcare professional in the future.

China's Struggle With Hepatitis B Discrimination

by Liu Shako
When Jack Wei graduated from college in 2006, he, unlike many of his classmates, decided not to apply for the big companies that he wanted to work for in Shanghai. His reasoning had little to do with a lack of courage, talent, or will, but rather something simpler: Wei was afraid of being rejected because he is a Hepatitis B carrier, and in China, this is a major obstacle to getting a job.
Wei then settled for work at a small company and stayed there for three years. In 2009, having found the courage to again apply for a major company, he received a job offer. But before he could begin, the company turned him away: He had tested positive for Hepatitis B. Discouraged and despaired, the then-26-year-old gave up job hunting.
“I felt like I fell into a hole and couldn’t get up,” Wei recalled. “It gradually pushed a normal person like me into depression.”
A combination of poor needle hygiene, a heavy reliance on injections and infusions in medical care, and a low vaccination rate have exposed a large number of Chinese people to Hepatitis B, and the virus’ victims are then often subject to employment discrimination. Despite a 2010 law banning Hep B tests in job and school admission applications, 61 percent of state-run companies continue to use the test as a part of their pre-employment screening process, according to the latest human rights report of the U.S. State Department. Companies collaborate with hospitals to test applicants in secret during the hiring process, and employees are fired if they test positive during annual physical checkups. As a result, victims struggle to obtain evidence and gain protection from laws.

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

Guangzhou oncologists develop better staging method for colon cancer

Guangzhou oncologists have developed an improved staging method for colon cancer that accurately predicts the risk of disease recurrence and benefit of adjuvant chemotherapy for patients who have had surgery for stage II colon cancer.
Researchers from the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, used expression patterns of multiple microRNAs (miRNAs) combined into a single model to improve postoperative risk stratification and prediction of chemotherapy benefit for these patients.
Using this tool, they were able to classify patients as at high risk or low risk of disease progression. Five year disease-free survival was was 85% for the low-risk group, and 57% for the high-risk group. The six-miRNA-based classifier was an independent prognostic factor for, and had better prognostic value than, clinicopathological risk factors and mismatch repair status.
Patients in the high-risk group were found to have a favourable response to adjuvant chemotherapy The clinicians developed two nomograms which combined the smiRNA-based classifiers and clinicopathological risk factors to predict which patients might benefit from adjuvant chemotherapy after surgery for stage II colon cancer.
“Our six-miRNA-based classifier is a reliable prognostic and predictive tool for disease recurrence in patients with stage II colon cancer, and might be able to predict which patients benefit from adjuvant chemotherapy. It might facilitate patient counselling and individualise management of patients with this disease,” they concluded.
Full study: Lancet Oncology

Infant health improves after coal power station shuts down

The closure of a polluting coal-fired power plant in Tongliang, Sichuan, resulted in a marked improvement in the health of local babies, researchers have reported.  
The power station was the major pollution source until its shutdown in 2004. Researchers from Chongqing Medical University measured prenatal exposure to polycyclic aromatic hydrocarbons and other pollutants before and after the closure and found that reduced levels were associated with improvements in birth outcomes, neurodevelopment and early childhood growth rates.
“The findings of this study are encouraging in that direct governmental interventions to remove a polluting coal-burning source can have rapid and direct benefits to children's health. This in turn is a strong motivation for China to further invest in renewable and energy- efficient fuels, a necessity for its future.
Full study: Environmental Pollution

Integration of private hospitals faces problems with insurance and working hours

The Party's decision to increase support for private hospitals presents an opportunity but with challenges, experts say, starting with access to insurance money and limits on doctors' working hours.
The broad policy approved by the Third Plenary Session of the Communist Party of China's 18th Central Committee, which ended on Nov 12, states the government should encourage the growth of medical institutions run by private companies or other NGOs.
Private hospitals are thought to be capable of competing with government-funded hospitals by providing more choices to patients. They can also help relieve pressure on an overburdened government system.
Since 2009, when national health reforms began, the central government and authorities in cities such as Guangzhou and Beijing have called for equal treatment for private hospitals — and even favorable policies that will stimulate their growth.
"The latest decision reiterates and emphasizes this," said Zhu Hengpeng, a researcher with the Chinese Academy of Social Sciences' Institute of Economics.
He said the Party's decision shows the willingness to conduct market-oriented reform in a health sector dominated by government-funded hospitals.
The Party also said private hospitals should get a slice of public healthcare insurance money, just as government-funded hospitals do.
But a majority of private hospitals operate outside the insurance program, which means their service costs are higher than their government-funded counterparts, Zhu said.

Upgrade of rural health system breeds corruption

The upgrade of China's rural medical system is breeding corruption among heads of medical institutions in the country's remote areas.
Between 2009 and August of this year, the presidents of six rural health centers were prosecuted by the local procuratorate for taking kickbacks in the coastal city of Fangchenggang in south China's Guangxi Zhuang autonomous region, making it the biggest commercial bribery case in the city's medical system.
According to procuratorate documents, the suspects received kickbacks from pharmaceutical sales representatives worth 934,800 yuan ($152,496) when purchasing medical equipment such as Color B ultrasound machines in Fangchenggang, home to ten rural health centers.
The case was just one more in a series of similar cases in a corruption quagmire that has trapped several public officers working for the country's rural medical system.
In 2012, six health center deans in Guangxi's Luocheng county, a poverty-stricken county under the jurisdiction of Hechi city, were busted for accepting commissions while buying expensive medical equipment between 2008 and 2011.
Official documents show that the sales agents provided kickbacks to the centers' heads ranging from 10 percent to a staggering 25 percent in an attempt to increase sales.

SBP of 130mmHg linked to target organ damage

by Lynda Williams, Medwire News
A study of Chinese patients warns of the risk for target organ damage from untreated hypertension, especially for younger patients.
The ambulatory blood pressure (BP) monitoring survey conducted in 1047 patients attending the Ruijin Hospital in Shanghai, China, showed that 24-hour systolic BP of 130 mmHg or higher alone or in combination with a diastolic BP of 80 mmHg or above significantly and independently increased the risk for organ damage independently of age.
In addition, increases in diastolic blood pressure alone were associated with significant elevation in the left ventricular mass index in patients aged less than 55 years old.
“[O]ur current study highlights the necessity to treat both systolic and diastolic hypertension to target in particular at younger age when the prevalence of isolated diastolic hypertension and combined hypertension is higher than in the elderly, among whom isolated systolic hypertension is more prevalent,” write Yan Li, from the hospital, and co-authors in Hypertension.

Liangshan region of Sichuan ravaged by HIV

by Andrew Lee
The Liangshan region has been ravaged by an AIDS epidemic for the past 25 years. Official numbers show Sichuan as having 50,000 cases of AIDS, but the actual numbers are sure to be much higher. Half of the cases are from Liangshan, home of the Yi people, and our destination.
Zi'er, 74, has had to bury two of her sons, who died of AIDS. Her other two sons are currently infected with HIV. (Andrew Lee/CBC)
In the small isolated villages lives the Yi minority. They lead a rural life, a world removed from China's big, booming cities. Chickens run across roads while cattle amble and heavy blue capes are worn almost like an unofficial uniform. Faces are darkened by sunshine and the elderly are stooped from carrying a lifetime of burden.
A local NGO worker took me to visit a family crushed by the disease, in a village where 10 per cent of the population has AIDS.
A wrinkled 74-year-old matriarch wanted to speak, and clutching a family photo collage, she started to tell me about how all four of her sons had AIDS; two had already died.
They had gone to the big city looking for work and a better life; instead they found hard drugs and an injection habit.

"Many medical professionals and hospital staff are prejudiced against HIV-positive people"

A young AIDS nurse at the Shanghai Public Health Clinical Center was forced to break up with her boyfriend when the young man’s parents found out about her job.
“They were scared of her job and possible risk to her and to the family,” said Dr Lu Hongzhou, director of Shanghai AIDS Treatment Expert Group. He is vice president of the Shanghai Public Health Clinical Center, a professional infectious disease hospital.
He told Shanghai Daily that the nurse’s sad story of thwarted love, ignorance and cruel prejudice prompted the hospital to make a micro move about the case.
“We hope to promote education among the public and help medical staff working in AIDS prevention and control get more respect and understanding,” the doctor said.
But many medical professionals and hospital staff are also prejudiced against HIV-positive people and AIDS patients, Lu said.
Hospitals — places where HIV-positive people and AIDS patients are supposed to receive help and compassion — are actually filled with fear and discrimination, according to doctors, nurses, patients and activists.

Premier Li Keiqiang - love not discrimination needed to help HIV patients

"Numerous stars are needed to light up the sky," -  this is how Premier Li Keqiang highlighted the necessity for social organizations and volunteers to contribute to the fight against AIDS in a letter to medical workers and patients in a hospital in Beijing.
The letter was to mark World AIDS Day on Sunday, which had the theme, "Shared Responsibility: Strengthening Results for an AIDS-free Generation".  President Xi Jinping also pointed out that efforts from all walks of life must be mobilized to provide AIDS patients with as good care as possible and eliminate discrimination against them.
Indeed, joint efforts are necessary, as apart from new medicines, people's awareness about how they should behave to avoid being vulnerable to the virus needs to be promoted.
Statistics show as of September, 434,000 people were detected with HIV/AIDS, the newly detected cases stood at 70,000 this year and nearly 90 percent involved sexual transmission.
As Premier Li wrote in his letter, the efforts of the government, along with the efforts of volunteers and social organizations, with whom he has been interacting and giving support for years, have stemmed the rapid increase of HIV infections. This has been no easy task for such a populous country as China.

North and South China need separate flu vaccination schedules

by Michael Woodhead
Climatic variation precludes a single national influenza schedule for China, and instead there should be two separate programs for northern and southern areas of the nation, say infectious disease experts.
Dr Yu Hongjie and co-researchers from the Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, have found that China has two distinct patterns of influenza in northern and southern regions.
In a study of influenza reports from 30 provinces between 2005 and 2011 they found that influenza A levels were much more prominent and seasonal in the north compared to the south of China. Epidemics peaked in January–February in northern China and April–June in southernmost regions. Provinces in central China showed semi-annual influenza A patterns with peaks in January–February and June–August. With influenza B, infections predominated in colder months throughout most of China. The researchers said their findings showed that regional-specific influenza vaccination strategies would be best for China;
“These findings show that influenza seasonality in China varies between regions and between influenza virus types and suggest that, as in other settings, some of these variations might be associated with specific climatic factors."
“Overall, these findings suggest that, to optimize routine influenza vaccination in China, it will be necessary to stagger the timing of vaccination over three broad geographical regions … Annual campaigns should be initiated 4–6 months apart in Northern and Southern China."
Full study: PLOS Medicine

X-rays help diagnose and monitor A (H7N9) influenza

X-rays are an effective way of diagnosing novel influenza A (H7N9) and monitoring the response of the viral infection to treatment according to radiologists in Shanghai.
In a case series of eight patients who had the infection, Dr Shi Yuxin and colleagues at the Department of Radiology, Shanghai Public Health Clinical Center, found that bedside chest radiography was helpful for evaluating patients with severe clinical symptoms of H7N9 influenza and for follow-up evaluation.
They found the most common imaging findings were a mixture of ground glass opacity and consolidation, and pleural effusion was common. Most cases of novel H7N9 influenza had a poor short-time treatment response, and seemed to have either rapid progressive radiographic deterioration or fluctuating radiographic changes.
“The distribution, rapid progression of fluctuations of pneumonia, and consolidations may help differentiate H7N9 infection from other causes of pneumonia,” the radiologists said.
Full study: Chinese Medical Journal

Schistosomiasis control program proves highly effective at Poyang Lake

Researchers from Shanghai have shown that a Schistosomiasis control program has been highly effective in almost eliminating the infection from the Poyang Lake region of China.
Researchers from the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai assessed the impact of a comprehensive schistosomiasis control program started in 2003. In 2003, the prevalence of Schistosoma japonicum infection ranged from 6.5% to 11.3% in the program sites. In 2006, the control program reduced schistosomiasis infection to levels of 0.6% to 1.6%. The US$10,000 cost of the program reduced prevalence of schistosomiasis nine-fold. And was deemed to be highly cost-effective.
“This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence.”
Full study: International Journal of Environmental Research and Public Health

Air pollution increases respiratory diseases in Lanzhou

A study from Gansu has shown a strong link between air pollutants and respiratory hospital admissions, especially in older women.

The study carried out by the College of Earth and Environmental Sciences, Lanzhou University, looked at level of air pollution and respiratory hospitalisations from 2001 to 2005, It found that three measures of air pollutants (PM10, SO2, NO2) had a lag effect of up to five days. The strongest effects of pollution on respiratory hospital admissions were seen in females and those aged over 65 yrs.
Full study: Environmental Pollution

President Xi stresses fight against HIV/AIDS

Chinese President Xi Jinping has called for legal and scientific prevention and control of HIV/AIDS as well as various social support for carriers and patients.
Xi made the remarks in a recent written instruction on the country's anti-HIV/AIDS work before the World AIDS Day, which falls on December 1.
According to Xi, the prevention and control of HIV/AIDS concerns people's life and health and social harmony and stability and is the obligatory responsibility of the Party and the government.
Xi urged Party and government organs at all levels to step up the fight against HIV/AIDS.
Xi stressed legal and scientific prevention and control work as well as the smooth implementation of support policies, calling on the public to jointly eliminate discrimination and help provide timely and effective treatment and support for HIV carriers and AIDS patients.
Commenting on a report submitted by the Communist Party of China (CPC) Beijing Municipal Committee on its anti-HIV/AIDS work, Xi praised progress in the work and urged the city to carefully summarize experience to strive for further achievements.
The Chinese government has intensified its fight against HIV/AIDS, with special fund allocated for the field for this year increasing by 10.5 percent from 2012. Efforts have been made to expand the coverage of HIV/AIDS check and treatment while reducing patients' burdens.
Source: China Daily

Big rise in HIV among young Chinese gay men

The share of young people around the age of twenty in all HIV infections in China almost doubled from 2008 to 2012, with male-to-male sex as the prominent contributing factor, a senior health official has said.
"Among all HIV cases reported across the country last year, 1.7 percent were Chinese youths aged between 15 and 24, up from the 0.9 percent in 2008, and the number of infected college students keeps rising," said Shang Hong, director of the HIV/AIDS key lab under the National Health and Family Planning Commission.
Revealing the figures at a promotional activity on Saturday for the World AIDS Day, which falls on December 1, Shang added that 95 percent of the infected in the group were boys, and 70 percent of these infections were through male-to-male sex.
Arie Hoekman, the United Nations Population Fund's representative in China, said previously about 40 percent of new HIV/AIDS infections every day around the world are people aged between 15 and 24.
In an earlier report, Chinese President Xi Jinping stressed legal and scientific prevention and control of HIV/AIDS, calling on the public to jointly eliminate discrimination and help provide timely and effective treatment and support for HIV carriers and AIDS patients.
Source: China Daily

Was "Empty Nose Syndrome" the cause of the doctor-stabbing case?

The Internet has lit up with conversations about an obscure complication from nose surgery this month, after an article titled "Empty Nose Syndrome - the real murderer of the doctor-stabbing case?" started circulating.
The tragic case happened last month in the No.1 People's Hospital of Wenling, Zhejiang Province, where Wang Yunjie, the chief physician of the ear-nose-throat department, was stabbed to death by Lian Enqing, a patient who had been dissatisfied by surgery performed at the hospital, the Global Times reported on November 1.
Lian was reportedly suffering from nasal obstruction, headaches and insomnia after nose surgery, but several examinations showed nothing wrong. Lian's family suspected him of having psychological problems and forced him to accept mental treatment.
The article said Lian killed the doctor because Lian suffered from Empty Nose Syndrome (ENS), a side effect of nasal surgery.